1.7 Million: The number of calls, texts and chats into the national 988 suicide crisis lifeline during the first 5 months of its existence. How the 988 staff deals with these situations and sets up emergency response or makes referrals is still an open question. US Surgeon General Vivek Murthy recently proposed “a national framework to rebuild social connection and community in America” given rising evidence of loneliness and depression in ~60% of young adults and ~50% of mothers with young children according to some studies.
Poor Urgent Care: Several insurers are now eliminating copayments in certain situations, except for urgent care. One source said there has been a quirk in benefit design that charges multiple copayments in situations when patients see the same physician for multiple services on the same day, “so if it’s an office visit, office surgery, an x-ray and lab work, patients were hit with 4 copays at $25 each, or $100,” a source from a national MCO confirmed. Now there will just be one $25 copay for that situation. For urgent care, up to two copays of $30 each or $60 total may apply.
Lyme Aide: In a meeting with an insurer’s utilization analyst this week we both saw an interesting trend in lab orders to test for Lyme disease in teenagers reporting significant fatigue. That makes sense, but what’s interesting is the orders tend to originate from requests by psychiatrists who want to confirm that that the teen’s “chronic tiredness” isn’t really Lyme masked as stress.
Golfers For Cataract: Not all of us have Danny Noonan to carry our bag down the fairway and track our wayward slices. The #1 question that ophthalmologists get from male patients who are about to get cataract surgery is, not surprisingly, ‘how soon after can I play golf….’ What is often not discussed is just how important the surgery is for these golf-obsessed seniors who don’t hit it quite as straight and can’t see the ball off the tee like they used to. A Medicare Advantage plan’s utilization analyst, Mary Kellogg, says the plan is studying cataract utilization trends and related social factors, like surgery by gender, climate and even something as obscure as whether the patient is an avid golfer. ‘Do they need it to see the ball better, or do they need it to drive to the course…two different things.’ While it seems unlikely that denials for cataracts increase drastically, with the increase in MA and medical management of vision, it wouldn’t be surprising to see greater analytics around medical necessity.
Don’t Get Caught Watchin’ Paint Dry: This is arguably the best line from a questionably sober Dennis Hopper in the classic Hoosiers and it is good advice to physician practices and home care agencies who, if they’re not careful, may find themselves stuck if they don’t get ahead of the wave of funding and premium dollars going to companies finding ways to address things like patient loneliness and social risks. Humana once had a pilot program with a company called “Papa” connecting college students with lonely at-risk seniors—one of several initiatives to screen for things like depression, substance abuse and fall risk, and react to them. How information from screenings makes its way into EMRs and back to primary care physicians and caregivers, will be important if this whole social determinant experiment is to work.
Solving The Shortage: How would you like to talk to a chatbot at your next doctor’s appointment? My kids would, but my folks – heck no! “You want me to talk to what?” my dad said. Many of us are probably in papa’s camp, preferring to speak directly to a person, but a recent study published in JAMA shows that AI-based chatbots had better “bedside manner” compared to physicians in about 78% of 585 evaluations. A team of healthcare evaluators said the ChatGPT responses were higher quality, more empathetic and typically longer.
Where To Hang The Infusion Shingle? You might want to put it about 10-25 minutes from the hospital, as it seems that most big insurers now have policies that encourage and in some cases pay cash or gift cards to patients to have their infusions done at independent ambulatory infusion centers or at home, as long as the services are within 30 miles or 30 minutes of the patient’s home. If not available, the patient can go to the hospital.
Match Game: A poll we did of 192 PCPs, OBGYNs and mental health therapists found that about 60% of the time the patient needs to change doctors or therapists. “It can take 2-3 at least to find the right fit, particularly therapists,” Molly Reader said, “but it often takes 3-4 visits to figure this out.” Figuring out how to address this could be a helpful measure of quality and distinguish a practice. Some companies, like Two Chairs, use clinical and patient data to try and match mental health patients to the right therapist from the start. It says that 98% of patients report a strong therapeutic alliance and 90% reach a fourth therapy session, compared to the 36% industry average. One thing to be measuring is patient satisfaction after each visit because reaching 4 sessions may not always indicate effectiveness.
Alzheimer’s Partner: Walgreens has entered into a partnership with Prothena, a late-stage clinical biotechnology company, to boost patient enrollment in the biotech’s ongoing Alzheimer’s clinical trials. Prothena is focused on diversifying the Alzheimer’s clinical trial through accessing clients of the pharmacy’s rural communities.
Extra Point: All you pharmacy fanatics probably will love this as under a new quite controversial Cote family policy effective May 1st Grub Hub orders are now excluded from the formulary as it were. I love the Grub Hub but with 3 kids in college and one a few years away there’s a budget crisis looming. There will now be a 75% cost share requirement and the loss of any right to complain about me not doing your laundry without public shame. Delivery from Chipotle directly is covered because it’s delicious, but for cost reasons, it is now non-preferred at 50% coinsurance and requires pre-authorization. Getting me to pick up takeout will be on the non-preferred 3rd tier at 50% coinsurance, unless I’m already out driving in the vicinity then it’s covered at 25% coinsurance. Grocery store pizza is 2nd tier with a $5 copay but only if I’m already at the store and if you make your own pizza, there is no cost. In fact, if you give me a slice and I like it, a value-based bonus payment will be provided in the form of doing laundry once. Tommy is appealing the policy, arguing that the Grub Hub ought to be an essential health benefit. But he’s 15, what does he know?