Maverick's Update

It may not be Independence Day yet, but for health plans, July 1st could be called Enforcement Day — the day the federal government can begin enforcing the Interoperability and Patient Access final rule. It is a big deal to think that people can ask their health plans to download their health information onto the app of their choice — anytime, anywhere, for free. Maybe celebrating with fireworks is appropriate for July 1st too — or, if you’re in charge of operationalizing the interoperability rule at a health plan, maybe a different type of explosion is in order.

Other fiery news this week:

1. On June 28, the U.S. Government Accountability Office reviewed HHS’ approach to cybersecurity and recommended seven things the agency should do to better protect healthcare from cyberattacks — most of which will fall to the new HHS Assistant Secretary for Preparedness and Response, Dawn O’Connell, who was confirmed only one week ago and also has that pesky pandemic problem on her to do list.

2. There is a lot of talk about how healthcare should be more accessible and equitable for everyone, but the HHS Office of National Coordinator of Health Information Technology (ONC) is gathering a group of experts to figure out how to make it so. On July 13, ONC will host a workshop about using social needs data — the conditions in which people live, learn, work, and play — to improve health.

3. The San Diego City Attorney filed a suit against three California health plans alleging that they misled consumers with inaccurate provider directories. Interestingly, both the interoperability rule (again, effective July 1st) and the No Surprise Billing law (regs are expected to be promulgated today-ish) require health plans to keep provider directories updated, but this legal action is based on a California law that requires plans to update them quarterly.

One Thoughtful Paragraph

When you track health information technology issues like Maverick does, you review sources of news like RACMonitor — a publication about third party contract auditor activity to help healthcare providers understand their business risks. They had an interesting tidbit yesterday about how the same enormous piece of legislation (passed and signed into law in 2020) that included the No Surprises Act (a bill that prohibits providers from surprise-balance billing people for medical services) also required U.S. intelligence agencies to release a report about UFOs. Remember, in the movie Independence Day, the President didn’t know that there was an alien spaceship and preserved alien species in Area 51 — but the CIA knew. So now our truth may be stranger than fiction… and while the UFO report is arguably more interesting … we need to acknowledge the enormous regulatory undertaking beginning today for health plans. Not only are they supposed to have interoperable claims and clinical data ready to go to any third party app, and very updated and accurate provider directories, but plans are also expecting new rules (maybe today) that will implement the No Surprises Act. Plans are anticipating new mandates for Advanced Explanation of Benefits (so people can know how much medical services cost BEFORE they get them) and price comparison tools (so people can compare healthcare prices). We may be on the right track to making more information available, but it will take a while to get these great ideas into a simplified and seamless format so people can actually use all this amazing digital health information. Like the Will Smith character says in the movie Independence Day, “It ain’t over until the fat lady sings.”