40%: Proportion of MVP Health Care’s Medicaid members who have not seen a primary care provider in the last 18 months. To change this, MVP, a health plan with members in New York and Vermont, recently launched a bilingual app for its Medicaid members that will connect them with primary and specialty care. The health plan partnered with Galileo, a tech-driven medical group, to create the virtual offering as a way to help members access services despite impediments many of them face, including transportation and language barriers.
Dog On It Ortho: Orthopedic specialists and some health insurers report an uncanny number of ankle breaks from dog owners who hang on to the leash while Fido sprints away, causing an unnatural twist of the ankle. Surgeries for ankle repair are rising and so is appetite to create a bundled payment for the surgery, like $7,500 for the surgery and a month of PT. Challenge for the patient is rehab is often a year-long struggle including strength and conditioning and pain management and, in many cases, need for surgery again. Pricing these is challenging. “The biggest challenge is the rehab – a lot of non-compliant patients,” says Mark Cote, director of outcomes research and quality for the UConn Musculoskeletal Institute.
Credentialing Gains: For behavioral health providers like Mella Health, a start-up telehealth provider, credentialing providers has been challenging and this has affected ability to schedule appointments, but it is getting better. “Initially it was 60-90 days, but now we have some group contracts (need at least 5 providers) so it’s taking less time,” says founder Ivy Patt, PhD, a clinical psychologist in Connecticut. On average, it is taking providers 30-45 days, but can take 3 months.
Welcome To The C-Suite: Not so long ago, circa 2002, health systems decided to create value analytics committees to assess the cost-benefit of devices and implants and now, two decades later, they are creating dedicated roles to expand value-based care. One hospital in New England appointed a Chief of Social Services to lead efforts to build joint community housing and wellness centers, Nemours Children’s Health System hired a Chief Value Officer, joining the ranks of NYC Health + Hospitals, Mayo Clinic, and Novant Health. Expect a majority of hospitals to create these positions by the mid 2020s, similar to how they have evolved chief strategy and chief patient experience positions.
Tele Advocacy Push: A new telehealth advocacy organization recently launched to help ensure patients across the country have permanent access to telehealth. ATA Action, led by the American Telemedicine Association, along with groups like HCA, Intermountain, Walmart, Teladoc and others, will advocate at the state and federal level for continued coverage beyond the pandemic as well as appropriate reimbursement policies. There are gaps that remain in telehealth, like restrictions limiting ability for psychologists to treat someone in a state where they aren’t licensed. But there is some progress. UCLA has created a problem gambling intervention service that several have used and it may be accepting patients outside of California given some relaxing of teletherapy regulations.
Mass Move: Earlier this month, Harvard Pilgrim Health Care and Tufts officially completed a merger that had been in the works since August 2019. The merger increases the overall market share of the new health plan, Point32Health, which now serves 2.4 million members across Massachusetts. BCBS MA is still the dominant payer in this market, but since Fallon Health announced in 2021 that they would be leaving the commercial insurance market, Point32Health will now be the second largest payer and more important for providers.
Imaging Network Change: UnitedHealthcare is launching a program to steer patients toward low-cost imaging centers. Hospitals and freestanding imaging centers contracted with UHC can submit an online questionnaire demonstrating their services meet certain thresholds required to become a Designated Diagnostic Provider. Beginning January 1, 2022, for fully insured small group plans and July 1, 2022, for large group commercial members, high-cost imaging services, including MRI, CT, PET scan, MRA, and nuclear medicine must be performed by a Designated Diagnostic Provider in order for a patient to get the lowest out-of-pocket cost. UHC implemented a similar program for diagnostic lab services last year, though there was significant pushback from providers.
Walmart Steering Care: Walmart employees now have more tools to help find top providers, thanks to the employer’s new collaboration with tech company Health at Scale. Health at Scale’s software shows provider recommendations based on outcomes, ratings and other metrics for over 25 different specialties, along with 34 procedures and imaging services. The company also utilizes AI to match patients to the right providers and treatments.
Retinal Screen: MedArrive, a tech and healthcare services business focused on home-based care, has partnered with data-science company Spect to bring retinal screenings to people’s homes. MedArrive providers can now use Spect’s AI-enabled telemedicine platform to perform screenings for diseases like diabetic retinopathy, glaucoma and age-related macular degeneration.
ASO vs. Fully Insured: In an example of differences in managing utilization, Regence BCBS is removing prior authorizations for most chiropractic, acupuncture, and massage services for its health plan members. Providers will no longer need to go through eviCore for authorizations, unless the member is part of an ASO group that requires them.
Olympic Dreams: Healthcare ought to form its own Olympic games, if for no other reason than to give us a more interesting alternative to curling. I mean, curling seems to be the only primetime option every time I turn on the TV and I’m pretty sure it’s the least entertaining event, like ever. One of the players was wearing a v-neck sweater and khakis of all things, looked like my 7th grade biology teacher Mr. Boehm. The sport looks at times like an aggressive dish washing contest and would be more palatable perhaps if players could blitz like in football, but what do I know. If healthcare formed its own games, there could be races pitting teams of caregivers and seniors filling pill boxes or optometrists competing to get as many teens as possible to put in contacts within an hour. PTs could square off to see who is faster at improving range of motion for patients coming off ACL repair and the new wave of home delivered meal companies could race, literally, to deliver the most meals. Of course getting patients to eat those meals is another story.
Extra Point: Please pray for my 14-year-old Tommy who has to write two actual paragraphs by next Thursday about what it means to be healthy, and for my 78-year-old dad who walked into the shower again this week wearing his hearing aids. My bride also could use a prayer – she started as an adjunct teaching religion to college freshman nursing and music students and is getting peppered with questions about how to talk to sick and terminal patients about faith, and perhaps if there may even be a way to cure disease just by holding a hand or singing a song.