56: Percent of 8,806 college students we polled who said they’ve skipped going to the clinic despite sore throats and congestion for fear of being quarantined and “miss the home opener” or frat-sorority “darty” – a daytime party in the quad, which is a term I did not know about until the kids filled me in. This is “the worst kind of mental health for a college kid” one sophomore said. A far greater portion of freshmen – around 75% - have avoided going to see a doctor or clinic because they live in “on-campus” dorms, so a positive Covid test is like getting grounded by your folks on a spring weekend. Problem is, if that sore throat is strep, it can cause kidney inflammation and eventually heart valve damage.
IDD Help: People with intellectual and developmental disabilities are 1.5 times more likely to go to the ER, compared to people without such disabilities, researchers from St. Michael’s Hospital recently found, and virtual providers are increasingly turning their focus to help prevent these visits. StationMD, a telehealth company that specializes in serving IDD patients, launched a pilot with Partners Health Plan in 2020 with the goal of reducing visits. Over the past two years, the company achieved a 93.1% treat-in-place rate, saving around $5.7 million. StationMD charges the health plan a PMPM. So far, usage has come mostly from patients in residential facilities.
Finding Your Behavioral Lane: In an effort to address increasing demand for behavioral health services, Empire, the New York Blues plan, has added four new providers of virtual services to its network—Alma, Headway, NOCD and Ophelia. These providers all have unique features and address specific behavioral health disorders. NOCD offers obsessive compulsive disorder treatment to individuals as young as 5, Headway offers members price transparency, and Ophelia combines provides medication-assisted treatment. Evernorth, Cigna’s health services division, is also expanding access to virtual providers by bringing virtual SUD treatment clinic Bicycle Health into their network. Bicycle provides MAT services is paid based on patient outcomes.
Old Idea: If you had to guess, you’d say that a majority of Floridians are over 65, driving golf carts to the Harris Teeter, hitting the early bird supper at Del Boca Vista. But just 21% of the Florida population is 65+.
Insomnia’s Marriage: The sleep condition has a “bilateral relationship with depression,” says Dr. M. Safwan Badr, former president of the American Academy of Sleep Medicine. Having insomnia for up to 3 weeks can often cause depression, ipso facto, can cause a higher risk of sleep disorders, he says. “Anything less than 7 hours increases depression risk.” We spend about one-third of our lives asleep—well most of us do—and it affects every aspect of our health, yet sleep medicine doesn’t always get the attention it deserves. “There is tremendous value to it - from our brain to our heart and emotional control,” says Badr.
Day In The Life Of A Medical Director: Dr. Kellogg hops to the passenger side of his Blue Saturn and flips me the keys. ‘You drive Cote – I have to take a few calls.’ I push aside a few Zone protein bar wrappers and the Journal Inquirer and sit down. Aerosmith’s Dream On is playing on the radio when I turn the keys and Kellogg, a medical director for a number of health plans in the region quickly taps the power button. He unexpectedly has to respond to requests for coverage in 5 different cases: bariatric surgery, an antidepressant, a series of pain injections, a cancer patient’s continued admission and testing, and a hospital patient who has been bouncing back and forth to a SNF. Kellogg immediately approves the extended stay and MRI for the cancer patient, and then starts reading notes out loud to the case manager for, I presumed, the hospital-SNF patient: ‘Had heart failure and shock with major comorbidity on 5/11, respiratory infection on 4/6, major GI episode on 3/11, esophagitis on 2/14 and kidney infection on 12/27. All discharges to SNF. Don’t let him leave the hospital. We’re looking at a sepsis situation. Have the attending call me. Let’s allow at least 2 more days.’ He puts the case manager on hold. ‘Take a left up here – we should go route 20,’ then proceeds to deny approvals for each of the other three cases. ‘Some of these cases are so black and white – these are lifestyle cases. Happens with the Medicare seniors who get dehydrated and fall because they are depressed and inactive and it happens with dads in their 40s.’ Dr. Kellogg orders a chicken sandwich and a vanilla coke during lunch with a side of fries. Some styles are hard to break.
Rapid Growth of Autism Services: Join BRG experts Misha Segal and Jim Teisl, with guests Mai Pham, Founder and President of Institute for Exceptional Care, and Lorri Unumb, CEO of The Council of Autism Service Providers, on Friday, September 9 at 1 PM ET as they discuss the rapid growth in autism services and the recent debate surrounding types of treatment and standards of practice. Panelists will also touch on lessons learned for other evolving areas, including medication-assisted therapy, outpatient mental health, residential treatment services, and home and community-based services. Pre-Register for the conference call here.
Extra Point: So, Clooney was probably right when he asked us how much our life weighs. “Imagine for a second that you're carrying a new backpack,” he said in the classic Up In The Air. “Only this time, I want you to fill it with people. Feel the weight of that bag. Make no mistake - your relationships are the heaviest components in your life.” But they are the most important and more businesses are getting the hint that their people and their health matter. Many are now encouraging patients who need surgery or specialized long-term treatment to fly far to do just that, picking a single center thousands of miles away for the diagnosis or treatment. Rush Medical Center and United Airlines partnered 6 years ago, City of Hope and Wellpoint partnered more than a decade ago. After meeting deductibles, employees could get the full treatment and cost of travel and accommodations covered. Dozens of companies are getting on board by broadening or creating these policies, some raising the allowed budget just for travel to $10,000, others more prescriptive identifying specific partners as the airline did. My old friend Dave Tofanelli used to promote the idea back in the late 1990s when he was in charge of contracting nationally for Wellpoint. “It is beyond me,” he said at the time, “why we aren’t paying for travel to get the right diagnosis and treatment, particularly for cancer." Tofanelli was among the first to advocate this at a national level. Now families can get cancer treatment, organ transplants, gender reassignment surgery, psychiatric treatment and reproductive care at so-called centers of excellence they could never imagine. It is a lifeline for some we sometimes don’t quite appreciate. That extra carry-on bag – well that’ll probably still cost you.