19: Percent of hospitals in a poll last week considering or establishing in-house specialty pharmacies. This developing trend is interesting given a new UnitedHealthcare policy starting in April. Hospitals will be required to obtain specialty medications from UHC’s specialty pharmacies when administered in the hospital outpatient setting, unless otherwise authorized. This means the hospital can’t bill for the medication and can’t bill the patient. The pharmacy will bill United and the hospital can only bill for ‘administering’ the drug. The insurer says they may deny the full claim if the hospital uses a non-participating specialty pharmacy. It will be interesting to see how the push and pull work between these new in-house pharmacies and shifting payer policies.
Retail CleaningHouse: Walmart is beginning a new healthcare approach at two stores in Georgia. There, customers will pay a standard rate of $30 for a checkup, $25 for a dental cleaning, and $1 per minute for counseling. More advanced services will also be available, and prices will be provided clearly before services are utilized.
Value Tracker: BCBS of Western New York has entered into its value-based reimbursement contract with Value Network, a behavioral health group with over 100 providers in New York. The model will use a PMPM capitated payment along with some FFS payments, specifically around preventive care.
Oral Health Progress: BCBS of Massachusetts is expanding value-based care contracting into dental services, through an agreement with the dental provider group 42 North, in the hopes of improving access to dental plan coverage. Blue Cross says it has seen success in VBC with medical providers and is hoping to expand these positive results to dental health.
Diabetes Cost Switch: Beginning in January 2021, CareFirst BCBS will begin offering insulin and other diabetic supplies as a covered benefit to its commercially-insured members, with no costs associated. In 2019, members in commercial plans paid a total of nearly $6M in out-of-pocket costs for insulin alone. Starting in 2021, CareFirst will also allow self-insured plans to have an option where they waive the cost of insulin.
Generic Buzz: The Blue Cross Blue Shield Association (BCBSA) and 18 of its member organizations are investing $55 million in the nonprofit Abbreviated New Drug Applications, with the goal of creating cheaper versions of certain expensive generic drugs. The partnership expects to start with a focus on roughly seven to ten products and expects some of the initial products to be available in early 2022.
Juul’s Rise: There was a 10% increase in the rate of use of Juul among middle schoolers in the last year 8 years, according to Truth Initiative data. The number of teens and young adults who have used Juul doubled in one year, according to a study published Jan. 21, 2020 in JAMA Pediatrics. “Yeah, big problem,” says Mayo Clinic’s Paola Sandroni MD. PhD. “Various cannabis preps can be vaped, as can bath salts, and I am sure more. Plus, folks are creative and will try to vape anything such as crushed pills mixed with some water or oil base.” Many teens don’t have the foresight to know what they are doing; it’s potentially fatal. And, because ‘vaping’ synthetic drugs is more discreet than other forms of drug abuse, they are easy to hide in places like schools.
Bipolar Stat: Among symptomatic youths at high risk for bipolar disorder, the time between mood episodes are longer for those receiving family-focused therapy, compared with enhanced usual care, according to a study published by JAMA Psychiatry.
Payer Direction, Addiction: Healthcare-technology company WEconnect announced a partnership with Pennsylvania managed care plan, Gateway Health, for an innovative program designed to help patients stay in recovery. Patients who undergo substance use treatment will use WEconnect’s app after they leave in-patient treatment, providing them with a comprehensive network of support during their first year of recovery. Pennsylvania’s rate of drug-related overdose deaths far exceeds the national average. Every year, 23 million Americans seek treatment for drug and alcohol addiction and more than 80% of patients relapse after treatment. WEconnect’s innovative app reduces relapse rates by providing comprehensive and reliable tracking metrics to bridge the gap from treatment to recovery, taking a 28-day program and turning it into a 365-day program.
Extra Point: Andy looked frail and he couldn’t find space on offense for a jumper. He had 22 in our last contest with #1 Plainville, but that seemed impossible today. He turned the ball over twice on consecutive possessions and then Plainville’s #15 easily wrestled the ball from Andy at half-court for a third. Our best player wasn’t just coming off the flu as mom thought. He was on the verge of a heart attack, and with 2:16 left in the first quarter, no one knew it. To read more, click here.