– Aledade raises $100 Million in Series D funding to help
more primary care practices thrive in value-based care.
– The new funding will power the growth of a nationwide network of more than one million patients by further expanding into Medicare Advantage Contracts.
a Bethesda, MD-based provider of value-based primary care, today announced it
has closed a $100 million Series D funding round following a year of
significant growth for its national network of risk-taking primary care
practices. Returning investor Meritech Capital led the round, which included new growth
Global Management andIVP,
and returning investor OMERS Growth Equity. The latest round of funding brings the
company’s valuation to over $2.1 billion dollars.
Delivering Value-Based Primary Care
Founded in 2014 by former National Coordinator for Health IT, Farzad Mostashari, Aledade began building ACO networks for independent physicians through the Medicare Shared Savings Program, but now also partners with commercial payers across the country. Aledade now partners with nearly 800 independent primary care practices, including more than 100 federally-qualified health centers, comprising more than 7,800 providers in 31 states. Through this nationwide network of independent practices, Aledade practices manage roughly $12 billion in health care spending through 35 Medicare and 51 other value-based contracts and care for nearly 1.2 million patients.
Why It Matters
As the healthcare system continues to be strained by the
COVID-19 pandemic, these value-based
practices are keeping patients healthy, at home, and out of the hospital with
proactive, coordinated primary care. Aledade technology helps practices
identify and better manage their most at-risk patients. Patients of practices
engaged with Aledade have fewer emergency department visits, inpatient stays
and readmissions; in the most recent year with public results from the Medicare
Shared Savings Program, Aledade practices reduced hospital stays by an average
of 9 percent, avoiding more than 10,000 unnecessary hospitalizations.
Aledade’s growth has been driven by the success of its
physician-led model, in which the company shares in the risk and reward of both
government and commercial value-based contracts with participating independent
practices. Aledade practices have improved the quality of care and health
outcomes while controlling costs in all types of public and private payer
contracts. To date, Aledade’s participating practices have received more than
$115 million in shared savings revenue.
Funding Will Support Strategic Partnerships with Medicare
Aledade will use this infusion of capital to expand its value-based care model with health plans across the country, with a particular focus on growing its strategic partnerships with Medicare Advantage (MA) plans to improve outcomes and quality for more seniors. Already, Aledade works with all of the largest MA payers and multiple Blue Cross plans to give Aledade practices access to Medicare Advantage value-based contracts. In 2020, Aledade more than doubled the number of patients served in these MA contracts, bringing the total to about 100,000.
As the company expands into more MA plan partnerships and
welcomes more practices to its national network of ACOs, Aledade will continue
to invest heavily in its cutting-edge technology platform to ensure primary
care physicians have a world-class operating system for population health.
Aledade also plans to launch several initiatives in 2021 to extend this
These include initiatives to extend the use of integrated
telehealth, predict and prevent the occurrence of unplanned dialysis, reduce
racial disparities in hypertension control, and enable even the smallest
primary care practices in the country to join value-based contracts with
In the face of COVID-19, healthcare witnessed how crises can become the long-awaited push for creativity and innovation that the industry needs. When our healthcare infrastructure’s weaknesses were exposed, telehealth helped to stitch them up, with the number of telehealth claims increasing 8,336% nationally from April 2019 to April 2020. Out of need, patients quickly turned to telehealth as a new model of care delivery; clinicians adapted to a new avenue for engaging with patients, policymakers began to improve incentives for its use; and home became our hospital.
As we continue the fight to control the virus in 2021, the industry is at a pivotal moment in ensuring this year’s telehealth momentum continues post-pandemic. Healthcare organizations should take time now to strategize how best to hardwire telehealth, so it is embedded into care delivery models long-term. In order to achieve this, leaders need to consider their collaboration with other stakeholders, longitudinal integration strategies that go beyond piecemeal solutions and transform the perception of what “home” means in healthcare to meet consumers where they are.
Step 1: Collaborate to advance technology
If we’ve learned anything from healthcare’s digitization over the years, it’s that technology for technology’s sake is not enough – solving healthcare’s issues is a systems problem, not a disease problem. For telehealth to last, there needs to be a clinical transformation where workflows are rewritten, policies strongly incentivize its use and companies and hospitals partner on outcome-based models that support its scalability.
In the last six months, we have seen more innovation and adoption in healthcare than we’ve seen in the last decade, with typical innovation timelines of years becoming weeks or days. In many ways, this creativity and open innovation saved the U.S. healthcare system from collapsing and helped us survive the initial surge. We also saw the collaboration of all sorts reach new heights, with organizations, federal agencies, private and public companies from different industries coming together to manage surge capacity while maintaining quality care. Another benefit of these partnerships is the emphasis on long-term policy changes that will empower lasting change and adoption of these innovative approaches. Industry efforts, like ours with the ATA, aim to promote telehealth’s growth and support hospitals, payers, and patients across care settings. The pandemic’s productive collaboration cannot stop here. Instead, we should continue to bring dimensions of policy, clinical experience, and consumer voices to imbed telehealth into our everyday systems.
Step 2: Determine avenues for seamless data integration across settings
Telehealth’s power is not in its technical claims, but in the power of presenting caregivers with actionable, meaningful patient data so they can make data-driven care decisions with confidence. This is only made possible with interoperable, cloud-based solutions that collect, digest, and analyze data to inform care. With constant transfer of key patient data through connected devices, such as hospital-grade wearables and biosensors, and translating the data into useable insights, remote patient monitoring empowers care teams with the knowledge needed to intervene earlier and keep patients healthy at home.
Telehealth’s power expands beyond the home, supporting a continuum of care no matter what setting a patient is in. Remote monitoring within the hospital is the crux of minimizing infection risk, handling sudden increases in patient volumes and allocating resources appropriately. These include solutions such as centralized clinical command centers to achieve remote, holistic patient views, or technology that activates scalable patient monitoring for ICU ramp-ups. The solutions we deploy need to be enablers of seamless data transfer – from the ED to ICU, to post-acute and home setting. We now must ensure our informatics backbones mature with these solutions, eliminating gaps in care while ensuring a secure flow of data where and when it’s needed. Deploying cloud-based platforms that bring together the right information across the care continuum will make for a powerful, integrated system that enhances patient and staff safety improves outcomes, and reduces costs.
Step 3: Transforming what “home” means in healthcare
2020 has transformed how we view “home.” Home has become the center of life operations for people across the globe – we work from home, we educate our children at home and we exercise at home. Healthcare is now becoming another cornerstone of the home. With a growing volume of telehealth offerings and household names providing care services, consumer behavior is changing to expect customization, convenience, and instant gratification. The consumer’s voice is loud, and tomorrow’s healthcare will move it from a whisper to a shout – We must be prepared to deliver care when and where patients want to receive it, increasingly let go of healthcare’s brick-and-mortar blueprint, and enable healthcare to match the ease and convenience of other areas of a patient’s life.
However, just like all these other ‘at-home’ activities that require getting used to or training, we need to support health literacy and engagement for all users. The pandemic has made the inequalities in our health system raw. Even before the pandemic, 5% of the patients account for about half of U.S. healthcare spending. This is a sign that they are not receiving the proactive care and support they need. We have an opportunity to change this equation with virtual care and bridge the digital divide by tailoring solutions to meet each patient’s needs and ensuring equitable availability to all patients.
Transforming telehealth into a standard of care
Technology isn’t the answer to telehealth’s success alone – it is virtualizing care where it is needed most and ensuring it is fully integrated across an institution. Healthcare organizations should reflect on where their greatest challenges and populations are, and look for systematic solutions for telehealth so that virtualization can scale efficiently and build from existing technology and workflows. With productive collaboration across sectors, robust data integration infrastructures, and an evolved perception of how we view healthcare, these tools have the power to influence how patients view and engage with their health, pushing the industry toward more proactive care that will have long-term benefits on outcomes and cost.
About Karsten Russell-Wood
Karsten Russell-Wood, MBA, MPH is the Portfolio Leader for Post-Acute and Home at Philips where he is responsible for Innovation and cross-business platform strategy and portfolio optimization. Prior to joining Philips, Karsten held global product management roles within GE’s healthcare businesses with an orientation to targeted patient populations and continues to be active in venture capital and startups in the digital health space.
The telehealth company and managed care organization are launching a new HMO plan on the Texas health insurance exchange. The ‘virtual-first’ plan is designed for those who do not qualify for Medicaid or Medicare.
– Healthcare private equity firm Heritage Group launches a $300M fund to invest in high-growth healthcare services and technology companies.
– Heritage is backed by some of the leading healthcare organizations in the nation, including large provider systems, payers, and healthcare service providers.
Heritage Group, a Nashville, TN-based healthcare-focused private equity firm, today announced the closing of over $300 million in its oversubscribed third fund, an increase of nearly $100 million over its prior fund in 2016. Heritage will continue its successful strategy of investing in solution-oriented, high-growth healthcare services, and technology businesses that are addressing the industry’s most pressing challenges.
“We are very pleased with the market’s response to our offering, especially during such a challenging economic environment,” said Paul Wallace, partner at Heritage. “We are grateful for the ongoing support of our longtime investors, and we’re excited to welcome several new LPs. We’re fortunate to have a great team and a unique model, which combine to create value for all of our stakeholders.”
Investment Model & Approach
The firm was founded by Rock Morphis and David McClellan in 1986, Heritage seeks to make majority and minority investments, ranging from $20 to $40 million per portfolio company, in high-growth healthcare services and healthcare technology businesses that address the challenges of the U.S. healthcare system. Heritage engages deeply with its strategic investors, who provide unique value and insights through all stages of the deal process, including the identification, evaluation, and subsequent growth of its portfolio companies. The firm’s strategic investors operate over 550 hospitals, with 90,000 beds, and handle approximately 3M discharges annually.
Heritage’s strategic investors and partners represent
national leaders in the payer, provider, IT, and service sectors of healthcare.
This diversity is particularly valuable as these sectors begin to converge in
the shift towards value-based care. Limited Partners include Adventist Health
System (Florida); Amedisys (Louisiana); Cardinal Health (Ohio); Cerner Corp.
(Missouri); Community Health Systems (Tennessee); Health Care Service
Corporation (Illinois); Horizon Healthcare Services (New Jersey); Intermountain
Healthcare (Utah); LifePoint Health (Tennessee); Memorial Hermann Health System
(Texas); Sutter Health (California); Tenet Health (Texas); Trinity Health
(Michigan); and UnityPoint Health (Iowa).
“Heritage’s strategic engagement is outstanding and allows us to work together as true partners. We are able to lend our expertise and share the key pain points that we encounter as we strive to provide care in a value-based model, which requires new ways of reaching and treating consumers and patients,” said Scott Nordlund, chief strategy and growth officer at Banner Health. “Heritage has been instrumental in identifying innovative businesses that solve these concerns for our organization.”
Heritage has invested in some of the leading healthcare
services and technology companies, including Aviacode, AllyAlign Health, Medical Solutions,
Sharecare, Abode Healthcare, MDLIVE, Lumere, Reload, Spero Health, etc.
The agency has finalized a rule that allows it to provide immediate Medicare coverage for FDA-approved products that are deemed “breakthrough devices.” The new coverage process would enable seniors to get access to these devices more quickly, but some provider and payer groups are concerned that this could cause patient harm.
– 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.
In a wide-ranging discussion at J.P. Morgan’s Annual Healthcare Conference, former CMS Administrator Andy Slavitt talked about the future of the ACA, telehealth and Medicare Advantage with a Democrat-led House, Senate and presidency.
– Net Health acquires post-acute market analytics platform PointRight to deepen the company’s analytics capabilities, post-acute presence, and support for SNF networks.
Health, a provider of cloud-based software for specialty medical providers
across the continuum of care, today announced that it has acquired PointRight Inc., a leading provider of
analytics and data-driven tools for the post-acute market. The acquisition adds
to Net Health’s expanding investments in analytics capabilities, which include
the recent acquisition of Tissue Analytics in April 2020 and the earlier
acquisition of Focus on Therapeutic Outcomes (FOTO).
Unlock the Power of Advanced Analytics for Post-Acute
Founded in 1995, PointRight provides analytics that shows a 360⁰ view of long-term and post-acute (LTPAC) facility performance and clinical outcomes. Equipped with these insights, LTPAC Provider and Payers can lower rehospitalization rates, improve clinical outcomes, and build and manage high-performing networks. Today, close to 2,400 SNFs use PointRight’s advanced analytics and data-driven decision support tools to further their clinical, financial, and operational objectives.
SNFs use PointRight to improve the accuracy of their reimbursement and regulatory submissions and to enhance overall performance in readmissions, quality, and outcomes, including more accurate and compliant patient assessments, reduced rehospitalization rates, and optimized care transitions.
More recently, health systems, ACOs, payers, and real estate investment trusts (REIT) have relied on PointRight to provide insight into the health of their SNF networks and to identify areas for improvement.
Acquisition Expands Net Health’s
Market Share in Growing Post-Acute Market
acquisition of PointRight expands Net Health’s position and scale in the
growing post-acute market. Additionally, the acquisition will enable Net
Health’s broad roster of hospital clients to better manage their skilled
nursing facility (SNF) networks and support outcomes measurement and performance
improvement in Medicare Advantage and managed Medicaid programs. As part of the
acquisition, Net Health
plans to fully integrate PointRight staff to accelerate the delivery of new
analytics solutions and expand the availability of PointRight to Net Health’s
customers and markets.
“Through PointRight, Net Health will significantly expand how we support SNFs and their health system, accountable care organization (ACO), payer and REIT partners,” said Josh Pickus, Net Health’s Chief Executive Officer. “It also strengthens our growing analytics capabilities by providing insights into post-acute performance, which enables providers and payers to align around value-based care initiatives.”
Financial details of the acquisition
were not disclosed.
– COVID-19 care deferrals lead to three major boomerang
conditions that payers and providers must proactively address in 2021,
according to a newly released report by Prealize.
– COVID-19’s hidden victims—those who avoided or deferred
care during the pandemic—will increasingly return to the healthcare system, and
many will be diagnosed with new conditions at more advanced stages. Healthcare
leaders must act now to keep this boomerang from driving worse outcomes and
Many procedures and diagnoses fell significantly in 2020,
with several dropping nearly 50% below 2019 levels between March and June. Total
healthcare utilization fell 23% between March and August 2020, compared to the
same time period in 2019.
To explore the full scope of healthcare utilization and
procedural declines in 2020, and assess how those declines will impact
patients’ health and payers’ pocketbooks in 2021, Prealize Health conducted an
analysis of claims data from nearly 600,000 patients between March 2020 and
Prealize identified the three predicted conditions likely to
see the largest increase in healthcare utilization in 2021:
1. Cardiac diagnoses will increase by 18% for ischemic
heart disease and 14% for congestive heart failure
These increases will be driven by 2020 healthcare
utilization declines, for example, patients deferring family medicine and
internal medicine visits. These visits, which help flag cardiac problems and
prevent them from escalating, declined 24% between March and August of 2020.
“Cardiac illnesses are some of the most serious and
potentially fatal, so delays in diagnosis can lead to significant adverse
outcomes,” said Gordon Norman, MD, Prealize’s Chief Medical Officer.
“Without early recognition and appropriate intervention, rates of patient
hospitalization and death are likely to increase, as will associated costs of
2. Cancer diagnoses will increase by 23%
Similar to cardiac screening trends, significant declines in
2020 cancer screenings will be a key driver of this increase, with 46% fewer
colonoscopies and 32% fewer mammograms performed between March and August 2020
than during that same time period in 2019.
“Cancer doesn’t stop developing or progressing because
there’s a pandemic,” said Ronald A. Paulus, MD, President and CEO at RAPMD
Strategic Advisors, Immediate Past President and CEO of Mission Health, and one
of the medical experts interviewed for the report. “In 2021, when patients
who deferred care ultimately receive their diagnoses, their cancer sadly may be
more advanced. In addition, an increase in newly diagnosed patients may make it
harder for some patients to access care and specialists—particularly for those
patients who are insured by Medicaid or lack insurance altogether.”
3. Fractures will increase by 112%
This finding, based on combined analysis of osteoporosis
risk and fall risk, is particularly troubling for the elderly patient
A key driver of increased fractures in 2021 is the number of
postponed elective orthopedic procedures in 2020, such as hip and knee
replacements. These procedural delays are likely to decrease mobility, and
therefore, increase risk of fractures from falls.
“In elderly patients, fractures are very serious events
that too often lead to decreased overall mobility and quality of life,”
said Norman. “As a result, patients may suffer from physical follow-on
events like pulmonary embolisms, and behavioral health concerns like increased
Why It Matters
“These predictions are daunting, but the key is that providers and payers take action now to mitigate their effects,” said Prealize CEO Linda T. Hand. “It’s going to be critical to gain insight into populations to understand their risk at an individual level, build trust, and treat their conditions as early as possible to improve outcomes. The COVID-19 pandemic has challenged every aspect of our healthcare system, but the way to get ahead of these challenges in 2021 will be to proactively identify and address patients most at risk. We’re going to see proactive care become an important driver for success next year, as providers and payers seek to mitigate unnecessary and expensive procedures that result from 2020’s decreased medical utilization. The right predictive analytics partner will be critical to providers and payers being able to take the right course of action.”
A new report, from cybersecurity firm Fortified Health Security, shows that nearly 200 more data breaches occurred in the first 10 months of 2020 compared with the year prior — around 80% of which targeted providers.
HIT Consultant sat down with Mike McSherry, CEO, and co-founder of Seattle-based digital prescription platform Xealth to discuss digital health lessons learned in 2020 and what we can expect in 2021. As Xealth’s CEO, Mike also works with Duke Health, UPMC, Atrium Health, and The Froedtert & the Medical College of Wisconsin health network where he uses his background in digital health to connect patients and care teams outside of traditional care settings.
HITC: In 2021, How can digital health reduce race and minority disparities in healthcare?
McSherry: The U.S. has struggled with health disparities, which this pandemic has widened. Many of these disparities can be linked to access, which digital health can assist with – telehealth makes care virtual from any location, clinical decision support can reduce human errors, remote patient monitoring helps keep patients home while linked to care.
Digital health removes hurdles related to transportation, taking time off work, or finding childcare in order to travel in-person for an appointment. It brings care to the patient instead of the other way around, making access simpler. Care through these pathways is also more cost-efficient.
There are still hurdles to overcome. Broadband is widespread but not everywhere and inclusive design of these tools should be considered. How digital tools, including wearables, are built should address differences in gender and ethnicity, especially as these tools are used more frequently in clinical trials, so as not to inadvertently perpetuate disparities.
HITC: Why some hospitals are offering digital health tools to staff but not patients?
McSherry: There are a few factors at play when hospitals offer digital health tools to staff but not patients. One, most health systems are not currently deploying system-wide digital health initiatives, leaving the decisions to individual departments or providers. This can lead to inconsistent patient experiences and more data siloes as solutions are brought in as one-offs.
The second issue is reimbursement. A hospital acting as an employer offering digital health tools as part of its benefits package is different than a patient, who must rely on their health insurance, whether it is a public or private plan. The fact healthcare organizations see digital health tools as a perk shows their value. Now, it is time for CMS and commercial payers to consistently enable their use to help providers care for patients and incorporate digital health as clinicians see fit.
HITC: How hospitals can remain competitive in 2021, especially after tighter margins from COVID-19?
McSherry: Large tech companies, like Google and Amazon, and huge retailers, including Walmart and Best Buy, are looking to deliver the promise of health care that has so far eluded the industry. Venture capital money has been pouring in for funding innovation, with digital health funding hitting a new high in 2020.
These initiatives are all racing to control health care’s front door and if hospitals don’t innovate as well, they run a very real risk of having patients turn elsewhere for care. Payers are also building digital front doors and telling members to go there. People have long expressed their desire to have the same consumer experience in health care that they receive in other industries. The technology is there. It needs to be incorporated with the correct care pathways.
One silver lining during the COVID-19 pandemic is that it showed fast-moving innovation can happen in health care. We worked with hospitals to stand up workflows around telehealth in four days and remote patient monitoring in seven days – an amazing pace. The key is to keep this stride going once we are on the other side of this crisis.
Providers are becoming more digitally savvy to engage patients and deliver holistic care. Hospitals should support this.
HITC: What will be Biden’s impact on COVID-19, how hospital leaders should respond, and what it means that we have a divided congress?
McSherry: Under the current administration, telehealth rules have been relaxed, at least temporarily, along with cross-state licensure so providers are better able to build a front door strategy, helping organizations roll out remote patient monitoring and chronic care management apps. Biden has been a proponent of digitalization in health care and will have a broader engagement. This could lead toward more funding and more covered lives.
A divided Congress will not make much easy for the Biden administration, however, getting on the other side of this pandemic as quickly and as safely as possible is best for everyone. Biden has shown he will make fighting COVID-19 a top priority.
HITC: Will remote patient monitoring become financially viable for hospital leaders in 2021?
McSherry: Why does a diabetic patient need to have every check-in be in-person or a healthy, pregnancy met every few weeks with an in-person visit as opposed to remote monitoring for key values and a telehealth check-in in place of a couple of those visits? Moving forward, hospitals will see the benefit of remote monitoring in terms of lower overhead, along with better patient engagement, outcomes and retention.
To make this work, providers must share risk, and determine digital strategies around attracting patients and then manage them in a capitated way with more digital tools because of the cost efficiencies.
HITC: How do we foster tighter physician-patient relationships?
McSherry: Patients trust their doctors, period. The struggle is going to be more obvious as more people do not have a PCP and turn to health care with a bandage approach to take care of an immediate concern. That will lead to entire populations without that trusted bond who are sicker when they finally do seek care, due to the lack of continuity and engagement early on.
By connecting with people now, where they are comfortable, there is a tighter physician-patient relationship by making it more accessible and reciprocal.
As the COVID-19 pandemic has gripped the world, many providers have adopted an all-hands-on-deck approach and mentality for treating COVID-19 patients, stretching their resources to the breaking point.
We have heard about the frontline heroes who have sacrificed their own health and safety to treat patients and, in less-fortunate scenarios, comfort patients in their last moments as they were quarantined from loved ones.
What has been less recognized is the work and sacrifice put forth by providers’ back-office staff. Many back-office workers have had to transform their operational practices after shifting to “work-from-home” mode to avoid potential exposure and minimize traffic to hospitals and physicians’ offices.
In addition to working in new environments, some of these back-office administrators who help process claims, receive reimbursements, check eligibility and manage denials are also seeing a higher volume of claims that are more complicated in nature due to the severity and complexity of managing COVID-19 symptoms in patients. Others are working with bare-bones staff as elective procedure volumes have decreased.
The biggest challenges with COVID-19 claims While many aspects of the pandemic are beyond providers’ control, proper coding of COVID-19 claims is one area they can focus on to help ensure efficient operations and revenues. Of course, that is easier said than done. The following are just a few challenges providers have been facing with COVID-19 claims.
Increased complexity: Due to the complexity of COVID-19 cases, which affect many elderly patients and those patients with chronic conditions and comorbidities, associated claims often take longer to code, file and process compared to more straightforward cases. More complex COVID-19 cases lead to longer hospital stays, which can create delays in submitting claims, resulting in delays in receiving reimbursements.
Continued shift to electronic transactions: While many hospitals and provider groups have shifted to submitting claims electronically, many processes, including prior-authorizations, eligibility and estimation requests and grievances, and appeals, rely heavily on manual intervention. These processes frequently require access to faxed or paper documents. Administrative staff members have had to quickly learn new systems and processes.
Difficulties with reimbursement for the uninsured: Through the Coronavirus Aid, Relief, and Economic Security Act (also known as the CARES Act) and other legislation, the federal government has appropriated funding earmarked for providers that deliver COVID-19 testing and treatment to the uninsured. While this was certainly a welcome gesture at a time when many have lost their health insurance due to unemployment, the support has come with some administrative strings attached that lead to challenges for providers.
For example, before submitting a claim, providers must show they have gone through an attestation process and document their efforts to find other medical coverage for the patient. Then providers essentially have just one shot at submitting a clean claim, as there is no appeals process for denials deemed inappropriate or unjustified. In cases of denials, providers themselves have little recourse for obtaining reimbursement and end up with a loss in revenue and increased costs. Although the efforts to help uninsured patients with COVID-19 testing and treatment are well-intentioned, providers must follow specific steps to realize the benefits.
Processing COVID-19 claims more efficiently It has become clear that COVID-19 claims, though in many ways similar to traditional claims, have unique impediments that create difficulties for hospital and provider administrators. We have observed this in our own data. When comparing COVID-19 claims to non-COVID-19 claims, the COVID-19 claims have demonstrated a greater error rate (9-12% compared with 5-7%) and a longer time to submit (45 days compared to 30 days).
Despite these challenges, providers can implement the following steps to manage the workload, process COVID-19 claims efficiently, and work within the constraints of their new “work-from-home” offices.
1. Leverage technology that identifies errors and provides upfront edits to all COVID-19 claims. Automated revenue cycle solutions should contain updated functionality to properly review claims and flag potential issues prior to the claim being submitted to a payer.
2. Move coverage discovery to the front end of the billing process and ensure it is performed for all patients. There are many solutions that will search for insurance coverage across both commercial and government payers. When identified, the payer information can be reviewed and added to a patient’s billing information.
3. Review analytics within the revenue cycle management system to identify COVID-19 claims. Analyze these claims by payer, claim amount, and number and severity of services rendered. Scrubbing and editing claims in advance will ensure accuracy while also highlighting anomalies to review and fix prior to submitting the claim.
4. Constantly review claims for inpatient stays to ensure that all charges are recorded and all medical records are updated and attached. Getting all documentation ready and prepared in advance will save time on the backend.
Though we all hope that the pandemic winds down and we soon return to some sense of normalcy, it takes more than hope for providers to get their COVID-19 claims reimbursed accurately and quickly. Following the tips above will help keep administrative processes running smoothly and alleviate burdens that will inevitably occur once patients are treated and the billing cycle continues.
About Lillian Phelps
Lillian Phelps is the senior director of product management for Availity, the nation’s largest health information network.
Optum, a subsidiary of insurance giant UnitedHealth Group, agreed to buy healthcare technology company Change Healthcare for $13.5 billion in cash. The acquisition will add data analytics, research and revenue cycle management offerings to Optum’s service roster.
– 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 insurer will pay $95 per share in cash to acquire Magellan Health, a company providing an array of services, including pharmacy benefit management and behavioral health and employee assistance program services. The companies aim to develop a behavioral health platform.
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
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
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 acquireCollective 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.
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, a data
analytics provider, announced today that it has acquiredFranco 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.
Healthcare data security has been a growing concern for CIOs for the last year or so, as hackers are increasingly targeting health information. Now, with a global pandemic forcing a shift to telemedicine and remote work, and new rules from the ONC and CMS introducing more regulatory burden, healthcare CIOs have more to manage than ever. Fortunately, it is possible to roll out new capabilities while simultaneously improving cybersecurity by following these three rules:
Rule 1: Think Like an Attacker
The coronavirus pandemic has forced healthcare providers everywhere to roll out new capabilities, processes, and workflows, such as telemedicine systems and new patient check-in procedures. These measures are being taken in addition to the necessary work being done to comply with the new mandates from ONC and CMS regarding patient data accessibility. Though these changes need to be implemented quickly, it’s important to follow cybersecurity best practices to avoid providing new openings for attackers.
When a hacker sees new systems and processes being implemented, they are thinking about:
– What software is being introduced? Are there known vulnerabilities or frequently unpatched exploits associated with it?
– How are new endpoints being added and are they secure?
– Since the new ONC and CMS rules require publicly exposed FHIR APIs, how can those be attacked? Are there social engineering exploits that can provide a way around security?
– Are there ways to perpetrate identity fraud if a patient does not need to be physically present to receive healthcare?
This approach should lead to a cybersecurity plan that puts measures in place for each identified risk. By thinking like the adversary, it is possible to identify and lock down the possible attack vectors.
Rule 2: Minimize the Attack Surface
Every way into an organization’s network needs to be secured, monitored, and maintained. The best way to make this process as efficient and fool-proof as possible is to minimize the number of ways into the network.
This is especially difficult in light of the ONC and CMS rules, which require that clinical systems must share data through publicly available FHIR APIs. At first, this seems like a mandate to radically expand the organization’s attack surface. Indeed, this is precisely what happens if the straightforward approach of exposing every clinical system through public APIs is followed.
A different approach, which provides the same capabilities and compliance with the rules, would be to route all API traffic through a central hub. Attaching all the clinical systems to a single point of API access provides a number of benefits:
– Most importantly, compliance is achieved while minimizing the new attack vectors.
– All traffic between clinical systems and the outside world can be monitored from a single place.
– The API hub can act as a façade that makes legacy systems compliant with the new rules, even if those systems lack native FHIR API capabilities.
The API hub need not be an expensive new component of the network architecture. Most healthcare organizations are already using a clinical integration engine to move HL7, XML, and DICOM traffic among their internal systems. The same technology can serve as an API hub. This is especially effective if a new instance of the integration engine is placed in an isolated part of the network without full access to other systems.
Rule 3: Have an Expert Review the Defenses
Even for healthcare organizations with cybersecurity experts on staff, it can be worthwhile to bring in a cybersecurity consultant to cross-check new implementations. Novel threats are constantly shifting and emerging, making it nearly impossible for internal IT staff to keep up with the looming threats of ransomware hacks, while also adequately carrying out the day-to-day responsibilities of their jobs. For that reason, it makes sense to bring in a professional who focuses exclusively on security. It is also often useful to have an independent review from someone who is looking at the implementation from an outsider’s perspective. Independent consultants can provide the necessary guidance, risk assessments, and other security support, to set healthcare organizations up for success and operate more securely.
Expanding an organization’s IT capabilities often means more exposure to risk, especially when implementations are subject to time constraints. However, given the value and importance of the data that’s being generated, transmitted, and stored, it is imperative not to let cybersecurity fall out of focus. By following best practices around design, implementation, and testing healthcare organizations can rise to meet the current challenges of the pandemic, address the mandates of the interoperability rules, and simultaneously improve data security measures.
About Scott Galbari, Chief Technology Officer
As Chief Technology Officer for Lyniate, Scott leads the development and delivery of all products and services. Scott has been in the healthcare IT domain for the past twenty years and has experience in developing and delivering imaging, workflow, nursing, interoperability, and patient flow solutions to customers in all geographies. He was most recently the General Manager for multiple businesses within McKesson and Change Healthcare and started his career as a software developer.
About Drew Ivan, Chief Product & Strategy Officer
Drew’s focus is on how to operationalize and productize integration technologies, patterns, and best practices. His experience includes over 20 years in health IT, working with a wide spectrum of customers, including public HIEs, IDNs, payers, life sciences companies, and software vendors, with the goal of improving outcomes and reducing costs by aggregating and analyzing clinical, claims, and cost data.
As we close out the year, we asked several healthcare executives to share their predictions and trends for 2021.
Kimberly Powell, Vice President & General Manager, NVIDIA Healthcare
Federated Learning: The clinical community will increase their use of federated learning approaches to build robust AI models across various institutions, geographies, patient demographics, and medical scanners. The sensitivity and selectivity of these models are outperforming AI models built at a single institution, even when there is copious data to train with. As an added bonus, researchers can collaborate on AI model creation without sharing confidential patient information. Federated learning is also beneficial for building AI models for areas where data is scarce, such as for pediatrics and rare diseases.
AI-Driven Drug Discovery: The COVID-19 pandemic has put a spotlight on drug discovery, which encompasses microscopic viewing of molecules and proteins, sorting through millions of chemical structures, in-silico methods for screening, protein-ligand interactions, genomic analysis, and assimilating data from structured and unstructured sources. Drug development typically takes over 10 years, however, in the wake of COVID, pharmaceutical companies, biotechs, and researchers realize that acceleration of traditional methods is paramount. Newly created AI-powered discovery labs with GPU-accelerated instruments and AI models will expedite time to insight — creating a computing time machine.
Smart Hospitals: The need for smart hospitals has never been more urgent. Similar to the experience at home, smart speakers and smart cameras help automate and inform activities. The technology, when used in hospitals, will help scale the work of nurses on the front lines, increase operational efficiency, and provide virtual patient monitoring to predict and prevent adverse patient events.
Omri Shor, CEO of Medisafe
Healthcare policy: Expect to see more moves on prescription drug prices, either through a collaborative effort among pharma groups or through importation efforts. Pre-existing conditions will still be covered for the 135 million Americans with pre-existing conditions.
The Biden administration has made this a central element of this platform, so coverage will remain for those covered under ACA. Look for expansion or revisions of the current ACA to be proposed, but stalled in Congress, so existing law will remain largely unchanged. Early feedback indicates the Supreme Court is unlikely to strike down the law entirely, providing relief to many during a pandemic.
Brent D. Lang, Chairman & Chief Executive Officer, Vocera Communications
The safety and well-being of healthcare workers will be a top priority in 2021. While there are promising headlines about coronavirus vaccines, we can be sure that nurses, doctors, and other care team members will still be on the frontlines fighting COVID-19 for many more months. We must focus on protecting and connecting these essential workers now and beyond the pandemic.
Modernized PPE Standards Clinicians should not risk contamination to communicate with colleagues. Yet, this simple act can be risky without the right tools. To minimize exposure to infectious diseases, more hospitals will rethink personal protective equipment (PPE) and modernize standards to include hands-free communication technology. In addition to protecting people, hands-free communication can save valuable time and resources. Every time a nurse must leave an isolation room to answer a call, ask a question, or get supplies, he or she must remove PPE and don a fresh set to re-enter. With voice-controlled devices worn under PPE, the nurse can communicate without disrupting care or leaving the patient’s bedside.
Voice-controlled solutions can also help new or reassigned care team members who are unfamiliar with personnel, processes, or the location of supplies. Instead of worrying about knowing names or numbers, they can use simple voice commands to connect to the right person, group, or information quickly and safely. In addition to simplifying clinical workflows, an intelligent communication system can streamline operational efficiencies, improve triage and throughput, and increase capacity, which is all essential to hospitals seeking ways to recover from 2020 losses and accelerate growth.
Michael Byczkowski, Global Vice President, Head of Healthcare Industry at SAP,
New, targeted healthcare networks will collaborate and innovate to improve patient outcomes.
We will see many more touchpoints between different entities ranging from healthcare providers and life sciences companies to technology providers and other suppliers, fostering a sense of community within the healthcare industry. More organizations will collaborate based on existing data assets, perform analysis jointly, and begin adding innovative, data-driven software enhancements. With these networks positively influencing the efficacy of treatments while automatically managing adherence to local laws and regulations regarding data use and privacy, they are paving the way for software-defined healthcare.
Smart hospitals will create actionable insights for the entire organization out of existing data and information.
Medical records as well as operational data within a hospital will continue to be digitized and will be combined with experience data, third-party information, and data from non-traditional sources such as wearables and other Internet of Things devices. Hospitals that have embraced digital are leveraging their data to automate tasks and processes as well as enable decision support for their medical and administrative staff. In the near future, hospitals could add intelligence into their enterprise environments so they can use data to improve internal operations and reduce overhead.
Curt Medeiros, President and Chief Operating Officer of Ontrak
As health care costs continue to rise dramatically given the pandemic and its projected aftermath, I see a growing and critical sophistication in healthcare analytics taking root more broadly than ever before. Effective value-based care and network management depend on the ability of health plans and providers to understand what works, why, and where best to allocate resources to improve outcomes and lower costs. Tied to the need for better analytics, I see a tipping point approaching for finally achieving better data security and interoperability. Without the ability to securely share data, our industry is trying to solve the world’s health challenges with one hand tied behind our backs.
G. Cameron Deemer, President, DrFirst
Like many business issues, the question of whether to use single-vendor solutions or a best-of-breed approach swings back and forth in the healthcare space over time. Looking forward, the pace of technology change is likely to swing the pendulum to a new model: systems that are supplemental to the existing core platform. As healthcare IT matures, it’s often not a question of ‘can my vendor provide this?’ but ‘can my vendor provide this in the way I need it to maximize my business processes and revenues?
This will be more clear with an example: An EHR may provide a medication history function, for instance, but does it include every source of medication history available? Does it provide a medication history that is easily understood and acted upon by the provider? Does it provide a medication history that works properly with all downstream functions in the EHR? When a provider first experiences medication history during a patient encounter, it seems like magic.
After a short time, the magic fades to irritation as the incompleteness of the solution becomes more obvious. Much of the newer healthcare technologies suffer this same incompleteness. Supplementing the underlying system’s capabilities with a strongly integrated third-party system is increasingly going to be the strategy of choice for providers.
Angie Franks, CEO of Central Logic
In 2021, we will see more health systems moving towards the goal of truly operating as one system of care. The pandemic has demonstrated in the starkest terms how crucial it is for health systems to have real-time visibility into available beds, providers, transport, and scarce resources such as ventilators and drugs, so patients with COVID-19 can receive the critical care they need without delay. The importance of fully aligning as a single integrated system that seamlessly shares data and resources with a centralized, real-time view of operations is a lesson that will resonate with many health systems.
Expect in 2021 for health systems to enhance their ability to orchestrate and navigate patient transitions across their facilities and through the continuum of care, including post-acute care. Ultimately, this efficient care access across all phases of care will help healthcare organizations regain revenue lost during the historic drop in elective care in 2020 due to COVID-19.
In addition to elevating revenue capture, improving system-wide orchestration and navigation will increase health systems’ bed availability and access for incoming patients, create more time for clinicians to operate at the top of their license, and reduce system leakage. This focus on creating an ‘operating as one’ mindset will not only help health systems recover from 2020 losses, it will foster sustainable and long-term growth in 2021 and well into the future.
John Danaher, MD, President, Global Clinical Solutions, Elsevier
COVID-19 has brought renewed attention to healthcare inequities in the U.S., with the disproportionate impact on people of color and minority populations. It’s no secret that there are indicative factors, such as socioeconomic level, education and literacy levels, and physical environments, that influence a patient’s health status. Understanding these social determinants of health (SDOH) better and unlocking this data on a wider scale is critical to the future of medicine as it allows us to connect vulnerable populations with interventions and services that can help improve treatment decisions and health outcomes. In 2021, I expect the health informatics industry to take a larger interest in developing technologies that provide these kinds of in-depth population health insights.
Jay Desai, CEO and co-founder of PatientPing
2021 will see an acceleration of care coordination across the continuum fueled by the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access rule’s e-notifications Condition of Participation (CoP), which goes into effect on May 1, 2021. The CoP requires all hospitals, psych hospitals, and critical access hospitals that have a certified electronic medical record system to provide notification of admit, discharge, and transfer, at both the emergency room and the inpatient setting, to the patient’s care team. Due to silos, both inside and outside of a provider’s organization, providers miss opportunities to best treat their patients simply due to lack of information on patients and their care events.
This especially impacts the most vulnerable patients, those that suffer from chronic conditions, comorbidities or mental illness, or patients with health disparities due to economic disadvantage or racial inequity. COVID-19 exacerbated the impact on these vulnerable populations. To solve for this, healthcare providers and organizations will continue to assess their care coordination strategies and expand their patient data interoperability initiatives in 2021, including becoming compliant with the e-notifications Condition of Participation.
Kuldeep Singh Rajput, CEO and founder of Biofourmis
Driven by CMS’ Acute Hospital at Home program announced in November 2020, we will begin to see more health systems delivering hospital-level care in the comfort of the patient’s home–supported by technologies such as clinical-grade wearables, remote patient monitoring, and artificial intelligence-based predictive analytics and machine learning.
A randomized controlled trial by Brigham Health published in Annals of Internal Medicine earlier this year demonstrated that when compared with usual hospital care, Home Hospital programs can reduce rehospitalizations by 70% while decreasing costs by nearly 40%. Other advantages of home hospital programs include a reduction in hospital-based staffing needs, increased capacity for those patients who do need inpatient care, decreased exposure to COVID-19 and other viruses such as influenza for patients and healthcare professionals, and improved patient and family member experience.
Jake Pyles, CEO, CipherHealth
The disappearance of the hospital monopoly will give rise to a new loyalty push
Healthcare consumerism was on the rise ahead of the pandemic, but the explosion of telehealth in 2020 has effectively eliminated the geographical constraints that moored patient populations to their local hospitals and providers. The fallout has come in the form of widespread network leakage and lost revenue. By October, in fact, revenue for hospitals in the U.S. was down 9.2% year-over-year. Able to select providers from the comfort of home and with an ever-increasing amount of personal health data at their convenience through the growing use of consumer-grade wearable devices, patients are more incentivized in 2021 to choose the provider that works for them.
After the pandemic fades, we’ll see some retrenchment from telehealth, but it will remain a mainstream care delivery model for large swaths of the population. In fact, post-pandemic, we believe telehealth will standardize and constitute a full 30% to 40% of interactions.
That means that to compete, as well as to begin to recover lost revenue, hospitals need to go beyond offering the same virtual health convenience as their competitors – Livango and Teladoc should have been a shot across the bow for every health system in 2020. Moreover, hospitals need to become marketing organizations. Like any for-profit brand, hospitals need to devote significant resources to building loyalty but have traditionally eschewed many of the cutting-edge marketing techniques used in other industries. Engagement and personalization at every step of the patient journey will be core to those efforts.
Marc Probst, former Intermountain Health System CIO, Advisor for SR Health by Solutionreach
Healthcare will fix what it’s lacking most–communication.
Because every patient and their health is unique, when it comes to patient care, decisions need to be customized to their specific situation and environment, yet done in a timely fashion. In my two decades at one of the most innovative health systems in the U.S., communication, both across teams and with patients continuously has been less than optimal. I believe we will finally address both the interpersonal and interface communication issues that organizations have faced since the digitization of healthcare.”
Rich Miller, Chief Strategy Officer, Qgenda
2021 – The year of reforming healthcare: We’ve been looking at ways to ease healthcare burdens for patients for so long that we haven’t realized the onus we’ve put on providers in doing so. Adding to that burden, in 2020 we had to throw out all of our playbooks and become masters of being reactive. Now, it’s time to think through the lessons learned and think through how to be proactive. I believe provider-based data will allow us to reformulate our priorities and processes. By analyzing providers’ biggest pain points in real-time, we can evaporate the workflow and financial troubles that have been bothering organizations while also relieving providers of their biggest problems.”
Robert Hanscom, JD, Vice President of Risk Management and Analytics at Coverys
Data Becomes the Fix, Not the Headache for Healthcare
The past 10 years have been challenging for an already overextended healthcare workforce. Rising litigation costs, higher severity claims, and more stringent reimbursement mandates put pressure on the bottom line. Continued crises in combination with less-than-optimal interoperability and design of health information systems, physician burnout, and loss of patient trust, have put front-line clinicians and staff under tremendous pressure.
Looking to the future, it is critical to engage beyond the day to day to rise above the persistent risks that challenge safe, high-quality care on the frontline. The good news is healthcare leaders can take advantage of tools that are available to generate, package, and learn from data – and use them to motivate action.
Steve Betts, Chief of Operations and Products at Gray Matter Analytics
Analytics Divide Intensifies: Just like the digital divide is widening in society, the analytics divide will continue to intensify in healthcare. The role of data in healthcare has shifted rapidly, as the industry has wrestled with an unsustainable rate of increasing healthcare costs. The transition to value-based care means that it is now table stakes to effectively manage clinical quality measures, patient/member experience measures, provider performance measures, and much more. In 2021, as the volume of data increases and the intelligence of the models improves, the gap between the haves and have nots will significantly widen at an ever-increasing rate.
Substantial Investment in Predictive Solutions: The large health systems and payors will continue to invest tens of millions of dollars in 2021. This will go toward building predictive models to infuse intelligent “next best actions” into their workflows that will help them grow and manage the health of their patient/member populations more effectively than the small and mid-market players.
Jennifer Price, Executive Director of Data & Analytics at THREAD
The Rise of Home-based and Decentralized Clinical Trial Participation
In 2020, we saw a significant rise in home-based activities such as online shopping, virtual school classes and working from home. Out of necessity to continue important clinical research, home health services and decentralized technologies also moved into the home. In 2021, we expect to see this trend continue to accelerate, with participants receiving clinical trial treatments at home, home health care providers administering procedures and tests from the participant’s home, and telehealth virtual visits as a key approach for sites and participants to communicate. Hybrid decentralized studies that include a mix of on-site visits, home health appointments and telehealth virtual visits will become a standard option for a range of clinical trials across therapeutic areas. Technological advances and increased regulatory support will continue to enable the industry to move out of the clinic and into the home.
Doug Duskin, President of the Technology Division at Equality Health
Value-based care has been a watchword of the healthcare industry for many years now, but advancement into more sophisticated VBC models has been slower than anticipated. As we enter 2021, providers – particularly those in fee-for-service models who have struggled financially due to COVID-19 – and payers will accelerate this shift away from fee-for-service medicine and turn to technology that can facilitate and ease the transition to more risk-bearing contracts. Value-based care, which has proven to be a more stable and sustainable model throughout the pandemic, will seem much more appealing to providers that were once reluctant to enter into risk-bearing contracts. They will no longer be wondering if they should consider value-based contracting, but how best to engage.
Brian Robertson, CEO of VisiQuate
Continued digitization and integration of information assets: In 2021, this will lead to better performance outcomes and clearer, more measurable examples of “return on data, analytics, and automation.
Digitizing healthcare’s complex clinical, financial, and operational information assets: I believe that providers who are further in the digital transformation journey will make better use of their interconnected assets, and put the healthcare consumer in the center of that highly integrated universe. Healthcare consumer data will be studied, better analyzed, and better predicted to drive improved performance outcomes that benefit the patient both clinically and financially.
Some providers will have leapfrog moments: These transformations will be so significant that consumers will easily recognize that they are receiving higher value. Lower acuity telemedicine and other virtual care settings are great examples that lead to improved patient engagement, experience and satisfaction. Device connectedness and IoT will continue to mature, and better enable chronic disease management, wellness, and other healthy lifestyle habits for consumers.
Kermit S. Randa, CEO of Syntellis Performance Solutions
Healthcare CEOs and CFOs will partner closely with their CIOs on data governance and data distribution planning. With the massive impact of COVID-19 still very much in play in 2021, healthcare executives will need to make frequent data-driven – and often ad-hoc — decisions from more enterprise data streams than ever before. Syntellis research shows that healthcare executives are already laser-focused on cost reduction and optimization, with decreased attention to capital planning and strategic growth. In 2021, there will be a strong trend in healthcare organizations toward new initiatives, including clinical and quality analytics, operational budgeting, and reporting and analysis for decision support.
Dr. Calum Yacoubian, Associate Director of Healthcare Product & Strategy at Linguamatics
As payers and providers look to recover from the damage done by the pandemic, the ability to deliver value from data assets they already own will be key. The pandemic has displayed the siloed nature of healthcare data, and the difficulty in extracting vital information, particularly from unstructured data, that exists. Therefore, technologies and solutions that can normalize these data to deliver deeper and faster insights will be key to driving economic recovery. Adopting technologies such as natural language processing (NLP) will not only offer better population health management, ensuring the patients most in need are identified and triaged but will open new avenues to advance innovations in treatments and improve operational efficiencies.
Prior to the pandemic, there was already an increasing level of focus on the use of real-world data (RWD) to advance the discovery and development of new therapies and understand the efficacy of existing therapies. The disruption caused by COVID-19 has sharpened the focus on RWD as pharma looks to mitigate the effect of the virus on conventional trial recruitment and data collection. One such example of this is the use of secondary data collection from providers to build real-world cohorts which can serve as external comparator arms.
This convergence on seeking value from existing RWD potentially affords healthcare providers a powerful opportunity to engage in more clinical research and accelerate the work to develop life-saving therapies. By mobilizing the vast amount of data, they will offer pharmaceutical companies a mechanism to positively address some of the disruption caused by COVID-19. This movement is one strategy that is key to driving provider recovery in 2021.
Rose Higgins, Chief Executive Officer of HealthMyne
Precision imaging analytics technology, called radiomics, will increasingly be adopted and incorporated into drug development strategies and clinical trials management. These AI-powered analytics will enable drug developers to gain deeper insights from medical images than previously capable, driving accelerated therapy development, greater personalization of treatment, and the discovery of new biomarkers that will enhance clinical decision-making and treatment.
Dharmesh Godha, President and CTO of Advaiya
Greater adoption and creative implementation of remote healthcare will be the biggest trend for the year 2021, along with the continuous adoption of cloud-enabled digital technologies for increased workloads. Remote healthcare is a very open field. The possibilities to innovate in this area are huge. This is the time where we can see the beginning of the convergence of personal health aware IoT devices (smartwatches/ temp sensors/ BP monitors/etc.) with the advanced capabilities of the healthcare technologies available with the monitoring and intervention capabilities for the providers.
Simon Wu, Investment Director, Cathay Innovation
Healthcare Data Proves its Weight in Gold in 2021
Real-world evidence or routinely stored data from hospitals and claims, being leveraged by healthcare providers and biopharma companies along with those that can improve access to data will grow exponentially in the coming year. There are many trying to build in-house, but similar to autonomous technology, there will be a separate set of companies emerge in 2021 to provide regulated infrastructure and have their “AWS” moment.
Kyle Raffaniello, CEO of Sapphire Digital
2021 is a clear year for healthcare price transparency
Over the past year, healthcare price transparency has been a key topic for the Trump administration in an effort to lower healthcare costs for Americans. In recent months, COVID-19 has made the topic more important to patients than ever before. Starting in January, we can expect the incoming Biden administration to not only support the existing federal transparency regulations but also continue to push for more transparency and innovation within Medicare. I anticipate that healthcare price transparency will continue its momentum in 2021 as one of two Price Transparency rules takes effect and the Biden administration supports this movement.
Dennis McLaughlin VP of Omni Operations + Product at ibi
Social Determinants of Health Goes Mainstream: Understanding more about the patient and their personal environment has a hot topic the past two years. Providers and payers’ ability to inject this knowledge and insight into the clinical process has been limited. 2021 is the year it gets real. It’s not just about calling an uber anymore. The organizations that broadly factor SDOH into the servicing model especially with virtualized medicine expanding broadly will be able to more effectively reach vulnerable patients and maximize the effectiveness of care.
Joe Partlow, CTO at ReliaQuest
The biggest threat to personal privacy will be healthcare information: Researchers are rushing to pool resources and data sets to tackle the pandemic, but this new era of openness comes with concerns around privacy, ownership, and ethics. Now, you will be asked to share your medical status and contact information, not just with your doctors, but everywhere you go, from workplaces to gyms to restaurants. Your personal health information is being put in the hands of businesses that may not know how to safeguard it. In 2021, cybercriminals will capitalize on rapid U.S. telehealth adoption. Sharing this information will have major privacy implications that span beyond keeping medical data safe from cybercriminals to wider ethics issues and insurance implications.
Jimmy Nguyen, Founding President at Bitcoin Association
Blockchain solutions in the healthcare space will bring about massive improvements in two primary ways in 2021.
Firstly, blockchain applications will for the first time facilitate patients owning, managing, and even monetizing their personal health data. Today’s healthcare information systems are incredibly fragmented, with patient data from different sources – be they physicians, pharmacies, labs, or otherwise – kept in different silos, eliminating the ability to generate a holistic view of patient information and restricting healthcare providers from producing the best health outcomes.
Healthcare organizations are growing increasingly aware of the ways in which blockchain technology can be used to eliminate data silos, enable real-time access to patient information, and return control to patients for the use of their personal data – all in a highly-secure digital environment. 2021 will be the year that patient data goes blockchain.
Secondly, blockchain solutions can ensure more honesty and transparency in the development of pharmaceutical products. Clinical research data is often subject to questions of integrity or ‘hygiene’ if data is not properly recorded, or worse, is deliberately fabricated. Blockchain technology enables easy, auditable tracking of datasets generated by clinical researchers, benefitting government agencies tasked with approving drugs while producing better health outcomes for healthcare providers and patients. In 2021, I expect to see a rise in the use and uptake of applications that use public blockchain systems to incentivize greater honesty in clinical research.
Alex Lazarow, Investment Director, Cathay Innovation
The Future of US Healthcare is Transparent, Fair, Open and Consumer-Driven
In the last year, the pandemic put a spotlight on the major gaps in healthcare in the US, highlighting a broken system that is one of the most expensive and least distributed in the world. While we’ve already seen many boutique healthcare companies emerge to address issues around personalization, quality and convenience, the next few years will be focused on giving the power back to consumers, specifically with the rise of insurtechs, in fixing the transparency, affordability, and incentive issues that have plagued the private-based US healthcare system until now.
Lisa Romano, RN, Chief Nursing Officer, CipherHealth
Hospitals will need to counter the staff wellness fallout
The pandemic has placed unthinkable stress on frontline healthcare workers. Since it began, they’ve been working under conditions that are fundamentally more dangerous, with fewer resources, and in many cases under the heavy emotional burden of seeing several patients lose their battle with COVID-19. The fallout from that is already beginning – doctors and nurses are leaving the profession, or getting sick, or battling mental health struggles. Nursing programs are struggling to fill classes. As a new wave of the pandemic rolls across the country, that fallout will only increase. If they haven’t already, hospitals in 2021 will place new premiums upon staff wellness and staff health, tapping into the same type of outreach and purposeful rounding solutions they use to round on patients.
Kris Fitzgerald, CTO, NTT DATA Services
Quality metrics for health plans – like data that measures performance – was turned on its head in 2020 due to delayed procedures. In the coming year, we will see a lot of plans interpret these delayed procedures flexibly so they honor their plans without impacting providers. However, for so long, the payer’s use of data and the provider’s use of data has been disconnected. Moving forward the need for providers to have a more specific understanding of what drives the value and if the cost is reasonable for care from the payer perspective is paramount. Data will ensure that this collaboration will be enhanced and the concept of bundle payments and aligning incentives will be improved. As the data captured becomes even richer, it will help people plan and manage their care better. The addition of artificial intelligence (AI) to this data will also play a huge role in both dialog and negotiation when it comes to cost structure. This movement will lead to a spike in value-based care adoption
The panel, What It Takes To Build A Successful, Regional BioInnovation Hub (sponsored by Independence Blue Cross) focuses on Philadelphia — one of many cities seeking to support the continued growth of cell and gene therapy and connected health industries.
In the new year, payers with an abundance of capital resulting from deferred care amid the pandemic will look to make investments in technology and ramp up acquisition activity in the primary care arena, a PwC expert predicts.
An email hacking incident exposed the information of close to 500,000 Aetna health plan members, the payer reported to HHS last week. The incident occurred when an unauthorized person gained access to an email account of Aetna’s vision benefit services provider.
Rideshare app Lyft is partnering with corporations and healthcare organizations to create an initiative that will help connect members of underserved communities to vaccination sites once the Covid-19 vaccine becomes widely available.
– Regence and MultiCare ink first-in-the-nation value-based
care partnership to deliver improved health outcomes at lower costs.
Health insurance provider Regence
and MultiCare Health System,
an independent accountable
care organization (ACO) have partnered to deploy a first-in-the-nation value-based model
that delivers better health outcomes to members at lower costs while
simplifying administration for health care providers. Regence serves
approximately 3.1 million members through Regence BlueShield of Idaho, Regence
BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and
Regence BlueShield (select counties in Washington). The new approach between
Regence and MultiCare Connected Care—the Accountable Care Organization that is
a wholly owned subsidiary of MultiCare Health System—marks a milestone in the
evolution of value-based partnerships between insurance payers and providers.
Da Vinci Member Attribution List Standard for Value-Based
The partnership will leverage utilized a soon to be
published HL7® FHIR® (Fast Healthcare Interoperability Resources) Standard
“Da Vinci Member Attribution List” which was developed by the HL7® Da Vinci Project for
value-based arrangements. This national standard provides an
interoperable method to share member attribution data assisting in reducing the
burden on provider organizations managing patient data and allowing providers
to spend more time with patients. The Regence and MultiCare partnership establish
a foundation for the development of future population data interoperability
applications, such as the exchange of data for measuring care quality and
Why It Matters
Value-based arrangements result in improved outcomes, lower
costs and fewer care gaps for health plan members, and higher patient and
provider satisfaction. Providers are eligible to earn financial incentives by
meeting established targets for patient outcomes, costs and satisfaction
By creating efficiencies and security in delivering patient data to providers more frequently, it allows provider organizations to spend less time acquiring the data and more time with the patient.” said Melanie Matthews, president of MultiCare Connected Care. “It frees up providers to do the work of population health and helps us embrace our mission of partnering for a healing and healthy future.”
Communication problems and inadequate information flow are two of the most common root causes of medical errors. The potential for miscommunication and faulty exchange of information in healthcare is substantial.
Consider: patient information is dispersed among multiple providers and payers along the continuum of care. Electronic Health Records (EHRs) and other clinical systems do not capture patient information or format medical documentation in a standardized manner. In an environment with incompatible systems, the easiest way for healthcare organizations to exchange records is to generate those records in a document format. It is not surprising then that many healthcare organizations are still heavily dependent on traditional, paper-based fax, which adds its own challenges to the process. Fax hardware and communication equipment are often unreliable, resulting in document delivery failures and delays.
As a result, an inadequate information flow can cause problems that impact the availability of essential knowledge needed for prescribing decisions, timely and reliable delivery of test results, and coordination of medical orders. The ensuing administrative and medical errors raise healthcare costs and may lead to poor health outcomes, including patient harm and readmissions.
The reality of mundane, manual processes
Document-based information exchange processes are highly inefficient. Staff often print and copy documents, creating a risk of accidental exposure of protected health information and resulting in needless costs. Moreover, documents – whether printed or stored on a workstation or server – still require manual data entry into EHRs and practice management systems. The tasks are tedious, prone to error, and negatively impact workflow, staff efficiency, physicians, and patients, and may lead to the following:
– Patient record errors, including filing or documenting information in the wrong patient file, and data entry errors;
– Poorly documented or lost test results; and
– Gaps in communication during transitions of care from one healthcare provider or setting to another.
In addition to these areas of concern that threaten patient safety, inbound documents often contain a lot of information on clinical, administrative, and financial matters that aren’t necessarily relevant to an intended recipient. That means a recipient must review all pages of the document and separate needed information from extraneous ones, which can further delay processing and patient transitions of care.
Smarter, faster document processing with AI
Healthcare providers need a document exchange and processing strategy that enables fully digital, secure, and efficient communication among numerous, highly customized EHRs, each with its own workflows and document processing preferences.
Such a strategy needs to include moving away from paper to fully digital documents. Healthcare organizations can accomplish this easily and without the need to overhaul the entire existing health IT infrastructure. The two main ways of transitioning from paper to digital are using digital fax instead of traditional fax and document imaging when documents are simply scanned into the system. In many cases, the resulting document format will be a TIFF image; and while it is not machine-readable, it enables paperless filing of clinical documents to the EHR.
Alternatively, converting the document into a readable format, such as a searchable PDF, will allow the healthcare organization to add value in document processing at every subsequent step. Making the document readable enables automatic identification of the type of document, data extraction, including patient name, medical record, date of birth, and physician name, as well as more effective management of the overall lifecycle of the document.
This step requires the utilization of AI and natural language processing techniques. Automatic extraction of data replaces the human labor required to manually index the information, which streamlines the triaging of documents to correct systems, teams, or recipients.
For example, if a digital document is clearly labeled as a discharge summary for John Harrison, a staff member can process it much easier and faster than when she has to open and read it to understand the type of the document and the identity of the patient. By mostly automating the receiving, reading, classifying, and triaging of medical documentation, providers are able to save time and ensure information is received and processed quickly by the right person, which typically means that the patient can be better served.
The COVID-19 pandemic has only driven home the need for seamless, 100%-digital exchange of patient information. If healthcare administrators depend on the physical fax machine to do their jobs, they won’t be able to work remotely. Most people don’t have fax machines at home, and especially fax machines routed to the hospital’s number, to be able to print information and then manually scan and enter that information into the patient’s health record. A fully digital document processing approach enables agility and flexibility necessary in the modern healthcare environment.
Moreover, recent ransomware attacks in the form of malware embedded into email attachments sent to users in hospitals lead to providers blocking inbound email attachments altogether. That means providers could not access their own patient data, let alone data from other institutions. As a result, emergency patients may have to be taken to other hospitals, and surgeries and other procedures delayed. Cloud-based platforms enable users to securely access patient information outside of the hospital’s network.
Small steps lead to big results
It’s essential from both a patient safety perspective and provider efficiency perspective that the exchange and processing of medical documentation be digitized. The benefits of digital document processing are significant, enabling fluid information exchange among all stakeholders.
By transitioning to fully digital document exchange, providers can significantly streamline administrative and clinical processes. The key to realizing the benefits of this approach is to take the first step by moving away from paper and then build on that by harnessing the power of AI to fully support the daily work of clinicians and administrators. Outbound and inbound documents can be prioritized, addressed, processed, and delivered appropriately, facilitating timely information exchange for processing prescriptions, medical orders, billing, reporting, analytics, research, and much more.
About John Harrison
As Chief Commercial Officer at Concord Technologies, John is responsible for the company’s revenue growth and brand development, ensuring Concord continues to create the right products to meet the needs of its customers. John brings more than 25 years of document communication and automation experience to the team. Prior to joining Concord, John held executive management positions at OpenText, Captaris, and Goaldata, overseeing business operations across multiple continents.
Congress finally reached an agreement on a $900 billion stimulus package, which includes a ban on surprise medical billing. A previous, but very similar version of the bill, raised concerns among providers and payers.
An in-depth look at twelve recently released COVID-19 vaccine management solutions as COVID-19 vaccines are being distributed nationwide.
launches a COVID-19 vaccine management platform with partners Accenture and
Avanade, EY, and Mazik Global to help government and healthcare customers
provide fair and equitable vaccine distribution, administration, and monitoring
of vaccine delivery.
Microsoft Consulting Services (MCS) has deployed over 230 emergency COVID-19 response missions globally since the pandemic began in March, including recent engagements to ensure the equitable, secure, and efficient distribution of the COVID-19 vaccine.
Accenture recently rolled out a comprehensive vaccine management solution to help government and healthcare organizations rapidly and effectively plan and develop COVID-19 vaccination programs and related distribution and communication initiatives. Expanding on Accenture’s contact tracing capability that leverages Salesforce’s manual contact tracing solution, the platform is rapidly deployable and designed to securely track a resident’s vaccination journey, from registration and appointment scheduling to final vaccine administration and symptom follow-ups.
VigiLanz, a clinical surveillance company launched their new mass vaccination support software, VigiLanz Vaccinate provides end-to-end management of the entire vaccination process, enabling hospitals to maximize the success of mass vaccination events for healthcare workers. VigiLanz Vaccinate streamlines vaccine administration and management by making it easy for staff to register and provide consent while automating workflows for program administrators. Its real-time insights into volume needs to reduce vaccine waste, while analytics give visibility into vaccination and immunity rates at the individual, department, hospital, and system-level.
UCHealth recently deployed BioIntelliSense BioButton™ Vaccine
Monitoring Solution, an FDA-cleared medical-grade wearable for continuous
vital sign monitoring for up to 90-days (based on configuration) to healthcare
workers receiving COVID-19 vaccine UCHealth’s staff and providers will wear the
BioButton device for two days prior and seven days following a COVID-19 vaccine dose
to detect potential adverse vital sign trends. Together with a daily
vaccination health survey and data insights, the wearer may be alerted of signs
and symptoms to guide appropriate follow-up actions and further medical management.
VaxAtlas launches a
digital platform to support the COVID-19 vaccination process making it easy for
anyone to schedule and manage their vaccinations. Through a comprehensive suite
of on-demand tools, VaxAtlas manages the process of getting COVID vaccinations
from beginning to end. The platform provides access to a national certified
pharmacy network for local appointment scheduling, recall alerts, second dose
reminders, as well as QR clearance passes for vaccine validation. VaxAtlas
alleviates the complexity associated with vaccine logistics and helps to get
people back to work and back to living their lives.
DocASAP launches COVID-19
Vaccination Coordination Solution to help healthcare providers and payers meet
the urgent demand for vaccinating the nation. DocASAP’s COVID-19 Vaccination
Coordination Solution will help providers and payers guide people through the
vaccination process with pre-appointment engagement, online appointment scheduling
and reminders, and post-appointment wellness tracking. This will help reduce
the burden on staff and call centers to manage the sheer volume and complexity
of these appointments, and better coordinate the influx so providers can
effectively deliver the needed care. DocASAP will support the phased approach
to rolling out vaccinations, beginning with front-line healthcare staff.
7. Allied Identity
Allied Identity announced the launch of Vaxtrac, comprehensive vaccination management and credentialing platform designed to aid in the local, national and international response to COVID-19 and other communicable diseases. Vaxtrac uses SICPA’s proprietary CERTUS™ service in order to ensure the security of vaccination records and credentials.
8. Net Health
Net Health has developed a proprietary web-based Mobile Immunization Tracking platform to more efficiently manage on-site
immunizations. To ensure compliance, Net Health’s Mobile Immunization
Tracking platform tracks verification and enables employee consent forms to be
electronically recorded. Immunization data and the Vaccine Information Sheet
(VIS) are pulled directly from the Centers for Disease Control (CDC) database
and fields are auto-populated so clinicians do not have to manually enter data.
This ensures information in the employee record is accurate and saves time as
the clinician moves from one employee to the next.
9. Traction on Demand
Vancouver tech company, Traction on Demand,
has developed a COVID-19 Vaccine Clinic Accelerator. The accelerator helps
health authorities track all the critical details of their clinics including
type, location, staff members, and cold storage units available on-site and
applies CDC’s COVID-19 Temporary Clinic Best Practices to a
Salesforce-based mobile app, providing organizations with a digitized CDC
checklist, auditable clinic administration including a permanent auditable
record of all vaccination clinics an organization holds, critical risk
identification, and shift tracking.
10. MTX Group
MTX Group launches a
comprehensive end-to-end COVID-19 vaccine administration, management, and
distribution Solution for state and local public health agencies built on
Salesforce. The MTX vaccine management solution brings together the various
components of a COVID-19 vaccination program, including vaccine administration
and inventory management. MTX also works with public health departments to
identify necessary steps to promote vaccination adoption within a community.
The vaccine management solution is secure, portable, interoperable, and
provides data-driven vaccination program management capabilities.
Vaccination Management (IVM) Salesforce Solution is an end-to-end offering
for automating tasks, integrating data sources, and delivering a seamless
vaccination program that offers supply chain visibility and future demand
forecasting. Disparate systems won’t work for this unprecedented health crisis.
Phresia provides an end-to-end COVID-19 vaccine management solution for outreach, intake, reminder, and recall tools to increase vaccine uptake. Key features include communicating with patients about vaccine availability, send appointment reminders and boost recall, manage your waitlist, automate patient intake for vaccine visits, including consents, questionnaires, and patient education, and screen patients for vaccine hesitancy and maximize uptake by delivering personalized messaging based on those survey results.
The health system and payer will coordinate care for eligible Medicare Advantage patients through the ACO, with the aim of improving health outcomes and reducing costs. The ACO expands a long-standing relationship between the two entities.
The newly created organization, dubbed OneTen, aims to create 1 million jobs for Black people over the next decade. Its founders include some big names in healthcare, such as Cleveland Clinic, Intermountain Healthcare and Humana.
The managed care company picked six mental health apps that it made available to its members over the past two years. It recently published a paper showing patients were more likely to download or use digital health tools when referred by a physician.
The HHS has proposed changes to the HIPAA Privacy Rule — the biggest in seven years, a healthcare lawyer said. But while the changes aim to improve information sharing, they could also bring about challenges for providers and payers.
By implementing a standardized, automated, and modernized set of processes to manage critical enrollment information across multiple lines of business, plans have greater potential to expand member footprint, enter new markets and drive competitive differentiation.
The rule would require payers in the Medicaid, CHIP and QHP programs to build and maintain application programing interfaces to improve data exchange and the prior authorization process. But the rule does not include Medicare Advantage plans, which the American Hospital Association called “disappointing.”
– DispatchHealth launches Clinic Without Walls, a new service line offering patients a telemedicine visit with in-person assistance for more complex medical visits.
– The initial service line will be available in a pilot to MultiCare patients in the Tacoma and Spokane areas in an effort to its senior patients’ alternative visits during the pandemic.
DispatchHealth, a provider of in-home high-acuity medical care, today announced
the launch of Clinic Without Walls. The new service line expands access to care
for vulnerable patients by offering enhanced virtual visits with hands-on
support. Clinic Without Walls is initially being offered to MultiCare patients
in the Tacoma and Spokane areas.
Meeting the Growing Needs of In-Home Medical Care Options
visits have become an increasingly popular option to help decrease a patient’s
risk of exposure to COVID-19. More
advanced capabilities are often required for vulnerable patients who are facing
chronic disease or require medically complex care. The Clinic Without Walls
model offers these patients hands-on support with an emergency medical
technician (EMT) to help guide them through a telemedicine presentation and
connect them with a physician.
“The pandemic has highlighted the need for more in-home medical care options during the pandemic and beyond,” said Dr. Mark Prather, chief executive officer and co-founder of DispatchHealth. “Our unique model continues to expand and meet the growing needs of patients, payers, and provider partners. We are excited to continue to grow our partnership with MultiCare to help their most vulnerable patients by treating medically complex issues through hands-on support and tele-presentation.”
How It Works
During a Clinic Without Walls visit, an EMT from DispatchHealth will visit a patient where they live. The EMT comes equipped with a handheld, telehealth exam kit developed by TytoCare, manufacturer of the hand-held telehealth device DispatchHealth uses. The kit allows them to assist a guided medical exam including assessment of the lungs, ears, throat, skin, and abdomen. In addition, comprehensive vital signs, social determinants of health intervention, and moderate-complexity lab work are available in the home. If additional lab work or imaging is required, the service will be coordinated by DispatchHealth.
“The goal of this program is to keep MultiCare’s vulnerable patients safe and healthy”, said Christi McCarren, senior vice president of retail health and community based care at MultiCare. “Many of these patients have been deferring care due to the fear of contracting COVID-19. Additionally, this program helps patients facing significant mobility and transportation issues receive the care they need.”
Clinical Without Models Care Model
DispatchHealth’s Clinic Without Walls model complements the organization’s additional service lines, which include Advanced Care, Extended Care, and Acute Care. Combined, DispatchHealth is able to reduce avoidable ER visits, hospital admissions, or a stay at a skilled nursing facility. The company has experienced a period of rapid expansion and record growth and has more than doubled its national footprint in 2020, with services available in 28 cities across the United States. DispatchHealth is open seven days a week, 365 days a year, including holidays. For more information, including market hours and areas of service, visit DispatchHealth.com
raises $130 million in Series D Funding to strengthen its machine learning platform
to continue helping hospitals achieve operational excellence during a time
where they are facing mounting financial pressures due to COVID-19.
– LeanTaaS provides software solutions that combine lean
principles, predictive analytics, and machine learning to transform hospital
and infusion center operations to improve operational efficiencies, increase
access, and reduce costs.
– LeanTaaS’ solutions have now been deployed in more than
300 hospitals across the U.S., including five of the 10 largest health networks
and 12 of the top 20 hospitals in the U.S.
LeanTaaS, Inc., a
Silicon Valley software innovator that increases patient access and transforms
operational performance for healthcare providers, today announced a $130
million Series D funding round led by
Insight Partners with participation from Goldman Sachs. With this
investment, LeanTaaS has raised more than $250 million in aggregate, including
more than $150 million from Insight Partners. As part of the transaction,
Insight Partners’ Jeff Horing and Jon Rosenbaum and Goldman Sachs’ Antoine
Munfa will join LeanTaaS’ Board of Directors.
Healthcare reform, an aging population, and a higher
incidence of chronic disease has caused the demand for healthcare services to
escalate quickly. At the same time, pressure from payers to eliminate waste
requires that healthcare providers do more with less to meet this skyrocketing
demand with the resources in which they have already invested. And this
situation is only going to get worse.
As more healthcare data gets digitized, the opportunity exists to leverage that data to help providers meet these challenges and more efficiently match supply and demand. Founded in 2010, LeanTaaS believes hospitals should use objective data and predictive analytics – not intuition and “tribal rules”– to better match resource supply with demand and to amplify the business impact of investments they have already made in EHR, BI, and Lean/Six Sigma.
Better Healthcare Through Math
LeanTaaS develops software that increases patient access to
medical care by optimizing how health systems use expensive, constrained
resources like infusion chairs, operating rooms, and inpatient beds. More than
100 health systems and 300 hospitals – including 5 of the 10 largest systems,
12 of US News and World Report’s top 20 hospitals. These hospitals use the iQueue
platform to optimize capacity utilization in infusion centers, operating rooms,
and inpatient beds. iQueue for
Infusion Centers is used by 7,500+ chairs across 300+ infusion centers
including 70 percent of the National
Comprehensive Cancer Network and more than 50 percent of National Cancer Institute hospitals. iQueue for
Operating Rooms is used by more than 1,750 ORs across 34 health systems to
perform more surgical cases during business hours, increase competitiveness in
the marketplace, and improve the patient experience.
“LeanTaaS is uniquely positioned to help hospitals and health systems across the country face the mounting operational and financial pressures exacerbated by the coronavirus. This funding will allow us to continue to grow and expand our impact while helping healthcare organizations deliver better care at a lower cost,” said Mohan Giridharadas, founder and CEO of LeanTaaS. “Our company momentum over the past several years – including greater than 50% revenue growth in 2020 and negative churn despite a difficult macro environment – reflects the increasing demand for scalable predictive analytics solutions that optimize how health systems increase operational utilization and efficiency. It also highlights how we’ve been able to develop and maintain deep partnerships with 100+ health systems and 300+ hospitals in order to keep them resilient and agile in the face of uncertain demand and supply conditions.”
Chief Marketing Officer Appointment
Concurrent with the funding, LeanTaaS announced that Niloy Sanyal, the former CMO at Omnicell and GE Digital, would be joining as its new Chief Marketing Officer. Also, Sanjeev Agrawal has been designated as LeanTaaS’ Chief Operating Officer in addition to his current role as the President. “We are excited to welcome Niloy to LeanTaaS. His breadth and depth of experience will help us accelerate our growth as the industry evolves to a more data-driven way of making decisions” said Agrawal.
As precision medicine gains steam, the question arises: how can reimbursement models evolve to support these often costly therapies and ensure patient access is not blocked? Drugmakers and payers are working together to find some answers.
In the last 20 years, access to genetic testing has expanded significant as technology has advanced. But there’s still lots of work to be done to get tests covered and make them more accessible, panelists said at a virtual conference hosted by MedCity News.
The new Geographic Direct Contracting Model aims to improve quality of care and slash costs for Medicare beneficiaries across an entire region. It involves setting up risk-sharing arrangements where participants will be responsible for the total cost of care for beneficiaries in the region.
The expanded partnership increases the number of Highmark health plan members eligible for enrollment in Lark Health’s AI-driven health coaching programs aimed at managing and preventing chronic diseases.
– On the heels of $225.5 million dollars in funding and a
$1.5B valuation this week, Olive today announced its acquisition of Verata
Health to create a combined AI prior authorization solution for providers and
payers under the Olive name.
– Prior authorization is a $31 billion dollar issue in
healthcare, and one of the top reasons patient care is delayed. Olive is now
able to reduce write-offs by over 40% and cut turnaround times for prior
authorizations by up to 80%, ultimately offering hospitals $3.5 million in
Olive today, announced
of Verata Health to solve prior
authorizations for providers and payers via artificial
intelligence as a combined solution under the Olive name. The acquisition
follows Olive’s recent $225.5 million financing round to bolster the company’s
R&D war chest and drive the growth of Olive’s AI workforce for providers
and payers. With Olive’s recent momentum, Verata’s suite of AI tools will
deepen Olive’s impact as it automates the $31 billion problem of prior authorizations
Leverage Powerful Prior Authorization AI
Verata is a leading healthcare AI company, enabling
Frictionless Prior Authorization® for providers and payers. Seamlessly
connected to the nation’s top electronic health record
(EHR) systems, Verata’s AI technology automatically initiates prior
authorizations, retrieves payer rules, and helps identify and submit clinical
documentation from the EHR.
When payers leverage its AI platform, Verata enables point-of-care
authorizations for providers and patients, dramatically accelerating access to
Solving the $31B Prior Authorization Burden
Prior authorizations were the most costly and time-consuming transactions for providers in 2019 and are among the top reasons patient care is delayed. As cash-strapped hospitals and health systems strive to meet patient, payer, and provider needs, the demand for AI technologies to increase efficiency and improve the patient experience has become critical. To help improve patient access to care and remedy the $31 billion prior authorization challenge, Olive and Verata’s combined prior authorization solution streamlines the process for providers, patients, and payers by reducing write-offs by over 40% and cutting turnaround time for prior authorizations by up to 80%.
Acquisition Will Provide End-to-End Prior Authorization
By integrating Verata’s solution, Olive is able to provide customers with a true end-to-end prior authorization solution. The solution starts with determining if an authorization is required, includes touchless submission of the prior authorization request, ends with automating denied claim appeals, and grants hospitals a 360-degree view of their authorization performance. This means patients not only get the care they need faster but also eliminates confusing bills patients receive post-service stating their claim has been denied by their insurance.
As part of the acquisition, more than 60 Verata employees
will join the Olive team following the acquisition, bringing Olive’s total
employee count to approximately 500. Olive’s senior executive team will
continue to grow as well:
– Lori Jones, Chief Revenue Officer, will retain her title
and will also take on the role of President, Provider Market
– Dr. Jeremy Friese, Chief Executive Officer at Verata, will
join Olive as President, Payer Market
– Dr. YiDing Yu, Chief Medical Officer at Verata, will
become Olive’s Chief Medical Officer
“A broken healthcare system is one of the biggest challenges humanity faces today and prior authorization issues, in particular, are costing our nation billions of dollars. After partnering with Verata earlier this year, we saw incredible potential for Verata’s technology to reduce the amount of time and money spent on prior authorizations, and to eliminate delays in patient care,” said Sean Lane, CEO of Olive. “This acquisition allows Olive to accelerate innovation in areas where we can drive the biggest impact, and further expands our solutions to providers and payers seeking to transform healthcare.”
Financial details of the acquisition were not disclosed.
Breaking Media’s MedCity News and Above the Law are collaborating to launch Healthcare Docket, a newsletter featuring the latest in litigation, regulation, transactions, and trends for in-house counsel in the healthcare and life sciences industries.
Millions of Americans without healthcare insurance could be eligible to get coverage for free, or nearly free, through financial assistance offered under the Affordable Care Act. But many who recently lost their employer-based coverage may not be aware of the options available to them.
CVS Health Corporation names Neela Montgomery Executive Vice President and President of CVS Pharmacy/Retail, effective November 30, 2020. Montgomery will oversee the company’s 10,000 pharmacies across the United States. Montgomery, currently a Board Partner at venture capital firm Greycroft, most recently served as chief executive officer of furniture retailer Crate & Barrel and has nearly 20 years of global retail experience.
The Cleveland Clinic and Amwell joint venture appoint Egbert van Acht as Executive Vice Chairman to the Board of Directors and Frank McGillin as CEO. Formed one year ago as a first-of-its-kind company to provide broad access to comprehensive, high-acuity care via telehealth, the company has made great progress scaling digital care through its MyConsult® offering. With an initial focus on clinical second opinions, the organization also offers health information and diagnosis on more than 2,000 different types of conditions including cancer, cardiac, and neuroscience issues.
Healthcare industry veteran Dana Gelb Safran, Sc.D. has joined Well Health Inc. as Senior Vice President, Value-Based Care, and Population Health. In her new role, Dr. Safran will expand WELL’s uses to improve healthcare quality, outcomes, and affordability through partnerships with payers and Accountable Care Organization (ACO) providers.
Talkdesk®, Inc., the cloud contact center for innovative enterprises appoints Cory Haynes to lead Talkdesk’s strategy for the financial service industry and Greg Miller to lead the strategy for healthcare and life sciences. Haynes and Miller are key members of the Talkdesk industries team led by Andrew Flynn, senior vice president of industries strategy for Talkdesk.
Imprivata appoints Mark McArdle to Senior Vice President of Products and Design. Mr. McArdle has more than two decades of experience in software development, Software-as-a-Service (Saas), in Cybersecurity, and advanced products for the enterprise, SMB, and consumer markets.
Eden Health names Jack Stoddard as executive chairman of its board of directors. Formerly serving in COO roles for Accolade and Haven, Stoddard brings two decades of healthcare innovation and operating experience to the board position, providing leadership, wisdom, and counsel during a time of monumental growth and adoption for the company.
Augmedix names Saurav Chatterjee Chief Technology Officer. Prior to joining Augmedix, he most recently served as Vice President of Engineering at Lumiata, Inc., where he led the engineering team that built a leading AI platform, focusing specifically on transforming, cleaning, enriching, featurizing, and visualizing healthcare data, and on building, deploying and operationalizing machine learning and deep-learning models at scale.
Tridiuum, the nation’s premier provider of digital behavioral health solutions names Philip Vecchiolli has joined the company as Chief Growth and Strategy Officer. Vecchiolli, who brings over 30 years of experience to the new role, has a successful track record of leading business development for large and mid-size healthcare companies.
Connect America appoints Janet Dillione as its new chief executive officer (CEO). Prior to joining Connect America, Dillione worked in the healthcare information services industry as CEO of Bernoulli Enterprise, Inc., GM of Nuance Healthcare, and CEO of Siemens Healthcare IT.
Health Catalyst, Inc. announces that current Chief Financial Officer Patrick Nelli has been named President, effective January 1, 2021. Following Nelli’s promotion to the President role, Health Catalyst has named Bryan Hunt, current Senior Vice President of Financial Planning & Analysis, Chief Financial Officer, also effective January 1, 2021.
Two additional promotions, also effective January 1, 2021, include Jason Alger, Senior Vice President of Finance, to Chief Accounting Officer, and Adam Brown, Senior Vice President of Investor Relations, to Senior Vice President of Investor Relations and Financial Planning & Analysis.
Apervita hires health IT veteran Rick Howard as Chief Product Officer. In his role, Rick will oversee product vision, innovation, design, and delivery of Apervita’s digital platform, which enables digital quality measurement, clinical intelligence, as well as value-based contract monitoring and performance measurement.
Conversion Labs, Inc. appoints Roberto Simon to its board of directors and as the chair of its audit committee. Following his appointment, the board now has eight members, with six serving as independent directors. Mr. Simon currently serves as CFO of WEX (NYSE: WEX), a $6+ billion fintech services provider.
PRA Health Sciences, Inc. appoints senior FDA official Isaac Rodriguez-Chavez, Ph.D., MHS, MS, as Senior Vice President, Scientific and Clinical Affairs. He will lead the company’s Global Center of Excellence for Decentralized Clinical Trial (DCT) Strategy. Dr. Rodriguez-Chavez’s responsibilities will involve the continued growth and development of PRA’s industry-leading decentralized clinical trial strategy, regulatory framework creation, and clinical trial modernization.
Proprio appoints three global thought leaders to its Medical Advisory Board. Dr. Sigurd Berven, Orthopedic Surgeon and Professor at the University of California, San Francisco, Dr. Charles Fisher, Professor and Head of the Combined Neurosurgical & Orthopedic Spine Program at Vancouver General Hospital and the University of British Columbia, and Dr. Ziya Gokaslan, Professor and Chair of the Department of Neurosurgery at Brown University and Neurosurgeon-in-Chief at Rhode Island Hospital and The Miriam Hospital will apply their globally respected surgical and research expertise to the development of the Proprio navigation platform.
Kaiser Permanente names Andrew Bindman, MD Executive Vice President and Chief Medical Officer. In this role, Dr. Bindman will collaborate with clinical and operational leaders throughout the enterprise to help lead the organization’s efforts to continue improving the high-quality care provided to members and patients throughout Kaiser Permanente. Dr. Bindman will report directly to Kaiser Permanente chairman and CEO Greg A. Adams.
Greenway names Dr. Michael Blackman Chief Medical Officer at Greenway. Dr. Blackman will further support the company’s ambulatory care customers, ensuring providers are equipped with the solutions and services they need to improve patient outcomes and succeed in value-based care.
Suki expands its leadership team with six key hires to support the company’s rapid commercial growth. Tracy Rentz, formerly Vice President of Implementation at Evolent Health, joins Suki as the Vice President of Customer Success and Operations to lead all customer operations, with a particular focus around deploying new Suki customers. Brian Duffy brings over 20 years of sales experience to Suki, joining the team as Director of Sales-East, after having most recently served as Regional Director at Qventus, Inc. Brent Jarkowski will also join Suki’s sales team this November as the Director of Sales-West, bringing over 15 years of experience in strategic relationship management. Brent joins Suki after serving as Senior Client Development Director at Kyyrus. Together, Brian and Brent will head the company’s efforts in building new partnerships across the country. And Josh Margulies, who previously served as the Director of Integrated Brand Marketing for the Jacksonville Jaguars, will serve as Suki’s new Senior Director of Field Marketing.
Healthcare can achieve optimum efficiency when patients are at the center of care. When patients have the necessary information to navigate their care journey, they will choose the path to high-quality care at the lowest costs. Cost-sharing and insurance premiums are rising consistently since the last decade for employer plans, which covers nearly half of the country’s population. Plan members are shouldering a part of the healthcare cost burden, so they want to keep it as low as possible. At the same time, they want maximum value for their money with access to quality care.
CMS identified this as an opportunity and issued the Final Interoperability and Patient Access rule. The rule allows patients to access electronic health data through any third-party application of their choice. The rule intends to allow patients to take control of their data and determine who can see which data. It will also make transferring data from provider to provider easier. So that patients can be ensured that their provider is fully aware of their medical history.
The Challenge of Providing Members Access to Healthcare Data
The biggest challenge that health plans will face is to extract data from multiple sources in-house, clean and scrub it, and ensure it is in the appropriate format as required by the Centers for Medicare and Medicaid Services (CMS). Some health plans have been in business for a really long time. Patient data has been accumulating through these years in legacy systems. Providing access to that data through certified third-party applications will require a lot of effort on the part of health plans. The health plans also have to ensure tight authentication standards so that only the people requested by the members have access to their healthcare data.
In addition, there are multiple problems associated with provider data. Incorrect data in the provider database costs close to $3 billion annually. CMS has also issued warnings for inaccurate provider directories, high claim-reprocessing volumes, and substantial encounter-data rejection rates. Payers have been addressing the data issues with short term solutions. But now they have to resolve the provider data problems for good and make health data readily available to the members.
The COVID Crisis Upended The Payer Compliance Initiatives
Payers are in solidarity with providers and patients in this time of crisis. While providers work tirelessly to help an increased number of patients access the required care, payers are providing support through fast track reimbursements and reduced utilization management.
Many health plans are focused on ensuring that their members have access to resources to fight COVID, which is why CMS extended the deadline for the Final Interoperability rule. Utilization patterns are witnessing a significant change. Many members are not receiving scheduled care as some elective surgeries are rescheduled and some provider offices are shut down. There has been a drop in certain kinds of utilization. Conversely, there has been a dramatic surge in telehealth office visits and behavioral health services.
The Road Ahead for Health Plans
Healthcare payers have endured significant claims-based, economic, and operational challenges during the pandemic. While they battle those bottlenecks, they also have to ascertain and prepare for the future and devise ways to ensure that their members have access to quality care.
Health plans will have to try to anticipate what utilization patterns will look like in the future, especially in the next year. Telehealth utilization will not be the same as it was pre-COVID. They will also have to ensure that members have access to care. They will have to reach out to members, especially those who are the most vulnerable. They will have to make sure members are not suffering from social isolation, they are taking their medication and they have access to transportation to get to the doctor.
Provider Alliance for CMS Compliance
CMS is handing over the reins of the care journey to the patients to improve care delivery through the Interoperability rule. Providers will play a key role in enabling access to healthcare data to patients by streamlining data and closing coding gaps. Payers must assist providers with their data needs to ensure compliance with the CMS rules.
As the pandemic ends and CMS comes out with more definitive long term rules and coverages, it is going to be important to ensure that providers are on the same page with payers. Health plans can partner with providers to educate them about the acceptable telehealth codes and what type of services are to be performed using those codes. Providers want to take care of their patients and they want to do it well. They want to leverage technology to ensure patient access to care and ensure their safety, especially for patients who suffer from multiple comorbidities.
About Elizabeth Bierbower
Elizabeth Bierbower is a strategic leader with more than thirty years of executive experience in the health insurance industry. She has experience scaling cost-effective and profitable growth strategies through internal innovation, and a reputation as being one of the industry’s most fiscally responsible and progressive leaders. Bierbower currently serves on the Boards of Iora Health, the American Telemedicine Association, and is on Innovaccer’s Strategic Advisory.
Previously Beth was a member of Humana’s Executive Management Team and held various roles including Segment President, Group and Specialty Benefits, and was an Enterprise Vice President leading Humana’s Product Development and Innovation teams.
WithMe Health, a startup trying to build a new approach to pharmacy benefits, spun off a medication guidance service that can be layer on top of existing PBMs. It also raised $20 million in funding, led by OMERS Ventures.
Signify Health, a leading provider of technology-enabled healthcare solutions designed to keep people healthy and happy at home has acquiredPatientBlox, an Atlanta-based technology company with deep expertise in applying distributed ledger technology in healthcare. The acquisition accelerates Signify’s prospective provider payment capabilities for episodes of care, supporting the company’s commitment to advance value-based care through novel payment and risk arrangements. Financial details of the acquisition were not disclosed.
Acquisition Will Accelerate Prospective Episode of Care
The addition of blockchain technology enables a further shift away from traditional fee-for-service models. By making payments to providers at the start of the episode, providers are incentivized to drive care redesign because there is shared measurement and accountability at every step of the process, which results in improved care coordination, outcomes, and cost savings.
An episode of care is a healthcare event — a condition or a treatment — that is marked by a sequence of interactions between a patient and providers. The blockchain can capture each of those interactions and the patient’s care milestones that trigger payments. The PatientBlox platform is designed to manage these transactions without relying on fee-for-service claims.
PatientBlox Integration Offers Payers/Providers Array of Payment Options
As part of the acquisition, Signify will integrate the
PatientBlox technology into its already robust and scalable value-based care
platform, which supports $6B in healthcare spend annually associated with
the federal government’s bundled payment program, BPCI-A, and episodes of care
payment programs by health plans and employers.
The proprietary PatientBlox technology is built-for-purpose and highly-secure, enabling functionality that facilitates contract and payment administration under a prospective payment model. Under its expanded platform, Signify will offer payers and providers a diverse array of payment options to meet them where they are in their value-based care journey.
“We combined our team’s healthcare, fintech, and supply chain experience with machine-learning and Distributed Ledger Technology (DLT) to build the PatientBlox platform for administration and management of prospective bundles,” said PatientBlox Co-Founder and CEO Rahul Sharma. “Our DLT based platform enables collaboration between Healthcare Payers and Providers and provides real time data synchronization across entities thus enabling rapid scaling of prospective bundled payment programs. We are excited to work with Kyle and the Signify team and are proud to have the novel technology developed by the PatientBlox team be part of Signify’s leading platform, which is already driving real change in the healthcare industry.”
The technology company is partnering with major insurers, including Aetna and Humana, as well as providers like Ochsner Health to expand access to its platform that connects patients to community-based social services.
– COTA, Inc., a healthcare technology company that uses
real-world data to bring clarity to cancer care, has secured $34M in funding.
– Access to over one million patient data records and additional
funding support enhanced real-world data and analytics services in oncology.
COTA, Inc., a Boston, MA-based healthcare technology company that uses real-world data to bring clarity to cancer care, today announced it has raised $34 million in Series D funding led by Baptist Health South Florida and ONC Capital with participation from EW Healthcare, Horizon BCBS and other existing investors. This also includes a $20M investment from Varian, who negotiated an option to acquire COTA at a later date.
Bringing Clarity to Cancer
COTA was founded in 2011 by a team of doctors, engineers,
and data scientists to create clarity from fragmented and often-inaccessible
real-world data. The company organizes fragmented, often hidden data from the
real world to provide clarity in cancer care. Combining clinical expertise in
cancer with proprietary technology and advanced analytics, COTA’s platform
helps inform decisions and action in oncology. COTA partners with
providers, payers, and life science companies to ensure that everyone touched
by cancer has a clear path to the right care.
COTA offerings include:
Providers: Curate EHR data that can be
used to drive research and standardization in order to improve patient outcomes
while also reducing costs at your institution.
Payers: Make clinical sense of claims data, providing
insight into performance and related outcomes across sites in order to support
value-based payment models.
Life Sciences: Deeplycurated real-world data accelerates drug development informing the decisions and actions that will deliver the best drugs to patients faster and at a lower cost.
The company will use the latest round of funding to expand
its data access by over 300%, which now well exceeds one million oncology
patient records. This growth will support the company’s commitment to
accelerating the use of real-world data to improve patient outcomes and
increase efficiency in oncology drug development. data helps life science
partners answer key research questions, and in 2020 alone, COTA is projected to
double its life science customers, growing from 8 to 16.
“COTA is proud to receive this validation from leading institutions across the oncology ecosystem.” said Michael Doyle, President and CEO of COTA. “The additional capital combined with our increased data access positions COTA for tremendous growth and enables us to drive innovation in oncology using real-world data. Our high-quality data and technology solutions will improve how cancer is treated and provide much needed clarity to patients as they navigate their cancer journey.”
Blockchain technology has somewhat infamously been described as “a solution in search of a problem,” but as the healthcare industry responds to the demands of the pandemic, several valuable use cases have surfaced that could benefit from employing the emerging technology.
Due in large part due to its ability to promote trust, transparency, and privacy, blockchain has emerged as today’s best technology-based option for accomplishing the important objective of delivering real-time access to critical information that is presented in a consistent format from trusted sources.
False positives, duplicate records, and privacy issues make it very difficult to derive actionable intelligence with confidence from the current data-sharing infrastructure that exists in the healthcare industry. Further, lack of trust represents another challenge that hinders the formation of greater transparency, as much of the healthcare industry remains reluctant to pervasively share data due to privacy and competitive barriers.
By design, blockchain allows for competing organizations to come together to share data about their patients in a completely auditable way, while maintaining their competitive independence and privacy concerns. It is these fundamental qualities that have helped blockchain emerge as a viable solution for a number of critical healthcare functions whose importance has grown during the COVID-19 pandemic, such as contact tracing, provider credentialing, and patient records-sharing.
Blockchain: The basics Before delving into the specifics of what blockchain can do for healthcare during the pandemic, it is important to establish a general understanding of blockchain’s basics. By no means is it necessary for most healthcare executives to develop a deep knowledge of the technology, but familiarity with its essential elements will enable business leaders to speak roughly the same language as healthcare technology experts as blockchain continues to gain prominence.
Blockchain is a distributed ledger technology that enables users to share trusted and verified information in a decentralized manner. Combined with security and cryptography technology, blockchain can protect the privacy of users who contribute data while also sharing the provenance of the data, enhancing trust.
Blockchain technology provides a safe, effective way to accurately document, maintain, store, and move data – from health records to financial transactions. With blockchain, people can directly engage with others to receive services, transfer money, and perform other common daily tasks we do in business today.
Blockchain use cases The biggest benefits offered by blockchain are associated with greater trust and privacy due to the technology’s ability to enable better data accuracy and verification. At its most basic level, blockchain changes ownership and control of data from one centralized source to multiple sources that contribute data. Following are three COVID-19-related use cases for blockchain in healthcare.
Contact tracing: To follow the potential transmission of the novel coronavirus, many governments have embarked upon contact tracing, in which infected individuals are asked to list all other people they’ve come into contact with over a certain period of time. Decentralization of data helps facilitate critical healthcare operations such as contact tracing because the process is reliant on using granular, sensitive data to inform public health officials of who may be at risk of exposure based on their movements and contacts. In contract tracing, maintaining individuals’ privacy is critical. Earlier this year, blockchain platform Nodle launched a contact-tracing app called “Coalition,” which emphasized user privacy.
Patient-record sharing: Another valuable use case for blockchain as it relates to COVID-19 is the aggregation of patient records during a crisis or disaster to create a “light” electronic health records system, which disparate groups of providers can use to share patient records while treating unfamiliar patients during the pandemic or other crises and natural disasters. Such a platform will allow providers to work with patients who may not have access to their usual provider, but still receive the full range of needed services and prescriptions. The main concept of the solution is that patients’ electronic health records follow them wherever they go. In other words, regardless of where the patient stays during a disaster, there is always access to their personal medical information and they are able to receive required medical services. This patient data can be delivered through a blockchain digital wallet, providing access, security, and integrity of data.
Provider credentialing: Provider credentialing — which is the process of verifying providers’ skills, training and education — is an often-tedious, time-consuming process for both providers and payers that can lead to delays in care that contribute to poor health outcomes. By using blockchain for the process, providers can maintain control of their own data and give health systems, payers and other authorities access to their credentials as they like. Earlier this year, five organizations announced plans to use a new blockchain credentialing system from ProCredEx with the aim of using distributed ledger technology to reduce time and costs associated with the traditional approach to credentialing.
The right technology at the right time It is important to note that blockchain technology requires a cultural and paradigm shift toward broader collaboration across traditionally disparate and potentially competitive entities. The technology facilitates a framework that allows organizations to contribute to joint efforts without risking their intellectual property or proprietary information. However, it will still require an intentional change in behavior to successfully work across different business interests toward a common goal. Nonetheless, to surmount the challenges posed by healthcare’s manual, time-consuming processes for contact tracing, patient record-sharing, and provider credentialing, blockchain represents the right technology at the right time.
About Brett Furst
A senior executive with nearly three decades of experience in selling and managing technology solutions within the manufacturing, CPG, and healthcare industries, Brett Furst serves as president of HHS Technology Group, a software and solutions company serving the needs of commercial enterprises and government agencies.
CMS will cover monoclonal antibody treatments for Medicare beneficiaries with Covid-19. Though this is a step forward in increasing access to these treatments, there are still hurdles to its widespread use.
Over the past few months, primarily as a result of the COVID-19 pandemic, telehealth has gone from a “nice-to-have” to a “must-have” for healthcare providers. The surge of COVID-19 patients in the spring, coupled with “stay-at-home” orders in many states, meant that many patients in need of care for chronic conditions and other non-emergent health issues were unable to visit their providers face-to-face.
Telehealth became the emergency solution, aided by relaxation of government regulations and improved reimbursement from health payers, led by the U.S. Centers for Medicare and Medicaid Services (CMS). But then a funny thing happened.
As COVID-19 restrictions eased, many patients and providers found they liked telehealth and wanted to keep it around. Patients liked it because they didn’t have to take hours out of their day to travel to an appointment, go through COVID-19 protocols, wait to be called, wait to see their provider, then travel home again.
Providers liked it because they could work more efficiently and, if they were incorporating remote patient monitoring, obtain a more complete view of their patients’ day-to-day health. Both sides also liked telehealth because, quite frankly, it helped them reduce their risk of contracting a highly contagious virus.
While we are not out of the woods yet – many experts are predicting a fall and winter surge that will make the spring surge look like a warm-up act – there are already discussions about whether telehealth was simply a stopgap measure in a crisis or should be viewed as a standard option for care going forward. In order to make telehealth permanent, however, healthcare organizations will want to know exactly what it can contribute once it’s safe to venture to the office once again.
Advanced analytics can help. They can show what worked, and what didn’t, so providers can make data-driven decisions about where, how, and whether to continue using telehealth. The following are eight ways analytics can contribute to present and future telehealth success.
1. Find the patients for whom telehealth visits offer the greatest benefits. Normally, these will be patients who can be diagnosed or assessed without direct laying-on of hands. They may have a condition such as a rash that can be inspected visually or may be able to use consumer-grade devices to take and report biometric readings. Advanced analytics can help discover them, enabling providers to close care gaps while improving Star ratings and HEDIS scores.
2. Prioritize patients by need. Analytics can help identify patients who are most at-risk of deterioration if they do not follow-up after preventive or elective procedures or are not closely monitored. They can also help providers make the appropriate adjustments to those priorities as patient health changes.
3. Get ready for additional surges. The next surge has already begun, and there are likely to be others before the pandemic is fully behind us. Providers need to have measures in place to keep staff safe and avoid the risk of more lockdowns or other changes that will disrupt their operations. Analytics can help them determine how much to invest in additional telehealth equipment and training to ensure uninterrupted service to their patients.
4. Measure telehealth’s impact on patient outcomes and reimbursement. Telehealth is so new, and the pandemic has caused so many shifts in reimbursement, that it can be difficult to determine exactly what effect it has had on outcomes and revenue. Analytics can uncover which changes have been positive and should be continued, and which should either be discontinued or adjusted to produce better health and/or financial result.
5. Uncover and rectify possible coding errors. As the pandemic took hold in March, CMS launched its “patients over paperwork” initiative. The goal was to ensure providers focused on care rather than worrying about coding accuracy, especially as the path to telehealth opened up. At some point, however, accurate coding will again be required. Analytics can help providers uncover and rectify any coding issues to ensure claims are paid fairly and completely.
6. Enable more effective remote patient monitoring. The presence of a global pandemic doesn’t halt chronic or other conditions affecting patient health. These conditions must continue to be managed to prevent them from deteriorating, which will place more of a health burden on patients while increasing long-term costs. Remote patient monitoring delivers the day-to-day data on these conditions. Analytics use that data to spot trends and update providers on the condition of all those patients, making it easier to ensure successful treatment for all of them.
7. Manage timed events more effectively. Risk-adjustment capture of previously documented conditions, which comes through CMS sweeps, retrospective reviews, and other means, can be disruptive to provider operations. Analytics can take the burden off an already exhausted staff by automating and simplifying the process.
8. Use trend and outcome data to inform the future. There is still much we don’t know about the effectiveness – and cost-effectiveness – of telehealth. This type of forward-looking analysis can be used to deliver policy and regulatory guidance for permanent reimbursement and best practices for telehealth-related visits.
As we continue to battle the global pandemic, telehealth does more each day to demonstrate its value. But what happens when the battle is finally won? Should it go back to the background or become fully integrated into a healthcare organization’s standard offerings?
Advanced analytics can be used to answer these questions and many others, helping providers make the decision that best fits their organization.
About Prasad Dindigal Prasad Dindigal serves as Vice President, Healthcare & Life Sciences, with EXL, a leading operations management and analytics company that helps our clients build and grow sustainable businesses.
The health insurer and Michigan-based physician organization are partnering to expand access to in-network care for around 40,000 individual and group Medicare Advantage plan members. The partnership will go into effect Dec. 1.
Now with a 6-3 conservative majority, the nation’s highest court still seems reticent to throw out the Affordable Care Act altogether. If the law stays in place, it would be the foundation for many of President-elect Biden’s planned healthcare policies.
CVS Health named a new CEO in its earnings call on Friday. Between plans to further integrate its pharmacy and insurance businesses, and discussion about how a Covid-19 vaccine would be distributed, here are four other things the company is preparing for in the coming months.
Although the Covid-19 pandemic has had a significant impact on healthcare delivery, in many ways it has underscored the need for a healthcare system that can help patients easily navigate healthcare concerns as well as price transparency.
The survey, conducted by Optum, shows that healthcare executives’ confidence in AI is high, and most expect to soon see cost savings from implementing the technology. Further, a majority are looking to hire talent with experience developing AI.
In a trial last year, a federal judge found that a UnitedHealth subsidiary had illegally denied mental health and substance use disorder claims. The same judge has now ordered the payer to reprocess all the claims and reform its guidelines.
A new survey of U.S. physicians shows that they have differing views on how the payer market needs to evolve, but a vast majority agree that affordable insurance is necessary to provide access to high-quality care while reducing costs.
– Cardiac patients and their cardiologists are
experiencing a high number of false positives with remote patient monitoring
devices as a result of signal artifact providing inaccurate data, which can
lead to many complications—other than medical, such as unnecessary tests and
increased medical costs.
– Ambulatory cardiac monitoring provider InfoBionic has devised a way to decrease false positives and increase efficiency.
Remote cardiac monitoring’s false positives—especially on atrial fibrillation (Afib)—hurt everyone, from the patient to the boss who will have to go without an employee when he or she has to go in for unnecessary tests. An estimated 12.1 million people in the United States will have Afib by 2030; Afib increases the risk of stroke, heart failure, and death, and is one of the few cardiac conditions that continue to rise.(1) “We must give the clinician more effective diagnoses, while at the same time increasing confidence in our healthcare technology systems with respect to the accuracy of the same patient data,” expressed Stuart Long, CEO of InfoBionic, a provider of ambulatory cardiac monitoring services.
Impact of Remote
Patient Monitoring on Afib
Afib is a “fluttering feeling that can point to a quivering heart muscle, a notable skipped beat as the mark of a palpitation, and a racing heart rate that sparks other discomforts.” (2) With the rise of remote patient monitoring (RPM) as an effective and economical modality to treat and monitor patients, false positives continue to rise to generate a lack of confidence in the accurate clinical data captured through RPM. False positives can overwhelm the clinician and result in the increased use of resources and downstream costs, and false negatives could have detrimental clinical consequences.(3)
Without a reliable RPM supported by powerful AI solutions, healthcare payers experience higher costs. Heart disease takes an economic toll, as well, costing the nation’s healthcare system $214 billion per year and consuming $138 billion in lost productivity on the job. (4) The cascading effect of false positives run the gamut of the human experience—from the physical and emotional health of the patient to the added out-of-pocket expenses of unnecessary and avoidable tests.
The increased risks of hospital readmissions at a time when healthcare systems are overtaxed and understaffed adds another factor of what could have been an unneeded situation. “InfoBionic AI has all but eliminated the need for physicians to deal with false positives. In fact, 100% of Atrial Fibrillation events longer than 30 seconds are detected accurately (true positive) by InfoBionic’s AI system(6),” said Long.
leveraging cloud computing with continuous arrhythmia monitoring to create a
reliable platform with accurate data collection, an ambulatory cardiac monitor,
such as the MoMe® Kardia device, optimizes AI solutions,
allowing for consistency in the treatment. Integrated sensor measures have been
shown to predict heart failure and might have the potential to
empower patients to participate in their own care.(5) Offering
24-hour monitoring through RPM technology that reduces false positives leads to
the patient becoming more comfortable with the RPM service, which increases the
likelihood the patient will adopt the practice of self-care well into the
future. Cardiac patients with pulmonary or electrolyte problems may need
continuous cardiac monitoring to screen for arrhythmias.
“A primary feature of our MoMe® Kardia is its ability to leverage technology in a way that makes physicians feel more confident via analysis precision that verifies detected cardiac episodes through the algorithm,” said Long. Another distinct advantage is the ability to provide 6 lead analysis instead of the 1 or 2 leads provided by other systems. This affords the physician a much better view of each heartbeat, thereby increasing physician confidence in the accuracy of diagnosis.
provides valuable clinical statistics that guide treatment with the best
patient outcomes. As the leading provider to collect every heartbeat and
transmit it to the cloud in near real time, explains Long, InfoBionic’s AI
algorithms are informed by over 15 million hours of electrocardiogram (ECG)
collected from the entire patient population. With full disclosure transmission
that allows AI algorithms to run on powerful servers in the cloud, the system
utilizes much more intensive processing than could be accomplished on other
patient-worn devices. Multiple patented algorithms are run concurrently on the
ECG stream, each with superior performance on a variety of clinical conditions.
Access to mental healthcare continues to be a hurdle amid the Covid-19 pandemic, prompting Aetna and telehealth provider Inpathy to expand their existing mental health partnership to include three more states.
Lark Health, which offers AI-powered digital care platforms for chronic diseases, has raised $70 million in new funds, which it plans to use to expand its relationship with Anthem and eventually deepen partnerships with other payers and telehealth providers.
CMS’ interim rule states that Medicare will cover Covid-19 vaccines approved by the FDA, including those receiving emergency use authorization, in a reversal from its usual policy. The vaccine will be made available at no cost to Medicare beneficiaries.
Expanding Medicaid and then adjusting Medicare coverage based on financial and income status would be one way to improve healthcare policy and make sure that more Americans have healthcare when they need it.
launches member engagement solution for healthcare payers to drive improvement
in healthcare cost and quality boosts member satisfaction and enhances member
enrollment and retention.
– Innovaccer’s solution create member-oriented care
plans, enhance connectivity with care managers, and drive interventions for
social determinants of health risks through the solution.
Innovaccer, Inc., a
technology company, has launched its member engagement
solution for healthcare payers. The solution will enable payers to use a
more consumer-oriented approach and allow the network members to take charge of
their own healthcare journeys. The solution will empower them with the right
information, resources, and the network’s best-performing providers.
Creating a Patient-Centered Care Paradigm
U.S. healthcare is making strides toward a more
patient-centered care paradigm. The latest Interoperability and Patient Access
final rule is one of the initiatives that put patients at the center of care.
The rule made it mandatory for payers to share electronic health data with
patients, which will enable them to participate more in their healthcare
In addition to meeting the regulatory requirements, the
member engagement solution enables payers to provide on-demand, mobile-based
educational materials, lab and test results, clinical visit notes, personalized
health assessments, and digitized services to health plan members.
Enabling Payers to Become More Patient-Centered
Innovaccer’s solution enables payers to become more
patient-centered. Payers can create member-oriented care plans, enhance
connectivity with care managers, and drive interventions for social
determinants of health risks through the solution.
“By building strong payer-beneficiary collaboration, we will be able to establish a more active, responsible, and value-driven care journey. Engaged members will know and understand exactly what is being done for the successful management of their medical conditions. A more informed and savvy member can potentially contribute to improving the quality of care, reduce excessive resource utilization, and decrease their costs,” says Abhinav Shashank, CEO at Innovaccer.
– Healthify in partnership with Algorex Health Technologies, announced the results of new social determinants of health (SDoH) population analysis of Excellus BlueCross BlueShield (BCBS) members.
– SDoH are non-clinical conditions that significantly
affect health outcomes. The analysis identified Excellus BCBS members who are
struggling with SDoH such as unstable housing, food insecurity and neighborhood
stress – which has enabled Excellus BCBS to develop a targeted SDoH strategy
focusing on members with the most need.
Healthify, a company that works with managed care organizations to integrate social determinants of health (SDoH) into the healthcare ecosystem, in partnership with Algorex Health Technologies, today announced the results of SDoH population analysis of Excellus BlueCross BlueShield (BCBS) members that identified high-risk members and the value of implementing SDoH initiatives. The data identified members who are struggling with unstable housing, food insecurity and neighborhood stress, which has enabled Excellus BCBS to develop a targeted SDoH strategy focusing on members with the most need.
Excellus BCBS turned to Healthify and
healthcare data analytics company Algorex Health to
provide deep analytic insights about how social determinants of health affect health quality
and cost. The SDoH data showed significant social needs
among members in Medicaid and other government sponsored programs and the value
of addressing the most prominent social determinants of health of
Healthify creates the infrastructure that drives
collaboration among community-based organizations, healthcare payers, providers
and policy makers to address social disparities with
aligned incentives and accountability. Healthify recently announced a
partnership with Algorex Health Technologies to expand its SDoH capabilities
to include SDoH predictive analytics that help health plan
and provider organizations better understand and proactively address the social needs
of vulnerable populations.
“SDoH analytics are critical for health plans that are implementing SDoH solutions,” said Manik Bhat, Founder and Chief Executive Officer of Healthify. “Analytics helps health plans build financial cases to solve for SDoH, prioritize highest-impact interventions in an accountable network and determine the right level of investment for SDoH initiatives.”
With the annual INVEST Population Health virtual conference coming up November 16-18, here’s a look at our collaboration partner New Orleans Business Alliance. It plays a vital role in helping to stimulate the local economy by supporting the development and advancement of the healthcare and biotech infrastructure.
The Centers for Medicare and Medicaid Innovation (CMMI) created the Direct Contracting Model to expand opportunities for more diverse providers and healthcare organizations to participate in value-based care arrangements for Medicare fee-for-service (FFS) beneficiaries.
The goal of the new model is to create the next generation of risk-sharing arrangements to improve outcomes for patients, lower costs, and ensure high-quality care. In developing the Direct Contracting model and associated payment options, CMMI decided to build on lessons learned from accountable care initiatives, in particular, the Next-Generation ACO (NGACO) Model, as well as Medicare Advantage and other innovative private payers. The new model specifically aims to attract providers new to Medicare FFS and Innovation Center models: “the payment model options appeal to a broad range of physician practices and other organizations because they are expected to reduce burden, support a focus on beneficiaries with complex, chronic conditions, and encourage participation from organizations that have not typically participated in Medicare FFS or CMS Innovation Center models.”
High risk equals high reward for the new Direct Contracting Entities (DCE). The payment model options that participants can choose from aim to (1) increase risk-sharing arrangements through capitated and partially capitated population-based payments, (2) include providers and organization new to Medicare FFS, (3) increase access and empower beneficiaries in their care, and (4) decrease provider burden by emphasizing only core quality metrics and making certain care delivery waivers available. Importantly, the model offers options for new entrant DCEs, meaning DCEs that have no or limited experience with Medicare FFS beneficiaries and associated Medicare risk-based contracts, as well as high needs DCEs that will focus specifically on high cost, high acuity beneficiaries.
The Direct Contracting model begins with an optional six-month implementation period on October 1, 2020, which is intended to support organizations that need additional time to align beneficiaries and optimize their care coordination and management functions. In light of COVID-19’s overwhelming impact on healthcare this year, CMMI announced the first Direct Contracting Model performance year will start April 1, 2021—a three-month delay from the original start date, with five performance years to follow. The second cohort of Direct Contracting participants will begin in January 2022.
The Innovation Center will initially test two risk-sharing options:
Professional – includes a 50% shared savings/shared losses provisions and Primary Care Capitation, a capitated, risk-adjusted monthly payment for enhanced primary care services that’s equal to seven percent of the total cost of care benchmark for enhanced primary care services
Global – is 100% full risk option with either Primary Care Capitation or Total Care Capitation, which is a capitated, risk-adjusted monthly payment for all services provided by Direct Contracting Participants and preferred providers.
CMS may test a third option, the Geographic Option, in the future, which would also be a 100% risk arrangement offering an opportunity for participants to assume the total cost of care risk for Medicare FFS beneficiaries in a defined region.
Achieving Success in the Direct Contracting Model:
Similar to existing accountable care models, critical elements to achieve success in the Direct Contracting model include a focus on workflows, systems, and partnerships that support care coordination activities, including connections to needed healthcare and wrap-around services, as well as supporting providers in attaining quality benchmarks while managing overall utilization. Underlying these capabilities is access to real-time actionable information to drive timely interventions and coordination activities.
Real-time information through admission, discharge, and transfer (ADT) event notifications for Emergency Department, hospital, or post-acute encounters enable care coordination teams to deploy workflows and resources to more easily and quickly support patients. Knowing when and where patients are receiving care and understanding the clinical context for their care allows providers and care teams to more seamlessly work together to provide the right care at the right time without unnecessary or duplicative interventions. It also allows care teams to identify patients at high risk for complications, including readmissions and can prompt time-sensitive outreach and connection to additional resources.
Having access to real-time information can not only improve patient outcomes and quality but will also help to maximize payment incentives for Direct Contracting participants. Coordinated care consistently leads to shorter lengths of stay, which not only has positive quality implications for patients but also financial benefits for Direct Contracting Entities.
In addition, healthcare organizations can use real-time information to continuously strengthen and refine care network partnerships and collaborations.
To effectively manage Medicare FFS patients within the Direct Contracting Model, participants will need to coordinate with other providers across care settings and deploy timely interventions that support patients’ health and well-being. Real-time information, through ADT data, will provide participants with a new level of clinical intelligence to successfully prioritize and deploy care coordination services and ensure seamless transitions of care for patients while also creating optimal opportunities to achieve shared savings.
About Vanessa Kuhn, Ph.D
Vanessa Kuhn, Ph.D., is the Director of Policy at PatientPing, a care collaboration platform that provides real-time visibility into patient care events across the continuum. PatinetPing works with hospitals, post-acutes, health plans, ACO’s and beyond, the platform connects providers across the nation to improve patient and organizational outcomes.
Insurance startup Bind Benefits just raised $105 million in a Series B funding round to further expand into the fully insured market. CEO Tony Miller sees the company’s health plan product as a way for employers to stay agile while offering insurance in a rapidly changing world.
The COVID-19 pandemic has forever changed patient expectations for healthcare delivery, including offered services and health office operations. Although health systems have remained dynamic in adopting telehealth capabilities, their long-term capital, like real estate and supply chain management (SCM) protocols, have not adapted to match these expectations. Health systems must be aware of current trends in both areas to inform their future decisions.
Divesting in healthcare real estate is also key to reducing unnecessary costs to a health system, especially if optimal use of these spaces is already lacking. The overwhelming costs of ownership and management lock money away in underutilized and obsolete real estate spaces. Divesting provides more capital liquidity, and frees capital to go towards investment in telehealth, diagnostic technology, and emerging specialties, assets that go towards increasing patient and workforce engagement and satisfaction. In addition, eliminating unused real estate assets allows freedom from liabilities and human capital investments, like facility maintenance and upkeep, not to mention the increased frequency of deep cleaning necessary in the post-COVID-19 bi-lateral operations era.
Further, years of mergers and acquisitions in the healthcare industry have left many health systems with the unwanted result of increases in real estate assets. This has led to increased consolidation of these assets, a trend that has been exacerbated by the pandemic pressure on health system funds. Future consolidation and reevaluation of assets should be informed by trends in patient expectations as well as trends in the market.
Here are five emerging trends driving the future of healthcare real estate and assets. Each encourages divestment out of health system real estate ventures or restructuring of existing spaces in order to better cater to forever changed patient expectations.
1. Rise of Telehealth
According to the Department of Health & Human Services, telehealth use is up around 50% in primary care settings since the beginning of the public health emergency and is projected to remain high in the time following. Most recently, in-person visits have increased and as a result, telehealth visits have declined due to the state’s reopening, and thereby some critics posit that this trend may not continue. However, that could not be further from the truth.
Moving forward, despite health system fear regarding long-term reimbursement may be lacking from federal, state, and commercial health plan payers for virtual care delivery, leveraging telehealth to augment traditional healthcare delivery will become a necessity because consumers will demand it and physicians in some studies have shown satisfaction with their video visit platforms. This will no doubt have an impact on office layout and services.
2. Convenience of Outpatient Services
Motivated in part by telehealth utilization, patients seek convenience and accessibility in their healthcare now more than ever. Health system expansion may therefore mean satellite offices in high traffic areas to cater to the patient’s need for accessibility, marking a movement away from the traditional, centralized hospital campuses.
3. Value-Based Care Transitions
As legislation and CMS regulation moves more towards a value-based care system, trends show a natural move towards lower-cost facilities that provide preventive care. These could also contribute to continued trends to more off-campus real estate and planning for alternative care delivery options, for example, mobile vans reaching more vulnerable, at-risk populations for care such as life-saving vaccinations.
4. Pandemic Precautions
Bilateral operations are likely to be maintained for some time even after more normal operations return, and healthcare real estate, especially with consolidation, will need to accommodate this precaution, and others like it in all locations.
New diagnostic and testing tools are constantly being released, forcing health systems to reevaluate their current assets and make room for new ones which contributes to wasted space. Furthermore, remote monitoring apps will continue to proliferate in the market and become more affordable and accessible to consumers while advancing interoperability standards and federal information blocking requirements will allow information to flow more freely.
Strategies to Optimize Healthcare Real Estate & Strategy
In order to unlock money trapped in assets, health systems should look to make their assets work better in response to current trends and patient expectations. To accommodate patient demands and changes to health industry regulation and reimbursement, it makes sense to ensure efficient use of all facilities and optimize real estate and assets using the following strategies:
– Divest underutilized assets of any kind: Begin with real estate and move smaller to reduce unneeded capital investment.
– Remove or reduce administrative spaces: Transition non-clinical workforces to partial or complete work from home status, including finance, legal, marketing, revenue cycle, and other back-office functions. Shared space or “hotel” workspaces are popular.
– Reconfigure medical office or temporary care buildings: As these are often empty several days a week, they must be consolidated.
– Get out of expensive leases for care that can be given remotely or in lower-cost options or by strategic partners: Take full advantage of telehealth capabilities and eliminate offices that have become obsolete.
– Integrate telehealth into real estate only where it makes sense: Telehealth is more applicable to some services and care modalities than others. Offices should reconfigure to meet these novel needs where necessary, even if it means forgoing leases for the near term.
– Assess other expensive assets: Appraise assets like storage and diagnostic tools. Those not supportive of the new post-COVID-19 care model or prioritized service lines and are otherwise not producing revenues should be sold or outsourced to strategic partners.
– Diversify with off-campus offices: Provide convenient access to outpatient care and new outpatient procedures by investing in outpatient medical offices in high foot traffic locations.
– Create space for services in high demand: Services like preventive care and behavioral health should be given physical or virtual space in the system to cater to patient needs.
About Moha Desai
Moha Desai is a Principal of Healthcare Strategy and Transformation where she focuses on driving forward strategic, planning, financial, revenue cycle, operational improvement, and patient engagement healthcare projects for providers, federal government health agencies, and various firms requiring growth, business development, and project implementation and management. She has previously served in leadership roles at Partners HealthCare, Deloitte Consulting, Bearing Point, etc. Moha received her B.A. in Economics and her M.B.A. at Yale University.
– FDA awards AppliedVR Breakthrough Device designation for
treating treatment-resistant fibromyalgia and chronic intractable lower back
– AppliedVR’s EaseVRx program helps patients learn self-management skills grounded in evidence-based cognitive-behavioral therapy (CBT) principles and other behavioral methods.
a pioneer advancing the next generation of digital medicine, today announced
its EaseVRx product received Breakthrough Device designation from the U.S. Food
and Drug Administration (FDA) for treating treatment-resistant fibromyalgia and
chronic intractable lower back pain. EaseVRx is now one of the first virtual
reality (VR) digital therapeutics to get breakthrough designation to treat
conditions related to chronic pain.
What is the FDA Breakthrough Device Program?
The FDA Breakthrough Device Program helps patients receive more timely access to breakthrough technologies that could provide more effective treatment or diagnosis for life-threatening or irreversibly debilitating diseases or conditions.
Clinical Trial Results/Outcomes
AppliedVR achieved this milestone after successfully
completing the first randomized controlled trial (RCT), evaluating VR-based
therapy for self-management of chronic pain at home. The RCT, which was
published in JMIR-FR,
found that a self-administered, skills-based VR treatment program for treating
chronic pain was feasible, scalable and was effective at improving on multiple
chronic pain outcomes – each of which met or exceeded the 30-percent threshold
to be clinically meaningful. On average, participants noted:
AppliedVR’s EaseVRx program helps patients learn self-management skills grounded in evidence-based cognitive-behavioral therapy (CBT) principles and other behavioral methods. The program was designed by AppliedVR, in partnership with the top pain experts and researchers, to improve self-regulation of cognitive, emotional, and physiological responses to stress and pain. AppliedVR has already been shown to be an effective treatment for acute pain in hospital settings.
Why Virtual Reality Is An Effective Approach for Pain
Lower back pain is one of the most common
chronic conditions that people face worldwide and represents one of the top
reasons why people miss work. Additionally, it’s an extremely
costly problem for insurers, especially as they look to cut costs related to back surgery. Recent research indicated that, when combined with neck pain,
lower back pain costs nearly $77 billion to private insurance, $45 billion to
public insurance, and $12 billion in out-of-pocket costs for patients.
Chronic pain more broadly also is a difficult and costly
problem that has contributed to many other major health problems in the U.S.,
including the opioid epidemic. A previous Johns Hopkins study in the Journal of
Pain found that chronic pain can cumulatively cost as high as $635 billion a year — more than the annual costs of
cancer, heart disease and diabetes — and lower back pain has been one of the most common reasons for prescribing opioids.
Cognitive behavioral therapies like VR are now seen by many providers as an
effective alternative or complement to pharmacological interventions that can
support their larger treatment tool belts.
“Since 1980, the American Chronic Pain Association has advocated a multidisciplinary approach to pain management—using a combination of medical and behavioral techniques to address pain,” said Penny Cowan, founder and CEO of the American Chronic Pain Association. “Virtual reality has the potential to be an important resource in this approach, helping people with pain to think differently about their conditions and learn strategies to reduce suffering and improve quality of life.”
Future Clinical Trials
AppliedVR is currently engaged in many other trials,
including feasibility studies with multiple well-known payers and with the
University of California at San Francisco (UCSF) to study how digital therapeutic platforms, including
virtual and augmented reality, can be used to improve care access for
underserved populations. AppliedVR also is advancing two clinical trials with
Geisinger and Cleveland Clinic to study VR as an opioid-sparing tool for acute
and chronic pain – specifically the company’s RelieVRx and EaseVRx platforms.
The National Institute on Drug Abuse (NIDA), part of the National Institutes of
Health (NIH), recently awarded $2.9 million grants to fund the trials.
– CommonWell Health Alliance enables payer access with the addition of a new service provider, DataFile Exchange to support the operational services specific to the Payment and Health Care Operations use case.
Health Alliance today announced it is extending its interoperability
services to enable additional use cases beyond treatment and patient access,
starting with Payment and Health Care Operations data requests.
Data File Exchange Background
To support this effort, CommonWell has added a new service
provider, DataFile Exchange, to support the operational services specific to
the Payment and Health Care Operations use case. Together, DataFile Exchange
and Change Healthcare, the technology service provider for CommonWell, will
facilitate the automated exchange of data requests from a broader set of users,
including payers, record locator vendors and other qualified entities.
Why It Matters
Despite strides made in electronic clinical data exchange, existing payments and operations processes providing access to protected health information (PHI) remain archaic, predominantly manual, expensive, error-prone, and time consuming. The additional functionality provided by the new use case aims to end these outmoded processes, improve the quality of care, and drive efficiency across the health care continuum.
DataFile Exchange was founded by Janine Akers, an industry leader in the exchange of PHI. DataFile Exchange will work closely with CommonWell, its members, and Change Healthcare, which continues to act as the CommonWell technology service provider and data broker for the CommonWell network––in addition to building the functionality needed to support Payment and Health Care Operations data requests.
“Improving data exchange of Payment and Health Care Operations is critical, particularly as we look at ways to help our health care system do more with less time and resources,” said Janine Akers, founder and CEO of DataFile Exchange. “DataFile Exchange has broad industry experience with handling PHI, so it’s only natural for us to shift our focus to automating the exchange of PHI. We’re well-positioned to partner with CommonWell in its effort to help patients, providers and payers benefit from these next-level interoperability services.”
Four CommonWell Service Adopters who provide record
Healthcare, Ciox, Inovalon and Moxe Health––currently are participating in
a pilot to refine the use case, with the goal of making CommonWell services for
Payment and Health Care Operations purposes generally available for these underserved
areas in the coming few months.
Today, the CommonWell network enables the federated exchange
of patient information across more than 17,000 provider sites representing 100
million individuals on its nationwide network alone. Combined with its CommonWell
ConnectorTM and collaboration connections like the Carequality Framework,
connected provider sites can exchange data with more than 50,000 clinics,
hospitals, specialty centers and more. To date, more than 790 million health
documents have been exchanged across the CommonWell network.
After Nebraskans cast their vote for Medicaid expansion in 2018, the state is finally expanding coverage to more residents. As part of the state’s rollout, it split its expanded Medicaid plans into two tiers, with work and other requirements to access dental and vision coverage.
The agreed sale price of $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. CarePort is included in Allscripts Data, Analytics and Care Coordination
reporting segment and represents approximately 6% of Allscripts consolidated
revenues. Reference should be made to the Allscripts quarterly earnings reports
and supplemental financial data for a reconciliation of non-GAAP Adjusted
EBITDA. William Blair and J.P. Morgan Securities, LLC acted as financial
advisors to Allscripts in connection with the sale of CarePort.
Acquisition Enhances Care Coordination Across Acute,
As part of the acquisition, WellSky and CarePort will facilitate effective patient care transitions across the continuum — driving better outcomes for patients, providers, and payers. With the addition of CarePort, WellSky is uniquely positioned to manage the acute care discharge process, track patients across post-acute care settings, apply patient and population-level analytics, and support EMR-based care protocols.
CarePort’s EHR-agnostic suite of solutions connects the
discharge process with post-discharge care coordination — allowing providers
and payers to track and manage patients throughout their care journey. By
providing end-to-end visibility across the continuum, WellSky and CarePort can
improve outcomes, lower costs, and increase patient satisfaction.
“As part of the WellSky team, we will be able to accelerate our mission to connect providers across the continuum. Both of our organizations are aligned in our dedication to proactively bridging gaps in care. Together, we have the technology, analytics, and network to ensure that patients receive seamless care,” said Dr. Lissy Hu, CEO of CarePort. “Joining WellSky means that we can increase vital connections between acute, post-acute, and community care providers to make a meaningful difference in the lives of more patients in more places.”
With WellSky’s deep experience in post-acute care and
CarePort’s suite of care coordination solutions, this combination is a natural
fit. CarePort clients will gain access to a broader network of post-acute
providers and can leverage WellSky’s powerful predictive analytics suite, and
leading value-based care technologies. This combination of capabilities will
enable health systems, payers, and post-acute providers to more effectively
collaborate in a data-driven way and enhance patient outcomes.
“Together with CarePort, WellSky will establish new, meaningful connections between historically disparate settings of care. We have the exciting opportunity to bring care coordination to more providers in service of delivering more informed, personalized care,” said Bill Miller, CEO of WellSky. “Through this agreement, we’re ensuring our clients have the intelligent technology they need to do right by their patients, collaborate with payers, and succeed in value-based care models. It’s WellSky’s mission to realize care’s potential, and this moves us that much closer to achieving it.”
Medicare doesn’t currently cover drugs approved under emergency use designations. But CMS Administrator Seema Verma said the agency was coming up with a plan to make sure Medicare beneficiaries were covered once a coronavirus vaccine is developed.
When it announced plans to go public through a blank-check company, Clover Health shared ambitious projections for its future membership. Much of that growth is pinned on plans to launch a direct contracting business.
– Virta is expanding its suite of treatment options to
include prediabetes reversal, obesity reversal, and type 2 diabetes management.
– By making this crucial expansion, Virta can scale its
treatment to support the tens of millions of additional patients with
prediabetes and obesity, as provide an on-ramp to reversal for those with T2D
that aren’t yet ready to reverse.
Virta Health, the
leader in type 2 diabetes reversal, today introduced the addition of new
services including prediabetes reversal, obesity treatment, and provider-led
management for type 2 diabetes. The expansion provides payers and covered
beneficiaries a single, full-service virtual clinic that offers
industry-leading outcomes for the most critical needs in metabolic health.
Virta’s fully-virtual, high-touch model demonstrates hope
for change, and stands in stark contrast to approaches that only slow the
diabetes downward spiral, as opposed to reversing it. Virta provides
individualized guidance from medical providers and behavioral specialists,
whenever and wherever it is needed. Patients interact with their dedicated
clinical team often multiple times per day. This novel telehealth
approach—called Continuous Remote Care—ensures successful adoption of Virta’s
individualized medical nutrition therapies and long-lasting results.
Why It Matters
Nearly half of adults in the United States suffer from obesity,
prediabetes, or type 2 diabetes. Thirty people die per hour of diabetes-related causes. The
economic burden continues to grow, and people with diabetes incur nearly $17,000
in medical expenses per year. They are also at high risk for severe illness
from COVID-19, and risk of dying from the disease is twice as high compared to
those without diabetes.
Obesity and prediabetes patients will benefit from the same
treatment that delivers the sustained type 2 diabetes reversal outcomes in Virta’s
clinical trial and commercially-covered population. Patients receiving type 2
diabetes management will receive support from a provider-led care team, with
personalized guidance and an option for a seamless transition to Virta’s
reversal treatment. All patients will receive individualized care via Virta’s
provider-led Continuous Remote Care platform.
Virta Type 2 Diabetes Reversal Results
Virta’s results in type 2 diabetes reversal have fueled continued triple-digit year-over-year growth for the company while creating strong demand to bring Virta’s evidence-based approach to other metabolic conditions. In Virta’s peer-reviewed clinical trial results, 60% of people at one-year reverse type 2 diabetes, and 94% reduce insulin use or eliminate it altogether.
Additionally, patients completing one year of the Virta
Treatment experience 14% weight loss. This figure exceeds the goal of the
National Diabetes Prevention Program and the FDA benchmark for weight loss
drugs by nearly 200%.
“This expansion provides our commercial partners and patients with the transformational outcomes they’ve come to expect from Virta, but don’t receive from other solutions on the market,” said Sami Inkinen, CEO & co-founder of Virta Health. “We can now meet every patient wherever they are on their metabolic health journey, while uniquely offering a path to reversing their chronic disease.”
Since COVID-19 emerged as a major health threat, virtual care has taken off. As many as 46% of patients reported in late April that they had used telehealth to replace a canceled healthcare visit in 2020, while 48% of physicians said they had started using telehealth to treat patients.
While a shift in care models was necessary to address business continuity amid the pandemic, these trends also represent positive movements as a growing body of evidence supports the real-life benefits of telehealth. Remote models of care are connected to safe and effective consultations across many use cases, low exposure to viruses, and much-needed access to care.
Yet the fact that physician adoption isn’t higher suggests two things:
1) Physicians may be taking a ‘wait and see’ approach in the hopes that patients will want to return to in-person care as economies reopen; or
2) Some physicians haven’t yet figured out their long-term telehealth strategy. In truth, many providers are treating telehealth as a “stop-gap” — or temporary — solution until life returns to normal.
But given the increasingly positive data around telehealth as a safe alternative to in-person care, as well as its track record in successfully treating patients, it’s time for providers to reframe their thinking. In the future, practices will need a healthcare strategy that balances virtual with in-person care.
As recently as ten years ago, telehealth reimbursement was largely limited to patients in rural areas, as payers didn’t yet see the value of compensating doctors for virtual encounters.
Today, most payers and providers recognize the value of telehealth on some level amid rising demand for services and severe professional shortages. In particular, remote care models have proven their worth during the pandemic as an effective means of preventing the spread of disease. Greater acceptance of telehealth is further demonstrated by the recent decision to relax HIPAA requirements by HHS’ Office of Civil Rights (OCR), allowing more providers and patients to virtually connect through FaceTime, Zoom, or other two-way communications systems during the current pandemic.
This is an important first step, although many providers remain resistant to change for a variety of valid reasons. Some of these include discomfort with remote care models, reimbursement concerns, and the cost of deploying telehealth.
Performing medicine in a way that doesn’t align with one’s training feels unnatural, and some providers have said that virtual encounters feel less personal. The fact is that most clinicians weren’t trained to diagnose patients remotely or engage over a screen and are simply hesitant to embrace this approach to care.
Also, providers may have trepidation about not getting paid. While CMS and private payers have expanded coverage, multiple healthcare providers have reported that bills are being delayed or only partially paid by health plans.
With limited insight into the potential return on that investment, concerns over the cost of implementing telehealth are also reasonable. A physician who is consulting with patients remotely through FaceTime, for example, might wonder if the investment in a more secure, robust telehealth platform will make sense in 12 months, should a COVID-19 vaccine materialize.
Yet by not adopting a more permanent telehealth solution, providers may be hurting themselves down the road. Patients increasingly believe virtual care is highly effective, and some even prefer it. According to a SYKES consumer survey administered in March, 60% of 1,441 respondents said the COVID pandemic has increased their willingness to try telehealth.
Also, while HHS has relaxed HIPAA enforcement at the moment, there’s no indication this will continue. Healthcare organizations will need to ensure that the platform or program they’re using is designed to keep protected health information (PHI) safe.
Investing in the Future
Given the upward trajectory of telehealth, it benefits providers to thoughtfully invest in the right strategies and solutions now to extract the greatest value and return on investment down the road. Here are four steps to take, when shifting to a long-term telehealth strategy:
– Identify needs. Many primary-care practices may have seen a bump in interest in telehealth due to COVID-19, while specialty practices may see increases stay steady, even when fears of the coronavirus fade. When planning long-term, put patient needs first: In what ways can telehealth improve care delivery, going forward? Look at data, such as virtual-visit utilization patterns, to see where there are opportunities to grow telemedicine (e.g., expanding chronic care management) based on needs.
– Consider workflows. The ideal telehealth program doesn’t interrupt clinical workflows – it enhances them. If you’re using a ‘stop-gap’ video conferencing solution to provide telemedicine, is it easy to integrate practice notes with your EHR? Or, do you have to take extra steps to document patient encounters for clinical and billing departments?
–Seek supportive partners. You can use any number of technology platforms to conduct telemedicine encounters, but not all platforms are created equal. When looking at implementing a telehealth platform, consider not only ease of use, and interoperability, but also what a particular vendor is offering: How well the telehealth platform in question can accommodate the needs of a particular specialty? What are existing clients are saying about things like training, vendor support, and the patient experience?
– Proactively engage. Your patients have most likely heard of telehealth, but they may not realize that telehealth is multifaceted and can be used to diagnose conditions such as skin disorders or allergies and can be just as effective as in-person visits. Educating patients about telehealth’s benefits, and making it easy for them to try telehealth, is essential to success.
Expanding telehealth’s role in the medical practice benefits everyone, from physicians to patients to payers. Moving past the “stop-gap” mentality now will reap greater benefits in the future, regardless of whether we’re in the midst of a pandemic, or simply trying to provide excellent care on a day-to-day basis.
About Roland Therriault
is the President and Executive Vice President of Sales at InSync Healthcare Solutions, a provider
of integrated EHR and practice management software, revenue cycle management
services and medical transcription to thousands of healthcare professionals
throughout the United States. Roland Therriault manages all operations of the
company, driving its go-to-market strategy and overseeing all sales activities.
His experience in healthcare and technology includes more than 20 years of
direct and channel sales, strategic planning and business development. Prior to
joining InSync, Roland served as Vice President of Sales for MD On-Line, a
provider of acute and ambulatory clinical and practice management solutions.
Chance Scott, a Director in life sciences at Guidehouse, talks about some of the challenges digital health innovators face, from reimbursement by private plans to the future of reimbursement for other telehealth tools and digital therapeutics.
– Amwell ranks highest among direct to consumer brands
and Cigna ranks highest among health plans for telehealth patient satisfaction,
according to the J.D. Power 2020 U.S. Telehealth Satisfaction Study
– Though telehealth has been pitched as a solution to
improve access to healthcare for everyone, more than half (52%) of telehealth
users say they encountered at least one barrier that made it difficult to use
The J.D. Power U.S. Telehealth Satisfaction Study, now in
its second year, measures consumer satisfaction with their telehealth service
experience based on four factors (in order of importance): customer service
(42%); consultation (28%); enrollment (19%); and billing and payment (11%). The
study is based on responses of 4,302 health consumers who used a telehealth
service within the past 12 months. It was fielded in June-July 2020.
“The COVID-19 pandemic has been a moment of truth for telehealth, and, by most accounts, the technology is rising to the challenge and delivering a high degree of satisfaction among those who use it,” said James Beem, managing director of global healthcare intelligence at J.D. Power. “However, even though the public awareness with Telehealth is higher due to the influence of COVID-19, the barriers for the consumer to engage with the technology has been a consistent theme in our research.”
Key findings of the 2020 study include:
– Amwell ranks highest in telehealth satisfaction among direct-to-consumer brands, with a score of 885. Doctor on Demand (879) ranks second.
– Cigna ranks highest among payers of health plan-provided telehealth services with a score of 874. Kaiser Foundation Health Plan (867) ranks second and UnitedHealthcare (865) ranks third.
– Great patient experience: The overall customer satisfaction score for telehealth services is 860 (on a 1,000-point scale), which is among the highest of all healthcare, insurance and financial services industry studies conducted by J.D. Power.
– Barriers to access persist: Though telehealth has been pitched as a solution to improve access to healthcare for everyone, more than half (52%) of telehealth users say they encountered at least one barrier that made it difficult to use telehealth. The most common hurdles are limited services (24%); confusing technology requirements (17%); and lack of awareness of cost (15%). Additionally, 35% of telehealth users indicate they experienced a problem during a visit. Tech audio issues (26%) are the most common problem.
– At-risk patients have lower levels of satisfaction: Overall satisfaction is 117 points lower among patients with the lowest self-reported health status than among patients who consider themselves to be in excellent health. Similarly, healthier patients are significantly more likely to understand the information provided during the visit, receive clear explanations, feel their visits are highly personalized and obtain a high-quality diagnosis.
– Safety becomes a top driver of utilization: Among patients who used a telehealth offering this year, 46% say their top reason for choosing telehealth was safety. That compares with just 13% in 2019.
The company, which was a winner of the MedCity INVEST Digital Health Pitch Perfect contest, was founded with the aim of using digital technology to improve the experience and efficiency of prior authorizations, in particular determining whether they are needed.
In the latest video installment from INVEST Digital Health, venture capitalist Michael Yang, Managing Partner, OMERS Ventures, and healthcare entrepreneur Shawn Wagoner, Chief Revenue Officer, Bind Benefits, go head to head to debate the future of health insurance.
Anthem will pay $39.5 million in a settlement related to a cyberattack in 2015. The settlement, reached with a group of state attorneys general, is separate from a class action case over the breach that Anthem settled in 2018.
CorroHealth—driven by helping clients navigate regulatory and
compliance complexities, ease physician burdens and improve financial
outcomes—emerges at a time when financial health is particularly important for
health systems and payers. CorroHealth combines the industry-leading domestic
middle revenue cycle group of TrustHCS, with the full-service global delivery
model of Visionary RCM, the emergency documentation technology solutions of
T-System, and the advanced coding solutions of RevCycle+.
“We knew health systems and plans would have a growing need for our solutions, so we worked hard and found a way to bring all 4,000 employees together as one company, united by our core. It’s been pretty amazing to see this joint venture come together at such a time as this,” said CorroHealth CEO Patrick Leonard.
The four legacy company names will remain through the end of
2020 with a final move to the CorroHealth name across all companies beginning
January 1, 2021.
Global investment firm The
Carlyle Group owns a majority stake in CorroHealth, with Cannae Holdings,
Inc. (NYSE: CNNE), Sanaka Group, and affiliates of TripleTree Holdings also
serving as investors.
Molina announced it will acquire the assets of Affinity Health Plan, a New York-based Medicaid managed care organization. It’s one of several Medicaid MCO purchases the insurer has announced this year.
The INVEST Digital Health Virtual conference Pitch Perfect competition, from September 21-25, had some intense competition between the healthcare startup participants. Thanks to all the entrepreneurs, judges and sponsors who took part.
A panel discussion at the conference will examine what is being done to address behavioral health needs from social isolation, accentuated by the public health crisis, to the stress experienced by healthcare professionals.
Alphabet’s healthcare subsidiary, Verily, will partner with Swiss Re Corporate Solutions to create a new stop-loss insurance company. The new entity, called Coefficient, will use data analytics to help self-funded companies manage unexpected areas of cost.
– Dignity Health Management Services (DHMSO), the largest
health system in the state of California to transform their network health data
into actionable insights.
– With this partnership, the organization will leverage
Innovaccer’s FHIR-enabled Data Activation Platform to better manage healthcare
services for its attributed patients.
Dignity Health Management Services
(DHMSO), a healthcare management company part of CommonSpirit Health, that helps providers
and payers deliver better clinical outcomes through innovative tools and
partnering with Innovaccer. As part of
the partnership, DHMSO will leverage Innovaccer’s FHIR-enabled Data Activation
Platform and built-in solutions to enhance its care management approach while
engaging their network providers and payers in real-time.
Transform Network Health Data Into
DHMSO will integrate its clinical
and financial data from multiple sources on Innovaccer’s FHIR-enabled Data
Activation Platform. Once the data is integrated on the platform, the
organization will power multiple care processes. This platform supports
critical FHIR API resources and solves numerous data-exchange challenges for
providers and payers. DHMSO will have the advantage of real-time data sharing
and true interoperability with the platform.
To achieve a comprehensive overview
of its network, Dignity Health Management Services will also use InGraph,
Innovaccer’s population health management solution built on top of the
FHIR-enabled Data Activation Platform. DHMSO’s leaders will view drilled-down
analysis of their under-performing parameters through InGraph’s 60+ patient
stratification features and advanced analytics offered by customizable
dashboards. They will be able to identify, have a complete overview of, and
gain insight into their cohort of at-risk patients to track utilization and
trends. The organization will be empowered to implement care management
improvements and follow results within different management spheres, adjusting
as needed to drive optimum healthcare delivery and patient outcomes.
Additionally, billing processes for patient visits will be simplified and
automated through the platform’s automated reporting feature.
InNote, Innovaccer’s point-of-care technology, the organization will furnish
its providers with a full view of their patient’s healthcare journey right at
the moment of care. This will enable DHMSO and its healthcare teams to focus on
closing the care and coding gaps in real-time to deliver quality outcomes with
Health Management Services, we believe in keeping our patients happy, healthy,
and whole every day. It is our goal to meet the physical, mental, and spiritual
needs of every patient. This partnership with Innovaccer will strengthen our
approach towards achieving this goal. Innovaccer’s FHIR-enabled Data Activation
Platform will assist us as we work toward improvements in our care delivery,
and will be a great addition to our strategy,” says Dr. Soham Shah, Medical
Director of Clinical Informatics & Quality Management, Dignity Health
The upcoming INVEST Digital Health virtual conference September 21-25 will offer a spotlight for this debate to continue. It will also include conversations spanning behavioral health and how hospitals are addressing the pandemic as well as healthcare startup pitches.
– New Chilmark Research report on revenue integrity
in healthcare reveals a transitional market making strides to address the new
burdens of modern care economics.
– The ongoing COVID-19 public health emergency underscores
the imperative need for automation and reduced administrative costs even
has and continues to be one of the most difficult challenges in healthcare.
These issues manifest in the claims process of submission, appeal, and
remittance, but the causes are found much earlier in clinical workflows. Rather
than think of these as separate issues, they should all be considered under a
broader category of revenue integrity. The latest report from Chilmark Research,
Revenue Integrity in Healthcare: Solutions Driving Payment Performance,
reveals a market in flux as new technologies are applied to old problems,
increasingly complicated by contracts that include performance and reporting
Modern Revenue Integrity Solutions Can Improve Financial
New software and platforms can accelerate, automate, and
improve the accuracy of these activities. Automated outreach, demographic and
eligibility checking, computer-assisted coding, natural-language processing,
and more traditional revenue cycle platforms.
These tools are offered by:
– Electronic Health Records (EHRs)
– Independent Platforms
– Best-of-Breed Solutions from outside the Revenue Integrity
space, but with powerful tools to address payment needs
These activities are essential for healthcare enterprises of
all sizes, scopes, and specialties. They are needed whether the organization is
primarily concerned with fee-for-service (FFS) reimbursement or value-based care (VBC).
The ongoing COVID-19 public health emergency has made the need for automation
and reduced administrative costs even clearer. With appointment volumes
dropping, provider organizations are faced with the need for reliable, accurate
payments for their care activities more than ever. These solutions are equally
valuable for traditional provider care and for modern virtual care solutions
“Accounting and revenue cycle work can never fix these issues. They need to be addressed where they occur and prevented from showing up in revenue cycle in the first place. One mistake in patient registration that was easy to fix can cause millions in complicated denials down the road.”– Lead Analyst Alex Lennox-Miller
Each type of solution (EHR, Platform, Best of Breed) is
evaluated based on how they address the needs of provider enterprises. The
report reviews the current state of the market, the maturity of solutions, and
the strengths and weaknesses of each solution type. While the current market is
valued at more than $20 billion, projections within the report show its
expected growth to nearly $35 billion in the next five years. The report shows
which segments of this market can expect annual growth rates exceeding 10% and
which will slow to under 2.5%.
Profile of Leading Revenue Integrity Vendors
In addition to the categorical analyses, this report includes 13 profiles of major and promising vendors: 3M, Allscripts, athenahealth, Cerner, Change Healthcare, Hayes|MDAudit, Medicomp Systems, Optum, PatientMatters, RevSpring, Sift, and ZOLL. Each profile includes an assessment of the vendor’s strengths and challenges, detailed descriptions and evaluations of the product capabilities and market execution, and rankings across 24 categories.
Managers and directors of healthcare organizations looking
for ways to address revenue cycle issues, lower clean claims rates, or improve
strategic revenue projections will appreciate the report’s clear breakdown of
vendor offerings and the impacts on their clinical and non-clinical staff.
Payers, including self-insured employers, and other organizations interested in
the total cost of care will find the market overview and product evaluations of
great value, helping them understand the tools and challenges their partner
organizations will be using.
– Bridge Connector raises $25.5 million in Series B funding to advance interoperability layer for healthcare organizations as demand for integrated health data intensifies during COVID-19 pandemic.
– The investment will support the growth of Destinations,
the company’s new integration-platform-as-a-service (iPaaS) that connects
health data systems using use-case-based interoperability blueprints to speed
integrations with major vendors.
a Nashville, TN-based interoperability company changing the way health care
communicates, today announced it has raised $25.5 million in Series B funding led
by Axioma Ventures. The round was also joined by all existing investors,
including veteran investor Jeff Vinick, and brings Bridge Connector’s total
funding to over $45 million.
COVID-19 Underscores Growing Demand for Integrated Health
The last decade has seen an explosion of digital health platforms and the U.S. health care system has taken incremental steps toward achieving interoperability between them. In March, the Department of Health and Human Services (HHS) issued new rules that force formerly closed vendor solutions to become interoperable.
However, the COVID-19 pandemic has exposed the urgent need for data liquidity as healthcare providers across the country have struggled to share essential patient information and provide comprehensive care via remote delivery methods such as telehealth. In the face of the pandemic’s disproportionate effect on minority communities, the industry has also recognized the critically important role that social determinants of health — the environments in which we are born, live and work — play in our overall well-being and the need to make this information available to health care providers.
A True Interoperability Layer for Healthcare
Founded in 2017, Bridge Connector provides a suite of vendor-agnostic integration solutions and a full-service delivery model, helping health care vendors, providers, and payers more easily share data between disparate systems, such as electronic health records (EHRs) or patient engagement solutions. The company’s technology is designed to democratize health care by allowing organizations of any size to equitably connect data systems and empower care teams with the most accurate patient data in real-time. Unlike other health care interoperability vendors, Bridge Connector’s unique approach does not lock customers into a forced data model or proprietary APIs, instead of employing a vendor-agnostic integration layer that works across data models without the need for standardization.
The investment will further support the company’s increasing
market share in healthcare interoperability and growth of Destinations, a new
integration-platform-as-a-service (iPaaS) that connects health data systems
using use-case-based interoperability blueprints to speed integrations with
Recent Integrations with Key HIT Stakeholders
The new funding comes shortly after Bridge Connector finalized various collaborations with some of the most influential stakeholders in health IT, including Epic, Allscripts, and Salesforce, as well as other system integrators such as MuleSoft. Those collaborations represent calculated steps toward creating a centralized hub of integration solutions for all data platforms that any health care provider or payer can access. The average hospital today uses approximately 16 disparate electronic health records platforms that limit data sharing within the walls of a single hospital, let alone between separate hospitals.
We need to keep in mind three key elements to successfully implement the final interoperability rules from CMS that require private payers to provide longitudinal claims data to members as well as the use of open APIs so a range of third-party applications can be built.
– 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.”
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.
UnitedHealthcare sent a notice to plan members stating that it would no longer cover Descovy to prevent HIV, while Truvada – after it goes generic next month – will be covered for free. Gilead reported that Descovy for PrEP had offset a second-quarter fall in product sales.
If you’ve been to a big-brand grocery or department store recently, you probably noticed some form of healthcare outlet – or maybe you didn’t. These in-store pharmacies and clinics have become so omnipresent, right there next to the diapers, dog food, and green beans, that unless you use them, you may not notice them at all.
This convergence of healthcare and retail has been happening for a few years and represents one of the fastest-growing corners of the healthcare market. In fact, retail health is growing at 10% each year – twice as fast as conventional healthcare.
The shared spaces are the latest and most obvious ways healthcare providers have emulated their retail counterparts. Just as retailers moved on from the 1980s mall archetype toward a more individualized, customer-friendly model, so too are healthcare providers – perhaps grudgingly. A large, decentralized healthcare system is more complicated than similar retail models, but patient expectations and other drivers are pushing the change. As a result, today’s hospitals increasingly are foregoing the traditional, centralized architecture in favor of distributed points of care – separate or offsite surgical, imaging and testing facilities are the norm for the modern health system.
The goal is the same whether it’s a hospital or a hardware store – improve and enhance the customer experience. Today’s hospitals are changing their models to make using their services easier, faster and, if not more enjoyable, certainly less irritating. Healthcare customers may not have the universe of options available to retail customers, but they do have options, including the easiest option of all – staying home.
Of course, this shift is about more than convenience. Because of the wave of healthcare consolidations across the country, rural America is increasingly underserved when it comes to healthcare. In those areas, these clinics offer an opportunity to receive expert care from medical professionals in other parts of the country through advanced applications and technologies. We also can’t ignore the affordability angle for patients. To some extent, productizing care and being able to access existing infrastructure in other, larger facilities, drives down cost in the overall system.
The Technology of Customer Experience
Of course, there is more to customer experience than physical accessibility. Retailers are leading the way in implementing technology to improve their customer interactions, and it’s about more than just e-commerce. You see it in everything from streamlined checkout and smart shelves to mobile coupons tailored to customer history.
The deployment of 5G networks will enable even more advanced, customer-friendly applications, something retailers and healthcare providers understand well. For that reason, they are exploring creative ways not just to leverage 5G services, but to partner with telecommunications providers to reach their shared customers.
The thinking is simple and sound: The ultra-low latency capabilities of 5G will enable innovations in all sorts of areas, including for the purposes of this conversation, intelligent retail and healthcare and telemedicine. In order for centrally located medical experts to access, read, and diagnose patients in remote clinic settings, often exchanging high-resolution medical imaging and other diagnostic information, low latency and high bandwidth are required. That’s where 5G comes in.
However, these networks require much denser networks with powerful computing that doesn’t yet exist across today’s networks. For users to take advantage of 5G’s many anticipated benefits, the network must be pervasive, and existing 4G LTE networks aren’t there yet.
That doesn’t mean providers aren’t trying. In fact, they clearly see an opportunity. Before COVID-19, Verizon estimated half the country would have access to 5G by the end of 2020, and in March the company announced an additional $500 million investment in its own 5G network. Our own industry survey conducted with 451 Research found that 86% of operators expect to be delivering 5G services by 2021. The projections are aggressive for good reason: IHS Markit expects 5G to generate some $12.3 trillion in annual revenue by 2035.
Meeting those timelines requires upgrades at existing cell sites but also fast, widespread deployment of new sites. Finding available real estate for that many new deployments – especially in the densely populated areas at the front of the line for 5G service – isn’t easy.
Enter the retail industry. Large retailers are in the business of reaching as much of the population as they can, and many of them already have a footprint that is the envy of cellular providers. The nation’s largest retail chain has 4,500 stores, and about 90% of the U.S. population lives within 10 miles of one of them. We look at that and see fast, easy, one-stop shopping. Telco providers see rooftops crying out for 5G equipment, with the potential to accelerate network densification and gain instant access to the vast majority of the U.S. population.
There is an opportunity emerging here for a symbiotic relationship between retailers, healthcare providers, and telecom operators to form a high-tech, customer-friendly hub for shopping and healthcare services. Let’s look at the possibilities from the perspectives of each party.
Telcos: It’s All About the Footprint
As always with network deployments, activity around 5G will follow demand, and demand follows the population. That means urban environments are likely to be first in the queue, and real estate in most cities is at a premium. Every rooftop and light pole are potential homes for 5G towers or equipment, a reality that has been the subject of considerable discussion – only recently moving toward a clear resolution.
Retailers already know the math, and most stores are placed strategically in proximity to as many consumers as possible. This is fertile ground for telcos, simplifying right-of-way negotiations and deployment times and ensuring significant network penetration. They also have ready-made customers in the retailers and healthcare providers occupying the buildings that support their towers.
Retail: Powering the Customer Experience
Customer experience has become a great differentiator in the retail space, as retailers evolve to meet the expectations of the Amazon generation. The last two years have been marked by growth in distribution centers and in the allocation of data center space supporting online retail and distribution.
Enabling the online shopping experience and bringing all the simplicity of online shopping to in-store customers are the threads that connect today’s most successful retail organizations. The tools and tactics making the in-store part of that possible include sensor and customer tracking, demand analytics, 360o customer learning, and artificial intelligence deployed in interactive customer environments that leverage the Internet of Things in new and creative ways.
These applications are only as effective as the networks upon which they exist and operate and 5G is simply far superior to our current 4G networks. The increase in bandwidth will enable speeds up to 100 times faster than 4G, eliminating the slow or dropped service common in highly populated environments – such as crowded department stores.
A retailer with a 5G antenna on the roof providing pristine service for all of its in-store technologies and large swaths of customers faces few limits in its deployment and adoption of advanced technologies.
Healthcare: Expanding With Confidence
The goal of retail healthcare is to make many common health services more accessible, and it’s working. There are more than 2,700 Convenient Care clinics (CCCs) in the U.S., and those clinics have received more than 40 million patient visits. Today’s consumers can buy a gallon of milk, pick up a prescription from the pharmacy, and get a flu shot in a single stop.
While these retailers and healthcare providers increasingly are sharing physical space and many of the same motivations – improving customer experience chief among them – there are some important differences. Protecting customer data certainly is a priority for retail stores – and a challenge, considering estimates that 80-90% of those who log in to a retailer’s e-commerce site are hackers using stolen data – but patient privacy may in fact be even more sensitive.
With that in mind, the security enhancements offered with 5G can harden existing retail healthcare networks and potentially open the door to even more patient services in those CCC settings. 5G has anti-tracking and spoofing features, including more encrypted data, to reduce the amount of raw data being transmitted and help protect against hackers. 5G relies more on software and cloud support than 4G, which enables better monitoring, and 5G networks can be sliced into smaller, virtual networks with security tailored for various devices and applications.
Those kinds of advanced security features may eliminate some lingering reservations among healthcare providers reluctant to dive fully into retail healthcare and embolden the more aggressive to expand their offerings. The increased bandwidth of 5G makes it easier to share and access not only sensitive files but also larger patient records, such as high-definition images and even videos from patient procedures. With no technological or security restrictions, it’s not a stretch to envision a world where anything short of surgery could happen in a CCC.
The Opportunity of Integration
There are plenty of arguments for this three-way marriage of convenience, but the full potential of this telco-retail-healthcare convergence will only be realized if the parties collaborate. There may be benefits for all parties in spite of siloed planning, but they’re also will be opportunities lost.
Retailers and healthcare providers who work closely with telcos can build offerings that take advantage of the on-site 5G capabilities, and telcos can gain not just rooftop real estate, but enthusiastic customers itching to stretch their data plans.
Of course, maximizing the partnership may mean new investments in IT systems and infrastructure. For example, you wouldn’t want to build the industry’s most robust customer experience program and then cross your fingers every time a storm threatened utility power. When you lean heavily into IT-enabled smart retail, power protection becomes paramount.
Similarly, retail healthcare centers, or CCCs, may seize the opportunity to expand their offerings and collect and/or transmit more sensitive patient data, but the enhanced security capabilities of 5G networks only go so far. Employees switching between external networks – to find an address for an insurance provider, for example – and more sensitive internal networks with private patient information will want to protect that sensitive information with secure KVM switches.
These types of investments can be managed separately or more efficiently as a single, integrated system. Mobile edge computing (MEC) is an increasingly common model for 5G-enabled computing hubs, and it brings the power and planning of an integrated, modular data center to these types of network edge locations.
MEC deployments can be housed inside or out, preserving valuable space in the store. They can be configured to support AC power-reliant IT systems as well as the DC power plants and equipment common to 5G sites. As with all modular solutions, they can be configured to meet the needs of a specific site and deployed in a matter of days. MEC systems also provide low-latency local computing when even 5G isn’t fast or secure enough for the user; most commercial transactions in these types of settings would be handled with local computing.
The key to optimizing these retail-healthcare-telco hubs is early communication between all parties and proactive planning to ensure the 5G capabilities are fully realized. A failure to communicate will result in squandered opportunities for everyone.
The Final Word
Eventually, all of this will happen with or without coordination between the interested parties. Retailers are going to continue to test the limits of technology to better serve their customers and give them more enjoyable experiences in their stores. Health systems are going to continue to decentralize their facilities and find ways to be closer to their patients and provide better interactions and outcomes. And telcos are going to find homes for their 5G antennas and expand their networks to deliver 5G services to both their subscribers and enterprises. There is an opportunity now, however, while all of these things are happening simultaneously, to do it all better, faster, and more efficiently while meeting the needs of all parties and their customers.
About Mitzi Amon, Director of Healthcare Marketing at Vertiv
Amon is the Director of Healthcare Marketing at Vertiv, where she has more than 20 years of experience in helping customers in healthcare, industrial and commercial environments optimize their operations. From researching the latest trends in the market to understanding the challenges faced by leading healthcare providers, payers, and vendors, Amon’s goal is to inspire conversations and build a collaborative environment where ideas are shared and solutions are created to help the industry stay ahead of what’s next.
There have been many memorable “where were you?” events since the 21st century began. But few can match the COVID-19 pandemic, at least from a healthcare perspective.
The effect on healthcare (and healthcare executives) has been particularly profound since our industry is in the center of everything. From the search for personal protective equipment (PPE) to setting up secure wings and field hospitals to instantly redeploying nurses from other floors to the emergency department (ED), the changes have been profound.
Yet it’s not just the front-line care areas that have experienced these challenges. They’ve also extended to the core operational functions, such as revenue cycle management (RCM) and business intelligence.
If there is a silver lining to all the trauma it’s that the pandemic has turned up the volume on the need to remove administrative waste and long-held assumptions. Many in healthcare have been far too comfortable for far too long saying “healthcare is 10 years behind other industries” in terms of business and operational technology. The pandemic has shown us the folly of that sentiment.
We have the opportunity now to take what we have learned and are constantly discovering and apply it to make hospitals and health systems data-driven paragons of efficient operations. Here are five RCM challenges healthcare executives are currently facing and how the industry can improve on them moving forward.
1. Allowing some employees to work from home
Prior to the COVID-19 pandemic, work from home was mildly embraced by some and driven more by increasingly expensive and/or unavailable office space. Many hospital and health system executives believed that RCM personnel were best managed and supported when together in the same building or campus as their managers. As such, few had plans in place to enable a real work-from-home option.
Then came the pandemic, and the options became A) allow work from home or B) cease RCM activities until the clinical side sounded the “all clear.”
While there were certainly challenges on the mechanical side, many healthcare organizations quickly discovered that their RCM staff was capable of performing most of their duties effectively while at home.
As they consider continuing work-from-home options, at least for those who want them, healthcare executives will need to be able to measure the productivity and effectiveness of their RCM staffs. This means they will need to get very good at workforce performance analytics.
The best analytics will be about performance versus activity and will enable them to gain an auditable, objective measure of the value-based performance of each employee and the department as a whole. They will then be able to set incentives and take a more practical look at workloads and what people can do. For example, if someone is currently working 50 claim exceptions per day with two touches, what can be done to incent them to double that amount? If a biller/collector can do double their current volume and get better yield while working seven hours instead of eight, then they should be paid for performance versus activity.
Organizations may still need to offer a minimal office environment for those who prefer to work that way. But they will have options that enable them to increase throughput and yield while also increasing employee satisfaction with their jobs.
2. Getting good at vendor/partner analytics
Let’s hope that the days when vendors and partners could make up for any mediocrity in their performance by dropping off a bigger box of donuts are long gone. Today, thanks to advanced analytics and data mining, healthcare executives can easily monitor and manage vendor performance to determine who is performing best on which types of issues so they can drive the best outcomes in each area. The reality is that partners should be measured as much as possible in the same manner as staff members. In RCM, cash remains king so key measures tied to cash performance, liquidity ratios, yield improvement as well as cost and “quality of touch” are best to measure the quantitative performance of a vendor, partner, or supplier.
3. Replacing dashboards with real-time command centers
If healthcare executives hadn’t already stopped relying on basic dashboards and scorecards by now the pandemic should have demonstrated why they should. Hospitals and health systems have no room for mistakes at present; they must capture every penny they can to make up for the revenue shortfalls driven by the canceling of non-emergent yet essential procedures.
Add to that a landscape that seems to be changing daily, or even hourly at times, and static and stale, dated views of organizational performance are no longer sufficient. It’s like looking at today’s weather forecast in yesterday’s newspaper.
What they need instead is a robust command center that offers streaming, real-time views of their current performance levels with deep insights including leading indicators into prospective problems, patterns, or other anomalies. With an RCM based command center, RCM executives can see how the organization is performing in multiple ways including yield, cost, quality, and velocity of payment from third-party payers and patients as well as internal process efficiencies or operational leakage.
They can compare the effectiveness of staff working in the office versus working from home to determine whether work-from-home is delivering value. They can also slice and dice the data further to determine if individual employees are more productive in the office or at home so they can make even better, more granular decisions.
The data-driven command center also enables decision-makers to look at what is being written off, where the leakage is occurring, and other factors in real-time so they can preserve and capture as much revenue as possible. The more molecular and atomic they can get at the source data level, the more effective they will be in managing organizational performance when it counts – as it’s happening. A data-driven command center delivers that capability. A robust data-driven command center also tends to put the spotlight on process problems and where the potential for robotic based automation exists.
4. Getting smarter through AI, Machine Learning & Robotics
There is a huge need right now to remove costs while improving yield. Fortunately, that is what artificial intelligence (AI), machine learning (ML), and analytical process automation (APA) are specifically designed to do because they are rooted in data.
Much of this is understanding what goes wrong and why claims are stalled or denied. For example, if Payer A requires two touches to resolve a denial or downgrade and the same denials or downgrades require four touches for Payer B, providers should ask themselves “Why?”. It could be a training or systems issue, but it could also be something occurring on the payer side.
Hospitals and health systems need to understand the patterns so they can ensure they are implementing the proper corrections. They should also be using APA to determine where costly manual labor can be replaced with automated systems.
When they are looking to increase RCM efficiency via Robotic Process Automation, healthcare organizations often start with authorizations and eligibility. Those are always the obvious places to start but yield improvement and process and cost efficiencies live in many places throughout the revenue cycle.
Data-driven APA can help them intelligently determine where the greatest potential gains from automation can be realized so they can start there, then work their way down.
5. Improve compliance efforts
While there will always be some exceptions, most compliance issues are unintentional. Fortunately, the more organizations get molecular and atomic with their data and processes, the more they have controls they can test, giving them full audibility and traceability of potential risk areas. These capabilities will help avoid false claims act violations, improper coding, and other unintentional risk markers.
More change to come
Although the overall number of daily COVID-19 cases may be trending downward, we are not out of the woods yet. Infectious disease experts are recommending caution for reopening the country; some are even predicting another surge in the fall to coincide with the start of the flu season, which could make the challenges even greater.
If that scenario takes hold, hospitals and health systems will be further challenged to get patients with chronic conditions who are fearful of the virus to come to the office for regular screenings so they can avoid negative outcomes in these other areas. More data-driven innovation will be required. And as it occurs on the care side, it will need to be matched on the business side so hospitals and health systems can continue to deliver these services.
The key is understanding not just what is happening but why it is happening so healthcare executives can make intelligent data-driven decisions. Hospitals and health systems would be wise to implement the appropriate technologies now so they are prepared for whatever the next “where were you?” moment brings.
For the quarter ending on June 30, when many health systems face a rising number of Covid-19 cases, the Kaiser Foundation Health Plan more than doubled its net income to $4.5 billion. The nonprofit managed care plans attributed the increase to reduced operating expenses and “market fluctuations.”
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– Healthcare Growth Partners’ (HGP) summary of Health IT/digital health mergers & acquisition (M&A) activity, and public company performance during the month of July 2020.
While a pandemic ravages the country, technology valuations are soaring. The Nasdaq hit an all-time high during the month of July, sailing through the 10,000 mark to post YTD gains of nearly 20%, representing a 56% increase off the low water mark on March 23. More notably, the Nasdaq has outperformed the S&P 500 (including the lift the S&P has received from FANMAG stocks – Facebook, Amazon, Netflix, Microsoft, Apple, Google) by nearly 20% YTD.
At HGP, we focus on private company transactions, but there is a close connection between public company and private company valuations. While the intuitive reaction is to feel that companies should be discounted due to COVID’s business disruption and associated economic hardships facing the country, the data and the markets tell a different story.
While technology is undoubtedly hot right now given the thesis that adoption and value will increase during these virtual times, the other more important factor lifting public markets is interest rates. According to July 19 research from Goldman Sachs,
“Importantly, it is the very low level of interest rates that justifies current valuations. The S&P 500 is within 4% of the all-time high it reached on February 19th, yet since that time the level of S&P 500 earnings expected in 2021 has been pushed forward to 2022. The decline in interest rates bridges that gap.”
Additionally, Goldman Sachs analysts also estimate that equities will deliver an annual return of 6% over the next 10-years, lower than the long-term return of 8%. Future value has been priced into present value, and returns are diminished because the relative return over interest rates is what ultimately matters, not the absolute return. In short, equity valuations are high because interest rates are low.
What happens in public equities usually finds its way into private equity. To note, multiple large private health IT companies including WellSky, QGenda, and Edifecs, have achieved 20x+ EBITDA transactions based on this same phenomenon. From the perspective of HGP, this should also translate to higher valuations for private companies at the lower end of the market. As investors across all asset classes experience reduced returns requirements due to low interest rates, present values increase across both investment and M&A transactions.
As with everything in the COVID environment, it is difficult to make predictions with certainty. Because the stimulus has caused US debt as a percentage of GDP to explode, there is an extremely strong motivation to keep long-term interest rates low. For this reason, we believe interest rates will remain low for the foreseeable future. Time will tell whether this is sustainable, but early indications are positive.
Noteworthy News Headlines
A $10.2 million “sole source” contract to run a centralized Covid-19 database for the Trump administration drew sharp criticism from congressional Democrats, who demanded that the federal Centers for Disease Control and Prevention be reinstated as the primary repository of coronavirus data. The contract drew scant public attention when it was awarded in April to TeleTracking Technologies, a Pittsburgh company whose core business is helping hospitals manage the flow of patients. But it drew scrutiny after the administration ordered hospitals, beginning on Wednesday, to report coronavirus information, including bed availability, to the new database, housed at the Department of Health and Human Services in Washington, instead of to the C.D.C.
With the CDC sidelines, some states lose access to timely COVID-19 hospital data. Just as the number of people hospitalized for COVID-19 approaches new highs in some parts of the country, hospital data in Kansas and Missouri is suddenly incomplete or missing. Earlier this week, the Trump administration directed hospitals to change how they report data to the federal government and how that data will be made available. Missouri Hospital Association spokesperson Dave Dillon called the move “a major disruption.”
Hospital giant ACA makes $822 million profit off CARES Act stimulus money. HCA’s biggest profit driver and boost to surviving the pandemic and the influx of Covid-19 patients in the second quarter came from the federal government. In HCA’s second quarter, the government stimulus passed by Congress and signed into law by President Donald Trump turned into a windfall as of the end of the second quarter.
HIMSS pushes back 2021 conference to August. HIMSS canceled its 2020 global health conference in March just days before it was slated to start due to concerns about COVID-19. HIMSS officials are planning a press conference Friday to offer more details about the HIMSS21 conference.
Noteworthy M&A transactions during the month include:
Workflow optimization software vendor HealthFinch was acquired by Health Catalyst for $40mm.
Tempo, developer of smart at-home fitness platforms, raised $60mm.
Public Company Performance
HGP tracks stock indices for publicly traded health IT companies within four different sectors – Health IT, Payers, Healthcare Services, and Health IT & Payer Services. Notably, primary care provider Oak Street Health filed for an IPO, offering 15.6 million shares at a target price of $21/ share. The chart below summarizes the performance of these sectors compared to the S&P 500 for the month of July:
The following table includes summary statistics on the four sectors tracked by HGP for July 2020: