20: Percent reduction in telehealth commercial reimbursement rates for medical visits, not behavioral, starting this spring for a few New England area insurers. The trend is accelerating in pockets of the US as we predicted with some insurers lowering rates 20-30%, one as much as 50%, but none changing the policy for behavioral sessions. One New Hampshire plan will keep telehealth rates for “medical sessions” at the same level as in-person.
Empire Strikes Back: Just like Vader’s effort to retaliate against the resistance, nonprofit health plans SCAN Group and CareOregon are merging to create HealthRight Group to "ensure sustainability against the growing threats of provider consolidation and investor-backed and for-profit insurers entering markets and seizing market share with low premiums,” according to SCAN’s CEO. The combined payer will cover almost 800,000 members, both Medicaid and Medicare.
Closing Equity Gap: BCBS Massachusetts has developed risk-sharing contracts with four health systems designed to combat racial and ethnic health disparities. The arrangements feature standalone performance payments based in part on ability to close equity gaps in certain quality measures, like colorectal cancer screening, diabetes care and blood pressure control.
EMT At Home: Superior Health Plan, a subsidiary of Centene, is partnering with mobile home healthcare provider MedArrive to serve 40,000 of Superior’s Medicare beneficiaries. MedArrive will provide in-home preventive care through paramedics, EMTs and others. This partnership follows MedArrive’s recent acquisition of virtual Medicaid mental healthcare provider Brave Health.
Imagine That: BCBS Michigan is the latest payer to partner with Covera Health on a radiology-focused quality improvement program. Participating practices and radiologists are eligible for high-quality or high-value designations, promoted during prior authorization requests.
Concierge: Health systems are getting in on the concierge medicine market, with Tampa General Hospital of Florida most recently launching a concierge primary healthcare practice in Palm Beach County called TGH. In a poll we did pre-Covid, about 35% of younger doctors were interested in pursuing concierge medicine, compared to just 9% of older doctors. Concierge practices often charge an annual fee to patients in order to receive a higher level of primary care including personalized plans, after-hours and weekend access.
Is Your Practice: Avoiding antibiotic treatment for acute bronchitis, because if so, this is a measure of quality that helped get 10 New England physician groups named into Harvard Pilgrim’s honor roll network.
Extra Point: NFL teams a few years ago were actually required to have a licensed behavioral health clinician on staff and three-quarters of franchises hired psychologists to fill the role, some hired multiple clinicians, and the league even required teams to hire a pain management specialist to work alongside the psych staff. Before Damar Hamlin’s injury, I wondered if the pro and college sports world’s poaching of the best behavioral health practitioners was almost unfair for much of the country where finding access to psychologists can be like trying to find Nemo. But seeing how the players have unified around the role of mental health and watching that moment when one of the Bill’s psych staff embraced a shaken player, maybe I was wrong - perhaps the NFL model embedding these practitioners on teams, in the locker room and partnered with the pain team, is a model to try and replicate.