$226: Women’s average out-of-pocket spend is this much more per year compared to men’s even when excluding maternity services, according to a new Deloitte report. That adds up to $15.4 billion more in out-of-pocket costs across 16 million women with employer-sponsored health insurance. Women use health care more often, with 10% more in total health expenditures relative to men, but out of pocket spend is still 18% higher. This may be due, in part, to the different type of care recommended for women such as gynecological exams and earlier annual checkups.
The VBA Effect: CommonSpirit, the nonprofit health system, is launching a physician management services organization to help more providers transition to risk-based value arrangements. The platform will provide services like population health analytics and network management. CommonSpirit already has experience in the value-based care space, currently managing 2.6 million people in VBAs, including ten ACOs.
Disrupter: Following in the footsteps of Capital Blue Cross and Blue Shield of California, Select Health becomes the third health plan to officially partner with the Mark Cuban’s Cost Plus Drug Company through its PBM, Scripius. Members will have access to over 1,000 prescription drugs, potentially with lower prices than they would find at a traditional pharmacy.
Sunny Days: Along with that jumbo pack of paper towels and free samples, members will soon be able to access medical care at Costco. The company announced that through a partnership with the healthcare platform Sesame it will begin offering its members $29 virtual primary care visits, $79 mental health visits and 10% off other medical services on Sesame’s platform.
Missing Care: Mass General is working with GE HealthCare to utilize an AI tool developed together that will hopefully predict missed care opportunities. The application will first be used in the health system’s Radiology Operations Module and is intended to predict missed visits and late arrivals. Better identifying these could help with targeted patient outreach and streamline administrative operations, while allowing more room in the schedule for walk ins. In preliminary tests, the algorithm was able to predict missed care opportunities correctly, at rates up to 96%.
TV Nurse: Multiple health systems have adopted virtual nursing, which is helping increase access to care despite staffing shortages. MUSC Health in South Carolina is expanding its program to four rural hospitals that are understaffed while other health systems report their virtual programs allow older nurses to stay in the profession longer.
Addiction Partners: Some specialized virtual providers are realizing the power of integrated care. Ophelia, an opioid use disorder treatment provider, is working with Vori, an MSK provider, to help patients manage pain without opioids. Vori will refer patients already suffering from OUD to Ophelia and Ophelia will refer patients to Vori for opioid-free pain management.
Fertile Ground: Care coordination company, Rightway, has partnered with Kindbody, a fertility clinic network and employer family-benefits provider, to increase access to fertility care benefits and streamline the care journey. A recent report highlights that 61% of employees who receive fertility benefit coverage report feeling more loyal and committed to their employer, showcasing the benefit of offering fertility coverage. On the flip side, about 1 in 4 Black adults said they or someone they know used fertility treatments compared to nearly half of white adults surveyed at the same time, according to a Pew study.
Mom Duty: BCBS Texas announced the launch of the first ‘Mom & Baby Mobile Health Center’ to increase access to maternal and infant care in rural areas of the state with limited options. 20% of birthing people in Texas received inadequate or no prenatal care in 2019-2021, higher than the 15% national rate. The mobile health center is set to launch in 2024 and will offer pre-conception, pregnancy, postpartum and newborn interventions, as well as primary, wellness and preventative care.
Delaying the Deal: Elevance’s merger with BCBS Louisiana has been put under regulatory scrutiny, delaying the deal. State regulators are worried it could reduce competition and increase healthcare costs so the insurers have chosen to withdraw the merger. They plan to refile a reorganization plan and acquisition application but that timeline is unclear.
Extra Point: So, is the quality of our nation’s mental health therapy a problem? Mental health therapists are trying, many moonlighting, many in their 20s just out of school, some talking to kids just 5 years younger who are in the midst of a crisis complicated by what they see, what they hear and what they know. 59% of the 374 therapists in our poll this week say they more often than not feel unable to treat, their readiness to solve the storm of pressures kids and young adults are facing today “is getting complicated.” Teen therapist Kelley, 29, said she had the supervision hours but “it wasn’t what I thought it would be, my supervisor wasn’t always present – they had a full panel,” she said. “I see a lot of teenagers who identify as LGBTQIA+, bullied on Instagram, struggling to find their footing at home and school. I’m doing my best, but this is hard – I’m having a hard time,” she admits. Kathie, a 46-year-old family therapist, says she left her corporate job to help people but admits it’s hard getting to the root of the issue for the 16- to 20-year-olds she works with who are struggling with transitions and self-worth. “I think the complexity of their experience is sometimes beyond the scope of my training and my experience.” Some say the issue is we box the patient into a set of diagnoses but fail to train the therapists on figuring out how to identify and treat childhood trauma, how to adjust what we ask and what we say. Others acknowledge that there are so many patients that it's difficult to match the specialist to the patient’s diagnosis – like the therapist trained around addiction is not necessarily the right fit for the 17-year-old with compulsion. Maybe the problem isn’t really the quality or training of the therapist but the lack of consistent physical movement and exercise as we come of age and go through transitions. In some ways, this isn’t surprising given the meaningful growth in coverage of mental healthcare and the rising demand in the wake of two epidemics, COVID and the opioid crisis, and the constant struggle of youth today to manage life on social media. These issues are exacerbated when therapists and psychologists stop taking insurance as is happening in some states or leave their jobs to join better paying work for a division 1 college sports team. If we are to improve quality and outcomes, we probably need to think about all of this and not just how we pay for therapy but how we pay for quality and help therapists learn how to “measure” progress. Maybe we should take a cue from Ronnie, 34, who completed training to be an LCSW last year. None of Ronnie’s sessions are over zoom and none are in the office – "I do 45 minutes around a lake, jogging, some walking, some talking.”