Category: ACOs

The company partners with independent practices, health centers and clinics to establish primary care-focused accountable care organizations.

What You Should Know:

– Aledade raises $100 Million in Series D funding to help
more primary care practices thrive in value-based care.

– The new funding will power the growth of a nationwide network of more than one million patients by further expanding into Medicare Advantage Contracts.

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Aledade,
a Bethesda, MD-based provider of value-based primary care, today announced it
has closed a $100 million Series D funding round following a year of
significant growth for its national network of risk-taking primary care
practices. Returning investor Meritech Capital led the round, which included new growth
investors Tiger
Global Management and IVP,
and returning investor OMERS Growth Equity. The latest round of funding brings the
company’s valuation to over $2.1 billion dollars.

Delivering Value-Based Primary Care

Founded in 2014 by former National Coordinator for Health IT, Farzad Mostashari, Aledade began building ACO networks for independent physicians through the Medicare Shared Savings Program, but now also partners with commercial payers across the country.  Aledade now partners with nearly 800 independent primary care practices, including more than 100 federally-qualified health centers, comprising more than 7,800 providers in 31 states. Through this nationwide network of independent practices, Aledade practices manage roughly $12 billion in health care spending through 35 Medicare and 51 other value-based contracts and care for nearly 1.2 million patients.

Why It Matters

As the healthcare system continues to be strained by the
COVID-19 pandemic, these value-based
practices are keeping patients healthy, at home, and out of the hospital with
proactive, coordinated primary care. Aledade technology helps practices
identify and better manage their most at-risk patients. Patients of practices
engaged with Aledade have fewer emergency department visits, inpatient stays
and readmissions; in the most recent year with public results from the Medicare
Shared Savings Program, Aledade practices reduced hospital stays by an average
of 9 percent, avoiding more than 10,000 unnecessary hospitalizations.

Aledade’s growth has been driven by the success of its
physician-led model, in which the company shares in the risk and reward of both
government and commercial value-based contracts with participating independent
practices. Aledade practices have improved the quality of care and health
outcomes while controlling costs in all types of public and private payer
contracts. To date, Aledade’s participating practices have received more than
$115 million in shared savings revenue.

Funding Will Support Strategic Partnerships with Medicare
Advantage Plans

Aledade will use this infusion of capital to expand its value-based care model with health plans across the country, with a particular focus on growing its strategic partnerships with Medicare Advantage (MA) plans to improve outcomes and quality for more seniors. Already, Aledade works with all of the largest MA payers and multiple Blue Cross plans to give Aledade practices access to Medicare Advantage value-based contracts. In 2020, Aledade more than doubled the number of patients served in these MA contracts, bringing the total to about 100,000.

As the company expands into more MA plan partnerships and
welcomes more practices to its national network of ACOs, Aledade will continue
to invest heavily in its cutting-edge technology platform to ensure primary
care physicians have a world-class operating system for population health.
Aledade also plans to launch several initiatives in 2021 to extend this
platform.

These include initiatives to extend the use of integrated
telehealth, predict and prevent the occurrence of unplanned dialysis, reduce
racial disparities in hypertension control, and enable even the smallest
primary care practices in the country to join value-based contracts with
Aledade. 

What You Should Know:

–  Net Health acquires post-acute market analytics platform PointRight to deepen the company’s analytics capabilities, post-acute presence, and support for SNF networks.

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Net
Health, a provider of cloud-based software for specialty medical providers
across the continuum of care, today announced that it has acquired
PointRight Inc., a leading provider of
analytics and data-driven tools for the post-acute market. The acquisition adds
to Net Health’s expanding investments in analytics capabilities, which include
the recent acquisition of Tissue Analytics in April 2020 and the earlier
acquisition of Focus on Therapeutic Outcomes (FOTO).

Unlock the Power of Advanced Analytics for Post-Acute
Performance

Founded in 1995, PointRight provides analytics that shows a 360⁰ view of long-term and post-acute (LTPAC) facility performance and clinical outcomes. Equipped with these insights, LTPAC Provider and Payers can lower rehospitalization rates, improve clinical outcomes, and build and manage high-performing networks. Today, close to 2,400 SNFs use PointRight’s advanced analytics and data-driven decision support tools to further their clinical, financial, and operational objectives. 

SNFs use PointRight to improve the accuracy of their reimbursement and regulatory submissions and to enhance overall performance in readmissions, quality, and outcomes, including more accurate and compliant patient assessments, reduced rehospitalization rates, and optimized care transitions.

 More recently, health systems, ACOs, payers, and real estate investment trusts (REIT) have relied on PointRight to provide insight into the health of their SNF networks and to identify areas for improvement.

Acquisition Expands Net Health’s
Market Share in Growing Post-Acute Market

The
acquisition of PointRight expands Net Health’s position and scale in the
growing post-acute market. Additionally, the acquisition will enable Net
Health’s broad roster of hospital clients to better manage their skilled
nursing facility (SNF) networks and support outcomes measurement and performance
improvement in Medicare Advantage and managed Medicaid programs. As part of the
acquisition, Net Health
plans to fully integrate PointRight staff to accelerate the delivery of new
analytics solutions and expand the availability of PointRight to Net Health’s
customers and markets. 

“Through PointRight, Net Health will significantly expand how we support SNFs and their health system, accountable care organization (ACO), payer and REIT partners,” said Josh Pickus, Net Health’s Chief Executive Officer. “It also strengthens our growing analytics capabilities by providing insights into post-acute performance, which enables providers and payers to align around value-based care initiatives.”

Financial details of the acquisition
were not disclosed.

The new Geographic Direct Contracting Model aims to improve quality of care and slash costs for Medicare beneficiaries across an entire region. It involves setting up risk-sharing arrangements where participants will be responsible for the total cost of care for beneficiaries in the region.

What
You Should Know:

–
PointClickCare announces its intent to acquire Collective Medical to create the
largest combined acute and post-acute care network in North America for $650M.

–
Collective Medical’s platform connects more than 1,300 hospitals, thousands of
ambulatory practices and long-term post-acute care (LTPAC) providers, as well
as accountable care organizations (ACOs) and every national health plan in the
country, across a 39-state network.

– With the acquisition of Collective Medical, PointClickCare will solidify its position as a high-growth, cloud-based SaaS leader, serving a large, diversified customer base across the acute, ambulatory, post-acute, and payer spectrum.

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PointClickCare
Technologies, a leader in senior care technology with a network of more
than 21,000 skilled nursing facilities, senior living communities, and home
health agencies, today announced its intent to acquire
Collective Medical, a Salt Lake
City, UT-based leading network-enabled platform for real-time cross-continuum
care coordination for $650M. Together, PointClickCare and Collective Medical
will provide diverse care teams across the continuum of acute, ambulatory, and
post-acute care with point-of-care access to deep, real-time patient insights
at any stage of a patient’s healthcare journey, enabling better decision making
and improved clinical outcomes at lower cost.

The acquisition follows a partnership, created between the
companies in August 2019, which streamlined the integration of Collective
Medical’s solution for care transitions with PointClickCare’s leading
cloud-based software platform. Hundreds of PointClickCare customers are already
leveraging this connection to the Collective platform to coordinate seamless
care transitions and influence decisions at the point of care.

COVID-19 Underscores Barriers to Care Coordination

Currently, hospitals, ACOs and health plans
lack the data and tools to effectively coordinate with LTPAC providers and
other disparate points of care – an issue spotlighted further by the COVID-19 pandemic.
And despite the healthcare system’s ongoing move to value-based payment
models, barriers to care coordination
persist, especially for seniors and other complex patient populations. Through
this acquisition, the company will be uniquely positioned to address these
challenges.

PointClickCare supports a network of more than 21,000
skilled nursing facilities, senior living communities and home health agencies.
In the United States, 97 percent of all hospitals discharge patients to skilled
nursing facilities using PointClickCare. Founded in 2005, Collective Medical’s
platform connects more than 1,300 hospitals, thousands of ambulatory practices
and long-term post-acute care (LTPAC) providers, as well as accountable care
organizations (ACOs) and every national health plan in the country, across a
39-state network.

These providers come together via the Collective platform to
support patients suffering from a variety of complex conditions, including
substance use disorder, mental and behavioral health issues, and other care
needs requiring multiple interventions and transitions across disparate care
settings. The combination of PointClickCare and Collective Medical will enable
care to be more seamlessly delivered for the most complex (high-cost,
high-needs) patients, including the rapidly growing aging population.

The acquisition will connect care teams, post-acute
providers, hospitals and health plans with better data about their patients,
ultimately reducing administrative burdens and bringing down the high costs of
complex care. Providers and health plans will be empowered as they work to
solve the complexities around the senior patient population by leveraging
increased information across diagnoses groups and unprecedented access to drive
behavior change at the point of care.

Acquisition Establishes PointClickCare As Leader in Acute and Post-Acute
Care Network

With the acquisition of Collective Medical, PointClickCare
will solidify its position as a high growth, cloud-based SaaS leader, serving a
large, diversified customer base across the acute, ambulatory, post-acute, and
payer spectrum. As the shift to value-based care fuels growing market demand
for intelligence and collaboration tools, the company will be best positioned
to provide the most fully integrated set of real-time care coordination tools
across the entire continuum of care, powered by the largest network of its kind
in the U.S.

“The healthcare ecosystem is a mix of disconnected providers, systems, plans, processes and data. Healthcare costs and risk are on the rise, while patient care and provider-to-provider coordination are inconsistent. Our mission is to improve the lives of seniors, and we believe the best way to meaningfully advance this goal is by connecting disparate points of care,” says Mike Wessinger, founder and chief executive officer of PointClickCare Technologies. “Collective Medical offers the right fit of people and technology and together we will initiate a new era of data-enriched collaboration across the continuum that radically transforms how data and people are empowered to liberate health.”

The acquisition is subject to receiving regulatory
approvals, including from The Committee on Foreign Investment in the United
States (CFIUS), and other customary closing conditions, and is expected to be
completed by the end of December 2020.

When doctors know their patients have been to the hospital, they can act fast to provide needed support. Widespread use of hospital event notifications is associated with all kinds of health benefits, including a 10 percent decrease in readmissions for Medicare beneficiaries. These event notifications are one of the simplest, easiest (most-bipartisan!), and most impactful changes we can make to improve patient outcomes in U.S. healthcare. 

To this goal, the Centers for Medicare and Medicaid Services (CMS) released new regulations in March that will require hospitals to share event notifications with community providers when a patient is admitted, discharged, or transferred (ADT). Hospitals have to comply by May 2021 if they want to keep getting paid by Medicare and Medicaid. 

This policy will improve care, reduce costs, and save lives. It’s also simple and straightforward.  CMS explains, “Lack of seamless data exchange in healthcare has historically detracted from patient care, leading to poor health outcomes, and higher costs.” ADT notifications close these gaps and many healthcare organizations have been using them for years, vastly improving care for patients.

Take the Utah Health Information Network (UHIN) which has utilized ADT notifications to reduce costs and readmissions for over a decade. According to the former UHIN President and CEO, Teresa Rivera,

“This level of care coordination quite literally saves both lives and money.” She continues, “This secure and cost-effective method provides the patient’s entire medical team, regardless of where they work, with the important information they need to coordinate care. That coordination is important to reducing readmission rates, and helps health care professionals provide a better experience to patients.”

ADT notifications are a standard set of messages that most electronic health record (EHR) systems can generate with minimal set-up. In fact, in a 2019 letter from the National Association of ACOs in support of CMS’ proposal to require hospitals participating in Medicare and Medicaid to send event notifications, they expressed that new standards efforts are not needed for the successful implementation.

The authors wrote, “In numerous conversations with HIEs, other intermediaries and providers, we were unable to find a single example where a hospital was unable to send an ADT notification today due to lack of standards.”

But you wouldn’t know it if you listened to the misconceptions that are currently being spread to hospitals about this requirement. Here are five myths that I’ve encountered just this month:

Myth 1: The ADT notification policies are strict and difficult to comply with. Not true. CMS listened to feedback that Meaningful Use requirements were too regimented and promoted a “check the box” not “get it done” mentality. CMS purposely worked to keep these ADT requirements broad and non-prescriptive. Hospitals don’t need to comply with any specific technical standard. The CMS regulations released in March are final.

Myth 2: You have to connect to a nationwide network. Wrong. Hospitals can choose from a wide variety of regional and statewide health information exchange (HIE) partners. The policy requires “reasonable effort” to send notifications to providers in your community. An intermediary can be used to comply with the rule as long as it “connects to a wide range of recipients.” Unlike what some nationwide companies are saying, the regulations do not mandate out-of-state alerts.

Myth 3: The policy creates a big technical burden for hospitals. More than 99 percent of hospitals have EHR systems in place today, and most of those can produce standard ADT transactions with relatively minimal effort. While the time to activate ADT notifications varies, it can usually be done in as little as a day by a hospital IT team. 

Myth 4: The timing isn’t right. It’s happening too fast. A global pandemic is exactly the moment when we need this kind of data sharing in our communities. With COVID-19, it is even more crucial that care teams are alerted promptly when a patient is seen in the emergency department or discharged from the hospital so that they can reach out and provide support. Regardless, CMS has given an additional six months of enforcement discretion for hospitals, pushing back the deadline to May 2021.

Myth 5: There’s no funding available for this work. Wrong again. In California and several other states, hospitals can take advantage of public funding to connect to regional HIEs that provide ADT notification services. There’s $50 million in funding available just in California. 

This new policy is an exciting step forward for patients and providers. It gives primary care and post-acute providers crucial, needed information to improve patient care. Hospitals can meet the requirements with minimal burden using existing technologies. Patients will have a more seamless experience when they are at their most vulnerable.

In healthcare, it’s easy to assume that great impact requires great complexity. But time and again the opposite is true. So let’s bust the myths, get it done, and keep it simple. 

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About Claudia Williams

Claudia Williams is the CEO of Manifest MedEx. Previously the senior advisor for health technology and innovation at the White House, Claudia helped lead President Obama’s Precision Medicine Initiative. Before joining the White House, Claudia was director of health information exchange at HHS and was director of health policy and public affairs at the Markle Foundation.

As COVID-19 continues to impact the country, providers across the continuum face new challenges delivering care and ensuring safety for their patients and themselves.  During this period, sharing real-time information about patients’ care encounters across provider types and care settings matter more than ever. In particular, hospitals sharing admission, discharge, and transfer (ADT) events with COVID-19 patients’ community-based providers is critical to ensure the best treatment course and safer more seamless care transitions for infected and recovering patients. 

Real-time ADT-based notifications include information about a patient’s current care encounter, demographic details, information about the provider or institution sending the notification, and, as permissible, clinical information. This data enables providers across the continuum to make informed and coordinated decisions about their patients’ treatment and care transition plans. Even before the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) recognized the importance of such ADT notifications in supporting patient care and finalized a new Condition of Participation (CoP) as part of the recently published Interoperability and Patient Access Final Rule (85 FR 25510). The CoP requires hospitals to share electronic patient event notifications, or e-notifications, with other community providers, such as primary care physicians (PCPs) and post-acute care providers, to facilitate better care coordination and improve patient outcomes. 

The necessity and benefit of these e-notifications has come into stark relief as providers and the healthcare system more broadly fight COVID-19. ADT-based e-notifications are an accessible and easy way to help enable better safety for COVID-19 patients and their providers while also ensuring efficient use and appropriate allocation of scarce resources. For example, ADT-based e-notifications can:

Enhance Safety for Patients Protecting patient safety and providing appropriate treatment is especially urgent during a crisis like COVID-19 when resources are limited and staff is stretched.  E-notifications allow hospitals that treat COVID-19 patients to more rapidly get in touch with a patient’s other providers and obtain important medical histories to help guide treatment and clinical decision-making.  Traditional exchange of data facilitated by phone calls, faxes, or labor-intensive data searches can introduce treatment delays, unnecessary or harmful interventions, and frustrations for providers. The faster information can be exchanged and a patient’s history is known by the hospital care team, the easier it is to effectively and safely treat the patient with the most appropriate interventions. 

Enhance Safety for Providers: Hospital e-notifications are especially important for post-acute and other community-based providers that will continue treatment for COVID-19 patients discharged from the hospital. Because e-notifications provide context about the patient’s most recent encounter, including diagnoses where permissible, they help guide the continuation of care.  Receiving e-notifications from hospitals allows such providers to appropriately prepare staff and put safety measures in place prior to treating COVID-19 patients. In particular, Skilled Nursing Facilities need time to properly and safely intake infected patients while Home Health Agencies need to prepare and equip their nurses for visits to homes of infected patients.

Open Hospital Beds for the Sickest Patients: Through real-time e-notifications, hospitals are able to more easily and quickly communicate and share information with COVID-19 patients’ other community-based providers who will care for recovering patients after they are discharged from the hospital. This exchange of information allows hospital care teams to more seamlessly and quickly transition recovering COVID-19 patients to the next level of care, which opens scarce hospital beds for the sickest patients.

Improve Care for COVID-19 Patients: Real-time e-notifications from hospitals allow PCPs and care coordinators to know when their patients have inpatient or ED events. In particular, discharge notifications can trigger critical follow-up services, including telehealth-based visits, to ensure COVID-19 patients recover safely and fully after they leave the hospital. Engaging COVID-19 patients after a hospitalization can help prevent readmissions and keep patients healthy in their homes. At the same time, PCPs are able to support the financial viability of their practices by being able to provide and bill for Transitional Care Management Services and ensure patient engagement in ongoing preventive and other clinical care.

Bolster Public Health Response: Aggregated and de-identified ADT-based notifications offer wide-ranging and powerful real-time data for local, state, and federal public health officials to detect emerging COVID-19 hotspots and intense ED, hospital, ICU strain.  Real-time data about the hospital and ED utilization can help public health officials direct and allocate scarce resources to the highest need areas quickly.

These are just some examples of how ADT-based e-notifications can play an important part in helping healthcare organizations effectively, efficiently, and safely deliver care for their patients during the ongoing pandemic – and beyond. 

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About Jay Desai, CEO & Co-Founder, PatientPing

Jay started PatientPing in 2013 with one goal in mind: to connect providers everywhere to seamlessly coordinate patient care. Prior to founding PatientPing, Jay worked at the CMS Innovation Center (CMMI) where he helped develop ACOs, bundled payments, and other payment initiatives. Jay’s passion lies at the intersection of technology, policy, and community building. He has an MBA in healthcare management from Wharton and a BA from the University of Michigan. 

What You Should Know:

– HealthEdge Software announces the acquisition of The Burgess
Group, LLC (“Burgess”), an innovative payment integrity software company
focused on improving healthcare payment operations for an undisclosed sum.

– The strategic acquisition will boost Health Edge’s position in
the payment integrity market and extends best-in-class claims processing to
include software-driven payment integrity

– Burgess’ product, Burgess
Source®, is the first solution to natively bring together claim payment
automation with business intelligence and enables a unified approach to ensure
payment accuracy. 

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HealthEdge Software, Inc.® (“HealthEdge”), a provider of the industry’s leading integrated financial, administrative and clinical platform for health insurers, today announced the acquisition of The Burgess Group, LLC (“Burgess”), an Alexandria, VA-based payment integrity software company focused on improving healthcare payment operations through technology. Financial details of the acquisition were not disclosed. TripleTree, LLC served as financial advisor and Debevoise & Plimpton LLP was legal advisor to HealthEdge and Blackstone. Seabrook Partners, LLC served as financial advisor and Vedder Price was legal advisor to Burgess.

Patient Accountability Platform

Founded in 1997, Burgess operates at the intersection
of healthcare, finance and technology. The company helps leading American
health insurers and ACOs set a new standard: Payment Accountability. The
company’s cloud-based platform, Burgess Source, is the only solution that
natively brings together up-to-date regulatory data, claims pricing and
editing, and real-time analytics tools. This unified approach allows clients to
make payments with total confidence, and make business decisions with real
intelligence.

Strategic Fit for HealthEdge to Power Next-Generation
Payor Technology

“The acquisition of Burgess is a great strategic fit for HealthEdge to enter the large, high-growth market of payment integrity, helping address the estimated $1 trillion in wasteful spending in the U.S. healthcare system. This partnership will extend HealthEdge’s best-in-class claims processing to include software-driven payment integrity, actioned before a claim is paid, delivering significant value to health plans beyond what is available in the market today,” said Ram Jagannath, Global Head of Healthcare for Blackstone Growth and Chairman of HealthEdge.  “We are excited to invest further in HealthEdge to continue building a market-leading software platform for health insurers.” 

HealthEdge provides
mission-critical next-generation Core Administrative Processing Systems
solutions to healthcare payors, enabling them to administer benefits, configure
plans, manage providers, and enroll participants seamlessly and efficiently.
The company’s products offer a modern, simple user interface, greater
flexibility, and a cloud-compliant solution well suited to the increasingly
complex and data-rich healthcare environment.

HealthEdge’s acquisition of Burgess follows the acquisition of a
majority stake in HealthEdge by funds managed by Blackstone (“Blackstone”) in
April 2020.