118: The amount of funding in millions that Workit Health recently raised for its telehealth SUD treatment. The venture funds of BCBS and CVS contributed, indicating continued interest from health plans on novel models for treating addiction. Workit currently offers SUD treatment in 10 states and plans to use the funding to expand to new markets.
Seeing Straight: Arrhythmias and orthostatic hypertension can cause dizziness, panic disorders can lead to blurry vision and acute stress can cause a range of issues, including migraines, and The Department of Defense has put out a range of guidelines and recommendations for these conditions, particularly to assist caregivers and healthcare providers dealing with veterans. The challenge for the health system is these conditions and patients show up at varying stages of risk, and at different sites of service. Figuring out a way to better coordinate and track diagnostics, care and monitoring of these patients is needed.
Risky Business: Teladoc has plans to move into risk-taking arrangements, the company announced last week. Using its new virtual primary program, Primary360, the telehealth company is planning to expand beyond basic fee-for-service arrangements. This will be the first national telehealth platform we’ve seen move into this area, but it’s not entirely a surprise given the success of the many in-person PCP groups performing successfully in this space.
The Next Gene: When actor Gene Hackman said “my team’s on the court” in the classic Hoosiers scene you knew it was an iconic moment, and you knew he’d pay a price for playing with just 4 kids. There’s a new famous Gene emerging in healthcare whose moment is coming amid rising prices. Aetna is launching a network of gene-based cellular and innovative therapies, available in 2022 for the plan’s fully and self-insured customers. The network will be structured like a Center of Excellence program and will include 75+ providers who treat rare diseases. 3 therapies in this field are currently FDA approved - Zolgensma and Spinraza for spinal muscular atrophy and Luxturna for inherited retinal disease - and Aetna expects up to 9 more to be approved over the next 2 years. Gene and cell therapies carry a very high price tag and payers have been working to develop novel ways to cover these treatments, which we reported back in July of 2020.
Into Head Space: Blue Shield of CA will offer their members access to Headspace, the mindfulness and meditation app with 1,000+ stress reduction exercises. This app is among a list of other apps offered through the plan’s customizable digitally based lifestyle medicine and health platform, Wellvolution, provided through collaboration with Solera Health.
Digital Therapy For SUD, ADHD: Digital therapeutic products for ADHD and SUD are considered investigational, but a new Premera Blue policy provides a framework for when these can be considered medically necessary, including FDA approval and high quality-evidence that shows clinically meaningful improvement in health outcomes. A recent study surveying health plans showed that many payers are unfamiliar with prescription digital therapeutics and those who are familiar with them largely do not cover them yet.
Psych Shortage: The shortage of mental health providers is only getting worse, estimates the Substance Abuse and Mental Health Services Administration, with new data suggesting that by 2025 the US will have a shortage of 10,470 marriage and family therapists, 15,400 psychiatrists, and 26,930 mental health counselors. Other shortages will include school counselors, psychologists and social workers. In general, professionals are aging out of these fields more quickly than they are being replaced.
Bone Loss: At Wyoming’s recent P&T Committee, there were questions about a combo medicine used for management of heavy menstrual bleeding associated with uterine leiomyomas. Potential for ~2% bone loss worse than placebo exists in Myfembree, but outcomes are better than relugolix monotherapy. Concerns about long-term effects have led to a 24-month limit on use. The Department of Health will suggest a cost analysis.
Block or Buster?: If you ever rented St. Elmo’s Fire from the Blockbuster you are (a) old, (b) probably still owe late fees or (c) can appreciate the fact that in healthcare there is a lesson to be learned from the buster’s fall from Friday date night grace. In the next several years look out for healthcare’s next Blockbuster—a model that had its moment, filled a need, but didn’t see the forest for the trees, as a good friend likes to say. In our upcoming 2022 Healthcare Payer Index of Index we will share what managed care veterans think might just be the next declining model—the next Blockbuster of healthcare….stay tuned.
Extra Point: Bet you didn’t know that I have turned to what my dad calls the dark side...It all started when I learned that the single largest referral cost for most Medicaid plans in Texas is, wait for it, POST. Okay, that’s PT, OT, and speech therapy for the laymen. 5 years ago, one Medicaid MCO was spending $27 million a year, but managed to carve it down to a cool $18 million with some good ‘ole fashion utilization management. PT and OT need to be careful about these UM and value-based trends – will they incentivize fewer referrals and change behavior? Will the PCP just do their own therapy? Probably not to any meaningful degree, but it’s worth monitoring. I am going to try to take a page out of the same utilization control playbook here at home. For example, my 14-year-old takes an inordinate number of showers in our bathroom singing We Are The World at the top of his lungs, which is both impressive and makes me a little nauseous, but rather than implement a pre-approval rule or shower cap, I’m just going to just charge him rent. That’ll steer him in the right direction. I might just even capitate it – I’ll pay him say $50 a month, but he owes me $10 for rent, $10 for food, 50 cents for every time he fails to do his own dishes and makes fun of me when I lose my keys twice each morning, so by month’s end he’ll probably owe me! But heck I’m not scrooge - if he does his own stinky laundry and takes showers in the other bathroom, he can keep 80% of the remainder. To be honest, this is part parenting, part my work seeping into my life, and partly to help pay for college.