Midweek update

Healthcare Dive reports on a House Energy and Commerce Health subcommittee hearing held yesterday on the surprise billing issue.  Payers prefer that Congress set a rate for surprise out of network care and providers prefer that Congress requires independent dispute resolution to resolve the surprise billing disputes, such as baseball arbitration in which a third party selects one the parties' proposals without negotiation. The Affordable Care Act does include a requirement that health plans pay a certain minimum amount for emergency care but that law does not require the out of network provider to accept the payment as setting the patient's debt. See ACA FAQ #15 at this link.    The payers want that finality.  In any event the new law will have a broader scope than true emergency care. The legislators were warning the industry representatives yesterday that they needed to resolve this issue quickly or legislation will happen. Expect enacted legislation.

Healthcare Dive also discusses how Humana has integrated real time benefit information, e.g., cost sharing, prior authorization, into the popular Epic electronic medical record via a tool called IntelligentRx. Smart move. Expect to see more of this integration.

Fierce Healthcare offers an interesting interview with Walgreen's Chief Medical Officer.

FH: Going forward, how do you see consumers' use of digital platforms for accessing healthcare services changing?
PC: We see that the digitization of healthcare has been well received by consumers, but there are some situations where you need to be physically there. For example: lab services. We’re running a full primary care practice at Walgreens and to be able to have that direct face-to-face interface with the provider we also find is valuable. I don’t think those two areas compete; I think they are more complementary than competitive.
As a primary care physician, I find these changes in offerings in terms of different venues of care to be very exciting. We have a challenge in this country in terms of an aging population and the increasing prevalence of chronic disease. I think we need many different ways to approach healthcare and the digital aspect is very exciting.