AT THIS HOUR

May 6, 2022

4,000: The amount Amazon will pay annually for its employees to travel for non-life-threatening medical treatments. The new benefit, effective to January 1 retroactively, applies if a procedure or treatment is not available within 100 miles of an employee’s home and virtual care is not an option. The benefit is open to all US employees, at any level, with coverage through Aetna or Premera. 

Behaving Differently: More and more insurers are now designating so-called centers of excellence for behavioral health, the latest from BCBS Michigan, which now has 14 substance use treatment and recovery distinction programs, up from 3 over the past year. Facilities with residential, inpatient, intensive outpatient or partial hospitalization services are considered for this designation. In total, the program has 367 designated providers across 42 states.

Famous Walts: There are many of them – there’s Frazier for the Knicks, the affable if not half-drunk Coach Buttermaker played by Walter Matthau, that famous Disney guy, and for those who knew him closely, Cronkite, who famously changed the nation’s views on the Vietnam War. There’s also the famous Walts we dance to, and I suppose you could argue they all have one thing in common – they make us feel better. Now a new company has formed with the same name to combat prescription drug cost increases. Waltz Health, founded by the former OptumRx CEO, will primarily be a search engine of drug-discount data sources that pharmacies can make available to customers. The company won’t disclose who its clients are but says it plans to announce “major pharmacy chain” clients later this year.

Cancer Partnerships: MD Anderson is partnering with Community Health Network to launch a clinical and research cancer program in central Indiana. The new program, called Community Health Network MD Anderson Cancer Center, will give Community physicians access to MD Anderson experts for peer-to-peer consultations. The community’s seven cancer centers will follow the same standard of care as MD Anderson and will provide medical oncology, radiation oncology, surgery, pathology, and imaging. Similarly, Cigna launched a new digital consult service through Evernorth that connects patients and their local oncologists with specialists at National Cancer Institute centers. Those oncologists can review treatment plans and diagnoses and recommend testing, therapies, or clinical trial options.

PT-OT-ST Hurdle: BCBS Michigan will begin using SecureCare to manage PT/OT/ST and chiropractic services for commercial and some MA members, effective July 5. All relevant therapists, chiropractors, and athletic trainers must register with SecureCare, which will manage services through a retrospective clinical review program.

Less Risk, More At Home Medicare: Humana will launch its value-based home health model in North Carolina and Virginia in June of this year with plans to expand to additional markets in 2023. Humana’s home-based care capabilities were accelerated last year with the acquisitions of onehome and Kindred at Home. Humana expects to have 15% of its Medicare Advantage members in these value-based models by the end of 2022, and 50% within five years.  In related developments, United Physicians, an independent physician organization with more than 1900 providers, is partnering with Agilon Health to provide a full risk value-based primary care model for MA members in southeast Michigan. Agilon already works with 17 other physician groups across the country in similar arrangements and plans to add five additional partners in 2023. BCBS Rhode Island also recently entered into a global capitation agreement for its Medicare Advantage members. The payer inked the agreement with Prospect Health Services, an ACO, and under the contract, positive patient outcomes will be linked to total compensation.

Treadmill Diagnostics: The Mayo Clinic developed an AI algorithm that can identify a left ventricular dysfunction, or a weak heart pump, based on patients’ Apple Watch data. The study, which was presented at the Heart Rhythm Society Conference last Sunday, showed that the AI analysis of the Apple Watch’s ECG data presented results as good as or slightly better than a medical treadmill test. Researchers at the Mayo Clinic are also developing an algorithm capable of detecting a weak heart pump from ECG data recorded on Apple Watches. 

Virtually OBGYN: Blue Shield of California recently made Maven’s virtual women’s and family care platform available to more than half its members. Blue Shield reported once members were notified, more than 500 members enrolled in one day. Through Maven, members can make virtual appointments with doulas, lactation consultants, childbirth educators, physical therapists, OBGYNs, and mental health providers. The partnership is part of the plan’s Health Reimagined strategy that focuses on maternal health.  

Extra Point: In case you missed it on the weather channel, my college kid landed home this week sweeping through the house like a category 4 hurricane.  I found an empty milk carton in the pantry this morning, a pair of dirty socks in the fridge and the trash bag I asked Jack to take out sadly sitting outside, near the barrel, half-eaten by Fred the Squirrel.  “What’s with the trash Jack – couldn’t put it in the barrel, really!?!” “Wait, what?” he said groggily. “You wanted me to put it in the barrel?” …  Back in the day we used to follow through, didn’t we? We didn’t rely on others, because perhaps we didn’t have a choice. We balanced our books and PB&J on the handlebars of our Huffy all 2 miles to school.  We didn’t have backpacks or carpools or ubers and if our bike tire hit a pothole and flattened, we’d get off and hoof it to make the second bell. Healthcare was like that too once upon a time. Doctor Bloom used to do it all. I remember how he’d flag pop’s rising cholesterol and expanding waistline - how he’d remove that nasty foot thingy and treat that belly pain with a good ole’ coca-cola. He’d make the spaghetti in the church hall after Saturday afternoon mass and hit flies to little leaguers on Sunday. Doc Bloom was part of the community, diagnosing us in the general store and following up on that itchy scalp outside the bank. He’d bring you the Sunday paper and check on that constipation. He knew too much and there was very little he couldn’t do for his patients and, well, in the rare chance he couldn’t figure it out, he’d send you to the emergency room. There was no middleman. There was no outpatient specialist or intensive therapy center, and no community cardiologist. As a teenager, Bloom was a starting pitcher on his city team near Springfield Mass – he’d begin the game, throw 150 pitches, and after 9 innings, win or lose, he’d hit the showers, and in the rare chance his 90 MPH fastball became a 70 MPH meatball in the 9th inning the coach would call to the dugout for an emergency reliever to stitch together the last couple outs. Like in healthcare, things are different now in baseball. You don’t pitch 9, there are set-up pitchers, lefty specialists and guys whose sole job is to throw 3 pitches to close it out. Starters have to know a lot about batters, their tendencies, their injuries and whether they’ll swing at a high fastball, but they are less and less responsible for actually finishing the game. Community doctors aren’t much different nowadays. Sure, they have to know a lot about us—our eating and exercise habits, our mental health and family history, our aches and pains, worries, warts and all—but they only have so much time with us and more and more often call in a relief specialist or refer us to a program. The art of the follow-through, the community doc, continues to fade away, right? Maybe not….maybe the latest wave of primary care at home models are bringing us back to a time when our healthcare was more personal. When our doctors knew us, and we knew them…

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