News Brief 4/29/19: Thinking Ahead

Today I share two articles and my thoughts on key concepts. Keep these in the back of your mind as you prepare for 2020.

This morning, the Nevada Independent published an article referencing a sponsored bill requiring all hospitals in the state to accept Medicare and Medicaid. The legislation, according to the authors, is targeted at one hospital, Elite Medical Center, which is not enrolled in those two programs, and is also not in any private provider network.

This should be an interesting one to follow, with a state proposing to mandate participation in a federal program. (Rhode Island, an insurance market which is arguably one of the most difficult to enter, has seen its share of bills targeted towards one insurer, one hospital, one university, under the guise that “everyone has to do it”.) Nevadans may need to be careful of what they wish for, and determine if there is a true undue burden on the other facilities in the area.

In other news, Anthem told Managed Care magazine they had a 14% enrollment growth in Q1 in Medicare Advantage, pointing to their new benefit offerings targeting Social Determinants of Health (SDOH).

CMS’ rule change opened doors to insurers to give chronically ill patients with Medicare Advantage the option of accessing a range of benefits that are not necessarily health-related, but can improve or maintain their overall health, and Anthem jumped on that opportunity. The organization spent quite a bit of time in acquisition-mode, and in 2019 will now focus on the employer group markets and the dual eligibles of their current service areas, according to CEO Gail Boudreaux in an earnings call.

Watch for the Anthem (and other industry innovators) to get very creative with service offerings, but don’t expect insurers to provide transportation or home carpet cleaning themselves. Vendors entering this space will need to be mindful of the contractual obligations pushed down from a payer. Furthermore, expect a bumpy road in the implementation of these relationships until CMS provides additional oversight guidance.

Be Antibiotics Aware

Far be it from me to provide medical advice. This place is about my personal perspective and experience, and this topic includes an important message for our community, especially now that the holiday season is coming. Families will be getting together, and oftentimes, someone at the dinner table feels under the weather.

The Rhode Island Department of Health (RIDOH) issued a press release today to remind Rhode Islanders to be “antibiotics aware”. It seems there is a special week for everything!  Last week was Corporate Compliance and Ethics week, but this week, apparently, is U.S. Antibiotic Awareness Week and World Antibiotic Awareness Week (November 13th -19th). These drugs are super helpful in the treatment of bacterial infections. However, according to the press release, the overuse of antibiotics and the use of these drugs when not appropriate have contributed to 2 million+ people falling ill with antibiotic-resistant bacteria.

Remember: antibiotics do not work on viruses. There is a distinction between viruses and bacteria that make us ill. Take it from an experienced patient: Let your physician properly diagnose your illness. Finish your prescription medication as directed. Alert your physician if you experience any significant side effects of antibiotics (as I have done; some of them pack quite a punch!) and safely discard any unused medication.

www.health.ri.gov/antibiotics

www.cdc.gov/antibiotic-use

The End of Oklahoma’s In-Home Support Waiver

Buried in my newsfeed today is an article from earlier this month regarding the state of Oklahoma’s decision to cut funding for a significantly needy population.  Families who care for developmentally disabled adults often require additional support, otherwise, working a full-time job would be difficult.

The Oklahoma Health Care Authority describes the In-Home Support Waiver as follows: In-Home Supports for Adults serves the needs of individuals 18 years of age and older with intellectual disabilities who would otherwise require placement in an ICF/IID [Intermediate Care Facilities for Individuals with Intellectual Disabilities].

According to the OHCA website,  services include: Respite, Nursing Services, Adaptive Equipment, Nutritional Services, Audiology, Occupational, Physical, & Speech Therapies, Habilitation Training Specialists (in-home care), Psychological Counseling, Medical Supplies and Services, Employment Services, and Transportation. Funding for these and more services will end December 1, forcing families to make some key decisions in the next few weeks.

I hope state lawmakers responsible for informing the budget can find something else to cut besides these valuable sevices. Parents and caretakers may need to choose between caring for these loved ones or keeping their jobs. From the article:

“We are still hopeful, still optimistic that the legislature will not allow these cuts to take place,” said DHS spokeswoman Sheree Powell. “There’s still time to pass funding bills, to make sure that the funding is available for these services. But come December 1, these programs will end and there will be nothing DHS can do about it.”

Give Memorial Hospital New Life

This past month, it was announced that Memorial Hospital in Pawtucket, RI will close. While it appears the low utilization and financial state of the facility support this clear choice, it is always disappointing to the local community that has depended on Memorial for generations.

Dr. Michael Fine notes in his article that we are healthier than we used to be, But he also provides a compelling alternative, which is to use the facility as a treatment center for those battling drug and alcohol addiction. There is such a great demand for these services, and having additional local access to high-quality treatment would be welcome in any community.

Now all we have to do is make it affordable and accessible. Who can come in and turn this Brewster St. facility into a place of treatment and recovery? Any takers?