1. Six Million: Adults in the U.S. who suffer from panic disorder. That’s 2.7% of the population. Women are twice as likely to be affected as men, according to research from the Anxiety and Depression Association of America. Many people don't know that their disorder is real and highly responsive to treatment. People with the disorder experience spontaneous feelings of panic as their brain goes into a fight or flight mode. The University Health News Daily states that causes of panic attacks in women arise more than men because researchers have identified 3 notable causes: serotonin deficiency, low vitamin B6 levels, and low iron levels. The disorder often occurs with other mental and physical disorders, including other anxiety disorders, depression, asthma, or substance abuse, which more than 84% of our surveyed physicians tell us complicates getting the correct diagnosis.
2. Military Ooopsy Daisy Or Intended Policy? In a bit of an interesting twist on what’s happening nationally, a military base in the south has required pre-approval for urgent care, but not for the ED. Guess what happened? Yes, this increased hospital ED visits. We will follow up this somewhat bizarre story as we learn more, though we have heard some in the health system community broadly questioning ‘overuse’ of urgent care, so perhaps this was the impetus.
3. Network Wins: Although still considered lower tier in the organization, a panel of 104 chief medical leaders and CEOs of health plans in 14 states we polled recently said that they have ‘elevated’ the role, responsibility and compensation of those in ‘network’ positions, tasked to help ensure the plan is ‘meeting regulations around adequacy of networks’ and also ‘supporting the contracting and value-based teams’ in identifying and rewarding the best of the in-network providers. ‘There’s not really a single specialty or service that is more important than the other – we’ve given the team a lot of leeway and the charge to build a better network. They were 3rd or 4th wrung in my book 5 years ago, now I have a standard weekly meeting with our VP’
4. Who’s The Payer Actually? When my youngest Tommy was 5 he said he wanted to be a payer, not the managed care kind like many of you are involved with, but the Harris Teeter grocery store cash register kind. ‘I want be a payer daddy so I can take the money daddy.’ He’s moved on to wanting to be a builder with scotch tape as his reinforcements. Good luck with that Tom. But his coming-of-age dream is interesting if you think what’s happening today. As you look at your mix of payers and think about expanding services to better serve patients and gain better positioning with employers and health plans and referral sources (including consumers), be aware of who the actual ‘payer’ is. A good example is Regence BCBS in the upper northwest. They may be the payer but if you’re in the physical medicine arena, all approvals go through eviCore, which is now part of Express Scripts, which may soon be part of Cigna, while sleep medicine and imaging must get approved by AIM, which is owned by Anthem. As providers integrate services, so too are payers. We would anticipate more integration in the next 2 years in the specialty benefit arena, so stay ahead of how this may impact your contracting and network position. It’s why we often say that the largest specialty benefit managers will be increasingly of interest because they will own a greater portion of the patient data around pharmacy and medical and ultimately behavioral utilization. How providers demonstrate an ability to improve all of these outcomes and costs will help offset pressure on rates.
5. HIV Rx: United Healthcare Oxford now covers the drug Trogarzo for the treatment of the multi-drug resistant human immunodeficiency virus (HIV) in patients who meet the criteria of both the diagnosis and the physician attestation that the patient has the multi-drug resistance. Criteria generally require that patient’s have failed on other treatments. HIV is a unique specialty class that payers have struggled to manage due to the lack of generics. Most have said they were eyeing the generic opportunity this year, such as for the drug Atripla.
6. Lower Cost Solution For MS: An online meditation course is reportedly helping MS patients manage their symptoms and reduce total costs of care according to results from a recent clinical trial. This training in meditation has been shown to ease depression, anxiety and sleep issues. The study recruited 139 MS patients in Italy who were randomly assigned to either an eight-week online mediation course or an online educational course. Participants had either relapsing-remitting or secondary progressive MS; patients with severe co-morbidities, severe neuropsychological impairment, psychosis, dissociative disorders, or who were pregnant were excluded. Those on meditation training were given a telemedicine mindfulness-based stress reduction course, which included music meditations, discussions about symptom acceptance, video conferences with a trainer, and live sessions via video-chat. A specific website was created to encourage the sharing of content among group members. The questionnaires assessed the patient’s quality of life, mental health and fatigue levels.
7. Opioid Rx Down But Not Out: Highmark Health has partnered with AxialHealthcare to assist prescribing physicians and other providers with pain management and safe opioid prescribing in Pennsylvania. This same program was enacted in West Virginia in 2016 and was very successful with patients. More than 250 providers received extensive, targeted clinical consultation on pain management. Patients receiving opioids from multiple prescribers has dropped by more than 28% and patients receiving opioids alongside certain sedatives — a significant risk factor for opioid overdose — fell by more than 25%. Additionally, a report from worker’s comp insurer conversations we’ve had suggests significant improvement in opioid spend year over year – as much as a 15% reduction in one case. These developments raise a question for those who own and operate substance abuse treatment centers – what will your opioid patient volume look like in 5 years?
8. TriCare Network Disruption: Changes to networks have caused a bit of disruption for eye physicians and should be evaluated if you have any Tricare patients in your practice. Tricare now slices the country into two regions, not three, using Humana and HealthNet and dropping United. EyeMed, which administers Humana’s optical network, says it was changing contracts with some physicians in the eastern US region to create what it called its own Tricare network. Some eye doctors who agreed to these EyeMed stipulations told us they were removed from the Humana Tricare network but apparently the American Optometric Association has come in to help advocate for these doctors to still be allowed to treat Tricare ‘Humana’ patients without agreeing to EyeMed’s contract amendments. While unclear where this has all ended up, it’s worth noting if any of your patients – regardless of specialty – are Tricare.
9. Extra Point: Bob Hope once said he’d give up golf if he didn’t have so many sweaters. I used to play a lot but have migrated to tennis and hoops in my quasi middle age. Still, on Masters weekend, golf has a way of bringing you back and for those of us in the healthcare field, it is part therapeutic, part disease. I asked 456 consumers and healthcare workers from our alumni network last fall to weigh in about their sports life. Of the 183 who had picked up a club in the past year, 103 said the sport was more therapeutic than disease while 80 said despite their love of the game, it usually added anxiety, depression, anger and quite often chronic pain. Said Mark Narens, Rph, who works for a hospital pharmacy in Rhode Island: I used to play 9 after shifts during residency and occasionally on weekends with my brothers but I found myself taking too many pills before and after rounds, and I’m a pharmacist! Narens, like many others, says he’s graduated to what I myself have: a few good rounds a year battling windmills on the mini-golf links. It’s no Augusta National, but there’s something about knocking your kid’s pink ball out of the way enroute to a hole in 4.