– Shields Health Solutions and Excelera announce a major
specialty pharmacy merger that will form a combined company that consults with
700+ hospitals in 43 states, including Mass General Brigham, Yale New Haven,
Intermountain Healthcare and Henry Ford.
– The network of hospitals is designed to improve patient
care through an infrastructure that helps with things like acquiring prior
authorization for specialty drugs and staying adherent to them. It can also
lower costs for patients by negotiating lower rates from manufacturers with the
leverage of insights from 1 million+ patients in those hospitals.
Shields Health Solutions (Shields), the leading health
system specialty pharmacy integrator, has joined
forces with ExceleraRx
Corp. (Excelera), a healthcare company that empowers integrated delivery
networks, health systems, and academic medical centers to provide personalized,
integrated care for patients with complex and chronic conditions focused on
improving patient care.
Merger Reflects Growing Need for On-Site, Integrated
Specialty Pharmacies
Serving 60+ health systems and academic medical centers, the
combined organization addresses 700+ hospitals that account for the opportunity
of $30B in specialty pharmacy revenue. The use of specialty medications to
treat complex patients – those with multiple, chronic illnesses or rare, hard
to treat diseases that require close monitoring and support – is increasing an
average of 17 percent per year, and health systems across the U.S. have been
building on-site, integrated specialty pharmacies to provide comprehensive,
streamlined care for this growing population to improve outcomes. Since 2015,
the prevalence of health system-owned specialty pharmacies in large hospitals has doubled, with nearly 90 percent of large
hospitals operating a specialty pharmacy in 2019.
“On-site, integrated specialty pharmacy is the future
of complex patient care and we look forward to combining forces with Excelera
to make our impact even greater. As we have shown, this model materially
improves clinical outcomes for patients and reduces total medical expenses for
covered patients,” said Lee Cooper, CEO, Shields. “Together, our
network of more than 60 of the country’s top health systems, representing
nearly 30% of non-profit healthcare systems based on net patient service revenues,
creates an unparalleled industry-first that will enable unprecedented best
practice sharing and ultimately lead to improved outcomes for complex
patients.”
Benefits of On-Site, Integrated Specialty Pharmacies for
Health Systems
Shields and Excelera offer programs for health systems to
build, operationalize and optimize integrated specialty pharmacies, as well as
help manufacturers and payors access critical patient and drug performance
insights. With a more personalized, high-touch approach to patient care,
Shields and Excelera have found that hospital-owned specialty pharmacies
dramatically simplify medication and care management for patients and can:
– Reduce medication co-payments from hundreds, sometimes
thousands of dollars, to an average co-pay of $10
– Streamline time-to-therapy, typically from several weeks
to an average of two days
– Decrease physician administrative paperwork by thousands
of hours
– Improve medication adherence rates to over 90 percent, on
average.
Financial details of the acquisition were not disclosed.
– RenalytixAI and DaVita announce a program partnership that
aims to slow kidney disease progression and improve outcomes for the nation’s
estimated 37 million adults with chronic kidney disease (CKD).
– This is the first clinical-grade program that delivers
advanced early-stage prognosis and risk stratification, combined with
actionable care management to the primary care level where the majority of
kidney disease patients are being seen.
– The program will use the KidneyIntelX in vitro
diagnostic platform from RenalytixAI to perform early risk assessment; after
risk stratification, patients identified as intermediate- and high-risk will
receive care management support through DaVita’s integrated kidney care program
RenalytixAI,
a developer of AI-enabled
clinical in vitro diagnostic solutions for kidney disease, and DaVita, the largest provider
of kidney care services in the U.S., today announced a partner program aimed at
slowing disease progression and improving health outcomes for the nation’s
estimated 37 million adults with chronic kidney disease (CKD). The program is
expected to improve patient outcomes and provide meaningful cost reductions for
health care providers and payors by enabling earlier intervention for patients
with early-stage kidney disease (stages 1, 2 and 3) through actionable risk
assessments and end-to-end care management.
The collaboration is expected to launch in three major
markets this year. As the program expands, DaVita and RenalytixAI intend to
pursue risk-sharing arrangements with health care providers and payors to drive
kidney disease patient care innovation, cost efficiencies and improve quality
of life.
Why It Matters
Kidney disease currently affects over 850 million people
globally — 20 times more than cancer. As such, it is a growing concern among
healthcare companies, medical providers and the government, and researchers, who are now investigating its connection to
COVID-19. In July 2019, the Trump administration announced the Advancing American Kidney Health (AAKH) initiative. And,
now organizations, administrations, and companies are calling on the Biden-Harris administration to expand on
that initiative and prioritize kidney disease in the first 100 days.
Early Risk Identification at Core of Innovative Kidney
Care
The program utilizes the KidneyIntelX in vitro diagnostic platform from RenalytixAI, which uses a machine-learning algorithm to assess a combination of biomarkers from a simple blood draw with features from the electronic health record to generate a patient-specific risk score. The initial version of the KidneyIntelX risk score identifies Type 2 diabetic patients with early-stage CKD as low-, intermediate- or high-risk for progressive decline in kidney function or kidney failure. The integrated program may also help reduce kidney disease misclassification, which leaves some higher-risk patients without recommended treatment. The expected outcome of the collaboration will also be used to expand indicated use claims for KidneyIntelX.
After risk stratification, program patients identified as
intermediate- and high-risk will receive care management support through
DaVita’s integrated kidney care program, for which Renalytix will compensate
DaVita in lieu of providing those services itself. DaVita’s integrated kidney
care program is comprised of a coordinated care team, practical digital health
tools, award-winning patient education and other offerings. Focused on the
patient experience, these services are designed to empower patients to be
active in their care, delay disease progression, improve outcomes and lower
costs. DaVita’s team also closely collaborates with the treating nephrologist,
who leads the care team, to create a seamless care experience.
For patients whose kidney disease does progress, earlier
intervention can provide the patient and treating nephrologist more time to
make an informed decision about the treatment option that is best for them,
including pre-emptive transplantation, home dialysis or in-center dialysis. For
those patients who choose to begin dialysis, the extra time increases their
chance for an out-patient dialysis starts, which can help them to avoid
starting dialysis with a costly hospitalization.
“This is the first clinical-grade program that delivers advanced early-stage prognosis and risk stratification, combined with actionable care management right to the primary care level where the majority of kidney disease patients are being seen,” said James McCullough, Renalytix AI Chief Executive Officer. “Making fundamental change in kidney disease health economics and outcomes must begin with providing a clear, actionable understanding of disease progression risk.”
As we re-examine the healthcare system in the wake of the pandemic, we are continually identifying opportunities to rebuild parts of the system to new and improved specifications. One critical facet is digital health, where we continue to struggle with what should really be table stakes: the ability to integrate data from disparate organizations and systems into a unified view of the whole person and take action.
During the height of the pandemic, telehealth made it possible to deliver care that was personal yet socially responsible. As a direct benefit, the use of digital health tools on both the clinical and consumer side picked up a tremendous and timely head of steam. But what will become of these innovations once we make our eventual return to normal?
Today, many healthcare consumers can talk to a therapist or a counselor through text, monitor glucose levels through a diabetes app and meet with their primary care provider over videoconference. The challenge is that a lot of this patient data is still landlocked in electronic medical record (EMR) systems that do not communicate or coordinate with one another or with payer systems or consumer apps.
The sustainability and applicability of digital health tools are still often questioned despite reports that investors had poured a staggering $5.4 billion into the digital health industry just by June of this year (Rock Health). The key to success is to seamlessly connect these tools with legacy systems and siloed access points to create a truly integrated healthcare continuum. Jumping between systems, each holding only its own limited slice of patient data, and then trying to take action on this data, is neither scalable nor sustainable.
Healthcare consumers have long looked at the seamless nature of apps in other areas of life and asked for a similar level of accessibility and on-demand, high-quality information from the healthcare system. Accenture found in its 2020 Digital Health Consumer Survey that although consumers are interested in virtual services, a cumbersome digital experience turns them off. Additionally, the survey found that concerns over privacy, security, and trust remain, along with difficulty integrating new tools and services into day-to-day clinical workflows.
The good news is that the Office of the National Coordinator (ONC) has made several major data exchange rulings this year that will push providers and payer organizations to update legacy systems to make consumer health data more assessable and sharable across all parties, all for the benefit of the patient.
The Stage is Set: Healthcare Leaders Must Act, Now
The incredible investments in the industry, increasing consumer demand, and data sharing regulation show that healthcare connectivity and interoperability have never been more essential. To ensure that the digital health transformation and remote healthcare delivery models progress optimally beyond the current environment, we must support healthcare organizations in evolving their infrastructure and software capabilities to support this kind of strategy. This is where health tech has a critical role to play in building flexible pipes to connect the full spectrum of repositories and players, including doctors, specialists, nurses, care managers, health coaches, caregivers, and, of course, the healthcare consumer.
What does this look like in practice? Imagine if an unusually high heart rate warning was triggered by a patient’s smartwatch, which then alerted the patient’s care manager to check-in. With a comprehensive view of that patient, the care manager calls the patient to assess if they are okay and learns the patient ran out of their prescription which helps lower the heart rate. Knowing that patient does not have access to a car and is afraid to take public transportation due to COVID-19, the care manager then sets up a prescription delivery straight to that patient’s doorstep.
Through this process, digital health tools, patient data, and social determinants of health all came together to equip that care manager to deliver personalized care to the patient. Sound like sci-fi? This innovative approach can actually be a reality for organizations that manage large populations. The key is educating more healthcare leaders about the benefits of a comprehensive healthcare platform that improves health outcomes, lowers costs and increases member satisfaction.
This all starts with a platform that coordinates and aggregates the siloes of data and tools (clinical and digital) into a central hub. that allows providers to oversee the access points, plans, and processes in a patient’s healthcare journey without the task of building or maintaining the system themselves. This can be a game-changer in the way we assess and treat patients and help the industry to fully realize the dream of truly comprehensive, coordinated care.
About Adam Sabloff
Adam Sabloff is the founder and CEO of VirtualHealth, provider of HELIOS, the leading SaaS care management platform, serving more than 9 million members across the U.S. Prior to VirtualHealth, Sabloff served as VP of Development and Chief Marketing Officer for Midtown Equities, a $7 billion real estate, media and aviation conglomerate, where he also oversaw its technology subsidiary, Midtown Technologies.
– Philips acquires BioTelemetry, a U.S. provider of
remote cardiac diagnostics and monitoring for $72.00 per share for an implied
enterprise value of $2.8 billion (approx. EUR 2.3 billion).
– With $439M in revenue in 2019, BioTelemetry annually monitors over 1 million cardiac patients remotely; its portfolio includes wearable heart monitors, AI-based data analytics, and services.
– BioTelemetry business is expected to deliver double-digit growth and improve its Adjusted EBITA margin to over 20% by 2025; the acquisition will be sales growth and adjusted EBITA margin accretive for Philips in 2021.
Philips, today
announced it has entered in an agreement to acquire BioTelemetry, Inc., a U.S.-based provider
of remote cardiac diagnostics and monitoring for $2.8B ($72 per share), to be
paid in cash upon completion.
USD 72.00 per share, to be paid in cash upon
completion. The board of directors of BioTelemetry has approved the transaction
and recommends the offer to its shareholders. The transaction is expected to be
completed in the first quarter of 2021.
BioTelemetry Background
Founded in 1995, BioTelemetry primarily focuses on the diagnosis and monitoring of heart rhythm disorders, representing 85% of its sales. BioTelemetry’s clinically validated offering includes wearable heart monitors (e.g. a mobile cardiac outpatient telemetry patch and extended Holter monitor) that detect and transmit abnormal heart rhythms wirelessly, AI-based data analytics, and services.
With over 30,000 unique
referring physicians per month, BioTelemetry provides services for over one
million patients per year. Additionally, BioTelemetry has a clinical research
business that provides testing services for clinical trials. The total
addressable market is USD 3+ billion, growing high-single-digits driven by an
increasing prevalence of chronic diseases, and the adoption of remote
monitoring and outcome-oriented models.
Acquisition Strengthens Philips’ Cardiac Care Portfolio
The acquisition of BioTelemetry is a strong fit with Philips’ cardiac care portfolio, and its strategy to transform the delivery of care along the health continuum with integrated solutions. The combination of Philips’ leading patient monitoring position in the hospital with BioTelemetry’s leading cardiac diagnostics and monitoring position outside the hospital, will result in a global leader in patient care management solutions for the hospital and the home for cardiac and other patients. Philips’ current portfolio includes real-time patient monitoring, therapeutic devices, telehealth, and informatics. Moreover, Philips has an advanced and secure cloud-based Philips HealthSuite digital platform optimized for the delivery of healthcare across care settings. Every year, Philips’ integrated solutions monitor around 300 million patients in hospitals, as well as around 10 million sleep and respiratory care patients in their own homes.
“The acquisition of BioTelemetry fits perfectly with our strategy to be a leading provider of patient care management solutions for the hospital and the home,” said Frans van Houten, CEO of Royal Philips. “BioTelemetry’s leadership in the large and fast growing ambulatory cardiac diagnostics and monitoring market complements our leading position in the hospital. Leveraging our collective expertise, we will be in an optimal position to improve patient care across care settings for multiple diseases and medical conditions.”
Post-Acquisition Plans
Upon completion of the transaction, BioTelemetry and its
approximately 1,900 employees will become part of Philips’ Connected Care
business segment. The acquisition is projected to be sales growth and adjusted
EBITA margin accretive for Philips in 2021. Philips targets significant
synergies driven by cross-selling opportunities (especially in the U.S.),
geographical expansion, and portfolio innovation synergies, such as Philips’
Health Suite digital platform. Additionally, Philips will drive operational
performance improvements through its proven productivity programs. The
BioTelemetry business is expected to grow double-digits and to improve its
Adjusted EBITA margin to more than 20% by 2025.
Scheduling an appointment shouldn’t be complicated. Yet too often, patients are left to figure out their next move alone, with just a single phone number to call.
Frustrated and confused, patients may drop out of the scheduling process entirely or miss the appointments they’ve already booked. Missed appointments can lead to critical gaps in care, poor health outcomes and possible readmissions, and they are also unnecessarily costly for providers.
But what if you could make scheduling easy? Minimizing the burden on patients could close more gaps in care, improve the patient experience and reduce call center workload at the same time. Automated, targeted outreach campaigns can help you do exactly this.
Using a simple text message or voice message, you can prompt patients to book their next appointment right there and then. Here’s how:
5 ways automated patient outreach can help close gaps in care
1. Quicker and easier for patients to book care
An automated solution can send targeted text messages (SMS) or interactive voice calls (IVR) to patients to remind them to book an appointment. By providing a self-scheduling link in the message, patients can book their appointment immediately. Patients are often more likely to schedule when they’re given a reminder plus a booking link, compared to a reminder message alone. There’s less risk of appointments being forgotten, sealing any potential care gaps from the start.
2. More appointments booked
Automation also means you can contact and schedule more patients than if your call center was contacting each person individually. One large Medicaid managed care plan saw a 140% increase in their scheduling rates since using
Patient Schedule. They’re able to match patients to the right provider first time, protecting calendars from errant bookings and eliminating the dreaded three-way calls between member, provider and payer.
3. More patients showing up to appointments
When automated patient outreach is paired with digital scheduling, patients are far more likely to show up to appointments. The Iowa Clinic found that when patients book online, they’re not only more likely to show up, but they feel more engaged and eager to follow their care plan. Their patient show rates are as high as 97% for appointments scheduled online. If those patients are also more engaged, that’s a good sign that care gaps can be minimized too.
4. Better coordination of transport services
One obstacle to attending non-emergency appointments that is often overlooked is the lack of access to reliable transportation. With automated scheduling software, this can be easily fixed. Once a member has booked an appointment, data analytics can flag up a potential need for transportation, so the member can be sent an automated text reminder to book transport. And if they need to reschedule for some reason, the transportation booking will auto-update too. Patients (and staff) no longer need to wrangle two separate systems for booking appointments and transportation.
5. Better management of wait lists and reduced call times
Another way to close gaps in care is to give patients the option to book an earlier appointment, if a slot becomes available. Seeing their doctor sooner can mean quicker treatment and reduce the chance of a patient disengaging with their care plan because of a long wait.
With automated outreach, you can send an automatic message to offer an earlier appointment, and then cancel the old booking (and offer it to others) at the same time. This enables better wait list management and can reduce call time for staff by an average of 50%.
Automated patient outreach is a win-win. It’s far more convenient for patients, and drives down costs for providers and payers. Learn more about how automated appointment reminders and digital patient scheduling can help your organization improve the patient experience and close costly gaps in care.
– DAS Health Ventures acquires healthcare
and managed IT company Randall Technology Services (RandallTech).
– This acquisition adds Allscripts® PM
and EHR solutions to the DAS portfolio of supported products, and DAS Health
has now added additional staff in Texas that will create opportunities for
greater regional support of its entire solutions portfolio.
DAS Health Ventures, Inc., an industry leader in health IT and management, announced today it completed the acquisition of Randall Technology Services, LLC (RandallTech) healthcare and managed IT company based in Amarillo, TX. As part of DAS’ growth strategy, this most recent expansion further strengthens its position in the US healthcare technology space.
Acquisition Enhances DAS Health Market Reach
DAS Health actively serves more than 1,800 clients, and
nearly 3,500 clinicians and 20,000 users nationwide, with offices in Florida,
Nevada, New Hampshire and Texas, and a significant employee presence in 14 key
states. This acquisition adds Allscripts® PM and EHR solutions to the DAS
portfolio of supported products, and DAS Health has now added additional staff
in Texas that will create opportunities for greater regional support of its
entire solutions portfolio.
Increased Support for Existing RandallTech Clients
Randall Technology’s clients will gain an increased depth of support, and a substantially improved value proposition, as DAS Health’s award-winning offerings are robust, including managed IT / MSP services, practice management, and EHR software sales, training, support and hosting, revenue cycle management (RCM), security risk assessments (SRA), cybersecurity, MIPS/MACRA reporting & consulting, mental & behavioral health screenings, chronic care management, telemedicine, and other value-based and patient engagement solutions.
Financial details of the acquisition were not disclosed.
Jenifer Leaf Jaeger, MD, MPH, Senior Medical Director, HealthEC
Senior isolation is a health risk that affects at least a quarter of seniors over 65. It has become recognized over the past decade as a risk factor for poor aging outcomes including cognitive decline, depression, anxiety, Alzheimer’s disease, obesity, hypertension, heart disease, impaired immune function, and even death.
Physical limitations, lack of transportation, and inadequate health literacy, among other social determinants of health (SDOH), further impair access to medical and mental health treatment and preventive care for older adults. These factors combine to increase the impact of chronic comorbidities and acute issues in our nation’s senior population.
COVID-19 exacerbates the negative impacts of social isolation. The consequent need for social distancing and reduced use of the healthcare system due to the risk of potential SARS-CoV-2 exposure are both important factors for seniors. Without timely medical attention, a minor illness or injury quickly deteriorates into a life-threatening situation. And without case management, chronic medical conditions worsen.
Among Medicare beneficiaries alone, social isolation is the source of $6.7 billion in additional healthcare costs annually. Preventing and addressing loneliness and social isolation are critically important goals for healthcare systems, communities, and national policy.
Organizations across the healthcare spectrum are taking a more holistic view of patients and the approaches used to connect the most vulnerable populations to the healthcare and community resources they need. To support that effort, technology is now available to facilitate analysis of the socioeconomic and environmental circumstances that adversely affect patient health and mitigate the negative impacts of social isolation.
Addressing Chronic Health Issues and SDOH
When we think about addressing chronic health issues and SDOH in older adults, it is usually after the fact, not focused on prevention. By the time a person has reached 65 years of age, they may already be suffering from the long-term effects of chronic diseases such as diabetes, hypertension or heart disease. Access points to healthcare for older adults are often in the setting of post-acute care with limited attention to SDOH. The focus is almost wholly limited to the treatment and management of complications versus preventive measures.
Preventive outreach for older adults begins by focusing on health disparities and targeting patients at the highest risk. Attention must shift to care quality, utilization, and health outcomes through better care coordination and stronger data analytics. Population health management technology is the vehicle to drive this change.
Bimodal Outreach: Prevention and Follow-Up Interventions
Preventive care includes the identification of high-risk individuals. Once identified, essential steps of contact, outreach, assessment, determination, referral, and follow-up must occur. Actions are performed seamlessly within an organization’s workflows, with automated interventions and triggered alerts. And to establish a true community health record, available healthcare and community resources must be integrated to support these actions.
Social Support and Outreach through Technology
Though older adults are moving toward more digitally connected lives, many still face unique barriers to using and adopting new technologies. So how can we use technology to address the issues?
Provide education and trainingto improve health literacy and access, knowledge of care resources, and access points. Many hospitals and health systems offer day programs that teach seniors how to use a smartphone or tablet to access information and engage in preventive services. For example, connecting home monitoring devices such as digital blood pressure reading helps to keep people out of the ED.
Use population health and data analyticsto identify high-risk patients. Determining which patients are at higher risk requires stratification at specific levels. According to the Centers for Disease Control and Prevention, COVID-19 hospitalizations rise with age, from approximately 12 per 100,000 people among those 65 to 74 years old, to 17 per 100,000 for those over 85. And those who recover often have difficulty returning to the same level of physical and mental ability. Predictive analytics tools can target various risk factors including:
– Recent ED visits or hospitalizations
– Presence of multiple chronic conditions
– Depression
– Food insecurity, housing instability, lack of transportation, and other SDOH
– Frailty indices such as fall risk
With the capability to identify the top 10% or the top 1% of patients at highest risk, care management becomes more efficient and effective using integrated care coordination platforms to assist staff in conducting outreach and assessments. Efforts to support care coordination workflows are essential, especially with staffing cutbacks, COVID restrictions, and related factors.
Optimal Use of Care Coordination Tools
Training and education of the healthcare workforce is necessary to maximize the utility of care coordination tools. Users must understand all the capabilities and how to make the most of them. Care coordination technology simplifies workflows, allowing care managers to:
– Risk-stratify patient populations, identify gaps in care, and develop customized care coordination strategies by taking a holistic view of patient care.
– Target high-cost, high-risk patients for intervention and ensure that each patient receives the right level of care, at the right time and in the right setting.
– Emphasize prevention, patient self-management, continuity of care and communication between primary care providers, specialists and patients.
This approach helps to identify the resources needed to create community connections that older adults require. Data alone is insufficient. The most effective solution requires a combination of data analytics to identify patients at highest risk, business intelligence to generate interventions and alerts, and care management workflows to support outreach and interventions.
About Dr. Jenifer Leaf Jaeger
Dr. Jenifer Leaf Jaeger serves as the Senior Medical Director for HealthEC, a Best in KLAS population health and data analytics company. Jenifer provides clinical oversight to HealthEC’s population health management programs, now with a major focus on COVID-19. She functions at the intersection of healthcare policy, clinical care, and data analytics, translating knowledge into actionable insights for healthcare organizations to improve patient care and health outcomes at a reduced cost.
Prior to HealthEC, Jenifer served as Director, Infectious Disease Bureau and Population Health for the Boston Public Health Commission. She has previously held executive-level and advisory positions at the Massachusetts Department of Public Health, New York City Department of Health and Mental Hygiene, Centers for Disease Control and Prevention, as well as academic positions at Harvard Medical School, Boston University School of Medicine, and the Warren Alpert Medical School of Brown University.
– GigCapital2 Inc has agreed to merge with UpHealth Holdings Inc and Cloudbreak Health LLC to create a public digital healthcare company valued at $1.35 billion, including debt, the blankcheck acquisition company said on Monday.
– The combined company will be named UpHealth, Inc. and
will continue to be listed on the NYSE under the new ticker symbol “UPH”.
Blank check acquisition
company GigCapital2 agreed to merge
with Cloudbreak Health, LLC, a unified telemedicine and video medical
interpretation solutions provider and UpHealth
Holdings, Inc., one of the largest national and international digital
healthcare providers to form a combined digital health company. The deal is valued
at $1.35 billion, including debt. the combined company will be named UpHealth, Inc. and will continue to be
listed on the NYSE under the new ticker symbol “UPH”.
Following the merger, UpHealth will be a leading global
digital healthcare company serving an entire spectrum of healthcare needs and
will be established in fast growing sectors of the digital health industry.
With its combinations, UpHealth is positioned to reshape healthcare across the
continuum of care by providing a single, integrated platform of best-in-class
technologies and tech-enabled services essential to personalized, affordable,
and effective care. UpHealth’s multifaceted and integrated platform provides
health systems, payors, and patients with a frictionless digital front door
that connects evidence-based care, workflows, and services.
“We are excited to partner with UpHealth and Cloudbreak through our Private-to-Public Equity (PPE)™ platform. The combined UpHealth has all the hallmarks we look for in a successful partnership, including a world-class executive team and an exceptional business model with scale, strong growth, and profitability margins in the digital healthcare industry. We are particularly excited about the opportunity to provide our Mentor-Investor™ discipline in partnership with an exceptional global leadership team, as well as participate in a high-tech integrated platform that comprises a variety of cutting edge disciplines, such as the Artificial Intelligence platform being developed by Global Telehealth in conjunction with the tech-enabled Behavioral Health divisions. We are confident UpHealth is at the inflection point and positioned for accelerated growth.” – Dr. Avi Katz – Founder and Executive Chairman of GigCapital2
Combined Company Offerings
Upon closing the pending mergers and the combination with Cloudbreak, UpHealth will be organized across four capabilities at the intersection of population health management and telehealth:
1. Integrated Care Management: Thrasys Inc. (“Thrasys”) has reinvested $100M of customer revenue to
develop its innovative SyntraNet Integrated Care technology platform. The
platform integrates and organizes information, provides advanced
population-based analytics and predictive models, and automates workflows
across health plans, health systems, government agencies, and community
organizations. The platform plans to add at least 40 million lives to UpHealth
in the next 3 years to support global initiatives to transform healthcare.
2. Global Telehealth: will consist of a U.S. division and an international division
that, together, are anticipated to grow revenues by an additional $47 million
in 2021.
The U.S. division of
Global Telehealth following the combination, Cloudbreak, is a leading unified
telemedicine platform performing more than 100,000 encounters per month on over
14,000 video endpoints at over 1,800 healthcare venues nationwide. The
Cloudbreak Platform offers telepsychiatry, telestroke, tele-urology, and other
specialties, all with integrated language services for Limited English Proficient
and Deaf/Hard-of-Hearing patients. Cloudbreak’s innovative, secure platform
removes both distance and language barriers to improve patient care,
satisfaction, and outcomes.
The international
division of Global Telehealth following the combination, Glocal Healthcare
Systems Pvt. Ltd (“Glocal”), is a global provider of virtual consultations and
local care spanning the care continuum. It has designed proven, affordable and
accessible solutions for the delivery of healthcare services globally. The
platform provides a full suite of primary and acute care services, including an
app-based telemedicine suite, digital dispensaries, and hospital centers. The
platform has signed several country-wide contracts with government ministries
across India, Southeast Asia, and Africa.
3. Digital Pharmacy: MedQuest Pharmacy (“MedQuest”) is a leading full-service manufactured and compounded pharmacy licensed in all 50 states that pre-packages and ships medications direct to patients. The company also offers lab services and testing, nutraceuticals, nutritional supplements, education for medical practitioners, and training for organizations, associations, and groups. MedQuest serves an established network of 13,000 providers. The MedQuest platform is poised for strong growth via targeted product expansion and expansive eCommerce capabilities for the entire provider network. UpHealth and MedQuest have mutually executed a merger agreement, the closing of which is awaiting regulatory approval for the transfer of licenses expected by the end of 2020 or early 2021.
4. Tech-enabled Behavioral Health: TTC Healthcare, Inc. (“TTC Healthcare”) and
Behavioral Health Services LLC (“BHS”) offer comprehensive services
specializing in acute and chronic outpatient behavioral health, rehabilitation
and substance abuse, both onsite and via telehealth. UpHealth’s Behavioral
Health capabilities have dramatically expanded use of telehealth for medical
and clinical services and are leveraging UpHealth’s platform to increase
volumes across its services. UpHealth and TTC Healthcare have mutually executed
a merger agreement, the closing of which is awaiting regulatory approval for
the transfer of licenses expected prior to the end of 2020.
Global Financial Impact and Reach
UpHealth will have agreements
to deliver digital healthcare in more than 10 countries globally. These various
companies are expected to generate approximately $115 million in revenue and
over $13 million of EBITDA in 2020 and following the combination, UpHealth
expects to generate over $190 million in revenue and $24 million in EBITDA in
2021.
While most of the public’s attention is focused on the horse race for an approved COVID-19 vaccine, another major hurdle lies just around the corner: the distribution of hundreds of millions of vaccine doses. In today’s highly complex and disconnected health data landscape, technologies like AI, Machine Learning, and robotic process automation (RPA) will be essential to making sure that the highest-risk patients receive the vaccine first.
Why identifying at-risk patients is incredibly difficult
Once a vaccine is approved, it will take months or years to produce and distribute enough doses for the U.S.’ 330 million residents. Hospital systems, primary care physicians (PCPs), and provider networks will inevitably need to prioritize administration to at-risk patients, potentially focusing on those with underlying conditions and comorbidities. That will require an unimaginable amount of work by healthcare employees to identify patient cohorts, understand each patient’s individual priority level, and communicate pre- and post-visit instructions. The volume of coordination required between healthcare systems and the pressing need to get the vaccine to high risks groups makes the situation uniquely different than other nationally distributed vaccinations, like the flu.
One key challenge is that there’s no existing infrastructure to facilitate this process – all of the data necessary to do so is locked away in disparate information silos. Many states have legacy information systems or rely on fax for information sharing, which will substantially hamper efforts to identify at-risk patients. Consider, in contrast, the data available in the U.S. regarding earthquake risk– you can simply open up a federal geological map and see whether you’re in a seismic hazard zone. All the information is in one place and can be sorted through quickly, but that’s just not the case with our healthcare system due to its fragmentation as well as HIPAA and patient privacy laws.
There are several multidimensional barriers that make it nearly impossible for healthcare workers employed by providers and state healthcare organizations to compile patient cohorts manually:
– Providers will need to follow CDC guidelines on prioritization factors, which based on current guidelines for those with increased risk could potentially include specific conditions, ethnicities, age groups, pregnancy, geographies, living situations (such as multigenerational homes), and disabilities. Identifying patients with these factors will require intelligent analysis of patient profiles from existing electronic health record data (EHR) used by a multitude of providers.
– Some hospital networks use multiple EHR and care management systems that have a limited ability to share and correlate data. These information silos will prevent providers from viewing all information about patient population health data.
– Data on out-of-network care that could require prioritization, like an emergency room visit, is often locked away in payer data systems and is difficult to access by hospital systems and PCPs. That means payer data systems must be analyzed as well to effectively prioritize patients.
– All information must be shared and analyzed in accordance with HIPAA laws, and the mountain of scheduling communications and pre- and post-visit guidance shared with patients must also follow federal guidelines.
– Patients with certain conditions, like heart disease, may need additional procedures or tests (such as a blood pressure reading) before the vaccine can be administered safely. Guidelines for each patient must be identified and clearly communicated to their care team.
– Providers may not have the capacity to distribute vaccines to all of their priority patients, so providers will need to coordinate care and potentially send patients to third-party sites like Walgreens, Costco, etc.
All of these factors create a situation in which it’s extremely difficult – and time-consuming – for healthcare workers to roll out the vaccine to at-risk patients at scale. If the entire process to analyze, identify, and administer the vaccine takes only two hours per patient in the U.S., that’s 660 million hours of healthcare workers’ time. A combination of analytics, AI, and machine learning could be a solution that’s leveraged by healthcare workers and chief medical officers in identifying the priority of patients supplemented with CDC norms.
How RPA can automate administration to high-risk patients
Technology is uniquely poised to enable health workers to get vaccines into the hands of those who need them most far faster than would be possible using humans alone. Robotic process automation (RPA) in the form of artificial intelligence-powered digital health workers can substantially reduce the time spent prioritizing and communicating with at-risk patients. These digital health workers can intelligently analyze patient records and send communications 24 hours a day, reducing the time needed per patient from hours to minutes.
Consider, a hypothetical situation in which the CDC prioritizes certain risk profiles, which would put patients with diabetes among those likely to receive the vaccine first. In this scenario, RPA offers significant benefits in the form of its ability to:
Analyze EHR and population health data:
Thousands of intelligent digital health workers could prepare patient data for analysis and then separate patients into different cohorts based on hemoglobin levels. These digital health workers could then intelligently review documents to cross-reference hemoglobin levels with other CDC prioritization factors (like recent emergency room admittance or additional pre-existing or chronic conditions ), COVID-19 testing and antibody tests data to identify those most at risk, then identify a local provider with appointment availability.
Automate patient engagement, communications and scheduling:
After patients with diabetes are identified and prioritized, communications will be essential to quickly schedule those at most risk and prepare them for their appointments, including making them feel comfortable and informed. For example, digital health workers could communicate with diabetes patients about the protocol they should follow before and after their appointment – should they eat before the visit, what they should expect during their visit, and is it safe for them to return to work after. It’s also highly likely that widespread vaccine administration will require a far greater amount of information than with other health communications, given that one in three Americans say they would be unwilling to be vaccinated if a vaccine were available today. At scale, communications and scheduling will take potentially millions of hours in total, and all of that time takes healthcare employees away from actually providing care.
While the timeline for approval of a COVID-19 vaccine is unclear, now is the time for hospitals to prepare their technology and operations for the rollout. By adopting RPA, state healthcare organizations and providers can set themselves up for success and ensure that the patients most critically in need of a vaccine receive it first.
About Ram Sathia
Ram Sathia is Vice President of Intelligent Automation at PK. Ram has nearly 20 years of experience helping clients condense time-to-market, improve quality, and drive efficiency through transformative RPA, AI, machine learning, DevOps, and automation.
Visits to emergency departments (ED) dropped by 42% in the early months of COVID-19, according to the CDC. In pre-pandemic times, this might have been a positive sign. Two-thirds of ED visits are thought to be avoidable, with emergency care used as a safety net in the absence of access to more appropriate services. Excessive emergency care also comes with a high price, often resulting in a poor patient experience. UnitedHealth Group estimates that the 18 million preventable visits per year cost the health system up to $32 billion annually.
Unfortunately, the rapid decrease in ED use during the pandemic isn’t a signal that care management and access challenges have been resolved. Social distancing, stay-at-home orders and fear of being exposed to COVID-19 have prompted patients to avoid seeking care in person altogether. Inevitably, as more individuals either postpone or forego the care they need, ED use will start to creep back up again.
For health plans, the worry is a sudden influx of their members returning to emergency departments with more complex care needs arising from delayed treatment. Medical costs could sky-rocket, while gaps in care could reach critical levels as health plans and providers struggle to keep track of ED admissions and readmissions.
As health plans look to curb ED utilization in the aftermath of COVID-19, digital tools can provide a valuable lifeline.
4 ways health plans can use digital tools to reduce unnecessary ED visits
1. Take action to engage members before acute episodes occur
Proactively involving members in their own care management can help head off unnecessary ED visits before they’re even a possibility. Understanding how the social determinants of health affect a member and how they access care can help health plans tailor their engagement strategies and close gaps in care.
Experian Health’s Member Engagement Solutions draw together all the insights needed to connect the dots between emergency visits, social and economic risk factors, and digital care coordination, so health plans can communicate with members in the most effective way.
2. Make it easier for members to access care when they need it
Part of the ED visit volume is based on members’ frustration of not being able to access care when they want or need it.
Health plans can prevent unnecessary ED visits by sending automated outreach prompts to encourage members to schedule appointments, via interactive voice response or text. A digital scheduling platform can give the member an easy way to book their appointment, without needing to call during office hours. With digital scheduling, health plan member engagement teams and call centers can facilitate member appointment scheduling with the right providers without the cumbersome three-way call.
3. Implement a real-time tracking strategy for ED admissions
One of the biggest challenges for health plans is not knowing when members are admitted to the emergency department.
A tool such as MemberMatch® can alert health plans of their members’ real-time ED encounters, so they can rally around active episodes of care – potentially avoiding unnecessary, out-of-network admissions and readmissions – and optimize the cost and quality of encounters across the continuum of care post-discharge. Using Experian Health’s leading referential matching system, a member’s care team can be notified via text, portal or email for quick insights that enable better care coordination.
4. Ensure better management of post-discharge follow-up care
Every health plan’s checklist for reducing readmissions should include a follow-up strategy when patients have visited the ED. Given that post-ED follow-up for members with chronic conditions is likely to be a STAR measure in the future, plans should prepare their proactive intervention strategy now.
USMD WellMed Health System used Experian Health’s Member Utilization Management Solutions for better care coordination for patients within 30 or 90 days of leaving hospital, significantly reducing their readmissions rate. Within just four months, the ROI trends gave them confidence to roll out Care Coordination Manager from USMD clinics to WellMed clinics too.
Reducing admissions and readmissions is not about making access to the ED more difficult, but making access to other services, care options, and care management solutions easier. With the right digital solutions, health plans can take action to make this unprecedented transition of care from the ED to other, more cost-effective arenas the ‘new normal’ and put the old model of ED over-utilization in the past.
Contact us to learn more about how Experian Health can help health plan reduce unnecessary ED visits.
The COVID-19 virus is ravaging the planet at a scale not seen since the infamous Spanish Flu of the early 1900s, inflicting immense devastation as the U.S. loses more than 200,000 lives and counting. According to CDC statistics, 94% of patient mortalities associated with COVID-19 were simultaneously suffering from preexisting conditions, leaving a mere 6% of victims with COVID-19 as their sole cause of death. However, while immediate prospects for a mass vaccine might not be until 2021, there is some hope among rural hospital health information technology consultants where the pandemic has hit the hardest.
The fact that four in ten U.S. adults have two or more chronic conditions indicates that our most vulnerable members of the population are also the ones at the greatest risk of succumbing to the pandemic. From consultants laboring alongside healthcare administrators and providers, all must pay close attention to patients harboring 1 of 13 chronic conditions believed to play major roles in COVID-19 mortality, particularly chronic kidney disease, hypertension, diabetes, and COPD.
Vulnerable rural populations must be supervised due to their unique challenges. The CDC indicates 80% of older adults in remote regions have at least one chronic disease with 77% having at least two chronic diseases, significantly increasing COVID-19 mortality rates compared to their urban counterparts.
Health behaviors also play a role in rural patients who have decreased access to healthy food and physical activity while simultaneously suffering high incidences of smoking. These lifestyle choices compound with one another, leading to increased obesity, hypertension, and many other chronic illnesses. Overall, rural patients that fall ill to COVID-19 are more likely to suffer worsened prognosis compared to urban hubs, a problem only bolstered by their inability to properly access healthcare.
Virus Helping Push New Technologies
COVID-19 has shown the cracks in the U.S. healthcare technology system that must be addressed for the future. As the pandemic unfolds, it’s worth noting that not all lasting effects will be negative. Just as the adoption of the Affordable Care Act a decade ago spurred healthcare organizations to digitize their records, the COVID-19 pandemic is accelerating overdue technological shifts crucial to providing better care.
Perhaps the most prominent change has been the widespread adoption of telehealth services and technologies that connect patients with both urgent and preventive care without their having to leave home. Perhaps the most prominent change has been the widespread adoption of telehealth services and technologies that use video to connect patients with both urgent and preventive care without their having to leave home.
Even if COVID-19 were to fade away on its own, the next pandemic may not. Furthermore, seasonal influenza serves as a reminder that healthcare is not a skirmish, but a prolonged war against disease. Rather than doom future generations to suffer the same plight our generation has with the pandemic, now is the time to develop innovative IT strategies that focus on protecting our most vulnerable citizens by leveraging existing healthcare initiatives to focus on proactive responses instead of reactive responses.
On the Right Road
While some of the most vulnerable people are the elderly, rural residents, and the poor, the good news for them is that CMS has long advocated the use of preventive care initiatives such as Chronic Care Management (CCM) and Remote Physiologic Monitoring (RPM) to track these geriatric patients. To encourage innovation in this sector, CMS preventive care initiatives provide generous financial incentives to healthcare providers willing to shift from conventional reactive care strategies to a more proactive approach focused on prevention and protection. This should attract rural hospital CEOs who have been struggling even more than usual because of the virus.
These factors led to the creation of numerous patient CCM programs, allowing healthcare executives and providers to remotely track the health status of geriatric patients suffering from numerous chronic conditions. The tracking is at a rate and scope unseen previously through the use of electronic media. Interestingly enough, the patients already being monitored by CCM programs overlap heavily with populations susceptible to COVID-19. To adapt existing infrastructure for the COVID-19 pandemic is a relatively simple task for hospital CIOs.
As noted earlier, one growing CCM program that could be retrofitted to deal with the COVID-19 pandemic are the use of telehealth services in rural locations. Prior to the pandemic, telehealth services were one of the many strategies advocated by the CDC to address the overtaxed healthcare systems found in rural locations.
Better Access, Funding and User Experience for Telehealth
Today, telehealth is about creating digital touchpoints when no other contact is possible or safe. It offers the potential to expand care to people in remote areas who might have limited or nonexistent access, and it could let other health workers handle patient screening and post-care follow-up when a local facility is overwhelmed. As a study published last year in The American Journal of Emergency Medicineaffirms, virtual care can cut the cost of healthcare delivery and relieve strain on busy clinicians.
Telehealth has also gotten a boost from the $2 trillion CARES Act stimulus fund, which provides $130 billion to healthcare organizations fighting the pandemic. The effort also makes it easier for providers to bill for remote services.
The reason for the CDC and hospital administrators’ interest in telehealth was that telehealth meetings could outright remove the need for patients to travel and allow healthcare providers to monitor patients at a fraction of the time. By simply coupling existing telehealth services with CMS preventive care initiatives focused on COVID-19, rural healthcare providers could detect early warning signs of COVID-19.
Integration Key to Preemptive Detection
This integration at a faster and far greater scale could mean much greater preemptive virus detection through routine telehealth meetings. The effect of telehealth would be twofold on hospitals serving rural and urban health communities. It could slow the spread of COVID-19 to a crawl due to decreased patient travel and improved patient prognosis through early and intensive treatment for vulnerable populations with two or more chronic health conditions.
This integrated combination would shift standard reactive care to patient infections to a new monitoring methodology that proactively seeks out infected patients and rapidly administers treatment to those most at risk of mortality. This new combination of preventive care and telehealth services would not only improve patient and community health but would relieve the financial burden incurred from the pandemic due to the existing CMS initiatives subsidizing such undertakings.
In conclusion, preventative care targeting patients with pre-conditions in rural locations are severely lacking in the context of the COVID-19 pandemic. By leveraging CMS preventive care initiatives along with telehealth services, healthcare providers can achieve the following core objectives.
First, there are financial incentives with preventive care services that will relieve the burden on healthcare systems. Second, COVID-19 vulnerable populations will receive the attention and focus from healthcare providers that they deserve to slow the spread through the use of early detection systems and alerts to their primary health provider. Third, by combining with telehealth service, healthcare providers can efficiently and effectively reach out to rural populations that were once inaccessible to standard healthcare practices.
– Healthify’s social determinants of health (SDoH) infrastructure will be integrated into Altruista’s GuidingCare® platform to support health plans in addressing the social needs of members.
– SDoH such as poverty, housing instability, and food insecurity can significantly impact health outcomes, so it is imperative that they are not overlooked.
Healthify, a
company that works with managed care organizations to integrate social
determinants of health (SDoH) into the healthcare ecosystem,
today announced that its technology will be included in Altruista Health’s care
management platform, GuidingCare®, to help health plans
seamlessly and efficiently address SDoH.
Effectively
Addressing SDoH Impacting Health Outcomes
Healthify creates an infrastructure that drives collaboration among community-based organizations, healthcare payors, providers, and policymakers to address social disparities with aligned incentives and accountability. Altruista will integrate Healthify into its GuidingCare platform to help health plans more effectively address SDoH – nonclinical factors such as poverty, housing instability, and food insecurity that impact health outcomes.
Integration
Approach
Altruista and Healthify will
implement an immersive integration using Healthify’s application programming interfaces (APIs)
which will make it easy for health plans to identify social needs among
their members, identify the right social service providers to address those
needs, coordinate referrals among clinical providers and community resources,
and track outcomes. The integration is scheduled to launch in December 2020
with GuidingCare Version 8.14.
“Health plans rely on care management platforms to coordinate healthcare services for members. This is especially important for people who either have or are at risk for developing complex medical conditions. However, previous care management technologies have primarily focused on clinical care,” said Manik Bhat, Founder and Chief Executive Officer of Healthify. “SDoH significantly impact health outcomes as well, and it’s imperative that they are not overlooked as part of whole-person care. We are proud to collaborate with Altruista to incorporate SDoH into care management strategies to improve member outcomes by simultaneously addressing both clinical and social needs.”
– Innovaccer unveils new risk adjustment solution to help providers better segment their population to refine the risk scoring process and improve coding accuracy and efficiency, thereby improving performance on risk-based contracts.
– The solution utilizes Artificial Intelligence (AI) and
Natural Language Processing (NLP) to make risk predictions.
Innovaccer, Inc., a
leading healthcare
technology company, has launched its Risk Adjustment
Solution. Leveraging Innovaccer’s industry-leading, FHIR-enabled Data
Activation Platform, providers can better segment their population to refine
the risk scoring process and improve coding accuracy and efficiency, thereby
improving performance on risk-based contracts. The solution utilizes Artificial Intelligence
(AI) and Natural Language Processing (NLP) to make risk predictions. By
improving care management workflows, Innovaccer works to help all members of
the health team care as one.
Addressing End-to-End Risk Adjustment
Innovaccer’s solution is designed to address end-to-end risk
adjustment needs by allowing providers to use actionable insights on dropped
codes and suspected codes across various risk models. The solution works with
the Centers of Medicare & Medicaid hierarchical condition categories
(CMS-HCC), Department of Health and Human Services hierarchical condition
categories (HHS-HCC), and the Chronic Illness and Disability Payment System
(CDPS), helping providers improve coding accuracy.
Segment Patient Population Based on Risk Scores
Providers can identify codes that can be integrated into the EHR using simple
steps through advanced risk adjustment analytics. Innovaccer’s platform can
also segment the patient population based on risk scores available through
historical data and provide dashboards to identify details related to Risk
Adjustment Factor (RAF) and risk capture trends. Providing curated insights to
risk coders prevents them from having to switch between multiple screens,
reducing the time spent on coding processes.
“Innovaccer’s Risk Adjustment Solution caters to all risk management needs through one seamless platform. It is AI and NLP ready, and by leveraging the platform’s smarter workflows and actionable insights, providers can decrease time spent on risk-related coding by up to 40%. The solution helps providers to refine the risk scoring process and improve coding accuracy and efficiency for improved performance on risk-based contracts,” says Abhinav Shashank, CEO at Innovaccer.
Dr. Keith Kosel is a Vice President at Parkland Center for Clinical Innovation (PCCI)
This question initially brings to mind many possibilities such as connection to the latest 5G cellular service, a new super-fast internet provider, or maybe one of the many new energy suppliers jockeying for market share from traditional utility companies. While all of these might represent legitimate opportunities to improve one’s community, here we are talking about a different concept; specifically, whether your community is ready to have a Connected Community of Care (CCC) to advance whole-person health.
The image of a CCC may seem obvious. After all, we all live in communities where we have some connections between hospitals, physician practices, ambulatory care centers, and pharmacies to name just a few. But here we are talking about a broader sense of connected community that includes not just health care organizations, but social service organizations, such as schools and civic organizations and community-based organizations (CBOs) like neighborhood food pantries and temporary housing facilities. A true CCC links together local healthcare providers along with a wide array of CBOs, faith-based organizations, and civic entities to help address those social factors, such as education, income security, food access, and behavioral support networks, which can influence a population’s risk for illness or disease. Addressing these factors in connection with traditional medical care can reduce disease risk and advance whole-person care. Such is the case in Dallas Texas, where the Dallas CCC information exchange platform has been operating since 2012. Designed to electronically bring together local healthcare systems, clinicians, and ancillary providers with over a hundred CBOs, the Dallas CCC provides a real-time referral and communication platform with a sophisticated care management system designed and built by the Parkland Center for Clinical Innovation (PCCI) and Pieces Technologies, Inc.
Long before this information exchange platform was implemented, the framers of the Dallas CCC came together to consider whether Dallas needed such a network and whether the potential partners in the community were truly ready to make the commitments needed to bring this idea to fruition. As more and more communities and healthcare provider entities realize the tremendous potential of addressing the social determinants of health by bringing together healthcare entities and CBOs and other social-service organizations, the question of community readiness for a CCC is being asked much more often. But how do you know what the right answer is?
Before looking at the details of how we might answer this, let’s remember that a CCC doesn’t don’t just happen in a vacuum. It requires belief, vision, commitment― and above all― alignment among the key stakeholders. Every CCC that has formed, including the Dallas CCC, begins with a vision for a healthier community and its citizens. This vision is typically shared by two or more large and influential key community stakeholders, such as a large healthcare system, school district, civic entity, or social- service organization like the United Way or Salvation Army.
Leaders from these organizations often initially connect at informal social gatherings and advance the idea of what if? These informal exchanges soon lead to a more formal meeting where the topic is more fully discussed and each of the participants articulates their vision for a healthier community and what that might look like going forward. This stage in the evolution of a CCC is perhaps the key step in the transformation process, as while all stakeholders will have a vision, achieving alignment among those visions is no small feat. Many hopeful CCCs never pass this stage, as the stakeholders cannot come to an agreement on a common vision that each can support. For the fortunate few, intrinsic organizational differences can be successfully set aside to allow the CCC to move forward.
It’s at this point in the CCC’s evolution that details begin to matter in truthfully answering the question, “Is this community ready to be connected?” While there may be agreement among the key stakeholders on a vision, the details around readiness may still divert or delay the best-laid plans. It is safe to say that the key to understanding a community’s readiness to form a CCC lies in the completion of a formal, comprehensive, and transparent readiness assessment.
A readiness assessment is a process to collect, analyze, and evaluate critical information gathered from the community to help identify actual clinical and socio-economic needs, current capabilities and resources (including technology), and community interest and engagement. Taken together, a comprehensive readiness assessment can help identify a community’s strengths and weaknesses in preparation for establishing a CCC.
A readiness assessment is not a tactical plan for building a CCC, nor is it a governance document that provides how all members of the CCC will relate to each other. Instead, the readiness assessment provides communities interested in establishing a CCC with an honest and unbiased yardstick to measure preparedness. Conducting and using the results of the readiness assessment is one of the best ways to ensure a successful CCC deployment.
A typical CCC readiness assessment covers five areas: (1) community demographics; (2) clinical areas of need (including trends); (3) social areas of need (including trends); (4) technology competency (e.g., what percent of the potential network participants are computer literate?), availability (e.g., what percent of the potential network participants have internet access?), and suitability (e.g., is the internet access, high speed?); and (5) what are the needs of potential network participants and can these be modeled as use cases for the information exchange network? This information is essential to help key stakeholder decision-makers decide to move forward with establishing a CCC and to know what specific challenges may lie ahead.
The collection of this essential information can be done in a number of ways, such as making use of existing publicly reported data or conducting surveys, interviews, focus groups and town hall meetings with community leaders and residents and clinical and CBO leaders and staff. Experience conducting the readiness assessment that provided the foundation for the Dallas CCC showed that no single information-collection method was sufficient to collect the necessary level and robustness of the data. In Dallas, we utilized all five approaches but found that in addition to researching publicly available data, initial surveys, followed by interviews and focus groups, yielded the most voluminous and reliable information to chart the course ahead.
In addition to the various methods to collect this essential information, the key to obtaining useful and reliable information requires a sufficient number of respondents/participants who are drawn from various organizations and organizational levels. Simply put, you must have a large enough sample and you must have diversity within the sample. It’s not enough to just interview leaders of potential network participants, as their understanding of the needs, trends, and capabilities may look very different from that of frontline staff.
Similarly, surveying only one category of potential network participants may not provide enough information to fully understand the socio-economic needs in the community or even the perspectives surrounding the prevalence of chronic conditions. Beyond the qualitative methods involved, it is important to note that if done right, this process takes a lot of time to complete. Cutting corners by reducing the sample size, for example, or doing selective sampling to speed the readiness assessment process along will only cause problems later when this insufficient information results in erroneous decision-making.
Once the data has been collected, it is important to carefully analyze what the data is trying to tell you. Results of the readiness assessment must be shared openly and honestly with all key stakeholders, particularly those serving in a governance capacity. The governance group (a topic for another day) that has formed in parallel with the readiness assessment must be able to evaluate and understand the main messages from the readiness assessment to make an informed decision as to whether to move forward with establishing a CCC.
Like the need for alignment around the key stakeholder’s vision for the CCC, there must be universal agreement by the key stakeholders as to the message of the readiness assessment and its implications for the road ahead. As with the vision alignment stage, substantive disagreements among the group at this stage are a sign of trouble ahead unless differences can be resolved.
At this point, you might be thinking that this all seems very complicated and fraught with potential land mines waiting to derail your effort to answer the original question “Is your community ready to be connected?” Again, I would emphasize the importance of unwavering commitment and alignment to achieve the vision. But I would also offer advice gleaned from working in the CCC space for the last eight years, which is to get help early and don’t wait until the horse is out of the barn!
We have seen first-hand many communities and consultants approach the conduct of a readiness assessment with a cavalier attitude, often exemplified by the statement, “we already know all of this,” only later to have to backtrack their pronouncements at substantial additional cost in time and resources. Fortunately, today there are a number of excellent organizations, including PCCI, with the experience, credibility, and integrity in the CCC space to help you on this journey. Don’t be afraid to seek them out. It will be a wise investment that you will not regret, particularly when you begin to see the results of improved whole-person health and well-being in your community.
About Dr. Keith Kosel
Dr. Keith Kosel is a Vice President at Parkland Center for Clinical Innovation (PCCI) and is the author of “Building Connected Communities of Care: The Playbook for Streamlining Effective Coordination Between Medical and Community-Based Organizations,” a guide that brings together communities to support our most vulnerable. At PCCI, Keith is leveraging his passion for – and extensive experience in – patient safety, quality, and population health by focusing on understanding social determinants of health and the impact of community-based interventions in improving the health of vulnerable and underserved populations.
Roland Therriault, President, InSync Healthcare Solutions
Since COVID-19 emerged as a major health threat, virtual care has taken off. As many as 46% of patients reported in late April that they had used telehealth to replace a canceled healthcare visit in 2020, while 48% of physicians said they had started using telehealth to treat patients.
While a shift in care models was necessary to address business continuity amid the pandemic, these trends also represent positive movements as a growing body of evidence supports the real-life benefits of telehealth. Remote models of care are connected to safe and effective consultations across many use cases, low exposure to viruses, and much-needed access to care.
Yet the fact that physician adoption isn’t higher suggests two things:
1) Physicians may be taking a ‘wait and see’ approach in the hopes that patients will want to return to in-person care as economies reopen; or
2) Some physicians haven’t yet figured out their long-term telehealth strategy. In truth, many providers are treating telehealth as a “stop-gap” — or temporary — solution until life returns to normal.
But given the increasingly positive data around telehealth as a safe alternative to in-person care, as well as its track record in successfully treating patients, it’s time for providers to reframe their thinking. In the future, practices will need a healthcare strategy that balances virtual with in-person care.
Rethinking Telehealth
As recently as ten years ago, telehealth reimbursement was largely limited to patients in rural areas, as payers didn’t yet see the value of compensating doctors for virtual encounters.
Today, most payers and providers recognize the value of telehealth on some level amid rising demand for services and severe professional shortages. In particular, remote care models have proven their worth during the pandemic as an effective means of preventing the spread of disease. Greater acceptance of telehealth is further demonstrated by the recent decision to relax HIPAA requirements by HHS’ Office of Civil Rights (OCR), allowing more providers and patients to virtually connect through FaceTime, Zoom, or other two-way communications systems during the current pandemic.
This is an important first step, although many providers remain resistant to change for a variety of valid reasons. Some of these include discomfort with remote care models, reimbursement concerns, and the cost of deploying telehealth.
Performing medicine in a way that doesn’t align with one’s training feels unnatural, and some providers have said that virtual encounters feel less personal. The fact is that most clinicians weren’t trained to diagnose patients remotely or engage over a screen and are simply hesitant to embrace this approach to care.
Also, providers may have trepidation about not getting paid. While CMS and private payers have expanded coverage, multiple healthcare providers have reported that bills are being delayed or only partially paid by health plans.
With limited insight into the potential return on that investment, concerns over the cost of implementing telehealth are also reasonable. A physician who is consulting with patients remotely through FaceTime, for example, might wonder if the investment in a more secure, robust telehealth platform will make sense in 12 months, should a COVID-19 vaccine materialize.
Yet by not adopting a more permanent telehealth solution, providers may be hurting themselves down the road. Patients increasingly believe virtual care is highly effective, and some even prefer it. According to a SYKES consumer survey administered in March, 60% of 1,441 respondents said the COVID pandemic has increased their willingness to try telehealth.
Also, while HHS has relaxed HIPAA enforcement at the moment, there’s no indication this will continue. Healthcare organizations will need to ensure that the platform or program they’re using is designed to keep protected health information (PHI) safe.
Investing in the Future
Given the upward trajectory of telehealth, it benefits providers to thoughtfully invest in the right strategies and solutions now to extract the greatest value and return on investment down the road. Here are four steps to take, when shifting to a long-term telehealth strategy:
– Identify needs. Many primary-care practices may have seen a bump in interest in telehealth due to COVID-19, while specialty practices may see increases stay steady, even when fears of the coronavirus fade. When planning long-term, put patient needs first: In what ways can telehealth improve care delivery, going forward? Look at data, such as virtual-visit utilization patterns, to see where there are opportunities to grow telemedicine (e.g., expanding chronic care management) based on needs.
– Consider workflows. The ideal telehealth program doesn’t interrupt clinical workflows – it enhances them. If you’re using a ‘stop-gap’ video conferencing solution to provide telemedicine, is it easy to integrate practice notes with your EHR? Or, do you have to take extra steps to document patient encounters for clinical and billing departments?
–Seek supportive partners. You can use any number of technology platforms to conduct telemedicine encounters, but not all platforms are created equal. When looking at implementing a telehealth platform, consider not only ease of use, and interoperability, but also what a particular vendor is offering: How well the telehealth platform in question can accommodate the needs of a particular specialty? What are existing clients are saying about things like training, vendor support, and the patient experience?
– Proactively engage. Your patients have most likely heard of telehealth, but they may not realize that telehealth is multifaceted and can be used to diagnose conditions such as skin disorders or allergies and can be just as effective as in-person visits. Educating patients about telehealth’s benefits, and making it easy for them to try telehealth, is essential to success.
Expanding telehealth’s role in the medical practice benefits everyone, from physicians to patients to payers. Moving past the “stop-gap” mentality now will reap greater benefits in the future, regardless of whether we’re in the midst of a pandemic, or simply trying to provide excellent care on a day-to-day basis.
About Roland Therriault
Roland Therriault
is the President and Executive Vice President of Sales at InSync Healthcare Solutions, a provider
of integrated EHR and practice management software, revenue cycle management
services and medical transcription to thousands of healthcare professionals
throughout the United States. Roland Therriault manages all operations of the
company, driving its go-to-market strategy and overseeing all sales activities.
His experience in healthcare and technology includes more than 20 years of
direct and channel sales, strategic planning and business development. Prior to
joining InSync, Roland served as Vice President of Sales for MD On-Line, a
provider of acute and ambulatory clinical and practice management solutions.
The COVID-19 pandemic is not just a medical crisis. Since the highly contagious disease hit American shores in early 2020, the virus has dramatically changed all sectors of society, negatively impacting everything from food supply chains and sporting events to the nation’s mental and behavioral health.
For some people, work-from-home plans and limited access to entertainment are manageable obstacles. For others, the shuttered schools, lost wages, and social isolation spell disaster – especially for individuals already living with socioeconomic challenges.
The social determinants of health have always been important for understanding why some populations are more susceptible to increased rates of chronic conditions, reduced healthcare access, and shorter lifespans. COVID-19 is throwing the issue into high relief.
Now more than ever, healthcare providers need to gain full visibility into their populations and the non-clinical challenges they face in order to help individuals maintain their health and keep their communities as safe as possible during the ongoing pandemic.
Exploring correlations between socioeconomic circumstances and COVID-19 vulnerability
Clinicians and researchers have worked quickly to identify patterns in the spread of COVID-19. Early results have emphasized the danger posed by advanced age and preexisting chronic conditions such as obesity, diabetes, and heart disease.
Further, data from the Johns Hopkins University and American Community Survey indicates that the infection rate in predominantly black counties is three times higher than in mostly white counties. The death rate is six-fold higher.
Data from the Centers for Medicare and Medicaid Services (CMS) confirms the trend: black Medicare beneficiaries are hospitalized at a rate of 465 per 100,000 compared to just 123 per 100,000 white beneficiaries. Hispanic Medicare beneficiaries had 258 hospitalizations per 100,000, more than double the white population’s hospitalization rate.
Researchers suggest that the social determinants of health may be largely responsible for these disconnects in infection and mortality rates. Racial, ethnic, and economic factors are strongly correlated with increased health concerns, including longstanding disparities in access to care, higher rates of underlying chronic conditions, and differences in health literacy and patient education.
Leveraging data-driven tools to identify vulnerable patients
Healthcare providers will need to take a proactive role in identifying which of their patients may be at enhanced risk of contracting the virus and experiencing worse outcomes from the disease.
They will also need to ensure that person gets adequate treatment and participate in contact tracing efforts after a positive test. Lastly, providers will have to ensure their public health reporting data is accurate to inform local and regional efforts to contain the disease.
The process begins by developing confidence in the identity of each individual under the provider’s care. Healthcare organizations often struggle with unifying multiple electronic health record (EHR) systems and other health IT infrastructure, resulting in medical records that are incomplete, inaccurately duplicated, or incorrectly merged.
Access to current and complete medical histories is key for highlighting at-risk patients. An enterprise master patient index (EMPI) can provide the underlying technical foundation for initiating this type of population health management.
EMPIs help organizations create and manage reliable unique patient identifiers to ensure that records are always associated with the correct individual as they move throughout the healthcare system.
When paired with claims data feeds, health information exchange (HIE) results, and interoperability connections with other healthcare partners, EMPIs can bring a patient’s complete healthcare status into focus.
This approach ensures that providers stay informed about past and present clinical issues and service utilization rates. It can also support a deeper dive into the social determinants of health.
Combining EHR data with standardized data about socioeconomic needs can help providers develop more comprehensive and detailed portraits about their patients’ holistic health status.
By including this information in EHRs and population health management tools, providers can develop condition-specific registries to guide outreach activities. Providers can deploy improved care management strategies, close gaps in care, and connect individuals with the resources they need to stay healthy.
Healthcare organizations can acquire socio-economic data about their communities in a variety of ways, including integrating public data sources into their population health management tools and collecting individualized data using standardized questionnaires.
Once providers start to understand their patients’ non-clinical challenges, including the ability to avoid situations that may expose them to COVID-19, they can begin to prioritize patients for outreach and develop personalized care plans.
Conducting effective outreach and interventions for high-needs patients
COVID-19 has taken a staggering economic toll on many families, including those who may have been financially secure before the pandemic. Routine healthcare, prescription medications, and even some urgent healthcare needs are often the first to fall by the wayside when finances get tight.
Healthcare providers have gotten creative about staying connected to patients through telehealth, drive-in consults, and other contactless strategies. But they must also ensure that their vulnerable patients are aware of these options – and that they are taking advantage of them.
Contacting a large number of patients can be challenging since phone numbers, emails, and home addresses change frequently and are prone to data entry errors during intake. Organizations with EMPIs can leverage their tools to ensure contact information is up to date, accurate, and associated with the correct individual.
Care managers should prioritize outreach to patients with complex medical histories and known clinical risks for vulnerability to COVID-19. These conversations are a prime opportunity to collect social determinants of health information or refresh existing data profiles.
Looking to the future of healthcare in a COVID-19 world
Combining technology-driven strategies with targeted outreach will be essential for healthcare organizations aiming to provide holistic support for their populations during – and after – the COVID-19 pandemic.
By developing certainty about patient identities and synthesizing that information with data about the social determinants of health, providers can efficiently and effectively connect with their patients to offer much-needed resources.
Taking a proactive approach to addressing the social determinants of health during the outbreak will help providers maintain relationships with high-needs patients while building new connections with those facing unanticipated challenges.
With a combination of population health management strategies and innovative technology tools, healthcare providers and public health officials can begin to view the social determinants of health as a fundamental component of the fight against COVID-19.
Andy Aroditis, is CEO of NextGate, the global leader in healthcare enterprise identification.
Finding previously unidentified insurance coverage can feel a little like a game of hide and seek. Patients may not always be aware of their insurance or eligibility for Medicare and Medicaid, and, in an effort to both improve the patient financial experience and simultaneously improve collections, providers are often tasked with finding this information on the spot. Historically, providers have used demographic information like Social Security Numbers (SSN) as a means to verify patient identities and locate this information, but that tactic is increasingly unreliable as it is possible for more than one person to use the same SSN and SSNs are a lucrative route to stealing someone’s identity.
With this in mind, many health plans are no longer using SSNs as an identifying number for insurance coverage. In fact, the Centers for Medicare & Medicaid Services recently removed SSN-based Health Insurance Claim Numbers (HICNs) from Medicare cards and are now using Medicare Beneficiary Identifiers (MBIs) for Medicare transactions like billing, eligibility status, and claim status.
The latest health plans to remove this piece of demographic information is Health Net Medi-Cal and Health Net National. Effective September 25, 2020, the search options for eligibility for this plan have changed. Providers will ONLY be able to find and verify coverage with a subscriber ID.
“Providers are often tasked with finding this information on the spot.”
While Health Net Medi-Cal and Health Net National are the latest health plans to do away with demographic searches, it’s certainly not a surprising trend and more will likely follow suit.
Bridging the gap with historical data
Uncovering previously unidentified coverage is critical for providers as it helps to eliminate costly self-pay situations, bad debt write-offs and unwarranted charity designations. And, without the proper insurance information, patients also risk delayed access to care and other financial hardships.
With demographic searches on the decline, providers will need a more efficient and reliable way to search for coverage. As a data-driven company with a historical repository of claims data, Experian Health is uniquely positioned to help providers search for coverage.
Combining search best practices, multiple proprietary databases and historical information, Experian Health’s Coverage Discovery locates patients’ billable commercial insurances that were unknown or forgotten, and combs through Medicare and Medicaid coverage. This flags accounts that may have been destined as a write-off or charity and maximizes reimbursement revenue by identifying primary, secondary and tertiary coverage. Not only do fewer accounts go to bad-debt collections, but providers can automate the self-pay scrubbing process.
A tool like Coverage Discovery is even more beneficial for providers during COVID-19, where limitations of face-to-face contact make it more difficult to complete the usual coverage checks. Coverage Discovery empowers providers to facilitate coverage checks remotely, avoiding delayed reimbursements during a time when revenue streams are already feeling pressure.
“As a data-driven company with a historical repository of claims data, Experian Health is uniquely positioned to help providers search for coverage.”
Want to learn more? Contact us to see how Coverage Discovery can help find previously unidentified coverage and reduce bad debt.
Four in ten Americans live with multiple chronic conditions. For these individuals, life is punctuated with physician appointments, visits to the pharmacy and referrals to different specialists. Their care should be coordinated with orchestral precision, but the reality is somewhat less harmonious. Snail-paced scheduling systems, poor communication and mismatched patient records can lead to a lack of proper support for patients, confusion about how the care plan is managed, and potentially dangerous (and costly) gaps in care. For health plans, quality markers are missed and incentive payments start to dwindle.
To help close these gaps, health plans must embrace a more innovative, consumer-focused approach to care coordination. Digital scheduling platforms make it easy for call center agents to help members find and book appointments, eliminating the need for a three-way call between the member and provider. Members are much more likely to be placed with the right clinician, at the right time and for the right appointment, while health plan call centers can operate far more efficiently. The automation and data integrity of digital systems makes it much easier to track and book appropriate post-discharge appointments and routine care management.
Digital scheduling has the potential to improve health outcomes, drive up operational efficiency and yield big savings down the line. It’s about more than just matching consumer expectations, though a great member experience is certainly a competitive advantage for health plans. Better coordinated care could be life-changing for patients with chronic conditions. And with more members switching plans and seeking call center support in light of COVID-19, there’s a short-term urgency to tighten up communications and direct members to the care they need. Could a digital scheduling platform help your health plan close gaps in care and create a better member experience?
Despite the majority of elective procedures
being up and running again, patients are still keeping their distance. Nearly
half of Americans say they or a family member have delayed care since the
beginning of the pandemic, while visits to the emergency room and calls to 911
have dropped
significantly. Patients are avoiding care, but it’s not for the reason
you’d expect.
Beyond obvious worries about catching and
spreading the virus, a second concern is becoming apparent: patients are
fearful of the potential cost of medical care. With so many furloughed, laid
off or losing their insurance coverage, medical care has become unaffordable for millions of Americans. It’s especially tough for
those who fall into the coverage
gap, where their income is too high to grant access to Medicaid coverage,
but too low to be caught by the ACA safety net.
If patients continue to delay care, it’s
only a matter of time before their symptoms worsen, leading to more complex and
expensive treatment or even risking their lives. For the hospitals and health
systems with revenue levels at a record low, encouraging patients to return for
routine care is a matter for their own financial survival too.
The answer lies in making sure patients feel safe and comfortable both when they come in for care, and when they look at their financial responsibilities.
5 ways to ease the return to routine care
1. Reassure patients about safety measures before and during their visit
Patients are understandably anxious about
what their visit is going to be like. Will they have their temperature taken?
What should they do if they have symptoms of the virus? Will seating areas be
spaced out and sanitized? Pre-visit communications and proactive
information on arrival will help them feel comfortable and eliminate the shock
factor of seeing more stringent infection control measures.
2. Minimize unnecessary contact by shifting patient intake online
From online scheduling and
pre-registration to telehealth and contactless payment, there are many ways to
keep face-to-face interactions to a minimum. Not only will this help reduce the
spread of the virus, it’ll make the whole patient experience more convenient
for patients. Exploring a virtual and automated patient intake experience can also free up staff to work on other tasks, thus also protecting the
organization’s bottom line through efficiency savings.
3. Encourage patients back to care with automated outreach campaigns
With so much uncertainty at the moment,
patients may be unsure if it’s even appropriate to come in for routine care.
Use automated outreach to prompt them to
book appointments and schedule follow up care. A digital scheduling platform
can help you set up text-based outreach campaigns, to reassure patients that
it’s safe (and essential!) to come in for any overdue care – without placing
any undue burden on your call center.
4. Provide price transparency before and at the point of service
With healthcare experts pointing to financial
worries as a major barrier to care, anything providers can do to improve the
patient financial experience is an advantage. Price transparency is the first step.
When patients have clear and accessible payment estimates upfront, they can
plan accordingly and/or seek financial assistance as quickly as possible,
reducing the risk of non-payment.
5. Screen for charity care eligibility with faster automated checks
Once those payment estimates have been
generated, the next step is to confirm whether the patient is eligible for financial support, in the event that they’re unable to cover their bill. Checking eligibility
for charity assistance is a time-suck for patient collections teams, but with
access to the right datasets, it’s a perfect candidate for automation.
These steps become even more urgent as
providers face the prospect of a ‘twindemic’ – or a surge in COVID-19 cases
colliding with flu season.
By avoiding delays to care, patients can avoid the need for more serious and
expensive treatment further down the line, when hospitals are likely to be
under even greater pressures.
Contact us to find out more about how our
data-driven, automated patient intake
solutions can help make your patients feel as safe and
comfortable as possible, both physically and financially.
The rates for closing gaps in care are
some of the most widely used, quantitative metrics to measure quality, allocate
incentives, and control costs. Unfortunately, health plans face numerous
obstacles closing gaps in care, from social determinants of health to
inconsistent coordination of care, and don’t always have a care gap closure
program in place. Thankfully, digital solutions like web-based scheduling and
automated outreach can help health plans jump many of these hurdles while also
helping to close gaps in care.
Call center scheduling Many health plans are still grappling with the difficulty of three-way scheduling calls between themselves, members and providers. Calls are lengthy and cumbersome as agents dig through binders of provider schedules and scheduling rules to determine and book the right appointment for each member. Members are often put on hold, sometimes more than once, and are much more likely to drop out of the scheduling process entirely when faced with this experience. As a result, these members may face significant care delays, or in some cases miss their necessary follow-up care entirely.
With web-based scheduling, member engagement call centers can eliminate three-way calls. Guided search helps to narrow down the right provider for each member and the scheduling platform allows for immediate, on-the-spot appointment selection. Health plans can more efficiently close gaps in care as members can quickly and easily schedule their appointments. This has proven to cut call times in half, and increase scheduling rates by 140%. To learn more, read this case study.
Automated Outreach Health plans typically have a list of individuals to follow up with on a regular (bi-weekly or monthly) basis to book whatever care service is needed to close the gap in care. Now, health plans have the ability to automate this outreach via interactive voice response (IVR) or text message (SMS) while simultaneously enabling members to schedule appointments on-the-spot, either through a link in the text or during the IVR call.
The automation improves the member experience with convenient access and helps close more gaps in care – all without a single call center agent.
The ultimate combination for closing gaps in care Used alone, automated outreach and call center scheduling are both effective for closing gaps in care. When used together, health plans can fast track the path to closing gaps in care and further improve efficiencies.
Members can first be reached via automated
outreach, prompting the individual to schedule an appointment. This allows
members the opportunity to self-schedule and essentially self-close their gap
in care, without a single live agent phone call. From there, call center agents
can pinpoint the members who didn’t schedule as part of the outreach campaign
and then call them directly to book the necessary care.
We know that despite the flexibility
and convenience offered by digital solutions, like automated outreach, there
are still individuals who prefer to schedule over the phone and have personal
interaction when booking care. The combination of web-based scheduling and
automated outreach enables omnichannel access for health plans while helping
call center agents focus their attention on the members who need their help
most.
Contact us to learn more about how Experian Health can help health plans fast track the path to closing gaps in care.
– Alphabet’s Verily has established a new subsidiary,
Coefficient, with a mission to create value by combining innovative health
technology solutions with new insurance and payment models. Verily is the
majority shareholder and Swiss Re Corporate Solutions, an established player in
the employer stop-loss market, has a minority stake in the new company.
– Coefficient will enter a segment of insurance called
employer stop-loss. Employer stop-loss typically protects self-funded employers
from unexpected and large health insurance claims.
Verily, an Alphabet company is announcing a new subsidiary, Coefficient Insurance Company, that will be backed by Swiss Re Corporate Solutions, the commercial insurance unit of the Swiss Re Group. Coefficient will combine innovative health technology solutions with novel insurance and payment models. It’s precision risk solution helps self-funded employers to control cost volatility through a data-driven model that is unique in the traditional employer stop-loss market. Employer stop-loss is a segment of commercial insurance that protects self-funded employers from unexpected and large employee health benefit claims by reimbursing employers for claims above a defined amount.
How Coefficient Works
Coefficient will leverage Verily’s core strengths integrating hardware, software, and data science and will also leverage Swiss Re Corporate Solutions’s risk knowledge, distribution capabilities, and reputation in the employer stop-loss market. Coefficient’s precision risk solution is designed to provide self-funded employers with more predictable benefit plan protection. It uses an analytics-based underwriting engine to identify unexpected areas of cost volatility and cover those exposures with more dynamic and precise insurance policy provisions. Over time, Coefficient plans to integrate Verily’s suite of health devices and tech-driven interventions for workers and dependents into its precision risk solution to improve health outcomes and control cost.
“Employers have been facing rising and increasingly unpredictable healthcare costs for years,” said Andy Conrad, CEO, Verily. “Coefficient is aimed at reducing blind spots and providing greater cost control mechanisms for self-funded employers, and we expect that partnering with Swiss Re Corporate Solutions will help us to better develop and distribute our precision risk solution to the employer stop-loss market. Over time, we look forward to integrating Coefficient with Verily’s employer health solutions, including mobile health devices and innovative care management programs, in order to align payment models with better health outcomes.”
Swiss Re
Corporate Solutions has agreed to make a minority investment in Coefficient,
subject to the satisfaction of certain closing conditions including regulatory
approvals. In connection with this investment, Ivan Gonzalez, CEO North
America, Swiss Re Corporate Solutions, is expected to join the Coefficient
Board of Directors upon closing.
– Dignity Health Management Services (DHMSO), the largest
health system in the state of California to transform their network health data
into actionable insights.
– With this partnership, the organization will leverage
Innovaccer’s FHIR-enabled Data Activation Platform to better manage healthcare
services for its attributed patients.
Dignity Health Management Services
(DHMSO), a healthcare management company part of CommonSpirit Health, that helps providers
and payers deliver better clinical outcomes through innovative tools and
technology is
partnering with Innovaccer. As part of
the partnership, DHMSO will leverage Innovaccer’s FHIR-enabled Data Activation
Platform and built-in solutions to enhance its care management approach while
engaging their network providers and payers in real-time.
Transform Network Health Data Into
Actionable Insights
DHMSO will integrate its clinical
and financial data from multiple sources on Innovaccer’s FHIR-enabled Data
Activation Platform. Once the data is integrated on the platform, the
organization will power multiple care processes. This platform supports
critical FHIR API resources and solves numerous data-exchange challenges for
providers and payers. DHMSO will have the advantage of real-time data sharing
and true interoperability with the platform.
To achieve a comprehensive overview
of its network, Dignity Health Management Services will also use InGraph,
Innovaccer’s population health management solution built on top of the
FHIR-enabled Data Activation Platform. DHMSO’s leaders will view drilled-down
analysis of their under-performing parameters through InGraph’s 60+ patient
stratification features and advanced analytics offered by customizable
dashboards. They will be able to identify, have a complete overview of, and
gain insight into their cohort of at-risk patients to track utilization and
trends. The organization will be empowered to implement care management
improvements and follow results within different management spheres, adjusting
as needed to drive optimum healthcare delivery and patient outcomes.
Additionally, billing processes for patient visits will be simplified and
automated through the platform’s automated reporting feature.
Using
InNote, Innovaccer’s point-of-care technology, the organization will furnish
its providers with a full view of their patient’s healthcare journey right at
the moment of care. This will enable DHMSO and its healthcare teams to focus on
closing the care and coding gaps in real-time to deliver quality outcomes with
high efficiency.
“At Dignity
Health Management Services, we believe in keeping our patients happy, healthy,
and whole every day. It is our goal to meet the physical, mental, and spiritual
needs of every patient. This partnership with Innovaccer will strengthen our
approach towards achieving this goal. Innovaccer’s FHIR-enabled Data Activation
Platform will assist us as we work toward improvements in our care delivery,
and will be a great addition to our strategy,” says Dr. Soham Shah, Medical
Director of Clinical Informatics & Quality Management, Dignity Health
Management Services.
– Innovaccer launches a perioperative
optimization solution for surgeons to realize clinical and financial goals with
patient-risk analysis.
– The solution redefines surgical planning and
post-surgical recovery with machine learning-based patient stratification for
optimized surgery experience and personalized patient care management.
Innovaccer, Inc., a San Francisco, CA-based healthcare technology company, recently launched its perioperative optimization solution for health systems. The solution optimizes surgeries and ramps up volumes by identifying high-risk patients for pre-surgical intervention while reducing the length of stay, readmissions, and cost. The solution uses advanced analytics and machine learning-based algorithms to proactively identify patients at greater risk for post-surgical complications. Patients are then referred to the pre-surgical optimization clinic for pre-surgical strategies which are personalized for individual patients and specifically designed to minimize post-surgical complications.
Impact of COVID-19 on Elective Surgeries, Non-Essential
Medical Care
COVID-19
has challenged traditional healthcare delivery systems and caused the
postponement of elective surgeries and other non-essential medical care. As
patients wait for their surgeries, it is likely their conditions could
deteriorate and/or patients would return to clinics during a pandemic surge.
Health systems will need to be prepared to address the potential for more
complicated patient health conditions with careful risk assessment.
Pre-Surgical Optimization Platform Features
Innovaccer’s “Pre-Surgical Optimization” solution guides patient prioritization based on an algorithm that factors medical history, patient demographics, allergies, chronic conditions, history, and social determinants of health. Based on the previous data on these patients from the electronic medical record, claims, and the individual’s risk factors, the algorithm estimates the future cost of care for the patient. The algorithm also assigns patients to appropriate case managers using a smart rule engine that assesses a variety of factors including the number of appointments, and the surgeon’s expertise to map the patient to the provider. This approach helps hospitals identify high-risk patients and focus on the patients that will benefit most from pre-surgical interventions.
Return on Investment Model for Healthcare Organizations
Innovaccer has also incorporated a refined return on
investment model designed to make the optimization process revenue positive for
healthcare organizations. The three key pillars of the exclusive model are
sensitivity analysis tools, deep data insights, and performance analytics.
Using this solution, hospitals can track their return on investment in
real-time on a customizable dashboard with metrics including reduced
readmissions, reduced length of stay, and emergency department visits with
their associated costs.
“With about 28 million surgeries canceled worldwide, non-COVID medical care has suffered tremendously. Canceled elective surgeries have impacted patient health conditions and the economic sustainability of health systems,” says Abhinav Shashank, CEO and Co-founder of Innovaccer. “As health systems plan to resume surgical procedures, care managers will need to engage the patient remotely for pre-surgical interventions. Our solution is created to redefine the entire process of optimizing surgery planning and to become more patient-centered and adaptable to the changing care environment. We want to ensure exemplary pre-optimization and post-discharge engagement to reduce readmissions and improve the hospital’s financial impact using the pre-surgical optimization process.”
– Today, Allergy Amulet announces $3.3M in seed funding
to launch the world’s smallest and fastest consumer food allergen sensor and
empower the allergy community by alleviating fears about what’s in their food.
– Allergy Amulet’s novel technology can improve the
quality of life for the millions of people living with food allergies or
intolerances by testing for common allergenic ingredients in seconds. The portable
device is made to fit every lifestyle — it’s small enough to fit on a
keychain, a necklace, or in a pocket.
– Every 3 minutes, a food allergy sends someone to the
ER. For the 32 million Americans and between 220-520 million people globally
who live with food allergies, the potentially fatal disease is a constant
threat.
Allergy Amulet, a Madison, WI-based company empowering the
food allergy community by alleviating fears about what’s in their food, today
announces $3.3 million in seed funding led by TitletownTech, a joint venture between Microsoft and the
Green Bay Packers.
Every 3 Minutes, a Food Allergy Sends Someone to the ER
Food allergies affect 32 million Americans and between 220
to 520 million people globally—that’s one in 13 children and one in 10 adults.
They can be fatal, even after ingesting only trace amounts of a known allergen.
The company has developed the world’s smallest and fastest consumer food allergen
sensor, which is capable of testing foods for common allergenic ingredients in
seconds. The patented technology fits on a keychain, a necklace, a wristband,
or in a pocket, and doubles as a medical alert system, making it easier and
safer to manage food allergies and intolerances.
Simple + Fast Detection
Allergy Amulet helps:
Individuals with food allergies: It makes testing for food allergens
easy, giving people additional assurances that their food is safe.
Parents with children who have food allergies: It gives
parents another tool to manage their children’s allergies, and helps children
live a normal childhood, maintain independence, and safely attend sleepovers
and birthday parties (or just school) with friends.
Businesses: It gives restaurant owners, schools, childcare
providers, summer camps, and hotels the power of extra precaution to save them
time, money, and worry.
How It Works
The Allergy Amulet is a fast and portable food allergen and
ingredient sensor, designed to fit every lifestyle. Its first-of-its-kind
detection platform pairs molecularly imprinted polymer (MIP) technology with a
conductive electrochemical platform to detect target allergenic ingredients.
The Amulet consists of two parts: a USB-sized reader (the “Amulet”) and a test
strip that houses the proprietary sensor chips. The case also accommodates
epinephrine and antihistamines, giving users a complete allergy care management
platform.
For consumers, testing for food allergens is made possible
in four simple steps:
Step 1: Users collect a sample of the food with
the test strip, and turn the top of the tester to grind the sample.
Step 2: A chip slides out from the test strip and is
inserted into the reader.
Step 3: Test results appear on the reader within
seconds, indicating the presence or absence of the target allergen.
Step 4: Optional: store test results in the mobile
app, connect and share results with the food allergy community, or hold down a
button on the reader to alert your emergency contacts.
The Team
The Allergy Amulet team has deep connections to the
communities they serve — Barnes has managed life-threatening food allergies
since childhood, and experienced a near-fatal anaphylactic event as a teenager.
After meeting her Co-founder and Scientific Advisor, Dr. Joseph BelBruno, a
Dartmouth chemistry professor emeritus with life-threatening food allergies,
the two worked to make Allergy Amulet a reality.
The company holds one issued U.S. patent with multiple
applications, and its waitlist has thousands of individuals signed up to
participate in an early beta release, scheduled to kickoff later this
year.
Expansion Plans
This infusion of new capital will be used to manufacture beta units, help to launch pre-orders, expand product offerings to cover more allergens, grow the company’s world-class team, add additional restaurant and company partners to its roster, and educate consumers on the benefits of additional food allergen management tools. In addition to Titletown, its seed financing includes participation from Great North Labs, Colle Capital, Great Oaks VC, DeepWork Capital, Dipalo Ventures, and Bulldog Innovation Group.
“The current standard of care — avoiding certain foods,
injecting epinephrine to treat reactions, and visiting the emergency room —
can take a serious emotional, financial, and physical toll on individuals,
caregivers, and families,” said Abigail Barnes, Co-founder and CEO of Allergy Amulet.
“Our hope is to help individuals more safely engage in the activities that
bring them joy, whether that means going to a restaurant with friends and
family or eating a cupcake at a party.”
Availability
Allergy Amulet is slated for pre-sales Fall of 2020 and
launch Fall of 2021.
– TransUnion, in partnership with CLX Health, a joint venture from UST Global and SiriusIQ, announced the launch of HealthyAmerica, a technology solution that will give individuals the power to securely share their COVID-19 testing results while maintaining their individual privacy – helping businesses and schools across the country to minimize risk and reopen with greater confidence.
– Businesses and schools seeking to welcome back their
employees and students will be able to use the solution to help prevent the
spread of COVID-19 and other communicable diseases by asking individuals to
download the HealthyAmerica app and, if the individual agrees, share their health
status.
To support
U.S. efforts to move forward safely and confidently in the wake of COVID-19, TransUnion and its partners are
developing the HealthyAmericaM solution.
HealthyAmerica gives people the power to securely share COVID-19 testing results
while maintaining individual privacy, helping businesses and schools to
minimize risk and reopen with greater confidence.
Helping Individuals,
Businesses and Schools Assess COVID-19 Risks
HealthyAmerica
combines TransUnion’s verified data identity with confirmed test results
through CLX Health, which indicates the presence of illness and/or the
existence of COVID-19 antibodies. The results, when received from a national
network of CLIA-certified laboratories performing FDA-approved tests, are
displayed in a simple application. The solution will easily adapt to changes in
testing and COVID-19 care management, including the ultimate development and
use of a vaccine. This
initiative is being led by TransUnion Healthcare and does not utilize any
credit information.
Businesses and schools seeking to welcome back their employees and
students as well as airlines, hotels and other organizations and events across
the country will be able to use the solution to help prevent the spread of
COVID-19 and other communicable diseases.
“People want to protect their health and lives and
they want the country to open,” said David Wojczynski, President of TransUnion
Healthcare. “With
HealthyAmerica, we can help them do both. The app helps people share their
vital information when they choose to do so. This helps avoid risks related to
COVID-19 in everyday interactions while maintaining privacy for individuals.”
HealthyAmerica Deployment
HealthyAmericawill be rapidly deployed and delivered in a simple
application with a user experience and process readily accessible by
individuals, employers, businesses and schools. The solution provides real-time
access to an established network of clinical laboratories, major hospital
systems and Federally Qualified Health Clinics, which combined perform over 90%
of all lab transactions in the United States.
“The COVID-19 pandemic has taken its toll on the world’s health – physical, mental and economic. This partnership was created leveraging each organization’s expertise to help make the country safer by deploying a solution individuals and businesses can access to make decisions and evaluate health risk based on real-time information,” said Joseph Gonzalez, Chief Strategy Officer with CLX Health. “Having the ability to assess the risk of where you’ve been and where you want to go is the cornerstone of what we all need to help mitigate the spread of the virus and help the economy to open safely and back to capacity.”
How The HealthyAmerica App Works
Organizations utilizing the solution to help ensure the safety of
customers, employees and/or students will prompt individuals to download the
HealthyAmerica app. If the user agrees, they can then schedule testing at a
certified laboratory near them. Once testing has been completed, results will
be added to HealthyAmerica and the individual may choose whether to share their
status-verified QR code.
An optional feature of the app leverages publicly-available “heat
maps” of known cases of COVID-19 and adds the general and de-identified
location of users who opt in, allowing to see their proximity to known COVID-19
viral areas which they may have visited or may be planning to visit. The Virus
Encounter Risk Analysis (VERA) feature creates the most current map of virus
location so people can better assess risk of visiting specific locations and
potentially reduce the number of people exposed to the virus. HealthyAmerica is
fully operational for those who do not choose this option.
“HealthyAmerica enables individuals to protect themselves from unnecessary exposure to COVID-19 and to share their health status with the schools and businesses they choose to. TransUnion, a leading global provider of risk and information solutions, is well suited to provide the data identity functionality of this solution,” added Jim Bohnsack, Senior Vice President and Chief Strategy Officer for TransUnion Healthcare.
– Innovaccer has recently partnered with CareSignal to
address healthcare’s urgent need amidst the COVID-19 pandemic: to create and
maintain solid, clinically actionable relationships with patients in a new set
of predominantly virtual care.
– CareSignal offers evidence-based end-to-end support services for chronic medical conditions such as asthma, CHF, COPD, diabetes, depression, hypertension, and hospital discharge support, and maternal health monitoring.
Innovaccer, Inc., and CareSignal today announce a partnership to address healthcare’s urgent need amidst the COVID-19 pandemic: to create and maintain solid, clinically actionable relationships with patients in a new setting of predominantly virtual care.
Partnership Details
The partnership combines more than two dozen
condition-specific patient monitoring programs with population
health data insights for a more integrated care and improved clinical
outcomes with industry-leading financial returns.
CareSignal offers evidence-based end-to-end support services for chronic medical conditions such as asthma, CHF, COPD, diabetes, depression, hypertension and hospital discharge support, and maternal health monitoring. With a focus on prevention and addressing the social determinants of health, each program offers personalized clinically-validated features to deliver even more value from Innovaccer’s population health, care management, and organization-specific offerings.
“Innovaccer has always stayed on top of delivering on promises to our customers, and our partnerships with leading organizations have been instrumental in achieving 100% client satisfaction,” says Abhinav Shashank, CEO at Innovaccer. “Working with CareSignal supports our mission to help healthcare care as one. With CareSignal as our partner, we will strengthen our approach towards better patient engagement and enable smart deviceless remote patient monitoring.”
– Both companies’ clients will gain an increased depth of IT and security support, and Technology Seed’s healthcare clients will now have a substantially improved value proposition
DAS Health Ventures, Inc., a provider of health IT and management, announced today it completed the acquisition of Technology Seed, LLC, a managed IT and cybersecurity services company based in Salem, NH. This acquisition strengthens DAS’ position in the MSP sector and significantly advances its growth strategy to build the leading managed IT and services provider to physician groups, hospitals, and healthcare systems throughout the country.
Impact of Acquisition
DAS Health actively serves more than 1,500 clients, 3,000 clinicians, and 15,000 total users nationwide. With its headquarters in Tampa, Florida, a regional office in Las Vegas, Nevada, and a significant presence in Georgia, Illinois, New Jersey, North and South Carolina, Texas, and Wisconsin, DAS Health serves clients throughout nearly all 50 states. The recent acquisition significantly enhances their presence in New England, and as a result, DAS Health has now added a regional office in New Hampshire that will create opportunities for greater regional support of its entire solutions portfolio.
This
is the largest of over a dozen acquisitions in the past several years made
by DAS, which has become known for its ability to
identify quality companies that are a strategic fit and rapidly integrate them
in order to continually enhance the customer experience for clients of both
companies. Cogent Growth Partners assisted DAS in
the acquisition.
Both
companies’ clients will gain an increased depth of IT and security support, and
Technology Seed’s healthcare clients will now have a substantially improved
value proposition, as DAS Health’s
offerings are robust, including practice management and EHR software sales,
support and hosting, revenue cycle management (RCM), managed IT services,
security risk assessments (SRA), MIPS/MACRA reporting & consulting, mental
& behavioral health screenings, chronic
care management, telemedicine, and other value-based and patient engagement
solutions.
“Technology Seed offers an exciting opportunity for DAS to strengthen and expand our managed IT services throughout
the country, and specifically in New England” stated David Schlaifer, DAS Health President and CEO.
“I am pleased to welcome Kurt Simione and his team to the DAS family.
With this strong addition to our portfolio, we look forward to unlocking additional
value for our clients.”
The focus on improving health plan member engagement and overall
experience has been steadily growing over the years, much of it being driven by
the push towards a more consumer-friendly healthcare experience. James Beem,
Managing Director, Global Healthcare Intelligence at J.D. Power, states, “health
plans are doing a good job managing the operational aspects of their
businesses, but they are having a harder time addressing the expectations
members have based on their experiences in other industries where their service
needs are more effectively addressed with better technology.” His remarks are
based off of findings from the annual Commercial
Member Health Plan Study, which also found that care coordination between
different providers and care settings is a top challenge health plans are
facing today.
Most of our conversations with health plan prospects and
customers revolve around how digital technology can improve health plan member
engagement and close gaps in care. From our experience, here are five key
digital strategies that health plans can employ to better engage members and
improve satisfaction.
Call centers remain a cornerstone of member engagement. From onboarding
new members to closing gaps in care, the call center is where the rubber meets
the road between health plans and their members. At Experian Health, we focus
on making it easier for call center agents to find and book appointments on
behalf of members – specifically, we eliminate the need for three-way calls
with providers by giving agents access to a digital scheduling platform. It
automates providers’ scheduling rules, while also protecting their calendars,
and allows health plans to schedule appointments for members without having to
call the provider office. In some cases, once our platform is in place, we’ve seen
scheduling rates increase by 140%, call times cut in half, and show rates go
up.
A large factor in social
determinants of health is the availability of transportation
– are your members physically able to make it to and from their appointment? While
members may know what care they need and are able to book an appointment, they
may not be able to show up for that appointment due to unreliable or non-existent
transportation. The member doesn’t show, the care gap remains, and health plans
take a hit on quality metrics. What’s worse, the member puts themselves at risk
for readmission or other, costly trips to the ED for care that remains
unaddressed – all an expensive medical cost for the plan. We are proud to work
with transportation vendors and ultimately, include the ability to schedule
transportation in a workflow while booking an appointment. By facilitating easy
access to transportation as part of the appointment scheduling process, we are
ensuring a better outcome for everyone.
Why not offer the functionality that consumers are accustomed to in
nearly every other industry? Booking a hotel, flight, or dinner reservation can
all be done online via a mobile device, so why not an appointment? Imagine
being able to extend this type of convenience and consumer-friendly experience
to your members. They come to the health plan’s site or app to search for an in-network
provider and can then schedule an appointment in real-time, on the spot, day or
night, no phone call required.
Instead of simply sending members text and phone call reminders to
schedule care, health plans can use automated outreach to send those messages with
the ability to schedule an appointment via self-service. The member would receive
a text message or phone call, and after confirming their identity, would
receive their personal health-related message along with the ability to
schedule an appointment as part of the outreach process. In a few clicks, or
with a few verbal responses, the appointment is scheduled, and the care gap is
closed with very minimal effort.
The struggle to find and maintain accurate contact info for
members is real. Fortunately, Experian Health has unprecedented access to
consumer data. With the largest
consumer database, collected on more than 300 million consumers, we
can provide a deeper understanding of your current members or prospects in your
markets. These data assets can enable the most effective marketing and
communication strategies to improve enrollment rates as members are more
successfully identified and reached. The data can also be leveraged to enhance
internal analytics, like member risk score algorithms or other models, to
improve member outcomes.
Learn more about how a digital care coordination platform can help your organization improve member engagement and the member experience.
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 PatientsProtecting 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.
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.
– Current Health has partnered with Dexcom to add continuous
glucose monitoring (CGM) capabilities to its remote patient monitoring (RPM)
platform – enhancing care and improving outcomes for diabetics.
– Dexcom CGM data will transmit directly into the Current
Health wearable and platform for review by the care management and clinical
teams, improving post-discharge and chronic care of diabetes patients outside
the hospital.
– Through this partnership, Current Health is now able to
offer a complete view of patients’ health indicators, no matter where that
patient is located – a critical need as keeping patients out of the hospital is
even more important than ever with the COVID-19 pandemic. With these insights,
healthcare providers are able to proactively address issues associated with
diabetes and provide the best possible care.
Current Health today
announced it has partnered with Dexcom to
add continuous glucose monitoring (CGM) capabilities to Current Health’s AI-poweredremote patient
monitoring (RPM) platform. By continuously monitoring patients’ glucose
levels – largely considered the fifth vital sign – the Current Health platform
will empower health systems to secure actionable and comprehensive insights
into overall patient health, resulting in improved patient outcomes and
decreased healthcare costs.
Integration Details
As part of the integration, Dexcom CGM data will transmit
directly into the Current Health wearable and platform for review by the care
management and clinical teams, improving post-discharge and chronic care of
diabetes patients outside the hospital. Dexcom and Current Health is supplied
pre-configured and ready to go out of the box with a setup time of less than 5
minutes, the patient applies Dexcom and the Current Health wearable, so
continuous vitals and continuous glucose are immediately available for review
by the care management or clinical team. The integration will be an optional
add-on for patients using the Current Health wearable, offered first to
patients with diabetes. The integration will become widely available later this
year.
COVID-19 Underscores Need for Continuous Glucose Monitoring
With an estimated 463 million people across the globe
– or one out of every 11 adults – suffering from diabetes, health systems need
insight into patients’ whole health – including glucose levels – to best manage
at-risk patients. With people with diabetes particularly vulnerable to a
variety of illnesses, including cardiovascular disease, nerve damage and
Alzheimer’s disease – not to mention COVID-19 –
healthcare providers need to be able to continuously monitor glucose levels to
ensure they can proactively address issues associated with diabetes and provide
the best possible care.
“Our focus has always been on delivering the best care to people with diabetes through continuous glucose monitoring,” said Matt Dolan, senior vice president and general manager of new markets at Dexcom. “By integrating our leading CGM system into Current Health’s RPM platform, we can expand the clinical utility of our technology and also offer a more comprehensive view into a patient’s whole health. These factors together mean that more patients will get the best care possible.”
Muthu Alagappan, MD, Medical Director at Notable Health
The COVID-19 pandemic has caused an unprecedented shift in the way consumers view and access a variety of goods and services—and healthcare is no exception. Recent studies show that many patients, including vulnerable populations like those living with cancer, are delaying recommended care and procedures—and will continue to do so for at least several months amid fears over the safety of in-person visits. In response, reports of providers adapting to offer care virtually are all the more commonplace, with almost half of physicians now treating patients through telemedicine platforms, up from just 18 percent in 2018.
These trends have solidified virtual care as a mainstay, and as a result, the virtual visit has become a commodity—a service that can be provided by many capable vendors. However, the logistics that power the adoption of virtual care are often overlooked. As healthcare administrators turn to telemedicine to resume “non-urgent” healthcare services, we must ensure that best-in-class technology solutions are utilized to improve the virtual care experience—for providers, clinical staff, and, importantly, patients.
Health systems and their networks face significant operational issues when delivering care in a remote setting, due to the range of potential interactions and diversity of devices—adding to the already recognized administrative burden that comes with routine patient care. With each patient visit comes over a dozen manual tasks, including patient intake and registration, in-visit clinical note writing, as well as back-office billing and claims processing. The virtual visit adds even more steps, such as helping patients access the appropriate technology for a two-way video interface or sending custom links to a “virtual waiting room” at the right time.
Facilitating a seamless virtual care experience before, during, and after a patient’s visit should be top-of-mind—particularly as patient expectations have heightened and healthcare has progressed towards a technology-enabled future. Fortunately, the automation of operational workflows can help healthcare administrators smooth the friction around conducting virtual visits at scale.
Intelligent automation extends our capacity in healthcare by enabling us to do more with the same workforce and technology infrastructure. In fact, digital medical assistants can use artificial intelligence to automate repetitive, cognitively tiring, and error-prone tasks. This technology can support the influx of virtual visits by offloading administrative processes, such as co-payment collection, clinical documentation, and pre-population of common clinical orders.
For patients not as familiar with digital interactions and the variety of telemedicine modalities, which can include platforms like Amwell, Doctor on Demand, and Teladoc or video conference solutions like RingCentral and Zoom, participating in virtual visits can be a daunting change. Additional technological challenges associated with virtual care can result in heightened frustration, increased no-show rates, or decreased activation, so maintaining patient engagement throughout the patient journey is even more important in a virtual environment. Digital medical assistants can automate appointment reminders, offer detailed setup guidance for patients, and provide “just-in-time” virtual visit links to ensure patients and providers can make the most of their time together.
The COVID-19 pandemic has also introduced new variables and risks that patients, providers, and healthcare institutions at-large must consider when seeking and delivering care. Until recently, it was a relatively straightforward process to determine where a patient should receive routine care. Now given the risk of disease spread, providers find themselves considering which patients to see when to see them and whether to see them virtually or in-person.
This creates additional complexity in determining when to schedule patients and in which medium to conduct the visit. Platforms that leverage intelligent automation can help clinical teams to pre-screen all scheduled patients, collect a thorough medical history, intelligently segment patients into risk cohorts and triage each cohort to an individualized destination, be it a return to in-person care or a virtual environment.
In the “virtual exam room,” things also look a little different. From the provider’s perspective, one of the oft-cited drawbacks of virtual visits is the limited ability to measure vital signs, perform a physical exam or order point-of-care diagnostics. At-home diagnostics, wearable devices and remote patient monitoring tools allow providers to collect continuous clinical data that can be gathered asynchronously and quickly, resulting in a more comprehensive picture of a patient’s health. Further, platforms that use intelligent automation algorithms to organize data collected across the care continuum can parse these data streams to identify at-risk patients and then automate outreach and care management to follow clinical care pathways.
The COVID-19 pandemic has given us a unique opportunity to reimagine healthcare using a modern suite of technology for patients, providers and staff that does away with outdated and inefficient processes. But we also have a responsibility to replace them with solutions that improve digital experiences by supporting patients before visits, automating repetitive workflows, and parsing large amounts of data to support clinical decision-making.
Combining intelligent automation with virtual visits creates a powerful tool to efficiently manage patient populations and offer an experience that feels intuitive while enabling healthcare systems to do more with less. By accelerating the digital transformation of healthcare today, we can position ourselves for a future of increased capacity, decreased overhead, and improved quality.
Muthu Alagappan, MD, is an attending physician at Massachusetts General Hospital, a trained engineer, and medical director at Notable Health, a healthcare experience automation company.
– GYANT raises $13.6M in Series A funding for AI-enabled digital front door solutions to drive meaningful patient-doctor engagement.
– The investment will enable GYANT to scale up its product development to meet rapidly increasing market demand and support its exponential customer growth.
– Current customers include Intermountain Healthcare, OSF
Healthcare, Adventist Health, Health First, Integris, etc.
GYANT, a San Francisco, CA-based care navigation company, today announced the close of a $13.6 million Series A financing round led by Wing Venture Capital. Wing VC is joined by Intermountain Ventures and existing investors Grazia Equity, Alpana Ventures, Techstars Ventures and Plug and Play Ventures. The financing will enable GYANT to continue providing best in class support and services for its fast-growing and high-profile customer base. In addition, GYANT will advance technology and interoperability to deliver the most user-friendly and personalized digital care navigation assistant on the market.
Connecting Patients & Managing Relationships
Patient expectations for a convenient and seamless healthcare experience continue to grow. As a result, health systems face an increasing need for digital health tools that improve patient experiences while optimizing workflow and reducing costs. Founded in 2016, GYANT has built the virtual front door to help health systems improve care utilization, cut costs through automation, and improve the patient experience. GYANT’s Front Door appears on a hospital system’s website or mobile app to chat with patients and guide them to the care and digital health tools they need, 24-7. GYANT is customizable to any organization’s branding, EHR, digital tools, and clinical endpoints.
GYANT ties together all of the digital tools a health system needs in a single interface, creating a seamless patient experience — increasing engagement, trust, and loyalty at each stage of the healthcare journey. GYANT’s unique combination of deep intelligence, physician oversight, and a human-driven, empathetic approach allows health systems to solve for traditional complex care issues, ensuring that patients receive the right care, anytime and anywhere.
GYANT’S AI-Driven Platform Increased Hospital’s Patient
Contact Rate by 39%
Cleveland Clinic first started working with GYANT to
virtualize patient outreach in 2018 to complement their existing post-discharge
call program. The combination of Cleveland Clinic’s care management processes
and GYANT’s AI-driven patient engagement platform has since fueled a 39 percent
increase in the hospital’s patient contact rate.
GYANT’s platform combined with live clinical engagement
helps patients stay in touch with their providers, while also offering a more
efficient patient and caregiver experience. This process allows more patients
to receive the support and resources they need following their hospital stay
and are escalated to a Cleveland Clinic caregiver should they require
additional assistance.
Recent Traction/Milestones
Demand for GYANT’s AI-enabled Front Door solution
skyrocketed this year, and was further accelerated
by COVID-19. The pandemic forced rapid,
widespread adoption of digital access. The digital health market is valued
at over $106 billion and expected
to grow significantly as providers innovate to meet the demands of
healthcare consumerization. Delivering on this need, GYANT’s financing follows
a period of remarkable growth, having expanded from 3 customers in July 2019 to
24 customers in July 2020 including Intermountain Healthcare, Geisinger, OSF
Healthcare, Adventist Health, Health First, Integris, etc.
“We are thrilled by the support of ambitious, successful investors who see the disruptive potential of AI in healthcare,” said Stefan Behrens, co-founder and chief executive officer, GYANT. “The need for digital access and care navigation has never been greater, especially with healthcare inequities and disparities in the spotlight today. This is the time for GYANT to continue growing and realize our vision of personalized patient experiences with digital navigation to the right, best possible care.”
– Emtiro Health, an
innovative population health company in North Carolina has selected Innovaccer
to deliver data-powered solutions to enhance the efficiency and effectiveness
of care delivery.
– Powered by Innovaccer’s FHIR-enabled Data Activation
Platform, Emtiro Health will create unified patient records that drive
comprehensive, whole-person care management, no matter where they are on the
care continuum. The FHIR-enabled Data Activation Platform will also deliver
highly actionable data, automated care management workflows, and smart patient
engagement.
Emitro Health, a
Winston Salem, NC-based population
health company, today announced a partnership with Innovaccer, a San Francisco, CA-based
healthcare technology to enable the effective delivery of services to the
patients and providers supported by Emtiro Health.
Emitro Health Background
Emtiro Health supports providers, systems, and payers with unparalleled expertise and knowledge augmented by data and analytics. This platform enhances the patient experience and improves outcomes while delivering effective healthcare at a lower cost. Emtiro Health addresses the systemic barriers to total wellbeing and helps patients chart a course to brighter futures. The organization’s experienced team brings diverse backgrounds and skillsets to complement a whole-practice approach from practice optimization and transformation, data analytics, and quality reporting to the integration of services, such as clinical pharmacy and behavioral health.
Leveraging FHIR-enabled
Data Activation Platform
Powered by Innovaccer’s FHIR-enabled Data Activation Platform, Emtiro Health will create unified patient records that drive comprehensive, whole-person care management, no matter where they are on the care continuum. The FHIR-enabled Data Activation Platform will also deliver highly actionable data, automated care management workflows, and smart patient engagement. Emtiro Health’s provider partners will be equipped with point-of-care insights that surface relevant information for patient health in real-time. The entire suite of solutions will enable Emtiro Health to improve the effectiveness and efficiency of both providers and care, management teams, allowing them to care as one for patients.
Unified Health Record
Innovaccer’s
FHIR-enabled Data Activation Platform helps healthcare organizations obtain a
complete picture through their unified patient record. The data is then
activated for smart analytics and decision support — so, care teams have the
crucial information they need to provide better care and to care as one.
“Emtiro Health selected Innovaccer to provide customized business intelligence and analytics solutions to our partners to revolutionize how the right level of care is delivered to the right patient at the right time. The Innovaccer data platform coupled with Emtiro Health’s expertise in delivering a total population health model of care management is a game-changer for providers and patients alike,” said Kelly Garrison, President and CEO of Emtiro Health. “In practice, this collaboration will mean more informed care, healthier individuals and healthier communities in North Carolina.”
– Health Catalyst announces an agreement to acquire
clinical workflow optimization solution healthfinch using a mix of stock and
cash.
– As part of the acquisition, healthfinch will be a new
application suite category called EMR Embedded Insights and its refills, care
gaps closure, and visit planning applications will continue to be available in
their original configuration.
Health
Catalyst, Inc., a provider of data and analytics technology and services to
healthcare organizations, today announced that it has entered into a definitive
agreement to acquire healthfinch, Inc., a Madison,
Wisconsin-based company that provides a workflow integration engine delivering
insights and analytics into EMR workflows to
automate physicians’ ability to close patient care gaps in real-time. Health
Catalyst expects to fund the transaction using a mix of stock and cash.
Clinical Workflow Optimization
Founded in 2011, healthfinch has developed the healthcare
industry’s most trusted, most used clinical workflow optimization solution,
Charlie. Charlie’s unique combination of EMR-integrated technology and protocol
content streamlines key workflows such as prescription renewal processing,
visit planning, and care gap closure. With Charlie, health systems are able to
deliver a better, safer patient experience, while also achieving lower rates of
provider and staff burnout, increased care gap closure, improved quality
metrics, and significant time and cost savings for providers and clinical
staff.
Integration with Health
Catalyst Analytics Application Portfolio
The healthfinch acquisition, which will allow Health
Catalyst’s customers to enhance clinical workflows in the EMR, further
strengthens the Health Catalyst Population Health portfolio, which was
bolstered by the Able Health acquisition in February 2020 and Care
Management Suite launch earlier this month.
Within the Health Catalyst analytics application portfolio,
healthfinch will be a new application suite category called EMR Embedded
Insights and its refills, care gaps closure, and visit planning applications will
continue to be available in their original configuration. Additionally, the
healthfinch technology will augment workflows across Health Catalyst’s product
portfolio, with data and insights powered by Health Catalyst’s cloud-based Data
Operating System (DOS™), a healthcare-specific, open, flexible, and scalable
data platform that provides customers with a single comprehensive environment
to integrate and organize data.
healthfinch’s industry-leading capabilities are already in demand from Health Catalyst customers and prospects across multiple product areas including quality measures, care management, population health, patient safety, and others. Providing these capabilities will bring even greater value to Health Catalyst customers by making the critical insights and analytics from the DOS platform actionable within clinical workflows – providing more effective care for patients and saving time for both doctors and staff through automation so they can work at the top of their license.
“We are thrilled to benefit from healthfinch’s decades of collective experience gained from working with customers across the United States that are using a variety of different EMRs. And we also find deeply compelling the strong mission and cultural alignment with our respected healthfinch teammates. We are excited to have the healthfinch leadership team and their talented colleagues join Health Catalyst, and we are grateful for the tremendous insights, knowledge and perspectives they bring, which will accelerate the achievement of our mission to be the catalyst for massive, measurable, data-informed healthcare improvement,” said Health Catalyst CEO Dan Burton.
Burton added, “This acquisition highlights Health Catalyst’s ability to integrate and scale software applications on top of our DOS platform. The healthfinch technology will easily serve up actionable insights, derived from DOS and other Health Catalyst analytics applications into the EMR, at the point of care.”
– Philips integrates the BioIntelliSense FDA-cleared
BioSticker™ sensor as part of its remote patient monitoring solutions for
patients outside the hospital.
– Multi-parameter sensors aid monitoring across multiple chronic conditions with medical-grade vital signs for physicians to remotely track core symptoms, including COVID-19.
– Healthcare Highways is the first to leverage the BioSticker sensor as a part of Philips’ RPM program in the U.S.
Philips, today announced it has formed a strategic collaboration with BioIntelliSense, a continuous health monitoring, and clinical intelligence company, to integrate its BioSticker™ medical device into Philips’ remote patient monitoring (RPM) offering to help monitor at-risk patients from the hospital into the home. With the addition of multi-parameter sensors, Philips’ solutions can enhance how clinicians monitor patient populations living with chronic conditions – including diabetes, cancer, congestive heart failure and more – in their homes with passive monitoring of key vital signs, physiological biometrics, and symptomatic events via a discreet wearable patch for monitoring up to 30 days.
COVID-19 Pandemic Underscores Need for Remote Patient Monitoring
Remote patient monitoring and telehealth-enabled clinical programs offer care teams a sustainable and scalable way to manage patient populations with chronic or complex conditions at home and plays a key role in supporting care for COVID-19 patients who do not require hospitalization. By regularly transmitting patient data that can provide critical insights into a patient’s condition, the collaboration will empower care teams in the U.S. with a more holistic patient view and the ability to intervene earlier before adverse events occur. With single-use sensors and patient-owned technology supporting remote monitoring, care teams can also help reduce the need for clinicians and patients to interact in person.
“With more patients interacting with their doctors from home and more hospitals developing strategies to virtually engage with their patients, remote patient monitoring is now, more than ever, an essential tool,” said Roy Jakobs, Chief Business Leader Connected Care, member of the Executive Committee at Royal Philips. “Building on Philips’ global leadership in patient monitoring, which includes an extensive suite of advanced monitoring solutions, platforms, and sensors, this is the latest example of our capability to allow more seamless, cloud-based data collection across multiple settings from the home to the hospital and back into the home. Patient data, coupled with our clinically differentiated and leading AI-powered technology, quantifies the data into relevant actionable insights to help detect deterioration trends and support care interventions – all while outside the walls of the hospital.”
Wireless, Secure Data Transfer of Key Vital Signs
The
BioSticker is a single-use, FDA-cleared 510k class II wearable medical device
to enable at-home continuous passive monitoring with minute level data across a
broad set of vital signs, physiological biometrics and symptomatic events (skin
temperature, resting heart rate, resting respiratory rate, body position,
activity levels, cough frequency) on a single device for thirty-days. Symptoms,
including those directly associated with COVID-19 such as temperature and
respiratory rate, can be remotely monitored in confirmed cases of Coronavirus
and also for those patients not sick enough to be hospitalized, or those
suspected of having COVID-19.
In
addition to COVID-19, the BioSticker device will help transform the way
clinicians monitor and manage patients living with chronic conditions from the
home.
“Multi-parameter
sensors are the natural next phase for remote monitoring, especially at a time
when more patients are engaging with their physicians from home,” said James
Mault, MD, Founder and Chief Executive Officer of BioIntelliSense. “Clinicians
need medical grade monitoring and algorithmic clinical insights for COVID-19
exposure, symptoms and management. Accelerated by the COVID-19 crisis, the
practice of medicine has been irreversibly enlightened as to the safety and
efficacy of virtual care. Philips is a demonstrated leader in remote patient
monitoring, and we look forward to BioIntelliSense’s technology playing
an integral role in simplifying and enhancing outcomes for patients and their
doctors.”
Healthcare Highways first to leverage BioSticker as a part of
Philips’ RPM solutions
Healthcare Highways, a provider of health plans, high-performance provider networks, pharmacy benefit management, population health management, and benefit plan administration, is the first to leverage the BioSticker sensor as a part of Philips’ RPM program in the U.S. Out of the seven programs that will be deployed with Healthcare Highways, one will focus specifically on monitoring patients with COVID-19. The remaining six will focus on conditions across the acuity spectrum, including patients with congestive heart failure, hypertension, diabetes, total joint replacement, cancer and asthma. The program will help Healthcare Highways improve insights to patient health status across its provider network.
“Healthcare Highways was built on the idea of delivering measurable value and access to quality care to our members. We work in partnership with our providers to innovate on the care model, and look at Remote Patient Monitoring as the next frontier of how providers will connect with patients,” said Creagh Milford, DO, MPH, Chief Medical Officer of Healthcare Highways and Chief Executive Officer of HighCare Health. “COVID-19 has underscored the need for proactive care management. Resources are strained and by integrating an RPM program with biosensor technology, we’ll be able to drive further value for our unique member base, providers and employers to establish a new way of care delivery.”
