91: No, not the year the Cold War ended or Dennis Rodman’s jersey number but the percentage of regions across the country that have a single health insurer with at least 30% of the commercial market share, according to the American Medical Association’s new report on health insurance competition. Three quarters of metropolitan areas lacked a competitive commercial health insurance market in 2021, 2% less than the year before. Competition was even weaker in the Medicare Advantage market - nearly 80% of the 380 MSAs surveyed were “highly concentrated.” That’s a slight improvement compared to four years before, when 87% of MA markets were uncompetitive. A single plan enrolled more than half of MA members in 34% of markets last year.
Dental Bridge: A new medical loss ratio system will be put in place in Massachusetts for dental care based on results of a ballot question voted on this week. Dental insurers in the state must now spend at least 83% of premium dollars on dental “services” or refund patients the difference. The vote also authorizes the state’s insurance division to approve insurance rates.
Healthcare’s Bluebook: Since July, Colorado state employees have had access to a book that ranks providers by cost and quality. Providers in the top 25% for quality are designated in green, the bottom 25% in red, and anyone in between in yellow. The same color scale is used for costs so if people go to an all-green provider, they’ll receive a check. The checks can range from under $50 to thousands, depending on the cost of the procedure. In many cases, the money helps offset the employee’s copay or deductible. But for preventive services that have no copay, like colonoscopies, the employee gets to just pocket that cash. The reward program is available to employees in the state’s self-funded health plan, which is administered through Cigna.
School Policy: More schools are putting policies in place to have their guidance counselors trained in mental health first aid and to encourage counselors to help certain high school seniors get a “talk therapist” before they go to college. “It establishes a relationship so that when crisis comes you have a lifeline beyond just mom or dad,” says Ron Youmans, an MSW who told us his son struggled with the transition to school and “would have benefited from having a therapist in place.” In our poll of 1,110 school administrators back in 2018, just 9% had this policy – now it’s up to 28%.
Marriage: That “bwessed event, the dweem within a dweem” that actor Peter Cook made famous in Princess Bride continues to take over healthcare. VillageMD is acquiring Summit Health, the parent company of CityMD, and the marriage will give the company 680+ locations. Walgreens is majority owner and Cigna’s Evernorth joined the deal as a minority owner. Privia and Novant Health are partnering to create a clinically integrated network and One Medical, the primary care platform being acquired by Amazon, recently reported that revenue from capitated Medicare contracts now make up half of their overall revenue, even though at-risk lives only make up 5% of total membership. The provider manages care for only 40,000 at-risk members compared to the 775,000 members who join by paying an annual membership fee or are sponsored by payers or employers.
Skip To The Point Already: An app called MYIO, short for “My Improved Outcomes,” now allows patients to join telehealth sessions, sign intake forms, complete assessments, and message their behavioral health provider. The app is from Valent’s EHR system and is designed to alleviate administrative burdens for behavioral health providers so they can just get to substance of the session.
Extra Point: Some research suggests that nearly 1 in 5 of all U.S. service members deployed to Afghanistan and Iraq have PTSD and depression, but seeing it firsthand in my own family, I would bet that number is at least 3 in 5. PTSD is a kind of magnet that draws you back and holds you, prevents you from keeping momentum. But there is a program called inTransition from the U.S. Defense Health Agency’s Psychological Health Center of Excellence that’s for all service members and veterans regardless of how long they’ve served. It coaches and coordinates care for active-duty members, National Guard members, reservists, veterans and retirees and we had a chance to sit down with the program’s manager, psychologist Dr. Nicholas Polizzi. “You don’t need a diagnosis to participate – we are come one come all and get a lot of people seeking help for the first time, and many who have tried cognitive therapy, but it hasn’t worked.” Reach out to us if interested in seeing a transcript of the conversation and learning how your organization can work with the program.