Jun 3, 2022 | Managed Care Friday
15: Even though Andy Warhol thought all people would be famous for this many minutes and Swifties know all too well about teenage angst in Taylor’s song about this age, it’s healthcare that has a claim to this number. In 2022, more providers report as much as 15% reimbursement increases to reflect inflation and pay for performance and several health systems are opening 15+ outpatient centers, like Michigan’s Henry Ford Health System, which hopes to open 15 urgent care centers this year with GoHealth to “patch holes in care across the region” and limit ED visits, which averaged more than 129...
May 27, 2022 | Managed Care Friday
26: Unofficial length of a marathon because, hey, those last 2 tenths are like a blur (or so I’m told), the number of hours in a day in 2050, because moms rise up and say they don’t have enough time to be “everything to everyone” and—today—the percent of drug cost savings Prime Therapeutics achieved in one year on a PMPM basis through its MedDrive program. That program uses analytics to flag ways health plans can reduce drug spend, with a particular emphasis on using biosimilars over brand-name biologics. The program focused on only three drug categories in its first year, one of which was...
May 13, 2022 | Managed Care Friday
63: Portion of 316 retired physicians polled who say too many doctors, PAs and nurse practitioners overtest. If you’re looking for a measure of quality, I say take Hamlet’s cue and look at your practice’s testing behavior—to test or not to test is increasingly an important question in healthcare. Most of the retired doctors say we ought to use our personal experience with patients more often—our clinical judgment—as a guide when making decisions about whether to order a clinical lab or imaging to figure out what’s wrong. Too many do not lean on that personal experience enough, and it matters...
May 6, 2022 | Managed Care Friday
4,000: The amount Amazon will pay annually for its employees to travel for non-life-threatening medical treatments. The new benefit, effective to January 1 retroactively, applies if a procedure or treatment is not available within 100 miles of an employee’s home and virtual care is not an option. The benefit is open to all US employees, at any level, with coverage through Aetna or Premera. Behaving Differently: More and more insurers are now designating so-called centers of excellence for behavioral health, the latest from BCBS Michigan, which now has 14 substance use treatment and recovery...
Apr 29, 2022 | Managed Care Friday
118-634%: The range of median price markups for oncology drugs purchased and administered by certain hospitals, according to a new study published in JAMA Internal Medicine. The study analyzed the prices of 25 top-selling cancer therapies at 61 National Cancer Institute-designated cancer centers and looked at how those negotiated prices for commercial payers compared to acquisition costs. Prices varied between cancer centers and between payers within the same center but for every drug included in the study, the median hospital negotiated price was at least twice the acquisition cost. ...
Apr 22, 2022 | Managed Care Friday
86: No, not the painful year for Red Sox fans when that ball scooted through Billy Buckner’s legs, but the portion of Aetna Medicare Advantage members in Florida who reported less loneliness, thanks to Aetna’s partnership with Papa, a platform connecting members with people for companionship, transportation and assistance with everyday tasks. The partnership began in 2020 after observing that 80% of eligible members felt lonely or depressed. By 2021, 62% of Aetna PPO members and 52% of Aetna DSNIP members reported feeling less lonely and happier overall after using the companionship...
