💡 HTN | Community Brain Trust | 9/5
🧵TOP THREADS OF THE WEEK
In case you missed them, here are highlights of a few interesting conversations from different channels:
Threads included below:
- The future of executive physical exams
- Setting up HIPAA compliant workflows with payors
- Clarifying the quality care gap closure process
- A list of hospitals with the most interesting digital health projects
- Best practices for patient lead generation & conversion
1. The future of executive physical exams
Q: Fascinating thread on the topic of executive physicals. @Will Manidis makes a compelling case that this type of service could become more mainstream in the coming 5-10 years. The emergence of body scans like Neko and Prenuvo and influencers like Huberman and Attia point in a similar direction.
I'm curious what people think – how hard would it be to recreate the essence of Mayo's multispecialty Executive Health Program in a virtual setting at a lower price point (say, $2500-3000 / year)? Would consumers pay if it was virtual-only or would it need to be a highly tailored in-person white glove experience?
– Ryan Gallagher | via #buildersask
Thread Summary: Following one HTNer's experience participating in Mayo Clinic's Executive Health Program, the crew explores the range and effectiveness of this class of healthcare models typically reserved for the ultra rich. The argument centers around the potential for a growing population (outside the ultra wealthy) with disposable income to increasingly side-step FFS care and voluntarily pay for a similar premium, highly comprehensive care model.
Eric Rose: More testing does not necessarily lead to improved health outcomes (at either an individual or population level) and may in fact have the opposite effect, because:
a. No screening test is perfectly accurate, and since follow-up testing may require invasive techniques and risk, false-positives may result in significant harm (e.g. death or disability from bleeding or infection resulting from an invasive procedure done to follow up an abnormality on an imaging study that turns out to have been nothing dangerous), and
b. There is often a lack of effective treatment for, or knowledge about how to treat, very early-stage disease. Simply identifying dangerous diseases at a very early stage isn't necessarily actionable information.
There is severe need to get better at screening for many diseases, e.g. pancreatic and ovarian cancer, which are usually diagnosed at a late stage when treatment options are limited. But there's a science to developing and evaluating screening strategies, and I think it's mistaken to equate lots of tests with high quality care.
2. Setting up HIPAA compliant workflows with payors
Q: Hi everyone! Would love your feedback on an issue my team is facing regarding insurer reimbursement and HIPAA compliance.
Our company is a prenatal fitness platform that is covered by health insurance, and we’ve just landed our first insurer. We’ve not yet implemented the infrastructure for HIPAA compliant transmission of user data to the insurer, which needs to know the identity of each of our users covered by one of their plans.
In order to avoid storing and transmitting protected health information about the user, we allow the user to submit a reimbursement request to the insurer on their own. We make this easy by asking the user for their insurance plan information (on device only), construct an email to the insurer with reimbursement details, and then give them the option to send that email from the email account installed on the device. We never store or transmit their identity or reimbursement information, we just make it easy for them to send this information to the insurer from their device. This is a temporary approach until we implement the fully-automated, HIPAA compliant infrastructure that allows us to submit information directly to the insurer.
Question for the Community:
Are there any other approaches that don’t require us to store PHI but which could remove the step of asking our users to email the insurer? In other words, is there some other compliant way (with fewer steps for the user) that we could inform the insurer the identity of each user covered by one of their plans prior to the point at which we setup a fully HIPAA compliant backend?
Thanks so much for your input!!
– Joseph Pacheco | via #buildersask
Thread Summary: A few HIPAA nerds jump in with some helpful perspective and advice on how one startup can set up infrastructure for a HIPAA compliant workflow to transmit user data to its insurer clients.
Michael Herrick: OK, I begin to see as through a glass darkly.
Forgive me if I'm shooting off my mouth here, but here's my hunch. You're a great tech company, but now you need to learn, fast, how to be a healthcare company. But you're naturally going to see everything through the tech lens and you're going to look for tech solutions. But I don't think you have a tech problem right now. I think you have a problem that a healthcare company might solve by hiring a part-time medical biller.
Build something that doesn't scale first.
I did a risk assessment a couple years ago for a SAAS on Firebase. I believe there's a Firebase starter offering that is outside the BAA covered services, but you can migrate to something called Cloud Firestore under the Google Cloud Platform with a BAA. It's been a couple years so things may have changed, but this is where I would look for HIPAA protections on GCP [link here]
My biggest concern with Firebase would be: why are you using a non-relational database for what is fundamentally relational data? I hate watching developers code data integrity, key constraints, and indexes at the application layer. You really want to write your own database layer on top of text files?
But now you've sucked me back into a tech conversation. See! This is what we do! This is our comfort zone!
I still say a healthcare business advisor and maybe a medical biller can do more for Joseph's company than any number of security experts with technical opinions.
3. Clarifying the quality care gap closure process
Q: I'm a primary care group looking to improve our quality gap closure process.
We pull CCDAs from CareQuality and CommonWell to inform patient treatment. Subsequently, we reuse that information to close quality gaps (ex: latest A1Cs). Our payer partners have stated they do not accept gap closures from HIEs.
Am I wrong that CareQuality and CommonWell are not HIEs? If I pull the entire CCDA record for treatment, and then reuse parts of it for gap closure, why is that not allowed? How is that different than faxing information requests?
The payer suggested working with an NCQA data aggregator. But again, I don't want to do this because I already pull the records myself from CareQuality/CommonWell.
What am I missing?
– Anonymous Bot | via #buildersask
Thread Summary: An insightful thread helping to clarify the requirements for a primary care group to improve its quality gap closure with its payor partners - digging into the technical scope of HIEs and data aggregators as means to help qualify the process to collecting relevant data.
Neha Mohnot: CommonWell and CQ are frameworks and do not have repositories of consolidated information like how some HIEs do. That works great for patient treatment purposes, but unfortunately not for some payors. Hence, several organizations also have to connect to HIEs or RHIOs in addition to CW and CQ to meet the HEDIS requirements (which unfortunately results in duplicate patient information if not setup correctly).
4. A list of hospitals with the most interesting digital health projects
Q: Which hospital systems have really interesting digital teams / digital health projects? UPMC is one that comes to mind.
– Anonymous Bot | via #buildersask
Thread Summary: This was a fun conversation among the group listing various health systems that are working on the cutting edge of digital health - top mentions include Ochsner, Providence, Mass Gen Brigham, NYU Langone, and more.
Bethany Vick: Agree that Ochsner does some interesting stuff, especially wrt underserved populations. Children's Hospital Los Angeles has a small but mighty digital team working on interesting projects in the peds space. And I'm biased, but I think we do some cool stuff at Providence.
5. Best practices for patient lead generation & conversion
Q: Question for product and ops folks: is client/patient lead generation and conversion to enrollment a pain for you? How do you do it now and what tools do you all recommend?
– Rahul Sharma | via #buildersask
Thread Summary: HTNers share a handful of clever growth strategies and tools for patient lead generation.
Lindsey Graff: DTC advertising and patient engagement are very different beasts - I’ve been doing this work for health plans and telehealth for years. Some suggestions:
- Events - be places where your target audience is going to be
- Influencer marketing (likely via social but potentially elsewhere)
- Promotions - can you offer a coupon/deal in a compliant way?
- Really thoughtful google search advertising
- Incentives (particularly valuable for driving specific types of engagement)
Re: getting flagged - do you have LegitScript certification? Are you getting reasons for getting flagged?
Here we highlight a question from the Slack that needs some additional community insights - if you have a helpful thought, jump in below!
Q: There has been a few questions that dance around this in the past. How are national virtual care organizations tackling the requirement for brick & mortar / provider practices in state? Increasingly seeing rejections for being telemedicine only. Know some companies will use virtual locations via a partner like Regis but to my knowledge that doesn’t cut it.
– Anonymous Bot | 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!
What are promising innovation ideas in health equity?
Knowledge Bot Answer:
Based on the conversations and articles I found, here are some promising innovation ideas in health equity:
1. Addressing social drivers of health: An article from STAT News discusses the big opportunity for tech entrepreneurs to address social drivers of health and promote health equity. You can read the article here.
2. Changing how we pay for care: The Commonwealth Fund has a thought-provoking article on promoting health equity by changing how we pay for care. This article explores innovative payment models that can help address health disparities. You can read the article here.
3. Health equity grants: If you’re looking for funding opportunities, the Robert Wood Johnson Foundation (RWJF) offers health equity grants for startups. One of the grants that might be relevant is the pioneering ideas grant. You can find more information about active funding opportunities on the RWJF website here.
4. Leveraging technology for health equity: The New England Journal of Medicine Catalyst has an article that explores how technology can be leveraged to advance health equity. The article discusses the potential of digital health tools, telemedicine, and data analytics in addressing health disparities. You can read the article here.
These resources provide valuable insights and ideas for promoting health equity through innovation. I encourage you to explore them further for a more in-depth understanding of the topic.
Here we highlight helpful resources from across the community:
- Common Paper's Business Associate Agreement via Jake Stein – A BAA created by the Common Paper Committee, which consists of 40+ attorneys.
- A Privacy-First Framework for HIPAA Compliance: Managing Third-Party Tracking on Healthcare Websites via Mark Rogers – This 5-step framework unpacks a HIPAA compliant process for managing third-party tracking - from auditing to governance to monitoring.
- A thread on the collapse of Babylon Health via Sina Haeri – Here is an interesting thread on X (formerly Twitter) unpacking the collapse of health tech company Babylon Health from the perspective of a former employee.