12,000: The number of people who called into the National Maternal Mental Health Hotline in its first 11 months. The hotline, launched on Mother’s Day in 2022, can be called or texted with any type of concern related to maternal health, and about 70% of contacts so far have been phone calls. The US has higher maternal mortality rates compared to other developed countries, and the hotline was launched as part of a broader effort to reduce these rates.
New E&M Requirement: Effective May 25, Cigna will require that providers submit office notes for E&M claims 99212-99215 when using modifier 25 when a minor procedure was billed. The health plan will deny the claim if notes do not support that a “significant and separately identifiable service” was done. In some cases other payers have started to cut E&M reimbursement 50% when combined with office procedures within 3-4 weeks of a separate office visit.
Prison Time: Americans dealing with mental health issues are 10 times more likely to be put in jail than hospitalized, according to a recent National Judicial Task Force report. While a majority of people who are then sent to state prisons report a history of mental health issues, more than 70% have not received treatment. Though there is a shortage of mental health providers overall, the legal system is even less equipped to treat these patients.
At Home DME: Humana is working with DME providers Rotech and AdaptHealth to provide at home services to their Medicare Advantage HMO members through a value-based arrangement. The agreement takes effect July 1, and each vendor will serve a different geographic region.
Foster Works: Blue Cross NC has a new apprenticeship program for adolescents aging out of foster care that will help teens enter community college or find jobs at the health plan’s retail centers. In its first year, there are two apprentices working in the Raleigh Retail Center and the health plan is working with organizations across the state to find future participants.
Obesity Rx Controls: Effective July 1, BCBS Tennessee will add a new prior authorization requirement for any commercial members seeking a prescription for GLP-1 drugs – the new wave of anti-obesity drugs. And they’re not the only payer adding more controls on these drugs. Though they can be very effective for some patients, particularly diabetic patients, an ICER report found that at their current prices, the GLP-1 drugs do not deliver an affordable long-term value for 99% of patients.
Staffing Hurdle: More acquisition is happening in the health staffing space, which could further complicate staffing shortages. Jackson Healthcare, the parent organization of 16 staffing, search and tech companies, is acquiring LRS Healthcare, which focuses on nurses and allied healthcare professionals. A recent report from McKinsey found that nurse turnover in hospitals increased from 18% to 27% from 2020 to 2021 though that number dropped to 23% in 2022. Hospitals have been trying to encourage nurses to remain in-house rather than joining staffing agencies, but they often cannot compete with payment offered.
PCP-Behavioral Integrate: Emory Healthcare and the Goizueta Institute are partnering with NeuroFlow, a cloud-based behavioral health company, to improve delivery of psychiatric services at Emory’s primary care clinics. They will also pilot a primary care suicide prevention program.
Extra Point: Dad and I once paid $110 to have the repair guy plug in our refrigerator after we thought the fuse box had blown leaving the fridge dark and warm. “The two of you are like the blind leading the blind,” mom said when she came home later that day. “I leave you alone for 2 hours!” Diagnostics is not everyone’s forte. George Costanza once asked his Seinfeld crew to diagnose a strange discoloring on his lip. “I’d get that checked out,” Kramer said skittishly, while George wondered if it could be cancer but his doctor said, “I don’t know what it is.” Diagnosing things is particularly difficult these days for parents, schools, pediatricians and indirectly insurers who often lack a true picture of a student’s health to figure out if something is anxiety, pain an auto-immune disease or something else. Here in this Eye on Healthcare, check out results of our poll, a sit down with a family about their teenager’s journey, a day in the life of a school therapist and an example of a solution that helped solve the problem for one teen.