51: Percent of private practice psychiatrists in this country accept cash only, down slightly since 2017 but still high, and 89% of them in our poll are flat out fully booked. This is an issue on several levels, one being that many sub-specialists stay cash-only. You can get in with a specialist, but you almost have to be connected personally to them. In one situation, a psychiatrist from the Seattle area known for treating panic disorders couldn’t accept more patients and had a wait list longer than that line I waited in with dad to see Return of the Jedi in ’83. They will bend and take patients either pro bono or as an exception at $275 an hour, but there are only so many hours in the day.
The New PBM: SmithRx, a newer PBM, announced they will offer a Humira biosimilar launching in July to its members at a 90%+ discount to the cost of Humira. The PBM will work with Mark Cuban Cost Plus Drug Company to offer the biosimilar Yusimry for $569 plus shipping and dispensing fees and then members will be able to apply any insurance coverage to further reduce out-of-pocket costs. Click here to register for today's 1PM EST call on PBMs and drug pricing,
Outside The Box: Healthgrades and OutCare Health, a nonprofit focused on LGBTQ+ health equity, have launched a new LGBTQ+ affirming care designation to help LGBTQ+ patients find providers they trust. Providers interested in joining the designation must undergo a review by OutCare and will then be added to OutCare’s “OutList” which is the largest international directory of such providers, helping millions of consumers each month find and schedule appointments. On a sidenote, if needing to call the 988 hotline for mental health crisis, you would press 2 if LGBTQ+.
The Blockade: A Louisiana Medicaid MCO has been requiring pre-authorization for mobile mental health crisis units before they can dispatch to help patients in need, according to Randal Gomez-Simon, the VP for Business Development at Woodlake Addiction Recovery Center. “It’s causing people to end up calling 911 and eventually end up in hospitals,” she told us Thursday during an event in New Orleans. Sometimes pre-authorization is counterproductive, sometimes it’s necessary as Elevance (Anthem) decided with a new policy requiring precertification this September for wilderness programs and VR-assisted therapy systems.
Room For Shared Savings? Rheumatologists could be the latest to benefit from payment innovation. Starting July 1, 2023, Blue Cross NC is launching an Autoimmune Pathways Program aimed at reducing costs for members with chronic inflammatory disease who need specialty drugs for treatment. As part of what the health plan calls a “shared savings program” rheumatologists will have access to a web-based machine-learning platform that suggests evidence-based care pathways – for members taking high-cost biologics, the pathways may encourage use of lower costs treatments or dose tapering or ceasing medication if the member is in remission.
Virtually 15% Less: Effective as of June 1st, Independence BCBS in Pennsylvania has started to reimburse providers for physical health telemedicine at 85% of the provider allowance. The reduction kicked in this June, only applies to Medicare Advantage members and, like other insurers who have lower rates this year, won’t apply to behavioral purposes.
Driving Spinach & Eggs: Uber Health is getting into the food as medicine movement with a new grocery delivery service for patients recently discharged from hospitals and other post-acute care settings. The new service will allow a provider to select foods that fit a patient's dietary needs and have it delivered to their homes. Like we predicted back in 2014 when we suggested grocery delivery service Peapod ought to add nutritionists and partner with healthcare insurers and hospitals (see video here – starting at the 4:20 minute mark until 5:55), nearly a decade later the grocery delivery service Instacart is moving into healthcare with the launch of Instacart Health. As part of the launch, the company will work with WellCare of Kentucky and digital health company, Good Measures, to make food prescription programs available for Medicaid members. Good Measures’ dietitians will work with members to create a nutrition plan for them, which will be accessible via Instacart. For low-income consumers, Instacart will allow people to use their Temporary Assistance for Needy Families benefits as well as Supplemental Nutrition Assistance Program assistance funds.
At Home Test Kit: Simple HealthKit, a provider of at-home testing kits and digital health tools, has entered a deal with Walmart to offer their products in stores and online. The retailer will now offer at-home diagnostic tests for diabetes, respiratory wellness and sexually transmitted diseases. Simple HealthKit provides physician oversight for users and those who receive abnormal tests are connected to a provider at no additional cost.
Double Trouble: Yet another cross-market merger was announced recently – this time between St. Louis-based BJC Healthcare and Kansas City-based Saint Luke’s Health System. We’ve seen several of these recently, like Advocate-Atrium and Kaiser-Geisinger. These types of mergers likely represent a new challenge for independent companies trying to recruit labor, negotiate for better reimbursement, and if they rely on referrals from doctors “absorbed” into these systems.
Extra Point: A policy quirk in one of Georgia’s 159 counties apparently didn’t allow 6’6” 20-year-old Sam to be taken voluntarily in an ambulance to a mental health crisis center, despite efforts by counselor Wendy Martinez Farmer to set up a bed at the center after driving to Sam’s family home when his mom called asking for help for a kid who had lost control. Turns out due to county law Sam had to first go to the hospital ER where he got tazed, afraid he would be poisoned by a needle. This policy – and the one earlier in our column here about requiring pre-approval for mobile crisis – seems to be remnants of a system in transition, like the typewriter that sits on my desk, next to my laptop. For Wendy, who works with Carelon and has helped set up several call centers for the 988 mental health system including a Spanish-speaking one in New Mexico, the hotline is one way to help people like Sam. She told me that the vast majority using the text and chat 988 service are under 25 and 80% of them confirmed recent suicidal thoughts. Surprising to me, about 80% of these calls/texts and chats are “resolved” but there is not great data on how well referrals are working for those needing it and Wendy admits “resolving” the crisis is often all they can do – “it’s an actual intervention – which is underappreciated” but it’s not a long-term solution for that patient. That’s why the 988 counselors do, in fact, set up appointments ideally for the next day for people who need it, but this is increasingly difficult and there is not great information on whether the individuals get to the appointments, let alone crisis centers same day or inpatient treatment in emergencies. A lot of people still call 911 but only some of those responders are trained and knowledgeable enough to transition the person over to 988. Like any new system, this should improve. In Houston, a 911 and 988 crisis center co-locates responders and is having better results. I suppose these quirks will work themselves so kids like Sam and their families can have a better outcome.