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Reporting on news that some people have been waiting on for a while, Kaiser Health News published a piece on a federal rule that recently took effect: healthcare providers are now required to provide patients with electronic access to their health information "without delay upon request, at no cost." It might seem odd that federal intervention is required for patients to have access to their health records -- it is, after all, their health -- but attitudes were very different even just fifteen years ago.

Reporting on news that some people have been waiting on for a while, Kaiser Health News published a piece on a federal rule that recently took effect: healthcare providers are now required to provide patients with electronic access to their health information "without delay upon request, at no cost." It might seem odd that federal intervention is required for patients to have access to their health records -- it is, after all, their health -- but attitudes were very different even just fifteen years ago.

The article notes benefits of patients reading doctor notes: understanding more about their condition, remembering their treatment plan, being more likely to comply with prescriptions. Non-white, less educated, and older patients appear to benefit more than others, perhaps suggesting that the availability of notes allows those patients to better overcome potential language barriers (for example) because they have information to refer to after their visits.

Despite these benefits, many in the medical community at one point objected to openly sharing medical records with patients. Perhaps some felt that patients might needlessly question their notes or misinterpret some concept. Hopefully, the effect of this regulation will be to further cement a cultural shift among healthcare providers towards transparency.

Kellogg School of Management released an interesting study suggesting that America should perhaps not be quite as keen to cut healthcare prices. Their study looked at a number of measures which they took to represent quality. The study reported that hospitals that were expected to have more privately insured patients had better quality measures.

Kellogg School of Management released an interesting study suggesting that America should perhaps not be quite as keen to cut healthcare prices. Their study looked at a number of measures which they took to represent quality. The study reported that hospitals that were expected to have more privately insured patients had better quality measures.

On some level, some of the findings make intuitive sense: hospitals that receive more money have more money to invest into technology (one of the quality measures that were considered). However, this finding goes against many observations that hospital pricing can vary wildly, even for procedures where there might not be discernible differences in quality (e.g. imaging procedures). Whether the conclusion of this study is correct in a meaningful sense could affect the dialogue regarding rising healthcare prices.

Not being an academic, I suspect that researchers who study the relationship between prices and quality would find a lot of room for improved clarity in this study. For example, the authors of this study used demographic information from the zip codes surrounding hospitals to estimate the share of privately insured patients that a hospital treats. A more direct way to discover payer mix would be to actually find out from hospitals themselves (or potentially through claims data). The more problematic area is with quality. For example, none of the listed measures seem to directly include outcomes and mortality measures. Theoretically, a fancy hospital might be investing in a lot of technology (which would raise their quality measure for this study), for example, but actually have worse outcomes than another hospital that has not made such investments.

In a vein similar to an earlier piece about the current California governor awarding a no-contract bid to Blue Shield to distribute vaccines, Kaiser Health News published another piece reporting on a number of other decisions whose optics look bad. Safesforce, whose CEO is a repeat donor to the governor's campaigns, helped create California's "vaccine clearinghouse" which has already cost the state $93 million. I am familiar with the scheduling portal functionality, although I do not know how much non-patient facing functionality was built into the site; nevertheless, a price tag close to $100 million seems very steep.

In a vein similar to an earlier piece about the current California governor awarding a no-contract bid to Blue Shield to distribute vaccines, Kaiser Health News published another piece reporting on a number of other decisions whose optics look bad. Safesforce, whose CEO is a repeat donor to the governor's campaigns, helped create California's "vaccine clearinghouse" which has already cost the state $93 million. I am familiar with the scheduling portal functionality, although I do not know how much non-patient facing functionality was built into the site; nevertheless, a price tag close to $100 million seems very steep.

An interesting take from the author of the piece is that the governor seems to prefer partnering with private corporations rather than investing in the state's public health infrastructure. Notably, before the pandemic, the governor denied local health departments' request for $50 million per year "to help rebuild core public health infrastructure." Public health leaders seemingly bemoan the channeling of public dollars into private corporations instead of buttressing public health departments. On one hand, this point seems very reasonable: instead of giving private corporations the money and being unsure of any lasting benefit to the services provided, the state could have built out its own infrastructure. On the other hand, government agencies are not known for moving quickly, and building technology infrastructure might have taken them too long in a circumstance that required speed. If the state had funneled the funds into its own infrastructure and the public health departments were unable to deliver, there would certainly be people criticizing the government taking the opportunity to enlarge its own empire without doing what is expedient.

Kaiser Health News published a piece that looked at Colorado's attempt to pass a government-run health insurance option (known as "public option"). Before the pandemic, it appears that there was sufficient legislative support for a public option, but as the article points out, healthcare workers have been seen as heroes in the fight against the pandemic and people have been less willing to support a major policy change that would mean less compensation for healthcare staff.

Kaiser Health News published a piece that looked at Colorado's attempt to pass a government-run health insurance option (known as "public option"). Before the pandemic, it appears that there was sufficient legislative support for a public option, but as the article points out, healthcare workers have been seen as heroes in the fight against the pandemic and people have been less willing to support a major policy change that would mean less compensation for healthcare staff.

Despite the sentiment this year, this article shows that people were concerned about health insurance premiums before the pandemic; people are likely to care more once again after the pandemic subsides. Even with the reduced support, it appears that the Colorado legislature was able to negotiate premium reduction targets, although the penalty for not attaining the targets seems much softer. Perhaps we will see more attitudes shift in favor of government action in the health insurance market this decade.

Kaiser Health News reported on an organization that specializes in virtual care. Given the surge of telemedicine during the pandemic, this piece takes a look at the relevant question of whether or not virtual visits warrant the same fee structure as in-person visits.

Kaiser Health News reported on an organization that specializes in virtual care. Given the surge of telemedicine during the pandemic, this piece takes a look at the relevant question of whether or not virtual visits warrant the same fee structure as in-person visits.

Before the pandemic, telemedicine still had restrictions in a number of states. In some places, for example, a patient's first visit with a physician had to be in-person. Beyond the regulatory restrictions, insurers typically paid less for a virtual visit than an in-person visit. The article talks about some of the differing perspectives on whether that disparity should continue.

On one hand, there is something that feels heftier about in-person visits: providers need to maintain buildings and additional support staff, and those costs should be reflected in payments. Traditionally, one concern has been about telemedicine being more vulnerable to fraud. On the other hand, there are some types of visits where virtual visits can be functionally the same as in-person visits, and there are many who believe that they should be compensated equivalently (in a similar vein to the site-neutrality rules that Medicare has tried to enact). Presumably, this issue will not be going away any time soon.