March 11, 2022

Maverick's Update

Only What Matters In Health Information Policy

If we can agree that George Clooney never should have played Batman, maybe we can further agree that the series of Batman movies are like the James Bond films -- a gift that keeps on giving. They are kinda dumb, kinda great, kinda dark -- and last week’s release of The Batman by Warner Bros. was no exception. In the One Thoughtful Paragraph below, we explain how a team of Batman-like superheroes -- that are typically in dark computer caves -- are shining a light on how to get necessary medical services paid for faster.

Some news about superheroes who are trying to improve our health care system:

• Several superheroes, led by the CARIN Alliance, are developing a digital identity for patients who want access to their health care records using a single login no matter who has the records.

• NCQA launched a website with resources for health plans and hospitals to advance health equity goals, including implementation frameworks, quality standards, and accountability programs.

• In the Omnibus spending package that Congress just passed, it allotted $100M to improve our country’s public health data infrastructure. Fun fact: this is exactly half what it cost to produce The Batman movie. To be fair, the Centers for Disease Control doesn’t have to recruit Robert Pattinson (Batman) or Zoë Kravitz (Catwoman).

One Thoughtful Paragraph

Everyone agrees that inappropriate and unnecessary medical care is bad and a waste of money, but the process of prior authorization (that is designed to solve those problems) is about as well-liked as a Batman villain. Health plans will not pay for certain healthcare services or products unless providers can prove, through the prior authorization process, that the recommended care is necessary, appropriate, and cost-effective. But like the Riddler in the latest Batman movie, the prior authorization process subjects providers and patients to a maddening number of questions before the desired goal may be reached. To address this slow and burdensome process, both the public and private sector have raised the call to automate the prior authorization process. This week, a public-private committee of experts offered its recommendations to HHS about what has to happen to solve the riddle of creating an electronic prior authorization process. Clearly, this will be a long series of staged rollouts to implement the new process, but spoiler alert: the prior auth Riddler will be foiled and it is no Joker.