Mar 27, 2020 | Managed Care Friday
15: A SNF in Connecticut has seen this much of a percentage boost in admissions due to bringing in patients with significant comorbidity who were at home and “went south.” Rather than be admitted to the hospitals without enough beds and staff, SNFs have become an alternative facility to help the sick patients, particularly those with dehydration or concerning vital sign changes requiring medical supervision and acute level care. This SNF could be an outlier, however, as we’ve heard reports of declining SNF volume, by as much as 30-40%. In some ways, the crisis puts a new spotlight on a...
Mar 20, 2020 | Managed Care Friday
50: Percent increase in Teladoc patient visits in the past week alone, up to 15,000 patients a day, with more than half considered ‘first time users’. Channel 5: A physician in the north shore of Massachusetts is starting to do a daily exercise show with his ‘fitness teacher’ bride on the local access TV channel to help Medicare seniors. He’ll run on the treadmill, show seniors at-home exercises, talk pillboxes, and discuss medication adherence issues. In one ‘scene’ from a pilot episode, the doctor shared an example of how NOT to take your medications. “Don’t eat them with peanut butter for...
Mar 13, 2020 | Managed Care Friday
94: The number of posts on a high school’s Facebook page up here in Connecticut from parents complaining about the canceling of the ‘championship’ basketball game. “Kids are being deprived of their opportunity for all their hard work,” one parent expressed. Juxtapose that community anger with the challenge ahead for getting take-home backpacks of food to the 49 some kids on free and reduced lunch at an urban school one town over, to kids who are likely to be out of school by next week. Puts the pandemic in some perspective. Social Experiment Continues: That health systems are starting to...
Mar 6, 2020 | Managed Care Friday
19: Percent of hospitals in a poll last week considering or establishing in-house specialty pharmacies. This developing trend is interesting given a new UnitedHealthcare policy starting in April. Hospitals will be required to obtain specialty medications from UHC’s specialty pharmacies when administered in the hospital outpatient setting, unless otherwise authorized. This means the hospital can’t bill for the medication and can’t bill the patient. The pharmacy will bill United and the hospital can only bill for ‘administering’ the drug. The insurer says they may deny the full claim if the...
Feb 21, 2020 | Managed Care Friday
77: Percent of employers in our poll of 219 small, midsize, and large companies who say the time to diagnosis for pain and orthopedic issues is “excruciatingly slow” and “wasteful,” and has led to issues with “presenteeism, productivity” and ultimately higher health cost spend per employee. “Not just low back pain, but neck pain, knee pain, upper back, elbow – we have been pressing in recent years to use PT first for several weeks but sometimes an X-ray is needed right away to rule out issues,” says Dave Simmons, a medical director consultant for self-insured employers. Palliative Care:...
Feb 14, 2020 | Managed Care Friday
Twenty: The number of emerging payer priorities ranked from 1 to 20 by commercial, Medicare Advantage and Medicaid managed care plan leaders are featured here in the 15th edition of our Healthcare Payer Index. A conference call to discuss the list will be held today, Friday, February 14th at 1 o’clock eastern. Dial 800-874-4559 (password is Cote41810). Nursing Rehab Center Turnaround: A northeastern nursing & rehab center is poised to turn a profit on their Medicaid business after years of losing millions, and has created a new behavioral health team of psych social workers, clinical...
