145,000: The number of health care providers that left their jobs across 2021 through 2022 – almost half of them physicians, according to a data analysis by Definitive Healthcare. Worryingly, specialties that lost the most providers were internal medicine, family medicine, and clinical psychologists.
Any Guess? The largest healthcare union is, wait for it, in Minnesota…where providers at Allina Health recently voted to unionize, which will create the largest healthcare union in the U.S.
Union Deal: Healthcare unions have been in the spotlight recently – unions representing 85,000 Kaiser staff who recently participated in a three-day strike came to an agreement with the health provider and insurer to raise wages, as well as invest in job training programs and other initiatives to address understaffing. For example, we were at the Pipefitters Union event in Boston last month where workers got training on substance use disorder and recovery. Charlene Verga, RN, the associate director of nursing for the Massachusetts Nursing Society, said most of the education today is about fentanyl. “Addiction is like a relentless stalker,” she said, “and fentanyl was present in 93% of opioid related deaths in the state.” Verga and her team demonstrated how they deal with an overdose at her hospital. Even though Fentanyl outlasts Narcan when it wears off, it’s a 1–3-minute spray with no real side effects. She said the new long-acting Opvee used in the emergency treatment of opioid overdose takes 5 minutes to work, then lasts for 8-10 hours. “It’s a gamechanger but needs to work quicker.”
Corner Drug Stop: Rite Aid filed for bankruptcy over the weekend, citing declining sales and over a thousand opioid-related lawsuits. The pharmacy chain had already closed more than 200 stores in the past two years and will reportedly close up to 500 more as part of the bankruptcy plan.
TikTok: The social media platform is often thought of as contributing to the mental health crisis, particularly among adolescents, but healthcare professionals are trying to harness the platform’s reach for good. Both Cleveland Clinic and Harvard are among the institutions working with the social media company and some of its most popular creators to try to correct misinformation and help connect those seeking care with appropriate mental health resources.
Ending Coverage: We heard from an Aetna source related to its recent wave of coverage changes for telehealth. About 80 types of virtual care services are losing insurance coverage in December under a new Aetna policy. “We are not ending telemedicine coverage for all behavioral health therapy,” explained Alex Kepnes, Aetna’s executive director of communications for health care benefits. “We will continue to cover outpatient behavioral health therapy via telemedicine as outlined in our policy and based on the billing code.” This will include services using real-time audio “visual” services when medically necessary for alcohol and/or drug treatment reasons, as well as intensive outpatient programs and intensive outpatient psychiatric services paid per diem. Coverage ends for some behavioral care services, ophthalmological care, services related to end-stage renal disease and more, according to a notice the insurer sent to healthcare workers. Aetna will also end audio-only coverage of nearly 60 services, including psychotherapy, counseling for alcohol use disorder, and obesity counseling. One of the services no longer covered will be intensive outpatient programs provided virtually. Kepnes said telemedicine services that remain covered for Aetna’s commercial plan employer sponsors are actually more extensive than what was provided pre-pandemic because of the access and value these services clearly bring to their members and providers.
In Other Virtual News: BCBS Massachusetts will now offer members access to Virta Health, a diabetes focused provider, and Oshi Health, which focuses on GI conditions. Another virtual GI company, Parsley Health, is launching a new GI program to self-insured employers across the country. Northeastern Blue Highmark will begin working with virtual mental health company Spring Health to expand access to behavioral care for its members. Together, they’re launching a mental well-being platform that integrates into the health plan’s existing member app. The platform will be available to fully insured, ACA and MA members in 2024. Cigna’s Evernorth also recently announced the acquisition of Bright.md, which provides asynchronous care, trials and healthcare navigation tools.
Surgery Lift: Blue Shield of California updated its bariatric surgery policy effective October 1, 2023, to no longer require failure of at least two different drugs before surgery will be approved. Members still need to meet other requirements for surgery to be considered medically necessary, but it seems that maybe the health plan found the cost of obesity medications was rising too rapidly.
Taking Risk: AdventHealth in Florida plans to transition its entire primary care network for Medicare and Medicare Advantage patients to a value-based arrangement. The health system is partnering with Wellvana to help with the transition. 10% of Advent providers will move into full risk on Day 1 while others will transition over several years.
Oncology Care: Beginning next year, a new cancer support program will be available to BCBS Michigan commercial members. The health plan will work with OncoHealth to provide supplemental services to those dealing with cancer diagnoses like 24/7 support from oncology nurses, oncology specific mental health support, nutritionists, peer mentors and care navigation.
Rate Hike: BCBC Texas will increase reimbursement for Licensed Marriage and Family Therapists, Licensed Professional Counselors, and those administering mental health Intensive Outpatient Programs starting in 2024. They will be paid at 100% of the Medicare fee schedule when seeing Medicare Advantage members, bringing these professionals’ rates in line with other midlevel providers.
Extra Point: At about 3 o’clock last Saturday my lovely wife said we were going to the Taylor Swift movie, which went from being news to me to a modern-day metamorphosis. “We are?” I said. “I thought we were watching the Ole Miss game.” Turns out I was wrong and on the way to the show I learned that the movie was really a concert, and that I’m encouraged to stand up and sing. “I am?” I said, “I thought I was going to be sitting down watching football on my phone?” Turns out I was wrong, so I asked what songs Taylor sings in the concert. Janine rattled off about 15 songs and the only one I knew was Cruel Summer. “Oh, well that’s a good one,” I said, optimistic that maybe the show wouldn’t be so bad. “That’s the Bananarama song from Karate Kid – awesome.” Turns out I was wrong, and this was not at all the same song. So, I decided I would just turn the movie into a market research exercise. I planned to interview all the other guys there about why they had to go, did they want to go, and did they too think Cruel Summer was the Bananarama version. But it turns out I was the only guy in the theater and instead of doing the research, I had moms asking me “why are you here?” I had 13-year-old swifties giving me a look like what are you doing here old person with the funny Italian cap, and 8-year-olds just giggling. One murmured, “I think he’s lost.” So I grabbed my box of Reeses Pieces and decided to just tolerate it, but as the movie played I started to realize there was a health benefit to the whole exercise – turns out I like Taylor Swift.