Amanda DiTrolio
💡 HTN | Community Brain Trust | 11/7
🧵TOP THREADS OF THE WEEK
In case you missed them, here are highlights of a few interesting conversations from different channels:
Threads included below:
- Unpacking the cost of Silver Sneakers for MA plans
- HIPAA-compliant e-commerce platforms for selling prescription and non-Rx products
- Finding and working with channel partners/resellers for companies selling into primary care
- Choosing a form builder tool for pre-appointment data collection
- Successful monetization of open source software
1. Unpacking the cost of Silver Sneakers for MA plans
Q: Does anyone have perspective on how much programs like silver sneakers cost MA plans? I assume it's some kind of PMPM, but I could be wrong
– Mike Maseda | via #buildersask
Thread Summary: HTNers discuss the cost of programs like Silver Sneakers for Medicare Advantage (MA) plans. One member shares a document from 2018 that estimates the cost at $2.37 PMPM. Another member adds that their experience managing SNP MA plans in 2021 showed costs in the $1.50 range PMPM, with the payer covering the other half.
Top Response:
Samir Unni: Is this what you're looking for?
- UHC will offer Uniform Benefits with Silver Sneakers, a wellness program including discounts for gym memberships. The proposed cost for Silver Sneakers is $2.37 PMPM
A bit dated (2018), but gives you a ballpark estimate.
And here's another one:
- The administrative services fee for the program is $0.80 PMPM with a program fee of $4.25 per member visit. The total administrative service and program fees are capped at $5.14 PMPM.
Check out the full HTN Slack convo here!
2. HIPAA-compliant e-commerce platforms for selling prescription and non-Rx products
Q: Hi crew! My first question here now in healthcare… so please forgive if it’s a dumb one! We will be selling both prescription products and cosmetic (non-medical, no-PHI) products on our site. Are there any e-commerce platforms out there that can support both showing, subscribing, and paying for Rx products in the same basket as non-Rx products in a HIPAA-compliant way? I’m a Shopify fan from my prior non-healthcare chapter, but I know the game is different here. (And we will be working with a third-party telehealth platform to get said prescriptions approved.)
– Michael Pollack | via #buildersask
Thread Summary: An interesting thread exploring e-commerce platforms that can support selling both prescription and non-prescription products in a HIPAA-compliant way. The discussion touches on corporate decision-making, personal data privacy regulations, and the importance of considering HIPAA standards even when they don't legally apply.
Top Response:
Michael Herrick: This can get complicated. I've seen Shopify integrated in a HIPAA environment. But are you sure HIPAA is a factor? You mention the customer paying for Rx products. Self-pay for a prescription medicine might not implicate HIPAA. More depends on your business model than on your data model.
In general, no insurance means no HIPAA. In such cases, I usually advise voluntarily adopting almost all of the HIPAA security rule, most of the breach notification rule, and some of the privacy rule. A good strategy could probably be put together using the tech stack you already are comfortable with. DM me, I can help.
Check out the full HTN Slack convo here!
3. Finding and working with channel partners/resellers for companies selling into primary care
Q: Anyone able to speak to finding and working with channel partners/resellers for companies that want to sell into primary care?
– Dan Witte | via #buildersask
Thread Summary: The crew digs into the process of finding and working with channel partners/resellers for companies that want to sell into primary care. The conversation covers topics such as partnering with EMRs, leveraging trust and proximity, and channel partnerships through cloud providers.
Top Response:
Siobhan Gibney Gomis: I've had mixed results with SaaS companies partnered with Athena. They have a big, formal partnership program, but you can get "above and beyond" partnership in a few ways. More generally speaking, the best fits for you will depend on your company (product/pricing model + amount/buyer/traditional barriers, etc). Not specific to PCPs, but a good way to think about who makes a good channel partner for you is: (A) who does your buyer already go to/talk to about their problems and/or advice on {whatever your solution is - tech/finance/staffing}. Often, if you're selling software, the EMR is the first candidate that comes to mind since most healthcare orgs, PCPs included, ask their EMRs for advice first when they are looking for tech to plug a hole. (B) who sees your buyer often, so has a friendly personal relationship with them where this topic may come up. This is where, even if you have a tech product, we are likely not talking about a tech partner, but could be a major supplier who has a rep in and out of that office week after week stocking them up on gauze/swabs/etc. Here you're leveraging trust & proximity, but if your product is complex software and those reps are trained in selling consumable commodities, a reseller agreement is unlikely to a be a good fit, you want lighter touch, like a lead gen partnership. Happy to chat further with anyone, if helpful!
Check out the full HTN Slack convo here!
4. Choosing a form builder tool for pre-appointment data collection
Q: Hey all, just starting to plan out pre-appointment data collection (past medical history, family history, etc.) for a patient-facing app. if this were going to live as a standalone form we ask patients to fill out digitally, it would be a no-brainer to use a good HIPAA-compliant form builder tool like Formsort. What I'm struggling with is that this form will be one step of many we have patients completing, and everything else will be native within our own app.
As i think through it, there are two decent options, each with challenges:
1. Embed a form from a tool like Formsort within a custom webview (no address bar, so it isn't obvious you're filling out a web form), and try to make the styling match as much as possible to the UX of the native app. Easier to build and can definitely support conditional logic, but might be tough to make it blend in with the app.
2. Find a form builder tool that returns conditional logic via their API, and render the questions ourself within the app. More work to build, and I haven't found a tool that definitely supports this conditional-logic-via-API requirement.
has anyone else worked through something like this, and how did you solve it if so? thanks in advance!
– Mike Gleichman | via #buildersask
Thread Summary: In a discussion about pre-appointment data collection for a patient-facing app, HTNers discuss different options for using form builder tools. The main considerations are embedding a form from a tool like Formsort within a custom WebView, finding a form builder tool that supports conditional logic via their API, or building the entire form natively. HTNers highlight the importance of considering design, compliance, and ease of building when making a decision.
Top Response:
Molly McGrath: I think this is a good one to overthink! (aka it will bite you down the road if you don't think of this stuff). We love Formsort and do render web views in a "native" (flutter) app. Will probably use it in the future for intake use case - we currently use our EHRs form's and they are not good we just have to prioritize updating them
Check out the full HTN Slack convo here!
5. Successful monetization of open source software
Q: I'm very new to the concept of open source software - I'm looking for examples of where open source models have been successfully monetized. Does not have to be a healthcare example (but also interested in any common use cases here). Feel free to share below or let me know if you are familiar with this topic and would be willing to informally chat! Thanks in advance
– Katie Kippley | via #random
Thread Summary: In this thread, HTNers discuss examples of successful monetization of open source software. The conversation covers a wide range of industries, including healthcare. Some notable examples mentioned include OpenEHR, OpenHIE, Open EMR, Red Hat, Kubernetes, Ruby on Rails, Basecamp, Linux, Android, MongoDB, WordPress, Git, Spark, MedPlum, CodeX, and Metriport. The discussion concludes with a request for examples of failed attempts at commercializing open source and strategies for upselling existing developer contributors.
Top Response:
Yarone (SteadyMD):
Linux -> Red Hat
Android -> Google
MongoDB -> MongoDB Inc
Wordpress -> Automattic
Git -> GitHub
Just a few, ChatGPT can give you a ton
Check out the full HTN Slack convo here!
🤖HTN KNOWLEDGE BOT
If you have your own question(s) to ask, don’t forget that a good place to start is our HTN Knowledge Bot. It’s our smart search tool that makes it easier to access the wisdom shared within the HTN powered by ChatGPT. You can log in and use it on the website (here) or see how to use it directly in Slack here.
Check out the example ask below!
Member Question:
What are key regulatory changes to monitor?
Knowledge Bot Answer:
Based on the conversations and articles I found, here are some key regulatory changes to monitor:
1. Medicare Remote Therapeutic Monitoring (RTM): The Centers for Medicare and Medicaid Services (CMS) has implemented new regulations for remote therapeutic monitoring in 2023. You can find more information on this topic in the article Medicare Remote Therapeutic Monitoring FAQs 2023.
2. Prior Authorization Rule: The Prior Authorization rule is expected to be finalized in 2023. This rule aims to streamline the prior authorization process for healthcare services. You can refer to the conversation here for more details.
3. MA Equity-related Quality Measures: There will be changes in Medicare Advantage (MA) equity-related quality measures in 2023. This is part of the ongoing efforts to improve the quality of care provided by MA plans. The conversation here provides additional insights.
4. Price Transparency: Price transparency initiatives are expected to have knock-on effects, leading to changes in the fee-for-service (FFS) market pricing and Medical Loss Ratio (MLR). This may also result in a reduction in claims adjudication services and Pharmacy Benefit Manager (PBM) services. You can find more information in the conversation here.
5. LIS Expansion and OOP Cap Reduction: In preparation for 2024, there will be an expansion of the Low-Income Subsidy (LIS) program and efforts to reduce the out-of-pocket (OOP) cap in 2025. This is aimed at providing more affordable healthcare options for low-income individuals. The conversation here discusses this topic.
Please note that these are just a few examples of regulatory changes to monitor. It's important to stay updated with the latest industry news and consult official sources for the most accurate and comprehensive information.
✨HIDDEN GEMS
Here we highlight helpful resources from across the community:
- Inevitability of GLP1s & Potential Acceleration of Health Equity via Nick Samonas – Ro's CEO explores big questions surrounding GLP-1s, including the potential future impacts on health equity.
- Ep 33: Aledade CEO Farzad Mostashari on Managing $20B in Healthcare Spending and Lessons on Succeeding in Value-Based Care via Jacob Effron – A great episode from Vital Signs for all the value-based care Nerds out there.