1. 174 of 221: Middle schools in our poll this week who said they hoped to add psych and mental health programming and staff into their 2020 offering, including experimentations with telepsych in some districts and partnerships with local mental health groups, but have ‘struggled to staff and recruit’ due to a shortage. Only 86 of the 174 say they filled their slots and started programming.
2. Extenders Win: In an effort to increase access to healthcare, Anthem Virginia now contracts directly with NPs and PAs for its Medicaid beneficiaries under new state regulations that took effect last month. These allied health practitioners, if credentialed with Anthem, must bill the company’s HealthKeepers system directly using their own ID; billing incident-to is longer applicable. Nurse midwives are contracted separately.
3. Second Opinion Out: While pre-authorization is still required, the city of Chicago will no longer require employees to get second opinions for hip, knee, shoulder, neck, gallbladder and gastric bypass surgeries. The city used to require its BCBS of Illinois insured members to go through a service called Best Doctors to get second opinions; the service reportedly reduced the number of surgeries needed by 10-15%. The new policy takes effect in January 2020.
4. Medication Drop Ship: UPS is expanding into healthcare, or at least the delivery of health care products. It has partnered with CVS to test delivery of prescriptions and retail products to the homes of CVS customers, not by the brown trucks we are all familiar with, but by drone. UPS Flight Forward, a subsidiary of UPS, already uses drones to ferry lab samples between locations of WakeMed hospital in North Carolina.
5. Uber Meet Cerner: Uber Health is partnering with Cerner to allow hospitals to schedule non-emergency medical transportation pick up and drop off through Cerner’s hospital EHR platform. Patients do not need to be Uber customers or have either the app or a smartphone because health care providers will set up the service.
6. Uninsured Target: In 2018, 5 million Texans had no health insurance but efforts to address this are here as BCBS of Texas will open 10 Sanitas-branded clinics in the coming weeks in areas where the highest number of uninsured people live like Irving, Mesquite, and Houston. These PCP-retail clinics will compete with Walmart’s health clinics and CVS Health’s 1,500 new health clinics opening by the end of 2021.
7. Behavioral Switch: In a continuing trend, insurers are moving management of behavioral in-house – the latest being BCBS of Illinois, which is set to take over behavioral benefit decisions for AT&T employees starting in January. It will replace Beacon Options, the current benefit manager.
8. Radically Different: Even as insurers begin to lay groundwork to require episodic payment for radiation treatment, they are adjusting the criteria for coverage, and sometimes in positive ways. Anthem, starting in February, tells us they will broaden the description of adjacent normal issues which may be a concern and allow for IMRT or SBRT and add new guidelines for fractionation with EBRT or IMRT in treating prostate cancer. AIM Specialty is making the changes and overseeing decisions. Contact me for full details.
9. United Changes to Site of Service, Technical Payments: In October, United Healthcare started doing site of service reviews for sleep studies for its Medicaid plan in Missouri and starting in February, United will start doing site of service medical necessity reviews on MRI and CT for its Oxford commercial plans. Additionally, UHC will no longer allow separate pay for the technical part of neurophysiological studies (billed with codes 92585 and 92587) and audiological function tests (billed with code 92588), when these are reported at a facility place of service. Currently, you can bypass the denial under certain exceptions. The new policy mirrors CMS rules.
10. Tech Boom: 46% percent of young people would prefer to have a broken bone than a broken phone, according to Margaret Laws, CEO of Hopelabs, which has developed technologies to improve the emotional health of teens and young adults, including mobile apps, wearable devices and virtual reality enabled diagnostic tools. These tools come at a time when depression is up 52% on college campuses and college counseling has increased 5 times due to anxiety, depression and stress. In high school, the numbers are equally staggering, with a 22% rise in the latest poll of freshman experimenting with eating disorder behavior, according to one of our latest polls of 812 parents. Using technology to help the Gen Z population access support more quickly is one solution. Laws, who we met at the Connected Health Conference in Boston in October, says teens are asking questions like “why can’t I text with my doctor?”
11. In case you missed it: Check out stats on where medical residents are looking to hang a shingle in our new poll-- click here.
12. Extra Point: I lived with my grandmother Carmella when she was about 10 years into the Alzheimer’s, so I was struck this week by a documentary about a boy and his dad and a disease that may be hard to understand and impossible to manage, but doesn’t need to be the end. Read more about it here.