7: The number of additional physician organizations BCBS of Michigan is adding to its risk-sharing payment model, Blueprint for Affordability. In total, 21 organizations are participating, representing roughly 38% of Blue Cross’ total commercial membership and 42% of the Medicare Plus Blue membership. The new physician organizations joining include ACOs and multi-specialty provider groups.
Bundle This: A maternity MAT initiative kicks off this month for all OB/GYNs and maternal and fetal medicine doctors in Blue Michigan’s physician performance program, this one focused on addiction. Providers who participate will receive initial funding of $10,000 and will then be eligible for $1,000 per patient treated with medication assisted treatment in 2021.
Health Disparity Study: Parexel and Signify Health are collaborating on a series of clinical trials to identify relevant social determinants of health. Parexel says to correct disparities in healthcare and drive more inclusion in clinical trials, first a more holistic understanding of non-medical factors that influence patients’ lives is crucial. The first pilot is set to launch this year.
Tough Break For Virtual Payment: Tufts Health is implementing some changes related to virtual services. Effective this year, Tufts will no longer routinely compensate for interprofessional telephone or internet consultation if any face-to-face service has been billed on the same day or within the previous 14 days. Tufts Health Plan will limit online digital E&M services to one combined unit within a seven-day period and will not routinely compensate online digital E&M services when billed within seven days of certain other E&M services.
The New Age HMO: Doctor on Demand is partnering with Community Health Choice to launch an HMO plan on Texas’s ACA exchange focused on virtual primary care. The plan targets Texans who do not qualify for Medicaid and Medicare and may otherwise fall into a coverage gap. Members will have access to video visits for preventive and urgent care, along with behavioral health. In the wake of COVID-19, we’ve seen a rise of virtual focused health plans and will be watching how these impact care over 2021 and beyond.
Cancer Care At Home: Coram, CVS’s infusion business, is collaborating with Cancer Treatment Centers of America to administer chemotherapy at home for some patients. Patients will begin their first cycles of chemo in a hospital or outpatient center and if tolerated well, will then transition to receiving the infusions in their homes. Coram nurses will provide in-home care, and patients will have access to telehealth visits and digital therapeutic check-ins with the rest of their care team.
Extra Point: If you look closely, the man pictured here donning a light gray winter cap, brown jacket and khakis was about to be turned down for a dose. On MLK day this week, the man didn’t know he needed an appointment, he just saw the big signs for vaccines here in Hartford, had heard the AM radio talk about it, so the man walked 4 blocks and waited in line. The nurse coordinator gave him a website, a phone number and an apology, but then with 100 circling the building, did what she had to do I suppose. That man is 83 and against my better judgment, I left my spot to find him. Wasn’t too difficult if I’m being honest, since each step took him great effort and obvious pain, plus I was already feeling out of place amidst the 75 and up crowd, even though the state had okayed part-time teachers. That man and I found a lonely bench and with the magic of the iphone and a little patience, I registered the man for an appointment for an hour later at the Pratt & Whitney drive-up location. The man didn’t have a car anymore and as he quipped in the moment, “What do I have to do today,” so I gave him a ride and changed my own appointment slot. The man had his wits about him but admitted he had felt overwhelmed lately. He talked about how “my Janie would do all this,” his angel until passing away 5 years ago to cancer. The man cried a little when he said that, but he smiled telling me how she used to make the best monte cristo. “I can still taste it,” he said. The man told me the story 3x on that ride. But I didn’t mind. The man, Jerry Wilder, thinks he retired in 2006, same year as my dad. He grew up in Brooklyn on Franklin Street but spent most of his adult life in greater Hartford. He and Janie had 3 kids and 5 grandkids who mostly live in the Midwest, but his daughter is nearby but busy. “She teaches the kids who have the special needs, autism, not sure which grade. I think it’s kindergarten.” I asked the man what he used to do. “I was a neonatologist. Was actually a pretty good ball player back in the 60s….had a call-up with the Kansas City Athletics, but I couldn’t hit the ball out of the infield enough." So you became a doctor I said. "I guess so," Jerry said. That man was my Moonlight Graham on Monday, on MLK day, when we think about dreaming a little and not about what is but what can be, and sometimes what was. I’m glad I left my spot to give him a shot. Was my gain.