42: The percent of physicians who just retired or changed jobs after an insurer acquired their business, according to our small poll of 103 who say their practice was bought by a health plan in the last few years. Age and quality of life and the ‘components’ of the deal were the leading factors. The 58% who stayed on were, for the most part, under 50.
Lab Testing Utility: Physicians sometimes order lab tests as cover, sometimes because it’s protocol and sometimes because they have a hunch. The science behind their lab ordering behavior is increasingly interesting given a range of healthcare developments like addiction, pain and payment reform. Here in this poll we did of 150 endocrinologists, cardiologists and health plan medical directors a couple years ago, we found out the so-called ‘utility’ of the test - when it helps and when it flops. Some interesting perspectives to consider if you are a practicing physician or run a physician office or hospital and are moving toward value-based payment. Click here for a 1-page poll. Note: if interested in additional research on this topic, reach out anytime.
Alzheimer’s Option: Science continues to make strides at slowing disease progression. Eagle Pharmaceuticals and the University of Pennsylvania have agreed to a licensing agreement for the development of dantrolene sodium for the potential treatment of people living with Alzheimer’s disease, including an agreement to fund additional research in January of 2020. Essentially, the study will be looking at dantrolene’s role in changing intracellular calcium levels or calcium signaling, which involves complex cellular pathways and may lead to neurodegeneration and neuron death. I lived with my grandmother for a few years back in the earlier 90s in the latter stages of the disease that took her brain, but not her humor. For my grandmother’s story, and that of a good friend of mine who developed Alzheimer’s in his 40s, click here.
First Rx Value Contract: Just as specialty pharmacies continue to be important to regional payers to help with distribution and care management, driving down acquisition cost and helping with pipeline management, there is a new dynamic in play to consider: insurers partnering directly with manufacturers. UPMC Health Plan will receive discounts for two multiple sclerosis drugs manufactured by Biogen in a first-of-its-kind, value-based contract. Patient-reported measures of disability progression will be used to determine effectiveness of the drugs instead of outcomes gathered by claims and EHR data. Value contracts have been slow to develop for medications. Some payers have tried to institute tumor shrinkage as a measure of success in value contracts with cancer treatment companies and NICE, the UK’s National Institute of Health & Clinical Excellence, has made strides in this area, but establishing the terms and shared savings is complex, which has kept development of these contracts at slower pace.
Social Determinant Buzz: Molina Healthcare is opening the National Molina Healthcare Social Determinants of Health Innovation Center in Columbus, OH. The Center plans to partner with local and national community-based organizations and providers. It intends to collect and analyze patient data and create a database to help develop best practices for supporting those who are addressing these issues. For this trend to take hold, it requires local collaboration and investment. I see that in my community where the Medicaid population of refugees has been able to address asthma, addiction and prenatal care costs through simple volunteer advocacy help. All local. Scaling social determinant focused businesses has challenges although models that can help local providers collect and disseminate data and provide support to local caregivers and volunteers are likely in demand.
Pilot Helps NY Medicaid: The benefits of care coordination were on display as part of a value-based care pilot that encompassed New York Medicaid patients with high mental health needs. Healthfirst, Mt. Sinai, and the Institute for Community Living have worked together to better integrate mental and physical healthcare as well as social service needs like housing and transportation for 400 patients with mental health or substance use disorders and chronic medical conditions, achieving $1.3 million in savings in Medicaid costs in 2018.
Addiction Model Innovation: With national focus on the opioid crisis, Workit Health is expanding their digital addiction care program to include medication for alcohol use disorder. Workit Health members in CA, MI, and NJ can now use telemedicine to meet with clinicians and then receive naltrexone. Alcohol use disorder is the third leading preventable cause of death in the US and Workit Health is hoping to use their successful platform to tackle this issue alongside opioid use disorder.
The SNF Conundrum: “Reduction of antipsychotics in SNFs is a big initiative with CMS and while we are not getting penalized for using antipsychotics right now, it does affect our quality rating because some people may not come to our facility and if we don’t reduce it, CMS might penalize us directly financially.” This from Ellen Casey, administrator at Wilton Meadows Nursing and Rehabilitation in Connecticut where Casey has implemented a new behavioral team and helped the facility break even on Medicaid after losing $1.5 million a year. Her story next week.
Extra Point: You want to show value, take your daughter who’s struggling out to supper and blast Ben Platt’s new album on the way. Sing an uncomfortably ambitious falsetto at the traffic light, with the windows down. Not because it sounds good, but because it makes her laugh. Use your gifts, for good. Nurse Jared Axen sings to patients at Los Angeles’s Valencia Hospital. His nursing director tells me his patients actually give the hospital a better satisfaction score even though they are often sicker or deal with more complications, and that they are “3x less likely to be readmitted.” Nurse Brenda Buurstra once sang ‘You Light Up My Life’ to Robert Olsen during the older man’s weeklong stay for breathing issues at Bronson Hospital in Michigan. Despite initial expectations that Robert’s lungs wouldn’t hold up, he was discharged home in a week and hasn’t been admitted back. Brenda sang to patients before things like readmission penalties and ACOs and social determinants were a thing. She has a gift. “I’ve been singing to patients for 14 years,” she told a CBS TV reporter. “It’s just the first time I got caught.” I showed Sophie these video clips last night after supper and after my own embarrassing stoplight song. She heard Brenda singing on key, and Jared moving his patient to tears. So, she didn’t get that part in Sound of Music this week. Like a lot of teens and young adults facing defeat, failure, the unknown—she was thinking of quitting the music club. She has a voice and a dream and loves to perform, but maybe she’s missing the point. We are trying to measure value in so many ways these days—in our healthcare businesses, in how we deal with patients, in how we parent, in ourselves, and for Sophie, well maybe she’ll be a Bernadette Peters or star as Belle on Broadway, but if not, something tells me there’s another leading role waiting for her bedside.