About 80: Types of virtual care losing insurance coverage in December under a new Aetna policy. Coverage ends for some behavioral care services, ophthalmological care, services related to end-stage renal disease and more, according to a notice sent to providers. The health plan will also end audio-only coverage of nearly 60 services, including psychotherapy, counseling for alcohol use disorder, and obesity counseling. We reached out for comment last week and expect a response shortly.
Watch Out: Samsung is working with several health systems, including Mass General and Tulane School of Medicine, to research how smartwatches can improve overall health and clinical care. The health systems are focusing on different types of measurements – for example, Tulane will look at a range of cardiovascular disease indicators while MIT will focus on how sleep affects health.
Diabetes Monitors? Next To The 42” Inch TVs: In a somewhat surprising move, tech retailer Best Buy will begin selling continuous glucose monitoring systems in the next few weeks. They will start with Dexcom G7 CGM and may expand to other systems in the future. Those looking to buy a CGM will be sent to Wheel, a telehealth platform, where a clinician will assess need and write a prescription if needed. Consumers can then buy the CGM through Best Buy’s website and have it delivered anywhere after HealthDyne, their pharmacy partner, receives and processes the prescription.
Bringing It Home: Uber continues to expand into the healthcare world, this time by partnering with Optum, United’s healthcare services group. Uber Health users with certain Medicare Advantage plans will be able to use their Optum benefit cards to pay for non emergency transport along with delivery of grocery and over the counter medical items. Only thing missing, the caregiver support service.
PPO Control: Carbon Health, the primary and urgent care provider, announced they’ve signed their first at-risk value based contract with United that will start in 2024 for California PPO members. Carbon Health says the arrangement is a “very novel deal which should benefit employers and members in California who are facing unprecedented premiums.” In recent years, there have been more at-risk deals involving United and physician groups. For decades, physicians didn’t want to take risk with PPO populations given lack of controls, but improved data analytics is changing this.
Dispatch: In Louisiana, a Medicaid MCO has been requiring preauthorization for mobile mental health crisis units before it can dispatch to help patients in need, according to Randal Gomez-Simon, the vice president for Business Development at Woodlake Addiction Recovery Center. “It’s causing people to end up calling 911 and eventually end up in hospitals.” In a positive alternative in Houston, a 911 and 988 crisis center co-locate responders, which gets better results. Full story in our upcoming “The Behavioral Ecosystem” paper.
Ladies First: My mother used to say that the “ladies choice” skate at the roller rink in 1982 was ‘a necessity to survive amongst you sweaty boys.’ Women-focused communities are now commonplace, even if less circular – there are sports teams and book clubs and in healthcare a growing number of services just for women. SCAN Health Plan is launching what it calls the first women-focused Medicare Advantage plan called SCAN Inspired. Initially the plan is only open to those in two California counties and is in partnership with Cedars-Sinai. Members will have access to a women’s health advocate, along with $0 estrogen therapy, reimbursement for weight management programs and more.
TeleHealth Market: At the HLTH conference that took place in Las Vegas this week, Amazon executives said their telehealth marketplace, Amazon Clinic, could soon move into partnerships with in-person providers to help decrease gaps in care when issues cannot be solved virtually. Meanwhile, Walgreens announced the launch of direct-to-consumer telehealth service.
New Lab Order: Labs like mine are known to be good hunters, persistent in finding the problem, but in healthcare there are some questions about the efficacy or necessity of lab tests. BCBS Illinois is relaunching its laboratory management program for commercial members that was paused earlier this year. Beginning January 2024, lab services provided in an outpatient setting will be subject to a post-service medical necessity review. Some testing policies may have narrowed medical necessity guidelines to reduce over-testing. There have been questions over the years about the utility of lab testing, particularly by allied health providers and PCPs. For instance, “borderline hormonal tests (like metanephrines, cortisol levels) are more confusing than helpful,” said one medical director. Our 2018 poll found that 15-22% of lab tests are inconclusive or useless, health plan medical directors said. Practices would benefit from dissecting their lab testing protocols.
Peer Support: BCBS Minnesota will begin offering both commercial and Medicare Advantage members with a behavioral health diagnosis access to Peer Specialists at $0 cost share in 2024. Peer Specialists have prior support receiving mental health or SUD services and have to go through training and certification by the Department of Human Services to be qualified and then provide support to members. They serve as an additional resource for members along with their healthcare providers.
Extra Point: A hurricane swept through our home last weekend when the two college kids blew in leaving wrappers on the couch, socks in the fridge, piles of wet towels on the floor, and hair in the sink. They took all the shampoo and protein bars, cleared out the iphone chargers, and somehow found a way to steal both of our favorite sweatshirts. There was arguing, complaining, crying and laughing, and even a few “that’s amores” after supper. The wife and I played part therapist, part nurse like these 20 year-olds were 9 again and despite the chaos, the pseudo ER meets All in The Family felt incredibly comfortable and familiar in the way you feel when you see kids next door guzzling apple cider before jumping in a giant leaf pile. Our kids left like hurricanes tend to do, back to NYC's big apple, and even though the house is a disaster, it felt like home again for a moment. They can sweep in any time if you ask me. For some folks today, a hurricane at any speed would be welcome if they could have their family back home safe. Prayers and peace to those who are suffering from the events unfolding overseas this week. Our struggles, disruptions and chaos at home, wait times and healthcare delays - as stressful as they may be - can be managed.