46: The percentage of veterans who have self-reported PTSD and depression in a recent poll, a slight decrease from the same poll in 2022. The U.S. Defense Health Agency has a transition program available to all service members and veterans regardless of how long they’ve served and connects them to those services using coaches. “What’s great about the program is we are diagnosis agnostic, meaning you don’t need a diagnosis or to already be in care to participate,” says Nicholas Polizzi, a psychologist who works at the DHA. “We are come one come all. If you’re experiencing stress about the transition you can talk to someone or if its comorbid depression and anxiety we can help figure that out. Our mental health coaches know all about it, they are generalists. Our goal is to help the individual get connected to care with their next therapist.”
Walmart Moves In: The retailer has announced its first deal with a health system, Orlando Health in Florida. Ambetter from Sunshine Health, a Centene plan, will be part of the partnership in which the trio aims to better improve care coordination between Walmart’s 23 health centers in the state and Orlando Health. Walmart’s centers will become preferred providers in seven counties in Ambetter’s Value Plan.
Retail Switch: Walmart will also be adding daily “sensory friendly hours” in which the retailer will lower the lights, turn off the radio and change their TV walls to a static image. The hours, targeted to those with sensory processing issues like autism and PTSD, will be from 8am-10am every day at all stores across the country.
AI Up & Down: Virtua Health, a New Jersey-based academic health system, is incorporating AI chatbots to provide behavioral healthcare to patients amid the provider shortage. The chatbots, created by Woebot Health, are referred to patients with mild-to-moderate signs of depression or anxiety. A number of digital health companies are utilizing voice and text-based AI during patient visits, but not all are proving successful. Olive AI, a digital health company that developed AI-based technology to help providers and insurers automate the revenue cycle, went out of business and sold its remaining assets last week, despite raising $832 million in funding since 2020.
Infection Surveillance: With cold temperatures approaching, the CDC is expanding its infectious disease surveillance program at four major US airports to screen for more than 30 pathogens, including flu, RSV, and COVID. The surveillance program was launched in 2021 to combat COVID-19 at seven airports. The four airports where the program will be expanded are JFK, Boston Logan, Dulles and SFO.
Sales Cycle: Allstate, the home and auto insurer, also has a health insurance division which it recently announced its intentions to sell. It will be interesting to see if any of the larger name health plans are interested in acquiring it. Meanwhile, Cigna is exploring selling its Medicare Advantage business. The health insurer has never had as much volume in that line of business compared with competitors like United and Humana, with MA revenue for Cigna coming in at only 4.4% of its 2022 total.
Make It Count: Starting in February 2024, Anthem will implement a new policy restricting some genetic tests to once in a member’s lifetime. Reinterpretation of the genetic sequence will be allowed as needed but will not be separately reimbursable.
Rate Cut Delay: Aetna will lower reimbursement rates for physical and occupational therapy assistants to 85% of the allowable rate starting March 1, 2024, a delay from its initial plan to start the policy in December.
Inhouse Infusion: Cigna will expand its Pathwell Specialty program in 2024 to more than 4 million additional commercial members. Members will need to use Pathwell Specialty designated providers when receiving specialty infusions.
Izzy Mandelbaum Healthcare: This Seinfeld icon once barked at Jerry that ‘it’s go time,’ a plea from the Lloyd Bridges character for the weaker, unhealthier comedian to shed some pounds. Managed care organizations are in a bit of their own go time these days, juggling the rise in weight loss drugs and trying to figure out the pros and cons, like adverse events of depression and anxiety that we’ll discuss during today’s forum on behavioral health at noon (Pre-register here). At a minimum, expect more MCOs to require patients on these medicines to be part of “programs” in the future. One managed care medical director in Indiana once talked to a medical group there that turned an old apartment building into a basketball court and gym for patients who needed more activity – office visits and check-ups took place at the facility. The health plan, Welborn, paid a PMPY to track BMI, obesity and other measures, including presenteeism in school and work. ‘This is the sort of thing that gets my attention – rather than come in saying you want a 10% increase because you added a clinic, show me how you’ll change the course of life for these patients.’
Extra Point: Unions are striking back with apparent wins for auto workers, actors and healthcare workers just this month that put organized labor back on the map after a two-decade downward trend. It’s interesting that the Screen Actors Guild negotiated protections against artificial intelligence, which no doubt will be a recurring theme of future healthcare labor union negotiations. I wonder how these developments will impact access, shortages, reimbursement rates for healthcare workers, quality of care, and investment. Labor remained the #1 concern of 127 healthcare investors according to our annual poll due out next month, mostly due to the rising cost of labor. There are many famous unions – there’s the one for students on college campuses, there’s the marital one, that Duran Duran song with the snake, and of course the state of the union. I’d argue that all of these have had some trouble in the last 30 years losing some of the cache they once had but, like a lot of things, they are making a comeback. Bruce Springsteen, perhaps the one musician most connected to the struggles of the average worker, may need to hold a reunion of the E Street Band to cut a new version of his 1978 song Factory. Perhaps that can be the new anthem for the current labor movement. I suppose the union resurgence is a good thing for those in the gig economy like my own daughter, an aspiring actress and singer, who sometimes finds herself singing to patients at hospitals or nursing homes. It’s plausible that she could be part of both the actor’s guild and maybe a healthcare union one day, or maybe a new union for singing nurses.
Editor’s Note: At noon today, I’ll interview a long-time worker for a union health plan when we’ll dive into issues largely around behavioral health utilization, but also interesting challenges like weight loss, medications and mental health. Pre-register here.