1. 49: Percent of 316 high school and college students we polled this month who say they ‘know someone’ with an eating disorder, ‘or think they do,’ but just 20% say they’ve told anyone about it. ‘It’s hard to talk about it. I’ve told a counselor,’ said one 11th grader, but others say they ‘aren’t sure exactly.’ One female polled said part of the issue is the classes and culture focus ‘so much on watching what we eat … and a lot of us don’t really know how to do that…and sometimes the issue ‘escalates.’ A freshman at a college in Texas says ‘it’s hard for a lot of kids who have had to deal with allergies and even been in the hospital for that so they’re already cautious,’ so add the stigma around weight, ‘and I know a number of kids who are anorexic, definitely bulimic too.’ Patrick Sweetland, a health teacher in my town, says they’ve struggled to manage kids who have been hospitalized due to a food allergy incident, who then ‘come back to school afraid to put anything in their mouth.’ One student, an eighth grader, was hospitalized in 2018 and eventually spent 3 months at a treatment center in Maryland ‘because there weren’t any options in our state,’ then came back to school with a better understanding that she needed to eat but ‘walked right back into a culture where kids are tough on you if you are fat’.
2. Payer Owes My Wife $7,200, Per Kid: United Healthcare is following the lead of other insurers we’ve noted here in fixing the payment rate for maternity services and likely opening the door for shared savings models for OGBYNs. My wife asked me if we will get a refund for ‘all the work she had to do to have our kids…estimating that our insurer during the time we had kids probably owes us around $7,200 ‘for avoiding c-sections and for dealing with the pain at home without going to the ER’. United’s change, announced yesterday, means OBGYNs will be paid per episode and incented to help the insurer limit c-sections and reduce pre-term ER trips. Rollout will be slow – two groups, Lifeline Medical Associates in New Jersey and Privia in Texas, are in the initial pilot, with their patients given a smart-phone app to communicate with the clinical team, ‘rather than just go to the hospital,’ with plans to roll out the initiative to 20 groups by next year. GE, a self-insured plan, Horizon Blue, Cigna and several Medicaid insurers have adopted similar approaches. The holy grail is addressing pre-term depression risk and stress that can lead to early labor and complications, as well as post-partum costs. The question for women’s health groups and multi-specialty practices with an OBGYN service line, is not whether the ‘bundle’ is better than the fee for service but when these payers will ‘require this approach’ for groups to be in the network. Being in these pilots early on brings more savings likely ‘given we’re more willing to share in the savings during the test phase’
3. Bundle Is Hip: 7 health systems and 64 surgeons have been participating in a bundled payment pilot that sets the goal for total cost of a total hip or knee replacement at about 10-12% lower than the typical level for ‘non-complex’ surgeries. The 90-day bundle will include costs for the surgery and rehab – if providers, on average, come in at the lower level they may be eligible for a share of the savings. Steve Anderson, who helps lead Blue Michigan’s contracting and networks, says fully insured employers with both the HMO and PPO networks have been eligible. Results due out soon.
4. Social Up, But Assessment Gaps Likely: Having spent the last 10 years working with refugee families and principally teen girls who are trying to play head of household and navigate home and health decisions for themselves, their parents and siblings, I’ve gotten to gain a moderately high level of understanding about how to talk to teens and sometimes their parents about healthcare. Trying to assess the root cause of a headache or back pain can’t be assessed in a checklist. The conversation, designed to help determine the reason for the pain and how to treat is, is more art than science. We try to help the volunteers who are assigned to each of these teens in the program with how to assess and then triage. 71% of payers see value in addressing social determinants, according to our survey, but there are gaps in implementing this mission: just 2 in 10 payers in a Change Healthcare poll they are training physicians on how to identify social determinants and 3 in 10 are offering a social assessment along with their health risk assessments. Assume that these tactics will increase in use but there’s are potential flaws in a lot of the assessment tools as they are often cookie-cutter. ‘I can barely get patients to talk about their mental health much less what’s happening at home, and the checklists are nice but not sure they are accurate,’ says pediatrician Kay Fiorella who says ‘her whole day is shot if she sees a patient with a mental health or social related issue come in’. The assessments, she argues, are checklists that don’t help much. Doctors, nurses and social workers ideally need to engage differently in these conversations – ‘I would argue we’d better to do these over a web telehealth type system where you get better eye contact’
5. Mississippi Burning: Several hospital ERs are ticked over a change in payment policy. Payment for ER visits is now going to be downcoded based on the diagnosis severity under a new, albeit controversial policy from BCBS of Mississippi that is in effect this spring. One source said about 25-35% of their level 4 visits were changed to level 2 or level 1 this year, ‘where we were basically paid what they called a triage fee’.
6. Pre Authorization Removed: Amerigroup, an Anthem Company, no longer requires pre-approval for behavioral health medication training and support, behavioral health skills training and development, targeted case management for behavioral health, crisis intervention, psychosocial rehabilitation, day treatment, and training and education services related to mental health problems. The company says this change will impact STAR, CHIP, STAR+PLUS and STAR Kids. A spokesman says federal and state law, as well as state contract language and CMS guidelines take precedence over prior authorization rules and must be considered first when determining coverage.
7. HIV and Addiction Program: New York State’s Department of Health AIDS Institute is partnering with Erie County Medical Center to host a hepatitis C preceptorship program targeting substance use providers and addiction specialists. The goal is to increase capacity in substance use treatment programs to provide on-site hep C treatment to those most likely living with the disease, says. Anthony Martinez, an addiction and HIV specialist leading the program.
8. Shatter This: Wendy Sherry, a Cigna Board Member, says the insurer hit its 3-year goal of reducing the opioid prescribing rate by 25% but says ‘we’re not seeing the same level of drop-off in the overdose rate.’ Cigna is one of many insurers – 19 of them – partnering with Shatterproof to address stigma issues and help create centers of excellence. Pilots are underway in New York, Massachusetts and Louisiana to deploy principles of quality care for addiction treatment. If you’re not ‘among the centers on the Shatterproof portal,’ be warned, acknowledged Jasmine Bass, a spokesperson we chatted with at the National Council on Behavioral Health meeting. There will be recommended providers and insurers will incent members (e.g., no copays, education) to use these programs. Full story next week.
9. Extra Point: So only in my town would parents get in an uproar over high schoolers speeding in cars around cul de sacs, hiding in bushes and chasing each other with water pistols in a seemingly innocent game they call Assassins. Seems harmless, but our town’s helicopter families have gotten so upset over Assassins that the Police Log had more than 100 calls in one week and a town forum was held last week to ‘get to the bottom of this terrible game.’ They have a point, right? I mean very few parents ever drive fast, and very few of us have ever used a water gun. And kids running after school in the neighborhood, often sprinting to chase down their target. Working together in teams. Outside. Not inside. This IS terrible…..One kid, Ben, was hiding in the backyard of my house for so many hours that his phone was ‘losing juice’ so he asked for a charge. ‘Um, Mr. Cote, I know I’m here to get your son, but could I come in and charge my phone?’ The Helicopter parents complained about ‘kids wasting time’ and ‘trying to hurt each other’. I see the opposite – kids who never would interact are playing together, competing. Kids of all shapes, colors, backgrounds, economic and school status classes, are on an even playing field, brought together in a good ole fashion water fight. Many of them sit the bench on their high school team, or spend 7 hours learning algebraic formulas they’ll never use….a little community camaraderie shouldn’t scare us. In fact, Assassins may be healthiest thing I’ve seen in this town in years.