80: The amount of new counties Cigna is adding individual plans in for 2021, increasing their ACA market size by 27%. Key benefits included in some of the plans are no copay for virtual visits, including behavioral health providers, a new diabetes care plan that includes no copay for diabetes equipment and supplies, and increased coverage for nontraditional healthcare services, like acupuncture.
Oral Health Uptick: Kaiser Permanente and Delta Dental of Washington have partnered to launch Health360, a medical-dental plan focused on better overall outcomes and a lower total cost of care. The plan is aimed at midsize employers and provides a single point of contact for many aspects of the medical and dental plan administration, allowing members to more easily receive the total care they need.
The New Center of Excellence: The Association of Blues plans will have its own health plan—its first in 25 years—launching in January and it will feature providers across 55 markets that will essentially be promoted to members as high value, high performing centers. This is an important development since the plan will direct patients to providers based on their quality and cost. Out-of-network coverage will not be available. The local Blues plans are helping to select local health care providers based on quality measurements.
Genetic Test Check: Horizon BCBS is the latest in a string of insurers to start aggressively monitoring genetic and molecular testing utilization. Starting in October, the New Jersey plan will start to require pre-service medical necessity reviews for molecular and genomic testing done in a physician’s office or clinical lab. Through eviCore, all fully insured and ASO members will need these medical necessity determinations completed before any testing can take place.
Pac-12: The Western athletic conference famous for UCLA’s Lew Alcindor and beach volleyball has signed an agreement with Quidel Corporation, a diagnostics company, to secure testing supplies for student-athletes. Testing machines and related tests are expected to be available at all 12 schools by the end of September. The ability to have rapid results may allow sports to come back sooner, even though the conference has currently postponed athletic contests until at least January 2021.
Rx Exclusive: Starting January 2021, AllianceRx Walgreens Prime will be the exclusive specialty pharmacy provider for Blue Cross Blue Shield of Michigan commercial members. This does not affect Medicare Advantage members, but commercial members will be required to use AllianceRx Walgreens Prime for all specialty medications.
Joint Effort: Tennessee will have one of the nation’s largest orthopedic groups, thanks to a three-way merger between Tennessee Orthopaedic Alliance, Tennessee Orthopaedic Clinics, and Mid-Tennessee Bone & Joint Clinic. Combined, the group will have 105 physicians and a staff of more than 800, with 27 locations in 17 Tennessee counties.
Disparity Gap Closing: Sinai Health System and DePaul University are partnering to build a community-driven research institute that will work to mitigate health disparities in Chicago. The agreement includes providing shared education programs for students and researchers, jointly pursuing research and grant opportunities, sharing expertise and data, and supporting sustainable community and academic partnerships aimed at reducing health disparities.
Caregiver Decline Addressed: Harvard Pilgrim is launching a new telehealth program to help caregivers take care of themselves while caring for others at home. Harvard Pilgrim will work with Ceresti Health to create a platform with education, coaching, and support programs for caregivers in Massachusetts and New Hampshire. The content will be organized to address how to take care of children, adults, spouses, and those with certain chronic conditions. A study on caregiver decline back in the spring indicates the impact of caregiver health: click here to read more.
Readmit Model: Unity Point Health in Wes Des Moines Iowa started a SNF at home model a year ago to provide in-home nursing level care to patients, just as VillageMD has developed primary care physician services at home. 78% of payment innovation and value-based strategy teams at commercial and Medicare plans we polled this summer said these are the kinds of models getting their attention.
Florida E/M Change: Starting in October, the Florida Blue plan will no longer pay for multiple evaluation and management (E/M) services reported on the same day for the same patient by more than one physician in the same specialty and the same group. Think two neurologists both billing for E/M. Only the first claim received will be paid.
Extra Point: Not sure about you, but my kitchen was like a Jack Klugman warzone this week, straight out of a Felix and Oscar episode from Neil Simon’s Odd Couple. At one point on Tuesday, there are five Zooms going on simultaneously, wires crossing, the dog eating egg scraps and Cliff bar wrappers, then barking every time he hears a bark coming from a computer, startling my daughter who spills her milk, which starts flowing under laptops like the Mississippi after a rain storm. There’s laundry in the sink and toothpaste in the freezer. My wife starts playing Perry Mason, challenging the kids about who stole her charger. “Not me”, they all say. Her voice carries from the living room as she teaches 65 students about hand washing protocols for the first day of class, as I sit frozen on a PowerPoint slide, staring at a bar graph that makes no sense, gripping my chipped ‘DAD IS #1’ coffee mug like it’s the only thing holding me together. It’s only 8 am but Tommy and his sticky syrup fingers start playing a video game on his phone while his French teacher figures out for 10 minutes how to share her screen. “Sois patience,” she keeps saying. My dad bangs on the door then barges in as he usually does but this time stumbles on one of Zaggy’s squeaky toys, loses balance, and head butts the wall like Rocky charging at Apollo. He drops and so I frogger my way through the power cord maze to help him to the couch, clean his wound, and call the doctor. There’s a bit of angst as we MASH unit our way around dad, but my daughter, in true Radar O’Reilly fashion, brings over some gauze before I could say “we need gauze.” Dad is a bit dizzy and still feeling effects of the vertigo, but he is going to be alright. By 9 am, I’m three Microwave reheats of my coffee into the morning and ready for conference calls. My 16-year-old senior? He’s oblivious, huddled in a corner, ear buds blocking out sound. “Papa fell and hit his head so I’m going out to urgent care – can you take out the trash and help your sister with that Algebra,” I said. “Wait, what, papa fell?”