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HIPAA Proposal Would Move Us Closer to Coordinated Care

While many people were privacy rule to clarify nity agencies that can mitigate those in the next two years as a way to prepare
paying attention to drug when providers can dis- determinants. for the growth of the aging population.
pricing, a proposal to update close protected health I know because I’ve spent 35 years as a Part of that has to do with the require-
the Health Insurance information to social physician and adviser to senior care ment of a physical site to provide adult
Portability and Accounta - and community-based providers working to support such coor- day services. But another part has to do
bility Act (HIPAA) flew organizations with the dination in the hopes of creating a better with Medicare’s limitations on the pro-
largely under the radar. But aim of coordinating care. health system for seniors. gram, such as restrictions on what the
if this proposal — or others Consider this exam- This has included helping run one of the interdisciplinary team is allowed to do
like it — were to be imple- ple: An elderly man country’s largest Programs of All-Inclusive for beneficiaries.
mented, they would reach whose wife recently died Care for the Elderly (PACE) initiatives in Simply put, regulations — those from
farther than any proposal to and who lacks a nearby New York City. Through adult day health HHS but also across the broader industry
lower drug prices to create support network appears centers, PACE provides preventive, pri- landscape — need to be updated to
better, more personalized to his care provider to be mary, acute, behavioral, and long-term reflect the shift in mindset happening
health care at lower cost. BY DAVID FRIEND, MD suffering from loneli- care services for people 55 and older, most across the industry: moving away from
The Department of ness. That puts him at 45 of whom are dual eligible, meaning they siloed care toward a more collaborative,
Health and Human Services percent greater risk for qualify for both Medicare and Medicaid. In coordinated care experience that reaches
published the Request for Information early death and 64 percent greater risk addition to traditional health care services, beyond the four walls of a doctor’s office
on Modifying HIPAA Rules to Improve for developing dementia. As the privacy PACE benefits can also include meals, or hospital and into patients’ communi-
Coordinated Care in December, seeking rule now stands, while the man’s health nutritional counseling, social work coun- ties.
input on ways to modify HIPAA that care providers can of course give him seling, and transportation, all supported The proposed updates to HIPAA have
would remove regulations standing in information on community organiza- by a well-coordinated interdisciplinary garnered more than 1,300 comments and
the way of coordinated or value-based tions he can leverage, they may be hesi- care team. are likely to be modified before the final
care. The well-reported request for feed- tant to flag their patient’s needs to those Instead of locking away seniors in hos- guidance is published. But the request
back focused on three key proposals: organizations because of the unclear pitals or nursing homes, PACE programs for information and broader regulatory
• encourage HIPAA-covered entities to HIPAA parameters around doing so. This embrace them into a sense of community. updates like it have the potential to bring
disclose protected health information to can eliminate the potential for these In New York City alone, a study com- us closer to the goal of a more coordinat-
other covered entities if done in the organizations to be aware of and reach paring hospital and skilled nursing facil- ed health care experience.
interest of care coordination out to the patient. ity utilization between PACE and a
• treat medical claims intermediaries But if social and community services Medicaid-sponsored, managed long-term Dr. David Friend is a managing director
as covered entities rather than business were clearly outlined as covered entities care plan found that PACE participants and chief transformation officer in the BDO
associates that could receive protected health infor- had a lower rate of hospitalizations than Center for Healthcare Excellence &
• encourage covered entities to share mation from care providers under certain those enrolled in the Medicaid plan. In Innovation.
protected health information with family circumstances, the man’s providers may California, PACE programs cost up to 34
members of opioid- or substance-abuse be more likely to directly share his infor- percent less than traditional facilities- Contact:
patients to support their recovery mation with the types of social services based care models serving the same dual- Alfredo Cepero, Managing Partner
The devil, as always, is in the details, that could help him most. Although eligible elderly patient populations. 305-420-8006/ acepero@bdo.com
and I’d like to focus on one of them — those organizations don’t fit the tradi- Yet according to a “Candid
disclosing protected health information tional definition of health care providers, Conversation on Elder Care” by BDO, Angelo Pirozzi, Partner
— to illustrate how ideas like those in their services are essential to patients’ the company where I work, just 12 per- 646-520-2870 / apirozzi@bdo.com
the request for information could help holistic health. cent of providers plan to invest in PACE
create a system that supports coordinat- When 81 percent of health care leaders
ed care. expect innovative mergers to continue
As HIPAA stands today, the extent to disrupting the industry, it’s clear that the
which covered entities can or cannot dis- traditional definition of a covered entity
close protected health information to no longer applies. (Just ask Amazon.)
social services or community-based sup- Any proposal, then — whether it’s from
port programs in order to coordinate HIPAA or someone else — to modernize
patient care is unclear. This lack of clari- regulations to the changing economics
ty can stand in the way of health care and boundaries of health care by
organizations connecting patients with acknowledging the importance of com-
community-based resources that could munity-based programs is a leap in the
help them more proactively manage their right direction.
health. Such resources include mental This is especially true when it comes to
health services, secure housing support, treating seniors, for whom familial sup-
counseling for substance abuse or nutri- port, housing, and access to transporta-
tion, injury and violence prevention tion are the social determinants of health
services, and more. most crucial to improving care. It’s essen-
HHS’ Office for Civil Rights, which tial to support coordination between
oversees HIPAA, proposes changing the clinical providers and social or commu-

South Florida Hospital News southfloridahospitalnews.com August 2019 9