Are You Walkin’ On Sunshine? If there’s a medical specialty that can claim this Katrina and the Waves hit, it’s probably the derms – skin cancer incidence is rising faster than an Olivia Rodrigo song on the charts and there aren’t enough dermatologists. Wait times are sometimes 3-4 months and, increasingly, it’s for the PA or NP not the dermatologist. The tele-derm experiment is a potential solution but a majority in our recent poll of 100+ doctors believe it will add cost, not limit skin cancer. But heading into 2022, these practitioners can evolve to impact health system costs in other ways, like staffing a behavioral therapist and figuring out a way to reduce teen acne that has led to a range of emotional and tragic situations for teens.
All You Need Is This: John, Paul, Ringo and George probably could have just been, that’s right, cardiologists, given they sang about love in pretty much every song and when entering their practice they could have just fixed our clogged arteries and genetic issues better than any stent procedure could with a simple rendition of “When I’m 64” from, what else, Sgt. Pepper’s Lonely Hearts Band. Cardiology is one of the Top 5 emerging priorities for both payers and healthcare investors headed into 2022 and interestingly the most “enticing” part of cardiology isn’t the procedure or the office visits, according to investors, it’s the remote monitoring potential.
In Your What? Peter Gabriel’s hit about your eyes was made famous by, who else, John Cusack who made it cool to lift your boom box above your head, but there’s a hidden message here to the vision community – make it easier for patients to get their glasses, contacts and help us figure out a way to see in 15 years when all this technology turns us blind. “It’s one of the underappreciated, least talked about issues,” says ophthalmologist Fran Salita, MD, who says some 20-somethings now in their 40s are “essentially blind” from technology overuse. Companies with an ability to screen and do prevention and follow up visits under a capitated rate likely have an advantage going forward.
Real Fine Place To Start: Sara Evans song is a regular in my home and it’s now the new anthem if you will for virtual health benefit design. United is among those deploying its Optum case managers to be virtual traffic cops under a health plan that allows people to call their health plan, explain their symptoms, then get a referral to the doctor or x-ray, if necessary. How this will ultimately work and whether virtual triage will become so common as to impact the need for in-person care is probably unlikely on a wide scale, but something to monitor.
Eat It: Weird Al was sort of ahead of his time. He must have known that we would be delivering meals on wheels for free to seniors, that food insecurity would become a real thing and that the country would start using healthcare policy and funding to address the problem. But Al was on to something too – it seems that a majority of patients getting these meals have some sort of cognitive issue and thus don’t always eat these meals. Some have serious dementia, some behavioral health issues that limit what they eat. If you’re a social service company, combine personal care, behavioral health and home delivered meals.
Every Breath You Take: Dr. House still best captures the difficulty of the health system in educating the public on how to use inhalers and how to manage asthma. The scene depicting a patient spraying her inhaler into her neck was made famous in the hit TV show and it’s an iconic symbol that we have issues with misunderstanding how to empower people to do good self-care, whether it’s a self-exam to check for potential signs of cancer or understanding how to know when to use the inhaler. Some practices are doing the right thing. For example, an allergy practice in east Texas is getting an incentive payment these days from a Medicaid plan for giving its highest-risk asthma patients portable spirometers that transmit results back to the physician, help the practice monitor pulmonary function, head off deterioration, and with any luck, see progress.
Don’t Stop Believing: I asked my kids who sang this song and they sadly think it’s Glee. It is of course not Glee and despite my disappointment, Journey carries the torch with what has to be “thee call to action” for families, caregivers, survivors and patients living with cancer. The diagnosis is a game changer. That yellow syrupy stuff that comes from that IV into your veins for 6 months at a slow drip – it is painful, makes you nauseous, shows you who really cares. It makes you fight and for those on the front line, cancer is both your life and your pain – it is tiring, sad, tragic but also gives you joy and hope. Surprisingly, limited private equity healthcare investment has occurred in the oncology space despite what may be the one sector with the greatest need, spend, and potential for innovation.
The Gambler: All Bets Off Kenny Rogers. More payers are covering therapy for gamblers but not in every setting and not as restrictive as you might think. Excellus BCBS in New York state allows OP therapy for gamblers without pre-approval. Residential, partial hospitalization and inpatient services are thought to be investigational.
Lean On Me: Few remember Bill Withers, but we all remember his song, and if there’s a healthcare service that can claim it, it’s hospice. The people who are there at the end, for caregivers, families, and the dying. Hospice nurses have a special place in our culture for those who know them. They bring a certain humanity and grace to the bedside. Most of those working in healthcare – doctors, nurses, nursing homes – would argue that we probably identify people too late for hospice. 80% of health system leaders say they would like to see more use of hospice but there is another societal question – how much families, consumers and our health system are willing to spend for an additional month of life.
Extra Point: Music can be therapy, for kids on the spectrum and moms and dads who can’t find the keys in the morning. It is therapy on Thanksgiving when your dog eats both pumpkin pies and when big Uncle Fred falls asleep on the remote. Music is also therapy for people with an addiction or traumatic brain injuries, and for people like my grandmother Carmella Antonelli who grew up in the mountains of Napoli and made me laugh when she snuck 2 anisette cookies onto my lap for breakfast. I lived with Carmella for a few years back in the earlier 90s in the latter stages of the Alzheimer’s that took her brain, but not her humor. A person with Alzheimer’s knows the pieces of the puzzle are missing …. and they are terrified. Carmella and I would watch tennis on the TV on Saturday mornings back in Fairlawn New Jersey and listen to Frank’s Fly Me To The Moon. She was 82 and I can’t remember a single time we talked about her Alzheimer’s. My friend Eric has. Maybe you know someone who has talked about their disease. Like Carmella, Eric was a young guy when he got the Alzheimer’s. I remember when his son Michael was born, just after Adam Viniteri kicked that ball in the snow to beat the Raiders. Michael talks to his dad here and if there’s a moment that hits home, it’s when the credits roll and the music plays…