22.2: Cents of every insurance premium dollar spent in 2020 went to prescription drugs, up from 21.5 cents in 2018, according to a recent analysis of commercial insurance claims from AHIP. Spending on hospital inpatient and outpatient costs held steady compared to 2018, making up a combined 38.9 cents of every dollar, while other medical costs, like physician office visits and ER trips, made up 21 cents on the dollar and the rest went to insurers’ administrative and operating costs and profits.
Isolation: Independence BCBS recently launched a new initiative aimed at addressing loneliness and isolation among seniors. The BlueBench Program creates settings where seniors can meet new people and socialize, the program kicked off by unveiling three new blue benches during a community cleanup in FDR Park in Philadelphia.
Mom vs. Dad: We polled 345 moms and dads a few years ago about a seemingly mundane question – how they decide where to go for healthcare. Moms seem more thoughtful – relying on their OBGYN or their neighbor who’s a pediatrician, or NPR, while Dads, somewhat predictably, rely on it getting better without them doing anything or, increasingly, the nearest urgent care. Moms are more often changing doctors and more thoughtful about where to go and whose advice to use. Unlike Elaine of Seinfeld fame who failed to change doctors because her last one wrote in her medical record that she was too difficult, today’s generation of Elaine’s have more access and control over their records, and more say in where to go. They tend to rely more on what they know, hear and see every day, sometimes for good and sometimes not. In our study of 345 adult consumers, there were some clues as to how people select specialists and how little people rely on insurance to guide them.
Student Insurance Change: Ithaca College of New York now requires each student to have health insurance, whether through the college costing $2,713 a semester, or an alternative like their parent’s commercial plan. Students have until September 15th to waive the student plan or they will be automatically billed. The college recently began using Cayuga Health System’s network to serve students. Before that, students were not charged a fee to visit the on-campus health center, or for any labs, and did not need to provide proof of coverage - they were only charged if using off-campus providers.
Back Pain: Anthem and AIM Specialty are launching a new Back Pain Management Program for fully insured commercial members next month in select Anthem states. The program will use predictive analytics to identify members with back pain, who will then be contacted and provided with customized education and provider options, including behavioral health support if needed. The goal of the program is to reduce risk of chronicity and minimize recurrences and complications.
Psych Gap: Half of U.S. counties do not have a psychiatrist or an addiction specialist as of 2020 and the total volume of prescriptions for mental health medications written by primary care providers far outweighs the total from behavioral health specialists, revealing a widespread dependence on generalists for behavioral healthcare. A newly launched Behavioral Health Workforce Tracker designed by researchers at George Washington University highlights these gaps and exactly where in the country mental health professionals are practicing. The database includes around 1.2 million behavioral health providers - approximately 600,000 psychiatrists, addiction medicine specialists, psychologists, counselors, and therapists, as well as primary care physicians and advanced practice providers who prescribe medication for mental health.
Group Therapy Payment Change: Effective December 7, 2022, Premera Blue Cross is implementing a new reimbursement policy for group psychotherapy services represented by code 90853. All professional services billed by a medical group/clinic, facility or individual will only be reimbursed for one unit per date of service per member, regardless of the length of the therapy session.
Credit Risk: More hospitals are teaming up with banks to offer medical credit cards, which patients can use to pay for bills they may not otherwise be able to afford. These credit cards often have some of the highest interest rates in the industry, as reported by Modern Healthcare. These medical credit cards aren’t new - one company has been offering them since 1987 – but the rise of high deductible health plans means more patients may feel the need to turn to them, especially when hospitals are pitching the cards “at the point of care, at discharge, and when the billing department contacts patients days later.”
Extra Point: So, my folks were late to Sunday supper this week because they were waiting for each other at the apple farm, sitting on benches maybe 15 feet apart pointed in opposite directions…dad having fallen asleep from one too many cider donuts. I love fall. There’s the leaf jumping, apple crisp and college football, the pumpkin seeds, bulky sweaters, and gramma’s mashed potatoes. There’s the Fall guy and the Fall of the Empire, Niagra and Tacko Fall, that 7’6” basketball player. There’s Fall Out Boy, falling in love and Fallen, that great Sara McLachlan song. But would you believe it, some people don’t like fall, even though they keep doing it. Some are just clumsy like me, some like Janice fall because their husbands fail to adjust the bike seat. Others have cataracts or glaucoma or live in the icy north, but many are older folks with dementia or weaker bones or malnourishment, for whom falls are as common as Uncle Bobby blaming me again for “deleting the internet” because I removed the shortcut to his browser. My dad has fallen a few times – once hospitalized – while my mother-in-law has fallen some 5 times since turning 80 that we know about, most of which have landed her in the hospital. What’s underappreciated about falls – the cause isn’t what you think. We once studied 65 seniors who had fallen and needed inpatient rehab only to learn that some 39 of them had lost a spouse, never really grieved and became sedentary. They fell into their spouse’s habits and into a health spiral. So if you are in healthcare and see seniors, take note not just of what’s happening inside their body but what’s going on inside their home and their heart.