In Brief: UCSF Launches Population Health Platform; DMHC Sued Over Alleged Lack Of Expedited Responses
UCSF Launches Population Health Platform
UC San Francisco has entered into a pact with New York-based CipherHealth LLC to create a platform to better monitor and manage patients with complex medical conditions.
Known as View, the platform allows UCSF clinicians and caregivers to view comprehensive data on patients, communicate with one another, and better coordinate care and population health management.
"In today's increasingly digital world, it only makes sense for healthcare providers to use a tool that connects them to one another and to the greater health goals of each patient,” said Zach Silverzweig, co-founder of CipherHealth
CiperHealth had previously provided UCSF with Voice, a platform that allows the hospital to automatically call inpatients after discharge to monitor their progress and avoid readmissions.
"We needed a comprehensive tool that would be able to help us manage our most complex patients across the care continuum and across disciplines," said Gina Intinarelli, executive director of population health and accountable care at UCSF Medical Center. "This enables us not only to understand longitudinal data for one patient, but also to visualize the types of care delivered to larger patient populations. It helps us know how to deliver the right care, in the right place, by the right person."
No timeline for the installation of the platform was announced. Terms of the deal were not disclosed.
DMHC Sued Over Alleged Lack Of Expedited Responses
The Department of Managed Health Care has been sued by a Los Angeles-based operator of psychiatric centers, claiming the agency does not respond to requests to make expedited decisions about coverage for psychiatric patients and other health plan enrollees.
The suit was filed by Evolve Growth Initiatives and an affiliate company, Psych-Appeal, Inc. It claims that the DMHC is taking as long as six weeks to settle appeals of denied claims even though it is compelled to provide a decision within 72 hours.
"While Evolve does not discharge patients pending appeals, we find that if they can't pay for treatment themselves, many patients simply won't stay in treatment,” said Evolve CEO Mendi Baron. “Also, mental health providers often delay or terminate care instead of taking on the risks associated with these delayed appeals. DMHC may tout mental health parity, but its practices are making a mockery of actual mental healthcare."
The DMHC has not yet responded to the suit.
"Expedited appeals submitted to DMHC are critical for patients who have been denied mental health care and need a final coverage decision before they can get approved for treatment," said Meiram Bendat, Evolve's counsel and president of Psych-Appeal, Inc. "The consequences of not receiving a timely decision can be devastating since patients must decide whether to pay for costly treatments out of pocket, with the very real possibility of not getting reimbursed -- or simply say 'no' and forego the care they desperately need."
