80: Percent of the total cost that Bluebird Bio will return to insurers if their new FDA-approved gene therapy Zynteglo doesn't stop the need for patients to get regular blood transfusions. The gene therapy costs $2.8 million.
Bundle This: We did a poll of 932 parents about what influences their healthcare usage. The amount of time they have to reschedule or miss appointments is going up, and if it were them, they would put pediatrics, dental, orthodontics and physical therapy into one center with a gym. "I'd want the gym for me," quips Molly Rastro, 37, of Connecticut, who says she's canceled 5 appointments already this month for her 3 kids. "Why the health system can't put it together is beyond me.” Physician practices report an alarming trend in missed visits - up to 30% no-shows or reschedules on average, according to one of our polls. The trend varies widely for PTs, therapists and diagnostics, depending on the age of the patient. "For kids needing a lab test or MRI or a specialist for something the PCP can't figure out, parents rarely miss - but the more routine, they do," notes Walter Roe, a practice administrator in the Northeast. The mindset of parents is increasingly important, particularly in an age of HDHPs, HSAs, and FSAs.
Legal Diagnosis: Mount Sinai recently launched a medical-legal program that aims to help patients who may have legal needs that are contributing to healthcare issues. The health system is working with the New York Legal Assistance Group and health insurer Healthfirst to proactively identify patients with unaddressed legal needs by using categories of legal risk, including immigration, housing and personal safety. Once identified, Mount Sinai care managers will screen patients and obtain their consent and then refer them to the legal group for consultations. In a 12-month pilot, the program identified 1,959 patients with potential need, and gave referrals to 165 of those of which 157 consented to assistance.
Therapy Rerun: Amazon is at it again, this time adding behavioral health services to Amazon Care, the medical care service it sells directly to employer health plans. The service will utilize care coordinators to refer patients to in-network behavioral health specialists for acute and moderate concerns. Amazon Care also is partnering with mental healthcare company Ginger. Last year, Ginger merged with Headspace, a meditation and mindfulness app provider, to create Headspace Health. Ginger’s services will be an optional add-on to Amazon Care.
Pharmacist Shortage: In a sign of the times, Walgreens is offering bonuses up to $75,000 to attract pharmacists as ~3,000 stores are understaffed, operating at reduced pharmacy hours, the company reports. Pharmacists must remain in the job for usually at least a year to get the bonus. A Walgreens spokesman said the bonuses are part of a larger focus on recruitment and retention.
Consolidation Movement: Humana plans to acquire Inclusa, a managed Medicaid organization that provides long-term care services and supports to about 16,000 in Wisconsin. Meanwhile, United is snatching up KS Plan Administrators, a Houston-based Medicare insurer affiliated with the provider group Kelsey-Seybold that United purchased in July.
Diagnostic Speed: Global tech company Becton Dickinson (BD) announced a collaboration with LabCorp to develop flow cytometry-based companion diagnostics to match patients with treatments for cancer and other diseases. Flow cytometry is an emerging technology in companion diagnostics, which is increasingly being used to identify which patients with specific cancer mutations will benefit most from targeted immunotherapies.
Extra Point: I've figured out how to solve the sports gambling problem. It dawned on me about 9 hours into our drive from New England to IU to move Jack back into college. One of his friends Ben had gambled away the $6,200 he earned this summer that was to help cover his tuition. His parents know, but don’t know how to help, Jack said. I say, "Bet on yourself." It’s really my wife’s mantra and, give her credit, it really ought to be the national rallying cry for the growing number of teens and young adults, typically males, losing thousands overnight, finding themselves addicted to the rush of a late-night Ping Pong match on ESPN 8. It's interesting, of all the addictions, sports gambling is unique as many say they see it as a potential career. Heck Jack has polled his 80,000 podcast followers and 3 of 4 say they think they could earn enough money at it, so they don't have to have a real job. I say bet on yourself, otherwise, we’re going to be headed down a long road. The health system is starting to see the effects of this underappreciated epidemic. "We see it as a gateway to other addictions," says ER physician Vu Narayans. It’s a bit perplexing that 20 some states and counting have legalized online sports betting, but these same states and others won’t allow mental health therapists or programs to treat these addictions unless they have a license in the state where the patient is. We’ve made a bet that people can gamble responsibly, the same pact we made to drink responsibly. Kenny Rogers was probably right – we ought to know when to fold ‘em, if we only knew how to walk away and replace the addiction with something different, something healthier. Therein lies one of the least discussed but most important quality measures for behavioral health practitioners, insurers and policymakers to prioritize – don’t just fix, solve. Don’t pay for a session, find a way to pay for “recovery.” For sports gambling, there is a growing continent of sub-specialists who are set up to get patients to recovery There's a specific certification that matters here (the ICOGS or ICCG) but often times people end up in treatment with someone who specializes in treating substance abuse. It's a different addiction and parents, providers and insurers need to understand and communicate the differences. If you’re looking to find your niche in the great big behavioral health market, or just looking to help your kid or friend stop the compulsion, maybe help them place a bet on themselves.