77: The percentage of mental health students and young practitioners ages 20-30 we polled who are both working toward a license as a therapist, psychologist or psychiatrist and would prefer to have or join a virtual practice.
Injection At The Rx Counter: Bicycle Health, a telehealth provider of opioid use disorder treatment, is partnering with Albertsons to make prescriptions for Sublocade available at Albertsons pharmacies, which also include Safeway and Acme. The injection can be administered monthly as an alternative to taking a daily oral version. Once Bicycle Health patients receive a prescription virtually, Albertsons pharmacists will be able to administer the treatment.
OTC To Stop Overdose: BCBS Massachusetts recently announced they will cover the drug designed to reverse opioid overdose as an over-the-counter medication, now that naloxone is available without a prescription. Most health plans have not yet issued any guidance on whether naloxone will be reimbursable similar to aspirin or vitamins, but the AMA is calling on insurers to do this, in order to help increase access.
Autism Policy Change: As of September 1, 2023, Blue Cross NC now will recognize North Carolina Board Certified Behavioral Analysts (BCBAs) as eligible for direct participation in their provider networks. Previously, the state used to require that BCBAs could only practice under licensed psychologists so the state did not require them to be independently licensed, so they likely couldn’t get credentialed directly or contract with plans.
Bringing It Inside: Just like radiology a decade ago and physical therapy currently, commercial payers continue to move benefit management of behavioral health in-house, a positive for outpatient providers. Point 32 and BCBS Michigan announced plans to move behavioral health prior authorization decisions and case management internally – Point 32 this fall, Blue Michigan starting January 2024. Lucet, formerly known as New Directions, currently handles these operations for BCBS Michigan’s commercial members. With the move in-house, BCBS is also dropping some prior authorization requirements, like those for IOP and neurofeedback services.
Referral Questions: A new study published in JAMA found that primary care physicians affiliated with large health systems drive up spending on patient care through increased referrals to specialists within those health systems. The study looked at data from 2013-2017 and found that a primary care health system relationship drove up specialist visits by around 23%, along with a roughly 14% increase in ER visits and a 22% increase in hospitalizations. Referrals to behavioral specialists, however, tend to go outside the health system according to our polling.
TelePsych: Castell, the Intermountain health system’s value-based care subsidiary, is partnering with Headspace to increase access to virtual mental health services. Headspace is now the first digital mental health provider in Castell's network.
Maternal Mental Health: We confirmed a study is underway by at least one insurer into the long-term cost of poor maternal mental healthcare both pre-term and after birth. One plan is considering adding reimbursement into its bundled rate for up to 3 pre-term therapy visits. While policies have improved to cover depression screening and services, improvements are needed and the cost of poor maternal care plays out over many decades, said Angela Glyder, RN, during our women’s health forum yesterday. Glyder, the VP of Clinical Operations for Lucina Analytics, agreed that payers should consider long-term costs as they develop value-based programs. Our paper on this issue can be found here.
Extra Point: I ran 5 miles with Julio Perez, Mike Udell, and Rory Tulienth a couple of weeks ago. The trio has been addicted to heroin, fentanyl, steroids and alcohol – and now they run in a club called The Boston Bulldogs. Clubs like this that empower people through movement are gaining traction in society. For the most part, they don’t require a pill or injection, no Zoom connection or copay – just a $52 pair of sneakers and an open mind. In Rory’s case, she had tried three to four residential programs at various points in a 10-year battle that started in her mid-20s – “good people, but it just didn’t stick – maybe I wasn’t ready – maybe the addiction was still in charge,” the 36-year-old said as we stumbled through a shady stretch in Quincy. “I found a home running–I’m not sure why, but it feels right,” I asked her how much it cost to pay for all the care she had during her 10 years. “How much?” she laughed. “I was in the hospital maybe 20 times…in prison, lost my job, my husband, my relationship with my daughter–am I supposed to put a number to that?”