AT THIS HOUR

May 20, 2022

224: The average percent that employers and commercial health plans paid hospitals above Medicare prices, according to a new report by RAND. The report found that hospital prices tended to correlate with hospital market share, which comes as no surprise. Some states, including Florida, West Virginia, and South Carolina, had prices at or above 310% of Medicare. If the same providers were paid Medicare rates for the same services, employers and private plans would have saved almost $50 billion, researchers said.

Roe V. Wade Response: Major corporate employers are making headlines this week by announcing they will cover travel expenses for employees who need out-of-state travel for an abortion if it is banned where they live. Some of those companies include Yelp, Citigroup, Microsoft, Starbucks, and Amazon. The level of coverage their plans provide for abortion services in or out of network is not clear. These announcements come ahead of the Supreme Court’s ruling that could overturn Roe v. Wade. 

Moms Rely On This: Unlike Elaine of Seinfeld fame who failed to change doctors because her last one wrote in her medical record that she was difficult, today's generation of Elaine’s have more access and control over their records, and more say on where to go for a diagnosis or treatment. Check out our poll on what drives our healthcare behavior, and how men and women are different and the same.

Parental Angst: In a recent survey on adolescent mental health conducted by Cigna, 36% reported having trouble finding a trustworthy mental health provider for their children. Full results here.

Macro IPA: No, this isn’t the next frontier of pale ales, instead Prospect Medical Holdings, which manages 16 hospitals and 160+ physician clinics, is partnering with Angeles-IPA, a multi-specialty physician association in Southern California, in an effort to extend their integrated delivery system to Medi-Cal beneficiaries. This partnership will expand access to 30,000 new Medi-Cal beneficiaries and aims to improve efforts in value-based care.

Prescriber Outreach: BCBS of Kansas has a new drug management prescriber outreach program through HighTouchRx, which employs clinical pharmacists who reach out to providers to make recommendations about specific patients. Providers still have the final say on what they choose to prescribe, but HighTouch outlines less costly alternatives.

Helper Bees: Sheila Patrice, 87, of Connecticut, says her weekly delivered meals are a large improvement in her life because “most of my family lives out of state so having food delivered makes me feel safe and secure”. Some seniors like Patrice lack access to nutritious foods, which can lead to dehydration, malnutrition, falls in the home and eventual hospitalization. Several home care companies are trying to serve this market. The latest, Homewatch CareGivers, recently announced a partnership with The Helper Bees to offer meal delivery services for Medicare Advantage members.

Mortality Fix? If you’re looking to actually provide value, perhaps try to halt these staggering trends. In 2021,102,000 people died of diabetes in the U.S., up from 67,000 in 2019 – numbers matching a similar trend in deaths due to drug overdose. Nearly 108,000 people died as a result of drug overdoses in 2021, according to provisional numbers released by the CDC. The 2021 provisional numbers are the highest recorded in a calendar year, increasing 15% from 2020. Cancer and heart disease-related deaths top the list at over 600,000, three times unintentional accidents and Covid-19. Alzheimer’s is rising at 134,000. 

Extra Point: There’s a legend that an older man on his death bed passed away because his poor family couldn’t remember his blood type. “We kept asking him, but dad kept insisting that we “be positive.” Attitudes about death have changed over the years as we can live much longer and as our healthcare has improved. Some believe you can come back from death – heck, Johnny Cammareri’s mom “recovered from death” of all things in the famous movie Moonstruck. Many of us have had to deal with death early in life and this has shaped how we live. In fact, many younger people say the loss of a parent due to an unhealthy lifestyle has led them to be more active, while older people who lose a spouse are more apt to “take on their life partners” habits and behaviors. Heck, my own mother-in-law acknowledges that in the years following Arnie’s passing. “I don’t understand why I drink Bud Lights, polish my shoes and play solitaire – I never did these things before.” For several years after Arnie died, Ellen would watch the Red Sox on the TV, but she’d put the volume down to zero and turn up the AM radio to hear Joe Castiglione call the game. Arnie did that. Ellen suffers from the effects of vascular dementia, one of the most underdiagnosed conditions in the US. It is as disabling as a leg break in that it takes the mind away and leaves only fragments of information, but no tools to piece those fragments together. This is a difficult disease to watch because it’s a slow path toward death, but I do believe we can laugh along the way. Ellen, like many seniors, may not have the capacity to remember the last 10 seconds, but she can “experience.” Others facing disease don’t necessarily hold a different view of death than everyone else, largely because their attitudes were essentially shaped by previous stages of their sickness, according to an interesting 2013 study on “Attitudes Toward Death in Healthy People vs. Those Living with Diabetes & Cancer.” Grief itself following death or in the period before it has a big cost. The Grief Recovery Institute found that employers lost about $75 billion annually back in 2003 due to grieving-related effects. That number is now well over $125 billion according to some estimates. For those in healthcare, death and grieving are unavoidable but they are also part of the great mission. Can you help bend the curve for people early enough to give them another year or two of quality life, or help caregivers have a year or two more with someone they love? 

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