AT THIS HOUR

June 17, 2022

#1: The top bestseller in psychiatry this week is none other than the DSM-5 aka “the bible” of the psychiatry world. The latest version of the Diagnostic and Statistical Manual of Mental Disorders, released in March after nearly a decade without updates, has become a surprise hit likely due to increased demand for mental healthcare. The DSM is the top psychiatry bestseller on Amazon and the Wall Street Journal’s list, though physicians warn the book is intended for mental health professionals and not for self-diagnosing. But given the difficulties many still face in accessing mental healthcare, the manual may stay on the bestseller list for a while - for better or worse.

Sleep Well: Premera BCBS will no longer review home sleep studies for prior authorization and medical necessity, effective July 1, 2022. Providers will no longer need to submit a request through AIM Specialty for these services though AIM will still review supplies/equipment and in-lab sleep studies.

The New Oral Health Referral Source: Teledentistry, much like telepsych, is driving up utilization of follow up in-person visits. 97% of 3,562 patients who had a teledentistry visit ended up doing an in-person follow up for diagnostic and restorative services like an oral surgery or endodontic procedure. The researchers from CareQuest say teledentistry resulted in average cost savings of 10-15% compared to in-person visits.

Predictive Analytics Victory: Use of an AI tool resulted in the highest reported rate of type 2 diabetes remission to date according to new research presented at the American Diabetes Association meeting earlier this month. Known as the Whole-Body Digital Twin Platform, the predictive analytic model gathers patient data and then provides guidance for clinicians and patients around proper nutrition, physical activity, and sleep. At 180 days, 94.9% of patients in the AI group achieved an A1C level of less than 6.5% while either taking no diabetes medications or metformin only, and the nine insulin-using patients in the group all stopped using insulin within 90 days because they had lowered their blood sugar to normal levels.

Homeless Health: Healthcare in Action is a nonprofit medical group that provides primary and behavioral healthcare to homeless people in Los Angeles. The group employs both clinicians and social workers to provide care wherever people need it, mostly outside though the group has vans that offer private exam space. After treating patients, patients are offered cell phones that providers can use to keep in touch for follow up care. SCAN Group, the parent company of SCAN Health Plan, debuted Healthcare in Action in January of this year. Within its first four months, the organization had served about 200 patients who otherwise may have had difficulty accessing care in community health centers or clinics.

Mother Nature: Anthem begins offering a new digital solution to support mothers’ maternal mental health in several markets by the end of 2022. Happify Health’s tool incorporates coaching and digital therapeutics while providing access to a range of providers, including obgyns, psychiatrists and dietitians. The tool also allows mothers to connect with each other. Anthem President of Health Solution Bryony Winn wants to “improve every aspect of the pregnancy experience” – whether it pertains to physical or behavioral health.

One Home: Humana is expanding its value-based home care model in Virginia through its subsidiary, Onehome. Onehome creates a single point of accountability and coordinates post acute care, including infusion, nursing, OT, PT and DME in patients' homes. This model will first become available to MA members in Richmond, Roanoke and Southern Virginia counties and will expand to the rest of the state and North Carolina over the several months to reach more than 500,000 members.

Surprise Party:  A recent study done by BCBSA and AHIP revealed that the No Surprises Act has spared commercially insured patients from over two million potential surprise medical bills. Apart from ensuring financial protection from hefty and unexpected medical bills, the study also demonstrates key benefits from the independent dispute resolution (IDR) process that the act establishes. This trend is expected to hold, as 12 million surprise bills are projected to be avoided in 2022. 

CenterWell: On June 13th, Humana announced it will be rebranding its pharmacy business to CenterWell. Humana Pharmacy and Specialty Pharmacy will now operate under the name CenterWell Pharmacy and CenterWell Specialty pharmacy, respectively. 

Foster To Prison Pipeline: Many pediatricians knowingly treat a child within the foster care system for severe mental illness and when the foster child goes into crisis the knee jerk reaction is often to send them to the ER but this stabilization process often fails and police are often called in. “By age 17, more than half of juveniles in foster care get into trouble with the law,” says Tiona Praylow, MD, MPH, from Riverwoods Behavioral Health. Foster care youth are 244% more likely to reoffend between adolescence and adulthood. Click to read more.

Extra Point: A medical student, federal judge and a healthcare investor walk into a presentation with a trio of panelists on a stage, sitting on bar stools, holding up large circular posterboards resembling traffic lights – one holding green, one yellow and one red. Panelists were given the same list of healthcare sub-sectors and asked to project their collective future as positive (green), proceed cautiously (yellow), or stop (red). The moderator asks for questions and the medical student John exuberantly and perhaps not surprisingly has one for the “green” panelist. The judge Sally, true to form, asks the “yellow” panelist to explain their thinking while the healthcare investor Sharon, smirking a bit, says – “let me hear from the one with the red sign.”  We are trained to carry a healthy level of skepticism and monitor and understand risk.  For my daughter Sophie who’s learning to drive, heck everything is a red—the sidewalk, the car behind and in front, the white cloud above – and yes, even the green light.  “You can go sweetie.” “But what if it turns yellow dad?”  I suppose like many of us she will learn to see risks earlier with experience…the person in red lowered their posterboard. It was a 71-year-old, quasi-retired psychologist who says she is working part-time because she loves the work and wants to keep giving back, and part-time as an advisor to a health insurer. She said OP clinic-based therapy is a red. “Surprised? My colleagues might not be happy with me but I look at it this way – to solve the issue we need more psychologists to do cognitive therapy for all the post-traumatic stress we all deal with, we need therapists to focus on the teen angst, social media, self-esteem conundrum and to head off eating disorders and from my lens having these sessions over a zoom or phone works and makes sense, can address the gaps and at a much lower cost per session. So if you ask me what I think of an in-office therapy practice – I say red.”