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

HealthEdge offers 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.

Spotlight

Duty of care is no longer a vague concept, but a reality for organisations that want to demonstrate a tangible commitment to the protection of their most valuable assets – their employees. As a result of discussions initiated by the Independent Taskforce on Workplace Health and Safety, and contributed to by the Royal Commission into the Pike River Coal Mine Tragedy, the standard of care required under New Zealand law has now changed.

Spotlight

Duty of care is no longer a vague concept, but a reality for organisations that want to demonstrate a tangible commitment to the protection of their most valuable assets – their employees. As a result of discussions initiated by the Independent Taskforce on Workplace Health and Safety, and contributed to by the Royal Commission into the Pike River Coal Mine Tragedy, the standard of care required under New Zealand law has now changed.

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HEALTH TECHNOLOGY

GE Healthcare Introduces Omni Legend: A First-of-its-Kind All-Digital PET/CT System to Drive Efficiency, Enhance Diagnostics

GE Healthcare | October 17, 2022

At the European Association of Nuclear Medicine Annual Meeting, GE Healthcare proudly introduces Omni Legendi, the first system on its all-new, all-digital PET/CT platform. This cutting-edge system features a brand-new category of digital BGO detector material with a small crystal size that delivers more than two times the sensitivity of prior digital scannersii, enabling faster total scan timesiii and impressive small lesion detectabilityiv. It is designed to improve operational efficiency, enhance the patient experience, and increase diagnostic power, ideally helping to enable improved patient outcomes. Additionally, the system’s theranosticsv capabilities and ability to image short life tracers, as well as dynamic protocolsvi, help empower clinicians with greater clinical information across more oncology, cardiology, and neurology procedure types than ever before. “Sensitivity and image quality are everything in PET/CT,” explains John Kennedy, Ph.D., Chief Physicist, Nuclear Medicine Department, Rambam Health Care Campus, and Lecturer at Technion – Israel Institute of Technologyvii. “Omni Legend delivers on both – meeting all our image quality criteria for oncology and providing impressive sensitivity to image high count tracers for cardiac and neuro imaging, which helps better inform patient diagnoses and monitoring. Also, we have been able to increase patient throughput by more than a third thanks to the system’s fast total scan times – even achieving 35 patient scans in a 9.5-hour shift – and reduce dose by 40% versus the previous equipment that was installed. This not only enables better patient access and experience but also allows us to increase overall hospital efficiencyviii.” As the pace of change in healthcare continues to increase, health plan leaders cite managing costs and driving operational efficiency as the top two challenges they face todayix. This is consistent with comments by global Molecular Imaging departments, which note operational efficiency as a top barrier to growing PET/CT procedure volumesx. Omni Legend is GE Healthcare’s response to these growing challenges, helping healthcare systems overcome today’s barriers with a collection of intuitive workflow solutions enhanced by artificial intelligence (AI), including its new Precision DLi solution for deep learning image processing in PET/CT as well as its AI-based Auto Positioning Camera. “Having access to high-quality images to determine patient care is foundational to administering quality healthcare,” adds Prof. Zohar Keidar, Director of Nuclear Medicine & the PET/CT Department at Rambam and an Associate Clinical Professor at the Technion Faculty of Medicinevii. “With this in mind, a department like ours – which has a very heavy workload – requires a system that enables flexibility for emergency cases, in addition to our already packed schedules. Omni Legend provides that flexibility. Within a few short weeks/months, we were able to increase our number of scans by 150 percent – going from 30 to 45 patient scans per day. We used to have a long wait list; but today, if something is urgent, we can quickly scan a patient while keeping our other scheduled appointmentsviii. And the system’s clinical protocols afford us additional flexibility, allowing us to stage patients on any scanner, regardless of the system the patients was previously scanned on – affording us new opportunities in fleet management.” More than a new processing technique, Precision DLi is engineered using Deep Learning with a sophisticated deep neural network trained on thousands of images created with different reconstruction methods. It was designed to provide the image quality performance benefits most associated with hardware-based Time-of-Flight, such as better contrast-to-noise ratio, contrast recovery, and quantitative accuracy. The capabilities of Omni Legend are further elevated by the inclusion of Q.Clear (BSREM), GE Healthcare’s pioneering PET image reconstruction technology, and MotionFree, the company’s proven, deviceless respiratory motion correction technology. Q.Clear helps to ensure reliable quantification, while MotionFree operates seamlessly in the background to correct respiratory motion artifacts for all patient types. Furthermore, the new system’s operational efficiency solutions help improve the PET/CT imaging experience for both the technologist and the patient with convenient features that provide A fast data quality assurance process that saves time with streamlined calibration; Simplified protocol selection on the gantry touchscreen and a new user interface to enable an easy PET/CT process from start to finish; and Enhanced patient positioning capabilities as a result of AI-based Auto Positioning that automatically centers the patient for a completely hands-free positioning experience. This streamlined patient setup frees up technologists to focus on making patients feel more comfortable. Omni Legend also features LED ambient lighting to encourage a calming mood as well as a graphic pattern for the patient to view in the system to help in both alleviating stress and reducing movement for nervous patients. “We built our scalable Omni platform from the ground up to meet the needs of our customers and their patients today and in the future. With the patient in mind, we leaned on our longstanding technological leadership and strong clinical collaborations to enhance the scan experience with entirely new components designed to help improve clinical outcomes. The result is an all-digital detector, a cutting-edge deep learning solution, and workflow enhancements to help enable more personalized care.” Jean-Luc Procaccini, President & CEO, Molecular Imaging & Computed Tomography, GE Healthcare Omni Legend was designed with theranostics in mind, enabling clinicians to reach new levels of sensitivity and detectability for incredibly clear images. Already, the system boasts the highest sensitivity per cm in the marketxi and images Gallium 68 for diagnosis, staging, or restaging. Future-ready capabilities include a multi-directional, upgradable platform that can potentially expand in each of the core dimensions of PET/CT imaging, including axial field-of-view, digital detector technology, software, CT capabilities, and imaging of new tracers. About GE Healthcare GE Healthcare is the $17.7 billion healthcare business of GE (NYSE: GE). As a leading global medical technology, pharmaceutical diagnostics and digital solutions innovator, GE Healthcare enables clinicians to make faster, more informed decisions through intelligent devices, data analytics, applications and services, supported by its Edison intelligence platform. With over 100 years of healthcare industry experience and around 48,000 employees globally, the company operates at the center of an ecosystem working toward precision health, digitizing healthcare, helping drive productivity and improve outcomes for patients, providers, health systems and researchers around the world.

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FUTURE OF HEALTHCARE

CareView Communications Executes Agreement with New Hospital in Pensacola, FL

CareView Communications, Inc. | November 17, 2022

CareView Communications, Inc. an information technology provider to the healthcare industry, announced the signing of an agreement with a health system building a new campus in Pensacola, FL. The new campus includes a new acute care hospital and behavioral health unit with room for future expansion. The agreement calls for the installation of the CareView Patient Safety System®, which facilitates continuous remote patient monitoring for patients who may be at risk of harm due to falls, behavioral issues, or suicidal ideation. The CareView solution leverages an in-room camera with audio capabilities and patented Virtual Bed Rails® and Virtual Chair Rails® technologies to improve patient safety. The Virtual Rails use machine learning to identify when the patient's movement indicates a fall may be imminent, and subsequently alerts the Safety Technician. Pre-recorded messages or 2-way audio allow for direct communication with the patient. The System offers a considerable impact on sitter reduction and overall patient safety. “We are pleased to be working with our newest partner and know that our System is the solution to address their needs to reduce patient falls and increase patient safety.” Sandra McRee, CareView’s Chief Operating Officer About CareView Communications, Inc. As a leader in turnkey patient video monitoring solutions, CareView is redefining the standard of patient safety in hospitals and healthcare facilities across the country. For over a decade, CareView has relentlessly pursued innovative ways to increase patient protection, providing next-generation solutions that lower operational costs and foster a culture of safety among patients, staff, and hospital leadership. With installations in more than 150 hospitals, CareView has proven that its innovative technology is creating a culture of patient safety where patient falls have decreased by 80% with sitter costs reduced by more than 65%. Anchored by the CareView Patient Safety System, this modular, scalable solution delivers flexible configurations to fit any facility while significantly increasing patient safety and operational savings. All configurations feature HD cameras, high-fidelity 2-way audio/video, LCD displays for the ultimate in capability, flexibility, and affordability. Corporate offices are located at 405 State Highway 121 Bypass, Suite B-240, Lewisville, TX 75067.

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HEALTH TECHNOLOGY

nference Launches AI-Driven Platform and Expands Partnership with Mayo Clinic, Offering Access to One of the Deepest Real-World

nference | September 22, 2022

nference, a science-first software company transforming healthcare by making biomedical data computable announced the launch of its AI-driven nSights platform, which will allow biopharma, medical device companies, and diagnostic firms to access and directly engage with curated, de-identified healthcare data to advance research and discovery. The company also expanded its exclusive 12-year strategic relationship with Mayo Clinic, providing nference partners and customers with access to Mayo Clinic Platform’s extensive de-identified electronic health data across a range of disease and therapeutic areas. This expanded collaboration will increase access to data-derived insights and knowledge by establishing a Mayo Clinic-branded version of nSights, called Mayo Clinic Platform_Discover, built and supported by nference to help its partners solve some of the most complex clinical challenges. nSights is a software platform that makes real-world data available across multiple data modalities (clinical, molecular, and imaging). The platform enables data exploration, hypothesis generation, analytics, and data science capabilities, including algorithm development, for users of all backgrounds. nSights provides a longitudinal, 360-degree view of each patient by leveraging an ensemble of biomedical information, such as electronic health records, electrocardiograms, radiology images and more. Future iterations will also include digital pathology and genomics. The platform is supported by a flexible data dictionary, allowing for the generation of new patient-level features for analysis. “The potential of electronic health data remains locked at medical centers and is frequently under-leveraged due to data complexity, privacy, and security concerns. Our expanded collaboration with Mayo Clinic Platform provides the framework for nference’s deployment of nSights and enables our customers to access de-identified ‘patient-level’ data to drive research and development of new therapeutics. I look forward to continuing to build and fortify our partnership with the Mayo Clinic team as we work together to improve healthcare through data-derived insights and knowledge.” Mike Koenig, chief commercial officer at nference As a result of the company’s partnerships with major academic medical centers like Mayo Clinic, nSights provides access to the deepest curated patient-level dataset available across all therapeutic areas, including cardiology, oncology, metabolic diseases, immunology, and infectious diseases. The platform offers insights from both structured and unstructured records, representing more than 20 years of longitudinality, including data from over 520 million clinical notes, 1.3 billion lab test results, 10.2 billion flowsheets, and more. “Over the past year, our collaboration with nference, leveraging nSights, has accelerated clinical decision support and care in significant ways," said Maneesh Goyal, chief operating officer, Mayo Clinic Platform. "Data-derived insights and knowledge help us accelerate and enhance innovation and meet the unmet needs of patients everywhere.” About nference Through its powerful technology platform and software, nference is transforming health care by making biomedical knowledge computable. Its partnership with Mayo Clinic has given nference an opportunity to synthesize decades of institutional knowledge, producing real-world evidence in real-time by converting large amounts of de-identified data into deep insights to advance discovery and development of diagnostics and therapeutics. Its proprietary AI-enabled software platform, nSights, has been used to accelerate life sciences research, development, and clinical care in significant ways, including biomarker discovery and validation, real-world evidence generation leveraging real-world data, early disease detection, public health policy generation and validation, and more. nference is headquartered in Cambridge, Mass.

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