AT THIS HOUR

April 8, 2022 —

57: Percent of 17-23-year-olds in our poll last month who are going to use urgent care as their primary care provider after college, down from 70 percent a year ago. The reason? Covid – for a meaningful portion of the 523 polled, senior relatives, parents and friends got sick, passed away, or did not get diagnosed quick enough with a serious or terminal condition like cancer. “I used to think urgent care could handle all of it but I think it’s probably more for the convenience,” Abby Knowles, 20 says. “I think having a regular doctor will be a good idea, particularly after what I’ve seen my family go through.”

Approval: In something few would have guessed a decade ago, Regence BCBS is now starting to use artificial intelligence (AI) to determine if preauthorization requests should be approved, without the need for an actual medical director or nurse case manager review.  The plan has started with just a few procedures, including transcranial magnetic stimulation and some genetic tests, and expects to expand to additional procedures eventually. This feels sort of like telling your 20-year old that when they want $50 to “get them through the weekend” you send them through a computer program and tell them, well, it’s frankly out of our hands. This insurance system apparently allows preauthorizations to be approved at a much quicker rate for providers and patients, but it also creates some questions on whether the AI system can handle the nuance of some requests, particularly for “therapy”. For those worried about denials, AI will never actually deny a request, for now, Regence says. If medical criteria aren’t clearly met, it will be passed on for clinician review.

Wellness Outcomes: As reported in our 2022 Payer Index (link here), health plans are increasingly prioritizing wellness, and Highmark has seen tangible positive results from members having access to wellness coaches. They found that members participating in the weight management program with a wellness coach saw an average weight loss of 4.5% and 42% of members who participated in the Tobacco Cessation Program were able to quit and stay tobacco-free for 30 or more days.

School Rules: Sen. Anthony Portantino has authored a bill that would require all California middle and high schools to train at least 75% of employees in behavioral health. “I don’t want to read about another teenager where there were warning signs and we looked the other way,” Portantino said. “Teachers and school staff are on the front lines of a crisis and need to be trained to spot students who are suffering.” The training program is operated by the National Council for Mental Wellbeing and is available in every state. Other states like New York require mental health education. Our team will be covering the National Council On Behavioral Health annual meeting April 11-12 in DC where this issue will be discussed – stories from the event in future weeks.

Check-Up: In Tennessee, children that are part of BCBS’s TennCare program for Medicaid beneficiaries are allowed additional check-ups beyond state guidelines.  For example, when a child visits the doctor’s office with a sore throat but is due for a checkup in one month, the practice can perform and bill for an early and periodic screening, diagnostic and treatment exam during the check-up, even though it’s only been 11 months since the last checkup. Doing so increases the likelihood that the child will stay up to date on well-child care because they don’t have to visit your office for another appointment.

Classified: Healthcare companies added an estimated 8,300 jobs in March, down from 66,400 in February, according to preliminary data the Bureau of Labor Statistics released last Friday. Providers continue to experience staffing challenges, but lawmakers, health systems and educators are trying to create real-time solutions. Read our report on nurse staffing here.

Extra Point: I have to admit I barely paid attention during my 14-year-old’s doctor’s appointment this week. That’s sort of what happens when you have teenagers and yet you still find yourself awkwardly in the exam room sitting on that sheet of Winnie the Pooh paper reading a frayed copy of Curious George Goes To The Hospital that candidly makes the hospital seem like the best place on earth. “Any questions Bry – are you clear on the plan?” Dr. Leo asked me. “100 percent,” I said.  But alas I was not clear. On the way home, Tommy turned to me at a traffic light at about 9:15 am en route back to school. “Dad, don’t we need to stop at the pharmacy?”  “Um, I suppose – but what would you say Tommy that we need to actually get there?”  At my dad’s appointment a day later I was far more focused, particularly when dad said he had 3 square meals a day. “Really pops – don’t you think that’s more like 3 a week?” I found it fascinating that the doctor paused, gave one of those “uh huh uh huhs” and then wrote on her iPad. I felt like I was transformed into that Seinfeld episode when Elaine’s doctor fake erased her medical record. Going to doctor appointments with your older parents is inherently awkward. First, “dad you don’t need to show the office manager your new mole.” Second, there are the uncomfortable old mannerisms like when dad takes 20 minutes to leave the lab sample because the toilet overflows. “Are you alright in there pops?” Then in the exam room, my parents tend to lie or act as though everything is perfect, then you challenge in a kind of patronizing way, the doctor plays arbiter and 30 minutes after the appointment your mom doesn’t remember any of it – when to take her medication, what she needs to record in her journal, heck why she was even there. I had my own appointment yesterday. My wife set it up. “Just scheduled a consult for you with Dr. B – for your shoulder pain you keep ignoring.” Thanks, honey, “but I won’t be going, shoulder is fine. I’m good.”  24 hours later I was at the appointment because, well, when you’re married, with kids, and you procrastinate, you go to the appointment. “So Dad,” said Tommy, “what did the doctor say about your shoulder, or were you not paying attention?”

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