1. 90: Percent of US population who live within 10 miles of a Walmart where finding home goods and supplies probably just got easier now that the retailer has partnered with home health company Amedisys. How the partnership will play out remains to be seen. The objective of ‘Walmart Health’ is to provide clinic-based primary care, counseling, home care, and dentistry, at reduced costs. If our straw poll is any indication, the medical director community isn’t buying yet – just 11% said they anticipate high-quality care at Walmart, with several ‘wondering if the partnership’ could potentially ‘disrupt our efforts to narrow home-care networks.’ Alternatively, these retail-healthcare partnerships seem to be increasing. Best Buy, if you might recall, bought an emergency call service called GreatCall to add to its home-based motion sensor and monitoring technology to help aging seniors. You could see risk-taking super groups promoting such a service and technology, perhaps MA plans too. Perhaps offering discounts on flat screens or DVDs if they even exist in 5 years. Can’t you just see it – while Best Buy installs the sensor in your mom’s condo, you ask the technician if he has Geek Squad credentials to help reboot your laptop. Then the Amedisys nurse arrives in a Walmart van to take your vitals.
2. Path to the Lab Side: Contracting changes over at Anthem are probably going to lead to some challenges for pathology companies. We’ve heard that the team that used to be responsible for contracting with pathologists is no longer involved, that the job has moved over to what’s called the ‘ancillary’ contracting department, which is the same group responsible usually for DME and clinical lab. And in their first move, commercial reimbursement will change to be in the range of 60-80% of 2018 Medicare rates. Now in some markets that’s only a bit lower than the usual, but in others it’s potentially a much bigger drop.
3. Contracting’s Next Life: This whole idea of changing who is responsible for contracts isn’t all that surprising if you consider how much insurers now have to change arrangements from fee-for-service over to value-based risk. It’s a new world so they’re trying to create specialized contracting experts. Sean Duddy, whom I’ve known for years in his role overseeing managed care contracting at the health system Franciscan Alliance in the midwest, says that ‘nowadays the number of personal contact relationships with each payer is growing exponentially,’ depending on the track you (the hospital or the physician practice) are discussing with the payer. ‘There’s a rep,’ Duddy says, ‘for the FFS contract and a different one for the ACO contract, and there are other reps involved with other lines of business.’ To listen to my conversation with Sean, click here.
4. The Groupon Phenomenon: Patients are using Groupon and other pricing tools to get deals on bundled medical treatments and services. MDsave, a site that contracts with providers to offer these discounts, offers deals at more than 250 hospitals in the U.S. and sells discount-priced vouchers for ultrasounds, MRI’s, back surgery, and more. My wife says she wonders how good these providers are if they’re partnering with online pricing tools. Fair question, but the market is asking for these more transparent healthcare options for the uninsured or underinsured, like those with high-deductible plans. These ‘coupons’ aren’t new per se. There are deals for dental work, eye care, mammograms, and medication.
5. UnderCare: Hospital visitation is down, membership in the public option MetroPlus declined, and post-acute care patient satisfaction is at the lowest point in 5 years here in NYC, according to a City report by Mayor de Blasio. At the same time, spending, staffing amounts, and overtime are rising. Approximately 1,081,000 people visited the 11 hospitals in the 2019 fiscal year compared to approximately 1,112,000 last year. MetroPlus, the city’s affordable health plan on Medicare and Medicaid, lost about 3,000 members. Pediatric care wait times rose approximately 1.5 days longer for care, blamed on a new EMS system, while fewer women received mammograms and prenatal care. Details here.
6. Cardio Screening Grows: After childbirth, Cigna is now recommending providers screen for cardiomyopathy, or weakened heart muscle, because each year 700 women die from complications of pregnancy and 60% of these deaths are preventable. It will be interesting to see whether the emerging episodic payment models for maternity that include the 3 months post-delivery will include screening like this, and how that will factor into the payment to OB-GYNs.
7. Social Screening Lags: Despite the hype surrounding the importance of social determinants of health, including new codes to report work in this area, just less than a quarter of hospitals and approximately 16% of physician practices screen patients for social needs that affect health outcomes, according to a report published on JAMA Network Open. It does appear that practices serving more economically disadvantaged populations screen more than others. Kaiser Permanente, United Healthcare, and the American Medical Association are working to address food insecurity, housing instability, and transportation, among other social barriers to good health. We reported on those new codes in the spring; click here for details.
8. Extra Point: So I was at my checkup a couple weeks ago and my internist had the audacity to give me homework! ‘I want you to keep a log and then record your BP.’ So here I am sitting on the couch last week, filling out my log, wearing my cuff, complying. It’s quiet and my bride heads out with a friend and I tell her, ‘no worries, I’ve got this.’ My daughter Sophie quickly says she needs help studying for her ancient civ test even though she has no notes, and no textbook. We start frantically googling things about the Ottoman Empire just as my middle schooler Tommy comes to ask me if I can help him simplify some improper fractions and solve for ‘X’ which—let’s be honest—I cannot do. I shuffle him off to Mukue, who gets As in math in high school, but I leave the kitchen unguarded, so the dog starts licking the rest of the chicken out of the frying pan while my oldest, Jackie, yells from his room as though he’s the only one in the universe, to ask me if I’ve seen his stretch cord for those at-home PT exercises he keeps avoiding. Orthonet, for what it’s worth, has stopped paying for his PT visits and frankly I agree with them. And now I’m not only doing my homework, I’m doing theirs! Flash forward about 3 hours and 2 of them are crying and none are in bed….and my bride, God love her, gets home and says ’what in the world did you do?’ So I respond like I thought I should, which is to say I stood up, tapped her on the shoulder, and said ‘you’re right honey, this is hard.’ Now I don’t know about all of you, but there are times managing the care of these kids can wear you down…but I will say these moments, like helping kids with homework, do connect us. It’s this sort of shared experience many of us have not just as working in healthcare, but as parents of teenagers. I know I’m trying not to wish this away, if for no other reason than because eventually these kids will be taking care of me!