20: The percentage of adults diagnosed with opioid use disorder in 2021 who received medication to treat it according to federal data. Encouragingly, people who utilized telehealth for substance treatment were ~38 times more likely to receive medication compared to those who were not treated virtually. We’ve seen a rise in telehealth companies focused on these disorders over the past several years, which hopefully means the percentage of those treated will continue to rise – especially considering the data also showed disparities by ethnicity, gender and location. For instance, those in urban areas were three times more likely to receive treatment than those in non-urban areas. The DEA recently announced they’d be holding public sessions to get input on prescribing controlled substances on telemedicine platforms and may consider a special registration allowing more telehealth providers to prescribe controlled substances without in-person visits.
New Behavioral Policy: Premera BCBS in Washington state has updated its residential treatment center behavioral health policy, effective August 1, to require a nursing assessment upon admission and subsequent nursing staff observation 24 hours a day. Treatment centers relying on outside nursing staff would benefit from a plan to recruit and retain addiction-trained nurses.
Screen This: In our poll of 1,136 people – a mix of teens, young adults and older adults, 68% said they had lied often on depression screens.
Cat A Racket: Humana has ended its cataract surgery prior authorization policy for Medicare Advantage members in Georgia a year after officially announcing it. The policy faced backlash from provider groups that argued the policy “caused unnecessary treatment delays and denials for people in Georgia.” Aetna announced a similar policy two years ago but later rescinded it in all but two states, one of which is Georgia, which these physician groups say they will aim for next.
VBC Wire: Two new value-based partnerships were announced recently – the first between the ACO ApolloMed and the value-based primary care network IntraCare from Texas and Oklahoma as part of the ACO REACH program. The second is between the nephrology group National Kidney Partners and Duo Health, a tech-enabled physician group that focuses on supporting patients with chronic kidney disease and end-stage kidney disease. The partnership will focus on a new care model for Medicare patients in Florida.
Rx Switch: Blue Cross NC is launching a new specialty pharmacy program for fully-insured commercial members through Free Market Health (FMH). The program utilizes an automated system that looks at each specialty medication authorization request and then matches the request to the “best fit” contracted specialty pharmacy in the network. Patients or providers can request their preferred pharmacy, but if they don’t, FMH uses a competitive bidding process to determine where to send the prescription. The health plan says this will allow more specialty pharmacies to fill prescriptions they previously couldn’t.
Milk, It Does A Body Good Until It Doesn’t: Did you know that in the late 19th century, milk was believed to be the perfect substitute for blood, and the fatty/oily qualities would become white blood cells? Despite a few successful procedures, most using milk led to death. In one instance, the injection immediately dropped the patient’s pulse, so they had to be resuscitated with a combination of morphine and whiskey. The patient apparently lived for ten days. The story is a lesson about nothing ventured, nothing gained and the more things change, the more they remain the same – in 2023, a study of nearly 150,000 adults from 20 countries found that a glass of whole milk can prevent heart disease – and not if combined with exercise, but combined with cheese of all things. The results, organized into the Prospective Urban and Rural Epidemiological Diet Score, could be helpful to mention during office visits.
Menopause Or Play: Progyny, mostly known as a fertility benefits management company, is now playing at the other end of the women’s health continuum by including specialized providers of menopause care in its network. Menopause services will include nutrition, sleep, mental health, and hormonal health support. Employers who already use Progyny can include these additional services “for a nominal fee.” To read more about the growth of menopause treatment, click here to read our recent Women’s Health whitepaper.
Telehealth Clinic: Amazon Clinic, the direct-to-consumer telehealth platform, is now available to people in all 50 states. The service relies on outside networks Curai, SteadyMD, Wheel Health, and Hello Alpha. Patients cannot use health insurance but can utilize HSA or FSA funds.
Run Forrest: I ran 5 miles with Julio Perez, Mike Udell, and Rory Tulienth this week – the trio has been addicted to heroin, fentanyl, steroids and alcohol – now they run in a club called The Boston Bulldogs. Clubs like this that empower people through movement are gaining traction in society. For the most part, they don’t require a pill or injection, no Zoom connection or copay – just a $52 pair of sneakers and an open mind. In Rory’s case, she had tried three to four residential programs at various points in a 10-year battle that started in her mid-20s – “good people, but it just didn’t stick – maybe I wasn’t ready – maybe the addiction was still in charge,” the 36-year-old said as we stumbled through a shady stretch in Quincy. “I found a home running – I’m not sure why, but it feels right.” I asked her how much it cost to pay for all the care she had during her ten years. “How much?” she laughed. “I was in the hospital maybe 20 times, in prison, lost my job, my husband, my relationship with my daughter – is there supposed to be a number?”
Extra Point: If my grandfather Henry were around today, I’m pretty sure he would shake his head in disbelief – there’s talk that Cal Berkeley and Stanford may join Notre Dame in the ACC football league – that’s the Atlantic Coast Conference, which last I checked isn’t near the Pacific. I remember watching the famous Cal-Stanford college game with Grandpa in 1982 when Cal lateralled five times through the Stanford defense and its marching band on the way to the shocking last-second victory. Cal’s runner knocked over Stanford trombone player Gary Tyrrell in the endzone, which incidentally is partly why our oldest Jack didn’t join his college marching band. Having the two California schools join the ACC would be like when a western medical group or a hospital joins a health system out east or when hospitals start moving their locations into people's homes – wait, this is actually happening. In fact, it wouldn’t surprise me if by 2030 nearly every hospital system in the US had a hospital-at-home service offering. Hospitals and home health are at two ends of the spectrum – opposite points in the continuum – and just like the potential college football realignment, the question will be, will it work? “I’m pretty convinced it will if you can staff the heart and lung patients adequately and set up very good screening systems – what I worry about,” Patty Joerns, MD, says, “is if this adds cost and avoidable mortality, the need for an ambulance back to the hospital during a cardiac event or sepsis.”