AT THIS HOUR

March 11, 2022 —

38%: Reduction in pediatric hospitalizations due to Cincinnati Children’s Hospital and the Legal Aid Society of Greater Cincinnati partnering to connect children to social services, including three primary clinics in schools. The partners manage about 900 referrals a year, connecting families with resources for housing insecurity, poverty-related issues, and educational concerns. Fundraising and grants are the primary sources to fund the program but reimbursement through insurance could help long term.

Self-Insured Coupe? BCBS Minnesota began offering a new product, Coupe Health, to self-insured employers at the beginning of the year. Coupe Health, which is administered by Alabama’s BCBS plan, leverages the Aware network, and then tiers providers based upon four attributes: quality, relationships, experience, and cost. Members search for providers through a phone or web-based app that reviews each provider’s quality rating, location, and co-pay option. The member receives one simplified bill at the end of the month from Coupe Health and providers will not be responsible for collecting member out-of-pocket costs. Providers are reimbursed 100% of the allowed amount by the plan.

Be Generic: Civica Rx, a nonprofit generic drug company created by a group of hospitals, plans to lower the cost of insulin by producing its own version. Civica plans to manufacture and distribute three different kinds of insulin that will be capped at $30 a vial and $55 for a box of five prefilled pens. The products will be biosimilars of the versions currently available and Civica hopes to have them ready for sale by early 2024.

Prenatal Diagnostics: Aetna now has preferred labs for noninvasive prenatal testing, a method of determining the risk that a fetus will be born with certain genetic abnormalities. No big surprise, those preferred labs are LabCorp and Quest.  Some insurers pay for testing as part of a global bundle that is increasingly 1-year to factor in post-partum depression. Other insurers, typically Medicaid MCOs, are very interested in trying to limit pre-term complications and one way to do that is to do depression screens during the pregnancy period. Elevated depression increases the risk of pre-term complications.

Jersey Blues: Horizon BCBS members can now get their medications delivered to their home by Amazon Pharmacy. Horizon members (excluding those enrolled in MA or Part D plans) also get a drug discount card called MedsYourWay built into the Amazon Pharmacy experience. All covered and eligible purchases count toward the member's deductible or out-of-pocket costs whether they use their insurance or MedsYourWay. Four other Blues plans are also adding this benefit.

Home Sweet Home: PIH Health, a Los Angeles-based health system, is launching a new in-home care business line with 24/7 home care in collaboration with home care provider company 24 Hour Home Care. The offering will include housekeeping, personal care, meal prep, transportation, and medication reminders.

Site Of Service: Insurers like Empire BCBS continue to add procedures to a list that can only be done in hospitals with a medical necessity review. A 33-page list of procedures, including gastroenterology, orthopedics, ophthalmology, auditory and nervous system procedures are included, and ASCs are the beneficiaries. These shifts come at a time hospital-insurer disputes continue. Blue Cross Blue Shield of Texas failed to reach a contract agreement with Memorial Hermann Health System after many months of negotiations, leaving Memorial Hermann hospitals, surgery centers and some health professionals out of network with certain BCBS plans effective this month.

What’s In A Name? 18-25-year-olds think urgent care is too slow and centers that call themselves “fast” or “go” sound more like Dr. Seuss healthcare than actual science. Their views, drawn from our poll of 2,100 nationally, are largely consistent with two themes with this age bracket – they have grown up expecting immediacy in all things and have their own views on what health means, and it doesn’t mean waiting at a so-called Fast Care for a test they may not need. Or as my 18-year-old who helps conduct these polls says, “This is stupid Dad.”  61% do, however, see some value in businesses trying to innovate with names like “health” and solutions to back it up like exercise tracks and dieticians and nurses. One 26-year-old from Missouri says she found an Ozarks wellness center that has a gym and nutritionists, plus childcare. “I’d rather go there to make the most of my time than some urgent care that doesn’t know me.” 91% say they see healthcare as more of an experience, a destination even, and the name ought to reflect that.  Perhaps that’s why the old guard of health insurers is rebranding. Cigna is now Evernorth and Anthem, as of this week, is now Elevance Health. Oh, to have been in the room for these renaming brainstorms! For Cigna, the name conjures images of snowshoeing and hot cocoa, both very healthy activities if you ask me, though I wonder if the name geniuses considered the geographic implications? Expanding into the deep south may be a harder sell, no? For Anthem, the move may be as much about reframing what these insurers want to be than trying to shift the narrative. Fewer claims payer and coverage denier, more of a healthcare support system. There’s proof, as most of the big insurers continue to acquire providers and open their own centers. If I had to guess, Anthem’s renaming brainstorm went something like this: “How about Escalate?” “Good, let’s keep spitballing.” “Elegance…Reverance…Excellence…Excitedtobehealthyance….Reverberance…Evolent.” Oh, wait, that one’s taken. “Wait - I got it - Evanescence!” Too bad, that’s taken by my daughter’s favorite rock band.

Extra Point (From The Archives): Who knew that everything we needed to know about healthcare we’d learn from Lloyd Dobbler: click here for the point.