1. 1.7 Million: Number of children under the age of 18 with major depressive episodes who did not receive treatment, according to the Suicide Prevention Resource Center. That’s enough to fill every major league baseball stadium on the east coast twice. There is a shortage of providers as well. In Alabama, there’s only one mental health professional per 1,260 people. To meet the need for mental health care, providers in the lowest ranked states would have to treat six times as many people than providers in the highest ranked states
2. MCO Monthly Rate For Rx: Tennessee’s Medicaid program launches a two-year pilot program permitting qualified pharmacists to provide medication therapy management to patients managed under the program’s patient-centered medical home and to enrollees of Tennessee’s Health Link program, which helps those with a lot of behavioral health needs. MCOs here will pay a monthly fee to the pharmacists based on the patient’s risk stratification. The pilot will incorporate a set of defined performance measures.
3. Paying For Adherence: It’s now a thing. You don’t pay a premium, the MCO pays you. Examples are cutting across all types of insured. Boston Medical Center researchers used a patient navigator to help people from low socioeconomic areas get nicotine replacement therapies and, get this, pay them up to $250 for quitting. Smokers who received the incentives and personalized support were the most successful in quitting. Others in managed are contemplating similar tactics to change behavior, like paying people needing infusions in Texas to stop using the hospital or physician office and instead use home services, or a California plan paying people to get colonoscopy if they go to a new single-price center that offers the health plan a deal on the screening ‘at half the cost of the market’
4. Unexpected Diabetes Hurdle: Two physicians weigh in on our story about a diabetic patient struggling with the limitations of her diabetic supplies, insurance coverage and overall challenges of managing diabetes. Read more here
5. Pending: In June, BCBS of TX will request medical records, patient symptoms, and an itemized bill from hospitals to determine inappropriate charges. Claims won’t be denied outright; they will be pending.
6. Working Dogs or Cancer Game Changer? As part of the Center for Public Health Initiatives’ (CPHI) innovation-themed seminar series, working dogs were used in research to detect early stage ovarian cancer at Pennsylvania State and Monell Chemical Senses Center. The dogs are able to detect malignant ovarian cancer using plasma samples from patients. The hope from this research is that it will translate into a device that can be used in clinics, including in creating an electronic nose comprised of nanosensors that mimic the ability of the dog’s nose. The five-year survival rate of stage-IV ovarian cancer is only 17%, but if it can be detected in its earliest stages, survival jumps to over 90%.
7. Teaching Autism: UnitedHealthcare and OptumHealth Education are starting an accredited medical education series on autism spectrum disorder; the six-part webinar series, which began this month, offers free continuing medical education credits.
8. Antipsych Delay: We heard Harold Brandt, MD, at Louisiana’s P&T committee meeting passionately argue in favor of adding the generic antipsychotic aripiprazole to the state’s Medicaid preferred drug list recently, although there was concern that the MCOs here have been taking too long to approve these medications, up to 2 days, whereas the rules are for a one-day turnaround. ‘I’ve seen people who are suicidal and then non-suicidal 4 days later just because of this drug,’ Brandt said. Senator Mills questioned how many PAs are actually denied and the committee suggested that ‘it’s a small number’. The University of Louisiana handles the state’s fee for service prior authorizations usually in less than 24 hours, according to Melwyn Wendth, RpH. In the end, the Committee agreed to add the drug.
9. Inpatient Cost Increase: Cigna has increased the cost share for inpatient hospital stays from $260 to $295 per day for the first week, according to an annual notice from the payer. There was no change in the zero-dollar cost share for days 8-90 although emergency care copayment costs went from $75 to $80 for Medicare-covered visits.
10. Outsourcing Wire: Blue Minnesota now uses SecureCare to handle all the contracting and credentialing for chirorpractors and uses United Concordia for dental and oral surgery contracting and credentialing.
11. Extra Point: My fourth-grade teacher Miss Rosebrooks once said that life doesn’t come with a manual, it comes with a mother. Well an academic center in the Northeast had an idea and searched medical records with the word ‘Mother’ in them, and wouldn’t you know it, found patient/physician readmit rates were lower for these patients due to ‘caregiver involvement’. The analysis, done at Yale, was used to educate physicians and support discharge planners and goes to show you that data analytics can work and that mom maybe deserves TLC and P4P. See here for a snapshot of the data: click here