41,000: The number of members in health insurer Highmark’s 2019 claims data diagnosed with alcohol use disorder (AUD), leading to more than $4 million in spending and there are assumptions these numbers are rising, and quickly, as recent data suggests more adults than ever are drinking excessively. Highmark is offering its members new ways to treat alcohol disorder. One new option is Ria Health, a technology-enabled telehealth medical practice that focuses on treating AUD by combining medically assisted treatment with digital tools to help members track and record progress. The Ria Health team includes addiction medicine physicians, psychiatric nurse practitioners, psychiatrists, certified addiction counselors, and social workers treating Highmark members.
Poll of the Week: In our poll on behavioral health plan spend, a not-so-surprising 67% report that 4-6% of current commercial health plan spend is related to behavioral health care—higher than many thought it was—but by 2024, nearly all surveyed expect an increase. Some surveyed expect up to 10% of commercial spend on behavioral, others predict 6-10%. When asked what will drive the increase, one respondent said, “I believe the patient can become more balanced and have less incidence of physical manifestation of disease when educated on the overall benefits of good mental health.” Respondents largely expect societal awareness and increased prevalence of anxiety and depression due to COVID as major forces.
Something’s Got To Give: If behavioral spend takes a bigger share of the pie, is there a service that loses out? Since it is healthcare, logic says everyone keeps winning particularly as America ages and deals with epidemics and pandemics, but when we chatted with a few medical directors this week, there was some consensus that behavioral health’s rise may impact one subsector – pain. “I haven’t looked at every claim but there’s a lot we see in medical necessity notes from pain physicians and PTs and chiropractors about mental health, depression, and anxiety – I would think a portion of these patients don’t have chronic pain.”
Lifting The Hays: In Major League, Willie Snipes’ character used to always say “I hit like Mays and run like Hays,” only to prompt his manager to say “You may run like Hays but you hit like s___”. It’s a funny line in a movie about what goes behind the seasons in baseball, and how an underdog takes chances to be a winner. We sit down with healthcare’s version of an underdog, a risk taker with sights on good change for healthcare in the great northwest. Gillian Hays is the new VP of network development for Regence BCBS and she says the insurer is “dedicated to pursuing innovative, value arrangements.” Our interview with Hays is coming soon, but if you’re looking to get attention in the meantime, note that she spends her down-time facilitating an art literacy program for Portland Oregon elementary schools.
Out of Pocket, Out of Style: Geisinger is offering a new billing solution that utilizes artificial intelligence (AI) to help patients pay their out-of-pocket expenses. Up to 75% of patients with out-of-pocket balances often resort to compromising behavior when they owe healthcare providers, like pill splitting or skipping appointments. Patients with more than $250 balances after insurance can choose customized payment plans offered at no fees or interest. An AI-based algorithm analyzes more than 30,000 patient finance data to determine how much they are able to pay monthly. Patients now can complete payments in 60 months instead of the traditional timeframe of 12 to 18 months. That information is merged with provider data to adjust payments based on the likelihood patients will need additional treatment in the future. A pilot was introduced last fall in one of Geisinger's service regions before eventually expanding system wide.
Caregivers Needed: Caregivers are the backbone of America's long-term care system, but these mainly volunteer family and friends are facing declining health issues themselves and now the pandemic has exacerbated these issues and revealed weaknesses in the healthcare system. Solving this underappreciated epidemic is likely to become more important over the next decade and will require more collaboration and solutions from policymakers, advocacy groups, healthcare providers, and families. Our recent report, which can be found here, explores the emotional and physical stressors associated with caregiving as well as financial programs that could assist with this role.
Heads Up Carolina: Cityblock Health and BCBS of North Carolina are collaborating to open five clinics across the state aimed at providing comprehensive care to eligible low income individuals.The model will address physical, behavioral, and social determinants of health and will first become available to low-income members in Charlotte, Greensboro, Winston-Salem, and High Point, and Fayetteville.
Kidney Bean Or Bust: Cigna is expanding its value-based kidney care program through at least 2023. The program, in collaboration with Fresenius, offers Cigna providers who treat members with kidney failure or ESRD additional incentives based on meeting quality metrics while lowering total cost of care. One measure is addressing the high incidence of depression, which can lead to less effective outcomes.
Home Depot Virtual: I went there the other day and felt quite a bit inept, almost invisible – for starters, there’s a lot of paint cans and colors and I never quite figured out the difference between flat, enamel, satin and eggshell, and finding someone to help you feels a bit I imagine like going into a busy hospital ER complaining about a paper cut. But Home Depot is making strides for its employees – an HR director told me that use of telehealth skyrocketed last year, up +265% from pre-COVID, which sounds like a lot, and they are continuing this by offering all employees a single healthcare virtual contact to help them with where to get care, like at an in-network option. Home Depot is pursuing regional centers of excellence partnerships for people who eventually need surgery and “is willing to pay to fly people out of their area” if it gets them to “best quality surgeon.”
Extra Point: I’m all for a good metaphor, like the Yankees 11-game win streak must feel a lot like what I suppose a doctor experiences after going 11 for 11 diagnosing the real reason behind her patient’s pain symptoms. But my colleagues and I are admittedly falling into a bad habit lately comparing the state of healthcare reform to baseball. Everything is either in the 1st or 3rd or 5th inning – I even oddly found myself saying pain management had moved into the bottom of the 5th the other day, which is both weird and awkward, although perhaps explainable because it was raining at the time and that would mean the game would be over, which some pain practices should be cognizant of if they are over-reliant on certain services and tests. I vote we change the metaphor, maybe to hockey for its 3 periods, although I’m not sure anyone wants to know what sudden death would be to a business or sector, so maybe cross country, which has the same starting and endpoint and, much like healthcare, just runs in circles sometimes, like haven’t we been down this capitation thing before? My daughter tells me golf should work, and I think she’s right – I mean doctors, therapists, pharmacists and nurses for the most part are comfortable when the case is up the fairway. They can see the target and, unless a wind blows like a non-compliant patient or poor concentration, they can hit it. Going into the rough usually requires a special club, ala a healthcare specialist, and going OB usually comes with a penalty, much like what hospitals and doctors have to deal with if they miss the mark on a patient’s diagnosis or treatment. Good golfers get caddies ala a doctor who increasingly rely on assistants and NPs and if you’re fancy like Rodney Dangerfield, with his laser putting technology in Caddyshack, you have special equipment to see the image. Pros like Tiger use yardage books just as doctors now use spreadsheets that tell them just enough about a patient’s history to pick the right treatment. So for our purposes, unlike baseball’s climactic 9th inning, golf never really ends, and nor will healthcare reform if I’m being honest. Yes, there’s the 18th, but increasingly in healthcare you are only as good as your last patient or last year and increasingly measured versus the field.