45: Percent of people who say technical issues interfered with their ability to effectively utilize telehealth services, according to a recent study conducted by the Bipartisan Policy Center and Social Science Research Solutions. For many of us, it’s because we can’t remember our passwords, but for rural and older populations, there are more barriers, including lack of broadband internet access. Roughly 4 in 10 report these obstacles compared to 2 in 10 among younger people and those who live in cities. Some Medicaid and MA plans have started covering broadband as a benefit, like Humana’s benefit that pays for data plans up to $1,000 a year, but similar benefits are not yet widespread for most people with health insurance.
Riders Of The Storm: Our interview with new Lyft Healthcare CEO Buck Poropatich reveals how rideshare companies are trying to improve access, lower cost, and play a new role as a traffic cop, but the discussion also raises new questions about driver training. “Are we walking into a perfect storm” wonders Melissa Sampson, an ER nurse, about drivers being put into difficult positions if symptoms occur during the ride. “Like will they be able to tell the difference between a heart attack and a panic attack?” Uber has of course also entered healthcare, partnering with CVS recently to help address transportation gaps in five “Health Zones” in Atlanta, Fresno, Phoenix, Columbus, and Hartford. Read the interview here.
When The Baseline Moves: John McEnroe never believed the baseline official had it right and his iconic if not incredulous stance serves as a metaphor for those of us in healthcare prepping for the world of bundled payment and total cost of care arrangements that force us to manage to a number. 321 of your peers weigh in here in this look back on what happens if that baseline changes. Click here.
Golfers For Cataract: Not all of us have Danny Noonan to carry our bag down the fairway and track our wayward slices. One of the top questions that specialists like ophthalmologists get from many male patients who are about to get cataract surgery is, not surprisingly, ‘how soon after can I play golf….’ What is often not discussed, is just how important the surgery is for these golf-obsessed seniors who don’t hit it quite as straight and can’t see the ball off the tee as they used to. A Medicare Advantage plan’s utilization analyst, Mary Kellogg, says the plan is looking to study cataract utilization trends and related social factors, like surgery by gender, climate, and even something as obscure as to whether the patient is an avid golfer. ‘Do they need it to see the ball better or do they need it to drive to the course…two different things’. While it seems unlikely that denials for cataracts will increase drastically, with the increase in MA and medical management of vision, it wouldn’t be surprising to see greater analytics around the medical necessity. A more likely debate and trend to at least acknowledge is the likely market move to more pay for lowering infections and more in-office cataract surgery. Questions about infection and anesthesia safety factors exist but there are outcomes – a Kaiser spokesperson told us they have performed about 50,000 in-office cataract procedures without any eye inflammation complications.
Ziplining The Script: Magellan Health’s PBM division will begin delivering medications using drones later this year, pending federal approval. Magellan Rx Management, through a partnership with Zipline, will begin with members in North Carolina who take specialty drugs for chronic or complex conditions. Patients will be able to schedule their deliveries within 15-minute windows without any additional costs.
Serenity Now: Pretty sure Frank Costanza could have used this instead of his Festivus for the rest of us airing-of-grievances pole in the iconic Seinfeld episode. Calm, a meditation and mindfulness app, is acquiring Ripple Health Group, a health tech company that connects users with healthcare options. These tech plus service combinations are accelerating, namely in behavioral health.
Oncology Circa 2008: 14 years ago, Highmark and UPMC partnered in what was one of the earliest shared savings models to address the cost of cancer. More than a decade later, payers continue to find ways to improve outcomes. Anthem has created the Cancer Care Navigator program to support oncologists and patients who are at high risk of complications during treatment. Practices get access to predictive analytics while patients get access to dietitians, medication adherence assistance, individualized care plans, goal setting, and remote after-hours support. These kinds of programs were ranked #15 in this year’s Healthcare Payer Index.
Palliative Oversight: CareCentrix will begin managing post-acute and palliative care for Horizon BCBS of New Jersey’s Medicare Advantage and fully-insured commercial members beginning this May. CareCentrix will take over authorization requests for members who are admitted to or require extensions of stay at SNFs and IRFs, along with care coordination and nurse coaching for up to 90 days for patients post-discharge. They will also manage a community-based palliative care program.
Lassoism: Ted Lasso said we “gotta remember, your body is like day-old rice. If it ain’t warmed up properly, something real bad could happen.” Payers like New Mexico Blue are seeing value in warming up kids, giving a grant to the Play Sharity Foundation, which helps low-income families create active play learning environments using free bikes and scooters. If you’re going to invest in social determinants, a tip – these payers have historically used grant funding to allocate millions a year through their foundations to support 10-20 non-profits focused on social risk.
Police Partner: Nashville is expanding a pilot project that pairs mental health professionals on the scene with police after the program’s first seven months producing positive results. Roughly one-third of the 247 calls flagged as potential mental health crises led to someone being transported to treatment compared to just 5% leading to arrest or use of force.
Extra Point: I think we ought to be careful about eating disorders and generalizing who they affect. I should know. I pretty much missed all the signs. Read the story here.