Viewpoint: 3 ways to retool Medicare coverage, reimbursement for the digital revolution

As society pushes toward the first stages of the “fourth industrial revolution,” there is an increased opportunity for technology to modernize the U.S. healthcare system, according to two national healthcare policy experts.

In an Oct. 23 viewpoint article for Health Affairs, Robert Horne, president of Forest Hill Consulting, and Lucia Savage, chief privacy and regulatory officer at Omada Health, explained the potential transformation opportunities for healthcare in the fourth industrial revolution, or the “fusion of technologies that is blurring the lines between physical, digital and biological sphere.”

To capitalize on these opportunities from digital acceleration, “policy makers should modernize the statutory and regulatory rules that govern how products and services are made available to Medicare beneficiaries,” Mr. Horne and Ms. Savage wrote.

Here are three principles policy makers should consider if interested in advancing legislative or regulatory reforms to modernize Medicare as part of the new digital revolution, according to the co-authors.

1. Create coverage and reimbursement policies around individual functions of digital technologies along with updates that better facilitate direct financial relationships with digital health suppliers. This has the potential to increase coverage options and consumer choice for digital health services.

2. Adopt a functional and integrated approach to digital technologies that allows for programs to consider digital coverage and reimbursement across various silos of care. This strategy would help better identify how digital coverage may generate benefits across the entire program as well as improve data integration at the point of care to strengthen care management for providers, patients and caregivers.

3. Reconstruct CMS coverage and payment capabilities to create financial relationships directly with manufacturers and transition digital coverage down into various payment systems. This new coverage division would ideally be able to collaborate with Medicare private plans to improve the program’s testing capabilities.

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