Digital health has seen great strides lately, fueled by the Affordable Care Act and the realization that information technology can reduce costs and improve outcomes. But President-elect Donald Trump has vowed to repeal or at least change major portions of that law, and he will have the support of a Republican-led House and Senate whose ranks have long sought to overturn the ACA.
Senate Majority Leader Mitch McConnell (R-Ky.) also said earlier this week, "When we come back Jan. 3 we'll be moving to the ObamaCare replacement resolution, the ObamaCare repeal resolution will be the first item up in the New Year," The Hill reported.
What can digital health expect under a Trump administration? The mood seems to be cautiously optimistic. Given the uncertainty of what a reimagined ACA might look like, concerns remain about a possible rollback in coverage and access to care, among other policy changes.
New policies and regulations that increase financial risks for consumers and ratchet up cost pressures on providers could fuel investment in digital technologies, HIT Consultant reports. Among possible winners the article cites are consumer-facing technologies, sensors and tracking tools, big data and population management and use of artificial intelligence and “smart” assistants.
There is also an expectation that the Trump administration won’t tinker much with the final regulations under the Medicare Access and CHIP Reauthorization Act, which enjoys broad bipartisan support in Congress.
“The tenets of accountable care are sound,” Justin Barnes, a partner at iHealth, told Healthcare IT News. “Anybody in power, or educated on this topic, is in support of SGR Reform through MACRA.” Barnes anticipates more guidance on MACRA in the coming year.
"Any technology, digital technology, that enables employers or consumers to be activated and to change their behavior, take control of their health, particularly for chronic conditions, will benefit greatly from any administration.”
Co-founder and chairman, Twine Health
Frank Moss, co-founder and chairman of Twine Health, expects Trump will focus on ways to cut healthcare costs for employers and that means helping them tap into services and capabilities that keep their employees healthy. He sees more companies resorting to direct primary care and on-site clinics, and believes consumer health coaching tools can help achieve that goal.
An administration focused on cutting costs could be good for telemedicine and devices that support home management as well — services that promote patient-centric care. But that depends, in part, on continued access for the millions covered under Obamacare. Moss worries those people won’t have access to affordable care if the ACA is repealed or replaced. Trump has “certainly indicated that his goal is to continue access, but I haven’t seen the answer to that yet. I don’t think anybody has,” Moss says.
Bradley Merrill Thompson, a partner at Epstein Becker Green who specializes in the Food and Drug Administration, says the Trump administration has already had a “profound impact” on digital health with Congress’ passage of the 21st Century Cures Act. The measure has been sent to President Barack Obama, who has promised to sign it.
What the legislation says is that the FDA won’t regulate the following categories of software: administrative and operational (eg. appointment software), wellness apps, electronic health records, software for transferring, storing or displaying medical device data, and clinical decision support software.
“Clarifying that FDA will not regulate those categories will help tremendously as companies plan their digital health strategies,” Thompson wrote in an email. “There have been many companies developing software in those categories that were concerned about the possible high cost and significant delays in bringing the software to market if FDA oversight was required.”
The bill also includes a provision supporting Medicare reimbursement for telehealth services.
"Beyond that legislation, macro drivers all seem to be pointing in the direction of expanded use of digital health."
Bradley Merrell Thompson
Partner, Epstein Becker Green
“No matter what Republicans replace Obamacare with, cost and outcomes will remain a concern,” Thompson says, adding the evidence is mounting that digital solutions can improve patient outcomes at lower cost.
The Veterans Administration has also been a strong proponent of digital health, and that is likely to continue under the Trump administration, Thompson believes. He notes the agency has a webpage focused on disseminating apps that is regularly updated.
Still, Trump has not officially tapped anyone to lead the VA. Rumors that he is considering former vice presidential contender Sarah Palin, who does not have experience on veterans issues, has raised concerns about how healthcare and other pressing concerns would be managed.
Digital health has seen significant growth in recent years. “We’re seeing some new technologies that really have clear clinical benefit,” Thompson says. "For example, there’s a huge push to develop apps to help people with diabetes do a better job of managing their chronic condition, including a better job of titrating and dosing various forms of insulin. With diabetes constituting a growing epidemic, the digital health tools will be much needed.”
But uncertainty about the future of Obamacare and other changes in the healthcare landscape under Trump could dampen financial investment in digital health and cause more risk-averse investors to hold off in a wait-and-see mode. “That’s certainly a concern as we fund these fragile new startups that have an appetite for financing that’s based upon risk,” Moss says. “It may not be easy for awhile.”