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Deborah Gersh, Data in Value- Based Health Care

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1
March 2, 2018
DATA IN VALUE-BASED
HEALTH CARE
Reconciling Data Sharing and
Privacy Protections

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2
Challenges
INTEROPERABILITY QUALITY OF DATA
EFFECTIVE USE OF
DATA
INDIVIDUAL
PRIVACY RIGHTS
CHALLENGES

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3
VBHC data challenges
 IT support critical for Value-based Health Care (“VBHC”)
– Major investments in Electronic Health...

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Deborah Gersh, Data in Value- Based Health Care

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March 02, 2018
Value-based health care is one of the most pressing topics in health care finance and policy today. Value-based payment structures are widely touted as critical to controlling runaway health care costs, but are often difficult for health care entities to incorporate into their existing infrastructures. Because value-based health care initiatives have bipartisan support, it is likely that these programs will continue to play a major role in both the public and private health insurance systems. As such, there is a pressing need to evaluate the implementation of these initiatives thus far and to discuss the direction that American health care financing will take in the coming years.

To explore this important issue, the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School collaborated with Ropes & Gray LLP to host a one-day conference on value-based health care. This event brought together scholars, health law practitioners, and health care entities to evaluate the impact of value-based health care on the American health care system.

For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/will-value-based-care-save-the-health-care-system

March 02, 2018
Value-based health care is one of the most pressing topics in health care finance and policy today. Value-based payment structures are widely touted as critical to controlling runaway health care costs, but are often difficult for health care entities to incorporate into their existing infrastructures. Because value-based health care initiatives have bipartisan support, it is likely that these programs will continue to play a major role in both the public and private health insurance systems. As such, there is a pressing need to evaluate the implementation of these initiatives thus far and to discuss the direction that American health care financing will take in the coming years.

To explore this important issue, the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School collaborated with Ropes & Gray LLP to host a one-day conference on value-based health care. This event brought together scholars, health law practitioners, and health care entities to evaluate the impact of value-based health care on the American health care system.

For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/will-value-based-care-save-the-health-care-system

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Deborah Gersh, Data in Value- Based Health Care

  1. 1. 1 March 2, 2018 DATA IN VALUE-BASED HEALTH CARE Reconciling Data Sharing and Privacy Protections
  2. 2. 2 Challenges INTEROPERABILITY QUALITY OF DATA EFFECTIVE USE OF DATA INDIVIDUAL PRIVACY RIGHTS CHALLENGES
  3. 3. 3 VBHC data challenges  IT support critical for Value-based Health Care (“VBHC”) – Major investments in Electronic Health Records (“EHRs”), but have not met expectations – Supporting VBHC Initiatives – Need to build for 2020 and beyond  Grappling with the interoperability millstone – legal and operational challenges  Seeking high quality data: rethinking the way we organize and support the collection, management and use of the data – Capturing and structuring data to support the shift to greater provider accountability
  4. 4. 4 Quality of data  Data not effectively captured or measured  Need for: – Effective sharing of data with integrated care team – Use of data for benchmarking purposes – Support for evidenced-based care planning – Support for Clinically Integrated Networks (“CINs”), Risk-bearing Organizations (“RBOs”), Health Information Exchanges (“HIEs”)
  5. 5. 5 Diabetes as example Range of clinical and supplemental needs  Pre-admission / screening  In hospital care  Post acute care  Physical Therapy  Diet and exercise  Patient Engagement through technology  Ancillary Support Services
  6. 6. 6 Privacy protections – the counterpoint  Strong public policy preference: protecting patient privacy and data-use rights  The conflict: desire to have benefits of big data but reluctance to share personal health information  Fragmentation of these protections – Like EHRs, patient privacy protections built around the legacy fee-for-service health care structure and patient consents and authorizations
  7. 7. 7 Array of data-use rights & privacy protections  Legal hurdles – Authorizations and consents  Non-“treatment” uses and data aggregation  Patient compensation for data; blockchain technology?  Coordination of consents and authorizations across the care team  Authorization of future, unforeseen uses (de-identification, “blanket” consents)  Effective data security  State-specific privacy laws (HIV, mental health, etc.)  Ongoing compliance with evolving federal standards – Office for Civil Rights enforcement – Punitive shift in Federal Trade Commission enforcement
  8. 8. 8 Balancing the values  Balancing patient privacy legal protections with the data sharing and aggregation required for VBHC: – Trusted Exchange Framework (“TEFCA”), a partial answer – Pursuant to the 21st Century Cures Act – Attempts to create a single “on-ramp” for provider and others’ data exchange – CINs  Difficult to establish  Still require substantial resources devoted to privacy – Complex to ascertain needed consents/authorizations  Business associate or covered entity status, and when? – New York State Medicaid Health Home program – Broad state-authored consent and authorization – Substantial compliance resources still required
  9. 9. 9 Balancing the values – HIEs  Exchanges of clinical information between disparate health systems  Variety of models (e.g., EHR vendors, consumer controlled, geographic based)  Still fundamentally rests upon a concept of consents and authorizations – Emerging trends  United Health Group – Payor provided data analytics and technology – Supporting Medicare advanced Bundled Payments for Care Improvement model  CVS – Aetna – Wellness clinics and pharma services – Community-based hub
  10. 10. 10 Conclusion  The move to VBHC requires harmonizing competing goals: (1) data sharing and aggregation necessary for VBHC (2) the moral and legal imperatives of patient privacy and control
  11. 11. 11 Deborah Gersh Partner Deborah.Gersh@ropesgray.com 312.845.1307

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