Lack of Transparency Continues to Haunt HHS

A lack of information is driving consumers into poor health care choices, and Health and Human Services is to blame; at least according tothe Government Accountability Office.

In a 43-page report released this September, the office slammed HHS, claiming that a lack of transparency is keeping consumers from easily accessing the pricing information of health care plans until after they are already covered. FierceHealthcare summarizes, “In one example, the agency contacted a variety of physician offices to get the price of a diabetes screening--and was consistently told an office visit was required prior to disclosure of such a price. The GAO also noted that the negotiated prices between an insurer and provider were often kept from consumers for legal and trade purposes.”

Transparency in HHS is not a new topic. In fact, the department was criticized for similar reasons when they removed public access to National Practitioner Data Bank in early September.

This new report, the creation of which was heavily pushed by congress, has found a severe lack of initiative from HHS when it comes totransparency.

Several health care and legal factors may make it difficult for consumers to obtain price information for the health care services they receive, particularly estimates of what their complete costs will be. The health care factors include the difficulty of predicting health care services in advance, billing from multiple providers, and the variety of insurance benefit structures.

The entire industry is keeping a close eye on this developing story, and Merrill Corporation will be among them.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

HIPAA Regulations as it relates to New Technology

We have written about HIPAA on several occassions on this blog (and even when we aren't writing about it, we are staying abreast on the subject). In the course of our recent research, we have found a number of articles discussing ideas on how new (and growing) technologies can fit into HIPAA regulations. We feel that, while this isn't the start, the fact that more consistent reporting is happening in this capacity will help bring the industry together to work towards a solution.

Mobile Technology:

The risk of fines (or worse) is still a major concern for those reluctant to convert to EHR, so the idea of a transition to developing mobile sites and apps is beyond most physicians' range of thought. However, Diversenet, a company focused on strengthening mobile health technology capabilities, recently developed a whitepaper with nine mobile security best practices, such as encrypting PHI on mobile devices, authentication of users prior to transmitting PHI and automatic session timeout, logoff and device locking. Additionally, it lists 10 questions about mobile health data that healthcare organizations should ask when evaluating mobile technology.

The problems with mobile devices are obvious. Once information leaves a server, there are any number of complications that can result in breaches, and mobile technology has not proven itself to be anywhere near consistently secure. However, according to the article, a number of small mobile health companies are providing targeted wireless personal health monitoring devices and services that collect and transmit health data, while others have developed mHealth apps for patient monitoring, scheduling medical appointments and medication reminders, all of which work. And, at the security end, global technology service providers are adapting existing security products for the healthcare sector.

This just leaves the actual mobile device as the key problem, but Diversinet has a solution for that as well.

To read the full article, click here...

Cloud Computing:

The advent of cloud computing, as it relates to HIPAA, is allowing certain organizations to reconsider certain security protocols and, according to a recent article in Tech News World. The story addresses how organizations are typically confused as how to meet the addressable requirements of the Security Rule, causing a refrain from full implementation, leaving the institution in the precarious position of not fully complying with the law -- at least not in the manner intended by HHS.

However, with cloud computing scenario, most security activities occur in partnership between vendor and client. So, while the onus still resides with the covered entity, components of the implementation can be handled by the business associate cloud provider. An organization that could commit, at some level, to helping maintain the HIPAA security requirements, would have a significant leg up.

To learn more about the technical aspects, click here...

Social Media:

"HIPAA is a well-intentioned, but poorly implemented law that is unnecessarily scaring doctors and keeping them in an unrealistic 'technology lockdown'."

This is a quote from Mark Britton, Founder and CEO of Avvo, a company that helps physicians deal with the legalities of new technology, such as social media. While Avvo has the ability to deal with specific issues, they do offer these five basic pieces of advice for managing their career online in relationship to HIPAA:

1. Use email, SMS and social media messaging
2. Feel free to share information with other providers
3. Feel free to answer general patient questions
4. Keep family members in the loop
5. Exercise common sense and reasonable practices in all instances

For more details on these tips and other potential issues, click here...

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Health Reform Legislation Threatens Mini-Med Plans

If there has been one clear victim of the new health plan regulations, Mini-Med Plans are it. Last year when the new MLR percentages became reality, hundreds of Mini-Meds began seeking alternative measures to survive. HHS has provided a solution for 1,040 such plans. Out of all the Mini-Med Plans that applied, 94% have been granted a waiver, allowing the plans to be considered exempt from the new law. The exemption lasts only for one year, but is renewable until the full weight of the reform falls in 2014.

The waivers are required because the Mini-Med Plans, which provide care for over 2.6 million people, do not meet the minimum annual dollar limit on essential benefits as outlined in the reform legislation. This limit starts at $750,000 in 2011, increasing to $2 million in 2013. By 2014, the law states that there is to be no annual limit on essential benefits.

Mini-Med Plans cater to low-income or part-time workers, who often do not qualify for more expensive plans. Unless the reform legislation is re-written to account for these smaller providers, 2014 will see the end of Mini-Meds, and those employees will be forcefully folded into the government-created health exchange planned for 2014.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

HHS, IT Infrastructure and Health Insurance Exchanges

Last week, HHS announced a new initiative that will provide competitive funding opportunities for states to design and initiate IT infrastructures that will be necessary for the operation of Health Insurance Exchanges. Because these Exchanges will need to be designed to present a large number of individuals and small businesses with affordable health care options by 2014, new and advanced IT systems will be necessary well before then.

Exchanges, as we know, will provide a form of one-stop shopping for individuals and small businesses, with interested parties being able to examine, select, and enroll in one of many available plans offered at competitive, affordable prices. However, while many are focused and debating the policy aspect of this initiative, what gets lost is the IT infrastructure that will need to be constructed in order to make this (or any) end goal possible. The infrastructure will need to be well thought out and be based on several best practice examples (especially in the areas of simplicity and approachablity) in order to allow the Exchanges to operate like other similar consumer industry sites.

To assist with this aspect, states can apply, through HHS, for “Early Innovator Grants.” The grants will provide states with the capital to get a head start on building these necessary infrastructure models. States are to be chosen based on their current efforts toward consumer-friendly IT infrastructure, as well as their leadership in cost-effective solutions.

The first round of winners will be announced before February 15^th, 2011, and will be followed by additional award announcements which all states – including those that already received funding – will be eligible to receive.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

The Patient and Protection Affordable Care Act…..6 months later

While The Patient and Protection Affordable Care Act (ACA) was enacted on March 23, 2010, it didn’t officially go into effect until last week on September 23. However, despite being enacted, there are still many debates and discussions raging on about the bill.

The goal of the ACA was to reduce the cost of healthcare, improve the quality of care and improve the overall member experience. Thus ACA included the following items:

• No lifetime or restricted annual limits on benefits
• Eliminated pre-existing conditions and rescissions
• Young adults covered to age 26 on their parent's policy
• Drug discounts for seniors (starting June 15, 2010)
• Tax break for small businesses

However, there are also additional changes taking place behind the scenes that many consumers are unaware of, but could greatly alter the healthcare landscape. Most notably, changes to Medicare Enrollment Period’s and Medical Loss Ratio calculations.

With reduced enrollment periods, plans will have to alter how and when they market to their members. This constricting timeline is going to make an already trying process, an even greater strain on resources. Additionally, the 80-85% Medical Loss Ratio that plans will be mandated to operate at will force some plans to change their plan type, or worse may force them to drop certain coverage in order to comply.

On top of all of this, with November elections looming, funding may be reduced or cut and each new member of Congress will push for what they think will be the best circumstance for their delegates. Like always, Merrill Corporation will be monitoring all these changes and more from HHS, CMS and all other regulatory bodies to ensure that health plans can successfully navigate and comply with Health Reform.

The CMS / CGI Partnership

The contract that most sports enthusiasts are pondering this summer is that of Lebron James. However, if you are interested in the healthcare / web development equivalent of this question you need not wait any longer.

This week, the Centers for Medicare and Medicaid Services (CMS) announced that it has awarded CGI Federal, Inc. a five-year, $73.2 million contract to redevelop three of their websites that enable Medicare beneficiaries to find information about their healthcare programs.

The three sites - www.medicare.gov, www.cms.hhs.gov and www.Mymedicare.gov - provides information for 44 million beneficiaries and receives a total of 500 million views a year. The sites are primarily focused on allowing consumers to view health claims information, compare health and drug plans based on quality measures and estimated costs, and create a report listing information that they can share with their healthcare providers. As an example of the importance HHS puts on the ability to navigate the site, the following video was released involving Secretary Sebelius walking viewers through the Medicare.gov:



The execution of this contract will be an extremely interesting task. It has been well documented that a large chunk of the healthcare reform package will be enacted and implemented over this period of time, and as new regulations are developed on items such as the role of social media, these three websites will have to be well managed.

CGI and CMS have had a long standing and successful collaboration, including projects like the Hospital Compare and Nursing Home Compare tools, which combine geographical data from Google Maps with healthcare provider quality-of-care information to help users locate and assess nearby healthcare facilities. Additionally, CGI was awarded the Enterprise System Development (ESD) contract, which covers systems development and integration, system and application engineering and technical support to improve the automated systems and agency-wide applications of the Health and Human Services Department.

However, this project will involve developing tools for the public at large, not a subset of experts in the industry. It is a different mode of thinking, but the potential is there for a new evolution of internet communication.