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Slavitt: Seeing Medicare and Medicaid from Both Sides

By Kerry Young, CQ Roll Call

February 26, 2016 -- Self-described "private sector guy" Andy Slavitt picked a challenging spot for a foray into government service.

He left a top post at insurance giant UnitedHealth Group in 2014 to join the Centers for Medicare and Medicaid Services (CMS), recruited to help get the federal health insurance marketplace on track after a troubled start.

Within six months he was named interim head of CMS, the nation's largest purchaser of health care with oversight of more than $1 trillion in annual spending. He was nominated last year as administrator and remains on the job in an acting role awaiting Senate confirmation.

He says he's tried to improve the agency's rapport with the health care firms it regulates. "From my not-so-distant past, I remember how CMS often felt opaque to me, and I probably said more than once how helpful it would be to know CMS's agenda rather than divining them by poring through an often intricate set of regulations," he told attendees of an industry conference last month.

One of Slavitt's top priorities is fixing CMS regulations on electronic health records. They are supposed to improve the quality of care by better tracking of patients' conditions, but doctors complain that compliance takes time and disrupts relationships with patients.

Slavitt appealed for help at last month's conference: "We have to get the hearts and minds of the physicians back because these are the people that our beneficiaries and consumers count on every day," he said.

Slavitt has extra credibility with people running health-tech startups because he's done that himself. 

"His years of experience give him a broad and thoughtful perspective on our challenges and how to work together to fix them," says venture capitalist John Doerr of Kleiner Perkins Caufield & Byers, one of Google's and Amazon's early backers.

A former Goldman Sachs banker and McKinsey & Co. consultant, Slavitt says he had focused on financial services before seeing a close friend die of a brain tumor in his early 30s. That experience put Slavitt on a path to found Health Allies, a firm that negotiates discounts for medical services. UnitedHealth bought the company in 2003.

"I was planning on staying and running this little health company, but one thing led to another and I ended up running a series of businesses" for UnitedHealth, he recalls. "That's the perch where I was at when I put in a call over here to the government and offered to come help with the turnaround" of the site.

At the time, Senate Judiciary Chairman Charles E. Grassley raised concerns about Slavitt's hire, given his ties to UnitedHealth. The company does a lot of business with CMS and was one of the contractors involved in building the federal marketplace.

A spokeswoman for the Iowa Republican says he is still vetting Slavitt's nomination, which remains in limbo. Whatever the Senate does, Slavitt will likely remain at CMS's helm through the end of 2016.

And CMS will be busy during the remaining months of the Obama administration. It's still completing work on rules implementing the 2010 health care law while embarking on an overhaul of the Medicare physician payment system enacted by Congress last year.

The so-called doc fix law that upended that system aims to trigger broad changes in American medical practice by raising or lowering reimbursements based on judgments about the quality of care delivered.

"Everything we are doing in health care right now is really at the implementation stage," Slavitt says. "That's where a lot of the excitement is."

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