21: Percent spike in the number of prescriptions filled per week for antidepressant, anti-anxiety, and anti-insomnia medications between February 16 and March 15, according to an Express Scripts report. Sales peaked the week ending March 15, when COVID-19 was declared a pandemic. Anti-anxiety medication use rose the most, at +34.1%.
Glidepath to Risk: Just because there’s a pandemic doesn’t mean risk contracting has stopped, interestingly, as we’re hearing more payers and providers continuing to explore risk contracts. And why not? With the downtick in visit volume, it’s not a bad time to be getting capitated payments if you’re a provider. In discussions we’ve had this week, several suggested that they are finding some success with upside only arrangements, essentially a FFS payment or flat cap with a ‘glidepath’ to risk, which is basically a way to limit exposure as the practice learns how to manage operations—and patients—in a new payment model. One idea is to set up the contract as FFS or flat primary care capitation and agree to share in the surplus or savings, typically 50%, but at 0% exposure to deficits. Then, as several noted, you move to a full global risk capitated payment the following year, like 2021 as some have done. “This gives us time to acclimate, to code up patients who should be coded higher based on acuity, to get the premium to the appropriate level,” one payer-contracting director noted. Most sophisticated MA payers are typically on board with glidepaths, as they do not want to see a provider group rack up deficits during the learning curve. Other providers tell us they have had some success convincing the insurer to agree to an ‘early switch to cap or risk’ before 2021, if they are finding success. “One MA plan was a little unsure but agreed to change to full risk earlier than the 12-month glidepath if we are doing really well.” This ‘early flip’ language allows the practice to stop giving away the 50% surplus back to the payer when they could be gaining the whole surplus, though it will have to prove it is meeting “minimum thresholds” of attributed members.
Paneling Wall: As we noted last week, recruiting solo practitioners is getting easier due to the impact of the pandemic but enrolling them into managed care networks is getting harder. Licensing has been waived in some states but “it still takes us 3-4 months to get a clinician paneled in a specific region,” according to some behavioral health providers. One company, Inovatel, says they are finding that smaller psych professionals are now looking for a new home, given the pandemic, but they can’t bill the insurer yet.
College Blues: 41% of families, up from 28% last week, say they likely need to either transfer their students to a lower cost community college or smaller school, or forgo planned medical or nursing school, due to changes in job status or income. Our poll has reached 667 parents to date. There has been little discussion to date on the impact of COVID-19 on nursing and medical school enrollment and on the quality of education. In Oklahoma, the Governor changed regulations to allow e-learning at home, to avoid having large groups of students in hospitals, but how valuable this online education is for nurses is an open question.
Isolation Solution: The link between social isolation and loneliness among older adults and health risks has been known for some time, and concerns are growing that lengthening periods of social separation, resulting from the coronavirus pandemic, could exacerbate these risks. Vivek Murthy, MD, former US Surgeon General, who spoke at the first virtual Yale Healthcare conference on April 17, said “if we don’t shift how we see our social connections” then physical outcomes will decline. “Loneliness is strongly associated with heart disease, dementia, depression, sleep disorders, and longevity as a whole.” Health plans are working on ways to connect with their members to help address some of these potential repercussions. Cigna, for example, is piloting a program to reach out to Medicare customers over the phone to assess their general health and see if they need any help with food, housing, or transportation. Members can request to receive follow-up calls from the same Cigna representative to “help cultivate meaningful connections”. Cigna is also identifying high risk MA customers to help answer questions about COVID-19, conduct health checks, and connect them to a medical professional, if necessary. The pilot program will reach 24,000 customers, with plans for expansion.
Urgent Care’s Latest Delivery Model: Back in 2019 we wrote about a new urgent care mental health crisis center for the uninsured in Tennessee that was overrun with commercially insured in its first few weeks (story here). Other markets are opening similar models and it will be interesting to see which patient populations show up. In Bozeman, Montana, a new behavioral health urgent care center opened recently, in response to COVID-19, as a way to reduce hospital ER volume. Bozeman Health partnered with Western Montana Mental Health Center.
Tele Expansion: Mount Sinai Health System is launching a personalized telehealth platform for nurses, which will contain the latest information on COVID-19 treatment and protocols. The platform, Project Florence, was developed with Sana Labs and will be available on any web-enabled mobile device and has an AI tool that will measure nurses’ knowledge and recommend content to fill in gaps. Centene, meanwhile, is providing grants and gift cards, to be used for essential items like OTC medications, and piloting programs in Arkansas, Kansas, Georgia, and Mississippi to help accelerate the rollout of telehealth to remote areas. It is using FirstNet, a nationwide wireless broadband service.
Extra Point: Like many of you, I’m a history buff, and at about 7 o’clock last night I was somehow corralled into writing a research paper for my 16-year-old about the media’s influence during the Vietnam War. I found myself googling, paraphrasing, teaching, then structuring and rewriting. With no formal classes, Jack needed guidance. I was Johnny Rose from Schitt’s Creek trying to fine tune his daughter’s C- into an A. I immersed myself in Cronkite’s famous 1968 telecast, helping Jack create a thesis around the power of the media to investigate and tell the truth. This is what I learned in journalism school and here we were at half-past-midnight, trying to summarize history. I changed sentences just as Jack updated footnotes. “The document is moving, Jack, my cursor is missing, for cryin’ out loud what in the world is happening,” I remember saying. “It’s called Google docs, dad – we can work together at the same time…you’ll be okay….” We titled it, “The Rise of Cronkite: How the Media Icon Changed American Views of the Vietnam War.” I sat up today thinking about the paper, wondering if there will be a Cronkite moment still to come during this pandemic. I thought about influence and wondered who today’s Cronkite will be. I can’t really think of any one influencer in this moment more important during this pandemic, more influential, than nurses. They are helping families FaceTime with mom from the hospital bed or say goodbye to dad. They are taking shifts in ICUs and ERs. They are coming out of retirement. They are our humanity right now, helping people feel safer in uncertain times. And just as I wonder if Jack will help his own kid in 45 years to write about this crisis, I wonder if today’s nurses will inspire future generations, as Cronkite has. If they’ll influence my own daughter to take her voice bedside, to help people feel less alone, just like she does here with a bit of laughter and a lot of love.