25-35: The age group now charting their own path around what their “health plan” will be. For better or worse, younger populations are the likely target of a new wave of virtual-first health insurance plans that package telehealth services to ensure people have a medical home even if it’s not the traditional one. Some Anthem members in Georgia will now have access to their new Virtual-First health plans. Other insurers also offer these and use them almost as traffic cops for healthcare, steering patients to services as needed. These plans provide people access to an AI-driven symptom checker, routine wellness care, chronic condition management, and behavioral health services through a digital platform. Virtual-First plans will become available to some of Anthem’s large group ASO plans first, and then large group fully ensured plans in July 2023.
The New ABA Pay: Fallon Health in Massachusetts is partnering with Autism Care Partners on a value-based care model that tries to address diagnostic barriers. This is the second insurer in Massachusetts to develop a model like this, Point 32 being the other. Case rates tied to acuity and potential bonuses for reducing “events” like hospitalizations or total costs are the typical components of these arrangements. One challenge to consider is how a child’s acuity level can change month to month. Fallon’s partnership will focus on engaging families waiting for a diagnostic evaluation. The idea is to provide continuity of care for the family, whether or not the autism diagnosis is confirmed.
Guess What Situation Drives Cognitive Decline: Sunshine Health, Florida’s largest MCO, has partnered with independent food relief organization Farm Share to open a new food pantry. Opened this month, it has already helped distribute food to 100 families. A new study published in JAMA in March found that food insecurity later in life is associated with “unusually rapid” declines in cognitive impairment.
Diabetes Model To Launch In Fall: Telehealth company Amwell is partnering with DarioHealth, a health management company, to add a cardiometabolic program to their platform to treat chronic conditions like diabetes. 37M adults in the U.S. have diabetes according to the National Institutes of Health. Amwell’s patients with diabetes, high blood pressure and weight management needs will be referred to Dario for health coaching and supplies like glucometers.
Friend Or Foe: 6 years ago, I asked a guidance counselor in my town if he had a suggestion for a therapist for my 8th grader. It is common for this age group to struggle with transitions and anxiety and also to show clearer signs of compulsive behaviors. I’ll never forget his advice – he said that the right fit may not necessarily be a therapist, that sometimes what matters is having someone they can just trust to talk to before anything else – a coach, another adult, a teacher. “Start with the person they already trust – I always ask students to name one adult other than their parents who they look up to or trust,” my friend Steve said. “Doesn’t mean a therapist or more intensive therapy isn’t eventually needed, but sometimes we underweight what the teenager wants and who they feel safe talking with.” New broader research is confirming this. College students are more likely to share their mental health issues with a friend before anyone else, according to a recent survey of roughly 1,000 Americans, half college students, and half parents of college students.
End Stage Renal JV: Oak Street and InterWell are forming a joint venture to integrate primary care for end stage renal disease patients directly in the dialysis clinic. This will begin with InterWell centers in Chicago, Dallas, and Houston. Oak Street providers will also provide behavioral health and renal pharmacy support.
Extra Point: A gold star to the first person to let me know the year when everyone going to a birthday party started getting a goodie bag. When I grew up, if you went to a birthday party you were lucky if you walked out of there with a dry piece of cake and only a few bruises from the Pinata battle for tootsie rolls. The healthcare system has seemingly followed suit. I got a toothbrush, toothpaste, floss, sugar-free lollipops that limit cavities, and the time and date for an appointment to see an oral surgeon when I left the dentist office last week. After my PCP visit, the doctor gave me a raffle ticket to win a heart healthy gift basket and list of freestanding imaging centers and a cost estimate for my likely uncovered coronary calcium CT scan. And like those parties when all the kids walk out with custom gear, dad’s ophthalmology nurse gave him a T-shirt bearing the practice’s name and a warmed-up homemade blueberry muffin for the road – “and one to take home to your wife” she said, after his cataract surgery this week. I’m not complaining – it’s a nice touch and perhaps the effort helps improve adherence with discharge plans. Now that I say it, it would be interesting to study the effect of the goodie bag on adherence—like does this type of personal touch at discharge reduce the likelihood of post operative complications, limit readmissions, and drug interactions? Maybe. For my family, I would argue yes, with the caveat that this trend is also making me hungry.