Medicaid plans cover doctor visits, hospital care—and now GEDs

FierceHealthcare | January 08, 2019

Emilia Ford became pregnant at 15 and, after her daughter was born, dropped out of high school. As she held down different jobs during the past decade—including housekeeping and working in a relative’s retail store—she always thought about going for her GED to show she met high school academic skills. But the Brookhaven, Pennsylvania, woman needed assistance finding tutors and paying for the set of four tests, which cost $20 each. She found help from an unexpected source: her Medicaid health plan. AmeriHealth Caritas, a Philadelphia-based insurer with 2 million Medicaid members in Pennsylvania and five other states, helps connect members with nonprofit groups providing GED test preparation classes, offers telephone coaching to keep members on track and pays the testing fees.

Spotlight

Increasing competition, lower margins and a need for scale are continuing to drive hospital merger and acquisition (M&A) activity, according to a new infographic by Agiliti. The infographic looks at three ways hospitals can improve post M&A integrations and outcomes.


Other News
HEALTH TECHNOLOGY

Viemed Announces Publication of Peer-Reviewed NIVH Study Finding Treatment Reduces Healthcare Costs and Saves Lives

Viemed Healthcare, Inc. | July 06, 2022

Viemed Healthcare, Inc. a national leader in respiratory care and technology-enabled home medical equipment services, announced a third peer-reviewed and published study demonstrating the benefits of non-invasive ventilation at home The study, titled “Early Initiation of Non-Invasive Ventilation at Home Improves Survival and Reduces Healthcare Costs in COPD Patients with Chronic Hypercapnic Respiratory Failure: A Retrospective Cohort Study” was published in Respiratory Medicine, an internationally renowned scientific journal devoted to respiratory medical research. “In addition to the significant clinical benefits demonstrated in previously published papers, this study demonstrates that NIVH improves health outcomes while simultaneously driving down overall healthcare costs. The study was also designed to investigate how the timing of NIVH initiation affected the outcomes. The results showed that the clinical and financial benefits of NIVH are greatest when therapy begins immediately following the diagnosis.” Dr. William Frazier, Viemed’s Chief Medical Officer and co-author of the study Using the 100% research identifiable fee-for-service Medicare claims from 2016 through 2020, the researchers found that using NIVH to treat chronic obstructive pulmonary disease with chronic hypercapnic respiratory failure is associated with significant reductions in mortality, hospitalizations, and total Medicare costs. In terms of cost-savings, Medicare expenditures for the year following NIVH initiation decreased by $5,484 compared to controls if treatment was begun within seven days of diagnosis. The cost reduction was $3,412 if NIVH was begun within 15 days of diagnosis. For patients whose therapy began more than 15 days after diagnosis, NIVH use was cost neutral and not associated with an increase in Medicare expenditures. The primary clinical benefit was a reduced mortality in patients treated with NIVH. When a patient began therapy within seven days of diagnosis, the risk of death was reduced by 43%. Those patients who began therapy between eight and 15 days following diagnosis showed a mortality reduction of 31%, and patients who began therapy between 16 and 30 days following diagnosis showed a mortality reduction of 16%. “NIVH is becoming widely accepted by clinicians as the standard of care for hypercapnic COPD-CRF treatment and this evidence supporting early initiation will help us to communicate the clinical and economic benefits to payors and partners,” said Casey Hoyt, Viemed’s CEO. “By accessing and treating more patients sooner, we can save lives, reduce hospital readmissions, and save money at the same time.” ABOUT VIEMED HEALTHCARE, INC. Viemed is a provider of in-home medical equipment and post-acute respiratory healthcare services in the United States. Viemed’s service offerings are focused on effective in-home treatment with clinical practitioners providing therapy and counseling to patients in their homes using cutting edge technology.

Read More

HEALTH TECHNOLOGY

NeuPath Health Unveils Accelerated Growth Plan and Announces Executive Changes

NeuPath Health Inc. | July 26, 2022

NeuPath Health Inc. owner and operator of a network of clinics delivering category-leading chronic pain treatment, announced its strategic growth plan to significantly accelerate the growth of its best-in-class and coordinated continuum of care for patients across Canada who suffer from pain and pain-related musculoskeletal conditions. Chronic pain now impacts 25% of all Canadians at some point in their life and it is often a treatment pathway that is fraught with uncertainty, significant delays and difficulty navigating the system, leading to unsatisfactory outcomes for patients. NeuPath, through its significant number of highly talented, trained and specialized physicians, nurses and staff, along with an important physical footprint across numerous clinics in Ontario and Alberta, intends to expand its geographic reach and the tools available to its teams in order to further deliver the most comprehensive and coordinated treatment solutions for its patients. NeuPath intends to bring to market this expanded and augmented, multi-modal and coordinated treatment through acquisitions, partnering, joint ventures, licensing or other business arrangements that provide NeuPath’s patients with best-in-class, outcomes-driven solutions. By offering a full and coordinated spectrum of care and with easier navigation for patients, NeuPath’s patients will lead lives more fully lived. About NeuPath NeuPath is a vertically integrated health care provider utilizing research, data-driven insights, technology, and interdisciplinary care to help restore function for patients impacted by chronic pain, spinal injuries, sport-related injuries, and concussions. With equity ownership in seventeen clinics in Ontario and Alberta, NeuPath is building out a large-scale network to better serve patients across Canada. NeuPath is focused on transforming the hope of a better life into the reality of a life more fully lived.

Read More

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.

Read More

FUTURE OF HEALTHCARE

Virta Health Highlights Lasting, Transformative Health Improvements In 5-Year Diabetes Reversal Study

Virta Health | June 07, 2022

Virta Health, the leader in type 2 diabetes reversal, revealed preliminary five-year results from its landmark clinical trial at the American Diabetes Association 82nd Scientific Sessions. Presenting four unique abstracts, Virta highlighted myriad, lasting health improvements for people with type 2 diabetes and prediabetes, including blood sugar control, clinically-significant weight loss, reduced inflammation, and improvements in other markers of cardiometabolic health. These transformative health outcomes coincided with medication reduction or elimination for many trial patients, including Jane Ann Dimitt. For over two decades, Jane Ann was prescribed increasing levels of medications as her blood sugar and weight continued to climb. By the time she joined Virta in 2015, her A1c had reached 11.4%; the next step was insulin. Through Virta’s treatment, Jane Ann lowered her blood sugar to 5.5% (below even the prediabetes threshold) and lost over 50 pounds, while drastically reducing her reliance on medications. She also saw improved mobility, decreased inflammation and neuropathy, and now has the energy to play with her grandchildren—all without needing the insulin doctors said was imminent. The outcomes of Jane Ann and Virta’s other trial patients contradict the belief that progression of diabetes—and a lifetime of increasing medications—is inevitable. One-fifth of Virta patients completing five years of treatment saw full remission. One-third of patients achieved A1c below 6.5% without any diabetes medications, or only requiring Metformin. Notably, inflammatory markers, triglycerides, and HDL cholesterol all improved significantly. These outcomes, in conjunction with previous research demonstrating improvements in cardiovascular disease risk factors, depression symptoms, sleep, and knee pain, establish the promise of Virta’s approach to impact a wide range of conditions amid America’s metabolic disease epidemic. In the U.S., costs are rising as patient outcomes continue to worsen, including surges in amputations, hyperglycemic events, and diabetes-related deaths during the COVID-19 pandemic. Meanwhile, getting patients to stick with an intervention remains a significant challenge in diabetes therapy. Rates of medication adherence—that is, whether patients take their medications as prescribed—fall as low as 34% over the first three years for those starting insulin. For the National Diabetes Prevention Program, considered the gold standard in lifestyle interventions, only 13% of patients were retained at one year. In contrast, in Virta’s trial nearly 50% of participants with type 2 diabetes were retained at five years. Of those who continued past year two, 72% remained for an additional three years to year five. For Kim Shepherd, who lost 55 pounds, eliminated 10 different medications, reversed her diabetes, and even saw her GERD (acid reflux) and plantar fasciitis disappear, the reasons to stick with the treatment are clear. “Diabetes runs in my family, and I know that this disease can rob you of your whole life; it can take your eyes, your feet, and your kidneys. I have 4 kids and 9 grandkids to keep up with. I’ve learned to love hiking and biking. Nothing is worth losing all of that and going back to how I was before.” Additional key outcomes demonstrating the success of Virta’s approach at five years include Sustained blood sugar control. Virta patients experienced persistent improvements in blood sugar on average, while requiring significantly fewer medications. Medication deprescription. Half of patients prescribed insulin at the start of the trial no longer needed it at five years. Across all diabetes drugs, prescriptions were reduced by nearly 50%. Weight loss. Average weight among Virta participants decreased by 7.6%, exceeding the 5% benchmark for clinically significant weight loss by more than 50%. Broad improvement in cardiometabolic health. In addition to improvements in triglycerides, HDL cholesterol, and markers of inflammation, patients even showed encouraging signs in reversing the progression of chronic kidney disease. “Virta’s patients are helping redefine what long-term success can look like in type 2 diabetes care. The patient outcomes set a new standard for real-world applications of diabetes treatment." Dr. Alan Moses, former Senior Vice President and Global Chief Medical Officer of Novo Nordisk, and Virta advisor Trial participants with prediabetes also saw meaningful improvements, with progression rates far below what has been demonstrated in other studies. Further, Virta patients sustained 6% weight loss over five years, exceeding the clinically-significant benchmark for diabetes prevention and far surpassing the 2% weight loss observed in the NIH Diabetes Prevention Program lifestyle intervention. The study is also notable for its longevity. Five-year published results are extremely rare in digital health, where most studies follow populations for no more than a year, and usually significantly less. For many Virta patients, the five-year clinical trial has facilitated a lasting lifestyle change, improving not only traditional markers of health but overall mood, quality of life, and outlook on the future. Says patient Denise Lamb, who has maintained diabetes reversal alongside a nearly 70 pound weight loss, “My journey has been phenomenal. The Virta program has not only helped me achieve healthy blood glucose, but also attain a far better weight, normal blood pressure, and better understanding of my body. Virta’s lifestyle changed my lifestyle!” About Virta Health Virta Health helps people reverse type 2 diabetes and other chronic conditions. Current approaches manage disease progression through increased medication use and infrequent doctor visits. Virta reverses type 2 diabetes through innovations in technology, nutrition science, and continuous remote care from physicians and behavioral experts. In clinical studies, 94% of patients reduce or eliminate insulin use, and weight-loss exceeds FDA benchmarks by nearly 150%. Virta works with the largest health plans, employers, and government organizations and puts 100% of its fees at risk based on clinical and financial outcomes.

Read More

Spotlight

Increasing competition, lower margins and a need for scale are continuing to drive hospital merger and acquisition (M&A) activity, according to a new infographic by Agiliti. The infographic looks at three ways hospitals can improve post M&A integrations and outcomes.

Resources