Industry Insight

House Removes Ban Impeding Progress on National Patient Identifier

Patient ID Now, a coalition of leading health care organizations, including the American College of Surgeons, AHIMA, the College of Healthcare Information Management Executives, HIMSS, Intermountain Healthcare, and Premier Inc, is pleased that the US House of Representatives has removed, for the third consecutive year, the long-standing ban in its Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) appropriations bill that has stifled innovation around patient identification for two decades.

This bipartisan movement in the House to remove barriers to accurate patient identification and increased patient privacy has been strengthened in the past year by the effects of the COVID-19 pandemic. Patient misidentification caused challenges for health systems during the pandemic, including thousands of duplicate records created during the vaccination registration process, and disruptions in vaccine availability at provider sites because of inaccurate patient documentation.

Patient ID Now is calling on the US Senate to finally follow suit to protect patient safety and patient privacy—and to bolster the public health system—by removing Section 510 from its Labor-HHS bill. In a letter sent this year to the Senate Appropriations Committee, more than 100 health care organizations called for the removal of this ban. With a third year of bipartisan support in the House of Representatives and overwhelming support from the health care community, this must be the year the Senate takes action to remove this outdated and harmful ban.

The coalition would like to thank Representative Bill Foster (D-IL) and Representative Mike Kelly (R-PA) for their steadfast leadership, and House Appropriations Committee Chair Rosa DeLauro (D-CT) and Representative Katherine Clark (D-MA) for their continued support to advance patient identification.

— Source: Patient ID Now

Study Finds Telehealth Helped Address Health Disparities During Pandemic

The Hispanic/Latino community was the most engaged in telehealth for mental health visits in 2020—adopting the technology more than any other ethnic or racial group, according to a new analysis of Medicaid members in 14 states as part of an Anthem, Inc State of the Nation’s Mental Health special report during National Minority Mental Health Awareness Month.

Telehealth served as a silver lining during the pandemic and a strong alternative to seeing clinicians and counselors in person. Telehealth visits—either via video or phone—for people with existing mental health conditions significantly increased during the height of the pandemic. Visits that started in the single digits before COVID-19 accounted for 49% of all Medicaid mental health visits during a six-month period in 2020. Telehealth regulations that were lifted during COVID-19 have assisted in removing barriers people may have experienced in accessing telehealth.

Overall gaps in getting mental health care between races and ethnic groups remained essentially the same before and during COVID. A higher percentage of Hispanics/Latinos were already receiving in-person or telehealth mental health visits before COVID-19. By greatly boosting the numbers of people using telehealth, COVID-19 may have jump-started broader adoption of telehealth for mental health conditions—especially with Hispanics/Latinos. In fact, during COVID-19, almost 40% of Hispanic/Latino members had a telehealth visit, while white members had 34%, Asian members had 33%, and Black members had 28%.

While telehealth did boost visits during COVID-19, it didn’t make up for the dramatic drop in in-person visits for all races and ethnic groups. And there were significant differences among them. In fact, Black people had the lowest percentage of combined telehealth and in-person visits (56%) before COVID-19 and remained the lowest with 49% after COVID-19.

On average, Black people had 7% fewer mental health visits compared with white people with similar demographic, clinical, and socio-economic backgrounds. The rates are particularly noteworthy, as surveys have indicated that people of color were experiencing more stress and mental health conditions than other populations in 2020 and people of color were disproportionately impacted by COVID-19.

“There are likely many reasons behind the differences in mental health care visits—including issues that prevent people from seeking care, such as medical injustices and a history of receiving culturally insensitive care,” says Anthem Chief Health Officer Shantanu Agrawal, MD. “Health equity is a key driver for mental and physical well-being. To achieve equity in our health care, we need to understand where and why barriers to health exist, and then couple these insights with the scale and scope of Anthem to drive changes to a new system of health that puts equity at the center.”

Historically, major depression and anxiety are underdiagnosed at rates of 32% to 40% less in Black and Hispanic/Latino communities, according to the BCBS Health Index. The American Psychological Association says that lower diagnosis rates are likely driven by lack of provider understanding of cultural differences, stigma around diagnosis or treatment, and barriers getting care.

For Medicaid members with an existing mental health diagnosis, the most common telehealth diagnoses were anxiety, depression, and bipolar disorder, according to the special State of the Nation’s Mental Health report. High blood pressure was among the top five diagnoses for Black, Asian, and Hispanic/Latino people, while high cholesterol was a top five medical diagnosis for Hispanic/Latino and Asian people. Opioid use disorder was one of the top five diagnoses for white people, while severe back pain was a top diagnosis for Black people. These data reinforce that mental health and physical health are connected and improving one can help the other.

“While telehealth wasn’t a panacea in eliminating health equity gaps, it helped boost connectivity for all and made internet visits possible when COVID temporarily closed physical doors, allowing health care to continue to be delivered with some semblance of normalcy,” Agrawal says. “This study is a key reminder that technology alone won’t be sufficient to bridge this gap and the bridge may not be the same for all people. However, it may be the connector needed by certain communities or geographic areas. Clearly, outcomes during the pandemic would have been much worse without telehealth.”

Interestingly, members used telehealth and in-person mental health services similarly whether they lived in an urban or rural area.

Anthem will continue to evolve the following efforts to ensure that it can bridge the gaps for all people that take into consideration their specific needs. Some of these efforts include the following:

• social drivers of health benefits that can assist in improving health equity for physical and mental health;
• peer programs, such as those offered by Anthem and Beacon, may also help create trust by pairing members with someone who has the same lived experience;
• education and informative efforts that involve connections to trusted sources, like churches and even barbershops, have been shown to have greater impact on community acceptance of health services; and
• CME programs, such as mydiversepatients.com, that train clinicians about bias and cultures different from their own, and go a long way in creating stronger, more trusting and culturally responsive relationships between clinicians and patients.

Anthem supports making permanent many of the telehealth policy changes that have occurred during COVID beyond the public health emergency. These include legislative and regulatory policies that do the following:

• allow consumers to see doctors or clinicians from their homes;
• allow providers with appropriate medical licensure to deliver services across state lines; and
• eliminate pre–COVID-19 policies that placed prohibitions on prescribing medications via telehealth.

— Source: Anthem, Inc

Nym Health Raises $25 Million for Medical Coding Software

Nym Health, a provider of explainable AI tech that automates medical coding, recently announced $25 million in new funding led by Addition. Following Nym's October 2020 Series A, this latest round brings the company's total funding to $47.5 million. Addition joins existing investors GV, Dynamic Loop Capital, Tiger Global, Bessemer Venture Partners, and Lightspeed, as well as angel investors Zach Weinberg and Nat Turner.

The new investment will be used to scale product development and accelerate the rapid adoption of Nym's automated medical coding platform in emergency departments. Additionally, the funding will support the expansion of Nym's footprint in urgent care centers and grow the company's New York office.

Deployed in more than 40 hospitals across the United States, including Geisinger and several other academic medical centers, Nym is reinventing medical coding for revenue cycle management (RCM). The Nym platform modernizes RCM using direct-to-billing, fully autonomous medical coding that reduces insurance denials and operational expenses, accelerates payment cycles, and maximizes audit readiness for health care providers.

“COVID has shown provider organizations that solely relying on people to perform business-critical work is unsustainable. We saw demand for our platform surge amid the global pandemic, when hospitals and urgent care centers across the US found they needed to work faster, smarter, and more efficiently under the most challenging of circumstances,” says Nym Health CEO Amihai Neiderman. “We are thrilled to have Addition join us and work alongside all of our investors to aggressively grow and scale Nym, leveraging our clinical language understanding engine to revolutionize the medical billing code process.”

Aaron Schildkrout of Addition, who previously served as head of data and growth at Uber, adds: “Antiquated, manual billing processes typically result in coding-related denials from insurers that add up to billions in lost revenue annually for health care providers, but Nym's automated, auditable medical coding platform is a game-changer. Nym is poised to transform revenue cycle management by significantly improving the speed and precision of billing, reducing denial rates and traditional staffing costs, and, in turn, enabling human coders to focus their attention on more complex cases and follow-up queries.”

Nym's clinical language understanding engine performs better than human coding and does so within seconds and with zero human intervention. The Nym engine tracks patient visits and processes patient charts, including highly individualized doctors' notes. Relevant codes are assigned to the patient chart and sent back to providers or RCM companies in less than five seconds—compared with the traditional five- to nine-day process involved when coding is entered manually. Along with speed, Nym delivers consistently superior accuracy, with rates skyrocketing from a less than 80% industry average for human coders to more than 98% accuracy with the company's engine.

— Source: Nym Health

Letter to NCVHS on Healthcare Standards Development, Adoption, and Implementation

WEDI submitted a letter in response to the National Committee on Vital and Health Statistics’ Request for Public Comment on “Healthcare Standards Development, Adoption, and Implementation.”

In the letter, WEDI emphasized the following:

• new or revised standards demonstrate meaningful and positive change for the health care community;
• social determinants of health data elements be incorporated by applicable standards developing organizations;
• the current lengthy time periods between mandated standards be replaced with a process that identifies and implements innovation with an accelerated timeline;
• reasonable and achievable implementation glidepaths be deployed; and
• government funding be made available to support industry efforts to develop and implement new and revised standards.

— Source: WEDI