24: No, not Kiefer Sutherland’s best performance but the portion of seniors who fall due to dehydration, end up in rehab, then fall within 6 months for the same reason based on a study of a cohort of patients with 6 common traits – undiagnosed dementia but significant short-term memory issues, live by themselves, widowed, limited caregiver support, limited social circles and no mention of “daughter” or “daughter or in law” in the medical record. The study, which we did in collaboration with 3 rehab centers in Boston’s north shore, is based on 292 admissions between 2019 and today related to a fall. It’s not surprising that one quarter have a reoccurring event with these common traits, particularly the lack of involvement of a family member. One nurse at Ledgewood Rehab told us that when a daughter or daughter in law is involved there tends to be a higher chance that mom or dad will be set up with more aid at home, including a personal emergency system and a companion to eat meals with. A “7th” trait was common in about 15 of the 192 patients was they or their families acknowledged that their parent had never fully grieved the loss of their spouse, never saw a counselor, and that this led to a general decline in health and socialization.
Tele Expands: Amwell, the telemedicine provider, purchased 2 digital health companies which it plans to integrate into its virtual care platform. SilverCloud Health is a digital mental health platform that offers cognitive behavioral health programs in Ireland and the UK, including to the UK’s National Health Service, and will help expand Anthem’s reach in those countries. The second company is Conversa Health, an automated health service, which will help Amwell improve care coordination.
Surgical Equity: Penn Medicine recently established a Center for Surgical Health that focuses on improving health equity and access to surgical care for underserved populations who may otherwise seek treatment at an ER. Surgical residents and faculty will oversee the center and expect to provide surgical care to 175 patients in 2021. Most patients will be referred to the surgical center from Puentes de Salud, a nonprofit that serves Philadelphia’s Latinx immigrant population, and the University City Hospitality Coalition, which provides meals to homeless individuals.
Hospital Goes Home: BCBS Michigan is expanding its Hospital Care at Home program, which it jointly runs with Michigan Medicine. The pilot began last year, focusing on commercial members with CHF, COPD, cellulitis, pneumonia and UTIs. The program will now include MA members, and a range of other acute care diagnoses that can be safely treated at home. In related news, more than 50 hospitals will use a new solution from Signify Health to provide Medicare patients with hospital at home services. Through virtual and telephonic clinical and social care coordination, Signify’s solution will support Medicare patients for 90 days following discharge from an acute care facility.
Diabetes Change: The FDA has approved the first interchangeable biosimilar for insulin, which is known as Semglee. An interchangeable designation means that Semglee can be substituted for Lantus automatically by pharmacists without physicians' permission. However, many states have enacted laws in preparation for this approval, and patients will have to be informed they are receiving a biosimilar substitute. The approval of this interchangeable biosimilar has many hoping it will result in more competition in the insulin market, bringing down costs.
Alzheimer’s Niche: Biogen, the company that created the Alzheimer's drug Aduhelm, says the FDA has narrowed use of it after the agency drew sharp criticism for its broad approval of the drug last month without proof of clear benefit against the disease. Biogen is now changing its label to be used only for Alzheimer’s patients with mild cognitive impairment or mild dementia. The new label also says there is no safety or effectiveness data on initiating treatment at earlier or later stages of the disease.
Carolina Integration: Centene announced WellCare of North Carolina will help coordinate physical health services for multiple Local Management Entities (LMEs) for the state’s Behavioral Health and Intellectual/Developmental Disability Tailored Plans in an effort to bring a more integrated member-centered approach to individuals living with significant behavioral health conditions. The changes are expected to take place August 2021.
Nebraska Emergency: BCBS Nebraska stopped requiring credentialing for ambulance providers, including air ambulances. Ambulance providers will still need to contract with the health plan.
Sports Complex: Peach State Health Plan of Georgia announced a new partnership with Healthy Foundations to assist in the development of the Health Community Resource Village, with the inclusion of a $25,000 donation from the Health Plan to be used for the construction of an outdoor sports and recreation pavilion on the planned community village campus. The community village campus will offer a variety of low-cost behavioral and healthcare services including housing, addiction care, and veteran services.
ExtraPoint: My 17-year-old and I take to the road this weekend for a 100-mile bike ride. I’m already nauseous, probably because I only ride a bike once a year and because I am awfully short and generally consider hills as things to slide down, not ride up. But I am looking forward to the companionship out there as Jack and I try to raise a few more dollars for cancer research and share a few laughs when I fall over at the stop sign. This will be my 11th year riding the Pan Mass Challenge, but my first time with the kid, and so he will see me at my worst. You see it is awfully embarrassing when I roll slowly into an intersection with 5-year-olds cheering, holding out flavored ice and holding “thank you for saving my mommy’s life” signs, unable to unclick my bike shoes and slowly and pathetically timbering, cursing on the way down, and then crying….but riding a bike is good for your health I’m told. A lot of healthcare companies are now adding spin classes into their set up, some removing the tired waiting rooms and replacing with stationary bikes. Some of the big insurers are buying housing units and revamping them with health services and gyms. A lot of the focus is on inner city Medicaid populations but there’s also a lot of need to support seniors. I did a spin workout this morning with a bunch of 70 and 80 somethings and I suspect if more seniors kept moving as they age that the incidence of falls from dehydration and being sedentary would diminish. When I ride, I tend to think back to those days where I came of age on a huffy. The Huffy was a right of passage for kids of my generation. Before skateboards and 10-speeds, there was this dirt bike that made you feel like you were on Fonzi’s motorcycle. Having it even for a summer meant you were cool and that your parents were cool for getting it. Sure, I may have had a bowl haircut, polyester bell bottoms, and the beginnings of a 5 o’clock shadow, which is rare and awkward for an eight-year-old, but that bike gave me street cred. Bobby Lynch and Ben Elleck, both a year older and 10 inches taller, were suddenly looking up to me. Even Bobby’s older brother, Mike, stopped teasing. “That yours?” he’d say gruffly. Then he’d nod his head, almost to say, “You’re okay Cote.” I decorated my Huffy for the July 4th “horribles” parade around Archie Lane that year, decked it out with cray paper and signs made from oak tag scraps held together with 5-layers of scotch tape. I rode in the center up-front position, Bobby and Ben flanking me, all of us holding red, white and blue popsicles. I put a lot of miles on my Huffy, at least a hundred that summer, I bet. I rode it through the back woods with a walk-man hooked to my shorts, playing track 1 from my Survivor cassette tape (“I Can’t Hold Back” for those who don’t follow the best band ever). We set up jumps over quick sand Mom told us to avoid, crashed into dirt piles, dusted off our cuts and scrapes and got right back on. I went everywhere on that bike. On Sunday this weekend I sort of hope to reimagine that time with Jack, hopefully do a little bit to help people suffering from cancer and, with any luck, fall into a nice bed of grass...