42: Percent of kids going off to college in August, according to a poll of my son’s 1,700 Instagram followers—up from 30% recently—who say they are bringing the following to college: a 10-pack of blue iPhone chargers, an old “beat up locker passed down from generations,” and the phone number and text for a mental health therapist. Here’s to something borrowed, something blue, and something new.
Insulin? Aisle 12: Walmart is launching its own brand of insulin, a less expensive version of Novo Nordisk’s analog insulin product, Novolog. The insulin will be under Walmart’s private label and will be known as ReliOn Novolog. It will be available at more than 4,800 pharmacies and Sam’s Club pharmacies by mid-July, with a cost of $72.88 for vials and $85.88 for a FlexPen version.
HomeRun: We’re seeing continued activity in the home health space, most recently with Amedisys acquiring Contessa Health, a hospital-at-home and skilled nursing company. This acquisition will allow the company to focus on serving higher acuity patients in the home setting. Humana also recently announced they plan to acquire onehome, a home health company, following their recent acquisition of Kindred At Home, as the plan doubles down on post-acute care.
A New ER Model Likely Faces Pressure: ProMedica is opening a dual emergency room and urgent care clinic in Toledo, Ohio, through a partnership with Intuitive Health, the health system. According to ProMedica, the new facility will be the first of its kind in the area and will eliminate the need for patients to self-diagnose and determine which level of care is appropriate. From our perspective, these models face some reimbursement challenges, so it will be interesting to see how successful these are. Payers have cracked down in the past on the door #1 vs. door #2 models, particularly in Texas where Freestanding ERs grew up. In recent years, pre-pay review is now emerging from major plans United, Anthem, and BCBS to limit over payment of visits that could be handled via PCPs or as a level 2 or 3 urgent care visit.
Latest PCP Model Goes Country: Main Street Health is a new startup with a goal of bringing value care models to rural areas. The company will help primary care clinics, independent pharmacies, and urgent care centers transform from fee-for-service to value-based contracts with private insurers and Medicare. Main Street’s initial offering, the Extra Access Program, will be available in 30 locations in Western Tennessee and will connect seniors treated by participating providers with a local health navigator and an on-demand care team.
If You Build MA, Benes Will Come: Wellmark, the Blues plan in Iowa and South Dakota, will begin offering MA plans in 2022. The health insurer currently offers only commercial and Medicare supplement plans.
Surprising Episodes: There are some episodes that catch you by surprise, some you see coming. Like I always knew we were moments from a commercial break when 1980s Mr. Roper stared with those glassy eyes into the TV on Three’s Company, but I was floored when Colonel Blake died in that MASH helicopter or when Tom Hanks purposely swallowed a bottle of Vanilla Extract because the Keaton’s were out of Miller High Life on Family Ties. In healthcare circles today, you hear a lot about episodes of care and payment innovation – some are sort of predictable, and I suppose that’s the point. Think Maternity, Hip and Knee. Some may surprise you going forward, and some seem to perhaps miss the mark on who ought to be accountable. A 12-month episode for dealing with drug addiction has promise, particularly Anthem’s, through a home-based provider out of New England, Aware Recovery. There’s a new one emerging that addresses predominantly Medicaid populations in poor housing areas who regularly present with asthma and co-occurring depression in ERs. The idea one PCP has is to use a simple home visit by a social worker, treatment led by an allergist and PCP, and a re-housing plan to either fix the environmental causes or find the patient a new home. United Healthcare is touting these kinds of community-focused models. Problem is, when you look at the traditional episodes of care (link here to Arkansas BCBS’s core list), most seem to put the ‘hospital’ as the principal accountable provider in these. For asthma, while there may be a triggering event bringing you to the hospital, the so-called accountable provider probably ought to be a PCP, a specialist, or perhaps the MSW given the social factors involved. As you build your episodes, try to see what’s coming by finding the right mix of providers and the right person to lead.
Extra Point: DAD IS AT IT AGAIN WITH A STRING OF ALL CAPS EMAILS OUTLINING ALL OF HIS HEALTH ISSUES, HIS SHOT-BY-SHOT GOLF ROUND AT THE LOCAL MUNICIPLE COURSE WITH MY 17-YEAR-OLD, AND HIS DISAPPOINTMENT IN THE YANKEES. ON MONDAY HE DELIVERED FIVE ALL CAPS EMAILS AND ONE TEXT WITH AT LEAST 30 EXCLAMATION POINTS THAT I’M SURE WOULD ANNOY JAY PETERMAN OF SEINFELD FAME. HE USED ONE EXCLAMATION POINT TO SAY THAT THE DOCTOR DID A GOOD JOB FIXING THE WOUND ON HIS FOOT WHEN HE STEPPED ONTO THE HOE SUNDAY, USED ANOTHER TO TELL ME HE HAD GRAPE NUTS AND VANILLA YOGURT FOR ALL THREE MEALS TUESDAY, THEN USED ANOTHER TO SAY HIS HEARING AIDE STOPPED WORKING BECAUSE HE WORE IT IN THE SHOWER! “MOM GOT PRETTY TICKED” HE WROTE, “BUT I COULDN’T ACTUALLY HEAR WHAT SHE WAS SAYING, SO I NODDED AND PUT ON THE BALLGAME!” SOMETIMES I STRUGGLED TO UNDERSTAND WHAT HE WAS ANGRY ABOUT AND WHAT HE WAS HAPPY ABOUT, BUT IT DIDN’T MATTER I SUPPOSE. HE WAS COMMUNICATING, AND I KNOW I’M LUCKY FOR THAT. HERE’S TO ALL CAPS!