42: Percent of people delaying healthcare appointments due to the pandemic, while just 16% delaying mental health appointments, a BCBS spokesman said, thanks largely to a system of virtual sessions that was already changing before the virus. A local solo therapist for teens in southern New England had hired 5 school psychologists in January for tele sessions, turning her caseload from 50 established to 200. On a national scale, Magellan saw a staggering 1,500% increase nationally in behavioral health telemedicine claims from February to early April this year while Talkspace volume is up 65%. The point: psych works virtually and patients like and trust the model.
Marriage Is What Brings Us Together...Today: Omada Health acquired the musculoskeletal and physical therapy company Physera last week, the latest in unusual but true healthcare unions. Unusual because this isn’t the traditional hospital or doctor’s group acquisition. Omada is a digital health company, offering a variety of services that range from diabetes prevention and management to mental health tools, and with the purchase of Physera, the company adds virtual PT services to its line-up. This collection is interesting in that it blends compatible services and providers who, in theory, should be coordinating care. Ask insurers what they think of virtual PT and you’ll get a tepid response at best. It’s one of the core outpatient services that we would expect to see limited impact on from telehealth.
Getting Attention: For those of you thinking about how to get managed care’s attention on value-based care in a way that makes sense for your business and doesn’t become just another cost of operations with limited upside, here’s a way to think about it: In 2005, a cancer care provider I interviewed in Michigan wasn’t getting reimbursed for daily phone calls it was making to patients to help keep them out of the hospital. It used the daily log and data from it to get a bump in its contracted rate and an annual bonus based on ER reduction. This was early telehealth in its truest form and was among the first value-based payment models. There was no consensus on measures beforehand, it was entrepreneurial and didn’t disrupt the insurer’s systems. In 2010, as opioid prescriptions were rising, a PT clinic in Connecticut trained its assistants and PTs to flag depression, addiction, and eating disorders as part of initial assessments, as well as a part of each of the first three visits. In about 10-20% of cases of chronic pain, the group was able to flag the root pain issue, contact the employer or PCP or both, and help create a new plan of care to treat the problem. That practice used its data to get a higher fee, not an incentive or a share of savings, but more for each visit because they showed they were doing more in an hour to save the system more later. But it can be difficult to get managed care’s attention these days, not just due to COVID-19, but with virtually every specialty and service trying to compete for value dollars. One concept to consider, and it’s by no means an easy one, is to think about your value on broader scale - not just ER savings or medication reduction, as most of the earlier models have focused on, but savings for the community that surrounds the patient. How is your service helping reduce costs for the patient and the caregiver or community? This study we started last year was the beginning of what we thought showed the next great epidemic - caregiver health decline. And while it reveals the cost of caring for sick patients, it is also partly a recipe for how to get managed care’s attention. Link here.
Remote Monitoring: In what is likely an escalating trend of integrated delivery networks adding nursing and remote monitoring to care for chronically ill and prevent admissions, Geisinger, in coordination with its health plan, launched a new mobile app to help those recovering from COVID-19 at home. Through Epic’s MyChart Care Companion, patients remain in contact with clinicians and report their symptoms, temperature, and oxygen levels. If there are any alarming findings, nurses can reach out immediately to patients and video calls with clinicians can be scheduled to determine if the patient needs to be moved to the hospital.
Tracing Virus: Employees at Medica, a non-profit health plan, will call patients with confirmed coronavirus as part of an effort to help the Minnesota Department of Health conduct contact tracing for the state. Over 200,000 Minnesotans have been tested, resulting in more than 20,000 positive cases and 881 deaths, as of May 25. Calls will run 45 minutes, with hopes of distinguishing any acquaintances or family members who may have been exposed to coronavirus through the patient. Blue Cross Blue Shield of Minnesota is also assisting.
Breaking Glass Ceiling: UnitedHealthcare has signed an agreement to bring online-only vision retailer GlassesUSA.com into its network, according to John Ryan, UHC’s vision manager. Members with employer-sponsored or individual vision plan coverage will have at most a $25 copay.
Re-Open for Business: For the latest on behavioral health re-openings, click here.
Extra Point: Ironically on the same day the space flight got delayed due to unpredictable weather, my 82-year-old mother in law went for a drive to Boston’s Logan Airport to pick up her 83-year-old brother who was flying in from the west coast. She left her condo before the pancakes were bubbling up in kitchens across America and by 6:30am, her brother was off the red-eye and in Ma’s car. They did what most 80-something siblings do during a global pandemic: they went to Kelly’s for a to-go order of fish ‘n chips, popped a squat on Revere Beach to feed the seagulls, then attended Father Dan’s 8 o’clock mass, where they prayed for doctors, nurses and, of course, the Red Sox. They returned home a tad after 3 o’clock and when we finally got through on the phone, Ma convinced us her brother was resting in the bedroom. She gave us the play-by-play of his cross-country voyage from Spokane to Boston, and hers from the North Shore to Terminal B. Now, if you know Uncle Mike, you might say that it’s not entirely strange that he’d fly across the country in the middle of a global pandemic. But of course, he did not do that. None of this actually happened, but Ma thought it had. This is dementia. And when coupled with anxiety and loneliness, it means eroding senses and disabling decision-making. In the days before, Ma visited grocery stores, had her tires rotated for $900, and bought an ice cream cone from the ice cream truck. So here I am on a Friday morning, on the way to bring Mom to us. My second attempt in as many weeks. She will invariably resist but has little choice. Like that weather pattern that forced NASA’s mission to delay, Ma can be a bit unpredictable and needs a safer, consistent environment. These caregiver challenges are happening nationwide, not just in my family, but in many of yours, and they will only become more pronounced as the virus continues, or if and when there is another wave in the winter. I would suspect that the demand for home healthcare workers during this next wave will rise, and businesses able to marry remote monitoring, symptom checks, and dementia management could thrive.