September 16, 2022
Maverick's Update
Only What Matters In Health Information Policy
If you haven’t watched the Blues Brothers movie in a while -- or, heaven forbid, ever -- it is time. The old Saturday-Night-Live-skit-turned-1980--feature-film is iconic, hilarious, and stars some of the best R&B musicians of all time -- Aretha Franklin, Ray Charles, John Lee Hooker, Cab Calloway, James Brown. When Jake (John Belushi) and his brother Elwood (Dan Aykroyd) bring their Blues Brothers band back together to raise enough money to save their Catholic orphanage from foreclosure, they go on an epic journey that includes scenes with Nazis, Princess Leia, and a high-speed chase that includes the Muppets. (Frank Oz, the voice of Ms. Piggy, has a bit part in the film, so that explains it.) In the One Thoughtful Paragraph below, we describe the Blues Brothers’ accidental visit to Bob’s Country Bunker, which reminds us of what is happening in health data policy this week.
Other news about raising money, but for digital health purposes instead of Catholic orphanages:
A 2020 Rock Health report revealed that investment funds are flowing mostly to white, male digital health entrepreneurs, which led to this week’s announcement of the Equitable Investments Initiative. In their first report, Reimagining Opportunity and Innovation in Digital Health, Rock Health identifies six ways that investors support underrepresented and underfunded digital health innovators.
Springboard Enterprises announced its 2022 Innovation Program: Digital Health Cohort, which will offer boot camps and adviser workshop series to eight women-led company start-ups. These include AllergenIQ, Amie Health, Flourish Fund, Health Care Originals, LunaJoy, Oral Genome, SoShe, and Wavely Diagnostics.
UPMC, General Catalyst, and CVS Health led a $65 million funding round for Redesign Health, a company that helps launch other health care startups.
One Thoughtful Paragraph
In the Blues Brothers movie, the newly re-joined band is looking for the location of their next gig when they come upon a place with a white, neon-light cowboy hat tipping up and down. Suddenly, Jake shouts “Bob’s Country Bunker -- here we are!” Knowing that the Blues Brothers band doesn’t play country music, an incredulous Elwood asks the bartender “Uh, what kind of music do you usually have here?” She responds, with enthusiasm, “Oh, we have some of each kind, country and western!” We, too, have some of each kind in health data policy this week -- one kind is electronic prior authorization and the other kind is price transparency data. The House passed the Improving Seniors’ Timely Access to Care Act, a bill that would require Medicare Advantage plans to streamline and automate the prior authorization process. Getting a green light from insurers - to make sure a medical service or treatment plan will be paid for -- is a manual, painful process that takes too long and is too often delaying care for patients and is a burden on providers. The bill now moves on to the Senate, where it enjoys bipartisan support, to address the prior authorization pain point for (only) the Medicare program. We also have a new Request for Information about price transparency from the federal agencies that oversee our healthcare system. As part of the No Surprises Act, hospitals and physicians must provide a Good Faith Estimate of an insured patient’s anticipated charges to their health plan, and the health plan must then give the patient / enrollee an Advanced Explanation of Benefits so they will know what their out-of-pocket costs are before services or a treatment regimen begins. This will require tight turnaround times for an electronic data exchange between plans and providers and patients, so it is a good thing that the agencies are asking for a reality check on the huge operational lift this will take for the industry. It is just like when James Brown asks Jake in the Blues Brothers movie: Can you see the light?! Yes, and we will get the band back together to move these health policy changes forward, but don’t count on us to do backflips anytime soon.