62: Percent of medical directors, out of 100, we polled who say they get pitched ‘all the time’ on value-based models or capitated payment concepts but often get rebuffed internally from the informatics or actuary team who ‘can’t figure out a way to code’ for the new model and handle all the claims. If there’s a lesson here, it’s that the medical director is important to get on board. You’ll need an ROI argument and a ‘time to ROI’, but ‘you’ll need to be prepared for pushback on how this can work administratively’.
Concierge Surgery Benefit: Employer Direct Healthcare of Texas, a healthcare services business providing solutions for self-funded employers and their members, is partnering with the small health plan Centerstone to offer its 4,300 members a concierge surgery benefit for more than 1,400 non-emergent procedures. Centerstone will waive all coinsurance and deductible obligations when the members elect to use a participating surgeon.
Rx Distribution Innovation: This week saw exciting technology advances - private company SpaceX successfully took men to space, and public company CVS Pharmacy teamed up with Nuro, a delivery robotics company, to test out medication deliveries using self-driving vehicles. The pilot will be limited to three different ZIP codes in Houston, and customers will be able to order their prescriptions, and other items, and have them delivered within three hours, for free. Earlier this year, CVS partnered with UPS Flight Forward in a pilot to deliver medications via drones to a retirement community in Florida.
Insurer Backs Multi Specialty Clinic: Most of the insurers who have opened their own centers, like BCBS of Texas, United, and Humana, have focused on primary care only or single specialties, like oncology. CDPHP, a health insurer based in New York, is working alongside four specialty medical practices, covering ENT/allergy, gastroenterology, cardiology, and renal to open a new multi-specialty medical center in upstate New York. The center will feature an on-site lab and pharmacy, along with a telemedicine hub. While each practice will remain independent, the goal is to create a unified patient experience that will utilize the latest technology when opened in spring 2021.
Senior Center Expands: Humana’s Partners in Primary Care unit is planning to open 20 new senior-focused primary care centers over the next year in Las Vegas and Louisiana, as well as expanding their current operations in Houston. Partners in Primary Care already operates 48 care centers across six states mostly in the southeast that treat about 35,000 MA members. The clinics’ goals are to make sure seniors are getting quality, low-cost preventive care in an outpatient setting.
Permanent Telehealth: Rhode Island is looking to make their COVID-19 telehealth policy changes permanent, with a bill headed to its Senate for a vote this past week. It would require payers to cover telehealth services, including audio-only phone calls, beyond the crisis. If signed into law, the bill will mandate that telehealth services by in-network providers “be reimbursed at rates not lower than the same services would have been had they been delivered in-person,” and it would require those services to “be subject to the same health insurer policies as in-person services, including medical necessity determinations and appeal rights.” Colorado lawmakers are also proposing a similar bill. Insurers are already taking steps to respond. Anthem of Virginia, for example, launched a virtual dental care program in partnership with The TeleDentists to offer consumers an alternative to ER or urgent care center visits, which can often cost between $400 and $1,000.
Flexibility During Virus: Aetna and Cigna have both decided to lengthen the period for which they will waive out-of-pocket costs related to the coronavirus, past the initial June 1 end date. Several regional plans, including Florida Blue, BCBSIL, and Regence are extending benefits around telehealth and prior authorizations. Cigna has a new pre-loaded debit card to help members pay for medical expenses, groceries, and child care.
Joint & Spine Site: For Regence Blue Cross members in the upper northwest, eviCore will begin reviewing spinal and joint surgery requests, starting this September, to determine if the proposed site-of-service is the right one. Some requests will likely be denied based on eviCore’s objective to shift procedures to outpatient settings. At this time, there are no plans to direct surgeries to a specific provider, but based on precedence, this is likely in the future.
Extra Point: One of my kids graduated high school on Wednesday night. This was a big moment for a kid who grew up in a war-torn refugee camp, who had a soldier once raid the bamboo hut she lived in. She and her sisters had to work hard to get here, to learn a new culture, a new healthcare system. She was due to play on the Thailand National Woman’s Soccer Team this summer but with the tournament cancelled, has turned to making money for college. On Wednesday, during a televised virtual graduation on the football field, a toddler streaked across the goal-line behind the podium. It was a light moment in what was a bit of a deflating ceremony. But the principal acknowledged the moment we are in. He talked about inclusion, racism, isolation. He also talked about hope, and just as he was reading our kid’s name at about 7:15 from the 20-yard line at the school’s grassy football field, she was starting the night shift at an Amazon warehouse.