Agadia Announces New Suite of Solutions for Formulary Benefit Management

Agadia | July 16, 2020

Agadia, a healthcare management technology company widely known for innovations in Utilization Management software, has announced the expansion of their suite of solutions to include FormularyHub, an RxContinuum SolutionTM, a fully customizable, web-based tool for Formulary Benefit Management. With the introduction of FormularyHub, the Managed Care market can now leverage an effective and condensed platform to control all attributes of a Formulary, with the ability to build, configure, and manage custom and standard formulary files across all lines of business. Custom integrations, real time updates, and ensured CMS Medicare compliance make this solution a top competitor in the space. Agadia's full suite of solutions is modeled to drive efficiency and automation across the continuum of care, specifically with respect to electronic prior authorization, medication therapy management, star ratings, medication adherence and opioid overutilization. This addition to RxContinuum aligns with Agadia's underlying mission to improve the quality of care and expedite the delivery of health care services by advancing and automating utilization management processes.

Spotlight

Around the time the first accountable care organizations were formed through the Centers for Medicare & Medicaid Services’ (CMS) Pioneer initiative in 2011, Memorial Hermann Health System executive leadership struggled with a common dilemma: how to control rising operating costs in the face of downward rate pressures and declining reimbursement? While the organization’s clinically integrated approach did help to keep costs down and enhance efficiencies, it would not be enough to sustain the new and emerging value-based payment models resulting from health care reform.


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MEDICAL DEVICES

Carestream Health Unveils New X-ray Detectors, Enhanced X-ray Rooms at World’s Largest Radiology Exhibition

Carestream Health | November 29, 2022

Carestream’s legacy of delivering quality medical imaging technology continues with the launch of new digital X-ray detectors that help improve clinical outcomes, while enhancements to its existing product portfolio reflect the company’s deep understanding of the radiology profession. At the annual meeting of the Radiological Society of North America (RSNA) in Chicago, the company is displaying its expanding portfolio of medical imaging systems that provide quantifiable benefits to healthcare organizations and their patients, including New Carestream Focus HD 35 and Focus HD 43 detectors that offer higher resolution with a 100 micron pixel pitch that allows for image magnification for better visibility of small objects and microstructures. The detectors’ Cesium (CsI) scintillator is ideal for dose-sensitive pediatric patients; and the detectors have an IP56 rating for better protection against dust and fluid ingress. Next generation of long-length imaging, the Carestream DRX-LC Detector (INVESTIGATIONAL – NOT AVAILABLE FOR COMMERCIAL SALE) captures long-bone and spine images with a single exposure, making it ideal for pediatric imaging and long-bone and spine images of people with limited mobility. In contrast, the traditional multi-shot approach requires three to five exposures followed by manipulation and stitching of the images. The new detector is designed to capture the full image in a single exposure to minimize dose and mitigate motion artifact that can appear from patient movement with a multi-shot exam. The DRX-LC Detector is designed with X-Factor so the detector can be shared across different Carestream X-ray systems and is compatible with both rooms and mobile units. Enhancements to the Carestream DRX-Evolution Plus that provide improved patient comfort and a better ergonomic experience along with improved workflow for the radiographer. Its new tabletop design eliminates rails that can cause strain and discomfort for both radiographer and patient, enabling patients to be moved more smoothly and with less effort to the exam table. New features in the Carestream DRX-Excel Plus provide a better staff experience with faster workflow and better diagnostic image quality. Designed specifically for large and mid-size hospitals and medical centers, this innovative system combines fluoroscopy and general radiology capabilities in one compact unit. It delivers accelerated workflow, high-resolution images and a wide range of patient exam options. “Our commitment to quickly respond to the needs of the radiology community with ideas that clearly work is as strong as ever, and we are solidly positioned to continue developing solutions that have quantifiable benefits to our customers and their patients. Organizations can have complete confidence in our ability to provide high-value technology that helps lower costs, and improves imaging workflow for radiology departments, technologists and other healthcare professionals—all with the goal of improving patient care.” David C. Westgate, Chairman, President and CEO of Carestream About Carestream Health Carestream is a worldwide provider of medical imaging systems; X-ray imaging systems for non-destructive testing; and precision contract coating services for a wide range of industrial, medical, electronic and other applications—all backed by a global service and support network.

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HEALTHTECH SECURITY

Zócalo Health’s Culturally Competent Virtual Healthcare Services for Latino Communities Now Available

Zócalo Health | October 12, 2022

Zócalo Health, a Latino-founded healthcare service designed for Latino patients, announced the launch of its primary care memberships for residents across California and Texas. Starting members can access same day virtual care visits and care navigation services via Zócalo’s website, introducing the Latino community to an improved and long overdue healthcare experience built on trust, relationships, and culture. Zócalo Health, which premiered as an invite-only service to select members earlier this summer, was founded by Erik Cardenas and Mariza Hardin to strengthen the health and wellbeing of the Latino community by eliminating barriers to high-quality healthcare services. This multi-state launch demonstrates the company’s continued commitment to delivering affordable and accessible primary care that blends tradition with innovation and prioritizes trusting relationships between providers and patients. Members will have access to a range of services and care options that would typically be addressed in primary care including: mental health conditions, preventative and lifestyle needs, chronic disease management, urgent care, and other more specific health conditions. The Zócalo primary care model includes the use of community health workers (CHWs) – or as they’re known in the Latino community, promotores de salud. Research shows CHWs are crucial to helping health systems achieve their full potential, since they work to connect patients to local resources and care. At Zócalo, promotores work individually with members to coordinate their care across a team of physicians, nurses, and mental health therapists, as well as connect members to needed resources across the community. Clinicians and promotores are hired from the communities they serve and can provide culturally competent care in both English and Spanish. By building care teams that come from and look like the communities they serve, the team is better able to foster a primary care relationship with patients. Once care has been established with Zócalo Health, members have 24/7 access to chat with their promotor de salud to receive individual guidance on personal health goals and needs. “Today, I am immensely proud to open up Zócalo Health’s services to the community. As a kid, I remember the long waits in the community health clinic to see a doctor who often did not speak Spanish. I had to act as a translator for my mom about my own care and help her navigate next steps. I felt guilty that my mom had to take time off from work for my appointment and pay for any prescriptions or additional care needed. For my family, no work meant no pay, so a doctor’s visit was a heavy burden on everyone,” said Zócalo Health CEO Erik Cardenas. “As the landscape for healthcare delivery has changed with technology, our community continues to get left behind. The one-size-fits-all model for healthcare doesn’t work for everyone. I owe it to my parents and my family to do better. Zócalo Health is focused on giving our people a community built around their healthcare needs.” Despite the major cultural impact the Latino population has had on the U.S., and their increased spending power year after year, the U.S. healthcare system has been slow to adapt its services to the needs of this community’s unique health and cultural needs. Latinos still experience disproportionate barriers to healthcare access, particularly in primary care, where the average wait time to see a doctor is 24 days. This long delay, combined with fewer in-person appointments, high-deductible plans, and high out-of-pocket fees, results in many Latino patients avoiding treatment, using informal networks (family/friends), or waiting for hours in expensive emergency rooms to seek care. In addition to the existing disparities in healthcare access, the COVID-19 pandemic and resulting economic impact have exacerbated health inequities for the Latino community, particularly when it comes to accessing high-quality primary care and preventative services. “I’ve always been community-oriented and my role as a promotora gives me the opportunity to help other Latinos manage their health and navigate a system that unfortunately has not adapted to our needs. “I’m so excited to be able to guide my community through what can often be a stressful experience in order to deliver personalized care management from someone who understands our culture and needs. Our Zócalo Health team is ready to advocate for our members and ultimately impact our community’s health, one person at a time.” Zócalo Health promotora Caroline Carbajal Zócalo Health’s membership and payment options are designed to make access to primary care easy and affordable for Latinos. Services are offered through monthly memberships, with pricing starting at $40 per month or at a discounted rate of $420 a year when paid upfront. Patients in California and Texas can now purchase a membership and schedule same-day virtual appointments by visiting zocalo.health. Zócalo Health plans to expand to other states in 2022 and beyond. About Zócalo Health Zócalo Health is a Latino-founded healthcare service designed for the Latino patient. Our primary care model blends tradition with innovation and prioritizes trusting relationships between care teams and patients. Each member of Zócalo Health is paired with a promotor de salud (community health worker) to establish a relationship to better understand members’ goals and connect them to a Zócalo Health physician. Our team of physicians, hired from the community, focus on prevention, primary care, behavioral health, and traditional practices that work together to support our members’ wellness. Operating in the states of California and Texas, Zócalo Health offers affordable and convenient care memberships that provide same-day access to culturally-aligned providers.

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HEALTH TECHNOLOGY

Signify Health Receives NCQA’s HEDIS Allowable Adjustments Certification

Signify Health | September 26, 2022

Signify Health a leading healthcare platform that leverages advanced analytics, technology, and nationwide healthcare networks to create and power value-based payment programs, has again achieved the National Committee for Quality Assurance certification for the Healthcare Effectiveness Data and Information Set. This is the second year in which the Company has received this certification. NCQA provides accreditations and certifications to evaluate a wide range of organizations across the healthcare system. More than 90 percent of health plans in the United States, covering 190 million people, rely on NCQA’s HEDIS measurement tool. The methodology that Signify Health uses to identify Medicare members who have gaps in their care and would benefit from in-home diagnostic testing was evaluated and certified by NCQA. Receiving this certification allows Signify Health to provide services that align with the industry's most rigorous data assessment processes, resulting in more accurate and timely clinical services for eligible members. “Through our comprehensive data set and analytics, Signify Health is able to effectively identify at-risk patients and connect them with the appropriate diagnostic and preventive services. We are proud to once again have achieved this NCQA certification, demonstrating our ability to effectively identify gaps in care and to support access to high-quality health services.” Marc Rothman, MD, Chief Medical Officer, Signify Health NCQA HEDIS measures relate to many of the most significant chronic health conditions facing seniors in Medicare. In 2021, Signify Health announced the certifications for diabetes care, kidney health evaluation in patients with diabetes, colorectal cancer screening, and osteoporosis management in women. In 2022, Signify Health was recertified for all of the measures from 2021 that are still recognized by NCQA and expanded its certification to include osteoporosis screening as a preventive measure for older women who have not had a fracture. Osteoporosis is a serious bone disease that impacts the quality of life, especially for women aged 67-85. With the appropriate screenings and interventions, the risk of future bone fractures related to osteoporosis can be reduced. HEDIS® is a registered trademark of the National Committee for Quality Assurance. NCQA Measure Certification Program™ is a trademark of the National Committee for Quality Assurance. About Signify Health Signify Health is a leading healthcare platform that leverages advanced analytics, technology, and nationwide healthcare provider networks to create and power value-based payment programs. Our mission is to build trusted relationships to make people healthier. Our solutions support value-based payment programs by aligning financial incentives around outcomes, providing tools to health plans and healthcare organizations designed to assess and manage risk and identify actionable opportunities for improved patient outcomes, coordination and cost-savings. Through our platform, we coordinate what we believe is a holistic suite of clinical, social, and behavioral services to address an individual’s healthcare needs and prevent adverse events that drive excess cost, all while shifting services towards the home. About NCQA NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set is the most widely used performance measurement tool in health care.

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HEALTH TECHNOLOGY

Stellar Health Announces Expansion of Value-Based Care Initiative for Highmark, Inc.

Stellar Health | October 19, 2022

Stellar Health a healthcare technology company changing the way health insurers and providers activate value-based care arrangements, announced the expansion of their value-based care initiative with Highmark Inc. upon results of its initial program that improved quality and chronic condition management across Highmark's Medicare Advantage and Commercial lines of business. Stellar announced the collaboration in 2021 to help Highmark accelerate new payment models and value-based care for independent practices in Pennsylvania. This initiative, called True Performance Lite, was an extension of Highmark's existing True Performance PCP Suite Program aimed at serving larger providers. The True Performance Lite program used Stellar's unique incentive design that rewards providers and staff for completing granular VBC actions focused on quality improvement, management of chronic conditions, reduced ED and inpatient utilization, and affordability of care for Highmark members. The program saw strong results across VBC metrics compared to 2020: The program also saw high engagement and satisfaction across providers involved in the True Performance Lite program. "I wish all health plans had program, it's the easiest of all platforms by far," said Renee Guistwite, Office Manager from Guistwite Family Practice. Cathy, an Office Manager from Dr. Dana E Bragg MD's office says "This app is really easy. Every part is user-friendly and it doesn't take much time now that we have a workflow going. We are really excited about Stellar!" Stellar's web-based, cloud-native, point-of-care application leverages historical patient information to prompt primary care providers and their care teams of gaps and opportunities relating to patients' healthcare regimens for Highmark members. Stellar Health partners with health insurers to enable providers and their staff to engage in these value-based opportunities through the application with granular action recommendations, ensure success in closing gaps, and pairs each action with a financial incentive for the time it takes to complete it. In 2022, Stellar and Highmark expanded the True Performance Lite program into Pennsylvania, West Virginia, and Delaware supporting over 60+ provider groups across multiple lines of business and are continuing to build on the overall momentum and results in 2023. The companies are continuing to innovate on new ways to engage the Highmark network and drive outsized results through several cost and utilization initiatives as they bring the model to new provider profiles. "Our provider-centric model lends itself to the success we have seen with Highmark over the last year as they lead value-based care delivery in the Mid-Atlantic region. We look forward to expanding with multiple lines of business to allow providers who handle all types of coverage to meaningfully participate in VBC and help deliver better primary care for all patients." Michael Meng, CEO of Stellar Health About Stellar Health Stellar Health is a healthcare technology company focused on enabling success across the value-based care continuum by bridging the incentive gap between providers and payors. The Stellar solution is the first point-of-care, cloud-based platform that helps primary care providers continually engage with their patients by providing them real-time information and tangible action-based incentives for improving quality of care. With Stellar, providers can achieve a range of VBC goals, like improving quality scores and optimizing the patient care journey through transitions of care and high-value referrals, all with the objective of improving patient health.

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Spotlight

Around the time the first accountable care organizations were formed through the Centers for Medicare & Medicaid Services’ (CMS) Pioneer initiative in 2011, Memorial Hermann Health System executive leadership struggled with a common dilemma: how to control rising operating costs in the face of downward rate pressures and declining reimbursement? While the organization’s clinically integrated approach did help to keep costs down and enhance efficiencies, it would not be enough to sustain the new and emerging value-based payment models resulting from health care reform.

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