Giving a patient medications in the ER, having them pop positive on a test, and then withholding further medications because…
Morning Headlines 1/25/22
DarioHealth, which specializes in digital chronic care management for providers, payers, and employers, acquires Israel-based digital MSK screening and risk assessment company Physimax.
Medication management startup Truentity Health has raised $1 million in pre-seed funding.
ONC issues an RFI seeking public input on electronic prior authorization standards, implementation specifications, and certification criteria that could be adopted within its Health IT Certification Program.
I’ve seen the underbelly of the ONC prior auth process for almost 10 years, so the RFI from the “public” on how they can improve the process really steams me. One idea: let Oncologists decide how to treat a patient, not a payor. What is the public going to say? “I wish you rejected that treatment I saw advertised during the news more efficiently?” The US government helps fund research, the pharmaceuticals develop meds, pay big bucks to advertise them heavily and then insurers will only provide under duress. The entire system is broken, to think improvements in moving data is going to help is a snapshot of what is wrong with US healthcare system.
It’s hard to disagree with letting an individual doctor and patient determine their course of treatment. But in aggregate, that strategy has resulted in obscene amounts of duplicated, costly spending. For example, the US has insanely high prescription drug prices among developed countries. Specialty drugs for oncology are a disproportionately large part of that overspend and there has been billions of dollars spent on new oncology drugs that don’t work better than alternative treatments. Even the fact that patients see cancer drugs advertised on TV is itself insane and unique to the US. Since much of oncology treatment is billed to Medicare, ultimately the US taxpayer, and really the younger US taxpayer, pays for this enormous waste. Just a reminder to readers, 2030 is when the Medicare trust is going to be gone, and benefits will get cut or payroll taxes will go up. The majority of americans pay most of their tax as payroll tax. Benefits won’t get cut much, so if youre planning to work post 2030, the gov will take more of your paycheck to give to pharma bros and millionaire oncologists.
Private insurance was originally proposed by doctors and now deeply entrenched in the political system. It has a mandate to reduce cost but can only use process enforced through market power as a mechanism. The ONC mandate and power is coordinating IT standards and work. ONC has no administrative ability to change the way the US pays for healthcare other than by coordinating information technology. What do you suggest they do instead of trying to standardize prior auth? It seems like a good use of their time within the constraints.