The big interview: We sit down with RFK Jr.'s No. 2 Chris Klomp

Happy Thursday, friends!

We have a special edition this week of our “four questions with” series featuring the Department of Health and Human Services’ advisor and Medicare chief Chris Klomp. As of several weeks ago, Klomp was named number two at the Department of Health and Human Services, reporting directly to Robert F. Kennedy Jr. He and his team oversee the healthcare of tens of millions of Americans.

Klomp is also a digital health entrepreneur by background, as the former CEO of Collective Medical and former board member at the women’s health unicorn Maven Clinic. He divides his time between Washington, D.C., and Park City, Utah, where he’s been involved with several of the state’s initiatives to bolster entrepreneurship via pilots, including the sandbox program. It’s that program that is ground zero for the state’s recent partnership with venture-backed Doctronic to test out AI for autonomous care delivery. 

I invited my friend Jon Gordon to join me in a conversation with Chris. Jon is a long-time healthcare leader who has been a founder, venture investor, and payor/provider innovation executive (full bio at the bottom). Today, he is currently building something new to radically humanize healthcare with a focus on patients. So I knew the three of us would have a lot to discuss. We would be remiss not to ask about the ACCESS program from CMS’s innovation center (CMMI), which is designed to provide new reimbursement pathways for companies improving outcomes for patients with chronic conditions. Several days after we spoke, CMMI dropped more information about the pricing for that program (Second Opinion covered the industry’s reaction to that here).

CMS also announced in the aftermath of our discussion that Klomp’s purview had increased across HHS. And for that reason, we primarily focused on our questions about Medicare, as that was his remit at the time.

Just a few of the topics we covered in the conversation:

• The decision not to raise Medicare Advantage rates.
• The ACCESS program from CMMI.
• CMS’s hiring plans (what they’re looking for and why);
• How to bring down healthcare costs and whether AI will make a difference.
• The lack of health data interoperability and what needs to be done about it.

Chris has been consistent that what he’s trying to do overall is create a healthcare system that makes it easier for entrepreneurs and innovators to build in a crowded market of incumbents and bring down cost while ensuring quality. Everyone in our industry knows that’s much harder said than done.  

Let’s get started.

Jon Gordon: Let’s start with your prior life as a digital health entrepreneur. What do you see as the role of technology in healthcare, especially now that you’re sitting in a very different seat?  

Chris Klomp: I firmly believe that technology should be a deflationary force in healthcare - in fact, it’s the only way we are going to be able to bend the cost curve. But our system has made it difficult for technology-driven insurgents to enter into the market and drive costs down. Today, innovators have to contort their products to align with reimbursement rules (or build direct-to-consumer products outside the system) rather than focusing on outcomes. The result is that innovation ends up being cost-additive. That’s backwards. We should level the playing field so insurgents can fairly compete and incumbents are pushed to either behave more like innovators or get left behind. I want to be clear, though: the enemy isn’t any one organization. It’s a broken system that leaves people behind, and rules and regulations that, while they were designed with the best of intentions, end up stifling competition. We need payment models that reward measurable improvements in outcomes rather than rewarding activity. If you can improve quality and do it efficiently, you should get paid, period. That creates real market competition and invites technology into care delivery in a deflationary, access-expanding way.

Accomplishing this requires three things. The first is real data access — clinical and financial — without incumbent gatekeepers blocking interoperability. We’ve spent tens of billions funding electronic health records, and this has ended up becoming a roadblock. That’s why we’ve funded the Office of the Inspector General to enforce million-dollar penalties per instance of data blocking.

Second, as I mentioned before, we need an outcomes-based deflationary payment model that rewards results instead of activities. This is especially true for emerging applications of AI:  fee schedules tend to be inflationary and not tied to outcomes, so we’re averse to the idea of creating an AI-specific fee schedule.

Third, we need a more deregulatory environment that doesn’t abandon safety, but instead uses evidence and data rather than fear to guide policy. We should have regulatory sandboxes where we can safely test new models and technologies, monitor them closely, and adjust as needed. Technology can drive real improvements in access, quality, and cost if we let it.

Christina Farr: Let’s look at a concrete example of this deflationary potential: Utah’s recent announcement of a partnership with the venture-backed company Doctronic to use AI to address a discrete use case around automating prescription refills. How do we balance that potential for progress while ensuring that we’re also protecting patients?