“There is no such thing as natural beauty. Honey, time marches on, and eventually you realize it’s marching across your face.” Of course, I was going to find a way to feature Dolly Parton in this week’s blog post, and this is one of her fantastic lines from the iconic movie Steel Magnolias. My daughter, who is 25 years old, just watched it for the first time in honor of Dolly’s passing – and she said “Mom, she was obviously just playing herself.” I love that. One of the reasons why we all loved Dolly is because she was always playing herself – whether she was inside a quiet room writing a song, being interviewed by talk show hosts trying to make fun, or being very public very early about her support of COVID vaccines. Being true-to-oneself is a good theme for today’s health policy issue, so I will run with that in the One Thoughtful Paragraph.
Some others who are staying true to themselves:
- Jack Hoadley is staying true to himself – he is a retired Georgetown research professor and former MedPAC Commissioner who has quietly offered his expertise on many health policy issues over the years. In particular, he helped Congress understand what states were doing right to protect patients when providers and health plans fought over the price tag for out-of-network medical services, which led to the passing of the No Surprises Act in 2020. This week, Mr. Hoadley co-authored a piece in Health Affairs Forefront that concludes, in part, that the No Surprises Act’s Independent Dispute Resolution process should be replaced with what Congress originally considered doing six years ago – creating a benchmark payment standard for what insurers should pay out-of-network providers.
- Mandy Cohen is staying true to herself – continuing to be a tireless advocate for Americans’ health. This time, Dr. Cohen contributed to the team examining how states design controlled testing environments for health AI tools. As part of the Coalition for Health AI (CHAI)’s health policy workgroup, Dr. Cohen contributed to an analysis that said state “sandbox” programs need “and so” metrics (my words, not theirs) to figure out whether the health AI solutions they test are a success or a failure. Their words are: “A sandbox that cannot say in advance what it is trying to learn will not learn it.”
- Eric Topol continues to stay true to himself – one of the few people that can reasonably be called a medical futurist (he is one of the top 10 most cited researchers in medicine). Given that one of Dr. Topol’s primary interests is the use of AI to support more personalized medical treatment, it is unsurprising that he just wrote an article in Nature about consumer health AI (e.g., ChatGPT Health, Claude for Healthcare). He argues how these models perform is only one part of the equation for examining public health implications – consumer health AI is changing where care is routed, which symptoms are interpreted, and what treatment is completed.
“Tumble outta bed and stumble to the kitchen / Pour myself a cup of ambition / Yawn and stretch and try to come to life.” That is Dolly Parton’s lyric from the theme song in the movie 9 to 5. It also describes my daily routine. I stay true to that routine, just like I stay true to my career routine – which is landing right in the middle of big health care system reforms. After playing a small Capitol Hill staffer role during the Clintons’ health reform attempt in the 1990s, I saw other major health policy shifts up close: HIPAA (both portability and privacy), the Affordable Care Act, the 21st Century Cures Act, and a few others. I now find myself in the middle of another reform moment that doesn’t have a clever name or acronym yet, but will likely be the biggest game-changer for the American health care system to date: artificial intelligence. Other people are playing their natural roles in this policy shift: John Whyte (AMA) and Jen Goldsack (DiMe) are playing their roles by releasing a framework outlining the physician’s role in the digital and AI era of medicine, Ezekiel Emanuel is playing his role as contrarian by being a physician who says autonomous clinical AI is inevitable, consulting firms are pontificating about how to make sense of the change (Chartis, PwC), institutions that say “this won’t last unless there is a good reason to pay for it” are making their point clear (PHTI, Deloitte), and technology companies (who, let’s face it, know the most about AI) are trying to keep policymakers informed. What I’ve learned about health reform movements is that change is inevitable and everyone plays a role in trying to make the change make sense. It is like Dolly said: “We cannot direct the wind, but we can adjust the sails.”
