CAQH CORE Approves Two-Day Rule to Accelerate Prior Authorization Process

HIT Consultant | February 06, 2020

CAQH CORE, a multi-stakeholder organization representing a broad spectrum of health plans, providers, vendors, and government entities, has voted to set two-day time limits on how quickly health plans must request additional supporting information from providers and make final determinations on prior authorization requests. With this operating rule, CAQH CORE participating organizations agreed to update requirements in the CAQH CORE 278 Prior Authorization Infrastructure Rule. The new requirements set national expectations for prior authorization turnaround times using the HIPAA-mandated standard to move the industry toward greater automation. In particular, the updated operating rule establishes maximum timeframes at key stages in the prior authorization process for both batch and real-time transactions:

Spotlight

With Congress pushing for more value-based care, hospital and organizational consolidation is on the rise. This consolidation goes beyond traditional mergers--healthcare systems have begun to acquire private primary and specialty practices as well. That’s why consolidation must benefit patients, caregivers, and organizational wellbeing as a whole. Bigger isn't always better, and consolidation ultimately should streamline and enhance the patient experience.


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FUTURE OF HEALTHCARE

SpineGuard Announces a New Partnership with Sorbonne, CNRS and Inserm to associate its DSG® Technology With Ultrasound and Serve Surgical Robots

SpineGuard | June 08, 2022

pineGuard an innovative company that deploys its DSG sensing technology to secure and streamline the placement of bone implants, announces the launch of a new three-year collaboration program with two labs of Sorbonne University CNRS and Inserm: the ISIR. DSG is based on the local measurement of electrical conductivity of tissues in real time without X-ray imaging, with a sensor located at the tip of the drilling instrument. Its efficacy was proven by more than 90,000 surgeries across the globe and 19 scientific publications. SpineGuard has entered in 2017 a collaboration with ISIR for the application of DSG to surgical robots and the enhancement of their safety, accuracy, and autonomy. SpineGuard and ISIR capitalize on first order outcomes published so far… At the close of a first collaboration phase, SpineGuard announced sub-millimetric accuracy experimental outcomes in bone boundary detection and automatic stop of a vertebral drilling performed by a robot using the DSG technology. These impressive outcomes were presented as they were produced successively at the Hamlyn medical robotics conference in London in May 2019, receiving the first price for best scientific paper, then in plenary session at the SMISS minimally invasive spine surgery (SMISS) in Las Vegas in November 2021, and lastly during the CRAS conference in Naples in April 2022. … and join forces with the LIB laboratory in order to add ultrasound to the project. Encouraged by this success, the research and development teams wish to go even further in surgical robots advancement: the guidance technologies that allow the robot to position itself properly relative to the patient to find the drilling entry point rely today on X-Ray imaging, dangerous for health, in combination with space-consuming optical registration. SpineGuard has long explored the possibility to use ultrasound complementarily to DSG for this preliminary step, before the tool is penetrating bone, and was granted two families of international patents on that topic. The LIB laboratory, who features an international level expertise in the field of ultrasound imaging, answered with enthusiasm the invitation to join the project. SpineGuard, ISIR and LIB thus start a new 3-year collaboration that is expected to produce breakthrough results in the field. “We are happy to launch this partnership that will allow us to go even further in improving surgical robots in orthopedics. This new phase of the project aims at enabling robots to perform bone drilling and cutting, as well as implant placement, in a secured and more autonomous manner in the human skeleton. Our goal is to implement first-class collaboration between French Research and Industry and trigger commercial ventures in the orthopedic field via strategic agreements with industry partners.” Stéphane Bette, co-founder and Deputy CEO of SpineGuard Guillaume Morel, Professor at Sorbonne University and ISIR Director, and Brahim Tamadazte, Researcher at CNRS and member of ISIR, added: “We are delighted to continue the close and dynamic collaboration initiated in 2017 with SpineGuard. The entry of robotics and associated new technologies in operating room is no doubt one of the biggest medical advances of the last twenty years. Robotic approaches often allow the surgical gesture to be less invasive, more accurate, safe and intuitive in numerous surgical procedures. The first outcomes from the previous collaboration gave us more visibility on the clinical added value that a robot with original and effective sensors can bring to Orthopedic Surgery in general and Spine in particular. This new collaboration will be about ultrasonic sensors coupled with robotics. This original and promising association will allow the surgeon to define the entry point and the pedicle screw trajectory accurately and non-invasively, without relying on ionizing or costly preoperative imaging (scanner, MRI). The association of two prestigious labs of Sorbonne University (ISIR and LIB), whose competencies are highly complementary to SpineGuard’s industrial vision constitute a stimulating work environment favorable to innovation. The journey with SpineGuard goes on for three more years with a target of several technologic and scientific innovations to serve patients and care providers.” Quentin Grimal, Professor at Sorbonne University and Manager of the team “Ultrasound and imaging for bone quality characterization” at LIB, concludes: “Using ultrasound to position a surgical tool is particularly relevant. Ultrasounds are danger free and provide real time information about interfaces, bone anatomy, even bone mechanical quality. The use of an ultrasound probe should allow to position the robotic arm in an optimal manner to place pedicle screws. In general, echography does not allow to see beyond the bone surfaces because ultrasounds are strongly reflected at the surface and strongly attenuated when propagating in bone. Low amplitude signals coming from inside bone can however be exploited through specific treatments which are a specialty of our team. Our team, pioneer in ultrasound utilization to probe bone, has introduced several approaches that offer an alternative to X-Rays for characterization of trabecular or cortical bone health. For our team, this partnership with SpineGuard and ISIR is a great fit: it will accelerate methodology and instrument developments for a broader utilization of ultrasound in orthopedic surgery. We are very happy to participate in this innovation rich project.” About SpineGuard® Founded in 2009 in France and the USA by Pierre Jérôme and Stéphane Bette, SpineGuard is an innovative company deploying its proprietary radiation-free real time sensing technology DSG® (Dynamic Surgical Guidance) to secure and streamline the placement of implants in the skeleton. SpineGuard designs, develops and markets medical devices that have been used in over 90,000 surgical procedures worldwide. Nineteen studies published in peer-reviewed scientific journals have demonstrated the multiple benefits DSG® offers to patients, surgeons, surgical staff and hospitals. Building on these strong fundamentals and several strategic partnerships, SpineGuard has expanded the scope of its DSG® technology in innovative applications such as the « smart » pedicle screw, the DSG Connect visualization and registration interface, dental implantology and surgical robotics. DSG® was co-invented by Maurice Bourlion, Ph.D., Ciaran Bolger, M.D., Ph.D., and Alain Vanquaethem, Biomedical Engineer. SpineGuard has engaged in multiple ESG initiatives. About ISIR ISIR is one of the largest French Research institutions in robotics and intelligent systems, reporting mainly to Sorbonne University, CNRS (National Center for Scientific Research) and Inserm (National institute for health and medical research). It regroups more than 50 teaching researchers and permanent researchers and approximately 80 PhD ad post-doc students. ISIR is structured around 6 research teams focused on artificial intelligence and machine learning, mobile robotics, small scale robotics, assistance robotics (physical therapy and mobility support), human-robot interaction and surgical gesture assistance. ISIR has a rich expertise in the design of innovative robotic architectures, simulation and control, clinical validation and transfer of high industrial potential results. Over the last 5 past years, 10 pre-clinical or clinical studies were conducted at ISIR. 8 patents were granted, and 2 start-up companies created. About LIB The Laboratory for biomedical imaging (LIB) is specialized in Fundamental and Applied Research for biomedical morphologic imaging methods, functional and molecular on small animal and human. It reports to Sorbonne University, CNRS and INSERM. It regroups 35 permanent researchers and teaching researchers, of whom half are also hospital practitioners, approximately 10 engineers and technicians and more than 30 PhD students and post-docs. LIB is structured around 6 teams whose focuses correspond to key priorities of 21st century Public Health: cancer, cardiovascular and neurologic diseases, bone quality. LIB develops new diagnostic and treatments methods exploiting various modalities: ultrasound, MRI, CT, SPECT-PET, etc. LIB has a strong commitment to technology transfer. Over the last 5 years, 6 patents were granted, 7 software were filed, and 5 startup companies launched.

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HEALTH TECHNOLOGY

Office Ally Announces Acquisition of Bluemark

Office Ally | May 11, 2022

Office Ally, a leading provider of electronic clearinghouse and healthcare software solutions,announced that is has acquired Bluemark, LLC, a provider of specialized healthcare software for healthcare professionals and community-based organizations. Financial terms of the transaction were not disclosed. Founded in 2001, Bluemark provides specialized healthcare software and adaptive technology, including revenue integrity and Medicaid enrollment solutions, for hospitals, health systems, nursing homes and community-based organizations across the country. Bluemark offers four unique products that span Payer Audit Management and Assistance Program Enrollment, enabling healthcare professionals to both enhance reimbursement processes and achieve workflow efficiencies. “As a leader in healthcare revenue cycle software, Bluemark has built an impressive suite of high-quality RCM products that are designed to provide mature cloud-based technology solutions that simplify some of the most complex processes in healthcare finance. Not only are Bluemark’s self-pay and health information handling solutions highly complementary to our solution set at Office Ally, but the company’s network of hospital and health system relationships expands our customer base into some of the largest providers of care in the US.” Chris Hart, CEO of Office Ally “We are thrilled to be growing the Office Ally platform with the addition of Bluemark. Together, we believe there is an incredible opportunity to leverage our extensive network of providers and combined solution set to further scale our offerings as a leading healthcare technology company,” continued Hart. With the acquisition of Bluemark, Office Ally will be able to expand its product set and add new health information handler credentials. In addition, the complementary nature of the two businesses will allow Office Ally to better serve existing customers with an integrated suite of healthcare software solutions now spanning self-pay management and Medicaid enrollment. “Over the last two decades, Bluemark has been a pioneer and innovator in healthcare finance by developing unique solutions to drive the enrollment of self-pay patients into Medicaid and associated benefit programs, as well as the electronic exchange of health information between providers and audit contractors. We are thrilled to be joining Office Ally, and look forward to better serving our customers as the healthcare market continues to evolve,” said Ken Sacks, CEO of Bluemark. About Office Ally Office Ally is a healthcare technology company that offers cloud-based solutions to healthcare providers, independent physician associations (IPAs) and health plans. Office Ally’s platform supports both the management of care and facilitates payments between providers, health plans and patients. Office Ally’s platform is paired with a clearinghouse that enables the secure exchange of healthcare information including claims, remits, and eligibility information between covered entities and across the healthcare market. About Bluemark Bluemark, LLC, is a specialized software and technology developer that provides expert solutions for healthcare professionals. Bluemark helps clients maximize reimbursement and achieve workflow efficiencies through the development of technology-based business process solutions for revenue cycle and HIM audit and compliance processes. Backed by a national footprint and strong industry relationships, Bluemark offers mature SAAS-based technology solutions that are time-tested, proven and positioned to evolve with the healthcare market’s changing needs.

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HEALTH TECHNOLOGY

Happify Health Weaves a New Path as Twill, the Intelligent Healing Company™

Happify Health | July 13, 2022

Happify Health has announced its transformation to become Twill. This change represents the culmination of a five-year journey to build in-house capabilities, which have enabled the company to transition from wellness apps to a clinical-grade platform that weaves together disparate strands of care to deliver a more connected care experience. As Twill, the company will shorten the distance between need and care to enable delivery of better care at a lower cost for the many, not the few. Twill offers Sequences™, which are configurable care experiences tailored to meet the needs of customers, specific medical conditions they cover, and the populations they serve. Sequences combine evidence-based digital therapeutics and well-being products, care communities, coaching, and third-party services on a clinical-grade platform designed to work seamlessly with the customer's existing digital solutions and resources. This enables a more precise, personalized and seamless care experience, at scale. “As we’ve grown to deliver care to more communities, the disconnectedness of our industry in addressing mental health along with physical health challenges has become abundantly clear. Instead of contributing to this problem, we saw an opportunity to take a different approach, one where we could make the meaningful connections between technology and humanity, body and mind, and need and care. As we’ve shifted our focus toward weaving together solutions that better support the whole person in the care journey, we wanted a name that better matched our mission: to make healing more intelligent.” Tomer Ben-Kiki, Chief Executive Officer at Twill Untangling the complexity of a fragmented healthcare system Today, there are over 350,000 consumer digital health apps, yet according to McKinsey, 90% of patients are looking for integrated healthcare journeys rather than single-point solutions. At the end of 2021, Twill conducted its own survey of large employers and health plans, to identify the largest barrier to executing a successful digital health strategy. Nearly half of all insurers and over a quarter of employers said that the biggest problem they faced was too many standalone point solutions. As Twill, the company is untangling the complexity of the healthcare system to deliver care that is more personal and connected. Twill's Intelligent Healing Platform™ integrates with, and augments, the customer’s existing offerings to give more people more choice in their care journey. This open-by-design architecture allows seamless integration with existing digital solutions, enhancing overall personalization and engagement to create a more personal, precise and connected experience. In doing so, Twill aims to usher in a new era of care built on a more human-centered, digital-first approach to guide each person to the care they need, when they need it, in the way they want. Weaving together a more connected approach to care through Sequences Sequences™ are the proprietary, configurable solution that enable Twill to provide simpler, more connected support for the care journey of a specific medical condition. Each Sequence is a bespoke configuration of evidence-based digital therapeutics and well-being products, care communities, coaching, third party services, and a customer’s own existing resources. They are open by design, in order to work seamlessly with a customer’s existing digital solutions, enhancing personalization and engagement to create a more personal, precise and connected journey. By the end of 2022, Twill will offer Sequences for four medical conditions: mental health, MS, pregnancy, and psoriasis. These have been developed with premier partners including Elevance Health Biogen, and Almirall, among others. Twill’s technology and science is designed to be scalable to a broad range of medical conditions. Intelligently guiding people through a more personalized and precise care journey Sequences are built on Twill’s Intelligent Healing Platform, which leverages deep understanding of each person’s unique clinical needs and personal preferences to guide people through a hyper-personalized and seamless care experience. About Twill Twill is The Intelligent Healing Company™, shortening the distance between need and care by intelligently guiding each person to the care they need, when they need it, in the way they want. The company delivers Sequences™, fully configurable, scientifically designed, digital-first solutions that support the care journey for specific medical conditions. Twill does this for pharmaceutical companies, health plans, jumbo employers, and those they serve. Available across 10 languages and covering more than 18 million lives, Twill creates a more precise, personal, engaging, and effective experience at scale for the many, not the few.

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HEALTH TECHNOLOGY

Nomi Health Acquires Everyone Health, Sano Surgery

Nomi Health | July 14, 2022

Everyone Health has agreements with self-funded employers and third-party administrators for pre-negotiated, all-inclusive prices that save employers up to 70% relative to commercial fee-for-service rates. The company delivers these savings via Sano Surgery’s direct contracting with more than 10,000 physicians and facilities — surgical hospitals, ambulatory surgery centers, endoscopy centers, radiology centers, labs and more — in 300 of the largest U.S. cities across 48 states, all now part of Nomi Health’s national provider network. “Nomi Health believes healthcare needs a rebuild, not a renovation. These companies share in our vision of extracting the complexity and cost from traditional healthcare, so buyers experience substantial savings and, most importantly, patients have greater access to more affordable care. In three short years, we expanded easy access to care to 15 million Americans, while significantly driving down cost of care to buyers. The immediate contributions of Everyone Health and Sano Surgery will accelerate this track record in the years ahead.” Mark Newman, founder and CEO of Nomi Health Founded by CEO Dutch Rojas 10 years ago, Sano Surgery has a network of nearly 6,000 medical facilities and 8,000 lab locations nationwide, ranging from radiology and orthopedics to women's health and oncology. This network enables Everyone Health to deliver higher quality medical treatments and services at lower prices. As a result, physicians benefit from predictable volumes and payments, while patients enjoy a more streamlined care and billing experience. “My goal is affordable and accessible healthcare for all. We’ve built a nationwide network of physicians and medical facilities that allows us to bring substantially lower pricing and more transparent transactions to the market, benefiting countless Americans,” said Rojas, founder and CEO of Sano Surgery and Everyone Health. “As the dual crisis of access and affordability grows on the heels of the pandemic, the time is right to increase our impact as part of Nomi Health.” The acquisitions enable buyers to turn to Nomi Health for a full suite of solutions — analytics, care delivery and a direct network — all underpinned by a modern claims infrastructure and payment rails. It also brings 12 full-time employees, including Rojas, to Nomi Health to accelerate the continued expansion of the company’s network of clinical partners, which is critical as Nomi Health takes its support and services into more communities nationwide. The acquisitions of Everyone Health and Sano Surgery come on the heels of Nomi’s $200 million acquisition of healthcare analytics leader Artemis Health in January. About Nomi Health Nomi Health is a nationwide direct healthcare system making it easier than ever for any buyer of healthcare to access the highest quality affordable care for their communities. The company’s direct care ecosystem encompasses a real-time operating and payment system — inclusive of analytics and payment rails — as well as an integrated care delivery infrastructure featuring essential care services, pharmacy and an open network. To date, Nomi Health has saved buyers of care an average of 30 percent compared to traditional healthcare costs, while enabling them to give their communities more access to lower cost, high quality care. From rural counties to some of the largest cities in America, Nomi Health has administered everyday healthcare services to more than 14 million Americans and counting in hundreds of communities nationwide. During COVID-19, this direct care model played a pivotal role in care access, public health and keeping economies open and operating. Based in Orem, Utah, Nomi Health employs more than 2,000 nationwide, working to lower healthcare expenses, widen care access and improve the patient experience. The company is led by an experienced, cross-functional leadership team with clinical, healthcare, technology and finance backgrounds. Nomi Health has so far invested more than $10 million dollars in improving the well-being of the communities it serves.

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Spotlight

With Congress pushing for more value-based care, hospital and organizational consolidation is on the rise. This consolidation goes beyond traditional mergers--healthcare systems have begun to acquire private primary and specialty practices as well. That’s why consolidation must benefit patients, caregivers, and organizational wellbeing as a whole. Bigger isn't always better, and consolidation ultimately should streamline and enhance the patient experience.

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