2.2B: The amount Centene is spending to acquire Magellan Health in an effort to strengthen its mental health business. The deal will add 2 million pharmacy benefit members and 16 million medical pharmacy members to Centene's portfolio, the company said. The deal will also bring Centene 18 million third-party customers of specialty health services, which includes physical medicine and rehabilitation to people with disabilities.
Acne: “I’m not sure if we’re missing an opportunity to reduce depression, alcoholism, violence and suicide by adding payment incentives to encourage dermatologists to work with teen therapists more regularly – it’s this kind of care coordination that’s value based.” – Mindy Carpenter, a payment transformation leader with a western Blue company.
Specialty Rx Revamp: Regence Blue Cross in the upper northwest is transitioning their preferred specialty and home delivery vendors from AllianceRx Walgreens Prime to Accredo and Express Scripts Pharmacy, effective April 1, 2021. Accredo will be the preferred specialty pharmacy and ESI will be the preferred home delivery pharmacy for Regence commercial members in Oregon, Utah and select counties of Washington who have Specialty Select. These members must fill their specialty drugs at Accredo or get them delivered by ESI to be covered by the health plan. Accredo and ESI will be new in-network options for all MA members and Idaho commercial members, where they have the option to use these but will not be required.
Consumer Choice: Beginning in March, the doctor finder and transparency tool “Find Care” in Anthem BCBS’s online directory will be available to search by procedure type. The sorting option will use algorithms based on a patient’s medical conditions and demographics to display the best physicians or providers. Surgeon-facility pairings, cost efficiency measures and the volume of patients treated by disease and outcome-based quality measures are factored into the algorithm.
PT Quality Measure: Worker’s Comp insurer The Hartford prefers to refer and partner with Select Medical for physical therapy, not because they have a lot of locations but because unlike a lot of PT practices they train therapists on how to ID addiction and other behavioral disorders. My dad, now 77 and himself getting at home PT for his 3rd fall, says he wished he was trained in this during his years as an athletic trainer. “Took me 2 months to figure out knee pain was really masked by an eating disorder in an athlete.” This is not a new concept, as we studied here 6 years ago, just an important component of figuring out what PT and orthopedic quality look like.
In case you missed: 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.
Boston Link: We had more than a feeling that these two health plans would sync up and as of January Tufts Health Plan and Harvard Pilgrim Health Care have merged in what will be a new nonprofit serving 2.4 million members across 5 New England states. A new name is expected. My 13 year old’s suggestion – Fenway Care, so you know where his allegiance lies.
Extra Point: I slid the old Peter Gabriel cassette into the boom box last night, rewound for 10 seconds, flipped the tape, hit PLAY then STOP then flipped and rewound 3 more times and alas there it was, In Your Eyes. I held it high like Lloyd Dobbler, stood atop the coffee table and told my kids “this was a quintessential 80s moment” epitomizing an era of persistence, optimism, big hair, great songs and surprising yet perfect marriages like Lloyd’s with Diane Court. When we rewind healthcare in 10 years I suspect we may see the same thing – partnerships that come out of left field but oddly work: Walgreens and Village MD’s primary care outfit, dentists and allergists teaming to treat gum disease in those with asthma, and autism therapists and gastroenterologists linking up to address prevalence of GERD in kids on the spectrum. Dermatologists and teen therapists to halt acne-induced suicide attempts, health centers revitalizing community hospitals and fall-detection alert devices helping seniors dealing with vertigo. As Diane told Lloyd, “No one really thinks it will work, do they?” No, said Lloyd. “You’ve just described every great success story.”