Pay grows for health care performance

Jan 09, 2024

By Erin Schumaker, Ruth Reader, Shawn Zeller, Carmen Paun and Daniel Payne

THE NEXT CURES

An ambulance is parked outside the Bellville Medical Center in Texas, on September 1, 2021.

The Biden administration is promising a payday for ideas that cut some common health risks. | FRANCOIS PICARD/AFP via Getty Images

After investing in forward-leaning health technologies last year — from 3D-printing human hearts to cybersecurity — the Advanced Research Projects Agency for Health has set its sights on a more analog concept to kick off 2024: increasing investment in preventive health care.

The new Health Care Rewards to Achieve Improved Outcomes, or HEROES program, is meant to encourage investment in preventive care in areas of the country where health outcomes are worse than the national average, the agency announced Tuesday.

The goal is to kick-start a virtuous cycle, where health organizations and their partners invest money in addressing critical and preventable health problems and are compensated if their efforts are successful.

"What if actually investing in prevention was not only the right thing to do, but it was also the smart thing to do if you're a business?" said Dr. Darshak Sanghavi, HEROES program manager.

How it works: ARPA-H wants proposals from what it's calling "health accelerators," like community health centers, health systems, nonprofits, insurers or combinations of groups working together.

That organization or group will target a geographic region, anywhere from around half a million to 5 million people, and one of several issues: maternal health complications, opioid overdoses, heart attack and stroke risk or alcohol-related harms.

Once awarded a contract, they'll go to work on a "pay for success" basis.

Sanghavi stressed that these are public-private partnerships. While ARPA-H will commit up to $15 million toward achieving certain health outcomes, they are giving preference to parts of the country that secure matching funds from entities such as large employers, insurers or philanthropies.

If the organization is seeking to reduce obstetric complications in its region and improves the rate of complications over time, ARPA-H and investors will pay them for that success.

"When the ARPA-H training wheels come off after several years, the program becomes sustainable over time," Sanghavi said.

What's next? A Proposer's Day is slated for Feb. 13-14 in Washington to learn about the program and share feedback before the final solicitation of proposals in the early spring.

WELCOME TO FUTURE PULSE

Quechee, Vt.

Quechee, Vt. | Shawn Zeller/POLITICO

This is where we explore the ideas and innovators shaping health care.

Hospitals are among the organizations using a customer service bot called Grace from the Los Angeles firm Gridspace. They can customize it to show different levels of empathy or emotion, CBS News reports.

Share any thoughts, news, tips and feedback with Carmen Paun at cpaun@politico.com, Daniel Payne at dpayne@politico.com, Ruth Reader at rreader@politico.com or Erin Schumaker at eschumaker@politico.com.

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DIAGNOSIS

Wal-Mart's sign hangs above one of its soon to be opened locations on September 21, 2006 in Chicago, Illinois.

Some Walmart shoppers can get their mammograms in-store. | Tim Boyle/Getty Images

Walmart is wading deeper into preventive care through a new AI-enhanced breast cancer screening pilot at a supercenter in Delaware.

Diagnostic imaging company RadNet already offers mammography at the store’s Milford location, not far from the state’s beach resorts.

How does it work? RadNet conducts a breast X-ray, and artificial intelligence reviews the image, looking for lumps that might be undetectable to the human eye.

RadNet then refers patients back to their primary care provider for follow-up.

RadNet, which operates independently of Walmart, sees an opportunity to make breast cancer screening more convenient, given the ubiquity of Walmart’s stores.

For Walmart, the partnership with RadNet is another example of its push into health care. The company started to move into primary care in 2019 and promises to have more than 75 health centers in its stores by the end of the year.

What’s next? The RadNet-Walmart partnership is slated to expand to stores in Hanford, California, in the state’s Central Valley, and Phoenix, where Walmart already operates six health centers.

CHECKUP

In this photo taken Oct. 29, 2010, Kristen Miller, a colonoscopy patient, views with Dr. Stephen Hanauer, gastroenterology chief at the University of Chicago Medical Center.

Gastroenterologists see promise in AI, but also the need to safeguard patient privacy. | Brian Kersey/AP

The millions of images generated by colonoscopies, laparoscopies and other endoscopic procedures are a prime use case for AI in health care.

AI that can quickly and accurately analyze an image for signs of disease could help patients get treatment faster.

But that possibility also poses new privacy dilemmas for doctors, given the lack of federal rules around many AI tools in development — and already in use — to take advantage of all that data.

In a new piece for the American Journal of Gastroenterology, researchers from Massachusetts General Hospital, Beth Israel Deaconess Medical Center and Penn State Dickinson Law, outline the regulatory gaps and suggest some best practices.

Health providers should:

— Update consent forms to better explain the data that will be collected, who can access it and its current and potential uses

— Require providers of software tools to agree to terms detailing what they might do with patient data

— Establish oversight mechanisms, such as by establishing data use and sharing review boards or appointing data protection officers

— Upgrade cybersecurity systems and protocols to protect patient data

Why it matters: The authors say private sector action is needed because neither Congress nor federal regulators are moving quickly enough and only a few states have set rules.

“Without a comprehensive federal privacy law (or alternatively, all 50 states passing new privacy laws), not everyone’s privacy in the United States will be properly protected,” they wrote.

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