ABL Healthcare Member News & Industry Trendletter * October 6, 2020
See Mimi Grant's Blog Below for Free eBook Download

>>> Christina Khouie is Founder of Behavioral Health Solutions, which guides mental health and substance abuse treatment facilities to clinical and financial success. The Behavioral Health Solutions team includes licensed clinicians and revenue cycle experts who work collaboratively with clients ranging from start-ups to nationally recognized treatment facilities. The company strives to optimize its clients' businesses to achieve clinical excellence, generate payer reimbursements, and increase company revenue. A Licensed Marriage and Family Therapist by background, Christina founded Behavioral Health Solutions in 2016, after working for large national healthcare organizations. She began her career as a Clinical Therapist, in private practice. Referred by Dan Manson, President of Elevate Addiction Services, Christina has joined the ABL-Health LA Round Table.

    These upcoming ABL Round Tables will be held via ZOOM to ensure Social Distancing for our Members. See your Round Table invitation for participation instructions, and the ABL.org Members Only website for all the Healthcare Round Table invitation specifics.

  • 10/07 - ABL-Health OC Zoom Table
  • 10/13 - ABL-Health SV Zoom Table
  • 10/14 - ABL-Health SF Zoom Table
  • 10/15 - ABL-Health OAK Zoom Table
  • 10/16 - ABL-Health LA Zoom Table
  • Explore Membership in ABL's Executive Round Tables >>>
Click on Headlines to Read Articles

Navigating the Prevailing Winds of Change

                     Blog by Mimi Grant

Even though Dave Berkus has been an ABL Technology Member for nearly 32 years, he's well-known to many of ABL's Healthcare Members for his awe-inspiring financial accumen and success as a serial entreprenuer and investor in - and advisor to - over 200 startups. He's also an international speaker, author of several books, weekly blogs, and for over 40 years, he regularly flew his own plane to work! In Dave's book, Extending the Runway, he masterfully blends his "lessons learned" as an experienced pilot, executive, and investor, packing it with great advice for the leader of any kind of company, particularly those dependent on outside financing. And, fortunately for all our Members, Dave's making his book available to you, for free, here.

Meanwhile, our newest ABL Technology Member, Cynthia Nelson, President of NexGen Talent, recently shared with her fellow ABL-Tech Orange County Members the results of NexGen's "Return to Work" Survey, reflecting the C-level responses from 1100 startups to Fortune 10 companies, representing most industries (except education and government). What I found most intriguing about these "real time" survey replies (less than 5 weeks old) is the sea change they represent for California businesses - particularly, for the healthcare industry.

As Dave shares in the opening pages of Extending the Runway, "...part of this book is devoted to finding and then taking advantage of the 'prevailing winds' of change that provide business-killing challenges and industry-creating opportunities, sometimes simultaneously." One of the most important "shifting winds" is the significance of the "WFH" movement. Of the respondents to Cynthia's "Return to Work" survey, 91% plan to allow their employees to continue to work from home - and nearly two-thirds (62%) will allow their remote employees to move out of state. Hmmm, 62% of 91% equals 56%!

Little wonder that last month, Mark Perry tweeted that the cost to rent a U-Haul 26-foot truck one-way between San Francisco and Phoenix was $2500, 9.6 times the $261 rate from Phoenix to San Francisco; LA-PHX had an even higher cost ratio: 10.6 times PHX-LA. These aren't just coders moving away: they're potential patients! The big aha moment of COVID in the spring was the move from in-person to telehealth. NOW is the time to capture patient tele-loyalty, so should your patients move away, you can retain your tele-relationship with them - even across state lines.

And, while the majority (52%) of employers will decide when employees return to "in office work" after a vaccine is widely available, only 18% of these employers will require all employees to be vaccinated, once a vaccine is widely available. Even assuming that percentage of employees vaccinated will be much higher in "patient-facing" healthcare organizations, based on the current spike in COVID cases in many states, and reflecting that the "1918 Spanish flu" had four waves, not just two (the last cases were reported in April 1920), it's fair to assume that this pandemic will have a long tail.

Now is the time to plan "what if" scenarios - actions you and your executive team will take as your company faces various challenges or opportunities - for the year (or possibly two) ahead. And, the "100 Questions" to use during this virtual or "masked retreat" Planning Session are featured in the first chapter of Dave's book. Happy reading and planning!

Click on Headlines to Read Articles
Alvaka Networks Addresses Backup & Disaster Recovery Challenges + Ransomware-as-a-Service

In Top Backup and Disaster Recovery Challenges, Alvaka Networks President and CEO Oli Thordarson answers questions posed by technology writer John Edwards. Oli's thoughts and experiences are based on 35+ years working in the IT profession, and alongside other IT professionals, and provide valuable insight for backup and disaster recovery preparedness. And, in Dharma Ransomware-as-a-Service Places SMBs at Significant Risk, Alvaka describes the "fast food of cybercrime," Ransomware-as-a-Service and cybercriminal firm Dharma. (Oli Thordarson, OC)

Bayer Teams with Recursion to Strengthen Digital Drug Discovery & Advance Fibrotic Disease Therapies

Bayer and Recursion Pharmaceuticals, a digital biology company industrializing drug discovery, are collaborating to leverage Recursion's purpose-built artificial intelligence-guided drug discovery platform and Bayer's small molecule compound library and deep scientific expertise to discover and develop new treatments for fibrotic diseases of the lung, kidney, heart, and more. In addition, Leaps by Bayer, the impact investment arm of Bayer AG, is leading Recursion's Series D financing with an investment of $50 million. (Rama Penta, SV)

Biospectal Honored as a Top Remote Patient Monitoring Startup by High-Tech Connect

Biospectal was selected as runner-up, out of 160 contestants, as a top startup innovator in remote patient monitoring at High-Tech Connect's recent International E-Healthcare Applications Summit in Winterthur, Switzerland. Biospectal said this clearly shows that remote patient monitoring, such as its blood pressure solution, is no longer the future but a necessity in today's world, especially when Covid-19 demands a shift to clinical monitoring at the point of patient care. (Eliott Jones, SV)

CEI's Linda Trowbridge's Life Celebrated & Honored at Recent Virtual Memorial

Over 300 friends of Linda Trowbridge, CEO of Center for Elders' Independence (CEI), celebrated her life at a virtual Memorial Tribute on September 25. Several ABL Members attended the event, and speakers included Grace Li, CEO of On Lok, who praised Linda for her contributions to the PACE community, and Cindy Hatton, CEO of Hospice East Bay, spoke about the contributions Linda made to their Hospice as a Board Member. In addition to this impressive Legacy Tribute to Linda's accomplishments, CEI's Board announced their decision to rename the newly renovated Downtown Oakland Center, the "Linda Trowbridge Center." The event also raised over $15,000 for CEI.

CHEQS Partners with Healthy Business Group to Offer Telehealth Solutions

CHEQS has announced a new affiliation with Healthy Business Group, to serve benefit advisers, TPAs, and risk bearers, providing access to critically vetted telehealth solutions at national account pricing with simple member enrollment. (Dave Brown, OAK)

Choice in Aging's Video Series Discusses California's Master Plan for Aging

Choice in Aging recently hosted a four-part video series of "Dishing with Debbie" on the Mechanics of the Master Plan for Aging. Each episode is now available on-demand:
Part 1: Justice & Equity, with Kevin Prindiville, Executive Director of Justice in Aging.
Pt 2: Access, Inclusion & Busting Ableism, with Christina Mills, Executive Director of the California Foundation for Independent Living Centers.
Pt 3: Alzheimer's & Dementia, with Susan DeMarois, Director of Public Policy at the Alzheimer's Association.
Pt 4: Ageism, with Dr. Louise Aronson, Geriatrician, Author of New York Times Bestseller Elderhood, and Professor of Medicine at UCSF. (Debbie Toth, OAK)

Cigna Launches Evernorth to Accelerate Delivery of Innovative, Flexible Health Service Solutions

Cigna Corporation has announced the launch of Evernorth, a new brand for its growing, high-performing health services portfolio. Evernorth will accelerate delivery of innovative and flexible solutions to meet the diverse needs of health plans, employers, and government organizations. Also, Cigna is expanding its Medicare Advantage offerings during the 2021 annual election period, including a $0 premium plan in every market. Cigna is offering telehealth services to all MA customers and, for the first time, adding virtual physical therapy services to its MA plans. (Chris De Rosa, OC)

Covered California Hits Record Enrollment

Covered California has issued a report that details how it set a record for enrollment by meeting the needs of Californians and promoting enrollment in the face of pandemic and recession. The report shows that as of June 2020, 1.53 million people were actively enrolled in Covered California, which represents the highest figure since the marketplace first opened its doors in 2014. Other major findings of the report include: 57% who signed up during the COVID-19 special-enrollment period were previously enrolled in employer-sponsored insurance; and 21% report having been previously uninsured. (Kathy Keeshen, JD, SF)

Elemeno Health Chosen for World Economic Forum's "COVID Innovators"

The World Economic Forum's UpLink platform has announced its first cohort of COVID innovators - 15 solutions addressing the immediate and long-term challenges of the COVID crisis, and Elemeno Health is among them. UpLink is a digital platform for surfacing and scaling innovations that could solve some of the world's most pressing challenges. The Forum will work extensively with these innovators over the next months to scale their impact, promote their work on social media platforms, present them at events, and introduce them to experts and potential funders who can accelerate their ideas. Also, Elemeno Health was a Semifinalist in the recent UCSF Digital Health Awards in the "Best Company with UCSF DNA" category. The event garnered 750+ submissions in 15 categories. (Arup Roy-Burman, MD, OAK)

Elevate Addiction Services Named to "America's Best Addiction Treatment Centers"

Elevate Addiction Services was named among Newsweek's and Statista's recent listing of "America's Best Addiction Treatment Centers 2020." Facilities were evaluated on quality of service, reputation, and accreditation relative to in-state competition. Meanwhile, Elevate has debuted a new podcast, The Elevate Experience, featuring genuine conversations concerning addiction treatment, recovery, personal journeys of healing and self-betterment, and behind-the-scenes looks at how the Elevate program breaks the mold of traditional addiction treatment. (Dan Manson, SV)

Home Safety Services Collaborates on Fall Prevention Program

Home Safety Services is partnering with the Area 12 Agency on Aging and their "Dignity at Home Fall Prevention Program," an evidence-based program centered on helping seniors avoid falls and remain safely in their homes. The program focuses on education, community outreach, and injury prevention equipment and services. It partners with other community agencies to conduct in-home environmental assessments and fall-risk assessments. (Martin Simenc, SV)

Hospice East Bay Presents Virtual "Giving in the Garden"

Hospice East Bay recently held a virtual version of its Giving in the Garden, a gathering to celebrate and support the work of the hospice. A 24-minute video of the event can be viewed here, which includes remarks from CEO Cindy Hatton, demonstrations of music therapy and pet-pal therapy, suggestions for coping with bereavement during the pandemic, and an update on Bruns House inpatient hospice facility. (Cindy Hatton, OAK)

HumanGood Partners with One Day University to Provide Online Learning for Residents

HumanGood has partnered with One Day University to provide residents of HumanGood's 21 life plan communities and 95 affordable housing communities, as well as HumanGood staff members, with online access to live and pre-recorded talks presented by professors from top-tier schools. Topics include history, science, the arts, literature, politics, psychology, culture, and more. Residents will also have opportunities to participate in interactive small-group discussions with professors. (Tara McGuinness, OAK)

Inglewood Imaging Center Announces "Less Squeeze & More Accuracy" with Upgraded Mammogram Tech

Inglewood Imaging Center recently announced its technology investment and center modernization, which for mammograms includes: 3D Wide-Angle Tomosynthesis; artificial intelligence and computer-aided detection; potentially 40% less call-backs compared to conventional digital mammograms; and improved patient tracking and reporting software. In addition, IIC has further improved the mammogram experience with its "5-Senses Approach" that includes: "comfort compression" that's rated as 46% less squeeze; warm, inviting lighting colors; aromatherapy; soft, calming music; and a piece of chocolate upon exam completion. (Brad Schmidt, LA)

Kaiser Permanente Allows for External COVID-19 Testing & Becomes Carbon-Neutral

Kaiser Permanente (KP) recently reported that in addition to testing for COVID-19 at KP facilities, members have options for getting tested at an external, independent facility (ie, CVS, Walgreens, Walmart, other retail locations, or a private lab). If the member is charged, KP will provide reimbursement for the test cost if it's conducted by a licensed facility. Meanwhile, KP has become the first healthcare system in the U.S. to achieve carbon-neutral status - eliminating its 800,000-ton annual carbon footprint, the equivalent of taking 175,000 cars off the road. (Marcos Vasconcelos, OAK)

King & Spalding's Webinar to Cover CMS's Latest Rule Affecting Hospital Medicare Reimbursement

On October 13, King & Spalding (K&S) will present a webinar - What You Need to Know About CMS's Latest Rulemakings Affecting Hospital Medicare Reimbursement, Including IPPS, OPPS and the Part C Proposed Rule - from 10-11:15 a.m. Pacific.
Also, K&S has published FDA Proposes New Rule Modifying its "Intended Use" Regulations. Meanwhile, the LMG Life Sciences Awards named K&S its 2020 Government Investigations Firm of the Year. The Awards honor firms, individuals, and companies behind the most innovative and challenging life sciences work of the past year. (Marcia Augsburger, JD, SF; Travis Jackson, JD)

KMD Architects Designs Healthcare Facility for Lummi Nation

In Tribal Wellness Center: Lummi Nation's proactive response to COVID 19, KMD Architects shares how the Lummi Nation, in Washington state, took a proactive approach to the outbreak of COVID-19 in nearby Seattle, as the tribe was in the midst of designing a new Wellness Campus, including a KMD-designed 50,000-square-foot healthcare and dental facility. Among their responses to the virus outbreak, the tribe asked KMD to redesign portions of the new facility to include a flexible HVAC system, with a goal to create zones of negative air pressure, in which infectious patients could be treated, but staff and non-infectious patients are better protected. (Rob Matthew, SF)

LifeLong Medical Care's Mike Stacey Interviewed on KCBS Radio

Mike Stacey, MD, of LifeLong Medical Care, shared that he has recently been working with the Alameda County public health team as a Physician Consultant to help cover health officer duties. And Mike recently talked on KCBS radio's Ask an Expert about issues health departments are grappling with related to COVID-19, extreme heat, fires and smoke. Meanwhile, LifeLong will hold their Annual Charity Golf Tournament on October 26 at the Richmond Country Club. (Mike Stacey, MD, OAK)

LigoLab & TestDirectly Spotlighted in Industry Journal & Executive War College

MedicalLab Management magazine recently published Product Spotlight: TestDirectly from LigoLab, and LigoLab Information System published How Our Lab Partner Embraced Innovation and Won a Statewide Testing Contract, which details how, in May 2020, the Florida Department of Health partnered with Northwest Laboratory, LigoLab, and TestDirectly to screen the state's 500,000 long-term-care residents and employees for COVID-19. This partnership was also spotlighted at the recent Executive War College, where LigoLab CEO Suren Avunjian co-led a virtual Master Class, detailing lessons learned. (Suren Avunjian, LA)

Mazzetti's COVID Webinar Available On-Demand; HQ Re-Certified a Green Business

Mazzetti is making its recent webinar and its slides available on-demand: Not Another COVID-19 Webinar, featuring CEO Walt Vernon and other panelists discussing a spectrum of responses in hospitals across the country, how the virus has been a catalyst in the bigger risk mitigation and emergency preparedness conversation, and more. Meanwhile, for the tenth year, Mazzetti's San Francisco headquarters office was recently recertified as a San Francisco Green Business, now part of the broader California Green Business Network. The recertification process involved completion of an extensive checklist to improve office operations for sustainability, from minimizing waste to utilizing less toxic products to energy and water efficiency measures, in order to meet the program's high environmental standards. (Walt Vernon, JD, SF)

MedWand Among "4 Medical Devices That Are Changing the Game in 2020"

MedWand is spotlighted in a recent TenoBlog post - 4 Medical Devices That Are Changing the Game in 2020. An excerpt: "MedWand for Remote Exams - A medical device called MedWand has offered a potential solution for video visits. Following the doctor's instructions, the patient plugs the device into their computer and runs the wand over their body to get vital signs. This allows for a more comprehensive virtual exam." Meanwhile, MedWand has published a 2.5-minute video of its device in action. (Bob Rose, OC)

Mission Hospice to Present Virtual Fundraising Gala, October 10

On Saturday evening, October 10, Mission Hospice & Home Care will present a virtual Diamonds & Denim Fall Gala, a fundraiser which will feature patient stories, music, an auction, and more. (Dolores Gomez, SF)

Nelson Hardiman Provides Healthcare Reimbursement Info

Harry Nelson, Partner in Nelson Hardiman (NH), will participate in the virtual California Addiction Conference, on October 22-25, 2020. Meanwhile, recent videos from NH include: Accounting & Tax Implications of Healthcare Reimbursement and Behavioral Health Commercial Insurance Reimbursement. And, NH has published a Client Alert: What to Do If the FBI Comes Knocking. (Harry Nelson, JD, LA)

Savi Group Reports on How Big Data Can Revolutionize Healthcare

In How Big Data Can Revolutionize Healthcare Forever, Savi Group reports that there are mountains of data that healthcare organizations can use to improve their operations, provide better patient care, reduce errors, and more. However, sorting and analyzing all this information requires proper management and sophisticated technology. Savi discusses the opportunities and what systems are needed. And, in Why You Should Care About Improving Patient Experience, Savi reports that by integrating data and digital technologies into operations, medical practices can identify areas of improvement and boost the overall health of their organizations. (Sumit Mahendru, OC)

VivaLNK Launches Multi-Vital Monitoring Solution for Infectious Respiratory Diseases + Teams with Mazzetti

VivaLNK recently announced the availability of its new multi-vital ambulatory monitoring solution for Infectious Respiratory Diseases. Currently deployed in Asia, Eastern Europe, and the Middle East, it's now available in the Americas and Western Europe. The solution works by automatically and continuously collecting patient vitals, and wirelessly sending it to a secure on-premise server, accessible by caregivers. In remote patient monitoring or remote field hospital deployments, an optional patient app and mobile device, and a cloud-hosted application are available. Also, UC San Francisco will utilize VivaLNK's continuous wearable ECG sensor for a 3,000-subject multi-year study on atrial fibrillation. Spanning up to 10 years, the study aims to detect biomarkers of early atrial transformation in AF.

Meanwhile, VivaLNK has partnered with Mazzetti, a provider of healthcare building systems engineering solutions, to deploy rapid response patient monitoring solutions for COVID-19 in the U.S. Already, VivaLNK's reusable wearable medical sensors have been deployed in China at 15+ hospitals throughout the virus outbreak. "As the pandemic continues to be unpredictable, we're preparing for the need to set up rapid response situations for patient monitoring," said Walt Vernon, CEO of Mazzetti. "Deploying this technology ensures our local health system is prepared to handle the patient flow while maintaining superior care for those in need." (Jiang Li, Ph.D., SV, & Walt Vernon, JD, SF)

Wipfli Partners with Microsoft & Nonprofits to Accelerate World-Changing Goals

Wipfli reports that five years ago, the UN outlined 17 ways to make the world better and identified Sustainable Development Goals to address global challenges. Microsoft pledged its support and launched the #Buildfor2030 campaign in March to help accelerate change. The campaign highlights ways innovative technology can enable powerful outcomes and recognizes Microsoft partners, like Wipfli, who are building world-changing solutions. Wipfli, leveraging platforms such as Microsoft Dynamics 365, is helping Operation Smile, Doctors Without Borders, and many other nonprofits, meet their goals more effectively. Meanwhile, Wipfli is providing an on-demand webinar: Student loan forgiveness programs for medical professionals. (Jeff Johnson, OAK; Steve Rousso)

Eckert & Ziegler Receives Approval for Gallium-68 Generator for Canada

Eckert & Ziegler Radiopharma GmbH has received approval for its pharmaceutical 68Ge/68Ga generator GalliaPharm from the Canadian regulatory authority Health Canada. About the size of a thermos flask, the generator significantly reduces costs and increases flexibility in nuclear medical clinics and practices. GalliaPharm is already successfully used for the diagnosis of neuroendocrine tumors and prostate cancer. (Frank Yeager, ABL-Tech SGV)

Tanner Research CEO to Present Virtual Nutrition Science Workshops

On the evening of October 20 (click here), John Tanner, Ph.D., CEO of Tanner Research, will present free Nutrition Science Virtual Workshops, via Zoom, where he will share his story about how he suffered a near-fatal cardiac arrest in 2009. Since then, he has studied intensely the causes of heart disease, the leading killer in this country, and found that it can be completely avoided through a proper diet - and cancer, stroke, diabetes, high blood pressure, and about 30 other diseases can be reduced, avoided, or reversed by this same diet. John will relay to participants the scientific information they need to avoid heart disease and other leading killers. The group will discuss strategies for change and John will field questions. (John Tanner, Ph.D., ABL-Tech SGV)

Welcome New Member: Cynthia Nelson, Founder and President of NexGen Talent
& NexGen's "Return to Work" Survey Results from 1100 Companies

Cynthia's firm of high-quality retained executive search recruiters serves early-stage start-ups to Fortune 10 companies. Additionally, during COVID, Cynthia created the NexGen Talent Survey to which 1100 companies across most industries (excepting education and government), responded to 12 key questions regarding how they're planning for their companies' "Return to Work." The responses to the latest survey are included here. Questions asked include timing of Return to Work, vaccination requirements, and whether employees will be allowed to move out of state.

Each of NextGen's recruiters are functional experts with a minimum of 10 years' experience, who work in a team of four - Research, Recruiter, Scheduler, and Client Manager. Prior to founding NexGen Search, in 2007, Cynthia spent 11 years building the West Coast HR search practice for three national search firms, where she recruited effective teams across multiple industries, including life sciences, professional services, technology, financial services, manufacturing, consumer products, and not-for-profit. Cynthia has joined the ABL-Tech OC Round Table.

About Two-Thirds of the U.S. is Seeing an Uptick in COVID-19 Cases

Particularly states in the Midwest and Rocky Mountain area, according to data tracked by The Washington Post, are seeing more cases. Texas, California, and Wisconsin have reported the highest number of new infections in the last seven days, according to Oct. 2 CDC data cited by The Wall Street Journal. North and South Dakota have reported the most new cases per capita, followed by Wisconsin. Due to increasing cases, New York City may reverse its reopening in areas with positive test rates above 3 percent, Mayor Bill de Blasio said Oct. 4, pending state approval, according to Politico. Snapshot of COVID-19 in the U.S. - Cases: 7,418,836; Deaths: 209,734; Recovered: 2,911,699. Counts reflect data available as of 8:45 a.m. CDT Oct. 5, reported by Becker's.

HHS Announces $20 Billion Provider Relief Fund Phase 3 General Distribution

Last week, HHS announced $20 billion for a Provider Relief Fund Phase 3 General Distribution, to support providers who have been most significantly impacted by COVID-19, as measured by changes in their revenues and expenses from patient care. Importantly, providers that have already received relief payments will be invited to apply for additional funding that considers financial losses and changes in operating expenses caused by COVID-19. (Read Article: King & Spalding Health Headlines, 10/5/20)

EARLIER, HHS Announced $2 Billion Provider Relief Fund for SNFs that Keep COVID Infection & Mortality Low

On September 17, HHS announced details about its $2 billion Provider Relief Fund (PRF) performance-based incentive payment distribution program for nursing homes and skilled nursing facilities originally announced on September 3, 2020. The program will be divided into four performance periods (September, October, November, December), with $500 million available to nursing homes in each period. Using data from the CDC, HHS will distribute payments to facilities who have demonstrated an ability to keep COVID infection and mortality low among residents in their facilities. (Read Article: King & Spalding Health Headlines, 9/21/20)

UCSF Testing New COVID Treatment

UCSF researchers are testing a promising COVID-19 drug that could lessen symptoms and keep people out of the hospital. The drug, called a monoclonal antibody, could eventually work on coronavirus much the way Tamiflu reduces flu symptoms. It is being rolled out in a clinical trial at Zuckerberg San Francisco General Hospital, one of many U.S. sites that are enrolling volunteers for the study. (Read Article: San Francisco Chronicle, 10/2/20)

California Remains at Forefront of Health Policy Innovation

Gov. Gavin Newsom recently concluded the chaotic legislative year by signing dozens of healthcare laws requiring more comprehensive coverage of mental health and addiction, a raft of COVID-related bills, plus moving the state into the generic drug-making business. Most of these new laws will take effect on Jan. 1: Read Article: California Healthline, 10/1/20
More Specifics - Click on Each Headline:
- New Law defines "medical necessity" in effort to get private health plans to pay for more mental health and drug addiction treatments.
- Nurse Practitioners able to Open Practices in 2023 - after 3 year "transition period" under a doctor's supervision.
- California can make its own insulin and other generic and off-patent drugs.
- Existing program expansion to allow more low-income seniors & disabled to receive care in their home, rather than SNFs.

Large Employers Accelerating Adoption of Virtual Care, Mental Health Services for 2021: Survey Finds

Large employers plan to expand virtual care offered to employees next year as well as double down on mental health and emotional well-being as they continue to address the COVID-19 pandemic, according to an annual survey by Business Group on Health. Employers project health benefits costs will rise by more than 5% in 2021 although the pandemic's impact is fueling uncertainty about overall costs. (Read: Press Release, 8/18/20)

Sam's Club to Sell Subscription Telehealth Plan

Sam's Club, Walmart's retail warehouse buying club, is partnering with app-based telehealth vendor 98point6 to sell a subscription plan to Sam's Club customers following a successful yearlong pilot. The price tag for a quarterly subscription starts initially at $20 for the first three months. The subscription includes $1 virtual visits, along with the ability to text physicians, order prescriptions and labs from a smartphone. After the first three months, members would pay $33.50 every three months. (Read Article: Healthcare Dive, 9/22/20)

MEANWHILE, Walmart Health expects to open two more of its in-store healthcare clinics in the Chicago area this fall and seven more locations in Georgia by the end of the fiscal year. In all, Walmart Health officials expect to have at least 22 clinics with locations in Georgia, Florida, Arkansas, and Illinois by the end of 2021. (Read Article: Fierce Healthcare, 9/17/20)

CMS Releases 2019 Medicare Shared Savings Program ACO Program Results

CMS Administrator Seema Verma recently announced the 2019 financial and quality results for ACOs in the Medicare Shared Savings Program: The 541 ACOs in the program generated $1.19 billion in total net savings for Medicare in 2019 - the largest annual savings to date. These savings were largely driven by reductions in spending on post-acute care, hospitalizations, and emergency department visits. In addition to achieving savings, most eligible ACOs met quality benchmarks. (Read Article: King & Spalding Health Headlines, 9/21/20)

CMS Issues Roadmap for State Medicaid Value-Based Payment Models

On September 15, 2020, CMS issued guidance to State Medicaid Directors to advance value-based care with State Medicaid programs. The guidance encourages States to consider adopting value-based payment models, including advanced fee-for-service payments, bundled payments, and total cost of care models in their State Medicaid programs. The guidance does not announce any new funding models or opportunities for federal funding, but instead aims to inform State Medicaid programs of the options available to them for implementing more value-based payment models. CMS's Fact Sheet announcing the new guidance is available here, and a copy of the letter addressed to the State Medicaid Directors is available here. (Read Article: King & Spalding Health Headlines, 9/21/20)

CMS Releases Part I of the 2022 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part C and Part D Payment Policies

On September 14, 2020, CMS published its 2022 Advance Notice containing information about proposed payment changes for Medicare Advantage and Medicare Part D payment methodologies. For Contract Year 2022, CMS's notice proposes to fully phase in the Hierarchical Condition Categories (HCC) model first implemented for Contract Year 2020 as required by the 21st Century Cures Act. This represents a change from the 2021 payment model, which used a risk score calculated by weighting the 2020 HCC model as 75%, and the 2017 HCC model as 25% of the total score. With this change, the risk score used for payment in 2022 would rely entirely on encounter data rather than relying in part on diagnoses submitted into CMS's Risk Adjustment Processing System by Medicare Advantage Organizations. CMS's press release announcing publication of the notice is available here. A Fact Sheet can be found here, and the complete text of Part I of the 2022 Advance Notice is available here. (Read Article: King & Spalding Health Headlines, 9/21/20)

Finalized HHS Payment System Encourages At-Home Kidney Care

On September 18, 2020, CMS announced that it has finalized the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model and the Radiation Oncology Model. The ETC Model adjusts payment on certain Medicare claims for selected ESRD facilities and clinicians. Participation for selected facilities and clinicians is mandatory, and the selection will be conducted according to location in randomly selected geographic areas so as to account for approximately 30% of adult ESRD beneficiaries in all 50 states and the District of Columbia so that CMS can evaluate the ETC Model. The ETC Model adjusts payments in two ways: (1) by increasing payments for home dialysis and home dialysis services in order to incentivize investment in home dialysis; and (2) by either increasing or decreasing payment to both home or in-center dialysis claims based on the participant's home dialysis rate, transplant waitlist rate, and living donor transplant rate. The CMS announcement about the ETC Model is available here, and CMS's Fact Sheet on the new ETC Model is available here. (Read Article: King & Spalding Health Headlines, 9/21/20)
MEANWHILE, HHS/HRSA Also Finalized the Rule Allowing Living Organ Donors to Recoup More Expenses for lost wages, child-care and elder-care expenses. The final rule is available here. (Read Article: King & Spalding Health Headlines, 9/21/20)

Illumina Buying Cancer-Screening Spinout Grail in Blockbuster $8 Billion Biotech Deal

Biotech has become one of the hottest areas of venture investment in recent years, as progress in machine learning, genetics, medical devices and biology fuse together into new products for the gargantuan health industry. Case in point: Grail, which began in 2016 as a spinoff from genetic sequencing giant Illumina and co-founded by longtime Google executive Jeff Huber (who was involved in the creation of the company's experimental laboratory Google[x]), is now being spun back in to the tune of an $8 billion acquisition. (Read Article: TechCrunch, 9/21/20)

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