Disrupting health care costs through local politics

Photo credits: "Moneybowl" by Ganamex; "Stethoscope" by surroundsound5000 licensed under CC BY-NC 2.0

As federal politicians debate over who pays for healthcare, far too little attention is paid to one central, non-partisan, agreement:  Healthcare in the U.S. costs too much.

At the Arizona Technology Council's MedTech Monthly meeting in April sponsored by iTether, U.S. Rep. David Schweikert (AZ District 6) spoke not about changes to, or the repeal of, the ACA or any counter plan proposed by the opposition party, but instead about what needs to be done to disrupt health care costs.

Representative Schweikert provided several examples of digital health solutions available today that would dramatically reduce costs but are encumbered by regulations, licensing standards, and reimbursement models designed to protect incumbent systems supported by lobbies like the American Hospital Association (Ranked #5 in 2018 for lobbying spending with close to $24 million) as well as many others in health care with a stake in healthcare spending. (Note: These lobbies today are gearing up today to kill any move towards a single payer system.)

As an example of the kind of cost saving, future-forward, solutions discussed, consider the AdviNOW Medical solution available in 12 Safeway stores in Arizona which employs artificial intelligence and augmented reality to augment clinical staffing.  Given a set of conditions collected from self-administered diagnostic tools, artificial intelligence (AI) provides a doctor or nurse with a short list of probable diagnosis and corresponding care plans.

Who is allowed to make a diagnosis and prescribe a care plan is regulated by Scope of Practice regulations which falls under state jurisdiction.  These regulations, ostensibly established to protect patients from unlicensed care, can also impede progress towards equivalent (and potentially greater) accuracy, accessibility, and cost-effectiveness in health care.

While Safeway's program is impressive, given the extensively connected world of today there is no reason you should need to leave the comfort of your home to get a diagnosis and prescription. While not everyone may be ready to have an AI solution replace their primary care physician, there are a great many potential patients who agree that the convenience of this solution is more desirable and cost-effective than the age-old tradition of making a potentially days or weeks later appointment to visit a doctor's office. The advantages of serving rural and even remote areas are exponentially more significant, especially in traditionally under-served communities. Further, remotely accessible AI-based solutions would take cost and burden out of the healthcare system, especially our over-utilized emergency rooms, especially given an impending shortage in physicians as baby boomers age out of the workforce,

Our best hope in disrupting healthcare costs lies in legislators who are willing to support bi-partisan policies that remove barriers to innovative healthcare solutions. A starting place might be with Scope of Practice Policies.

I researched to learn what the Arizona legislature is doing in support of reducing healthcare costs through changes to Scope of Practice, and spotted two bills that are on the right path:

SB 1089: Current law requires that insurance policies include coverage for certain healthcare services that are delivered through telemedicine if such healthcare services would be covered when delivered through in-person consultation between the healthcare provider and the policyholder. Telemedicine coverage may be limited to the healthcare providers that belong to an insurer's provider network. SB 1089 expands the definition of telemedicine to include asynchronous store-and-forward technologies and remote patient monitoring technologies and becomes effective Jan 1, 2021.

HB 2068  Signed on 4/16/2019, addresses clinical Nurse Specialists prescribing authority.  The legislation allows a clinical nurse specialist (CNS) to prescribe and dispense pharmacological agents if the CNS has met educational and training requirements and holds a national certification.  The passing of this bill reduces cost by providing increased autonomy to fill gaps in healthcare in specific situations.: "Advanced practice nurses provide this service at a lower cost than an all-physician workforce would allow. Public health is better served by removing the barriers to full CNS practice."

You can learn about what policies are being proposed in your state that expand the scope of practice through Legislative Search provided by Scope of Practice.org.

In a blog last year, I posted that it sometimes takes years for new policies to get a hearing and that it is essential that healthcare entrepreneurs be aware of evolving politics and policy initiatives and be ready to take advantage. The policies above had the backing of lobby groups whose voices caused these initiatives to be heard. Arizona Entrepreneurs can take advantage groups like The Arizona Technology Council to network and connect with policymakers to push for a change regulations, licensing standards, and reimbursement models to allow for more efficient, and ultimately more effective, healthcare delivery.

What did I learn by attending MedTech's monthly meeting? Disrupting the cost of healthcare has less to do with who pays and more to do with pushing our local legislatures to drive policies that will expand access, demand high-quality, and reduce the cost of healthcare.

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