1M: Blue Shield California’s community investment to help the California Department of Education expand support for youth mental and behavioral health services within the state’s public school system. California’s Department of Education specifically needs help expanding access to preventive programming, scaling youth mental health training for educators, and creating a statewide Medi-Cal technical assistance guide to help more families access mental and behavioral health services across the state.
Papa Does Preach: Maybe Madonna had it wrong after all. A senior companionship company, Papa, is partnering with consulting firm Milliman to provide a mobile platform called “HealthIO” to help seniors with complex conditions keep track of their health status and recognize urgent issues. Papa will be enlisting their non-clinical companions to help seniors with socialization, technology and housework. Papa is currently in all 50 states and contracts with Medicare Advantage, Medicaid, and employer sponsored health plans.
Smoke Em If You Got Em: Aetna has expanded coverage for low dose CT lung cancer screenings. People 50 and older who have smoked 20+ packs a year are now eligible, a change from the age 55 and 30+ pack a year minimum.
Imagine All The People: Intermountain Healthcare is, wait for it, launching its own outpatient imaging business.
Playing The Blue Card: Regence BCBS and Intermountain Healthcare are launching a new preferred provider organization (PPO), Preferred Blue Option. It is part of the BlueCard program which means that by enrolling in the Preferred Blue Option network, US companies with at least 51 employees appear as though they will have state-wide access to all of Intermountain’s hospitals and clinics in Utah, including, presumably, its new outpatient imaging centers. The network will be available January 2022.
Strip Mall Senior Care: MetroHealth, the Cleveland-based health system, is opening new senior health sites beginning early next year. The program is known as the Spry Senior Care initiative and so far, MetroHealth has at least four locations identified with a goal to have 20 to 25 locations in the next three to five years. They'll be located not in larger medical buildings but in strip malls or standalone locations. Doctors will see no more than six patients per day and will aim to spend at least an hour with each.
A Network For The Little Guys: Truli for Health, a Florida Blue-affiliated company, is a new HMO being offered in select Florida markets to give small and medium-sized businesses a new option for health care coverage for their employees. Truli’s network of providers includes Baptist South Florida, Cleveland Clinic, HCA Central, Sanitas Medical Centers, Guidewell Primary Care, Guidewell Emergency Doctors, among others. Truli will also use a Center of Excellence program with the Mayo Clinic in Jacksonville.
Recruiting Nurses: To counteract the aging baby boomer population and shortage of skilled nurses in the industry, one company is partnering with a community school district to reach children as young as middle school age about the skilled nursing profession. Bedrock Healthcare of Milwaukee, Wisconsin is creating interest in young pre-teen minds for the career field of skilled nursing, especially in rural areas. The demand for skilled nursing, certified nursing assistants and aides has been steadily increasing over the past 10 years, studies have shown.
Extra Point: I was trying to figure out the source of a leak this morning when I stumbled across an old stack of steno notebooks in my attic. A few were from 2001, and one had notes from an interview I did exactly 20 years ago today with Dave Tofanelli. Dave spent a good part of his years running enterprise-wide network contracting for what was Wellpoint at the time, now Anthem. We were talking about cancer broadly when he said, “We need to change how we do this. I want to see us fly the patient, their spouse or partner or support person to one of the major cancer centers like City of Hope or MD Anderson. Pay for the hotel, the travel, everything. Make them comfortable, allow the doctors to figure out the right clinical protocol, the right drug regimen, and do a call with the local oncologist so that everyone is on the same page. I know we need to do this for cancer and other conditions. Too many things go wrong when we don’t. Wrong treatments, wrong doses. Avoidable hospitalizations.” Since that time, Tofanelli’s vision has certainly started to play out as more academic centers have expanded partnerships and more payers have expanded their benefit design to include these 1-week treatment kickoffs. Over the next 20 years, I suspect we will see more of this for other conditions and situations, particularly in the severe mental health field. Here’s an example of how this fly out diagnostic and treatment support model worked for one family whose son had been diagnosed and undiagnosed over 5 years with epilepsy, ADHD, autism and in one visit, “too difficult to diagnose.”