Demand for mental health services outstrips the supply of psychiatrists. Aggravating the situation: Many psychiatrists don’t take insurance. Nurse practitioners and physician assistants are beginning to fill the gap.
Palliative care would fill a need and could save health care dollars in the process. But providers often need to patch together CPT codes to get paid for it.
Opioid overdoses have killed more than 300,000 since 2000—and the death rate is rising. Buprenorphine could save thousands more lives than it does—if it weren’t for legal barriers, a fear of disruptive patients, and insurance red tape. And it can be prescribed in the primary care physician’s office.
This old standby’s ultimate demise will likely take place when cervical cancer incidence declines as the HPV vaccine starts to take effect at a population level. New guidelines are being written, but insurers could have a major influence on how closely those guidelines are followed. So far, though, they haven’t waded very far into the Pap-HPV debate.
High Caesarean section rates. Too many babies in the NICU. There are indications that maternity and newborn care in this country is far from ideal. Some payers are betting that bundled payments for obstetricians will create incentives to make changes and reduce low-value care.
The medical home model for delivering health care is getting tested for people with mental health problems. Missouri has been a pacesetter. By using a cost-based prospective payment system for health home patients, Missouri Medicaid shifted providers’ emphasis from periodic acute care-to-care management with a focus on preventing high-cost exacerbations.
Anthem’s vice president of provider alignment solutions wants providers to know that the spigot of upside-only risk arrangements will not stay open forever.
Insurers are playing “small ball” and not showing leadership, says the former congressman. And some “spin-dry” inpatient providers are doing more harm than good in combating the opioid epidemic. Meanwhile, Kennedy, who chronicled his own harrowing mental health and addiction struggles in a 2015 memoir, says he has been sober for more than six years.
The 37-year-old has a title: executive vice president of Optum. But she wears many hats, including running a division that sells affordable hearing aids that cost from free to $599 for UnitedHealthcare members. Non-plan members can get similar hearing aids for up to 70% less than they’d pay in other outlets.
Population health should be about collective societal benefits like disease prevention and better health—better behavioral health included. Substantial investment is admittedly hard to make with no line of sight on where and when the cost benefits will come. It will take a leap of faith. Are you ready to jump?
Women make up most of the workforce, but men are in positions of power. Sexual harassment and abuse are common and deep-seated problems in American health care. Women in health care are speaking up and forcing executives and physicians to face the issue.
Research has pointed to ways that falls can be prevented, but logistical and financial barriers get in the way.
Medicare’s new bundled payments program is expected to be popular, despite unanswered questions about the target prices for the episodes, risk adjustment, and use of quality data. Here’s what we know—and don’t know.
Because physicians and health plan members both value choice, the current weak market for Inflectra and Renflexis could be a passing phase. Attitudes could change once there is more data that show people do well after switching from Remicade to the newcomers.
