8 is Not Enough: An 8% reduction in chronic care condition downstream costs from frequent exercise among commercially insured has health plans seeing the potential of movement and many are creating new CEOs. Blue plan executives we chatted with this week say they are appointing chief exercise officers who will head up a range of initiatives following results of the new national study. Ideas floated in our poll: exercise breaks at a set time each day led by mix of celebrity instructors like Glee’s Sue Sylvester or using supplemental benefit Star bonus dollars for Medicare enrollees to build at home and small community aerobic classes. In most cases, a capitated PMPM system would be used to bring in vendors to help run the program.
Gene Therapy Expanded: Cigna has recently widened its gene therapy program. The program covers two gene therapies at no cost to patients for the medications. Employers and unions would pay a PMPM fee to access Cigna’s network but would first have to submit pre-authorizations. Steve Miller, MD, Cigna’s Chief Medical Officer, hopes PMPM will reach $1. Originally, Express Scripts and eviCore were helping Cigna with the program and now they have also brought Accredo, their new specialty pharmacy partner, into the operations.
Denial Tracker: We chatted with a member of Cigna’s coding and coverage team recently and heard of four updates taking effect this spring: They will no longer cover the inflammatory pre-filled Stelara syringes under the medical benefit. It will only be covered through pharmacy, but the vial will continue to be covered under medical. Secondly, tests used to measure drug concentration to treat conditions like irritable bowel syndrome are getting attention. Cigna will deny serum drug level tests when billed with an IBD diagnosis. Third, starting this spring, Cigna will rebundle CPT codes used into a single panel code for individual genetic tests that compose a molecular cancer lab panel. Lastly, Cigna has found that several OON ambulance companies are billing EKGs, oxygen and drugs separately at times. Cigna will deny these if billed separately by non-participating providers.
Filled Up Psych: Baton Route Medical Center in Louisiana has opened a special unit for coronavirus patients needing psychiatric stabilization. Ten of the unit’s 32 beds filled up quickly this week.
San Francisco Treatment: The city’s health department is collaborating with licensed physicians to distribute “limited quantities” of alcohol, marijuana, and tobacco through private funding to addicts in quarantine under the city’s program for housing homeless people in hotels. The idea is to increase the number of homeless people staying in hotels and limit hospital care for life threatening alcohol withdrawal. The model is a “harm-reduction technique,” estimated to help 700 people living on the streets.
Free Ride: Cost share is waived through September at least for United Healthcare’s Medicare members when seeing primary and specialty physicians.
Advanced Pay: InnovaCare Health, a value-based healthcare service company, will fully compensate PCPs in Florida and Puerto Rico for April and May, along with specialists, dentists, hospitals, and hospitalists to help with the financial loss from reduced patient volumes. Hospitals are receiving payments based upon average monthly billings while hospitalists are receiving full payment based on their contractual agreements.
Rural State Changes Course: Wyoming is the nation’s least populated and second most sparsely populated state, which makes one think telehealth would be a great option. But Dr. Lisa Finkelstein, who heads the telehealth program at St. John’s Medical Center in Jackson, Wyoming, says “there was very little buy-in for telehealth - there wasn’t any interest in trying it.” But that’s changed since COVID-19. Wyoming’s Telehealth Network had almost 1,900 providers join the network in March, compared to a couple dozen per month previously. Wyoming’s Medicaid program, as well as BCBS, have encouraged telehealth and expanded their policies and Dr. Finkelstein said she is prepared to lobby to keep these new policies in place, long after the pandemic ends.
Virus Treatment: Pharmaceutical company Acer Therapeutics has entered into an agreement with the National Center for Advancing Translational Sciences to develop emetine hydrochloride as a potential treatment for patients with COVID-19. Clinical trials are targeted to begin this year.
Mood Monitor: A new University of Oxford study of nearly 60,000 people suggests mood improvement is highly culture specific: exercise led to the highest increase of mood in a high-income country, religion did so in low and middle-income countries.
Trained Therapist: Blue Cross Blue Shield of Michigan is launching new telehealth programs with behavioral health providers, so its members can participate in group sessions to discuss the impact of COVID-19 on their mental health and share their experiences with others under the supervision of a trained therapist. The programs are available for free to members with Blue Cross and Blue Care Network behavioral health coverage through June 30.
Extra Point: When my 47-year-old sister gave my son $20 for losing a tooth a couple years ago, Tommy did what any 10-year-old would – he found his brother, ate a bag full of skittles, tied a string to the doorknob, the other end to his back molar and had his brother slam the door shut. He suddenly had $60. I told him “that covers all your teeth for the rest of your life.” It’s a lifetime cap, a per member per year. No more $1 per tooth, kiddo. Like any kid, he didn’t think through the costs. He bizarrely developed pain from one of the pulls, let it fester, and got an infection. He had to go to the dentist and miss the neighborhood kickball game. In Tom’s defense, he took risk, but it backfired. Dentistry risk-taking has been slow to develop but the coronavirus is initiating new models that may accelerate the trend. The TeleDentists company is now partnered with Anthem to do virtual checks for patients. The impact on clinic-based dentistry is probably limited post-COVID-19 but I would not be surprised to see Anthem and other insurers using these virtual dentist companies to steer patients to their favored practices. I haven’t verified if they are taking any risk per se, but I assume there’s a per encounter payment and maybe some incentives for steering kids, like Tommy, from going to the ER—or from pulling their own teeth.