90%: Amount of hospitals undertaking artificial intelligence initiatives, up from just 53% in 2019, according to a new report published by Sage Growth Partners. While many of these programs are still in the planning or early implementation phase, it’s clear that healthcare executives understand the benefits of this technology and are using AI to make health systems better for both patients and providers, particularly in the wake of the pandemic.
Doctor Amazon?: The online retailer runs health clinics near worksites in Dallas-Fort Worth, Phoenix, Louisville and, more recently, Michigan and California. Amazon’s clinics are operated by Crossover Health and have provided services to over 115,000 workers and their dependents since the program first launched in late 2020. Earlier this month, Amazon also expanded its virtual and in-person care program into 21 states through the company Care Medical.
Ultrasound Guidance: Horizon BCBS in New Jersey now only allows 2 ultrasounds during pregnancy under a new policy effective this April. Additional ultrasounds may be allowed in certain situations but will require a medical director’s review. 3D and 4D ultrasounds are considered investigational and will not be covered. Some changes in payment whereby the insurer bundles pre-natal care, diagnostics, labor, delivery and post-partum care into a single rate are emerging in several areas that can give the OB “more flexibility.”
How Urgent?: Urgent care continues to move into the hands of either payers or health systems. Trinity Health, one of the country’s largest nonprofit health systems with more than 90 hospitals, is the latest mover, acquiring a majority stake in urgent care chain Premier Health, which has 73 sites in 9 states. In related news, several insurers have said they aren’t big fans of the hospital-urgent care alignment. “Has its pros and cons – how many times a day do we need to transport patients from the strip mall urgent care 5 miles away to the hospital ER? There’s a cost-benefit here. I think 30% of these trips are probably unnecessary.”
Specialty Pharmacy Preference: Regence BCBS is making Accredo Specialty Pharmacy and Express Scripts Home Delivery Pharmacy their preferred pharmacies across most networks starting April 1, 2021. Most national health plans own their own specialty or mail order pharmacies, and we are increasingly seeing local and regional plans, like Blues, choose to partner with 1 or 2 preferred pharmacies.
Pre Approval: Most UHC Community Plans, which cover Medicaid recipients, are increasing their prior authorization requirements for select orthopedic, ENT, and vascular procedures. Going forward, procedures may require images to determine if medical criteria are met. Some procedures with the new PA requirement include knee replacement surgery FESS, surgical and ablative procedures for venous insufficiency and varicose veins, and shoulder replacement surgery.
In & Out: Molina has removed knee replacement surgery from its inpatient only list in New York, a change that is in line with current CMS guidelines. The Medicaid plan will continue to reimburse inpatient knee replacement procedures for varied reasons such as comorbid conditions, but these exceptions must follow a prior authorization process.
Grand Partnership: Doctor on Demand is merging with Grand Rounds, creating a massive digital health company. Grand Rounds offers a clinical navigation platform and patient advocacy tools, while Doctor on Demand is one of the largest telehealth companies in the space. The merger is taking place with the goal of integrating medical and behavioral healthcare with patient navigation and advocacy to better coordinate care.
ExtraPoint: March madness is a time when we pick #12 Harvard over #5 Cincinnati because if any student-athlete can figure out the right angle at which to shoot a basketball, it’s gotta be a Harvard kid. Some of us only pick teams if they are a state, like Florida or Arizona, rather than Wofford or Mercer which sound more like states of depression. “Hi Honey, you seem down today.” “Yeah, I’m feeling very Wofford.” Some of us pick Cleveland State because Jimmy's dad went there, others choose schools that have a healthcare feel. I mean, what dentist out there isn't putting all his chips on Oral Roberts and Colgate? Click here for the full essay.