20: Number of primary care centers Humana opens in four states this year, including Atlanta, New Orleans and Las Vegas. Leaning on Humana as your major Medicare payer for your primary care operation brings upside given the company’s investment in risk-based models and in some cases elevated PMPMs, but it also brings this evolving dynamic of competition from Humana’s Partners in Primary Care owned practice.
Staff Boom Or Zoom? Two companies merged in January to become the biggest healthcare staffing firm in Washington state. The joint company, now known as Actriv Healthcare, will employ over 400 nurses and aides and offer services in Idaho, Oregon, California and Washington. Pandemic factors have elevated the role of staffing and shined a new challenge on the system – training physicians and allied providers on how to diagnose on a Zoom.
More Fluoride or Less? Other than Seinfeld’s Tim Whatley who clearly was ahead of his time as a value-based dentist offering patients schtickles of fluoride at every visit, few oral health practitioners even know what value-based means. 86% say they haven’t heard of alternative payment models or know little about them, according to a Dentaquest poll. The study highlights the need to educate dentists about these arrangements, and underscores the potential opportunity for more sophisticated practices to become more involved in pilots and rollouts to demonstrate the impact they can have both on oral health and medical cost savings.
Ride Share: Michigan’s Blue plan is sharing more reimbursement this quarter with ground ambulance providers. Payment (billed with code A0425 and based on mileage) will depend on the number of providers who sign an agreement, but the more providers who sign on, the higher the reimbursement will be. Reach out for details.
Hear This: A hearing aid benefit is now included in Regence BCBS’s medical benefit for employer groups in Washington state with 51 or more employees. The new benefit includes a hearing aid evaluation and hearing aids.
Asleep At The Wheel: Superior Health Plan, Centene’s Medicaid managed care plan in Texas, will begin using a third party to manage certain ENT surgeries (including sinus surgery) and sleep studies beginning May 2021. TurningPoint Healthcare Solutions will process prior authorization requests for medical necessity and appropriate length of stay across all settings, inpatient, outpatient, and in home.
Monitoring Moving Up: In February, CareFirst BCBS starts covering remote patient monitoring for patients discharged from an inpatient facility or emergency room for heart failure, heart failure chronic hypertension, chronic obstructive pulmonary disease, chronic kidney disease, and COVID-19.
Not Your Grandpa’s Gym Class: BCBS of Illinois’ Little Village Wellness Center located on the Southwest side of Chicago is having its grand opening this weekend and although the pandemic prevents the center from launching its full spectrum of in-person low-impact fitness classes and health literacy sessions, the center will host virtual programs including Zumba and cooking demonstrations. The program further illustrates the changing role of health insurers from payer to provider, but also underscores their challenge—Little Village is located around the corner from Pizza Castle.
Extra Point: My Jack looked part Maria von Trapp, part Troy Bolton today hustling from jazz band rehearsal to hoops practice, swinging his trombone case in one hand, his Converse sneakers in another. The 17-year-old senior is doing what no one said he could - juggle the intensive schedule of competing winter activities in a community that says it supports kids who want to do both, but doesn’t really. He’s been trying to convince his coaches and conductors and school system for nearly a decade that he can do both and out of sheer perseverance finally is seeing the rewards. Once upon a time healthcare aired the same movie. Oncologists used to log long hours in clinic and then take unreimbursed calls from home from patients suffering from the effects of chemo. It took data, stories and perseverance to convince the health system that there had to be a better way and now, a decade removed from some of the earliest payment innovation for cancer care, these oncology practices are getting rewarded. If you listen closely, you can hear Jack warming up the instrument these days during our team’s morning call, and like a lot of you with kids who’ve come of age I’ll admit I’m going to miss that next year when he’s off to college. But I will have this as my reward from Jack’s Troy Bolton moment.