💡 HTN | Community Brain Trust | 7/11
🧵TOP THREADS OF THE WEEK
In case you missed them, here are highlights of a few interesting conversations from different channels:
Threads included below:
- Understanding referral compliance in Florida
- Helpdesk vendor reviews
- ELI5 US payor system resources
- Plan enrollment guidance for virtual care orgs
- Viability of VC-backed model in mental health space
1. Understanding referral compliance in Florida
Q: Do providers of the group (or providers at folks' orgs) communicate the status of a received patient back to the referring provider in Florida without a getting an ROI (Request of Information) signed with the patient? Use case here is that we want PCPs to be up to date on their patients when they refer to us.
My understanding has always been that HIPAA actually enables comms back and forth between providers that are treating the same patient. However, I've gotten conflicting reports on state laws in Florida requiring an ROI for a provider to even acknowledge that they've received the referral from a provider, which strikes me as crazy.
Would love folks' thoughts! We want to be collaborative but also compliant of course
– Jake Powell | via #buildersask
Thread Summary: HTNers share anecdotal experiences and provide legal clarification on the HIPAA PHI disclosures related to the state laws in Florida.
Aaron Maguregui: HIPAA permits disclosures of PHI for treatment, payment, or healthcare operations. So disclosures to a PCP who is staying up to date on a patient for care coordination purposes (healthcare operations) are permitted. This is also true if the disclosure is for treatment purposes.
2. Helpdesk vendor reviews
Q: Does anyone know what’s the best helpdesk (Zendesk, Front, etc) that works with Dialpad SMS integration? We were looking at Front, but the floor price is $3600/yr if we want to manage SMS there and it’s a lot for us.
– Yansen Zhou | via #buildersask
Thread Summary: The crew discusses alternative helpdesk options including Front, Helpscout, and Fresh Desk. One HTNer provides a detailed product review of Front, the migration experience, and things to consider.
Jarrad Hicks: Huge fan of front for the last 6yrs - great support team too. Zendesk implementation is painful > I ran a switch from front to Zendesk (recommended at scale) for ~600 seats, the UX/UI with front is dreamy in comparison. Process harder to standardize via front, but also lower lift. Their tags system is pretty powerful.
It’s such a good product - impossible to perfect but a company I was at rolled out Front in mid-2018 (from shared gmail inboxes) - so very fond of the UX/UI on how much of a savior it was for us, only got better with age and funding. Responsive support, forward thinking product teams [I recall shipping a WhatsApp API within a month of it being available within frontapp]. Pretty much the figma for collaborative email/SMS - I can’t compare to new tech offerings, but we only migrated to Zendesk because of business complexity [global markets, headcount, varying process] - employee satisfaction went down in that process.
Front + Pipedrive (sales CRM) was my home away from home as a user.
@Yansen Zhou to caveat I would mention is how not for purpose it is as an issue led help desk - it’s collaborative inbox (including sales, product, etc), not a help desk, webhooks are good, but it’s partly why we plugged zendesk into Asana, jira & other tools, the zendesk architecture and webhooks made it easy to scale management of issues, timeframes with automations & triggers for updating tickets (though it takes several months to build with true success). if <500 daily cases raised, front is hands down your startup UX winner (excluding whatever great features they’ve shipped in the last 3 years)
3. ELI5 US payor system resources
Q: Does anyone have any resources that eli5 the US payor system? Covering FFS, inpatient vs outpatient, bundled payments, VBC models, generally “how the money flows” but with enough detail actually understand motivations of private and governmental insurers? Bonus points if the resource is physician-focused and not related solely to improving billing documentation
– Sarah Gebauer | via #eli5
Thread Summary: The group shares a full list of resources and explainers for various US payor system topics, including VBC, Medicare Advantage, and more!
Colin DuRant: There’s not a lot of true ELI5 resources out there covering such a big topic, but a few things that may be useful:
1. this blog post is maybe as simplified as you’re going to get on VBC specifically
2. from that same blog (The Prescription) the section on US health system here is also quite simple.
3. if you want a very much not ELI5 but pretty comprehensive history and overview, this congressional research report (while 13 years old now) holds up well.
4. my favorite general reference textbook on the structure of the health system I recommend to folks is The US Healthcare System: Payers, Providers and Producers which is, expectedly, very textbook-y but solidly touches on most topics having to do with the health system structure.
4. Plan enrollment guidance for virtual care orgs
Q: Hi all - looking for guidance on what address to use for plan enrollment and claim submission. An org I'm working with currently does telehealth only care delivery, no physical offices. We have a temporary physical office for some of our admin/Corp staff but we do not see patients there. We don't want to use provider or exec home addresses because we don't want to expose those in the provider directory, nor do we want to have payer mail being sent to home addresses.
What have others done in this scenario? We're thinking about paying for a virtual office (with BAA) but can't seem to get clear guidance on whether that's compliant and acceptable.
If it's helpful, we see Medicare, duals, and commercial members.
– Jessica Green | via #topic-rev-cycle-management
Thread Summary: An interesting thread sharing advice and best practices on how to handle plan enrollment and claim submission in a virtual care-only environment.
Hamza Rehman: Payer contracting you cannot use P.O. Box as a service location. Many payers require service location (it can be a virtual office) and in many instances a lease agreement as a proof.
P.O. boxes and lock boxes can be used for mail-only, after you have established payor contracts. Where you can receive EOBs and checks.
You’d need a virtual office at minimum, with a lease agreement to show as a proof. With commercial plans some times there may be some leniency, but Govt payers will not budge.
This may be helpful too: [Link to HTN convo]
5. Viability of VC-backed model in mental health space
Megan’s comment on the above article prompted me to put down some thoughts I’ve been having and see if the rest of you have some thoughts of your own! Because it seems something really is going on right now in digital mental health.
1. It seems like a lot of the more niche players are starting to hit their max market share. Layoffs at Brightline, Headspace (and other less public ones) seem to suggest that revenue isn’t matching projections and companies are starting to conserve runway. My guess is that we’ve reached saturation and it’s going to be contract knife fights and consolidation from here on out. (Not a radical suggestion - only saying we’re finally close if not already there)
2. I talk to a lot of clinical leaders - and they’re all looking for new jobs. All of them. Like everyone just pick up and move one company to the left. They are really disillusioned with their lack of input within the company and inability to make changes - probably due to bottom lines being affected by #1.
3. Similarly clinical talent is increasingly hard to come by. A lot of companies are having trouble recruiting, again see #1, but also because I think there is a fundamental mismatch.
Clinicians are feeling burnt out in many traditional settings (again, not a shock) - and they see tech as a lifeline. The see salaries at Google and think tech can give them more money and more flexibility when it comes to how they practice and when. But on the flip side, companies increasingly seem to want the “uberification” of MH. Hotswapping clinicians or working them to extract as much as possible. (Which is nothing new, but it’s also exactly what they’re running from in traditional practice leading to more disillusionment and worse provider recruitment as word gets around)
I don’t know if I have solutions of any of these - more curious to hear if the rest of you are seeing the same things.
– David Cooper | via #topic-behavioral-health
Thread Summary: Following the news that Headspace Health laid off a group of therapists, HTNers debate how the VC-backed model starts to become at odds with the needs of patient care.
Chris Turitzin: re: #1
While layoffs are correlated with market saturation, that may not be what's happening here. Basically every unprofitable company has had to reforecast their plans from expecting to raise funds every 12-18 months to raising in 24-36 months. Naturally, for money to last longer, you need less expenses, which usually means a smaller team.
My read is there is some saturation in the first VC focal markets in MH: cashpay and commercial insurance for less complex pts. Other areas that have had less focus: Medicaid, SMI, or SUD, I believe the unserved demand is as strong as ever. We certainly see this with our service area in OUD. Most companies in our space have pulled back some (reducing markets, layoffs), but I believe that is primarily based on the desire to drive company sustainability in this new capital market, less competition.
Here we highlight a question from the Slack that needs some additional community insights - if you have a helpful thought, jump in below!
Q: Has anyone used RPA to pull information and autofill in PracticeFusion? What RPA tools have ya'll used?
1. Looking into seeing if RPA by looking for specific HTML tags/id's is doable and how MFA is taken care of
2. We're trying to put together a MVP before paying for UiPath, so any experience with tools like OpenRPA?
– Aditya Singh | via #buildersask
🤖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!
Here we highlight helpful resources from across the community:
- How to Calculate Member Months via Andrew Rosenthal
- Virtual Office Worldwide Locations via Bridget Krueger
- The Future of Medicine: Are We Training the Right Kind of Leaders? by Arpan Parikh, MD MDA FAPA, Amit Parikh, MD & Ankur Parikh
- MIT Artificial Intelligence in Healthcare: Fundamentals & Applications course via Paulius Mui, MD