Sep 17, 2021 | Managed Care Friday
24601: Les Miserable fans know this number too well as the mark symbolizing Jean Valjean’s bread stealing moment during the end of the French Revolution, and in a symbolic way this is exactly the number a Medicaid managed care plan’s medical director is advocating the insurer pay per beneficiary per year (well, $24,600 to be exact, but what’s an extra dollar for effect?) to cover housing, health and wellness, transportation, job support and food as part of a social family support concept targeting underserved, typically refugee, populations. Dose E Doh! Several insurers are looking to reduce...
Sep 3, 2021 | Managed Care Friday
60: “Percent of the time…it works…EVERY time,” or so said Paul Rudd’s news character in Anchorman about his potent cologne, which Ron Burgundy sternly replied in a way that only Will Ferrell can, “Well that just doesn’t make sense” – which is of course logical and funny to say out loud, but Rudd’s stat isn’t so illogical if you think about it. In baseball, 60% gets you in the Hall of Fame, in high school it gets you a diploma and in healthcare it can get you “coverage” for novel treatments and increasingly that better-than-half goal will be part of more and more outcomes-based contracts,...
Aug 27, 2021 | Managed Care Friday
41,000: The number of members in health insurer Highmark’s 2019 claims data diagnosed with alcohol use disorder (AUD), leading to more than $4 million in spending and there are assumptions these numbers are rising, and quickly, as recent data suggests more adults than ever are drinking excessively. Highmark is offering its members new ways to treat alcohol disorder. One new option is Ria Health, a technology-enabled telehealth medical practice that focuses on treating AUD by combining medically assisted treatment with digital tools to help members track and record progress. The Ria Health...
Aug 20, 2021 | Managed Care Friday
50: The number of new medical centers Anthem is opening in partnership with CareMax, a senior healthcare provider focused in the Florida market. The medical centers will primarily be in areas where Anthem is focused on value-based care efforts, including Indiana, Texas, Kentucky, Wisconsin, Georgia, Connecticut, and Virginia. Self Insured Strategy: Aetna is rolling out virtual primary care services to self-funded employers across the country. By partnering with Teladoc, the new Aetna Virtual Primary Care service will be available to members at no cost, and includes access to in-person visits...
Aug 13, 2021 | Managed Care Friday
5: The number of new states where Aetna is entering the ACA marketplace in 2022, including Nevada, Missouri, Texas, Florida, and North Carolina. Meanwhile, HCSC will expand its Medicare Advantage (MA) footprint to an additional 90 counties next year, which the company says is its largest MA expansion ever. Per Member Per Month, And Then Some: A Medicaid managed care plan in Kansas is playing Oz by setting up a series of multi-level payment per month models for youth behavioral health care. In one design, you can get a $1 PMPM for doing follow up calls within 7 days of IP discharge, $20 for...
Aug 6, 2021 | Managed Care Friday
24: No, not Kiefer Sutherland’s best performance but the portion of seniors who fall due to dehydration, end up in rehab, then fall within 6 months for the same reason based on a study of a cohort of patients with 6 common traits – undiagnosed dementia but significant short-term memory issues, live by themselves, widowed, limited caregiver support, limited social circles and no mention of “daughter” or “daughter or in law” in the medical record. The study, which we did in collaboration with 3 rehab centers in Boston’s north shore, is based on 292 admissions between 2019 and today related to...
