1. $1.6 Trillion: If you had to guess, what you would think is the largest single source of economic burden in the world? If you guess cancer, diabetes, respiratory disease or heart disease you’re wrong. The estimated global cost of mental health problems is higher than all of those.
2. Talk Is Cheap, But Does It Work? A therapist messaging app called ‘Talkspace’ has serviced over one million people and is trying to help solve issues of access, stigma and cost for those suffering from mental health conditions, says app cofounder Roni Frank MD. The new solution has implications for therapy providers who offer residential and outpatient treatment. Don’t hesitate to reach out to discuss. Click here to read the story.
3. PT Milestone: George nearly fell off Jerry’s chair in Seinfeld when he heard there’s health insurance for physical therapy. His angst over getting a male therapist notwithstanding, the episode highlighted what many considered a milestone for PT in the 90s. Flash forward 20 some years and what’s been an at times bumpy road for PT providers has just gotten easier as Humana is the first insurer to remove pre authorization requirements for outpatient PT. Commercial and Medicare Advantage patients benefit from the change. Annual visit limits would still apply for specific ‘plans’ but the announcement is a plus for providers. One source said the rise of opioid addiction is one key factor as is the relative maturity of the authorization process itself – PTs are getting pretty good now at what to request and how to document the need for more visits.
4. Urine Testing Policy Change: BCBS Tennessee has a new outpatient drug testing policy. Urine/serum drug testing will be limited to 20 episodes per annual individual benefit period, effective May 1, 2018. An episode is defined as either a presumptive or confirmatory test (or both for the same date of service per provider billed on the same claim). A presumptive test is also known as a qualitative point-of-care test (POCT) or a drug screen. A confirmatory test is a definitive or combined qualitative/quantitative test. This policy does not apply to BlueCare Tennessee, CoverKids, FEP or the Medicare Advantage members.
5. Eye & Knee Medication Update: Several plans will now require prior authorization across all lines of business for the gene therapy drug Luxturna, designed to help people with vision loss, and for a pair of osteoarthritis treatments, TriVisc and the injectable Durolane. Opthamology and orthopedic practices may want to explore specific use of these products as ancillary solutions.
6. The PAC-12 Misses, But Northwest MCOs Score: While the major players are out of the NCAA men’s hoops tourney, the major ‘payers’ are all in on a strategy to limit hospital costs. Blue Idaho and Regence BCBS are among plans continuing to increase the number of physicians in shared savings arrangements. Idaho’s plan added six more groups this year, raising the number of providers in these arrangements to 25, while Regence Utah’s ‘Total Cost of Care’ program has had good results, as patients who are seeing participating physicians are readmitted to hospitals 28% less than patients who see other doctors.
7. New Heart Procedure Success: Santa Rosa Memorial Hospital of California completed the first Transcatheter Aortic Valve Replacement (TAVR) procedure, which took place last week. Memorial Hospital is offering a less invasive option to patients with severe aortic stenosis who may otherwise not receive adequate treatment due to their high risk for open heart surgery. Approximately 70% of patients with severe aortic stenosis are at an extreme risk for open heart surgery.
8. Extra Point: New York will become the first state in the nation this June to require schools to incorporate mental health into curriculums. How many states adopt similar policies may not be the major question as much as how quickly they do it and perhaps more importantly which model or companies can figure out a way to help schools. I’m biased as my bride and I have worked at an inner city school that uses these models, some of which are classroom focused, some playground oriented. Health plans are in some ways already showing their hand, some saying they will ‘prefer’ providers who have experience and affiliations with schools, at least as a way to ‘better manage transitions, reduce crisis’ and ‘make it easier for families’. With all the talk about which mega healthcare deal will be next – and there will be 2 or 3 more no doubt – I would not be surprised to see a ‘behavioral’ powerhouse emerge that either focuses on kids and prevention or builds a model.