59: Percent of dentists reporting increasing prevalence of stress-induced oral health problems like bruxism or teeth grinding, chipped and cracked teeth, and temporomandibular disorder symptoms like jaw joint pain.
As CMS Goes: CMS will begin paying doctors to use two different AI systems, one focused on diagnosing diabetic retinopathy and the other that alerts specialists when a brain scan shows a patient may have suffered a stroke. MA and commercial plans may also provide coverage, though the parameters around reimbursement may vary. Both products were approved by the FDA back in 2018, and will now finally be reimbursable, allowing more widespread use in the medical field.
Buying Risk: Centene is buying health analytics and risk adjustment company Apixio, which analyzes sources of patient data like physician notes and medical charts. The move is designed to complement Centene’s existing data analytics products and help ease the transition to more value-based care arrangements, which heavily rely on accurate patient data.
Biosimilar Boost: Wellmark BCBS is launching a new drug strategy program in the first half of 2021, focused on promoting preferred biosimilars. No prior authorization (PA) will be needed if the biosimilar does not have a PA in place today, and for those that do have one in place, no PA will be required for 12 months. PAs will be required for non-preferred products. The fee schedule will not change, in order to encourage the adoption of biosimilars.
Blue Light Ahead: Dependents under the age of 19 years old who are enrolled through employer-sponsored plans may now receive anti-reflective coating on eyewear at no additional cost under new benefits from United Healthcare. The coating helps reduce exposure to blue light, something that many young people have seen an increase of over the past several months, thanks to remote learning.
Home Addiction Model Q&A: Tufts Health Plan is expanding an in-home addiction treatment pilot for substance use disorder through a partnership with Aware Recovery, which works off a PMPM model. Tufts is the first health plan in Massachusetts to cover this treatment. To hear our interview with Aware, click here.
TelePsych Expansion: Aetna is expanding its mental health partnership with Inpathy to include members in three new states, Illinois, Texas, and Florida. Inpathy connects members with therapists and psychiatrists via online video sessions and has partnered with the plan since 2016. A recent meta-analysis indicates that remote therapy can be more effective than face-to-face in treating some mental health conditions.
Extra Point: A game of two-on-two hoops went south last weekend when I dove (okay, awkwardly tripped) trying to win a loose ball on the blacktop down at the park. I jammed my big toe into the court like a hammer, essentially breaking it. My teammate, who works in medical HR at Aetna, says I was fouled, even though no one was near me. Seven unanswered points later, we lost the game and my big toe swelled up, but I did get the skinny on Aetna’s new efforts to hire a new chronic conditions solutions executive director. The title isn’t as interesting as the responsibilities, which include operating and managing the diabetes solution program, overseeing commercial and government plans and PBM clients, and designing and launching pilots that improve health, reduce medical spend, and enhance experience. I asked if solving chronic losing was a possible pilot.