1. 406: The number of responses to our recent caregiver story about the health impact of being a caregiver and what was most shocking was that about half came from those in healthcare, and the other half from educators or business owners, almost all of whom are struggling themselves to take care of their parents. The response is by far the biggest reaction to any one story in the 20 some years of this managed care column. Our full study will be published by 2020 and we will make every effort to incorporate everyone’s ideas. A teacher from Oregon said she wishes her dad trusted others. She doesn’t have any support from other family members and has had to leave her job while she sees her own health declining. A construction worker from Illinois lost his job because ‘I needed to travel back home to help my parents deal with their cancer’, and with all the travel his own lack of exercise and mental stress caused him to have a heart attack earlier this year. A health plan contracting manager is weighing whether to put her mom in a home or leave her job – an impossible choice, she says. See last week’s preliminary study results by clicking here.
2. Copay Out, PT In...But What Does It Mean?: In a bit of an outlier but predictable move, United Healthcare has started waiving copays and deductibles for up to 3 physical therapy visits for patients presenting with low back pain. We think the decision has more to do with curtailing addiction than expanding access to therapy. PTs in five states will be part of the rollout (Connecticut, Florida, Georgia and North Carolina), with other states likely added in 2020 and 2021. The decision is a plus for PTs for now, but if you look more closely it almost pushes PT into a hybrid model as more so a diagnostic service than treatment provider. United, like other large insurers, has found that more patients use PT almost as their primary care provider, presumably to deal with pain and hard to fix musculoskeletal issues. But patients using PT have other conditions – possibly early onset of substance abuse, ongoing psych and mental illness, or as my own dad found in his years as a PT and athletic trainer, eating disorders masked as knee pain. The traditional 7 approved visits is likely still the norm but the 3-visit, no-copay allowance is no accident in our opinion. The insurer likely wants to motivate enrollees to use their PT to get the right diagnosis earlier, and motivate PTs to better manage care. This means PTs need to improve their ability to identify symptoms. Our study, now about 5 years old, illustrates that most groups have not been focused on finding out about addiction (click here for the study). This also means that primary care providers, orthopedic practices and probably even educators and sports coaches need to make sure they have good relationships with a PT group. Cigna and Evicore are two other entities who are likely to explore similar initiatives as United given their focus on musculoskeletal costs, and it’s possible BCBS and Anthem do as well. BCBS of Louisiana has started to offer an enhanced payment to PTs for sharing patient outcomes related data. At a minimum, the pilot program diverts somewhat from the trend of higher cost share for using specialists and often times requiring PCP referrals. UHC will email enrollees quarterly ‘as they gain access to the benefit’ but there are some rules: patients have to use in-network PTs and will need to have PT benefits remaining in their plan for that year to use this benefit.
3. Extra Point: There’s a misconception that value-based care is only for primary care when, in fact, there are a lot of specialists who become the defacto PCP for patients, like cardiologists, oncologists, or psychologists. Several insurers say they are trying to create tools to help physician groups take on more risk and have more success. ‘We were tired of having too many conversations with groups who were failing at this….so we created an entire dedicated team.’ By our poll’s count, 79 of 103 insurer executives say they have formed ‘payment innovation teams’ designed to provide tools to support doctors take risk. I’m noticing a similar issue with sports coaches in our area, too many of whom are struggling to juggle the growing number of kids on the autism spectrum playing sports. This is a good trend, but not without challenges. I once had Max with Tourette’s and Ollie with Asperger’s. The health system had labeled them on the spectrum. I had them as fast defenders. Coaches today, particularly those who like to hold 3 to 5 practices a week, are in many ways becoming a kind of specialty parent. They see youngsters a lot. They see little Bobby roll around the midfield swallowing dirt while Lucy dribbles past. They see Andy put the orange cones on her feet and Donnie put the ball under his shirt. They are teaching and disciplining, but many are failing as they try to dictate plays and structure to a diverse roster. Like their healthcare counterparts who are trying to find their footing in value-based payment design, these coaches could use their own tools to help them learn how to work with kids on the spectrum, teach kids how to behave, hustle, keep stats, make decisions by knowing the odds, and to ultimately take risks on the field without second guessing every decision. Seems like a similar lesson those of us in healthcare need as well.