99: No not red balloons or that Prince classic but the amount in dollars that it costs people to get a cardiac CT calcium score, a scan that takes less than 10 minutes typically to see the amount of hardened plaque in your heart vessels and likely build-up in arteries. Insurers rarely cover this, but they may start to. “I could see it for healthy and active 50–60-year-olds with significant family history of heart attacks who would easily pass a stress test,” says Marla Calcaveccia, a medical director. Depending on the “score,” primary care doctors may recommend a statin or some other treatment to head off future blockages.
Drug Price Change: Insurer Highmark in September will move from a tiered pricing model for generic and brand drugs or biologicals to a standardized reimbursement method based on the average sales price plus 20%. The change applies to facilities and physicians. ASP, according to some studies, can be up to 30 percent below AWP at the median for brand drugs and 70 percent below AWP for generics. It can be complicated to understand how this type of change could impact your drug reimbursement. Reach out anytime.
Filling The Rocky Mountain Bed Gap: Colorado is offering a hiring bonus of $14,000 to nurses to work in mental health facilities in an effort to fill nearly 200 open positions. Facilities located in Pueblo and Fort Logan in Denver can have as many as 100 beds open at a time but are not available to patients because of the lack of staff. Patients often remain in jails while they wait for a bed to open. Colorado is one of the 5 states most in need of nurses, with an estimated shortage of 10,000 RNs by 2026, according to a Mercer study.
College Gap: Solutions to help college kids with their health tend to still rely on the student to reach out which “rarely happens” if you are suffering from depression, eating disorders or anxiety. College’s ought to use a database that collects input from professors about students who have missed classes. If a student is missing multiple classes and across multiple courses this could create a flag in the system and prompt student services to reach out. I say this as someone who barely knows how to open an Excel document, much less create a flag in a system, but these kinds of solutions will be important if the country wants to seriously change the narrative around suicide. In a good step, more college health programs are partnering with behavioral health contractors. Companies like Mantra Health and Uwill have partnered with hundreds of college campuses across the country to offer digital mental health services to students. “I like the database idea because you create a more holistic set of information,” says Haley Gregory, an MSW from New Jersey. “Leaving it up to one professor at these big schools, even small ones, is asking a lot – the students will invariably find their person, but the question is when.”
Resuscitate Child Care: Since March 2020 two thirds of childcare centers have closed, according to the National Database of Childcare Closures in the U.S., worsening a childcare crisis that further exacerbates the national nursing shortage. Many experts say providing childcare to retain nurses on staff is the answer. Ballad Health is in the process of expanding to include 11 more childcare sites throughout Northeast Tennessee and Southwest Virginia particularly for recruitment and retention of staff. Wellstar Health, a health system in Georgia, conducted an internal study reporting a low turnover rate of staff members because they used the childcare center – only 1.5%.
ROI, But You Have To Wait For It: Employers and insurers have a couple challenges ahead figuring out how to pay for people to lose weight – the benefit is obviously lower long-term medical costs but “sometimes we only have a member for 2-3 years, that is the average for us, so time to ROI on a lot of the new services and drugs matters,” benefits manager Paul Lorne told us. Take Noom, the digital weight loss platform that has launched a telemedicine company to include prescriptions for weight loss drugs such as Ozempic and Wegovy, or WeightWatchers who recently acquired Sequence, a digital platform for clinical weight management and prescribing. Are these services and drugs bending the cost curve-and how quickly? If you’re a health system owned plan like Presbyterian Health Plan, you can try simpler tactics like partnering with New Mexico-based TruFit to offer a weight-loss app to enrollees with self-directed benefits. But if you’re a big insurer trying to get primary care doctors incentives for managing care, how do you navigate when employers are carving out services and giving these telemed companies direct access to patients without rules around communicating back to the PCP?
Extra Point: I sometimes like to think I’m Dick Clark on The $100,000 Pyramid when he’d jump in after the contestants fell short because they couldn’t come up with the perfect clue for “Things That Disappear.” If I were channeling my inner Dick Clark, I’d lean in over that cheesy circular gameshow railing and say something like “the other sock…a golf ball sliced into the woods….the eggs in a house of teenage boys….a job in a down market…your car keys when you have to take the kid to work…a loved one.” For me personally and a lot of folks as they get older, the list of things that disappear or lose seems to be growing - like my poise and energy, my hearing, posture and patience, dad’s discharge instructions, and time with people who matter. But it’s okay. When things disappear, it doesn’t mean they are gone forever. They just found a new home is all and maybe will turn up in some other form when you least expect. Just ask 2-year-old Hayden Wheeler whose red golf ball disappeared (see below) at Castle Creek Mini Golf in Salem, Massachusetts back in 2000. I would think Hayden, now 25, probably came across that ball again – maybe it was the same one or maybe it just had a new look and a fresh perspective.