400: The percent increase in virtual care utilization since the pandemic started according to United Healthcare’s Kristin Rantala, national VP of sales and client management. Rantala says the level of telehealth “climbed so much throughout the pandemic” and has continued. Based on data from the past two years, BCBS of North Carolina has announced plans to expand telehealth coverage for primary care, behavioral health, and outpatient visits and BCBS of Massachusetts is following suit by rolling out a new virtual primary care option, allowing members to receive comprehensive telehealth through a “team of primary care providers.” The team will aim to address mental health issues and provide health coaching from healthcare providers Carbon Health and Firefly Health.
Heart Partner: Phoenix Heart, a cardiology group in Arizona, has partnered with weight loss app Enara Health to create a service focused on preventing heart disease and diabetes. Patients meet with Phoenix Heart physicians and, if eligible, use Enara’s digital platform for diet consultations, lifestyle evaluations and medication aimed at reducing cardiovascular risks and other health issues associated with obesity. The average Enara patient loses an average of 41 pounds over 18 months using the app.
LGBTQ Payer: The first Medicare Advantage plan specifically for LGBTQ adults is launching in California from SCAN Health Plan. Available to members in only two counties for now, Los Angeles and Riverside, benefits will include virtual behavioral services, legal service reimbursement and companion care services.
The Twilight Zone: Apple is planning to enter the health insurance market in 2024 through a partnership with a “major payer” Forbes reported this week. Apple will likely rely on data collected by Apple Watches, which could give the company an advantage when it comes to developing value-based arrangements, like those that are outcome-based. Feels a little too much like an episode of Black Mirror, or for those of us over 50, The Twilight Zone.
Believe It Or Not: No, not the theme song to the 80s classic TV show Greatest American Hero but a Medicaid managed care plan out west has entered into a 2-part value-based contract with, wait for it, a skilled nursing facility. The goal is to incentivize the SNF to limit weekend admissions to hospitals, particularly for patients who have 101+ fevers, and separately pay a monthly stipend on top of the per diem to help the SNF manage residents with SUD.
Rx Frequency: GoodRx is launching a platform specifically to help providers track prescription frequency and text, email or print a coupon for the patient during a visit. Providers will also be able to reach out to pharma companies directly to ask about new therapies and patient assistance programs and allow providers to compare drug costs based on a patient’s insurance.
Mental Health Access: Only 46% of 12 to 27-year-olds receive follow-up mental health care within a month after a crisis hospitalization or ER visit, according to researchers at the University of Massachusetts, and just 29% received follow-up care within seven days of that crisis. Patients who already have a PCP or mental health provider are more likely to receive follow-up care, even more so if they have both. Follow up rates are much lower for those with SUD.
Extra Point: Maybe it’s me but it seems increasingly difficult to figure out what to do. Like should I rake the leaves so I can jump into a big pile or let them wilt into the lawn. “What are you, like 6?” my wife says. Or now that I am 50, I have to start doing tests I’ve only heard my folks complain about – like that new study suggesting colonoscopy doesn’t lower the risk of mortality from colorectal cancer any more than if you just skip the procedure. I mean, that’s sort of like saying doing your homework doesn’t lower your risk of being dumb any more than if you just skip the assignment. Then there’s eating - dark chocolate can apparently increase caffeine levels in your blood and raise your heart rate, which doesn’t sound so good, but it can lower blood pressure too, which my doctor Jon Wenceslao, MD says he likes since sometimes my BP runs high. If you have kids, youth sports club teams can apparently get your young athlete a shot at playing in college, maybe a scholarship, but can lead to a higher incidence of eating disorders according to a study we have coming out on this issue, so is the old rec team better? None of my kids played on these clubs nor did they get sports scholarships to college, although our oldest Jack says he’s “not on the Indiana hoop team by choice…because I easily would dominate dad if I wanted to.” At least he doesn’t lack confidence. If you’re a doctor or nurse, figuring out what to do seems tough these days – like do you treat the pain with a drug knowing it will probably cause inflammation in the eye, requiring another drug – a steroid – creating more cost and confusion for your patient? Do you take risk or stay the course, and do you join a multi-specialty practice, hospital system, or sell to an insurer because staying independent is difficult? Maybe it is me, but maybe the easiest way to choose sometimes is just to flip a coin as Joe Dee Messina sings. Heads Carolina, Tails California.