83: Percent of acute care hospitals that collect data on patients’ social determinants of health, according to a 2022 American Hospital Association survey, though only 54% are doing this routinely. Small, rural, critical access and independent hospitals are the least likely to do so – likely due to lack of resources – but these hospitals are probably seeing the highest numbers of patients who are experiencing SDoH challenges.
Refugee Breathe Easy: 20% of the ~600,900 refugees admitted to the US from 2010 to 2020 were from Myanmar/Burma and nearly 70% of these households reportedly have multiple members with undiagnosed, undertreated or mismanaged asthma, typically developed after arrival – their story is a lesson on challenges managing subsets of the Medicaid population. Click here to read the full story in the first of a new 6-part series called Fairness Factor, created by BRG, and supported by Equality Health.
Oral Health Fixture: A panel of dental experts, including BCBS of Massachusetts’ Dr. Robert Lewando and former Metlife dental director Dr. Alan Vogel, outlined a list of quality measures key for dental companies to track to get value based/outcomes-based payment. Click here to access the recording. Passcode: 7x#0CBtK
Embryo Policy: Highmark is updating its assisted reproductive technology policy to require that all viable embryos from a previous cycle, along with any previously frozen oocytes, must be utilized prior to beginning a fresh cycle. This update will only apply to members in Delaware, Pennsylvania and West Virginia, not to members in New York.
Relief Pitcher: Effective September 1, BCBS Kansas will provide a 0.7% cost relief adjustment to all providers except for labs, ambulances and pharmacies, a decrease from last year’s 1% adjustment. The adjustment is not keeping up with the cost to recruit and retain labor, 91% in a recent poll said.
Modify Weight: Starting in September, BCBS Michigan plans to shorten the initial pre-authorization approval to four months from 12 months for weight loss medications and requires healthcare providers to attest that patients are actively engaged in “appropriate lifestyle modifications” while taking these drugs. In related news, the virtual care platform Hello Alpa launched a weight management program for employers that will focus on “whole-person primary care.” The program, Ahead with Alpha, combines weight loss support with care for more than 100 other medical conditions. Patients who successfully lose weight will be migrated into a lower-cost maintenance program, likely an enticing option for employers.
Rebrand: Elevance is going old school and rebranding its Amerigroup business as Wellpoint, which was its original name from its founding. The health plan says the new (old) name signifies its “commitment to whole person health.” Amerigroup plans in Maryland were already rebranded as Wellpoint earlier this year and plans in six states will follow in January 2024. A few other states are on a separate timeline for rebranding. Amerigroup is owned by Anthem, which is now Elevance, which is not to be confused with the 90s band Evanescence.
DME Narrows: Humana is partnering with two national DME providers – AdaptHealth and Rotech – for its Medicare Advantage HMO members. Effective October 1, HMO members will need to get all durable medical equipment from these providers.
Algorithm: Cigna and United are both being accused of improperly rejecting thousands of medical claims. In Cigna’s case, the health insurer used an algorithm called PXDX, shorthand for ''procedure-to-diagnosis,” to identify whether claims met certain requirements, spending an average of just 1.2 seconds on each, according to the lawsuit. Providers and members have long been frustrated with why certain procedures are approved or covered and looks like health plans will now have some explaining to do.
Behavioral Back Inhouse: Following a delay due to a cyber security incident, Point32 will move forward with insourcing behavioral health management for Harvard Pilgrim commercial members, effective November 1. Some Medicare Advantage members will still be managed by Optum, but the health insurer’s move follows a broader trend of more payers bringing behavioral in-house, in an effort to better integrate care.
Extra Point: So, for most of Saturday’s Pan Mass Challenge bike ride last year, it felt as though all 5,454 riders passed me at some point during the nearly 7 hours on the road. It’s always a great feeling when a wave of cyclists blows by you like an 18-wheeler on I-95. But you battle through, gobbling three peanut butter Clif bars for extra energy, taking short breaks on rest stops, and somehow, with all of your body telling you to stop, you finish. My bike crossed the line in Bourne, Massachusetts among one of the first 2,500. “So basically what you’re saying Dad, is you lost” Jack said later. I suppose he’s right, but thankfully we like to think of this ride not as a race, but as a charity. I rode with different people that day during the event that raises money for cancer research – most imaginary, but some real. Mary Ellen from York Maine, a 72-year-old, was riding in her 19th Pan Mass Challenge. Cancer had never affected her family until 1998 when she felt her first lump. “It was like I was putting a downpayment on my medical care,” she quipped as we approached a flat stretch of the ride. “I go at my own pace, not as fast as I did back in my 60s.” Mary was easy to spot in the sea of bicycles and blue jerseys. She had an orange bike, purple and yellow streamers dangling from her helmet and hair the color of a perfect cloud on a sunny day. Mary’s breast cancer treatment worked, thanks to Dana Farber. Six years after Mary’s first infusion, her sister was diagnosed with a more aggressive tumor, found in stage III, and despite a great fight ultimately lost her life in 2006. Mary says she feels her sister grab hold of the pedals on heartbreak hill every year. “Maybe it’s my imagination, but I feel something.” Money raised for Cancer research is important given that many who get cancer may not be able to access one of the best centers, but the research is used to improve treatment and protocols that make their way to local oncologists. I’ll be out riding again this weekend – if you’re there, give a holler, I’ll be the one with the wobbly bike going about 7 miles an hour.