76: Percent of high school seniors polled here in my home town this past week who are reportedly going to pursue a career in nursing.
Homeward Bound: SCAN Health Plan is offering a new type of plan for members who are homebound or reside in SNFs or assisted living, called the Embrace plan. The plan, an Institutional Special Needs plan for MA enrollees, will focus on allowing these members to remain in their homes or facilities while receiving care that would typically be provided in a doctor’s office or hospital. Enrollment in Embrace for calendar year 2022 begins on October 15, 2021.
Georgia On My Mind: HCA is selling another Georgia hospital to AdventHealth, months after selling 4 to Piedmont, which means HCA will no longer have a footprint in northwest Georgia. AdventHealth is acquiring Redmond Regional Medical Center in Rome, which also comes with physician clinics and outpatient services.
PAs Come and Go: Beginning January 7, 2022, Premera Blue Cross will require prior authorization for all non-malignant, non-gender affirming hysterectomies. Site of service reviews will also be part of the PA. Meanwhile, Horizon Blue Cross is removing PA and medical necessity determination reviews, either pre or post service, for Psychological and Neuropsychological testing, effective November 1, 2021.
Moving On Up: Molina is buying AgeWell’s Medicaid long-term care business in New York, which will add 13,000 lives to Molina’s NY footprint. Molina has been focused on adding more government lives to its business, buying Cigna’s Medicaid business in Texas in August of this year, and Passport Health Plan’s Medicaid and dual eligible business in Kentucky late last year.
Dark Side of Social Media: Eating disorders are one of the deadliest mental health disorders, and social media plays a major role in promoting potentially triggering content. Large social media companies have been in the news lately with claims that the platforms are aware of their harmful mental health effects on young teens. Click here to read the full report.
Food’s Here: Blue Shield in California has will expand benefits for MA beneficiaries in 2022, including the addition of a new home-delivered meal benefit, which includes up to 22 meals and 10 snacks per hospital discharge with a limit of 2 discharges per year. They are also adding dental benefits to Central and Northern CA plans, which include preventive and diagnostic dental services such as cleanings, exams, and x-rays.
Pop! Goes My Heart: GuideWell backed PopHealthCare, a national provider of home-based and risk adjustment services, launched Emcara Health, a national value-based medical group. Emcara’s offerings include 24/7 Home-Based Advanced Primary Care, transition care, ER diversion, SDoH assessments, and other services for vulnerable seniors and adults.
AirLine Charging For COVID: People that are unvaccinated against COVID-19 may have to pay more for health insurance premiums. Delta Airlines will charge their unvaccinated employees an additional $200 a month for their company health plan due to the high cost of COVID hospitalizations which can cost the company up to almost $50,000 per patient. Delta Airlines is not currently requiring employee vaccination, but this cost may incentivize employees to get vaccinated.
Dental Meet Medical: In our poll of the week, 95% believe dental should be included under traditional health care coverage. Oral health, if unchecked, can contribute to conditions like heart disease and pneumonia, and in reverse, conditions like diabetes, depression, and Alzheimer’s can negatively affect oral health. “Most bacteria from the oral area are the very same bacteria that can infect our heart or respiratory system,” said one respondent. The American Dental Association predicts dental and medical benefits merging will happen soon, saying that “medical plans have a clear or significant advantage over standalone dental insurers in a bundled scenario.”
Extra Point: Dr. Van Norstrom from the clinic once told the receptionist in Seinfeld that he needed Elaine Benes’ chart, because “she’s not going to make it. It’s very bad, very messy.” He was lying, of course, but if you’re burning the candle as I seem to be lately, and as I suspect many of you are if you are somehow connected to healthcare, you start to wonder where the tipping point might be and if you can make it at this pace. When the work moves you from excitement to exhaustion to sick you start wondering if you need a session with Dr. Van Norstrom, from the clinic. Wherever that is. I know I hit a wall this morning when I went to sleep during breakfast standing up, which is really hard to do and also painful when you wake up and smack your funny bone, which startles the dog and knocks over the kids gramma. I also put the hot coffee pot in the fridge, which is probably a good idea in July, but not so much today. I managed to make my way outside at 7:15 to drive someone to school – I couldn’t tell who because the hood over their head shielded their teenage angst - and then, perhaps still reeling from my funny bone injury - I drove the truck into the garage door. It’s very messy this work-life balance. But on the upside, there’s always those 2-days every week at the end of the week to recharge the batteries, and as will be the case this weekend, fix the garage door.