• Julie Barnes

July 15, 2022

Maverick's Update

Only What Matters In Health Information Policy

Is anyone a little weirded out that we have a space telescope that can see into the past? The images of galaxies from the James Webb space telescope are not only stunning, but they are also, somehow, showing things that happened billions of years ago. Even President Biden, who must have been briefed on how this thing works, said “It’s hard to even fathom.” Um, yeah. If we weren’t health policy wonks constantly struggling to fathom a system that makes little sense, these photos would be too mind-blowing. In the One Thoughtful Paragraph below, we explain how you don’t need a telescope to understand how our health policy history can help us improve our future system.

Other news that is about learning from our past history:

  • When the pandemic began, Apple and Google collaborated to create a notification system for users of their COVID-19 exposure -- and Forbes just published a list of the lessons learned from their efforts.

  • Particle Health, a startup that just raised millions of dollars, allows doctors to pull patient medical histories (if they have a certified treatment purpose for a patient they're actively treating) from almost any medical facility, so they know exactly how best to treat the patient.

  • The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, launched Calling All Sectors: State Agencies Joined for Health in 2019. Pew just published a report on how its grantees for this initiative identified and collected data from multiple sources to address health care disparities, so policymakers can learn from their experience and create solutions.

One Thoughtful Paragraph

It wasn’t quite billions of years ago, nor was it in a galaxy far, far away, but American health care services have been subjected to prior authorization processes for a very long time. Right now, prior authorization is a hot topic, so a number of entities have done a nice job explaining (see here, here) why there is a process to determine whether a medical service or product should be reimbursed by health insurance. It is certainly a pain point for doctors and patients -- waiting for the nod from the guy with the wallet. So we were very interested in the recent piece by Mark Fendrick, a doctor and University of Michigan professor, who calls prior authorization “an important tool to ensure safe, clinically appropriate, and cost-effective care.” In the 1990s, Dr. Fendrick invented value-based-insurance-design, or VBID, -- which was finally implemented as a Medicare Advantage model by CMS Innovation Center (CMMI) in 2017 (so he must feel like he has to look through a space telescope to see how the system is learning from his long-ago idea). In his recent blog post, Dr. Fendrick endorses the automation of the prior authorization process so it focuses on eliminating harmful and wasteful care and is quick and easy (or just not applied at all) for high-value services. We hope we don’t have to wait for a billion years to learn this lesson -- the images will not be as pretty as NASA’s.

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