In my last issue, I mentioned we would spend the September issue covering the White House's "Time is Money" Initiative. However, given all the headlines that healthcare has seen over the past month, I've decided to expand the focus to add 2 additional topics that might have flown under the radar.
This issue's focus will serve as a roundup of the latest healthcare news and my thoughts on these developments, including the Biden admin's Time is Money Initiative, the recent Mental Health Parity Rule and California's Data Exchange Framework.
Time is Money
Earlier this month, the Biden Administration announced their "Time is Money" initiative, aimed at protecting consumers in healthcare, various other industries and large corporations. Among the many outputs outlined, this could look like:
- Simplifying the process of canceling subscriptions and memberships
- Ensuring accountability for airline refund policies
- Making it easier to connect to a human on customer service calls
- Removing deceptive product reviews
Essentially, this initiative aims to restore agency to the consumer and save them from confusing or deceptive business practices. I am sure each of you has an example of one of the situations listed above and personal experience with the resulting frustration that can result. In terms of healthcare, the initiative aims to make patient engagement with the system easier. An example would be to allow patients to submit health claims directly to their insurer online.
The official release cited private insurance companies often making it difficult for consumers to access their coverage with strict and inconsistent submission requirements, extended wait times and decreased customer service access. The Department of Health and Human Services (HHS) Secretary followed this announcement by publishing a letter to CEOs of health insurance companies and group health plans to reaffirm the shared commitment to improving access to patients and members and ensure the agency's partnerships in these efforts.
My thoughts: First, any time we aim to improve or establish a minimum standard across the healthcare system, it may help create enhanced opportunities for people and communities to seek and access care. It's equally promising to see efforts from the current administration to protect and advocate for consumers' time and money.
While I do think the goal of this initiative is positive, there are potential pitfalls we need to watch for. Having worked with health plans for over 30 years, I have seen tremendous effort placed on creating simplified materials, claim submission tools and improved customer service efforts. Creating additional regulations or requirements without understanding the current environment fully can result in additional administrative burden and expense.
It's more productive to take stock of what currently exists and foster creative ways to ensure innovation and accountability across organizations. Ensuring that patients and members have access to information that is easy to obtain, use and understand and tools to maximize their coverage (and their health) will result in healthier communities overall -- and it may save time too!
Mental Health Parity
The Biden administration recently finalized a rule to improve access to mental health care and substance use coverage for those with private insurance and to expand benefit parity standards for health plans.
Taking effect on January 1, 2025, the rule requires private health plans to ensure their standards, rates and processes are the same across mental and physical health benefits. If plans are non-compliant or don't meet certain requirements, insurers would be fined or be required to increase coverage through actions like expanding networks to include more therapists or removing prior authorization requirements for services.
My thoughts: It's promising to see mental health continue to be normalized and included in the conversation around whole-person care. But while this news may seem like a major development, the parity conversation is not a new one and in fact, extends back decades with previous legislation like the Mental Health Parity and Addiction Equity Act (MHPAEA) passed in 2008. More recently, the mental health effects of COVID and the heightened awareness of the number of individuals without access to care spurred this additional regulation.
The question I ask myself is if these new parity requirements will address underlying issues -- proving access does not improve access. Instead, how do we ensure individuals have access to the mental health services that meet their specific needs (for example: group therapy, funded school counselor programs, virtual care, affordable care)? And how do we use technology and innovation to create more access?
Additionally, establishing a regulation doesn't fix the issue that many mental health providers don't take insurance and operate outside of many health plan networks due to historic low reimbursement. As we think about regulation as a solution, we need to make sure it holistically addresses the problem (and doesn't just add a layer of administrative burden to insurance companies and providers).
Data Exchange Framework (DxF)
Zooming into the state level, California's latest law aims to enact a framework that improves health equity and streamlines the sharing of information.
To overcome the challenges of fragmented data storage, the DxF establishes a common set of policies for secure data exchange and requires new connections between health providers and social services to better provide whole-person care to citizens of the state.
My thoughts: While the goal of this framework is positive, I'm curious about how it will be implemented. First and foremost, is there actual funding for this effort -- both to include parties that have previously not been connected and to maintain it for the long-term? Second, would it be possible to scale federally? Something that might be broadly accepted in one state is unlikely to pass in another state. Additionally, a patchwork system of state-based requirements could create more room for complexity and error since auditing and regulating entities would be different.
Advocating for standards will always be important for any kind of data-driven work as we look to more efficiently share and action data. However, disparate, state-led efforts like these can often result in higher complexity, create additional burdens and make it difficult to establish national standards. We need a national solution for data definition and exchange standards in healthcare -- and now is the time to move forward.
Looking Ahead + Final Thoughts
While many of the efforts outlined aim to address real problems within healthcare, I worry they could be unproductive or duplicative to existing efforts or work currently underway. At a high level, they don't offer holistic, practical solutions that could easily be adopted across the system. However, I remain optimistic about the outcome and can appreciate the focus on protecting and increasing access to care for patients and making engaging in healthcare easier.
Next month, we'll talk about what individuals should know as we head into Open Enrollment season.
Until next time.
-Ruth 🌸
