1. 64: Percent of high school seniors in our poll earlier this month who say they are interested in medical school or healthcare jobs, but when ‘breaking out the results’ by gender, the numbers change a lot—girls (73%) and boys (49%).
2. Stroke of Genius: A new remote monitoring program has reduced bad ‘LDL’ cholesterol by 40% in less than 12 weeks, and cut blood pressure values in half according to results we found from Always Health Partners, formally known as Neighborhood Health Plan of Massachusetts. The plan’s remote medical management program is focused on reducing the risk of heart attacks and stroke. The program became available recently for all of the plan’s commercial members.
3. Breaking Ankles: 57 percent of network contracting directors from 132 in our poll Monday who said they are going to create ‘tiers’ eventually of surgeons by specialty, and specify a top tier of providers who have the best outcomes for highly common, but often unsuccessful ankle surgeries. ‘Part of the issue is that the follow-up care isn’t good—some of the surgeons are better than others, and some do a much better job in getting the patient to the right PT and trainer, some just let the patient decide… we looked at claims for those who had an ankle surgery in 2017 and needed to have another one last year and nearly all of them, something like 90%, were with the surgeons who I’d say aren’t part of an integrated team. The best outcomes were from those who are with the University programs that have more of a musculoskeletal interdisciplinary team in place.’ The cost comparison, one network director said, was in the $16,000 to $20,000 range—meaning the top tier surgical groups cost that much less.
4. Autism Test Ruled Unnecessary: There’s not a day that goes by where one of my teenagers doesn’t complain about all the overtesting in school. ‘Dad, we had like 3 quizzes today on English and Math and Social Studies…. it was all stupid.’ I asked Sophie why the tests were stupid, and she said ‘they just are.’ Insurers are putting more evidence into their testing decisions, specifically whether to cover lab tests and genetic tests to the point where one insurer, Regence BCBS, puts out new coverage criteria weekly, and another, Aetna, said they have an internal group evaluating the cost and outcomes of testing by endocrinologists and primary care physicians. Behavioral health and autism are emerging sectors of attention. In one example, testing for metabolic markets in the blood, urine, tissue, and other biologic material is not medically necessary for Autism disorder screening and assessment under a revised Anthem of Georgia policy just released. One thing to keep in mind with all these decisions is how coverage criteria and testing decisions change over time as more insurers push physicians into risk-based payment models.
5. TeleHealth Impact: An urgent care provider in Texas told me its volume is down 48% in the last two years due to a range of factors—more competition, for one, but also an emerging trend in younger populations relying on hotlines, and payers ‘intervening’ to direct care or provide ‘over the phone treatment.’ United Healthcare now uses ‘virtual visits’ whenever a patient needs care 24 hours a day 7 days a week for treating colds and fevers to caring for migraines and allergies, a service that continues to increase in popularity among employers. Payment for telehealth continues to inch closer if not get paid at the same level as in-office visits, according to 64% of insurers we polled, who say ‘shortages’ in many of their markets are the reason. For providers like pediatricians, urgent care, or PCPs, these developments are creating volume challenges. In fact, 71% of pediatricians polled this week said they are looking to change their business model in the next 2 to 3 years, or ‘probably retire’ given the ‘headaches’ of ‘losing so much’ volume to both urgent care and now telehealth. This service is available on your mobile phone, tablets, and computers. Video chats with doctors are 20 minutes or less, and patients can receive prescriptions if needed in certain states. United claims this saves $1,500 in comparison to going to the ER. Two apps used often include “Dr. On Demand” and “Amwell”, which United recommends for pink eye, migraines, allergies, sinus problems, or a quick assessment of severity. They do not recommend using these apps for chronic conditions, anything that needs a test or hands-on exam, or broken bones and sprains.
6. Nashville: On Monday, we will be reporting live from the National Council on Behavioral Health and covering a number of panels, including one on payer outlook. Details next week.
7. Extra Point: Bryant University, a small school in Rhode Island with its roots in finance and business education, now has the nation’s 17th-ranked physician assistant program and is looking to expand its healthcare footprint, considering a physical therapy program ‘to attract young students who love being around sports’ and further broaden its business curriculum to include anatomy and other healthcare classes. I went to Bryant in the early 90s when it was a college known for two things: the Patriots pre-season practice facility and the school where Coach from Cheers went. We were 2,500 strong at the time, and 99% of students were accounting or finance majors without a lick of writing skills, much less healthcare acumen. I made money for weekend pizza my junior year by writing 50 some cover letters for seniors—back then, the Bryant students applied to Big 6 accounting, but they didn’t know how to stand out to Arthur Anderson. Today, they are pursuing CFO-type roles for startup healthcare businesses, or revenue cycle posts within health systems. Last night, it felt a bit like déjà vu as I was the only ‘communications’ major on the panel. There was a CFO for RallyBio, a genomics company, and a managed care executive who handles ‘contracting’ for a hospital system, and used to do managed Medicaid work in Wyoming and Connecticut (before it changed course), so you can imagine how we were getting a bit too excited talking about value-based payment and how colleges like Bryant are at an important crossroads: they need to prepare students for a new kind of healthcare. As my oldest kids get ready to choose a college, I look at their interests—jazz, the stage, and journalism—and I love it, don’t get me wrong, but suspect they could benefit from a little more business. I know I did.