6: The number of states with fewer than 30% of needed physicians available, according to data from the Health Resources and Services Administration. They include Alaska, Washington, Nebraska, Missouri, New Jersey and Delaware. In Delaware, only 16.4% of the primary care physicians needed are available. Rhode Island is the state with the greatest share of need met at 72.1%.
Look What’s On Channel 9: Samsung is bringing primary care to your living room, courtesy of your smart TV. Through a partnership with virtual primary care company HealthTap, Samsung Smart TV users can connect to the company's healthcare platform and see a provider using the built-in camera on their television. People can get access to free texting with their doctor for $15 per month, along with $39 video appointments and $59 visits for 24/7 urgent care with the first available clinic doctor. The platform also includes a network of 90,000 providers across 147 specialties providing free informational answers to health questions.
Picture This: A virtual hospitalist uses digital tools to consult with a paramedic or nurse who’s inside a patient's home. This interaction is the idea behind Ovatient, a new primary care company "built for health systems, by health systems," according to Dr. Patrick J. Cawley, the CEO of the Medical University of South Carolina, who developed the company along with Metro Health System. The company plans to offer the concept to other hospitals in the future.
Pre & Post Surgery: A consumer-facing app focusing on digitizing and automating existing perioperative processes is in the works under a UPMC pilot. The app “Pip Care” provides one-on-one health coaching and education to prepare patients for surgery and recovery and includes appointment reminders, goal trackers and access to certified health coaches. Pip Care will be piloted at all three of UPMC’s Centers for Perioperative Care and is the first company created out of a collaboration between UPMC Enterprises and Redesign Health. How these types of services are paid for and embedded into bundled payment for a surgical episode remains to be seen but one would expect insurers to pay for or “value” aspects of this care, particularly if playing a role in reducing post surgical complications.
Trio HMO: Blue Shield of California is partnering with Aspire Health on a new HMO plan for Monterey County residents. The plan, called Blue Shield Trio HMO, features concierge medicine support from a team of professionals including nurses, social workers and pharmacists. It also features a $0 copay for telehealth appointments and a platform for digital health and wellness apps, as well as meal delivery and non-emergent transportation for members recovering from serious illness. Trio HMO will be available starting January 1, 2023.
Coherent Cardio Decisions: Humana is looking to improve their prior authorization process for cardiovascular and surgical services through a partnership with Cohere Health. The insurer will use Cohere’s digital platform and clinical intelligence starting in January 2023 for its Medicare Advantage members and Humana employees.
New PBM Winner: Beginning in 2024, Express Scripts will administer pharmacy benefits for 20 million Centene members and provide access to its retail pharmacy network.
Imagine That: In what may not be a surprise, a new analysis of data from more than 2,000 hospitals showed that negotiated reimbursement rates for imaging services can vary wildly. The average maximum negotiated price was 3.8 times more than the average minimum price within the same hospital and in the most extreme case, the average maximum price for a brain CT was 17.9 times higher than the minimum price in the same hospital. Researchers blame hospitals’ and physician groups’ size and negotiating leverage and insurers’ negotiating proficiency as reasons for the differences.
Extra Point: Would you believe it, Nebraska is home to the invention of Kool-Aid but now the state’s largest health insurer has invented a policy that could cool the jets, as my Uncle Bobby used to say, on telehealth. A 50% cut in reimbursement for most telehealth services is now apparently in effect and only behavioral health from our sources is excluded. There have not been meaningful cuts in telehealth nationally even though there has been more attention to billing and authorizations. The reduction itself is not surprising as much as the level. Back in late 2020, we were thinking post-pandemic of the potential for 15% to 30% reductions, and some insurers have said they would lower the rate by 25%. That behavioral is excluded is not surprising, given growing claims of its popularity and efficacy and importance in expanding access. For other services, like an encounter between a physician and patient to discuss lab results or side effects from medication, the change suggests that the insurer either sees the value of this as half of what it would be in person, or they are assuming the cost to conduct the same visit in person is twice as much. We have asked the insurer to clarify, though I’m not certain it matters. A more important question is how the system responds. We suspect patients just want to have the conversation and, often, a virtual meeting is the most convenient, lower stress and just as effective, even if it loses some of the nuances of being there and the physician can’t do everything it might normally. Will physician practices and other clinics start to change how often they are willing and available for these tele sessions if the revenue is 50% less? In a straw poll of doctors here in my neighborhood, most said they like it when patients come in but there is value to the zoom, at any price. “Once upon a time we didn’t get paid a nickel for that, so beggers can’t be choosers,” says Peg O’Flannery, a pediatrician. My own son is a good proxy too – I gave him $10 to mow the lawn last weekend, half of what I apparently gave him a few years ago, which is the last time I remember him mowing. “Alternatively, you could mow the lawn for nothing,” I said. “No no, I’ll get right on it dad.”