ABL Healthcare Member News & Industry Trendletter * September 7, 2023
  • 9/06 - Orange County ZOOM Table - Discussion Topic: "How Do You Prepare for the Unexpected?" - Featuring Larry Blocher, MD, CEO of Bio-Options

  • 9/15 - Los Angeles ZOOM Table - Discussion Topic: "Against All Odds: How to Fan the Flame of Innovation" - Featuring Naresh Menon, CEO of ChromoLogic LLC

  • 9/21 - Bay Area ZOOM Table - Discussion Topic: "Top Trends and Changing Players in Your Healthcare Field" - Featuring Kaiser Permanente Health Plan's Marcos Vasconcelos, Executive Director, Strategic Market Planning and Analytics, and Adam Gall, Director, Strategic Market Planning and Analytics

  • Explore Membership in ABL's Executive Round Tables >>>
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Angle Health (Andy Leeka) Spotlighted in Recent Reports

Angle Health was recently featured in Gallagher's InsurTech Q2 2023 report, in an article that highlights companies that have had successful Series A funding rounds, referred to as early-stage acceleration.
AND, Becker's Healthcare has published an article - Inside Angle Health's plan to rebuild health insurance from the ground up. (LA)

Catalight CEO Susan Armiger Honored + New Performance Feedback Tool Unveiled

Catalight CEO Susan Armiger has been named to the 2023 Forbes 50 Over 50 list, an annual list honoring women in four categories: Lifestyle, Impact, Innovation, and Investment. Susan is one of 50 women in the Impact category.
ALSO, Catalight recently unveiled its new Catalight Paraprofessional Competency Checklist. Developed by clinicians, it's a performance feedback tool designed to be used by supervisors during direct observation of the paraprofessional implementing applied behavioral analysis (ABA) intervention. The goal is to improve the clinical quality of the paraprofessional's work and strengthen their skills in implementing ABA treatment for children with autism spectrum disorder.
MEANWHILE, recent articles from Catalight include Solving the Access Issue Once and For All - Delivering for today's needs and planning for tomorrow's realities and Doing More with Less: High Quality Care with Greater Efficiency. (BA)

Choice in Aging (Debbie Toth) to Hold Bedford Block Party on October 7

Choice in Aging (CiA)'s 6th Annual Bedford Block Party will take place on Saturday afternoon, October 7. "Flamingo Fiesta" will include live music, libations, a delicious Mexican feast, bocce ball tournament, and online auction. Proceeds will support The Bedford Center in Antioch, funding scholarships, meals, program activities, art, music, physical and occupational therapies. For decades, The Bedford Center has provided services for adults with disabilities, Alzheimer's disease, and other chronic conditions.
ALSO, click here to watch the latest episodes of Dishing With Debbie video interview series with senior industry leaders. (BA)

Cigna Healthcare (Chris DeRosa) Removes 25% of Medical Services from Prior Authorization

Cigna Healthcare announced the removal of nearly 25% of medical services from prior authorization (or precertification) requirements. With the removal of these 600+ additional codes, Cigna has now removed prior authorization on 1,100+ medical services since 2020, with the goal of simplifying the health care experience for both customers and clinicians. With this update, prior authorization now applies to less than 4% of medical services for most Cigna Healthcare customers. Cigna will also remove prior authorization for nearly 500 additional codes for Medicare Advantage plans later this year. (OC)

Eitan Medical (Roger Massengale) Chosen by Intramed Plus

Eitan Medical announced that - following its recent launches of Sapphire Connect and Eitan Insights - South Carolina's Intramed Plus, a recognized leader in infusion services, has begun utilizing Eitan's new innovative connected infusion technology. Eitan's new technology enables remote visibility of Sapphire infusion data, a unique capability which is supporting data-driven insights to Intramed's clinicians. (OC)

El Camino Health (Cecile Currier) Achieves Milestone Using da Vinci Robot

The surgery team at El Camino Health (ECH) recently performed its 15,000th procedure using the da Vinci robotic surgical system. ECH is number one in the Bay Area for cumulative volume of patients treated using the da Vinci robot.
MEANWHILE, the El Camino Healthcare District and ECH announced that they will jointly grant $11.02 million to support local health programs and initiatives in the coming year. The funding will go to agencies that help create healthier populations and support health equity for community members in Campbell, Cupertino, Los Altos, Los Altos Hills, Los Gatos, Mountain View, San Jose, Santa Clara, Saratoga and Sunnyvale. (BA)

Elemeno Health (Arup Roy-Burman, MD) Solution Expanded Among OSF Facilities

OSF HealthCare announced it's expanding use of the Elemeno Health just-in-time microlearning solution as a foundational element in its transformation of clinical learning. OSF Innovation piloted the Elemeno best practices nursing platform last year and has decided to implement it among its 15 hospitals and within ambulatory, hospice, and home care settings. (BA)

Elevance Health (David Pryor, MD) Named Best Large Employer in U.S. Healthcare

Fortune has named Elevance Health the best large employer to work for in U.S. healthcare, according to its list of 40 top workplaces published in September. (Technically, David works for Anthem, the former name of the parent organization and now one of the better known Elevance subsidiaries.) The "Best Workplaces in Healthcare in 2023" ranking was created in partnership with global analytics firm Great Place to Work and represents feedback from 208,000+ employees. (LA)

Fomat Medical (Nick Focil) Launches AlzWell App & Asks for Feedback

Nick Focil, CEO of Fomat Medical, recently shared a post about a technology they have been working on for four years and that has now launched - called AlzWell. Nick says, "Please download it and give me your honest feedback. It's an app for families that have to take care of a loved one with Alzheimer's. It helps them collaborate, find out when the loved one has wandered off, and so much more. It has been a crazy ride, but I'm super excited to let everyone know." AlzWell can be downloaded here.
ALSO, Fomat Medical has published an article - Navigating the Maze of New Weight Loss Shots: A Personal Exploration of Concerns. (LA)

GrandCare Health (David Bell, Ph.D.) Chosen for Keck Medicine USC Collaborative + Launches Cardiac Surgery Rehab Program

GrandCare Health has been selected as a key participant in the Post-Acute Care Collaborative (PACC) by Keck Medicine of USC, comprised of top-performing SNFs, home health agencies, home pharmacy infusion providers, and acute rehab units across Keck Medicine's key service areas. The PACC's primary focus is to elevate the quality of patient care, enhance overall patient experience, and drive down the total cost of care throughout the entire care continuum. GrandCare successfully underwent a rigorous and comprehensive evaluation process, which included the application of standardized quantitative and qualitative criteria.
ALSO, GrandCare recently launched their Cardiac Surgery Rehabilitation Program, "From Surgery to Strength: Rebuilding Your Heart and Your Life," designed to support patients by providing personalized care within the comfort of their own homes. (LA)

Illumination Foundation (Pooja Bhalla, DNP) a Nominee for OCBJ Women in Business Award

Illumination Foundation CEO Pooja Bhalla has been nominated for an Orange County Business Journal 2023 Women in Business Award, for her innovative leadership in integrating housing and healthcare services for those experiencing homelessness. The awards luncheon and program will take place October 5. (OC)

Kaiser Permanente (Marcos Vasconcelos) & Risant Featured in Recent Article + Opens New San Diego Hospital & All 39 Hospitals Ranked 'High Performing'

In a recent article in Becker's Health IT, Greg Adams, chair and CEO of Kaiser Permanente (KP), said that competing with disruptors was part of the reason for starting Risant Health. "While some new players share our vision of integrated value-based care for all, we see other new and disruptive market entrants whose business models seem aimed at serving just the healthiest people, which increases fragmentation and ultimately increases the cost of care for everyone." Despite his 39-hospital system inking a deal to buy a 13-hospital group, Mr. Adams said Risant Health's goal is not consolidation but, rather, "supporting nonprofit community health systems." Its name, he said, comes from helping others "rise" while remaining "constant" in its mission and values. That would be done through data-driven population health, addressing social determinants, and aligning financial incentives with quality to drive down costs. He said smaller health systems' move toward value-based care could stall if they "don't have access to the best practices, tools, technology, and systems - all of which Risant Health can bring."

Catherine MacLean, MD, PhD, senior vice president and chief value medical officer of New York City-based Hospital for Special Surgery, commented: "CVS and Optum are focused on ambulatory care and do not own or control any hospitals. Given that 40 percent of U.S. healthcare expenditures occur in the hospital, I think Risant will have greater control over total care costs through judicious use of hospitals and by managing hospital efficiencies."

ALSO, KP recently opened its new 206-bed San Marcos Medical Center in the San Diego region. The $400 million hospital produces its own electricity, heat and cooling with plants and irrigation systems that save 400,000 gallons of water per month, which adds up to the amount used monthly by 1,000 homes. AND, on the U.S. News & World Report's 2023-24 Best Hospitals rankings, all 39 KP hospitals are "high performing" for one or more measures - for the third year in a row. (BA)

Life Adjustment Team (Cynthia Sampson) Examines the Mental Health Case Management Process + Evolution of Mental Health Programs

In An Overview Of the Mental Health Case Management Process, Life Adjustment Team (LAT) explores mental health case management as a multidimensional approach, as well as the nine stages and value of the process.
AND, in The Evolution of Intensive Outpatient Programs and Partial Hospitalization for Mental Health, LAT discusses intensive outpatient programs, which balance care and flexibility, plus partial hospitalization programs, which bridge the gap, and the impact of modern advancements. "These programs offer a middle ground between full-time hospitalization and sporadic outpatient visits, allowing individuals to access consistent and structured support while maintaining vital connections to their communities and home lives," LAT explains. (LA)

LigoLab (Suren Avunjian) Explores Funding Vs. Bootstrapping for an Enterprise Software Company

LigoLab CEO Suren Avunjian recently penned an article for Forbes - Funding Versus Bootstrapping For An Enterprise Software Company. Suren shares that at LigoLab, "we made the strategic choice to bootstrap. This decision allowed us to grow organically, solely accountable to our clients. Free from the perpetual cycle of fundraising, our focus remains unwavering: delivering maximum value to our partner laboratories instead of appeasing investors.
ALSO, LigoLab announced that its platform is now available in a tiered pricing model that caters to various laboratory discipline types, sizes, and complexities. The tiered pricing fills a void, allowing independent pathology groups and molecular and reference labs to select the LIS platform tier that aligns best with their current operations instead of settling for a one-size-fits-all LIS solution. (LA)

MedWand (Bob Rose) Lands Cover Story in Business Journal + Launches VirtualCare Kiosk Services

The Orange County Business Journal recently featured MedWand as its cover story, in MedWand Expects $50M in Sales as Device Grows at Homes and More. The article dubs MedWand as "the 21st century digital house call."
MEANWHILE, MedWand has launched VirtualCare Kiosk services for its telemedicine platform, offering providers an innovative solution to conducting comprehensive MedWand exams from various locations, including patients' homes, regional clinics, or any distant remote areas. This convenient feature enables providers to effortlessly review and share examination results with fellow clinicians in their network, eliminating the need for extensive time and costly formal EHR integration. (OC)

Mission Hospice (Dolores Miller) Looks Forward to Fall Gala on October 14

Mission Hospice will hold its Auxiliary Fall Gala on the evening of Saturday, October 14, at the Grand Bay Hotel in Redwood City. Mission's biggest fundraiser of the year will include dinner, dancing to a live band, an auction, and more. (BA)

Nelson Hardiman (Harry Nelson, JD) Discusses FTC's New Guidance for Health Data Privacy

Nelson Hardiman (NH) has made its recent webinar available to watch on demand: The Future of Healthcare Privacy: Projecting What's Ahead and Planning Next Steps.
PLUS, read NH's article - Coping with the Clampdown: FTC's New Guidance for Health Data Privacy. It has become critical for businesses that collect, use, store or disclose consumer health data to fully understand and implement practices to protect consumer health data privacy and security. In late July 2023, the FTC provided new practical guidance to help businesses stay within evolving regulatory guidelines and maintain the trust of their consumers, and NH discusses some of the main points. (LA)

On Lok (Grace Li) Took Part in Seniors Roundtable + Named a Great Place to Work

On Lok CEO Grace Li was honored to attend the recent "Protect Our Seniors Roundtable" hosted by Speaker Emerita Nancy Pelosi - watch a video of the event here.
AND, Great Place to Work Institute and its senior care partner Activated Insights have honored On Lok with certification as a Great Place to Work for 2023-2024 - for the third time. The certification process involved surveying 100% of employees from across On Lok's locations and evaluating 60+ elements of team members' experience on the job. (BA)

PreludeDx (Dan Forche) Interviewed in Feature Article

PreludeDx CEO Dan Forche was recently interviewed by Pulse 2.0 to discuss how his company got its start, challenges and milestones, what differentiates it from the competition, and what's next. An excerpt: "It is estimated that precision medicine testing will grow from $66.22 billion in 2021 to $175.6 billion by 2030, with oncology being the most prominent disease state benefiting from precision medicine." (OC)

Sheppard Mullin (Linda Igarashi) Launches AI Industry Team + Addresses Staffing Requirements for SNFs

Sheppard, Mullin, Richter & Hampton LLP has launched its multi-disciplinary Artificial Intelligence (AI) team with more than 110 attorneys across the firm's global platform. It helps clients with an array of AI-related legal and operational issues across a wide range of practices and industries. In addition to advising companies which are actively utilizing or developing AI technology on the legal issues they face, the team provides strategic counseling to such companies regarding risk analyses and mitigation strategies and are intimately involved in the development and implementation of their AI go-to-market and monetization initiatives. Additionally, the team develops policies and frameworks governing the proper use of AI platforms, tools and solutions across the enterprise and conducts legal and operational audits of the same.
ALSO, on September 27, Sheppard Mullin will present a live webinar - CMS Proposes Minimum Staffing Requirements for Skilled Nursing Facilities.
PLUS, read their article - Long Term Care Facilities Face Mandatory Minimum Staffing Requirements. (OC)

WestFax (Barry Clark) Announces Significant Changes to Print Driver

WestFax's print driver is a software package that works on all 32/64 bit Windows machines and acts as a virtual printer allowing any application that supports printing to send a fax as easily as printing a physical document. Recent updates include updated cover page functionality to map additional fields; auto-updater that can update the driver without uninstall; and interface updates and UI Improvements. (OC)

Wipfli (Jeff Johnson) to Present Live Webinar on How Growth in Managed Care Impacts Senior Service Providers

On September 19, Wipfli will present a live webinar - How growth in managed care impacts senior services providers. As Medicare Advantage enrollment continues to outpace traditional fee-for-service coverage, senior living providers face new challenges in providing high-quality care while grappling with reduced reimbursement rates. Participants will learn how data transparency can be the catalyst for positive change and effective negotiations in securing fair reimbursement rates with managed care.
ALSO, Jeff recommends a recent article - Exclusive: Recent Increases in Hospital Revenues - A Blip or a Trend? - which includes Wipfli perspectives. (BA)

GIDEON Informatics (Uri Blackman) Utilized by University of New Mexico Researchers

Researchers at the University of New Mexico used GIDEON Informatics epidemiological data to measure and compare nonzoonotic and zoonotic pathogen prevalence, and test the unique nature of nonzoonotic pathogens. The study used this data to relate infectious disease rates as a predictor of human rights violations.
MEANWHILE, in What Is the Chain of Infection and How to Break It?, GIDEON explains that the chain of infection is a concept that tells us how infections spread, just like a chain reaction. Understanding the chain of infection is crucial in combating the transmission of diseases. (LA)

Marshall Toplansky on: California's Business Climate
Amazon's One Medical Keeps Growing; CEO to Leave Company

One Medical CEO Amir Dan Rubin plans to leave the company later in 2023. He has led the hybrid primary care company since 2017, growing it from eight to 29 markets and overseeing its $3.9 billion acquisition by Amazon in February. One Medical has 200+ clinics, offering an annual fee-based subscription with in-person visits and 24-7 telehealth. Mr. Rubin will work closely with the team over the coming months to transition the CEO role smoothly to Trent Green, who is currently One Medical's COO. Under Amazon's ownership, One Medical has continued to expand and enter into more partnerships with hospitals. One Medical has exclusive specialty care referral agreements in local markets with 17 health systems. One Medical also has 46 clinics specifically for seniors after its $2.1 billion purchase of Iora Health in 2021. (https://www.beckershospitalreview.com/digital-health/one-medical-ceo-to-leave-company.html)

Providence St. Joe's CEO Leaves

Jeremy Zoch, PhD, CEO of Providence St. Joseph Hospital in Orange, Calif., left his role as of Sept. 1 after 11 years of service. Brian Helleland, interim COO of Providence South, will take over as the hospital's interim CEO. Mr. Helleland wrote that the pair had spent several months discussing Dr. Zoch's leadership involvement in the system's "care delivery network strategy," and decided to part ways. "As I talked to Brian Helleland about my role and the division's plan for greater alignment, it was clear to me this was the right time for me and for St. Joes," Dr. Zoch wrote. (https://www.beckershospitalreview.com/hospital-executive-moves/ceo-leaves-providence-hospital.html)

Doctor, Nurse Practitioner Pay Rising as Amazon, CVS & Walgreens Buy Providers

Demand for nurse practitioners and primary care physicians is escalating along with their compensation as retailers from Amazon and CVS Health to Walmart and Walgreens build primary care clinics across the country. A new report from AMN Healthcare shows nurse practitioners topped the staffing company's list of "most requested search engagements for the third consecutive year," according to an annual report from AMN Healthcare's Physician Solutions division, formerly known as Merritt Hawkins. "Demand for NPs is being driven by a growing number of 'convenient care' providers, including retail clinics, urgent care centers and telemedicine platforms, which employ large numbers of NPs," the report said. To be sure, the entrance of large retailers into the business of providing healthcare is causing bidding wars for primary care medical care providers. Average salary offers made to nurse practitioners were up 9% this year, to $158,000, compared to $138,000 last year, "underscoring the strong demand for advanced practice nurses," AMN Healthcare said. (https://www.forbes.com/sites/brucejapsen/2023/08/14/doctor-nurse-practitioner-pay-rising-as-amazon-cvs-and-walgreens-buy-providers/?sh=52bdb88e350a)

Several Healthcare Positions Among 20 Fastest-Growing Occupations

The number of jobs in the U.S. will increase by 8.3 million from 2021 to 2031 - according to projections from the Bureau of Labor Statistics, which classifies workers into occupational categories based on the work they perform and their skills, education, training and credentials. Among the top 20 occupations forecast to see the greatest percent employment change by 2031 are: Nurse practitioners - 45.7%; Medical and health services managers - 28.3%; Physician assistants - 27.6%; and Physical therapist assistants - 26.5%. (https://www.beckershospitalreview.com/workforce/20-fastest-growing-occupations-nurse-practitioner-is-no-1.html)

States Take on "Doctor" Title Debate

Several states are taking on the debate of whether to prevent nonphysicians from using the doctor title, but nurse practitioners with doctorates are pushing back, The Washington Post reported recently. Many states are contending with the question of how much independence to allow advanced practitioners, including what they can call themselves. The longstanding debate has become more relevant as the physician shortage continues. In 1994, only five states allowed nurse practitioners full practice authority. Today, 27 states and the District of Columbia no longer require physicians to oversee nurse practitioners. Physicians worry that nurse practitioners don't have the experience to properly treat patients which could lead to adverse outcomes, and nurse practitioners meanwhile point to "50 years of research" on providing similar outcomes to physicians. (https://www.beckershospitalreview.com/nursing/states-take-on-doctor-title-debate.html)

How to Tear the "Paper Ceiling" & Broaden the Talent Pool

A term has been coined for those without a bachelor's degree: the "paper ceiling." More than 60% percent of American adults do not have a university diploma, according to a recent report from Quartz. When degrees are required, 76% of Black, 83% of Latino, 81% of rural, and nearly 70% of veteran workers are drained from the talent pool. To make job mobility more accessible, major companies are dropping degree requirements from some job postings, and certain states are removing them from public sector jobs. Nearly 50 organizations mobilized to rip the paper ceiling in fall 2022, acknowledging that many jobs that ask for a bachelor's degree could actually be performed with on-the-job training, community college learning or certificate programs. Healthcare's paper ceiling can be tougher to tear, as many clinician roles require specialized training. But some degree requirements are wants, not needs, and eliminating them can open up a broader talent pool. (https://www.beckershospitalreview.com/workforce/how-to-tear-the-paper-ceiling.html)

The Starting Salary Slowdown

Big pay hikes that came with job changes in recent years are beginning to flatten or fall across many industries - a signal for healthcare employers that the bidding wars for talent spanning industries are cooling down. Average pay for the majority of 20,000+ jobs on ZipRecruiter this year has declined from last year, The Wall Street Journal reported Aug. 21. In 2022, on the other hand, compensation for 75% of advertised job titles increased from the year prior. In a July survey of about 2,000 employers conducted by ZipRecruiter, nearly half said they have reduced pay for recent job openings. The Journal notes that more in-demand workers in certain industries continue to get pay bumps, such as tourism and construction, without mention of healthcare. Signs of starting salary slowdown may be welcomed news for health systems, which saw a 21% increase in overall labor expenses from 2019 to 2022 with contract labor expenses up 258%, according to the American Hospital Association. (https://www.beckershospitalreview.com/compensation-issues/the-starting-salary-slowdown.html)

Nurses Are Restless

A strike is set at Cedars-Sinai hospital, and despite a statement shared online ahead of a Labor Day protest, Kaiser Permanente said it was "committed to bargaining with our Coalition unions in good faith and in the spirit of partnership." Yet roughly two dozen people, seated in the street, were arrested in a civil disobedience action in front of the Kaiser Permanente LA Med Center in Hollywood after a Labor Day demonstration, which the police declared an unlawful assembly. SEIU-UHWW organized the rally co-sponsored by the LA County Federation of Labor, as the Coalition of Kaiser Permanente Unions, representing about 85,000 workers in KP hospitals, clinics, and facilities in seven states and WDC who are in negotiations. If a strike occurs, union representatives say it would be the largest healthcare strike in U.S. history. (https://www.beckershospitalreview.com/hr/strike-set-at-cedars-sinai-hospital.html) (https://www.beckershospitalreview.com/hr/dozens-arrested-in-labor-day-protest-outside-los-angeles-kaiser-facility.html)

Nurse Staffing Ratios Win Over West Coast

Mandated nurse-to-patient ratios now span the West Coast, from California to Oregon to Washington. Oregon Gov. Tina Kotek signed the state's mandate Aug. 16. Under the new law, hospitals will be required to establish staffing committees for nurses and professional, technical and service staff, with specific criteria. Hospitals that do not comply with their staffing plans can be penalized. Washington Gov. Jay Inslee inked a similar measure April 20, requiring hospitals to create internal staffing committees and maintain at least 80 percent compliance with their assigned nurse-patient ratio. California was the first state in the nation to mandate nurse staffing ratios two decades ago; results have been mixed, depending on whom you ask. Nurses say working conditions and patient outcomes have improved, bettering retention in the profession. Hospitals, meanwhile, say the ratios are ineffective and require money and resources they do not always have. Regardless, California has set the stage for a nationwide push toward nurse staffing laws. Several states on the East Coast - including New Jersey, Connecticut and Massachusetts - are mulling similar regulations. (https://www.beckershospitalreview.com/workforce/nurse-staffing-ratios-win-over-west-coast.html)

All Nurses Reportedly Laid Off at 100+ Optum-owned Clinics

A chain of urgent care clinics owned by UnitedHealth Group's Optum is laying off all nursing positions nationwide. Morgantown, W.Va.-based MedExpress Urgent Care will eliminate registered nursing positions at nearly 150 facilities as part of a larger group of layoffs at Optum, nurse.org reported. (https://www.beckershospitalreview.com/nursing/all-nurses-reportedly-laid-off-at-more-than-100-optum-owned-clinics.html)

Medicare Names First 10 Drugs Up for Price Negotiations with Government

CMS recently announced the first 10 prescription drugs that will be subject to Medicare price negotiations under the Inflation Reduction Act. Next year, Medicare for the first time will be able to directly haggle with drugmakers over prices for the costliest medications. The negotiated prices will go into effect in 2026. The drugs selected to undergo negotiations are: blood thinners Eliquis and Xarelto; diabetes drugs Januvia, Jardiance, Fiasp and NovoLog; Enbrel, a rheumatoid arthritis drug; Imbruvica, a drug for blood cancers; Farxiga, a drug for diabetes, heart failure and chronic kidney disease; Entresto, a heart failure drug; and Stelara, a drug for psoriasis and Crohn's disease. Together, the 10 drugs selected accounted for $50.5 billion, or 20%, of Medicare Part D spending from June 1, 2022, to May 31, according to CMS. (https://www.nbcnews.com/health/health-care/medicare-names-first-10-drugs-price-negotiation-government-rcna101166)

CMS Issues Draft Guidance for Implementing Medicare Prescription Payment Plan for 2025

CMS issued the first of two draft guidance documents for implementing the Medicare Prescription Payment Plan that was established in the Inflation Reduction Act and signed into law on August 16, 2022. Beginning in 2025, the Medicare Prescription Payment Plan requires all Medicare prescription drug plans to offer Part D enrollees the option to pay out-of-pocket prescription drug costs in monthly payments over the course of the plan year, rather than paying all at once at the pharmacy. CMS is soliciting comments on the draft guidance and will finalize the guidance by spring 2024. (https://kslawemail.com/128/10599/pages/art3.asp?sid=78cbb23d-a511-4446-830e-cffde6cad67c)

FDA Approves Pfizer Maternal RSV Vaccine for Infants

The FDA recently approved a vaccine from Pfizer that protects infants from respiratory syncytial virus, the leading cause of hospitalization among babies in the U.S. Pfizer's RSV shot is already approved and available in the U.S. for older adults. It's now the second treatment approved by the FDA to prevent RSV in infants and the first vaccine. It uses maternal immunization, which refers to vaccinating pregnant mothers so they can pass protective antibodies to their fetuses. Pending a recommendation by the Centers for Disease Control and Prevention, Pfizer hopes the vaccine will be available to the public by the end of October or the beginning of November, which marks the beginning of RSV season. (https://www.msn.com/en-us/health/other/fda-approves-pfizer-maternal-rsv-vaccine-for-infants/ar-AA1fAmi0)

Blue Shield of California Says It Aims to Save Millions on Drug Costs, Plans to Drop CVS Caremark as PBM

Blue Shield of California said it is dropping CVS Health's Caremark, the pharmacy-benefit manager it currently uses, which negotiates drug prices and wraps in other services such as a mail-order pharmacy. Instead, Blue Shield, a nonprofit health plan with about 4.8 million members, will work with a selection of companies that each perform a designated function. Amazon will offer at-home drug delivery. Mark Cuban said his Cost Plus Drug Company will provide access to low-cost medications, including through retail pharmacies. Another company, Abarca, will process drug claims. Blue Shield said that, working with its partners, it aims to negotiate prices with pharmaceutical makers eliminate rebates and hidden fees. Blue Shield said its plan, which it hopes to fully launch in 2025 after a limited rollout next year, could save the company about $500 million annually, or about 10% to 15% of what the insurer currently spends on drugs. The nonprofit said it would pass along savings to its clients. Ultimately, Blue Shield said, other insurers and employers around the country would be able to use its new structure. (https://www.wsj.com/health/healthcare/a-big-health-insurer-is-ripping-up-the-playbook-on-drug-pricing-ec152227?mod=hp_lead_pos10)

Amazon Clinic Adds Virtual Primary Care Company to Marketplace

AI-powered virtual primary care company Curai Health has been added to Amazon Clinic's virtual healthcare marketplace, allowing patients to go through a message-based platform to reach clinicians. Through Curai Health's platform, patients will be able to receive virtual primary and urgent care from licensed doctors and nurse practitioners, according to a recent news release from Cura, which also offers care for UTIs, COVID-19 and birth control. (https://www.beckershospitalreview.com/disruptors/amazon-clinic-adds-virtual-primary-care-company-to-marketplace.html)

CommonSpirit Name to Adorn Hospitals for 1st Time in 4 Years

The name of Chicago-based CommonSpirit Health will adorn its 143 hospitals for the first time since San Francisco-based Dignity Health merged with Englewood, Colo.-based Catholic Health Initiatives in 2019, creating the nation's third-largest health system. With CommonSpirit and Altamonte Springs, Fla.-based AdventHealth folding their joint venture - Centennial, Colo.-based Centura Health - CommonSpirit's Centura hospitals will soon feature the nonprofit Catholic health system's name. The CommonSpirit Health name will also be featured on 20 hospitals and 240 care sites in Colorado, Kansas and Utah that are now part of Centura.
CommonSpirit's other hospitals are currently branded as Dignity Health in Arizona, California and Nevada; Virginia Mason Franciscan Health in Washington; St. Joseph's and St. Luke's Health in Texas; Trinity Health System in Ohio; and CHI in Arkansas, Georgia, Iowa, Kentucky, Minnesota, Nebraska, New Mexico, North Dakota, Oregon, Pennsylvania and Tennessee. (CommonSpirit is also taking over Centura Health's naming rights agreement with the NFL's Denver Broncos.) (https://www.beckershospitalreview.com/digital-marketing/commonspirit-name-to-adorn-hospitals-for-1st-time.html )

Hospital Growth Area: Critical Access

The number of critical access hospitals has increased by 446 since 2004 and as rural hospitals face a financial crunch, more could be trimming their services in exchange for increased federal funds. To obtain critical access status, hospitals need to have no more than 25 beds and an average duration of stay under 96 hours. While cutting services to meet these requirements might seem like a difficult choice, hospital leaders told Becker's that the designations give them a path toward financial stability. Some hospital leaders also see the critical access designation will allow them to remain independent and not merge with a larger system. (https://www.beckershospitalreview.com/finance/why-some-hospitals-are-turning-critical-access.html)

Mayo Clinic to Charge for MyChart Messages

Rochester, Minn.-based Mayo Clinic plans to charge patients up to $50 for patient portal messages to their providers, the Star Tribune reported recently. Mayo joins a growing list of health systems that have started billing for MyChart messages in response to an explosion of digital interactions. The charges will apply to messages that require a diagnosis or other clinical decision, according to the story. Mayo providers received 6.4 million messages from patients in 2022. Other health systems that now bill for the messages include Cleveland Clinic, Baltimore-based Johns Hopkins Medicine, and Renton, Wash.-based Providence. (https://www.beckershospitalreview.com/ehrs/mayo-clinic-to-charge-for-mychart-messages.html)

The Upheaval at America's Disappearing Nursing Homes

The U.S. has at least 600 fewer nursing homes than it did six years ago, according to a Wall Street Journal analysis of federal data. More senior care is happening at home, and the Covid-19 pandemic caused many families to shun nursing homes while draining workers from an already short-staffed industry. The result? Frail elderly patients are stuck in hospitals, a dangerous place for seniors, waiting for somewhere to go - sometimes for months. Beds are disappearing while the need for senior care is growing. The American population 65 and older is expected to swell from 56 million in 2020 to 81 million by 2040. Data show capacity in the nursing-home industry has lagged behind growth in the ranks of older Americans for many years. (https://www.wsj.com/health/healthcare/the-upheaval-at-americas-disappearing-nursing-homes-in-charts-9aa8d2f9)

Patients See Better Outcomes with Female Surgeons, Studies Find

Patients treated by women surgeons had better outcomes, according to two population-based cohort studies from Canada and Sweden, both of which were published in JAMA Surgery. The retrospective Canadian study found that, compared with male surgeons, patients treated by female surgeons had a lower risk-adjusted likelihood of adverse postoperative outcomes at 90 days (13.9% vs 12.5%) and at 1 year (25.0% vs 20.7). Findings were similar for mortality at 90 days (0.8% vs 0.5%) and at 1 year (2.4% vs 1.6%). The findings of the Swedish study showed that patients treated by female surgeons have more favorable outcomes compared with those treated by male surgeons when looking specifically at cholecystectomies. (https://www.medpagetoday.com/surgery/generalsurgery/106142)

Where Are All the Women Doctors in Movies?

Men have been represented as physicians in movies four times more often than women, according to a cross-sectional analysis of three decades of films. Among a total of 2,295 physician characters in 1,226 movies released from 1990 to 2020, 81.4% were men and 18.6% were women, reported Reshma Jagsi, MD, DPhil, of Emory University in Atlanta, and co-authors in a JAMA Internal Medicine research letter. Representation of female physician characters in movies did increase by about 2% per decade, from 16.6% to 18.6% to 20.8%, but most movies still depicted physicians as men (71.5%). However, today about 37% of active physicians in the U.S. are women, around 47% of residents and fellows are women, and approximately half the students in med schools are women. (https://www.medpagetoday.com/special-reports/features/106093)

Good Friends Are Good for Us, Yet 40% of Americans Say They Don't Have a Best Friend

Good friends are good for us. They help us get through bad times, listen when we need them and offer advice. A lack of someone you can confide in can lead to loneliness and isolation, which have been labeled a public health threat, on par with smoking and obesity. Yet as important as they are, people have fewer close friendships than they once did. Four in 10 Americans say they don't have a best friend at all, up from 25% in 1990. The best-friend gap is more pronounced for men, who typically have fewer close friends than women do. The percentage of men without any close friends jumped fivefold to 15% in 2021 from 3% in 1990, according to the May 2021 American Perspectives Survey. (https://www.wsj.com/health/wellness/theyve-been-friends-for-60-years-lew-and-bobby-have-figured-out-what-most-men-dont-e44063ac?mod=wknd_pos1)

ChatGPT on Par with an "Intern or Resident," Mass General Brigham Finds

ChatGPT is 72% accurate at making clinical decisions, performing better at final diagnoses and worse at determining possible diagnoses, according to an Aug. 22 study by Mass General Brigham researchers. Adam Landman, MD, CIO and senior vice president of digital at Mass General Brigham, said that the health system "sees great promise" for large language models such as ChatGPT. "We are currently evaluating LLM solutions that assist with clinical documentation and draft responses to patient messages with a focus on understanding their accuracy, reliability, safety and equity," he said. (https://www.beckershospitalreview.com/innovation/chatgpt-on-par-with-an-intern-or-resident-mass-general-brigham-finds.html)

Epic Is Allowing Generative AI "Pals" Into Its Walled Garden

Epic is integrating new artificial intelligence clinical documentation capabilities for its customers through a partnership with generative AI company Abridge - Epic's first "Pal" in its "Partnership and Pals" collaboration program. Through the program, "Epic works with companies like Abridge to develop deep integration for their products and services, helping them innovate quickly for the benefit of more patients and providers," according to Epic VP Alan Hutchison. Abridge uses generative AI tools to reduce the administrative documentation burden on clinicians. According to the company, the tool can save providers two hours per day on average. (https://www.beckershospitalreview.com/ehrs/epic-gets-new-generative-ai-pal.html)

Almost 80% of Healthcare Organizations Experienced Cyber Incidents in Past Year

78% of respondents to a new Claroty survey experienced a minimum of one cybersecurity incident over the last year, which impacted a broad range of asset types, including IT systems, sensitive data, medical devices and building management systems. More than 60% of respondents reported a moderate or substantial impact on care delivery, and another 15% reported a severe impact that compromised patient health or safety. The financial ramifications mainly fell in the $100,000-$1,000,000 range, with 26% paying ransoms. (https://www.healthcarefinancenews.com/news/almost-80-healthcare-organizations-experienced-cyber-incidents-past-year)

Thoma Bravo to buy NextGen Healthcare in Take-Private Deal

Electronic health record vendor NextGen Healthcare announced on Wednesday it agreed to be acquired in a take-private deal by private equity firm Thoma Bravo, for $23.95 per share. This represents a 46% premium on NextGen's closing price on Aug. 22, according to a press release. The acquisition is expected to close in the fourth quarter this year. (Members of ABL-HEALTH OC's Round Table will probably remember Steve Plochocki, formerly the CEO of QSI, which formally changed its name to NextGen in 2018, after Steve retired, having scaled the company to 100,000+ provider clients across the U.S.) (https://www.healthcaredive.com/news/thoma-bravo-acquires-nextgen-healthcare/692792/)

Judy Faulkner Touts New Plans for Epic

Judy Faulkner told audiences at the company's annual Users Group Meeting that the EHR company is providing more training with software systems, connecting millions more patient records to data systems, and using generative AI to reduce provider workload. Among recent milestones is Epic's move to offer ongoing training for workers struggling with its software, as well as launching Lyceum, a training program to help medical and nursing students learn its software. The company is also looking to expand its databases of patients so that sharing health information for research and treatment purposes becomes easier. This initiative is called Look-Alikes, which matches patients who have unidentified conditions with others who share similar symptoms. The program aims to provide more information or potential treatments for the conditions. (https://www.beckershospitalreview.com/ehrs/judy-faulkner-touts-new-plans-for-epic.html)

J&J's $40 Billion Split-Off Sets Stage for Pharma, Medical Tech Expansion

Johnson & Johnson plans to tap billions in proceeds from the recent split-off of its consumer-health business to fuel growth in pharmaceuticals and medical technology through capital allocation, which could include new acquisitions and investments in product offerings and robotics. The healthcare giant in May sold shares in Kenvue, which owns brands such as Band-Aid and Tylenol, through an IPO that netted J&J $13.2 billion in cash. In August, J&J shed about 80% of its Kenvue shares through a roughly $40 billion split-off, whereby some investors chose to trade in their shares of J&J for Kenvue ones. The moves marked the conclusion of a multiyear effort, a plan decided upon in 2019 and put into action in 2021 when J&J embarked on untangling its finances and operations for such a split. The split allows J&J's executives to focus more on developing innovations and expanding the businesses of medical technologies and pharmaceuticals. (https://www.wsj.com/articles/j-js-40-billion-split-off-sets-stage-for-pharma-medical-tech-expansion-817701c1?mod=hp_minor_pos7)

Saudi Arabia Dangling Billions for Research on Aging; Scientists Are Lining Up to Take It

Crown Prince Mohammed bin Salman, the de facto Saudi ruler, has allocated more than a billion dollars a year to an effort called Hevolution Foundation to develop new treatments for aging. That could dramatically expand the available global funding for research on longevity biology, which now comes mainly from the U.S. National Institute on Aging. The prospect of a huge surge of funding into the area, whose budgets pale in comparison to research on diseases like cancer, is causing a stir among scientists who study aging. The Saudi foundation's chief executive, Dr. Mehmood Khan, says much of the initial grant money is likely to end up at universities and startups in the U.S., where scientists are trying to develop treatments that slow, prevent or even reverse the aging process for humans. (https://www.wsj.com/science/biology/saudi-arabia-is-dangling-billions-for-research-on-aging-scientists-are-lining-up-to-take-it-7f459eff)

Ozempic Settles the Obesity Debate: It's Biology Over Willpower

Ozempic and similar drugs are transforming the world's understanding of obesity. It isn't so much about willpower: It's about biology. The success of the powerful new class of diabetes and weight-loss drugs shows how important chemistry is in determining a person's weight. The brain is the body's chief chemist, regulating appetite and making it difficult for many people to shed pounds and keep them off. The brain determines how much fat it wants people to carry, according to years of research bolstered by the new drugs. The amount is like a setting on a dial, or what many researchers call a "set point" or "defended fat mass." The brain maintains the dial setting or set point by regulating how much a person eats. Ozempic, its sister drug Wegovy and another, Mounjaro, lower the dial setting, or set point, in effect by acting on the brain to reduce hunger and make a person feel full sooner, some obesity researchers say. (https://www.wsj.com/health/pharma/weight-loss-drugs-obesity-e4bb2173)

Ozempic, Weight-Loss Drugs Carry Costly, Complicated Logistics

The soaring popularity of Ozempic and similar weight-loss drugs is driving big business for some of the largest pharmaceutical distributors in the U.S. But the benefits aren't necessarily flowing to companies' bottom lines, partly because of the complicated and costly logistics involved in shipping the refrigerated medications, industry experts say. The medications help patients lose weight by mimicking a gut hormone called GLP-1. They are designed as once-weekly injections that patients administer on themselves using a penlike needle, similar to using an EpiPen, that must be stored between 36 and 46 degrees Fahrenheit to prevent the medication from losing its effectiveness. That raises the stakes for patients and drug distributors to keep the medications' temperature stable. For patients, that means sticking the pens in the fridge. But for wholesalers, it means arranging industrial-scale logistics designed to keep the medications cold throughout transport and storage, including protecting the injections from unpredictable events such as a truck breaking down in a heat wave. (https://www.wsj.com/articles/ozempic-weight-loss-drugs-carry-costly-complicated-logistics-a73385de?mod=hp_minor_pos13)

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