20%: The difference in reimbursement rates for ABA providers now that BCBS of Texas will begin tiering them for ABA therapy, effective April 2021. RBTs, Board Certified Assistant Behavior Analysts or clinicians with a bachelor’s degree will receive the existing rate, while clinicians with less than a bachelor’s degree and no RBT certification will receive 20% less. BCBAs and master’s level clinicians will receive an increase in rate of 20%.
Gender Policy Winners: A new policy on gender surgery is likely a boost to mental health provider volume. Aetna is updating its commercial policies to include gender-affirming surgeries for transgender women, after several members came forward who had been denied coverage for breast augmentation. Aetna worked with a law firm and a nonprofit org representing these women to redesign their clinical policies around transgender surgeries. Under the new policy, the member must have a letter of referral from a mental healthcare provider, offer evidence of their history with gender dysphoria, and have already completed a year’s worth of hormonal therapies before they receive the surgery.
Puerto Rico: Like the game of RISK, payers continue their move into new markets. Anthem will acquire the largest MA plan in Puerto Rico, the plan announced last week. By purchasing MMM from InnovaCare, Anthem will also gain the 2nd largest Medicaid plan in PR, alongside a network of specialized clinics with over 10,000 providers.
Monitoring Parkinson’s: Apple released a new study showing that the Apple Watch can be used to monitor symptoms of Parkinson’s disease. The watch is able to detect the motor symptoms that result from Parkinson’s and by monitoring these movements, researchers can identify the “on” and “off” patterns of a medication’s effects. Physicians often have to rely on clinical visits and self-reporting to monitor Parkinson’s progression; adding something that is relatively low cost and tracks data constantly could be a real help to patients and their physicians as they make healthcare decisions around treatment
Home Run Or Risk: Humana is launching a home healthcare service that includes remote patient monitoring. They are partnering with DispatchHealth to launch the hospital-at-home program in Denver and Tacoma, WA, for patients requiring care management for multiple chronic conditions, with plans to expand the service to Texas, Arizona and Nevada later this year. One medical director is intrigued by these models but acknowledges the risks – “Reminds me of freestanding ERs – they ended up costing us a lot more by splitting true emergencies like chest pain – how much of this care can really be handled at home?”
Doctor Baker: Straight out of Little House on the Prairie, Heal, a provider of in-house primary care services, including physician house calls, has expanded into Illinois, the Carolinas and Louisiana. Previously, its services were mostly confined to the East Coast. Heal is now available in 12 states and can reach 134 million Americans, the company said. It offers a combination of house calls and telemedicine services on demand.
Dental Switch: Careington, a TPA that also owns and operates large discount and PPO dental networks, is launching a national teledentistry program through affiliate company DialCare, offering 24/7 access to licensed dentists via phone or video consultation. Teledentistry has become a trend over the past year, with more payers promoting these services and more members utilizing them.
Stage 3 Wounds: United’s Medicaid plan Texas has partnered with a wound company targeting patients with stage 3 or 4 pressure wounds. Vohra Wound Physicians will manage outpatient wound care via telemedicine, dispense wound care dressing shipped directly to the member’s home, and prescribe wound related medications or antibiotics.
Extra Point: I love my mom’s stories about the nursery school kids peeing on her in the hallway. She would take about 3 hours to tell them but boy were they funny when she finally got to the punchline. She always laughed as she shared how little Johnny “made a puddle by the legos.” But mom didn’t always laugh, especially when I used to drop an F-bomb about my below par social life. It was as though she had a bar of Dove soap in her pocket for those moments. If I learned anything about mom over the years, it’s that she may have been behind the scenes, but she was in charge – the President in our house. On Monday, we celebrate the country’s 46 presidents, none of them women. Overall, women make up about half of the U.S. labor force but less than 5% of Fortune 500 companies, as of 2018, had a female CEO. There’s been some progress. In healthcare, Helen Arteaga Landaverde started as new CEO at Elmhurst Hospital in Queens this month and about 22% of hospital CEOs are women today, up from 10% back when I worked for Rosanne Griswold at Charlotte Hungerford Hospital in 1998. I was a nervous pup reporter back then writing publications on the side for the community hospital but I didn’t really blink when I was interviewing her. After all, I was used to female Presidents – my mom Brenda Antonelli, and now today, my