May 19, 2023 | Managed Care Friday
12,000: The number of people who called into the National Maternal Mental Health Hotline in its first 11 months. The hotline, launched on Mother’s Day in 2022, can be called or texted with any type of concern related to maternal health, and about 70% of contacts so far have been phone calls. The US has higher maternal mortality rates compared to other developed countries, and the hotline was launched as part of a broader effort to reduce these rates. New E&M Requirement: Effective May 25, Cigna will require that providers submit office notes for E&M claims 99212-99215 when...
May 12, 2023 | Managed Care Friday
$114 Million: The amount L.A. Care Health Plan and Health Net will invest over the next several years to address the homelessness crisis in Los Angeles County. Due to the growing number of seniors and people with disabilities experiencing homelessness, the funding will be used to identify the daily living needs of unhoused people and connect them with caregiver help, along with securing leases on as many as 1,900 housing units and paying for things like vacancy coverage and trash services. Buckeye Health Decline: Ohioans have experienced a clear decrease in overall health, according to...
May 5, 2023 | Managed Care Friday
1.7 Million: The number of calls, texts and chats into the national 988 suicide crisis lifeline during the first 5 months of its existence. How the 988 staff deals with these situations and sets up emergency response or makes referrals is still an open question. US Surgeon General Vivek Murthy recently proposed “a national framework to rebuild social connection and community in America” given rising evidence of loneliness and depression in ~60% of young adults and ~50% of mothers with young children according to some studies. Poor Urgent Care: Several insurers are now eliminating copayments...
Apr 28, 2023 | Managed Care Friday
70: Percent of this age group lie to their doctor and parents, particularly about their mental health. Any guesses? Imaging Cut: Effective Father’s Day, Blue Cross NC will stop reimbursing for any imaging services – X-ray, CT, or MRI – when billed within 28 days of a principal diagnosis of uncomplicated lower back pain. The health plan is trying to reduce “excessive tests or procedures that result in unnecessary medical expenses.” Consumer Behavior: Dr. House once asked on his TV show, “do I get bonus points if I act like I care?” Short answer is heck yeah. Last we broadly studied what...
Apr 21, 2023 | Managed Care Friday
1 In 575: The average ratio of psych counselors to students based on our poll of 340 school districts in 19 states. We learned that the proportion of calls to 911 or 988 related to a suicide situation were about 4-5 times more likely in the schools that had to rely on an extremely high case load for each counselor. New PBM Pricing Model: Express Scripts has launched a new pricing model called ClearCareRx to allow employers, health plans, and government employers to pay exactly what Express Scripts pays for drugs. ESI’s new copay assurance plan will cap copays for members – $5 for...
Apr 14, 2023 | Managed Care Friday
20: The percent of current prior authorization requirements United announced it will roll back beginning in the third quarter of this year. Beginning in early 2024, the insurer will also implement a Gold Card program for eligible provider groups that would eliminate prior authorization for many procedures. Keep in mind that for some services, like pain management, even if the health plan doesn’t require pre-approval they likely still have coverage criteria and step therapy rules to follow. In Prison: Ventura County of California is finally opening a mental health unit at the Todd Road Jail...
