Dive Brief:

• Period tracking app Flo has rolled out an anonymous mode to protect users’ sensitive reproductive health data months after the U.S. Supreme Court overturned Roe v. Wade.
• The company, which has dominant market share with 48 million monthly users and has faced regulatory scrutiny over privacy in the past, pledged to release the mode shortly after the court’s decision.
• The new anonymous mode gives users the option to use the app without their name, email address or technical identifiers associated with their health data.

Dive Insight:

The Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization overturned decades of precedent and threw the nation’s healthcare system into chaos. The ruling gave rise to a patchwork system of reproductive health access in the U.S., and concerns among pro-abortion activists and privacy advocates that states could use data from period tracking and other reproductive health apps against patients seeking abortion services.

In the wake of the decision, a number of popular women’s health apps pledged to enhance their privacy and security protocols, including Flo. The U.K.-based women’s health app launched its anonymous mode Wednesday for all iOS users. The company said Android users will get access next month.

To secure patients’ data, Flo partnered with security firm Cloudflare to integrate a system ensuring no single party that processes user data for anonymous mode accounts has complete information on who the user is or what they’re trying to access. That’s on top of steps Flo has already taken, including encrypting all data and passcode protection to lower risk of unauthorized app access, the company said.

“Women’s health information shouldn’t be a liability,” Cath Everett, VP of product and content at Flo, said in a statement. “Now, more than ever, women deserve to access, track, and gain insight into their personal health information without fearing government prosecution.”

The company doesn’t have a spotless track record when it comes to keeping user data in-house. Last year, the Federal Trade Commission finalized a settlement with Flo requiring it to obtain user consent before sharing their personal health information, after finding Flo shared sensitive health data from millions of users with marketing and analytics firms including Google and Facebook.

Flo is offering anonymous mode as an option and not as a default because there are some downsides to the setting. Once anonymous mode is activated, users won’t be able to recover their data if their device is lost or stolen, and it may limit personalization benefits, the company said.

Democrats in Washington have been taking a harsher line on data privacy in a post-Roe world.

In July, the House Oversight Committee began investigating how the business practices of reproductive health apps and data brokers could potentially weaponize consumers’ private information, and the FTC pledged to crack down on medical and location data sharing, following an executive order from President Joe Biden.

One month later, the agency sued Idaho-based data broker Kochava for selling geolocation data that could be used to track consumers’ locations, including to and from sensitive areas like reproductive health clinics.

But advocates say the administration could be doing more. On Tuesday, dozens of Democrat senators asked the HHS to safeguard women’s privacy through the Health Information Portability and Accountability Act, by restricting providers from sharing patients’ reproductive health information without their explicit consent. However, it’s unclear how much the administration could lean on HIPAA to protect abortion data without congressional action.

Name: Warner Thomas

Previous title: Chief executive officer and president, Ochsner Health

New title: Chief executive officer and president, Sutter Health

Effective Dec. 1, Thomas will take the helm of Sacramento, California-based Sutter Health, becoming the system’s first external CEO in more than 40 years, according to a press release.

Thomas joins Sutter from Louisiana-based Ochsner Health, where he led the system’s 40 hospitals and more than 300 urgent care and health centers for a decade.

He was Ochsner’s first non-physician CEO and was responsible for launching the system’s think tank and health incubator, InnovationOchsner, which focuses on analytics and digital health.

Thomas’ appointment comes as non-profits across the country report poor financial performance as labor costs rise and patient volumes remain depressed. Sutter Health posted a $457 million net loss in its second quarter this year compared to a $636 million net gain a year ago. Last month, Fitch Ratings downgraded its non-profit financial outlook to “deteriorating.”

Prior to his role at Ochsner, Thomas was president of Foundation Medical Partners.

He will succeed James Conforti, Sutter Health’s chief operating officer, who has served as the system’s interim CEO since January.

Advocate Aurora and Atrium Health’s merger plans hit a road block on Tuesday, threatening to delay the creation of a $27 billion health system, which would make it one of the nation’s largest nonprofit systems.

Illinois state health regulators will reconsider Advocate-Atrium’s application after initially voting against the application that sought a change in ownership, a step in the regulatory process needed to complete the deal.

Members of the Illinois Health Facilities and Services Review Board voted 3-2 against the application on Tuesday in suburban Chicago. One member abstained.

However, later in the meeting, the board allowed a motion to reconsider, deferring the application to be considered at a later date.

“They felt like they didn’t have what they needed to make an informed decision,” John Kniery, administrator for the board told Healthcare Dive after Tuesday’s meeting.

Advocate Aurora Health said it was surprised by the decision to delay.

State law requires the board to approve exemption applications that are deemed complete, Advocate said in a statement. “Our application was deemed complete last month, thus, we were surprised by today’s delay and will work with the Review Board to address their questions.”

In the state of Illinois, certain healthcare projects require a permit or exemption to proceed, according to the Illinois Health Facilities and Services Review Board.

Advocate and Atrium were seeking an exemption, which is required for closures, a discontinuation of services or a change in ownership.

The Advocate-Atrium deal required the parties to obtain an exemption because the deal constitutes a change in control, Kniery told Healthcare Dive. The staff report on the deal explains that it is “considered a change of 50% or more of the voting members” of the board.  

The board change triggered the need for the exemption application.

Advocate has said that the deal with Atrium will not result in “any change of ownership as assets will remain within each respective organization and state.”

Kniery maintained it “clearly was a change of control being proposed.” This is causing the confusion for board members, Kniery said, who added that neither the board nor staff have seen the agreement between Advocate and Atrium.

“First, it has been clear that there will be no change in assets. However, yes, it is fair to say some of the questions the board is seeking is around the change in control … what does control look like,” Kniery said.

Advocate and Atrium are proposing to create a new corporate entity, Advocate Health Inc.

The two systems will then delegate “certain operational functions” to the new entity through a joint operating agreement. The new entity will not be considered a parent company and ownership of existing facilities will remain with the current corporate entities, according to the staff report. The staff reports notes that the board has not received a copy of the joint operating agreement.

The new entity, Advocate Health Inc. will have 20 board members, with 10 designated by each system.

The transaction is expected to be complete by Sept. 30, according to the staff report. However, it’s unclear when the board will reconsider the application.

“Obviously, we don’t want to hold it up any more than it has to be,” Kniery said.

In Illinois, Advocate Aurora owns and operates 10 healthcare facilities, nine hospitals and one ambulatory surgery center.

The American Medical Association has joined plaintiffs in a class-action lawsuit against Cigna, alleging that the payer engaged in misconduct by underpaying provider claims in its MultiPlan network.

Other medical groups, including the Medical Society of New Jersey and Washington State Medical Association, have also joined the plaintiffs.

The lawsuit, which was filed in a Connecticut District Court, claims that Cigna reimbursed MultiPlan providers at its non-participating provider rate, rather than the participating provider rate, leaving clients “exposed to the threat of balance billing” and ultimately underpaying claims.

Balance billing is when providers bill patients for the cash difference between original charges billed and discounted rates, something that MultiPlan providers are prohibited from doing in their contracts with the network, according to the suit.

The No Surprises Act, which went into effect in January, outlaws balanced billing and is meant to protect patients from receiving out-of-network bills from care they received at in-network facilities. However, one in five Americans reported receiving surprise bills this year, despite the NSA going into effect.

Cigna is a client of MultiPlan, the country’s largest “third-party network” company, which allows Cigna to contract with MultiPlan providers. MultiPlan has contracts with over 1.2 million providers, according to the suit.

Cigna “breached its fiduciary duties, including its duty to honor written plan terms and its duty of loyalty, because its conduct serves Cigna’s own economic self-interest and elevates Cigna’s interests above the interests of plan member patients,” according to the lawsuit, filed on June 10.

Jack Resneck, president of the AMA, said that the insurer has allowed its “economic self-interest to be prioritized ahead of their promises to physicians in the Multiplan Network and their patients.”

“Patients and physicians have a right to expect health insurers to uphold their promise to provide fair and accurate payment for medical services,” Resneck said in a statement. “By joining Stewart v. Cigna as a plaintiff, the AMA hopes to shed light on Cigna’s misconduct and create remedies so that patients and physicians can look forward to getting what they are promised.”

Cigna did not respond to a request for comment.

Dive Brief:

• Oregon will launch the country’s first Medicaid-supported mobile crisis intervention program providing stabilization services to people with mental health or substance use conditions, including opioid use, the HHS announced. The program offers immediate assessment, stabilization and de-escalation help for people in crisis, and coordinates referrals for other social services like life skills training.
• Immediate, appropriate behavioral health care can help reduce the risk of harm and the need for costly inpatient services, the HHS said. The initiative also allows law enforcement to focus more on accountable policing and less on work that should be handled by mental health counselors or social workers, the agency said.
• Oregon was the first state to apply and gain approval for the new Medicaid option, created through the Biden administration’s American Rescue Plan. HHS Secretary Xavier Becerra, in a statement announcing the approval, encouraged additional states to take advantage of the opportunity for funding to expand access to crisis care.

Dive Insight:

The mobile intervention program is part of President Joe Biden’s strategy for addressing the country’s mental health crisis, a steadily worsening problem that has become more acute during the COVID-19 pandemic. Biden laid out plans to strengthen the national crisis response infrastructure earlier this year as part of his State of the Union agenda.

That strategy includes the transition in July to the 988 crisis hotline, which replaced the 10-digit National Suicide Prevention Lifeline. Community-based mobile crisis intervention services such as Oregon’s are expected to support the 988 network of state and local call centers, the HHS said.

The American Rescue Plan, which became law last year, included $15 million in planning grants to help 20 state Medicaid agencies develop crisis care programs.

Oregon is the first of the 20 states that received planning grants to qualify for a higher federal Medicaid match of 85% for the next three years to reimburse mobile crisis services delivered to Medicaid beneficiaries.

People throughout the state experiencing a mental health or substance use crisis can connect to a behavioral health specialist 24 hours a day, every day of the year, the HHS said.

“Prioritizing behavioral health treatment by putting crisis care in reach for more Americans is critical — in Oregon and beyond,” Becerra said.

The Biden administration has spent $432 million in fiscal 2022 to support the 988 transition, scale up crisis center and national back-up center capacity, improve response rates, and ensure that calls are first routed to local, regional or state crisis call centers, the HHS said.