1. 59: Percent of school teachers and administrators in our poll of 1,306 last month who say 2 of their top 3 challenges they need help addressing in the next school year are health related—autism and mental health.
2. Jet Blues: The airline operator now will give its employees access to psychologists and psychiatrists 7 days a week at $20 a session.
3. Pre Approval Coming: BCBS of Texas will require pre approval starting at the end of August for genetic testing and sleep studies. Evicore will handle the decisions.
4. Lung Outcomes: Kramer took dog pills to treat his chronic respiratory condition during a classic Seinfeld but much has changed since the 90s – now, drug companies take risk if their treatments don’t work, so people like Kramer don’t need to experiment….for instance, commercially insured with Highmark BCBS in mid Atlantic states Delaware, West Virginia, and Pennsylvania can benefit from an outcomes-based contract between the insurer and drug company Astrazeneca’s Symbicort, which helps decrease lung inflammation in patients with asthma and COPD. Essentially, Astrazeneca gives a rebate back to the insurer if patient’s Symbicort falls short of its marketed goals.
5. Rx Review: At a recent drug utilization review board meeting we attended, the committee said it will look back for several ICD-10 diagnosis codes for those with depressive disorder, and then look back as far as possible for prior diagnosis. Other topics to be investigated: patients on long acting injectable drugs may not need oral antipsychotic drugs, and those diagnosed with epileptic seizures or muscle disorders should be flagged for chronic use of benzodiazepines because these aren’t first-line treatments for seizure treatment.
6. Falling Down: Falls in seniors was named as the number one risk to injury and hospitalization and unexpected medical costs that can impact a risk-taking primary care group….and I would argue that the root cause of falls is not poor balance or drinking or slippery conditions – yes, these are all factors particularly in gloomy, icy New England in about 6 months – but moreso dehydration or malnutrition stemming from often untreated grief and loss, or PTSD. As risk taking groups, it’s important to understand your patient’s home environment and what drives their behaviors – learn not just about their medical history, says Nancy Feller, MSW, who does home visits for physicians taking risk, but learn about their ‘social’ history too.
7. Teach Your Children: As Crosby Stills & Nash would say, teach ‘em well and let them lead the way…74% of academic centers in our poll say they are concerned about the future of their model as care shifts out of hospitals, but a majority of them say they are creating a strategy to partner with community-based practices and expanding their teaching programs to incorporate other sites of care, including value-based models where the academic centers will acquire or partner with pediatric specialists and care management providers who can ‘get into the home’ as patients are discharged.
8. Tiered HMO: Starting in October, BCBS of Rhode Island will offer a so-called tiered HMO network. Only high performing providers are included and, interestingly, there is at least one provider for each of the 6 New England states, including for surgical treatment. As a lifelong New Englander, it is nice to see a network that gives us Yankees access to specialists we may not have in our area, and it’s particularly beneficial for the large number of New Hampshire and Rhode Island residents who work in Boston and can sit up to 3-4 hours in traffic to get home or work.
9. Extra Point: I’m writing today from Babson College, site of the opening of the Pan Mass Challenge charitable bike ride for cancer research. It’s so humid here the air is sticking to me like cellophane. I’m wearing humidity like a hoodie and I’m not looking forward to pedaling for 7+ hours. But that’s New England in August – generally miserable. My Aunt Jane and Uncle Bobby from the south part of Boston used to have me over the night before my first few rides in their 197 degree apartment. ‘Turn on the fan Bry, don’t be shy, crank it on, but not too high because it’ll blow all my papers…’ Jane would say, holding her ashtray like a catcher’s mitt and dangling a cigarette over the Schitzu. Jane’s papers were mostly old Funnies and crosswords, and a stack of bulletins from Church with the ‘megabucks’ numbers scribbled on them in red pen. ‘No, I’m good Aunt Jane…I tend to really enjoy suffocating…’ ‘Well that’s nice,’ she would say, her mostly deafness preventing any of us from having an actual conversation….This is my 9th ride and this time is particularly tough as I’m, one, out of shape, and two, riding for the guy who, even in his 50s, still shoots hoops and back cuts like his days playing for Pete Carril at Princeton. Burke and I are often matched up on Sunday hoops as the two short guys who never stop moving. Burke’s family has been hit from both ends – his wife a tough but beatable breast cancer, and now his teenage son with a surprising but all-too-real testicular cancer. John is 17 and himself is a good ballplayer. I am hopeful for John and Carol’s recovery and for the good doctors taking care of them, and I’m hopeful for Burke who takes on the role so many of us have had to as caretakers. In fact, I was talking to several insurer medical directors last week about the idea of studying the impact of diseases like cancer on caregiver health. Like most of you impacted by cancer, I’m hopeful that all of the good things we see lately in cancer treatment and payment innovation will have a real impact. In my days as a correspondent covering oncology, I remember how Highmark took a chance on sharing savings with UPMC for keeping cancer patients out of hospitals. Now, even drug companies are taking chances that their treatments can shrink the size of tumors faster than plan, willing to risk sales if the tumor wins. These are bold times and I could use a bit of boldness this weekend myself….to read more on my ride, click here. I’ll be interviewing physicians, patients, and families along the way and will report back next week.