62: The percentage of consumers who are not familiar with value-based care, according to a recent study conducted by EmblemHealth. The health plan surveyed 970 consumers online in 2021 and found that more than half were not familiar with the concept at all, and only 25% of those familiar with VBC could correctly define the model. My own bride, who occasionally has to listen to me carry on about all things value, thought it had something to do with vouchers for supplies for people who stop smoking or lower cholesterol. If the healthcare system wants to truly move toward value-based payment models, maybe we should make sure that the patients themselves are in the loop.
A New Pack: In an interesting move, Quest Diagnostics is acquiring Pack Health, a patient engagement company that tracks behaviors like medication adherence, diet, exercise and other issues with the goal of improving the health of patients with chronic conditions.
Toothpicks: Seinfeld dentist Tim Whatley has competition. Two recent partnerships will expand access to remote dental care. First, BCBS AZ members will now have access to 24/7 virtual emergency dental care through a partnership with teledentistry.com while Oral-B has partnered with Grin to expand access to their app that can measure changes to patients’ teeth.
Faster Time To Behavioral Screen: FL Blue’s behavioral health benefit manager, New Directions, acquired digital behavioral health company Tridiuum, which has automated behavioral health screening, triaging, and matching capabilities. This acquisition was built from a partnership the two companies had, which within 5 weeks resulted in the screening of over 450 individuals and reduced the average speed to a first appointment from 25 days to 4 days.
Go Doc Go: Aetna is now working with home health provider, DocGo, providing 2.5 million Aetna MA and commercial members in New York and New Jersey access to mobile at-home care, including episodic and emergency care.
At Home Kidney Care: Medica is one of many health plans focusing more on members’ kidney health. Starting this year, at-risk patients will receive Health.io’s Kidney Check kit in the mail, which allows members to perform an at-home urine test, looking for elevated levels of albuminuria. Patients who receive abnormal results will be able to then schedule an in-person appointment with a provider.
Trying To Curtail Duplicative Care: A new study by Cigna and MDLive found, unsurprisingly, that utilizing virtual healthcare visits saved members both money and time. By looking at actuarial data, Cigna found that patients who saw virtual providers had 19% fewer visits to the ER or urgent care. In addition, virtual urgent care visits reduced duplication of care by 16% compared to other virtual primary care providers or specialists. Their study also shows that the average cost of a non-urgent virtual care visit is $93 less than an in-person visit, with virtual specialist visits averaging $120 less and virtual urgent care visits averaging $141 less.
Baby Shark’s Script: Shark Tank judge Mark Cuban launched an online pharmacy last week that focuses on offering generic drugs at a lower cost. The Mark Cuban Cost Plus Drugs Company is a pharmaceutical wholesaler, which means they purchase drugs directly from manufacturers, bypassing middlemen to lower the price of more than 100 medications. The online pharmacy’s prices for generics factor in a 15% margin on top of actual manufacturer prices and a $3 pharmacist fee and the company does not accept insurance. Customers will pay out of pocket, but the pharmacy said those costs will be less than most health plans’ deductibles or copays.
Carrot & Stick: In our recent poll on the adoption of value-based arrangements, nearly 50% of respondents said value-based payments will be the dominant form of how healthcare providers are paid in 10 years. Most expect the models to look similar to models that exist today, including pay for performance, shared savings, and full risk, but expect more providers to enter these arrangements, perhaps whether they want to or not. As one health plan executive noted, “Dangling carrots no longer works” – maybe we’ll see health plans focusing more on sticks?
Top 20: Unlike the often stale Top 20 of college football and basketball, healthcare’s rankings are beginning to get a fresh new look. Cardiology and social services crack the Top 10 of healthcare payer priorities this year, representing nine services making their way up the rankings, while five services debuted in the Top 20, including interventional pain management and wellness centers—both likely getting more managed care attention in the year ahead. GI, perhaps the least managed specialty, moved up nine spots to no. 3, as more payers expect to focus on medical necessity of procedures like esophagoscopy. Stay tuned for the 2022 Payer Index coming out in February.
Extra Point: I’m lucky that I have access to more behavioral health therapists, psychologists, psychiatrists and social workers than I can manage – so many I should probably just start my own network – but when it came time this week to help an old friend find a specialist for his kid to help him deal with his addiction, I struck out like poor Casey at the Bat. Everyone tried to help, offering connections, advice, even sub-specialists, and yet despite this kind of VIP access, the rules have left me waffling without a next step, much less an appointment. Regulations limit the ability for a licensed therapist to treat someone in a state where they don’t have a license, making it awfully difficult to get appointments at all, much less halt a crisis. So if I struggle to get access, I wonder about those far less connected, and I wonder if there might be a better way, not just to allow for treatment without barriers but to measure and rank therapists like we do athletes or songs, or at least organize them by skill, efficacy, empathy – let the market drive choice. I mean, with my Connecticut license to drive I’m pretty sure I’m allowed to make my way west in my blue-rusted 1998 Volkswagen all the way to say, Missouri, pay the state tolls there, pay the rest stop gas station for a fill-up and a cup of coffee, pay the Super8 for a bed and breakfast and even get reimbursed for the whole trip…but a license to treat mental health across state lines - to help a kid who’s struggling 2,000 miles away to prevent a spiral that’s already started - that doesn’t seem to mean squat.