40: The number of additional onsite primary care clinics Walgreens and VillageMD are opening in 2021 through their partnership, focused on sites in Texas, Arizona, and Florida. Physicians, nurses, and pharmacists will staff the clinics, and an app will allow patients to also utilize virtual and telehealth services. Walgreens has stated its long-term plan is to open as many as 700 of these clinics over the next five years.
Moving to the Pharm: BCBS of Michigan is moving two drugs from the medical benefit to the pharmacy benefit because “they can be safely administered in the member’s home.” Skyrizi, for plaque psoriasis, and Tegsedi, for hereditary transthyretin-mediated amyloidosis (ATTR), are covered under the pharmacy benefit as of October 8, 2020. The drugs will be available through specialty pharmacies, lowering the drug cost to the plan, and increasing patient convenience.
Texas Hold ‘Em: The Center for Cancer and Blood Disorders in Texas is using artificial intel to help patients avoid unnecessary ER trips. The AI program helps providers predict which patients are most likely to go to the ER in the next 30 days and then recommends actions the providers and case managers can take to prevent this. The center is one of three practices piloting an AI platform from Jvion that uses 25 different variables to identify risk, including social determinants.
Best Buy Health Play: Next year, members enrolled in a Regence Medicare Advantage plan will have access to Lively Mobile Plus, a PERS (personal emergency response system) offering from Best Buy Health. The device offers a 24/7 connection to trained staff that can help in medical emergencies and non-emergency situations, along with built-in fall detection technology. The Lively Mobile Plus benefit can also help Regence members navigate social risk factors like transportation concerns, social isolation, and food insecurity, helping maintain their overall level of health.
Infusion Biz Adds Vaccine: CVS Health, through its infusion business Coram, will administer COVID-19 treatment in patients’ homes and in long-term care facilities. The treatment, manufactured by Eli Lilly, requires an hour-long infusion and administering the treatment at these sites of care will allow patients to avoid hospitals during the latest surge. Hospitals, PCPs, urgent care centers, and long-term care facilities can refer patients to receive a home infusion, starting in seven markets in the initial phase, which begins mid-December and will expand over the next few months.
In Case You Missed It: We released the latest version of our Healthcare Investment Index on Thursday. Check it out here and reach out with any questions.
Extra Point: I had a Carl Spackler moment during Tuesday’s managed care panel. My internist was tuned in and texted me about the same time I was peppering BCBS Chief Pharmacy Officer Dr. Mona Chitre about why virtual clinics have become a disruption in western New York. “Bryan – set up zoom session. Your eyebrow has a growth that looks to be getting bigger.” Talk about real time diagnostics - and I didn’t have a copay for the unsolicited consult! So, I got that going for me. Which is nice, as Bill Murray’s Spackler would say. In truth, I find Dr. C’s point about virtual clinics a fascinating paradox – they are fresh, offering choice, fancy apps, and data, and are lowering A1Cs, giving self-funded employers a way to cater to younger employees and those with chronic conditions. Very Gen X, or is it Z? But they disrupt the progress a health plan is seeking with its physician network. They add another cook in the kitchen and they go against the tide of integrated care, to say nothing of the challenges they may create around attribution, data sharing, outcomes measurement, and value pay. As the former greenskeeper Spackler might say…gunga galunga.