Four: Autism is 4x more common in boys and ADHD prescribing is far more common too, spurring a new wave of sports-focused programs led by counselors, coaches and educators that take the principles of applied behavioral analysis and put them into practice. Literally. Several models have popped up as alternative offerings for parents whose idea of a win is not measured in points or playing time or whether Robby will make the elite team, but in exercise, focus, social development. One of the earlier models we covered is discussed here. Expect continued interest in these alternative models as the cost of autism rises and more kids get diagnosed sooner. Also expect more insurers to take a closer look at the diagnosis and treatment plan given what about a third we’ve polled say can be a misdiagnosis, given that kids labeled with autism spectrum often have ADHD symptoms.
Women’s Health First Click: WebMD is launching a new platform that will allow users to search its database for physicians based on specialty, openings and insurance. Back in 2016, we polled moms in our health accountability study about where they turn first for healthcare insights and 38% said WebMD. Incidentally, Dr. Oz was third at 15% and ‘my mom’s group or book club’ was second at 24%, up from just 6% in the first poll of the same 375 moms back in 2010. Building off its physician database, the WebMD Care platform will also include chiropractors, dentists and health care professionals specializing in acupuncture and holistic modalities. It will also boast a free prescription savings service where visitors can compare prices at local pharmacies.
Now Hear This: Starting in May, hearing screening with or without the use of audiometers or other electronic devices and vision screening will be separately reimbursable from preventive medicine evaluation and management visits under a new Anthem Indiana policy.
Cardiology Innovation: In our healthcare payer index publishing this month, cardiology moves into the Top 20, the first time on the list in the 15 years of the index. Medical directors, particularly those board certified in cardiology, say there are few big trends to keep an eye on including the shortage of adult congenital trained cardiologists and a new pulmonic valve from Medtronic that should help treat patients with congenital heart abnormalities, as about two thirds of those with this condition have an anatomy too big to be able to have a percutaneous value, so they end up having a more risky open heart surgery.
Triple Threat: Cigna and Oscar Health are partnering up to provide more health plans for small businesses. Fully insured plans will be sold under the Cigna + Oscar brand and will focus on integrating medical, behavioral and pharmacy services in a kind of triple threat. Technology will also be a focus with 24/7 no-charge telemedicine.
Free Food For Thought: Starting in 2021, Optum will begin offering pre-paid debit cards to its members...for the full story, click here.
Habit Change: Constanza once famously started doing the exact opposite of his usual behavior in a last-ditch effort to lift himself from being a self-prescribed loser. George was ahead of his time as healthcare companies like Newtopia are working now on habit changes to help employers prevent disease. They tout savings of 70% or more under an Aetna study. The program includes genetic testing and 1-on-1 coaching with a focus on keeping people healthy and changing behaviors in those who have signs of potential disease. These employer programs aren’t new, per se, but they are evolving, with more focus on mindfulness and yoga and use of test results to guide habits and avoid disease onset. But they have the same challenge - they get a PMPM for a period with a goal of bending the cost curve and ultimately need to show ROI quickly up.
Rx In and Off: In 2020, insurers are adjusting drug formularies more than my daughter sings Frozen. Several trends: Gonal becomes the preferred drug for in vitro fertilization while Follistim AQ moves to non-preferred. Xolair wins as the preferred treatment on a number of formularies for asthma, while cancer therapies Tarceva and Xytiga are now off formulary given generic alternatives. ADHD medications are now increasingly requiring pre-approval, as well as tighter evaluation after 6 months, as insurers see value in non-medication approaches. Forteo and Tymlos, two osteoporosis drugs, will now have quantity limits and require pre-approval. For GI practitioners, Xifaxan will require quantity limits but Trulance will become a preferred agent for irritable bowel disease.
Extra Point: My cousin Matt could sketch a lion or tiger leaping through a meadow in just minutes. He would captivate my kids after Sunday supper more than any iPad could. ‘Matty can you show me how to do that like you?’ He then had the patience and imagination to show my youngest Tommy how to draw a dolphin riding a bicycle. He had a gift but passed away a week ago today from a 20-year battle with addiction. The Heroin ultimately got him. His parents found him. He just could never get enough. It seems so many more of us know someone with addiction. Perry Meadows, a medical director I’ve done panels with, always chokes up talking about his son’s addiction and what might have been. His son’s story has very much framed Dr. Meadows' work in trying to address addiction at Geisinger. There are signs that the opioid crisis has turned and that there are new ways to address addiction, new treatments, new delivery models. Matt never had any success in treatment and never did medication assisted therapy. I wonder what if. I wonder if he could have one day worked for one of the companies some of you lead - those changing the outcome of addiction. Could he have done art therapy? There are tons of regrets when you outlive your kids as my aunt and uncle did or when you are giving a eulogy at your cousin’s funeral. There are no words. For those who have gone through this they know that managing the disease is nearly impossible, that it cannot be solved in a day, or with words or treatment alone. It takes something more. I would argue the unique models popping up like Aware’s at-home addiction treatment or Eleanor Health’s global risk-taking featuring MAT and social support are great successes that show what’s possible. Question is whether stigma lifts and whether more creative models can be developed.