May 17, 2019 | Managed Care Friday
1. 30 for 30: According to the NCQA, patients with a new onset low back pain diagnosis normally should not receive imaging within the first 30 days of diagnosis but there may be instances when imaging should be considered. You can access an evaluation chart to use with patients presenting low back pain: click here 2. Fall Risk: In our poll of Medicare Advantage plan care managers and medical directors, 91 of 153 said this was the number one ‘avoidable outcome’ issue that their networks are struggling to reduce. My dad fell down stairs two years ago and, though he luckily survived, continues...
May 10, 2019 | Managed Care Friday
1. 49: Percent of 316 high school and college students we polled this month who say they ‘know someone’ with an eating disorder, ‘or think they do,’ but just 20% say they’ve told anyone about it. ‘It’s hard to talk about it. I’ve told a counselor,’ said one 11th grader, but others say they ‘aren’t sure exactly.’ One female polled said part of the issue is the classes and culture focus ‘so much on watching what we eat … and a lot of us don’t really know how to do that…and sometimes the issue ‘escalates.’ A freshman at a college in Texas says ‘it’s hard for a lot of kids who have had to deal...
May 3, 2019 | Managed Care Friday
1. 25,000: People living with Parkinson’s in Michigan out of the roughly 1 million nationally. BCBS of Michigan is teaming up with the Kirk Gibson Foundation to raise awareness and provide resources. In the meantime, there continues to research on Parkinson’s. A new study released this year says a new device may be helpful in slowing or reversing the progression of the disease. The experimental study investigated whether using a novel delivery system could regenerate dying dopamine brain cells in patients with Parkinson’s and even reverse their condition. It could be ‘the first...
Apr 12, 2019 | Managed Care Friday
1. 16,752. No, this isn’t another Rent song, it’s the average cost believe it or not that a diabetic person will spend on average each year on medical costs, according to a recent study by the ADA. Cigna and Express Scripts introduced a patient assurance program to cap the out of pocket costs at $25 for every 30-day insulin prescription. Cigna says this reduces the out-of-pocket costs for insulin by 40% or more and improves affordability of insulin costs for people with diabetes. The Patient Assurance Program will be available to members in participating non-government funded pharmacy plans...
Mar 29, 2019 | Managed Care Friday
1. 700: Number of direct primary care practices in the US via a new coalition of doctors who provide a kind of low-cost monthly membership to serve people without insurance and those with high deductible plans. The new delivery model has a concierge feel with higher touch care and a new-age pricing model: Memberships are $75 a month for adults, $25 for those under 21, with unlimited telemedicine and office visits and house calls for $25. Labs and meds are charged at wholesale cost plus 10%, according to Jonathan Bushman, who runs Reliant, a practice in Oklahoma that’s part of the emerging...
