Payer Roundup—Utah takes another step toward slimmed-down Medicaid expansion

FierceHealthcare | February 12, 2019

Utah’s state House has approved legislation that would scale back the number of people eligible for the voter-mandated Medicaid expansion. Voters in the state approved Medicaid expansion in the 2018 election, and under the Affordable Care Act that would allow the state’s program to add people making up to 138% of the poverty level to the rolls. However, the newly passed House tweak would cut that to 100% of the poverty level. Such a change would need to be approved by the Centers for Medicare & Medicaid Services before being finalized. The state’s Senate and governor would also need to sign off on the plan. “We’re doing the very best we can, and I think we’ve got a great solution here,” Stuart Adams, president of the state’s Senate, said.

Spotlight

According to a recent study conducted by AmericanEHR, nearly 40 percent of physicians would not recommend their Her solution to another provider; only slightly fewer said they would not purchase the same software again. Conversely, a study conducted this year by an EHR vendor, the approximately 60 percent of physicians who are satisfied see improvements to care and workflow. What makes the difference?


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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

VBA Partners With Healthcare Bluebook to Provide Enhanced Reporting of Quality Data for Physicians and Hospitals

Healthcare Bluebook and VBA | September 09, 2022

VBA, a leading-edge healthcare technology company, has teamed up with Healthcare Bluebook to incorporate Quantros quality scores for over half a million physicians and hospitals into its VBAnalytics reporting solution. This move is just one of many exciting enhancements around quality-based care reporting planned in 2022 to make VBAnalytics the premier population health and business insight solution for healthcare payers. VBAnalytics already provides robust analysis and reporting of healthcare utilization and costs and offers insight to help payers make the necessary changes to ensure their health plans are performing effectively. “As the healthcare industry continues to strive for transparency in both cost and quality, the Quantros quality data is essential for our clients to remain competitive. Being able to benchmark their results against millions of healthcare claims from all regions of the country provides invaluable insight to manage their plan performance.” Michael Clayton, President and CEO of VBA With VBAnalytics Value-Based Care Reporting, powered by Quantros, health plans can easily combine cost and quality data to determine which providers are performing the best under their value-based care arrangements. Equipped with this information, payers can make adjustments to their provider networks to ensure that patients have access to the best providers. The Quantros quality scores include important measures of physician and hospital performance including patient safety, complications from a procedure or hospitalization, mortality, and hospital readmissions. Data is combined among multiple providers to create an episode of care, which allows for a more comprehensive view of the patient’s experience. VBA has also integrated Healthcare Bluebook’s online shopping tool within its VBAGateway member portal to make it simple for members to access cost and quality information they need with just a few clicks. “When consumers are equipped with accurate information on cost and quality, everybody wins,” said Clayton. “As consumers become more educated about their healthcare decisions, it will lead to more thoughtful choices that can have a positive ripple effect throughout the healthcare system.” Providing consumers with better information also helps to reduce the overall cost of healthcare for employers, who cover a significant portion of the healthcare costs for their employees. About VBA VBA is a leading-edge healthcare technology company providing comprehensive solutions to the insurance industry. Uniquely delivered on a secure, cloud-based platform, VBA provides a suite of technology solutions for benefits administration, user experience, customer support, business insight and more. About Healthcare Bluebook Healthcare Bluebook's purpose is to protect consumers and companies nationwide from overpriced, low-quality healthcare. Since 2007, Healthcare Bluebook has helped millions of people by making it easy for them to find high-quality care at a Fair Price™.

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HEALTH TECHNOLOGY

Paradigm Oral Health Announces Acquisition by BlackRock Long Term Private Capital

Paradigm Oral Health | September 23, 2022

Paradigm Oral Health a leading oral surgery and digital dentistry platform announced that BlackRock Long Term Private Capital has entered into a definitive agreement to acquire a majority interest in the company from shareholders including InTandem Capital Partners. LTPC will partner with Paradigm’s executive leadership team, led by founder and CEO Dr. David Rallis, to support the company’s continued expansion and strategic growth plans. Founded in 2018, Paradigm has developed an industry-leading model designed to attract and retain best-in-class surgeons focused on delivering the highest quality of oral health care and dental implant surgery while fostering a medically-driven, patient-friendly culture of excellence. The company partners with leading oral surgery groups in markets across the United States, allowing them to maintain their unique brand identity while operating on the same platform. Paradigm’s proprietary practice management technology, Paragon, utilizes cutting-edge technology and data analytics to provide and store proprietary information and intelligence generated by the business, leading to enhanced performance as well as increased patient and provider satisfaction. Today, Paradigm and its team of over 100 surgeon partners provide patient care in 75 state-of-the-art facilities throughout the United States. “We are pleased to invest in Paradigm, which has established itself as an industry defining platform for the development and delivery of next-generation oral health solutions. Through its focus on providing superior clinical care, advanced technology, and continued training and education to its surgeon partners, the company is well positioned for long-term growth. We look forward to partnering with Dr. David Rallis and the entire Paradigm team.” Colm Lanigan, Head of BlackRock LTPC, Americas David Rallis, DDS, MD, and CEO of Paradigm Oral Health, commented, “Paradigm is advancing oral surgical outcomes and patient experience through a culture that places the needs of the patient first. At Paradigm, we validate our clinical performance through a proprietary data ecosystem and use data to reinforce our culture of excellence and accountability. Through innovation, and the rapid adoption of technology, we continue to set the standard for dental implant surgery. Aligning our company with world-class partners, first InTandem Capital and now BlackRock LTPC, has allowed Paradigm to emerge as a leader. We are humbled by the opportunity to partner with BlackRock LTPC, and excited to work with Colm Lanigan and his team as we continue to advance Paradigm as the global leader in oral surgery.” Elliot Cooperstone, Managing Partner of InTandem Capital Partners, Paradigm’s financial sponsor since 2019, commented, “InTandem Capital invests in healthcare companies that are local leaders with the ambition and potential to become a national powerhouse. Dr. David Rallis and the leadership team at Paradigm embraced our playbook for accelerated growth with amazing skill and dedication. Our deep trust in each other has allowed our partnership to flourish. My colleagues and I wish David and the Paradigm team the very best as they build on their well-deserved position as the country’s leading oral health company.” Paradigm is BlackRock LTPC’s sixth investment to date and its fourth investment in North America. Houlihan Lokey acted as financial advisor and Goodwin Procter acted as legal advisor to Paradigm. Simpson Thacher acted as legal advisor to Blackrock LTPC. About Paradigm Oral Health Paradigm Oral Health is the preeminent provider of oral surgery. Paradigm’s uniqueness comes from their ability to hire the most elite oral surgeons in the country and train them on their proprietary platform of excellence. Paradigm Oral Health continues to revolutionize and reinvent implant surgery through their ongoing technology and digital work-flow advancements. With a passion for excellence, Paradigm embraces every opportunity to meet the needs of their patients and referring dentists. About BlackRock LTPC BlackRock LTPC is an innovative private equity strategy focused on investing in high-quality businesses and value creation through active collaboration with management teams. The strategy's flexible duration and prudent approach to leverage preserve optionality for growth and help enable compounded capital appreciation. LTPC's team of 23 professionals are based in New York and London and invest across North America and Western Europe. LTPC is backed by BlackRock, Inc., which manages $320 billion in alternative investments and commitments on behalf of clients worldwide as of June 30, 2022. About InTandem Capital Partners InTandem Capital Partners is a private equity firm that invests in and helps accelerate the growth of select healthcare services companies. Its goal is to build excellent businesses of significant value working collaboratively with its management team partners. InTandem is comprised of former business executives and experienced investors, and is uniquely qualified to provide strategic, acquisition and operating expertise to help companies significantly increase their value over time. InTandem provides active support to the management of its portfolio companies directly and leverages its network of industry executives to augment its capabilities.

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HEALTHTECH SECURITY

Intuit to Acquire Financial Health Startup SeedFi

Intuit | December 02, 2022

Intuit the global financial technology platform that makes TurboTax, Credit Karma, QuickBooks, and Mailchimp, announced it has entered into an agreement to acquire SeedFi, the partner behind Credit Karma’s Credit Builder1, which helps low, or no-credit borrowers build credit while saving money, all for free. Credit Builder offers a line of credit and a secured savings account enabling members to build their credit while building up savings. By combining SeedFi’s Credit Builder technology with Credit Karma’s long standing relationships with credit bureaus and others in the credit ecosystem, Intuit will be able to move with greater speed and scale to help Credit Karma members make financial progress. Late last year, Credit Karma entered into a partnership with SeedFi to offer Credit Builder to its members, enabling them to make regular payments, starting with as little as $20 per month or $10 per paycheck. By reporting these payments to the credit bureaus, members took steps toward improving their financial health. Through this partnership, members increased their score by an average of 21 points in as little as 30 to 45 days2 and built up over $10 million in savings. This acquisition will enable Credit Karma Money to continue to build on that momentum and help put more members on a path to financial security. “Credit Karma Money was built to change consumers’ relationship with money and help them develop responsible financial habits, like staying on top of their bills and spending within their means. With Credit Builder, we are able to differentiate ourselves as one of the best accounts for building credit. We have long standing relationships with credit bureaus and others in the credit ecosystem, and SeedFi has built great technology, so when combined, we will move even faster and build products to help more members, including those who need it the most.” Poulomi Damany, SVP and GM for Credit Karma Money and Tax A recent study from the Consumer Financial Protection Bureau showed that nearly three-quarters of Americans with no emergency savings have credit scores below 660. The correlation between low credit scores and lack of emergency savings persists over time, and SeedFi takes that problem head-on. Similar to Credit Karma, SeedFi’s mission is to break the cycle of debt and help Americans realize their financial potential. “We have already been working with the Credit Karma Money team for over a year to help members build their credit score and have been impressed with how Credit Karma’s mission comes through in everything the company does. SeedFi has a similar mission to help consumers become financially fit, so joining forces just makes sense,” said SeedFi co-founder and CEO Jim McGinley. “Together, leveraging Credit Karma’s resources and scale, we will be able to accelerate the momentum of Credit Builder and SeedFi’s technology capabilities to help more consumers improve their financial health.” The transaction between Intuit and McBurberod Financial, Inc. which does business as SeedFi, is subject to closing conditions, and is expected to close in the coming months. Upon close, SeedFi will become part of Intuit’s Credit Karma business. The transaction is not expected to have a material impact on Intuit’s operating results for the full fiscal year 2023. Terms of the transaction have not been disclosed. Intuit Ventures was an investor in SeedFi’s last financing round. About Intuit Intuit is the global financial technology platform that powers prosperity for the people and communities we serve. With more than 100 million customers worldwide using TurboTax, Credit Karma, QuickBooks, and Mailchimp, we believe that everyone should have the opportunity to prosper. We never stop working to find new, innovative ways to make that possible. Please visit us for the latest information about Intuit, our products and services, and find us on social. About Credit Karma Founded in 2007 by Ken Lin, Credit Karma, an Intuit company is a consumer technology company with nearly 130 million members in the United States, U.K. and Canada, including almost half of all U.S. millennials. While best known for pioneering free credit scores, the company’s members turn to Credit Karma for everything related to their financial goals, including identity monitoring, applying for credit cards, shopping for loans auto insurance, savings accounts and now checking accounts through our bank partner, MVB Bank, Inc., Member FDIC — all for free.

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Spotlight

According to a recent study conducted by AmericanEHR, nearly 40 percent of physicians would not recommend their Her solution to another provider; only slightly fewer said they would not purchase the same software again. Conversely, a study conducted this year by an EHR vendor, the approximately 60 percent of physicians who are satisfied see improvements to care and workflow. What makes the difference?

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