ABL Healthcare Member News & Industry Trendletter * June 1, 2023

>>> Linda Igarashi is a Partner in the Corporate Practice Group in Sheppard Mullin's Orange County office and is a member of the firm's Healthcare, Private Equity, and Latin America teams. Linda represents public and private companies, private equity firms, strategic investors and financial institutions. Her practice encompasses mergers and acquisitions, joint ventures, private equity investments, debt and equity financing, business formation and structuring, and general corporate governance matters. She is a tireless advocate and trustworthy advisor in complex M&A transactions. She also represents clients in cross-border transactions, particularly in Mexico, as she speaks Spanish fluently. Prior to her legal career, Linda worked as a financial analyst with the Federal Reserve Bank and as a risk management consultant with Deloitte. Linda co-leads Sheppard Mullin's Orange County Diversity and Inclusion Working Group. She earned a BS in Business Administration and a BA in Economics, both from UC Berkeley, as well as an MPA, International Development from Harvard Kennedy School, and a JD from UCLA School of Law. Linda represents Sheppard Mullin as a Sponsoring Member of ABL's Orange County Healthcare Round Table.

  • 6/07 - Orange County ZOOM Table - "The Hospital @ Home: An Opportunity or Threat?" - Featuring Roger Massengale, CEO of Eitan Medical, NA, and Chief Commercial Officer of Eitan Medical

  • 6/13 - Silicon Valley ZOOM Table - "Lessons from Onboarding New Team Members to Minimize Fatal Errors" - Featuring Arup Roy-Burman, MD, CEO of Elemeno Health

  • 6/15 - Bay Area ZOOM Table - "True Grit: What It Takes to Rebuild America's Rural Hospitals" - Featuring Nick Smith, Principal, and Sydney Diekmann, Sr. Consultant, Wipfli Healthcare Practice (Minneapolis)

  • 6/16 - Los Angeles ZOOM Table - "Anthem, Elevance Health & More: What's in a Name?" - Featuring David Pryor, MD, Regional VP, Medical Director, Anthem, Inc.

  • Explore Membership in ABL's Executive Round Tables >>>
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ICYMI: The Video Recording of ABL's Recent Round Table Presentation - "Cybercrime. How Not to Be Next" - Is Now Available on the Password-Protected "MEMBERS ONLY" Section of the ABL Website, Under "Presentations"

To help us Understand the Threat Ransomware Poses to Your Healthcare Organization - and How to Mitigate It, Oli Thordarson, Founder & CEO of Alvaka, shared an eye-opening presentation on all things ransomware related, including types of extortion, and shared real-world examples of recent attacks (with names you'll recognize). He also presented valuable Strategies for Ransomware Prevention and Mitigation, including Cyber Breach Policies - and their Loopholes.Oli also left us with Key Questions to Ask Your IT Team regarding your organization's level of cybersecurity.

Addiction Research Institute (Gene Barduson) Launches Podcast

Addiction Research Institute has announced the launch of its new podcast, "Addiction Research Institute: Is There a Cure?" The 25-minute episode explores the latest research on addiction and discusses whether there is a cure for this complex and devastating disease. Guests include leading experts in the field, as well as people who have personally struggled with addiction. Listen on Apple or Spotify. (OC)

Angle Health (Andy Leeka) Partners with Ideon to Power Seamless Benefits Enrollment & Management

Angle Health announced a new partnership with Ideon, the API platform powering digital experiences in health insurance and benefits. Most brokers, employers, and members now enroll and manage benefits via third-party HR and benefits software. Leveraging Ideon's API, Angle can quickly and easily connect and exchange enrollment data with these platforms. (LA)

Biospectal (Eliott Jones) Featured in International Video & at Harvard University

Biospectal's OptiBP is featured in a recent video, published by NGO Summit Institute for Development, that spotlights its integration into the OpenSRP solution and the Bunda app, to measure and manage hypertension in pregnant women. ALSO, following Biospectal's recent presentation to Harvard School of Engineering and Applied Science students, A blood pressure monitor in your pocket was published about the device. (SV)

Choice in Aging CEO Debbie Toth Honored for Distinguished Advocacy

Debbie Toth, CEO of Choice in Aging (CiA), recently received the Paul Nathanson Distinguished Advocate Award from Justice in Aging, a national non-profit legal advocacy organization that fights senior poverty through law. PLUS, the Rotary Club of Rossmoor recently gave CiA a $10,000 donation for its Alzheimer's Day Care Resource Center.
ALSO, Debbie asks fellow ABL Members to THANK - via call, email, text, or tweet - your legislators for prioritizing older adults and people with disabilities and asking them to stand firm through negotiations so they invest $50 million to support older adult behavioral health and extend the timeline for some programs in the Home and Community-Based Services (HCBS) Spending Plan to September 2024. Don't know who your legislators are? Click here: https://findyourrep.legislature.ca.gov MEANWHILE, click here for recent episodes of CiA's "Dishing with Debbie" video series. (Bay Area)

Donor Network West CEO Janice Whaley Featured at Fortune Brainstorm Health & in Article

Janice Whaley, CEO of Donor Network West (DNW), is featured in a Fortune article - 3 factors driving health care inequality - and ideas for how we can solve it, which interviewed participants in the recent Fortune Brainstorm Health Conference. Janice remarked that it was an honor to share the work that DNW is doing to increase organ donation rates amongst people of color. "Our organizations must represent the communities that we serve to foster trust and engage families in end-of-life conversations. Likewise, studies have shown that a lack of diversity in the healthcare workforce can have a detrimental effect on patient outcomes, access to care, trust, and employee retention," she shared. (Bay Area)

Eitan Medical (Roger Massengale) Increases Semi-Automated Production Capacity & Achieves Updated Certification

Eitan Medical announced that less than a year after building its first semi-automated line, the company recently installed in its clean rooms a second semi-automated line for its Sorrel devices. With advanced manufacturing and testing technologies, this new line will allow Eitan to increase its devices' reliability and collect extensive data on the manufacturing processes. Eitan now has even greater capacity to support pharma partners and provide simplified and efficient drug administration for patients. AND, Eitan announced that its Sapphire Infusion Pump now has an updated MDR certificate supporting perineural infusions in Europe, in addition to previously cleared routes, better positioning it to support acute pain management. (OC)

El Camino Health (Cecile Currier) Hospitals Earn 'A' in Leapfrog Hospital Safety Grades for Spring 2023

For the second consecutive cycle, El Camino Health's Mountain View and Los Gatos campuses both earned an 'A' in the spring 2023 Leapfrog Hospital Safety Grade program, making it one of the only health systems in the South Bay to have two hospitals that received the top grade. Leapfrog's grades are based on 30+ national performance measures reflecting errors, accidents, injuries and infections, as well as the systems hospitals have in place to prevent harm. (SV)

FOMAT Medical Research (Nick Focil) Celebrating 10 Years of Achievements

Marking its 10th anniversary, FOMAT Medical Research has published a 2:45-minute video that reflects on a decade of milestones and successes. Its journey showcases the power of "Innovating Healthcare Through Diversity." CEO Nick Focil remarked, "One of the best feelings is to see something you worked on being used on patients. Great feeling that is shared amongst our industry. Here is to 10 more!!" (LA)

Illumination Foundation Names Pooja Bhalla, DNP, as CEO + Raises $, Wins Award

Illumination Foundation (IF) recently announced that Pooja Bhalla is now CEO, promoted from her recent role as Co-CEO. AND, IF and 24 aligned nonprofits recently partnered with the Orange County Community Foundation to raise over $2.2 million to support efforts combating homelessness and its devastating impact on The OC community. MEANWHILE, IF was honored with the Chick-fil-A 2023 True Inspiration Award in the Care for Communities Category. PLUS, read Pooja's recent blog: Addressing Adverse Childhood Experiences in Families Experiencing Homelessness. (OC)

The Innovation Institute Appoints Mike McKinnon as President and CEO

The Innovation Institute has named Mike McKinnon as its new President and CEO, to which he brings a wealth of knowledge and expertise, particularly after serving as the Institute's General Counsel for the past ten years, during which it grew to $230 million in revenues. The Institute is an independent, for-profit LLC owned by non-profit health systems for cultivating innovative solutions to transform healthcare delivery. Most recently, Mike was a Partner at Sheppard Mullin, where he focused on M&A transaction for healthcare and life sciences companies. Among the clients he assisted were home infusion and diagnostic imaging providers, medical groups, physician practices, surgery centers, PPO networks, diabetic supply businesses, clinical trial companies, and urgent care centers. (OC)

Kaiser Permanente's (Marcos Vasconcelos) Risant Health Captures National Attention

Kaiser Permanente (KP) shares that Kaiser Foundation Hospitals' announcement of the creation of Risant Health and its pending acquisition of Geisinger Health has captured the attention and interest of healthcare leaders and major news media across the nation, since the announcement was made on April 26. 2023. For example, Becker's Hospital Review published We never saw Risant Health coming': What leaders are saying about the Kaiser-Geisinger deal.
MEANWHILE, for the sixth year in a row, KP was named to the DiversityInc Top 50 Hall of Fame, an award which recognizes that diversity and inclusion remain at the core of KP's mission. (Bay Area)

Life Adjustment Team (Cynthia Sampson) Discusses Coordinating Care for Patients with Mental Health Issues

In The Role of Healthcare Providers in Coordinating Care for Patients with Mental Health Issues, Life Adjustment Team says that mental health problems are common, and thankfully, can usually be successfully treated if identified early enough. However, coordinating care for patients with mental health issues can be challenging due to the complex nature of their conditions. This article discusses the best practices involved in coordinating care for these patients. (LA)

LigoLab (Suren Avunjian) Explores Technologies of the Future Lab + Shares Success Story

LigoLab CEO Suren Avunjian recently moderated a webinar with industry leaders to explore the current state of lab technology and its potential impact on the future of laboratory science. Watch a recording of the webinar here, and read a recap of the session here.
ALSO, read LigoLab's recent articles - ECPC's Success Story: Tripling Productivity & Boosting Net Collections by 35% with LigoLab Informatics Platform and How to Turn an Economic Downturn into an Opportunity for Your Clinical and Pathology Laboratory. (LA)

MedWand CEO Bob Rose Co-Leads Panel on Connecting Devices with Services

At the recent Connected Health Summit, Bob Rose, CEO of MedWand, joined several other healthcare executives to present a panel entitled "Connecting Devices with Services," which addressed the role of connected health and medical-grade devices along with the services that enable data sharing and integration with care providers. Some industry insights from the panelists are here, including this from Bob: "I used to be a pilot, and while flying I would use the autopilot tool (which is essentially AI), but there was still the need of placing my professional hands-on expertise - same in healthcare, the human touch is essential, so in this space, we need to look at AI as an Anomaly Indication tool." (OC)

Mission Hospice (Dolores Miller) to Present Drumming Circle for Grief Workshop

Mission Hospice & Home Care will present a free outdoor Drumming Circle for Grief workshop on June 10, 2:30-4 pm PDT. According to Mission, a drumming circle invites us to find wholeness in our grief journey through a creative, musical experience. Grief lives in the body and drumming can release stress, offering a healing outlet for grief. No experience is necessary, and drums will be provided. Registration in advance is required. (SV)

Nelson Hardiman (Harry Nelson, JD) Contemplates Future of Healthcare Privacy, Telehealth & More

Nelson Hardiman (NH) continues its presentation of its multi-part webinar series analyzing the history, progression, and future of healthcare privacy. Upcoming episodes include: A New Sheriff in Town: The Groundbreaking Emergence of the FTC in Privacy Enforcement (June 13); California Calling: How States are Closing the Federal Gap in Consumer Healthcare Privacy (July 18); and The Future of Healthcare Privacy: Projecting What's Ahead and Planning Next Steps (August 15). All one-hour sessions will begin at noon. ALSO, read NH's recent articles - Is Private Equity in Healthcare on Trial? Confusion over the Corporate Practice of Medicine and Telehealth Gets 11th Hour Federal Reprieve as the Public Health Emergency Ends May 11, 2023. (LA)

PreludeDx (Dan Forche) Announces DCISionRT Validated to Have ≥ 95% Sensitivity, Specificity & Accuracy/ Reproducibility

Prelude Corporation (PreludeDx) announced that a recent paper was published in Frontiers in Oncology, presenting the results from analytical validation and summarizes the clinical validation for the company's DCISionRT test. The analytical validation demonstrated that the DCISionRT assay has high sensitivity, specificity, and accuracy/reproducibility of ≥95%. These findings validate the continued increase in clinical adoption of the DCISionRT test to guide shared decision making for patients with ductal carcinoma in situ, often referred to as Stage 0 breast cancer. (OC)

Providence Digital Innovation Group (Marcee Chmait) Hails the Power of Digital to Fuel Evidence-Based Care

Providence DIG has published an article - The Power of Digital in Proactively Fueling Evidence-Based Care Journeys, which makes the case that digital has the power to fight inertia. Digital offers the opportunity to deliver the necessary personalized recommendations at scale, in ways that are meaningful for people and helpful in aligning limited resources. (LA)

Onward (Steve Grau) Chosen for AgeTech Collaborative Accelerator Program

Onward announced that it's part of the AgeTech Collaborative Accelerator program from AARP Spring 2023 Cohort. Over the course of eight weeks, Onward is working with mentors and AARP community leaders to elevate Companion Rides, Onward's signature Door-Through-Door transportation solution, as they chase their mission of eradicating transportation as a Social Determinant of Health. (SV)

Select Data (Ed Buckley) Discusses Using AI to Streamline Patient Referral Intake

In Using AI to streamline patient referral intake, Select Data describes how AI-powered systems rapidly analyze referral medical records and identify information like patient history, symptoms, diagnoses, medications and social determinants of health. (OC)

Wipfli (Jeff Johnson, Steve Rousso & John Dao) Examines Rural Health, Revenue Cycle Management, & EHR Implementation

Upcoming and recent healthcare-relevant resources from Wipfli include:
>> On-Demand Webinar with Jeff Johnson: Keeping up with changes in rural health.
>> Upcoming Live Webinar: Capital planning strategies for rural health, on June 20.
>> Article: How to harness data to revolutionize RCM.
>> Article: Choosing a project manager for EHR implementation. (Bay Area)

Zymo Research (Yap Ching Chew) Unveils New Full-length 16S Sequencing Service

Zymo Research has officially launched its full-length 16S Sequencing Service, offering researchers high-quality, full-length 16S rRNA gene sequencing for microbiome analysis. The new service combines PacBio's HiFi sequencing and a bias-free and carefully controlled sample processing to help researchers achieve unrivaled species-level taxonomic resolution. (OC)

Eckert & Ziegler Appoints Frank Yeager to Executive Board & Receives Manufacturing Authorization for GMP-grade Lutetium-177

Frank Yeager, who is responsible for Eckert & Ziegler Isotope Products, was recently appointed to the Executive Board of Eckert & Ziegler AG (EZ). [An impressive accomplishment for a non-German!] ALSO, EZ Radiopharma GmbH has received the manufacturing authorization for Lutetium-177 in GMP grade from the German authority. The approval is the basis for the marketing authorization of Lutetium-177 as a drug, AND for use of this radioisotope as a starting material for the manufacture of radiopharmaceuticals, enabling EZ to further its successful strategy as one of the world's leading isotope suppliers. (SGV)

GIDEON Informatics (Uri Blackman) on: Economic Impacts of Disease Outbreaks

Curious about the connection between infectious diseases and economics? Prof. Rodolphe Desbordes from SKEMA Business School used GIDEON as a data source for his paper exploring the economic impacts of disease outbreaks - Read this case study to learn more. PLUS, read GIDEON's recent posts: Types of Infectious Disease Tests: An Overview and Infectious Diseases Conspiracy Theories: How to Fight Them? (WLA)

ChatGPT, Bard, Bing AI: Which Gives the Best Health Advice?

Healthcare providers say ChatGPT gives better health advice than other generative artificial intelligence platforms, according to a report from health IT company Tebra. Here is which platform each of the 500 providers surveyed said gave the "best advice": 1. ChatGPT: 44%; 2. Google Bard: 42%; 3. Microsoft Bing AI: 14%.
"After examining the medical guidance provided by ChatGPT, 46% of healthcare providers reported feeling more optimistic about the use of AI in healthcare," the report found. "This represents a significant shift in perspective, with 95% of those surveyed indicating a more positive attitude towards AI technology in healthcare." (https://www.beckershospitalreview.com/disruptors/chatgpt-bard-bing-ai-which-gives-the-best-health-advice.html)

AI Helps Researchers Find New Antibiotic to Fight Deadly Superbug

Scientists have found a drug that could combat drug-resistant infections - and they did it using artificial intelligence. Using a machine-learning algorithm, researchers at the Massachusetts Institute of Technology and Canada's McMaster University identified a new antibiotic that can kill a species of bacteria, Acinetobacter baumannii, which is often found in hospitals and can lead to pneumonia, meningitis and other serious infections. (https://www.usatoday.com/story/news/health/2023/05/27/scientists-use-ai-to-discover-antibiotic-to-fight-deadly-hospital-bug/70262067007/)

Google "Supercharging" Search with Generative AI

Google has been hinting at big changes to its search engine since April to rival Microsoft-backed ChatGPT. At an investor meeting May 10, the company unveiled the Search Generative Experience. Google's search engine now has conversational features, according to The Wall Street Journal. The Search Generative Experience integrates artificial intelligence to provide responses for a range of queries, welcomes follow-up questions and includes a new interface. Google's signature list of relevant websites and article links to queries may soon be obsolete, in favor of mixed media posts and videos. Google aims to make query responses "visual, snackable, personal, and human," according to the Journal. (https://www.beckershospitalreview.com/digital-marketing/google-supercharging-search-with-generative-ai.html)

MEANWHILE, Google is Using Generative AI to Synthesize Medical Imaging Data by adding capabilities to its generative AI model, Med-PaLM 2, in which it can synthesize information from medical imaging. Med-PaLM 2 will take data from X-rays and mammograms to see if it can help communicate with clinicians about data routinely used in patient care, according to a May 10 YouTube video from Google. The news comes shortly after the company touted the AI model as an "expert" at answering medical exam questions. Med-PaLM 2 was found to have 85% accuracy when it comes to answering medical licensing exam questions. The generative AI model is not yet publicly available. (https://www.beckershospitalreview.com/disruptors/how-google-is-using-generative-ai-to-synthesize-medical-imaging-data.html)

Generative AI Could Augment 40% of Healthcare Working Hours

A new report on generative artificial intelligence from research and consulting firm Accenture shows how advances in large language AI models - the technology that powers applications like ChatGPT - can transform the future of healthcare. According to the report, the positive impact of generative AI on human creativity and productivity will be massive:
>> 98% of healthcare providers and 89% of healthcare payer executives agree that advancements in generative AI are ushering in a new era of enterprise intelligence.
>> 40% of all working hours in healthcare could be supported or augmented by language-based AI.
>> Half of healthcare organizations plan to use ChatGPT for learning purposes, and more than half are planning pilot cases this year. (https://www.healthcareitnews.com/news/generative-ai-could-augment-40-healthcare-working-hours)

Hippocratic AI Launches with $50M to Build Large Language Model for Healthcare

Hippocratic AI, a generative AI company developing safety-focused large language models for healthcare, launched with $50 million in seed funding, co-led by General Catalyst and Andreessen Horowitz. Hippocratic AI is initially concentrating on non-diagnostic, patient-facing applications. The company is focusing on ensuring proper bedside manner for patient well-being and reinforcement learning from human feedback through a panel of healthcare professionals. The company said the aim is to reduce healthcare costs, expand access to care and increase the supply and availability of healthcare workers. (https://www.mobihealthnews.com/news/hippocratic-ai-launches-50m-build-large-language-model-healthcare)

Top 5 Medical Services Americans are Skipping

Financial uncertainty and the high cost of medical expenses have caused many people to forgo medical treatment, a Federal Reserve report released in May found. The report found 23% of adults had major, unexpected medical expenses, with the median amount between $1,000 and $1,999, and 16% of adults had debt from medical care for themselves or a family member, though not necessarily accrued in the past year. In 2022, 28% of adults went without some form of medical care because they could not afford it. The following were the top five medical services Americans did not undergo due to cost (Survey participants could vote for more than one option): 1) Dental care: 21%. 2) Physician or specialist visit: 16%. 3) Prescription medication: 10%. 4) Follow-up care: 10%. 5) Mental healthcare: 10%. (https://www.beckershospitalreview.com/hospital-physician-relationships/the-top-5-medical-services-americans-are-skipping.html)

The Healthcare Plan Most People Should Buy - and Why They Don't

Every fall, during open-enrollment period, over 100 million families can choose a health plan. Anyone who receives health insurance through their employer, Medicare, Veterans Affairs, the exchanges, is invited to participate in this national ritual. In the end, for most people (who have no chronic conditions and don't anticipate needing an expensive medical procedure), one simple type of plan makes the most sense. So, most insureds should: 1) Choose a plan instead of succumbing to inertia. 2) Realize that for most people "the best choice is a high-deductible health plan (HDHP) paired with a health savings account (HSA)." (https://www.wsj.com/articles/health-insurance-deductible-hsa-9a8a8b98?mod=hp_trending_now_article_pos5)

Eli Lilly Results Signal Arrival of Blockbuster New Drug Class

Eli Lilly's announcement that its experimental drug, Donanemab, slowed declines in Alzheimer's patients' ability to perform daily tasks means there could soon be two drugs available on the market for people with early stages of the debilitating disease. That is great news for patients after billions of dollars and years of studies failed to produce a single treatment that could slow the disease's progression. The results are good for not only Eli Lilly but also Biogen, whose new drug Leqembi has an accelerated approval from the FDA. [Of course, getting CMS and health plans to pay for them may be challenging.] (https://www.wsj.com/articles/eli-lillys-results-signal-arrival-of-blockbuster-new-drug-class-bf7802cd?mod=hp_lista_pos3)
ALSO, read "Eli Lilly Drug Slows Alzheimer's in Large Study": https://www.wsj.com/articles/experimental-drug-slows-alzheimers-in-large-study-eli-lilly-says-192425a7?mod=hp_lista_pos2

Medicare Payers Vow to Keep Covering Remote Patient Monitoring

Private insurance companies that contract for Medicare will continue to pay for remote patient monitoring, Politico recently reported. The Medicare Administrative Contractors [MACs], which serve fee-for-service patients across most of the country, decided to keep reimbursing for devices that monitor patient vital signs from home, according to an email obtained by the news outlet. Politico called it a "significant win for the telehealth industry." Groups such as the American Medical Association, the Alliance for Connected Care and the Connected Health Initiative had advocated for the coverage continuation. (https://www.beckershospitalreview.com/telehealth/medicare-payers-vow-to-keep-covering-remote-patient-monitoring.html)

Oscar Health Will Exit from California

Oscar Health will exit the Covered California marketplace at the end of this year after failing to meet performance metrics in the state, executives announced during a recent first-quarter earnings call. The insurer plans to exit the state - where it said it had expected to have 35,000 members at the end of this year - after consistently recording medical loss ratios over 100%, executives said. Newly appointed CEO Mark Bertolini said on the call that Oscar would "pause" implementation in California with the intention of reentering the state in the future after reshaping its product offerings and strategy. (https://www.healthcaredive.com/news/oscar-health-exit-california/649949/)

Providence Cuts Operational Losses in Bid to Return to Profitability

Providence may be on its way to being in the black following a difficult 2022, according to recently reported financial results. Providence, which operates 51 hospitals and 1,000+ clinics in seven states, cited inflation, labor shortages, delayed reimbursements and supply chain disruptions as reasons for its quarterly losses. The health system is addressing patient discharge issues affected by post-acute care staff shortages and is working to increase surgical capacity, the company said. Providence has also renegotiated some payment rates with health insurance companies. Last year, Providence announced plans to reduce its seven operational divisions to three, cutting executive leadership roles and reducing shared services. (https://www.modernhealthcare.com/finance/providence-revenue-operational-losses-hoag)

DEA Officially Extends Electronic Prescribing of Controlled Substances for 6 Months

The U.S. Drug Enforcement Agency and HHS recently said it would temporarily extend telemedicine flexibilities for the prescription of certain controlled medications granted under the COVID-19 Public Health Emergency, which expired on May 11. Subsequently, the DEA allowed an extension of six months, through Nov. 11, 2023, and, in tandem with HHS' Substance Abuse and Mental Health Services Administration, promising a grace period for virtual prescribing of certain controlled medications to last at least until November 2024. (https://www.healthcareitnews.com/news/dea-officially-extends-remote-epcs-flexibilities-6-months) ALSO, Read Telehealth Gets 11th Hour Federal Reprieve as the Public Health Emergency Ends May 11, 2023, from Nelson Hardiman.

Administration Announces Proposal to Advance Prescription Drug Transparency in Medicaid

HHS, through CMS, is proposing steps to further drive down prescription drug costs in Medicaid and build on President Biden's executive order to lower Americans' prescription drug costs. Under CMS' latest proposal, Medicaid would have increased access to the drugs actual costs and be able to hold drug manufacturers accountable for what Medicaid programs pay for drugs. ABL's NOTE: Lack of transparency has raised concerns about PBMs using spread pricing arrangements to increase their profit margins by charging an MCO more for a drug than the amount a PBM pays a pharmacy. To address this issue, CMS is proposing that contracts between states, Medicaid-managed care plans, and third-party contractors, such as PBMs, reflect transparent reporting of drug payment information among third-party contractors. This proposal will help ensure that taxpayer dollars are actually going to pay for drugs and not increased profits. (https://www.hhs.gov/about/news/2023/05/23/biden-harris-administration-announces-proposal-advance-prescription-drug-transparency-medicaid.html)

HHS Details $5 Billion 'Project NextGen' Initiative to Stay Ahead of COVID-19

An initial investment of $5 billion, collectively referred to as Project NextGen, will accelerate and streamline the rapid development of the next generation of vaccines and treatments through public-private collaborations. Based at HHS and led by the Administration for Strategic Preparedness and Response Biomedical Advanced Research and Development Authority and the NIH's National Institute of Allergy and Infectious Diseases, Project NextGen will coordinate across the federal government and the private sector to advance the pipeline of new, innovative vaccines and therapeutics into clinical trials and potential review by the FDA for authorization or approval, and commercial availability for the American people. (https://www.hhs.gov/about/news/2023/05/11/fact-sheet-hhs-details-5-billion-project-nextgen-initiative-stay-ahead-covid.html)

CMS Takes Steps to Lower SNF Medicare Payment Error Rates

The Medicare Comprehensive Error Rate Testing program projected error rate for skilled nursing facilities showing a significant increase in 2022 (15.1%, up from 7.9% in 2021). Therefore, CMS has instructed each of its Medicare Administrative Contractors (MACs) that review SNF Medicare claims to initiate a five-claim probe and educate medical review for each SNF in the MAC's jurisdiction. CMS surmises that the source of the increase in improper payments may lie with the change from resource utilization group (RUG) IV to the patient driven payment model (PDPM) and has noted that the primary root cause of SNF errors is missing documentation. (https://www.sheppardhealthlaw.com/2023/05/articles/centers-for-medicare-and-medicaid-services-cms/cms-takes-steps-to-lower-snf-medicare-payment-error-rates/)

California Lawmakers Approve Emergency Loans for Struggling Hospitals

On May 15, 2023, California Governor Newsom signed into law Assembly Bill 112 (AB 112), which is designed to provide critical relief to qualified struggling hospitals across the state. AB 112 creates the $150 million Distressed Hospital Loan Program, which is intended to provide zero-interest cash flow loans to qualified not-for-profit and public hospitals experiencing financial distress, as well as qualified government entities representing hospitals that closed after January 1, 2022. Hospitals across California, particularly those in underserved areas or serving vulnerable populations, have been hit hard by rising costs, budget cuts and strains on resources caused by the COVID-19 pandemic. By securing access to necessary capital, hospitals may be able to sustain their operations, maintain staffing levels, and continue delivery of care to their communities. (https://www.sheppardhealthlaw.com/2023/05/articles/hospitals/update-to-a-lifeline-amidst-turbulent-times-california-lawmakers-approve-emergency-loans-for-struggling-hospitals/)

Michigan Bill Would Set Nurse Staffing Ratios in Hospitals

Bills to limit the number of patients a nurse can care for at one time have been re-introduced in the Michigan Legislature. The package would also reduce a hospital's ability to mandate nurses to work extra shifts. Senator Sylvia Santana (D-Detroit) said stretching nurses too thin has negative consequences for public health. This week's bills are similar to ones introduced in the past, with the exception of updates to ratio levels. Despite receiving bipartisan support, the policies have stalled in the Legislature in past years. (https://www.michiganradio.org/politics-government/2023-05-11/lawmakers-re-introduce-bills-to-set-limits-on-nurse-to-patient-ratio)

California Counties Face Unknowns in Launching Mental Illness Court

In four months, California's first CARE Courts will be in session. Seven counties opted for an Oct. 1 rollout of the law that orders each county to create special courts, whose judges have the authority to order treatment plans for individuals with untreated schizophrenia and related disorders. Even though the plans are not compulsory, the courts hope for compliance as the law tries to straddle a line between voluntary and mandated treatment. The CARE Act, signed into law by Gov. Newsom last September, requires counties to come up with the bureaucratic mechanisms that will support the goal of easing an epidemic of severe mental illness on the streets and in communities.. Among the many challenges with the CARE Act is developing a manageable workflow for disparate groups - from individuals appearing in court to the clerks who will process them to insurance companies. The first group - San Diego, Orange, Riverside, San Francisco, Stanislaus, Tuolumne and Glenn - reflects the geographic and demographic diversity of California. Their courts will serve as a template for Los Angeles and the 50 other counties. (L.A. County will open its court on Dec. 1; the rest of the state has until Oct. 1, 2024.) (https://www.latimes.com/california/story/2023-05-21/counties-scramble-care-court-preparations)

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