1. 345: The number of moms and dads we polled about a seemingly mundane question – how they decide where to go for healthcare. Moms seem more thoughtful – relying on their OBGYN or their neighbor who’s a pediatrician, or Dr. Oz and NPR, while Dads, somewhat predictably, rely on ‘it getting better without them doing anything or, increasingly, the nearest urgent care. Moms are more often changing doctors and more thoughtful about where to go and whose advice to use. Unlike Elaine of Seinfeld fame who failed to change doctors because her last one wrote in her medical record that she was too difficult, today’s generation of Elaines have more access and control over their records, and more say in where to go. They tend to rely more on what they know, hear and see every day, sometimes for good and sometimes not. In our study of 345 adult consumers there are some clues as to how people select specialists and how little people rely on insurance to guide them. Full study, click here.
2. Acupunture on Rise: BlueCross BlueShield of Tennessee will now cover acupuncture, a traditional Chinese medicine practice used to relieve pain and treat other conditions. Additionally, the insurer will replace Oxycontin with Xtampza and Morphabond, whose formulas make them more difficult to crush and “delay the high.” The replacement drugs cost more, but BCBS is keeping the member co-pays the same as they were for Oxycontin. BCBS is also lowering their daily morphine milligram equivalent (MME) of any opioid, patch, pill or syrup to 120 ml.
3. Circulation Devices: Effective July 15, 2019, Cigna will be updating their Pneumatic Compression Devices and Compression Garments medical coverage policy to deny pneumatic pump claims billed with international classification of diseases. Pneumatic compression devices are machines with an attached inflatable garment that has multiple chambers that inflate one after the other to stimulate circulation in the right direction. Additionally, they will deny claims billed with Healthcare Common Procedure Coding System (HCPCS) code EO676 as experimental, investigational and unproven for any indication in the home setting.
4. RadioPharma OP Approvals: Effective May 1, 2019, UnitedHealthcare will require prior authorization for therapeutic radiopharmaceuticals administered on an outpatient basis for UnitedHealthcare Community Plan members in Arizona, California, Florida, Iowa, Maryland, Michigan, Mississippi, Nebraska, Ohio, Rhode Island, Texas, Washington and Wisconsin. The process to request a PA for therapeutic radiopharmaceuticals for UnitedHealthcare commercial members changes too.
5. Urologists Complaining: Urologists in particular are seeing issues with prior authorizations. “More than nine in 10 doctors said prior authorization has a significant or somewhat negative impact on clinical outcomes. More than one-fourth (28%) said prior authorization has led to a serious adverse event such as a death, hospitalization, disability, or permanent bodily damage. Three-fourths of physicians said prior authorization can lead to treatment abandonment, and 91% indicated it results in care delays,” reported the Urology Times.
6. Marriage Vows: My parents enter their 50th this year and mom wants to do her vows at the same church her dad was baptized in the hills of Monte Cicerele, Italy, near Napoli, but their anniversary is on the same weekend when dad usually preps the garden and watches the US Open on TV so this vow exchange likely stays local. In managed care, the next marriage to watch now that Anthem has acquired Beacon, is United and Magellan – and these marriages will be far from “local.” These integrations can change contracting and network considerations particularly for behavioral health and primary care, and likely increase attention and use of things like centers of excellence and telepsych. As predicted here, Anthem this week announced they will be purchasing Beacon Health Options, which will add a national network of behavioral health services in an effort to care for “the whole person.” This transaction is expected to close in the fourth quarter of this year. Beacon currently manages mental health and substance abuse services for more than 36 million people in the United States.
7. Extra Point: My son complained of a sore throat last night. My wife said “it’s probably strep.” My daughter said it’s definitely because Tommy doesn’t wash his hands and hasn’t changed his clothes in 2 weeks, so he’s sick. Jack had another diagnosis – “Um, Tom, maybe it has something to do with the half bottle of Sprite you just chugged…” Indeed, drinking soda and fast can’t be good, and Tommy’s so-called sore throat was simply an acute version of GERD. On the downside, he was complaining all night, but on the upside, he is swearing off Sprite.