Site of Care Management

Spike in Remote Patient Monitoring During Pandemic Is Driven by a Fraction of Providers

Billing for remote patient monitoring (RPM) jumped by more than four times during the first year of the pandemic, according to a recent Health Affairs study. The increase was mostly driven by a handful of primary care providers. Using medical claims data from the OptumLabs Data Warehouse collected between Jan. 1, 2019 to March 31, 2021, the researchers found that there were 19,762 general RPM claims in March 2021, compared with 4,355 claims in February 2020. Continuous glucose monitoring, however, only saw a slight increase over the same period of time.

In addition, RPM claims were highly concentrated. The top 0.1% of primary care providers — identified by the researchers as “high-volume provider group” — accounted for 69% of all general RPM claims.

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Humana Will Buy One Primary Care Group — and Could Snap Up Another

Humana Inc. will spend between $450 million and $550 million in debt and cash to gain full control of a group of primary care clinics that it launched with private equity firm Welsh, Carson, Anderson and Stowe (WCAS), and company executives said during the firm’s recent investor day that Humana plans to double down on its existing primary care M&A strategy. Health care finance experts tell AIS Health, a division of MMIT, that insurers’ spending spree on providers is only likely to accelerate, but that Humana is in pole position to benefit from deep investments in Medicare Advantage-focused primary care.

Health insurers have spent billions to acquire outpatient providers since the onset of the COVID-19 pandemic. Finance experts tell AIS Health that the spending spree has two sources of capital. Carriers are spending huge cash reserves taken in during the deepest parts of the pandemic, which saw utilization plummet as premium revenues increased. In addition, Wall Street is bullish on managed care: Lenders are lining up to offer generous terms to acquisition-hungry insurers, which have enjoyed strong stock performance since the start of the pandemic era.

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Pharmacist Care Managers Could Help Improve Diabetes Outcomes

Pharmacists and other non-physician care managers can improve the quality of diabetes care in the primary care setting, but structural issues make it difficult to fully leverage their potential, according to research published in the July issue of the journal Health Affairs.

“We need to have a different way of taking care of people with a chronic illness,” said Thomas Bodenheimer, a professor emeritus of family and community medicine at the University of California, San Francisco, who spoke at a Health Affairs briefing on July 19. The briefing convened several researchers who published diabetes-focused articles in the journal’s July issue.

Quality of Diabetes Care Declines as Health System Grows More Fragmented

In a series of articles in the July issue of the health policy journal Health Affairs, researchers evaluated diabetes care in the United States through several lenses, including care management, prevention, interventions, health equity, quality measures and value-based payment design. Several of them also spoke at a July 19 policy briefing in which a key message was that the fragmented U.S. health system is contributing to a plateau in improving diabetes care — and value-based diabetes payment programs may be causing still more fragmentation.

Despite remarkable advances in clinical understanding and treatments for diabetes, the U.S. has stagnated over the past decade in preventing and managing the condition, said Mohammed Ali, a professor in the Hubert Department of Global Health at Emory University. Ali served as the theme advisor for Health Affairs’ diabetes-focused issue and also was a co-author of the issue’s overview article, “Diabetes And The Fragmented State Of US Health Care And Policy.”

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More Employers Adopt Onsite, Near-Site Clinics

More employers are looking at offering near-site or onsite health clinics to employees and their families, in a bid to improve employee retention, elevate quality of care and better manage medical and pharmacy costs. To optimize these clinic offerings, employers should incorporate high-performing providers and align incentives between patients and primary care physicians (PCPs), say experts who spoke at a recent conference held by the Business Health Care Group (BHCG) of Wisconsin.

According to Mercer’s “Health & Benefit Strategies for 2023” report (see infographic), 17% of large employers said they currently provide onsite or near-site health services to employees, while 12% are planning or considering doing so. The survey was conducted April 26 to May 13, 2022, and included 451 organizations with 500 or more employees.

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Employer Purchasers Mull Virtual-First Plans, Virtual Primary Care

More purchasers than ever are offering virtual primary care to their members and may be on the verge of launching “virtual-first” plans, according to recent surveys by benefits consultants and brokers. However, health care experts tell AIS Health, a division of MMIT, that there’s an important distinction between the availability of such options to members and actual uptake — and point out purchasers aren’t yet convinced that virtual offerings will reduce costs or improve the member experience.

Recent benefit surveys show increasing interest from employer purchasers in the availability of virtual primary care — which places a member with a telehealth primary care provider inside a traditional health benefit — and virtual-first plans, which are benefit designs that require members to use some sort of telehealth option (usually a telehealth PCP) as their primary point of contact with the health care system.

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Kaiser Permanente, in No-Bid Deal, Will Take Members From California MCOs

California elected officials approved a controversial plan that will enroll members of Medi-Cal, the state’s Medicaid program, in Kaiser Permanente’s MCO — shifting those same enrollees off the books of the insurers that currently claim them as members. That’s despite the vociferous objections of 16 county-run MCO plans, which stand to lose hundreds of thousands of members in the transfer to Kaiser Permanente, according to the CEO of the largest plan involved.

Kaiser Permanente did not have to participate in the normal Medi-Cal MCO bidding process to strike the deal. Instead, the integrated health system and insurer, which is based in Oakland, worked directly with the office of Democratic Gov. Gavin Newsom to develop a bill, Assembly Bill No. 2724 (A.B. 2724), authorizing the no-bid contract. State legislators approved the bill on June 29, with the lower chamber, the Assembly, voting 48-15 in favor and the Senate approving the deal 25-7.

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Mobile Health Clinics May Reduce Disparities in Care, Help Companies Reach Business Objectives

Mobile health clinics can help health care organizations achieve their business objectives and reduce disparities in care, according to a report released on July 6. The researchers involved in the project tell AIS Health, a division of MMIT, that insurers and other payers can benefit by helping care for people who otherwise would not receive treatments and reduce overall spending by improving people’s health over the short and long term.

The report was sponsored by the Mobile Healthcare Association, a nonprofit trade group, and Mobile Health Map, an initiative led by Harvard Medical School and MHA to provide an online resource to track, research and analyze mobile health clinics. The researchers conducted interviews via telephone or video conferencing with 25 health care leaders, including executives at Harvard Medical School, Cedars-Sinai Medical Center, Kaiser Permanente and Blue Cross Blue Shield of Massachusetts.

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Medically Integrated Dispensing Chops Waste, Signals Expansion

Newly released results of a Prime Therapeutics LLC oncology program suggest that if the PBM were to expand its highly coordinated oral oncology dispensing model beyond the pilot population, cost savings could exceed $1 million. And these promising results signal that the model may be on the brink of expanding into more disease states.

Prime’s medically integrated dispensing (MID) model, which takes a high-touch, care coordination-intensive approach, cut waste by limiting overfills, according to a Prime study released June 2. Compared with the traditional central specialty pharmacy dispensing of oral oncology drugs, the MID pilot involving 627 patients across three commercial insurance plans showed the potential to cut $1,800 in costs “per medication dose change,” according to the results.

How Will Interstate Telehealth Licensure Waivers’ Expiration Impact Medicare Beneficiaries?

During the pandemic, all 50 states and Washington, D.C., issued licensure waivers that allowed out-of-state clinicians to perform telehealth with patients across state lines. By analyzing telehealth usage by Medicare beneficiaries from 2017 to 2020, researchers found that out-of-state telehealth made up only a small percentage of all outpatient visits during the first year of the pandemic, though the percentage varied by state, according to a recent study published in Health Affairs.

The number of out-of-state telehealth services jumped from 17,286 in the first quarter to 171,754 in the second quarter of 2020, and then slightly declined. Before 2020, less than 1% of out-of-state new patient visits occurred via telehealth nationwide, while in 2020, the number jumped to 6%.

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