1. 25: That’s the number of attempts of suicide estimated per suicide death. It’s a tragic stat and one that has created a new support model in Europe. Emergency medical services obviously can play an incredible role in managing patients who have attempted suicide in getting them to proper care. In London, the Ambulance Services NHS Trust is recruiting Mental Health Practitioners to increase their 24/7 specialist-enhanced clinical assessments and to support people who have called the service for mental health issues. They are looking for practitioners who can make clinical decisions, and coordinate complex situations. The very first Mental Health Ambulance was operated in Sweden in late 2017 after it was revealed that more than 1,500 people die by suicide annually in the country. Called the Psychiatric Emergency Response Team the group responds to over 130 calls a month in Stockholm related to suicide risk. At the University of York in London, about 50% of ambulance emergencies were for self-harm or suicide attempts at the university in 2016, according to the BBC. Studies point to that number being higher in 2018. ‘Very interesting concept. I see it as a positive to prevent suicide, defuse situations, but I’m a bit concerned it could be seen as an alternative to psych care. That would be a major misuse and disservice, so not sure how this would work here,’ says neuroscientist Paola Sandroni MD, PhD. For the full story, click here
2. A New Specialty Benefit: 41% of 212 payer pharmacy and medical directors we polled said they are discussing alternative benefit design models to better address the shifts in patient care and rise in specialty medications. The health plans said they want to try and create a benefit that manages the pharmacy utilization and cost, ensures adherence, but allows for medical management in the home setting supported by strong care management services. ‘Right now the existing benefit structure doesn’t really allow us to pay the provider appropriately and it creates more hurdles and administrative costs – ideally, we move to a specialty benefit that is focused on the patient’s disease, medications and care needs that limits multiple copays and hurdles to treatment…,’ one medical director said. The poll, which included representatives from more than 37 MCOs, found that these payers are ‘forming committees’ to discuss alternative approaches. The trend is a plus potentially for businesses with integrated offerings for specialty populations.
3. Home Health Encounter Policy: Highmark BCBS has amended its commercial policy in Pennsylvania for home health services, releasing new time frame requirements for an encounter with an RN, nurse-midwife, or physician assistant. In situations when a physician orders home health care for the patient based on a new condition that was not evident during a visit within the 90 days prior to start of care, the certifying physician or an allowed professional provider must see the patient again within 30 days after the start of care.
4. Extra Point: So I entered a capitation arrangement with my 5 kids - $5 per kid per month, baking in bed-making, walking the pup, making their own breakfast and lunch, getting themselves to school, and doing their own laundry. My model was flawed as there was significant underutilization this month. The kids school, sports and music commitments were to blame. I’m not the only one struggling with capitation – many physician groups have gone down this path of late, not just in primary care but in other services. One group took full risk but never shared its data with doctors. Another never did follow up calls with its female patients who were pregnant, many who would use the ER throughout their pregnancies. Next Friday, we’re going to share some of the strange but true stories and new lessons from the recent wave of provider capitation. In our first in what will be an ongoing series, we’ll kick off a radio-style chat – I’ll have guests from medical, pharmacy positions and those involved in various aspects of health reform, either providers, managed care or employers. The Managed Care ‘Friday Forum’ will be a 15-20 minute chat and call-in show. Recordings will be available. We will kick off on the 28th. Stay tuned for call-in details next week.