3: The amount of free PCP visits Blue Cross NC members will have through a new feature designed to encourage their members to go to the doctor’s office. Effective January 1, 2021, select Blue Cross NC members have no copay for their first 3 visits when visiting their PCP on file. Benefit available to ASO, fully insured, and fully insured individuals under-65 with a copay for office visits.
Kidney Care: Beginning this month kidney care management company Somatus launched a pilot to better integrate care for CareFirst BCBS patients with chronic kidney and end-stage renal disease. 250 members in commercial, fully insured groups with policies issued in Washington, D.C. and Northern Virginia are part of the pilot at no additional cost to the member. Patients get connected to a Somatus care team including a nurse care manager, community health worker, renal pharmacist, renal dietitian and social worker. We assume this model is paying a PMPM but what we need to understand is the effect on nephrologist and the impact on the dialysis companies. At a minimum, this is another example of the trend toward disease focused care management partnerships.
Scaling Social Determinants: CareSource is partnering with Healthify to build a network of community based organizations across Ohio, which will provide members of the Medicaid insurer referrals to address social determinants of health. The network will be made up of community organizations that provide a range of services that address SDoH such as food insecurity, lack of transportation, unemployment, inadequate housing, and financial instability. In Michigan, Priority Health is launching a new web presence that will focus on SDoH and health inequities by providing visitors with educational background information on SDoH, among other content. Payers are increasingly recognizing the importance of addressing SDoH for their members’ overall health. Stay tuned for a special report on SDoH from the Managed Care Friday team, out later this month.
HIV First: A new health system in the Pacific northwest includes the first skilled-nursing and outpatient chronic care management program in the US designed specifically for people living with HIV/AIDS. The Bailey-Boushay House is part of the newly formed Virginia Mason Franciscan Health system, which boasts 300+ sites, 11 hospitals and 5,000 providers.
Scripted: Iowa was once only famous for the great Moonlight Graham and that small ballfield in Kevin Costner’s backyard, but now Wellmark, the BCBS plan here, is building its own field of dreams - a new preferred drug strategy for drugs covered under the medical benefit will make Biosimilars the preferred drug without prior authorization for applicable cancers, asthma and rare diseases under a new policy taking effect fully by April this year. Wellmark is joining the many health plans who are looking to help control drug spending by making biosimilars the first line choice.
Change Up: UnitedHealth’s Optum is buying Change Healthcare, a technology company with an array of services including claims processing and data analytics. Analysts say the goal of the acquisition is to leverage the amount of data both companies control in order to help improve care and lower costs. We saw at least one other health insurer buy an analytics firm in 2020 and it doesn’t appear this trend is going away anytime soon.
Extra Point: Mom and dad still use a rotary phone, keep a checkbook balanced to the penny and if they’re lucky Dr. Blume will come by the house to check their BP and run a rapid strep test. Some days I think they are straight out of Little House on the Prairie, others I think they are just brilliant. House visits ala Dr. Baker are now becoming the norm in SNF and hospital at home models and primary care like Village MD. It’s a trend you could see coming as I discussed here 6 years ago when I had a bit more hair. Ma’s heart condition fueled by 18 some years eating Italian in a village near Napoli and dad’s age – just about 80 now – have both of them in line for a vaccine here in the nutmeg state. I’ll be driving both to the convention center on MLK Day – first to get their Covid vaccine and then to get my own. I’m not exactly tier 1, but in Connecticut, since I coach sports at an inner-city middle school, that puts me on the list. Part of me feels like I’ve cut the line like I used to do at Vecchitto’s Italian Ice shop in Middletown, but I hope that by getting vaccinated it will protect the kids, many of whom have lost a relative to Covid, all of whom are part of a state free lunch program and none of whom think of things like college or gym time as a right, but rather a hope. It’s not lost on me that MLK himself once said that “of all the forms of inequality, injustice in healthcare is the most shocking and inhumane”. Hopefully we move into a new phase soon that equalizes healthcare and raises our collective health. I am hopeful – for more house calls by doctors like Pete Blume, vaccines for those in need, and maybe a cell phone for mom and dad.