⚡️ NIMITZ HEALTH NEWS FLASH ⚡️ 

“Modernizing Care Coordination to Prevent and Treat Chronic Disease”

House Way & Means Health Subcommittee

November 19th, 2025 (recording linked here)

WITNESS & TESTIMONY

• Michael Hoben, M.D.: Chief Medical Officer of Population Health Services, Novant Health

• Allison Reichert: Pharmacist, Bode Drug

• Ashish Parikh, M.D.: Chief Population Health Officer, Summit Health

• Brian Connell: Vice President of Federal Affairs, Blood Cancer United

HEARING HIGHLIGHTS

MEMBER OPENING STATEMENTS

• Chair Buchanan (R-FL) opened by emphasizing the urgency of reducing and preventing chronic illness in the United States, noting that the nation spends around $5 trillion a year on healthcare while outcomes continue to worsen. He highlighted that chronic diseases account for roughly 80 percent of the leading causes of death and that the U.S. has far higher rates of obesity and chronic conditions than peer countries, affecting even children and young adults who are often ineligible for military service due to obesity. He stressed that about 90 percent of healthcare costs are tied to chronic disease and argued that the system focuses too much on reacting to crises instead of preventing them. He concluded by underscoring the need for more prevention and patient empowerment rather than waiting for cancers, heart disease, and other conditions to develop.

• Ranking Member Doggett (D-TX) praised the chairman’s focus on lifestyle medicine and care coordination but warned that millions of Americans risk losing access to family physicians and medications if current policies change. He referenced a constituent named Walter, a small business owner with diabetes, to illustrate how the Affordable Care Act’s protections for preexisting conditions and marketplace coverage have been vital, and he criticized Republicans for rolling back enhanced tax credits that will raise Walter’s premiums by $700 per month next year. He argued that Republicans have repeatedly failed to offer a meaningful replacement for the ACA, criticized proposals to rely on health savings accounts as inadequate and regressive, and expressed skepticism about former President Trump’s vague promises on lowering drug prices. Rep. Doggett concluded that extending ACA tax credits is the best way to ensure people like Walter can afford care and said Congress should improve care coordination only after first protecting access to coverage.

WITNESS OPENING STATEMENTS

• Dr. Hoben described Novant Health’s large, integrated, not-for-profit system focused on prevention and chronic disease management. He explained that coordinated, team-based, patient-centered care allowed them to anticipate needs, avoid complications, and deliver simpler, more comprehensive experiences across value-based programs and Medicare ACOs, which had saved CMS over $90 million since 2017 while achieving top-tier quality scores. He highlighted how unified electronic health records, predictive analytics, telehealth, community paramedics, and community health workers led to measurable improvements like a 40 percent reduction in sepsis mortality and significant drops in hospitalizations and ER visits in underserved neighborhoods. He closed by urging policymakers to help reduce regulatory complexity and support proven models like team-based care, aligned incentives, stable access to virtual and community-based care, and top-of-license work so that Novant and others could continue building a system that keeps communities healthy.

• Mrs. Reichert emphasized that community pharmacists were often the most accessible healthcare professionals in rural areas. She described how pharmacists provided after-hours access, vaccines, screenings, chronic disease monitoring, and frequent touchpoints for patients with hypertension, diabetes, kidney disease, COPD, and heart disease, and she noted that the main barrier was not training but access to data and supportive systems. She argued that community pharmacists were an underutilized resource that could reduce emergency department use and hospitalizations and shared stories showing gaps in care that pharmacists were willing but unable to fill under current rules. She endorsed legislation like H.R. 3164 to reimburse pharmacists for clinical services under Medicare and asked Congress to empower pharmacists to fully use their skills to improve access, coordination, and chronic disease management in rural communities.

• Dr. Parikh told a story about a suicidal patient who avoided an ER visit and hospitalization because of immediate, integrated behavioral health support in his clinic. He argued that this kind of seamless, team-based care was what every American with chronic disease deserved, but said unstable reimbursement rates and misaligned incentives made it difficult for groups to invest in population health infrastructure like care managers, pharmacists, social workers, and advanced analytics. He explained that alternative payment models and shared savings arrangements had allowed his organization to achieve higher preventive screening rates, better chronic disease control, fewer ER and hospital visits, and significant savings that could be reinvested in care coordination. He closed by urging Congress to stabilize Medicare reimbursement, expand and improve alternative payment models, enhance payments for primary and preventive care, and make telehealth flexibilities permanent so that more patients could receive timely, coordinated, value-based care.

• Mr. Connell stressed that care coordination was vital for patients with complex conditions like blood cancers but should not become a pretext for provider consolidation that drives up costs. He warned that the imminent expiration of enhanced premium tax credits would make coverage less affordable for 22 million Americans and completely out of reach for nearly 2 million people with preexisting conditions, illustrating the impact with specific patients whose monthly premiums would skyrocket in 2026. He argued that, instead of scrapping current premium tax credits and designing a new system on short notice, Congress should extend the existing credits to give families stability while policymakers work on broader cost-cutting reforms that do not harm patients with preexisting conditions. He urged members to choose policies that lower costs while protecting the sickest patients, warning that cuts made at their expense would lead to more medical debt, bankruptcies, shuttered small businesses, and preventable deaths even when cures already existed.

QUESTION AND ANSWER SUMMARY

• Rep. Smith (R-NE) highlighted the massive burden and cost of chronic diseases and argued that policy should fully leverage pharmacists and other non-physician clinicians. He promoted his Ensuring Community Access to Pharmacist Services (ECAPS) bill as a way to let pharmacists test and treat common conditions for Medicare patients, similar to what many Medicaid and commercial plans already allow. In response, Mrs. Reichert said pharmacists currently coordinate mostly by phone and that better interoperability and ECAPS reimbursement would improve outcomes and help keep struggling community pharmacies, especially rural ones, open.

• Ranking Member Doggett (D-TX) warned that letting enhanced ACA premium tax credits expire would hurt patients and providers, including pharmacies, and asked about the impact on blood cancer patients. Mr. Connell said the named individuals he cited were blood cancer patients or caregivers and that replacing tax credits with HSAs would push many into high-deductible plans, causing them to cut back on necessary care and accumulate unpayable medical debt. Rep. Doggett criticized HSAs as tax shelters with weak verification and high junk fees and previewed legislation to add consumer protections, while stressing they were no substitute for the ACA.

• Rep. Murphy (R-NC) praised concerns about consolidation but argued that ACA subsidies mainly bolstered insurer profits and were always intended to be temporary. He framed HSAs as a way to give patients choice and modest “skin in the game,” blaming inflation and insurer behavior more than the phase-down of enhanced credits.

  Turning to chronic disease, Rep. Murphy asked about drivers of U.S. chronic disease. Dr. Hoben cited lifestyle, food environments, and lack of time and incentives for healthy behaviors.

  Rep. Murphy also raised worries about ultra-processed food, patient choices, and vertically integrated PBMs possibly creating perverse incentives if pharmacists gained broader authority.

• Rep. Thompson (D-CA) criticized recent Republican actions such as cutting Medicaid, failing to extend ACA tax credits, and allowing telehealth flexibilities to lapse, which he said contributed to closures and reduced services at rural hospitals and clinics. He described a chronically ill constituent who depended on telehealth but now faced $200 in rideshare costs per visit after flexibilities expired. Mr. Connell emphasized that blood cancer care is so costly that self-pay is unrealistic and that coverage plus tools like telehealth are essential to maintain treatment and avoid catastrophic financial harm.

  Rep. Thompson emphasized the need for permanent telehealth flexibilities and continued ACA subsidies.

• Rep. Kelly (R-PA) yielded his time to Rep. Murphy, who asked what truly drives healthcare costs and how to bend the curve. Dr. Parikh said the keys were deeper investment in prevention and screening and aligning incentives through value-based models so providers are accountable for population outcomes, not just volume. He explained that uncoordinated fee-for-service encourages duplicative services and complications, while shared-savings ACOs reward outreach, chronic disease control, and avoiding unnecessary ER visits and hospitalizations.

  Rep. Murphy agreed fee-for-service has real downsides, sharing that his own Medicaid-heavy practice went bankrupt and questioning whether EHR investments have delivered commensurate clinical value.

• Rep. Chu (D-CA) argued that care coordination is meaningless without affordable coverage and blamed Republican decisions and Trump-era policies for stripping coverage and allowing ACA premium tax credits to lapse. She cited California constituents facing premiums more than doubling, while noting that insurers’ highest margins come from Medicare Advantage, not ACA exchanges. She asked what losing ACA subsidies would mean for blood cancer patients. Mr. Connell projected about 1.7 million people with serious conditions could lose coverage, leading to deteriorating health, job loss, and catastrophic medical debt.

  Rep. Chu rejected HSAs as a replacement, emphasizing they cannot pay premiums and leave patients exposed to full unsubsidized costs and high cost sharing.

• Rep. Hern (R-OK) highlighted Oklahoma State University’s mobile virtual care vans, which use telehealth to manage non-emergent chronic conditions and link rural patients to primary care. He asked about the benefits of mobile and telehealth access, and Dr. Hoben said such models improve chronic disease outcomes and reduce ER use by connecting patients quickly to primary and specialty care.

  Rep. Hern then argued that premium tax credits do nothing for roughly 168 million people with employer coverage and that the core challenge is high underlying healthcare costs. He emphasized that COVID-era enhancements were designed to expire and called for bipartisan work to lower systemwide costs rather than continually expanding subsidies.

• Rep. Miller (R-WV) described West Virginia’s high chronic disease burden and the central role of independent rural pharmacies as accessible, trusted care sites. She asked how federal recognition of pharmacists’ clinical services could stabilize these businesses. Mrs. Reichert answered that ECAPS would let Medicare reimburse pharmacists for test-and-treat services, shifting appropriate care from distant ERs to local pharmacies.

  Rep. Miller then raised kidney disease and a forthcoming bipartisan Kidney Care Access Protection Act, asking how multidisciplinary and digital tools can improve kidney outcomes. Dr. Hoben described team-based models with diabetes educators, nurse care managers, pharmacists, nutritionists, and remote monitoring to catch problems early and slow progression from diabetes and hypertension to kidney failure.

• Rep. Evans (D-PA) shared constituent stories about skyrocketing premiums and asked whether expiring ACA credits would raise costs for marketplace enrollees. Mr. Connell said nearly all would see increases, with some facing monthly hikes of $1,500–$2,000, and warned that high-deductible, HSA-centered replacement ideas would immediately expose patients to aggressive collections and up-front payment barriers for medications.

  Rep. Evans asked what Congress should do. Mr. Connell recommended first extending the enhanced credits due to the short timeline, then pursuing broader, patient-friendly cost reforms that also lower spending in employer plans and Medicare. He stressed that comprehensive cost work should follow only after patients are no longer hanging in the balance.

• Rep. Fitzpatrick (R-PA) focused on fragmented Medicare care, increased specialist use, and the promise of telehealth and value-based models for chronic disease. He asked how telehealth had been used at Novant. Dr. Hoben said telehealth allowed chronic care managers and pharmacists to adjust treatments based on real-time data and reduced ER and hospital use, but Medicare gaps during the shutdown disrupted this.

  Rep. Fitzpatrick then asked how alternative payment models worked in his group. Dr. Parikh explained that ACOs compare actual spending to benchmarks, tie shared savings to quality metrics, and push practices to perform primary, secondary, and tertiary prevention and to proactively reach out to high-risk patients, which has yielded better control of chronic conditions and significant savings.

• Rep. Moore (R-UT) defended HSAs and introduced his bipartisan HOPE Act to create more flexible, tax-advantaged “hope accounts” for out-of-pocket costs regardless of income or plan type.

  Rep. Moore asked about pharmacists’ role in chronic care. Mrs. Reichert reiterated that pharmacists are underutilized and that ECAPS would empower them to test, treat, and manage conditions for Medicare beneficiaries.

  Turning to telehealth, Rep. Moore asked about its impact on chronic disease management, and Dr. Parikh explained that telehealth improves access for acute issues, routine follow-ups, and early intervention in exacerbations, especially in rural areas.

• Rep. Davis (D-IL) placed the debate in the context of Medicaid expansion and enhanced ACA premium tax credits that allowed millions of low-income adults to gain coverage. He argued that cuts to hospitals, health centers, SNAP, Medicaid, and graduate medical education undermine any effort at care coordination by destroying the underlying infrastructure. Drawing on rural sayings, he said there was “nothing to coordinate” if hospitals and clinics close and patients lose coverage. Asking whether meaningful coordination is possible under such conditions, Mr. Connell answered that it is extremely difficult to coordinate care when patients cannot access services at all.

• Rep. Kustoff (R-TN) asked how remote patient monitoring supports Novant’s mission in chronic disease management. Dr. Hoben said continuous data from home devices and “hospital at home” programs provide longitudinal information on blood pressure, oxygen saturation, and other vitals, enabling earlier interventions and preventing complications, as long as teams of nurses and care managers are properly resourced to manage the data.

  Rep. Kustoff then asked about EHR-related administrative burden. Dr. Hoben said complex coding rules for combining annual wellness and chronic care visits consume valuable clinician time and argued that streamlined coding and team-based documentation would let physicians focus on the sickest patients.

  Rep. Kustoff then asked how many of her patients lack primary care. Mrs. Reichert said many essentially rely on the pharmacy as their main access point.

• Rep. Steube (R-FL) emphasized Florida’s high Medicare and chronic disease burden and promoted his Chiropractic Medicare Coverage Modernization Act as a way to expand non-surgical, non-opioid chronic pain care. He asked how Novant treats chronic pain. Dr. Hoben described multidisciplinary teams that include neurologists, anesthesiologists, surgeons, physical therapists, chiropractors, and pharmacists, addressing physical, psychological, and social dimensions, with chiropractors integrated as part of the care plan.

  Rep. Steube then asked how to expand telehealth for rural and low-income patients. Dr. Parikh called for making pandemic-era flexibilities permanent and said telehealth plus remote monitoring can be life-saving in regions without nearby hospitals. He suggested simplifying technology access and allowing audio-only visits and asynchronous messaging to accommodate seniors with limited digital literacy.

• Rep. Horsford (D-NV) sharply criticized what he coined “Trumpcare,” arguing that cuts to premium tax credits, hospitals, and research would drive up costs and reduce access nationwide. He asked how letting advanced premium tax credits lapse would affect costs across demographics. Mr. Connell said exchange enrollees would see immediate premium hikes, with some forced to drop coverage, and that increased uncompensated care would eventually raise costs for everyone with insurance.

  Rep. Horsford then noted that Medicare Part B premiums are rising faster than Social Security COLAs and asked how general inflation in essentials affects seniors’ ability to access care. Mr. Connell replied that Medicare already carries substantial out-of-pocket burdens, so higher premiums and living costs leave many seniors barely able to maintain necessary treatment.

• Rep. Tenney (R-NY) asked how ACOs and value-based incentives encourage early risk identification and intervention for patients with multiple chronic diseases. Dr. Hoben said that incentives for prevention and screening, combined with team-based, top-of-license care, allow physicians to focus on complex patients while other team members manage monitoring and education, leading to fewer hospitalizations, readmissions, and ER visits. He cited Medicare Shared Savings Program results as proof that well-run ACOs can both improve outcomes and generate substantial savings.

  Rep. Tenney also flagged long-stagnant reimbursement for ground and air ambulance services as a serious rural and suburban access issue.

• Rep. Bean (R-FL) argued that the ACA is a broken, Democrat-designed system propped up by temporary COVID-era premium tax credits and that many enrollees never file claims while insurers raise prices. He stressed the scale of U.S. healthcare spending and chronic disease and insisted that simply adding money is unsustainable given federal debt levels.

  Focusing on diabetes as a “gateway disease,” Rep. Bean asked how to better coordinate care without dramatically higher spending. Mrs. Reichert said pharmacists already check vitals, monitor adherence, manage interactions, and interpret continuous glucose monitors, and that formally integrating them into care teams would improve outcomes.

  Rep. Bean briefly asked whether choice and competition should be central to healthcare reform, and Dr. Parikh agreed.

• Chair Buchanan asked whether fee-for-service should remain dominant. Dr. Hoben said some transactional services will likely stay fee-for-service, but chronic disease management benefits most from comprehensive, team-based value models that use top-of-license work and reduced regulatory burden to get patients to the right care at the right time.

  Chair Buchanan pressed on prevention and education, and Dr. Hoben said health systems must support growing patient interest in healthier lifestyles with education, screening, and supportive care structures.

  When invited for final thoughts, Mrs. Reichert reiterated that prevention saves lives and money and said embedding pharmacists in coordinated care teams, backed by policies like ECAPS, would strengthen early testing and treatment and improve outcomes.