1. 50: The percent of all lifetime cases of mental illness that begin by age 14. And 75% develop by age 24, according to the National Alliance on Mental Illness. Talkspace, an online therapy company, now has a service for teens rather than just adults. With parental consent, teens can be connected with a licensed therapist in their state. By 2022 we think that the national telehealth community will get behind a change in policy to allow credentialed/licensed therapists to treat a patient outside their region. Full story here.
2. Surprising Episodes: There are some episodes that catch you by surprise, some you see coming. Like I always knew we were moments from a commercial break when Mr. Roper stared with those glassy eyes into the TV on Three’s Company, but I was floored when Colonel Blake died in that MASH helicopter or when Tom Hanks purposely swallowed a bottle of Vanilla Extract because the Keaton’s were out of Miller High Life on Family Ties. In health care circles today, you hear a lot about episodes of care and payment innovation – some are sort of predictable, and I suppose that’s the point. Think Maternity, Hip and Knee. Some may surprise you going forward, and some seem to perhaps miss the mark on who ought to be accountable. A 12-month episode for dealing with drug addiction has promise, particularly Anthem’s through a home-based provider out of New England, Aware Recovery. There’s a new one emerging that addresses predominantly Medicaid populations in poor housing areas who regularly present with asthma and co-occurring depression in ERs. The idea one PCP has is to use a simple home visit by a social worker, treatment led by an allergist and PCP, and a re-housing plan to either fix the environmental causes or find the patient a new home. United Healthcare is touting these kinds of community focused models. Problem is, when you look at the traditional episodes of care (link here to Arkansas BCBS’s core list) most seem to put the ‘hospital’ as the principal accountable provider in these. For asthma, while there may be a triggering event bringing you to the hospital, the so-called accountable provider probably ought to be a PCP, a specialist, or perhaps the MSW given the social factors involved. As you build your episodes, try to see what’s coming by finding the right mix of providers and the right person to lead.
3. The Cayman’s In Network: 64% of risk taking PCPs across 11 predominantly southern states polled (about 200 doctors in all) say they are interested in a story we posted a couple weeks back about a business called Price MDS that helps groups avoid super high cost drug expenditures or treatment costs, like 80% below typical levels. In a common example, there are some rheumatology drugs that are in the millions each year so "this network helps us send the patient basically to a 1-day vacation to an outpatient center that’s fully licensed and meets all the requirements, for ‘mere pennies’ " – it’s a good model for risk takers, and an indicator for any risk taking practice – where are you sending patients and are you sure you know the cost of that decision?
4. Social Stat: One unhealthy day equates to 10 hospital admits per 1,000 people or $15.64 per member per month in additional costs. I asked my kid Tommy to read this for his quasi 20-minutes of reading time he’s supposed to do every day and he fired back, ‘….um, but dad, I thought you wanted me to read…this is math.’ He has a point and this is the latest statistic that insurers are starting to lean on to shape programs to address social determinants of health. In what they’re calling Bold Gold, Humana says 5 of 7 communities reduced unhealthy days last year. Loneliness, for example, causes Medicare seniors to have an average of 24.4 unhealthy days a month; food insecurity averages 26.6. But there are community programs that are beginning to address these stats – and for provider groups like medical groups taking risk, these are indicators of a rapidly shifting trend in where the MA value dollar is headed. In New Orleans, those with CHF had a 9% improvement in unhealthy days due largely to a food bank program and San Antonio reports a nearly 10% decrease in unhealthy days. In contrast, some cities where Humana members have struggled – including Broward County Florida where unhealthy days increased by 4% as did depression prevalence among members. By the end of the year, the insurer hopes to ‘screen’ 1 million for social related determinants of health.
5. PTSD Returns: 53% of parents who have senior moms and dads, up from 44% in our poll 3 years ago, say at least one of their parents has had a post-traumatic stress condition due to a childhood incident, time serving in the war, or most commonly due to the loss of a spouse. Of the 429 polled, about 220 said the PTSD ultimately led to alcohol abuse, dehydration or malnutrition, and eventually to a hospitalization due typically to a fall in the home. PTSD is likely top of mind for many veteran’s families during this July 4th weekend. Question is whether your businesses are equipped to train practitioners to identify this condition early enough in care.
6. Extra Point: Ever think about who is diagnosing you and if they are getting it right, if they are undertreating, missing something, or perhaps overthinking it? The cancer doctor who hits you with one more round of that yellow syrupy stuff that they tell you is just Methotrexate but really feels like chemotherapy. The internist who takes a sore throat to mean you may have a Thyroid issue and sends you to a specialist because your cousin had Thyroid cancer. Your scalp is itchy because you haven’t showered in weeks, but you’re 47 and the primary care doctor you play pickup hoops with says it could be a sign of stroke if you’re not careful. It’s a bit like school, or camp – who’s teaching your kids, right? Three of my kids were in fact teachers themselves this week at what my bride calls Vacation Religion School – or since this doesn’t exactly roll off the tongue, what I call it: Bible camp. What’s confusing isn’t the 3-hour format where kids sing songs and do arts and crafts but that my youngest, Tommy, is a lead counselor. He’s 4 foot nothing and is still carryable on my shoulders. His on-pitch singing is flat. He barely knows the Our Father, and despite all that time in the Pew at church still sets his hands the wrong way for Communion. And he admittedly lacks some basic training in dealing with a wide variety of kids on the spectrum here who are using art supplies as paper airplanes. ‘Dad, I’m just surviving’ he said at dinner last night. The bar was obviously fairly low here for counselors if you ask me. Janine tells me ‘it’s good for the kids’ but it sounds more like McDonalds where if you spot a hamburger you’re suddenly a manager. Locate an apple pie and heck you’re a district manager. In healthcare, the consequences of under-prepared staff are more important obviously. There continues to be an effort to address gaps in care and access and one solution is taking less experienced staff into healthcare settings, and training them. Deploying social workers to the home to deal with seniors after a hospital inpatient stay, sending younger aides out of college to schools to work with autistic children, asking nurses and PAs to diagnose respiratory conditions, blurry vision, emotional disturbances in urgicare or the ER. These are all important developments driven more out of necessity and demographics than policy. Having more allied health professionals is important, as is an emerging cause of using consumers to volunteer to provide healthcare education or social services to at-risk populations. But what will be equally important to evaluate is how well they are trained, how well versed they are in making clinical decisions and understanding when to treat, how and what the cause of the condition may be, and how quickly they can find the doctor.