6: The number of independent physician associations in Philadelphia that merged to create the Constitution Physician Alliance network. The group includes over 200 specialists and primary care physicians, and will collaborate to focus on disease prevention and reducing hospital admissions. The network is managed by CareAllies, a Cigna company.
A Whole New World: Disney is embracing telehealth. As part of Disney World’s partnership with Florida health system AdventHealth, the theme park will now make connected health services available to guests, employees and others, including a telehealth platform that can be accessed at any time and a mobile health app for scheduling virtual care. Not sure if this means you can get a nurse to virtually check your BP on Space Mountain, but it’s Disney – so magic happens. AdventHealth is also building a brick and mortar ER at the theme park to address urgent care needs.
Safe & Tasty Transitions: In another show of support for home-based care, United is launching a new program for their Group Retiree MA members to safely transition home after discharge from a hospital or SNF. Beginning January 1, 2022, UnitedHealthcare Healthy at Home will provide all retirees in an MA plan with up to 28 meals, 12 transportation rides and up to 6 hours of in-home personal care after discharge, in an effort to prevent hospital readmission. We’ve seen a rise in MA plans offering supplemental benefits like these and expect this to continue.
Renal Revitalization: Centene is partnering with Somatus Inc. in several states to offer care management programs for Medicaid and/or Medicare members with chronic kidney disease and end-stage renal disease. In addition to care management, social workers will also be available to help patients with transportation, food, or other issues that make it hard for a patient to access or comply with treatment.
Mom To Be: UnitedHealthcare Community Plan members in Texas are now eligible for a new program called Wellhop for Mom and Baby. Wellhop is an app that expectant mothers can use to connect with a group leader and other expectants mothers through bi-weekly chats, discussion boards, and an online library.
Rerun Or Latest Episode? You may think you’ve seen this one but BCBS Michigan is introducing a new value-based reimbursement opportunity for orthopedic surgeons. Orthopedic surgery practices will be evaluated on cost trends in their knee and hip replacement episodes. Episodes begin with the replacement surgery and continue for 90 days post-surgery. Practices with the lowest episode cost trend will be rewarded with an additional 5% value-based reimbursement starting in March 2023.
SDOH Coverage: Upon evidence of a -25% reduction in total cost of care and a +60% increase in behavioral health treatment, Horizon is expanding their SDoH program to cover members across 15 New Jersey counties and 127 zip-codes. The original pilot program, which launched in April 2017, initially targeted 1,000 members with SDoH needs in 4 Newark zip-codes. 2021 focus areas will include COVID-19, vaccine education, and increased provider engagement.
Tele Jump: BCBS MA released a report indicating that between March 2020 and March 2021 outpatient mental health services increased +20% and spending on substance use disorder (SUD) increased by +10%. The report also found that approximately 70% of mental health visits covered by BCBS MA have been conducted via telehealth. In fact, 54% of total telehealth visits across specialties have been focused on mental health and 60% of mental health diagnoses made via telehealth have been for anxiety.
Pre Approval: United is making prior authorization (PA) and site of service changes for its commercial plans, including removing PA for 170 codes. The health plan is adding PA and site of service reviews for 32 surgical codes if being done in the hospital outpatient setting, including mastectomy and some arthroscopic procedures. Another 7 codes will require PA and site of service reviews if being done in the hospital outpatient or ambulatory surgical setting. These include injections and excisions.
School Choice: SchoolCare, a health technology company, is teaming up with Managed Health Services (MHS), an Indiana MCO, to coordinate care for underserved pediatric populations through school nurse offices in Indiana with the utilization of an electronic health record system. The software provided by SchoolCare in K-12 school nurse offices will be integrated with care management resources at MHS so that parents, MHS Care Managers, and school nurses will be coordinated.
Extra Point: When I grew up only 3 kids didn’t look like me. We had diversity, for sure, but it was Irish Catholics at one table, Italian Catholics at another, and a few protestants. Now our kids are growing up in a far more diverse world, with friends born from other parts of the world, some with disability, some LGBTQ, others non-binary, and many trying to bust down stereotypes, like why shouldn’t the soccer player on the girl’s team kick field goals for the football team, or why can’t Lucy play Shrek? I mean, he’s an Ogre, not a man. Diversity is making its way into healthcare too – in our patients, in the services we’re offering, in what our policy leaders cover, where we get treatment, and now how clinicians are paid. Maybe this complicates things, but it sure seems that the more diverse we become the more culturally competent we need to be. Maybe that doesn’t get you a better contracted rate, but it may just get you more patients and a better reputation.