Solving ‘wicked’ health problems is his job

By Ben Leonard and Erin Schumaker

States | Courtesy of Leith States

Leith States is the chief medical officer in HHS’ Office of the Assistant Secretary for Health, where he has a broad portfolio that includes telehealth, long Covid and InnovationX, the department’s self-described bid to solve “wicked problems.”

He joined the Department of Health and Human Services in 2018 from the Navy Medical Corps.

Ben caught up with States to discuss audio-only telehealth, the future of the Office of Long Covid Research and Practice, InnovationX and more.

This interview has been edited for length and clarity. 

Congress has extended telehealth coverage in Medicare, and lawmakers are looking to make it permanent. But they are skeptical about covering audio-only visits. What do you think?

Telehealth is a really helpful disrupter. It’s going to fundamentally change the way care delivery is provided. But it’s not a sledgehammer. It has a targeted space.

There are a variety of indications where you may have true value with video — the ability to pick up body language and informal cues. The issue with trying to push through audio-only is that, in certain instances, you could do more harm than good if you are using that checkpoint on equal footing with an in-person or video teleconference.

If you have someone with a history of substance use, serious mental illness or suicidality, these are some things you might pick up on as a clinician by seeing the person in person or on video.

What are InnovationX’s biggest challenges? 

The unfortunate part for InnovationX is that while we have a density of innovators, technologists and data scientists, the funding can be a mismatch with our charge: looking for ways to complement ongoing or nascent efforts across the department.

PandemicX was part of InnovationX that aimed to tackle issues tied to Covid. Any lessons learned? Will there be something similar in the future?

That’s the issue with unfunded mandates. A lot of times, they are based in really great ideas, but we haven’t gotten to the point where there’s been the capacity to even capitalize on or share anything that’s come from those experiences.

We’re hoping we can come back to it.

HHS hasn’t yet stood up the Office of Long Covid Research and Practice it announced last year, prompting questions from Democrats in Congress. What’s next?

We are in the process of not just the formal standup, but also the meaningful and pragmatic operationalization.

We’re building out the personnel, staffing and capacity to have some identifiable workstreams.

We’re ready, hopefully, to have a director named in the near future. Before the end of the fiscal year, we fully anticipate a true announcement that it’s launched.

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Today on our Pulse Check podcast, host Katherine Ellen Foley interviews Erin about President Biden’s choice to lead the Centers for Disease Control and Prevention, Mandy Cohen, and the challenges she faces as a result of the agency's politicization during the Covid-19 pandemic.

When you adopt rules to encourage telehealth, you get more of it, a study has found. | AP

The number of providers offering telehealth for mental health care increased in states that adopted pandemic policies to expand access to the service.

A new JAMA Network Open study by researchers from Harvard and the Rand Corporation looked at data from nearly 13,000 medical facilities and found that the number of sites offering telehealth for mental health went from 39.4 percent in the second quarter of 2019 to 88.1 percent in the third quarter of 2022.

State policies were a driver:

— Facilities in states that allowed Medicaid and the Children’s Health Insurance Program to pay for audio-only care were 73 percent more likely to offer telehealth than states that didn’t.

— State participation in either of two agreements allowing access to care across state lines were the next biggest drivers of expanded telehealth services at 40 and 21 percent, the researchers found. That was followed by state-mandated insurance payment parity between telehealth and in-person care.

The authors had expected payment parity to make a more significant impact in expanding availability than it did.

“Historically, enforcement of parity laws has been weak, and mental health treatment facilities may have been skeptical about the extent to which private insurers would be forthcoming with telehealth reimbursement,” they wrote.

Why it matters: States’ Covid emergencies that authorized the eased regulations have expired.  

The system of state licensure allowing care across state lines has reverted to a patchwork since the end of the pandemic emergency and has confused patients and providers alike.

There’s no consensus on a solution, though.

Some telehealth lobbying groups have pushed for reciprocity, meaning a license in one state works in another.

Others, including the Federation of State Medical Boards and the American Medical Association, have pushed back, arguing that reciprocity could compromise state boards’ ability to oversee providers and ensure patient safety.

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Info blocking is become less of a problem, HHS says. | AFP via Getty Images

Patient data flows more freely six years after Congress enacted legislation ordering providers to share their data upon a patient’s request.

An American Hospital Association survey that the HHS Office of the National Coordinator for Health IT analyzed found substantially fewer hospitals reported that providers weren’t sharing patient data, down from 36 percent in 2021 to 12 percent in 2022.

The health IT office suspects that’s partly because of the information-blocking rules barring providers from hoarding patient data that it promulgated in October, the agency said.

It also speculated that hospital leadership is becoming increasingly knowledgeable about information blocking and helping to combat it.

The same can’t be said for electronic health records developers — 22 percent of hospitals said the developers weren’t sharing in 2022, up from 17 percent in 2021.

Why it matters: Congress mandated regulations to promote data-sharing and prevent information-blocking in a 2016 law, the 21st Century Cures Act.

Its purpose was to encourage competition among providers by allowing patients to bring their records with them and reduce the chance of medical errors.

The Health and Human Services Department and its health IT office have argued that patients are better served when they have easy and quick access to their records. But doctors have suggested that, in some cases, allowing them to first review tests and then explain the results could spare patients anxiety.

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