15: Percent increase in reimbursement starting in February for physicians who do certain procedures in ASCs rather than hospitals under a Michigan Blue plan policy. The change applied to PPO membership, as HMO patients are "managed" and use ASCs more often already.
Penn & Tella: This is how my brother-in-law from Boston’s north shore pronounces the magician pair but it’s also a new telehealth program from Penn Medicine that has reduced rehospitalizations 75% among patients who’ve had hip or knee replacements. The program, Home Connect, gives patients wearable devices and text messages to help them monitor pain levels. According to researchers, only 3% of those using the connected care platform returned to the hospital within 45 days of their surgery to deal with complications, compared to 12% of those in standard care.
Raising Arizona: Magellan Health continues its move into care delivery, acquiring a 70% interest in Bayless Integrated Healthcare, an integrated outpatient behavioral health and primary care provider in Arizona. We expect more benefit managers, insurers, and health assessment companies in 2021 to continue to add services to their models or try to. Bayless has 175 providers across eight locations in central Arizona and will serve as a growth platform for Magellan to enter new geographies as a partner to, or a provider of, integrated primary care and behavioral health.
Lyft Off: The transportation company is continuing to expand its presence in the healthcare field, this time by launching a nationwide campaign to provide rides to vaccination sites for those in need. By partnering with United Way and Anthem, Lyft’s goal is “to provide 60 million rides to and from vaccination sites for low-income, uninsured, and at-risk communities.”
Big Apple Medicaid: Starting in March, Medicaid beneficiaries enrolled in several of United Healthcare’s New York plans will need a primary care provider to make a referral for them to see certain specialists, like cardiologists and dermatologists, although a specialist who has arranged to act as a PCP is exempt. The referral must be in place prior to the specialist visit for the specialist claims to be paid. Several situations do not require referral – HIV screening, dental care, women’s health, behavioral health, maternal depression screening, some eye care, and ER and inpatient hospital consults, like anesthesia or radiology. This applies to United Healthcare Medicaid beneficiaries in a Family, Wellness4Me, or Child Health Plus benefit plan.
The Florida Effect: Florida-based risk-taking primary care provider, ChenMed, owns Detroit-based Dedicated Senior Medical Centers and, starting summer 2021, the centers will partner with Michigan’s Blue plan under a model to reward physicians for health outcomes improvement. Six total centers will open in the Detroit metro area.
Waste Not, Want Not: 81% of 1,612 consumers in our healthcare poll say they did not go to the doctor in 2020 and 79% say they have “significant amounts” of unused health savings dollars left over. One issue is a majority say their employers didn’t adjust their FSAs to allow them more time and flexibility to use the savings for medical care in the year ahead. A majority polled say they are moving from FSAs to HSAs in 2021 or were considering. Look for full results in our consumer poll briefing coming in January.
Extra Point: I just saw that Modern Healthcare is looking for nominations for the best places to work. I’m no expert in this area but here are my top 5 nominations. (5) My parent’s attic, because no one is there and in between meetings I can line up the Smurfs and GI Joes for battle. (4) My deck, because it’s the only place where I can get Vitamin D and catch the neighborhood teenagers sneaking into our shed. (3) My basement, because I can do a few loads of laundry while drafting emails. Clearly important, given the extent of my wardrobe right now—sweatpants, gray shirt, brown socks, repeat. (2) Front seat of the wife’s car but only when she’s home from school and I can say “I heard something weird coming from the engine so I’m going to take it to the shop” for several hours, which gives me bonus points, peace and quiet, and a smidge of guilt. And (1), the bathroom floor because for some reason it has the best reception. Today I woke up at 6am and started work in #1 but, for a change, felt a bit less like Groundhog Day’s Phil Connors. Sure, the lab was chewing another N95 mask and, yes, there are no New Year’s Day Italian meatballs at Uncle Cosimo’s to look forward to, but 21 has finally edged out 20 like a George Blanda extra point for Chicago’s Bears. Groundhog Day’s hold on us is breaking. Happy – and of course healthy – new year to you and your families. -BC