Note: We will reporting live from the Payer’s Behavioral Health Summit in DC Oct 16-17; the first Managed Care Friday Forum series will be held at the end of this month; guests and topics to be announced.
1. 1 in 5: That’s the number of women who suffer from post-partum depression in some states according to CDC research. New studies show that most post-partum depression symptoms actually occur during pregnancy. 1 in 4 men can also experience post-partum. Read more from an interview with a Connecticut delivery nurse by clicking here.
2. MA Drug Step Down: United’s step therapy program for its Medicare Advantage enrollees kicks off in January. The pre-approval strategy will take United around 2 weeks to approve a drug that’s not preferred. There must be evidence patients have tried and failed preferred drugs. When patients use the preferred, lower cost drug, United says it will share the savings with them as part of their participation in the plan’s care coordination program. 8 acid polymers, 1 immunomodulator (Remicade) and a pair of ESAs (Aranesp and Procrit used for cancer) are among the Part B drugs that will be subject to these guidelines as non-preferred agents.
3. PT Continues To Ride Wave: Starting today, the Newman’s of the world get physical therapy without pre-approval under a new coverage policy from the health plan for federal and postal employees and retirees. The plan, called MHBP, is supported by Aetna’s national network and impacts members enrolled in the Mail Handlers Benefit Plan, the Foreign Service Benefit Plan, or the Rural Carrier Benefit Plan. Pre-certification is not required for cardiac catheterization, cardiac imaging, chiropractic services, transthoracic echocardiogram and physical and occupational therapy.
4. Out of Site: Starting in January, United joins Anthem in doing site of service reviews for outpatient imaging, the goal being to pre-approve and if necessary will decide where the imaging should take place. To promote its favorite facilities, not just in imaging but other so-called premium physicians, the MCO started this month designating preferred providers in its directors; if not listed, physician groups have a process to appeal the payer’s commercial decision.
5. A New Curriculum: In our poll last year of teachers, 411 of 633 said they dislike what’s known nationally as the ‘common core’ but they would welcome more standardization and support to help address the behavioral health of the kids in their classrooms. New York became the first state to launch mandatory mental health classes in all schools from kindergarten to 12th grade. The nine key points that are being taught include: identifying signs of mental health issues, negative stigma that surround mental illness and resources for help. This is a new state law that took effect on July 1st.
6. AstroGames: NASA has released a virtual reality game called “Mentalblock” to predict astronaut behavioral health on future missions into space.
7. Cosmetic See-Saw: Kaiser Permanente released their payment policies for cosmetic procedures to include chin implants, dermabrasion and septoplasty. Kaiser will consider coverage of these on a case-by-case basis.
8. Survey Says: Richard Dawson will not be coming to your office but an email from Medica Behavioral Health will be later this month in hopes of parsing through unmet needs and issues facing primary care and specialty practices. Medica will ask for feedback on patient access to care, care coordination, referrals to specialists and availability of clinic appointments. PCPs, cardiologists, OBGyns, oncologists, neurologists and behavioral health care practitioners will be sent the survey electronically in late October.
9. Extra Point: My dad is retired now but in recent years was a PT in a University clinic in Hartford working about 12 hours a week mostly with athletes. A college athletic trainer and coach for 35 years, dad told me about this one kid who was having pain around her knee, what he described as patellofemoral pain. But after 2 months, she wasn’t progressing much at all and dad was frustrated. He expressed this to the 19-year-old and asked how she was feeling, what she wanted to do, given that the lack of progress was keeping her from the soccer field. She opens up, telling him she has an eating disorder and anxiety. The condition, dad said, was in total control – it was as though she couldn’t deal with her pain or that her pain wasn’t really pain at all. “It was preventing her from getting better … and I couldn’t do anything for her, didn’t even know how to help her deal with that’ And here I was thinking dad always had the answers. It would seem that doctors, let alone coaches, PTs and educators, no doubt struggle with identifying these sorts of conditions. Finding a better way to assess, treat and transition those facing these mental health hurdles seems to be exactly the point of value based care.