Consulo Indicium - 11/14/19

Information for your Consideration…

And, Are We Surprised? – The big health care news of the past week was the front page article by The Wall Street Journal that Google has coupled with Ascension Health – the second largest health care system in the nation – on “Project Nightingale.” In essence, the partnership between the two entities is an effort for Google to develop and enhance its artificial intelligence and machine learning platform in understanding patient data; and, for Ascension to work on developing better protocols and guidelines to gain efficiencies, effectiveness and quality in care delivery.  The project has now triggered a federal inquiry on whether or not all of the HIPAA requirements were met or are being met by the deal.  Quite frankly, knowing a bit about the players on both sides of that aisle, I will be very surprised if the HIPAA requirements are not being met.  In fact, there is no reason that Ascension cannot have a “business associate” relationship with Google.  In fact, the HHS requirements state:

 The Privacy Rule allows covered providers and health plans to disclose protected health information to these “business associates” if the providers or plans obtain satisfactory assurances that the business associate will use the information only for the purposes for which it was engaged by the covered entity, will safeguard the information from misuse, and will help the covered entity comply with some of the covered entity’s duties under the Privacy Rule. Covered entities may disclose protected health information to an entity in its role as a business associate only to help the covered entity carry out its health care functions – not for the business associate’s independent use or purposes, except as needed for the proper management and administration of the business associate. 

The key factor will be the highlighted area noted above on whether Google is doing anything in terms of “independent” use of the data.  Again, I would be surprised.  More importantly, from a generic standpoint, I fully anticipate that these types of arrangements will become more prevalent in the next couple of years.  The Google-Ascension partnership is the first.  I strongly suspect that the Amazon-XXX, Microsoft-YYY, Dell-ZZZ and other similar partnerships are not too far away from announcements as well.  In fact, I’ll go one step further: it is through these types of partnerships that we will gain a better toe-hold on how to manage costs more effectively, deliver more efficient care and enhance the quality of care we provide.  It will be the new norm.  If there are concerns about privacy – as there should be – the focus should be on resolving those issues.  In fact, I’ve argued for some time that the entire HIPAA framework needs to be revisited.  HIPAA was enacted in 1996 – nearly 24 years ago or, a quarter of a century.  During that time period the technology, the care delivery models and the cost of care have all exploded!!  So, are we surprised? If we are, then we’ve been living under a rock.  It’s time to deal with the real issues of privacy in an era of transparency. 

Perhaps It’s My Age – I was struck by a report from the Global Coalition on Aging (GCOQ) and United Nations Department of Economic and Social Affairs (UN DESA) along with several other organizations who report on a 21st century megatrend – the skyrocketing rates of vision loss and visual impairment among the growing numbers of elderly.  The report was introduced by having the dinner guests blindfolded for their entire meal so that they could learn first hand the impact of visual disruption.  Christine Ha, an American celebrity chef who is blind cooked the meal and explained for the guests the dynamics of blindness in visually dominated cultures.  Vision loss is, indeed, a major cause of morbidity among the elderly because of falls, social isolation, and withdrawal.  I know that in my household, I have become the leading voice for “more light” and “bigger print” – along with “louder, clearer talking”.  Hmmm, perhaps I’m next?

Canada To The Rescue – Not! – In the last couple of months, a number of advocates have suggested that given the shortage of certain prescription drugs and cost of those same drugs in the USA (even generics) that we should turn to Canada as a source of supply.  However, Kirsten Hillman, the Acting Ambassador to the United States issued a statement this past week stating: “Not only are we too small of a market, Canada cannot increase its domestic pharmaceutical drug supply to meet U.S. demand. Canada remains dedicated to working with the U.S. to improve our citizens’ health and well-being, recognizing that Canada’s priority is to ensure a steady and solid supply of medications at affordable prices for Canadians.”  We need a similar perspective on our side of the border… 

And, Speaking Of Shortages – It seems absolutely crazy that a drug which has been in use since 1922 – when the first person (a young boy) was injected with insulin – is increasingly unavailable OR, beyond the financial reach of diabetic patients! Yet that is the case.  A recent study was published in the New England Journal of Medicine highlighting this increasingly important problem. Today, the price of 100 units of insulin is about $18.00.  And, for the average 150 pound person that amount of insulin will last about 2 days with the cost of insulin running about $270+/month.  That is a chunk of change by any standard. The issue is the insulin is a “biologic” drug which requires more sophisticated capabilities in production.  The drug companies are arguing that their costs keep going up but the naysayers are suggesting that the price increases are going up at a rate far faster than inflation or other associated costs.  There are a number of pieces of legislation at both the state and federal level which are intended to level the playing field and create penalties for drug increases on these generic drugs that go beyond the inflationary production factors.  The issue is that insulin is not the only drug.  There are any number of generic antibiotic medications (e.g. plain old tetracycline) which continue to be effective treatments where the same phenomenon is occurring.  This is real and deserves our special attention. 

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