Why UnitedHealthcare wants to expand diagnostic codes to the social determinants of health

UnitedHealthcare | February 11, 2019

UnitedHealthcare wants to see diagnostic codes for services targeting the social determinants of health—such as transportation or healthy meals—expand nationwide. In an interview with FierceHealthcare, Sheila Shapiro, senior vice president for national strategic partnerships in UHC's clinical services team, said that one of the key barriers to expanding access to nonmedical care for social needs is a lack of coding standardization. So the insurer has begun to roll out new ICD-10 codes that providers can use to document these needs. Adding new code options ensures that social services are tracked effectively and patients actually receive them, while also avoiding additional administrative work for physicians, Shapiro said.

Spotlight

Right now, theres about $400 billion of healthcare construction underway around the world. This includes everything from cutting edge hospitals to groundbreaking research campuses and from telehealth centers to small specialty clinics. Whether you are part of the building team breaking ground on your citys newest medical center or you are helping to renovate a new ward on an existing facility, its an exciting time to be building in this diverse and growing sector.


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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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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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FUTURE OF HEALTHCARE

Dalrada Accelerates Its National Healthcare Model With Acquisition of Watson Rx Solutions

Dalrada Corporation | June 09, 2022

Dalrada Corporation announced that it had acquired the pharmacy, Watson Rx Solutions, Inc. The move highlights Dalrada’s aggressive growth plans within the healthcare sector and paves the way for a total end-to-end total healthcare solution. Adding the 10-year-old pharmacy to Dalrada Health’s comprehensive model expands the subsidiary’s synergies with potential opportunities across its products and services portfolio and offers another solution to meet patient requirements. Dalrada envisions a comprehensive healthcare solution for all Dalrada Health clients with unique offerings that will now include: a pharmacy to facilitate prescription processing, physicians and clinicians at treatment clinics, expanding into telemedicine, engagement of Dalrada-owned testing facilities and laboratories, and utilization of Company-specific technologies to facilitate immediate growth of the business. “Watson Rx has a long history of providing excellent pharmacy services. This acquisition allows Dalrada to expand its healthcare footprint and continue to build a total health management solution on an already successful turnkey operation. As a result, the Company will be able to successfully address the health needs of even more patients.” CEO and Founder, Brian Bonar Through comprehensive prescription management, education, nursing, and total health management, Watson Rx Solutions' leadership team holds more than six decades of combined experience in various complex pharmacy disease states and retail services, always putting patients first. Dalrada plans on entering the pharmaceutical space with an accelerated strategic plan to leverage the Company’s existing capabilities. Research reveals that the U.S. online and mail-order sales of drugs, health, and beauty aids were valued at 75.5 billion USD in 2020. Additionally, E-commerce pharmaceutical sales and beauty aids increased from 51.7 billion USD the year prior. Online, E-commerce, and mail-order sales increased from around 31 to 38 percent during the same period. Pharmacy and drug store sales reached 300 billion USD in 2020, with over-the-counter (OTC) medication accounting for over 36 billion USD in sales during the same year, the highest-selling year to date for the OTC segment. Dalrada and its subsidiaries provide value by making timely and impactful products and services available within health, technology, and clean energy markets. About Dalrada Dalrada Corporation drives innovation that positively impacts people, businesses, and the planet. With subsidiaries that are firmly positioned in the world’s top three-growing industries of healthcare, clean energy, and technology, Dalrada creates solutions that are sustainable, affordable, and accessible. The company works continually to produce disruptive products and services that accelerate positive change for current and future generations. Dalrada’s global solutions directly address climate change, post-pandemic gaps in the healthcare industry, and technology solutions for a new era of human behavior and interaction, ensuring a bright future for the world around us.

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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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Spotlight

Right now, theres about $400 billion of healthcare construction underway around the world. This includes everything from cutting edge hospitals to groundbreaking research campuses and from telehealth centers to small specialty clinics. Whether you are part of the building team breaking ground on your citys newest medical center or you are helping to renovate a new ward on an existing facility, its an exciting time to be building in this diverse and growing sector.

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