53%: The increase in spend on mental health services between March 2020 and August 2022, according to a new study in JAMA Health Forum. The study from the Rand Corporation and Castlight Health analyzed claims from about 7 million privately insured adults who are covered through workplace health plans, which means this number may not accurately reflect the true demand for these services. Those with government-sponsored plans and with coverage through the exchanges likely also saw an increase in mental health spend over the past few years.
5 Pillars: Severe mental illness and substance use disorder are 2 of the 5 pillars of behavioral spend and insurers are realizing that the portion of people with “multiple” behavioral conditions like these is growing. In efforts to continue leading way among insurers on behavioral health, Blue Cross NC launched a new program August 25 for members with serious mental illness and/or substance use disorder. The program will replace the Blue Premier Behavioral Health Advanced program in partnership with Mindoula. 12 new counties will be added to the 14 participating in the previous program. Behavioral health care coordination services will be provided for commercial, FEP and MA members. Blue NC organizes its behavioral spend into 5 pillars – SUD, SMI, Anxiety and Depression, Co-Occurring Medical and Multi Behavioral.
Biosimilarity: CVS Health, parent of Aetna, launched a new subsidiary, Cordavis, that will work with drug manufacturers to commercialize and/or co-produce lower cost biosimilars. The first partnership is with Sandoz to produce its Humira biosimilar, Hyrimoz. The drug will be available in the first quarter of 2024 at a list price around 80% cheaper than the Humira list price.
Talk About A Site Of Service Shift: In Airplane circa 1980 actor Leslie Nielsen’s Dr. Rumack asked Ted Stryker, “Can you fly this plane, and land it?” Today, Stryker might need to take care of the health of the passengers too. Delta and other airlines are partnering with MedAire to provide telemedicine 35,000 feet above the ground. Services include on-demand medical advice to flight crews via audio or text messages and, in the future, may even include video-based telemedicine similar to what you can access in your living room.
Nurse UnShortage: Optum-owned MedExpress urgent care centers announced plans earlier this month to lay off registered nurses at roughly 150 locations across the country as part of a restructuring to cut costs. The urgent care model may be under some stress as we settle into a new normal post-COVID – while needed in some markets, most payers would prefer members seek care from primary care providers and start, if needed, with telehealth, given the widespread belief that 30-50% of urgicare visits are for the worried well.
Consumer Misconception: Only 26% of consumers surveyed by insurer EmblemHealth had familiarity with the term “value-based care” but when given the definition, 61% say they prefer it over fee-for-service. We are not entirely sure consumers fully understand the implications but the survey may at least guide the NY insurer’s strategies. Many employers also misunderstood the value-based concept, only one-third of those familiar could actually provide a definition. Additional education on value-based care for both employers and consumers is likely needed to achieve healthier outcomes. In our own poll of consumers, we got more cynicism than clarity—“Is value-based care when they give me a room with a window while I wait 45 minutes for the NP who has no idea about my medical history.”
Shooting Par: For pro golfers, par is like a bogey but for amateurs, it’s like a birdie and we would argue that a recent decision in Nebraska may feel like a hole-in-one for providers. BCBS Nebraska recently informed providers that all who are eligible to provide telemedicine services will be reimbursed at 100% of the in-person allowed amount – or “at par” – as mandated by the Nebraska Department of Insurance as of September 1, 2023. Previously, BCBS had lowered telemedicine rates to 50% of in-person except for behavioral health, which has and will remain at par.
Kidney Bean: There seems to be a new focus on kidney care, with a couple of high-profile partnerships launched this month. Oak Street Health is collaborating with Strive Health to provide value-based kidney care to people with stage 4 and end-stage chronic kidney disease. And Interwell will begin providing kidney care services to Humana’s Medicare Advantage members in 13 states. Multiple other payers also work with Interwell or Monogram Health in similar partnerships.
Correction: 23.5% of middle-class Americans have medical debt according to a KFF estimate – the number with debt previously reported in the August 25th edition was incorrect. Middle-income Americans, who earn $50,000-$100,000 a year, are more likely than those with lower incomes to seek care but they don't qualify for Medicaid or charity care to help pay for it and often fall into the gap between affordable ACA plans and Medicaid.
Extra Point: My bright, kind and hard working 16-year-old is oddly happy about his health class syllabus but on upon further inspection I think he ought to drop it. “Dad, it’s going to be an easy A. We have to write 5 paragraphs just describing what different doctors do—isn’t that your job?” Tommy said. Kind of, I said, which doctors – do you want to interview me? “I was just going to use ChatGPT,” he said, smirking, “but you’re probably right.” So Tommy pulled out the syllabus and started to read off the 5 doctors he figured he’d write about. “There’s All Hair Gists, whatever they do?” I said I think they do a lot of their work in August when people are sneezing outside. “Really?,” he said. “How about Ofailmolgists – wonder if they fail at things?” “I hope not,” I said, helping him understand that ophthalmologists fix people’s eyes. “What about Pu Hy Cal The Repeatists,” he said, “is that a good one to write about? “Yes, because maybe they do stuff twice when they shouldn’t when rehabbing your knee,” I said, “plus this is Papa’s profession.” Tommy said he also liked “New Rol Guy,” looking at me somewhat desperate to know if he pronounced it right. “Um, well, whatever this doctor is, they have a new role apparently so we’ll have to look that one up - my hunch is they study the brain.” I asked Tommy when his assignment was due. “After Labor Day, so I’m in great shape,” he said. "Well, maybe, I said. “I’m fairly sure you might want to actually drop this class and re-take English – just a hunch.”