7M: The number of women in the US who live in maternal health care “deserts,” areas with limited or no access to these health services, according to a new report from March of Dimes. The number of counties without any obstetric providers or obstetric care in local hospitals has grown 2% since 2020 and one of the driving factors is hospital closures – since 2005, over 180 rural hospitals have closed. These deserts are also more likely to be found in states that have restricted abortion, creating an even bigger imbalance in healthcare options for women in these areas.
Waiving “Test” Approval: In a positive trend, starting January 1, 2023, prior authorization will be waived for certain biomarker testing for Premera BCBS Washington members living with cancer. The cancer must be stage III or IV, or has come back after treatment, not responded to treatment or spread throughout the body. AIM Specialty may still perform retrospective reviews for these services occasionally.
Move Over Medicine: 21,418 males age 12 to 22 took our sports poll last week – 28% think Kansas City will win the super bowl, 32% don’t have Larry Bird in their top 20 all time – which is ridiculous, but what do the youth know anyway? Actually, maybe a lot more than we give them credit for. 57% have had or would consider using mental health therapy to help them “juggle stress, including the ups and downs of sports pressures”- nearly 1 in 4 who’ve had a therapy session say their friends know and, not surprisingly, for the 21% who say they have had at least one session with a therapist, the number 1 best advice they got and used was, drum roll, “low stress exercise therapy.” Think kickball or pickup volleyball.
Retail Diversity: Walmart is launching a research institute focused on improving clinical trial diversity. The company will leverage its large consumer base and try to expand access to older adults, rural residents, women, and minority populations by serving as a connector between drug researchers and potential trial participants. They plan to start with trials of drugs that most impact underrepresented communities, including treatments for diabetes, cardiovascular disease, COVID-19, and asthma, and are considering areas of research like HIV and dementia. Similarly, CVS is partnering with historically black colleges including Florida A&M, North Carolina A&T and Morehouse College to elevate opportunities in underserved areas. Its pilot program with Morehouse called Accelerating Growth Activators consists of 13 minority-owned businesses that supply services and products to the healthcare industry.
Shark Attack: Capital Blue Cross in Pennsylvania is the first health plan to partner with Mark Cuban’s Cost Plus Drug Company. Beginning in 2023, members will be able to get their prescriptions from Cost Plus Drugs, which sells medications for only 15% more than it pays manufacturers. Because BCBS plans don’t own their own pharmacy benefit manager and specialty pharmacies, we may see more signing up to work with Mr. Cuban.
Homeless Center: The city of Austin has partnered with the public hospital district here in Travis County called Central Health to build a permanent healthcare facility for those experiencing homelessness, a Public Health Committee meeting confirmed last week. The district is contemplating 30 to 40 respite beds to the 10 that are already available through various medical facilities. For providers, do these new housing investments represent opportunity to provide healthcare services?
Who’s Right?: 46-year-old Jane’s pinched nerve became debilitating. After two weeks out of work without improvement, her PCP prescribed Gabapentin to treat the pain but her physical therapist said the drug had significant side effects, including drowsiness, may be difficult to taper from and may make it difficult to know whether the PT exercises and strengthening were working. “Tylenol would seem sufficient, even for a severe pinched nerve,” the PT said. Six weeks since onset, mobility has improved and pain persists, but Jane is at ~75% function – so much better – but still on the drug. Were both practitioners right? Could Jane have recovered more quickly? Is there still risk? These are the kinds of very specific treatment plan decisions that can be improved when PCP and specialists talk. In Jane’s case, she played middleman, advocate and was confused about what to do. The PT and PCP haven’t spoken once.
Extra Point: Well, there seems to be a movement away from having to get pre-approval for everything in healthcare, even if that same trend isn’t happening for husbands. Several laws are in the works – including one moving through Congress that if enacted would require Medicare Advantage plans to publicly share their pre-approval rules and denial rates. That may not move the needle right away, but insurers are at least now more willing to waive pre-approval for providers who meet a certain standard, or for patient situations where requiring pre-approval makes little sense. The cost to pre-approve can be significant – for insurers, it can be hundreds per case, and for practices, it can mean taking clinical staff away from patients. Insurers often kick back requests faster than the Roadrunner. “It’s fairly automatic - we usually require a couple of weeks of progress notes when it’s a reauthorization – sort of why we exist,” quipped one of my basketball buddies who works as a utilization analyst for a northeast insurer. Lifting pre-approval requirements is probably good for patients on the whole, but candidly I’m not holding my breath that this same trend will sweep through my house. God love her, but my bride requires me to get pre-approval for many things, likely because I let my 3-year-old run free during a birthday party at the mall in 2006, while I typed on my laptop in the food court. I didn’t pre-verify birthday etiquette. “Did you even know Jack was running naked through Filene’s Basement?” Bridget said during our post-mortem. “Well, no, but in my defense, I managed to get him home with his clothes on. So we got that going for us.”