What You Should Know:
– UnitedHealth Group has reached an agreement to acquire
Change Healthcare in a deal valued at more than $13 billion, marking the first
major acquisition of 2021.
– Change Healthcare will be combined with OptumInsight to
advance a more modern, information, and technology-enabled healthcare platform.
has reached an agreement to acquire
healthcare technology leader Change
Healthcare for more than $13B. As part of the acquisition, Change
Healthcare will be combined with OptumInsight
to provide software and data analytics, technology-enabled services and
research, advisory and revenue cycle management offerings to help make health
care work better for everyone. The acquisition marks one of the largest deals
for UnitedHealth Group as it continues to expand it’s health services under the
Financial Details of Acquisition
UnitedHealth will pay $25.75 a share in cash, the companies said in a joint statement, a 41% premium over Change Healthcare’s closing price Tuesday of $18.24. The $13 billion valuation includes more than $5 billion in debt owed by Change Healthcare. Shares of Change Healthcare were up 31.72% at $24.02 in trading on Wednesday. UnitedHealth shares were up 0.6% at $346.67.
“Together we will help streamline and inform the vital
clinical, administrative and payment processes on which health care providers
and payers depend to serve patients,” said Andrew Witty, President of
UnitedHealth Group and CEO of Optum. “We’re thrilled to welcome Change
Healthcare’s highly skilled team to create a better future for health care.”
Acquisition Impact for Providers and Patients
The combination of OptumInsight and Change Healthcare is expected to simplify services around medical care to improve health outcomes and lower costs
– help clinicians make the most informed and clinically
advanced patient care decisions, more quickly and easily. Change Healthcare
brings widely adopted technology for integrating evidence-based clinical
criteria directly into the clinician’s workflow, while Optum’s clinical
analytics expertise and Individual Health Record can strengthen the evidence
base needed to deliver effective clinical decision support at the point of
care. This can ensure appropriate sites of care and consistently achieve the
best possible health, quality and cost outcomes.
– well-positioned to make health care simpler, more efficient and more effective. A key opportunity is to enhance with insights drawn from billions of claims transactions using Change Healthcare’s intelligent health care network, combined with Optum’s advanced data analytics. This will support significantly faster, more informed and accurate services and processing.
– Change Healthcare’s payment capacities combined with
Optum’s highly automated payment network will simplify financial interactions
among care providers, payers and consumers and accelerate the movement to a
more modern, real-time and transparent payment system. This will ensure
physicians get paid more quickly, accurately and reliably, and provide
consumers the same simplicity and convenience managing their health care
finances they experience with other transactions.
“This opportunity is about advancing connectivity and accelerating innovations and efficiencies essential to a simpler, more intelligent and adaptive health system. We share with Optum a common mission and values and importantly, a sense of urgency to provide our customers and those they serve with the more robust capacities this union makes possible,” said Neil de Crescenzo, President and CEO of Change Healthcare. Upon closing, Mr. de Crescenzo will serve as OptumInsight’s chief executive officer, leading the combined organization.
The combination of Teladoc Health and Livongo creates a
global leader in consumer-centered virtual care. The combined company is
positioned to execute quantified opportunities to drive revenue synergies of
$100 million by the end of the second year following the close, reaching $500
million on a run-rate basis by 2025.
Price: $18.5B in value based on each share of Livongo
will be exchanged for 0.5920x shares of Teladoc Health plus cash consideration
of $11.33 for each Livongo share.
Siemens Healthineers Acquires Varian Medical
On August 2nd, Siemens Healthineers acquired
Varian Medical for $16.4B, with the deal expected to close in 2021. Varian is a
global specialist in the field of cancer care, providing solutions especially
in radiation oncology and related software, including technologies such as
artificial intelligence, machine learning and data analysis. In fiscal year 2019,
the company generated $3.2 billion in revenues with an adjusted operating
margin of about 17%. The company currently has about 10,000 employees
Price: $16.4 billion in an all-cash transaction.
Gainwell to Acquire HMS for $3.4B in Cash
Veritas Capital (“Veritas”)-backed Gainwell Technologies (“Gainwell”),
a leading provider of solutions that are vital to the administration and
operations of health and human services programs, today announced that they
have entered into a definitive agreement whereby Gainwell will acquire HMS, a technology, analytics and engagement
solutions provider helping organizations reduce costs and improve health
Price: $3.4 billion in cash.
Philips Acquires Remote Cardiac Monitoring BioTelemetry for $2.8B
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.
Price: $2.8B ($72 per share), to be paid in cash upon
Hims & Hers Merges with Oaktree Acquisition Corp to Go Public on NYSE
Telehealth company Hims & Hers and Oaktree Acquisition Corp., a special purpose acquisition company (SPAC) merge to go public on the New York Stock Exchange (NYSE) under the symbol “HIMS.” The merger will enable further investment in growth and new product categories that will accelerate Hims & Hers’ plan to become the digital front door to the healthcare system
Price: The business combination values the combined
company at an enterprise value of approximately $1.6 billion and is expected to
deliver up to $280 million of cash to the combined company through the
contribution of up to $205 million of cash.
SPAC Merges with 2 Telehealth Companies to Form Public
Digital Health Company in $1.35B Deal
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.
Price: The merger deal is worth $1.35 billion, including
WellSky Acquires CarePort Health from Allscripts for
WellSky, global health, and community care technology company, announced today that it has entered into a definitive agreement with Allscripts to acquire CarePort Health (“CarePort”), a Boston, MA-based care coordination software company that connects acute and post-acute providers and payers.
Price: $1.35 billion represents a multiple of greater
than 13 times CarePort’s revenue over the trailing 12 months, and approximately
21 times CarePort’s non-GAAP Adjusted EBITDA over the trailing 12 months.
Waystar Acquires Medicare RCM Company eSolutions
On September 13th, revenue cycle management
provider Waystar acquires eSolutions, a provider of Medicare and Multi-Payer revenue
cycle management, workflow automation, and data analytics tools. The
acquisition creates the first unified healthcare payments platform with both
commercial and government payer connectivity, resulting in greater value for
Price: $1.3 billion valuation
Radiology Partners Acquires MEDNAX Radiology Solutions
Radiology Partners (RP), a radiology practice in the U.S., announced a definitive agreement to acquire MEDNAX Radiology Solutions, a division of MEDNAX, Inc. for an enterprise value of approximately $885 million. The acquisition is expected to add more than 800 radiologists to RP’s existing practice of 1,600 radiologists. MEDNAX Radiology Solutions consists of more than 300 onsite radiologists, who primarily serve patients in Connecticut, Florida, Nevada, Tennessee, and Texas, and more than 500 teleradiologists, who serve patients in all 50 states.
PointClickCare Acquires Collective Medical
PointClickCare Technologies, a leader in senior care technology with a network of more than 21,000 skilled nursing facilities, senior living communities, and home health agencies, today announced its intent to acquire Collective Medical, a Salt Lake City, a UT-based leading network-enabled platform for real-time cross-continuum care coordination for $650M. Together, PointClickCare and Collective Medical will provide diverse care teams across the continuum of acute, ambulatory, and post-acute care with point-of-care access to deep, real-time patient insights at any stage of a patient’s healthcare journey, enabling better decision making and improved clinical outcomes at a lower cost.
Teladoc Health Acquires Virtual Care Platform InTouch
Teladoc Health acquires InTouch Health, the leading provider of enterprise telehealth solutions for hospitals and health systems for $600M. The acquisition establishes Teladoc Health as the only virtual care provider covering the full range of acuity – from critical to chronic to everyday care – through a single solution across all sites of care including home, pharmacy, retail, physician office, ambulance, and more.
Price: $600M consisting of approximately $150 million
in cash and $450 million of Teladoc Health common stock.
AMN Healthcare Acquires VRI Provider Stratus Video
AMN Healthcare Services, Inc. acquires Stratus Video, a leading provider of video remote language interpretation services for the healthcare industry. The acquisition will help AMN Healthcare expand in the virtual workforce, patient care arena, and quality medical interpretation services delivered through a secure communications platform.
CarepathRx Acquires Pharmacy Operations of Chartwell from
CarepathRx, a leader in pharmacy and medication management
solutions for vulnerable and chronically ill patients, announced today a
partnership with UPMC’s Chartwell subsidiary that will expand patient access to
innovative specialty pharmacy and home infusion services. Under the $400M
landmark agreement, CarepathRx will acquire the
management services organization responsible for the operational and strategic
management of Chartwell while UPMC becomes a strategic investor in CarepathRx.
Cerner to Acquire Health Division of Kantar for $375M in
Cerner announces it will acquire Kantar Health, a leading
data, analytics, and real-world evidence and commercial research consultancy
serving the life science and health care industry.
This acquisition is expected to allow Cerner’s Learning
Health Network client consortium and health systems with more opportunities to
directly engage with life sciences for funded research studies. The acquisition
is expected to close during the first half of 2021.
Cerner Sells Off Parts of Healthcare IT Business in
Germany and Spain
Cerner sells off parts of healthcare IT business in Germany and Spain to Germany company CompuGroup Medical, reflecting the company-wide transformation focused on improved operating efficiencies, enhanced client focus, a refined growth strategy, and a sharpened approach to portfolio management.
Price: EUR 225 million ($247.5M USD)
CompuGroup Medical Acquires eMDs for $240M
CompuGroup Medical (CGM) acquires eMDs, Inc. (eMDs), a
leading provider of healthcare IT with a focus on doctors’ practices in the US,
reaching an attractive size in the biggest healthcare market worldwide. With
this acquisition, the US subsidiary of CGM significantly broadens its position
and will become the top 4 providers in the market for Ambulatory Information
Systems in the US.
Price: $240M (equal to approx. EUR 203 million)
Change Healthcare Buys Back Pharmacy Network
back pharmacy unit eRx Network
(“eRx”), a leading provider of comprehensive, innovative, and secure
data-driven solutions for pharmacies. eRx generated approximately $67M in
annual revenue for the twelve-month period ended February 29, 2020. The
transaction supports Change Healthcare’s commitment to focus on and invest in
core aspects of the business to fuel long-term growth and advance innovation.
Price: $212.9M plus cash on the balance sheet.
Walmart Acquires Medication Management Platform CareZone
Walmart acquires CareZone, a San Francisco, CA-based smartphone
service for managing chronic health conditions for reportedly $200M. By
working with a network of pharmacy partners, CareZone’s concierge services
assist consumers in getting their prescription medications organized and
delivered to their doorstep, making pharmacies more accessible to individuals
and families who may be homebound or reside in rural locations.
Verisk Acquires MSP Compliance Provider Franco Signor
Verisk, a data
analytics provider, announced today that it has acquired Franco Signor, a Medicare Secondary Payer
(MSP) service provider to America’s largest insurance carriers and employers.
As part of the acquisition, Franco Signor will become part of Verisk’s Claims
Partners business, a leading provider of MSP compliance and other analytic
claim services. Claims Partners and Franco Signor will be combining forces to
provide the single best resource for Medicare compliance.
Rubicon Technology Partners Acquires Central Logic
Private equity firm Rubicon Technology Partners acquires
Central Logic, a provider of patient orchestration and tools to accelerate
access to care for healthcare organizations. Rubicon will be aggressively driving Central Logic’s
growth with additional cash investments into the business, with a focus
on product innovation, sales expansion, delivery and customer support, and
the pursuit of acquisition opportunities.
Price: $110M – $125 million, according to sources
Healthcare data security has been a growing concern for CIOs for the last year or so, as hackers are increasingly targeting health information. Now, with a global pandemic forcing a shift to telemedicine and remote work, and new rules from the ONC and CMS introducing more regulatory burden, healthcare CIOs have more to manage than ever. Fortunately, it is possible to roll out new capabilities while simultaneously improving cybersecurity by following these three rules:
Rule 1: Think Like an Attacker
The coronavirus pandemic has forced healthcare providers everywhere to roll out new capabilities, processes, and workflows, such as telemedicine systems and new patient check-in procedures. These measures are being taken in addition to the necessary work being done to comply with the new mandates from ONC and CMS regarding patient data accessibility. Though these changes need to be implemented quickly, it’s important to follow cybersecurity best practices to avoid providing new openings for attackers.
When a hacker sees new systems and processes being implemented, they are thinking about:
– What software is being introduced? Are there known vulnerabilities or frequently unpatched exploits associated with it?
– How are new endpoints being added and are they secure?
– Since the new ONC and CMS rules require publicly exposed FHIR APIs, how can those be attacked? Are there social engineering exploits that can provide a way around security?
– Are there ways to perpetrate identity fraud if a patient does not need to be physically present to receive healthcare?
This approach should lead to a cybersecurity plan that puts measures in place for each identified risk. By thinking like the adversary, it is possible to identify and lock down the possible attack vectors.
Rule 2: Minimize the Attack Surface
Every way into an organization’s network needs to be secured, monitored, and maintained. The best way to make this process as efficient and fool-proof as possible is to minimize the number of ways into the network.
This is especially difficult in light of the ONC and CMS rules, which require that clinical systems must share data through publicly available FHIR APIs. At first, this seems like a mandate to radically expand the organization’s attack surface. Indeed, this is precisely what happens if the straightforward approach of exposing every clinical system through public APIs is followed.
A different approach, which provides the same capabilities and compliance with the rules, would be to route all API traffic through a central hub. Attaching all the clinical systems to a single point of API access provides a number of benefits:
– Most importantly, compliance is achieved while minimizing the new attack vectors.
– All traffic between clinical systems and the outside world can be monitored from a single place.
– The API hub can act as a façade that makes legacy systems compliant with the new rules, even if those systems lack native FHIR API capabilities.
The API hub need not be an expensive new component of the network architecture. Most healthcare organizations are already using a clinical integration engine to move HL7, XML, and DICOM traffic among their internal systems. The same technology can serve as an API hub. This is especially effective if a new instance of the integration engine is placed in an isolated part of the network without full access to other systems.
Rule 3: Have an Expert Review the Defenses
Even for healthcare organizations with cybersecurity experts on staff, it can be worthwhile to bring in a cybersecurity consultant to cross-check new implementations. Novel threats are constantly shifting and emerging, making it nearly impossible for internal IT staff to keep up with the looming threats of ransomware hacks, while also adequately carrying out the day-to-day responsibilities of their jobs. For that reason, it makes sense to bring in a professional who focuses exclusively on security. It is also often useful to have an independent review from someone who is looking at the implementation from an outsider’s perspective. Independent consultants can provide the necessary guidance, risk assessments, and other security support, to set healthcare organizations up for success and operate more securely.
Expanding an organization’s IT capabilities often means more exposure to risk, especially when implementations are subject to time constraints. However, given the value and importance of the data that’s being generated, transmitted, and stored, it is imperative not to let cybersecurity fall out of focus. By following best practices around design, implementation, and testing healthcare organizations can rise to meet the current challenges of the pandemic, address the mandates of the interoperability rules, and simultaneously improve data security measures.
About Scott Galbari, Chief Technology Officer
As Chief Technology Officer for Lyniate, Scott leads the development and delivery of all products and services. Scott has been in the healthcare IT domain for the past twenty years and has experience in developing and delivering imaging, workflow, nursing, interoperability, and patient flow solutions to customers in all geographies. He was most recently the General Manager for multiple businesses within McKesson and Change Healthcare and started his career as a software developer.
About Drew Ivan, Chief Product & Strategy Officer
Drew’s focus is on how to operationalize and productize integration technologies, patterns, and best practices. His experience includes over 20 years in health IT, working with a wide spectrum of customers, including public HIEs, IDNs, payers, life sciences companies, and software vendors, with the goal of improving outcomes and reducing costs by aggregating and analyzing clinical, claims, and cost data.
What You Should Know:
– HealthStream acquires Change Healthcare’s staff
scheduling business for $67.5M in cash which includes the ANSOS™ Staff
Scheduling (“ANSOS”) platform and related products.
– The acquisition will help establish HealthStream as a
market leader in healthcare workforce scheduling business.
leading provider of workforce and provider solutions for the healthcare
industry has entered into a definitive agreement to acquire
Change Healthcare’s staff
scheduling business, which includes their market-leading ANSOS™
Staff Scheduling (“ANSOS”) application and related products. : The purchase
price payable upon the closing of the ANSOS acquisition will be approximately
$67.5 million in cash (subject to working capital and other customary purchase
price adjustments), which will be funded with cash on hand.
ANSOS Platform Background
ANSOS is an enterprise solution for healthcare providers
that want to anticipate workload requirements, manage labor costs, apply
complex work rules, and meet credential requirements for shifts—all for the
purpose of optimizing staff deployment. Today, the platform is used by over 300
hospitals and health systems and continues to be recognized as a market leader
in nurse and staff scheduling by KLAS™.
In addition to the ANSOS Staff Scheduling application, the
contemplated acquisition includes related products: Enterprise Visibility™, a
patient tracking system, and Capacity Planner™, a predictive analytics tool.
Importantly, all three products (i.e. ANSOS, Enterprise Visibility, and
Capacity Planner) work in concert with each other, creating a powerful solution
suite for aligning staff and scheduling based on patient acuity, predicting
patient demand, and adjusting resources for optimal outcomes.
Acquisition Expands HealthStream’s Portfolio of Staff
Scheduling & Workforce Solutions
The addition of Change Healthcare’s staff scheduling
business will expand HealthStream’s growing portfolio of solutions for staff
scheduling and workforce management, which began in early 2020 with the
acquisition of NurseGrid and grew further with the acquisition of ShiftWizard
last month. The complementary positioning of ANSOS, ShiftWizard, and NurseGrid
will enable future data integrations and advanced analytics that yield smarter
schedule development while enhancing engagement with staff.
“We are excited to add ANSOS to HealthStream’s growing nurse
and staff scheduling business for healthcare providers as we believe this is a
major win for everyone: customers, partners, employees, and shareholders,” said
Robert A. Frist, Jr., Chief Executive Officer, HealthStream. “The closing of
this transaction will establish HealthStream as an industry leader in nurse and
staff scheduling for healthcare providers. Considering our strong track record
of strengthening acquired products and solutions to deliver even greater value
to customers, I believe we are well positioned for continued growth and
innovation in workforce management.”
Following the acquisition, customer support for each of
these products will remain in place. Approximately 90 employees from Change
Healthcare will join HealthStream upon closing. Together, ANSOS, ShiftWizard,
and NurseGrid represent HealthStream’s portfolio of nurse and staff scheduling
solutions with executive oversight provided by Scott McQuigg, Senior Vice
President, HealthStream. These solutions will be included in HealthStream’s
Workforce Solutions business segment.
Revenues for the business to be acquired are primarily
associated with sales of perpetual software, maintenance, and professional
services. HealthStream expects incremental revenues in 2021 to range between
$16.5 and $19.5 million, taking into account an estimated reduction of between
$7.0 and $8.0 million related to deferred revenue write-downs. While the
business has historically sold perpetual software licenses, future product
development and sales efforts are anticipated to be directed towards a
HealthStream plan to make investments in the areas of sales,
marketing, product development, and operations to support this initiative. In
addition, we anticipate the amortization of acquired intangible assets to range
between $3.0 and $4.0 million during 2021. Considering the additional investments
intended during 2021, the deferred revenue write-downs, the amortization of
intangible assets, and transition services expenses, we expect the acquired
business to generate an operating loss in 2021.
What You Should Know:
– Change Healthcare launches national data resource on
social determinants of health (SDoH) for doctors, insurers and life sciences
organizations to better understand the connection between where a person lives
and how they live their life to the care a patient receives and their health
– 80% of U.S. health outcomes are tied to a patient’s
social and economic situation, ranging from food, housing, and transportation
insecurity to ethnicity.
Change Healthcare, today announced the launch of Social Determinants of Health (SDoH) Analytics solution that will serve as an innovative national data resource that connects the circumstances of people’s lives to the care they receive. The SDoH Analytics solution is designed for health systems, insurers, and life sciences organizations to explore how geodemographic factors affect patient outcomes.
Understanding Social Determinants of Health
SDoH includes factors such as socioeconomic status, education, demographics, employment, health behaviors, social support networks, and access to healthcare. Individuals who experience challenges in any of these areas can face significant risks to their overall health.
“All the work I do—for Mayo Clinic, the COVID-19 Healthcare Coalition, and The Fight Is In Us— is predicated on equity,” said John Halamka, president, Mayo Clinic Platform. “The only way we can eliminate racism and disparities in care is to better understand the challenges. Creating a national data resource on the social determinants of health is an impactful first step.”
The SDoH Portrait Analysis includes financial attributes, education
attributes, housing attributes, ethnicity, and health behavior attributes.
3 Ways Healthcare Organizations Can Leverage SDoH
Healthcare organizations can now use SDoH Analytics to
assess, select, and implement effective programs to help reduce costs and
improve patient outcomes. Organizations can choose one of three ways to use
1. Receive customized reports identifying SDoH factors that
impact emergency room, inpatient, and outpatient visits across diverse
population health segments.
2. Append existing systems with SDoH data to close
information gaps and help optimize both patient engagement and outcomes.
3. Leverage a secure, hosted environment with ongoing
compliance monitoring for the development of unique data analytics, models, or
Why It Matters
Scientific research has shown that 80% of health outcomes
are SDoH-related. Barriers such as food and housing availability,
transportation insecurity, and education inequity must be addressed to reduce
health disparities and improve outcomes. Change Healthcare’s SDoH Analytics
links deidentified claims with factors such as financial stability, education
level, ethnicity, housing status, and household characteristics to reveal the
correlations between SDoH, clinical care, and patient outcomes. The resulting
dataset is de-identified in accordance with HIPAA privacy regulations.
“Health systems, insurers, and scientists can now use SDoH Analytics to make a direct connection between life’s circumstances and health outcomes,” said Tim Suther, senior vice president of Data Solutions at Change Healthcare. “This helps optimize healthcare utilization, member engagement, and employer wellness programs. Medical affairs and research are transformed. And most importantly, patient outcomes improve. SDoH Analytics makes these data-driven insights affordable and actionable.”
What You Should Know:
– CommonWell Health Alliance enables payer access with the addition of a new service provider, DataFile Exchange to support the operational services specific to the Payment and Health Care Operations use case.
Health Alliance today announced it is extending its interoperability
services to enable additional use cases beyond treatment and patient access,
starting with Payment and Health Care Operations data requests.
Data File Exchange Background
To support this effort, CommonWell has added a new service
provider, DataFile Exchange, to support the operational services specific to
the Payment and Health Care Operations use case. Together, DataFile Exchange
and Change Healthcare, the technology service provider for CommonWell, will
facilitate the automated exchange of data requests from a broader set of users,
including payers, record locator vendors and other qualified entities.
Why It Matters
Despite strides made in electronic clinical data exchange, existing payments and operations processes providing access to protected health information (PHI) remain archaic, predominantly manual, expensive, error-prone, and time consuming. The additional functionality provided by the new use case aims to end these outmoded processes, improve the quality of care, and drive efficiency across the health care continuum.
DataFile Exchange was founded by Janine Akers, an industry leader in the exchange of PHI. DataFile Exchange will work closely with CommonWell, its members, and Change Healthcare, which continues to act as the CommonWell technology service provider and data broker for the CommonWell network––in addition to building the functionality needed to support Payment and Health Care Operations data requests.
“Improving data exchange of Payment and Health Care Operations is critical, particularly as we look at ways to help our health care system do more with less time and resources,” said Janine Akers, founder and CEO of DataFile Exchange. “DataFile Exchange has broad industry experience with handling PHI, so it’s only natural for us to shift our focus to automating the exchange of PHI. We’re well-positioned to partner with CommonWell in its effort to help patients, providers and payers benefit from these next-level interoperability services.”
Four CommonWell Service Adopters who provide record
Healthcare, Ciox, Inovalon and Moxe Health––currently are participating in
a pilot to refine the use case, with the goal of making CommonWell services for
Payment and Health Care Operations purposes generally available for these underserved
areas in the coming few months.
Today, the CommonWell network enables the federated exchange
of patient information across more than 17,000 provider sites representing 100
million individuals on its nationwide network alone. Combined with its CommonWell
ConnectorTM and collaboration connections like the Carequality Framework,
connected provider sites can exchange data with more than 50,000 clinics,
hospitals, specialty centers and more. To date, more than 790 million health
documents have been exchanged across the CommonWell network.
By JESSICA DaMASSA, WTF HEALTH
From his vantage point at the helm of one of healthcare’s biggest IT infrastructure companies, Change Healthcare’s President & CEO, Neil de Crescenzo, has an unrivaled perspective at how covid19 has impacted hospital systems and payers. His business builds the “connective tissue” that not only supports the administrative management and patient engagement aspects of “Big Healthcare,” but it also literally helps those organizations make money, processing about $1.5 Trillion in claims each year. So, what’s he seen so far in 2020? And what’s ahead for 2021? Neil stops by to talk about current challenges facing healthcare provider orgs and payers — and what’s ahead in the “new” healthcare economy where “change” is the only constant. From HHS’s new interoperability rules to telehealth and the more dispersed healthcare system it will inevitably create, we dive into all things future of health including the details behind Change’s two recent health tech acquisitions (each over $200M), what Neil thinks about the Teladoc-Livongo merger, and how digital health startups have an unprecedented opportunity to help expand the healthcare system beyond its traditional footprint.
With the rise of healthcare consumerism, people are looking to hospitals, health systems, and physician practices to deliver the same user-friendly, digital experiences they receive from other industries. A recent survey found that more than 80% of consumers surveyed believe “shopping for healthcare should be as easy as shopping for other common services.” Specifically, they want streamlined access points online where they can shop for and purchase healthcare, easily make appointments, understand what they need to pay, make payments, and set up payment plans – or even obtain financing for care if the estimated costs exceed their budgets.
These types of digital experiences help providers recruit new patients and keep them engaged, which leads to better outcomes for both the health of the patient and the financial health of the practice. Unfortunately, most healthcare organizations aren’t ready to provide this level of convenience. In part, this is because they have relied on patient portals as their main digital engagement tool to date.
The problem with portals
There are a few reasons why patient portals underdeliver. First, portals are only for patients that have an existing relationship with a provider. However, the patient experience begins when consumers start shopping for care. Relying on a portal alone is a missed opportunity to generate new patient business.
Second, portals don’t mirror what consumers expect from digital solutions. The interfaces are clunky, the functionality is limited, and the technology only supports a pull strategy, meaning that it waits for the patient to come to it rather than periodically reaching out and prompting the individual to take action.
Third, a patient must be logged into a portal before they can do anything with it. This makes it harder to schedule appointments with new physicians because there is not an established connection. In these cases, the patient must pick up the phone, wait on hold, set up an account, possibly wade through insurance approval and pre-authorization, and then make the appointment.
Finally, portals aren’t ideal for communicating costs. While some allow the patient to pay co-pays, they aren’t designed to give realistic cost estimates, offer payment plans, suggest alternative funding sources, and so on.
Taken together, these challenges result in low, inconsistent portal use. Even if a hospital indicates that 50% of its patients access the portal, one-time or limited use should not be viewed as patient engagement. Instead, to realize true engagement, organizations should be thinking about ways to foster two-way conversations to keep new and existing patients focused on their health and how the hospital, health system, or physician practice can meet their needs. This improves patients’ experience and builds loyalty, while also reducing leakage and growing revenue.
What are the risks of poor digital engagement?
Without a well-considered plan for providing a retail-like shopping experience that includes transparent cost information, healthcare organizations run the risk of losing patients. This is especially important as the marketplace becomes more competitive and focused on patient experience, and retail clinics continue to pop-up around the country.
In addition to market changes, regulatory pressures are also making patient-centric financial communications a necessity. Several states are implementing price transparency regulations, and a federal requirement is right around the corner. To meet these standards, organizations will need effective tools that reliably determine and share prices with patients in advance of their appointments.
So where do organizations go from here?
It’s clear that patient portals are not the answer. But how can organizations do a better job of giving patients the convenience they seek? Here are four best practices to consider.
1. Evaluate your organization’s digital tools.
The first step is to take a hard look at the digital solutions you currently provide and compare them to those available from other industries, such as travel, retail, and financial services. Consumers want a digital, retail-like shopping experience where they can search local providers, compare reviews and costs, schedule their treatment, and even pay – all in one intuitive place.
Don’t be fooled into thinking that only younger people want these tools. Research shows that more and more older adults are embracing mobile activities like online banking. In fact, The Harris Poll found that 80% of Baby Boomers (individuals between 56-76 years old) “wish there was a single place to shop for and purchase care.”
Digital tools designed to improve access and transparency while making it easier to pay create more engaged consumers and provide a better patient experience. Achieving this dual dynamic requires digital tools are part of a comprehensive end-to-end solution.
2. Streamline access to shoppable services
These are elective procedures and screening tests that an individual can schedule in advance and include things like planned joint replacements, colonoscopies, and mammograms. Healthcare organizations offer standardized pricing for these services, allowing patients to shop around for the best price, location, and experience.
When patients are able to use a digital tool to research a service, set an appointment, and make a payment, it can drive patient satisfaction and increase the chances the individual will choose to have the procedure with the organization supplying the tool. With 67% of consumers stating they would “shop for healthcare entirely online, like any other products and services,” streamlining access to shoppable services will drive engagement and revenue.
3. Adopt tools that help people understand their care costs.
More than half of consumers surveyed for The Harris Poll said they have “avoided seeking care because they weren’t sure what the price would be.” The biggest hurdle to accessing care is price transparency, resulting in patients not getting the treatment they need and in poor revenue management for a practice.
Patients are more likely to pay their portion up front when they understand what they owe and feel confident that the cost information provided has taken into consideration their current insurance, deductibles, and co-pays. A key to accurate estimates is an automated solution that checks the patient’s insurance digitally, determines the benefits, reviews the amount of any deductible, and verifies whether the individual has already met their deductible. When a patient financial tool also offers the ability to make payments or set up a payment plan, it can increase patients’ propensity to pay, boost the amount of self-pay funds the organization collects, and substantially reduce the cost-to-collect.
4. Enable digital appointment scheduling
Consumers view scheduling and rescheduling appointments as a very difficult task. Digital solutions can address this pain point. Mobile tools and apps that patients can use to schedule appointments monitor wait times, digitally complete forms, and check-in for appointments are essential to breaking down some of the barriers to patient access.
Before onboarding a tool like this, organizations must think through the change management challenges in getting all stakeholders on board. Historically, physicians have been hesitant to open up their calendars to permit digital scheduling. However, transparency and standardization are becoming increasingly important to meet patient demand and are necessary to make these types of tools work smoothly.
Although digital tools are gaining popularity among all generations, there are still people who prefer to pick up the phone to price, schedule, and pay for care. In addition to digital solutions, organizations should have service-oriented call centers to work with these patients. Such centers should have well-trained professionals who are available during and outside of traditional business hours so patients can access the information they need when they need it.
Relying on the status quo is not wise
Healthcare is only going to become more consumer-driven as high-deductible health plans continue to disrupt the industry. Hospitals, health systems, and physician practices cannot afford to rely on outdated technologies that don’t facilitate two-way conversations or the digital experience patients expect. To compete today and in the future, organizations need a comprehensive, retail-like solution that offers a seamless user experience and spans the entire patient journey. Tools and technologies used in combination with putting the patient first will build loyalty while also improving an organization’s clinical and financial outcomes.
About Bill Krause
Bill Krause is the Vice President of Experience Solutions at Change Healthcare. Serving the healthcare industry for over 12 years, Bill leads innovation and solution development for patient experience management at Change Healthcare. In this role, he is responsible for the development and execution of strategies that enable healthcare organizations to realize value through leading-edge consumer engagement capabilities.
Previously, Bill provided insights and direction into new product and service strategies for McKesson and Change Healthcare. He also managed business development planning, partnerships, and corporate development across a variety of healthcare services and technology lines of business for those companies.
Prior to McKesson, Bill worked at McKinsey & Company as a strategy consultant, serving a variety of clients in healthcare and other industries. He received his MBA from Harvard Business School and his undergraduate degree from the University of Virginia. He also served as a lieutenant in the United States Navy.
What You Should Know:
– Change Healthcare acquires Nucleus.io to create the first of its kind end-to-end, cloud-native Enterprise Imaging to integrate Change Healthcare’s next-generation medical imaging platform.
– The acquisition will accelerate Change Healthcare’s
timeline to implement a complete cloud-based, end-to-end Enterprise Imaging
solution with customers by leveraging the 7,500+ organizations Nucleus.io
Change Healthcare (Nasdaq: CHNG) today announced the acquisition of Nucleus.io, a leader in the development of advanced, fully enabled, cloud-native imaging, and workflow technology. Nucleus.io’s state-of-the-art, cloud-native imaging technology, including a zero-footprint diagnostic viewer with patented streaming technology, workflow, and image sharing solutions, completes Change Healthcare’s next-generation medical imaging platform.
Medical Image Exchange Solution
Nucleus.io ingests, stores, routes, and provides lightning-fast access – from just about anywhere – to all medical images regardless of file size. Nucleus.io’s market-leading medical image exchange solution is utilized by over 7,500 organizations across the U.S., with approximately 150 new organizations onboarding each month. Their advanced, fully enabled, cloud-native imaging technology includes a zero-footprint diagnostic viewer with patented streaming technology, workflow, and image sharing solutions, and more.
“We began our journey eight years ago with the goal of improving patient care by using the power of the web to make medical imaging instantly accessible to patients, providers, and hospitals,” said Dr. Vishal Verma, chief executive officer, NucleusHealth. “Change Healthcare was the clear choice when searching for an organization to deliver our technology to the world. We couldn’t be happier about the opportunity to have Change Healthcare bring our unified vision to light.”
Acquisition Creates Complete Cloud-based, End-to-End
Enterprise Imaging Solution
Today’s acquisition supports Change Healthcare’s commitment
to focus on and invest in core aspects of the business to fuel long-term growth
and advance innovation. This will accelerate Change Healthcare’s timeline to
implement a complete cloud-based, end-to-end Enterprise Imaging solution with
customers. Nucleus.io expands Change Healthcare’s addressable market by
leveraging the over 7,500 organizations Nucleus.io currently serves.
Change Healthcare’s Enterprise Imaging Network (EIN) is the
first of its kind, fully managed, cloud-native platform. The foundations of the
platform, including its Archive and Analytics applications, have been
successfully delivered to the market as a cloud-native solution. The
combination of both companies’ technologies and experienced teams will enable
physicians to read, diagnose, and collaborate from anywhere, reduce IT
complexities, and leverage data and Artificial Intelligence (AI) to improve
Why It Matters
“Now more than ever, customers are seeking ways to lower cost, reduce complexity, protect their patient data, and deliver the best care possible. Our next-generation Enterprise Imaging Network platform helps meet those needs in ways not previously possible and delivers exceptional value to our customers,” said Tracy Byers, senior vice president and general manager, Enterprise Imaging, Change Healthcare. “This transaction will accelerate the realization of our vision and the innovation our industry has been waiting for.”
Financial terms of the acquisition were not disclosed.
What You Should Know:
– New Chilmark Research report on revenue integrity
in healthcare reveals a transitional market making strides to address the new
burdens of modern care economics.
– The ongoing COVID-19 public health emergency underscores
the imperative need for automation and reduced administrative costs even
has and continues to be one of the most difficult challenges in healthcare.
These issues manifest in the claims process of submission, appeal, and
remittance, but the causes are found much earlier in clinical workflows. Rather
than think of these as separate issues, they should all be considered under a
broader category of revenue integrity. The latest report from Chilmark Research,
Revenue Integrity in Healthcare: Solutions Driving Payment Performance,
reveals a market in flux as new technologies are applied to old problems,
increasingly complicated by contracts that include performance and reporting
Modern Revenue Integrity Solutions Can Improve Financial
New software and platforms can accelerate, automate, and
improve the accuracy of these activities. Automated outreach, demographic and
eligibility checking, computer-assisted coding, natural-language processing,
and more traditional revenue cycle platforms.
These tools are offered by:
– Electronic Health Records (EHRs)
– Independent Platforms
– Best-of-Breed Solutions from outside the Revenue Integrity
space, but with powerful tools to address payment needs
These activities are essential for healthcare enterprises of
all sizes, scopes, and specialties. They are needed whether the organization is
primarily concerned with fee-for-service (FFS) reimbursement or value-based care (VBC).
The ongoing COVID-19 public health emergency has made the need for automation
and reduced administrative costs even clearer. With appointment volumes
dropping, provider organizations are faced with the need for reliable, accurate
payments for their care activities more than ever. These solutions are equally
valuable for traditional provider care and for modern virtual care solutions
“Accounting and revenue cycle work can never fix these issues. They need to be addressed where they occur and prevented from showing up in revenue cycle in the first place. One mistake in patient registration that was easy to fix can cause millions in complicated denials down the road.”– Lead Analyst Alex Lennox-Miller
Each type of solution (EHR, Platform, Best of Breed) is
evaluated based on how they address the needs of provider enterprises. The
report reviews the current state of the market, the maturity of solutions, and
the strengths and weaknesses of each solution type. While the current market is
valued at more than $20 billion, projections within the report show its
expected growth to nearly $35 billion in the next five years. The report shows
which segments of this market can expect annual growth rates exceeding 10% and
which will slow to under 2.5%.
Profile of Leading Revenue Integrity Vendors
In addition to the categorical analyses, this report includes 13 profiles of major and promising vendors: 3M, Allscripts, athenahealth, Cerner, Change Healthcare, Hayes|MDAudit, Medicomp Systems, Optum, PatientMatters, RevSpring, Sift, and ZOLL. Each profile includes an assessment of the vendor’s strengths and challenges, detailed descriptions and evaluations of the product capabilities and market execution, and rankings across 24 categories.
Managers and directors of healthcare organizations looking
for ways to address revenue cycle issues, lower clean claims rates, or improve
strategic revenue projections will appreciate the report’s clear breakdown of
vendor offerings and the impacts on their clinical and non-clinical staff.
Payers, including self-insured employers, and other organizations interested in
the total cost of care will find the market overview and product evaluations of
great value, helping them understand the tools and challenges their partner
organizations will be using.
As the COVID-19 pandemic continues to change healthcare operations in the world, foundational systems are being adapted to meet these new demands. Sometimes it takes extreme circumstances to see the cracks in a system. COVID-19 has exposed areas with more room for improvement in the healthcare system, such as optimizing operational efficiency. Organizations and individuals have changed their interactions, processes, ways of working, treatment plans, and even foundational technology. As the United States is beginning to reopen, many questions arise – namely, are these changes temporary fixes during the pandemic, or are they here to stay?
Physicians have been inundated during this time of crisis, and their ongoing main priorities amplified: saving as many lives as possible and providing the best patient care. Recent estimates from the beginning of July say, worldwide there have been more than 10.7 million COVID-19 cases and at least 516,000 deaths from the disease, according to Johns Hopkins University (JHU). JHU also revealed that in the United States, there have been 128,000 deaths out of a total of over 2.6 million cases. To say this has been a time of great stress and pressure for physicians who are on the frontlines is an understatement.
This pandemic has increased providers’ already heavy workload, amplifying where physicians need support. Patients need to remain the top priority, even in the first generations of the digital age where the list of backend administrative tasks and paperwork can feel endless, thus reducing the number of patients physicians can see each day. Finding a way to streamline administrative tasks with advanced technology can bring physicians back to why they went to medical school in the first place: to help patients.
One example of an important, and time-sensitive task is communicating with payers around treatment plans and reimbursement. Using technology to streamline this process to get the patient the optimal treatment and maximize use of their insurance coverage is essential, especially in this time of crisis where there is an increased number of patients in need and a depressed economy. Whether processing prior authorizations or checking eligibility, hospitals and health systems need technology to keep operations efficient, including smooth payer-provider communication to ease physicians’ workload, help to ensure providers will be reimbursed for care, and optimize business operations, ultimately providing an improved patient experience.
Three foundational ways in which payer-provider information exchange technology provides immense value to healthcare organizations are:
– Creating Administrative Efficiency: To help physicians stay focused on patients, administrative efficiency is key. Solutions can come in many shapes and sizes – technology can help to automate workflows and avoid care delays. Modernizing the prior authorization workflow can shorten average time to care, reduce the risk of treatment abandonment, and improve the quality of care. With changing legislation, updated laws encourage the use of technology to increase efficiency while keeping data secure in near real-time exchanges.
– Streamlining Exchange of Information: Interoperability and the technology standards needed to achieve it is an ongoing discussion in healthcare. Technologies that provide efficient, secure, and near real-time and even automated exchange of information are in high demand and will bring about the next era of healthcare. For example, technology has the power to align providers and payers efficiently and consistently, create an open exchange of information, centralize information, provide rapid and organized data transfer, ensure appropriate reimbursement by treatment plan, show pre-authorized treatment plans for the most successful and affordable care and aid health plans’ adaptability in health crises, like COVID-19.
– Increasing Value-Based Care: Optimizing the quality and cost of patient care is a leading principle of healthcare. The COVID-19 pandemic has exposed areas of healthcare where improvements in patient experience and provider reimbursement desperately need to be accelerated. Using technology with built-in normative databases of accepted treatment paths allows for evidence-based treatment decisions, which in conjunction with efficient payer-provider communication to ensure reimbursement, allows for optimal patient outcomes – creating value for all stakeholders.
Adopting technology to provide administrative efficiency, streamline information exchange and increase the value of all aspects of care will continue to be a fundamental pillar of healthcare; the pandemic has ignited a critical need for even faster change. COVID-19 has brought with it increased stress and uncertainty across the healthcare industry, amplifying the burden on physicians and their staff. Organizations have moved quickly to adopt technologies, such as those that provide a more efficient way to organize and analyze massive amounts of treatment plan decision inputs and aid communication between stakeholders, in order to better support physicians, and ultimately patients.
Tools and technology that automate processes, streamline communications and provide dynamic solutions have proven their value and are now “need to have” rather than “nice to have” for providers. These technologies are foundational to the healthcare system, providing the base from which all stakeholders operate. The pandemic has helped to realize the true value of efficiency technologies, galvanizing the adoption of these tools. Ultimately, more operational efficiency can bring the focus of care back to the patient.
About Christina Perkins
Christina Perkins is VP of Product Management and Strategy for NaviNet at NantHealth. She joined NaviNet in 2003 and has spent the last 17 years expanding the company’s products and services. Prior to joining NaviNet Christina spent seven years designing and building web-based solutions for Partners Healthcare and other hospitals in the Northeast U.S. and Ontario, Canada. Christina on LinkedIn.
What You Should Know:
Healthcare’s SmartPay integration with Epic MyChart helps facilitate patient
payments both pre- and post-service, and connectivity with Hyperspace® creates
a “one-stop shop” experience that lets providers’ staff stay within Epic to
process point-of-service payments.
– Change Healthcare’s SmartPay Payment Integration for
MyChart and encrypted device integration is available in the Epic App Orchard.
Healthcare announced the launch of its SmartPay
Payment Integration solution integrated with Epic
MyChart and encrypted device integration within Hyperspace. This latest
integration with Epic’s EHR
technology allows providers to offer their patients a wide range of payment
options––letting them easily pay their healthcare bills how and when they want,
with Change Healthcare providing phone and mail-in payment channels to give
providers a multi-channel payment solution.
Epic Integration Benefits for Providers and Patients
Using SmartPay Payment Integration, provider users won’t
have to leave their workflow in order to collect patient payments. Providers
also can take advantage of features including phone pay, consumer lockbox, patient
statements created with design thinking to boost patient engagement.
With SmartPay™ Payment Integration, patients can make
payments online from within the MyChart® clinical patient portal. Multiple
payment options are offered to accommodate patient needs and preferences,
including using debit, credit, HSA, and FSA cards, as well as setting up
Change Healthcare’s SmartPay Payment Integration for MyChart and encrypted device integration is available in the Epic App Orchard.
What You Should Know:
– 8 in 10 consumers said COVID-19 made telehealth “an indispensable part of the healthcare system, according to a new study commissioned by Change Healthcare.
– 2020 Change Healthcare – Harris Poll Consumer
Experience Index reveals 65% said they plan to use telehealth more after the
pandemic, and 78% said COVID-19 has shown how badly the U.S. needs more
A majority of consumers agreed COVID-19 will
fundamentally change healthcare delivery (81%), with most believing the
pandemic will speed digital adoption, according to a new study commissioned by
Change Healthcare. Eight in 10 said COVID-19 made telehealth “an indispensable
part of the healthcare system,” 65% said they plan to use telehealth more after
the pandemic, and 78% said COVID-19 has shown how badly the U.S. needs more
These findings and more are detailed in the 2020 Change
Healthcare – Harris Poll Consumer Experience Index, a national study of
1,945 consumers conducted by The Harris Poll and commissioned by Change
Healthcare. Researchers asked consumers to rate the ease or difficulty required
to find, access, and pay for care across 29 tasks, using an index of 1 to 200,
with 200 being the “hardest” effort, 1 being “effortless,” and anything above
100 being “difficult.” The result: Not one healthcare activity was described by
consumers as effortless. Rather, consumers ranked the difficulty of dealing
with the healthcare system as high as 149, and the average across all tasks at
117. More than two-thirds of consumers said every step of the healthcare
process is a chore, most said they don’t know how much a treatment or visit
costs until months later, and nearly all said they want shopping for healthcare
to be as easy as shopping for other common services—including making it a fully
connected digital experience.
The study, conducted among 1,945 U.S. adults in May 2020,
explored consumer effort throughout the journey of finding, accessing, and
paying for healthcare. The Harris Poll combined all tactical-level attributes
of the journey into a single summary statistic (the Change Healthcare – Harris
Poll Consumer Experience Index) that can serve as a performance benchmark for
healthcare year over year. A reading above 100 indicates the task is generally
difficult for consumers, while a score below 100 indicates it is relatively
easy. The distance from 100 indicates the level of difficulty or ease.
The research segments
respondents and insights into six enrollee groups: those with Medicare
Advantage plans, high-deductible employer-sponsored health plans, other
employer-sponsored plans, individual plans, Medicaid plans, and uninsured. Some
of the research’s other findings include:
– Consumers want accurate cost estimates from payers, and price transparency from providers. More than half (53%) said they avoided care because they weren’t sure what it would cost, 6 in 10 have gone to an appointment without knowing if they could afford it, 68% reported they don’t know how much a treatment or appointment will cost until months later, and an overwhelming 85% said it should be as easy to compare prices for healthcare as it is for other consumer services.
– A majority of consumers (62%) said the healthcare system feels like it’s designed to be confusing, 61% reported their bills feel more complex than a mortgage payment, and two-thirds said they are asked to manage so many care-related tasks that they “feel like a general contractor” when it comes to addressing their healthcare needs.
– One chief request is for a simple, transparent Explanation of Benefits (EOB)/explanation of charges. Only 1 in 3 consumers said their provider and health plan communicate too much. The vast majority said they want their health plan (71%) and provider (68%) to communicate using more modern platforms.
– Consumers overwhelmingly are seeking a retail-like e-commerce experience when it comes to shopping for care: 81% said shopping for healthcare should be as easy as shopping for other common services, 76% said they wish there was a single place they could shop for and buy healthcare, and 67% said they want to shop for healthcare entirely online.
“The majority of consumers said their healthcare experience is a struggle that’s taxing and burdensome, as illustrated through the difficulty they expressed at every phase of finding, accessing, and paying for care,” said Abbey Lunney, director at The Harris Poll. “In an e-commerce world, consumers want the experience of shopping for healthcare to be simple and streamlined. And this has never been more important, as digital healthcare reaches a tipping point amidst the COVID-19 pandemic.”
The 2020 Change Healthcare – Harris Poll Consumer Experience Index is available for download at https://www.changehealthcare.com/consumer-experience-research.