AT THIS HOUR

April 29, 2022

118-634%: The range of median price markups for oncology drugs purchased and administered by certain hospitals, according to a new study published in JAMA Internal Medicine. The study analyzed the prices of 25 top-selling cancer therapies at 61 National Cancer Institute-designated cancer centers and looked at how those negotiated prices for commercial payers compared to acquisition costs. Prices varied between cancer centers and between payers within the same center but for every drug included in the study, the median hospital negotiated price was at least twice the acquisition cost.

Robots of Dawn: Robots are coming to nursing homes and no, this isn’t the beginning of a science fiction novel. Several programs, including one at the University of Minnesota Duluth, are part of a newly energized effort to use technology, including robots, to help nursing homes address staffing issues and isolation for their residents. The program in Minnesota plans to place 16 robots in eight nursing homes around the state later this year. The robots can socialize with residents, lead fitness classes, tell jokes, play games, and lead something called reminiscence therapy, which helps residents relive specific memories. They are not designed to replace staff, but rather to help fill some of the gaps nursing homes are currently experiencing.

Pregnant Pause: Brave Health, a virtual behavioral health company, launched a maternal mental healthcare program to help the rising number of mothers experiencing postpartum depressive symptoms. A recent study by the University of Michigan found that one in three new mothers screened positive for postpartum depression during the early pandemic—nearly triple pre-pandemic levels. The program is in partnership with the Doula Network, a service that pairs pregnant Medicaid patients with doulas.  Depression during pregnancy can lead to a higher risk of pre-term labor and some Medicaid MCOs have agreed to pay for and encourage this screening, or find ways to “bake it into the global 1-year rate.”

Bidding For Authorizations: Highmark has expanded a value-based specialty pharmacy program they launched in August 2021 with Free Market Health, a healthcare technology company. Effective April 18th, drugs for chronic inflammatory disease, hepatitis C, and MS have been included, along with some oral oncology drugs. Free Market’s program works by utilizing a marketplace where contracted specialty pharmacies can bid on authorizations instead of payers utilizing an exclusive pharmacy for all members. This can allow for dynamic pricing and the opportunity for specialty pharmacies to earn additional value-based reimbursement on eligible drugs.

Out Of Character: In a change for Kaiser, the integrated delivery network has signed a five-year agreement to give its commercial members access to in-network Cigna providers outside the eight states Kaiser covers. This will be Kaiser’s first partnership that allows members to use non-Kaiser providers without paying out of network rates. As part of the agreement, Cigna’s Accredo will become Kaiser’s preferred external pharmacy for some drugs.

Joint Approach: BCBS Michigan is piloting a joint and spine program with TurningPoint for their commercially insured members. BCBS will identify members who are candidates for the program and TurningPoint will then reach out to them to head off surgery by helping members understand the next best step in their musculoskeletal care and where to go for that treatment. The program will run through December 2022, at which point BCBS will evaluate whether to continue with the service.

Help Wanted At The Next Site Of Care: Judge Reinhold’s character Brad Hamilton may be able to get his job back at the iconic All American Burger joint depicted in the 1980s flick Fast Times At Ridgemont High now that 32 malls across the country house healthcare services, and need staff. He may not be flipping burgers but may be able to take orders for lab tests and throat cultures.  A Georgia Tech professor has maintained a list of the mall-to-healthcare conversions including those revamped by Inova in Virginia and Vanderbilt in Tennessee.

Speaking Of Malls: A Florida auto mall owner, tired of his commercial insurance options, created his own health plan for his employees. Concerned about rising premiums and lack of benefits, the Florida man worked with an employee benefits advisor to create a new plan that offers his employees an on-site physician every two weeks and a nurse navigator service that helps direct to appropriate specialists. The new plan has led to savings of 20-60%, depending on the service.

Spending Spree: UnitedHealthcare and Optum picked up two more independent primary care groups recently, the latest a pair of Oregon practices with about 120 providers at 11 facilities.

Extra Point: A family guidance center in Southern California worked out a deal with one of the Medicaid managed care organizations here a couple of years ago where it got $1.20 every month for every kid it helped to avoid an adverse event and another 75 cents every month for every kid it screened for diabetes. You see, there was a problem in this community with troubled youth, broken homes run by parents struggling to break poverty’s cycle, some dealing with addiction, some working two jobs leaving kids to raise themselves, eating unhealthy, sugary foods. The center took this money, around $2,300 over the year, and it put in one of those river rock climbing walls. They hired one of the kid’s dads, Pa Dah, to build it, paying him $750 out of the $2,300. Pa Dah made minimum wage at a factory in town but “I used to build homes out of bamboo in Thailand” he said before he moved his family to California to flee from violence in Myanmar. That rock wall is now a source of hope for the kids and the community, and points to just how far even a dollar can go sometimes, if used for good.

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