23,500: The number of Blue Shield of California members reporting weight loss, reduced stress, and even chronic condition reversal, under a program from non-profit digital app platform Wellvolution. In the program's first year, nearly half of diabetics who signed up for a digital app like Digbi or Betr experienced disease reversal, like normalized A1C. Emily Morales, 33, an intake therapist in Pasadena, stopped eating a meat-heavy European diet after getting gut-biome and genetics results. Elementary teacher, Abebi Bain, 47, says she was eating foods that were aggravating her asthma and allergies until she started using the Betr health app.
Cleveland Still Rocks: Singer Ian Hunter is the voice behind the 1980 hit “Cleveland Rocks” - an anthem Hunter wrote to change public perception about his favorite city. 40 years later, one of the most well-known national healthcare providers, Cleveland Clinic, is changing perception by launching an accountable care organization and health insurance plan for certain fully-insured and self-insured employers in northeast Ohio. Cleveland Clinic will receive rewards, from Aetna, for meeting quality and cost goals and Aetna commercial plan members nationwide will have access to virtual second opinion services from Cleveland Clinic providers, as well as a Cardiac Center of Excellence program.
Capitated Pay at Home: Aetna is partnering with WellBe Senior Medical to deliver primary care services to about 10,000 high-risk seniors in their homes. The program began in Atlanta last month and is now available for certain seniors in the Chicago area. Eligible seniors will have access to at-home care 24/7. Aetna assigns eligible high-risk patients to WellBe, which is then responsible for managing their care and receives capitated payments from Aetna. Those eligible are typically seniors in their 80s with multiple chronic conditions, including diabetes, heart failure, osteoarthritis and dementia.
Specialty Pay per Episode: Since last week’s piece about global-risk primary care medical practices setting up episodic payment arrangements with one referral partner per specialty as a way to limit cost and improve outcomes, we’ve had a flurry of inquiries from PCPs about how to determine which specialist, and what to pay. “I’d like to create my own network, not rely on the insurers,” lamented Mary Horton, an administrator for a medical group in Massachusetts. “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,” said 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 us back in 2018. His concern is legitimate for certain specialties, but not all, and Riordan is essentially laying out the opportunity.
Uber Expands: Uber is further expanding its move into the healthcare space, this time by partnering with NimbleRx to deliver prescription drugs. The initiative launched in Seattle and Dallas, and with Nimble already in use by more than 700 pharmacies in 34 states, the partnership has plenty of room to grow.
Google’s Latest Play: Google is investing $100M into telehealth company Amwell as part of a multi-year partnership. As telehealth shows little signs of going back to pre-pandemic levels, this partnership will focus on improving access for patients through Google Cloud artificial-intelligence and machine-learning technologies to assist patients and front-line workers with intake, inquiries, and triage and providing natural language and translation services for non-native speakers. Several health insurers use Amwell as their primary telemedicine vendor.
Fertile Ground: In Vitro Sciences (IVS), a network of fertility centers, is partnering with InVia Fertility, a reproductive services clinic with multiple locations operating in the greater Chicago area. This partnership will allow IVS to expand its current footprint in the Southwest and Northeast to the Midwest.
Tackle Depression: A new law in New Jersey requires kindergarten to 12th grade schools to teach mental health and for behavioral health companies, the trend represents a potential growth market, particularly now that schools are scrambling to find therapists as more students self-report depression. In New Jersey, football coach Bill Kvaleim started clothing company Tackle Depression to promote anti-stigma messages on hats and hoodies. Parents can find a mental health directory for the state, or volunteer, on the “Tackle” website, similar to Shatterproof’s directory of addiction treatment centers. Coach Kvalheim was diagnosed with depression and anxiety but he’s not alone. High schoolers and college athletes are a new mental health population these days, given the lack of team sports. The Athlete Mental Health Index has tracked the connection between playing sports and mental health since 2010. Read the details here.
Autism Treatment, Until Further Notice: Michigan’s Blue plan has started allowing direct‑line applied behavioral analysis interventions through telemedicine. They developed a set of informal guidelines to help providers think through which members may benefit most from telemedicine interventions and they will allow providers to provide these services “until further notice.”
Cross Country: Back in April, we reported how a team of medical professionals from Intermountain Healthcare in Utah were deploying to NYC’s Northwell Health to help combat COVID-19, and now Northwell Health is returning the favor. 10 ICU nurses arrived in Utah earlier this month, and though the state is not experiencing a surge in the virus, the medical team is there to support ICU teams at Intermountain as they cross-train and share best practices with one another while treating COVID-19 and non-COVID patients.
Disparities: Centene’s new task has 12 members dedicated to helping close gaps in healthcare disparities. Given its reach into underserved populations, namely Medicaid, Centene’s group could have a big impact. Read the details and view taskforce members by clicking here.
Extra Point: Joel once bought a horse with his daughter Jen and they traveled across the I-90 West to go watch that horse race at the Fairgrounds in Saratoga. He was Old Stewball meets Black Stallion – fast, raw, a fairytale. But Joel and Jen didn’t buy that horse for the money or fame. Before their horse retired, they took their winnings and bought a horse of a different color, this one much slower and often injured, seemingly on his last leg, but on race day it poured like the rain in Spain and, wouldn’t you know it, that aging horse mucked her way to a win, like OId Rosebud circa 1916. The last time Joel and his daughter went to the races was August 2016. Joel’s Parkinson’s has sidelined those summer trips to the Fairgrounds and kept Jen from watching dad’s excitement down the stretch. On Saturday, amid a Kentucky Derby-like downpour, Jen married Craig, with 12 others by her side, but dad wasn’t there, held up at the nursing home, crippled by a disease that is pulling away his cognitive function, his movement and speech. But a day later, Jen took the cash from her Aunt Linda’s Hallmark and bought a couple cups of coffee and a few anisette cookies and popped a squat with her dad on the nursing home grounds. Joel didn’t say much but it didn’t matter. The disease may have won yesterday, but not on this day, and if stem cell researchers continue to find ways to stop deterioration in Parkinson’s patients, maybe, just maybe, Jen and her old man will have another ride around the track.