In-Person Clause For Telemental Health Impedes Access, Say Providers
A clause in December's Medicare spending bill demands patients see a mental health practitioner in person within six months before virtual treatment, and it's now being targeted by advocates who argue it impedes access. Anthem, Atrium, quitting smoking, refugees and AI are also in the news.
Modern Healthcare:
Providers Push Congress To Repeal In-Person Telemental Health Requirement
Congress has made steps to improve Medicare's telehealth coverage, but there are still restrictions that provider groups, advocates and lawmakers across the aisle argue will impede access to mental healthcare. The $2.3 trillion government spending bill passed in December permanently allowed Medicare to cover mental health services delivered virtually but with a catch: beneficiaries must see the practitioner in person within six months before virtual treatment begins. Lawmakers added the requirement amid concern over potential Medicare fraud and waste. But some congressional aides say the restriction was added to bring down the cost of the bill, the biggest spending package passed in congressional history. (Hellmann, 7/26)
In other health care industry news —
Modern Healthcare:
Anthem, Humana Drop Nearly $140 Million To Launch New PBM
Anthem and Humana have invested nearly $140 million to form a new pharmacy benefit manager, as criticism over traditional PBMs' operations kickstarts business at startups that promise transparency. The insurers will hold a minority stake in the new joint venture, named DomaniRx, which is being championed by SS&C Technologies. The Windsor, Conn.-based fintech company owns approximately 80% of the new business, according to a filing submitted to the U.S. Securities and Exchange Commission on July 15. SS&C's existing claims processing platform—RxNova—will serve as the new PBM's technological backbone. By combining claims administration with data analytics, DomaniRx aims to offer payers more transparency into their drug costs and help them better comply with changing government regulations. Payers use PBMs to manage their benefits and negotiate drug pricing with pharmaceutical companies and drugstores. (Tepper, 7/26)
North Carolina Health News:
Atrium Closes Deal For Georgia Hospital System
A Charlotte-based health care system has finalized a deal to acquire a nonprofit hospital organization based in Rome. Floyd Medical Center, a hospital in Cedartown and one in Alabama will now become part of Atrium Health under the long-delayed agreement, announced Wednesday. It’s the second big foray into Georgia for Atrium Health, which in 2018 acquired the Navicent system in Macon. Atrium may now look to expand further in the state, experts say. (Miller, 7/27)
AP:
Never Too Late: Cancer Centers Push Patients To Quit Smoking
When cancer patients stop smoking, they heal faster, experience fewer side effects from treatment and lower their chances of tumors returning. Now, top cancer hospitals are helping patients quit as evidence mounts that it’s never too late. The newest research, reported Monday, shows lung cancer patients who stopped smoking gained nearly two years of life compared to those who continued to smoke. (Johnson, 7/26)
Modern Healthcare:
AI Can Tell Insurers When Commercial Customers Need Social Supports
Insurers are increasingly investing in predictive analytics to identify social determinants of health needs among commercial enrollees, as a growing number of payers recognize that social support must not begin and end with government customers. Eighty-three percent of large employers named addressing the social determinants of health as essential to their strategy over the next three years, according to a Willis Towers Watson survey released in April. In response to employers' demands, insurers are leaning on tech to inform these new benefits structures, although some question the validity of the data these companies rely on. (Tepper, 7/26)
KHN:
How A Doctor Breaks Norms To Treat Refugees And Recent Immigrants
Fatumo Osman, a 65-year-old Somali refugee who speaks limited English, was in a bind. She made too much money at a meal prep service job so she no longer qualified for Medicaid. But knee pain kept her from working, so her income had dropped. She could reapply for Medicaid, get her knee fixed and return to work, at which point she’d lose that safety-net health coverage. Her first step was getting a note from a doctor so she wouldn’t lose her job. So, Osman came to Mango House, a clinic in this eastern suburb of Denver that caters primarily to refugees and turns no one away, regardless of their ability to pay. Dr. P.J. Parmar designed the clinic to survive on the Medicaid payments that many doctors across the U.S. reject as too low. (Hawryluk, 7/27)
