Will Smith, the co-director of Grand Teton National Park, demonstrates some daring-do to rescue people from mishaps in the mountains of Wyoming. But just like medical directors for health systems, insurance companies, and pharmacy benefits management firms, Smith is in the business of setting policies and protocols.
The company has more than 15,000 employees—or about a third of the eligible employees in those four locations—enrolled in direct contracts. Boeing has dubbed the direct contracts its Preferred Partnership health plan. Should insurers worry that other large companies will cut them out?
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.
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.
The insurer’s general manager of behavioral and EAP services wants to make mental health care more mainstream. Only 17% of American adults function with optimal mental health. “We talk about it as if it’s them over there, but 83% of us have a need.”
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?
Seven biosimilars have crossed the FDA-approval finish line. The FDA has largely held to the abbreviated pathway it laid out originally. The big change is that the rest of the world is starting to understand it. Approvals are based upon “the totality of evidence,” “analytic similarity,” and clinical performance with much less emphasis placed on phase 3 trials.
Medical directors have been around for a long time. Today, to reflect expanding duties, there’s a bewildering array of other titles too. Are we all agreed on what titles mean, then? No way. For example: Many executives who are called CMOs—or something else—are also taking on the new duties of value-based care.
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.