Weekend Update

Congress returns to Capitol Hill this week following the Thanksgiving holiday. The most pressing issue is completion of FY 2019 appropriations.  (FY 2019 began on October 1, 2018.) The bulk of FY 2019 appropriations (in terms of dollars) were resolved in September.  The following appropriations measures are funded with a continuing resolution through December 7, 2018: Agriculture; Commerce, Justice, Science; Financial Services & General Government (which includes OPM/FEHBP); Homeland Security; Interior, Environment; State, Foreign Operations; and Transportation, Housing and Urban Development. For more details check out the Committee for a Responsible Federal Budget's Appropriations Watch.

Healthcare Dive discusses a Health Care Cost Institute report on primary care visits covered by employer sponsored plans like the FEHBP.  The highlights of the report are as follows:

Office visits to primary care physicians (PCPs) declined 18 percent from 2012 to 2016 for adults under 65 years old with employer-sponsored health insurance, while office visits to nurse practitioners (NPs) and physician assistants (PAs) increased 129 percent. 

Comparing 2012 to 2016, there were 273 fewer office visits per 1,000 insured individuals to primary care physicians over that span, while visits to nurse practitioners and physician assistants rose from 88 visits per 1,000 insured members to 201. The rate of office visits to specialists and other non-physician providers remained relatively unchanged over the period. 

While the utilization of office visits to NPs and PAs increased dramatically over the study period, the substitution did not result in cost savings. Since 2012, the average cost of an office visit to a primary care physician remained closely aligned with the cost of a NP and PA visit. In 2016, the average cost per visit to a primary care physician was $106 compared to $103 for an office visit to a NP or PA. 

Every state saw declines in office visits to PCPs and an increase in office visits to NPs and PAs between 2012 and 2016.

Modern Healthcare tells us about an innovative company called 98point6.

Ever since house calls fell out of favor, most medical care has been delivered in hospitals and doctor's offices. But apply smartphones and AI to the situation, and that need not be the case, at least not for primary care. The company 98point6, for one, wants to take primary care virtual, through text conversations.

For patients, the experience begins with 98point6's automated assistant, which asks what's wrong. Behind the scenes, natural language processing and machine learning analyze the chat to narrow in on the relevant topic, allowing the assistant to ask questions that will give human physicians the information they need to diagnose and treat the problem.

The software itself isn't handling treatment—a physician is. After the initial narrowing, the software presents the case to 98point6's board-certified physicians, all of whom are permanent employees of the company. In anywhere from a few seconds to a couple of minutes, the physician connects with the patient, messaging to ask any additional questions—using video and photos, if necessary—and then will submit an electronic prescription, order labs, or recommend the patient see someone in person. But that last option is rare: More than 95% of cases are resolved virtually.

98point6 is currently focused on the self-insured employer market. Employers pay a single fee for unlimited access for their employees. “That's key,” Cape said, since a single fee doesn't limit patients' use of the service. 98point6 also has a direct-to-consumer offering, which costs $20 for the first year and $120 per year after that.

Perhaps this approach will be more appealing to consumers than telehealth.