5: The number of BCBS plans that have created a new pharmacy solutions company, Evio. The Blues plans in Massachusetts, Michigan, and California, along with Highmark and Independence are behind the company, which will use member data to track how drugs perform. One main goal is to enter into outcomes-based arrangements with drug manufacturers, so the plans are only paying when drugs are effective for members.
Biosimilar Bait & Switch: Cigna is also looking into innovative ways to save on drug costs, by focusing on biosimilars. The health plan is launching the new Shared Savings Program in which eligible patients will be offered a $500 debit card to use on healthcare services or medications if they switch to a biosimilar. The program is opening first to patients currently on the anti-inflammatory drug, Remicade. Two preferred biosimilars will be moved to Cigna’s preferred tier in July.
Virtual Competitor: Starting in July, BCBS Michigan will allow large employer groups to purchase a rider that lowers members’ copays for virtual services. Members whose employers choose this option can see providers virtually for either $0 or $10, depending on their specific plan, which is less than their in-person copays.
Paying For Patient Engagement: Health insurers continue to factor in patient satisfaction into reimbursement rates – some health plans will pay a higher fee to specialists, like allergists, orthopedists, and ophthalmologists for increasing patient satisfaction, “because we know there’s a link between that and a person’s overall outcomes and adherence,” Peg Riordan, a source involved in payment innovation for a national MCO, told us. Several new companies are creating tools to help improve patient experience. In June, health data analytics company, Health Catalyst, said they plan to acquire Twistle, a patient engagement company with software that automates text message, patient portal, and other methods of communication between care teams and patients to support patients as they navigate an episode of care. That will add to Health Catalyst's population health tools, which identify populations at risk for poor outcomes, and will strengthen their offering for customers who are moving to value-based models.
New England Market: The combined health plan formed from the merger of Tufts and Harvard Pilgrim earlier this year finally has a new name: Point32Health. This combined entity will have greater leverage in the New England market, now serving 2.2 million members across the region. Look for more efforts to recalibrate reimbursement, develop more value-based contracts, and shift procedures and services downhill. The plan’s new name is inspired "by the 32 points on a compass" and "represents the role the organization plays in guiding and empowering its members and making a meaningful impact across the healthcare industry," according to a press release.
Caregiver Decline: The strain on caregivers is an underappreciated challenge for the health system and families across the US, and in recent conversations with managed care plans, many are saying that if your company can help address not only direct patient costs but also the indirect costs of caregiver physical and mental health decline, “you probably have a leg up with us in contracting,” Michael Atwood, RN, a home health network development manager, told us this week. What that might look like is “up to the market to innovate,” but includes emotional support, respite, personal care, and other services that help direct caregivers reduce stress. As background, in early 2020 we did a poll on caregiver decline that we may be redoing. Read the results here. To discuss, reach out anytime.
Insane Vein: Kim Green has spent nearly two decades battling cancer and, like so many people who go through chemotherapy, she’s had to learn over time to be an advocate in the treatment room. Recently, the Connecticut native needed an IV for a medical issue and told the nurse that the only vein available was in her finger, given years of IVs in other veins. The nurse didn’t agree and tried to get the IV set up through another vein, but failed, then another nurse tried, despite Kim’s pleading. The attending physician came in and dismissed Kim’s preference as ridiculous, but he also couldn’t get the IV set so in the end the staff settled on the finger. Kim was right but it took a lot of unnecessary and painful work to get there. If there’s a lesson here to providers, it’s probably to listen to the patient, particularly for those who’ve had chronic diseases and are forced into being advocates for themselves.
Extra Point: A good friend is in the end stages of saying goodbye to her dad Joel who’s battled several years now with Parkinson’s. Managing the care of someone with this condition takes a village – family, friends, nurses, physical therapists, and increasingly, scientists who are studying ways to address disease cost and quality of life. For anyone who has family with Parkinson’s, Alzheimer’s, and other neurological conditions, you try to find humor in what is a painful condition, and live day to day trying to draw on the memories of the person you know is there but is hiding behind the disease. There is hope in many new studies and treatments and we should honor those who’ve struggled with the disease and their caregivers for helping drive change. Here’s my attempt at honoring Joel and my good friend.