Payer Roundup—Maine's new governor rejects state’s planned Medicaid work requirements

FierceHealthcare | January 24, 2019

Newly instated Maine Gov. Janet Mills has rejected work requirements in the state’s Medicaid program, which were requested by her predecessor and approved by the Centers for Medicare & Medicaid Services. The waiver request submitted by former Gov. Paul LePage was approved on Dec. 21 shortly before he left office. Mills sent a letter to CMS saying that Maine would not implement the changes approved in the waiver and would instead offer job training and other supports to enrollees in its MaineCare program. The state’s Acting Commissioner of Health and Human Services Jeanne Lambrew noted that Maine is facing a workforce shortage, which could be exacerbated if people lose access to crucial care, such as coverage for mental healthcare or substance abuse treatment.

Spotlight

BioNJ, the life sciences trade association for New Jersey, is delighted to release the white paper, A Framework for Demonstrating the Value of Medical Innovation.” This white paper came to fruition as a result of BioNJ’s Beyond Value Frameworks: Defining the Value of Medical Innovation workshops. With nearly 3,300 life sciences establishments, including 12 of the world’s largest biopharmaceutical companies, having a headquarters or significant presence in the Garden State, New Jersey’s life sciences ecosystem was responsible for more than 40% of all new novel FDA drug approvals over the last two years – more than anyplace else in the world. It is crucial for patients to have access to this life-changing medical innovation. However, under current benefit designs, patients often don’t have access to the right medicines at the right time. The current paradigm frequently assumes a “one size fits all approach. As a result, innovator companies need to provide more information and insights to overcome these barriers to access. This white paper, authored by Shailja Dixit, M.D., M.S., M.P.H., President & Founder, ApexBio and Robert Goldberg, Ph.D., Vice President & Founder, Center for Medicine in the Public Interest, outlines a framework for assessing the true value of the innovation and identifies steps that innovator companies can take to demonstrate Differential Value of their innovation.


Other News
FUTURE OF HEALTHCARE

Trillium Community Health Plan Successfully Resolves Corrective Action Plan with OHA

Trillium Community Health Plan | June 03, 2022

Trillium Community Health Plan is pleased to announce it has successfully closed the Tri-County Expansion Corrective Action Plan (CAP) with Oregon Health Authority effective June 1, 2022. As a result of this process, Trillium has implemented many practices that have further strengthened the plan's ability to coordinate high-quality healthcare and services, with a special focus on increasing access to care and addressing social determinants of health for Oregon Health Plan members in Clackamas, Multnomah, and Washington counties. In September 2020, OHA issued a CAP for Trillium's Medicaid plan as a condition of expansion into the Tri-County service area. OHA asked Trillium to focus on specific improvements to its network, health equity and language access, community engagement, and intensive care coordination. Leveraging the extensive expertise of its many work groups, committees, and community partnerships, including the Network Adequacy Collaborative and Health Equity Strategy Committee, and with contributions from tribal liaisons, traditional health worker liaisons, and the development of the Community Advisory Council, Trillium has addressed and resolved all CAP requirements. Today, Trillium serves more than 28,000 members in the Tri-County area. Through the CAP, the health plan made several improvements to enhance access to care and services for all members, including The creation of a fully compliant and engaged Community Advisory Council, made up largely of Trillium members representing diverse demographics and lived experience; New partnerships with the regional health equity coalition, tribal organizations, and community-based groups, which further support Trillium members with access to culturally sensitive healthcare, food insecurity, and other investments A robust behavioral health provider network to meet the needs of members; The Network Adequacy Collaborative to ensure all network related issues, including health equity, are identified and addressed promptly; and, A renewed internal committee structure to align plan efforts and center equity on strategic planning. "Trillium is committed to providing equitable, culturally sensitive, integrated care for all of our members in Oregon. We want to thank OHA for their continued partnership throughout this process, which has allowed us to enhance our systems, processes, and partnerships, improving our ability to identify local needs, remove barriers to care, develop service innovations, and collaborate across organizations to enact lasting change within our communities." Justin Lyman, Interim President and CEO of Trillium Trillium extends its appreciation to OHA for its partnership throughout this process. About Trillium Community Health Plan Trillium Community Health Plan serves Oregon Health Plan members through the CCO model, which began in 2012. Trillium is a recognized leader for outstanding coordination of care. It was first awarded a contract with the state of Oregon to help manage care for the Oregon Health Plan in 1999. Trillium partners with an extensive group of providers to improve care and access to services for OHP members.

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HEALTH TECHNOLOGY

Harris Williams Advises The CM Group on its Pending Sale to OPEN Health

Harris Williams | August 01, 2022

Harris Williams, a global investment bank specializing in M&A advisory services, announces it is advising The CM Group, a portfolio company of NaviMed Capital (NaviMed), on its pending sale to OPEN Health, a portfolio company of Astorg. The CM Group is a leading medical communications platform offering a set of integrated solutions to the U.S. domestic biotech and pharma industries. The transaction is being led by Paul Hepper, Nick Owens, Lucas Scholl, Rob Crampton and Gabby Struckell of the Harris Williams Healthcare & Life Sciences Group. “Investor interest in outsourced pharma commercialization services is driven by complex therapies becoming an increasing portion of new drug launches, declining access to physicians, and the increasing importance of directly reaching patient populations. Differentiated platforms such as The CM Group are benefiting disproportionally from these trends,” said Paul Hepper, a managing director at Harris Williams. “The combination of OPEN Health and The CM Group brings together two best-in-class commercialization businesses, with stellar reputations in the industry and an exciting opportunity to service leading pharmaceutical companies globally,” said Nick Owens, a director at Harris Williams. “Harris Williams was a phenomenal partner and exceeded our expectations throughout the transaction. The team’s knowledge of the sector and extensive buyer relationships led to an optimal outcome. We look forward to the next phase of growth with the OPEN Health and Astorg teams and are excited about building a global leader in pharma commercialization,” Daniel Leonard, CEO of The CM Group Grounded in science—and powered by the patient voice—The CM Group is an integrated healthcare agency of innovative and imaginative subject-matter experts dedicated to providing scientific and commercialization strategies and services to the life sciences industry. NaviMed is a Washington, D.C.-based private capital firm with over $400 million of assets under management, focused exclusively on the healthcare industry. NaviMed invests in fast-growing lower-middle market healthcare businesses that it believes are poised to benefit from the reform and technology innovation reshaping the healthcare industry. The firm focuses on healthcare services, healthcare IT, hospital products and pharmaceutical services businesses. NaviMed targets profitable private companies with up to $10 million of EBITDA and double-digit revenue growth. NaviMed’s senior investment team has a track record of value creation spanning, in the aggregate, dozens of investments and more than $11 billion of enterprise value created over the course of their combined careers. OPEN Health brings together deep scientific knowledge, global understanding, and broad specialist expertise to support its clients in improving health outcomes and patient wellbeing. OPEN Health is united as one flexible organization, harnessing the power of the collective to solve complex challenges. Astorg is a European private equity firm with over €17 billion of assets under management. Astorg works with entrepreneurs and management teams to acquire market leading global companies headquartered in Europe or the U.S., providing them with the strategic guidance, governance and capital they need to achieve their growth plans. Enjoying a distinct entrepreneurial culture, a long-term shareholder perspective and a lean decision-making body, Astorg has valuable industry expertise in healthcare, software, technology, business services and technology-based industrial companies. Astorg has offices in London; Paris; New York; Frankfurt, Germany; Milan; and Luxembourg. Harris Williams, an investment bank specializing in M&A advisory services, advocates for sellers and buyers of companies worldwide through critical milestones and provides thoughtful advice during the lives of their businesses. By collaborating as one firm across Industry Groups and geographies, the firm helps its clients achieve outcomes that support their objectives and strategically create value. Harris Williams is committed to execution excellence and to building enduring, valued relationships that are based on mutual trust. Harris Williams is a subsidiary of the PNC Financial Services Group, Inc. The Harris Williams HCLS Group has experience across a broad range of sectors, including healthcare providers; payors and payor services; outsourced pharmaceutical services; medical device supply chain; healthcare IT; and pharmacy. Harris Williams LLC is a registered broker-dealer and member of FINRA and SIPC. Harris Williams & Co. Ltd is a private limited company incorporated under English law with its registered office at 8th Floor, 20 Farringdon Street, London EC4A 4AB, UK, registered with the Registrar of Companies for England and Wales (registration number 07078852). Harris Williams & Co. Ltd is authorized and regulated by the Financial Conduct Authority. Harris Williams & Co. Corporate Finance Advisors GmbH is registered in the commercial register of the local court of Frankfurt am Main, Germany, under HRB 107540. The registered address is Bockenheimer Landstrasse 33-35, 60325 Frankfurt am Main, Germany. Geschäftsführer/Directors: Jeffery H. Perkins, Paul Poggi.Harris Williams is a trade name under which Harris Williams LLC, Harris Williams & Co. Ltd and Harris Williams & Co. Corporate Finance Advisors GmbH conduct business.

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DIGITAL HEALTHCARE

Habersham Medical Center first hospital in Georgia to adopt digital diagnostic image-sharing platform, PocketHealth

PocketHealth | June 18, 2022

Habersham Medical Center (HMC) announced that it will engage PocketHealth to help make it much easier for the hospital's 80,000 patients to access, share and store their medical imaging and reports securely on any device, enabling them to be more informed and active in their own healthcare journeys. Patients will no longer need to travel to the healthcare facility to collect a CD-ROM of their records and transport it to their next appointment or hope that their critical health information makes it safely to their primary care physician. With PocketHealth, HMC's patients will be able to actively engage in their own healthcare journey by accessing and sharing their imaging reports with their physicians, caregivers, or family members from any device, anywhere in the world. Physicians and other healthcare professionals who share and receive diagnostic images with Habersham will be able to work within the medical center's existing infrastructure and won't need to worry about additional software or account setup. They will be able to view patient imaging instantly in full diagnostic quality or import those images into their local PACS for diagnosis. "We are very excited to make the healthcare experience much easier than it has been for patients at Habersham Medical Center, and in implementing PocketHealth at our hospital, we are equipping patients to be participants in their own medical journey. Until now, when medical imaging and reports were shared it required our patients to make unnecessary trips to the site. Tyler Williams, President, and CEO of Habersham Medical Center PocketHealth equips healthcare providers with the most efficient and effective way to share medical imaging while bringing patients into the center of the process, fueling better outcomes through direct access to diagnostic imaging and reports. Patients can now request all of their imaging records from HMC on the PocketHealth website and gain better insights into their reports with PocketHealth's Report Reader functionality, which breaks down and defines complex medical terms found within radiology reports. "Diagnostic Imaging is essential to understanding a treatment course or for soliciting second opinions and can often be the spark for a long-term care journey," said Rishi Nayyar, co-founder and CEO, PocketHealth. "PocketHealth is thrilled to work with Habersham Medical Center to make it easy for patients and care providers to move through an image-based journey without the unnecessary frustration that often comes with records release and CD-ROM hardware." Habersham Medical Center is focused on serving its communities by providing high quality healthcare to its patients and clinical partnerships. The Center conducts approximately 125,000 imaging exams each year. About PocketHealth PocketHealth is the world's first patient-centric image sharing platform. With PocketHealth, patients can instantly access, share and take ownership over their own medical imaging and records - anytime, anywhere, and with anyone. PocketHealth also enables direct sharing between hospitals and physicians, as well as instant DICOM retrieval and automated importing capability, creating a unified image management solution for more than 600 hospitals and imaging clinics across North America. PocketHealth believes that by placing patients at the center of their care journey, records move more ethically, easily and securely throughout the healthcare system. About Habersham Medical Center Serving over 80,000 residents across northeast Georgia, Habersham Medical Center (HMC) is a 53 licensed-bed, acute care hospital delivering exceptional care and service. As a substantial economic partner for Habersham County, HMC operates three physician practices, a comprehensive rehabilitation program, an 84 licensed-bed, skilled nursing home and the area's only hospital-based, home health service.

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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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Spotlight

BioNJ, the life sciences trade association for New Jersey, is delighted to release the white paper, A Framework for Demonstrating the Value of Medical Innovation.” This white paper came to fruition as a result of BioNJ’s Beyond Value Frameworks: Defining the Value of Medical Innovation workshops. With nearly 3,300 life sciences establishments, including 12 of the world’s largest biopharmaceutical companies, having a headquarters or significant presence in the Garden State, New Jersey’s life sciences ecosystem was responsible for more than 40% of all new novel FDA drug approvals over the last two years – more than anyplace else in the world. It is crucial for patients to have access to this life-changing medical innovation. However, under current benefit designs, patients often don’t have access to the right medicines at the right time. The current paradigm frequently assumes a “one size fits all approach. As a result, innovator companies need to provide more information and insights to overcome these barriers to access. This white paper, authored by Shailja Dixit, M.D., M.S., M.P.H., President & Founder, ApexBio and Robert Goldberg, Ph.D., Vice President & Founder, Center for Medicine in the Public Interest, outlines a framework for assessing the true value of the innovation and identifies steps that innovator companies can take to demonstrate Differential Value of their innovation.

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