1. 18 and Counting The number of ancillary contracting directors for insurers who have confirmed with me that they have had at least one conversation with Amazon in the last 2 years.
2. New #1: Orthopedics has moved past maternity as the #1 episodic payment contracting focus for payers.
3. 7 Wonders of the Lab World: Now that UnitedHealthcare has tapped 7 preferred clinical and anatomic path labs for its preferred network set to go live in July the question is can this mix of big chain and specialized genetic companies improve outcomes and satisfaction. UHC says it will work with the labs to track outcomes for patients using them to see whether labs can play a meaningful role in outcomes improvement. This will be a 5+ year effort. Mayo, LabCorp, Quest, Invitae, GeneDx, BioReference and Quest subsidiary AmeriPath made the cut.
4. Peter and Paul: Anthem Blue Cross in California is increasing reimbursement for evaluation and management services starting in July, but physicians in the state report some decreases for other services. We are looking into which ones and meantime, worker’s comp rates will change – physicians will be paid whatever is lower: 85% of the state’s work comp fee schedule, the physician’s billed charges or something called a prudent buyer fee schedule Anthem will put into contracts.
5. Enhanced Pay For Early Pain Diagnosis: In a move to reduce addiction and hospitalizations due to overdose, 14 of 31 medical management contracting managers for large group insurers say they are contemplating an enhanced payment rate initiative, either through contracting or a special code, whereby providers like physical therapists could identify addiction early, make an assessment and a streamlined referral to a behavioral health or addiction specialist. The 14 include 7 Medicaid plans and 7 commercial, and all said ‘they would pilot the concept first’. We had studied the issue on PT groups showing value by identifying addiction early in patients with pain. That story here for those who missed: click here
6. Don’t Get Caught Watchin’ Paint Dry: It’s the best line in Hoosiers, when a questionably sober Dennis Hopper tells the team to avoid standing still at the key point in the game….and it’s a good lesson for traditional primary care and home care companies these days who, if they’re not careful, may find themselves stuck if they don’t get ahead of the social determinant wave. Caraline Coats, Vice President of Humana's Bold Goal and Population Health Strategy, says the insurer has a pilot program with a company called “Papa” in Tampa, FL connecting college students with lonely seniors. This is one of several initiatives to screen for things like depression and substance abuse and react to them. How information from screenings makes its way into EMRs and back to primary care physicians, or mom and dad’s caregivers or kids, will be important if this whole social determinant experiment is to work. That said, there will be a flurry of companies in the social-health arena continuing to seek a piece of the insurer’s Medicare Advantage budget. It’s already happening. For the Bold Gold story, click here
7. Extra Point: I was chatting last week with a soon-to-be UVM student who says she’ll help ‘pay her way’ at the Vermont University by working in a new 8-week outpatient pain management program that includes yoga, acupuncture and culinary medicine. For purposes of this example we’ll call the student Mary. Mary’s volunteering as a yoga teacher in high school landed her the gig. BCBS of Vermont confirmed that they are supporting the program. Doctors in the state must refer patients with chronic pain to the program. Lou McLaren, who directs provider relations and quality improvement for the insurer, says the program should reduce prescriptions and, as I predict, reduce the need for the oft-times ineffective injections. Mary says she’s motivated to participate because many of her high school friends have suffered chronic pain due to sports injury. Her dad says she’s motivated ‘because I told her it’s the only way we can afford the school…’