Behavioral Health Insights

13: No not Apollo but the number of facilities Cano Health will add to its Florida footprint through its $600M acquisition of Miami-based University Health Care. Cano operates value-based primary care centers for seniors in Florida, Texas, Nevada, and Puerto Rico.

Bundle of Pain: Under a new United Healthcare Medicaid reimbursement policy taking effect in July, using nerve blocks either as a component of anesthesia or a post-operative pain protocol are no longer reimbursed separately as United considers them part of the anesthesia time for surgeries when performed by the same physician or their associates.

Rocky Mountain High: Colorado employers have joined the Colorado Purchasing Alliance and Purchaser Business Group on Health to create a regional network of excellence. The group’s goal is to negotiate directly with health systems to set prices. Employers in the group include Larimer County along with the State of Colorado. As healthcare costs continue to rise, we expect to see more of these unique arrangements on local, regional, and national levels.

The Weight: Take a load off Fanny was a bit of an anthem in my home growing up when mom would spin the 8-track record from The Band’s hit “The Weight.” In healthcare, we seem to be spinning into a new era where Fanny better get moving. Cigna’s health services business, Evernorth, is adding the newly approved Wegovy to its weight management care value program from Express Scripts. The program provides members with personalized coaching, digital tracking tools, peer support, and exercise regimens, along with access to physicians through MDLIVE. These physicians will now be able to prescribe Wegovy, which was approved by the FDA in June for the treatment of obesity.

Discount Debate: Walmart and Amazon have both added prescription discounts to their respective memberships. Walmart’s program allows members to use the discount instead of health insurance and receive up to an 85% discount. Amazon’s Prime program will offer some prescription drugs at the equivalent of $1 per month for a 6 month supply.

Side of Mayo: The Mayo Clinic is continuing to err on the side of tech innovation, this time by signing a multi-year collaboration agreement with Visage Imaging. Through the collaboration, Mayo will use the Visage AI Accelerator, an AI platform that combines AI solutions with diagnostic imaging, and the pair will be able to commercialize developments.

Wasted on the Way: CareSource is partnering with a medical disposal company, DisposeRx, to help families avoid opioid misuse and accidental poisonings. DisposeRx makes a powder that disables the active ingredients in unused medications, which can be added to water and poured into prescription bottles. The drugs can then be safely disposed of. CareSource is offering this solution to Indiana and Ohio members first with plans to expand the solution’s availability to more members throughout the year.

SNF Diversion: Beginning Aug. 1, 2021, naviHealth will manage post-acute care for United Medicare Advantage members in Alabama, Maine, Massachusetts, New Hampshire, Rhode Island, Tennessee and Vermont. This includes prior authorization and continued stay review and discharge planning for members who are receiving care in or transitioning out of SNFs, acute inpatient rehab and long-term acute care settings.  naviHealth already manages this process in several other states.

Scoring Home Care: New York-based Citus Health released a report focused on communication between providers and patients in home health. They surveyed 300 patients and family caregivers who have utilized home-based services over the past year and 95% of users said communication responsiveness impacted how satisfied they were with a provider, especially when dealing with a question or urgent need. Just 40% of respondents said they were content with their providers’ responsiveness regarding treatment in the home, scheduling, medical changes, and more. Means of communication have changed since COVID-19, with 96% of respondents reporting they favor providers that employ real-time communication technology via smartphone, tablet or computer.

Extra Point: There were 117 awards during high school graduation this week, felt sort of like if healthcare had an awards night and honored everyone who showed up wearing scrubs. There were 11 art awards, 16 english, 14 science, and 30 for music. If your instrument made a sound – award. If you sang low and high - award. And if you could write a sentence, run a mile, and make a half decent oral argument why Pluto ought to be a planet, which it obviously should, then that was like 3 awards. There was a writing award for best prose, one for best persuasion, and even one for best passion. Even math had a moment, with honors for best parallelogram and best impersonation of Matt Damon’s Will Hunting. Really? Only history seemed to be light on the honors. There was the ancient civilization award, US history, and then one of those awards you love as a parent, but you also feel embarrassed about, the “this kid really showed interest and tried and showed creativity award” given to the student who when asked to name his favorite era, said “Bill Buckner. Because I’m a Met fan.” Back when I graduated high school there were 5 awards: history, math, english, gym and the arts. Music, band, orchestra, singing were all one award and James McKenzie’s cool solo drum set to the Moody Blues got him the nod. There was no science award, even though green was a Pictionary category. The history, math and English awards all went to Becky Kerstein, our valedictorian. I got the gym award. I feel like healthcare is in a bit of similar situation these days, doling out more awards than a rural high school with mostly average students whose parents think all their kids are above average. We’re giving extra reimbursement just for “sharing data,” enhanced rates for opening up a clinic, and a $1,000 payment just if you offer medication assisted treatment each month. Many major specialists can now negotiate up to a 50% share of savings if they can keep patients from going to the hospital, which adds up to tens of thousands of dollars in bonus payments if you are good at your job. We’ve set a bar and it’s low enough many are hitting it, but we are about 4 years out, if I had to venture a guess, from a moment when that bar needs to move or we learn that all those awards and rewards we got were nice, but aren’t coming anymore. Some of us will keep innovating. Some are like Becky and James, one a college professor, the other a former Julliard teacher. Some may not get bonuses, revert to being average again, and get paid just because, which is nothing to sneeze at – at least when you’re in healthcare. That’s because we need average. Average means access and it helps us know who to reward. Maybe in 4 years we ought to devise a new set of honors to recognize the mediocre doctors and nurses among us. We can celebrate by applauding clinicians who do just enough, but rarely more like clinicians who spend the least amount of time talking to patients, but still somehow manage to make a halfway decent diagnosis without the help of a fancy lab or imaging center. How about them apples....

$20M: The amount of drug cost savings Blue Shield of CA reported between 2018 and 2020 through its partnership with Gemini Health. This partnership made the Drug-Cost Transparency Service available to healthcare providers in California. This tool allows providers to view patient-specific lower-cost alternative medications and compare prices during appointments. Blue California recently announced it will expand the platform to pharmacists with the goal of encouraging greater collaboration with physicians.

A Dozen Specialties: Premera Blue in Washington is introducing its new higher-performance provider designation program for 12 specialties including primary care and in the next few weeks will list the providers on its patient/member facing search tools, showing the patient if the practice is high quality, low cost, or both.

Wheels Up: A new OhioHealth clinic on wheels is meeting residents where they live for healthcare with a 45-foot-long RV that has two exam rooms, a waiting area, two offices, and two restrooms. The clinic serves underserved areas of Linden, Ohio and its goal is to reduce the need for emergency room visits. The clinic is parked outside the new Linden Opportunity Center 7 days a week and is the third mobile unit from OhioHealth.

ER Policy On Hold: Earlier this week, United announced that beginning July 1^st they would assess all emergency department commercial claims to determine if a trip to the ED is truly needed, but has decided to delay implementation due to provider pushback. They are not the first payer to implement this policy, as Blue TX already does pre-pay reviews like this to make sure the trip for say an itchy scalp or a sore throat is warranted, or could have been handled by urgent care or a PCP. Policymakers and providers including the American College of Emergency Physicians expressed concern that the policy could prevent people from seeking medical care for true emergencies, due to worries about coverage and cost. United says it will delay the policy until at least the end of the pandemic. Once implemented, claims determined to be non-emergent will be subject to limited or no coverage, meaning the patient will then be responsible for the majority of the cost.

Latest Marriage: Maybe not as magical as Wesley and Princess Buttercup’s marriage, but One Medical is buying Medicare-focused primary care company Iora Health in what seems like a perfect match - both providers employ alternative payment models over traditional fee-for-service reimbursement. One Medical focuses on a direct to consumer model, while also contracting directly with employers and some health systems. Iora is participating in CMS’ direct contracting model. The acquisition will increase One Medical’s presence to 28 markets.

Palliative Partner: VCU Health System in Virginia is getting into home health and palliative care by collaborating with Bayada. The two will launch a new company, VCU Health at Home by Bayada, which will allow VCU patients to continue receiving services through the health system after they are discharged. The new company will start serving patients in 2022.

Room For Value: United Rheumatology is welcoming Horizon to its value-based program model in a collaboration aimed to help control costs for New Jersey patients. The model incorporates shared decision making between United Rheumatology’s affiliated physicians and their patients and the Horizon Episodes of Care team to improve outcomes, improve the patient experience, and manage cost of care for treatment of rheumatoid arthritis and psoriatic arthritis.

Extra Point: Please pray for my 17-year-old – he’s about to graduate high school, hasn’t seemed to be in any classes for 6 months, golfs with teachers during school hours, and now perhaps as a bit of payback took an elbow in the nose during one of a half-dozen school pranks today, which means we are off to urgent care. Never a dull moment, this thing they call parenting.

12: The number of Pennsylvania healthcare organizations that are incorporating tech into member care. UPMC Health Plan has a virtual concierge service that integrates into Alexa and Google Home machines. Members can use the service to ask about coverage, care options and other topics. Geisinger is using biometric technology to check patients in. They have checked in 5,600 patients so far.

Nail Biter: Google is planning to release a new tool later this year that will use AI to help identify skin, hair and nail issues. The AI-based tool is not meant to replace a physician’s opinion but to inform users and help them decide when a physician visit is needed. To use the tool, patients will upload three photos of the affected area, then answer questions about their skin type and symptoms. The AI model will analyze that information and will provide a list of possible matching conditions out of a pool of 288 conditions, Google said.

Baby Script:  A virtual care platform for managing obstetrics now allows patients to share weight and blood pressure data and use other remote monitoring tools before and after a pregnancy. The tool is from Cerner, which has partnered with Banner Health on the launch. Obstetricians and family practitioners system-wide at Banner have access. Next, clinical teams will be able to order tools for patients related to chronic conditions and behavioral health through their Cerner EHRs.

House or Home: University Hospital, the academic medical center in NJ, is venturing into affordable housing through a partnership with the state and housing developers. Hospital Partnership Subsidy Program will provide 78 rental apartments to lower-income people and some units will be considered supportive housing, which includes access to medical services. These units will be on top of a ground floor outpatient clinic run by UH. This is another example of fast-moving social determinants of health space. Our healthcare researcher Samantha Guarneri led a study on stakeholder initiatives featured here.

LGBTQ Addition: The newly formed telehealth giant created by the merger of Doctor on Demand and Grand Rounds has already acquired another player in the space, Included Health, a care navigation platform for the LGBTQ community. Research has shown that LGBTQ individuals often struggle with access to necessary medical care and virtual health companies like Included Health are trying to alleviate some of these challenges. A recent piece from our behavioral health reporter Erin O’Donnell addressed the issue – check out the story here.

Rx Benefit: According to recent studies, Cigna and Highmark observed cost savings and higher member engagement for plans with integrated medical and pharmacy benefits, compared to plans that carve out pharmacy benefits. Highmark’s integrated benefits saved an average of between $150 and $230 per member per year between 2017-2019 and Cigna saved an average of $227 per member per year. Stay tuned for an upcoming Eye on Healthcare that further explores the findings.

UnDisabled: The University of Houston College of Medicine and the Humana’s Integrated Health System Sciences Institute have teamed up with Lone Star Circle of Care, a federally qualified health center, and Lone Star Legal Aid, a free legal aid provider, to host a medical legal partnership at Lone Star Circle of Care’s clinic at UH. This partnership developed because of patients struggling with workplace discrimination, disability issues, and inadequate housing, factors know as health harming legal needs, that can lead to serious illness, along with depression, anxiety, and high-risk behaviors such as substance use disorder. The Humana Institute will assess the outcomes to determine how these patients can be helped.

Cornhusker: BCBS of Nebraska is removing AllianceRx as their preferred pharmacy and moving to Accredo for specialty pharmacy and Express Scripts for home delivery, effective July 1, 2021. This is one of several pharmacy priorities for insurers this year, another is developing outcomes-based contracts to manage growing demand for gene therapy. Researcher Ashley Chilton explored developments in this recent report.

Extra Point: One of my old high school buds is an internist at a growing practice down south and bent my ear this week complaining how he came up just short on getting a bigger bonus from one of his more important payers. “I got 79% of the high risk diabetic patients to lower their A1C to a better level but to get the $50,000 kicker I needed to get to 80% - total bull”.  Back in high school, Doctor Laney used to wear an ACDC t-shirt and rocked out to Guns N’ Roses during homeroom in 1987. He would always try to haggle with Mr. Whittier over his algebra grades, but teach never gave in, and it sounds like things haven’t changed for “Laney.”  I told him my kid Tommy is facing similar growing pains. “Tom came home ticked off about his 79.6 in math – his teacher gave him a C+, which I sort of love. I mean, if there’s any class that should go with the exact number, it’s got to be math. English lit, sure. Art, of course. But math, and maybe healthcare outcomes payment, maybe not. Rounding up feels nice momentarily, sort of the way you feel after you cheat to beat your kid in monopoly, but I’m not so sure it is helping anyone. Here’s to holding your ground.

This week’s column includes some of the most read items of the past two years and a few new ones. Happy Memorial Day!

$4,229: The average total savings when using bundled payment programs for surgeries, according to a Rand study of one payer’s program in which procedures including knee and hip replacements, spinal fusion and bariatric weight loss surgeries used a set bundled payment for all care within a 30-day period.

Finding Oneself In A Non-Binary:  Healthcare is getting an education on the fly of how to manage and document their encounters with patients who are non-binary. My 78-year-old father just got his lesson after Sophia’s dance recital last week. “I always love watching you kiddo, but I gotta be honest I couldn’t exactly see your plie’s since the boy in front kept blocking my view.”  He’s not a boy, papa - he’s a they, Sophia explained. “He’s a what?” A they – non-binary.  “I don’t know what he is but he’s certainly not a dancer like you.” “Oh my gosh papa! Let me explain – it is a boy, but he doesn’t want to be identified as that. He’s in the middle if you will. Not a he or a she.  “Well he was certainly in the middle of my view.”  In healthcare, non-binary is coming up in more patient encounters namely for young patients and teens who are changing from Ava to Atlas and forcing a new world of education for clinicians and office managers. At least most of the documentation is already non-binary, a case manager we spoke to said. “It’s not been a major change in terms of the medical record, but it is a big deal for our clinicians – we lost a few patients because of this.”

Multiple Sclerosis Pilot: Highmark has partnered with AllianceRx Walgreens Prime to launch a Social Determinants of Health (SDoH) pilot outreach program targeted at Highmark members who have multiple sclerosis (MS) and use AllianceRx as their specialty pharmacy. Through a voluntary member survey, the program will identify and notify patients impacted by social risk factors in order to refer them to necessary social or behavioral resources. This program began on April 19th and will initially be one year long, with future phases dependent on the success of the pilot.

Bundle This: A maternity MAT initiative kicks off this month for all OB/GYNs and maternal and fetal medicine doctors in Blue Michigan’s physician performance program, this one focused on addiction. Providers who participate will receive initial funding of $10,000 and will then be eligible for $1,000 per patient treated with medication assisted treatment in 2021.

20% Swing: The difference in reimbursement rates for ABA providers now that BCBS of Texas will begin tiering them for ABA therapy, effective April 2021. RBTs, Board Certified Assistant Behavior Analysts or clinicians with a bachelor’s degree will receive the existing rate, while clinicians with less than a bachelor’s degree and no RBT certification will receive 20% less. BCBAs and master’s level clinicians will receive an increase in rate of 20%.

Toothpaste, GoldFish & Therapy: CVS is adding virtual and in-person behavioral healthcare services in select HealthHUB locations but in a straw poll of shoppers I talked to while waiting for my 13-year-old’s vaccine appointment to end I heard low enthusiasm. Brianna Jenkins, a mom of 4, said “It doesn’t seem too private or calming – I have used telehealth.” Anyone needing services will be connected with a clinical social worker who will do an assessment and refer to specialists if needed. As of now, HealthHUBs are only available in select locations in Houston, Philadelphia, and Tampa but 34 new locations are slated to open in the spring of 2021.

Doctor Amazon?: The online retailer runs health clinics near worksites in Dallas-Fort Worth, Phoenix, Louisville and, more recently, Michigan and California. Amazon’s clinics are operated by Crossover Health and have provided services to over 115,000 workers and their dependents since the program first launched in late 2020. Earlier this month, Amazon also expanded its virtual and in-person care program into 21 states through the company Care Medical.

A Richard Kimble Moment: At about the same time as my oldest son was leading the marching band down main street on Memorial Day a couple years ago my dad was pulling a Richard Kimble back home, wrapping a deep shin wound with one hand using amateur tape and gauze like the Fugitive character, driving himself to the urgent care in what was a race against time. He had fallen in the garden trying to relocate a hosta only to slip or get dizzy and slam his right shin into a rock. He would later tell me he ‘wanted to get it stitched up before mom found out….’ But the so-called 24-7 urgent care was closed—two of them in fact—so I made my way to dad’s house to pick him up. We averted going to the hospital ER, finding the only urgent care open in the region. The PA was sharp, and a great teacher – allowing his assistant, a Bay Path College student, just enough independence to clean the wound and put in 8 stiches on his own, with a small bit of oversight. I think back to Memorial Day – yeah, I missed the barbeque, but I spent a day with a veteran, my dad, and stories about his penchant for falling and first aid. Here’s to all the vets out there.

A Point (From The Archives): My kids complain a lot about how I go down the ‘when I grew up’ road way too often. It’s just so easy sometimes. Helps me make a point, like my latest rant: When I grew up, we ate supper together on Sundays. At 2 o’clock. Not because we were hungry, or it was raining, but because grandma said so. Afterwards, we played kickball ‘til dark. We didn’t have hover boards or Fortnite or Twittergrams or Snapbook. When we fell on the driveway during a game of ‘Red Rover’, mom didn’t rush us to urgent care. There was no urgent care. She layered on three Band Aides and gave you a slice of warmed up apple pie. We didn’t have depression—at least not in the way it’s understood today. Yes, we were sad when the Yankees and Sox were in a rain delay, but dad cheered us up by putting the Polka on the record player and throwing us on his shoulders. We danced. We had a simple life with at most three principles, and I’m pretty sure two of them had something to do with mashed potatoes. We didn’t text or Jabber or FaceTime, we stood by an answering machine hooked up to the rotary dial, replaying Sam’s message because you couldn’t hear the phone number the first dozen times. ‘Download’ was not a word. To hear Survivor’s You Can’t Hold Back, we had to rewind Side B for six seconds, then flip the cassette at least a half dozen times to get to Side A to just the right time. When we were bored, we picked up a shovel and dug a hole, found some worms and put them under my sister’s pillow. Our friends were mostly the seven people we shared the upstairs bathroom with. The same seven we fought with for the Raisin Bran. We wrestled with grandma, played ‘setback’ with papa, and listened to Joe Castiglione call the game on the AM dial. On a good day, I would hold the bunny ears on the RCA, so we could watch the game on TV. What strikes me about then is how strikingly familiar it is to now. Last weekend, I asked Tommy to lean the phone against the wheelbarrow when we weeded the driveway. We listened to a replay of the inning Fisk hit that homerun. We ate spaghetti around two and then played Twister, until the dog peed on the green circle. What’s past is prologue. I would argue that, for some of us lucky enough to be safe and healthy, we aren’t standing still at all as it may seem. We are going back, and there’s some good to come from that...

6: The number of independent physician associations in Philadelphia that merged to create the Constitution Physician Alliance network. The group includes over 200 specialists and primary care physicians, and will collaborate to focus on disease prevention and reducing hospital admissions. The network is managed by CareAllies, a Cigna company.

A Whole New World: Disney is embracing telehealth. As part of Disney World’s partnership with Florida health system AdventHealth, the theme park will now make connected health services available to guests, employees and others, including a telehealth platform that can be accessed at any time and a mobile health app for scheduling virtual care. Not sure if this means you can get a nurse to virtually check your BP on Space Mountain, but it’s Disney – so magic happens. AdventHealth is also building a brick and mortar ER at the theme park to address urgent care needs.

Safe & Tasty Transitions: In another show of support for home-based care, United is launching a new program for their Group Retiree MA members to safely transition home after discharge from a hospital or SNF. Beginning January 1, 2022, UnitedHealthcare Healthy at Home will provide all retirees in an MA plan with up to 28 meals, 12 transportation rides and up to 6 hours of in-home personal care after discharge, in an effort to prevent hospital readmission. We’ve seen a rise in MA plans offering supplemental benefits like these and expect this to continue.

Renal Revitalization: Centene is partnering with Somatus Inc. in several states to offer care management programs for Medicaid and/or Medicare members with chronic kidney disease and end-stage renal disease. In addition to care management, social workers will also be available to help patients with transportation, food, or other issues that make it hard for a patient to access or comply with treatment.

Mom To Be: UnitedHealthcare Community Plan members in Texas are now eligible for a new program called Wellhop for Mom and Baby. Wellhop is an app that expectant mothers can use to connect with a group leader and other expectants mothers through bi-weekly chats, discussion boards, and an online library.

Rerun Or Latest Episode? You may think you’ve seen this one but BCBS Michigan is introducing a new value-based reimbursement opportunity for orthopedic surgeons. Orthopedic surgery practices will be evaluated on cost trends in their knee and hip replacement episodes. Episodes begin with the replacement surgery and continue for 90 days post-surgery. Practices with the lowest episode cost trend will be rewarded with an additional 5% value-based reimbursement starting in March 2023.

SDOH Coverage: Upon evidence of a -25% reduction in total cost of care and a +60% increase in behavioral health treatment, Horizon is expanding their SDoH program to cover members across 15 New Jersey counties and 127 zip-codes. The original pilot program, which launched in April 2017, initially targeted 1,000 members with SDoH needs in 4 Newark zip-codes. 2021 focus areas will include COVID-19, vaccine education, and increased provider engagement.

Tele Jump: BCBS MA released a report indicating that between March 2020 and March 2021 outpatient mental health services increased +20% and spending on substance use disorder (SUD) increased by +10%. The report also found that approximately 70% of mental health visits covered by BCBS MA have been conducted via telehealth. In fact, 54% of total telehealth visits across specialties have been focused on mental health and 60% of mental health diagnoses made via telehealth have been for anxiety.

Pre Approval: United is making prior authorization (PA) and site of service changes for its commercial plans, including removing PA for 170 codes. The health plan is adding PA and site of service reviews for 32 surgical codes if being done in the hospital outpatient setting, including mastectomy and some arthroscopic procedures. Another 7 codes will require PA and site of service reviews if being done in the hospital outpatient or ambulatory surgical setting. These include injections and excisions.

School Choice: SchoolCare, a health technology company, is teaming up with Managed Health Services (MHS), an Indiana MCO, to coordinate care for underserved pediatric populations through school nurse offices in Indiana with the utilization of an electronic health record system. The software provided by SchoolCare in K-12 school nurse offices will be integrated with care management resources at MHS so that parents, MHS Care Managers, and school nurses will be coordinated.

Extra Point: When I grew up only 3 kids didn’t look like me. We had diversity, for sure, but it was Irish Catholics at one table, Italian Catholics at another, and a few protestants. Now our kids are growing up in a far more diverse world, with friends born from other parts of the world, some with disability, some LGBTQ, others non-binary, and many trying to bust down stereotypes, like why shouldn’t the soccer player on the girl’s team kick field goals for the football team, or why can’t Lucy play Shrek? I mean, he’s an Ogre, not a man. Diversity is making its way into healthcare too – in our patients, in the services we’re offering, in what our policy leaders cover, where we get treatment, and now how clinicians are paid. Maybe this complicates things, but it sure seems that the more diverse we become the more culturally competent we need to be. Maybe that doesn’t get you a better contracted rate, but it may just get you more patients and a better reputation.

4: Number of hospitals HCA is selling in Georgia to Piedmont Healthcare, the Atlanta-based clinically integrated network. The sale gives Piedmont 15 hospitals, reducing HCA’s footprint in the state to 5 hospitals. But HCA appears to be increasingly focusing on post-acute and home-based care, having acquired a majority stake in Brookdale Senior Living’s home health, hospice, and outpatient therapy business earlier in the year. Piedmont is also picking up 3 additional hospitals in the Augusta region through another deal, announced soon after the HCA news.

Where’s The Beef: Tyson Foods is opening the first of 7 Bright Blue health centers in Wilkesboro, North Carolina later this month, for employees and their dependents enrolled in a high deductible plan. The health centers will be operated by Marathon Health and will provide primary and preventive care, including behavioral health counseling. Don’t be surprised to see Tyson layer in a nutritional food delivery program that pushes things like grass fed beef.

Portable Contracts: In a poll of 52 health plan network contracting sources from a majority of the top 30 U.S. plans, our research team found that the likelihood of getting the same contract when acquiring a practice in a different city is difficult if the markets are unique but increases if the acquiring practice is in a value-based arrangement. Which specialists have more success transitioning contracts may surprise you. Stay tuned for the full report coming up.

Maternal Instincts: Anthem Nevada is partnering with the Reno Doula Project to launch a maternal health program that will make doula services available to its pregnant Medicaid members at no cost. The program was designed in response to Nevada’s poor health outcomes; the state ranks 46th for women’s and children’s health. Doulas provide education along with physical and emotional support during pregnancy and delivery and have been shown to improve birth outcomes.

Trust Your Heart: I play hoops with a couple cardiologists, both former D1 players who block my jumpers ala Bill Russell, which I’ll admit is reassuring when I start sweating before the first possession, and also good for post-game shop talk. On Sunday on the outdoor slab I found out one of them is interestingly going multi-specialty, his practice adding a nutritionist, an osteoporosis specialist and a behavioral therapist. Talk about all in the family.  “You’d be surprised how these can all connect,” he said. My mom should be happy – at 77, her diet plans from her cardiologist and PCP had her eating different yogurts causing confusion and stress, so an integrated group should help limit the amount of times she calls me asking for medical advice. While up to 80% of cardiologists are hospital-owned, two thirds of the roughly 3,000 cardiology practices in the US have fewer than 5 physicians. These small practices, like my hoops squad, have an opportunity to really innovate, like if a patient needs a new PCI (an angioplasty with a stent) it’s important that cardiologists know the date of the earlier procedure, the stent type and size and vessel location, but most practices and hospitals don’t educate patients enough on the importance of knowing this information, or patients ignore doctor’s orders. If you’re looking at cardiology, don’t just consider the fragmentation – consider how to influence the behavior of heart patients, manage care with sub-specialists, and get paid for it.

Gut Check: This new field focuses on the relationship between mental health and diet and how eating certain foods can promote mental health, which I’ll admit seems obvious but historically nutrition has been focused on physical health. “There is a lot of research on the role of gut microbiota in health and disease,” says Paola Sandroni, a neuroscientist at the Mayo Clinic. “We know certain diets like the Mediterranean diet are better to prevent Alzheimer’s.” I am personally still waiting on what glazed donuts prevent. Read the full story here.

Not Your Father’s Health Plan: Harvard Pilgrim Health Care is the latest to create virtual health plans. Its SimplyVirtual and Virtual Choice, both in New Hampshire, offer virtual visits with PCPs and care team support through its existing partner, Doctor On Demand. Both virtual health plans will be available to large employers starting in September.

No More Blues: The Blue Cross and Blue Shield Association dropped a rule that limited the amount of revenue its 35 plans could generate from non-Blues business. Sources say this could lead to longer-term consolidation between the smaller plans and more partnerships and joint ventures among the larger plans.

Mass Time: Catholics are notoriously late for Mass, heck my dad would always say “it only really matters if we make it in time for last 20 minutes of Father’s homily to get credit”. Hospital systems in Massachusetts have been anything but late to healthcare reform. UMass Memorial Health will launch its own non-profit health insurance company, Central Mass Health, later this year. The health plan will provide care through managed care programs, HMOs and alternative healthcare delivery programs.

Home Base: Kaiser’s Built for Zero partnership aimed to end chronic homelessness has expanded to 30 communities and is showing promising results, reducing homelessness in 10 communities since launching in 2019. Use of data tools has helped track patterns of homelessness, which helps hospitals and local social services providers better target resources.

Extra Point: When I was pup reporter I used to write a day in the life column and 25 years ago this week I joined Lynn Vevier on a home visit to widower Elaine Bryne who at 75 had been in and out of the hospital more than a dozen times over a year. Lynn was moonlighting as a case manager for Aetna to play detective on so-called train-wreck cases. Elaine was sweet, offering me chocolate chip cookies and a cup of milk while we sat at her mahogany dining table scattered with index cards, Parade magazines, stacks of coins and an uncovered jar of Skippy. Lynn knew Elaine was taking 4 prescriptions for hypertension and other conditions and said “show me how you take your pills.” So Elaine grabbed the bottles, opened them up, dumped a few into the Skippy, mixed the spoon around and raised it to her mouth. “Hold the phone,” Lynn said peering into the jar. “Elaine dear, your spoon doesn’t have any of the pills, just peanut butter.” “But it’s crunchy so I figured I was getting the medicine,” Elaine said. That was true to a degree, only thing was the Skippy was the “crunchy” brand so some days Elaine was getting too many pills, some days none at all. This was causing all sorts of problems, like hypotensive shock and fainting. Lynn figured out a new way to right the ship combining a make-shift pill box, peanut butter cups and a weekly home aide visit. Over the next year Elaine only needed the hospital once. I didn’t stay in touch with her much after that but I always tell her story. My colleagues have probably heard me tell it dozens of times over the years but like few other tales it captures so much about our behavior and isolation but also how a little conversation over milk and cookies can change a life.

60: Humana is purchasing the remaining 60% interest of Kindred at Home and will rebrand the company through Humana’s new healthcare services brand, CenterWell, going by CenterWell Home Health. Fully integrating home health allows Humana to accelerate their value-based operating model at scale, more closely focusing on improving patient outcomes and reducing the total cost of care. The payer plans to divest their majority stake in Kindred’s hospice and community care operations.

Home Care Oversight: BCBS Michigan is contracting with CareCentrix to manage home health care services for MA members, effective June 1, 2021. CareCentrix will be managing all prior authorizations and recertifications for home health care services, including PT, OT, and ST.

Before We Pay: Somewhat like reviewing the bill at the Denny’s diner to make sure you are not on the hook for the side of pancakes you never actually got, several payers including Anthem are now using analytics to target physician practices who are billing higher levels of evaluation and management codes. The goal is to inspect patterns and potential upcoding. Anthem will review claims prior to payment and, in a likely case, adjust reimbursement to a lower level, though in some cases may just ask for more documentation.

Actually It’s Not What You Thought: Despite reports of big jumps in anxiety medication scripts, alcohol treatment admits, crisis center waitlists and suicide attempts, actual mental health diagnosis was down among children and older adults in 2020 vs. the prior year, mainly due to fewer in-person interactions like school and church that lead to earlier intervention and diagnoses for depression, anxiety or dementia, according to new findings from the Anthem State of the Nation's Mental Health Report. Anthem found a -10% overall decline in mental health diagnosis among children and a -13% overall drop for adolescents diagnosed with ADHD. Experts theorize this is because children involved with distance learning have had less face time with teachers and counselors, which often plays a role in diagnosis. This has been the issue for a 13-year-old 7^th grader in Hartford whose isolation has led to more than 9 suicide attempts. The positive is re-entry to in-person school has allowed teachers to monitor and form a plan and, more importantly, diagnose and treat the issue. Getting the teen involved in a daily sports exercise program has been one part of the effort, but as the girl’s teacher said, “This is going to be a long haul for her.” Nearly three out of four mental health specialists and primary care doctors agree, estimating that mental health repercussions from the virus will last up to three years or longer, the study found.

Removing Authorization: BCBS Texas is removing some prior authorization (PA) requirements through their third-party benefit manager, AIM. As of April 16th, a PA is no longer required for certain sleep medicine DME codes and effective July 1st, PAs will be removed for select codes in advanced imaging, genetic testing, and pain management.

The MCO Giveth And Taketh Away: Just like the Bible passage, the positive news above from Blue Texas comes as Aetna will begin requiring precertification for cataract surgery procedures as of July 1, 2021. Placing cataract surgery on the National Precertification List (NPL) will allow the health plan to review cataract procedures for medical necessity before any member undergoes surgery.

Don’t Miss This Episode: Horizon BCBS in New Jersey recently expanded its Episode of Care program to include a new prospective breast cancer episode. Through a partnership with Astera Cancer Care, the episode will provide coordinated, early-stage breast cancer treatment to members. All healthcare services provided throughout treatment will be part of the episode, including lab work, imaging, surgery and post-surgical care, no matter how long the episode lasts.

Van With Care: It may not be Matt Foley’s famous motivational “van down by the river” that inspired David Spade to stop using drugs on Saturday Night Live in the 90s, but this van will likely save other lives as Anthem California has donated $100,000 to the Fresno Center to help the non-profit purchase an office van to bring case management and therapy visits into neighborhoods. This is just continued evidence that managed care plans will continue to fund non-profits focused on social services.

Extra Point: Being predictable may be boring but it pays the bills if you’re a meteorologist in New England, and increasingly if you work in healthcare. I mean in movies we say we like the unpredictable, but to be honest we watch Apollo 13 over and over like 50 times not because Tom Hanks is a convincing astronaut but because we know the ending before it starts, and we love it. We sing with Icelandic Eurovision duo Will Ferrell and Rachel McAdams every morning before school this week because the music lifts us up and makes us laugh before the day starts. If it’s 7:20am, it’s time to play their Song-Along. It becomes our behavior. In healthcare we wish we could predict every outcome, but we can’t. We want to know that the surgery will take 3 hours, require 1 night in the hospital, no complications, 3 weeks of rehab and have Sally running pain free again by the time the Boston Marathon takes off from Hopkinton. We want to know that 20 visits with the behavioral therapist will cost the same each time, that the therapist will have Sally talking freely and confidently by the time she hangs her raincoat in that nursery school cubby in September. We want a good outcome but are sometimes afraid to pay for it. We are stuck often times in paying for each service and don’t have the systems to pay for a good result. We are afraid to change because it’s unpredictable. We ask our doctors to diagnose our pain, treat it and tell us that it will all be fine, but sometimes we forget this is life – and those tumors are unpredictable and might need more than a miracle drug. I predict that by 2030 there will no longer be a fee for service, not without a guarantee that what you’re buying – a drug, a new knee, a better behavior, a pain free shoulder, a working heart, a clearer eye, a cure and a second chance – will be predictable. I’m as certain as I am that tomorrow’s weather will be mostly sunny. Here’s to hoping.

24/7: Dartmouth-Hitchcock, along with MDLive, announced a virtual urgent-care service earlier this month. The 24/7 virtual urgent care will connect patients anywhere to clinicians at Dartmouth-Hitchcock, while MDLive physicians will provide back-up coverage.

Dementia Risk Rising: Researchers say it’s probable that COVID-19 can increase the risk of getting dementia based on several new studies. You can read the full story here.

Multiple Sclerosis Pilot: Highmark has partnered with AllianceRx Walgreens Prime to launch a Social Determinants of Health (SDoH) pilot outreach program targeted at Highmark members who have multiple sclerosis (MS) and use AllianceRx as their specialty pharmacy. Through a voluntary member survey, the program will identify and notify patients impacted by social risk factors in order to refer them to necessary social or behavioral resources. This program began on April 19th and will initially be one year long, with future phases dependent on the success of the pilot.

Heads Carolina, Tailwinds For SDOH: In an attempt to decrease food insecurity among their members, BCBS NC is partnering with the Benefits Data Trust, Manna Food Bank of Central & Eastern North Carolina, and Second Harvest Food Bank of Northwest NC to boost enrollment in SNAP and the Food and Nutrition Service. BCBS NC also launched a food delivery and health coaching program for low-income members with Type 2 diabetes and transportation programs for members in need of assistance getting to and from grocery stores.

Symptom Checker: Anthem is partnering with Blackstone to scale an AI-powered app, K Health, that helps consumers check symptoms and provides virtual care. In our poll of 1,524 adults, 58% say they would be interested in tools to help them do in-home assessments “rather than relying solely on going to the doctor.” Moms are far more interested than others (71% polled), particularly in tools both for their aging parents, their kids, and themselves.

PCP Partnership: Accolade, a health benefits platform, is acquiring virtual primary care company, PlushCare. The combined company will be able to streamline access to acute, chronic and preventive care both virtually and in-person. Earlier this year, Accolade purchased another virtual care company, 2nd.MD.

Moving Health Home:  Home care is the #1 payer priority this year – including more contracting and payment models – and Advocate Aurora Health of Milwaukee and Pittsburgh-based UPMC are two of the latest health systems to join Moving Health Home, a healthcare coalition founded by Amazon Care, Intermountain and Ascension earlier this year. Expect more of these arrangements between health systems and suppliers.

Good Rep: Some health systems are looking to better their reputations by engaging more patients to leave reviews. Sharp HealthCare in California and Ochsner in Louisiana are both working with Podium, a reputation management vendor, in an effort to increase online reviews. While other industries have long relied on Yelp and other platforms for positive reviews, healthcare has not historically focused on collecting this data. Now health systems, along with health plans and their providers, are increasingly focused on making sure patients’ voices are being heard.

Extra Point: I’ve heard it said that if we just handle things like dogs we’d all be better off – that’s if you can’t eat it or play with it, just pee on it and walk away. This is true to a point I suppose, until you own a dog like mine whose idea of healthcare is licking his toes. After a 6-hour wait in the ER, the doctor and her team finally was able to see us Tuesday. “Sorry, we had some real emergencies – really appreciate your patience.” I didn’t mind, but did wonder what “real emergencies” meant exactly. Within 30 minutes the doctor diagnosed a “bizarre ear infection”, prescribed Prednisone and began the discharge process. It was like I was seeing my daughter’s allergist for bronchitis and knowing the side effects of Prednisone, I was admittedly skeptical. “You sure about this doc?” Dr. Zee paused, petted Zaggy and looked up, “Let me put it this way Bry, do you want the infection to spread or do you want to deal with some mild side effects?” I gave in, grabbed the meds and put the lab in the car. The $310 bill seemed high but understandable given I keep resisting insurance. Maybe I should sign up for an Exchange plan if they have such a thing, though I’ve heard that people with dog health insurance still often have to pay big bucks for this kind of treatment. Is it time for an ACA for pooches? Since Tuesday, Zaggy has been dehydrated and dizzy and so anxious he barked at the air for an hour last night, but the itching and soreness is fading. If there’s a lesson here it’s that if you have a dog, it’s not unlike having an infant or toddler - clean their ears, lest you’ll find yourself spending 6 hours with nothing to show for it other than a $300 bill and a dog with a whole new set of issues.