The Innovative Potential Of Venture-Backed Primary Care

JORDAN ANDERSON, BRIAN POWERS, AND SACHIN JAIN | 167 views

There is an urgent need for innovation in primary care delivery — inadequate access for patients, poor care coordination, and a broken reimbursement system are well-documented challenges facing the field. Despite promising efforts and important pilots to overcome these obstacles, wide-spread innovation and improvement has been constrained by financing structures that incent the piecemeal, volume-driven delivery of clinical services rather than promoting care redesign...

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Oceania Healthcare

Oceania Executive are on the board of both the NZ Aged Care Association (NZACA) and the Retirement Village Association (RVA). Being a member of the RVA requires us to follow strict standards and guidelines that govern how we operate and the service we offer senior New Zealanders.

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HEALTH TECHNOLOGY

Predictive Analytics: A Blessing for Healthcare Spaces

Article | August 29, 2022

Introduction Over the past couple of years, there has been a substantial rise in the burden of chronic conditions and treatment costs, along with the growing elderly population, which is transforming the healthcare sector at a rapid pace. As per a study, healthcare spending across the globe is anticipated to reach an unprecedented value to total US$ 18.3 trillion by 2030. In response to these trends, volume-based payment models are being replaced by outcome- or value-based models. Predictive analytics helps health organizations to get in line with these new models and improve patient care and outcomes. From predicting critical conditions such as heart failure and septic shock to preventing readmissions, the recent advancements in big data analytics are boosting the adoption of new predictive analytics solutions that aid clinicians improve outcomes and cut costs. Predictive analytics in healthcare is most helpful with clinical care, administrative tasks, and managing operations. More importantly, the technology is already making a difference in a wide range of healthcare settings, from small private doctor's offices and large academic hospitals to healthcare insurance companies. How is Growing Healthcare Data Favoring the Penetration of Predictive Analytics? The growing inclination toward digitalization in the healthcare industry has led to the creation of huge new data sets. These include radiology images, electronic medical record (EMR) systems, lab results, and health claims data. The amount of data is expected to reach new avenues with increasing genomics and cytogenesis research data in the near future. New data is being generated and collected by the novel medical devices at the edge, such as monitors and patient wearables. In addition, outside the healthcare setting, patients are generating quasi-health data through the use of health monitoring applications, fitness trackers, and personal wearable devices. By using data from these sources, health care providers can find new ways to use predictive modeling for health risks, predictive analytics for medical diagnosis, and prescriptive analytics for personalized medicine. Predictive analytics has become a crucial component of any strategy for health analytics. Today, it's an essential tool for measuring, combining, and making sense of biometric, psychosocial, and behavioral data that wasn't available or was very hard to get a hold of until recently. Here are some of the applications of predictive analytics for healthcare Identifying Patients at Risk Clinical Predictions Disease Progression and Comorbidities Predicting Length of Stay Speeding Treatment of Critical Conditions Reducing Readmissions The Future Story With the growing prominence of innovative technologies across the healthcare industry, a number of health IT providers are focusing on developing their own analytics software and engines to assist healthcare spaces deliver optimal patient care. For instance, in 2020, Eversana, a U.S.-based provider of innovative solutions to the life sciences industry, announced the introduction of its ACTICS predictive analytics solution, which enables clinical spaces to combine multiple data sources into a single comprehensive system. Also, some U.S. companies are partnering with healthcare institutions to develop proprietary algorithms designed to enhance organizational performance, improve clinical care, and increase operational efficiency. Such developments are projected to increase the popularity of predictive analytics solutions in the healthcare sector in the coming years.

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HEALTH TECHNOLOGY

Medical Computers: A Necessity of the Future Healthcare

Article | July 19, 2022

Over the last couple of years, the healthcare industry has witnessed significant technological advancements transforming numerous procedures and treatments, ranging from magnetic resonance imaging scanners and radiotherapy to antibiotics and anesthetics. In addition, the introduction of novel technologies (new pharmaceuticals and treatments, new equipment, new social media support for healthcare, etc.) has further provided air to the fire for innovation in the sector, encouraging healthcare providers to upgrade their technological infrastructure. Medical Computers Paving the Way in Healthcare Use of modern technology, such as medical computers, is becoming more and more crucial in healthcare institutions, including hospitals, clinics, and specialized treatment centers. These computers are used in hospitals for a variety of purposes, from better laparoscopic, minimally invasive surgical techniques used by surgeons to patient tracking and health monitoring gadgets. Medical computers are becoming more prevalent as they help medical professionals make faster, more reliable, and more accurate decisions. Additionally, they enable the emergence of new data, integrate advanced technologies such as artificial intelligence, and enhance decision-making processes, which are particularly crucial when it comes to medical diagnostics and treatment. New computer and technology solutions in the healthcare sector are enabling a wide range of outcomes that were previously unimaginable. They assist medical practitioners in both data collection and data interpretation, enabling them to make decisions that are thoroughly informed by insight. Here are some of the applications that have experienced immense transformation in recent years Hospital Information Systems Medical Personnel and Staff Management Data Analysis in Medicine Medical Imaging Computer-assisted Therapy Laboratory Computing Critical Patient Care Computer Assisted Decision-making (CMD) Patient Check-In and Status Growing Adoption Encouraging Product Launches With technologies like medical computers becoming essential for processing numerous day-to-day operations in the healthcare industry, the need for these computers is growing at a rapid pace. Hence, a number of medical equipment providers are emphasizing on offering cutting-edge solutions to modern healthcare facilities. For instance, in 2021, American Portwell Technology, Inc., a world-leading innovator of the Industrial PC, unveiled two certification-ready all-in-one medical computers - MEDS-P2410-P200 (23.8″) and MEDS-P2210-P200 (21.5″) with features such as true-flat capacitive touchscreen and optional hot-swappable batteries.

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HEALTH TECHNOLOGY

Wearable Technology: A Pool of Opportunities in Healthcare

Article | July 21, 2022

Introduction The field of smart wearable devices has advanced significantly in recent years as a result of the advent of mobile medicine, the development of new technologies like smart sensing, and the increased penetration of personalized health concepts. These Internet of Things (IoT)-based smart devices not only help people pursue a healthier lifestyle, but also offer a constant flow of healthcare data, which can be used for disease diagnosis and treatment, by actively recording, tracking, and monitoring metabolic status and physiological parameters. Wearable technologies have the potential to completely change the ways to monitor health behavior and are increasingly finding clinical implementation for patients with various types of diseases. Wearable Technology: New Ways of Patient Monitoring While wearable technology has demonstrated value in the fields of entertainment, fitness, and gaming, it is making inroads into the healthcare industry at a rapid pace. Increasing advancements in sensor technology and artificial intelligence (AI) are assisting millions of people in detecting and managing chronic health conditions and avoiding serious illnesses using devices that are as small as a patch the size of a penny or small enough to be worn on the wrist. According to a study, nearly 320 million consumer health and wellness wearable devices are estimated to be shipped across the globe in 2022, and the number is likely to surpass 440 million units as a number of new devices come out and more healthcare providers start using them. Most wearable devices, such as smartwatches, now include heart rate monitors, and some have FDA approval for detecting abnormalities such as atrial fibrillation, a major cause of stroke. As these devices become more intelligent, the percentage of patients and consumers who use them to manage chronic health conditions and diagnose symptoms of serious diseases is likely to rise. This is expected to assist the sales of wearable devices in healthcare to exceed $195 billion by the end of 2027, presenting huge prospects for healthcare equipment providers and associated companies to benefit from the opportunity. The Future of Wearable Technology in Healthcare Though wearable technology is experiencing rapid growth, the field is still considered to be in its nascent stage, presenting massive remunerative prospects for the manufacturers of smart devices, especially in the healthcare industry. Hence, companies of all kinds, from giants to upstarts, are emphasizing on investing and developing new wearable devices with new features and functionalities to meet the surging demand for wearables across healthcare in coming years.

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HEALTH TECHNOLOGY

The Long-Term Care Software: Mapping the Future

Article | July 13, 2022

Long-term care comprises all the health services that help patients with chronic illnesses or disabilities meet their medical and non-medical needs. It caters to those who cannot care for themselves for extended durations. For care providers, it becomes critical to meet the needs of patients on time while delivering top-notch quality, especially at a time when virtual care is more important than ever. To remedy this, many of the tasks and processes within long-term care are supported by digital solutions. These long-term care software applications enable care providers to automate aspects of patient scheduling, inventory control, regulation and compliance, data management, care delivery management, and much more. Some of the end users of long-term care software include home healthcare agencies, nursing homes, and residential hospice care facilities. What is Driving the Growth of Long-Term Care Solutions? Digitalization has swept the healthcare industry, and medical technology now occupies a significant area of medical care delivery. With the demand for a robust healthcare infrastructure aggravated by a shortage of medical professionals, the need for automation is driving the growth of medtech across all areas of healthcare. In addition, fewer medical specialists and medical cost reduction initiatives combined are powering the long-term care software market’s growth. Challenges for the Long-Term Care Software Market Despite the rapid growth in the use of digital solutions to manage administrative and compliance tasks, technological transformations are expensive. The high maintenance costs incurred by care providers are a major hindrance towards a full-fledged adoption. Many care providers are also unwilling to adopt new applications due to the implementation and staff training costs involved in doing so. What the Future Holds? With an increase in remote care and the use of technologies like the Internet of Medical Things to deliver diagnostic services and preventive care, medtech is witnessing a revolution. Long-term care is bound to follow suit thanks to areas like remote patient monitoring and wearable technology. While the long-term care market is slated to grow by leaps and bounds, solution makers must find a way to help care providers warm up to the use of technology and de

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Spotlight

Oceania Healthcare

Oceania Executive are on the board of both the NZ Aged Care Association (NZACA) and the Retirement Village Association (RVA). Being a member of the RVA requires us to follow strict standards and guidelines that govern how we operate and the service we offer senior New Zealanders.

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DIGITAL HEALTHCARE

Revibe Technologies Announces Clinical Development Updates for its Investigational FokusRx Prescription Digital Therapy for the Treatment of ADHD

Revibe technologies | February 09, 2022

Revibe technologies, a commercial-stage digital therapeutics company, announced today the positive results of their feasibility study examining the efficacy of FokusRx in school aged children with attention deficit hyperactivity disorder (ADHD). FokusRx is an investigational SaMD (Software as a Medical Device) that has the potential to provide a new nonpharmacologic approach to treating attention, focus and hyperactivity deficits associated with ADHD, and other mental health conditions. ADHD is one of the most commonly diagnosed and increasingly prevalent mental health disorders in children and adolescents.Inthe United States, 6.1 million children aged 2-17 years have been diagnosed with ADHD. Approximately 50% of families stop using prescription drug treatments for ADHD within a year.Over 30% of parents refuse pharmacologic treatment for their children with ADHD. In this, single-arm multi-rater feasibility study, parents (n= 38) and teachers (n= 26) rated youth aged 8-12 years with a parent-reported diagnosis of ADHD. Youth were attending in-person classroom learning and not taking medication for their ADHD. The study included a number of outcome measures including the ADHD-RS-5 (Home and School versions), Conners 4 – short version, Weiss Functional Impairment Rating Scale-Parent Form (WFIRS-P), and the Academic Performance Rating Scale (APRS). To be included in the analyses, youth had to have worn the Revibe Connect wearable device to school Monday to Friday for a at least three days per week or a minimum of 15 days total for a period of four weeks. "We are pleased that the feasibility study has proven to be a successful exercise that de-risks our upcoming randomized sham-controlled pivotal trial. The moderate to large effect sizes observed and change scores that exceed standards for minimally important (clinically significant) differences, provide encouraging preliminary evidence supporting the efficacy of our intervention", says Dr.Lindsay Ayearst, Chief Scientific Officer of Revibe. Revibe's Scientific and Medical Advisory Board member, Dr.Margaret Weiss, Director of Clinical Research in Child Psychiatry at Cambridge Health Alliance, stated, "These results are consistent across both symptoms and functioning, and across informants.They would translate into clinically significant change. Most impressive is the demonstration of an effect on academic performance." "The data from the classroom feasibility study suggests FokusRx can effectively and safely improve ADHD symptoms and functioning in school-aged children. It is our intention that FokusRx will provide kids and parents another option to help them succeed and reach their full potential. We are excited to begin designing our pivotal trial planned for the fall." Joseph Koziak, Chief Executive Officer of Revibe About FokusRx FokusRx is an investigational SaMD designed to provide a new nonpharmacologic approach to treating symptoms and impairment associated with ADHD. The FokusRx software is embedded within a dedicated smart watch to act as a digital therapeutic wearable. About Revibe Technologies Revibe Technologies is passionate about leveraging technology to help children and adults with focus and attention problems overcome obstacles in order to succeed in life. Revibe Technologies hopes to be a resource for students, parents, teachers, schools, and clinicians.

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HEALTH TECHNOLOGY

Thea Health Partners with athenahealth’s Marketplace Program to Improve Provider Communications

Thea Health | November 19, 2021

Thea Health, a fast-growing medical communications provider, today announced a partnership with athenahealth, Inc. through the company’s Marketplace program. As part of the athenahealth® Marketplace, this newly integrated application is now available to athenahealth’s growing network of healthcare providers to improve communications between primary care physicians and local specialists. “Thea Health is focused on making it easier for providers to collaborate on their patients’ care. Our eConsult platform allows our growing network of primary care providers to seamlessly communicate with local specialists.Our platform reduces wait time for specialist expertise, improves local referral networks and, ultimately, saves patients money. Thea Health and athenahealth share a passion for moving toward a more connected and cost-effective healthcare system.” Harry Cooke, Founder of Thea Health Studies have shown eConsults resolve patient issues without an in-person appointment 54% of the time and reduce overall healthcare expenditures by $541 per patient. athenahealth is a network-enabled, results-oriented software and services company that offers medical record, revenue cycle, patient engagement, and care coordination services for ambulatory and hospital clients nationwide. The company’s vision is to build a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all. As a Marketplace partner, Thea Health joins a community of innovative, like-minded healthcare professionals who are looking to bring best-in-class solutions to the athenahealth provider base. About Thea Health Thea Health's eConsult system allows primary care physicians to ask specialists questions and include relevant labs, images, and other clinical data ahead of a treatment decision while ensuring they are reimbursed by payers for their time. Thea Health provides a HIPAA-compliant platform that is easy to use and fits with existing physician workflows and integrates seamlessly with EMRs. This allows our providers to communicate securely, naturally, and efficiently, while getting reimbursed without doing any extra work. About athenahealth Marketplace The athenahealth Marketplace, the largest EHR app store, is where athenahealth customers find innovative healthcare IT solutions that extend athenahealth services and allow customers to create highly tailored user experiences. Customers use Marketplace partner solutions to boost practice efficiency, increase patient satisfaction, and engage patients in their own care. The Marketplace has more than 250 solutions across 60 categories that are seamlessly integrated with athenaOne, athenahealth’s network-enabled platform through which the company offers medical records, revenue cycle, patient engagement, and care coordination service offerings.

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DIGITAL HEALTHCARE

HealthEdge Brings Colorado Access Into a Modern, Integrated Core/Clinical Ecosystem to Streamline Key Health Plan Operations

HealthEdge Software | November 17, 2021

HealthEdge Software today said it is excited to upgrade long-time Altruista Health customer Colorado Access to a fully integrated ecosystem with the addition of HealthRules Payor®(HRP) to its operations via HealthEdge’s complementary Business Process as a Service (BPaaS) partner, UST HealthProof, a UST company. Colorado Access has relied on Altruista’s GuidingCare®care management platform to manage plan members for more than a decade, and is now poised for a major transformational effort to integrate the HealthEdge solution in core administrative processing. It will be one of the first health plans to adopt all three HealthEdge solution suites as it adopts Burgess Source®payment integrity software in 2022. “Colorado Access is one of the first of many health plans we expect to recognize the value of our fully integrated core/clinical solution going forward. The unique value proposition that comes with integrating a health plan’s three most important value streams is becoming more apparent every day as plans push forward with value-based care.” Steve Krupa, HealthEdge Chief Executive Officer HealthRules is the leading modern core administrative system for health plans driving more agility, efficiencies, compliance and innovation than any other solution on the market. The vision for an integrated payer “digital nervous system” became possible with the HealthEdge acquisitions last year of SaaS innovators, The Burgess Group and Altruista Health. Burgess offers a leading payment integrity solution for editing, pricing and modeling. Altruista leads the industry in utilization management, care management, population health, social determinants of health, provider collaboration, member engagement and predictive analytics. The new opportunity for Colorado Access came at contract renewal time for their incumbent provider of a core administrative processing system. The health plan found the prospect of moving to an integrated ecosystem intriguing. “When we learned about the acquisition of Altruista Health by HealthEdge at the end of 2020, we were excited,” said Paula Kautzmann, Chief Information Officer at Colorado Access. “This presented a great opportunity to explore what an integrated ecosystem could deliver for us, our members and providers.” “We serve our regional health plans with high quality, and our connected technology with the HealthEdge solution suite is a comprehensive yet cost-effective solution that reduces the need for customization and is proven to increase customer engagement and provider satisfaction,” said Raj Sundar, President, UST HealthProof. Colorado Access has used GuidingCare to close gaps in care, enhance quality and compliance, and automate clinical workflows on behalf of its 545,000 members since 2010. After a review, Colorado Access concluded they could achieve cost savings, better performance, streamlined operations and a better member experience in moving to an integrated model with HealthEdge. “We are really excited about the integration because it makes us more nimble,” said Kautzmann. “It gives us a way to leverage a 360-degree view of the member to more completely understand their needs and support them to optimal health. When our care management team see claims data in the care management environment, it gives them a chance to make preventive interventions that can improve a member’s health.” Kautzmann noted that there are cost savings and overall efficiencies with integration, including not having to maintain separate membership, provider and benefit systems. The payment integrity solution from Burgess also reduces the administrative burden associated with recovering provider overpayments. In an environment of rigorous public budgets, the new arrangement is a better deployment of resources. Colorado Access also opted to implement the new GuidingCare®Authorization Portal, which electronically streamlines the prior authorization process and eases the paper work burden between providers and the plan. Altruista introduced the Authorization Portal last year, generating sufficient utilization review data for one plan to actually reduce its list of services requiring preauthorization, reducing administrative burden and cost. Some 80 percent of services are auto-approved with the electronic tool, dramatically streamlining the process at the same time it aligns care with the world’s leading clinical guidelines. About Colorado Access As the largest and most experienced public sector health plan in the state, Colorado Access is a nonprofit organization that works beyond just navigating health services. The company focuses on meeting members’ unique needs by partnering with providers and community organizations to provide better personalized care through measurable results. Their broad and deep view of regional and local systems allows them to stay focused on our members’ care while collaborating on measurable and economically sustainable systems that serve them better. About HealthEdge HealthEdgeoffers the health insurance industry’s leading next-gen solution suit providing automation and seamless connectivity between all parts of a payer’s administrative and clinical systems. HealthEdge provides modern, disruptive healthcare IT solutions that health insurers use to leverage new business models, improve outcomes, drastically reduce administrative costs, and connect everyone in the healthcare delivery cycle. Its next-generation enterprise solution suite is built on modern, patented technology and is delivered to customers via the HealthEdge Cloud or onsite deployment. In 2020, funds managed by Blackstone became the majority owner. HealthEdge and its portfolio of mission-critical technology assets for payers, including Source®and GuidingCare®, are collectively driving a digital transformation in healthcare. About UST HealthProof UST HealthProof, a UST company, is on a mission to reduce administrative cost and play a role in shaping how the future of healthcare is delivered through consumer centricity. Our proven core admin solutions and business process-as-a-service (BPaaS) provide transparency, improve operational efficiency, break down operational barriers to scale and drive strategic growth.

Read More

DIGITAL HEALTHCARE

Revibe Technologies Announces Clinical Development Updates for its Investigational FokusRx Prescription Digital Therapy for the Treatment of ADHD

Revibe technologies | February 09, 2022

Revibe technologies, a commercial-stage digital therapeutics company, announced today the positive results of their feasibility study examining the efficacy of FokusRx in school aged children with attention deficit hyperactivity disorder (ADHD). FokusRx is an investigational SaMD (Software as a Medical Device) that has the potential to provide a new nonpharmacologic approach to treating attention, focus and hyperactivity deficits associated with ADHD, and other mental health conditions. ADHD is one of the most commonly diagnosed and increasingly prevalent mental health disorders in children and adolescents.Inthe United States, 6.1 million children aged 2-17 years have been diagnosed with ADHD. Approximately 50% of families stop using prescription drug treatments for ADHD within a year.Over 30% of parents refuse pharmacologic treatment for their children with ADHD. In this, single-arm multi-rater feasibility study, parents (n= 38) and teachers (n= 26) rated youth aged 8-12 years with a parent-reported diagnosis of ADHD. Youth were attending in-person classroom learning and not taking medication for their ADHD. The study included a number of outcome measures including the ADHD-RS-5 (Home and School versions), Conners 4 – short version, Weiss Functional Impairment Rating Scale-Parent Form (WFIRS-P), and the Academic Performance Rating Scale (APRS). To be included in the analyses, youth had to have worn the Revibe Connect wearable device to school Monday to Friday for a at least three days per week or a minimum of 15 days total for a period of four weeks. "We are pleased that the feasibility study has proven to be a successful exercise that de-risks our upcoming randomized sham-controlled pivotal trial. The moderate to large effect sizes observed and change scores that exceed standards for minimally important (clinically significant) differences, provide encouraging preliminary evidence supporting the efficacy of our intervention", says Dr.Lindsay Ayearst, Chief Scientific Officer of Revibe. Revibe's Scientific and Medical Advisory Board member, Dr.Margaret Weiss, Director of Clinical Research in Child Psychiatry at Cambridge Health Alliance, stated, "These results are consistent across both symptoms and functioning, and across informants.They would translate into clinically significant change. Most impressive is the demonstration of an effect on academic performance." "The data from the classroom feasibility study suggests FokusRx can effectively and safely improve ADHD symptoms and functioning in school-aged children. It is our intention that FokusRx will provide kids and parents another option to help them succeed and reach their full potential. We are excited to begin designing our pivotal trial planned for the fall." Joseph Koziak, Chief Executive Officer of Revibe About FokusRx FokusRx is an investigational SaMD designed to provide a new nonpharmacologic approach to treating symptoms and impairment associated with ADHD. The FokusRx software is embedded within a dedicated smart watch to act as a digital therapeutic wearable. About Revibe Technologies Revibe Technologies is passionate about leveraging technology to help children and adults with focus and attention problems overcome obstacles in order to succeed in life. Revibe Technologies hopes to be a resource for students, parents, teachers, schools, and clinicians.

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HEALTH TECHNOLOGY

Thea Health Partners with athenahealth’s Marketplace Program to Improve Provider Communications

Thea Health | November 19, 2021

Thea Health, a fast-growing medical communications provider, today announced a partnership with athenahealth, Inc. through the company’s Marketplace program. As part of the athenahealth® Marketplace, this newly integrated application is now available to athenahealth’s growing network of healthcare providers to improve communications between primary care physicians and local specialists. “Thea Health is focused on making it easier for providers to collaborate on their patients’ care. Our eConsult platform allows our growing network of primary care providers to seamlessly communicate with local specialists.Our platform reduces wait time for specialist expertise, improves local referral networks and, ultimately, saves patients money. Thea Health and athenahealth share a passion for moving toward a more connected and cost-effective healthcare system.” Harry Cooke, Founder of Thea Health Studies have shown eConsults resolve patient issues without an in-person appointment 54% of the time and reduce overall healthcare expenditures by $541 per patient. athenahealth is a network-enabled, results-oriented software and services company that offers medical record, revenue cycle, patient engagement, and care coordination services for ambulatory and hospital clients nationwide. The company’s vision is to build a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all. As a Marketplace partner, Thea Health joins a community of innovative, like-minded healthcare professionals who are looking to bring best-in-class solutions to the athenahealth provider base. About Thea Health Thea Health's eConsult system allows primary care physicians to ask specialists questions and include relevant labs, images, and other clinical data ahead of a treatment decision while ensuring they are reimbursed by payers for their time. Thea Health provides a HIPAA-compliant platform that is easy to use and fits with existing physician workflows and integrates seamlessly with EMRs. This allows our providers to communicate securely, naturally, and efficiently, while getting reimbursed without doing any extra work. About athenahealth Marketplace The athenahealth Marketplace, the largest EHR app store, is where athenahealth customers find innovative healthcare IT solutions that extend athenahealth services and allow customers to create highly tailored user experiences. Customers use Marketplace partner solutions to boost practice efficiency, increase patient satisfaction, and engage patients in their own care. The Marketplace has more than 250 solutions across 60 categories that are seamlessly integrated with athenaOne, athenahealth’s network-enabled platform through which the company offers medical records, revenue cycle, patient engagement, and care coordination service offerings.

Read More

DIGITAL HEALTHCARE

HealthEdge Brings Colorado Access Into a Modern, Integrated Core/Clinical Ecosystem to Streamline Key Health Plan Operations

HealthEdge Software | November 17, 2021

HealthEdge Software today said it is excited to upgrade long-time Altruista Health customer Colorado Access to a fully integrated ecosystem with the addition of HealthRules Payor®(HRP) to its operations via HealthEdge’s complementary Business Process as a Service (BPaaS) partner, UST HealthProof, a UST company. Colorado Access has relied on Altruista’s GuidingCare®care management platform to manage plan members for more than a decade, and is now poised for a major transformational effort to integrate the HealthEdge solution in core administrative processing. It will be one of the first health plans to adopt all three HealthEdge solution suites as it adopts Burgess Source®payment integrity software in 2022. “Colorado Access is one of the first of many health plans we expect to recognize the value of our fully integrated core/clinical solution going forward. The unique value proposition that comes with integrating a health plan’s three most important value streams is becoming more apparent every day as plans push forward with value-based care.” Steve Krupa, HealthEdge Chief Executive Officer HealthRules is the leading modern core administrative system for health plans driving more agility, efficiencies, compliance and innovation than any other solution on the market. The vision for an integrated payer “digital nervous system” became possible with the HealthEdge acquisitions last year of SaaS innovators, The Burgess Group and Altruista Health. Burgess offers a leading payment integrity solution for editing, pricing and modeling. Altruista leads the industry in utilization management, care management, population health, social determinants of health, provider collaboration, member engagement and predictive analytics. The new opportunity for Colorado Access came at contract renewal time for their incumbent provider of a core administrative processing system. The health plan found the prospect of moving to an integrated ecosystem intriguing. “When we learned about the acquisition of Altruista Health by HealthEdge at the end of 2020, we were excited,” said Paula Kautzmann, Chief Information Officer at Colorado Access. “This presented a great opportunity to explore what an integrated ecosystem could deliver for us, our members and providers.” “We serve our regional health plans with high quality, and our connected technology with the HealthEdge solution suite is a comprehensive yet cost-effective solution that reduces the need for customization and is proven to increase customer engagement and provider satisfaction,” said Raj Sundar, President, UST HealthProof. Colorado Access has used GuidingCare to close gaps in care, enhance quality and compliance, and automate clinical workflows on behalf of its 545,000 members since 2010. After a review, Colorado Access concluded they could achieve cost savings, better performance, streamlined operations and a better member experience in moving to an integrated model with HealthEdge. “We are really excited about the integration because it makes us more nimble,” said Kautzmann. “It gives us a way to leverage a 360-degree view of the member to more completely understand their needs and support them to optimal health. When our care management team see claims data in the care management environment, it gives them a chance to make preventive interventions that can improve a member’s health.” Kautzmann noted that there are cost savings and overall efficiencies with integration, including not having to maintain separate membership, provider and benefit systems. The payment integrity solution from Burgess also reduces the administrative burden associated with recovering provider overpayments. In an environment of rigorous public budgets, the new arrangement is a better deployment of resources. Colorado Access also opted to implement the new GuidingCare®Authorization Portal, which electronically streamlines the prior authorization process and eases the paper work burden between providers and the plan. Altruista introduced the Authorization Portal last year, generating sufficient utilization review data for one plan to actually reduce its list of services requiring preauthorization, reducing administrative burden and cost. Some 80 percent of services are auto-approved with the electronic tool, dramatically streamlining the process at the same time it aligns care with the world’s leading clinical guidelines. About Colorado Access As the largest and most experienced public sector health plan in the state, Colorado Access is a nonprofit organization that works beyond just navigating health services. The company focuses on meeting members’ unique needs by partnering with providers and community organizations to provide better personalized care through measurable results. Their broad and deep view of regional and local systems allows them to stay focused on our members’ care while collaborating on measurable and economically sustainable systems that serve them better. About HealthEdge HealthEdgeoffers the health insurance industry’s leading next-gen solution suit providing automation and seamless connectivity between all parts of a payer’s administrative and clinical systems. HealthEdge provides modern, disruptive healthcare IT solutions that health insurers use to leverage new business models, improve outcomes, drastically reduce administrative costs, and connect everyone in the healthcare delivery cycle. Its next-generation enterprise solution suite is built on modern, patented technology and is delivered to customers via the HealthEdge Cloud or onsite deployment. In 2020, funds managed by Blackstone became the majority owner. HealthEdge and its portfolio of mission-critical technology assets for payers, including Source®and GuidingCare®, are collectively driving a digital transformation in healthcare. About UST HealthProof UST HealthProof, a UST company, is on a mission to reduce administrative cost and play a role in shaping how the future of healthcare is delivered through consumer centricity. Our proven core admin solutions and business process-as-a-service (BPaaS) provide transparency, improve operational efficiency, break down operational barriers to scale and drive strategic growth.

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