1 In 575: The average ratio of psych counselors to students based on our poll of 340 school districts in 19 states. We learned that the proportion of calls to 911 or 988 related to a suicide situation were about 4-5 times more likely in the schools that had to rely on an extremely high case load for each counselor.
New PBM Pricing Model: Express Scripts has launched a new pricing model called ClearCareRx to allow employers, health plans, and government employers to pay exactly what Express Scripts pays for drugs. ESI’s new copay assurance plan will cap copays for members – $5 for generics, $25 for preferred brand name, and $45 for preferred specialty drugs. But its formulary exclusion list for 2023 contains more than 600 medications, so it is unclear what prices will be for the substantial number of “non-preferred” drugs.
Remedy For Waste: A nonprofit that collects unused drugs from patients, hospitals, and providers and redistributes them via mail order pharmacies to other patients in need has partnered with BCBS of North Carolina. RemediChain is primarily focused on limiting waste for chemotherapy drugs but has expanded to include other specialty medications.
Pre-Surgery Reimbursement Change: If you’re involved in a surgery practice, take note - beginning July 1, Horizon BCBS in New Jersey will no longer reimburse any diagnostic or non-diagnostic outpatient services prior to an admission or same-day surgery when these outpatient services are directly related to the admission or surgery. The only exceptions will be maternity-related services.
Uber Pilot: A recent pilot between Uber and health behavior research company Surgo Health showed that providing free rides to pregnant patients in DC resulted in increased appointment attendance. Between January 2021 and June 2022, about 450 mostly low-income patients were offered 4,500 free Uber rides, either through a special app for coordinators or by giving patients a voucher to use on their own apps. After the pilot, some managed Medicaid plans agreed to pay for the service, but Uber’s goal is to get more of them to do so outside the scope of the pilot.
Maternal Outcomes: Breastfeeding relaxation therapy can improve maternal and infant outcomes particularly if the mom is juggling stresses such as a low weight infant, according to a clinical trial published in 2019 in the American Journal of Clinical Nutrition. Several services have emerged to help moms. A lactation services startup is partnering with Nature’s One, for example, to increase access to baby formula. SimpliFed offers virtual support to navigate breast pump selection and insurance benefits and is available to members of TRICARE and Aetna as well as Medicaid members in several states.
Big Apple Addiction: Reklame Health, a mental health platform that focuses on treating young adults and people of color, is launching a new in-home program for those dealing with alcohol use disorder in the New York City area. Patients will have a telepsych visit with a provider who will assess medication tolerance, then nurses will visit patients’ homes monthly to provide shots of Naltrexone. Depending on how the NYC program goes, it may be rolled out to other locations.
Staying Independent: Much like the wave of college athletic conference mergers, more health system consolidation may be coming to the Midwest as Froedtert Health and ThedaCare announced plans to merge. According to KaufmanHall’s quarterly M&A report published last week, hospital M&A has increased over the last two quarters, and it doesn’t look like it’s slowing down. The two health systems previously launched a JV in fall 2022 and if the merger goes through, will command a significant presence in Wisconsin with 18 hospitals and 225 outpatient locations.
Extra Point: My kids got a hold of the 40-minute fireside chat I gave last month on the top 20 payer priorities and stories about how I try to rationalize my poor healthcare decisions (click here) – and perhaps as a bit of payback for all the times I call them out in this column, they let me have it. “Dad, first off, for God’s sake clean your glasses before you go on a zoom! And what’s with the 77 times you touch and fidget with your glasses?” My daughters are my favorite but even they gave it to me. “Nice work almost choking and nice that you made fun of your own doctor visit and not us for a change!” Welp, now that they mention it…I find it interesting that when your middle daughter fails her first driving test you buy her an ice cream cone but when she fails the second you give her a hug and tell her to hang in. On Wednesday, after Sophie failed the third time, I headed for the shed and dusted off the 10-speed… It’s hard to raise kids amidst all the priorities we have. I’ve heard it said you’re only as happy as your least happy kid and sometimes, even when it isn’t easy, you acknowledge defeat and move on, as I did this week after her driving test. A primary care clinic had to do that last month. After a 3-year effort to try and raise its payments from one of the biggest insurers in Rhode Island, it had to go back to the standard rate. “We tried 3 times to get these incentive payments but we fell short each year,” office manager Roy Sastain says. He said the payments would have meant about a 20% increase in reimbursement rates per visit all in, paid out in installments, but “we never hit the quality thresholds.” He blames a range of factors – patients are tough to manage, particularly Medicare and Medicaid, and he blames his own skills at getting the staff to screen and document issues and follow up with patients. “I didn’t appreciate how difficult it would be. We may just have to acknowledge we’re not cut out for this.” Sort of like Sophie, who had to look in the mirror last week and admit that she just isn’t ready to drive. “I’m going to college in NYC in 4 months – I don’t need a license,” she said. True sweetie, but pretty sure that’s called rationalization. Welcome to life…