24601: Les Miserable fans know this number too well as the mark symbolizing Jean Valjean’s bread stealing moment during the end of the French Revolution, and in a symbolic way this is exactly the number a Medicaid managed care plan’s medical director is advocating the insurer pay per beneficiary per year (well, $24,600 to be exact, but what’s an extra dollar for effect?) to cover housing, health and wellness, transportation, job support and food as part of a social family support concept targeting underserved, typically refugee, populations.
Dose E Doh! Several insurers are looking to reduce doses for non-oncology related specialty medications. The goal is to avoid vial waste. PBMs like IngenioRx will evaluate dosing during the pre-authorization process and will be asked if the suggested dose is clinically appropriate, and likely will be asked to lower it if it is within 10% of the nearest whole vial. Payment is typically linked to the dose, so the review has some reimbursement implications. For now, only Anthem and a few Blue plans acknowledge starting the program this fall.
The New PCP: If you operate a practice with NPs, there’s a good chance your patients have or can start selecting them as their designated primary care provider. Under a new policy set to take effect in December this year, Anthem says it will begin allowing NPs collaborating with PCP groups “to be set up in the system for selection” for applicable plans. Other insurers have done this for years, for NPs and even Urgent Care centers. The insurer is reviewing provider data to identify candidates. It is unclear if the NPs could be eligible at some point if serving in a specialty practice like allergy or endocrinology, or if payment would be at the same level as the physician – odds are the payment would be 85% of the physician’s rate, but contractually some managed care plans will pay the same level and at a minimum being designated as a PCP can open up the NP for incentives tied to clinical quality and performance.
Social Investment: Penn Medicine and the Wharton Social Impact Initiative have invested $750K in businesses that focus on addressing social determinants of health. The money is going to Kinvolved, which has software to reduce school absenteeism, Uptrust, which provides reminders for probation appointments and RecoveryLink, a substance use telehealth platform.
Home Monitoring: Independence Blue Cross and LabCorp are providing the insurer’s Medicare diabetic members with home specimen collection kits they can use to monitor blood sugar levels and screen for certain cancers. The kits will include several tests, including an HbA1c test used to monitor blood sugar levels, an occult blood, fecal, immunoassay test to screen for colorectal cancer and diagnose other conditions that cause bleeding in the digestive tract, and a urine albumin test to screen for early kidney disease in people with risk factors such as diabetes and high blood pressure. The kits are no cost to members, but they do require doctors' orders to get them. Patients will receive kits in the mail and send them back to have their samples tested.
Nurse Shortage Ripple Effect: As the delta variant takes the country by storm, the nurse staffing shortage is becoming an increasingly dire situation. In our poll of the week, about 75% are currently facing a nurse shortage in their hospital or practice, forcing health systems to bring in both costly travel nurses and younger nurses with less experience. A younger nurse in NY transferred off her hospital’s COVID floor over to labor and delivery this month. She’s dealing with the PTSD of her first 6 months on the job and now finds herself in unfamiliar territory - unprepared for handling a stillborn case and a baby coming into the unit without a heartbeat. Some hospitals report needing at least 50-75 more nurses to be at an adequate level. Increasing compensation and benefits will help recruit and retain nurses but health systems say they can’t keep up with travel nurse agencies, some of which offer up to $5,000 a week. Georgia’s Augusta University Medical Center reported 20 to 30 resignations per week from nurses taking travel staff jobs. Recent vaccine mandates have also exacerbated the shortage. One hospital in NY is no longer delivering babies since 30 employees resigned due to the mandate. Some systems are trying to adapt. West Virginia University Medicine is offering new nurses bonuses up to $15k for a three-week work commitment and Monument Health in South Dakota is offering a $40k bonus to intensive care and operating room nurses.
On Second Thought: George Costanza once asked Kramer if he ought to get a second opinion about a rash on his arm, to which Kramer said, “I wouldn’t go outside looking like that until you do!” Perhaps Anthem’s new partnership with Cleveland Clinic could have helped. Anthem members from large employers will have access to second opinions virtually. The Clinic has 3,500 providers available to provide concierge-style service and video consultations. The program may roll out to a broader membership base in the future.
Medicare Coverage Expands, Impacting Drug Prices: The Build Back Better Act would expand Medicare coverage of dental, hearing and vision. In early September, The House Committees on Ways and Means and Energy and Commerce released draft legislation in early September and changes would be paid for largely through drug-pricing reforms. You can find more details here.
Mental Health Day: Employers are beginning to take a step in the right direction to prioritize employee’s mental health by implementing “mental health days.” Companies like Nike, Intel, Microsoft, Marriott International, and others are making changes because burnout caused by depression or anxiety in the workplace can affect not only a person’s personal life but their work performance as well. Studies have shown that working 55 or more hours per week is associated with a higher risk of a stroke and dying from heart disease than just 35-40 hours a week. And this idea doesn’t just affect adults, as studies have shown that children can be impacted by school-life mental strain as well. A new Illinois law will allow students to take up to 5 mental health days starting in 2022.
Extra Point: It’s quite remarkable that a 79-year-old has the patience to write this much over text and not a single lower case letter. Dad’s text this morning is both comical and impressive and for those of you with older folks in your life, you know about these messages – they are your window into the reality of getting old and how often times the kid becomes the parent: BRY! NEED TO CANCEL COFFEE THIS MORNING. I GOT DIZZY AT STOPSHOP YESTERDAY AND STUMBLED INTO THE FRUIT LOOPS. THEY GAVE ME A CHAIR TO REST BUT DR. B WANTS TO SEE ME TODAY. MOM IS DRIVING BUT HAS HER CARDIOLOGIST APPOINTMENT AT 2. HER TEST CAME BACK WITH ABNORMAL CARDIAC ENZYME TEST. I THINK IT’S THE VANILLA YOGURT SHE ATE. I PUT MY CHOLESTEROL PILLS IN THERE AND SHE ATE THEM! SO SHE’S PRETTY MAD. CAN YOU TAKE HER? IM UP TO 15000 STEPS A DAY AROUND THE YARD BUT A GARDNER SNAKE SCARED ME OTHER DAY SO I’M BACK TO DOING IT INSIDE. THE GIANTS ARE AWFUL. REALLY BLEW THAT GAME. I THINK THE PATRIOTS WILL BE FINE. UNCLE AUGGIE’S FUNERAL WAS GOOD. DID MOM REMEMBER TO TELL YOU HE PASSED AWAY? 99! HE USED TO SNEAK ANISETTE COOKIES TO YOU. WE WATCHED THE SCHITT CREEK THIS WEEK. I DON’T UNDERSTAND IT. IPAD WONT TURN ON AGAIN. CAN ONE OF THE KIDS HELP? I HEAR FROM JACK EVERY WEEK. COLLEGE IS GOOD FOR HIM. LOVE TO JANINE AND KIDS. XOXOXO.