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HHS Issues Cybersecurity Rule

The U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), issued a proposed rule to improve cybersecurity and better protect the healthcare system from cyberattacks.

The proposed rule modifies the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule. It requires health plans, healthcare clearinghouses, most healthcare providers, and most business associates, to strengthen cybersecurity protections against external and internal threats. It requires updates to existing cybersecurity safeguards, using modern best practices, to reflect advances in technology and cybersecurity. It provides greater detail on what covered entities and business associates need to do to protect the security of electronic protected health information (PHI). Policies and procedures would have to be in writing, reviewed, tested, and updated on a regular basis.

Specifically, HHS says the rule reacts to:

• Changes in the environment in which healthcare is provided.
• Significant increases in breaches and cyberattacks.
• Common deficiencies OCR has observed in investigations into Security Rule compliance by covered entities and their business associates.
• Other cybersecurity guidelines, best practices, methodologies, procedures, and processes.
• Court decisions that affect enforcement of the Security Rule.

The rule is in response to growing cybersecurity incidents, including the Change Healthcare attack earlier this year that made much of healthcare come to a standstill.

Th fact sheet is well written and explains many of the details of the rule.  I am surprisingly impressed with the proposal and its details. I think it is a good start to protecting the nation from emerging cyberattacks.  The problem, though is the readiness of health plans and providers, especially many who have limited expertise and knowledge. They do not have the dollars or know-how to implement protections.  As such, I think we need a true national cyber plan with a strong budget and implementation strategy.  The rule is a start but is not enough.

Rule at Federal Register: https://www.federalregister.gov/public-inspection/2024-30983/health-insurance-portability-and-accountability-act-security-rule-to-strengthen-the-cybersecurity-of .

Fact Sheet: https://www.hhs.gov/hipaa/for-professionals/security/hipaa-security-rule-nprm/factsheet .

#cybersecurity #healthplans #providers #cms #hhs

https://www.hhs.gov/about/news/2024/12/27/hhs-office-civil-rights-proposes-measures-strengthen-cybersecurity-health-care-under-hipaa.html

Wakely Finds VBID Sunset Could Impact Medication Adherence Rates

Many Medicare Advantage (MA) proponents have said that the sunset of the Value Based Insurance Design (VBID) in Medicare Advantage (MA) as of 2026 could have impact on outcomes and complicate affordability of healthcare for beneficiaries. Wakely Consulting, an actuarial and consulting firm, has found that this could be true in the area of medication adherence.

Plans have used the VBID program to target waiver of pharmacy cost-sharing for low-income (LI) beneficiaries. These are the same targeted individuals in the new Health Equity Index (HEI) rolling out in Star Year 2027. Wakely found that medication adherence for diabetes, hypertension, and hyperlipidemia could be impacted if the cost-sharing waivers disappear. The analysis found that removing copays on maintenance medications improved beneficiary adherence, which is tied to improved quality of care and health outcomes. These are three key star measures in the Part D program. Wakely argues eliminating copays for this LI group needs to remain a focus after the VBID sunset.

Wakely found that in the first year of waiving LI cost sharing, every plan demonstrated improvement in at least one medication adherence measure. Five out of the eight plans observed improvements in all three adherence measures. Two others showed progress in two of the measures, while the remaining plan improved in just one measure. Wakley says that eliminating copay barriers for LI individuals enhances their ability and willingness to consistently fill their prescribed medications.

The normalized improvement observed in medication adherence was significant in all three measures: 2.2% improvement for diabetes, 2.5% improvement for hypertension, and 1.2% for cholesterol.

#cms #stars #vbid #medicationadherence #quality

https://www.wakely.com/blog/advancing-medication-adherence-does-waiving-drug-copays-improve-medication-accessibility-for-medicare-advantage-members/

What More Could The CMS Actuary Do For Its Annual Healthcare Spending Report?

Interesting Health Affairs Forefront Blog on what more the Centers for Medicare and Medicaid Services (CMS) Actuary could do in terms of analysis of National Healthcare Expenditures Data (NHED) each year. As the author notes, there are some crucial missing pieces that could aid analysis and reform.

• The NHED do not report prices by payer sector. We know that the commercial world is saddled with huge prices compared with the government sector. Interestingly, the author does note that healthcare inflation declined in a real sense. As I noted in a reent blog, the surge in overall spending was tied to utilization. That blog is here: https://www.healthcarelabyrinth.com/national-healthcare-expenditure-data-issued-for-2023-what-does-it-all-mean/ .
• The NHED do include estimates of the change in volume and intensity — overall and by provider sector. The author opines that: “What matters is the specifics of which prices could be reduced with little decline in access or quality and which care is not improving health. … Identifying opportunities for more efficient care delivery, and payment systems/delivery models that encourage those efficiencies to be realized, is crucial.”
• The NHED do not capture costs that are not funneled through providers or insurers. The commercial sector has vast costs in this area. Also, many activities directed toward studying and managing the complexity of the healthcare system are not counted.

(Article may require a subscription.)

#nhed #cms #healthcare #spending

https://www.healthaffairs.org/content/forefront/beyond-national-health-expenditure-data-three-things-wish-were-better-measured

CMS Pushing Streamlining Of Quality Measurement

Interesting article on the Centers for Medicare and Medicaid Services’ (CMS) push to streamline quality metrics across programs. Its approach, called the Universal Foundation, is meant to ease complexity, burden, and the administrative costs on providers and health plans by establishing standardized metrics and financial incentives. Right now, CMS has about 20 measure sets that encompass hundreds of discrete measures.

I certainly endorse standardization and streamlining, but migrating to the Universal Foundation will take years. Further, given differences in demographics, we will always have some unique measures in each program. But standardizing Accountable Care Organization (ACO) and Medicare Advantage (MA) measures would be a great place to start.

(Article may require a subscription.)

#quality #stars #acos #medicareadvantage #cms 

https://www.modernhealthcare.com/policy/cms-universal-foundation-quality-data-reporting-measurement