Former CMS Administrator Seema Verma On The Biden Healthcare Agenda

In her early career, she served as vice president of the Health and Hospital Corporation of Marion County and worked at the Association of State and Territorial Health Officials in Washington, D.C. In 2001, she founded a health policy consulting firm, SVC, Inc., an organization she was a part of until serving as Administrator of the Centers for Medicare & Medicaid Services (CMS) under former President Donald Trump from 2017 to 2021.

Now, she serves as a health policy expert, consultant, and board member for both Lumeris and Monogram Health.

In a conversation with HealthLeaders, Administrator Verma shares what drives her to work in healthcare policy, her goals while serving on the board of directors for both Lumeris and Monogram Health, her thoughts on the Biden Administration, and advice for future leaders.

This transcript has been edited for clarity and brevity.

HealthLeaders: What originally drove you to work in healthcare policy and what has kept you in this line of work?

Seema Verma: Healthcare impacts every single person in some way, even if you’re healthy. [Healthcare is] a $3 trillion industry, it’s complex and convoluted. But you can always count on healthcare to never being boring. I am always learning something new.

The other thing is that when you have an accomplishment, when you figure something out, you feel like you are impacting somebody’s life. There’s an old saying, ‘If you don’t have your health, you don’t have anything.’ That’s the most important thing for every person.

HL: In early April, you joined the board of directors for Lumeris, a value-based care managed services operator. Why are you passionate about value-based care models and what are you hoping to accomplish while serving on the board?

Verma: What I like about value-based care is that it tries to get at the root of some of the problems that we have in our healthcare system today. We have a system that pays for sick care … and doctors are paid for volume or the services that they provide. Value-based care says ‘Let’s change the financial incentives here. Let’s tell providers that we’re going to pay them on the basis of cost and quality.’ Essentially, they’re at risk and so they’re going to start making the types of investments to keep people healthy.

Lumeris is not just a Medicare Advantage plan, they’re working with providers on the frontlines to implement value-based care, giving them the technology and data to understand their patients better, so that they can provide more coordinated seamless care.

It’s the same thing with Monogram. They are focused on chronic kidney disease. Kidney disease in our country is one where the quality is concerning. You have a lot of people that are on dialysis and Medicare pays a lot for these services, but there are alternatives. People don’t have to go into a dialysis center two or three times a week, there’s home dialysis. If we do a good job on the front end, hopefully, we’re preventing a person from getting to that stage.

Both of those companies are focused on value-based care and improving health outcomes. They’re creative, innovative, and driving results at the patient level.

HL: Outside of addressing the COVID-19 pandemic, what are your thoughts on the Biden Administration’s healthcare agenda thus far?

Verma: [The Biden administration] is focused on the vaccine rollout; we’re all anxious for life to return back to normal, and so I appreciate the focus on that. There has also been a lot of emphasis on health equity and addressing healthcare disparities; those are long-standing issues that we face.

One of the things that I’m concerned about is that we have to still go back to addressing some of the key problems in our healthcare system, [including] addressing the drivers of healthcare costs. It’s not just about expanding coverage. If you’re expanding coverage, you’re dealing with something more in the short-term, but you’re not addressing the underlying issues of why costs are going up in our healthcare system.

There have been some delays on some of the models that have come out from CMS, which were promoting value-based care, [and] kidney care, which has real implications for patients. That model, which was delayed, was intended to promote home dialysis and create incentives for improving quality and transplantation rate. Delaying those types of things has a real impact on the lives of patients.

The other thing that is important is price transparency. The Trump administration had made some significant regulatory changes to require hospitals to display their prices. This is a significant effort that is important to patients, and so I hope that the Biden administration will be strong in enforcing the guideline.

Ultimately, we’re seeing a lot of moves on the expansion of the coverage programs and trying to put more people on public programs. It’s understandable for people, especially in the short-term, if they’re without coverage, but I think it’s important that we’re focusing on costs, whether it’s drug pricing, whether it’s value-based care, whether it’s addressing the healthcare monopolies and the lack of competition in the marketplace. There must be a parallel strategy, otherwise, costs continue to go up, the government continues to pay more, and employers [also struggle] to cover their healthcare costs.

HL: What has been your experience as a woman working in healthcare policy?

Verma: Generally, I would say that my experience is not very different from other leaders, including my male counterparts. There are also increasingly more women in leadership positions, so I don’t think that I’m a unicorn anymore.

We must be careful in suggesting that women are different when it comes to leadership, and if they’re different, then that means that they’re having different experiences, and they could be producing different results. That suggests that perhaps women are not capable of doing what men can do, and I don’t think that that’s true at all.

As a woman, I want to make it very clear, I don’t think that I need any special treatment or support, and I don’t want anyone to hire me, because I’m a woman or a minority. I only want to be considered on the value of my work, what I bring to the table, and what I can get done.

HL: What advice do you have for women and others who want to serve in leadership roles in the healthcare sector?

Verma: When you are the leader of an organization, your job is setting the direction for your organization, and you’re making decisions all the time based on that direction. It’s important for all leaders to have what I call a ‘decision framework.’ It’s an internal checklist so that when things difficult decisions come to you, you can look at your checklists and say, ‘Does this meet the criteria?’

When I was at CMS, my criteria were all about putting patients first. ‘How is this going to impact patients? How is this going to impact the program?’ I would be looking at the finances, the operations, I’d be thinking about providers and what the reaction was going to be. It’s important to have that framework and understand what those priorities are.

It’s important to always listen to all sides of the story. Those that are positive about the direction that you’re going in, but also those people that don’t agree. You learn a lot from the naysayers. When I think about my best work, it’s when I have been able to listen to the other side and take their viewpoint into the final product.

The other part of that is, once you make a decision and once you set that goal, there’s always going to be the naysayers. You have to learn to keep going in the face of adversity. If you’ve made your decision with that decision framework, and you feel strongly that this is the right thing to do, you can’t get deterred by those people that are trying to knock you down. You must stay focused, not only for yourself and what you’re working on but for your entire team. That is the essence of leadership, to keep everybody moving in the right direction, despite that outside pressure.

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