What You Should Know:
– NeuroFlow raises $20M to expand its technology-enabled behavioral
health integration platform, led by Magellan Health.
– NeuroFlow’s suite of HIPAA-compliant, cloud-based tools
simplify remote patient monitoring, enable risk stratification, and facilitate
collaborative care. With NeuroFlow, health care organizations can finally
bridge the gap between mental and physical health in order to improve outcomes
and reduce the cost of care.
NeuroFlow, a Philadelphia-based digital health startup supporting technology-enabled behavioral health integration (tBHI), announces today the initial closing of a $20M Series B financing round led by Magellan Health, in addition to a syndicate including previous investors. Magellan is a leader in managing the fastest growing, most complex areas of health, including behavioral health, complete pharmacy benefits and other specialty areas of healthcare.
NeuroFlow for Digital Behavioral Health Integration
NeuroFlow works with leading health plans, provider systems,
as well as the U.S. military and government to enhance virtual health programs
by delivering a comprehensive approach to whole-person care through digital
behavioral health integration – an evidence-based model to identify and treat
consumers with depression, anxiety and other behavioral health conditions
across all care settings.
Key features of the behavioral health platform include:
– Interoperability: Seamless EHR and system integrations minimize administrative burden and optimize current IT investments.
– Measurement-based Care & Clinical Decision Support: NeuroFlow enables MBC at scale, keeps the patient in the center of care, and continuously monitors for a consistent connection to critical data and clinical decision support.
– Performance Management & Reporting: Recognize
the impact of your BHI program, monitoring the impact of clinical interventions
on quality and cost of care while recognizing outliers requiring program
– Consumer Engagement & Self-Care: personalized
experience that encourages, rewards and recognizes continuous engagement and
Maximize Efficiency, Revenue and Reimbursements
By integrating behavioral health into the primary care setting, increasing screening and self-care plans – NeuroFlow’s BHI solution can reduce ED utilization by 23% and inpatient visits by 10%. 80% of NeuroFlow users self-reported a reduction in depression or anxiety symptoms and 62% of users with severe depression score improve to moderate or better.
Telehealth Adoption Underscores Need for Behavioral
With record growth in telehealth adoption and historic spikes in depression and anxiety due to the ongoing pandemic, workflow augmentation solutions and the delivery of effective behavioral health care have been identified as top priorities in the industry. NeuroFlow’s technology increases access to personalized, collaborative care while empowering primary care providers, care managers, and other specialists to most effectively support patient populations by accounting for and addressing behavioral health.
“Behavioral health is not independent of our overall health — it affects our physical health and vice versa, yet most underlying behavioral health conditions go unidentified or are ineffectively treated. Most healthcare providers are overburdened, so introducing the concept to account for a person’s mental health in addition to their primary specialty can be overwhelming and lead to inconsistent and inadequate treatment,” said NeuroFlow CEO Chris Molaro. “Technology, when used strategically, can enhance and augment providers, making the concept of holistic and value-based care feasible at scale and easy to implement.”
Strategic Partnership with Magellan
Magellan Health’s network of more than 118,000 credentialed
providers and health professionals are now poised to join NeuroFlow customers
across the country by leveraging the best-in-class integrated data and
analytics platform to meet the rising demand for enhanced mental health
services and support. By partnering with and investing in NeuroFlow, Magellan
has the opportunity to drive further adoption of NeuroFlow’s behavioral health
integration tools and drive collaborative care initiatives with its customers
as well as its vast network of credentialed providers and health professionals
across the country.
NeuroFlow will use the Series B proceeds to scale its
operations and support its growth in data analytics, artificial intelligence,
and direct health record integrations. NeuroFlow’s contracted user base has
grown 10x to over 330,000 in support of almost 200 commercial health systems,
payers, accountable care organizations, independent medical groups, and federal
agencies to provide technology-enabled care solutions.
Six months after rebranding from BHE, Panalgo has won a contract to supply the European Medicines Agency (EMA) with its IHD data analytics platform, pledging to streamline its public health efforts.
IHD – or Instant Health Data – will be used by the EMA to carry out data analyses and examine medicinal product utilisation, answer questions about safety and efficacy, and understand how treatments perform in real-world settings, said the Boston, US-based company.
The use of real-world evidence (RWE) has grown rapidly in pharma over the last few years, as healthcare payers and regulatory agencies have tried to get a deeper understanding of the impact medicinal products have in actual practice, rather than just within clinical trial settings.
“Our company is strongly aligned with the EMA’s public health goals, for which timely evidence-based insights are of particular importance, especially during this COVID-19 pandemic,” commented the US company’s CEO Joseph Menzin.
Panalgo is also opening an office in Amsterdam, the home of the EMA, in order to provide close support for the roll-out and management of the new software at the regulator.
Panalgo says IHD’s library of healthcare-specific algorithms does away with the need for complex programming and allows users to “focus on what matters most: turning data into insights”, using sources like electronic health records and patient registries.
There has been a spike in the use of data analytics by healthcare organisations during the coronavirus pandemic to try to guide the public health response to the crisis, for example to make effective, real-time use of resources.
The new agreement with the EMA adds a new dimension to Panalgo’s data analytics business, as most of its clients have so far been life science companies and research organisations.
The company says IHD passed a rigorous assessment by the EMA – in competition with software from other providers – and will support decision-making at the population level, including therapy risk/benefit and life cycle analyses that can be used in public health planning.
“Most of Panalgo’s life sciences clients already rely on IHD to perform rapid analyses that support regulatory initiatives,” said Menzin.
“The IHD platform will be a valuable tool to allow collaboration between drug manufacturers and regulatory agencies, such as the EMA,” he added.
Image by Ceescamel – Own work, via Wikimedia, CC BY-SA 4.0
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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
What You Should Know:
– 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.
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.
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.”
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.
What You Should Know:
– Data analytics and digital health company MDClone
announced a partnership with the Department of Veterans Affairs’ (VA) VHA
Innovation Ecosystem to democratize data and provide better, smarter, faster
healthcare to U.S Veterans.
– By leveraging MDClone’s data platform, the VHA is able to tackle this massive problem by securely accessing, organizing, and analyzing the critical health data of Veterans with the use of synthetic data – a breakthrough method pioneered by MDClone.
a digital health
company, and the VHA Innovation Ecosystem, a division of the United States
Department of Veterans Affairs (VA) today announced a partnership to
democratize data at the Veterans Health Administration (VHA). The partnership
will provide unprecedented, secure access to clinical data to better understand
and improve the health of the more than nine million veterans it serves.
The VHA Innovation Ecosystem aims to empower a wider network of VHA clinical and operational staff to explore data and discover insights that can be used to impact the lives of veterans nationwide. MDClone worked closely on this initiative with Dr. Amanda Purnell, Senior Innovation Fellow at the VHA Innovation Ecosystem, who is part of the Care & Transformational Initiatives (CTI) in the VHA Innovation Ecosystem. This program is specifically focused on testing and refining innovative care models and transformational initiatives that can be meaningfully scaled to impact Veteran care.
Improving Healthcare for Veterans with Synthetic Data
It’s no secret that Veterans have historically had a difficult time adjusting to normal life following service, which leads to many mental health issues that go unnoticed and un-treated – often leading to homelessness and the tragic loss of lives. By leveraging MDClone’s data platform, the VHA is able to tackle this massive problem by securely accessing, organizing, and analyzing the critical health data of Veterans with the use of synthetic data – a breakthrough method pioneered by MDClone. Synthetic data sets are virtually identical to the original patient data, so there’s no identifying information that can be traced back to individual patients. Synthetic data also has the potential to help the VHA collaborate with external agencies, healthcare providers, and the industry.
Non-technical users can quickly ask important questions, find answers, and take action – dramatically shortening timelines for quality improvement, innovation, and grassroots clinical research. The initial collaboration with MDClone will center around suicide prevention, chronic disease management, precision medicine, health equity, and COVID-19. For example, practitioners can tackle issues like suicide by identifying leading indicators and proactively intervening with patients most at risk.
“The VHA has long been at the forefront of healthcare informatics and the use of data to improve patient outcomes and drive operational improvements,” said Ziv Ofek, Founder and CEO, MDClone. “The selection of MDClone’s unique platform builds upon this tradition. With one of the largest medical databases in the world, the VHA requires enterprise-scale tools to explore data, innovate, and improve patient care. MDClone’s dynamic environment will help VA staff deliver on their mission to provide the best healthcare services to Veterans across the U.S.”
What You Should Know:
– H1, the largest database of information on every doctor
in the world raises $58M in Series B funding, just six months after raising its
Series A round during the pandemic.
– H1 is the largest database in the world connecting that
provides comprehensive in-depth profiles of more than 9 million healthcare
professionals and 16,000 institutions in 70-plus countries, all of which are
kept up-to-date weekly.
H1, a global
platform for the healthcare ecosystem, announced today that it has closed a $58
million Series B round of funding co-led by IVP and Menlo Ventures, which led
the Series A round in April 2020. Transformation Capital, Lux Capital, Lead
Edge Capital, Novartis dRx and YC also participated.
Over 9 Million Healthcare Professional Profiles
Co-founded by Ariel Katz and Ian Sax in 2017, H1 is a developer of a healthcare data analytics platform intended to help companies make smarter scientific decisions. H1 has created the largest healthcare platform to forge connections in the healthcare ecosystem. The H1 team has taken a unique approach to building the platform that combines AI, human-powered engineering, third-party data sources, and government partnerships, to create the largest platform of healthcare professionals, currently spanning over 9 million healthcare professions around the globe.
The company specializes in providing real-time data to support the end-to-end therapeutic development process from fundraising to product development to product launch, thereby providing the healthcare industry, organizations, and professionals with on-demand, live insights from across the data universe to accelerate the discovery and development of therapies to fight diseases.
H1 has enjoyed tremendous growth in 2020, surpassing
projections and proving the need for its platform of doctors is stronger than
ever. Following its Series A announcement in April 2020 of $12.9 million, the
company has grown from approximately 100 employees globally to nearly 250 and
anticipates expanding its headcount significantly over the next year, including
further expansion into Europe and Asia.
With over 50+ customers to date and growing rapidly, H1 is
slowly becoming the standard that companies think about when they want to find
the right Key Opinion Leading Doctors to collaborate with for Clinical Trial
Activity, Medical Activity, and Educational Activity.
The platform has been a unique and powerful resource for
global pharma companies, including those working on COVID-19 vaccines and
therapeutics. In fact, 13 of the top 20 pharmaceutical companies are currently
using the platform for research and insights.
“We have created a platform for the healthcare ecosystem to connect in the same way Linkedin connected professional workers in the early 2000’s. There hasn’t been a global platform like H1 before that has connected industry to the right doctors the way H1 does,” said H1 co-founder and CEO Ariel Katz. “This next round of funding, with our excellent investment group, including Menlo who has been a great partner for us, will help us continue to become the largest healthcare professional platform and ultimately create a healthier future.”
As 170 research teams race to develop a vaccine for COVID-19, some that are in late-stage approvals have seen recent progress, but it is still not yet clear when a vaccine will become widely available. Until then, healthcare organizations continue to rely heavily on data analytics to try to improve COVID-19 outcomes and public health.
Since the novel coronavirus became widespread in the U.S., healthcare data scientists have leveraged clinical and claims data to pinpoint which underlying conditions put patients at higher risk of complications from COVID-19. Health systems are mining clinical data to predict surges in COVID-19 cases and looking at key factors—including increases in hospital website traffic, such as searches for emergency department (ED) wait times and physician page clicks—to understand how COVID-19 is ramping up locally in real-time. Meanwhile, risk-based modeling has helped health plans address social determinants of health that could impede recovery.
Now, providers and health plans are refining their approach. The more they learn, the greater the benefit to public health and long-term outcomes. Three evolving use cases for using claims and clinical data to combat COVID-19 stand out.
Reduce disparities in care. Early in the pandemic, lack of complete information around patient demographics prevented the identification of members in communities that were most vulnerable to COVID-19 infection. The impact: severe differences in mortality rates. In Chicago, the rate of mortality among Black residents was alarmingly high—70% of COVID-19 deaths—even though these residents comprise just 29% of the city’s population. Meanwhile, Spanish-speaking residents account for 18.3% of the nation’s population, yet comprise 34.3% of coronavirus cases.
One of the reasons demographic data was often missing from COVID-19 lab tests is that laboratory and hospital staff were too overwhelmed with cases to have time to input all of a patient’s non-clinical information. Today, data scientists are working to fill in the gaps using clinical history and medical claims. With these analyses, healthcare organizations are closing gaps in care, such as by expanding access to COVID-19 testing for the nation’s most vulnerable populations and increasing access to professional interpreters to more effectively gather key patient details. They are also addressing social determinants of health that heighten risks, such as food insecurity and lack of access to prescription medications.
Alleviate reliance on spotty testing. Not everyone who contracts COVID-19 has a healthcare encounter. For instance, if one member of the household tests positive for the coronavirus, other members may decide not to undergo testing if their symptoms are mild. These are instances where analyses of clinical and claims information already in the system—both emerging and historical data—can help spot unconfirmed cases of COVID-19. Such analyses give public health officials the information they need to contact, test,s and quarantine individuals that have contracted the virus, helping to limit the spread of the disease.
On a wider scale, data analysis can also provide early warning surveillance of potential COVID-19 cases, strengthening the pandemic response. For example, by observing increases in medical claims for telemedicine, rapid flu tests, and chest X-rays, data scientists can detect patterns in claims that suggest a COVID-19 outbreak is likely to occur. From there, they can forecast demand for hospital care up to 10 days in advance, ensuring that facilities have sufficient staff, supplies, and beds available to meet their community’s needs. Similarly, disruptions to seasonal flu trends, which remain fairly consistent within a region year over year, could alert public health officials to a potential COVID-19 outbreak.
Avoid preventable deaths. Information regarding patients’ underlying medical conditions can be hard to come by during a public health crisis as overwhelming and widespread as the current pandemic. In fact, just 5.8% of medical records for patients hospitalized with COVID-19 in Q1 2020 had data available related to their underlying health conditions and other risk factors. Today, it is known that certain chronic conditions raise the patient’s risk for severe complications from COVID-19—and that list of conditions is growing. The insight gained from these analyses not only informs how healthcare providers treat an individual’s illness, but also gives those with chronic disease the ability to make informed decisions based on their risk level for infection.
Moreover, the availability of actionable, real-time intelligence to improve health can set the stage for increased care collaboration. During COVID-19, healthcare providers across geographies are sharing their knowledge, especially regarding treatment protocols. Such learnings include the value of using high-flow nasal oxygen in treating severe cases of COVID-19. Early results show that this technique has a positive impact on patients with mild to moderate respiratory failure. It also reduces intubation rates and improves clinical prognosis for patients with acute respiratory failure. By sharing data-driven insights, organizations can work together to improve COVID-19 outcomes and reduce avoidable deaths.
Improving Outcomes and Reducing Risk
Clinical and claims data analysis helps healthcare organizations respond proactively to COVID-19. With the race toward a COVID-19 vaccine well underway, these analyses will help identify which populations should receive the vaccine first, assess reactions to the vaccine by demographic group and spot trends that could affect vaccination protocols. They also give healthcare organizations up-to-date contact information to engage patients, which will be critical to clinical efficacy if a second dose of the vaccine must be administered. In 2020 and beyond, continued focus on clinical and claims data analysis will be key to facilitating a robust response that enhances outcomes and saves lives.
About Emad Rizk, M.D.
Emad Rizk, M.D., is President and CEO of Cotiviti and brings a 30-year, well-documented track record of delivering improved quality and financial performance to healthcare organizations through forward-thinking leadership, business acumen, and clinical expertise.
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 training to 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 analytics to 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
– 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.
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:
– Centene Corporation acquires AI healthcare analytics platform
Apixio to additional data and AI capability to technology portfolio.
– Apixio will remain an operationally independent entity
as part of Centene’s Health Care Enterprises group to continue bringing value
to its clients and the industry.
Centene Corporation, today
announced it has signed a definitive agreement to acquire
Apixio Inc., a AI healthcare analytics company offering Artificial
Intelligence (AI) technology solutions. The transaction is subject to
regulatory approvals and is expected to close by the end of 2020.
Better Data. Better Healthcare
More than 1.2 billion clinical documents are generated each year in the U.S., but there is very little analysis of that unstructured information. Founded in 2009. Apixio helps organizations use their data for knowledge about patient health. This ultimately translates into more effective care delivery, lower costs and streamlined processes. Apixio’s machine learning and deep learning algorithms analyze unstructured data embedded in electronic health records, scanned notes, facsimiles, and handwritten notes to produce high-quality predictions for measurement, care, and discovery.
The Apixio Platform
The Apixio Platform can mine textual data and combine its generated insights with available structured data to craft computable individual health profiles or phenotypes. We analyze our assembled phenotypes in real-time using a flexible rules engine. This automates the execution of clinical guidelines, quality and risk measures, payment or reimbursement policies, and other operational and administrative rules, to support critical healthcare activities.
Acquisition Complements Centene’s Existing Data Analytics
“Centene is committed to accelerating innovation, modernization and digitization across the enterprise and solidify its position as a technology company focused on healthcare. Apixio’s capabilities are closely aligned with our plans to digitize the administration of healthcare and to leverage comprehensive data to help improve the lives of our members,” said Michael F. Neidorff, Chairman, President and Chief Executive Officer for Centene. “Apixio’s technology will complement existing data analytics products including Interpreta, creating a differentiated platform to broaden support for value-based healthcare payment and delivery with actionable intelligence.”
As part of the acquisition, Apixio will remain an
operationally independent entity as part of Centene’s Health Care Enterprises
group to continue bringing value to its clients and the industry, while also
realizing the benefits of enhanced scale with Centene. Financial details of the
acquisition were not disclosed.
What You Should Know:
– Nuance Communications, Inc. announced the Kettering
Health Network has selected ED Guidance for Nuance Dragon Medical Advisor.
– This AI-powered computer-assisted physician
documentation (CAPD) solution will help reduce physicians’ administrative
burden while lowering the risk of adverse safety events, missing diagnoses, and
malpractice litigation – priorities for all physicians, especially in the ED
where the nature of care presents special challenges and risks.
Communications, Inc., today announced that Kettering Health Network has
selected ED Guidance for Nuance Dragon Medical Advisor, an AI-powered computer-assisted
physician documentation (CAPD) solution that gives emergency room
physicians workflow-integrated diagnostic and clinical best practices advice at
one of the earliest and most critical points of care.
Kettering Health is deploying ED Guidance for Nuance Dragon
Medical Advisor to improve patient safety, alleviate the administrative burden
on clinicians, and reduce the risk of missing diagnoses by:
– Extending the Nuance CAPD solution to physicians in its 12
full-service emergency centers through its existing use of the Nuance Dragon
Medical One HITRUST CSF-certified conversational AI platform for documenting
care in the electronic health record (EHR).
– Empowering physicians with integrated real-time,
evidence-based emergency medical guidance from The Sullivan Group.
– Supporting best-practices-based clinical decision-making
and accurate documentation of the severity of illness and acuity of each
patient at the point of care within clinician’s standard EHR workflows.
– Using Nuance conversational AI to automatically identify
and add critical details that may impact patient treatment in real-time.
Sullivan Group Outcomes/Results
The Sullivan Group’s content has been shown to decrease the
occurrence of adverse safety events and reduce diagnosis-related malpractice
claims by up to 70 percent, and with the integration into Nuance Dragon Medical
Advisor, this guidance can be delivered in real-time while the patient is still
in the ED. ED Guidance for Nuance Dragon Medical Advisor also provides powerful
analytics for assessing ED performance and improving care quality and financial
“We see Nuance Dragon Medical One and Dragon Medical Advisor as essential tools that help physicians use the EHR efficiently for delivering high-quality patient care,” said Dr. Charles Watson, DO, Chief Medical Information Officer at Kettering Health. “Patient safety and reducing the administrative burdens of documentation and compliance are priorities for all physicians, especially in the ED, where the nature of care presents special challenges and risks. The ability to add those tools and data analytics via the cloud will help us align our clinical and compliance practices with diagnostic drivers more quickly and accurately.”
You Should Know:
– Today, FundamentalVR, global pioneers in immersive VR
surgical skills training and skills data analytics, announced the expansion of
its surgical specialty capabilities with the addition of ophthalmology. The new
capabilities allow it to support medical device and life science companies in
improving the way they bring new tools and procedures to market.
– Powered by the company’s patented HapticVR™
technology that mimics the physical cues of surgical actions, medical tools,
and tissue variations, FundamentalVR can now create educational simulations for
ophthalmology as well as orthopedics on its Fundamental Surgery platform.
FundamentalVR, global pioneers
in immersive VR surgical skills training and skills data analytics, today
announced the expansion of its surgical specialty capabilities with the
addition of ophthalmology. Powered by the company’s patented HapticVR™
technology architecture that mimics the physical cues of surgical actions,
medical tools, and tissue variations, FundamentalVR can now create immersive,
data-driven medical educational simulations for ophthalmology as well as
orthopedic device and pharmaceutical brands.
Why It Matters
Traditional ophthalmology teaching methods and the way Life
Science brands, medical institutions, and students interact, typically include;
classroom lectures, instructional videos, medical meetings, operating room (OR)
observations, and tissue-based wet lab training, which is considered the gold
standard for medical training. Low-cost immersive simulations now offer
solutions to continue remote, socially distant learning, while accelerating
skills transfers, thanks to the ability to collect and objectively measure
performance data previously unattainable.
Simulations, featuring the interactions with human tissue
essential for learning, can be created to cover various ophthalmology
procedures. These interactions include incisions, trocar placement, scleral
tissue manipulation, lens manipulation, lens implant insertion, posterior
chamber manipulations, bimanual manipulation of the eyeball, and subretinal
The ophthalmology capabilities were first developed in
collaboration with international eye charity, Orbis Flying Eye Hospital. Orbis is currently deploying cataract surgical simulations
created by FundamentalVR in select residency training programs and prospective
digital training hubs to further software developments.
“Industry analysts now estimate adoption curves for immersive technologies have accelerated by around three years as COVID-19 permanently changes traditional teaching methods,” said Richard Vincent, co-founder and CEO of FundamentalVR. “With the addition of ophthalmology capacities, we are meeting this increased demand with proven technology that allows medical device companies and medical educators to more effectively train the next generation of surgeons and bringing innovative new procedures and equipment to market permanently.”
XRHealth appoints Deepa Javeri as CFO and is significantly expanding their US headquarters.
Boston, MA-based provider of extended reality therapeutic applications and XR telehealth
services, today announced Deepa Javeri – a seasoned, global
financial expert and executive – has been named Chief Financial Officer
effective immediately. Javeri’s appointment comes at an exciting moment of
global growth and expansion for XRHealth.
“Deepa brings XRHealth a high level of expertise in fundraising, resource allocation, strategic planning and international financial markets at a time when our company is growing exponentially,’’ says Eran Orr, CEO of XRHealth. “Having her on board will enable XRHealth to continue to expand both domestically and internationally.”
Prior to joining XRHealth, she served as the Chief
Financial Officer at FRANK, where she closed a $10m Series A financing
round. Earlier in her career, Javeri spent fifteen years as a capital
markets investor most recently at Bank of America Merrill
Lynch. Throughout her time at Bank of America Merrill Lynch, she held a
variety of positions in the U.S., Asia, and Europe focused on equity portfolio
management, corporate bankruptcies, and reorganizations.
“We are living in a moment that is asking us to transform the way healthcare is delivered,” says Deepa Javeri, CFO at XRHealth. “It is exciting to be part of a team that is answering that call. At XRHealth, we are revolutionizing remote patient care.”
XRHealth’s Telehealth Clinic operates in the US, Israel and
Australia, utilizing immersive medical applications which are FDA & CE
registered. Using an advanced data analytics platform and external controls,
XRHealth-certified clinicians manage and customize their patients’ care.
What You Should Know:
– Revenue cycle management provider Waystar acquires eSolutions, a provider of Medicare and Multi-Payer revenue cycle management, workflow automation, and data analytics tools at a $1.3B valuation.
– The acquisition will create the first unified
healthcare payments platform with both commercial and government payer
connectivity, resulting in greater value for providers.
Waystar, a provider of healthcare payments software, today
announced a definitive agreement to acquire Francisco Partners-backed eSolutions, a revenue cycle
technology company with unique Medicare-specific solutions at a $1.3B valuation,
according to sources close to the deal. In bringing these two industry leaders
together, Waystar will be the first technology to unite both commercial and
government payers onto a single payments platform. The transaction is expected
to close later this year, subject to customary conditions and approvals.
Founded in 1999, eSolutions’ technology maximizes revenue
collection, accelerates cash flow, and reduces administrative burden across
numerous sites of care. The company has over 6,000 payer connections and
maintains a powerful and growing data set of billions of transactions. In addition
to hospitals and ambulatory providers, eSolutions has deep expertise in serving
the post-acute market across the entire revenue cycle, including skilled
nursing, senior living facilities, home care, hospice, federally qualified
healthcare centers (FQHCs), and durable medical equipment providers. eSolutions
is backed by Francisco Partners.
“eSolutions is thrilled to be joining forces with Waystar, a company like ours that relentlessly focuses on delivering exceptional customer service,” said Gerry McCarthy, Chief Executive Officer of eSolutions. “The combination of our technology platforms and data solves a major pain point in revenue cycle management to drive stronger results for our clients, partners, and for healthcare.”
Acquisition Creates Unified Healthcare Payments Platform
Medicare has become the largest payer in the United
States and as baby boomers age, the mix of insurance coverage is
increasingly shifting to Medicare. Historically, providers have had to leverage
two different systems – one to handle commercial claims, and another to handle
Medicare. For healthcare providers, leveraging a single, end-to-end platform to
manage both private and government payments solves a major pain point and
creates significant efficiencies, freeing up time to deliver care.
“Together, Waystar and eSolutions will deliver unprecedented innovation to the industry, helping healthcare organizations accelerate revenue collection while reducing administrative expenses and repetitive tasks,” said Matthew Hawkins, Chief Executive Officer and board member of Waystar. “Uniting our companies’ data sets will further power Waystar Hubble, our artificial intelligence solution, providing access to even greater insights and value for our clients. We have long-admired eSolutions for its unique Medicare-specific revenue cycle capabilities, which are a perfect complement to the Waystar platform. We are excited to move forward as one team.”
6th Waystar Acquisition Since 2018
Waystar has integrated several other transformational
technologies onto its single instance cloud-based platform since uniting
Navicure and ZirMed in 2017. This marks Waystar’s sixth acquisition in the last
couple years, as the company rapidly expands within the space (not including
their own $2.3B acquisition by two private equity firms last year).
Recent acquisitions include Recondo, a patient estimation and prior authorization
technology, PARO, a presumptive charity scoring solution, UPMC’s Ovation, a claims monitoring tool, and Connance, leveraging predictive analytics to offer agency
manager, advanced propensity to pay (AP2P), and presumptive charity. Waystar is
backed by EQT, Canada Pension Plan Investment Board, and Bain Capital.
What You Should Know:
– Lumeon, the leader in care pathway orchestration
announced it has raised $30M in Series D funding to extend the reach of its
Care Pathway Management (CPM) platform.
– The platform empowers providers to improve care
quality, deliver better outcomes, reduce costs, and ultimately develop and
scale new models of care delivery – particularly important right now as
COVID-19 accelerates the technology-driven transformation of healthcare.
Lumeon, a Boston, MA-based provider of care pathway orchestration, today
announced that it has closed $30M in Series D funding led by new investors
Optum Ventures and Endeavour Vision, with participation from current investors
LSP, MTIP, IPF Partners, Gilde and Amadeus Capital Partners. The investment
will enable the company to extend the reach of its Care Pathway Management
(CPM) platform, which helps healthcare providers automate their patient care coordination
to improve care quality, deliver better outcomes and reduce costs.
Why Care Pathways?
With proven ability to reduce unwarranted
variation and lower the overall cost of care delivery, care pathways are
an increasingly attractive proposition for healthcare providers.
The challenge, however, has always been to take paper-based pathways off the
page and into operational reality. This means being able to direct tasks and
coordinate care across clinicians, ward managers, nurses, patient educators –
the entire team responsible for successful care delivery – even the patient
Deliver Engaging Virtual Care Journeys
Founded in 2005, Lumeon’s platform connects
the care journey across the care continuum, operationalizing care plans beyond
the four walls of your hospital. Lumeon’s CPM platform
uses real-time data to dynamically guide patients and care teams along their
care journeys. By automating, orchestrating and virtualizing care delivery
across care settings, Lumeon’s solutions allow health systems to operate with
predictability and efficiency, delivering optimal care to each patient while
substantially lowering costs for healthcare providers.
Lumeon’s CPM platform
integrates with all electronic health record (EHR) systems in addition to
incorporating required clinical and administrative data from point solutions
and devices, addressing the fragmented nature of healthcare technology and the
challenge of interoperability. By extending beyond the confines of a healthcare
provider’s EHR, Lumeon’s configurable solutions maximize current investments as
organizations evolve their care delivery models.
“While the markets for data analytics, clinical decision support and patient engagement are well established, what is missing today is the ability to effectively connect them to solve the problem of personalizing care delivery in a scalable way,” said Lumeon Founder and CEO Robbie Hughes. “The ‘last mile’ that turns the insight into action is the hardest part for health systems, and is the core of the Lumeon proposition.”
What You Should Know:
– Blue Shield of CA and kidney care provider Cricket
Health announced a partnership to offer a personalized, virtual,
multidisciplinary care available for members with kidney disease or kidney
failure at no extra cost
– By offering remote care, via phone or virtually online,
Cricket Health’s approach to kidney care is designed to keep Blue Shield
members living with kidney disease healthy at home, and out of clinics or
hospitals whenever possible.
Health insurer Blue Shield of
California and kidney care provider Cricket
Health today announced a new innovative, personalized and comprehensive
care coordination program for members who have late-stage chronic kidney
disease or end-stage renal disease at no additional cost to them.
As part of the long-term collaboration, Cricket Health will offer a multidisciplinary care team that includes nurses, pharmacists, social workers, dieticians, and trained patient mentors to provide an evidence-based approach to help patients better manage chronic kidney disease and end-stage renal disease.
How It Works
The team, available online and by phone, work closely with the participating member’s medical providers including primary care physicians, nephrologists, and other specialists to ensure that, as much as possible, the patient remains healthy, at home, and out of the hospital. The program is especially relevant in today’s COVID-19 environment and is available to members enrolled in Blue Shield’s fully insured Preferred Provider Organization (PPO) benefit plans.
Blue Shield’s claims data and Cricket’s advanced data analytics capabilities are used to identify members with or at risk for chronic kidney disease, and Cricket invites them to participate in the program. Once enrolled, Cricket Health will deploy a multidisciplinary care team and virtual programs with the goal of slowing the progression of the disease, reducing health complications, and avoiding emergency room visits or hospitalizations.
By intervening well before kidney failure, Cricket Health can deliver an evidence-based, personalized kidney care plan for each patient that improves health outcomes. For members whose kidney disease does progress, Cricket Health will help them understand their treatment options — such as in-center dialysis or transplant — and empower them to make their preferred choice.
Why It Matters
This offering comes at a critical time, as those living
with chronic kidney disease or end-stage renal disease have
an elevated risk of complications from COVID-19. By offering remote care, via
phone or virtually online, Cricket Health’s approach to kidney care is designed
to keep Blue Shield members living with kidney disease healthy
at home, and out of clinics or hospitals whenever possible.
This innovative kidney care is the latest example of Blue Shield of
California’s Health Reimagined initiative to transform the
healthcare system for individuals, families and communities, and also address
health inequities often found among minority communities. Kidney disease
impacts communities of color disproportionately and Blue Shield’s
collaboration with Cricket Health seeks to expand access to quality kidney
“We recognize that for too long, the healthcare system in the U.S. has fallen short of providing patients who suffer from kidney disease – an estimated 37 million Americans – with the highest quality health care at an affordable cost,” said Seth Glickman, M.D., chief health officer, Blue Shield of California. ”By working with Cricket Health, we can reimagine kidney care and expand health care options for members with late-stage chronic kidney disease and end-stage renal disease so they can live the healthiest lives possible.”
What You Should Know:
– To help meet the needs of ambulatory care practitioners in a post-COVID environment, Greenway Health, a leading health information technology, and services provider, today announced a new strategic partnership with Amazon Web Services (AWS).
– Leveraging AWS cloud services, Greenway is developing a
new cloud-based, data services platform, Greenway Insights, that creates new
data insights and healthcare interventions to advance the breadth of Greenway’s
products and services.
Greenway Health, a leading health information technology, and services provider, today announced a new agreement with Amazon Web Services (AWS), Inc. The agreement will promote collaboration in the healthcare industry with the primary goal of developing transformative healthcare products that will further meet the needs of ambulatory care practices in a post-COVID-19 world.
Insights Build on AWS
will develop a new cloud-based, data services platform, Greenway InsightsTM, on AWS that creates new data insights and healthcare
interventions to advance the breadth of Greenway’s products and services.
Greenway Insights will leverage AWS cloud services, giving Greenway engineering
teams direct access to a robust set of data analytics and machine learning
capabilities, such as Amazon SageMaker and Amazon Comprehend Medical, that will
enable product innovation to occur at an accelerated pace.
Initially, Greenway will leverage the platform to deliver a
regulatory analytics solution to help customers meet the evolving reporting
requirements of quality payment programs and value-based care
initiatives. The solution will enable practices to receive data insights in
real time, increasing practice performance and positively impacting patient
“Technology is key to improving patient care and health outcomes. This collaboration via our Digital Innovation Program to deliver the Greenway Insights data and analytics platform will bring needed solutions to the market quickly,” said Paul Zimmerman, Worldwide Head, Private Equity at AWS. “Our team is currently working with three Vista portfolio companies on innovative solutions, and we are particularly proud of our work with Greenway. The project is operating on a rapid implementation timeline, and we have already seen initial success and proof of concept. We are looking forward to a continued collaboration in developing solutions that streamline workflows and improve the way healthcare providers care for their patients.”
What You Should Know:
– In the age of COVID-19, healthcare CIOs cite interoperability,
cybersecurity, and operationalizing SDOH data priorities as top three priority
areas, according to the third annual LexisNexis focus group of CHIME
– The survey results also highlighted the importance of
a team approach with support across the organization in helping CIOs
achieve the vision of connected healthcare.
The Health Care business of LexisNexis® Risk Solutions announced
the results of its annual
focus group, comprised of over 20 healthcare IT executives that are members
of the College of Healthcare Information
Management Executives (CHIME). The focus group participants accepted more
accountability than in previous years to provide the safe and
reliable technology tools necessary to deliver high-quality, connected,
and cost-effective care. The survey results also highlighted the importance of
a team approach with support across the organization in helping CIOs
achieve the vision of connected healthcare.
In light of the COVID-19
pandemic, data sharing and security to using data analytics to help vulnerable
populations – have become more urgent in light of the pandemic challenges. For
example, recent months have illustrated the need for data access to inform
decisions about population health, wellness and care capacity.
The surveyed healthcare CIOs identified three main priority
1. Managing interoperability: Members acknowledged
challenges amid the surge of digital touchpoints, such as mobile phones, smart
devices and remote services. Goals include a common patient identifier to combine
and verify disparate patient records for a true health information exchange.
2. Bolstering cybersecurity: Members are confronting
new cybersecurity risks, confusion over who bears the ultimate responsibility
for patient data, and the competing goals of seamless user experience and data
safety. To address that final challenge and strike an appropriate balance,
executives are moving to multifactor authentication strategies for optimal user
workflow and security.
3. Integrating Social Determinants of Health (SDOH):
As the pandemic has highlighted, incorporating SDOH
data is a vital, immediate requirement for improving the delivery of patient
support and value-based care, and ultimately, outcomes. Executives shared SDOH
implementation challenges, including data aggregation and operationalization
within IT and EHR systems, especially when not utilizing third-party data to
support their efforts. While CIOs previously had not perceived specific
accountability for SDOH data, that changed as its value was demonstrated.
“CHIME’s executive health IT members are approaching evolving patient and industry needs with careful consideration, ingenuity and focus,” said Josh Schoeller, chief executive officer of LexisNexis Risk Solutions Health Care. “Our annual focus group presents valuable insights about how healthcare decision-makers are strategically using technology solutions to overcome hurdles regarding cybersecurity, data governance, and interoperability, all of which have become more urgent during the COVID-19 pandemic. It’s a big challenge but with the right data integration and analytics they continue to make great progress even in the face of the COVID-19 pandemic.”
To access the group insights, download the report here.
What You Should Know:
– 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
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.
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
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.”
With public and private healthcare spending significantly outpacing that of other countries, U.S. hospitals face intense pressure to find new ways to capture greater value. More and more, organizations are finding that partnerships with existing vendors can help unlock next-level performance gains in a transformative environment.
Take Nebraska Medicine, for example. In the early 2000s, the health system created multidisciplinary committees to boost revenue integrity and adopted new revenue cycle management processes that strengthened performance—with strong results. But best practices alone are no longer enough to fuel revenue cycle gains at a time of decreased reimbursement, rising out-of-pocket costs, and staffing issues. “You’ve got to be able to get to the data,” says Jana Danielson, Executive Director, Revenue Cycle for Nebraska Medicine—a $1.8 billion academic medical center with two hospitals, ~450 revenue cycle staff, 913,000 hospital billing claims, and 1.6 million physician billing claims per year.
“Without real-time access to data and data analytics, revenue cycle teams risk making decisions based on emotions, not facts,” Danielson says. “Our partnership with a vendor enables our revenue cycle team to more effectively use data to identify our pain points and empower team members to take the right steps for improvement.”
Nebraska Medicine’s experience points to four ways healthcare organizations can establish partnerships with vendors that drive innovation and performance excellence.
1. Look for a partner that will challenge your assumptions around performance
The right partner will dig deeper, not only tracking key performance indicators (KPIs) but also taking a hard look at how these KPIs were calculated.
For example, in revenue cycle management, there are many ways to track clean claim rates, a measure that reflects the quality of claim data that is collected and reported. Some organizations consider a clean claim rate to be the percentage of claims accepted by the payer on the first pass. Others calculate it as the percentage of claims that pass through the organization’s billing department without manual intervention before being submitted to the payer. Depending on how this metric is calculated, sometimes a percentage that seems to indicate above-average performance in comparison with peers may not reflect breakdowns in processes that have occurred before a claim is submitted.
At first glance, Nebraska Medicine’s clean claim rate in 2017 was strong:
95.87 percent for a physician billing and 87.59 percent for hospital billing. However, using claims analytics, the health system uncovered a hidden challenge. Some billers were bypassing the claim edits. In those instances, claims were being submitted before corrections were made. The result: a lower-than-expected clean claim rate.
Nebraska Medicine’s revenue cycle leaders worked with the organization’s vendor to tackle this challenge. The revenue cycle department developed scorecards by individual employees that showed their performance against key metrics, including their rate of bypassed edits, and reiterated expectations for revenue cycle processes. Within three months, the number of bypassed edits significantly decreased. Today, Nebraska Medicine’s clean claims rate averages 93.78 percent—well above the industry standard—for more than 900,000 hospital claims per year.
At Nebraska Medicine, Reduction in Bypassed Claim Edits Drives High Clean Claims Rate
2. Make sure the vendor has both product knowledge and operational expertise
Many vendors make the business case for partnership based on the quality of their product or system, such as a 99 percent clean claim rate or a 3 percent denial rate. Some back up their product expertise by regularly working with clients to optimize their use of a technology or service—and it’s a solid step toward a true partnership.
But the best vendors also commit to understanding the context in which their products or services are used in your organization. They examine your team’s work processes and draw upon their operational expertise to make suggestions for improvement, even when the modifications they propose fall outside their paid relationship with your organization.
Consider that 90 percent of patients expect out-of-pocket estimates before care is delivered—not surprising, given the rise in high deductibles and patients’ expected contribution toward their healthcare costs. Providing a patient financial “concierge” at the point of contact not only helps patients better understand their out-of-pocket obligation but also bolsters an organization’s ability to:
– Collect copays upfront
– Explore barriers to payment and patient-tailored solutions
– Increase point-of-service collections and revenue
The right vendor will offer both tried-and-true and out-of-the-box suggestions to drive increased efficiency and revenue, regardless of whether this boosts the vendor’s bottom line.
3. Ask bold questions—and expect thoughtful responses
We’re at the tip of the iceberg when it comes to using artificial intelligence (AI) in healthcare. AI offers a massive set of capabilities for innovation and improvement in healthcare, including in revenue cycle. For example, the use of machine learning has the potential to elevate revenue cycle performance by predicting:
– When a claim will be paid—and how much—down to the hour of remittance
– The probability that a claim will be denied payment—and why
– Whether a patient encounter will require prior authorization before the date of service
– Whether new edits need to be incorporated into existing workflows based on payer responses and denials
But is now the right time for your organization to invest in AI for revenue cycle, or are there other, more foundational competencies your team should hone first? The best vendors keep a pulse on the industry’s newest innovations and partner with you in determining the right approach for your organization. They also help make the business case for innovation to senior leaders, when appropriate.
As Nebraska Medicine examines opportunities to leverage AI in revenue cycle, it has worked with a claims analytics vendor to assess how payer behavior affects revenue, both in the short term and long term. At a time when the nation’s biggest health plans vary greatly in their time to payment, instant access to payment trends by individual payers empowers Nebraska Medicine to have more candid conversations with payers around performance. It also strengthens Nebraska Medicine’s contract negotiating power.
“We want to make sure we’re not at the bottom of the pile when it comes to our relationships with payers,” Danielson says. “If we are, we need to be able to dive into the specific issues that need to be fixed to improve performance.”
4. View your vendor as a strategic ally
Sometimes, you don’t know what you need until you see it. Other times, the pain points you’re sure to require dedicated focus turn out to be pebble-sized problems, not boulders. The key to finding a true partner in innovation is to actively seek a vendor that demonstrates not just a superior level of service, but also a strong willingness to listen to clients and share candid feedback.
For example, senior leaders at Nebraska Medicine once asked revenue cycle leaders to uncover what they viewed as “skyrocketing denials rate.” Danielson partnered with the health system’s claims analytics vendor to drill down, by payer, into first-pass denial rates, partial denial rates, and more to provide a complete picture of denials status. These efforts showed one payer’s clean claim rate was 10 points lower than that of its peers.
However, the payer did not account for significant patient volume, translating to a small impact on revenue cycle performance. Nebraska Medicine determined it could make a bigger difference in lowering denial rates by focusing on the organization’s largest payer—avoiding a complete overhaul to the revenue cycle team’s payer relations approach.
Creating an Innovation Mindset
The bar for revenue cycle performance is rising, especially with continued dips in reimbursement rates, an uptick in challenges to claim payment, and an environment where consumers are the new payer. Moving past the traditional mindset of what a vendor relationship should look like toward an innovation mindset enables leaders to more fully benefit from a vendor’s subject matter expertise and accelerates gains in performance.
About Eric NilssonEric Nilsson joined The SSI Group, LLC (SSI) as the Chief Technology Officer to lead SSI’s long-term technology vision. He brings nearly 30 years of experience in the software industry with the last 10 in healthcare technology. Prior to joining SSI, he served as the chief technology officer at Nextech and Surgical Information Systems (SIS), where he focused on SaaS, on-premise EMR and practice management solutions as well as inpatient and ambulatory surgery providers from large hospital networks to surgery centers.