$20M: The amount of drug cost savings Blue Shield of CA reported between 2018 and 2020 through its partnership with Gemini Health. This partnership made the Drug-Cost Transparency Service available to healthcare providers in California. This tool allows providers to view patient-specific lower-cost alternative medications and compare prices during appointments. Blue California recently announced it will expand the platform to pharmacists with the goal of encouraging greater collaboration with physicians.
A Dozen Specialties: Premera Blue in Washington is introducing its new higher-performance provider designation program for 12 specialties including primary care and in the next few weeks will list the providers on its patient/member facing search tools, showing the patient if the practice is high quality, low cost, or both.
Wheels Up: A new OhioHealth clinic on wheels is meeting residents where they live for healthcare with a 45-foot-long RV that has two exam rooms, a waiting area, two offices, and two restrooms. The clinic serves underserved areas of Linden, Ohio and its goal is to reduce the need for emergency room visits. The clinic is parked outside the new Linden Opportunity Center 7 days a week and is the third mobile unit from OhioHealth.
ER Policy On Hold: Earlier this week, United announced that beginning July 1st they would assess all emergency department commercial claims to determine if a trip to the ED is truly needed, but has decided to delay implementation due to provider pushback. They are not the first payer to implement this policy, as Blue TX already does pre-pay reviews like this to make sure the trip for say an itchy scalp or a sore throat is warranted, or could have been handled by urgent care or a PCP. Policymakers and providers including the American College of Emergency Physicians expressed concern that the policy could prevent people from seeking medical care for true emergencies, due to worries about coverage and cost. United says it will delay the policy until at least the end of the pandemic. Once implemented, claims determined to be non-emergent will be subject to limited or no coverage, meaning the patient will then be responsible for the majority of the cost.
Latest Marriage: Maybe not as magical as Wesley and Princess Buttercup’s marriage, but One Medical is buying Medicare-focused primary care company Iora Health in what seems like a perfect match - both providers employ alternative payment models over traditional fee-for-service reimbursement. One Medical focuses on a direct to consumer model, while also contracting directly with employers and some health systems. Iora is participating in CMS’ direct contracting model. The acquisition will increase One Medical’s presence to 28 markets.
Palliative Partner: VCU Health System in Virginia is getting into home health and palliative care by collaborating with Bayada. The two will launch a new company, VCU Health at Home by Bayada, which will allow VCU patients to continue receiving services through the health system after they are discharged. The new company will start serving patients in 2022.
Room For Value: United Rheumatology is welcoming Horizon to its value-based program model in a collaboration aimed to help control costs for New Jersey patients. The model incorporates shared decision making between United Rheumatology’s affiliated physicians and their patients and the Horizon Episodes of Care team to improve outcomes, improve the patient experience, and manage cost of care for treatment of rheumatoid arthritis and psoriatic arthritis.
Extra Point: Please pray for my 17-year-old – he’s about to graduate high school, hasn’t seemed to be in any classes for 6 months, golfs with teachers during school hours, and now perhaps as a bit of payback took an elbow in the nose during one of a half-dozen school pranks today, which means we are off to urgent care. Never a dull moment, this thing they call parenting.