1,000: The approximate number of deaths prevented by a naloxone vending machine, according to a recent study published by the University of Cincinnati and Caracole. The vending machines are placed outside a targeted naloxone distribution and syringe service program. Anyone can access the program’s counselors as well as two injectable doses and two nasal spray doses of naloxone, a sharps disposal kit, kits for safe injections, smoking, and sex, as well as a pregnancy test, PPE and a box of bandages every seven days. 637 individuals registered for the program in the first year, 12% of them having never previously used harm reduction services. People access the package by calling a phone number and completing a survey giving them access for up to 90 days.
Full Risk Reward: About 30% of Blue Michigan’s total MA membership will receive services through full-risk reimbursement arrangements, now that six physician organizations in the state have inked new value contracts with BCBS. Full risk can mean a lot of things, but typically it’s limited to professional costs, not inpatient. Idaho Blue is also focusing on value-based arrangements this year, with 15 partnerships across its QHP, MA, and commercial health plans. Idaho Blue developed a payment model for rural providers, rewarding them for improved patient management.
Buy And Bill Beware: Elevance (aka Anthem) and 14 BCBS plans, along with their PBM Prime and their independent pharmacy solutions startup Evio, are all investors in the Synergie Medication Collective, which aims to extract better deals from pharma companies and providers that administer their drugs – namely high-cost specialty drugs. Synergie will not act as a full medical benefit manager because it won’t provide UM services like pre-authorization but will act more as a GPO for specialty drugs and operate under a “transparent, pass-through model” according to the CEO.
Menopause Model: AI-platform Upliv focuses on women’s health, specifically treating menopausal symptoms through video consultations and coaching with menopause experts, alongside prescription treatment. Northwell Health and Aegis Ventures partnered to pilot Upliv’s platform with select nurses, with plans to fully launch in 2024. The platform will be offered as a benefit to employees at $0.
Digital Diabetes: Care manager Omada Health is partnering with Intermountain Health’s subsidiary Castell to identify diabetics who receive primary care through Intermountain. Eligible patients will receive pre-connected cellular scales, continuous glucose monitors and blood glucose meters that allow physicians to track data in real time.
Chronic Rising: A 29% increase in cardiorenal syndrome and a 19% increase in ischemic heart disease are expected this year according to a recent report from Prealize. Care for intellectual and development disorders is expected to increase 13.7% while utilization related to pediatric substance abuse disorders is predicted to jump 24.5%. Care for chronic conditions, including COPD, are expected to increase across all ages by 21%.
MA Landscape: Humana shifted gears over last year and boosted investments into Medicare Advantage products after struggling to hang on to MA lives in 2022. Based on these efforts, Humana reports gaining 500,000 members during the 2023 annual enrollment period, which is expected to boost their overall MA membership to 625,000, which would be a 13.6% increase from 2022.
#18: Asthma is back in the top 20 payer priority rankings thanks to poor education and environmental factors including gas stoves – full report coming out this month. The condition is now considered as a subcomponent of SDoH initiatives this year, but the focus is not on what you might think. Payers are interested in models specifically for inner city populations and rural areas to prevent hospitalization. “Problem is we don’t have any. It’s vastly underappreciated and poorly managed.”
Extra Point: So I apparently got my AARP card this week but I couldn’t find it since my bride put it on the fridge near our 15-year-old’s B+ English paper, just below a copy of our daughter’s college tuition bill, above a list of chores like “fix the wobbly bathroom door hinge - you know the one, you walk by it every morning,” and next to the bill I owe for the colonoscopy I skipped over the summer. Putting it on the fridge is a big deal but I’m not sure if she thinks I’ve accomplished something turning 50, or if she’s giving me not-so-subtle hints. Probably that. 68-year-old RN Wendy Abraham from Maryland has long since hinted that healthcare is not for the faint of heart, particularly when you start getting older, and her fascinating story about the difficulty getting an appointment after a hard-to-hear diagnosis is a great example. Wendy was advised to get a Cologuard test last fall even though she was not scheduled for a colonoscopy until 2024. The test came back positive, but her GI first required a tele consult the day after Christmas and asked her if anything new had happened medically in recent memory. It had. About 3 months earlier Wendy had a mini-stroke called a TIA and was put on Clopidrogel for 21 days and a baby aspirin that she now takes daily. The GI decided the colonoscopy couldn’t be scheduled until a neurologist gave clearance to allow her to have anesthesia but getting that appointment has been harder to deal with than the colonoscopy prep drink. The neuro consult wasn’t going to be until the end of April – not ideal with that positive Cologuard test lingering out there – so using her inside healthcare know-how, Wendy got in at a neurologist who had a cancellation. “The doc asked me why I was there, and I said, ‘I need a colonoscopy’,” Wendy told me this morning. He laughed and said, “You know I don’t do those,” so the meeting started off on a funny note and ended well, since he cleared Wendy for the colonoscopy. All this for an RN who knows how to navigate healthcare. Imagine the 68-year-old who doesn’t? Take it from an old man, it’s already no picnic. Like when I finally found that AARP card, Tommy happened into the kitchen. “So dad – did you see my B+? Not too shabby eh – right next to that thing mom says you got for turning 60.”