Sep 18, 2020 | Managed Care Friday
74: Percent of medical directors from 103 plans we polled who say imaging studies for uncomplicated low back pain are a consistent problem, often ordered unnecessarily with the first month of diagnosis. Health plans like BCBS of Illinois say they have to collect and report this type of data to the National Committee for Quality Assurance. Like Pulling Teeth: A Midtown Manhattan dentist’s practice is thriving, despite being almost completely shut down for a few months during the peak of the pandemic. Why? Tooth fractures. The dentist, Dr. Tammy Chen, wrote in The New York Times that she’s...
Sep 11, 2020 | Managed Care Friday
80: The amount of new counties Cigna is adding individual plans in for 2021, increasing their ACA market size by 27%. Key benefits included in some of the plans are no copay for virtual visits, including behavioral health providers, a new diabetes care plan that includes no copay for diabetes equipment and supplies, and increased coverage for nontraditional healthcare services, like acupuncture. Oral Health Uptick: Kaiser Permanente and Delta Dental of Washington have partnered to launch Health360, a medical-dental plan focused on better overall outcomes and a lower total cost of care. The...
Sep 4, 2020 | Managed Care Friday
3: The number of Walmart locations that the company is replacing with Oak Street Health clinics in the Dallas-Fort Worth area this fall. Newly public Oak Street has a network of 60 value-based primary care centers and the three new centers will offer preventative primary care and urgent care services focusing on patients of all ages. 5 and Dime: Payments focused on improving patient outcomes will be five to 10 times larger than what is contained in a typical outcomes-based, risk-bearing agreement under a new Blue Cross Blue Shield of Minnesota multiyear pact with Allina Health, a Minnesota...
Aug 28, 2020 | Managed Care Friday
23,500: The number of Blue Shield of California members reporting weight loss, reduced stress, and even chronic condition reversal, under a program from non-profit digital app platform Wellvolution. In the program's first year, nearly half of diabetics who signed up for a digital app like Digbi or Betr experienced disease reversal, like normalized A1C. Emily Morales, 33, an intake therapist in Pasadena, stopped eating a meat-heavy European diet after getting gut-biome and genetics results. Elementary teacher, Abebi Bain, 47, says she was eating foods that were aggravating her asthma and...
Aug 21, 2020 | Managed Care Friday
134: The number of physicians who have begun to offer medication assisted treatment (MAT) for opioid use disorder in Michigan, under a plan’s new initiative. At least one new primary care provider is delivering MAT in 31 Michigan counties since the program started last fall. Specialty Pay per Episode: We are starting to see more examples of global-risk primary care medical practices setting up an episodic payment arrangement with one referral partner per specialty as a way to limit cost and improve outcomes when they have to refer. “If it’s a specialist we need who might need to see the...
Aug 14, 2020 | Managed Care Friday
200K: The number of Medicare Advantage members across 23 states who will receive a free monthly membership to home delivery service, Shipt, through its new partnership with WellCare. Going Downhill: Like an Alberto Tomba race, more insurers are pushing volume down and out of hospitals. BCBS Minnesota will require that certain hernia, gynecology, and orthopedic arthroscopy and foot procedures be performed in a non-hospital outpatient setting, as of October 2020. The insurer already established this policy for ENT and upper and lower gastrointestinal endoscopy procedures in 2019. There will...
