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By Roy Poses, MD, Clinical Associate Professor of Medicine at Brown University, and the President of FIRM – the Foundation for Integrity and Responsibility in Medicine. Originally published at Health Care Renewal
We continue to see a remarkable stream of people transiting the revolving doorfrom high-level positions in health care corporations to high-level positions in health care policy or regulation for the Trump administration. Lately, though, these transitions have not been without missteps.
The most recent cases we have found, in the order of their public appearance, appear below.
John Bardis, Who Went from MedAssets to Assistant Secretary of Health and Human Services for Administration, Resigned Under Fire
We first discussed the appointment of Mr Bardis in May, 2017, here. We noted then that most recently Mr Bardis was the CEO of a health care financial firm and thus was responsible for that company’s financial fortunes. While he has previous experience running other health care related companies, he seemed to have no direct experience in health care or public health, per his official biography.
John Bardis, a top HHS official who signed off on ex-Secretary Tom Price’s charter jet flights, is resigning effective April 6, the agency confirmed Thursday.
The health care entrepreneur and longtime friend of Price’s from Georgia served as HHS assistant secretary of administration since March 2017 and was responsible for departmental operations. He also helped oversee the ReImagine HHS project, an initiative to overhaul the agency and cut costs.
Bardis’ office has been the focus of a probe about whether Price’s use of charter-jet flights for routine domestic travel — which cost more than $400,000 — complied with federal regulations. The HHS inspector general’s office, which is conducting the probe, told POLITICO that the final report is expected later this spring.
Note that the resignation under fire of Dr Tom Price, Trump’s first Secretary of the Department of Health and Human Services (DHHS) after accusations of conflicts of interest and abuse of his office was a signal example of major issues affecting the leadership of health care and public health agencies in the Trump administration. We had written about some of Dr Price’s less well publicized conflicts of interests and questionable conduct before we was appointed Secretary of DHHS, here, and here.
Now a good buddy of Price’s, who also had a severe conflict of interest, has come a cropper.
Daniel Best from Corporate Vice President of Industry Relations at CVS Health, and from Pfizer Before Then, to Senior Adviser to the Secretary of DHHS for Drug Pricing Reform
This transition was described in some detail in FierceHealthCare on March 29, 2018:
Daniel M. Best, the former corporate vice president of industry relations for CVS Health’s Medicare Part D business, will serve as senior adviser to the secretary for drug pricing reform.
The Trump administration has outlined a number of policy changes it believes can drive down drug prices, and the president predicted during his State of the Union address that drug costs ‘will come down substantially.’ But skeptics argue that some of those changes—like making generic drugs free for Medicare patients, or moving expensive drug coverage out of Part D plans—would merely shift the cost and raise premiums.
Best, who will help oversee some of those efforts, worked at Pfizer for 12 years prior to his time at CVS. HHS highlighted his expertise in the pharmaceutical industry generally, and his familiarity with Medicare Part D specifically, as critical to the task of trying to reduce prescription drug costs.
However, this appointment rapidly generated some public political push-back because of its revolving door nature. As reported by Vox on April 9, 2018,
Rep. Keith Ellison (D-MN), one of the top progressives in the House and deputy chair of the Democratic National Committee, sent a letter Monday to HHS Secretary Alex Azar inquiring about the appointment of Daniel Best to oversee drug pricing reform. Best most recently worked at CVS CareMark before starting at HHS last week. He also worked at Pfizer for four years in the early 2000s.
‘Given Mr. Best’s career working for the pharmaceutical and pharmacy industry, the decision to hire him poses significant potential for conflicts of interest, placing him in a position to make decisions that may pit the income of his former employers against the interests of patientsin reducing prescription drug prices,’ Ellison said in the letter, shared exclusively with Vox.
Ellison flaggedpast drug price hikes at Pfizerand a lawsuit filed against CVS CareMark by HIV patients over access to drugs. In general, pharmacy benefits managers are under the microscope of both parties these days for their role as mysterious administrators with great power over drug transactions.
The Congress member includes a string of questions about who was involved in hiring Best, whether outside groups (particularly pharmaceutical lobbying groups) were consulted, and how Best will prevent any potential conflicts of interest from getting in the way of his job description.
So this case of the revolving door has not gone without (negative) notice, although whether that will be sufficient to change anything remains to be seen.
Note that public biographical information on Mr Best seems to be scanty, but there is nothing to indicate that he has training, experience, or expertise in biomedical science, health care, or public health.
Adam Boehler from CEO of Landmark Health, Previously Founder of Avalon Healthcare Solutions and Trellis Rx, and Operating Partner of Private Equity Company Francisco Partners, to Director of Center for Medicare and Medicaid Services (CMS) Innovation Center (CMMI)
As reported, again by FierceHealthCare, this time on April 6, 2018,
Health and Human Services Secretary Alex Azar has named a successful healthcare entrepreneur to lead the Centers for Medicare & Medicaid Services Innovation Center.
Adam Boehler, the founder and former CEO of Landmark Health, will join the department next week as the deputy administrator and director of the center. Landmark is a medical group that uses a technology platform to deliver medical services to complex and chronically ill patients at home.
The article also documented that:
He is also the founder of Avalon Healthcare Solutions, a company which provides lab benefit management services, and Trellis Rx, a company that partners with health systems to fund, build and operate specialty pharmacies. Boehler was formerly an operating partner at Francisco Partners, a global private equity firm focused on healthcare technology and services investing.
According to Bloomberg, Mr Boehler has extensive background in the financial sector:
Mr. Adam Boehler serves as Executive Chairman at Avalon Health Management LLC and Avalon Health Services, LLC. Mr. Boehler served as Principal at Accretive, LLC. He served as Vice President of Business Development at MedeAnalytics, Inc. since July 2005. Mr. Boehler joined MedeAnalytics, Inc. in February 2005 and was responsible for all hospital sales, product marketing, and business development. He also drove several major product solutions from concept to customer sale and established MedeFinance’s international business in London. Prior to joining MedeAnalytics, Inc. (formerly MedeFinance), Mr. Boehler was an Associate at Battery Ventures. While at Battery, he focused on investments in software and emerging technologies. Previously, Mr. Boehler was an investment banker at Wasserstein Perella in their media, telecommunications, and technology group, where he worked on merger and acquisition transactions with leading companies such as News Corp., Imax, and SpectraSite Holdings. In addition, he spent time as a public finance consultant for the Financial and Fiscal Commission in South Africa, where Mr. Boehler focused on provincial revenue issues
His educational background was:
Mr. Boehler graduated magna cum laude from the Wharton School at the University of Pennsylvania.
So he also seems to have no training, experience, or expertise in biomedical science, health care, or public health.
Dr Kenneth William Staley from Consultant for McKinsey to Coordinator of US Government Activities to Combat Malaria
The information made public about this appointment was extremely sparse, e.g., see this brief item from the Kaiser Family Foundation on April 10, 2018, in its entirety:
President Donald J. Trump Announces Intent to Appoint Personnel to Key Administration Posts On Monday, President Trump announced his intent to appoint several individuals to key positions in the administration, including Kenneth William Staley,a consultant at McKinsey, to the position of Coordinator of U.S. Government Activities to Combat Malaria Globally (4/9).
At least he actually is Dr Staley, according to the US Department of State website.
Acting Deputy Assistant Secretary for Counterproliferation in the Department of State’s Bureau of International Security and Nonproliferation. His portfolio includes preventing the smuggling of weapons of mass destruction (WMD), international threat reduction, nuclear nonproliferation policies, tracking, controlling, and securing dangerous chemical and biological material, multilateral arms control, nonproliferation, WMD terrorism, disarmament issues, and responsible use of chemical and biological sciences.
Previously, Dr. Staley served as Director for Biodefense Policy at the White House Homeland Security Council, where he coordinated implementation of the National Strategy for Pandemic Influenza and the development of policies related to biodefense and the medical consequences of weapons of mass destruction.
So he does have a substantial clinical and public health background relevant to his appointment.
We have long chronicled cases in which people leave government leadership positions having to do with medical science, health, health care and public health and soon wind up working for corporations regulated or affected by the policies of these government agencies. These were examples of the outgoing revolving door. Such transitions raise worries that people in government might behave in ways that increase their attractiveness for such jobs when they leave.
However, in the Trump regime, we have seen a new a even more pernicious species of the revolving door, transitions from leadership positions in or lobbying/ advocacy positions for health care corporations directly into positions in government agencies that regulate or whose policies influence those selfsame corporations.
So, as I have said before, e.g., one month ago,
The revolving door is a species of conflict of interest. Worse, some experts have suggested that the revolving door is in fact corruption. As we noted here, the experts from the distinguished European anti-corruption group U4 wrote,
The literature makes clear that the revolving door process is a source of valuable political connections for private firms. But it generates corruption risks and has strong distortionary effects on the economy, especially when this power is concentrated within a few firms.
The ongoing parade of people transiting the revolving door from industry to the Trump administration once again suggests how the revolving door may enable certain of those with private vested interests to have excess influence, way beyond that of ordinary citizens, on how the government works, and that the country is still increasingly being run by a cozy group of insiders with ties to both government and industry. This has been termed crony capitalism. The latest cohort of revolving door transits suggests that regulatory captureis likely to become much worse in the near future.
Remember to ask: cui bono? Who benefits? The net results are that big health care corporations increasingly control the governmental regulatory and policy apparatus. This will doubtless first benefit the top leadership and owners/ stockholders (when applicable) of these organizations, who are sometimes the same people, due to detriment of patients’ and the public’s health, the pocketbooks of tax-payers, and the values and ideals of health care professionals.
The continuing egregiousness of the revolving door in health care shows how health care leadership can play mutually beneficial games, regardless of the their effects on patients’ and the public’s health. Once again, true health care reform would cut the ties between government and corporate leaders and their cronies that have lead to government of, for and by corporate executives rather than the people at large.