40: Percent of coverage policies with step therapy protocols for getting medications, according to a recent study published by Health Affairs. Using data that covers 17 of the 20 largest payers in the US, the study shows that more payers are implementing step therapy protocols for certain diseases compared to previous years, and some payers’ plans may be stricter than needed. Those with step therapy protocols used an average of 1.5 steps but 90 protocols, 3.1%, included as many as four steps and one plan had eight steps protocol. Researchers emphasized “onerous step therapy protocols can add to the complexity and burden of health care”.
Tea, Jam, Bread & Behavior: Earlier this month, CareFirst joined with a global behavioral health company called 7 Cups of Tea to offer free support forums and licensed therapists through a smartphone, computer, or tablet.
Before You Do Anything: Cigna is the latest insurer to launch a virtual-first plan for 2022 and is well positioned to do so, having bought telehealth platform MDLive earlier this year. Cigna will offer virtual-first primary, dermatology, behavioral and urgent care services for employers, beginning with large, self-insured plans, and will offer digital dermatology to its exchange members.
Sliding Scale Care: A new health center, the Dr. Ala Stanford Center for Health Equity, just opened in Philadelphia, offering preventive care, behavioral health, and social services. The clinic grew out of efforts last year to provide care in underserved communities, including COVID-19 testing clinics, led by Dr. Stanford. The center has 8 exam rooms and 5 doctors currently, along with nurses and other staff and will offer care on an income-based sliding scale.
Hospital At Home: In recent weeks the National Nurses United group has argued that hospital-at-home models like those Kaiser and Mayo Clinic have been investing in do not allow for the same level of care a hospital does, and threaten nurse’s jobs. Kaiser’s program is currently operating at two pilot sites in California, using iPads to remotely monitor patients, but it remains to be seen whether this backlash will impact Kaiser’s plans to roll out the program system-wide.
Family Ties: For those who remember, Alex Keaton once told his Uncle Ned played by Tom Hanks that he needed help after Ned downed a bottle of vanilla extract. Family counseling is making strides in the real world - starting in 2022, Blue Cross NC will provide coverage of family psychotherapy, even without the presence of the patient. This will allow providers to better incorporate the families of those dealing with mental health or substance abuse issues.
Kidney Prevention Partner: Anthem is the latest payer to focus on managing patients with kidney disease, by investing in kidney care startup Somatus with a multi-year value-based care partnership. Somatus will provide clinical services to Anthem’s MA members with chronic kidney disease and end-stage renal disease (ESRD). Somatus has also developed technology that will help Anthem flag patients at risk of developing kidney disease and connect them to the necessary care and resources.
Complicated Feet: Independence Blue Cross is partnering with virtual care management company Podimetrics to care for members with diabetes and have a history of diabetic foot ulcers. Certain members with diabetes will be monitored using the company's cellular-connected SmartMat, which can detect warning signs of diabetic foot complications earlier, allowing for interventions to help prevent diabetic amputations.
Extra Point: AA is no longer so anonymous and it seems to me to be a good example of a paradigm shift in how we think about and talk about belonging. “Mom, you can’t just go to the AA meeting,” Kristen Wiig’s character said to her mom Jill Clayburgh in the comedy Bridesmaids, only to have mom say, “Well, honey, that’s only because I haven’t had a drink – there’s some really good people in there who need my help…” It’s no longer a place to get help, it’s a place to help. In a conversation this week during a slow jog in the dark at 5:30 (by slow I mean pathetic, like 15 minute mile pace), I bumped into a friend who works for a regional health plan here in the northeast. He says he’s leaving his job and family to go to a treatment center for alcohol recovery and also said the amount of claims related to alcohol abuse are up something like 120% since last year, that’s right 120%. “It’s coming in from all areas – seeing more hospital but a much bigger jump in our own network spend in treatment programs.” The biggest age group impacted – 27 to 35, like my friend. He’s hoping like a lot of us to find where he belongs and how to reset – “I hope to walk out of there with a new purpose … but I am scared,” he said. We’ve always been a culture that likes to put itself into groups and for the longest time we’ve also liked that we know exactly what we’d get out of them. It used to be that if I went to church on Sundays I knew I’d get a 5 minute homily from Father O’Shea on being good, and donuts in the basement, and if I didn’t go to church I knew I would go to hell. But now, the rules are changing. We are evolving in where we belong, what we expect, and how we talk about it. No more hell when I skip church, just limbo and maybe Heaven if I keep holding the door for grandma. In healthcare, there was a time kids, when you’d get sick, take two aspirin and call your doctor but in the future you will go on your support group app to find the fastest urgent care appointment and they will just treat you in the waiting room, because, well, we all know each other’s stuff. We belong to a more connected world, and everything from our peccadillos to our addictions are on display. And maybe that’s okay. Yes, we want to belong to something as Pat Benatar rocked, and we want to get something from it, but we are now finally more willing to share that and to wear our stuff on our sleeves. And if you're anything like Jill Clayburgh’s character in Bridesmaids, you get satisfaction from belonging to something not for your benefit, but for someone else’s.