Jul 13, 2018 | Managed Care Friday
1. 6157: The name of a Senate bill in Washington state that forced Regence BCBS to do away with a policy requiring pre-approval for PT, chiropractic, massage, OT and speech therapy for the first 6 visits after an initial evaluation. A source with Evicore, which handles these requests for the insurer, told us it will identify patients who won’t need the authorization in this state. Pre-approval is required for visits after 7 and, due to the policy, an Evicore therapy evaluator said, ‘this sort of makes it harder to get approval for more than 3-5’ unless it’s a youth injury situation or a...
Jul 6, 2018 | Managed Care Friday
1. 26: Percent of plan premium dollars, according to a poll of 19 regional insurers, that goes to physician services, 25% to inpatient, 21% to outpatient facility care, and 10% to Rx, but pharmacy varies by plan and over the last few years has definitely taken a larger chunk of the total premium dollar, driven by specialty pharmacy cost. Today, the annual trend in specialty pharmacy net of rebates is 15-20% (e.g. the PMPM on total drug costs), say some sources, compared to the 9-11% it was a few years ago, whereas whereas for traditional (non-specialty drugs) the trend is in some cases...
Jun 29, 2018 | Managed Care Friday, Part D, Payers
As a reporter for nearly 15 years and 3 with a community newspaper in Swampscott Massachusetts, it is a difficult thing to hear about the Maryland tragedy. The investigative research team members here are, at our core, reporters, and we all extend our prayers to the newspaper’s family. 1. Where There’s Smoke: People with schizophrenia are 3 times more likely to smoke than other people and tend to smoke more heavily in an effort to control their symptoms related to their mental illness, according to the Mental Health Foundation. Of note, Rhode Island’s BCBS insurer just partnered with...
Jun 15, 2018 | Managed Care Friday
1) 2040: The year when Alzheimer’s disease will consume about 25% of the Medicare budget, according to a new study, aided in part by addiction to smart phones that can cause plaque buildup in the brain, the same plaque linked to Alzheimer’s. Brain scan of people in their 20s showed high levels of buildup due to excessive iphone use. The findings and outlook have implications for policymakers as well as families and employers given the massive direct and indirect cost of the disease. Read neurologist reaction by clicking here 2) Genetic Test Plus: Testing for Cadasil, a hereditary stroke...
Jun 8, 2018 | Managed Care Friday
1) 425: Dollars that several surgeons told us they are charging Anthem patients upfront before cataract surgery to cover anesthesia services since the insurer no longer considers anesthesiologists or nurse anesthetists medically necessary for administering and monitoring sedation during the eye procedures. Kids under 18 aren’t impacted but adults are and one practice here in my state told us the policy has changed patient behavior – in some cases the patient flat out refuses and leaves rather than doing the procedure, others ‘have got wind of the charge’ and ‘cancelled’ the procedure,...
