Jan 7, 2022 | Managed Care Friday
131: Number of hours PA Lauren Valley worked at a busy urgent care clinic this past week in my town, often spending off time sleeping at the clinic, filling in for staff who were quarantined. Lauren is a terrific PA – smart, thoughtful, doesn’t just prescribe antibiotics and tests needlessly, calls the sinus issues the little kids have “boogies” but can adapt to help the older lady find her busstop after her appointment. There are thousands of Lauren Valley’s out there – but right about now, we need thousands more… DropOut: Cigna dropped Livongo from preferred status in its digital formulary...
Dec 17, 2021 | Managed Care Friday
50%: Increase in families requesting grief support services in 2021 according to Boston Medical Center. Primary care doctors in Boston identify families who could benefit from the Good Grief Program and refer children to the medical center. The program estimates that about 10% of the new families are grieving a loss from COVID-19. Maureen Patterson-Fede, the clinical social worker who oversees the program, expresses worry about the future for these children, “I think we're all holding our breath. We're feeling like we're just seeing the tip of the iceberg about what's going to play out for...
Dec 10, 2021 | Managed Care Friday
2.3: Percent of 8-year-olds in 11 states diagnosed with autism in 2018, up from 1.9% in 2016, according to new data released by the CDC, which shows that childhood autism rates are at their highest level yet. Utilizing a new ASD surveillance method that relies on ASD diagnosis, special education classification and medical billing codes, researchers were able to capture more fully all those diagnosed. A separate report shows that 4-year-old children born in 2014 were 50% more likely to be diagnosed with autism or given an ASD special education classification compared to 2010. Luckily, most...
Dec 3, 2021 | Managed Care Friday
75: The percent in our Poll of the Week who believe a virtual visit for someone with substance use disorder is less effective than in-person treatment even though there are examples of companies like Eleanor Health able to use telehealth without worrying about whether it’s a billable visit given they are paid differently to manage a patient from addiction through recovery. They use the telehealth encounter as a way to check-in, to do anxiety and craving scales, and stay in front of patients as part of a goal toward recovery. A recent study published in AMA’s journal Psychiatric Times...
Nov 19, 2021 | Managed Care Friday
Are You Walkin’ On Sunshine? If there’s a medical specialty that can claim this Katrina and the Waves hit, it’s probably the derms – skin cancer incidence is rising faster than an Olivia Rodrigo song on the charts and there aren’t enough dermatologists. Wait times are sometimes 3-4 months and, increasingly, it’s for the PA or NP not the dermatologist. The tele-derm experiment is a potential solution but a majority in our recent poll of 100+ doctors believe it will add cost, not limit skin cancer. But heading into 2022, these practitioners can evolve to impact health system costs in other...
Nov 12, 2021 | Managed Care Friday
40: Percent of coverage policies with step therapy protocols for getting medications, according to a recent study published by Health Affairs. Using data that covers 17 of the 20 largest payers in the US, the study shows that more payers are implementing step therapy protocols for certain diseases compared to previous years, and some payers’ plans may be stricter than needed. Those with step therapy protocols used an average of 1.5 steps but 90 protocols, 3.1%, included as many as four steps and one plan had eight steps protocol. Researchers emphasized “onerous step therapy protocols can add...
