AT THIS HOUR

March 4, 2022 —

$1.76M: The amount CareFirst has awarded to local health organizations to help address the diabetes epidemic and the social determinants of health that drive the chronic condition’s development. The grant recipients included 27 local health groups and represent Phase 1 of CareFirst’s commitment to addressing diabetes through a $10.5 million contribution.

Lab Utility: The utility of lab testing and the overall cost, namely physician referral to out of network labs, is creating demand from health plans to manage and change physician behavior in more proactive ways. Later this year, several health plans, including BCBS of Michigan and the HCSC plans in Illinois and Texas, will begin working with Avalon to manage lab spending and utilization. North Carolina’s Blue plan recently reported saving $112 million since beginning its partnership with Avalon in 2017. Lab testing for some patients is considered unnecessary, as noted in a poll we did several years ago (click here). One medical director said he sees a lot of “borderline” hormonal tests like to check for metanephrines or cortisol levels. “They are more confusing than helpful.”

This Disorder Doubled In 2020: The number of people hospitalized for eating disorders doubled in 2020, according to research published in JAMA. To help meet the growing demand for providers, Aetna is partnering with Equip, which provides virtual, evidence-based eating disorder treatment for young adults ages 6 to 24. The Equip partnership is currently available in six states, including New York and Texas, and will possibly include more in 2023. Equip employs the Family-Based Treatment model with a five-person dedicated care team consisting of a therapist, dietitian, physician, a peer, and a family mentor to support the person in their recovery. Eating disorders in younger athletes are among the reasons for the spike I suspect. One story by clicking here.

Is There A Doctor In The House? First Taylor Swift, now Doctor House. Amazon’s Alexa users will now be able to play more than music, now they can say, “Hey Alexa, I want to talk to a doctor,” and Alexa will connect them with Teladoc’s call center. A provider will then return the patient’s call through the Alexa device. The service only has audio capabilities, but Teladoc plans to add video visits. For managing care, this has pros and cons – it no doubt ought to limit hospital visits and overreliance on misinformation people tend to glean from the Internet – no offense, Internet - but it also may mean people start calling in every symptom and scratch.

Disruption Of Direct-To-Employer Models: In recent years, a wave of virtual disease companies has created some disruption for insurers who find themselves in a catch-22. These models have potential, but they tend to go direct to employer and can upset local physician networks who are kept out of the loop on their patients. “It bifurcates care delivery, messes up all the work we’re doing to address diabetes, incent physicians to manage those patients, do value pay correctly.”  But there is a renewed effort it seems from some virtual platforms to now partner directly with insurers. Integrated delivery network Highmark Health is partnering with Onduo to launch a virtual diabetes care program for adults with type 2 diabetes. Through a tech platform, Onduo will reach out to eligible members and deliver lifestyle and clinical interventions to those that sign up. In the joint pilot of this program, Highmark and Onduo saw 92% of participating members with a baseline A1C of 9% or higher improve their A1C by an average of 2.7 points upon follow-up. On average, members also reported losing 13.3 pounds or 5.7% of their starting weight. 

SpartanVille: A Geropsychiatric Evaluation and Management Service unit to care for more patients afflicted with memory disorders and to train more physicians focused on addressing the mental health crisis is part of a new $600 million healthcare facility jointly opened by McLaren Health and Michigan State University. The site has a cancer center and 240 hospital beds.

Rx Speed: Optum has launched a new program, Specialty Fusion, meant to manage specialty medication costs, along with easing administrative burdens, like prior authorization processes. The program has one portal that providers can use to request a PA for specialty drugs, while having access to their patients’ diagnoses and medical and pharmacy coverage, allowing providers to choose the best option. An internal analysis by Optum predicts that Specialty Fusion will result in 17% total cost savings on specialty drugs as providers will be able to “conduct a best benefit evaluation at the drug level, lowering both the medical and pharmacy spend”. Florida Blue is also trying to streamline the PA process by using an AI platform called Olive. In the pilot program authorization turnarounds shrunk by 10 days. 

Oral Health For Underserved: This summer, the large dental service organization Aspen Group plans to open an oral health center for underserved patients in Chicago. This 25,000 square foot oral care center will provide free dental care and procedures to low-income residents in Illinois.  

State Of The Union: On March 1st President Biden gave his first State of the Union address, citing several emerging health care priorities including nursing home quality and mental health. Click here to read more.

Refer? Nah, You Got This.  Dr. Van Nostrand from the clinic in Seinfeld once had to evaluate Costanza’s boss for moles but Van Norstrand got upset when Constanza wouldn’t let him use his meat slicer to remove a mole.  Can’t imagine why. “George! Why would I, a Julliard trained dermatologist, need to refer your boss to a different doctor?” Kramer’s fictional Dr. Van Nostrand character was perhaps ahead of his time, even if a tad mistaken about what Julliard is for. In a poll of primary care doctors 40 and younger, 64% say they want to expand their medical knowledge and skills to be able to “do more at the point of care” rather than just refer. PCPs over 40 are more conservative, just 30% fall into this camp. The results are a lesson as you build out your companies and services – can you refer less and improve health?

Extra Point: The kids in my gym class don’t have much access to physicians and nurses who look like them and know their culture, much less a grocery store in their neighborhood with a half-decent selection of fresh fruit and veggies.  Aryanna, 11, says “we usually just go to the hospital if one of us is sick” but “none of the doctors are black.”  Hter, whose family migrated from refugee camps in war-torn Myanmar, says her aunt takes her to a place but no one speaks her language or understands her culture and the breathing issues they suffer from, exacerbated by not understanding how to use the inhaler properly. These are difficult situations, but the healthcare community is starting to figure out ways to tailor services. Spora Health is a small telemedicine platform in Texas and Tennessee specifically for people of color. It just started collaborating with a health insurer for self-employed people and their families. The insurer, Decent, will help its members select a Spora provider for primary care – one that looks like them and understands their situation, inequities. I hear about these models and it’s encouraging, but telemedicine is only one component. These families and kids need more of an overarching social service support “home” than a medical home. Bifurcating the two is a mistake. On Wednesday the kids named their volleyball teams before playing. “What’s your team’s name Jaylah? “P.O.C.” she said proudly.