4: Stage of cancer one of my friends has. He found out the other day. Colon cancer spread to the body. Missed his annual checkup in the office but had a tele-encounter with his PCP. If there’s a cautionary tale here, it’s that my friend had no symptoms but didn’t get to the lab for an annual lab test his doctor ordered.
700: Percentage increase in addiction-related hotline calls during the pandemic, according to the Indiana Family and Social Services Administration. Sudden stoppages of in-person therapy or group sessions of Alcoholics Anonymous can have major impacts on addiction, including higher mortality rates.
AWP Out: Starting in February 2021, CareSource will base prescription drug reimbursement for small, local pharmacy chains on National Average Drug Acquisition Costs. Using this reference-based pricing will decrease some of the volatility that comes with AWP-based models. The new pricing methodology is the latest initiative by CareSource, a Medicaid payer, to change the pharmacy reimbursement environment, allowing pharmacists to focus on taking care of patients. Earlier this year, CareSource launched a value-based reimbursement program to incentivize pharmacies to target medication adherence and patient outcomes. They also began reimbursing pharmacists for clinical services provided to Medicaid patients in Ohio.
Cancer Path: Cigna is launching an oncology clinical pathway program in January 2021 designed to make sure patients are receiving appropriate and cost-effective therapies. The program will be available for specific cancer types and stages and will provide oncologists with evidence-based data to help select the best chemotherapy regimens. If a provider requests a regimen that is not part of the pathway program, they may have to work with eviCore medical oncologists to get the regimen approved.
Virtual Psych: Magellan will start using Kaden Health’s virtual behavioral care platform to help patients with substance use and those who need psychiatric consultations; the move toward tele-psych continues to accelerate and represents both opportunity and risk for outpatient therapy practices.
Work Comp Changes Behavior: A national worker’s comp insurer is targeting behavioral health as it reshapes its PT networks. Roughly 40-60% of injured worker claims are for patients with at least some psych issues that could complicate recovery, the insurer has found. In an interview with their western claims manager this week, we learned that they are using Healthy Systems, a kind of benefit manager with its own preferred network, to direct injured workers to services like physical therapy, including one large PT practice that screens patients for psycho-social issues, such as depression, and trains its PTs to deal with these patients. We’ve long discussed the importance of a PT practice adding behavioral health capabilities. This will be an important component for PT practices to “fend off reimbursement pressures” and become preferred providers for commercial, worker’s comp, and Medicare Advantage insurers.
Renewal Insight: CVS has a new at-home contact lens prescription renewal tool, QuickRenew, that aims to make re-ordering contact lenses a breeze. The tool is available on the CVS Optical website and customers can renew their prescription in just a few minutes. Independent ophthalmologists review the vision tests and confirm prescriptions, which can then be used anywhere to purchase more contacts.
Not Playing by Ear: Widex, a hearing aid manufacturer, is using artificial intelligence to help optimize hearing settings. The system uses algorithms to help create personalized hearing settings and the company said the process would take more than two million tests if they did not leverage AI, compared to around 12. The settings can then be securely stored in the cloud to help enhance the hearing experience of other users.
Radiation Therapy Innovation: Mayo Clinic and Google Health have launched their first research project together, building AI and machine learning tools to optimize radiation treatment plans for cancer patients. The project will focus on creating an algorithm that can automatically distinguish tumor margins from healthy tissue. They are starting with cancers of the head and neck, which can be particularly difficult to manage, given the many anatomic structures in narrow spaces.
Closing Health Disparity: COVID-19 has made health inequities across the country highly visible and BCBS of Illinois is launching a new provider program to combat this issue. BCBSIL created the Health Equity Hospital Quality Incentive Pilot Program to support hospitals serving the highest concentrations of BCBSIL members who are most at risk of contracting COVID-19. Long term, the program aims to improve healthcare outcomes in minority groups and will focus on reducing racial and ethnic disparities in care. BCBSIL will provide $100M in funding to participating hospitals, including Memorial Health System and UI Health.
Baby Bundle: AmeriHealth Caritas Louisiana is expanding its PerformPlus value-based care program to include a new pregnancy-focused option, Bundles for Babies. Providers will be evaluated and compensated based on the episode performance and delivering timely prenatal and postpartum care, along with STI screenings for pregnant women. The health plan will provide data analytics to help participating providers. Women’s Clinic of Acadiana is the first to sign on.
Extra Point: We played futbol with the middle school kids last Saturday over a frost on the muddy lawn at Bushnell Park. The girls brought their inhalers and little brothers, some brought their moms, none wore cleats, and only one had shin guards. My bride brought the hot cocoa, my daughter the Halloween candy, and after a few whiffed kicks and a dozen falls, we all wore a thick layer of dirt and a thicker smile. Those 50 kids live in 4th floor apartment buildings that breed asthma and limit hope, and this year have in some cases taken their families – the 75 year old aunt who brought them to the states or the 45 year old dad who was on time every morning at the factory for minimum wage and a COVID infection. This school is trying to reverse the story. It now starts school online at 10am, not because the kids need sleep but because they are up late paying bills and up early making breakfast, running laundry, and teaching their little brothers how to use an inhaler. Since the change to the late start and weekend futbol, there’s been a 60% drop in depression, a 50% drop in ER trips, and an increase in attendance and test scores. These changes don’t yet change the trajectory for these teens, but they hold the line. And for those of you trying to make sense of social determinants and how to build or scale social service businesses, this is your population – inquisitive, young, struggling to breathe, burdened by circumstance, but motivated to elevate their health and their families.