235K: The number of additional ED visits the Center for American Progress projects this summer alone due to increasing temperatures, along with an additional 56,000 hospital admissions.
Social Risk Payout: BCBS Michigan recently rolled out a new Social Risk Adjustment Initiative, designed to support providers caring for patients with high levels of social needs which often affects overall health. Providers must opt into this program by August 1 and then they will receive funding based on the number of members they have with ADI scores of 8 or above. The Area Deprivation Index numbers are determined neighborhood by neighborhood and the higher the number, the more disadvantaged the area.
R2D2: Dartmouth Hitchcock Medical Center has taken a page from Star Wars and Short Circuit’s Johnny 5 robot and started using 4 foot tall wheeled robots to deliver medications from their pharmacy to patients. Two robots are preprogrammed with regular delivery routes, and a third can be custom programmed by staff members, saving pharmacy technicians and nurses time.
Biosimilar Out of Gate: It isn’t taking long for PBMs to move new biosimilars into the front of the line. Cigna’s PBM Express Scripts announced it will add three biosimilar versions of Humira to its formulary as “preferred” drugs. The biosimilars should be cheaper with manufacturers announcing their versions would be offered anywhere from 5% to 81% cheaper than Humira’s list price. But PBMs negotiate rebates and fees with drugs manufacturers, which means the list price doesn’t always ultimately matter. But the preferred position of these biosimilars should be a positive development for patients looking for a cheaper alternative. SmithRx, a newer PBM, says it now offers the Humira biosimilar Yusimry for $569 plus shipping and dispensing fees through the Mark Cuban Cost Plus Drug Company.
Oral Health Adjustment: Starting in October, kids under 13 get free dental care and adults with certain IDD and mental health diagnoses will get preventive and periodontal services under expanding coverage guidelines from BCBS Massachusetts
Retail Behavioral Health: BCBS Arizona has launched Prosano Health Solutions to blend behavioral health and holistic care. The platform allows members to access primary care teams, behavioral health practitioners, lab services, and more. Prosano will first be available to members of its two PPO plans, but AZ Blue plans to expand to employer groups in 2024 and open four brick-and-mortar locations by the end of 2024.
Urgent Care: Baylor Scott & White Health will add 41 urgent care locations in Texas through a partnership with NextCare Urgent Care. The health system already owns five urgent care centers, on top of their 51 hospitals, and the joint venture will allow them to increase their footprint outside the Dallas and Austin metro areas.
Extra Point: So I tend to hear a lot of complaining from my family as we approach the table at a restaurant – it’s either too loud for Uncle Roland, too close to the kitchen for cousin Jeff, or too drafty for Aunt Adelline. “This bacon isn’t burnt enough – send it back,” says Uncle Bobby. “Dear Lord Uncle B – it’s already black!” In healthcare, I am hearing a lot of complaining lately from companies about where they sit with insurers - how the payers are too rigid, unwilling to meet much less compromise. Well, there’s some truth to that I suppose but if you really know your history, it’s been 15 some years of many insurers being both flexible and innovative. I dusted off this interview with Lynn Nishida, the clinical director up at Regence BCBS in Washington. Back in 2008, I called her about an article I was writing on payer-provider marriages in oncology. Lynn chuckled, then told me how Puget Sound Cancer Center in Seattle had convinced her to lift pre-authorization on erythropoiesis-stimulating agents widely used in managing anemia in cancer patients. Regence spent $70 for each authorization and wanted a better way to limit that cost, address safe use of ESAs, and guide doctors on when to initiate therapy based on blood cell count. The cancer center had developed a protocol checking iron levels first then starting patients on ESAs with hematocrit under 30 and stopping at 36, according to Richard McGee, the CEO. “The protocol intrigued us,” she said. “I would have expected some patients to fall out of the thresholds but that wasn’t the case, and [PSCC] got 100% of its physicians to follow the orders without any prior authorization.” PSCC’s standing orders did not necessarily align with Regence’s medication policy, but they were a jumping off point. “We were willing to align their orders with our already developed policies,” Lynn said. “We weren’t bypassing the PA—there’s still a standard review through a quarterly retrospective audit,” clarifies Nishida, “but what we’re doing is selecting prescribers who are actually performing well and have a commitment to safety and the right use of medications based on science.” So for anyone complaining in healthcare, maybe take a page from the past and show the payer you have a better way – you might be surprised. And for anyone in my family - that especially means you Uncle Bobby – yes, the chair is wobbly and the bacon not crispy enough, but doesn’t this beat another TV dinner with Wheel of Fortune reruns?