600,000: Number of people who are weekly users of the drug methamphetamine in the United States. The State of South Dakota launched a media and billboard campaign -- ‘Meth: We’re on it’ -- to bring awareness to the epidemic and destigmatize substance abuse disorder. The campaign went viral on social media with many people questioning the ad’s message. The campaign uses a website to help educate people in the U.S. on the signs of meth addiction and provides the resources available to combat addiction.
Volunteers Back: First Tennessee’s college football team, which heads to the Gator Bowl in 3 weeks, and now a study showing that volunteering reduces depression and improves overall health, including lower blood pressure. A survey for Charity Community Service Volunteers found that half of those who had volunteered for more than two years said it made them feel less depressed. The poll of more than 600 volunteers also found that 63% of 25-34 year olds and 62% over 65 said volunteering reduced their stress levels.
Gene Therapy Outcomes Pay: Cigna has developed a coverage program, the Embarc Benefit Protection, for two gene therapies that don’t require any out-of-pocket payments related to the cost of the medicine. The insurer will pay a per-member per-month (PMPM) fee, starting in 2020, to access Embarc’s gene therapy network and physicians are required to submit prior authorization requests for patient eligibility. Novartis subsidiary AveXis developed the gene therapy Zolgensma and is partnering with Cigna’s coalition members offering payers pay-over-time options up to five years and outcomes-based agreements up to five years for the drug.
The Caymans In Network: 70% 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?
Integration Rx: In the latest move by the big insurers to integrate medical and pharmacy, UnitedHealth is acquiring the specialty pharmacy and infusion services provider, Diplomat, which manages medications for patients with complex diseases, such as cancer, hepatitis, HIV and multiple sclerosis. The company will be part of the Optum organization.
Falling Down: I mentioned last week at our conference’s managed care panel in DC that my mother-in-law fell 3 times over a 2-year period because she was orthostatic and dehydrated and, ultimately, wasn’t being monitored enough. Humana will soon be able to deliver a more integrated, meaningful care experience for its high-risk Medicare Advantage members, like my mother-in-law, through a partnership with Royal Philips. Humana will identify at-risk MA members and offer them a Philips Lifeline medical alert service, including a fall detection device that is supported by predictive analytics technology. The partnership will also aim to help those members with CHF, allowing these patients to proactively manage their own care from their homes with remote monitoring.
Avoidable Admit: Several hospital systems are combining efforts to provide in-home care to patients who would otherwise have to be admitted. Ascension, CommonSpirit and Highmark Health are among those in the collaboration. A Highmark executive says they were initially surprised at how many patients were flagged as potential candidates for at-home care, according to a spokesperson. Messina Health noticed that at least 40% of the system’s admissions were for medical complications that did not require 24/7 monitoring.
MacEnroe The Boat Ashore: The tennis legend never believed the baseline official had it right and his iconic, if not incredulous, stance depicted here in this story serves as a metaphor for healthcare leaders today trying to figure out the right baseline target for total cost of care. Click here.
Extra Point: In 2020, United will start to pay oncologists for following evidence-based pathways. The program will reward physicians for following the pathways at least 75-80% of the time. This is not novel - Aetna started this back around 2010 and Highmark BCBS before that. Ira Klein, MD, a medical director for Aetna at that time, told me when I was reporting on these issues that the idea would be to share savings by encouraging the right choice of drug protocol and post-treatment at home, but that there are always circumstances when the patient or tumor type requires a unique approach. If I tried this model with my kids, it would fail miserably. Of my 5 kids, 2 of them will eat the chicken and rice and veggies, the rest say they need some combo of mac ‘n cheese, Oreos and Honey Nut Cheerios. 1 will clean her room, the rest will have too much homework. 3 will practice their instruments, 2 wing it on concert night. And as I’ve instructed, 3 don’t use semicolons in their essays, as they are the lazy man’s comma, but 2 still do. Well, you can’t always change behavior and here’s hoping United has more success than I have...