The Centers for Medicare & Medicaid Services (CMS) released the final annual Notice of Benefit and Payment Parameters for the 2020 benefit year, also known as the 2020 Payment Notice. The rule reduces user fees for plans offered on HealthCare.gov, and encourages the use of lower-cost generic drugs, while improving market stability and consumer choice.
“The rule issued today will give consumers immediate premium relief for 2020 by reducing the federal Exchange user fees thanks to successful efforts to improve the efficiency of the Exchange,” said CMS Administrator Seema Verma. “At CMS we have improved the operations of the Exchange to deliver a better consumer experience at a lower cost.”
Generally, Exchange user fees are passed directly on to the consumer in the form of higher premiums, and this reduction in the user fee allows issuers to pass along savings to consumers in 2020. The 0.5 percent reduction in the user fee rate comes as a result of CMS’ focus on reducing costs through increased operational efficiency, including successful efforts to upgrade IT functionality, a more efficient approach to outreach, and investments focused on proven methods to achieve a seamless enrollment experience and high consumer satisfaction.
This follows the first ever 1.5 percent drop in average premiums for plans selected through HealthCare.gov for the 2019 coverage year. With consumers facing rising premiums and limited choice in their health coverage leading up to 2017, the Trump Administration introduced a series of actions to encourage competition and bring down the price of healthcare for people in the individual market. The final 2020 Payment Notice builds on these prior actions to further strengthen America’s health insurance markets.
Building on the President’s American Patients First blueprint, the final rule also supports lower premiums by promoting the use of lower-cost generic drugs. Drug companies can offer consumers coupons to incentivize them to purchase the company’s brand name drugs even when an appropriate, less-expensive generic medication is available. This rule allows issuers to stop applying the value of these coupons towards an enrollee’s maximum-out-of-pocket costs in situations where a generic medication is available and medically appropriate, in order to encourage generic use and result in lower drug spending.
To improve market stability, a key element of this final rule refines the risk adjustment program to improve the accuracy of the data used to calculate the program’s charges and payments to issuers. This program is designed to reduce incentives for insurers to avoid enrolling people with expensive health conditions. The rule finalizes several proposals regarding the validation of the accuracy of the diagnosis codes, prescription drug data and codifies a number of exemptions to lessen burden on small issuers.
This rule also aims to increase the choices available to consumers for trusted enrollment pathways. Last fall CMS successfully launched Enhanced Direct Enrollment (EDE), which allows consumers to shop for and enroll in the Exchange plan of their choice through an approved partner website. In regards to enrollment, the final rule streamlines and updates regulations to accommodate future innovation and improve the consumer experience.
The EDE pathway allows CMS to partner with the private sector to provide a more user-friendly and seamless enrollment experience for consumers by allowing them to apply for, and enroll in, an Exchange plan directly through an approved issuer or web-broker without the need to be redirected to HealthCare.gov. In recognition of the new pathway, the final rule increases transparency as well as the privacy and security of consumer data by allowing CMS to require web-brokers to provide lists of the agents and brokers who use their websites.
The rule also enhances consumer protections and improves program integrity by allowing CMS to more easily suspend or terminate agents, brokers and web-brokers that violate applicable Marketplace requirements. As EDE continues to expand, to guarantee consumers continue to receive a high level of service, being able to more easily suspend or terminate agents, brokers and web-brokers that violate rules will better enable CMS to ensure agent/broker and web-broker compliance, respond to cases of noncompliance, and to protect sensitive Exchange data and systems.
Further, the rule finalizes a technical change to the premium index for the 2020 benefit year in order to better align our premium adjustment percentage methodology with the experience of the individual markets and premiums overall. Under the new methodology, CMS would use the CMS Office of the Actuary (OACT) estimates of projected health insurance premiums for both the private individual and group market (excluding expenditures for Medigap and property and casualty insurance). This change would replace the current methodology which utilizes only employer-sponsored group market insurance (ESI) premiums, which do not reflect the situation of the individual market premiums. This technical change in the premium adjustment percentage methodology will provide a more comprehensive and accurate measure of private market premiums.
Today, CMS also issued the Final 2020 Letter to Issuers in the FFE which provides guidance to issuers that want to offer Qualified Health Plans (QHPs) on the FFE, as well as the Key Dates Charts for the 2019 Calendar Year.
A foundational research roadmap for artificial intelligence (AI) in medical imaging was published this week in the journal Radiology. The report was based on outcomes from a workshop to explore the future of AI in medical imaging, featuring experts in medical imaging, and hosted at the National Institutes of Health in Bethesda, Maryland. The workshop was co-sponsored by the National Institute of Biomedical Imaging and Bioengineering, the Radiological Society of North America, the American College of Radiology, and the Academy for Radiology and Biomedical Imaging Research.
The collaborative report underscores the commitment by standards bodies, professional societies, governmental agencies, and private industry to work together to accomplish a set of shared goals in service of patients, who stand to benefit from the potential of AI to bring about innovative imaging technologies.
The report describes innovations that would help to produce more publicly available, validated and reusable data sets against which to evaluate new algorithms and techniques, noting that to be useful for machine learning these data sets require methods to rapidly create labeled or annotated imaging data. The roadmap of priorities for AI in medical imaging research includes:
new image reconstruction methods that efficiently produce images suitable for human interpretation from source data,
automated image labeling and annotation methods, including information extraction from the imaging report, electronic phenotyping, and prospective structured image reporting,
new machine learning methods for clinical imaging data, such as tailored, pre-trained model architectures, and distributed machine learning methods,
machine learning methods that can explain the advice they provide to human users (so-called explainable artificial intelligence), and
validated methods for image de-identification and data sharing to facilitate wide availability of clinical imaging data sets.
Article
Langlotz, CP, et al. A Roadmap for Foundational Research on Artificial Intelligence in Medical Imaging: From the 2018 NIH/RSNA/ACR/The Academy Workshop. Radiology. April 16, 2019.
Co-authors of the report with Curtis P. Langlotz were Bibb Allen, M.D.; Bradley J. Erickson, M.D., Ph.D.; Jayashree Kalpathy-Cramer, Ph.D.; Keith Bigelow, B.A.; Tessa S. Cook, M.D., Ph.D.; Adam E. Flanders, M.D.; Matthew P. Lungren, M.D., M.P.H.; David S. Mendelson, M.D.; Jeffrey D. Rudie, M.D., Ph.D.; Ge Wang, Ph.D.; and Krishna Kandarpa, M.D., Ph.D.
Telehealth is a really exciting field with masses of opportunity to build successful companies and to help people quite literally all across the globe. Technology has afforded us the opportunity to administer all sorts of things at vast distances and now that includes medical help. It’s not a field without some issues though and plenty of people will find getting into telehealth quite complex and confusing. So, here are a few tips for starting out in this industry.
Pick an appropriate field
Telemedicine is limitless in some ways, limited in others. This is an area with some limitations. “There are only certain sorts of medicine which it is practical to apply to the telehealth model, not to mention legally speaking,” warns Shane Marlon, career manager at PaperFellows and AustralianReviewer. You have to be able to guarantee that whatever it is you are doing will be of use without needing an ‘in-the-flesh’ consultation. But you’ll be surprised at how long that list of applicable practices is!
Look to the future
Tech development moves very, very quickly so it’s safe to say that telehealth, as a rising industry, will look completely different in ten years’ time. Now, you’re not a prophet, nor are you a trend-predicting supercomputer. However, with a little research you will quickly ascertain which elements of telehealth are set to change and develop. To capitalize effectively on these when the time comes, you need to be preparing now. For example, more detailed consultations of patients will be possible in the future, so the list of applicable fields will increase, and you need to be ready for that.
Find telehealth professionals
Though it is a relatively new field, there are already telehealth specialists who are out there. These people will be immensely useful to you as you try and develop in the industry. It’s vital that you bring in some outside expertise into your team as you develop, since it is such a new field with so few precedents in place to ensure that you are doing the right things.
What if, in an emergency, you reach for your epinephrine shot and it’s not there? It would be if you were wearing it.
Rice University students have designed a small, foldable epinephrine delivery device meant to be worn on a wrist, like a watch, or elsewhere on the body by a person at risk of an allergic reaction that requires an immediate response.
The tri-fold device they call EpiWear has a unique, spring-activated injection system that would provide a full dose of the drug to a person experiencing an allergic reaction.
The team – junior bioengineering majors Albert Han, Alex Li, Jacob Mattia and Justin Tang, and freshman Callum Parks – said the device is intended for all but small children, and could be a good alternative to other delivery systems on the market.
“The idea came from me, because I suffer peanut allergies,” said Tang, who worked on the device at the Brown School of Engineering‘s Oshman Engineering Design Kitchen with adviser and Rice lecturer Deirdre Hunter. “I’m very self-aware and worried about my life, but it was always difficult for me to bring something as bulky and obtrusive as this when going to dinner with friends or just going out at night.”
Tang held up the pen-like syringe he carries in case of emergency. Such pens were the focus of controversy a few years ago when Congress held a hearing on the sharply rising price of the devices.
The Rice team hopes its creation will lead to a delivery device that is less expensive, more stylish and thus more likely to be worn by users.
“We designed the optimal device to house the minimal amount of epinephrine necessary for injection,” Mattia said, holding a scaled-up prototype.
EpiWear is designed to inject a dose of 0.3 milliliters of epinephrine, the same as commercial devices that contain more of the drug.
“They actually only inject a fraction of what they hold,” Li said.
Zipnosis launched ZipPlus, a services and tech enablement program that creates a multi-year, integrated virtual care road map for health systems using Zipnosis’ virtual care chassis while leveraging 10 years of virtual care leadership and experience.
Jonathan Pearce
“We continue to hear from our health system customers that virtual care deployment is narrow and integration is a challenge, and in many cases prohibiting widespread adoption,” said Jon Pearce, CEO, Zipnosis. “ZipPlus breaks down these barriers in two ways. The first barrier is technology. Within the ZipPlus program, we can fully integrate the patient and provider experience via FHIR or API’s into Epic, Cerner and Athena. The second barrier is an aligned strategy for virtualizing care.
With ZipPlus, Zipnosis and our partners sit down to create a multi-year roadmap for clinical business lines, such as behavioral health, post-surgical follow-up, travel medicine, hypertension – or any service using our powerful virtual care technology platform as the foundation. These unique roadmap partnerships are truly a first for the industry and position us well as the undisputed standard in virtual care.”
Research from Zipnosis’s recent benchmark report shows that health systems are not fully realizing the benefits of virtual care as they struggle to overcome disparate technologies that are designed without the patient at the center, and implemented without provider workflow and integration considerations. Specifically, 54 percent of health systems say they expect integrating virtual care with existing technology solutions to be a challenge and 61 percent expect roadblocks when it comes to gaining provider acceptance. That’s in addition to the 64 percent who report that patient utilization has been a challenge since deploying their virtual care solution.
ZipPlus directly addresses these challenges by combining Zipnosis’ leading edge technology with unparalleled consultative support. “We’re leading the transition from siloed, cumbersome telemedicine, into integrated value-driven virtual care. ZipPlus will accelerate our partners’ success in building their digital front door,” added Pearce.
Jefferson Health, a 14-hospital system in Philadelphia and New Jersey with more than $5 billion in revenue, named Chicago-based Prepared Health its digital technology partner for post-acute and transitional care. Prepared Health’s platform enables hospitals to connect, collaborate and react in real-time with the multiple providers involved in a patient’s care post discharge including post-acute, home and social determinants of health partners.
The digital care coordination platform will launch at Jefferson’s Cherry Hill, Stratford and Washington Township hospitals in New Jersey.
“It’s up to healthcare professionals to use technology to get care to where patients are instead of getting patients to where care is located,” said Stephen K. Klasko, MD, MBA, president of Thomas Jefferson University and CEO of Jefferson Health. “We are thrilled to develop and deploy Prepared Health’s technology to partner with our post-acute providers. They are aligned with our mission of healthcare with no address, which underpins our model of healthcare innovation across the nation.”
Prepared Health’s cloud-based, mobile-friendly platform connects caregivers across the entire care continuum: skilled nursing facilities, home health care, non-medical home care, durable medical equipment providers, pharmacists, geriatricians, family caregivers, and companies that address social determinants of health. The tool fosters collaboration in real time to reduce communication gaps that can occur when multiple providers are involved with patient care post-discharge. The intent of the collaboration is to reduce readmissions, curb uncompensated care due to unnecessary ER utilization, and streamline patient transitions to post-acute and the home. The connected platform includes DINA, an AI technology that analyzes patient data and suggests evidence-based interventions to caregivers.
“Dr. Klasko is an inspiring leader and we are excited to work together to provide the highest quality patient experiences as care continues to move outside of the hospital and into the home,” said Ashish V. Shah, CEO of Prepared Health. “To achieve our shared vision and connect many different providers, we need to activate data to provide the right care at the right time.”
According to Patrice Miller, enterprise vice president of care management at Jefferson Health: “Our partnership with Prepared Health will help us reach our shared vision of re-imagining healthcare and improving patient care and coordination.”
While advancements in data collection, analytics and electronic health records can lead to better healthcare, it also creates challenges for the healthcare sector’s IT departments. That’s because serious obstacles exist in terms of systems management and capacity. The sheer amount of healthcare data has skyrocketed from even a decade ago. Through advanced predictive analytics, this data can save lives by fostering the diagnosis, treatment and prevention of disease at a highly personalized level.
To maximize the benefits all of this information can offer, healthcare organizations will need to make significant investments in data storage and infrastructure. With simple software fixes, many healthcare IT departments could easily free up half their bandwidth — essentially doubling IT budgets — by more efficiently using the infrastructure already in place.
The health data tsunami
Healthcare institutions must comply with more than 629 different regulatory mandates in nine domains, costing the average community hospital between $7.6 and $9 million. Much of that spending is associated with meaningful use requirements –- government standards for how patient records and data are stored and transmitted. The average hospital spent $760,000 on meaningful-use requirements and invested an average of $411,000 in hardware and software upgrades for their records systems in 2016 alone
Because of the demands of healthcare record-keeping and continued advancements in medical technology, IT spending is rising exponentially. Along with that, medical research and development is booming to the point that institutions can’t keep up with the amount of data that needs to be stored and analyzed. Pharmaceutical and healthcare systems developers are also affected by the gap between data acquisition and analysis. Life sciences companies are launching products faster and in a greater number of therapy areas.
This fast-paced technological evolution places even more pressure on healthcare IT departments to deliver both innovation and efficiency.
I/O performance
Performance degradation occurs over time as the input/output (I/O) movement of data between the storage and computer/presentation layers declines. This degradation is particularly prevalent in the Windows environment. Luckily, targeted software solutions do exist that can improve system throughput by up to 50 percent without additional hardware.
If I/O drags, performance across the entire system slows, which primarily impacts computers running on Microsoft SQL servers (the most popular database in the world.) The Microsoft operating system is also notoriously inefficient with I/O. In fact, I/O degradation is much more common than most organizations realize. More than a quarter of organizations surveyed last year reported that poor performance from I/O-heavy applications was slowing systems down.
Amazon recently announced the availability of a HIPAA-eligible development environment for Alexa-enabled devices. This environment allows select developers to create healthcare “skills” or applications that enable voice-based access to personalized health information. Six healthcare companies are already operating in this new environment and have developed skills “designed to help customers manage a variety of healthcare needs at home simply using voice,” writes head of Alexa health and wellness, Rachel Jiang, in Amazon Alexa’s official announcement.
Amazon Alexa’s move to support handling of personalized health information, whether to make it easier for individuals to book a medical appointment, access hospital post-discharge instructions, provide recovery updates to physicians, check on the status of a prescription delivery or make better food choices based on their latest blood glucose measurements, is reflective of a broader movement of healthcare towards empowering the consumer. This is for good reason, because the traditional approach to healthcare is broken.
Despite astounding medical advances and technologies such as whole genome sequencing, modern health care systems aren’t helping people to live in a healthy state any longer than they did a decade ago. For example, the percentage of the U.S. population with diabetes has been steadily growing over the last decade, and the share of the world population with cancer has been stable or has risen over the past 30 years. Some of the health care problems that contribute to our stagnant health span, or the length of our disease-free lives, include unequal access to healthcare, top-down health care recommendations that don’t translate into people’s daily lives and lack of patient engagement outside of the clinic.
Popular technologies including health and fitness apps, wearables and virtual assistants, like Amazon Alexa, are forcing and enabling a revolution in healthcare. Amazon’s creation of a HIPAA-eligible environment for developers of Alexa-enabled device applications indicates that health care is moving out of the fortress of the hospital and the clinic and coming into each patient’s hands for their own control. It won’t be long before we will all be able to access our health data through devices like Alexa and mobile apps like Apple Healthkit and LifeOmic’s LIFE Extend health tracking app. This data will live more securely in the cloud and will help inform our day-to-day decisions about our health.
A voice-enabled move on precision health
Alexa’s HIPAA-eligible environment is one participant in the broader precision health movement. Precision health is a mission of most modern health care providers that involves intervening at the right time for the right patients in order to best treat and prevent disease. Precision health is practically impossible without individual patient engagement. Treating the right patient at the right time with the right drug or intervention requires having information about that person’s genome, environmental exposures, lifestyle factors, health barriers, existing health literacy and more. To not only collect this data from individuals but also to engage them in preventive screening, interventions and health behaviors that fit into their lives, providers need to meet patients where they are: on the go, not in the clinic.
The future of healthcare involves delivery of personalized health information and recommendations through smartphones and voice-enabled devices like Alexa that follow people throughout their homes and out of their doors on a daily basis. Virtual assistants that can help people more quickly and easily make decisions that are best for their health are particularly exciting. People are turning to AI assistants to help them reduce their stress, pick the right nutrition plan and more.
The Centers for Medicare & Medicaid Services (CMS) released the final annual Notice of Benefit and Payment Parameters for the 2020 benefit year, also known as the 2020 Payment Notice. The rule reduces user fees for plans offered on HealthCare.gov, and encourages the use of lower-cost generic drugs, while improving market stability and consumer choice.
What if, in an emergency, you reach for your epinephrine shot and it’s not there? It would be if you were wearing it.
“It’s up to healthcare professionals to use technology to get care to where patients are instead of getting patients to where care is located,” said Stephen K. Klasko, MD, MBA, president of Thomas Jefferson University and CEO of Jefferson Health. “We are thrilled to develop and deploy Prepared Health’s technology to partner with our post-acute providers. They are aligned with our mission of healthcare with no address, which underpins our model of healthcare innovation across the nation.”
