46: The percentage of Americans who have been in debt due to medical bills according to a new survey conducted by Babylon, a digital first primary care service. Another 34% of Americans said they are struggling or will struggle to pay their healthcare maintenance costs, emergency needs and private health insurance. Younger adults between the ages of 25 and 34 were most likely to report struggling with costs, with 56% saying they are struggling or will struggle to pay for health maintenance costs.
Case In Point: Monthly and weekly case rate or value-based agreements tied to acuity level and specific quality metrics, like lowering use of prescriptions, limiting side effects from co-occurring medical issues and preventing readmissions, are growing in popularity. The insurer Point32 in Massachusetts now has one for an autism treatment company, Aetna’s Medicare Advantage plan now has one with Amedisys for home-based care and Cigna reportedly has one with in-home primary care group Heal in Georgia, Illinois, North Carolina, and South Carolina.
Retail Therapy: Walmart Health plans to open 16 new health centers in Florida in 2023, adding to the first 6 Walmart Health locations that opened in the sunshine state in 2022. The new Walmart Health locations will be in the Jacksonville, Orlando, and Tampa metro areas. Florida Blue will begin using Amazon Pharmacy as its exclusive home delivery pharmacy provider next year, giving 2 million members access to the retail giant’s growing healthcare business.
Spinal Tap: Primary care providers, including NPs and PAs, can now earn $200 through Excellus BCBS’ Spine Health Program. Providers must complete a 90-minute online workshop, developed in collaboration with Spine Care Partners, that covers diagnostic, treatment, and communication skills for managing patients who present with spinal issues.
Cancer Coordination: ChristianaCare, the dominant hospital system in DE, won an award from the Association of Community Cancer Centers for their pilot program to embed primary care providers in ChristianaCare’s Helen F. Graham Cancer Center and Research Institute. The program started in January 2021 after Christiana saw increasing numbers of cancer patients without regular PCPs, meaning patients often had no other physician that was helping manage comorbidities or provide care coordination. The embedded PCP manages care while patients are undergoing cancer treatment, connects patients with local PCPs when possible, and manages the timing and handoff, including education on the patient’s case.
Approval First: Home based providers are likely to encounter myNEXUS for visit authorization and clinical support for an increasing number of Medicare Advantage insurers, such as Empire Blue in New York and Elevance (known as Anthem), which owns the company and started using them in 15 states this fall.
Fitness Frenzy: Col. Potter from M.A.S.H. lore once ordered the entire out-of-shape unit to participate in Olympic games, like the “Crutches Race” when Hawkeye lost because Klinger tripped him up. Beginning in 2023, Aetna will deploy its version of Olympics for seniors with a free subscription to Apple Fitness+ to its 3.2 million MA members. Apple recently partnered with fitness solutions provider Tivity to offer subscriptions through its SilverSneaker program. SilverSneakers members will have access to 3000+ fitness programs that can now be integrated into Apple products. Aetna will be the first plan to offer this integrated Tivity-Apple solution to its members.
Breathing Easy: An old episode of Dr. House aired this week – the one when his asthma patient famously used her inhaler like perfume, revealing that people don’t always know how to use devices. Maybe Google can help. They have acquired a digital health startup called Sound Life Sciences that developed an app that monitors breathing. The app keeps track of respiratory rate and may help to diagnose sleep apnea and other disorders. Google has yet to say how they will utilize the acquisition.
Cultural Therapy: Brightline, a virtual mental health solution designed for families, has partnered with a company that provides cultural competence training for clinicians. Through the partnership, Brightline works with the company Violet to address disparities for BIPOC and LGBTQ+ youth. Some insurers have hinted to us that these sorts of partnerships may be required to be in network in the future.
Cardio Spotlight: Regence BCBS is launching a cardiology program in the new year to review outpatient cardiovascular tests and procedures, with the goal of better managing costs and quality for the most complex and prevalent cardio services. The program will be managed by AIM and will apply to both fully insured commercial and MA members.
Extra Point: So my bride and I occasionally try to match our snacks to whatever is on the TV. A Fish Called Wanda? Cod tacos. C.H.I.P.S, the greatest motorcycle cop show of all time, well, a bag of Tostitos. Seinfeld? A big salad, because there’s no soup. I actually think that people should at least have the option to bring a snack instead of a copay when going to the clinic, matched to reflect the specialist of course – like nuts and blueberries for the neurologist, a protein shake for the PT, dark chocolate for the psychologist, a tall glass of milk for the rheumatologist, and a double quarter pounder with cheese for the cardiologist. Talk about a value-based payment. As ridiculous as this is, maybe there’s an underlying lesson in here somewhere – that perhaps what you bring can help you better see and talk about your health, your relationship with food, and how to move forward.