134: The number of physicians who have begun to offer medication assisted treatment (MAT) for opioid use disorder in Michigan, under a plan’s new initiative. At least one new primary care provider is delivering MAT in 31 Michigan counties since the program started last fall.
Specialty Pay per Episode: We are starting to see more examples of global-risk primary care medical practices setting up an episodic payment arrangement with one referral partner per specialty as a way to limit cost and improve outcomes when they have to refer. “If it’s a specialist we need who might need to see the patient several times and monitor care, it makes sense for us to create an episode, say 30 or 60 days, and figure out a payment based on that, and make them our exclusive partner,” says Paula Riordan, executive director of a PCP practice in the Atlanta area looking to establish this for a range of conditions—pain, orthopedic, GI, skin, and respiratory issues, like asthma. “If it’s more repetitive care, like for mental health, then I think we’d consider a per patient per month amount with a partner or telepsych vendor.” Specialty doctors we have been interviewing and polling in the last three years lament their limited role in value-based care. “It’s not for us and I’m unclear where we fit,” Greg Thisis, MD, an ophthalmologist, told me back in 2018. His concern is legitimate for certain specialties, but not all, and Riordan is essentially laying out the opportunity.
At-Home Lab Boost: At least three payers are partnering with home care companies to test patients at home. In Illinois, at-risk members of BCBS of Illinois who have not been screened for colorectal cancer may qualify for an in-home testing kit, at no extra charge, to encourage screening. The insurer will notify members that they will receive the test kit and that using it is voluntary. The member then submits the test for processing to Home Access Health Corporation. Premera Blue Cross in Washington state is partnering with Home Access Health to offer in-home test kits to Medicare Advantage (MA) members for colorectal cancer screening, diabetic blood sugar control, and diabetic kidney disease screening. Humana launched a similar initiative for their MA members at no cost, through September 2020.
BMI Link to Alzheimer’s: Are your medical practices evaluating body weight and the potential impact on brain function? If not, they should, as BMI has an astounding impact on brain function and ultimately Alzheimer’s disease, according to a new brain imaging study in the Journal of Alzheimer’s Disease. All regions of brain activity lose activity and blood flow with a higher BMI. Scientists analyzed 35,000 functional neuroimaging scans to measure blood flow and brain activity. The temporal and parietal lobes, hippocampus, posterior cingulate gyrus, and precuneus areas of the brain are vulnerable to Alzheimer’s disease and were found to have reduced blood flow along the spectrum of weight classification from normal to overweight, obese, and morbidly obese.
Pregnancy Link to Guess What?: A recent study found that women who used cannabis while pregnant had a 50% increase in the risk of autism spectrum disorder in their children, according to a report published in Nature Medicine. The data was recorded with 500,000 Canadian mothers and the question of whether cannabis affects the fetus’s neurodevelopment had not been explored much beforehand. Children were followed for an average of seven years, during which 7,125 were diagnosed and the in-utero cannabis exposure was 2.2%, compared to 1.4% for mothers who did not use cannabis during pregnancy.
15-30: This is not the score three points into an epic Borg-McEnroe tilt but a new BCBS of Louisiana policy taking effect in one year that will stop payment in situations when a patient is readmitted to the same hospital for the same or similar condition or complication to the original condition within 30 days of discharge. The current policy denies payment when this occurs within 15 days. COVID-19 has delayed implementation of the 30-day rule.
Site of Care Stop Sign: A national MCO expanded precertification requirements for CT and MRI scans to include a site of care review, effective August 1, 2020. eviCore will handle these reviews and determine if the appropriate site of care is being used; outpatient hospital settings will only be approved when deemed medically necessary.
Angel En Route: A Los Angeles MCO has funded a van and partial nutritionist salary as part of a new program to help the underserved. Read the full story, from our correspondent Lauren Stroger, by clicking here.
Extra Point: An allergy practice in east Texas is getting an incentive payment these days for giving its highest-risk asthma patients portable spirometers that transmit results back to the physician, help the practice monitor pulmonary function, head off deterioration, and with any luck, see progress. As many of us send our kids back to school next week, to college clusters, crowded high schools and recess yards, I think we could all use a spirometer too. Something to help us monitor and to help us breathe easier. Mine came Wednesday when our oldest came home armed with a giant roll of bubble wrap. “Packing up boxes?” I asked her. “No, it’s for my bed at Springfield,” Mukue said. “The egg crate thing.” Of course – she didn’t know the difference, a light moment that in an oddly reassuring way makes me feel at ease about sending my oldest girl off to Springfield College next week. I’ll breathe easier knowing our kid—the same one who once scored six times on her own team and only eats Frosted Flakes for supper—will at least rest soundly at school on a bed of popping bubbles.