Since the presidential and Congressional elections concluded, Advisory Board has been working with leaders across the industry to prepare for a new era of health policy. As expert partner, I've had the opportunity to speak virtually with executives about their hopes and fears for the Biden era, including through our invitation-only 2021 Health Policy Executive Briefings over the past month. Reflecting back on those briefings and my private conversations with a range of executives, I'm struck by three observations that offer a glimpse into health care leaders' mindsets in the early days of the new administration.

Radio Advisory episode: Political hype or practical change? Health policy under a unified government

Observation 1: Executives are serious about understanding political and policy realities, not just hypotheticals.

It isn't always easy to get on a CEO's calendar—even for Advisory Board. So, when I saw dozens of C-suite executives not only sign up for our virtual discussions, but also show up on time and stay engaged through the whole session, I knew they weren't popping in just for fun. There's a real sense that health care could be on the verge of major change, and leaders know they need to be up to speed on the issues.

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But the mood is not one of agitation, excitement, panic, or dramatics. Overwhelmingly, the leaders who joined the virtual sessions and who I've spoken to separately are calmly and professionally assessing the situation and preparing for likely eventualities. I can't help but compare it to the mood when former President Barack Obama began pushing for the Affordable Care Act, or when President Trump sought to repeal and (perhaps) replace it. For many reasons, and for better or worse, the dawn of the Biden administration seems a slower, calmer, and more deliberate time. Credit is due to those executives who aren't jumping to conclusions or getting distracted by what-ifs, especially when managing the pandemic and vaccine rollout rightfully demands their fullest attention.

Observation 2: There's a much wider issue set facing real-world health care leaders than what's in the media spotlight.

One reason for the more measured approach may be that Democrats' razor-thin majority in the Senate means ambitious policy proposals such as a public option or even Medicare for All have little to no practical likelihood for now. Executives need to understand why the budget reconciliation process isn't a silver bullet for Democrats and why eliminating the filibuster, while not impossible, is probably a bridge too far for many Senate moderates.

But none of that means there won't be plenty of policy changes coming. Our conversations with executives covered everything from prescription drug spending (plenty of political agreement on the problems, but less on the solutions) to price transparency (a Trump-era priority likely to remain prominent in the Biden era) to antitrust policy (a huge wild card for executives often competing at break-neck pace in the race for scale). These are issues that depend on administrative rulemaking, legal challenges, executive appointments, and other mechanisms of policy that don't necessarily grab headlines the way massive legislative battles do.

Momentum for that roll-up-your-sleeves policymaking will build just as the novelty of a new administration wears off. Executives will need to find ways to maintain diligent focus—or deputize trusted partners to keep them up to speed.

Observation 3: State-level dynamics will matter as much or more than what happens in Washington, D.C.

Our virtual sessions, which included leaders from all across the country, made clear once again how much depends on state-level policy. For example, while the Biden administration will have national influence over Medicaid policy through CMS' waiver authority and other tools, the Chief Strategy Officer of a prominent Florida health system was rightly far more focused on the posture of Florida's Republican-led state government when we discussed the possibility of coverage expansion under the Affordable Care Act.

Indeed, almost every policy issue of national prominence has a state-level dynamic: Lawmakers in Colorado and Washington have dipped their toes into the public option space. The future of telemedicine depends in part on licensure decisions. Site-of-care shifts move faster or slower depending on local Certificate of Need laws. Every executive who began a comment with, "In [my state]…" reminds all of us why we should be thinking outside the Beltway.

I don't know exactly what the Biden era will bring. (Well, I have some ideas—check out this episode of Radio Advisory where my Advisory Board colleagues, Rob Lazerow and Rae Woods, and I discuss the possibilities.) But I am certain that as long as our member executives care about the rules of the game, Advisory Board will be working to help you understand them. If you're interested in scheduling a virtual health policy briefing or workshop for your leadership team or board, we would be honored to join you.