Jun 21, 2019 | Managed Care Friday
1. 18 and Counting The number of ancillary contracting directors for insurers who have confirmed with me that they have had at least one conversation with Amazon in the last 2 years. 2. New #1: Orthopedics has moved past maternity as the #1 episodic payment contracting focus for payers. 3. 7 Wonders of the Lab World: Now that UnitedHealthcare has tapped 7 preferred clinical and anatomic path labs for its preferred network set to go live in July the question is can this mix of big chain and specialized genetic companies improve outcomes and satisfaction. UHC says it will work with the labs to...
Jun 7, 2019 | Managed Care Friday
1. 345: The number of moms and dads we polled about a seemingly mundane question – how they decide where to go for healthcare. Moms seem more thoughtful – relying on their OBGYN or their neighbor who’s a pediatrician, or Dr. Oz and NPR, while Dads, somewhat predictably, rely on ‘it getting better without them doing anything or, increasingly, the nearest urgent care. Moms are more often changing doctors and more thoughtful about where to go and whose advice to use. Unlike Elaine of Seinfeld fame who failed to change doctors because her last one wrote in her medical record that she was too...
May 31, 2019 | Managed Care Friday
67: My high schooler is getting roped into two things – kids asking him to do juul or vape and online gamers called Hofr urging him to predict results from the NBA finals without paying a dime. Jack isn’t biting on the juul offer, thankfully, but he and buddies are all-in on the latest pre-gambling addiction craze Hofr. It seems harmless, but in a straw poll of 74 boys in my son’s high school, 67 of them are betting on these games ‘almost daily.’ This may seem outside of managed care trends but if you look closely it’s another symptom of the iphone generation’s obsession with their apps –...
May 24, 2019 | Managed Care Friday
1. 16: Number of cancer groups participating in Humana’s new oncology payment model for Medicare Advantage and commercial patients. The program is in its 5th month – but efforts to pay differently for cancer aren’t new by any stretch. Before the days of ‘value-based payment’ there were pioneers at Aetna and Humana designing shared savings models from scratch. The model is the fourth for the plan to target specialty services – orthopedics, maternity, and spinal fusion for MA patients. 2. The Cayman’s: Perhaps not a fit for the big insurers, but a handful of medical groups taking global risk...
May 17, 2019 | Managed Care Friday
1. 30 for 30: According to the NCQA, patients with a new onset low back pain diagnosis normally should not receive imaging within the first 30 days of diagnosis but there may be instances when imaging should be considered. You can access an evaluation chart to use with patients presenting low back pain: click here 2. Fall Risk: In our poll of Medicare Advantage plan care managers and medical directors, 91 of 153 said this was the number one ‘avoidable outcome’ issue that their networks are struggling to reduce. My dad fell down stairs two years ago and, though he luckily survived, continues...
May 10, 2019 | Managed Care Friday
1. 49: Percent of 316 high school and college students we polled this month who say they ‘know someone’ with an eating disorder, ‘or think they do,’ but just 20% say they’ve told anyone about it. ‘It’s hard to talk about it. I’ve told a counselor,’ said one 11th grader, but others say they ‘aren’t sure exactly.’ One female polled said part of the issue is the classes and culture focus ‘so much on watching what we eat … and a lot of us don’t really know how to do that…and sometimes the issue ‘escalates.’ A freshman at a college in Texas says ‘it’s hard for a lot of kids who have had to deal...
