Dec 18, 2020 | Managed Care Friday
49: The percent of Medicaid, Medicare, and commercial payers who named this their top priority for 2021 in what is a bit of surprise but an indication of how the health system continues to evolve. The new #1, the full Top 20 priorities and what moved up and moved out since last year will be reported in the 15th edition of the Healthcare Payer Index coming out soon. Stay tuned. Alternative Pay: 31% of surveyed payers say they are thinking about the next generation of payment models and one model, likely developed by some insurers, will target severely mentally ill populations. But creating...
Dec 11, 2020 | Managed Care Friday
40: The number of additional onsite primary care clinics Walgreens and VillageMD are opening in 2021 through their partnership, focused on sites in Texas, Arizona, and Florida. Physicians, nurses, and pharmacists will staff the clinics, and an app will allow patients to also utilize virtual and telehealth services. Walgreens has stated its long-term plan is to open as many as 700 of these clinics over the next five years. Moving to the Pharm: BCBS of Michigan is moving two drugs from the medical benefit to the pharmacy benefit because “they can be safely administered in the member’s home.”...
Dec 4, 2020 | Managed Care Friday
Social Service Payment: Identifying the social factors of health is part of a new program from a Michigan health plan. Starting in January, the plan will provide financial incentives to healthcare providers if they screen patients and report back these social risk factors. Click here to read more. Extra Point: At about 11:45am on Tuesday the 8th, one of our panel discussions will feature Mona Chitre, the longtime chief of pharmacy and VP of integrated clinical strategy for Excellus BCBS, the head of healthcare strategy and payment transformation from Blue Carolina, Troy Smith, and a pair of...
Nov 20, 2020 | Managed Care Friday
$100M: The amount Ochsner Health in Louisiana committed to spending over the next five years to build community health centers in underserved areas. Louisiana consistently rates in the very bottom of US health rankings and the health system aims to increase their ranking by opening 15 centers across the state. They will be located strategically in rural and underserved areas, providing more alternatives to patients who frequently use the ER as primary care. Interception: An adult and pediatric practice in Nevada says Anthem’s teledentistry partner has “picked off some of the patients we...
Nov 13, 2020 | Managed Care Friday
59: Percent of dentists reporting increasing prevalence of stress-induced oral health problems like bruxism or teeth grinding, chipped and cracked teeth, and temporomandibular disorder symptoms like jaw joint pain. As CMS Goes: CMS will begin paying doctors to use two different AI systems, one focused on diagnosing diabetic retinopathy and the other that alerts specialists when a brain scan shows a patient may have suffered a stroke. MA and commercial plans may also provide coverage, though the parameters around reimbursement may vary. Both products were approved by the FDA back in 2018, and...
Nov 6, 2020 | Managed Care Friday
4: Stage of cancer one of my friends has. He found out the other day. Colon cancer spread to the body. Missed his annual checkup in the office but had a tele-encounter with his PCP. If there’s a cautionary tale here, it’s that my friend had no symptoms but didn’t get to the lab for an annual lab test his doctor ordered. 700: Percentage increase in addiction-related hotline calls during the pandemic, according to the Indiana Family and Social Services Administration. Sudden stoppages of in-person therapy or group sessions of Alcoholics Anonymous can have major impacts on addiction, including...
