AT THIS HOUR

July 1, 2022

$12-36: The amount Optum claims their new lab benefit management solution can save health plans on a per member per year basis. Optum is launching a new program to combat unnecessary clinical testing, which can account for up to 30% of all tests ordered. Optum will work with Avalon to administer the solution.

As Good As It Gets? Jack Nicholson’s character Melvin Udall in the 1997 movie put OCD on the map, showing moviegoers just how debilitating obsessive-compulsive disorder can be when ordering breakfast, navigating sideways, and trying to court the waitress. 25 years since the movie debuted, some 2.3% in the US suffer from the condition and the World Health Organization considers OCD among the top 10 most debilitating conditions. Health insurers have been forced to improve coverage policies given mental health parity laws and because a significant portion of patients with OCD don’t respond to first-line drug treatments. More recently, some insurers like HCSC and Highmark have started to cover a neurostimulation system called BrainsWay. It will be interesting to see how widely adopted coverage will become and if any insurers will relax fail-first requirements. Our assumption is no, but outcomes data may change that approach.

Picture This: A 26-year-old woman with 3 kids is referred to a neurologist. She presents with a malignant brain tumor, and she is pregnant. To stay alive, the woman needs immediate surgery, radiation and chemotherapy that she cannot get while pregnant. This scenario is one of the potential unexpected consequences of the overturning of Roe v. Wade. To read our interview with Mayo Clinic on the issue, click here.

3 RBTs In 6 Months: Colorado ranks high among U.S states for the level of services available to children with autism, according to Autism Parenting Magazine, but there are still barriers to access including a lack of RBTs. “There’s high turnover in RBTs and it’s hard on families,” Lea Anne Paskvalich told us. “I spoke with a family that had 3 different RBTs in 6 months…change is hard for a person on the spectrum.”  

Cognitive Therapy Partner: Effective July 15, BCBS Michigan members will have access to more behavioral health providers through AbleTo, a network of approximately 2000 therapists that provide telehealth services, including an eight-week cognitive-behavioral treatment program for adults.

Hawaii vs. Nevada: Thinking about where you can bring your new healthcare service to solve problems, consider Kentucky, Nevada and Wyoming—3 states with among the worst healthcare systems according to a Commonwealth Fund report. Hawaii, Massachusetts, and Connecticut are among the states with the best overall performance based on 56 metrics including access, quality, cost, health disparity, and health outcome metrics. COVID-19 response played a major role in overall rankings and was part of why Hawaii came out on top.

Digital Experience Upgrade: 57% of payers say it’s challenging to provide a seamless digital experience for members throughout their member journey– including everything from the process of enrolling and setting up benefits to proactively reaching out about care management programs after getting a new diagnosis. Unsurprisingly, health plans generally struggle to design good experiences for their members. Most payers in the Forrester and Smart Communications poll describe their digital experience as basic and 63% said it is a top priority to improve.

Mobile Health: Insured and uninsured individuals in Las Vegas, NV and Richmond, VA will have access to free preventive screenings, mobile units, and community events aimed at identifying, preventing and managing chronic conditions under a CVS project to expand mobile care. 14 other cities are part of the Project Health program.

Grassroots: In cities like Philadelphia and Houston, a myriad of individuals are working together to address housing instability, city planners in places like Dallas are bringing greenery into low-income neighborhoods, students are working with civic leaders in Memphis to fix food waste and try to halt the social factors driving health decline, and healthcare providers in many states are trying to curtail maternal mortality, an area where the US ranks last among developed countries. Despite many of the challenges the US is confronting and the mood of the country, there is a grassroots spirit that is unfolding. Click here.

Extra Point: It took me 129 minutes to get my mom to turn on the TV this morning.  “Mom, press the down button…the down one. The red thing with the arrow….” Mom and dad are fairly independent as they approach 80 – they drive a bit during the day, they make their own turkey grinders, still cut the lawn and rake the leaves and find time to play backgammon on the porch, but figuring out how to get Netflix to show up is complicated.  I get it, and I try to embrace the good that comes from their independence knowing it probably won’t always be like this. It can be hard to stay independent – as seniors, teenagers who migrate into young adulthood and healthcare providers trying to cultivate freedom and find their niche. Here’s to independence, for as long as you can hold on to it.