112M: The cost savings BCBS of NC experienced through its partnership with laboratory benefit manager, Avalon Healthcare Solutions. Since initiating the partnership in 2017, Avalon helped move more lab services in-network and implemented pre-approval to ensure tests were medically necessary. There’s a growing focus on the “clinical utility” of lab tests. In 2020, 99% of all lab services were provided within BCBS NC’s network, compared to 86% in 2017.
Good Genes: Beginning January 2022, BCBS Michigan will begin allowing genetic counselors to join their network and receive direct reimbursement. Participating genetic counselors will be able to bill their professional services using codes 96040 and S0265. They can receive direct reimbursement for covered services at 85% of the applicable fee schedule.
The New Social Network: AmeriHealth Caritas is launching a new subsidiary focused on social determinants of health (SDoH). Social Determinants of Life will invest in and support solutions that help people improve their life outcomes. The company’s first investment is Wider Circle, a California-based startup that designs tech-enabled health programs and peer-to-peer social networks. The investment in Wider Circle will allow the company to harness social networks, which research has found can contribute to better health by boosting resilience and leading to improved life trajectories. BCBS of Minnesota is also focusing on SDoH by adding no-cost community health worker services to commercial health plans beginning January 2022. They will be the first health plan in that state to expand use of health care liaisons beyond public health programs.
Doctor, Can You Hear Me?: Amazon Web Services will offer hospitals three new ways to improve communication with patients. Health systems will soon be able to automate outbound calls, texts, and emails with patients via Amazon Connect without the need for third-party integrations with other systems. AWS will also allow providers to verify a caller's identity based on their voice through Amazon Connect Voice ID, potentially eliminating the need to screen each caller manually and speeding up customer service calls. Last, Amazon Connect Wisdom can automatically detect patients' issues and give customer service representatives access to real-time information from in-house databases or third parties using speech analytics to help them resolve patients' problems.
Sweet Home Chicago: Rush University is partnering with DispatchHealth to provide at-home care to patients who would otherwise need to receive care at the health system’s ER or urgent care. After initial triage to ensure a patient should not be rushed to an ER, the typical DispatchHealth home visit involves a nurse practitioner or physician's assistant traveling to a patient's location, treating the condition, and connecting the patient with a DispatchHealth medical doctor, usually through telehealth. The DispatchHealth car carries all the tools for most emergency care needs, including lab tests, medications, and medical imaging equipment. The program began October 7.
Primary Expansion: Group Health Cooperative of South-Central Wisconsin is partnering with UW Health and UnityPoint Health, which adds 19 primary care clinics to GHC’s network. With these additions, starting in 2022, GHC members will have the largest primary care network in Dane County, with access to 38 total clinics and over 300 primary care providers.
Baby Bundles: BCBS of NC will begin offering a Maternity Episode-Based Payments Program (EBP), which includes incentive payments for providers able to keep costs below the average episode cost. During years 1 and 2 there will be no downside risk for providers, but in year 3 downside risk will be introduced with a protection cap.
Hospice Partnership: Pharos Capital is acquiring THEMA Health Services of Arizona to build a new hospice and home health platform. THEMA provides hospice care, routine medical care, pain, and symptom management for terminally ill patients. The acquisition will help THEMA expand its hospice and post-acute care service offerings in rural markets.
Extra Point: Please pray for my son Tommy. He wrote me a text today at 10:30 am saying this – “I hav soar throt. Can you pick me up now? All I have is english class that I’m getting a in doing reely good so can you get me."