544: The number of healthcare stakeholders who weighed in for our multi-year study on the impact of social determinant of health initiatives, a majority of whom note challenges in scaling and achieving a quick ROI but significant longer-term savings and outcomes from sustained programs. Our report delves into ways to invest in social service models to help address gaps via technology, analytics, and infrastructure. Click to read more.
Total Cost of Care: Health insurers are entering into these arrangements with selective behavioral health providers, not just primary care groups, so the notion that these arrangements are too difficult for this sector is not true. Both commercial and Medicaid payers are driving this and giving providers a chance to coach patients and essentially take the keys and be the medical home.
Mom Knows Best: Readmission rates are higher among Medicaid beneficiaries under 25 and over 60 who are in the ER without a caregiver or “mom” present, a small study reveals. The idea for the study first occurred 12 years ago in Connecticut and found that when mom is involved in the discharge planning and education, readmit risk drops significantly.
Specialty RX: Independent specialty pharmacies and physicians relying on buying and billing take note as another insurer is adding specialty pharmacy capability. Elevance, formerly Anthem, is acquiring specialty pharmacy BioPlus. The insurer said BioPlus will operate as part of its existing pharmacy benefit manager, IngenioRx, by “providing patients with specialty drugs and a whole-health approach.” BioPlus is one of the largest remaining independent specialty pharmacies, dispensing more than 8 million prescriptions a year.
Only The Lonely: Orbison would be proud as an interesting app called Papa connects college students to older adults to provide senior companionship and general assistance in the home, and studies have shown use of the app results in notable decreases in medical costs. The study doesn’t get specifically into the benefits for the college students—many who are themselves struggling with the transition—but one study showed that members of health insurer SummaCare had 34% fewer ED visits and an 11% decrease in readmissions after using Papa.
Cataloging Patient Conditions: Clover Health will begin paying its MA members if they visit a provider who uses special software that helps physicians catalog patient conditions. Clover already pays providers $200 for each visit during which they use the Clover Assistant software that acts as a kind of electronic medical record combined with an artificial intelligence tool. The tool prompts physicians for diagnoses, code entries and care protocols.
Pick Your Condition: Despite Amazon choosing to shut down its virtual Amazon Care service at the end of this year, the company isn’t giving up on virtual services entirely. Their newest endeavor, Amazon Clinic, is a telemedicine marketplace where consumers can select their condition, then choose their preferred provider from a list of telehealth vendors. Patients complete an intake questionnaire, then chat with a provider via a message-based portal. There are no video capabilities but afterward the provider will send a personalized treatment plan via the portal, including any necessary prescriptions. Consultations start at $30 and insurance is not accepted.
CrossOver: Aetna is partnering with Crossover Health to provide a hybrid care model of medical service combining tech-enabled in-person primary care and virtual doctor visits in the Seattle area. The new benefit, called Aetna Advanced Primary Health, will be available next year and the pilot program available to self-insured employers will offer care at two Seattle metro Crossover Health Centers. They plan to eventually expand the model to other markets.
Extra Point: Phone chargers disappear in my house like Taylor Swift tickets, Teddy’s peanut butter runs out faster than Usain Bolt on the last leg of the 1600 relay and affordable bedside nurses are becoming harder to find than an open lane at the grocery store at noon before the NFL kicks off on Sundays. And now, just when I thought access to clinical psychologists might be improving, they are being poached by professional and major college sports teams. As we increase coverage and understanding of mental healthcare we are walking into a potential issue — less experienced and less specialized therapy professionals are on the other end of the video as sports teams make a play for the top talent. If you’re an elite athlete I suppose that’s great, but if you are reading this as an insurer in need of providers for your network or a mental health company trying to recruit, you are at a competitive disadvantage. These sports teams offer compensation 3-5x what typical psychologists can get, and incentives tied to performance, like touchdowns. As many as 200 of the 350 division 1 NCAA programs have psychologists on staff, and some I’ve talked to have multiple psychologists “dedicated” to each team. “It’s great to see a major university willing to fund mental performance consulting positions,” Brian Lomax, Ed.D., said after seeing the news that Cal Berkeley was hiring sports psychologists. The University of California’s Cameron Institute was looking for 2 full-time certified mental health consultants and it took less than a week to find a candidate. One of the interesting roles is to meet with each head coach twice a year to establish mental performance goals and to meet with prospective student athletes during campus visits. A doctorate or master’s level degree is required, along with "knowledge of NCAA rules” – sounds a bit like psychologists who need knowledge of Medicaid rules, by comparison. There is a silver lining to all these recruitment issues: a large number of Americorp volunteers are “going back to school” to become psychologists, public schools like the one in Denver are actually becoming training grounds for healthcare, both nursing and psychology, and residency programs for psych are growing in places like underserved Iowa. In the meantime, the cost to recruit staff and meet demand and get access to the best seems to be getting more difficult. Sort of like trying to find a pair of socks that match in my house.