51: Percent of 6,382 18–22-year-old males in our poll who say they will likely sign up for one of those virtual primary care health insurance plans when they get a job after college and a not so surprising 28% say they may not get any insurance, one junior music theater design major saying he thinks he can just use urgent care if needed. Scrubs TV character John Dorian sort of captures the mindset of today's college age males. "It's funny," Dr. Dorian said, "I guess sometimes when you do nothing at all, things just have a way of fixing themselves.”
No Longer Taboo: Starting January 1, 2023, BCBS Michigan will cover generic and select brand-name male condoms that comply with the ACA’s preventive care benefits requirements. The amount that can be filled will be limited to 12 units per 30 days. Generic condoms will be dispensed where available. The payer notes that members must obtain a prescription from a doctor for preventive care drugs and products, including over-the-counter drugs, for them to be covered at no cost.
Getting Paid For Authorizations: In a new policy, one health plan is paying doctor groups a higher reimbursement rate for letting the payer access their EMR and use the access to help fill out pre authorization requests and build up intel on what a quality outcome really looks like - like are symptoms improved after a certain drug for IBD or a diet change, or both. "It's a step toward redefining how we value treatment and it's also a way to maintain some of the authorization process but allow us to help these small practices do the work," our source said. "We can look back in the record to figure out symptoms, conditions to justify the request."
Mobility Gains: Peach State Health Plan of Georgia is partnering with the National Council on Independent Living to identify and support healthcare providers in need of specialized patient care equipment or structural improvements at their facilities. This includes structural improvements that are compliant with The Americans with Disabilities Act, including handrails, wheelchair ramps and sliding doors. The partnership aims to increase the number of providers in Georgia that meet these standards.
Predicting The Future: Like we predicted back in 2014 when we suggested grocery delivery service Peapod ought to add nutritionists and partner with healthcare insurers and hospitals (see video here -- starting at the 4:20 minute mark until 5:55), nearly a decade later the grocery delivery service Instacart is moving into healthcare with the launch of Instacart Health. As part of the launch, the company will work with WellCare of Kentucky and digital health company, Good Measures, to make food prescription programs available for Medicaid members. Good Measures’ dietitians will work with members to create a nutrition plan for them, which will be accessible via Instacart. For low-income consumers, Instacart will allow people to use their Temporary Assistance for Needy Families benefits as well as Supplemental Nutrition Assistance Program assistance funds.
High-Cost Therapy?: In an effort to better manage the influx of behavioral health cases at urgent care, a growing portion of hospital-owned urgent care operators are partnering with talk therapy services nationally. How much uptake these businesses will see is to be determined but it will be interesting to monitor given the price tag. Hartford Healthcare’s Urgent Care clinics of Connecticut, for example, will now be offering behavioral health talk therapy on a self-pay basis of $95 per session, not covered by insurance - compare that to lower cost and sometimes $0 copay insurance coverage. A patient does have an initial session with a provider that can be covered by insurance, then they are paired with a licensed therapist for a 40-minute virtual talk therapy session.
Specialist Steerage: Beginning next year, endocrinologists and pulmonologists will now be included in Aetna's Smart Compare program that provides information to patients on the best physicians to use. PCPs, orthopedists, cardiologists, and ob-gyns are already part of these informational reports that score physicians based on two measures, effectiveness and clinical quality. Additionally, the health plan will allow providers to indicate if they are an “LGBTQ Champion” and actively participate in and support provider care to the LGBTQ+ community.
Mom Knows Best: Readmission rates are higher among Medicaid beneficiaries under 25 and over 60 who are in the ER without a caregiver or “mom” present, a small study reveals. The idea for the study first occurred 12 years ago in Connecticut and found that when mom is involved in the discharge planning and education, readmit risk drops significantly.
Extra Point: 22-year-olds Emma and Emily just graduated with a degree in interior architectural design, paid their way through school as the first in their family to go to college and when I sat next to them on a flight home last night it occurred to me how much I still don’t know. They both said their favorite class in school taught them how to help people living in wheelchairs navigate space and not just to design spaces for them, but to design spaces that "make an impact" that are "welcoming and freeing" so that "our best self can thrive." "We had to simulate it - we tried to get around in wheelchairs – it changed our perspective," Emily said. I suppose I never thought of design in this way, but I like how the young twins from Wisconsin talked about their degree and their hopes. They are wise beyond their years and perhaps they are on to something for those of us in healthcare - think about how you can design a space and a plan and a place for your patients and your families to be their best self too.