Payer Roundup—Harvard Pilgrim reports 7% revenue increase in 2018

FierceHealthcare | March 06, 2019

Harvard Pilgrim HealthCare reported a net income of more than $80 million in 2018 and an increase in revenue of 7%. The results were surprising after a net loss of $8.7 million in 2017. Harvard Pilgrim Chief Financial Officer Charley Goheen attributed the success to strong regional performances and higher-than-expected revenue by subsidiaries Health Plans Inc., TrestleTree and MedWatch. In 2015, Cigna CEO David Cordani publicly backed the merger with rival health insurer Anthem. However, Cordani now regrets supporting the deal, which reduced his role in the company, lawyers for Anthem said in court this week. While investors walked away with a 30% premium for their stock in Anthem’s buyout, Cordani lost his role to then-Anthem CEO Joseph Swedish.  Cordani later expressed in emails “remorse about making the decision,” lawyers said. A federal judge blocked the deal, ruling it anticompetitive, in 2017. Cigna and Anthem are still battling over which company owes the other for billions of dollars in damages from the collapse of the deal.

Spotlight

Over the past decade, a shift has occurred within the healthcare industry. Patients have become empowered as cultural changes, increasing care options, and policy adjustments enable populations to make informed decisions about their care. The 2010 Affordable Care Act ensured that patients were protected while pressing payers and providers to move into technically advanced systems. Payer and provider groups then began combining to offer new innovative care options, while life science professionals experienced a surge in treatment advancements.


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HEALTH TECHNOLOGY

Vitestro unveils autonomous blood drawing device, combining artificial intelligence, ultrasound imaging and robotics

Vitestro | May 31, 2022

Vitestro, a Dutch medical robotics company, unveiled the world's most advanced autonomous blood drawing device at the annual meeting of the Netherlands Society for Clinical Chemistry and Laboratory Medicine in Rotterdam. Vitestro's device combines AI-based, ultrasound-guided 3D reconstruction with robotic needle insertion, ensuring accurate and secure blood collection. The venipuncture technology is adaptable to patients of 16 years of age onwards, comorbidities, and puncture difficulty. From 2023, Vitestro will initiate pivotal clinical studies for regulatory approval in Europe. EU-market introduction is anticipated in 2024. Healthcare shortages spark revolutionary developments Within healthcare, the clinical laboratory is the driving force. Accuracy and timeliness of laboratory tests are critically important, as they shape approximately 70% of all medical decisions made by physicians. It is unsurprising that blood collection is the most common invasive medical procedure, performed billions of times per year globally. Blood collection holds a pivotal role in clinical diagnostics yet is also burdened by the scarcity of skilled workers. By automating this labor-intensive procedure, we can transform the quality of care and create a sustainable healthcare system. Proprietary laboratory automation technology standardizes handling of the blood sample while the blood is collected. The device allows almost complete automation of the pre-analytical phase. This has the potential to reduce high blood test error rates, mainly caused by manual variability. In clinical studies, Vitestro already performed 1,500 automated blood draws in more than 1,000 patients with its prototype. Toon Overbeeke, Vitestro's Co-Founder and Chief Executive Officer said: "The mounting shortage of healthcare personnel is imminent. The pandemic has further led to loss of workforce, causing a bleak outlook for hospital output around the globe, and leading to reduced access and continuity of care. That's why revolutionary automation like our blood drawing device is inevitable to solve the industry's biggest problem." Outpatient phlebotomy care is redefined At first, Vitestro will implement the device in outpatient phlebotomy departments. Patients will have the option to choose between Vitestro's venipunture device or standard method. The device is intuitive to use, empowering patients to be self-reliant in the full blood collection procedure. In previous clinical trials, patients of all ages showed a high degree of openness, enthusiasm and willingness to adopt the innovation. A trained healthcare professional is able to supervise several devices, managing multiple patients simultaneously. The increased efficiency enables hospitals and clinical laboratories to address workforce shortage or even free up staff and deploy them where they are really needed. "We have spent nearly five years on the development of this breakthrough medical device. All relevant disciplines are represented in our dedicated, specialized team of 35 people. To prepare for production and commercialization, the team will double in size in the next two years. We have clear momentum in the market and will be the first to bring autonomous technology to European hospitals. With our technology we can help to build a more robust and resilient healthcare system." Toon Overbeeke, Vitestro's Co-Founder and Chief Executive Officer Anja Leyte, Director OVLG Laboratories, participating in clinical studies commented: "By introducing automated blood drawing, high quality as well as capacity is guaranteed in our laboratories. Vitestro's technology helps solving staffing shortages at our blood drawing department and improving sample standardization. Patients are also very enthusiastic." About Vitestro In 2017 Vitestro's founders rose to the challenge to create a better blood drawing experience. Today Vitestro is well underway to achieve its goal with a committed team of 35 highly skilled people with a track record in medical robotics, imaging software, AI, QA/RA and business development. Vitestro is based in Utrecht, the Netherlands. Vitestro is well funded by private investors and government subsidies.

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HEALTH TECHNOLOGY

Tebra Secures More Than $72 Million at Over $1 Billion Valuation to Expand Digital Healthcare Technology Platform

Tebra | July 08, 2022

Tebra, the digital backbone for independent healthcare practices, announced that it has closed more than $72 million in funding at a valuation greater than $1 billion. Golub Capital led the investment which includes both growth equity and debt financing. Late last year, Kareo and PatientPop, cloud-based leaders in clinical, financial, and practice growth technology, joined forces to form Tebra to support the connected independent practice of the future and modernize patient care. This capital infusion will accelerate Tebra’s merger plans including expanding market share, developing and launching the combined product line and advancing the new branding for the company. Tebra supports over 100,000 providers who are delivering care to more than 90 million patients in the U.S. A New Era of Healthcare Consumers expect digital access, simplicity and convenience in all aspects of their lives. You can quickly research and order a meal online, hail a ride, and buy a car from your smartphone. Meanwhile, healthcare has been left behind in a sea of complexity and fractured solutions. Tebra is simplifying and modernizing this experience through a platform of tools built for the new era of healthcare. The platform connects patients to the best providers in seconds and delivers a modern, digital-first patient experience. Tebra is the Digital Backbone for the Connected Healthcare Practice Tebra provides independent healthcare practices with a complete operating system for practice success. Built through the combination of Kareo and PatientPop, the offering includes modern websites, messaging and scheduling, telehealth, EHR, care delivery, practice management, billing, payments, and analytics. Since the companies merged in late 2021, the company has successfully built and launched a two-way product integration that allows both platforms to share scheduling information and physician availability. The integrated solution also reviews appointment information and sends out surveys for better reputation management. Over 800 providers now use the combined operating system, and the company plans to grow significantly both into their existing base and the healthcare industry at large. “With this new investment from Golub Capital, we’ll be able to accelerate Tebra’s mission to unlock better healthcare by helping independent practices bring modernized care to patients everywhere. Simultaneously, we will broaden our market reach and launch new solutions, helping an even larger number of physicians with digital tools and support to attract new patients, get paid quicker, and operate their practice more efficiently.” Dan Rodrigues, Co-Founder and CEO of Tebra From practice growth technology to clinical and financial software, Tebra’s complete operating system is structured to modernize every step of the patient journey and support the connected practice of the future. Headquartered in Southern California, the company currently has over 1,000 employees. Golub Capital’s Late Stage Lending team was administrative agent and led the investment. Golub Capital also supported the 2021 merger with $65 million in growth funding, bringing its total commitment in the last year to more than $137 million. “We are delighted to be a long-standing financing partner to Tebra, supporting them through multiple growth phases, add-on acquisitions and new product development since 2017,” said Peter Fair, Managing Director at Golub Capital’s Late Stage Lending team. “Our mission is the success of our clients and being able to offer flexible solutions that meet the changing goals of their business.” Golub Capital is one of Tebra’s top-tier institutional investors, which also includes CommonFund, HLM Venture Partners, OpenView Venture Partners, StepStone Group, Stripes Group, Montreux Equity Partners, Toba Capital, Transformation Capital and Vivo Capital. About Tebra In 2021, with a combined mission to unlock better healthcare, Kareo and PatientPop joined forces to form Tebra — the operating system for the connected practice of the future. With an all-in-one, purpose-built platform to drive practice success and modernize every step of the patient journey, Tebra provides digital tools and support to attract new patients, deliver modern care, get paid quickly, and operate efficiently. Tebra’s all-in-one platform includes a fully certified Electronic Health Record (EHR), scheduling, insurance billing, patient payments, telehealth and more. About Golub Capital Late Stage Lending Golub Capital is a market-leading, award-winning direct lender and experienced credit asset manager. The firm’s Late Stage Lending group provides flexible growth capital to venture-backed, late stage SaaS companies. Our custom financing solutions are designed to help proven SaaS businesses accelerate sales growth, drive new product development, pursue strategic acquisitions and provide shareholder liquidity. As of April 1, 2022, Golub Capital had over 620 employees and over $50 billion of capital under management, a gross measure of invested capital including leverage. The firm has lending offices in Chicago, New York, San Francisco and London.

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MEDICAL DEVICES

Anthem Announces Subsidiary Brands Under Elevance Health

Elevance Health, Inc | June 20, 2022

As Anthem, Inc. moves closer to rebranding to Elevance Health, Inc. later this month, the company announced the launch of healthcare services brand Carelon and health plan brand Wellpoint to join the company’s family of brands that includes Anthem Blue Cross and Blue Shield. The move will optimize and streamline the company’s brand portfolio, reduce complexities, and further underscore its evolution to deliver solutions beyond traditional health insurance, simplify the healthcare experience, and advance health beyond healthcare. “An important part of being a lifetime, trusted health partner is grounded in our ability to ensure consumers have access to services that will meet their whole health needs across their entire healthcare journey. The addition of our new brands to our family of companies will bring together services and products within their respective brands that further integrate our business and health expertise across the industry to solve complex challenges and improve consumers lives.” Gail K. Boudreaux, President and CEO Anthem, Inc Blending a powerful suite of solutions to solve complex healthcare challenges Bringing together decades of experience, the company introduces its new healthcare services brand Carelon to consolidate the company’s existing broad portfolio of capabilities and services businesses under one brand to address the most complex healthcare challenges and support clients and consumers across the entire healthcare continuum. Derived from the word ‘care’ and suffix ‘lon’ meaning full and complete, the name Carelon stands for the importance of providing full and complete care. Carelon will serve one in three people in the U.S. With services ranging from research to integrated whole person care delivery, pharmacy, behavioral health to digital platform and technology services, Carelon will build better care for people and enhance efficiencies systemwide. Through partnerships across healthcare, Carelon will improve outcomes and reduce total cost of care through digitally enabled solutions to improve whole person health. The company expects to fully transition its capabilities and services under the Carelon brand over the next two years. This change further helps to streamline the end-to-end experiences for providers, clients and consumers. “Carelon makes connected care possible for everyone by putting people at the center of what we do and delivering the right balance of care, technology, data-driven insights and expertise to solve complex challenges and help consumers lead healthier lives,” said Pete Haytaian, Executive Vice President of Anthem, and President of Carelon. “Bringing together these solutions will help deliver our strategy, drive growth, and exceed expectations for care providers, consumers, and our other partners.” Launching a brand focused on improving the health of individuals and communities at all stages of life. The company will also launch the Wellpoint brand to unify its Medicare, Medicaid, and commercial health plans in select markets, simplifying interactions that consumers have with these health plans. Wellpoint’s suite of products and services are designed for consumers at any stage of life seeking to make the right care decisions and will offer access to simple, supportive health solutions that will help foster independence, confidence, and whole person health for consumers. ​The company plans to make this transition over the next few years. This change will not impact the company’s affiliated Anthem Blue Cross and Blue Shield and Anthem Blue Cross health plans. “Unifying many of our non-Blue Medicare, Medicaid, and commercial health plans under one brand helps consumers, care providers, and the healthcare industry better understand how our organization works together to deliver our distinct set of products and services that address the health and wellbeing of those we serve,” added Boudreaux. “Our Wellpoint health plans will continue to address consumer needs at a personal level, removing barriers and creating more meaningful connections across a lifetime of milestones and experiences.” This step in the company’s rebranding is a continuation of its bold and ambitious purpose to improve the health of humanity by serving people across their entire health journey; connecting them to care, support and resources; and simplifying every step of the healthcare journey to make health more equitable and accessible. On June 28, Anthem will become Elevance Health and will commemorate its official rebranding by ringing the opening bell at the New York Stock Exchange (NYSE). Shares of the company’s common stock will begin trading under the new ticker symbol ELV as of that morning. About Anthem, Inc. Anthem, which will become Elevance Health on June 28, 2022, is a leading health company dedicated to improving lives and communities, and making healthcare simpler. Through its affiliated companies, Anthem serves approximately 118 million people, including nearly 47 million within its family of health plans. Delivering health beyond healthcare, Anthem is expanding from being a partner in health benefits to a lifetime, trusted health partner.

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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.

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Spotlight

Over the past decade, a shift has occurred within the healthcare industry. Patients have become empowered as cultural changes, increasing care options, and policy adjustments enable populations to make informed decisions about their care. The 2010 Affordable Care Act ensured that patients were protected while pressing payers and providers to move into technically advanced systems. Payer and provider groups then began combining to offer new innovative care options, while life science professionals experienced a surge in treatment advancements.

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