Part D plans take on more risk in new CMMI model

Healthcare Finance | January 22, 2019

The Centers for Medicare and Medicaid Services is testing new models through the Center for Medicare and Medicaid Innovation to bring down prescription drug costs in Part D and to add benefits and increase competition in Medicare Advantage plans. Both models are voluntary. The Part D payment modernization model is aimed at giving plans an incentive to reduce costs. Currently in Part D, once a patient's prescription drug spend is high enough for the patient to enter the final phase of the benefit, known as the "catastrophic phase," Medicare is responsible for 80 percent of drug costs.

Spotlight

Stem cells that produce sperm use a genetic trick to stay perpetually young across generations, Howard Hughes Medical Institute (HHMI) Investigator Yukiko Yamashita and colleagues have discovered. Certain sections of the fruit fly genome get shorter with age. But remarkably, some reproductive cells can repair the shrinkage, Yamashita’s team reports February 13, 2018 in the journal eLife.


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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

PointClickCare Launches Integrated Virtual Health Solution for Long-Term and Post-Acute Care Providers

PointClickCare | October 11, 2022

PointClickCare Technologies, a leading healthcare technology platform enabling meaningful collaboration and access to real‐time insights announced the launch of its Virtual Health offering – an integrated telemedicine solution to the Skilled Nursing Facilities market. With the help of partner Sound Physicians, this technology is currently being implemented in more than half of the states across the U.S. Over the next two days at the AHCA/NCAL Convention and Expo, PointClickCare will be showcasing the innovative ways providers can better achieve quality care and reach the full potential of virtual health in the post‐acute setting. According to the Forrester U.S. Tech Outlook, 2022 Report, investment in virtual health, remote monitoring, and hospital-at-home, are spending priorities in 2022. Forrester analysts have confirmed that these technologies have the power to reduce the cost of administrative complexity, which is currently $265 billion. Recent data from the US Department of Health & Human Services explains that the share of Medicare visits conducted through telehealth rose to 52.7 million in 2020, from approximately 840,000 in 2019. Knowing that telehealth has become an increasingly important, yet sometimes complicated component of healthcare, PointClickCare has developed an alternative to traditional telehealth by applying technological improvements to offer an integrated solution. “Telehealth is no longer a futuristic concept in long-term care, it’s table stakes. Our customers continue to navigate between care settings and our team has sought to innovate and push the envelope on providing virtual care. We’re proud to announce this technology that has been specifically designed to meet the mission‐critical needs of post‐acute providers to improve clinical care and reduce healthcare costs, consistently driving down hospital readmissions by 30%.” Travis Palmquist, Senior Vice President and General Manager of Senior Care at PointClickCare With PointClickCare’s Virtual Health offering, providers can now Improve patient care & staff satisfaction: By streamlining operations through a sophisticated level of integration into existing workflows, care teams have access to shared patient records, and can cut down on administrative tasks and can focus on what matters most – patient care. Reduce healthcare service costs: With the ability to “treat in place,” facilities experience stabilized occupancy rates and can reduce the need for after-hours readmissions or emergency room department transfers, ultimately lowering overall costs. “The ongoing staffing crisis has created a new level of pressure for our staff. With PointClickCare’s Virtual Health solution, our care teams can access an on-shift physician with just one click, streamlining operations and cutting down on a lot of the administrative burdens we are faced with, all while ensuring our patients are getting the best quality of care, any time,” said Kevin Baxter, Vice President of Operations at Health Services Management. About PointClickCare PointClickCare is a leading healthcare technology platform enabling meaningful collaboration and access to real‐time insights at any stage of a patient’s healthcare journey. PointClickCare’s single platform spans the care continuum, fostering proactive, holistic decision‐making and improved outcomes for all. Over 27,000 long‐term post‐acute care providers, and 2,700 hospitals use PointClickCare today, enabling care collaboration and value‐based care delivery for millions of lives across North America.

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HEALTH TECHNOLOGY

Philips advances AI-powered diagnostic systems and transformative workflow solutions at RSNA 2022

Royal Philips | November 28, 2022

Royal Philips a global leader in health technology announced its portfolio of smart diagnostic systems and transformative workflow solutions featured at the Radiological Society of North America annual meeting. Powered by AI, the company will showcase its latest systems and informatics solutions designed for providers to efficiently deliver patient-centric, high-quality imaging services. Overwhelming volume of radiology data compounding staff shortages and burnout Radiology plays a critical role in diagnosing and guiding patients into the right treatment plans. However, with increasing staff shortages and workloads, radiologists and staff continue to struggle to manage and interpret the huge volume of data captured to provide quality care for each patient. In the recent Future Health Index 2022 report commissioned by Philips, 24% of radiology leaders surveyed stated that managing the sheer volume of data available to them is their top data-related issue, with nearly two-thirds (65%) indicating their staff are overwhelmed by data overload. “With 47% of radiologists experiencing burnout [1], our customers are looking for innovations to help reduce their workloads and seamlessly integrate into their day-to-day operations. With smart intelligence built into imaging systems and informatics across the radiology workflow, Philips’ integrated solutions condense large volumes of data into patient-centric actionable insights for earlier and more definitive diagnosis and treatment.” Kees Wesdorp, Chief Business Leader of Precision Diagnosis at Philips AI-powered solutions enhance operational efficiencies and simplify complex workflows Some of the biggest challenges facing radiology leaders today are driven by managing complex, disconnected workflows which can negatively impact patient care, staff experience, outcomes, and cost. Visitors to the Philips booth at RSNA will see how the company’s latest interoperable and vendor-neutral operational solutions and strong portfolio of smart connected imaging systems help streamline and transform the radiology workflow to improve patient and staff experience; advance clinical and diagnostic confidence for better health outcomes; and drive a sustainable, resilient diagnostic infrastructure to help lower the cost of care. Featured at RSNA will be Philips’ AI-enabled technology [2] that automates and accelerates routine and repetitive tasks to generate patient-centric insights from large volumes of data to help improve productivity. Solutions include Philips Imaging Orchestrator – ROCC and Philips Ultrasound Collaboration Live, both pioneering the virtualization of radiology, extending care and collaboration beyond traditional models. Philips Imaging Orchestrator – ROCC, a vendor-neutral, multi-modality, multi-site telepresence solution provides advanced tele-acquisition capabilities and seamlessly connects imaging experts at a command center with technologists at scanning locations across an organization. Philips Ultrasound Collaboration Live tele-ultrasound, available on Philips ultrasound systems – EPIQ Elite and Affiniti – allows teams to securely video stream from their ultrasound system to a PC or mobile device for remote, on-demand access to clinical expertise regardless of location. Philips will also introduce the latest in AI-enabled image interpretation to help prioritize patient worklists based on clinical outcomes and expand diagnostic capabilities with its new Philips Advanced Visualization Workspace, with enhanced features to automate reporting and help drive earlier and more definitive diagnosis. Also featured is Philips Enterprise Performance Analytics – PerformanceBridge – to enhance operational decision-making through a vendor-neutral, real-time data analysis solution to help improve productivity and reduce costs. Smart connected imaging systems advance clinical and diagnostic confidence New at RSNA, Philips’ AI-powered MR SmartSpeed is designed to increase speed, image quality, and productivity and drive diagnostic confidence with improved image resolution via the AI reconstruction algorithm. It utilizes Philips’ state-of-the-art speed engine and an award-winning [3] AI reconstruction technology delivered at the source of the MR signal to ensure no data loss. SmartSpeed joins the company’s expanding portfolio of AI-driven MR solutions which includes AI-based touchless patient sensing, SmartExam, and MR Workspace. Philips will also showcase MR 5300, Philips’ newest BlueSeal Magnet, and industry-first wide bore helium-free operations system design for sustainable imaging at lower site costs without image quality or clinical compromises. Philips will spotlight its award-winning Spectral CT 7500, the company’s latest dual-detector CT system helping radiologists better characterize disease and reduce scan times at the same dose levels as conventional scans. Used in oncology imaging, cardiac imaging, and interventional radiology, the system has demonstrated a 34% reduction in time to diagnosis, a 25% reduction in repeat scans and a 30% reduction in follow-up scans [4]. Philips will also demonstrate its latest innovations in minimally-invasive care with the company’s SmartCT 3D suite of interventional tools including its Azurion 7 C20 with FlexArm Image-Guided Therapy System and Zenition 70 Mobile C-arm with Flat Detector. Philips will also introduce the Ultrasound Compact 5000 Series system and the Philips Lumify Handheld Ultrasound, now featuring pulse wave Doppler for all physicians – from cardiologists and radiologists to emergency care – to quickly assess hemodynamics in cardiac function anytime, anywhere. Also making its first appearance at RSNA is Philips Fluoroscopy 7000 N – ProxiDiagnost N90, combining digital radiography and high-end nearby fluoroscopy to help enhance clinical confidence and improve patient and staff satisfaction. About Royal Philips Royal Philips is a leading health technology company focused on improving people's health and well-being, and enabling better outcomes across the health continuum – from healthy living and prevention, to diagnosis, treatment and home care. Philips leverages advanced technology and deep clinical and consumer insights to deliver integrated solutions. Headquartered in the Netherlands, the company is a leader in diagnostic imaging, image-guided therapy, patient monitoring and health informatics, as well as in consumer health and home care. Philips generated 2021 sales of EUR 17.2 billion and employs approximately 79,000 employees with sales and services in more than 100 countries.

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HEALTH TECHNOLOGY

NextGen Healthcare Announces New Foster Care Functionality in Behavioral Health Suite

NextGen Healthcare, Inc. | September 15, 2022

NextGen Healthcare, Inc. a leading provider of innovative, cloud-based healthcare technology solutions, announced the newest release of its NextGen® Behavioral Health Suite. Built upon the company’s award-winning NextGen® Enterprise electronic health record and practice management system, the suite is the industry’s first platform to integrate comprehensive physical, dental, behavioral health and human services. The latest release offers tools that support the delivery of foster care services. These services benefit over 672,000 youth – most with complex health concerns – who are part of the U.S. foster care system, according to federal statistics. Additionally, NextGen Behavioral Health Suite now offers state-specific reporting, allowing behavioral health providers in states such as New York and Indiana to meet complex regulatory requirements. The release comes on the heels of recent upgrades that simplify caring for people with Intellectual & Developmental Disorders and includes residential content features. “The enhancements to our behavioral health suite were developed with our clients and the communities they serve in mind. The addition of foster care capabilities enables providers to expand care to some of the most vulnerable and precious members of our society – our children. And our new automated state-reporting capabilities enable providers to spend more time delivering care and less time on regulatory compliance.” Srinivas (Sri) Velamoor, chief growth & strategy officer for NextGen Healthcare New features in the latest release will aid providers as they work to build healthier communities Demographic Details of Foster Parents and Children – Enables foster care or adoption agencies to collect the demographic details of foster and adoptive families and children. Initial Screening of Foster or Adoptive Parents – Clinicians can document the initial screening of prospective foster or adoptive parents. Home Interview of Foster or Adoptive Parents – Users can collect in-depth interview details of prospective foster parents and determine the foster placement preferences of foster parents. Placement Dashboard of Foster Children – Providers can view availability of foster families to assign children to, and track/manage the location of each foster child within the foster care and adoption services programs. In addition to the human services enhancements, NextGen Healthcare works in unison with its client partners to create solutions tailored to their unique needs, including regulatory reporting requirements. “Through due diligence and thoughtful conversation, NextGen Healthcare weaved through the complexities of New York State legislation to create a tool that meets every requirement needed for documentation, regulatory and reporting. This is vital to the livelihood of our practices,” said Carl Coyle, chief executive officer of Liberty Resources, a NextGen Healthcare client based in Syracuse, NY. 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.

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Spotlight

Stem cells that produce sperm use a genetic trick to stay perpetually young across generations, Howard Hughes Medical Institute (HHMI) Investigator Yukiko Yamashita and colleagues have discovered. Certain sections of the fruit fly genome get shorter with age. But remarkably, some reproductive cells can repair the shrinkage, Yamashita’s team reports February 13, 2018 in the journal eLife.

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