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 be geographic exclusions for any members that do not live within 25 miles of an in-network ASC or physician office that can perform these procedures. The insurer is also moving injectable drug treatment for hereditary angioedema (HAE) from their medical policy to a pharmacy benefit. Any members taking these drugs will now go through Prime Therapeutics for a prior authorization for the self-administered drugs.
Pharmacy Shift: Cigna will end its contract with CareCentrix for home infusion therapy in February 2021. Accredo, Cigna’s specialty pharmacy, will take on most of those services, with eviCore assisting members who require non-specialty infusions. In other home infusion news, Empire BCBS in New York is requiring commercial members move their oncology drug administration to the home for certain immuno-oncology treatments, including Keytruda, Opdivo, and Yervoy, among others. Effective August 1, 2020, members are no longer permitted to receive these infusions in the hospital outpatient setting.
Northern Exposure: No, not the strangely interesting Alaskan TV series, but a strategic effort by Arizona's Banner Health to acquire Wyoming Medical Center. While not final yet, the deal would include a $100M investment by Banner into the medical center’s “facilities, technologies, programs, people, and operations over the next 10 years,” including telehealth capabilities.
Hill Street Blues: Avera Health, a health system in South Dakota, is using a $1M grant to launch a telehealth program that will connect police and court officers with mental health experts to help assess and treat people in crisis. The Virtual Crisis Care Program will cover 23 counties and aims to use the connected health platform to increase the level of care that can be provided at the scene.
Virtual MA Plan: Alignment Healthcare is launching a virtual Medicare Advantage plan in 2021, which will feature digital, concierge-style services for both primary and specialty care. The plan will incentivize members to use digital solutions, but will also cover in-person visits when necessary. Another MA plan, SCAN, is also using technology to improve healthcare for members, by launching artificial intelligence predictive models to help avoid hospital admission.
Extra Point: Like the healthcare system pushing surgeries out of hospitals, my wife and I are chasing the kids out of the house in two weeks, taking two to college, one to tour Midwest universities, and two others back to public school chaos. Needless to say, this fall comes with mixed emotions, to say nothing of the price tag ahead and uncertainty over COVID. I’m a bottle of stress: yelling at my daughter for burning the waffles, working when I should sleep, sleeping while driving. Might explain why on Monday I woke up on the couch at 1am to a man standing in my kitchen. For the full story, click here.