– Shields Health Solutions and Excelera announce a major
specialty pharmacy merger that will form a combined company that consults with
700+ hospitals in 43 states, including Mass General Brigham, Yale New Haven,
Intermountain Healthcare and Henry Ford.
– The network of hospitals is designed to improve patient
care through an infrastructure that helps with things like acquiring prior
authorization for specialty drugs and staying adherent to them. It can also
lower costs for patients by negotiating lower rates from manufacturers with the
leverage of insights from 1 million+ patients in those hospitals.
Shields Health Solutions (Shields), the leading health
system specialty pharmacy integrator, has joined
forces with ExceleraRx
Corp. (Excelera), a healthcare company that empowers integrated delivery
networks, health systems, and academic medical centers to provide personalized,
integrated care for patients with complex and chronic conditions focused on
improving patient care.
Merger Reflects Growing Need for On-Site, Integrated
Serving 60+ health systems and academic medical centers, the
combined organization addresses 700+ hospitals that account for the opportunity
of $30B in specialty pharmacy revenue. The use of specialty medications to
treat complex patients – those with multiple, chronic illnesses or rare, hard
to treat diseases that require close monitoring and support – is increasing an
average of 17 percent per year, and health systems across the U.S. have been
building on-site, integrated specialty pharmacies to provide comprehensive,
streamlined care for this growing population to improve outcomes. Since 2015,
the prevalence of health system-owned specialty pharmacies in large hospitals has doubled, with nearly 90 percent of large
hospitals operating a specialty pharmacy in 2019.
“On-site, integrated specialty pharmacy is the future
of complex patient care and we look forward to combining forces with Excelera
to make our impact even greater. As we have shown, this model materially
improves clinical outcomes for patients and reduces total medical expenses for
covered patients,” said Lee Cooper, CEO, Shields. “Together, our
network of more than 60 of the country’s top health systems, representing
nearly 30% of non-profit healthcare systems based on net patient service revenues,
creates an unparalleled industry-first that will enable unprecedented best
practice sharing and ultimately lead to improved outcomes for complex
Benefits of On-Site, Integrated Specialty Pharmacies for
Shields and Excelera offer programs for health systems to
build, operationalize and optimize integrated specialty pharmacies, as well as
help manufacturers and payors access critical patient and drug performance
insights. With a more personalized, high-touch approach to patient care,
Shields and Excelera have found that hospital-owned specialty pharmacies
dramatically simplify medication and care management for patients and can:
– Reduce medication co-payments from hundreds, sometimes
thousands of dollars, to an average co-pay of $10
– Streamline time-to-therapy, typically from several weeks
to an average of two days
– Decrease physician administrative paperwork by thousands
– Improve medication adherence rates to over 90 percent, on
Financial details of the acquisition were not disclosed.
A recent Advisory Board briefing examined the annual Centers for Medicare & Medicaid Services (CMS) Readmission penalties. Of the 3,080 hospitals CMS evaluated, 83% received a penalty for payments to be made in 2021, based on expected outcomes for a wide variety of treated conditions. While CMS indicated that some of these penalties might be waived or delayed due to the impacts of the Covid pandemic on hospital procedure volumes and revenue, they are indicative of a much larger issue.
For too long, patients discharged from the hospital have been handed a stack of papers to fill prescriptions, seek follow-up care, or take other steps in their journey from treatment to recovery. More recently, the patient is given access to an Electronic Health Record (EHR) portal to view their records, and a care coordinator may call in a few days to check-in. These are positive steps, but is it enough? Although some readmissions cannot be avoided due to unforeseen complications, many are due to missed follow-up visits, poor medication adherence, or inadequate post-discharge care.
Probably because communication with outside providers has never worked reliably, almost all hospitals have interpreted ‘care coordination’ to mean staffing a local team to help patients with a call center-style approach. Wouldn’t it be much better if the hospital could directly engage and enable the Primary Care Physician (PCP) to know the current issues and follow-up directly with their patient?
We believe there is still a real opportunity to hold the patient’s hand and do far more to guide them through to recovery while reducing the friction for the entire patient care team.
Strengthening Care Coordination for a Better Tomorrow
Coordinating and collaborating with primary care, outpatient clinics, mental health professionals, public health, or social services plays a crucial role in mitigating readmissions and other bumps along the road to recovery. Real care coordination requires three related communication capabilities:
1. Notification of the PCP or other physicians and caregivers when events such as ED visits or Hospitalization occur.
2. Easy, searchable, medical record sharing allows the PCP to learn important issues without wading through hundreds of administrative paperwork.
3. Secure Messaging allows both clinicians and office staff to ask the other providers questions, clarify issues, and simplify working together.
There are some significant hurdles to improve the flow of patient data, and industry efforts have long been underway to plug the gaps. EHR vendors, Health Information Exchanges (HIEs), and a myriad of vendors and collaboratives have attempted to tackle these issues. In the past few decades, government compliance efforts have helped drive medical record sharing through the Direct Messaging protocol and CCDAs through Meaningful Use/Promoting Interoperability requirements for “electronic referral loops.” Kudos to the CMS for recognizing that notifications need to improve from hospitals to primary care—this is the key driver behind the latest CMS Final Rule (CMS-9115-F) mandating Admission, Discharge, and Transfer (ADT) Event Notifications. (By March 2021, CMS Conditions of Participation (CoPs) will require most hospitals to make a “reasonable effort” to send electronic event notifications to “all” Primary Care Providers (PCPs) or their practice.)
However, to date, the real world falls far short of these ideals: for a host of technical and implementation reasons, the majority of PCPs still don’t receive digital medical records sent by hospitals, and the required notifications are either far too simple, provide no context or relevant encounter data, rarely include patient demographic and contact information, and almost never include a method for bi-directional communications or messaging.
Delivering What the Recipient Needs
PCPs want what doctors call the “bullet” about their patient’s recent hospitalization. They don’t want pages of minutia, much of it repetitively cut and pasted. They don’t want to scan through dozens or hundreds of pages looking for the important things. They don’t want “CYA” legalistic nonsense. Not to mention, they learn very little from information focused on patient education.
An outside practitioner typically doesn’t have access to the hospital EHR, and when they do, it can be too cumbersome or time-consuming to chase down the important details of a recent visit. But for many patients—especially those with serious health issues—the doctor needs the bullet: key items such as the current medication list, what changed, and why.
Let’s look at an example of a patient with Congestive Heart Failure (CHF), which is a condition assessed in the above-mentioned CMS Readmission penalties. For CHF, the “bullet” might include timely and relevant details such as:
– What triggered the decompensation? Was it a simple thing, such as a salty meal? Or missed medication?
– What was the cardiac Ejection Fraction?
– What were the last few BUN and Creatinine levels and the most recent weight?
– Was this left- or right-sided heart failure?
– What medications and doses were prescribed for the patient?
– Is she tending toward too dry or too wet?
– Has she been postural, dizzy, hypotensive?
Ideally, the PCP would receive a quick, readable page that includes the name of the treating physician at the hospital, as well as 3-4 sentences about key concerns and findings. Having the whole hospital record is not important for 90 percent of patients, but receiving the “bullet” and being able to quickly search or request the records for more details, would be ideal.
Similar issues hold true for administrative staff and care coordinators. No one should play “telephone tag” to get chart information, clarify which patients should be seen quickly, or find demographic information about a discharged patient so they can proactively contact them to schedule follow-up.
Building a Sustainable, Long-Term Solution
Having struggled mightily to build effective communications in the past is no excuse for the often simplistic and manual processes we consider care coordination today.
Let’s use innovative capabilities to get high-quality notifications and transitions of care to all PCPs, not continue with multi-step processes that yield empty, cryptic data. The clinician needs clinically dense, salient summaries of hospital care, with the ability to quickly get answers—as easy as a Google search—for the two or three most important questions, without waiting for a scheduled phone call with the hospitalist. X-Rays, Lab results, EKGs, and other tests should also be available for easy review, not just the report. After all, if the PCP needs to order a new chest x-ray or EKG how can they compare it with the last one if they don’t have access to it?
Clerical staff needs demographic information at their fingertips to “take the baton” and ensure quick and appropriate appointment scheduling. They need to be able to retrieve more information from the sender, ask questions, and never use a telephone. Additionally, both the doctor and the office staff should be able to fire off a short note and get an answer to anyone in the extended care team.
That is proper care coordination. And that is where we hope the industry is collectively headed in 2021.
About Peter Tippett MD, PhD: Founder and CEO, careMESH
Dr. Peter S. Tippett is a physician, scientist, business leader and technology entrepreneur with extensive risk management and health information technology expertise. One of his early startups created the first commercial antivirus product, Certus (which sold to Symantec and became Norton Antivirus). As a leader in the global information security industry (ICSA Labs, TruSecure, CyberTrust, Information Security Magazine), Tippett developed a range of foundational and widely accepted risk equations and models.
About Catherine Thomas: Co-Founder and VP, Customer Engagement, careMESH
Catherine Thomas is Co-Founder & VP of Customer Engagement for careMESH, and a seasoned marketing executive with extensive experience in healthcare, telecommunications and the Federal Government sectors. As co-founder of careMESH, she brings 20+ years in Strategic Marketing and Planning; Communications & Change Management; Analyst & Media Relations; Channel Strategy & Development; and Staff & Project Leadership.
– New study out from Propeller and Chicago’s NorthShore
University HealthSystem shows that asthma patients maintain higher medication
adherence and decrease their rescue inhaler use when using a digital health
– The study looked at 100 patients recruited from
NorthShore practices, half of whom used Propeller to manage their condition and
half of whom did not.
– The treatment group maintained their high medication adherence at 68%, while the control group experienced a 17% decline in adherence over the course of the study. The treatment group also increased days without needing their rescue inhaler by 19%, 13% more than in the control group.
Poor adherence to asthma medication and overuse of rescue
inhalers have both been associated with increased asthma morbidity in previous
research. Studies reveal that patients often overestimate their level of
adherence to their clinician, leading to costly treatments that may not be
appropriate or necessary to curb symptoms.
Randomized Clinical Trial Details
The published study features a randomized controlled trial
that enrolled 100 patients with uncontrolled asthma, 25 to 65 years of age.
Patients were recruited between April 2018 and 2019 from allergist and
pulmonologist practices at NorthShore University HealthSystem in Chicago. Treatment
and control group participants were both attached a small sensor to their
controller and rescue inhalers. The treatment group received insights on their
medication use in the Propeller app, including reminders to take missed or late
doses and reports on their usage and possible triggers.
Utilizing Propeller’s digital health platform, clinicians
had had access to the treatment patients’ controller and rescue medication
data. If patient utilization indicated poor adherence or worsening control,
patients were contacted to address adherence and review asthma control status. The
control group’s medication use was remotely monitored, but they did not receive
insights in the app or outreach from providers.
Clinical Trial Outcomes/Results
The study’s treatment group maintained its high medication adherence at 68%, while the control group experienced a 17% decline in adherence over the course of the study. In addition, Propeller users’ days without needing their rescue inhaler increased 19% in the treatment group, 13% more than in the control group.
“Increasing adherence and reducing rescue use are critical to improving the health and well-being of asthma patients,” said Giselle Monsaim, MD, lead author of the study and attending physician in the Departments of Medicine, Division of Pulmonary, Critical Care, Allergy and Immunology at NorthShore University HealthSystem. “We’re pleased to add to the body of research that shows digital health can play an important role in maintaining high adherence rates and increasing days without symptoms for people with asthma.”
– Innovaccer partners with Surescripts to power its data activation platform
with the most comprehensive medication data.
– The partnership will enable the company to conduct
smart medication reconciliation and ensure that patients are complying with
their care protocols.
Innovaccer, Inc., a San
Francisco, CA-based healthcare
technology company, announced its partnership with Surescripts, the nation’s leading health
information network, to leverage the industry’s most comprehensive medication
data. This partnership will enable Innovaccer to enhance its medication
adherence powered by its FHIR-enabled Data Activation Platform.
Integration Provides Access to Medication Data for Specific Patient Populations
The integration of Surescripts with Innovaccer’s data platform will strengthen their ability to identify and triage at-risk patient populations and drive better care coordination. With access to integrated data on 314 million patients through Surescripts’ nationwide health information network, the company will enhance its analytics and care management capabilities.
The partnership will enable Innovaccer to leverage
Surescripts Medication History for Populations to confidently pinpoint and
close care gaps in the patient data that is refreshed daily. Additionally, it
will empower them to highlight cases of medication non-adherence and potential
abuse. This capability will allow Innovaccer’s provider clients to measure
medication metrics for the Centers for Medicare & Medicaid Services (CMS)
reimbursement and avoid penalties.
Addressing Medication Adherence Pain Points
Together, Surescripts and Innovaccer will address the major pain points with medication adherence among the patients and healthcare organizations. With the insights provided by Surescripts medication data, Innovaccer will assist physicians and care teams in driving better care management by creating personalized care plans. Integrating this information on the data platform, users can obtain the whole view of the patient in a single click.
“With access to medication information for specific patient populations, providers in value-based care arrangements can help manage cost-effective care and optimize clinical interventions for patients at risk of medication non-adherence,” explained Ryan Hess, Vice President of Innovation at Surescripts. “Our nationwide network delivers a more complete and accurate electronic picture of patients’ medication history for better informed, more efficient and safer care decisions.
– Apstar Pharma acquires the assets of respiratory health company Cohero Health to expands its digital portfolio with a focus on respiratory disease management.
– Cohero Health develops digital tools and technologies to improve respiratory care, reduce avoidable costs, and optimize medication utilization.
AptarGroup, Inc., a global leader in consumer dispensing, active packaging, drug delivery solutions, and services, announces that it has acquired all operating assets and the proprietary portfolio of Cohero Health, Inc. (“Cohero Health”), a digital therapeutics company transforming respiratory disease management for asthma and chronic obstructive pulmonary disorder (COPD). Financial details of the acquisition were not disclosed.
Start breathing smarter
Founded in 2013, New York-based Cohero Health develops innovative digital tools and technologies to improve respiratory care, reduce avoidable costs, and optimize medication utilization. With this transaction, Aptar Pharma acquires Cohero Health’s turnkey digital health platform and device assets including:
· BreatheSmart Connect digital health platform – care coordination and HIPAA-compliant SaaS cloud service which captures and securely stores data from Cohero Health’s devices and BreatheSmart® software for remote monitoring and patient communications to help manage patient therapy;
· BreatheSmart® App – designed for patient habit creating and behavior change, driving appropriate medication utilization. Provides real-time tracking of medication adherence and lung function, along with reminders, educational materials, and symptom/trigger recording;
HeroTracker® Sensors – Bluetooth enabled medication smart inhaler sensors
designed for both control and rescue medications. Attaches to respiratory
medications to automatically record time and date of doses taken
· mSpirometer™ and cSpirometer™lung function diagnostic sensors – enable comprehensive pulmonary lung function testing in a handheld wireless device.
Acquisition Expands Aptar’s Digital Portfolio
“Cohero Health further strengthens and expands Aptar’s digital portfolio, in this case, with a focus in respiratory disease management,” commented Sai Shankar, Aptar Pharma’s Vice President, Global Digital Healthcare Systems. “Aptar has made previous investments in digital respiratory company Sonmol in China and digital health company Navia Life Care in India. With this strategic bolt on, Aptar now has global capabilities to deploy digital respiratory health, utilizing either the Cohero or Aptar device portfolio/platform. The investment will also facilitate Aptar’s ability to provide diagnostic solutions in respiratory and a significant number of other disease categories.”
– Humana Inc. and Fresenius Medical Care North America
(FMCNA) today announced an agreement to broaden their collaboration toward
improving the health of eligible Humana Medicare Advantage members
agreement between Humana and Fresenius Medical Care North America goes into
effect Jan. 1, 2021.
Humana Inc. and leading renal care company Fresenius Medical Care North America (FMCNA) announced an agreement to broaden their collaboration toward improving the health of eligible Humana Medicare Advantage and commercial members with chronic kidney disease (CKD) and end-stage renal disease (ESRD) through more coordinated, holistic care.
The expanded partnership is in keeping with the goals
outlined in the 21st Century Cures Act, which enables people with ESRD to
enroll in Medicare Advantage Plans, and with federal initiatives that call for earlier diagnosis and
treatment of kidney disease; a reduction in the number of Americans developing
ESRD; and support for patient treatment options such as home dialysis or kidney
transplant as applicable.
The agreement between
Humana and Fresenius Medical Care North America goes into effect Jan. 1, 2021,
and encompasses the following:
Expanded Availability of Care Coordination Services:
FMCNA currently provides specialized care coordination services for Humana
members with CKD in three states: Iowa, Kentucky, and North Carolina. The
agreement expands the availability of these services to eligible Humana members
in an additional 39 states, with the goals of improving quality of life and
health outcomes, increasing access to care and minimizing care gaps, slowing
disease progression and lowering hospitalization rates, and reducing the cost
FMCNA’s care coordination services include early detection of CKD to slow
disease progression; medication reviews and regimen adherence guidance;
behavioral health screenings; nutritional counseling; strategies for managing
multiple comorbidities; education about – and support for – home dialysis
treatment when applicable and beneficial to the patient; transplant education;
and palliative care.
FMCNA partners with InterWell Health, a physician-led population health
management company working to improve clinical outcomes and lower medical costs
through its network of over 1,100 nephrologists across the country.
Transitional Care Units: These units are
designed to help people recently diagnosed with kidney failure learn about
treatment options available to them – including transplant and home dialysis –
and be more empowered in managing their own care. Transitional Care Units may be either a space within a
dialysis center or a standalone facility, offering comprehensive, hands-on
education from dedicated staff that is individualized for each patient. This
includes the importance of renal nutrition, medication adherence, and vascular
access care; assisting patients transitioning between modalities (e.g., from
in-center dialysis to home dialysis); and supporting individuals returning to
dialysis from transplant. The agreement is intended to locate Transitional Care
Units in select areas where Humana has significant Medicare Advantage
Value-Based Agreement: The expanded
collaboration also improves upon the parties’ existing clinic network contract,
which provides eligible Humana Medicare Advantage and commercial members with
ESRD access to dialysis at more than 2,600 centers of Fresenius Kidney Care, the dialysis services division of
Fresenius Medical Care North America. By implementing a value-based payment
model for in-center and home dialysis services and at Transitional Care Units,
as well as for CKD care coordination services, compensation will be based on
meeting agreed-upon quality improvement and patient outcome goals, and reducing
overall costs to the system.
Individuals with CKD have kidneys that do not filter blood
properly, which causes waste and fluid levels that can be dangerously high. CKD
and ESRD affect a wide spectrum of the population but the degree of impact is
not uniform. For example, kidney failure rates among Black Americans are about
three times that of white Americans. In total, approximately 15% of American
adults, or about 37 million people, have CKD, but many are unaware of their
condition. CKD management is complex, and failure to appropriately manage the
condition may cause considerable symptoms and worsening health outcomes,
This agreement represents an evolution of our work with
Humana and leverages our over 10 years of industry leadership in value-based
care,” said Bill Valle, Fresenius Medical Care North America’s Chief Executive
Officer. “Our scale, integrated nephrology network, and standardized clinical
interventions and protocols uniquely position us to predictably and
consistently improve health outcomes and reduce overall costs. We welcome this
opportunity to offer more coordinated, holistic care to Humana’s members, with
a keen focus on education, comorbidity management, early detection, and
treatment options, including home dialysis. This approach also helps eliminate
barriers to keep renal disease treatment uninterrupted for at-risk
– Propeller Health announced
it will co-package a new asthma medication from Novartis, which was
approved by the European Commission this week for use in the EU.
Breezhaler® plus Propeller Health sensor is the first asthma medication to be
co-packaged and co-prescribed with a digital health platform.
– Propeller’s solution
works by attaching a sensor to the Enerzair® Breezhaler® inhaler, which then
delivers objective data on medication use to the Propeller app on the patient’s
Propeller Health today announced a collaboration with Novartis to co-packaged the Propeller digital health platform with Enerzair® Breezhaler® (QVM149; indacaterol acetate, glycopyrronium bromide and mometasone furoate [IND/GLY/MF]), a recently approved Novartis medication developed to treat uncontrolled asthma. Propeller previously announced a collaboration with Novartis to develop a custom add-on sensor for the Breezhaler® inhaler, a device used for the company’s portfolio of COPD treatments (Ultibro® Breezhaler®, Onbrez® Breezhaler®, and Seebri® Breezhaler®), connecting these medications to Propeller’s digital health platform. The same sensor will be co-packaged with Enerzair® Breezhaler®.
Why It Matters
This collaboration marks the first time a digital health tool will be packaged and prescribed alongside an inhaled asthma medication. Enerzair® Breezhaler® and Propeller sensor and app received approval from the European Commission in July and will launch across Europe starting in 2020. Healthcare professionals in Europe will have the option to prescribe Enerzair® Breezhaler® with or without the companion digital health platform. The medication is not available in the U.S.
Enerzair® Breezhaler® was approved as a maintenance treatment of
asthma in adult patients not adequately controlled with a maintenance
combination of a long-acting beta2-agonist
(LABA) and a high dose of an inhaled corticosteroid (ICS) who experienced one
or more asthma exacerbations in the previous year.
Impact of Uncontrolled Asthma
Asthma affects an estimated 358 million people worldwide and can cause a significant personal, health, and financial burden when not adequately controlled. Despite current therapy, over 40% of patients with asthma at Global Initiative for Asthma (GINA) Step 3, and over 45% at GINA Steps 4 and 5 remain uncontrolled. Patients with uncontrolled asthma may downplay or underestimate the severity of their disease and are at a higher risk of exacerbation, hospitalization, or death. Barriers, such as less than optimal adherence, incorrect inhaler technique, treatment mismatch, safety issues with oral corticosteroids, and ineligibility for biologics, have created an unmet medical need in asthma.
Enerzair Breezhaler is provided in a transparent capsule that allows patients to see that they have taken their medication and will be administered via the dose-confirming Breezhaler® device, which enables once-daily inhalation using a single inhaler. The digital companion includes a sensor that attaches to the Breezhaler device and can be linked to the Propeller Health smartphone app, providing patients with inhalation confirmation, medication reminders, and access to objective data that can be shared with their physician in order to help them make better therapeutic decisions.
Propeller’s solution works by attaching a sensor to the
Enerzair® Breezhaler® inhaler, which then delivers objective data on medication
use to the Propeller app on the patient’s smartphone. The app also sends the
patient reminders to take their prescribed dose and keeps a record of adherence
data over time. The patient can share that data with their clinician to help
inform the patient’s treatment plan.
In previous clinical studies unrelated to this collaboration, the Propeller platform has been shown to increase asthma control by up to 63 percent, increase medication adherence by up to 58 percent, and reduce asthma-related emergency department visits and hospitalizations by as much as 57 percent.
“Our collaboration with Novartis to co-package Propeller with Enerzair® Breezhaler® is the first time a pharmaceutical company and digital health company have worked together to package a digital health platform with an asthma medication,” said David Van Sickle, co-founder and CEO of Propeller Health. “The ability to prescribe a maintenance medication with Propeller will make it easier for healthcare professionals to engage their patients in self-management.”