Payer Roundup—Insurance groups call for HRA protections; Maine governor signs Medicaid expansion

FierceHealthcare | January 04, 2019

America's Health Insurance Plans (AHIP), the Blue Cross Blue Shield Association and the Association for Community Affiliated Plans (ACAP) are opposing a Trump administration proposal to allow usage of health reimbursement arrangements to buy short-term limited duration health plans. "Enforceable safeguards and non-discrimination protections are essential for these options to work for Americans," AHIP wrote in its comments in response to the proposal. The proposed rule would allow workers to use their HRAs to buy the short-term plans that are not required to comply with the Affordable Care Act or to cover people with pre-existing conditions.

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New regulations such as “meaningful use” requirements, the implementation of ACOs and other recent changes in federal healthcare law and regulations, such as Medicare and Medicaid financial incentives and penalties are driving change.


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HEALTHTECH SECURITY

Komodo Health Appoints Lauren Stahl as Head of Sales

Komodo Health | September 29, 2022

Healthcare technology company Komodo Health announced that Lauren Stahl has been appointed as the company’s Vice President and Head of Sales, effective immediately. In this capacity, Stahl’s responsibilities include sales team leadership across Komodo’s entire portfolio of customers, overseeing operational strategy to drive business efficiencies amid year-over-year growth and market expansion. As Komodo’s new Head of Sales, Stahl will oversee the company’s entire sales organization, with responsibilities for driving business and revenue growth as Komodo scales its offerings and footprint across more than a dozen market segments. Today’s appointment is the latest example of strategic business enhancements being made to power the next phase of innovation, growth, and productivity for the company. The new sales structure will further optimize business development and customer collaboration opportunities as the company introduces new capabilities across its technology platform and software applications. “Lauren has demonstrated an exceptional track record of deepening customer relationships and unlocking new market and customer sales channels. As Komodo continues to invest in its end-to-end technology platform, having Lauren at the helm of our sales teams will only further accelerate our efforts to put Komodo’s best-in-class technology platform and patient-centric insights in the hands of organizations across Life Sciences, payers, government entities, and more.” Aswin Chandrakantan, MD, Chief Operating Officer at Komodo Health Stahl has been driving value for Komodo and its customers for more than three years, quickly rising through the ranks as an individual sales executive to their most recent position as Komodo’s Vice President of Healthcare Sales, where Lauren and their team focused on strategic partnerships with a variety of healthcare innovators to deliver data-driven impact for health plans, digital marketers, consultancies, and more. In this new role overseeing Komodo’s entire sales organization, Stahl will serve as a key sales leader to deliver impact in new market segments and continue to drive hypergrowth revenue for the company. “I’m humbled and inspired to expand my leadership responsibilities and am eager to continue building on the company’s success and impact in the market,” said Stahl. “Representing Komodo means being a champion for how we are redefining the way healthcare and Life Sciences companies drive innovation into the market. Our technology platform and solutions empower our customers to transform extraordinary amounts of data into rich and meaningful insights that can improve health outcomes.” Stahl brings nearly 15 years of deep healthcare expertise to this new role, along with extensive financial and sales knowledge drawn from their career on Wall Street and leadership at several digital health companies. Before joining Komodo, Stahl was Head of Customer Success at Datavant, and was previously the CEO and founder of Sparkite, a company focused on addiction and substance abuse aftercare treatment. About Komodo Health Komodo Health is a technology platform company creating the new standard for real-world data and analytics by pairing the industry’s most complete view of patient encounters with enterprise software and machine learning that connects the dots between individual patient journeys and large-scale health outcomes. Across Life Sciences, payer, provider, and developers, we help our customers unearth patient-centric insights at scale — marrying clinical data with advanced algorithms and AI-powered software solutions to inform decision making, close gaps in care, address disease burden, and help the enterprise create a more cost-effective, value-driven healthcare system.

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HEALTH TECHNOLOGY

HeartBeam Announces FDA Submission of HeartBeam AIMI™ Product

HeartBeam, Inc. | August 17, 2022

HeartBeam, Inc. a developmental stage digital healthcare company with a proprietary ECG telemedicine technology for heart attack detection, announced it has submitted a 510(k) application to the US Food and Drug Administration for its HeartBeam AIMI™ platform technology for use in diagnosing heart attacks. “The 510(k) submission of our first product, based on our platform technology, is an important milestone toward commercialization and underscores our continued progress toward making the HeartBeam AIMI platform widely available to help Emergency Department physicians correctly and expeditiously diagnose patients with chest pain or other symptoms of a heart attack. I am proud of the HeartBeam team for their commitment to achieving this critical step in bringing the Company’s technology to market. We look forward to working through the FDA review process toward our goal of clearance for the US market.” Branislav Vajdic, PhD, HeartBeam CEO and founder The HeartBeam AIMI platform technology is anticipated to assist health care professionals in identifying patients who present with chest pain to facilitate rapid detection of a heart attack and determine an appropriate treatment regimen. Chest pain is the second most common reason for an emergency department visit with high costs associated with these visits. The goal of HeartBeam’s technology is to offer more accurate heart attack detection to triage patients and expedite treatment. HeartBeam AIMI is software as a medical device with a 510(K) regulatory pathway. The HeartBeam algorithm used in an emergency department setting slots into existing physician workflow, leverages existing 12-lead ECG hardware and provides the attending physician with an instant comparison of the patient’s baseline and symptomatic ECG for their consideration in the patient’s diagnosis. This will allow physicians to quickly determine if a patient needs intervention or can be discharged which helps manage patient flow. Jon Hunt, PhD, HeartBeam Executive Vice President and Chief Business Officer, added, “Our FDA approval process doesn’t require any human or animal trials, so there is good reason to believe that we will receive FDA clearance for a limited market release by end of 2022 and full commercial roll-out in Q1 2023. While the FDA conducts its regulatory review, our team will focus on executing key components of its commercialization plan and subscription revenue model. We continue to engage in positive discussions with strategic institutions, including academic centers, regional healthcare systems and regional community hospital systems that can utilize our products. We look forward to approval and offering our HeartBeam AIMI platform in an expected $500 million total addressable market.” About HeartBeam, Inc. HeartBeam, Inc. is a development stage digital healthcare company with proprietary ECG telemedicine technology that will redefine the way high risk cardiovascular patients are diagnosed in an ambulatory setting at any time and any place. Its breakthrough solution employs a reusable, credit card sized, 3D vector ECG recording device and cloud-based software capable of assisting a physician in diagnosing a wide range of cardiovascular disease. HeartBeam is initially focusing on a huge unmet need of helping diagnose heart attacks in patients outside of a medical institution. No single lead ECG technology can offer this value to patients and their physicians. This underserved market is several times larger than the cardiac arrhythmia detection market based on the prevalence of patients with coronary artery disease at high risk of heart attack.

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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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HEALTH TECHNOLOGY

KAID Health Technology Demonstrates the Value of Natural Language Processing to Improve Preoperative Care

KAID Health | August 02, 2022

KAID Health, an AI-powered health care data analysis and provider engagement platform, announced the results of a study that validates the potential utility of its Natural Language Processing technology to improve provider efficiency and care quality. The peer-reviewed “doctor vs. artificial intelligence” paper found that KAID Health’s NLP technology greatly aligned with the clinician reviewers in completing a pre-operative checklist, and further was able to identify 16.6% of instances where the presence or absence of a specific condition was not found by the anesthesiologist. The research study was undertaken at UCSD’s Department of Anesthesiology, Division of Perioperative Informatics. The authors of the manuscript were Harrison S. Suh, BS, Jeffrey L. Tully, MD, Minhthy N. Meineke, MD, Ruth S. Waterman, MD, MS, and Rodney A. Gabriel, MD, MAS. “We have demonstrated that NLP technology can help identify critical medical conditions relevant to preanesthetic evaluation. Key to this was KAID Health’s ability to utilize unstructured free-text input from the electronic medical record to flag critical medical conditions for anesthesiologists,” researcher and senior author Dr. Rodney Gabriel explained. “This research shows that NLP may be a useful tool to aid preoperative anesthesia providers in screening and evaluation of surgical patients.” For each of the 93 patients in the study, researchers collected all pertinent free-text notes from the EMR. The free-text notes were then processed by a Named Entity Recognition pipeline, which incorporated an NLP machine learning model developed by KAID Health. The model recognizes and labels spans of text that correspond to medical concepts. Medical concepts were then mapped to a list of medical conditions that were of interest for a preanesthesia evaluation. The most common conditions that the NLP pipeline captured that the anesthesiologist did not include cardiac arrhythmias, angina, anticoagulation, peripheral vascular disease, obstructive sleep apnea, and neuromuscular disease. “We are proud that leading academic institutions, such as UCSD, are partnering with KAID to ensure our NLP and AI models meet the demanding accuracy and usability standards required of the industry. KAID Health’s NLP technology played a vital role in this study in identifying pertinent preanesthesia history to optimize efficiency for anesthesiologists. Our model demonstrated that NLP holds the potential to reduce clinician workloads, improve profitability, and, most importantly, make surgery safer.” Kevin Agatstein, CEO of KAID Health The International Anesthesia Research Society published the study, “Identification of Preanesthetic History Elements by a Natural Language Processing Engine,” in its journal, Anesthesia & Analgesia, one of the leading anesthesiology journals in the world. About KAID Health KAID Health makes care delivery more efficient, effective, and profitable for providers and their payers and Accountable Care Organization partners. Its Whole Chart Analysis platform extracts all relevant data from electronic medical records, including structured data and text, using artificial intelligence and natural language processing. The solution identifies the patient care interventions needed for providers to achieve their clinical, financial, or operational objectives. In parallel, KAID Health extends to payers a comprehensive view of members’ health by combining claims and EMR data. Today, KAID Health’s technology is used by leading providers, health systems, academic medical centers, and payers to automate a variety of workflows, including coding accuracy, quality measurement, prior authorization support, and pre-operative assessment. The company was founded by a veteran team of healthcare information technology and population health innovators. It is based in Boston, MA.

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Spotlight

New regulations such as “meaningful use” requirements, the implementation of ACOs and other recent changes in federal healthcare law and regulations, such as Medicare and Medicaid financial incentives and penalties are driving change.

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