1.7M: The number of Americans who rely on so-called health sharing plans, which are typically arrangements for people who usually share similar religious beliefs and agree to pay one another’s medical bills. A new report from the Colorado Division of Insurance concluded that even though 1.7 million people is higher than previously realized, the true number is likely still undercounted. These plans do not function as typical commercial health plans, but do not always advertise that appropriately. They do not guarantee payment for health services and are not held to the same standards and consumer protections as commercial plans, such as covering preexisting conditions. The report found that these plans often require people to seek charity care first and many people do not realize that coverage isn’t guaranteed.
Predicting Workflow: OSF Health is utilizing AI to assist with cancer care navigation. The Illinois health system has 15 care navigators at its largest hospital, all of whom focus on specific cancers. The AI model will help predict the upcoming week’s work for existing patients and then factors in which navigators have the bandwidth to take on new patients. The team behind the model hopes this will help even out workloads and prevent burnout.
Heading Off Crisis: Insurer Elevance (formerly Anthem) is using a predictive analytics process to identify teens with risk of suicide, contact their families early, and lower the ~59% of commercial behavioral spend tied to residential and inpatient treatment, according to David Lederman, a product manager at Elevance. This behavioral health initiative is focused on the insurer's ASO business line. The Blue Cross Blue Shield Association is also trying to head off crisis by partnering with the Boys & Girls Clubs of America. $10 million in funding will go towards a variety of things including professional development to help train 48,000 staff in trauma informed approaches and provide youth with virtual therapy as needed. This investment is expected to reach 3.6 million children nationwide.
A Pickle Of A Problem: Injuries for America's latest phenomenon, pickleball, could cost between $250-500 million this year, according to a recent UBS analysis. Injuries among players 60 and older have risen the most and one study noted that pickleball has become “an increasingly important cause of injury" - even though I'd argue it's a great way to keep people moving. The analysts estimated medical trips and procedures due to injuries will result in approximately $377,000,000 of medical costs, 80% of which likely tie to outpatient care. Many health insurers report outsized outpatient health services utilization in the first half of this year and the pickleball craze could be a part of that. For our part, predicting pickleball injuries is fairly easy - you can see it in people when they walk on the court, or don't stretch, but also in those who try to play like they are Rafael Nadal.
Predicting Weight Loss Drug Impact: Pharmaceutical company Novo Nordisk announced it will seek FDA approval for its oral version of the weight loss drug Ozempic. Predicting whether people will use the medicine and maintain health is to be determined. Clinical trials found the oral alternative to be just as effective as the injectable but there is no timeline for when the semaglutide pill will hit the market. Pharmaceutical competitors Eli Lilly and Pfizer are also in active trials with their own versions of oral weight loss drugs. The estimated cost of the current injectable versions of these medications are around $10,000 per member per year and utilization has skyrocketed, likely forcing payers to react. Oral versions would likely appeal to more people so we expect payers will continue to think through how to control the adoption.
Extra Point: I once called a colleague Radar O'Reilly for her knack of doing things before I even ask for them. "I don't know who that is," she said in response to my email. Realizing my blunder, I quickly called her and tiptoed through my reason saying she, like the short 1970s M.A.S.H. TV character, had a knack of doing things before even being asked, like predicting what I'd need. "Well that makes me feel better," she said. "I was worried because I looked up his picture online." Predicting things to do before being told to do them like Radar is no small feat. There's quite a lot of that innovation these days in predicting disease, like genetic tests and imaging that can mark what's to come even when you have no idea and feel great. You can figure out stuff, predict a condition at its earlier point, and plan your future. There's a lot of attention to this so-called predictive analytics era, particularly from those who have responsibility for paying for it, like is there utility to the test, will it tell us something we already know, is it necessary even if there's family history? These are fair questions, but maybe a bigger one is will the results actually change behavior? Would the answer give people enough information to adjust how they live? I mean, these genetic testing and imaging advances are nice until they aren't. We asked a few thousand people and about half of them don't even want to know - "Nah, not interested - no test is going to stop Jack Daniels from visiting every night," said Charlie, a 57-year-old from southern Missouri. 52% do, but half of them say they probably wouldn't change - "if it were predicting cancer, I might stop using the pesticide on my lawn but I do like the lawn really green," said Marge, 49, of eastern Pennsylvania. I'm on the fence personally. I just had a coronary calcium scan using CT imaging that "shocked" my internist. My score was so high that he summoned me to his office, prescribed a statin and referred me to a cardiologist - this all from a doctor who until now described my health profile as "unremarkable," that I'd pass a stress test easily. I guess I'm happy I know, I think, but I'm not sure my behavior is going to change. Perhaps this is precisely why insurers are reluctant to cover these advances at least not without oversight. Parents are in a similar position I suppose. Like on Wednesday, Tommy asked me if he could use my credit card to buy a $77 kit to diagnose ph levels in our soil. "If it's higher than a 7, it's high sodium," Tommy said. "I know, I researched it." Why in the world do we need to diagnose it - "because I'm trying to find the best area to plant a garden so we don't have to keep buying blueberries - and if it's more than 7 it won't work." I asked him if the soil was chalky and he said, "yeah yeah - so what does that mean?" It means we just diagnosed the soil kiddo. It's not going to grow us blueberries, and we're not going to spend $77. How 'bout dem apples!