48: The percent increase in the number of in-network behavioral health providers among commercial health plans over the past 3 years, according to a recent AHIP survey.
Against All Odds: Even Phil Collins could not have predicted this, beginning January 2023 Excellus BCBS will cover gambling disorder treatment services for managed Medicaid members.
New PBM: The Mark Cuban Cost Plus Drug Company is partnering with EmansaRx Plus, a PBM created by the Purchaser Business Group on Health, which represents almost 40 large non-hospital self-insured employers. EmansaRx Plus will start with generic drugs and offer some branded drugs early next year, according to the CEO of Cost Plus Drugs. The PBM will collect a 1.5% flat fee for each claim managed, which means it is passing on all rebates. The goal of the partnership is to provide employers with lower cost drugs through employer plans rather than going through a third party with drug discount cards.
If You Can’t Stand The Heat: Heatstroke and heat exhaustion are becoming far more common among privately insured individuals seeking medical care, according to a FAIR Health analysis. The analysis looked at more than 39 billion healthcare claims and found patients sought treatment for heat exhaustion 52% more in June 2021 compared to June 2016. This is something payers likely haven’t spent much time thinking about given competing priorities the last few years, but this analysis shows heat-related conditions are likely becoming more costly.
Inclusive Rehab: IncludeHealth, a digital musculoskeletal health company, will provide their hardware-free musculoskeletal platform called MSK-OS, developed with Google, to the Yale New Haven Health System. The platform will provide an interactive virtual home exercise program to supplement in-person services. Yale is one of the systems in the US that has an exclusive physical therapy partner.
Modern Day Dispatch: Louie De Palma was the quintessential 1980s dispatcher from the classic TV series Taxi but times have changed, and today’s dispatchers are far more compassionate. Blue Shield of California is teaming up with DispatchHealth to provide new in-home services for members with chronic illnesses for example. Members will be able to receive daily in-home visits for more than 40 conditions including respiratory infections, pneumonia and COPD.
SDoH Behind The Scenes: Google Cloud has launched three new health care data engine accelerators to help health systems and payers strengthen health-equity programs, streamline patient flow management and better evaluate population health metrics. These tools are being developed to connect patients to community resources. They were developed in a collaboration between the Mayo Clinic, Lifepoint Health, and Hackensack Meridian Health.
HandOff: CalOptima Health has partnered with the National Alliance for Mental Illness (NAMI) Orange County to launch a peer support program for Medi-Cal members recently discharged from a psychiatric inpatient hospital stay or ER visit. NAMI trained mentors will try to help Medi-Cal members schedule and get to follow-up care. The five-year program starts in 2023.
Extra Point: Great Aunt Mary used to hate this time of year. “I don’t get what all the gifts are about – I have everything I need right here,” she’d tell me, pointing to her Virginia slim cigarettes and mini powdered donuts. “Mary!” my Uncle Auggie would say, “it’s not about what you have, it’s about giving to others.” She would shrug with a distasteful Ebeneezer look and puff on the cigarette. But every once in a while Mary would surprise me. “Comere kid – you play Gin right? Let’s play Carmella." She has the dementia so it’s an easy win. My aunt Adeline once described Mary as a real-life dry heave. To her face. You can’t make this up. We would see Mary at Sunday suppers throughout the year but never at Christmas Eve or on Christmas Day. Mary was a nurse, an LPN, over at the Mercy Medical Center in Springfield, Massachusetts. She worked double shifts on those days. “Someone has to,” she’d say. I interned there in the early 90s and I remember visiting the hospital on Christmas Day for a small holiday party for staff. Mary wasn’t there at the party. I was told she was sitting bedside with a patient up on the 8th floor of the 300-bed hospital. Best I could see, she was holding a full house in her left hand, and holding the patient’s hand with her right. I’m not sure I miss Mary in the way you miss the fun aunt who gets down on the floor and plays football with you and races matchbox cars, but I bet her patients miss her. She wasn’t exactly the model of compassion we talk about, but she was there. On Christmas. I suppose as I think about it, maybe Mary was the gift.