Feb 7, 2020 | Managed Care Friday
42: The percent of physicians who just retired or changed jobs after an insurer acquired their business, according to our small poll of 103 who say their practice was bought by a health plan in the last few years. Age and quality of life and the ‘components’ of the deal were the leading factors. The 58% who stayed on were, for the most part, under 50. Lab Testing Utility: Physicians sometimes order lab tests as cover, sometimes because it’s protocol and sometimes because they have a hunch. The science behind their lab ordering behavior is increasingly interesting given a range of healthcare...
Jan 31, 2020 | Managed Care Friday
20 Million: The amount Blue Shield of California has pledged for behavioral health services, largely to support California’s large homeless population. The money will go to the California Access to Housing and Services Fund, a new initiative proposed by the governor in the most recent budget. Blue Shield of CA also recently launched a 10 year, $10M plan, Blue Sky, focused on supporting mental health for students. Gateway to Value: If you ever doubted insurer investment in value care models, look to Blue KC, which has partnered with Cedar Gate Technologies to use analytics to help the insurer...
Jan 24, 2020 | Managed Care Friday
13: Number of newly awarded contracts that BCBS is going to give out this year alone to physical education vendors focused on movement, exercise and fitness solutions to address both physical and mental health, a spokesman confirmed. Companies will focus on chronic adult patients, seniors, new moms and youth as part of tailored programs designed to limit prescriptions and reduce stress and downstream medical complications of events such as stroke. One of the leading ‘companies’ in the mix, PLAY, previously had a grant with BCBS of Rhode Island, while others are more data and fitness focused,...
Jan 17, 2020 | Managed Care Friday
Four: Autism is 4x more common in boys and ADHD prescribing is far more common too, spurring a new wave of sports-focused programs led by counselors, coaches and educators that take the principles of applied behavioral analysis and put them into practice. Literally. Several models have popped up as alternative offerings for parents whose idea of a win is not measured in points or playing time or whether Robby will make the elite team, but in exercise, focus, social development. One of the earlier models we covered is discussed here. Expect continued interest in these alternative models as...
Jan 10, 2020 | Managed Care Friday
50,000: The number of Medicaid enrollees Molina gains in Illinois’ Cook County now that it has just agreed to acquire the Medicaid managed care organization NextLevel Health Partners, which is a community-based health plan focused on social determinants. Home Rx: Beginning January 1, 2020, members of Oscar’s insurance plan in New York can select Capsule’s same-day pharmacy service through the Oscar app to start receiving meds straight to their homes at no cost. Yelp The Doctor: Cigna is now giving 5 specialists access to patient reviews and will likely add 7 others this year to help both...
Jan 3, 2020 | Managed Care Friday
39: Percent of insurers, up from 14% last year, who will focus on adjusting or trying to ‘rework’ value/shared savings contracts given first wave of contracts are ‘too easy’ to hit targets for. Results published in the upcoming Managed Care Investment Index. ENT's Balloon: A number of insurers are updating policies for balloon procedures done by ENTs to address chronic rhinosinusitis. Starting this year, several Blues will require a full course of treatment for all of the following before considering balloon dilation: nasal lavage, intranasal corticosteroids, and antibiotic therapy if the...
