On June 23, Crowell & Moring and Accenture co-hosted the Fostering Innovative Digital Health Strategies Conference in Crowell’s D.C. office. The conference provided a broad analysis of the business and legal issues that must be addressed as health care organizations and technology companies consider innovative strategies to use digital health technologies. The conference covered several topics including trends in the health care economy’s Internet of Things, setting up digital health platforms, legislative activity related to telehealth, and the use of digital health technology to support new payment models.
The fifth session of the conference, “New Payment Models and New Sources of Data for Care Coordination and Quality Improvement” featured John Brennan (Partner, Crowell & Moring), Dr. Elizabeth Raitz-Cowboy (Southeast Medical Director, Aetna Life Insurance Company), Barbara Ryland (Senior Counsel, Crowell & Moring), and Soph Sophocles (Associate General Counsel, Biogen).
The discussion addressed changes and themes in the wake of digital health technology and growing use of data. Key takeaways from the session:
- Market Shifts. Digital health and the Internet of Things (“IoT”) are changing the amount of available data and the way health care is delivered. Payors increasingly use new payment models, where outcomes are measured and demonstrated, to optimize care. Demonstrating and defining “value” presents an ongoing, and sometimes technical, challenge.
- Trends in Contracting. Companies like Aetna Life Insurance and Biogen engage in value-based contracting and use data for disease management. Physicians increasingly use data and algorithms in the everyday practice of medicine. As companies are able to generate more data, there is a push for more value-based contracting and increasingly sophisticated metrics.
- Utilization Challenges. Under certain health care plans, physicians are able to use and bill for telemedicine services but are largely not doing so. The utilization of telemedicine for the betterment of patient care is increasing but is not yet widespread. Educating physicians and incorporating telemedicine into everyday health care remains a challenge, particularly given legal limitations, challenges regarding medical licensure, cultural impediments, and reimbursement limitations.
- Legal Challenges. Value-based contracting and outcome-based payment models present legal challenges including HIPAA privacy and fraud and abuse concerns. Fraud and abuse waivers may not cover certain financial arrangements created under value-based contracting or alternative payment models. Exceptions under the Stark Law also may not apply to certain financial arrangements, making legal compliance a challenge.
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