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Paper Urges Deidentified Data Protection

The Health Privacy Project at the Center for Democracy & Technology recently released a paper advocating the need for stronger standards for “deidentified” personal health information when used for medical research, to promote public health, or for other specialized purposes. Stronger standards are needed to ensure that deidentified data cannot be reidentified in order to maintain patient privacy and build trust in the healthcare system.

However, technological advances have made it more difficult to ensure that data remain deidentified. In addition, current laws may not provide sufficient incentives to use anonymized instead of fully identifiable data. The paper, “Encouraging the Use of, and Rethinking Protections for De-Identified (and ‘Anonymized’) Health Data,” makes several policy recommendations on how to strengthen the current deidentification standard found in the HIPAA privacy rule and increase the use of anonymized data for many healthcare purposes.

The paper’s recommendations are based in part on a one-day workshop held by the Health Privacy Project in September 2008 in which some of the nation’s best thinkers on data security and policy explored issues associated with the deidentification of health data.

— Source: Center for Democracy & Technology


Report Highlights HIT’s Power to Save

Savings of $332 billion in national health expenditures could be achieved over the next decade by making better use of technology and streamlining administrative processes, according to a new report released by UnitedHealth Group’s Center for Health Reform and Modernization.

The report is a companion to the center’s first paper released in May that identified $540 billion in potential federal medical cost savings by applying to traditional Medicare some of the techniques UnitedHealth Group uses in the funding and management of care for more than 70 million Americans.

This second research report provides practical ways in which technology can save money by modernizing the administrative and transactional aspects of healthcare. The paper’s focus is on savings across the healthcare system as a whole—savings that will accrue to physicians, hospitals, and health plans and to consumers, employers, and the government.

“There is too much administrative waste in our healthcare system; this report shows how technology can help fix it,” says Simon Stevens, executive vice president of UnitedHealth Group and director of the UnitedHealth Center for Health Reform and Modernization. “Patients, physicians, hospitals, and insurers will benefit from applying streamlined modern approaches to the day-to-day support of care delivery. Now is the time to insist these changes happen across the healthcare system.”

The report estimates that perhaps one half of the $332 billion savings would accrue to physicians and hospitals, 20% directly to the government in its role as a healthcare payer through Medicare and Medicaid, and 30% to health plans. However, there are various ways in which a higher share of the savings could become available to the federal government.

The paper details how in practice these reforms could be designed and implemented through the following:

• tighter mandatory data and transaction standards;

• elimination of antiquated manual processes, unnecessary paperwork, and redundant intermediaries;

• automated payment accuracy processes across the healthcare system;

• a single credentialing and quality measurement process; and

• a sophisticated and consistent regulatory regime.

“Shared action is now needed across all payers—commercial and governmental—in partnership with physicians and hospitals,” says David Wichmann, president of UnitedHealth Group Operations and one of the report’s coauthors. “UnitedHealth Group, for example, now has 30 million magnetic swipe cards in circulation that would eliminate much red tape for patients, but the full potential of these cards will not be realized without agreed upon universal standards adopted across the healthcare system.”

Examples of approaches that could achieve administrative simplification and significant administrative cost savings over the next 10 years include the following:

• broader use of automated swipe cards ($18 billion);

• creation of a national payment accuracy clearinghouse ($41 billion); and,

• elimination of paper checks and paper remittance advice ($109 billion).

— Source: UnitedHealth Group


Telemedicine Doesn’t Cut Medicare Costs, Study Says

Home telemedicine holds promise for the cost-effective delivery of monitoring, educational, and therapeutic services to people with chronic illnesses. However, findings from Mathematica’s congressionally mandated evaluation of the Informatics for Diabetes Education and Telemedicine (IDEATel) demonstration, reported in the July issue of Diabetes Care, show no overall cost savings for Medicare.

The demonstration was designed to provide telemedicine services to Medicare beneficiaries older than the age of 65 who had diabetes and who lived in medically underserved areas of New York City and upstate New York. The demonstration sought to improve the health of Medicare beneficiaries with diabetes and reduce the complications they faced by improving access to care and conformance with physician guidelines. A consortium led by Columbia University designed and implemented IDEATel in two four-year phases.

In the first phase, beneficiaries received a desktop personal computer with a monitor, mouse, and keyboard; a video camera; speakers; a microphone; and glucose and blood pressure meters. They used the equipment to measure and monitor their blood sugar and blood pressure, interact with an IDEATel nurse case manager through scheduled video conferences, and access Web-based educational materials. In the second phase, beneficiaries recruited in the first phase and a new refresher cohort of eligible beneficiaries received a newer, smaller, and easier-to-use home telemedicine unit to replace the computer.

The demonstration was neither as intensive nor as technologically sophisticated as originally designed. IDEATel was clinically effective at only one site and had no cost-reducing effect on Medicare total, Part A, or Part B expenditures or on the use of expensive services, such as hospital care. Furthermore, the intervention’s costs were high—more than $8,000 per person per year—when compared with costs for programs with similar-sized clinical impacts.

In addition, the demonstration’s specific type of home telemedicine intervention was not generalizable to other telemedicine interventions. As a result, findings from the evaluation do not imply that home-based telemedicine cannot increase value for the Medicare program.

“With adjustments, a Medicare program such as this might provide real benefits to beneficiaries,” says Lorenzo Moreno, lead author of the article and a senior researcher at Mathematica. “Increased home-based televisits from nurses and self-tracking of progress could improve patients’ self-care behaviors. These improvements could help participants avoid long-term health complications, which in turn would reduce use of acute care services, hospitalizations, and Medicare costs.”

— Source: Mathematica Policy Research, Inc