In the News: Apr 11–18

BCBS of Texas to Open 10 Primary Care Centers in 2020

According to a Modern Healthcare article, Blue Cross and Blue Shield (BCBS) of Texas recently announced plans to open 10 primary care centers in Houston and Dallas in 2020. Health Care Service Corporation (owner of BCBS of Texas), will partner with medical center operator Sanitas USA to open and operate the centers, which will include lab and diagnostic imaging, urgent care and disease management programs. Other BCBS plans across the country, including Florida Blue and BCBS of New Jersey, have previously partnered with Sanitas USA to open clinics.

Several insurers have opened clinics or purchased medical practices to have greater influence controlling health care costs of their members. Other organizations, such as CVS Health and Walgreens, have announced retail clinic expansions to provide urgent care and primary care services. Walgreens recently announced a partnership with primary care provider VillageMD to open clinics next to Walgreens drugstores in Houston.

The low-acuity landscape continues to evolve as new market entrants challenge existing care models by focusing on providing more convenient, cost-effective care. For health systems, Sg2 believes urgent care and retail services can serve as an extension of current primary care services, enabling greater access to convenient care. To learn more on the role of different low-acuity assets within the primary care ecosystem, watch the on-demand Sg2 webinar Primary Care Ecosystem: Reconfiguring Assets to Meet Future Demands.

Morbidity Data Can Target Interventions for Prescription Opioid Overuse

A recent American Journal of Public Health study reviewed morbidity data to estimate how many cases of prescription opioid harm are projected to visit EDs across the US, using a 60-hospital sample that reviewed 7,769 cases of prescription opioid harms that corresponded with over 267,000 ED visits. The study also examined additional patient characteristics such as clinical manifestations, intent of opioid use and the active ingredient within the medication. This morbidity data review allowed researchers to reveal insights to help target interventions based on specific population characteristics; for example, the patients that were prescribed opioids long-term might benefit from screening and treatment of substance use disorder.

Substance use disorder treatment in the US remains largely segregated from the rest of health care and serves just a fraction of those in need, with only 10% of people with a substance use disorder receiving treatment. Sg2 believes that partnering with key community stakeholders, including first responders and social services, is key to addressing the scope of the problem and designing the right solutions to best serve the community. To learn more about the future outlook for substance use and substance use disorders, as well as key services and innovative treatments that are being deployed throughout the System of CARE, read the Sg2 FAQ Treating Substance Use Across the System of CARE.

Telehealth Now Included in Medicare Advantage

A recent Modern Healthcare article highlights CMS’s decision to expand Medicare Advantage coverage, including telehealth services in the home. Previously, telehealth home services were an add-on and paid for with rebate dollars or premiums, but now this service is part of the basic, government-funded Medicare Advantage benefit.

This change was proposed in October 2018, amongst others regarding consolidating the appeals process for dual-eligible special needs plans and potential changes to Medicare Advantage audits. Sg2 expects Medicare Advantage to continue growing, which means the significance of the program as a source of hospital revenue will also increase.

For insights on key drivers of Medicare Advantage growth, its potential wildcards and disrupters, and strategic options and essential competencies and metrics for Medicare Advantage success, read the Sg2 report Medicare Advantage: Too Big to Ignore.

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