99: No, not the number of red balloons one guy is sending his girlfriend on Valentine’s Day, but the amount in dollars that it costs out of pocket for a coronary CT calcium score test that gives PCPs and cardiologists a window into heart attack risk, but insurers basically do not cover the test, which 84% of cardiologists we polled find absurd. “It’s a baseline and an important one – it shows the amount of hardened plaque and guides treatment, particularly for those in their 50s,” one cardiologist said. Insurers may argue about its utility and value, as it typically kicks off other tests like an echocardiogram and a stress test.
Cardiac Mobility: Premera BCBS now pays for mobile cardiac outpatient telemetry, a method using a small portable device to record a patient’s heartbeat as they exercise. It was previously considered investigational.
MAT Gain: Effective April 1, 2024, BCBS Minnesota will remove the visit limitation for medication therapy management services for their Medicaid members. For CPT code 99606, there will no longer be a hard limit on visits, but after seven, the provider will need to send clinical documentation to justify more.
Cancer Going Downhill: Starting March 15, BCBS Michigan will add 11 oncology drugs to its site of care program, including Keytruda and Opdivo, which will now need to be administered in an outpatient infusion center, provider’s office, or home setting for commercial members.
Switching To Telehealth: Psychiatric nurse practitioners lead a group of clinicians more likely to shift their practices to telehealth only, 19% in all, according to research published in JAMA’s Health Forum. By contrast, 13% of psychiatrists shifted to telehealth only in 2022. Those working in highly populated counties with higher real estate prices (17%) – typically urban areas – were more likely to shift compared to those working in low density areas (9%). Pediatric focused practices (7%) were among the least likely to switch compared to general clinicians (14%) and females made the move more than males, 14% to 11%. A “telehealth-only” practice was defined as a practice where more than 95% of visits were conducted virtually.
Finding Pharmacy: Walgreens is partnering with 17 pharmacy schools to better align training with the changing pharmacy business model and increase supply. Pharmacists are increasingly expected to provide more healthcare services, but the industry is dealing with burnout. Applications to pharmacy schools fell 64% between 2012 to 2022.
Enroll With The Changes: 293 million Americans (88%) had dental coverage in 2022 according to a National Association of Dental Plans report. Enrollment in commercial health plans – 61% of which was tied to employer sponsored plans – was flat between 2021 and 2022 while enrollment in publicly funded plans increased ~22%, just ~2% of which was specific to MA plan enrollment, indicating that the biggest growth driver was continuation of PHE policies that halted Medicaid redeterminations during those two years.
Incentive: Regence BCBS is adding a financial incentive for providers who submit at least 10 months of data for at least 80% of their attributed members.
Weight For It: GLP-1 weight loss drugs are the centerpiece of a range of new programs. Mayo Clinic is launching an Rx program combining meal planning, at home fitness and GLP-1s, when appropriate. Cigna’s EncircleRx from Evernorth uses GLP-1s to treat obesity, diabetes and cardiovascular disease, and Calibrate, a clinician-guided obesity treatment program, says its patients achieved 18% sustained weight loss combining GLP-1s with intensive lifestyle intervention, better than what GLP-1 clinical trials alone have shown. Supply issues for one drug, Wegovy, may improve now that Novo Nordisk acquired drug manufacturer Catalent.
Extra Point: Schools are trying to find funding to reinvest in physical education the way it was once upon a time in the 70s and 80s when recess was kickball and sweat and scooter races. Most schools want to change but don’t have the staff or, admittedly, the training to get today’s kids moving. Well-intended policies like California’s new law protecting student rights to at least 30 minutes of unrestricted play time may force schools to reallocate budgets, like reluctantly taking from art or music. It’s a good move to resurrect recess after 25 years of gym-less days, but 30 minutes for the “possibility” kids will play handball on the blacktop candidly only scratches the surface. Today after recess most middle schoolers check their phones, back then we checked our pits. Funding for play programs serving schools has been rising with some districts getting north of $1M, tapping into foundation grants from the private sector, sometimes pro-sports teams. But these programs are now competing for that funding with mental health services. My son polled his teenage listeners about this and just 27 percent of the 14,609 still have gym class. Believe it or not, nearly 30% of the other 73% say they have thought about suicide, sometimes for a friend’s struggles, sometimes their own. I wonder when we’ll realize play is mental health and that it’s time we re-learn what things like recess can do.
Editor: Ashley Chilton; Contributors: Samantha Kaishian, Hannah Landi; Extra Point: Bryan Cote