If you had a choice, would you pick money or love? The correct answer is “both.” Maybe that’s why there are so many movies about getting both (e.g., Sabrina, Maid in Manhattan, Crazy Rich Asians). And the dreaming about getting both love and money starts early: Cinderella, Aladdin, The Princess and The Frog. And for those of you purists who are thinking “love is free” – (or maybe you’re just a Sheryl Crow fan, which would be understandable) — then why did Americans spend more this Valentine’s Day than ever? In the One Thoughtful Paragraph below, we explain how the love of money is generating a lot of activity in the health information space.
Love it or hate it, this is the news this week:
- Texting is a way to communicate love. Maybe that’s why CMS released a memorandum ahead of Valentine’s Day to state survey agencies stating providers working in hospitals and critical access hospitals may now text patient information and patient orders among care members. The texts must be sent through a HIPAA-compliant secure texting platform.
- Redesign Health, a venture capital firm that creates lots of healthcare startups, is laying off 77 employees. Oh, but there is a plot twist: One of the companies launched by Redesign Health, digital metabolic health company Calibrate, named Rob MacNaughton as their new CEO. MacNaughton previously served as the venture chair at Redesign Health.
- KKR and Veritas announced equal ownership stakes in Cotivity, now valued at $10.5B, for the company’s AI-enabled data analytics platform that helps health plans identify improper payments, improve consumer engagement, quality management, and provider network performance. Remember: It wasn’t that long ago that the Carlyle Group fell out of love with Cotivity.
People love to get paid for what they do. So, it makes sense that health care professionals are interested in health plans approving payment for patients’ treatment plans as quickly as possible. This is one of the reasons why CMS blessed a provider-payer industry plan to engineer the electronic exchange of information to make coverage decisions faster (we discussed this electronic prior authorization rule in a prior post). But this is not happening fast enough for some. Like the football player tells his agent in the Jerry Maguire movie, the message is: SHOW ME THE MONEY. That’s why state governments are swooping in to force health plans to pay providers faster by limiting prior authorization processes. What’s interesting about this state activity is that sometimes – like in Georgia – bills are being introduced that would prohibit health plans from using AI tools or automating these decisions. But automatically approving coverage makes things faster. Faster is good. So, it isn’t so much that states and doctors don’t want automation; they don’t want automated denials. There are many reasons for coverage denials, but one of them is incomplete documentation: a request for prior authorization of a service would be denied if there are not supporting medical records or relevant diagnostic test results. The federal electronic prior authorization rule is designed to solve that problem by making the payer’s computer system tell the doctor’s computer system what is required to get a request approved ASAP. So why aren’t states pushing for this fix to happen faster? Is it because they want the fairy tale?
