(This story previously appeared in The Hill Extra)
A recent report from the National Governors Association (NGA) aims to help states work around conflicting medical privacy laws and policies that block the flow of health information, hampering healthcare efficiencies and savings, analysts said.
“There are hundreds and hundreds and hundreds of state medical privacy laws, and the ugly truth is that it’s not possible to comply with all of them,” attorney Ann Waldo said upon release of the NGA report.
The report, unveiled on Friday, addresses legal and market challenges that block the flow of patient information between providers, offers examples of states that have developed successful strategies, and proposes measures to evaluate progress.
Analysts at the NGA Center for Best Practices’ health division, which published the report, highlighted states that aligned federal and state policies and created financial incentives to enable the sharing of clinical, claims and social services data.
Assemble, attack.
The NGA recommends states first assemble a core team of state government officials, including attorneys general and state employee benefit officials, who have authority to make policy decisions.
In addition, states should create an advisory group of people who could speak to the practical considerations for policy change, such as providers, health systems, privacy and consumer advocates, health information organizations and academic experts.
The next step would be to assess legal and market barriers, and prioritize which ones should be handled first.
For example, there are usually a number of privacy protections to sort through, starting with the federal Health Insurance Portability and Accountability Act (HIPAA) law. Other federal laws and regulations restrict the sharing of information related to drug and alcohol abuse treatment.
Add to that state laws pertaining to different types of health information, such as mental health records, genetic data, or information about minors. Health information organizations, which facilitate the exchange of information between healthcare groups, and individual hospitals and providers may have unique privacy policies as well.
State strategies.
The report offers eight strategies states can take to address legal and market obstacles, pointing to examples where states have already taken the lead and outlining key considerations for policymakers.
For example, to fully align state privacy laws with HIPPA, the report points to states like Hawaii, Kansas, Wisconsin and Utah that have passed legislation to supersede existing, more restrictive state laws and allow providers and hospitals to exchange patient information. Kansas had a patchwork of 200 state laws before aligning with HIPAA, the report notes.
The report also includes examples of state efforts to develop standardized patient consent forms and options for possible regulatory guidance.
“The laws and policies that exist are intended as safeguards to protect privacy but they’re also intended to allow information to flow under specified conditions, so it’s just a matter of understanding when it’s possible,” said Lauren Block, program director for the NGA Center for Best Practices’ Health Division.
Monetary drivers.
As state budgets are squeezed, the best driver of change could be a shift toward value-based purchasing initiatives, which pay providers based on the value of care delivered and allow team-based care that requires information sharing.
The report suggests governors use their regulatory and oversight authority through Medicaid, the Children’s Health Insurance Program, state employee health benefits, state retiree health programs and health insurance marketplaces to drive change. For example, states can link Medicaid payments to performance metrics that tie directly to the exchange of health information, the report says.
Alternatively, states can use legislative, regulatory and contracting authority to mandate information exchange. For example, Michigan recently required its Medicaid health plans to participate in health information exchange and believes it could be used to create health goals for specific populations in the state.
New roads to map.
NGA’s “road map” on information exchange is only one piece of a greater conversation the governors’ association is driving about connections between healthcare and socioeconomic factors.
On Monday, the NGA Center for Best Practices is hosting another discussion about its report on the nexus between healthcare and housing, including understanding the critical flows of information and funding. The group is also exploring how states can tackle the opioid crisis, with a focus on using teleconsultation to expand treatment in underserved communities.
Frederick Isasi, director of the NGA Center for Best Practices’ Health Division, said NGA just finished part of its work on complex care patients — those with the highest needs and subsequently higher healthcare costs — an effort that is focused on the savings states can find if they use data to make smart, inexpensive changes to their healthcare systems.
He said one state found a quarter of their high-needs patients resided in one area, and by building a clinic with late hours, they saved about $15 million in one year.
“Data and governors really grabbing the reins, looking at what’s happening in their programs, and then working collectively with their managed care organizations, social service agencies, on building an infrastructure that allows the data to drive policy and run it at greater efficiency can make a huge difference,” he said.
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