Challenges of Creating Medicare Advantage Supplemental Benefits

HealthPayerIntelligence | December 10, 2019

Medicare Advantage plans are slow in creating benefits that serve more than medical needs for severely ill members, potentially because designing and implementing a new healthcare benefit is challenging and time-intensive,  researchers from the Duke-Margolis Center for Health Policy found. The Medicare Advantage market is a fertile testing ground for new care delivery models for people with serious illness,” said Robert Saunders, PhD, research director at the Duke-Margolis Center for Health Policy and one of the study’s co-authors The program’s capitated payment structure encourages new approaches because plans share in cost savings, earn bonus payments, and receive rebates (that they can use to offer enhanced benefits or reduce member cost sharing) if they are able to reduce costs while maintaining or improving the quality of care delivered, as measured by Medicare’s Star Ratings program

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DIGITAL HEALTHCARE

Hero and AdhereHealth Establish Strategic Partnership to Improve Medication Adherence Among Vulnerable Patients

AdhereHealth | December 18, 2021

AdhereHealth, a healthcare technology leader in medication adherence insights and health outcomes, has entered into a strategic partnership with Hero, the market leader in digital in-home care. This new agreement enables AdhereHealth to deploy Hero's digital in-home care platform to help high-risk, high-cost, chronically ill patients adhere to complex medication regimens. Hero's platform includes a connected smart pill dispenser, which automatically sorts and dispenses medications according to a patient's unique medication schedule. Hero's connected app then tracks what a patient took and when, and sends real-time alerts to the patient's care team if a dose is missed or a medication is ready for refill. Hero continually monitors the patient's medication inventory and facilitates real-time medication reconciliation and synchronization. "Combining Hero's industry-leading medication management platform with AdhereHealth's advanced technologies and its nationwide AdhereRx digital pharmacy creates the first complete lifecycle medication management service," said Kal Vepuri, founder and CEO of Hero. "Our partnership will also simultaneously improve patient safety by focusing on medication management, further support caregivers and help people take more control of their health," added Mr. Vepuri. AdhereHealth's digital pharmacy, AdhereRx, leverages data analytics to identify and prioritize vulnerable populations most at risk for nonadherence or drug safety problems. Trained pharmacists then connect via phone with patients to conduct comprehensive medication reviews and address social determinants of health (SDOH) that might get in the way of medication adherence. "Hero's patient-centric technology will enable care managers, providers and health plans to remotely monitor medication intake, providing real-time visibility into how patients are adhering to medication regimens at home. Combined with our medication synchronization technologies and our nationwide AdhereRx digital pharmacy solution, we can drive better patient experience and improve value-based outcomes for vulnerable populations." Jason Z. Rose, CEO of AdhereHealth Poor medication adherence is a leading cause of re-hospitalizations and ER visits, especially among the elderly and those with chronic conditions. The financial impact is significant: medication nonadherence accounts for 16% of U.S. healthcare spending annually, accounting for more than half a trillion dollars. About Hero Hero is a leading digital in-home care platform delivering the first end-to-end medication management service for patients and caregivers. Hero's solution includes its award-winning smart pill dispenser, medication management app, automatic refills with free delivery and 24/7 live support. Since launching in 2018, Hero has dispensed more than 70 million medications. Hero is used as a care management solution by individuals, caregivers and medical providers. About AdhereHealth™ AdhereHealth delivers purpose-built, innovative technology solutions to improve quality of care, medication adherence, and cost outcomes – all with an emphasis on overcoming social determinants of health (SDOH) and improving patient experience. AdhereRx, an AdhereHealth digital pharmacy, provides high-risk, underserved patients with personalized pharmacy services that drive medication compliance and reduce unnecessary utilization costs. This unique combination of predictive analytics, intelligent clinical workflow software and proactive telepharmacy outreach performed by a nationwide team of licensed clinicians addresses an estimated half a trillion dollars of unnecessary annual medical costs attributed to medication adherence issues. Today, the Adhere™ Platform touches nearly 30 million patients across dozens of health plans, self-insured employers and other risk-bearing entities.

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DIGITAL HEALTHCARE

Nemaura Medical Launches Metabolic Health Program for Employers and Insurers

Nemaura Medical, Inc | January 14, 2022

Nemaura Medical, Inc.(“Nemaura” or the “Company”), a medical technology company focused on developing and commercializing non-invasive wearable diagnostic devices and supporting personalized lifestyle coaching programs, announces the launch for employers and insurers of Miboko, a new metabolic health program using a non-invasive glucose sensor along with an AI mobile application. The Company’s goal is to achieve broad adoption of Miboko as a form of preventative medicine for a wide user base through these commercial channels and is aligned with the general trend in consumer digital healthcare. “Introducing Miboko to the population at-large through employers and insurers will allow Nemaura to reach a much wider audience in much faster fashion than solely relying on a direct-to-consumer campaign, and in the Western world, these institutions are the most reliable gateway toward wider adoption of preventative health maintenance practices. Being aware of one’s metabolic health and how the body uniquely regulates sugar is key to one’s health. Patients, of course, want to be as informed as possible about their health, and employers and insurers are also aligned with patients in that regard, given the massive productivity losses and healthcare costs at stake on a larger scale across their employee and insured base, respectively. Miboko can help address this substantial market opportunity through our non-invasive, revolutionary approach to healthcare.” Nemaura CEO Dr. Faz Chowdhury Nemaura has also submitted a Premarket Approval (PMA) to the United States Food and Drug Administration (FDA) for approval of its glucose monitoring device as a Class 3 medical device. The Company’s PMA was the subject an on-site FDA bioresearch monitoring (BIMO) audit that generated a single Form 483 observation, for which the Company has committed to a full response this quarter. A follow-up BIMO audit of the clinical investigator site has also been scheduled for the current financial quarter. Miboko has been in development for nearly two years and addresses a significant mass market opportunity that the Company believes could benefit roughly a third to half of the population by using a non-invasive glucose sensor to measure and monitor a user’s metabolic health score, which is based on glucose tolerance or insulin resistance. Those with prediabetes or obesity concerns -- or even those looking to maintain better health through more careful glucose control -- may benefit from such a metabolic health program. How one’s body metabolizes sugar is the main influencer of one’s appetite, weight, sleep quality, and energy and mood levels and even plays a critical factor in chronic diseases (beyond just diabetes), such as heart disease and dementia. At the heart of the Miboko offering is Nemaura’s non-invasive glucose sensor that is designed to measure insulin resistance, reported as a metabolic health score, and priced to be highly affordable with the program running for an initial two-year period. The program also uses a mobile app to provide users with personalized information by tracking their metabolism. A user can find out how well their body responds to sugar through their metabolic health score — and how what they eat and what they do every day uniquely affects their metabolic health. Along with the capability to follow metabolic health progress on the app, Miboko users receive weekly and monthly reports that show and explain their body’s unique metabolic health score and a breakdown of how each of their habits are impacting their overall health and wellbeing. Suggestions for small, manageable changes to daily routines, such as eating more or less of a certain kind of food or exercising at a different time of day to coincide with peak energy levels, provide Miboko users with personalized, usable data. About Nemaura Medical, Inc. Nemaura Medical Inc. is a medical technology company developing and commercializing non-invasive wearable diagnostic devices. The company is currently commercializing sugarBEAT® and proBEAT™. sugarBEAT®, a CE mark approved Class IIb medical device, is a non-invasive and flexible continuous glucose monitor (CGM) providing actionable insights derived from real time glucose measurements and daily glucose trend data, which may help people with diabetes and pre-diabetes to better manage, reverse, and prevent the onset of diabetes. Nemaura has submitted a PMA (Premarket Approval Application) for sugarBEAT® to the U.S. FDA. proBEAT™ combines non-invasive glucose data processed using artificial intelligence and a digital healthcare subscription service and has been launched in the U.S. as a general wellness product as part of its BEAT®diabetes program that is currently undergoing pilot studies. Additionally, Nemaura has launched Miboko, a new metabolic health and well-being program using a non-invasive glucose sensor along with an AI mobile application that helps a user understand how certain foods and lifestyle habits can impact one’s overall metabolic health and well-being. Nemaura believes that up to half the population could benefit from a sensor and program that monitors metabolic health and well-being. The Company sits at the intersection of the global Type 2 diabetes market that is expected to reach nearly $59 billion by 2025, the $50+ billion pre-diabetic market, and the wearable health-tech sector for weight loss and wellness applications that is estimated to reach $60 billion by 2023.

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FUTURE OF HEALTHCARE

House Rx Secures $30 Million in Financing to Improve the Specialty Pharmacy Experience for Patients and Their Care Teams

House Rx | March 15, 2022

House Rx, a health technology platform focused on improving affordability and patient access to specialty medications, announced it has secured $25 million in Series A financing led by Bessemer Venture Partners, bringing total funding to $30 million. House Rx's technology platform and pharmacy service enable specialty practices to offer medically-integrated dispensing, which means patients can receive both their physician and pharmacy care from one team, collaborating on a unified technology platform. Since it launched in March 2021, House Rx has partnered with four medical specialty practices and 30 prescribers in California and Washington. "We have a simple idea: partner with specialty clinics all over the country to enable medically integrated dispensing where the physician, pharmacist, nurses and techs can work together as one team, under one proverbial roof, to improve patient care. Our vision for the future of specialty pharmacy is a more local, more collaborative, and ultimately a more affordable system that leads to much better outcomes for patients." Ogi Kavazovic, CEO and a co-founder Specialty medications, which include treatments for cancers, rheumatic diseases and other chronic and acute conditions, are some of the most expensive drugs available. Unlike infused therapies which are administered in the clinics, the burden of specialty medication access and adherence often falls on patients, who typically need to battle several large bureaucracies to gain access to their medications. These often lead to multi-week delays in treatment and much lower adherence rates compared to medications administered in clinics. Currently, specialty medications are mainly dispensed via mail by a patient's insurance company, not their doctor or a pharmacy a patient chooses. A growing body of research demonstrates that when patients obtain timely access to cancer treatments directly from their care team, they have better outcomes, including improved quality of life and increased survivability. House Rx currently has over 30 employees, who are mostly software engineers and pharmacy operations. In addition to Bessemer Venture Partners, First Round Capital, Character.vc, and 1984.vc participated in the Series A funding. First Round Capital led the seed round as the initial investor alongside Khosla Ventures, Maverick Ventures, and 1984.vc. The funding from this latest round will go towards continued investments in House Rx's technology platform and scaling pharmacy operations. "The specialty pharmacy market is in much need of a new approach - the current system severely lacks in patient choice and innovation, and we think House Rx's vision for a more modern, more decentralized approach will have incredible impact," said Steve Kraus, Partner, Bessemer Venture Partners. "Bessemer is proud to back a company with a mission to ultimately make it easier and more cost effective for patients to get the treatment they need." In addition to Kavazovic, the health technology start-up was co-founded by Tesh Khullar, who serves as the company's President. Kavazovic and Khullar are former Flatiron Health executives, where they gained experience working closely with hundreds of oncology clinics. The company's Chief Pharmacy & Operating Officer is Denali Cahoon, PharmD, who is a former executive at Trellis Rx. "The antiquated pharmacy systems developed decades ago inhibit coordinated patient care and increase costs. The current system also prevents patients from choosing where they can get their medically prescribed life-sustaining therapies," said Tesh Khullar, President and a co-founder. "We started House Rx to make the medically integrated dispensing model the new normal in specialty pharmacy. With the right technology, and the right distribution partners, we can re-establish the partnership between physicians and pharmacists that brings a new level of transparency and patient care." House Rx's technology platform helps prescribers and pharmacists collaborate more effectively via one integrated system. Built based on in-depth feedback from pharmacists and physicians, the platform is designed specifically for the management of specialty medication, and includes built-in analytics to enable continuous improvement in operational efficiency and quality of care. The specialty medical practices that have already partnered with House Rx include Care Oncology Center, California; Sarcoma Oncology, California; Arthritis Northwest Washington; and Northwest Medical Specialties, Washington. About House Rx House Rx is a technology-enabled service company focused on making specialty medication more accessible and affordable. We do so by helping clinics dispense specialty medications to their patients in a medically-integrated way using pharmacist expertise and modern technology. By helping physicians and pharmacists collaborate on patient care, we're able to improve patient outcomes, lower the cost of care, and create a better experience for patients and their caregivers.

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FUTURE OF HEALTHCARE

NextGen Healthcare Partners with Circuit Clinical to Bolster Diversity in Clinical Trials by Extending Access to Underserved Communities

NextGen Healthcare, Inc. | May 05, 2022

NextGen Healthcare, Inc. a leading provider of innovative, cloud-based healthcare technology solutions, announced a partnership with Circuit Clinical to bring clinical trial access to patients of Federally Qualified Health Centers through over 14,000 providers that utilize NextGen Healthcare solutions. Historically, these underserved communities have not had easy access to participate in transformative clinical research that can provide enhanced treatment options. Such research-as-care can also improve health outcomes and offers revenue generation for the clinics that participate. NextGen Healthcare’s innovative collaboration with Circuit Clinical, whose mission is to transform how patients find and choose clinical trials by bringing them to the doctors they know and trust, will improve the participation of diverse patients in clinical trials and provide greater health equity by facilitating access to the underserved. “This partnership underscores NextGen Healthcare’s commitment to FQHCs and highlights our commitment to serving diverse patient populations. NextGen Healthcare’s technology is empowering providers to build healthier communities. Our work with Circuit Clinical is a milestone that provides real impact for our clients and their patients, and delivers on our pledge to facilitate better healthcare outcomes for all.” Srinivas (Sri) Velamoor, chief growth and strategy officer at NextGen Healthcare The collaboration contributes to the vision of the NextGen® Community Health Collaborative, a first-of-its-kind initiative announced late last year that offers data benchmarking, comparative analytics and reporting services, plus a forum for members to connect and share best practices to advance the mission of community health and health equity among underserved populations. NextGen Healthcare-powered practices, in conjunction with Circuit Clinical, will now be able to offer clinical trial patient recruitment, referral and enrollment services, eliminating obstacles to such care. Furthermore, participation provides tangible benefits to participants, including extra care visits without co-pays, therapeutic improvement on a better regimen, and patient stipends. “Our partnership with NextGen Healthcare will create a comprehensive solution for improving access to clinical trials for diverse communities across the country,” said Dr. Irfan Khan, founder and chief executive officer of Circuit Clinical. “Combining NextGen Healthcare’s comprehensive data insights and national reach with Circuit Clinical’s expert ecosystem offers pharmaceutical, biotech and vaccine companies a groundbreaking opportunity for accelerating therapeutic development and improving diversity in clinical trials.” In April, the Food & Drug Administration (FDA) issued updated guidance to provide recommendations to those developing medical products on the approach for developing a Race and Ethnicity Diversity Plan to help enroll adequate numbers of participants in clinical trials from underrepresented racial and ethnic populations. Adequate representation in clinical trials helps ensure that the data generated reflects the racial and ethnic diversity of the intended use population and may potentially identify safety or efficacy outcomes, the FDA said. About NextGen Healthcare, Inc. NextGen Healthcare, Inc. is a leading provider of innovative healthcare technology solutions. We are reimagining ambulatory healthcare with award-winning solutions that enable high-performing practices to create healthier communities. We partner with medical, behavioral and dental providers in their journey toward whole-person health and value-based care. Our highly integrated, intelligent and interoperable solutions go beyond EHR and Practice Management to increase clinical quality and productivity, enrich the patient experience and drive superior financial performance. We are on a quest to achieve better healthcare outcomes for all. About Circuit Clinical Circuit Clinical®, one of the largest integrated research organizations in the USA, is dedicated to empowering patients to choose clinical research as a care option. Circuit Clinical® is committed to transforming the way physicians and their patients find, choose, and participate in clinical research. The company delivers clinical research services and an award-winning patient engagement platform, trialjourney.com.

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