Healthcare in 21 years will be driven by 'radically interoperable data'

The 340B Saga Continues

This week, a federal court found the administration’s 340B program rates to be fatally flawed; the HHS Secretary “patently violated” the governing law.

The 340B program is designed to support critical access hospitals and other safety-net providers by providing targeted subsidies for their outpatient prescription drug costs; an administration rule appealed by industry associations would have cut this support by about 30% from 2017 levels. As described by the court, the agency elected to adjust 340B rates “based not on the drugs’ average sale prices — as dictated by the statutory text — but on the drugs’ estimated acquisition costs.”

This ruling applies to the 2019 rates, much as a previous ruling reached the same conclusion with respect to the 2018 rates. The court has ordered the agency back to the drawing board for both years, and “expects HHS to resolve this issue promptly,” ordering the parties to provide a status report in three months’ time. The court said it was a very close call, but decided to stop short of invalidating the rules entirely — noting that vacating two years’ Medicare reimbursement rules could wreak havoc on administering Medicare, especially since budget-neutrality laws likely mean that any increase in 340B payments would have to be offset by reductions in other Medicare payments. Re-setting other payment levels, recouping payments from other providers, and recalculating patient-pay amounts would be an administrative nightmare. (It may be interesting to explore further whether the budget-neutrality rules would necessarily apply in the case of a court-ordered revision to a single reimbursement rule.)

What Will Being Healthy Mean In The Future?

According to common beliefs, a healthy lifestyle means a diet rich in vegetables and proteins, low in sugar, fat, and processed foods, regular sports, a balanced schedule, no alcohol, no smoking, no stress, and good night sleep. We believe it is almost impossible to reach this optimal state of body and mind, but does that mean only a handful of people are living healthily? What does health mean in this context?

While for the majority of people, health nowadays does not only mean the opposite of disease – not experiencing crippling symptoms, not feeling any pain and being able to undertake daily tasks – but in the last couple of decades, the concept of health was augmented with the idea of “well-being”. The rise of the fitness industry from the 1960s onwards brought with it bodybuilding and aerobics, nutrition science and practice have been burgeoning, smoking has been publicly chastised and gradually expelled from public institutions, schools, airplanes, and other public places.

That’s already beyond the notion of not getting into the healthcare system and rather means struggling for the optimization of the body to avoid falling ill – with means such as sports and dietary restrictions. Lately, fitness and health technologies joined the forces promising well-being, fitness, and wellness. What will happen if big data and artificial intelligence-based wearables and health sensors will also get into the picture? Will our understanding of health and “health optimization” change?