13: Percent of Cologuard tests that are reportedly positive, but the colonoscopy ends up negative, a "false positive," and so the anxiety of waiting isn't great for patients and now some payers are wondering exactly how many false positives there are, which might be a bigger issue.
Where's The Surgery? Cigna has launched an education program for their Medicare members to push more procedures to non-hospital affiliated surgery centers, like shoulder arthroscopies and knee cartilage removal procedures at rates $1500 to $1800 less compared to health system owned facilities, a JAMA analysis showed.
UnSelf Insured: The growth of self-insured plans has competition from trends among big payers. Minnesota's HealthPartners is working with health system Avera Health to launch a new health plan option for employers with fewer than 50 employees. The plan is modeled after a similar option for large employers that launched earlier last year. Meanwhile, the company G&A Partners that handles HR for employers will be the first in Florida to offer a Cigna master health plan to their small and mid-size businesses. Cigna traditionally has catered to larger companies with 1,000 or more employees but the G&A plan includes 14 different options, including PPO plans and high-deductible health plans.
Maternal Medicaid: No, not Uma Thurman, but Ouma Health, a maternity telehealth services company now partnering with MedArrive, a mobile integration company, to bring maternal care into homes of women on Medicaid. They focus on high-risk pregnancies and closing gaps in transportation and nutrition assistance.
The New PCP: Patients in 4 mid-Atlantic states now have access to a new virtual primary care plan from ChristianaCare's Center for Virtual Health via a monthly, quarterly or yearly subscription starting at around $35 per month to get matched with a digital advisor to set up visits and receive tools to monitor things like BP and weight.
It’s a Lifestyle: BCBS of Vermont appears to be one of the first health plans to appoint a program director for Lifestyle Medicine, a medical specialty born 20 years ago but increasing in prevalence. The specialty uses therapeutic lifestyle interventions like whole-food, plant-based diets, exercise, restorative sleep, and stress management to treat chronic conditions. Probably things all of us should be prioritizing on a day-to-day basis.
In Case You Missed It: 68-year-old RN Wendy Abraham has long since hinted that healthcare is not for the faint of heart particularly when you start getting older. Wendy was advised to get a Cologuard test last fall even though she was not scheduled for a colonoscopy until 2024. The test came back positive, but her GI first required a tele consult the day after Christmas and asked her if anything new had happened medically in recent memory. It had. About 3 months earlier, Wendy had a TIA, which is a mini stroke, was put on Clopidrogel for 21 days and a baby aspirin that she now takes daily. The GI decided the colonoscopy couldn’t be scheduled until a neurologist gave clearance to allow her to have anesthesia but getting that appointment has been harder to deal with than the Colonoscopy prep drink. The neuro consult won’t be until the end of April, all the while that positive Cologuard test lingers out there. All this for an RN who knows how to navigate healthcare. Imagine the 68-year-old who doesn’t?
Suicide: Kids bullying other kids online and sometimes in person is perhaps the chief cause of kids thinking about killing themselves. Not an easy thing to read, for sure, but it's real. A poll of pediatricians who are heavily involved in prescribing medicine to help kids already in therapy reveals their angst over "feeling disconnected" from what might really be happening with the kid. 81% confirmed what one pediatrician explained, "We have limited time and interaction - we're often being asked to prescribe a medication, getting push back about side effects and the stigma around these medicines - it's all fair, but what we're trying to avoid is suicide, and this is sometimes the right step."
Sleepy: 33% of people with anxiety and depression say it keeps them up at night and affects their overall sleep, compared to 29% in 2022 according to a ResMed survey of 20,000 people from 12 countries. About one third with these issues were not seeking help for sleep conditions and say their doctors were not asking questions about sleep quality.
Dewey Decimal Would Be Proud: Mount Sinai health system is teaming up with The New York Public Library to expand access to and education around telehealth. They plan to offer classes including information on how to find a new doctor, how to schedule a virtual doctor's appointment, and how to access medical records and test results. Participants will also have access to a Chromebook borrowing program so they can actually use telehealth resources.
Extra Point: I grew up in UCONN country but married a Gonzaga alum whose uncle is a Jesuit priest and teaches political science at Gonzaga, so we named our lab Zaggy and every March root for the Zags, and sometimes they play UCLA and hit a game winner. Like they did last night. It's nice to get a win after a long week -- two days earlier I hammered a nail into my finger trying to reattach a shutter. "Are you a dummy?" my bride said at the urgent care. Yes, I would say that's fairly accurate. The shutter repair was incidentally #9 on my bride's list of 13 chores she nicely laid out for me this week. The only one I was able to actually complete involved removing a filter I was supposed to remove in 2016. My stat line was like Gonzaga's free throw shooting. So, it’s fair to say I’m not bringing a whole lot of value to the table, not with household care anyway. I share this to make the point that it’s one thing to delegate a to-do list, quite another to see it knocked out. In healthcare, same thing I suppose. Every year, there are 20 things health insurers tell us they intend to do or ask physicians to do but actually getting them to do it can be painful, maybe not nail in finger painful, but still. I talk about all this amidst a 40-minute monologue you can access here about healthcare payer priorities (enter this code to listen, X1@73cKU). Speaking of priorities, my bride asked me this morning how that wobbly door hinge is doing that I said I'd fix in December. "It’s not rocket science,” she said. Probably true, I said, "but in my defense, I’ve learned that fixing that hinge may, in fact, actually be rocket science."