Groundbreaking Court Ruling Against Insurer Offers Hope in 2020

Katherine G. Kennedy
Psychiatric News
Originally posted 9 Jan 20

Here is an excerpt:

In his 106-page opinion, Judge Spero criticized UBH for using flawed, internally developed, and overly restrictive medical necessity guidelines that favored protecting the financial interests of UBH over medical treatment of its members.

“By a preponderance of the evidence,” Judge Spero wrote, “in each version of the Guidelines at issue in this case the defect is pervasive and results in a significantly narrower scope of coverage than is consistent with generally accepted standards of care.” His full decision can be accessed here.

As of this writing, we are still awaiting Judge Spero’s remedies order (a court-ordered directive that requires specific actions, such as reparations) against UBH. Following that determination, we will know what UBH will be required to do to compensate class members who suffered damages (that is, protracted illness or death) or their beneficiaries as a result of UBH’s denial of their coverage claims.

But waiting for the remedies order does not prevent us from looking for answers to critical questions like these:

• Will Wit. v. UBH impact the insurance industry enough to catalyze widespread reforms in how utilization review guidelines are determined and used?

• How will the 50 offices of state insurance commissioners respond? Will these regulators mandate the use of clinical coverage guidelines that reflect the findings in Wit. v. UBH? Will they tighten their oversight with updated regulations and enforcement actions?

The info is here.

Crispr Fans Fight for Egalitarian Access to Gene Editing

Megan Molteni
Wired.com
Originally posted June 6, 2018

Here is an excerpt:

Like any technology, the applications of gene editing tech will be shaped by the values of the societies that wield it. Which is why a conversation about equitable access to Crispr quickly becomes a conversation about redistributing some of the wealth and education that has been increasingly concentrated in smaller and smaller swaths of the population over the past three decades. Today the richest 1 percent of US families control a record-high 38.6 percent of the country’s wealth. The fear is that Crispr won’t disrupt current inequalities, it’ll just perpetuate them.

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CrisprCon excels at providing a platform to raise these kinds of big picture problems and moral quagmires. But in its second year, it was still light on solutions. The most concrete examples came from a panel of people pursuing ecotechnologies—genetic methods for changing, controlling, or even exterminating species in the wild (disclosure: I moderated the panel).

The information is here.

Apple’s Move to Share Health Care Records Is a Game-Changer

Aneesh Chopra and Safiq Rab
wired.com
Originally posted February 19, 2018

Here is an excerpt:

Naysayers point out the fact that Apple is currently displaying only a sliver of a consumer’s entire electronic health record. That is true, but it's largely on account of the limited information available via the open API standard. As with all standards efforts, the FHIR API will add more content, like scheduling slots and clinical notes, over time. Some of that work will be motivated by proposed federal government voluntary framework to expand the types of data that must be shared over time by certified systems, as noted in this draft approach out for public comment.

Imagine if Apple further opens up Apple Health so it no longer serves as the destination, but a conduit for a patient's longitudinal health record to a growing marketplace of applications that can help guide consumers through decisions to better manage their health.

Thankfully, the consumer data-sharing movement—placing the longitudinal health record in the hands of the patient and the applications they trust—is taking hold, albeit quietly. In just the past few weeks, a number of health systems that were initially slow to turn on the required APIs suddenly found the motivation to meet Apple's requirement.

The article is here.