42: The number that hangs from baseball’s rafters and now also the percentage reduction in the rate of asthma-related emergency department visits and hospitalizations, thanks to a collaboration between health insurer HCSC and the American Lung Association. The project, Enhancing Care for Children with Asthma, launched 9 years ago and works with community clinics across the insurer’s 5 states to implement a quality improvement program to support asthma management in children.
Devising An Outcomes Contract: Spectrum Health, the integrated health system in Michigan, is entering into a risk-based deal with Medtronic. Heart failure patients who receive a certain type of Medtronic pacemaker will have their progress tracked, including 30-day hospital readmissions. Medtronic will reimburse Spectrum if the patient has suboptimal outcomes. While Spectrum has no obligation to use Medtronic products, their senior director of procurement says they likely will, “assuming we see the outcomes”.
Specialty Rx: Anthem has started to create a designated network for select specialty pharmacy medications administered in the office or the outpatient facility setting. Its Designated Specialty Rx Network applies to commercial patients as of April 1. Anthem is not the only insurer moving in this direction, and as far as we can tell more insurers are exploring this pseudo narrow network approach both for outpatient and the home.
Bold SUD Fix: Regence BCBS is bringing Boulder Care’s virtual addiction treatment model in network to provide members with additional access. As of March 15th, Boulder Care is now available to all Regence members, no matter where they are located. Members will have access to a full care team, including clinicians, care advocates and peer coaches, who can share their own experience with recovery.
Specialty, On Call: SOC Telemed has acquired telehealth vendor Access Physicians to form the so-called largest acute telemedicine provider in the US, according to the companies. The acquisition will add infectious disease, cardiology, maternal-fetal medicine and nephrology to SOC Telemed’s core services of neurology, psychiatry, critical care and pulmonology.
Disability Solution: Delta Dental’s philanthropic arm is funding an online professional development program designed to help oral health professionals better understand and care for persons with disabilities through Penn Dental Medicine.
Along Comes A Sports Benefit: I played 2 on 2 hoops last weekend with an Orange Theory business development leader who on the one hand played a bit like Phillip Seymour Hoffman’s character in Along Came Polly but on the other opened up about the OT’s move into modern day healthcare. The new-age exercise center has been in talks to partner with a regional primary care and cardiology group and an insurer to form a kind of preventive care meets exercise benefit targeting the 26-35 age group. The OT center uses a point system and cross-training approach to get people into their optimal calorie-burning zone. Before COVID hit, I gave the OT a try and my personal theory was that it made me nauseous, but that’s just me. In case you missed it, click here for the full review.
New #1: Simon & Garfunkel sang about it and my gym class slid into it at the park – that’s right, “home” healthcare has moved up 13 places to the top ranked health plan priority for 2021 according to our 16th annual Healthcare Payer Index. 2020’s #1 primary care moves out of the top spot and seven services actually left the Top 20 entirely, including ophthalmology, while three services made their debut, including social services. “We’ve always been a bit reactive and we had to be last year,” says a Blue plan’s payment transformation director, “but 2020 also gave us a chance to reset priorities and cut down on some silos that used to hinder innovation.” Stay tuned for the full rankings and analysis later this month.
Cologuard: Two weeks ago we reported that 59% of 35-45 year olds in our consumer poll said they will “likely” or “definitely” choose Cologuard’s at home test for colon cancer when the time comes over Colonoscopy, several citing advantages like “not having to do the prep my dad did” or not “having to be sedated” and even financial benefits for those who say they may just pay cash “and I think the at home is a lot cheaper”. If a Cologuard test is positive, the patient will need a Colonoscopy, but only 39% knew this. However, the cost of the Colonoscopy in this situation would be applied to the patient’s deductible if they are using insurance. 20% said they would “definitely” choose the test, 39% “likely.”
Social Solution: On April 15th we will host a live event releasing results of our recent survey of 544 healthcare stakeholders about the evolving role of social risk investment in healthcare. To register, click here and stay tuned for the full report.
Extra Point: Golfers sure do have it a lot tougher than doctors. Justin Spieth carded a triple bogey at the Masters but somehow finds himself on the leaderboard after an eagle at the Par 5 15th. Imagine cardiologists needing 3 tries to get a triple bypass done correctly and yet still finding themselves among the best. Then there’s Brooks Koepka – the pro blamed the wind for his tough round at Augusta Thursday, sort of like a doctor saying the air conditioning in the OR wasn’t working well today during surgery, so it’s not my fault the surgery didn’t end well. Rory McIlroy, the great hope of pretty much every Irish Catholic in my family, actually hit his dad after a wayward iron during the opening round. The ball struck pop’s back leg. If only there were a doctor there to check the bruise.