Sunday, March 28, 2010

DURSA, health reform, and California privacy rules

The National Health information network has now provided a template agreement for organizations seeking to participate in health information exchange -- the Data Use and Reciprocal Support Agreement (DURSA).

California is one of the states challenged to determine what modifications to the DURSA, or state law, for health information exchange (HIE) to achieve its full potential. In my view, the DURSA review is a timely opportunity to address the proliferation of disease management services that may diverge from the disease management services contemplated in California Civil Code Sec. 56.10(c)(17). 

Certain features of “accountable care” and “medical home” approaches contained in the recent health care legislation seek to enlist the services of a disease management firm to provide both the types of disease management services described in Health Code Section 1399.901, and additional services that would arguably provide better quality assurance and cost control in California if the disease management organization was more broadly permitted by the California law to participate in HIE under DURSA. A disease management organization seeking to validate population health trends or evidence-based practices, for example, would have to seek the support of either a multitude of physicians (Sec 56.10(c)(17)(A)), or the health services plan (56.10(c)(17)(B)), making such validations more difficult.

Tuesday, March 23, 2010

HR 3590 Signed!

Time for all manner of vendors to consider whether their services will be rendered invaluable, redundant, or worthless as a result of the new legislation.

To support the political claims of "immediate impact", the bill contains certain sections will require states to procure new consulting and technology services.

Among the most straightforward requirements are those found in Section 1103, requiring states to establish new web services in just 3 months. An extension may be granted, or the exact meaning of "establish" can be argued, but no doubt resource-strapped states will be turning to vendors for assistance.

Here's the text:

2010,  the  Secretary, in consultation with the  States, shall estab- lish  a mechanism, including an  Internet website, through which  a resident of any  State may  identify affordable health insurance coverage options in that State.
(2)  CONNECTING   TO   AFFORDABLE   COVERAGE.—An Internet website established under  paragraph (1)  shall, to  the   extent practicable, provide  ways  for  residents of any  State to  receive information on at least the  following  coverage options: ...

This will be quite a boon to outfits like, which already have a clear and concise platform for giving realtime price quotes. The question will be the various states' appetites for making, buying, or renting the solutions they need.

Larger vendors like Accenture, with a long history of Medicaid management information systems, will have the ability to offer the full suite of information required to be provided by the sites. The information required requires tapping databases that have seldom been brought together in one place:

(A) Health insurance coverage offered  by health insurance  issuers, other than coverage that provides reimburse- ment only for the  treatment or mitigation of—
(i) a single disease or condition; or
(ii)   an   unreasonably  limited  set   of  diseases  or
conditions (as determined by the Secretary);
(B)  Medicaid coverage under  title  XIX  of  the   Social
Security Act.
(C)  Coverage under  title  XXI  of  the   Social   Security

(D) A State health benefits high  risk  pool, to the  extent
that  such   high   risk   pool  is   offered   in   such   State;  and
(E)   Coverage under  a  high   risk   pool

Friday, March 5, 2010

Population Health Management

As someone who lived in Wisconsin for 3 years, "population health management" sounds like issuing licenses to hunters to shoot deer. As applied to people, however, the hunt in population health management is for behavioral causes of disease within a population, and then identifying strategies to prevent the disease. Sounds harmless enough. To find the diseases and causes does require aggregating personal information of people within the population, raising some objections.

In Buck Consultants 2009 survey, several employers engaged in "managing wellness" announced 2 vision statements that are remarkable, especially since the trend has been for employers to shift away from defined benefits and towards defined contribution plans. Perhaps this shift is not indicative of an overall decrease in taking responsibility for employees' healthcare.

  • “valuing employees’ health as much as their intellectual knowledge”
  • “our vision is to make people feel better than they ever thought possible"
No doubt each of these statements will include qualifications and disclaimers of liability prior to becoming actual policy. Indeed, finalized corporate HR policies are often difficult to discern due to the care that is taken to avoid offense. If the above statements really do become the core of health benefits policy, it is worth considering the implications in the context of privacy and anti-discrimination regulations.  

Valuing employees' health seems to give the employer the right incentives during the course of the employment relationship, but the hiring and termination decisions are also implicitly impacted by valuing employees' health. With average employment tenure approaching just 3 years, firing and hiring happens a lot.  While various regulations protect employees in the hiring and firing process, those regulations cannot reach secret motives. In this case, the employer is making its preference for the health of its employees explicit. Careful wording of such preferences will be required to steer clear of privacy and ADA issues here.