Disease Management and the Application of Privacy Guidelines

Today, privacy is a concern for many individuals. The United States has followed the path of other countries in strengthening the legislation to protect privacy. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was enacted to provide improved portability of health benefits and greater accountability in the area of healthcare fraud. The legislation is divided into five titles with title II addressing the prevention of healthcare fraud and abuse, and the promotion of administrative simplification and privacy. The far-reaching impact of the legislation will affect hospitals, payors and physicians’ practices in every area of healthcare. HIPAA specifically governs (and identifies) all healthcare providers and payors, and clearinghouses maintain individually identifiable patient information. This legislation was in response to requested improvements including greater privacy of health information. The legislation defined some parameters but many areas remained undefined. Through the lack of definition, disease management entities were tasked with making assumptions as to the interpretation of the legislation. One of the areas that was difficult to determine was disease management. To provide more specificity, the Disease Management Association of America (DMAA) had repeatedly met with the Department of Health and Human Services to understand the intent and purpose behind the legislation.At the time of this article, the Department of Health and Human Services are collecting comments on the legislation and have already provided some updated information. The DMAA provided input to the Department of Health and Human Services regarding the application of HIPAA to disease management. The article addresses the new legislation and addresses how a disease management organization can apply the new legislation to its operation.