$4,229: The average total savings when using bundled payment programs for surgeries, according to a new study published by Rand on March 1st. The study looked at one payer’s program in which procedures including knee and hip replacements, spinal fusion and bariatric weight loss surgeries used a set bundled payment for all care within a 30-day period.
More Than A Feeling: Nonprofit Atrius with more than 30 primary care medical offices and 715 physicians in the Boston area is now an Optum company.
High Life: Highmark Health, which increased membership recently through its acquisition of HealthNow New York, is collaborating with Alphabet’s life sciences arm, Verily, to help clinicians provide better care for patients with chronic issues. Verily will use Highmark member data to build AI tools that flag patients with conditions like diabetes, COPD and CHF and help clinicians engage with the patients using various solutions best suited for each individual.
Moving Down: Intermountain Healthcare and Ascension Health, along with several home-based care companies including Amazon Care, are forming the Moving Health Home Coalition, with the goal of making COVID-19 changes to CMS home healthcare reimbursement permanent. Another request will be to allow hospitals to continue hospital-at-home programs. In Intermountain’s program, 90% of Medicare participants preferred the hospital-at-home program to traditional hospital care.
The Next Center Of Excellence: Cigna is starting a program, this time for those treating substance use, mental health and eating disorder patients. Centers can be added and removed from this distinction based on a rolling “cost efficiency score,” based in part on average length of stay.
Just Breathe: Portable electric devices that apply rapid pressure to a patient’s airway, used as cough assistive therapy to treat neuromuscular disorders, will be denied more often by Cigna and its benefit manager eviCore under a new more restrictive medical necessity policy.
Pregnancy Support: United Healthcare’s Community Plan in New York, a Medicaid MCO, has created a digital tool known as Care Conductor that allows physicians to more efficiently notify the insurer about pregnant patients, helping United use case managers to reach out to higher-risk members who may need additional support, such as food, housing and pre-natal care.
Iowa Targets Rx: Insulin, sympathominetics known as stimulants and antiretrovirals comprised the top 3 therapeutic classes by total spend according to Medicaid plan Iowa Total Care, based on its analysis of 98,000 users from March to June 2020. In comparison, Amerigroup reports 143,000 members most used antidiabetic, antipsychotic, antiasthmatic and ADHD agents. The most expensive medication for Amerigroup was Vyvanse, while Iowa Total Care’s most expensive was Humira Pen. Iowa’s drug utilization review board said it is looking into claims to identify potential misuse, specifically members with multiple SNRI and SSRI claims over a 3 month period, as well as members with multiple claims for seizure and nerve pain drugs gabapentin and pregabalin.
Diagnostic Innovation: BCBS of Kansas City now covers a new diagnostic platform used by physicians to detect Barrett’s esophagus (BE), pre-cancer, and cancerous cells in the esophagus. 611,00 members across Kansas and Missouri will now have access to the WATS-3D diagnostic tool. The Hawaii Medical Services Association, BCBS South Carolina, and Avalon also added the system to their benefits.
Extra Point: At 16, Sophie is the youngest of my three daughters but probably the healthiest, and wisest. She thinks a double bogey on a Par 5 cannot possibly be a 7. “If a bogey’s a 6 dad, well that would mean a double bogey is a 12.” Maybe it’s her namesake. Sophia, named for my great Aunt who grew up in Napoli’s mountains, means “wisdom” and, like her, our daughter seems to know what matters and tries to live it. She treasures a good John Mayer tune, 15 minutes uninterrupted on the piano, and a good complement. She no doubt benefits from living with boys who tend to see only what is and not what can be. They accidentally put Kit Kats in the washing machine but “at least they are trying to wash the clothes,” Soph says. She sees the glass not so much half full but full of surprises. She has strong opinions about the environment and LGBTQ rights but doesn’t flaunt them, except that day she wore a self-made Ben Platt for President t-shirt. When Soph grows up she wants to be in WandaVision, not as a character in the TV show but actually living in that reality. She manages to let her imagination keep her even, an underappreciated if not vital part of coming of age as a teenager. If Wanda doesn’t work out, Soph wants to teach dancers how to Plia to songs like Thriller, or help “98% of the world’s off-key singers” to harmonize. She sort of thinks the way today’s healthcare innovators do – not how to fix a problem with a Band-Aide, but how to start over. Clean canvas, a new partner, an open mind.