Edifecs
Posted on October 31, 2024 | 4 min read
How the 2024 Election Could Impact Healthcare Data Exchange
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Consumer Experience
Healthcare Data
Regulatory Compliance
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A contentious election season is drawing to a close, and with Vice President Kamala Harris and former President Donald Trump virtually tied in national polling averages it’s still anyone’s guess as to what will happen on November 5. Regardless of the outcome, one thing is certain: this election has the potential to impact a few key areas of particular importance to the healthcare industry, including interoperability and data exchange.
The legislative considerations of healthcare information exchange (HIE) are rife with complexity, and few people are more qualified to navigate that complexity than John Kelly. Kelly was the architect and technical lead for the Commonwealth of Massachusetts’ statewide HIE project and served on the Board of Directors for the Workgroup for Electronic Data Interchange (WEDI). He currently serves on the National Committee on Vital Health Statistics (NCVHS) and on the Board of Directors for the Massachusetts Health Data Consortium.
At Edifecs Connect Healthcare® 2024, our annual event for industry executive leaders, Kelly sat down with Edifecs CEO Venkat Kavarthapu to share his thoughts on how the 2024 election could impact the healthcare industry’s push to achieve true, seamless data interoperability.
Affordable Care Act
The HITECH Act, passed in 2009, offered financial incentives to eligible professionals to move away from paper charting and to adopt electronic health record (EHR) systems. A year later, the Affordable Care Act (ACA) built on the HITECH Act by expanding EHR incentives to drive adoption in underserved communities and introducing metrics for care coordination, quality tracking, and outcome-based provider payments. Together, the HITECH Act and the ACA created the foundation for healthcare interoperability as we know it today.
Despite an unsuccessful attempt to repeal the Affordable Care Act (ACA) during his first term, Trump has indicated a willingness to try again if he wins the election in November. However, Trump has also said that he prefers to make the ACA “much much better and far less money” rather than eliminate it outright.
In Kelly’s view, the backlash generated by the last attempt to repeal the ACA—through which a record-high 21.4 million people enrolled in health plans this year—has led to “reticence to take people’s healthcare policies away unless they really have a substitute.” Like most industry experts, Kelly believes repealing the ACA without a suitable replacement would be tremendously unpopular with millions of voters. Though he acknowledged that anything is possible, Kelly said he is “relatively confident that the ACA is here to stay.”
Interoperability & Patient Access
The Biden administration has supported interoperability regulations like CMS’ Interoperability & Prior Authorization (CMS-0057-F) and Interoperability & Patient Access (CMS-9115-F) final rules, and a Harris administration would presumably continue down the same path. However, as Kelly pointed out, the same could be said of a second Trump administration.
CMS-9115-F—and, by extension, CMS-0057-F, an earlier version of which was first proposed by CMS in December 2020—originated as part of the MyHealthEData Initiative that aimed to give patients full control over their medical data. As Kelly noted, that initiative was launched by the Trump administration in 2019, which could indicate that interoperability is one of the few areas where the candidates’ legislative agendas overlap.
Irrespective of the election’s outcome, Kelly expects the healthcare industry to continue improving interoperability and expanding patient access to healthcare data.
“There’s a lot of opportunity for payers to look for real value in the democratization of patient information,” Kelly said, citing the growing market for health apps which are popular with younger generations. Because these apps rely on the patient’s ability to access and share their healthcare information, data accessibility will be “increasingly supported by Gen Z and millennials [saying] that’s their data, they want access to it, and they want to do everything on their cell phone,” said Kelly.
“If payers can keep their eye on the ball and leverage the power of information mobility, I think the momentum of the technology and generational change will drive us forward.”
How the Healthcare Industry Can Prepare
The results of the 2024 election will undoubtedly influence future healthcare legislation, but with razor-thin polling margins between the candidates, the list of potential outcomes is simply too long for healthcare leaders to effectively anticipate them all. The coming weeks should bring more clarity on the outcome of the election and allow us to take a deeper dive into the specific policy changes that could be in store for the healthcare industry. But Kelly believes the industry has more influence over the future of healthcare data exchange than many of its leaders may realize.
As Kelly pointed out, the recent CMS rules regarding prior authorization, quality metrics, and EMR vendor certification are primarily aimed at enforcing requirements already established in previous rules, not establishing new ones, and he expects this trend to continue. “There will be targeted legislation around the [actors] who are blocking the existing initiatives, [but] I do not believe there will be a whole lot of revolutionary legislation to instantiate new models of care for interoperability,” Kelly said.
In other words, Kelly feels the future of interoperability will largely be guided by the healthcare industry itself, not by whoever takes office in January 2025. The key is investing in technology companies that are “grounded in the processes of healthcare, leveraging the idea of the value of information, and creating true value in the market.”
“If those companies align with leaders on the payer and provider side, then there’s huge opportunity to advance the interoperability initiative without relying on government policy.”
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