70,000: The number of new healthcare jobs added in July, according to the Labor Department’s monthly job report, bringing the industry within 0.5% of its February 2020 employment level. In a sign of the way healthcare is moving, the majority of those jobs were in ambulatory services, ~47,000 compared to just 13,000 in hospitals. 9,000 new jobs were in nursing and residential care facilities.
Drug Cost Sea Change: CivicaScript, part of a nonprofit launched by several health systems and 18 BCBS plans, launched its first drug this month, abiraterone, the generic form of Zytiga. Prostate cancer patients taking this drug will likely pay thousands of dollars less through CivicaScript. A month's supply will be sold to pharmacies for about $160 a bottle, with a maximum retail price of $171 — about $3,000 less than the average cost for someone with Part D coverage, according to the company. The company plans to launch several more generic drugs, with the goal of addressing drug shortages and bringing drug costs down.
Prepay Review: Outpatient claims for more than $100,000 billed as a percent of charges will be reviewed before payment is made under an expanding program from Anthem (now Elevance). This prepay policy has been in effect in NH, NY and VA and now expands to other Anthem states retroactive to July 1. Other Anthem states are expanding these reviews to include ASC claims and claims when a patient is out of the normal network area and a different BCBS plan processes the claim on behalf of the patient’s home plan. Anthem CO, IN and NV are also lowering the dollar threshold to require line-item claims review starting at $50,000.
CVS’s Direct Care Strategy: “We can’t be in … primary care without M&A—we’ve been very clear about that,” CEO Karen Lynch said on a recent earnings call about how the retailer will acquire providers, possibly starting with Signify Health, a home health company, as part of a direct care strategy. “We are expecting to enhance our health services in 3 categories…primary care, provider enablement and home health,” The healthcare conglomerate will also continue to focus on expanding their existing MinuteClinic and HealthHUB offerings and working with Amvell on a new virtual primary care offering.
Post-Acute Hurdle: Beginning November 1, Empire Blue of NY will begin requiring prior authorization for admission to or concurrent stay in a skilled nursing facility, an inpatient acute rehab facility, or a long-term acute care hospital. Reviews will be completed by myNEXUS services for Medicare Advantage individuals, group retiree solutions, and dual-eligible plan members. Clinicians will collaborate with patients, caregivers, and facility care managers/discharge planners to provide transition planning as well as authorizations.
Brain Miss: A new study shows that depression is probably not caused by a depletion of serotonin as once previously believed. Research published in Molecular Psychiatry states that the theory of depression resulting from a chemical imbalance, while still influential, is likely hypothetical. The study showed that serotonin receptors were no different in people with depression and people without depression, and that serotonin activity was actually increased in people with depression.
What’s Your ETA? MedArrive, a home-based technology company launched by a former Lyft and Uber executive in 2020, is partnering with Brave Health, a telebehavioral health company focused on Medicaid and Medicare populations, to integrate virtual mental healthcare services in the homes of Medicaid patients. Through the partnership, if MedArrive identifies an eligible health plan member in need of mental health support, their field providers can immediately refer that member to Brave Health’s behavioral health providers in real-time and schedule care within 72 hours.
Mobile Clinic West: Perhaps not the nostalgia of the covered wagon circa 1850 but a new initiative to provide mobile healthcare services in underserved areas in six Oregon counties and parts of Southwest Washington offers the same concept. The Care & Connect Clinics, part of a new Kaiser Permanente Northwest and Medical Teams International program, will offer emergency dental services, referrals for low-cost specialty services, and screenings for hypertension, diabetes and mental health issues. They’ll also help patients connect with community-based organizations to address SDoH issues like food insecurity and housing needs. Kaiser Permanente says they are offering 14 community-based and culturally specific organizations $20,000 each to help host the clinics and support referral work.
Extra Point: What if healthcare had its own fantasy draft? There’s less than a month to football season and for what seems like most of the U.S. that means draft night, an odd but important tradition of churning out a so-called fantasy roster, then bragging about it. I’ve never won, but I find the entire industry a fascinating study of human behavior. A fantasy healthcare team is not that unlike a multi-specialty practice if you ask me. I suppose most would draft a strong primary care doctor at QB, perhaps not first, but in an early round, though it’s conceivable many draft a specialist first like a cardiologist or orthopedist, though I’m inclined to say an allergist or behavioral therapist may be worth a flier, particularly in leagues where you get points for “catching” things early. Heck, three-quarters of actual NFL teams employ psychologists. I would be shocked if podiatrists would be selected as kicker any earlier than the final round, and outside of helping treat planter fasciitis and diabetic-related foot issues, their role in helping your team win is likely limited. No offense podiatrists. You could roll the dice on a plastic surgeon in round 4 or 5 as your tight end, obviously, but that might be costly if you’re in a league where physical therapists, aka running backs, gets lots of points per yard. If you could draft a medical trainer, I’d say the most accessible might be Uber, and if you like to shake things up and draft your defense early to annoy everyone, just do what most do, order lots of lab tests and get yourself some beta blockers.