1. Nine: That’s the number of splat points I had at Orangetheory Fitness before Christmas, the lowest in the class, 15 worse than my bride and 25 worse than my daughter leading me to believe that managing my own care is exhausting, humiliating and undoubtedly hurting my status in the family. The hit gym classes aren’t just winning with families, millennials and 30 and 40 somethings, they are getting the attention of self insured employers and a few large group plans. We asked 12 different benefits administrators for leading employers with more than 15,000 employees – 10 of them said they are looking at developing a contract and perhaps a pilot program to measure productivity and wellness for employees. I’m hopeful splat points won’t be a measure companies or insurers use. At least not until I figure out how to do more than 5 burpees.
2. Ortho’s New Age: Starting this month, Blue Florida has expanded its utilization program to include non emergency hip and knee surgeries for ACA plans under 65; previously the policy only applied to Medicare HMO and PPO Medicare Advantage patients. Magellan handles the program.
3. California Advances: Anthem of California, in an effort to invest more in primary care, will reimburse chronic care management advance care planning for commercial patients starting in late February
4. PreEmption, Infusion Style: Home infusion provider will like this trend as Blue Michigan is tightening up its approach to infusions. Pre-approval will be needed for hospital-outpatient infusion of Xolair (the Asthma drug), Cinquair and Nucala
5. Genetic Test Oversight: New Jersey’s Blue Plan, Horizon, has tapped Evicore to intervene doing pre-authorizations for a litany of genetic and molecular tests starting in March 2019
6. In Sickness & In Health: You know what they say. Want to lose 10 pounds, get the flu. Most of my family had a version of it during Christmas break in what has become nearly an annual tradition. My grandfather, John Antonelli, who spent most of his youth in the mountains of Napoli, once told me that my great Uncle Cosimo infected the entire coast of Italy in 1913 simply because he didn’t wash his hands before supper. I still wash up before pasta to this day and I have more recently decided to get flu shots, even if this year’s shot didn’t prevent last week’s bout. The CDC, for what it’s worth, says getting the flu shot has benefits even if you get the flu, reducing ICU admits and length of stay for patients who get hospitalized from the virus. Health plans have been telling us that there has been a dip in the number of males getting flu shots in recent years, particularly at primary care offices, though the number of flu shots at urgent care sites has been steadily increasing.
7. Extra Point: 49% of schools in our December poll of middle school principals said their schedules are changing so much so that they are starting to look more like health and wellness centers than academic institutions. Gone are the days of home rooms where Billy steals the fish from the tank and Donnie plays hangman on the chalkboard. Now, it’s mindfulness class. Fourth period study hall is out. Mental health, taught by counselors and licensed psychologists, is in. Sessions are lecture based but ‘quickly seeming more like group therapy’ says Pamela Youmans, principal for a 5th through 8th grade junior high in Tennessee. Gym, which has in recent years lost out to budget cuts, is bouncing back with structured play sports blocks that allow kids to run relays or play small games of 2 on 2 basketball. The physical and mental coursework is also forcing school boards to look at staffing, some looking at hiring trained professionals to lead these new health-like departments and many plucking staff from local psychology practices. 81% said they are likely in 2019 to find some budget to partner with a local practice to help lead these classes as well as after school programs. These are all great developments and with states, like New York, mandating some of this, policy is helping drive the trend too. I will say I miss the days when home room was a guaranteed 20 minutes of sleep before Mr. Linardo’s geometry class, but perhaps that’s the tired parent in me talking.