30: If a person’s BMI is above this number, standard guidelines say they are considered obese, but a new report from the AMA states that BMI is an “imperfect measurement” and has caused “historical harm” including racist exclusion. The AMA suggests that if BMI is used, it should be used in combination with looking at other factors such as waist circumference and genetic or metabolic factors.
Screening AC: Effective September 1, eviCore will lower the age needed for coverage of an annual screening of MRI for two genetic mutations ATM and CHEK2 to 30 years of age instead of 40. eviCore is a part of Cigna and also handles benefit and coverage decisions for many other insurers.
Understocked: Less than 60% of US pharmacies stock buprenorphine, used for treating substance use disorder, resulting in treatment deserts across the country. Barriers to prescribe buprenorphine have loosened in recent years, but many patients still struggle to get their prescription filled, which can lead to withdrawal and relapsing. Buprenorphine is even more challenging to find for teenage patients, and despite being the only medication approved for youth, it is only offered at 24% of adolescent residential addiction treatment facilities.
The Digital Formulary: More health insurers are now developing "digital formularies" or digital "networks" to address the avalanche of new companies. "We are setting up a dedicated contracting unit and policies both to vet these providers and oversee them - long time coming," Ken Han told me. A good example might be eLovu, a new digital maternal care platform that works with obstetricians to prevent maternal mortality and head off issues like preeclampsia or postpartum depression. eLovu is currently covered by commercial insurance and Medicaid, and partners with hospitals and health systems, and Han said that with any of these businesses one of the keys to their inhouse contract unit will be to connect with the "provider network team" to understand the implications of adding these businesses. "It's a positive usually but we need to think about how the doctors are paid and incented and if adding one digital company creates bifurcation, upsets the network, creates duplicate services - and how to control for that."
Nurse On Screen: Providence Health System recently announced it was implementing virtual nursing models at eight hospitals in Texas, as are several other health systems across the country, in part to staff shortages. Virtual nurses can handle admission, taking medical history, assessing symptoms and handling discharge and transfers. Nursing unions have expressed concerns about clinicians providing care remotely but hospitals that have implemented virtual programs have responded strongly ensuring they have put safety precautions in place.
Moving In: As Humana moves out of the commercial insurance space, other health plans are stepping up to cover those members, including Humana’s own employees. Effective July 1, Blue Cross NC will begin providing coverage to Humana workers with employer sponsored coverage. The same issue is likely starting to unfold as people are disenrolled from Medicaid due to the end of COVID's public health emergency, but as with all these changes there is often a gap in insurance and often access to care. "We saw this in 2008 during the economic downturn - people lost jobs, lost insurance, stopped going to the doctor and then we had a wave of late-stage IV cancer diagnoses," Patti Journs, RN, said.
Extra Point: I once heard legendary baseball announcer Vin Scully tell this story during a game about how he put on a Dodgers uniform and crept into the Cubs dugout just after the Anthem at a Cubs-Dodgers tussle. "I kept my cap down at the brow and arms crossed at the chest, so no one seemed to know who I was for a good half inning," Scully described in that relaxed pace only he could. That's until the 1st base coach hollered "Vinny" and flipped a ball right at Scully as the players were heading in for the bottom half of the first. Scully caught it and saw written on the ball these words - "if a fight breaks out, I want you," and it was signed by Cubs manager, Don Zimmer. A good friend of my family Stephen Szydlowski reminded me the other day that baseball games in 2023 may be faster but there's no time for these stories, no time to give the audience the inside scoop, the perspective from the trenches. We rush through a lot of stuff these days if you think about it, in a culture where everything has to be instant, faster - rushing through meals, backroads, grocery aisles, and checkout lines, through work meetings, a good page in a good book, an email reply. Schools seem to always be rushing at the bell and in healthcare I'd argue that most of the last 50 years have largely been a rush - in one of our recent consumer polls of 3,135 people some 45% felt rushed out of their appointment in an office or even at home, without a chance to give the nurse or doctor their perspective, their vantage point, the context. Storytelling is somewhat a lost art and, yeah, maybe it doesn't fit the core curriculum for educators or meet the requirements for doctors to bill insurers - but it means something to people, and I'd argue its vastly underappreciated in its ability to make an impact and change a life.