Payer Roundup—Ohio's biggest Medicaid payer ditches CVS for Express Scripts

CVS | April 10, 2019

Pharmacy benefit managers in Ohio’s Medicaid program have been under fire for using spread pricing to maximize profits, and amid that debate the state’s largest Medicaid insurer is breaking up with CVS to contract with Express Scripts instead.  CareSource, which provides Medicaid managed care to 1 million Ohioans, said it “saw an opportunity” to rethink its PBM model2 with a focus on greater transparency.  CVS Caremark, the healthcare giant’s PBM arm, has been under major scrutiny in the state for its pricing practices. A state report found that in 2017 it earned $200 million through spread pricing in Ohio’s Medicaid program. Blue Cross Blue Shield of Texas announced that it plans to open 10 medical centers by the beginning of next year. The facilities will offer primary care, lab testing, urgent care, imaging and wellness services in the Dallas and Houston markets. The insurer says the clinics will help it manage rising healthcare costs.

Spotlight

The big issues impacting healthcare—such as rising costs and decreasing margins—revolve around healthcare IT. And though the data produced from EMRs may be plentiful, this whitepaper posits that Meaningful Use has broken its promise to support improvements through ready access to that data. A data-first analytics and application platform can help.


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FUTURE OF HEALTHCARE, MEDICAL DEVICES

Optimize your time and investment by downloading a networking info app for the 41st Annual JP Morgan Health Care Conference

Novateur Ventures | December 13, 2022

Novateur Ventures, a leading global life sciences advisory firm and Biotechnology Innovation Organization the world's largest advocacy association for biosciences, research and academic institutions, launched an industry networking information app, Event Guide to JPM 2023, which provides listings for an anticipated >200 satellite networking events taking place during the 41st Annual J.P. Morgan Health Care Conference on January 9-12, 2023, in San Francisco, CA. The Event Guide to JPM 2023 app, developed by Novateur Ventures and co-managed by BIO, features event search and filter capabilities, provides links to event and registration information, and in the case of in-person events, loads mapping software for directions to the event. Organizations can also use the app to list their scheduled events being held during the conference timeframe. "It was important for me to develop an app that allowed life science professionals to make important industry connections because, over my career, some of the most transformational relationships I have developed are the direct result of industry networking events. Novateur is delighted to be collaborating with BIO, to give the app a global reach," Ali Ardakani, Founder and Managing Director of Novateur Ventures “I see the app as a natural addition to BIO Partnering at JPM Week. We’re always working to help the industry partner more easily and effectively, and I’m excited to bring the whole JPM Week networking landscape to the palm of your hand. We are excited to be partnering with Novateur on managing and launching this app,” says Mackensie Vernetti, BIO’s Director of Partnering Operations. About Novateur Ventures Novateur Ventures is an established life sciences advisory and investment firm with extensive experience in business development and product development of therapeutics, medical devices, and digital health products. About Biotechnology Innovation Organization BIO is the world’s largest trade association representing biotechnology companies, academic institutions, state biotechnology centers and related organizations across the United States and in more than 30 other nations. BIO members are involved in the research and development of innovative healthcare, agricultural, industrial and environmental biotechnology products. BIO also produces the BIO International Convention, the world’s largest gathering of the biotechnology industry, along with industry-leading investor and partnering meetings held around the world. Good Day BIO is the only daily newsletter at the intersection of biotech, politics and policy. Subscribe here.

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FUTURE OF HEALTHCARE

Tebra CTO Kyle Ryan Named to the Healthcare Technology Report’s List of Top Healthcare Technology CTOs of 2022

Tebra | November 22, 2022

Tebra, a leader in practice growth technology and cloud-based clinical and financial software, announced that its Chief Technology Officer Kyle Ryan was named in the Healthcare Technology Report’s list of Top 25 Healthcare Technology CTOs of 2022. The annual list recognizes the most accomplished executives in healthcare technology who are leading teams in delivering cutting edge products that boost operations and improve efficiency for their customers. The CTOs on this year’s list have a wide range of impressive backgrounds, but each is the driving force behind their company’s technology innovations, ensuring software functionality and effectiveness. Read the full report here. “Kyle has been an integral part of the executive leadership team at Tebra and has built a strong partnership between product management and the technology team within the organization. He has vast knowledge about healthcare IT and how it applies to solving business problems and is keenly customer focused and is always taking time to understand customer needs at a deeper level. Kyle’s an outstanding ambassador for the company and prides himself on developing a healthy and high-performance culture.” Dan Rodrigues, CEO of Tebra Kyle is responsible for all areas of technology with a focus on the vision and strategy for Tebra’s suite of products and services. He believes that great products are created through a keen customer focus, groundbreaking ideas, precise engineering, and efficient execution. “I am honored to be included in this list of prestigious technology leaders,” Kyle said. “This recognition also highlights the technology team’s passion for improving healthcare and the company’s mission of providing independent practices with digital tools and support to thrive in a new era of healthcare.” 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.

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MEDICAL DEVICES

Signify Health and Ardent Health Services Collaborate to Improve Healthcare Outcomes

Signify Health, Inc. | December 15, 2022

Signify Health, Inc. a leading healthcare platform that leverages advanced analytics, technology and nationwide healthcare networks to create and power value-based payment programs, today announced an expansion of its relationship with Ardent Health Services, a premier provider of healthcare services with more than 200 sites of care across six states. A former participant in the Center for Medicare and Medicaid Innovation’s Bundled Payments for Care Improvement-Advanced program, Ardent will join a 2023 Signify-enabled accountable care organization (ACO) to implement care transformation, manage risk and provide high-quality, coordinated care for its Medicare patients. Ardent’s affiliated network of facilities and physicians in New Mexico, Oklahoma, Texas, and Kansas will work together with independent providers in a collaborative ACO model to achieve the benefits of scale and to effectively manage risk. The strategic collaboration will support alignment with the Centers for Medicare & Medicaid Services’ (CMS) goal of having all Medicare beneficiaries enrolled in an accountable relationship by 2030. “Ardent is proud of our success to date in value-based care, including the work we have done to transform our patient experience after discharge to achieve an over 26% reduction in our 90-day readmission rate and improve the clinical outcomes among participating patients,” said Marty Bonick, President and CEO of Ardent Health Services. “We are excited to expand our partnership with Signify Health to bring our patients proven preventive and care management services that will help drive better health and improve the overall experience for both patients and care teams.” Earlier this year, Signify Health acquired Caravan Health, a leader in enabling sustainable ACO and population health programs. With this acquisition, Signify Health supports one of the largest networks of at-risk providers and offers one comprehensive platform to manage total cost of care. In 2020 and 2021, 100% of Signify Health’s collaborative ACO participants earned shared savings. According to Tim Gronniger, Chief of Value-based Care Solutions, Signify Health, “CMS has stated that providers will soon be expected to move away from fee-for-service and take accountability for their cost of care. We are thrilled to work with Ardent Health Services to deliver the infrastructure needed to support their success with accountable care. Through our work together, Ardent’s Medicare patients will receive increased access to preventative and in-home services that can help to diminish health inequities and increase savings.” 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. For more information on how we are taking health homeward, visit us at signifyhealth.com. About Ardent Health Services Ardent Health Services invests in people, technology and communities. Through its subsidiaries, Ardent owns and operates 30 hospitals and nearly 200 sites of care in six states with more than 24,000 employees, including 1,200+ employed providers. With a focus on evidence-based practices to improve quality care and patient outcomes, 95% of eligible Ardent hospitals received a Leapfrog Hospital Safety Grade of A or B for Fall 2022, compared with 57% of all ranked U.S. hospitals. In 2022, Modern Healthcare recognized six Ardent entities as "Best Places to Work," marking the 14th consecutive year an Ardent facility was recognized. Based in Nashville, Tennessee, Ardent is owned by current and former members of Ardent’s management team; Equity Group Investments (EGI), a Chicago-based private investment firm; and Ventas, Inc. (NYSE: VTR), a publicly traded real estate investment trust.

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HEALTHTECH SECURITY

HeartCore Signs Fifth Go IPO Agreement with SBC Medical Group

Heartcore Enterprises Inc. | November 24, 2022

HeartCore Enterprises, Inc. a leading software development company, announced that it has signed an agreement with SBC Medical Group, Inc. for its fifth Go IPO consulting service within an eight-month period. As part of the Consulting Agreement, HeartCore will assist SBC Medical in its efforts to go public and list on the Nasdaq Stock Market Through Go IPO, the Company services clients by assisting throughout the audit and legal firm hiring process, translating requested documents into English, assisting in the preparation of documentation for internal controls required for an initial public offering or de-SPAC, providing general support services, assisting in the preparation of the S-1 or F-1 filing, and more. As compensation for its services, HeartCore expects to generate from SBC Medical an aggregate of $900,000 in initial fees. In addition, HeartCore has received a warrant to acquire 2.7% of SBC Medical’s common stock, on a fully diluted basis. “Japanese companies continue to express interest in listing on the U.S. markets, and our team has successfully taken advantage of this wave as we executed our fifth Go IPO win of 2022. Prospective Japanese Go IPO clients have appreciated our expertise in helping private companies kickstart and navigate their capital markets journey with our white glove service and catered consultation, which has resulted in a robust business pipeline for HeartCore.” CEO Sumitaka Yamamoto About HeartCore Enterprises, Inc. Headquartered in Tokyo, Japan, HeartCore Enterprises is a leading software development company offering Software as a Service solutions to enterprise customers in Japan and worldwide. The Company also provides data analytics services that allow enterprise businesses to create tailored web experiences for their clients through best-in-class design. HeartCore’s customer experience management platfor includes marketing, sales, service and content management systems, as well as other tools and integrations, which enable companies to enhance the customer experience and drive engagement. HeartCore also operates a digital transformation business that provides customers with robotics process automation, process mining and task mining to accelerate the digital transformation of enterprises. Furthermore, HeartCore offers “Go IPO,” a consulting service where it assists private companies with uplisting onto the Nasdaq Stock Market.

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Spotlight

The big issues impacting healthcare—such as rising costs and decreasing margins—revolve around healthcare IT. And though the data produced from EMRs may be plentiful, this whitepaper posits that Meaningful Use has broken its promise to support improvements through ready access to that data. A data-first analytics and application platform can help.

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