50: The reimbursement rate increase for child psychiatrists agreeing to be in the BCBS of Massachusetts network. This is a big deal - we only see these hikes when traditionally out-of-network service providers perhaps agree to come in-network for a deal, and even then, they can be rare. Child psychiatrists are in high demand throughout the US. Meanwhile, primary care doctors who "integrate" mental health into their practice here will be eligible for incentives. Question is whether integration will include using telepsych platform and whether PCPs will be effective at this, given the length of time it can take to diagnose and assess mental health. "If you think the checklists are effective, you're mistaken," says Prudence Fry, an RN who works at a pediatric practice in Massachusetts.
Down in the Bowels: While Don Draper might have made the midday cocktail iconic in 1960s ad agency life, 2020 drinking due to the pandemic is having a downstream impact on health risk. Nearly 4 in 10 GI doctors and internists we polled report rising incidence of symptoms related to irritable bowels or constipation, and some are proactively addressing it. Click here to read more.
ABA Win Out West: No, this is not a headline from the 1970s basketball league, it’s the latest victory for autism providers; effective this September, Regence Blue Cross will remove pre-authorization requirements for applied behavior analysis for any members 17 years or younger. Regence is making this change to better establish parity between behavioral health and physical health services.
Schtickle of Fluoride: Tim Whatley used to give his patients “a schtickle of fluoride” and send them on their way during Seinfeld-era dentistry, but if the comedy aired today, Dr. Whatley might first bring the patient over to the PCP. That’s right - the integration of dentists and primary care practices is increasing. CareOregon was already working to integrate dental care into primary care in the state and COVID-19 has sped this up, as dental staff from Virginia Garcia Memorial Health Center were redeployed to the primary care side early on in the pandemic. CareOrgeon has now invested $2M across five clinics in the Portland area, including Virginia Garcia, to help dental and primary care staff integrate their services.
Heal at Home With PT: Humana invested $100M into a primary care startup that focuses on in-home care for Medicare and Medicare Advantage patients. Heal offers in-home primary care and telemedicine visits, and recently expanded to include teletherapy visits. It currently operates in eight states and may potentially add on services like physical therapy.
New Health Plan: AllWays Health Partners, a commercial health plan in Massachusetts, is working with Newton-Wellesley Hospital and Mass General Brigham to launch a new integrated health insurance product, Allies. The product’s model will focus on members receiving primary care at the hospital and those with more complex conditions seeing physicians at Mass General Brigham centers. Allies members will reportedly receive savings of up to 20% of AllWays’ traditional HMO plans.
In-Home Lab Draw: Oscar Health is launching a new virtual primary care benefit at no cost to their members that includes unlimited virtual visits with PCPs, and some members will be eligible for free at-home vital monitors and in-home lab draws. The program rolls out first in Florida, Texas, California, Colorado, and New York.
Extra Point: I’m going fishing with my youngest son on his 13th birthday. My buddy DWalter says fishing with his dad and brother was part of coming of age. “I love those times,” he says. Last time Tommy and I fished, I hooked my wife by casting in a kind of bizarrely pathetic boomerang motion. I’m hopeful this fishing expedition will be less stressful and painful, but I have low expectations. One time I fish-hooked my buddy Troy when we were skipping school and his dad had to bring him to the ER. The problem is fish hooks have a rigged shape, so the ER doctor couldn’t just rip off the hook like you would out on Golden Pond; otherwise Troy’s scalp, yes his scalp, would bleed a lot. Medical costs due to fishing injuries are unlikely a major problem, nothing like viruses and mental health and diabetes. But if you’re in my boat, maybe take cover.