ABL Member News * Healthcare Industry Trends * April 3, 2018


Everyday Low Prices Are On Their Way to Healthcare

Reflecting on the historic changes in healthcare, one typically thinks of clinical breakthroughs. Like ether, as a surgical anesthetic; or penicillin, the first widely-used antibiotic; or even sequencing the human genome. But, that’s not what’s rocking the world of healthcare now. Today’s headlines (particularly in this ABL Healthcare Online issue) are all about the dramatic changes occurring in healthcare – from both within and without. Nearly any one of these stories alone would give pause, but in the aggregate they spell what many had despaired of: Controlling Healthcare’s “Unsustainable” Spending Growth. READ MORE...

Axene Health Partners Opens New Headquarters in Temecula

Axene Health Partners has opened new corporate headquarters in Old Town Temecula, in Southern California. This move puts Axene's actuarial consultants under the same roof as the firm's IT development team, which will help them all better serve clients and continue to drive innovation in the healthcare space. (John Price, Bay Area)

Ceresti Achieves Positive Outcomes in Program with Landmark

A recent update from Ceresti shared the company's positive outcomes from the first cohort of Landmark patient/caregiver dyads enrolled in Ceresti's digital caregiver empowerment program. Ceresti achieved high satisfaction, a significant reduction in caregiver burden, and received heartfelt testimonials from families impacted by dementia. Ceresti also observed a reduction in ED visits and hospitalizations for patients enrolled in its program. Based on these positive results, Ceresti is working with Landmark to make the program available to potentially thousands of patients. Ceresti is also engaged in several other demonstration projects with potential customers. (Dirk Soenksen, Orange County)

Choice in Aging's Work Featured in Newspaper Article

Debbie Toth, CEO of Choice in Aging, was spotlighted in a recent Martinez News-Gazette article, for her company's work with Contra Costa County to help prepare for the growing aging population, looking at access to healthcare, transportation access, and other needs. Debbie notes that she's a proponent of 8 80 Cities, an organization whose mission is to get cities to become places where residents who are 8 and those who are 80 feel comfortable. To this end, she has invited two members of the Martinez City Council to attend a “learning laboratory” workshop on May 30 that will examine barriers to the elderly and how city governments can make their municipalities places that can better accommodate older residents.  Meanwhile, Choice in Aging will hold an Open House on Saturday, May 5, 10 a.m. to noon. (Debbie Toth, Bay Area)

Cigna Reduces Opioid Use by 25% - Year Ahead of Goal

Cigna, in partnership with 1.1+ million prescribing clinicians, has achieved a 25% reduction in opioid use among its customers, reaching this key metric one year ahead of its initial goal. In May 2016, Cigna brought together resources across its medical, behavioral, and pharmacy programs to identify ways that the company could harness its physician-partnership model to interrupt the cycle of addiction while assuring that people who have no alternatives to manage their pain retained clinically appropriate access to the remedies prescribed by their doctor. One key metric in the effort was to reduce opioid use among its customers by 25% by 2019 - chosen because this reduction would return customers’ usage of opioids to pre-epidemic levels. (Chris De Rosa, Orange County)

CoveredCA to Hospitals: Shape Up or Get Out of ACA Networks

KQED recently reported that, in the next three-year contract that Covered California strikes with insurance companies, there will be a quality-focused stipulation: any hospital that doesn't meet certain targets for safety and quality can be excluded from the health plans sold through the marketplace. The chosen targets require hospitals to perform fewer unnecessary C-sections, prescribe fewer opioids, and cut back on the use of imaging (X-rays, MRIs, and CT scans) to diagnose and treat back pain - procedures and technologies that have been overused to the point of causing patient harm. Lance Lang, chief medical officer for Covered California, says every hospital in California should be able to reach the quality targets, though some may need help identifying and fixing obstacles along the way. Covered California, along with other state health programs, has been working closely with hospitals through a partnership called the Smart Care Collaborative. (Kathy Keeshen, Sacramento)

El Camino Hospital Deemed Leader in LGBTQ Healthcare Equality

The Human Rights Campaign Foundation (HRC), the education arm of the nation’s largest LGBTQ civil rights organization, has designated El Camino Hospital as a "Leader in LGBTQ Healthcare Equality," based on policies and practices dedicated to the equitable treatment and inclusion of their LGBTQ patients, visitors, and employees. Of facilities surveyed, 418 earned a top score of 100, and received HRC’s "Leader" designation. (Jeff Gruer & Cecile Currier, Silicon Valley)

ElderConsult Geriatric Medicine Presents Q&A + Annual Conference

On the evening of April 5, Elizabeth Landsverk MD, of ElderConsult Geriatric Medicine, will present Have You Ever Spoken to a Geriatrician? Ask Her Anything! in Santa Clara. She will answer questions, discuss aging well, and what that means regarding nutrition, exercise, social engagement, and medications.  Also, on April 13 and 14, ElderConsult will present Living In the Moment Dementia Conference 2018, in Campbell, featuring two half-days of experts in their fields discussing many issues common to dementia. Elizabeth will make the keynote presentation both days. Along with the conference will be a Resource Fair, with trusted companies and agencies providing information and services to attendees, including Alegre Home Care, Mission Hospice & Home Care, and Pathways Home Health. (from ElderConsult: Elizabeth Landsverk MD; from Alegre: Charles Symes; from Mission: Dwight Wilson - all Bay Area; from Pathways: Barbara Burgess, Silicon Valley)

GeBBS Healthcare Opens 2nd Delivery Center in Aurangabad, India

GeBBS Healthcare Solutions recently opened its latest global delivery center in Aurangabad, India, with the capacity to accommodate 1,200 employees and adding to GeBBS' scalability to onboard clients of any size and meet the BPO needs of its ever-expanding healthcare client base. The new facility also provides invaluable business continuity capabilities with GeBBS’ Mumbai and Manila locations. In all, GeBBS employs 5,000+ experienced revenue cycle management staff throughout the world, supporting hospitals and providers across the U.S. (Nitin Thakor, Los Angeles)

Gorman Health Group Examines Effects of Rising Healthcare Costs

In The Effects of Rising Healthcare Costs in the U.S., Dave Sayen, of Gorman Health Group, says that we in the U.S. don’t actually have a higher proportion of specialist care than our peer nations, don’t use more services like images or hospital care, and our social spending is not very different from that of our more socialist peers. But U.S. healthcare prices are running at 2% over inflation now. There is an opportunity for providers who can squeeze out that extra cost and purchasers who can build a better mousetrap, Dave suggests, noting that CMS will save $26 billion over 10 years thanks to competitive bidding for Durable Medical Equipment - the tip of an iceberg, he concludes. (Dave Sayen, Bay Area)

Kaiser Permanente Improves Heart/Stroke Risk Factors in Diabetics

Over a 10-year period, control of three key cardiovascular risk factors improved faster for Kaiser Permanente diabetes patients in Northern California than in the rest of the U.S., according to research published in the American Journal of Medicine. This study marks the first investigation to systematically assess the effects of "Preventing Heart Attacks and Strokes Everyday" (PHASE) program, launched in Northern California in 2004, on multiple risk factors. The study reviewed annual blood pressure, blood sugar, and blood lipid levels in approximately 100,000 PHASE patients with diabetes in Northern California, and compared them with data on commercial enrollees from the NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS). (Walt Meyers, Bay Area)

King & Spalding & Nelson Hardiman to Participate in Seminar

Upcoming webinars from King & Spalding (K&S) include Making the Most of Worksheet S-10: How Hospitals Can Fully Capture Their Uncompensated Care, on April 10, at 10 a.m., and at the 5th Annual K&S Cybersecurity & Privacy Summit, on May 1, from 9 a.m. to 3 p.m.  Meanwhile, Travis Jackson, of K&S, and Harry Nelson, of Nelson Hardiman, will both be speakers at the California Society for Health Care Attorneys Annual Meeting & Spring Seminar, on April 13 in Napa, CA. Travis will explore the impact of tax reform on California’s healthcare industry, and Harry will address the evolving challenges presented by the opioid crisis. (from K&S: Marcia Augsburger, Sacramento, & Travis Jackson, Los Angeles; from Nelson Hardiman: Harry Nelson, Los Angeles)

NorthBay Healthcare Heralds Opening of Ortho-Rehab Center

NorthBay Healthcare’s new Center for Orthopedics and Rehabilitation recently celebrated the opening of the 14,300-square-foot facility. The orthopedic side features a teamwork area for staff, 10 exam rooms, a procedure room, a casting room, and a paramedic bay. The physical and occupational health side includes six private treatment rooms, exercise equipment, five powered treatment tables, and an onsite X-ray room. (Elnora Cameron, Bay Area)

Oscar Health Raises $165M to Further Invest in Tech & Expansion

In a recent post, Oscar Health announced that its has closed a $165 million funding round, led by Brian Singerman and Founders Fund and including 8VC, Verily Life Sciences, Fidelity, General Catalyst, Capital G, Khosla Ventures, and Thrive Capital, among others. "After generating an underwriting profit in 2017 and enrolling nearly 250,000 members this year - projecting north of $1 billion in gross premium revenue - Oscar stands strong as the first technology-driven health insurer," Oscar says. "... Bolstered by new partnerships with industry leaders, such as Cleveland Clinic, Humana, and AXA, Oscar now has a proven, replicable growth playbook: secure competitive prices with new health systems, acquire and engage membership in significant volumes, build market share for our provider partners, and begin to drive health care costs down." Oscar plans to expand at a rate of 4-5 cities every year, in individual, small group, and other market segments. (John Puente, Sacramento)

Satellite Healthcare CEO Named Board Chair of Kidney Foundation

Rick Barnett, President & CEO of Satellite Healthcare, has been elected Chairman of the Board of the National Kidney Foundation, serving Northern California and the Pacific Northwest. As Chair, Rick's top priority is developing a three-year strategic plan that focuses on creating results in two life-saving areas: living kidney donation and diagnosing patients with kidney disease before their kidneys fail. (Rick Barnett, Silicon Valley)

SCU’s Dr. of Acupuncture/Chinese Medicine Program Accredited

Southern California University of Health Sciences (SCU) has announced its accreditation, through 2025, for its Doctor of Acupuncture and Chinese Medicine program by the Accreditation Commission for Acupuncture and Oriental Medicine, a specialized accreditation agency recognized by the U.S. Department of Education. Meanwhile, SCU was the first university to offer a First-Professional Doctorate of Acupuncture and Chinese Medicine (FPD) program, which graduated the first FPD in the U.S. (John Scaringe, Orange County)

Select Data Provides Check List to Assist in Proper Documentation

Select Data is providing a list designed to assist hospice agencies in preparing the proper documentation to support Medicare hospice services. The list provides a format to present the portrait of each patient and their specific needs. (Ed Buckley, Orange County, & Ted Schulte, Los Angeles)

Share Our Selves Ready for a Wild & Crazy Taco Night

On the evening of April 12, Share Our Selves (SOS) will present its 25th Annual Wild & Crazy Taco Night, in Costa Mesa. The fun and festive evening gathers a group of Orange County’s finest chefs and restaurants, each preparing an unusual and unique taco. All tacos are conceived exclusively for this event and can’t be found anywhere else. Event proceeds benefit the SOS Food Pantry, which feeds more than 235 OC families each day. (Karen McGlinn, Orange County)

Surgery One Examines How Bundled Payments Mesh with Big Tech

In Transparent Bundled Payments Mesh with Big Tech in Race for Healthcare Value and Cost Savings, Scott Leggett, CEO of Surgery One and Global One Ventures, extols the bundled payment approach, which consolidates fees for whole treatment regimens from start to finish, allowing an objective decision and a transparent financial transaction for the patient. "In the face of the sophisticated technology tidal wave engulfing healthcare, the simple technology of bundling healthcare services and fees stands as the surest way to reduce costs and deliver true value to the patients," Scott says. He also discusses how this relates to the recently unveiled partnership among Amazon, Berkshire Hathaway and JPMorgan Chase, as well as Apple's medical records initiative. (Scott Leggett, Orange County)

The Health Trust Awards Health Partnership Grants

The Health Trust Board of Trustees has approved six Health Partnership grants totaling $363,002 to support The Health Trust’s mission of building health equity in Silicon Valley. Specifically, the awarded grants will support community events that promote physical activity, increase food access for individuals living in affordable, supportive housing complexes and mobile home parks not currently accessing any food services, and increase the capacity of the only community partner delivering meals to shelters during the weekend. Recipients include: City of San Jose, Department of Parks, Recreation & Neighborhood Services; Community Seva; Happy Hollow Foundation; John Snow, Inc.; Second Harvest Food Bank; and Silicon Valley Leadership Group Foundation. (Todd Hansen, Silicon Valley)

Catasys Launches Enrollment of OnTrak-H in 16 States

Catasys, Inc. has launched enrollment of its OnTrak-H solution with a leading national health plan partner. Eligible Commercial members in 16 states will now be able to take advantage of this integrated 52-week program that identifies, engages, and treats members with untreated behavioral health conditions and high medical costs. As part of this deployment, Catasys will integrate new artificial intelligence capabilities to identify those who are suffering from substance use disorders even if they have not yet been diagnosed. These expanded machine learning/ AI capabilities are expected to meaningfully expand the number of eligible members. (Rick Anderson, West Los Angeles Technology)

State of California Files Antitrust Suit Against Sutter Health

Sutter is accused of preventing insurance companies from negotiating with the health system on anything but an all-or-nothing basis, which requires insurers to contract with the entire health system, and not just parts of it. The lawsuit also alleges the health system has prevented insurance companies from offering low-cost health plan options and set excessively high out-of-network rates. Additionally, the state has accused Sutter of restricting the publication of provider cost information for patients’ review. [CLICK FOR FULL ARTICLE: Sacramento Business Journal, 3/30/18]

UnitedHealth Seeks Damages from $1B+ Medicare Lawsuit

UnitedHealth Group is seeking damages from the federal government after the Justice Department tossed much of a lawsuit accusing the payer of using incorrect risk scores to inflate Medicare Advantage payments. [CLICK FOR FULL ARTICLE: Becker's Hospital Review, 3/27/18]

Health Care Mergers and Rising Prices Under Scrutiny in California

Hospital mergers - and the effect of those mergers on medical costs - have caught the eye of California elected officials, as a new report from the UC Berkeley Petris Center on Health Care Markets finds a rapid consolidation of health insurance and care providers in the state has raised prices, and decreased consumer options. [CLICK FOR FULL ARTICLE: Capital Public Radio, 3/26/18]

CMS Lowers Cost of Prescription Drugs for Medicare Beneficiaries

CMS has finalized polices for Medicare health and drug plans for 2019 that will save Medicare beneficiaries money on prescription drugs while offering additional plan choices. [CLICK FOR FULL ARTICLE: CMS.gov/Newsroom, 4/2/18]

Senate Probe Launched Over 1,400% Jump in Price of Lomustine

Three U.S. senators are seeking more information from a Florida company that has steadily increased the price of a 40-year-old cancer drug, lomustine, in recent years. [CLICK FOR FULL ARTICLE: Wall Street Journal, 4/2/18]

CDC: A Second Flu Outbreak May Be Here

While this season was mainly dominated by the H3N2 virus, an influenza A strain that is more severe and less receptive to vaccines than other types of the flu, influenza B has now overtaken influenza A. And that, says the CDC, could be setting the stage for a second wave of misery. [CLICK FOR FULL ARTICLE: The Mercury News, 3/28/18]

Trump Taps His Doctor to Replace Shulkin at VA

President Trump recently fired his embattled Veterans Affairs secretary and tapped as his replacement the president’s personal physician. [CLICK FOR FULL ARTICLE: The Washington Post, 3/29/18]

U.S. Can End AIDS Epidemic Within Seven Years: CDC Director

Dr. Robert Redfield, a former AIDS researcher who has spent decades treating people infected with HIV, said that health officials have all the tools they need to prevent its spread. [CLICK FOR FULL ARTICLE: Stats, 3/29/18]

Thousands Mistakenly Enrolled in State’s Medi-Cal Expansion: Feds

California signed up an estimated 450,000 people under Medicaid expansion who may not have been eligible for coverage, according to a report by the U.S. Health and Human Services’ chief watchdog. [CLICK FOR FULL ARTICLE: California Healthline, 3/26/18]

California Assembly Pitches Alternatives to Single-Payer Healthcare

California Assembly Speaker Anthony Rendon is refusing to advance this year a controversial single-payer health care bill that would dramatically reshape the state's health care financing and delivery system. Instead, he's orchestrating an alternative, narrower approach that seeks to achieve universal coverage and make Obamacare more affordable. [CLICK FOR FULL ARTICLE: Sacramento Bee, 3/26/18]

Hospitals Fear Competitive Threat From Potential Walmart+Humana

Early-stage deal talks between Walmart and Humana are deepening anxiety in the hospital sector, which already has been grappling with sluggish growth and competition from cheaper healthcare options. [CLICK FOR FULL ARTICLE: Wall Street Journal, 4/1/18]

Meanwhile, Other Plans Aren't Standing Still

The emergence of talks between Walmart and Humana creates pressure on the healthcare companies that haven’t yet made deals, amid the rapid-fire integration that is reshaping the business of managing health care. [CLICK FOR FULL ARTICLE: Wall Street Journal, 3/30/18]

Healthcare Costs 30% More in Northern Cal Than in Rest of State

People living in areas where there is greater consolidation among hospitals, physician groups and insurance companies pay more for health care, according to a new study. It found that prices for medical procedures are 20% to 30% higher in Northern California than in Southern California - even after adjusting for the Bay Area’s higher cost of living and wages. [CLICK FOR FULL ARTICLE: San Francisco Chronicle, 3/26/18]

Hospital Giants Halt Merger Talks: Ascension & Providence St. Jo

Two major hospital systems have halted talks about a possible merger, shelving for now the prospect of a combination that would have created the nation’s largest owner of hospitals, according to people familiar with the discussions. (CLICK FOR FULL ARTICLE: Wall Street Journal, 3/28/18)

GE Healthcare Sells HIT Lines to Veritas Capital for $1.05 Billion

GE Healthcare is selling a portion of its healthcare information technology lines to Veritas Capital, a private equity investment firm, in a deal valued at $1.05 billion. (CLICK FOR FULL ARTICLE: Health Data Management, 4/2/18)

City of Hope Proposing $200 Million Cancer Center in Irvine

City of Hope is planning to build a $200 million cancer center, which would anchor a future medical campus south of the Orange County Great Park in Irvine. The new outpatient center, equipped with “leading-edge technologies and dedicated oncology specialists,” would open on land donated by FivePoint. (CLICK FOR FULL ARTICLE: Orange County Register, 3/30/18)

Healthcare is Americans' Greatest Worry: Gallup Poll

Americans worry more about healthcare than any other issue, topping crime and violence, federal spending, and the availability of guns, according to a new survey. (CLICK FOR FULL ARTICLE: Becker's Hospital Review, 3/26/18)

Generic Drug Venture Could Have Third of Hospital Market

Seventy U.S. hospitals expressed interest in joining a nonprofit generic drug company venture formed by four health systems across the country and the U.S. Department of Veterans Affairs, according to Politico. (CLICK FOR FULL ARTICLE: Becker's Hospital Review, 3/20/18)

Aetna to Pass on Drug Rebates to Consumers

Aetna Inc. said it would pass on drugmaker rebates directly to consumers who take the medications, in the latest move by a health insurer amid pressure to reduce costs and improve transparency around pharmaceuticals. (CLICK FOR FULL ARTICLE: Wall Street Journal, 3/27/18)

US News' Community Health Honor Roll Includes Two in California

US News & World Report's project scores nearly 3,000 counties on approximately 80 indicators across 10 categories: population health, equity, education, economy, housing, food and nutrition, environment, public safety, community vitality and infrastructure. Researchers then identified the top 500 healthiest communities, which include California's Mono County (#11) and San Mateo County (#27). (CLICK FOR FULL ARTICLE: Becker's Hospital Review, 3/26/18)

Monarch: New Platform from Surgical Robot Pioneer Frederic Moll

Auris has revealed the Monarch Platform, which swaps the da Vinci’s surgical approach for something far less invasive. The system utilizes the common endoscopy procedure to insert a flexible robot into hard to reach places inside the human body. A doctor trained on the system uses a video game-style controller to navigate inside, with help from 3D models. (CLICK FOR FULL ARTICLE: TechCrunch, 3/24/18)

Self-care Apps are Booming

In the first quarter of 2018, the top 10 grossing self-care apps in the U.S. earned $15 million in combined iOS and Android revenue, and $27 million in worldwide revenue, according to Sensor Tower. (CLICK FOR FULL ARTICLE: TechCrunch, 4/2/18)

Opinion: DC Mandates EHRs but "Stands in Way of Innovation"

Physicians write in the Journal's "Opinion" section: EHRs were forced on the healthcare community by the 2009 stimulus, and Congress has allocated $37 billion so far to help providers upgrade from mostly paper files. Nearly a decade later, the promised efficiencies and savings haven’t materialized. (CLICK FOR FULL ARTICLE: Wall Street Journal, 3/20/18)

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