94: The number of posts on a high school’s Facebook page up here in Connecticut from parents complaining about the canceling of the ‘championship’ basketball game. “Kids are being deprived of their opportunity for all their hard work,” one parent expressed. Juxtapose that community anger with the challenge ahead for getting take-home backpacks of food to the 49 some kids on free and reduced lunch at an urban school one town over, to kids who are likely to be out of school by next week. Puts the pandemic in some perspective.
Social Experiment Continues: That health systems are starting to line up to partner with payers to prevent social determinants of health from increasing morbidity and mortality should be a sign of opportunity. Humana is starting a new value-based care model precisely for its Medicare Advantage members focusing on food insecurity, housing, social isolation and loneliness. Ochsner Health has signed up as the first health system to participate. It would not surprise us to see a wave of more MA and Medicaid plans go all-in on similar initiatives. The one mistake vendors may make if looking to capitalize is that a tech or center based solution is unlikely to work; the models that will prevail are more likely those with local feet on the street, more 1 to 1 caregiver interaction and support that taps into volunteers and social workers. The question is who has the strategic foresight to amass these resources and use data systems to deploy?
Virus a Gamechanger for Tele: The new coronavirus (COVID-19) federal spending bill includes a major expansion of Medicare coverage of services provided remotely and while the expansion is temporary, assuming it turns out to be helpful, it may turn into a large-scale real-life test of telehealth’s value, not to mention accelerate coverage and payment of these services.
Corona’s Mental Impact: One wonders how Jack Nicolson’s obsessive-compulsive character in the movie ‘As Good As It Gets’ would have even gotten to breakfast at his favorite diner had a pandemic like coronavirus hit. Truth is stranger than fiction as mental health professionals are preparing for a spike in demand due to the pandemic. “Anyone with underlying anxiety or OCD will have a flare when a new external stressor occurs,” says Paula Sandroni, MD, a neurologist at the Mayo Clinic. “The external stressor of the coronavirus definitely qualifies. So I would anticipate a flurry of panic attacks,” she said. People suffering from mental health issues such as anxiety or OCD, including cleanliness fears, could be affected through sensation expressed in the media. “Having said that, some are so self-focused that they are impermeable to even major world events. We all witnessed that after 9/11 for instance. Either response needs to be addressed.”
Amazon Payer Partnership: Priority Health, a Michigan based health plan, recently announced a new collaboration with Amazon that allows its insured members to use their Amazon accounts to order and pay for eligible healthcare items. This also includes members using their health savings account (HSA) for products such as vitamins, bandages, and more. Members can save receipts to get reimbursed by Priority Health or add their savings plan debit cards to their Amazon account.
Diagnosis Stop & Go: Blue Illinois will not allow for reimbursement when mutually exclusive diagnosis codes are submitted for Blue Cross Community Health Plans and Blue Cross Community Medicaid plan members as of March 31, 2020. An example is code E78.00 for pure hypercholesterolemia unspecified and E29.1 for testicular hypofunction. Anthem was regularly denying these codes when billed together.
Silver & Gold: Ohio University’s Chillicothe Health & Wellness Center is hosting the SilverSneakers benefit through leading Medicare Advantage plans to help older adults to take control of their health through fitness training. Some insurers, like Humana, have pulled back in offering this benefit given low uptake.
Genetics Mark the Date: Blue Shield of CA is the first health plan in the US to cover whole genome sequencing to help critically ill children who have unexplained medical conditions. Whole genome sequencing scans your entire genetic makeup and can help medical teams make more precise decisions around treatment. Blue Shield members under individual, family and employer-sponsored plans who have a critically ill child, up to 18 years of age, may be eligible.
Extra Point: My sister Laura says the insanity at Whole Foods is at an all-time high - people are fighting over toilet paper, flavored water, and gummy bears! My bride had me scurrying around after work today to buy lentils, black beans, and wipes. I suspect I’m not the only one who got that text and I’ll admit I stopped on the way home for a bottle of Chianti too. I’ll toast my Italian relatives tonight who are held up in Monte Cicerale, a mountain town near Napoli. Tommy, our often anxious 12-year-old, sees the pandemic as an early spring vacation. In a refreshing 180, he asked if he could play outside with buddies over the next couple weeks now that Connecticut, like so many states, is closing schools. I told him why not—fresh air, running, mental health— but I sort of don’t know if that’s right and four of my doctor buds I called today all gave me a different answer. My point is that I don’t know. Life is going on in some ways: Jack had his hoops banquet tonight without parents, trophies, and handshakes, though “not sure of the point of this,” he quipped as I dropped him off. Sophia’s play postponed its Brigadoon musical, which seems right on point since the only people who would go to that anyways are grandparents over the age of 70. Janine’s middle school classes will close for the month, but teachers will keep teaching through the Google classroom and staying in touch with families, particularly since all of them are from underserved areas in Hartford. Starting Saturday, I’ll be delivering food backpacks to the three-dozen families who are on the free and reduced lunch circuit. I just hope I can manage to stay healthy and not run out of gas like usual, since one can only assume that’s the next thing – long gas lines. Nurses like my cousin Erin in Rhode Island aren’t shutting anything down – they are holding up in the ER, checking temps and BP, finding beds, and running low on respiratory equipment. “We had a woman in here last night with sepsis, one today with a severe respiratory infection. That’s the healthcare I see, but now this – every sniffle and headache is showing up.” They are no doubt heroes in all this – handling so much of the brunt of the unknown and taking one for the team. Here’s to hoping they can manage to stay healthy.