55%: The portion of rural hospitals that don’t offer maternity care, according to a new report for the Center for Healthcare Quality. And in 10 states, that portion is more than two thirds. More than 200 rural hospitals have stopped delivering babies over the past decade, leading to increased travel times for expecting mothers, and often poorer outcomes.
Staffing Pivot: A new initiative funded by Bloomberg Philanthropies is pairing high schools with health systems, setting up students with guaranteed jobs in the healthcare sector. The first partnership is between a public school in Boston and Mass General Brigham. MGH will develop the curriculum to prepare students for careers in nursing, lab science, emergency medicine, medical imaging and more. By the end of the 10th grade, students will choose a specialty and after graduation, instead of college, students can start full-time jobs at the health system, which currently has about 2,000 vacant job positions.
Autism Training: 77% of parents of kids on the autism spectrum say they need more help despite ongoing ABA services. Parent-led autism therapy startup Forta, for example, certifies parents as technicians after a 50-hour training course and assessment, then creates a therapy plan for the child. If parents commit to 20 hours of therapy a week with their child, they can receive hourly compensation through their health plan.
SNF Transfer: BCBS Massachusetts is once again temporarily waiving authorization requirements for patient transfers from hospitals to SNFs and rehab hospitals to help manage an influx of inpatient admission requests. Until April 1, patients can be transferred to post-acute facilities without prior authorization, but providers should notify the plan within 24 hours of admission. The first five days are approved and then the plan will require clinical documentation to support additional days.
Cancer Spend Plan: Roughly a third of all cancer patients also have a behavioral health issue, and a study from the Evernorth Research Institute shows that having a person with a cancer diagnosis engaged in behavioral health treatment significantly impacts avoidable ER visits and boosts outcomes. Some health plans and medical centers are integrating behavioral health and oncology by incorporating distress screenings into oncology case management, bringing together specialists and referring patients to community support groups.
Gene Therapy Risk: Blue Cross Blue Shield’s Synergie Medication Collective has signed risk-sharing agreements with drugmakers BlueBird and Vertex to offer their multimillion-dollar gene therapy treatments to some self-insured employers, making it the first insurer to cover these new gene therapies for sickle cell disease. There is currently no cure for sickle cell disease, and patients typically live with intense pain, frequent ER visits, potential organ failure and early death. New therapies are intended as cures and are expected to dramatically improve life for those living with sickle cell. More insurers are expected to cover the therapies. BlueBird recently signed a similar deal with another major payer and is negotiating a pilot program deal with CMS.
Midwest Move: Commercial payer policies tend to start on the two U.S. coasts then slowly move inward and a new BCBS of Nebraska decision is a good example. Effective April 1, 2024, the plan will do what most other commercial plans have done, reducing payment when multiple diagnostic imaging services are provided to the same patient on the same day by the same provider.
Device Launch: Dexcom plans to launch a new CGM for people with Type 2 diabetes who don’t take insulin. The new device, known as Stelo, will be based on the company’s G7 CGM but will include custom features tailored to people who don’t take insulin. Users will have to pay directly out of pocket for the device, but Dexcom said they plan to seek insurance coverage and reimbursement at some point in the future.
Teacher’s Pet: The American Federation of Teachers will partner with Talkspace to offer therapy and other digital behavioral health resources to 1.7 million union members to help with issues like burnout. For context, read our paper here on the behavioral health ecosystem.
Extra Point: So, I think society may have underappreciated the value of the donut as a health benefit. The donut isn’t just empty calories – it’s camaraderie around a table with wobbly legs, the centerpiece of stories from vets and old friends about people like Sister Mary who used to discipline kids by throwing chalk and pulling them by the ear down to the principal’s office. An academic center here in the northeast actually found donut-holding families in their ERs appeared less stressed and more receptive to discharge instructions. The rate of readmission among those with donuts in the exam room was about 30% less compared to those without one. Donuts have had a love-hate relationship with the healthcare system but given the state of the mental health crisis, there is an argument that donuts could play a role in treatment. “It’s not the donut, it’s the conversation you have with someone when eating one,” psychologist Vern Stanton told me while we shared cinnamon munchkins and coffee last year at the local Dunkin. Some people who swear by a daily donut often seem to have a glass half full attitude. Kelly Saven, a nurse’s aide in Connecticut, told me she likes the jelly ones, “because my doctor said I need to eat more fruit.” Dissolution of the family these days and family meals has been a major driver of mental health deterioration in both kids and adults. Suicide care is now necessary and for many the common reason is a lack of social interaction, real connection, laughing about stories, people watching. “My daughter is 37 and says it’s hard to find time to make supper and sit down with the family – her kids constantly being raced around,” laments Norm Tartaglia, 70. “She should slow down and have a donut and coffee once in a while.” I caught up with three old men and a lady down at the local donut shop in my hometown last week – 92-year-old Benny, 95-year-old Sam, 87-year-old Kristine and 86-year-old Roger. They’ve met here off Lasalle Road for coffee and a donut and a conversation for most days since the 1970s. “I remember when the place opened,” Roger said. “Used to have penny candy, peanut brittle and hot donuts. We’d come after school.” Fred Marcucci, a Marine Corp vet living in West Brighton New York said today that he is upset about the local D&D closing for 3 hours each afternoon given unruly students and parents causing traffic issues. “This prevents us from going inside to sit and enjoy a cup of coffee and a donut,” he said. I’m personally not suggesting the healthcare industry needs to lean into donut shop franchises or that we’ll lower healthcare costs with more donut diners. Nor am I advocating Medicare insurers should use supplemental benefit dollars to give free donut vouchers to seniors, but the broader public might want to re-think about the value of the donut. When I was a kid, my folks would take us to Gil’s Bakery for a cinnamon cruller and Very Fine grape drink after Sunday mass. We would just tell stories, listen to the people, savor each bite – maybe coincidence, but afterwards I always felt lighter.
Editor: Ashley Chilton; Contributors: Samantha Kaishian, Hannah Landi; Extra Point: Bryan Cote