Behavioral Health Insights

263,999: Square feet, the size of the new ambulatory surgical center Kaiser is building in northern Virginia that will host multiple specialties, including radiology and infusion treatments. The building will boast a farmers' market and a health park with workout stations. Other services planned include nuclear medicine, diagnostic imaging, clinical lab, oncology pharmacies, primary and specialty clinics and a community center. Kaiser is also trying to double its retail clinic network by 2022, according to the company, and is adding 4 clinics in Southern California Target stores.

Up In The Air: Intermountain, the Utah-based health system, is buying Classic Air Medical, an air ambulance company with bases in 22 states. Intermountain plans to operate it as an independent group, which should help with the health system’s goal of better coordinating virtual and physical care, particularly for patients in rural areas. It’s possible the air ambulance will be able to transport patients across states to its services, which include expanding inpatient units dedicated to behavioral health.

Different Stroke Of Genius: While the “world doesn’t move to the beat of just one drum, everybody’s got a special kind of story” and back in 2011, Arkansas may have been ranked first in per capita stroke deaths but the University of Arkansas for Medical Sciences set out to change that launching a statewide digital health program of stroke education and treatment. The state is now ranked 13th based on the most recent year of data. The Digital Health Stroke Program provides 56 Arkansas hospitals with 24/7 access to neurologists who can quickly assess whether a stroke patient can be helped by a clot-busting drug that often restores complete function to the patient.

Lady’s Choice…Concierge Care: CommonSpirit is partnering with concierge healthcare provider, Tia, to build a series of women’s health clinics connecting inpatient and outpatient care in a one-stop shop for women’s health, including primary and gynecological care and I would expect behavioral health at some point. One idea is to have mental health therapists at the ready via teleconsult. I could envision a partnership between a telepsych provider and CommonSpirit. The initial pilot will launch virtual-first in the spring, followed by the first clinic in Phoenix this October, with planned expansions in Arizona and other CommonSpirit markets over the next few years.

System Expands: University of Maryland Shore Regional Health and Choptank Community Health System have entered a partnership to expand primary care, behavioral health and dental care services. Choptank currently serves more than 30,000 patients in 3 counties.

Detection: The Mayo Clinic has launched 2 tech companies, both focused on using AI, and one, Anumana, is starting with a project to detect heart conditions using data from electrocardiogram device. The company will seek FDA regulatory approval.

Lyft Off:  The transport company is launching a new health care program called Lyft Pass for Healthcare, which will allow organizations to send prepaid passes to patients that they can use for rides to doctor’s appointments. The program will allow health systems and other agencies to create a budget and set approved pickup and drop off locations.

Extra Point: Bob Hope once muttered that he’d give up golf if he didn’t have so many sweaters. I heard Sharon Fields, an administrator at a primary care office in Michigan, say she’d give up fee for service billing if she didn’t have so many spreadsheets. Roger Ogden, a 72-year-old orthopedist from Vermont, told me he’d give up 4AM wake-ups for ACL surgery “if there weren’t so many God awful skiers.” Empty nester Aubrey Knight works at an allergy practice in western Massachusetts and says she’d rather move her husband and dogs south if the pollen wasn’t so high here – “we have too many patients,” she says. Heidi Lapit, a clinical pharmacist, says she’d give up switching patients to generics if she didn’t have so many payers requiring it. It seems our senior Jack, 17, actually did give up studying this year and when I mentioned the comedian’s sweater story Jack said “Wait, I don’t get it, who in the heck is Bob Hope?”

Save the Date: On Thursday, April 29^th at 1PM tune in to our annual release of the Top 20 managed care payer priorities. Complementary registration here.

42: The number that hangs from baseball’s rafters and now also the percentage reduction in the rate of asthma-related emergency department visits and hospitalizations, thanks to a collaboration between health insurer HCSC and the American Lung Association. The project, Enhancing Care for Children with Asthma, launched 9 years ago and works with community clinics across the insurer’s 5 states to implement a quality improvement program to support asthma management in children.

Devising An Outcomes Contract: Spectrum Health, the integrated health system in Michigan, is entering into a risk-based deal with Medtronic. Heart failure patients who receive a certain type of Medtronic pacemaker will have their progress tracked, including 30-day hospital readmissions. Medtronic will reimburse Spectrum if the patient has suboptimal outcomes. While Spectrum has no obligation to use Medtronic products, their senior director of procurement says they likely will, “assuming we see the outcomes”.

Specialty Rx: Anthem has started to create a designated network for select specialty pharmacy medications administered in the office or the outpatient facility setting. Its Designated Specialty Rx Network applies to commercial patients as of April 1. Anthem is not the only insurer moving in this direction, and as far as we can tell more insurers are exploring this pseudo narrow network approach both for outpatient and the home.

Bold SUD Fix: Regence BCBS is bringing Boulder Care’s virtual addiction treatment model in network to provide members with additional access. As of March 15th, Boulder Care is now available to all Regence members, no matter where they are located. Members will have access to a full care team, including clinicians, care advocates and peer coaches, who can share their own experience with recovery.

Specialty, On Call: SOC Telemed has acquired telehealth vendor Access Physicians to form the so-called largest acute telemedicine provider in the US, according to the companies. The acquisition will add infectious disease, cardiology, maternal-fetal medicine and nephrology to SOC Telemed’s core services of neurology, psychiatry, critical care and pulmonology.

Disability Solution: Delta Dental’s philanthropic arm is funding an online professional development program designed to help oral health professionals better understand and care for persons with disabilities through Penn Dental Medicine.

Along Comes A Sports Benefit: I played 2 on 2 hoops last weekend with an Orange Theory business development leader who on the one hand played a bit like Phillip Seymour Hoffman’s character in Along Came Polly but on the other opened up about the OT’s move into modern day healthcare. The new-age exercise center has been in talks to partner with a regional primary care and cardiology group and an insurer to form a kind of preventive care meets exercise benefit targeting the 26-35 age group. The OT center uses a point system and cross-training approach to get people into their optimal calorie-burning zone. Before COVID hit, I gave the OT a try and my personal theory was that it made me nauseous, but that’s just me. In case you missed it, click here for the full review.

New #1: Simon & Garfunkel sang about it and my gym class slid into it at the park – that’s right, “home” healthcare has moved up 13 places to the top ranked health plan priority for 2021 according to our 16^th annual Healthcare Payer Index. 2020’s #1 primary care moves out of the top spot and seven services actually left the Top 20 entirely, including ophthalmology, while three services made their debut, including social services. “We’ve always been a bit reactive and we had to be last year,” says a Blue plan’s payment transformation director, “but 2020 also gave us a chance to reset priorities and cut down on some silos that used to hinder innovation.”  Stay tuned for the full rankings and analysis later this month.

Cologuard: Two weeks ago we reported that 59% of 35-45 year olds in our consumer poll said they will “likely” or “definitely” choose Cologuard’s at home test for colon cancer when the time comes over Colonoscopy, several citing advantages like “not having to do the prep my dad did” or not “having to be sedated” and even financial benefits for those who say they may just pay cash “and I think the at home is a lot cheaper”. If a Cologuard test is positive, the patient will need a Colonoscopy, but only 39% knew this. However, the cost of the Colonoscopy in this situation would be applied to the patient’s deductible if they are using insurance. 20% said they would “definitely” choose the test, 39% “likely.”

Social Solution: On April 15^th we will host a live event releasing results of our recent survey of 544 healthcare stakeholders about the evolving role of social risk investment in healthcare. To register, click here and stay tuned for the full report.

Extra Point: Golfers sure do have it a lot tougher than doctors. Justin Spieth carded a triple bogey at the Masters but somehow finds himself on the leaderboard after an eagle at the Par 5 15^th. Imagine cardiologists needing 3 tries to get a triple bypass done correctly and yet still finding themselves among the best. Then there’s Brooks Koepka – the pro blamed the wind for his tough round at Augusta Thursday, sort of like a doctor saying the air conditioning in the OR wasn’t working well today during surgery, so it’s not my fault the surgery didn’t end well. Rory McIlroy, the great hope of pretty much every Irish Catholic in my family, actually hit his dad after a wayward iron during the opening round. The ball struck pop’s back leg. If only there were a doctor there to check the bruise.

5G: Vitas Healthcare, a hospice and palliative care provider, is working with AT&T to test whether virtual reality delivered through a 5G network can help reduce pain and anxiety for patients receiving end-of-life care. Large institutions like USC, Spectrum Health, Emory and the VA have all launched programs utilizing 5G in unique ways to try to better patient care.

Value Contracts: 79 health plan payment innovation directors out of 100 we polled last month say they are building out condition-based episodic structures that will be the same across patient populations – commercial, Medicare and Medicaid – to allow for uniformity, easier measurement and value-based pay, but also for aligned incentives for providers who treat patients who migrate from commercial to Medicare.

Home Buy: Anthem is expanding its home health business by acquiring myNEXUS, a home healthcare company that provides integrated nursing management to seniors in 20 states. The company currently serves around 1.7 million MA members and the acquisition will allow the company to expand its footprint, while adding to Anthem’s focus on shifting site of service to the least costly setting.

Type 1: Passport Health, Molina’s Medicaid health plan in Kentucky, is partnering with the Kentucky Cabinet for Health and Family Services to help improve diabetic control among adults enrolled in Medicaid and reduce the prevalence of type 1 diabetic ketoacidosis among children. Interventions will include more referrals to diabetes self-management and support programs, enhanced care management and care coordination, and increased follow ups and interventions from endocrinologists following adverse A1C lab results.

UberMove: Last fall we reported that Uber partnered with NimbleRx to deliver prescription drugs and now Uber is teaming up with another prescription delivery service, ScriptDrop, to deliver medications in 37 states. Uber will be the default delivery service for ScriptDrop pharmacies, which plan to extend to all 50 states eventually.

Food Advocate: Wisconsin-based health system Advocate Aurora has invested in San Francisco-based Foodsmart, which offers nutrition counseling and other digital services to make it easier for people to eat well on a budget. Advocate’s new investment arm aims to fund businesses that promote health and wellness, specifically enabling people to age independently, supporting parents in raising children and helping people achieve their whole health goals.

Anesthesia Union: CRNAs at 3 of Beaumont Health’s Michigan hospitals have formed a union in order to negotiate with their new employer, NorthStar Anesthesia. In January, 180 CRNAs were outsourced by Beaumont to NorthStar, who began providing anesthesia services to the health system. NorthStar employs more than 500 anesthesiologists and 2000 CRNAs and this will be the first unionized group at any of the 140 centers where NorthStar manages anesthesiology services.

ExtraPoint: I know many of us may be trying to see relatives this weekend and on some level it just has to happen. My 83-year-old mother-in-law started packing her car Tuesday when we told her we were coming up on Good Friday. She got so confused about who was going where and actually began to drive to us in Connecticut before turning around because she “forgot to bring mustard we might need.” Last night she called my brother-in-law to say we had already visited and went to Fenway Park to see the Red Sox. Mom was panicking, not because we are a handful when we visit – which we are – but because cognitive decline has a cruel but real way of limiting brain function. Mom taught middle school religion for 35 years before retiring in 2008 about a decade after Arnie passed, but in retirement she’s been unable to replace that social interaction and stimulation. If we’ve learned anything from this, it’s that keeping the mind and body active in retirement can be awfully difficult when you are alone and controlled by anxiety. Her brother, 84-year-old Father Michael Connolly, rides a bike every morning through Spokane before his political science lecture class at Gonzaga. He still teaches, still engages, uses google drive and eats coffee ice cream every afternoon in the student union. Unlike mom, Uncle Mike surrounds himself with stimulation. On Saturday, we will begin what we hope will start a new chapter for mom. We will sit down around 8 o’clock and watch the Zags play UCLA in the basketball tournament. It won’t really matter that mom won’t remember the game a day later, what will matter is the walk around the neighborhood on Easter morning with her grandkids, and a few chocolate bunnies at noon.

59: Percent of 35-45 year olds in our consumer poll who said they will “likely” or “definitely” choose Cologuard’s at home test for colon cancer when the time comes over Colonoscopy, several citing advantages like “not having to do the prep my dad did” or not “having to be sedated” and even financial benefits for those who say they may just pay cash “and I think the at home is a lot cheaper”. If a Cologuard test is positive, the patient will need a Colonoscopy, but only 39% knew this. However, the cost of the Colonoscopy in this situation would be applied to the patient’s deductible if they are using insurance.

Sports Meets Health: Sanford Health is investing $300 million to boost rural healthcare in South Dakota, adding additional sports fields to its complex in Sioux Falls and expanding its youth and adult recreational sports leagues. The investment also allows Sanford to create a virtual hospital and 8 new medical residencies and fellowships that the health system hopes will spur a network of specialists in underserved rural communities.

Y Sports: Last month we reported on the grand opening of BCBS IL’s Little Village Wellness Center, now this month BCBS of NC has established a three-year partnership with YMCA of the Triangle to provide discounted medical memberships to qualifying members with a doctor’s referral. Memberships will include tailored health classes, a personal health coach, and access to YMCA facilities.

Telehealth Permanente: The Northwest seems to be taking the lead on formalizing telehealth payment policies. Regence BCBS says they will continue to reimburse telehealth services at the same rate as in-person visits this year for Idaho, Oregon and Utah-based providers. For Washington state providers, the plan will reimburse in accordance with Senate Bill 5385, Telemedicine Payment Parity. Premera in Washington has standardized teledentistry payment while Kaiser Permanente has gone even further, launching its first virtual-first health plan in Washington in an effort to make telehealth a “foundational modality of care”. A consulting nurse service includes video chats with a patient’s “usual clinicians.” Data will be available through EMRs.

Hear This: Right2You now allows UnitedHealthcare members to customize their hearing aids remotely with a smartphone or tablet paired to the technology. The virtual care option is available both to Medicare Advantage and employer-sponsored members.

Reimbursement Down: If ER patients have a non-emergent diagnosis health plans are continuing to downcode these before paying. Molina is the latest payer to establish a policy that will automatically adjust payment for the professional ER services from a level 4 or 5 to a level 3 when a non-emergent diagnosis is reported.

Medicaid Stronger: Behavioral health company Strongwell is helping Medicaid beneficiaries in programs specifically for pregnancy and postpartum and substance use. Texas health plan Superior is among the partners.

Toothpaste, GoldFish & Therapy: CVS is adding virtual and in-person behavioral healthcare services in select HealthHUB locations. 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.

Extra Point: It’s good to see sports continue to make its way into healthcare benefits and services. The news today about Sanford and BCBS follows a 5 year trend of health systems and insurers investing in gym and if you look closely the type of investment is changing. We’ve gone from gym members as a supplemental benefit and grants to programs designed to get kids and seniors moving into more contractual relationships. It’s the new primary care. I’ve taught gym class for about a decade myself in inner-city Hartford and I will say that even at my age a good ole fashion game of kickball is just about the best thing. Unless of course you forget you are teaching and start running so fast around third that your head gets ahead of your legs and you fall shoulder-first into home. There I was under a maple tree Wednesday - nauseous and seeing stars, and I quickly became a pathetic man’s Q&A: “What’s wrong with Coach Cote? Naomi muttered. Mista, you alright? Why is he on all fours crying?” No, kids, Coach Cote is not okay. He’s a dummy. I’m a dummy. But healthcare, well, it’s moving in the right direction.

90%: Amount of hospitals undertaking artificial intelligence initiatives, up from just 53% in 2019, according to a new report published by Sage Growth Partners. While many of these programs are still in the planning or early implementation phase, it’s clear that healthcare executives understand the benefits of this technology and are using AI to make health systems better for both patients and providers, particularly in the wake of the pandemic.

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.

Ultrasound Guidance: Horizon BCBS in New Jersey now only allows 2 ultrasounds during pregnancy under a new policy effective this April. Additional ultrasounds may be allowed in certain situations but will require a medical director’s review. 3D and 4D ultrasounds are considered investigational and will not be covered. Some changes in payment whereby the insurer bundles pre-natal care, diagnostics, labor, delivery and post-partum care into a single rate are emerging in several areas that can give the OB “more flexibility.”

How Urgent?: Urgent care continues to move into the hands of either payers or health systems. Trinity Health, one of the country’s largest nonprofit health systems with more than 90 hospitals, is the latest mover, acquiring a majority stake in urgent care chain Premier Health, which has 73 sites in 9 states. In related news, several insurers have said they aren’t big fans of the hospital-urgent care alignment. “Has its pros and cons – how many times a day do we need to transport patients from the strip mall urgent care 5 miles away to the hospital ER? There’s a cost-benefit here. I think 30% of these trips are probably unnecessary.”

Specialty Pharmacy Preference: Regence BCBS is making Accredo Specialty Pharmacy and Express Scripts Home Delivery Pharmacy their preferred pharmacies across most networks starting April 1, 2021. Most national health plans own their own specialty or mail order pharmacies, and we are increasingly seeing local and regional plans, like Blues, choose to partner with 1 or 2 preferred pharmacies.

Pre Approval: Most UHC Community Plans, which cover Medicaid recipients, are increasing their prior authorization requirements for select orthopedic, ENT, and vascular procedures. Going forward, procedures may require images to determine if medical criteria are met. Some procedures with the new PA requirement include knee replacement surgery FESS, surgical and ablative procedures for venous insufficiency and varicose veins, and shoulder replacement surgery.

In & Out: Molina has removed knee replacement surgery from its inpatient only list in New York, a change that is in line with current CMS guidelines. The Medicaid plan will continue to reimburse inpatient knee replacement procedures for varied reasons such as comorbid conditions, but these exceptions must follow a prior authorization process.

Grand Partnership: Doctor on Demand is merging with Grand Rounds, creating a massive digital health company. Grand Rounds offers a clinical navigation platform and patient advocacy tools, while Doctor on Demand is one of the largest telehealth companies in the space. The merger is taking place with the goal of integrating medical and behavioral healthcare with patient navigation and advocacy to better coordinate care.

ExtraPoint: March madness is a time when we pick #12 Harvard over #5 Cincinnati because if any student-athlete can figure out the right angle at which to shoot a basketball, it’s gotta be a Harvard kid. Some of us only pick teams if they are a state, like Florida or Arizona, rather than Wofford or Mercer which sound more like states of depression. “Hi Honey, you seem down today.” “Yeah, I’m feeling very Wofford.” Some of us pick Cleveland State because Jimmy's dad went there, others choose schools that have a healthcare feel. I mean, what dentist out there isn't putting all his chips on Oral Roberts and Colgate? Click here for the full essay.

$4,229: The average total savings when using bundled payment programs for surgeries, according to a new study published by Rand on March 1st. The study looked at 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.

More Than A Feeling: Nonprofit Atrius with more than 30 primary care medical offices and 715 physicians in the Boston area is now an Optum company.

High Life: Highmark Health, which increased membership recently through its acquisition of HealthNow New York, is collaborating with Alphabet’s life sciences arm, Verily, to help clinicians provide better care for patients with chronic issues. Verily will use Highmark member data to build AI tools that flag patients with conditions like diabetes, COPD and CHF and help clinicians engage with the patients using various solutions best suited for each individual.

Moving Down: Intermountain Healthcare and Ascension Health, along with several home-based care companies including Amazon Care, are forming the Moving Health Home Coalition, with the goal of making COVID-19 changes to CMS home healthcare reimbursement permanent. Another request will be to allow hospitals to continue hospital-at-home programs. In Intermountain’s program, 90% of Medicare participants preferred the hospital-at-home program to traditional hospital care.

The Next Center Of Excellence: Cigna is starting a program, this time for those treating substance use, mental health and eating disorder patients. Centers can be added and removed from this distinction based on a rolling “cost efficiency score,” based in part on average length of stay.

Just Breathe: Portable electric devices that apply rapid pressure to a patient’s airway, used as cough assistive therapy to treat neuromuscular disorders, will be denied more often by Cigna and its benefit manager eviCore under a new more restrictive medical necessity policy.

Pregnancy Support: United Healthcare’s Community Plan in New York, a Medicaid MCO, has created a digital tool known as Care Conductor that allows physicians to more efficiently notify the insurer about pregnant patients, helping United use case managers to reach out to higher-risk members who may need additional support, such as food, housing and pre-natal care.

Iowa Targets Rx: Insulin, sympathominetics known as stimulants and antiretrovirals comprised the top 3 therapeutic classes by total spend according to Medicaid plan Iowa Total Care, based on its analysis of 98,000 users from March to June 2020. In comparison, Amerigroup reports 143,000 members most used antidiabetic, antipsychotic, antiasthmatic and ADHD agents. The most expensive medication for Amerigroup was Vyvanse, while Iowa Total Care’s most expensive was Humira Pen. Iowa’s drug utilization review board said it is looking into claims to identify potential misuse, specifically members with multiple SNRI and SSRI claims over a 3 month period, as well as members with multiple claims for seizure and nerve pain drugs gabapentin and pregabalin.

Diagnostic Innovation: BCBS of Kansas City now covers a new diagnostic platform used by physicians to detect Barrett’s esophagus (BE), pre-cancer, and cancerous cells in the esophagus.  611,00 members across Kansas and Missouri will now have access to the WATS-3D diagnostic tool. The Hawaii Medical Services Association, BCBS South Carolina, and Avalon also added the system to their benefits.

Extra Point: At 16, Sophie is the youngest of my three daughters but probably the healthiest, and wisest. She thinks a double bogey on a Par 5 cannot possibly be a 7. “If a bogey’s a 6 dad, well that would mean a double bogey is a 12.” Maybe it’s her namesake. Sophia, named for my great Aunt who grew up in Napoli’s mountains, means “wisdom” and, like her, our daughter seems to know what matters and tries to live it. She treasures a good John Mayer tune, 15 minutes uninterrupted on the piano, and a good complement. She no doubt benefits from living with boys who tend to see only what is and not what can be. They accidentally put Kit Kats in the washing machine but “at least they are trying to wash the clothes,” Soph says. She sees the glass not so much half full but full of surprises. She has strong opinions about the environment and LGBTQ rights but doesn’t flaunt them, except that day she wore a self-made Ben Platt for President t-shirt. When Soph grows up she wants to be in WandaVision, not as a character in the TV show but actually living in that reality. She manages to let her imagination keep her even, an underappreciated if not vital part of coming of age as a teenager. If Wanda doesn’t work out, Soph wants to teach dancers how to Plia to songs like Thriller, or help “98% of the world’s off-key singers” to harmonize. She sort of thinks the way today’s healthcare innovators do – not how to fix a problem with a Band-Aide, but how to start over. Clean canvas, a new partner, an open mind.

200,000: Highmark’s increase in membership now that state regulators approved an affiliation agreement with HealthNow New York last week. They will be the primary Blue plan in western and northeastern NY, plus in central and western Pennsylvania, West Virginia and Delaware. If you’re doing managed care contracting and looking to expand your healthcare business in this region, Highmark matters – it can help you take a young model to another state, or on the flip side put pressure on payment and utilization.

Cancer Care Bundle: Memorial Sloan Kettering in New York is partnering with Carrum Health to launch a new cancer care bundle for any employers that collaborate with the cancer center. The partnership will offer bundles that cover in-person treatment at MSK for eligible patients with non-metastatic breast and thyroid cancers. For these patients, the bundle will cover complete medical treatment for up to two years. For patients with all forms of cancer, bundles will cover remote diagnosis, treatment planning and care guidance.

Losers From Cigna’s Tele Play: As predicted, payers will insource telehealth and Cigna’s newly formed health services sector, Evernorth, is acquiring telehealth vendor MDLive. Cigna has partnered with MDLive for a while, but by bringing the telehealth company in-house the plan can handle lower acuity patients and incent patients to use MDLive. This means risk to commercial primary care and urgent care.

Hospitals Strike Back: Like the Empire, if you thought hospitals were just going to let the outpatient and telehealth providers take over, think again. Hospitals continue to find ways to hold on to patients post discharge. In Rhode Island, the Blue plan is partnering with Butler Hospital’s transition to outpatient program leveraging the staff to do counseling, medication support and case management up to 3 months after leaving the hospital. Humana meanwhile has partnered with central US health system Mercy to expand access to virtual healthcare for MA patients. The value-based agreement allows patients of Mercy’s health system in Arkansas, Kansas, Missouri and Oklahoma to access Mercy’s 300 clinicians for in-home virtual support.

Yellow Flag: UPMC out of Pittsburgh is piloting a new machine learning tool that will help inform patient transfers between the health system’s hospitals. The algorithm will predict mortality for patients who may be transferred to another hospital for a higher level of care. Patients at highest risk will be flagged so that they can converse with their providers and families about the benefits and risks of transfer. The algorithm, known as SafeNET, is not meant to make medical decisions for patients, but instead to flag the patients for which these decisions are most crucial.

Atlanta Dream: The WNBA team has partnered with Anthem BCBS to address social injustice and promote health and well-being throughout Atlanta. The two organizations will undertake efforts to address food insecurity, mental health and health disparities.

Back In The Game: Aetna recently announced the company will re-enter the ACA marketplace in January 2022, though individual markets have not been confirmed yet and likely will not until later this year. Aetna left the individual market in 2017, and was subsequently acquired by CVS Health. After some volatile years, the individual marketplace is growing. In 2021, 30 payers entered the individual health insurance market across 20 states and over 60 payers decided to extend their footprints.

App Wins vs. Office For SMI: For patients with bipolar, schizophrenia and major depression, a University of Washington School of Medicine study has concluded that mental health apps are just as effective and cost less than clinic. The 163 participant study revolved around costs of using a smartphone app called FOCUS in which 49% had a diagnosis of schizophrenia or schizoaffective disorder, 28% had bipolar disorder, and 23% had major depressive disorder. The treatment was given through the app with the help of a support specialist which included daily self-assessments and on-demand 24/7 digital interventions. Researchers compared results from the patients using the app to a clinic-based group intervention of 90 minutes per week. The app cost was $1,011 vs. $1,956 for group-based intervention.  A question we would have is how the health insurer pays or handles the “on-demand” element. It’s likely to be a PMPM, not FFS.

Extra Point: Elaine Benes got an earful if you recall when she tried to pawn off a bag of muffin stumps to a homeless shelter back in the bizarre 1990s Seinfeld world. “You just assume homeless will eat anything huh….but where’s the top of the muffin!” the shelter’s director complained. Elaine’s argument – that “if the homeless don’t like ‘em, they don’t have to eat ‘em” – well, it seems a bit heartless I think, even if well intentioned. Seems we’re having a similar dilemma today: one COVID-19 vaccine being rolled out to underserved and homeless populations is a potential game changer, but reportedly 72% effective, the others 95%. Even if efficacy on one is much higher when all is said and done, perception matters. We took a van of seniors from an affordable housing community in Hartford to a clinic last Saturday. Barbara, a former school teacher now 77, was thankful and happy to be getting the vaccine, but said many of her relatives in other cities don’t have transportation like this, and are “reluctant” about getting a vaccine that isn’t at the top.

5: The number of chronic conditions that cost employers $2.5B over 2 years, according to a new study published by UnitedHealthcare’s Center for Advanced Analytics, using claims issued by the Health Action Council’s 57 employer members. Asthma, diabetes, hypertension, mental health/substance abuse, and back disorders were the top offenders and the study found that more than 60% of workers experience at least 1 of these conditions. This probably comes as no surprise to most employers, who are increasingly turning to new programs and strategies, including digital health options, to help manage their employees’ conditions, in hopefully a cheaper and more effective way.

Landslide: No not Fleetwood’s classic but the latest move by United Healthcare’s Optum, which has allegedly acquired in-home medical group, Landmark Health. Details of this alleged acquisition remain largely unknown but speak to the broader trend of payers increasingly moving toward being providers. Humana is the clearest example of this, having acquired Kindred at Home and Curo Health Services in recent years.

Top 20: 3 of the Top 20 managed care priorities for 2021 are newly ranked according to this year’s index of priorities. The 16^th edition of the Healthcare Payer Index includes a new #1 ranked priority and six services that left the Top 20.  Stay tuned for the release and a call in March.

Oncology Rx: Fidelis Care, Centene’s New York Medicaid plan, implemented an oncology prior authorization requirement. All oncology related chemotherapy medications require pre-approval from New Century Health before being dispensed at a pharmacy or administered in a physician’s office or outpatient setting.

Side Of Mayo: Google is opening a new office near the Mayo Clinic in Minnesota in order to accelerate their long-term relationship. The companies began working together in 2019 with the goal of using the Mayo Clinic’s patient data to develop new artificial intel and machine learning tools. Areas of focus include testing AI in radiotherapy for oncology and providing more efficient care. Google is also part of the new diabetes virtual model Onduo in partnership with drug maker Sanofi.

Don’t Back Out: Like an Izzy Mendulbaum moment when the iconic Seinfeld character told Jerry “it’s go time”, only to fall over in writhing back pain, healthcare stakeholders in Michigan are going all in like Izzy to address low back costs. The Michigan Back Collaborative will be led by PCPs and chiropractors, with support from Michigan Blue, its goals to improve service patterns, outcomes, and patient adherence and satisfaction with the plan. The collaborative will have two levels of participation for clinicians—evidence-based training and a more robust level focused on collecting patient-reported outcomes.

New World: Humana is now working with IBM Watson Health to improve member engagement by using artificial intelligence. The program will use an AI-enabled virtual assistant to provide accurate and real-time information about benefits, co-pays and providers to agents, employers and plan members.

Extra Point: A doctor at Beth Israel Deaconess Hospital in Massachusetts has created a “Vaccinated Volunteers” program, through which vaccinated hospital workers in any role can volunteer to spend time with patients during their free time. The pandemic has restricted the number of visitors that most hospitals allow and many patients have remained alone and isolated throughout their stays. My grandmother June was a volunteer nurse even after retiring from a 30 year career at Baystate Hospital in Springfield Massachusetts. I remember June telling me about nursing and social work when she first started in the ER during the depression. “I was just 22 and FDR hadn’t quite yet been elected. It was a hard time. We had very little…and we were the lucky ones. And most days the ER was crowded with desperation.” June, like today’s nurses and social workers young in age and young at heart, was as much companion as caregiver. When I went off to college in 1990 she got the cancer but on Saturdays she and I used to split some anisette cookies around the kitchen table I used during my early days as a poor reporter. I used to stack nickels and dimes on that table thinking about what grandma and her family must have experienced in 1932. The stories they would share. June told me to just listen to people, particularly those who seem lost, and to give them a chance because “everyone has a story” she’d say. And volunteer your time to help them tell it.