6.5%: The average increase in US employers spend for employee healthcare coverage in 2023 compared to this year, according to an Aon report, bringing the average cost per employee to around $13,800. The year-over-year rise between 2021 and 2022 was only 3.7%, indicating inflation will likely begin to show up in healthcare costs next year. Because healthcare providers are often in years-long contracts with insurers, the impact is not always felt as immediately as in other industries.
Capping PT Pay: A growing number of insurers are capping the amount PTs and OTs can get paid per visit. A strategy first used around 2010 by Aetna in the northeast, the capping is spreading. On September 1, Highmark BCBS starts using a daily dollar maximum for evaluation services and a different daily bundled maximum for therapy services performed by PTs, OTs and chiropractors. Once upon a time there was very little PT coverage, insurers and doctors considered it a commodity and TV shows like Seinfeld mocked the idea that you could actually get insurance to pay for a physical therapist. “You mean I can get a massage for free?” George said. Well, sort of. 20 years later PT is widely covered, and many insurers have even dialed back authorization requirements, but there are adjustments like this to control spend.
Dog On It Ortho: Orthopedic specialists and some health insurers report an uncanny number of ankle breaks and related hospitalizations from dog owners who hang on to the leash while Fido tries to sprint away. More than 23 million Americans bought dogs during Covid and surgeries for ankle repair started to rise, as did calls to adopt a bundled payment for the surgery, like $7,500 for the surgery and a month of PT. Challenge for the patient is rehab is often a year-long struggle including strength and conditioning and pain management and, in many cases, the need for surgery again. Pricing these is challenging. My cousin Mark Cote, a PT doctor and director of outcomes research at UConn’s Musculoskeletal Institute, says the “biggest challenge is the rehab – a lot of non-compliant patients.”
Hospital At Home: More than 6 in 10 parents say they are “intrigued” by the hospital at home model as a way to “limit stress on the family. In recent examples, Resilient Healthcare is partnering with Dallas-based White Rock Medical Center and Pennsylvania’s WellSpan Health recently announced their program freed up more than 1,500 hospital bed days between September 2020 and April 2022. Some consumers are, however, skeptical – citing safety risks and questions about emergencies.
See, I Told You So: If you have a teenager, you have told them that they will be blind by the time they are 25 if they keep looking at their phone, and so it’s not all that surprising to see innovation around vision benefits. UnitedHealthcare now offers its members discounts on blue-light-blocking laptops as part of their vision benefits. UHC partnered with Dell to offer members a 20% discount on Dell XPS laptops with blue-light-blocking screens.
Building Behavioral: At some point, insurers will put requirements in place to measure and score the quality of behavioral health sessions, but until then, insurers continue to be on offense. Anthem in Virginia has partnered with Confidant to offer members access to virtual addiction treatment while Project Healthy Minds is a new nonprofit aiming to be a one-stop shop for finding a crisis line or mental health provider or program. The nonprofit hopes to help build national standards to guide companies’ mental health efforts.
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 as about 90% in our recent consumer poll like the convenience, even though 55% of doctors, down from 70% last year, 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.
Network Growth: The number of in-network behavioral health providers increased by an average of 48% in the last 3 years--the biggest increase from ABA providers, providers eligible to prescribe MAT and psychiatric nurse practitioners, according to an Association of Health Insurance Plans poll. Many insurers now use data about the performance of these providers and share it in hopes to steering care. About ~80% said they have added navigation and support tools and specialized case managers for follow up after emergency or inpatient care.
Extra Point: 63-year-old John Davis could not have foreseen this when he was 11. The tall Pittsburgh sports fan was a good ballplayer then, batted .660 one season in little league, “had great control as a pitcher” and went on to some tryouts for big league clubs. He married Debbie and the pair raised 3 kids in Hartford, Connecticut. Over the last several years John was the crossing guard at a middle school here. “It’s a great day to be alive” he would say. This summer, John’s bone cancer spread, and his doctors say they can’t control it. He entered hospice at home this week and gripped a baseball signed by the kids from the school. “No curve balls in the house John – you don’t want to break a window,” I said. He seemed to smile a hair but didn’t have much strength. He was cuddled up with a Pittsburgh Steelers blanket, peaceful but small, a shell of that big personality we’d see at the bus stop. I wonder if John could have foreseen this, if there would have been a way to extend his survival and control the cancer. I will think of my friend when I cross with the kids for soccer at the corner of Elm and Hudson. “It’s a great day to be alive” I might say. John would like that.