Healthcare Innovation & Regulatory Updates - July 2024

Welcome to the latest edition of our healthcare innovation newsletter, where we bring you the most recent developments in healthcare and AI, along with crucial regulatory changes in the US. Stay informed and ahead of the curve with these key updates!

Global Impact of AI in Healthcare

AI is set to revolutionize global healthcare by improving chronic care management and enhancing clinical trials. Embracing AI responsibly is crucial to maximize its benefits while mitigating risks. Read more about the global implications of AI in healthcare here .

We are in the early days of the AI "gold rush" in healthcare. Like the gold rush of the past, we need to be thoughtful and responsible in its usage. This World Forum article gives some good perspective on areas to consider as the world accelerates rapidly in the usage of AI.

Broader Applications and Future Prospects of Generative AI

Generative AI is also being utilized across various healthcare segments, from payers and providers to pharmaceutical firms and public health agencies. Applications include synthesizing clinical notes, generating care plans, creating personalized training content for doctors, and improving administrative processes like claims management. As the technology evolves, it holds the promise to significantly increase efficiency, improve care quality, and create value for healthcare organizations. Read more in this great article by McKinsey & Company .

Transition from HCC version v24 to v28

The transition is in motion. The stakes are high with billions of dollars on the line and more importantly making sure we "accurately" know a patients full history and can leverage those insights to position critical services such as "care management" MedeAnalytics we wrote an e-book to help you understand the changem, its impact and ways you and your organization can position to be successful in the transition! Read more here !

Nondiscrimination Protections (Section 1557 of the ACA)

The Biden-Harris administration has strengthened nondiscrimination protections in healthcare. New rules extend civil rights protections to Medicare Part B recipients and clarify that AI tools in healthcare must comply with nondiscrimination principles. Explore the details here .

Streamlined Prior Authorization

New regulations aim to reduce delays in prior authorization for Medicare Advantage beneficiaries, requiring electronic processes and annual policy reviews. This initiative ensures continuous treatment and reduces administrative burdens. Find out more here .

This "should" reduce the burden on this process in MA plans. Each plan does need a clear strategy on how to implement the changes!

Enhancing Behavioral Healthcare Access

Expanding access to behavioral healthcare is a priority. New rules include network adequacy requirements and add clinical psychologists and licensed clinical social workers to evaluated specialties for Medicare Advantage plans. Learn more here .

We are going to see massive investment (and much needed) coming into the Behavioral Health space. Recent regulatory proposals and changes are expanding the co mingling of BH services wqith primary care, finding new ways to get reimbursement in the hands of BH providers and expand the workflorce. It will take time but I am bullish on BH expansion and its connection to VBC.

Interoperability and Data Exchange

CMS has proposed expanding APIs for patient data exchange, improving continuity and quality of care. These measures will create comprehensive patient records and enhance healthcare outcomes. Read the full story here .

If your organization does not have a clear interoperability strategy you are going to fall behind. In fact if regardless if you are a payor, provider, or healthcare software maker you need to understand this expansion and have a clear strategy for it!

Medicare Drug Price Negotiation

CMS continues to negotiate drug prices under the Inflation Reduction Act, aiming to lower prescription costs and extend negotiation capabilities to high-cost medications. Discover more about this initiative here .

Just think if Mark Cuban 's drug company could get a shot at this. The savings will be MASSIVE to the Medicare program!

Minimum Staffing Standards for LTC Facilities

CMS has introduced new minimum staffing standards for long-term care facilities, with phased implementation over three years. These standards aim to ensure adequate staffing levels and improve patient care. Read more here .

The main challenge here is going to be finding the nurses to meet these demands. This will be challenging especially as LTC's are starting to see their day in value based care contracts / programs!

Health Equity Framework

CMS has launched a new framework to advance health equity, focusing on reducing disparities and improving access to healthcare services. This initiative involves collecting standardized demographic data and providing culturally tailored services. Learn more about this framework here.

Stay tuned for more updates on healthcare innovations and regulatory changes in our next edition. Thank you for reading and for your commitment to advancing healthcare!

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If you need help with any of these topics. Please reach out. My team of consultants stands ready to assist you and your team!

Best,

Brian Norris MBA, RN, FHIMSS