$43.9b: The amount spent on outpatient drugs through the 340B program in 2021, according to a new government breakdown of spending. Disproportionate share hospitals are the largest purchaser of 340B drugs by far, followed by children’s hospitals, rural referral centers, and Ryan White programs. The difference between list prices for drugs and discounted 340B purchases grew to $49.7b, per Drug Channels.
Mind Games: A collaboration between Highmark Wholecare, the health plan’s Medicaid and Medicare division, and Posit Science aims to utilize brain training software to prevent falls. By identifying members who have a high fall risk, the app uses exercises that target accuracy and visual processing speed. These games aim to help the brain adjust body movement and prevent falls. The program is offered at no extra cost to eligible members, which Highmark reports is close to 7,000.
Hospital At Home Expands: We previously reported that Elevance (known as Anthem) began accepting claims for acute hospital at home services just in Virginia but it appears the insurer is going even further and is accepting hospital at home claims under all of its commercial, Medicare Advantage and Medicare Advantage Special Needs plans across all states. The policy went into effect over the summer and Elevance continues to encourage qualified hospitals or other entities that meet its requirements to reach out to their health plan contractor to get an appropriate participation agreement in place.
Walmart’s New Partner: Walmart Health is partnering with United on a 10-year affiliation in an effort to bring affordable health services to select Walmart locations. The collaboration involves Optum, a United business, and will assist Walmart Health clinicians through analytics to deliver care for seniors and Medicare beneficiaries. The partnership begins in 2023 with 15 locations in Florida and Georgia and likely expands to new states over time.
Shine Bright: Popular behavioral health app Headspace is focusing on more personalized mental health care through the acquisition of an app designed for the unique challenges with the black and indigenous people of color community. The app, called Shine, serves 45,000 paid subscribers and 6 million total users and tailors its content to marginalized communities including women and people of color.
Virtual Benefit ReDesign: HCSC will begin offering virtual primary care in 2023 to limited midsize and large employer groups in IL and TX. The virtual primary care network is supplemented by Teladoc and is intended to help employers with employees scattered across diverse geographies get timely access to care. Members receive a welcome kit with a blood pressure cuff and heart rate monitor so they can provide vital data to their health care team. The offering also includes virtual urgent care, behavioral health, and dermatology.
Scheduling A New Patient: In 2022, it takes 8% longer than it did in 2017 and 24% longer compared to 2004, according to a new survey from AMN Healthcare. The staffing agency tracked appointment wait times in five specialties: obstetrics/gynecology, cardiology, orthopedic surgery, dermatology and family medicine. The average wait for an appointment across 15 large metropolitan markets is now 26 days, up from 24 days in 2017 and 21 days in 2004, when the survey was first conducted.
Extra Point: Next year our two daughters are transitioning – one into college, one out – and, like a lot of healthcare companies, both are facing the obvious questions like are they ready for what’s next, do they have the skills and tools, where should they go, who should they go with, and how much risk should they take. Healthcare companies are facing similar transitional questions—are they ready to make the change to value-based arrangements, do they have the skills, the tools, and the culture? There’s been comfort and familiarity in fee for service, but there’s an unknown ahead. Are their clinical protocols the right ones? Will they need to adjust how often and why they order diagnostics – do they manage patients by testing or clinical judgment? Will they need to spend more to monitor their patients after they leave the clinic and is the cost of this investment worth the bonuses and fewer administrative requirements? And even if transitioning to these arrangements is necessary, which one is best--pay for performance, share of savings, global risk, or something in between? My daughters are facing similar uncertainty – which job or school is right – and like the doctor group who takes care of young and older adults, how much “downside” risk should they take and on what services, with which insurers and patient populations? How quickly will they need to transition and show performance and is there a state or city they should go to that will make the transition the most successful? It would seem obvious, to most, that you’d pick the biggest insurer in a state like BCBS to partner with, but that’s not always the case. In fact is your partner always the insurer or is there another better, safer, smarter partner to align with? And perhaps most of all are they ready for when things go wrong and every right decision doesn’t go your way and the patient ends up in the hospital 5 times in 5 months? For our girls, I hope they have learned how to be independent and make good decisions and, yes, how to make an egg without burning down the house, but I suppose it’s more important for them to know that when they fail or when things go sideways, that they have a way to get back up.