AT THIS HOUR

May 27, 2022

26: Unofficial length of a marathon because, hey, those last 2 tenths are like a blur (or so I’m told), the number of hours in a day in 2050, because moms rise up and say they don’t have enough time to be “everything to everyone” and—today—the percent of drug cost savings Prime Therapeutics achieved in one year on a PMPM basis through its MedDrive program. That program uses analytics to flag ways health plans can reduce drug spend, with a particular emphasis on using biosimilars over brand-name biologics. The program focused on only three drug categories in its first year, one of which was oncology, which led to the most savings.

Precision Med:  If not the next TV medical drama phenomenon, it ought to be. Mount Sinai and Rensselaer are creating a Center for Engineering and Precision Medicine to find treatments for uncured diseases. The new center opens next year at Hudson Research Center in Manhattan and will focus on cancer, Alzheimer’s disease, tissue degeneration and other conditions.

Cultural Care Pay:  We’ve heard from a few health plan “payment transformation” teams of late who say a sure way to differentiate for more pay is to have a real way to educate and engage an underserved culture. One Medicaid plan is considering constructing a ~$30 PMPM to a group focused on serving about 400 refugees and families who are frequently using the ER in a few markets, at a total annual cost nearly 4-5x what the pilot program will be. The group uses interpreters and people the patients can trust “to explain treatment plans”. The American Medical Association and two partners are also leading a pilot program to help health systems integrate equity into care delivery. The year-long program, called Advancing Equity Through Quality and Safety Peer Network, aims to improve health outcomes for marginalized patient populations by removing social and structural barriers to patient-centered care. Some early adopter organizations include CHOP, Dana Farber, and Ochsner. Other models are forming throughout the US with payment incentives to reward providers for the time and expertise required for offering culturally specific care. For example, CareOregon and the Alliance for Culturally Specific Behavioral Health Providers reward “culturally specific” providers up to a 20% rate. 

Dr. Baker Medicine: The wave of on-the-go physician models ala Dr. Baker from Little House on the Prairie continue to make their mark. The latest, DocGo, has just entered a multi-year agreement with Empire BlueCross BlueShield in metro New York. Beginning June 1st, Empire’s Medicare and Medicaid members in New York and their Medicaid members in New Jersey will now have access to DocGo at-home services, including preventive care, urgent episodic care and chronic care management.

Generic Jump: Insurer HCSC is partnering with CivicaScript to provide their 17.5 million members in IL, MT, NM, OK and TX with access to lower-cost generic medications. CivicaScript partners with generic manufacturers and works with payers, PBMs and pharmacies that agree to pass along the cost savings to their customers. Other Blues plans have already partnered with CivicaScript and along with HCSC member plans account for 120 million customer lives.

Richer Benefits:  BCBS Massachusetts recently debuted new benefit designs to provide richer mental health benefits to customers and members. Employers can opt to select these 3 options for their employees (1) waiving an employee’s first set of visits (1, 3 or 6) for a mental health “diagnosis” or “SUD,” (2) medication cost-sharing waivers for MH or SUD medication, and (3) wellness incentives for employees to participate in programs, classes and apps for relaxation and stress reduction. The new benefit designs are intended to strengthen and more strongly align incentives for all parties, including patients, employers, and clinicians. It will be interesting to follow uptake of these models amidst the rising prevalence of direct-to-self-insured-employer telepsych models.

Coming Up: In a special report to be released May 31, learn which 5 specialties are among the highest-paid and most expected to be impacted by value-based contracting.

Extra Point:  If Denzel hasn’t given just about every youth sports coach the perfect pre-game huddle fodder with his “If we don’t come together…” speech in Remember The Titans, then I’m not sure who could. Sports fans remember that line and its power to influence, just like young girls and boys of the 80s were inspired by Fame’s Irene Cara who sang about how we hadn’t seen the best of her yet—that she just wanted us to “remember my name.” I remember, heck I still sing that song to my kids. I also remember when ma used to remember my name and used to razz me for being a Yankee and Celtics fan because, well, that is a pretty ridiculous combination. I remember when I was 7 and how dad read the box score just before school and showed me how to figure out why the Yankees were 3 ½ down to the Sox and how I sorta paid attention because all I really wanted to do was read the puzzles on the back of the Honey Nut Cheerios box. After school, I remember when grape soda pop was good for you because it was delicious and came in a 6-ounce plastic cup for a quarter. I also remember when we used to use most of our senses to learn stuff – our eyes, ears and nose, heck even our intuition sometimes. I suppose we had no choice unlike most kids today who just use touch and, voila, they have the answer, the song and the directions. I remember when the journey mattered more than the destination and when we got our news from 3 sources –neighbors named Roger who could tell us precisely when the eye of the Hurricane was coming, the morning paper and the nightly news, and that was never more important than during the Vietnam War when Cronkite showed up on the bunny ear RCA every night to tell us “that’s the way it is,” shaping our opinion about what was happening in the war. By 1972, we were fortunate to have a new distraction from the crisis with the war comedy M.A.S.H. I remember how it gave my folks a few laughs amid a sad time and how Hawkeye used to say funny things like “give me life, liberty and the pursuit of happy hour,” and how I’d laugh but didn’t have a clue what happy hour was. I remember watching that show not really understanding the sacrifice Hawkeye and the 4077 unit were really making. I think Memorial Day is probably if nothing else about that – remembering the sacrifice of so many who have served in different ways and given us the freedom to have grape soda and box scores, fictional heroes and some real ones too. Hawkeye, a self-proclaimed “meatball” surgeon, had to make choices like when he had to forgo trying to reconstruct a patient’s damaged artery saying if “I save this leg, I lose that life.” Healthcare has had its own contingent of crises and pioneers and leaders who we ought to remember for the sacrifices they’ve made for some of the things we take for granted now. Once upon a time, there was no touch a button and your therapist could talk you through a crisis. Nurses would talk to you on the rotary phone at 11 pm to help you figure out how to get through the nausea from that round of chemo, but they wouldn’t be reimbursed for that call, nor the reminder calls to elderly patients the next day to take just the pink medication. There was a whole generation who served with a purpose but without the payment.  A cancer practice in Michigan had to “pilot” a program in ’05 where the state’s biggest insurer would pay them for follow-up phone calls. That debate has changed a lot. Now healthcare companies aren’t arguing so much to get paid for follow-up, in fact, many are incented to start doing it. They are able to do things with a combo of clinicians and one-touch technology and get paid for it. They are given time and tools to solve problems. Hawkeye had neither.  It’s a good trend and one that continues to evolve, but I think as it does we ought to remember the people who started it. They had to make decisions and sacrifice using every sense they could, without a reward or promise of fame, but in my book, they are Titans, and that’s the way it is.

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