CMS seeks feedback on selling health plans across state lines

CMS | March 07, 2019

CMS is seeking feedback on ways it can make it easier for payers to sell insurance across state lines. The Centers for Medicare & Medicaid Services issued (PDF) a request for information Wednesday evening, and in the document the agency said that it’s especially looking for recommendations on how states can take advantage of a regulatory framework in the Affordable Care Act that would allow for plans to be sold across state lines. The RFI was mandated in an executive order signed by President Donald Trump in October 2017. “Americans are in desperate need of more affordable health insurance options,” CMS Administrator Seema Verma said in a statement. “Eliminating barriers to selling health insurance coverage across state lines could help provide access to a more competitive and affordable health insurance market.”

Spotlight

Heart diseases are one of the leading causes of
death across the world, especially in middle- and
high-income countries. According to the World
Heart Federation, heart diseases were responsible
for almost 17.7 million deaths in 2016.1 In the US,
deaths related to heart diseases numbered 633,840
in 2017,2 and the associated disability-adjusted
life years (DALYs) were 3,821 per 100,000 persons
in 2016.3 Coronary heart disease (CHD) is one of
the most common heart diseases, and occurs as
a result of clogged arteries or atherosclerosis, with
rupture of an atherosclerotic plaque causing blood
clots, which are the leading cause of a heart attack.4
Worldwide deaths related to CHD were 7.4 million in
2015.5


Other News
FUTURE OF HEALTHCARE

Radius XR™ Named as the CES 2023 Innovation Award Honoree for Wearable Device That Combines Therapy and Diagnostic Capabilities

Radius XR | November 17, 2022

Today at the CES Unveiled New York event, Radius XR™, a new fashion-forward wearable healthcare technology brand, was named a CES® 2023 Innovation Awards Honoree in both the Digital Health and Virtual & Augmented Reality categories. Radius was selected from among a record number of submissions to this year’s CES Innovation Awards program. The announcement was made ahead of CES 2023, the influential technology event, happening Jan. 5-8 in Las Vegas, NV. Radius XR builds on the therapeutic legacy of IrisVision, a leader in digital vision technologies and itself a 2019 CES Innovation Winner. The Radius proprietary XR assistive device brings together—for the first time—multimodal diagnostics, practice management, and patient engagement. “This is a tremendous honor for our new company. It follows on the success of our IrisVision visual assistive device, which has provided a life-changing solution for thousands of individuals living with legal blindness and low-vision conditions. Radius expands on our commitment to vision health by providing the eyecare industry with an easy-to-use wearable device capable of performing standard perimetry tests. Other exams include color vision, visual acuity, contrast sensitivity—a comprehensive suite of standard vision tests. Development of additional exams is ongoing.” Radius founder and CEO Ammad Khan Radius enables patients to quickly and easily conduct vision tests with minimal guidance or intervention by the staff. The device’s RadiusExam® software and proprietary algorithms provide diagnostic testing results equivalent to current exam gold standards. “By designing our own hardware and software, we’re able to overcome many of the challenges inherent in the off-the-shelf headsets already on the market. Matching visual field strategies, background luminance, stimulus size and dynamic range allows us to mirror the current standards, making it easy and intuitive for clinicians to transition to Radius,” said John Trefethen, Radius Chief Marketing Officer. In addition, the included Business Suite helps clinicians manage everyday aspects critical to their practice's ongoing success. Features like patient education, staff training and clinician onboarding are now possible inline with the Radius platform. Radius is the industry’s lightest wearable device and has the look and feel of a pair of stylish sunglasses. The compact, lightweight design overcomes the challenges of expensive and bulky legacy devices that force patients to sit in uncomfortable positions for testing. With Radius, exams can be conducted anywhere, even in the waiting room, eliminating the need to shuttle patients between machines, which can be challenging for individuals with mobility or vision issues. The CES Innovation Awards program, owned and produced by the Consumer Technology Association (CTA)®, is an annual competition honoring outstanding design and engineering in 27 consumer technology product categories. Those with the highest rating receive the “Best of Innovation” distinction. An elite panel of industry expert judges, including members of the media, designers, engineers and more, reviewed submissions based on innovation, engineering and functionality, aesthetics, and design. The CES 2023 Innovation Awards honorees, including product descriptions and photos, can be found at CES.tech/innovation. Radius will be on display at the Innovation Awards Showcase at CES 2023 in Las Vegas in January. About Radius XR The Radius XR platform is a portable vision diagnostic and patient engagement system that combines medical-grade diagnostics, business management, and patient education tools in a single wearable XR device. The RadiusExam® and proprietary algorithms provide diagnostic testing results equivalent to current exam gold standards, with the clinical science validated by Deming regression. As the algorithm presents stimuli to patients, it adapts to responses to maximize the algorithm's speed. The total hardware and software system helps medical professionals diagnose patients with accuracy, grow their eyecare practices, enhance patient engagement, and reduce staff workload by enabling patients to perform self-guided vision exams with minimal supervision.

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HEALTH TECHNOLOGY

Annuo Med Tech Solutions Enters Partnership Agreement with WeKo GP

Annuo Medical Technology Solutions Pty Ltd | October 17, 2022

New health networking platform, Annuo™, has entered a working agreement with WeKo GP to assist with the identification and treatment of patients with chronic disease in Australia. This key partnership will facilitate the management of people living with chronic disease by General Practice teams using WeKo and Annuo™. WeKo’s Clinical System solution launched in 2019 and provides proactive chronic disease screening and detection based on patient medical data. “We believe our solutions are highly complementary and have the ability to offer an amazing patient and clinician experience,” commented WeKo Founder, Ross Hadfield. “We are excited to announce a trial partnership between Annuo and WeKo GP which will open up more possibilities for Annuo™ to help the 10.8M Australians currently living with chronic disease,” Dr Jeni Wellington, Founder and CEO of Annuo Med Tech Solutions At a high-level, the partnership will facilitate the identification and treatment of patients at high risk of chronic disease, using the Annuo platform and WeKo’s Clinical System. It will ensure patients are engaged in the creation of an agreed care plan and that the clinical teams involved are fully supported. About Annuo Med Tech Annuo Med Tech Solutions is a new Australian digital health technology company developing Annuo - a healthcare networking platform for doctors, patients and allied health professionals. Annuo™, is the first medical networking platform in Australia designed by specialists. More than that, Annuo™ is advocating for collaborative care for patients living with chronic disease in Australia. With 47% of Australians today living with one or more chronic diseases, there has never been a better time to help improve the lives of everyday people trying to navigate their treatment. Annuo™ encourages people living with chronic disease to engage with their treatment in an holistic way. Annuo promotes collaborative care for patients and is inclusive of those seeking to make diet, exercise and alternate therapies as part of their treatment planning. Annuo™ will engage with healthcare providers and enable them to better connect with their patients through the digital health space. The platform comes fully customised for each medical specialty at a competitive price.

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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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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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Spotlight

Heart diseases are one of the leading causes of
death across the world, especially in middle- and
high-income countries. According to the World
Heart Federation, heart diseases were responsible
for almost 17.7 million deaths in 2016.1 In the US,
deaths related to heart diseases numbered 633,840
in 2017,2 and the associated disability-adjusted
life years (DALYs) were 3,821 per 100,000 persons
in 2016.3 Coronary heart disease (CHD) is one of
the most common heart diseases, and occurs as
a result of clogged arteries or atherosclerosis, with
rupture of an atherosclerotic plaque causing blood
clots, which are the leading cause of a heart attack.4
Worldwide deaths related to CHD were 7.4 million in
2015.5

Resources