3 COVID-19-Driven Healthcare Changes to Make Permanent
Living through a pandemic has taught us a lot about necessity — from what we can and cannot live without in our daily lives to the programs, policies and systems that support our nation’s critical infrastructures.
Take healthcare, for instance. When a novel coronavirus emerged, it necessitated swift and sweeping action to eliminate needless barriers to care and equip the system to handle the demands of a pandemic. Included in these actions were several programmatic and regulatory changes that, although introduced as temporary, could have positive long-term implications for public health. Now, more than a year since COVID-19 was declared a public health emergency, we can begin to assess the impact of these changes along with their long-term viability — both in addressing the crisis at hand and the many other pressing healthcare issues that transcend it. Here are some of the COVID-19-driven changes that, if made permanent, could change healthcare for the better.
1. Programmatic Changes to Support the Continued Viability of Telehealth
During the pandemic, healthcare providers and consumers alike found, seemingly at long last, the value in delivering and receiving care virtually. Temporary measures from the Centers for Medicare and Medicaid Services had a hand in this revelation, making it far more feasible for vulnerable seniors and low-income adults and children to access telehealth services from the comfort and safety of their homes. While in-person care has resumed, the temporary expansion of telehealth during the COVID-19 emergency period has shown that certain healthcare services can and should be rendered virtually — and has made clear the value of these capabilities for vulnerable populations in particular.
It’s time to integrate telehealth into the healthcare system as a routine care pathway — providing coverage for these services regardless of modality and making permanent the regulatory changes that supported their viability during the pandemic. At the same time, modality-appropriate program integrity controls are needed in order to mitigate fraud, waste and abuse in this new and evolving environment.
2. Telephone Consumer Protection Act (TCPA) Emergency Order Extension
Enacted in 1991, the TCPA restricts the use of automatic dialing systems and artificial or pre-recorded voice messages in order to protect consumers from unwanted and harmful robocalls. However, as a residual effect, the law has historically hindered valuable healthcare communications from providers to consumers, despite a 2015 order meant to exempt these calls from TCPA rules. During the COVID-19 public health emergency, the Federal Communications Commission (FCC), which enforces the TCPA, issued an emergency order that, in effect, authorizes calls and text messages from healthcare entities and government officials to patients.
This emergency exemption has been instrumental to sharing critical information and resources with consumers, both directly and indirectly related to COVID-19. However, the need for unobstructed outreach from providers and government officials to patients is not unique to a pandemic. Each year, hundreds of thousands of Americans die from cancer and chronic illness — outcomes that, in some cases, could have been prevented had those individuals been identified and engaged sooner. And in devastating instances of natural disasters, acts of terrorism and other catastrophic incidents that are hyperlocal in nature, there should be no barriers inhibiting state and local officials from reaching their residents on the ground.
Enacted three decades ago, when landlines were predominant and man-made disasters were fewer and farther between, the TCPA is in need of modernization that includes, at a minimum, meaningful exemptions with regard to healthcare communications and localized disasters.
3. Expanding Business Associate Rights Under HIPAA for Data Interoperability Purposes
According to the Health Insurance Portability and Accountability Act (HIPAA), covered entities and their business associates must comply with all rule requirements to protect patients’ health information. Covered entities, as defined by the U.S. Department of Health and Human Services (HHS), include healthcare providers, health plans and healthcare clearinghouses, while business associate are parties engaged by covered entities to help carry out their healthcare activities and functions.
Under normal circumstances, a business associate may generally only use and disclose personal health information (PHI) on behalf of the covered entity for which it is performing services and is limited to the strict terms of the agreement between the two parties. Because business associates often work with various healthcare programs and health plan types, they have access to cross-entity data that could be valuable from both a population health management and cost containment perspective.
In response to the COVID-19 public health emergency, HHS’ Office of Civil Rights (OCR) has temporarily allowed business associates to share PHI with public health and oversight agencies in accordance with certain exceptions under HIPAA. This expansion is significant, both within and beyond the confines of the pandemic — from transmitting immunization information between public health entities and providers to identifying aberrant billing patterns affecting multiple payers. Continuing the expansion of business associate data rights, while maintaining a highly secure data environment, has the potential to significantly improve public health surveillance, payment integrity and healthcare interoperability.
Change for the Better
It’s been said ad nauseam that healthcare has been forever changed by the COVID-19 pandemic. And while that is certainly true, it is up to us as an industry and the bodies who regulate it to ensure that change is for the better. Over the past year, we have seen what happens when needless, longstanding barriers to care are removed and antiquated systems are modernized for the needs of today; as we cautiously near the end of this devastating crisis, let’s ensure we’re emerging more equipped to handle the many other urgent challenges that will endure in its aftermath.
HMS advances healthcare by helping organizations reduce costs and improve health outcomes. Through our industry-leading technology and analytics solutions, we save billions of dollars annually while helping consumers lead healthier lives. HMS provides a broad range of payment accuracy, care management and member engagement solutions that help move the healthcare system forward. Visit us at www.hms.com or follow us on Twitter at @HMSHealthcare.