October 4, 2024

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Blue Cross Blue Shield of Massachusetts adds virtual gastrointestinal care model to network

Blue Cross Blue Shield of Massachusetts adds virtual gastrointestinal care model to network

Maybe IBS *doesn’t* have to be for hot girls.

Blue Cross Blue Shield of Massachusetts (BCBSMA) this month added a virtual care provider to its health plan aimed at addressing gastrointestinal (GI) conditions.

BCBSMA’s nearly 3 million BCBSMA members will have access to Oshi Health, a synchronous telehealth service for GI conditions—a speciality that’s historically not covered by insurance—the payer announced last month.

“We understand the challenges members face accessing high-quality, affordable specialty care,” Lisa Glenn, BCBSMA’s VP of network partnerships and innovation, said in a statement. “Bringing in these physician groups helps ensure we provide a top-notch experience to our members.”

How it works

Patients can begin receiving care with a referral from a primary care provider, Sam Holliday, Oshi’s co-founder and CEO, told Healthcare Brew.

Oshi’s care team includes gastroenterologists and GI providers, as well as behavioral health providers and registered dieticians who specialize in digestive health. Traditionally, those medical professionals haven’t been included in covered treatment plans for chronic GI conditions like irritable bowel syndrome (IBS), Crohn’s disease, or ulcerative colitis, Holliday said.

During the first telehealth visit with a patient, an Oshi nurse practitioner reviews the patient’s history and asks which GI treatments they have previously tried, such as dietary changes or over-the-counter treatments. The telehealth company can also track down previous health records ahead of an appointment, Holliday added.

The nurse practitioner can then order any necessary lab tests through a local provider and develop a care plan, including meeting with an Oshi dietician to see if eliminating certain foods can alleviate symptoms, Holliday said.

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“We methodically work with you to figure out which [foods] are triggering your symptoms. And then, if our nurse practitioner thinks that the behavioral interventions might help you, you could meet with our psychologists, social workers, and start learning about how the gut and brain work together,” Holliday said.

Why it matters

Cognitive and dietary interventions may help patients control their symptoms in the long run. For example, a behavioral health provider can prescribe gut-directed hypnotherapy to treat food anxiety, Holliday added.

“If you don’t give [patients] back control, they’re going to keep going to different parts of the healthcare system looking for answers, or their symptoms are going to get bad enough that they land in the emergency room,” Holliday said.

In 2021, there were over 8 million digestive disease-related emergency room visits, according to the CDC.

Oshi’s virtual GI treatment model has the potential to decrease healthcare utilization and save payers thousands of dollars, he said.

Patients with chronic GI conditions who used Oshi for a nine-month virtual treatment program had a 64% decrease in GI-related emergency room visits, and six months into the program, payers saw an average of $10,292 in overall healthcare savings per patient, according to a clinical trial study of more than 300 patients published earlier this year.

Massachusetts isn’t the only state where Oshi provides care. Earlier this month, the company partnered with the Gastroenterology Associates of New Jersey to provide patients with both telehealth and in-person access to GI specialists.

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