1. 25,000: People living with Parkinson’s in Michigan out of the roughly 1 million nationally. BCBS of Michigan is teaming up with the Kirk Gibson Foundation to raise awareness and provide resources. In the meantime, there continues to research on Parkinson’s. A new study released this year says a new device may be helpful in slowing or reversing the progression of the disease. The experimental study investigated whether using a novel delivery system could regenerate dying dopamine brain cells in patients with Parkinson’s and even reverse their condition. It could be ‘the first neuro-restorative treatment for people living with Parkinson's,’ according to Steven Gill, who designed the infusion device used in the study. My good friend is dealing with Parkinson these days with her dad in and out of the hospital. The attention to treating Parkinson’s is likely to increase inside managed care in the next 10 years with the increase in the number of insurers partnering with behavioral health companies. ‘Just our access to neuro-specialists alone will be helpful in guiding us to provide a more substantive benefit for patients and families, and to do more to help in earlier diagnosis and management.’
2. College Play: Beacon Health, the behavioral company, has launched a national program specifically for college age students. The model will include virtual counseling designed to head off suicide risk and address depression, anxiety and a host of other mental health challenges that stem from being away from home for the first time. Though Beacon says theirs is the first in the nation, there are smaller start-up models that exist featuring licensed psychologists or coaches who help colleges address shortages and deal with the flow of students who show up to the campus clinic. I would assume that the goal here is also to meet the demands of mental health parity and the Affordable Care Act and, over time, it would not be surprising to see the bigger managed care companies looking at this service as another entrée into managing behavioral, and an in-road to the youth population.
3. Middle America Capitation Conundrum: Anthem paid out more than 11 million in performance bonus payments to 43 medical groups back in 2008, at an average annual payment of $300,000 per group. There were 91 total groups that participated in the risk sharing initiative back then. The program was done to entice medical groups to reduce ER, hospital IP, and outpatient surgery. Flash forward more than a decade later and these risk sharing models continue, though the plans have largely tried to move more groups into taking more risk, even ‘global risk’. But in our poll of physicians from 131 groups in 11 midwestern or central US states, just 19 said they are willing and able to enter global risk. ‘We just got an EMR’ said one practice director, another said we ‘have had an EMR but don’t know what to do with all the reports…I keep asking my manager to help me see my data…my patient’s activity.’ Others complain about acuity, one saying ‘we have too many patients with 2 or 3 chronic conditions….[so] it’s really hard to avoid the hospital….’ That said, there is growing demand from both CMS and payers to gently push more doctor groups into risk in middle America. One of the chief issues cited by 94 of the 131 is the lack of resources to address the mental health needs of patients – ‘I’m just not trained to talk to people about this….I know hypertension and cardiovascular….it’s very time consuming and I often try to refer or else these eat up my entire morning…but referring isn’t really effective since I have no idea if the patients end up going to the therapist.’
4. School Walkout: Unless you have kids in the primary or secondary school system, you may have missed the wave of teacher strikes or protests across the country recently designed to help raise the debate about teacher pay and the new challenges educators face. Schools in West Virginia, North Carolina, Kentucky are among the recent districts impacted and there’s a hidden theme across all the protests – teachers want more money, and more help, to prevent suicide. To be blunt, teachers across these districts and others who’ve orchestrated 1-day walkouts say their jobs have shifted dramatically in the last 10 years….our school seems more like a healthcare facility or a doctor’s office at times than a school, said Val Stills, a 7th grade math teacher in North Carolina, who says she would like more staffing resources like aides and therapists available to teachers, embedded in the classrooms, in much the same way that special ed teachers are used. Behavioral health companies, particularly those focused on autism, have already begun to offer school-based services. A bigger debate will emerge in the next 5 years about the best way to deploy these services for kids both on the spectrum but also those facing adolescent challenges and potential suicide risk, and how to pay for it.
5. Tech Behavior Change: So I was given a hard time by my colleague Ruth today because I asked if I call the Hotel app she suggested I use to book my hotel. ‘You don’t call apps!,’ she laughed. Technology, while seemingly helpful to save time, can’t break old habits . Innovations in technology was a key topic at Yale University’s annual healthcare event back in April. Trent Haywood, chief medical officer at BCBS, was on the panel and our correspondent Erin O’Donnell attended the session. Highlights here
6. Best Site of Care….Hospital: Counter to everything we talk about, there’s a little-known but growing trend of drug treatment shifting to certain hospitals in certain markets. 16 of 21 commercial insurers told us they are ‘being pursued’ by 340b hospital systems who are seeking to cut a deal to bring more volume to their hospital and affiliated providers in exchange for a lower reimbursement rate on Part B drugs. This is really only in more competitive markets and the arrangements give the payer a chance to close the network and shift volume to providers whose total cost of care is less than everyone else. Patients are pushed to use these lower-cost facilities for treatment through lower copayments or coinsurance. Said a pharmacy director: ‘It’s odd to think about but for as much as we are trying to shift care out of hospitals, when it comes to patients needing certain drug treatment, the 340b hospitals are a better deal on something like infusions particularly in cancer because so much of the total cost is tied up in the drug.’
7. 700: Measles cases topped this number nationwide and public health officials now worry that the disease is gaining significant foothold in the US, Kaiser Health News reported in their morning briefing this week. 13 individual outbreaks have occurred in 22 states in 2019 reports the CDC and New York officials have issued fines over people who are missing their measles shots. Officials in New York closed more schools to contain the measles outbreak and suburban Rockland County account for the majority of the cases.
8. Autism Meet GI: So many of you are following the growing autism treatment field or GI sector – well marry the two and you may solve a complex condition common in kids on the spectrum. Many children with autism have gastrointestinal issues. ‘The human gut and brain interact in complex ways, and abnormal conditions in the gut may predispose individuals to neurodevelopmental disorders,’ Arizona State University have found. 95% of children with autism have co-occurring conditions, almost 5 on average.
9. OON Change: Texas Blue removed 14 hospital emergency rooms after negotiations with the ER contractor fell through and the change took effect immediately in April. Many of ER’s are contracted by third-party companies, so many patients walking into the ER are often unaware of the additional costs. In the statement sent out to BCBS of Texas members, Texas Medicine Resources ER doctors who work at several Texas Health Resources hospitals will be out of network. This means the third-party company can charge members whatever they want for their services. The hospitals themselves, which include Texas Health Harris Methodist Hospital, Texas Health Presbyterian Hospital Dallas and Texas Health Arlington Memorial Hospital, will still be in the Blue Cross Blue Shield network, but their ERs will not.
10. Extra Point: 70% of 353 women age 35 to 52 we polled earlier this month about the health of their families told us they are getting Facebook ads from the likes of 23 and Me, AncestryDNA and Vitagene who are offering $29 to $99 intel to help women redesign their diets. My bride is interested in the service and says the local Orange Theory has ‘had discussions’ with these health genome services as part of a potential diet and exercise product. I told Janine that I’m all for it, and would be happy to do the swab myself, though I’m admittedly nervous 23andMe will tell me my SmartFood obsession is not good for me. These direct-to-patient services have implications for a few businesses: primary care, genetic testing services, women’s health providers, and oncology. Whether they will impact my health or my family’s….I’m skeptical, but like any good husband, I’ll be open to change.