13: Number of newly awarded contracts that BCBS is going to give out this year alone to physical education vendors focused on movement, exercise and fitness solutions to address both physical and mental health, a spokesman confirmed. Companies will focus on chronic adult patients, seniors, new moms and youth as part of tailored programs designed to limit prescriptions and reduce stress and downstream medical complications of events such as stroke. One of the leading ‘companies’ in the mix, PLAY, previously had a grant with BCBS of Rhode Island, while others are more data and fitness focused, like Orange Theory. Read my essay on this here.
Gene Therapy Innovation: A new crop of expensive but potentially revolutionary therapies is getting attention from insurers who are unusually ahead of the curve in establishing policies, perhaps better versed in how to address expensive treatments after a decade plus dealing with novel treatments for cancer and hepatitis C. Policies seem to be focusing on providing wider coverage, fewer barriers, cost sharing and centers of excellence, but also outcomes refunds and more accountability on manufacturers. Novel indeed. Reach out anytime for a primer on developments.
Women’s Health Monitoring: The University of Pittsburgh Medical Center has created a remote monitoring program to measure blood pressure for new moms after leaving the hospital that is increasing the number of women who are keeping their postpartum appointments, 90% compared to the national average of 60%. Women were discharged from the hospital with an automatic blood pressure pump and then a computerized system within the participants’ electronic health records prompted them to take their own blood pressure and heart rate readings. In 2020, UPMC plans to expand the program to all 15 of its hospitals.
Fertile Ground: Insurer focus on fertility is going up. Starting this year, BCBS of Illinois started requiring some members with group coverage to obtain fertility benefit pre-authorization through WINFertility, a company which helps insurers manage fertility benefits and costs. Think of them much like you would OrthoNet for physical therapy or eviCore for surgery. WINFertility handles both the medical and pharmacy benefit, as well as genetic testing, egg freezing, and surrogacy services. This comes at a time of increasing interest in fertility benefits from employers and investors. In October last year, another fertility benefit manager, Progyny, joined Nasdaq as it went public with its IPO.
Glass Half Full for OP Psych: In a positive development for psych therapy providers, Kaiser Permanente has lifted its previous 20 visit limit on outpatient psychotherapy and says it will only require re-authorization annually through an abbreviated form. The code for the service is 90834. Other insurers, like BCBS of Illinois, have leaned somewhat the other way by requiring re-authorization after 7 visits, much like they had done in prior years for physical therapy when use of those benefits began to increase. In the aggregate, the attention to psych should put any outpatient provider on notice that it will need to capture and demonstrate visits are needed even if there is a swing in momentum to allow more access. In our 15th edition of the Healthcare Payer Index, several behavioral services made the Top 20, including previously unranked ‘telepsych’ cracking the Top 10.
Latest Payer Investment: Optum, the health services platform of United, is partnering with Allina Health Systems in Minneapolis to open as many as a dozen new ASCs over the next five years. Optum has grown in the ASC space after it acquired Surgical Care Associates (SCA) in 2017. SCA already managed several ASCs in Minnesota prior to this deal.
Predicting Health: If you had to guess, what are the top two factors most associated with risk of an inpatient admission or ER visit? Well, a study published in the American Journal of Managed Care showed that a machine learning algorithm was able to accurately predict inpatient and emergency department utilization using only publicly available social determinants of health data, and the top two factors most associated with risk were air quality and income. The team who conducted the study hopes that health systems can use this information to inform future initiatives and reach out to those most at risk.
Profile: Check out our recent profile with BCBS of North Carolina’s chief of behavioral health Kate Hobbs Knutson. Click here.
Extra Point: So, I’m getting older. My kids now leave the room when I start to say, “You know when I was your age,” we didn’t have PayPal and lunch accounts, we brought a rusted Star Wars metal box with Chewbacca stickers into the cafeteria and hoped-to-God Lenny wouldn’t corner you for the SuzieQ dad snuck inside. Even with a diet of Twinkies and Pop Tarts, if you passed your physical the nurse would give you a lollipop. No cavities, and you got a plastic ring. We didn’t have special boots for sprains and breaks, we wore hard casts that smelled like old pillows. There were no electronic records. Our doctors didn’t talk. They asked us the same questions each time. Urgent care was dad telling you to take a hot shower and throw back a few Halls lozenges. We didn’t have ‘Play’ programs before school or weekend travel teams with shorts donning our last name. Our contact sports had names like 'Red Rover'. We wore blue t-shirts with a faded REO Speedwagon on the front because the coach said, “wear dark,” so you did. I’m getting older. I consider it a good day when I look at my to-do-list and check off items like ‘take kids to school, reply to that email you deleted, reorganize to-do list’. My bride says I’m just stretched thin. She’ll say, “You’re stretched thin,” which only makes me think I either need to eat more carbs after 8 or stop yoga. At least I’m not the only thing getting older. Doctors. Hospitals. Fee-For-Service. Nursing Homes. Antidepressants. Opioids. All getting older or at least entering a new era that tests their behavior, patience, value. I suppose I’m not much different. Here’s to embracing age, appreciating your roots but being open to pivoting, carefully.