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The potential downside of 'social determinants'
By ARTHUR ALLEN
With help from Darius Tahir and Mohana Ravindranath
Editor's Note: This edition of Free Morning eHealth is published weekdays at 10 a.m. POLITICO Pro eHealth subscribers hold exclusive early access to the newsletter each morning at 6 a.m. To learn more about POLITICO Pro's comprehensive policy intelligence coverage, policy tools and services, click here.
THE POTENTIAL DARK SIDE OF INCORPORATING 'SOCIAL DETERMINANTS OF HEALTH' — It has become a buzz phrase, one based on an essential truth: life outside the clinic accounts for most of a patient's health. Now, ostensibly to help providers increase their awareness of these socioeconomic and cultural factors, data brokers such as LexisNexis and Acxiom are starting to sell them detailed analyses of their patients, incorporating criminal records, online purchasing histories, retail loyalty programs and voter registration data.
... While focusing on the patient's housing, transportation and food needs, Mohana Ravindranath reports in an investigation for Pros this morning, providers could end up subjecting them to invasions of privacy or to pigeonholing that could make insurance or health care harder to get in the future, depending on political and business trends.
...Google, Amazon, insurers and credit card companies have long been able to tell whether you vote, own a dog, spent time in prison or drive a rusty 1997 Chevrolet. Now, that type of information is starting to pop up in front of doctors when you walk into their examination rooms.
... Some health systems think the data may drive better medical decision-making — helping them identify patients at risk of expensive care or re-hospitalization, for instance, and enabling them to connect injured patients with follow-up care or social work programs.
... But there are few safeguards on how such outside information can be used within the health system. The algorithms that companies use to classify some patients as "high risk" are rarely made public, so patients may not know their purchasing history or lifestyle could identify them in a way that puts them at a disadvantage. For every health plan that uses algorithms to predict substance abuse and help patients get treatment, there could be one that turns patients away when it learns they have a chronic illness.
... Pro subscribers can read Mohana's original story here.
Tweet of the Day: Matthew Holt @boltyboy "I'd like to meet Elizabeth Holmes in a dark alley one night" says @meghanconroy from @captureproof -- @Theranos has made life so much harder for those of us who are using real data in health tech, especially as a female CEO #SERENDIPITY2018
Welcome to Monday morning eHealth. Condolences to all of our Pittsburgh friends and colleagues including Squirrel Hill native Mohana Ravindranath and Ashley Gold, former eHealth and current Pro Tech reporter. A reminder from Leviticus 19:33-34: Welcome strangers. Send tips to aallen@politico.com or via Twitter @ravindranize, @arthurallen202, @dariustahir, @POLITICOPro, @Morning_eHealth.
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TELEHEALTH ADVOCATES CHEER CMS PROPOSAL: CMS's proposal to expand telehealth benefits under Medicare Advantage plans has support from virtual care trade groups including the Alliance for Connected Care. Director Krista Drobac tells Morning eHealth the proposal includes "many big wins after years of struggling to convince CMS that telehealth is simply health care by another modality."
Drobac was especially encouraged that the proposal pooh-poohed the notion that telehealth benefits will drive up health services utilization.
Per CMS's proposal, published Friday, Medicare Advantage plans could offer "additional telehealth benefits" that that aren't already available to Medicare enrollees as "basic benefits."
The proposal would afford Medicare Advantage plans "more flexibility to innovate in response to patients' needs," CMS Administrator Seema Verma said. Pros can read the rest of the story here.
LEAVE CYBER OUT OF THE ANTI-KICKBACK RESTRICTIONS: Two letters, from the College of Healthcare Information Management Executives and the Healthcare Sector Coordinating Council both call upon HHS to create a waiver under anti-kickback rules that would allow for the donation of technology and services to help improve the cybersecurity posture of providers and improve the protection of patient information.
... The letters came in response to an Aug. 27 proposed CMS rule seeking information on exceptions to the kickback rule that would enhance data and information sharing. Comments on the rule were due today.
VA MITRE REPORT RELEASED: A FOIA request got us a copy of the January MITRE Corp. report on interoperability. The 42-page report recommended that the VA stand firm in demanding that Cerner maximize ease of access to its data for building third-party APIs and apps for future community innovations. It also called for holding Cerner accountable for reducing the administrative burden in clinician workflow with the objective of increasing efficiency and that the system have the capacity for bulk data export based on standards, with no proprietary formats, and a "push" capability to insert patient data back into the VA database
The VA concurred with all the recommendations in the report, and most were included in the final contract signed in May.
... The report also reveals that the 12 private-sector members of the review panel included health IT luminaries such as Cris Ross, CIO of the Mayo Clinic, Chuck Christian of the Indiana Health Information Exchange, Kenneth Mandl of Harvard Medical School — and Bruce Moskowitz, an internist who belongs to President Donald Trump's Mar-a-Lago country club.
… In its 3rd Quarter earnings report last week (a small earnings shortfall led to a 11 percent stock price hit on Friday), Cerner said it expected to ramp up work at year's end on the initial four VA sites, which are to go live in 2020.
It also reported that everything was going fine on the MHS Genesis project, despite reports of a negative preliminary review by independent inspectors at Madigan Army Medical Center, the largest of the four initial rollout sites. "The project is moving along well and is on track," Chief Financial Officer Marc Naughton said. "We believe we're on target with what we've been tasked to do."
IBM BUYS RED HAT IN GIANT TECH MERGER: Red Hat is a major distributor of open-source software and technology, and the deal is worth around $34 billion, the companies announced on Sunday.
According to a joint statement, IBM will pay cash to buy all shares in Red Hat at $190 each. Shares in Red Hat closed at $116.68 on Friday before the deal was announced. Red Hat will become part of IBM's Hybrid Cloud division. More from CNBC.
NATIONALISM IS ALSO SCIENCE'S PROBLEM: At the Italian Embassy in Washington on Friday we interviewed Iain Mattaj, director of the new Human Technopole, a government-funded research center just getting off the ground in Milan. Mattaj has headed the European Molecular Biology Laboratory in Heidelberg, Germany, for many years and is known for his research on how RNA and proteins are transported between the cell nucleus and cytoplasm. Mattaj spoke of the value of interdisciplinary science, the availability of health data sets to researchers there and the uncertainty that Brexit has created in the scientific community (and everywhere else) in Europe.
... "Countries are becoming more nationalist at this point of history [Italy's new prime minister is a populist], so it becomes more difficult to do things internationally, and nobody can answer definitively how Brexit will affect science," Mattaj said. That said, all the political parties in Italy have shown support for his Human Technopole, he said, adding rather surprisingly: "even some of the crazy people who are in charge of Italy now are positive about it."
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Kenneth Mandl, Dan Gottlieb and Josh Mandel of Smart on FHIR effort urge Trump administration to tighten interpretation of API rule
Some Spokane-area veterans are skeptical of the Cerner EHR deal, local paper reports
10 haunting tales of "unicorn" startups gone awry (led by Theranos)
Arthur Allen @ArthurAllen202
Mohana Ravindranath @ravindranize
Darius Tahir @dariustahir
About The Author : Arthur Allen
Arthur Allen is a Health Care reporter for POLITICO Pro.
Arthur Allen became the founding member of the eHealth team at POLITICO in 2014 and recently added the pharmaceutical industry to his beat. Prior to POLITICO he was a freelancer for 18 years, writing for publications and websites such as the Washington Post, The New York Times, The New Republic, Slate.com, Landscape Architecture, Science and Mother Jones. He is the author of three non-fiction books, The Fantastic Laboratory of Dr. Weigl (WW Norton, 2014), Ripe (Counterpoint, 2010) and Vaccine: the controversial story of medicine's greatest lifesaver (WW Norton, 2007). Allen worked for The Associated Press for the better part of 13 years, including stints in El Salvador, Mexico and Germany. He is married to Margaret Talbot and has two grown children. He likes playing pickup basketball, reading, studying languages and hunting fruitlessly for morels and other edible mushrooms.
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