13: No not Apollo but the number of facilities Cano Health will add to its Florida footprint through its $600M acquisition of Miami-based University Health Care. Cano operates value-based primary care centers for seniors in Florida, Texas, Nevada, and Puerto Rico.
Bundle of Pain: Under a new United Healthcare Medicaid reimbursement policy taking effect in July, using nerve blocks either as a component of anesthesia or a post-operative pain protocol are no longer reimbursed separately as United considers them part of the anesthesia time for surgeries when performed by the same physician or their associates.
Rocky Mountain High: Colorado employers have joined the Colorado Purchasing Alliance and Purchaser Business Group on Health to create a regional network of excellence. The group’s goal is to negotiate directly with health systems to set prices. Employers in the group include Larimer County along with the State of Colorado. As healthcare costs continue to rise, we expect to see more of these unique arrangements on local, regional, and national levels.
The Weight: Take a load off Fanny was a bit of an anthem in my home growing up when mom would spin the 8-track record from The Band’s hit “The Weight.” In healthcare, we seem to be spinning into a new era where Fanny better get moving. Cigna’s health services business, Evernorth, is adding the newly approved Wegovy to its weight management care value program from Express Scripts. The program provides members with personalized coaching, digital tracking tools, peer support, and exercise regimens, along with access to physicians through MDLIVE. These physicians will now be able to prescribe Wegovy, which was approved by the FDA in June for the treatment of obesity.
Discount Debate: Walmart and Amazon have both added prescription discounts to their respective memberships. Walmart’s program allows members to use the discount instead of health insurance and receive up to an 85% discount. Amazon’s Prime program will offer some prescription drugs at the equivalent of $1 per month for a 6 month supply.
Side of Mayo: The Mayo Clinic is continuing to err on the side of tech innovation, this time by signing a multi-year collaboration agreement with Visage Imaging. Through the collaboration, Mayo will use the Visage AI Accelerator, an AI platform that combines AI solutions with diagnostic imaging, and the pair will be able to commercialize developments.
Wasted on the Way: CareSource is partnering with a medical disposal company, DisposeRx, to help families avoid opioid misuse and accidental poisonings. DisposeRx makes a powder that disables the active ingredients in unused medications, which can be added to water and poured into prescription bottles. The drugs can then be safely disposed of. CareSource is offering this solution to Indiana and Ohio members first with plans to expand the solution’s availability to more members throughout the year.
SNF Diversion: Beginning Aug. 1, 2021, naviHealth will manage post-acute care for United Medicare Advantage members in Alabama, Maine, Massachusetts, New Hampshire, Rhode Island, Tennessee and Vermont. This includes prior authorization and continued stay review and discharge planning for members who are receiving care in or transitioning out of SNFs, acute inpatient rehab and long-term acute care settings. naviHealth already manages this process in several other states.
Scoring Home Care: New York-based Citus Health released a report focused on communication between providers and patients in home health. They surveyed 300 patients and family caregivers who have utilized home-based services over the past year and 95% of users said communication responsiveness impacted how satisfied they were with a provider, especially when dealing with a question or urgent need. Just 40% of respondents said they were content with their providers’ responsiveness regarding treatment in the home, scheduling, medical changes, and more. Means of communication have changed since COVID-19, with 96% of respondents reporting they favor providers that employ real-time communication technology via smartphone, tablet or computer.
Extra Point: There were 117 awards during high school graduation this week, felt sort of like if healthcare had an awards night and honored everyone who showed up wearing scrubs. There were 11 art awards, 16 english, 14 science, and 30 for music. If your instrument made a sound – award. If you sang low and high - award. And if you could write a sentence, run a mile, and make a half decent oral argument why Pluto ought to be a planet, which it obviously should, then that was like 3 awards. There was a writing award for best prose, one for best persuasion, and even one for best passion. Even math had a moment, with honors for best parallelogram and best impersonation of Matt Damon’s Will Hunting. Really? Only history seemed to be light on the honors. There was the ancient civilization award, US history, and then one of those awards you love as a parent, but you also feel embarrassed about, the “this kid really showed interest and tried and showed creativity award” given to the student who when asked to name his favorite era, said “Bill Buckner. Because I’m a Met fan.” Back when I graduated high school there were 5 awards: history, math, english, gym and the arts. Music, band, orchestra, singing were all one award and James McKenzie’s cool solo drum set to the Moody Blues got him the nod. There was no science award, even though green was a Pictionary category. The history, math and English awards all went to Becky Kerstein, our valedictorian. I got the gym award. I feel like healthcare is in a bit of similar situation these days, doling out more awards than a rural high school with mostly average students whose parents think all their kids are above average. We’re giving extra reimbursement just for “sharing data,” enhanced rates for opening up a clinic, and a $1,000 payment just if you offer medication assisted treatment each month. Many major specialists can now negotiate up to a 50% share of savings if they can keep patients from going to the hospital, which adds up to tens of thousands of dollars in bonus payments if you are good at your job. We’ve set a bar and it’s low enough many are hitting it, but we are about 4 years out, if I had to venture a guess, from a moment when that bar needs to move or we learn that all those awards and rewards we got were nice, but aren’t coming anymore. Some of us will keep innovating. Some are like Becky and James, one a college professor, the other a former Julliard teacher. Some may not get bonuses, revert to being average again, and get paid just because, which is nothing to sneeze at – at least when you’re in healthcare. That’s because we need average. Average means access and it helps us know who to reward. Maybe in 4 years we ought to devise a new set of honors to recognize the mediocre doctors and nurses among us. We can celebrate by applauding clinicians who do just enough, but rarely more like clinicians who spend the least amount of time talking to patients, but still somehow manage to make a halfway decent diagnosis without the help of a fancy lab or imaging center. How about them apples....