77: Percent of employers in our poll of 219 small, midsize, and large companies who say the time to diagnosis for pain and orthopedic issues is “excruciatingly slow” and “wasteful,” and has led to issues with “presenteeism, productivity” and ultimately higher health cost spend per employee. “Not just low back pain, but neck pain, knee pain, upper back, elbow – we have been pressing in recent years to use PT first for several weeks but sometimes an X-ray is needed right away to rule out issues,” says Dave Simmons, a medical director consultant for self-insured employers.
Palliative Care: Anthem has entered into an agreement to acquire Aspire Health, the nation’s largest non-hospice and community-based palliative care provider. Aspire currently provides services under contracts with more than 20 health plans to consumers in 25 states. The company uses patient algorithms to identify patients with a serious illness who may benefit from an extra layer of support. Once patients are identified, Aspire assigns a comprehensive care team that includes physicians, nurse practitioners, nurses, and social workers.
Autism Testing: Researchers at the University of Virginia are conducting tests for autism when a baby is born in an effort to detect certain DNA markers. The research will especially narrow in on premature babies, as they have a higher chance of having autism. This testing is made possible because of a grant from the UVA Alumni Association.
MRI Direction: My neighbor convinced her insurer that an MRI was the only way to figure out her neck pain, that PT would do little – and she was right, having had a successful spinal stenosis procedure last week. But the cost of the MRI matters, and AIM Specialty Health has developed an imaging clinical site of care program to determine where MRI and CT scans can be done, particularly on weekends when access is limited. Through AIM’s portal, referring clinicians have access to a variety of data that identify lower cost imaging sites. Comparative imaging-facility scores highlight self-reported measures of adherence to standards established by the American College of Radiology and the Intersocietal Accreditation Commission. Anthem owns AIM.
Telehealth TakeOver: Premara BCBS in Washington has started to push doctors and nurses in primary care settings to encourage patients to use Talkspace for mental health sessions, as part of a new partnership. Meanwhile, Wellin5, an online telehealth counseling platform, has acquired Therachat, a San Francisco, CA-based mental health platform designed to help therapists, psychologists, and mental health counselors to keep their patients engaged in between therapy sessions. And as of February 1, PreferredOne, a subsidiary of Fairview Health Services, is partnering with Learn to Live, a digital platform that offers cognitive behavioral therapy tools. PreferredOne’s self-insured clients with 200+ employees are able to offer Learn to Live’s interactive digital programs to help with anxiety, depression, and substance use.
Pre-Authorization Around the Horn: United’s commercial plans in most states will start to require pre-approval this spring for 50-some arthroscopy procedures, destruction of cutaneous vascular proliferative lesions, and extracapsular cataract removal with insertion of an intraocular lens. Only commercial members in Alaska, Kentucky, Massachusetts, Texas, Utah, and Wisconsin are not impacted.
In Case You Missed It: A Northeastern nursing & rehab center is poised to turn a profit on their Medicaid business after years of losing millions, and has created a new behavioral health team of psych social workers, clinical psychologists, and full-time music therapists as a way to reduce psych-related medication use, head off potential Medicare readmission penalties, and better manage dementia and Alzheimer’s patients. Read the interview by clicking here.
Top 20: The number of emerging payer priorities, ranked from 1 to 20 by commercial, Medicare Advantage, and Medicaid managed care plan leaders include five from behavioral health and several new entrants previously unranked. A recording of the 20-minute podcast we did discussing the rankings can be accessed by clicking here.
Extra Point: My daughters take at least one of these a month, my sons maybe two, and if I’m being honest, I probably take at least four. No, not showers, though my 12-year-old is close to setting a record-low this month in bathing. I’m talking about mental health days. Some states are allowing students to just take off class, in recognition of some of the highest rates of depression, anxiety, and suicides among young adults. The Montgomery County school district of Virginia now allows students to use “mental health” as an allowable excused absence, while Oregon, Utah, California, New York, and Florida have proposals in their legislature. Florida’s would allow one mental health day per semester. Advocates say adding mental health as a reason for excused school absences puts it at the same level as physical illness and reduces stigma. 50% of mental health issues are established by the age of 14, and 75% by age 24, according to the Polaris Teen Center. New York, last year, started to require mental health education in its schools. In Colorado, the Denver Public School system has increased their number of psychologists and social workers by 96% in the last five years, and recently implemented a sports program for youth and teens, called 241 Sports, to provide more movement and exercise as a way to address physical and mental health. We all take mental health days, or at least hours in a day, but what’s noteworthy here is how this cultural norm is moving into law.