HHAeXchange Names Scott Schwartz as Chief Operating Officer, Announces New Senior Vice President of Product
New appointments highlight the company’s commitment to equipping providers, managed care organizations (MCOs), and state Medicaid agencies with solutions that enable more effective homecare
NEW YORK, Feb. 21, 2024 – HHAeXchange, a leading provider of homecare management solutions for providers, managed care organizations (MCOs), and state Medicaid agencies, today announced that Scott Schwartz, formerly Chief Revenue Officer, has been appointed to Chief Operating Officer, and Lori Harrington has joined the team as Senior Vice President of Product.
After serving as Chief Revenue Officer, Senior Vice President, and Vice President of Sales & Marketing at HHAeXchange for nearly seven years, Scott Schwartz will step into a new role as Chief Operating Officer. In his new position, Schwartz will lead implementation, revenue cycle operations, integrations, technical customer care, training, and customer education. Bringing these functions under Schwartz’s leadership will evolve operations to enable more effective services and solutions.
“Over the past seven years, Scott has been integral in establishing HHAeXchange as the leader in homecare software through helping nearly 10,000 homecare provider agencies leverage technology and spearheading our robust Partner Connect program,” said Paul Joiner, Chief Executive Officer at HHAeXchange. “As we work to expand our platform and create better solutions for homecare providers and payers, Scott’s top priority will be driving operational excellence and delivering an improved end-to-end client experience.”
In addition to the appointment of Schwartz as COO, the company has announced Lori Harrington as the new Senior Vice President of Product. With over twenty years of experience in the industry, Harrington brings an extensive healthcare product strategy and management background to the organization. In her most recent role, Harrington served as Vice President of Product Management for Teladoc, where she led product strategy for value-based care initiatives and was instrumental in developing a client innovation hub for strategic health plan clients, creating a streamlined experience for clients based on their emerging needs.
“Lori’s deep understanding of healthcare and her customer-centric approach will be crucial in advancing our product solutions to serve providers and payers better,” said Tim Brewer, Chief Technology Officer at HHAeXchange. “With her vast experience, Lori will play a pivotal role in driving product evolution and execution, improvements to our current products, and delivering solutions that meet the evolving demands of our customers and the homecare industry to ultimately provide better customer satisfaction.”
As aging populations across the country continue to increase and more members express a preference for homecare, these new appointments will advance HHAeXchange’s commitment to setting new industry standards that enable providers, caregivers, payers, and families to deliver the best care in the home.
Founded in 2008, HHAeXchange is the leading technology platform for homecare and self-direction program management. Developed specifically for Medicaid home and community-based services (HCBS), HHAeXchange connects state agencies, managed care organizations, providers, and caregivers through its intuitive web-based platform, enabling unparalleled communication, transparency, efficiency, and compliance. To learn more information, visit hhaexchange.com or follow the company on Twitter, LinkedIn and Facebook.
By Beth Noyce, RN, BSJMC, HCS-C, BCHH-C, COQS Home health & hospice consultant
The Hospice Outcome Patient Evaluation is a step closer to implementation.
After four years of considering options, the Technical Expert Panel (TEP) has finished its work that will inform future Hospice Quality Reporting Program results. The TEP considered quality measures to include in hospice’s future assessment tool and best choices for risk adjustment and exclusion.
The panel convened in 2019 “[we are] committed to improving the quality of care given to hospice patients,” says the 2022-2023 TEP Summary Report: Hospice Quality Reporting Program. The panel aimed to ensure that hospice quality measures are meaningful for hospice beneficiaries, transparent to hospice providers, and useful to consumers. They considered quality measures from both HOPE and claims data.
“From day one it was very clear Medicare wanted to make this a very different experience for hospice teams and make it a more valuable thing for consumers,” says Dr. Jeff McNally, Hospice Medical Director at Utah’s Intermountain Hospice,” describing his participation on the HQRP TEP. “I was actually encouraged and inspired by it,” he says. “It was the first time I had first-hand experience working with any kind of CMS entity.
“The reality is some clinicians in the field and leaders don’t have the best things to say about CMS,” he explains, but “whatever we were considering we always circled back to whether it would be burdensome to the clinical team and would it be valuable to consumers.”
The panel initially planned to meet multiple times in person, with two meetings per year and potential virtual meetings as needed. “Then COVID hit,” Dr. McNally says. “It slowed the process considerably. We never did meet again in person.”
The HQRP TEP met eight times over four years, virtually after the initial meeting. McNally described participants as coming to each meeting prepared with data and proposals for HOPE measures for which they would request input from panelists.”
From TEP recommendations early in their work, Abt Associates developed two outcome measures and two process measures in harmony with hospice’s central tenet to manage symptoms:
Process measures:
Timely Reassessment of Pain Impact
Timely Reassessment of Non-Pain Symptom Impact
Outcome measures:
Timely Reduction of Pain Symptom Impact
Timely Reduction of Non-Pain Symptom Impact
“The most important [recommendations] were some of the outcome measures about symptom management,” McNally explains. “What should we be helping agencies show that they’re doing well? And how do we do that? Deciding which ones, and how many symptom management measures to use and the most valuable way to show it in a fair way.”
During the past two years, TEP members prioritized which of the risk-adjustment factors suggested by Abt. Associates should apply to outcome measures and which exclusions should apply to both outcome and process measures.
The report describes risk adjustment as using statistics to exclude “confounding factors,” or elements that are outside of a hospice’s control, from calculations that could make a hospice’s performance appear either better or worse than it is. In essence, risk adjustment increases the fairness in outcome-measure calculations while exclusions do the same for both outcome and process measures.
For the outcome measures being considered, the report says that the “TEP broadly agreed that risk adjustment is very important because it accounts for external factors outside hospices’ control and more accurately reflects the quality of care provided.”
Judi Lund Person, Principal of LundPerson & Associates, LLC, agrees. “The discussion of risk-adjustment factors is vitally important to the success of upcoming process measure implementation,” says Lund Person.
Determining which risk-adjustment factors to bring to the table was not easy. “There were some nuance things that we hashed out to try and decide how to weigh some factors in risk adjustment” for outcome measures, McNally explains.
Exhibit 5 (below) summarizes the TEP’s rankings of risk adjustors suggested.
While the TEP’s priorities seem clear, the discussion concerning each risk adjustor was more complex. The TEP broadly agreed that the most important risk-adjustment factors are age and diagnosis. Some diseases are more difficult to manage than others, and patient condition tends to decline with age regardless of provider activity. Therefore, the TEP recommended that CMS adjust for these factors to ensure that common external factors do not adversely affect reported hospice care quality.
Here’s part of the nuance – the TEP also raised concerns that how well other patients with certain diseases or of certain age groups are treated might be valuable to some patients and their families seeking care for someone of the same age group or condition. Panelists fretted over possibly obscuring that information for consumers seeking hospice care by adjusting for those risk factors.
Living situation as a risk adjustor ranked as important to TEP members because hospices have no control over what level of assistance is available to patients. Similarly, site of service ranked high as a risk adjustor because, said some panelists, care is delivered very differently across settings, and patients and/or caregivers tend to provide higher hospice satisfaction ratings for hospices in home settings than for those in facilities,” according to the report.
Lund Person, who is also former Vice President of Regulatory and Compliance at the National Hospice and Palliative Care Organization (NHPCO), notes that the TEP recognized living situation and site of service as “important” risk adjustment recommendations.
“Identifying site of service will help to distinguish between care at home and care in a facility,” she says. Also vital, she continues, “is the recommendation from the TEP to consider length-of-stay as a risk-adjustment factor, including the differences between a 4-day length of stay and a 6-month length of stay.”
One TEP member cautioned that using payment sources, IV therapy, and risk of hospitalization as risk adjustors might tempt some hospices to use them to distort a hospices’ apparent care quality.
TEP members did not recommend using as risk adjustors gender, clinical symptoms, functional status and management of care needs. They did not discuss why they rejected gender, but several agreed that using clinical symptoms would not be of value because of their high correlation with diagnoses. Because hospice providers typically see hospice patients decline in ADL and IADL abilities, and hospice goals are focused on comfort rather than functional improvement, functional status was on the TEP’s “Do Not Include” as a risk adjustor list. And finally, one TEP member strongly opposed adjusting for patients’ medication management, supervision or safety assistance needs (management of care needs), explaining that “the public and CMS should hold hospices accountable for planning around oral medication, injectable medication management, and supervision and safety assistance,” the report says.
The TEP did suggest that using some risk adjustment factors as part of the HQRP could assist hospices internally with quality improvement while others would be more valuable to patients and families. For example, Patients and families would benefit from more straightforward risk adjustment that helps them select a hospice,” the report says, “including factors such as diagnosis. For publicly reported data used to select a hospice, the TEP suggested using demographic factors (including age but excluding gender), socioeconomic factors, living situation, and diagnoses.”
Dr. McNally hopes eventually to use HPRP data to promote Intermountain Hospice’s care. Intermountain Hospice is part of Intermountain Health, a health care provider with presence in multiple states. “You can’t take the current metrics to doctors’ offices and families to show anything meaningful,” he says. “It’d be great to have metrics we could take to our neurology docs and other docs,” he says. “I really think we provide better care and more options when patients stay within our system.
This article is the first in a series about implementation of HOPE. Next week, Beth Noyce shares details from the panel as it evaluated process measures.
HealthRev Partners Launches Velocity as a SAAS, Transforming Revenue Cycle Management for the Home Health and Hospice Industry
Meta: Discover how HealthRev Partners’ innovative SAAS solution, Velocity, is transforming revenue cycle management in the healthcare industry. Gain insights into its key advantages, AI capabilities, and data exchange interface engine feature set. Learn how Velocity empowers agencies with transparency, efficiency, scalability, and security to enhance profitability and operational excellence. Contact HealthRev Partners for a demo and revolutionize your revenue cycle management today.
Ozark, MO – April 1st, 2024 – HealthRev Partners, a leading innovator in healthcare technology, has announced the launch of Velocity as a Software as a Service (SAAS), revolutionizing revenue cycle management in the home health, hospice, and palliative care industries. This game-changing solution is designed to transform revenue cycle management (RCM) for multi-site agencies. In an era where the aging population in America increasingly desires to age in place, mergers and acquisitions in the home health space are driving the necessity for centralized data and operational processes. The trend of overseas hiring to reduce costs has created gaps in insights, emphasizing the critical need for real-time data to impact care promptly.
Michael Greenlee, Founder and CEO of HealthRev Partners, expressed his enthusiasm about the launch, stating, “Velocity as a SAAS represents a significant leap forward in revenue cycle management technology. By offering agencies unprecedented insights into their operations and empowering them with tools for optimization and growth, HealthRev Partners is setting a new standard in RCM solutions.”
Empowering Multi-Site Agencies and Enhancing Management Insights
As multi-site agencies navigate the complexities of managing diverse locations and teams, the demand for comprehensive insights and seamless integration becomes critical. HealthRev Partners recognizes this challenge and introduces Velocity as a SAAS to address the evolving needs of growing agencies. With a focus on providing real-time analytics and enhancing operational efficiency, Velocity bridges the gap between disparate locations and centralizes data for streamlined management.
Seamless Integration with Any EHR System
A key component of Velocity is the data exchange interface engine feature set. The ability to connect, integrate, translate, and import financial, claims, coding, clinical, operational, EHR, clearinghouse, and diverse data sets is vital for any organization. Velocity uses its proprietary interface technology engine along with robotic processing technology (RPA) to connect all disparate data sets within Velocity resulting in actionable data at your fingertips.
AI Capabilities to Increase Coding Accuracy
Velocity harnesses AI capabilities to automatically assign charts to coding professionals, enhancing efficiency and accuracy. By leveraging artificial intelligence, it streamlines the ICD-10 coding process and provides intelligent suggestions for selecting codes at the highest level of specificity to maximize reimbursement. Additionally, it utilizes advanced algorithms to analyze data and offer insights into PDGM-approved primary codes and comorbidity adjustment categories. Furthermore, Velocity’s AI-driven system assists in risk and comorbidity adjustments by recommending compatible code combinations and presenting primary and secondary code sets to facilitate precise coding decisions.
Key Advantages of Velocity:
Increased Transparency and Visibility: Real-time insights into all aspects of the revenue cycle across multiple sites. Identify bottlenecks, track productivity, and optimize operations seamlessly.
Enhanced Efficiency and Accuracy: Streamlined processes and standardized procedures that ensure consistency across all locations. Improve accuracy in coding, claim submission, and reimbursement.
Improved Communication and Collaboration: Facilitate real-time data sharing between clinical, financial, and operational teams at different sites. Enhance collaboration and decision-making.
Scalability and Security: Easily scale operations to accommodate growth needs while maintaining top-tier data security standards. Ensure compliance with regulatory requirements across all locations.
Michelle Mullins, MHA, BSN, RN – Partner & Chief Operating Officer of HealthRev Partners, highlighted the transformative impact of Velocity by stating, “Velocity illuminates your RCM’s path to predictable revenue. It empowers agencies with granular insights, customizable control, streamlined operations, and trustworthy security. This tool is not just a solution; it’s a revolution in revenue cycle management.”
The launch of Velocity as a SAAS marks a pivotal moment for agencies seeking to optimize their revenue cycle processes. With its focus on transparency, efficiency, communication, scalability, and security features, Velocity is poised to reshape how agencies manage their RCM operations.
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For more information about Velocity as a SAAS or to schedule a demo, visit HealthRev Partners’ website.https://healthrevpartners.com/
by Bryan Robinson, PH.D. Contributor author of Chained to the Desk in a Hybrid World: A Guide to Balance
April is National Stress Awareness Month with the goal of raising awareness of the impacts of stress. According to the American Psychiatric Association, 26% of respondents anticipate they will be more stressed in 2023 and their mental health will be worse. Two out of five adults ranked their mental health from “fair” to “poor.” When you have fewer stressors, you have increased emotional stability, better moods and overall superior health. This month is a time to pay special attention to how you can remain stress-free throughout your workday, and you can do that in very simple ways. You don’t have to quit your day job or even work fewer hours. You can continue your daily work routines while practicing stress reducers at the same time. The one thing you must do is have a stress awareness plan that you can practice at work.
A Stress Awareness Plan Keeps Job Stress At Bay
My 2023 New Years Resolution was to do one kind thing each day for someone—especially strangers. It has heightened my awareness of how important and easy it is to be kind to others without taking extra time. Plus, how simple it is to practice and how good it makes me feel (and hopefully the other person) in just minutes. A work stress awareness plan has the same effect. Here’s how it works. Simply choose one thing to commit to each day that you can accomplish in three to five minutes to mitigate stress during your workday.
A max of five minutes of chill a day can have mental and physical benefits to keep you engaged, calm and energized on the job. These short work breaks lead to higher job engagement and performance as well as better sleep, increased immunity, lower blood pressure, improved digestion and increased emotional well-being. In fact, research from scientists at North Carolina State University shows the value of what I call Microchillers or taking what the researchers call Microbreaks throughout the workday. These short breaks—I recommend five minutes or less—are effective energy management strategies as simple as stretching, walking up and down stairs, gazing out a window at nature, snacking or having a five minute mindful meditation.
Viventium Releases its 2024 Caregiver Onboarding Experience Report, Demonstrating a Need to Raise the Bar for Onboarding in the Post-Acute Care Industry
BERKELEY HEIGHTS, N.J., April 02, 2024 (GLOBE NEWSWIRE) — Viventium, the leading SaaS-based human capital management platform serving the post-acute care industry, released its 2024 Caregiver Onboarding Experience Report, a comprehensive research study analyzing survey responses from 175 post-acute care administrators and 220 caregivers. The report finds a shockingly low bar for what passes as a “good” onboarding experience in home-based and facility/community-based care, with strong indications that raising that bar could correlate to higher retention rates.
“Staffing shortages and high turnover rates within post-acute care are recurring issues in need of solutions,” said Navin Gupta, Viventium CEO. “Our research illuminates a crucial pathway towards addressing these persistent challenges, and it begins with onboarding.”
Findings point to post-acute care managers and administrators having a major impact on the steps their organization can take to better engage, motivate, and retain its caregiving staff.
“The study significantly advances our knowledge of what it takes to recruit and retain caregivers in today’s highly competitive workforce market. The onboarding process is fully within the control of the employer, and the study shows that doing it right pays dividends. Most notably, many of the elements of successful onboarding are simple improvements in the process that bring a real return on investment. I would encourage all of home care to learn from this study.”
About Viventium
Viventium provides a SaaS-based human capital management solution that is focused on the post-acute care industry. The company’s mission is to enrich the lives of caregivers through technology so they love going to work every day. By providing specialized software and expert guidance, Viventium helps its clients throughout the lifecycle of each caregiver. The company has clients in all 50 states and supports over 420,000 client employees each year.
Stakeholders praised the DEA for their leadership and actions taken to ensure continued patient access to care be delivered through telemedicine in advance of the final telemedicine regulations expiring at the end of this year. The letter also urged DEA to propose the updated rules immediately for the following reasons:
To ensure stakeholders have adequate time to provide feedback on any policy proposal.
If DEA were to create a special registration process for telehealth prescribers, as proposed by DEA and many stakeholders, substantial operational lead-time would be needed to implement the new process and comply with other potential operational requirements and guardrails.
A rulemaking late in the year that makes significant policy changes would affect the ability of patients and clinicians to make appointments and ensure consistent access to care.
There will be operational staff training needs for pharmacies and other parts of the healthcare delivery system to ensure patients uninterrupted access to needed medical treatments offered through telehealth.
DEA’s national leadership is needed to set a clear path forward for the nation and to encourage more consistent definitions and aligned requirements from state regulatory bodies – to encourage care in our most underserved areas, without geographic barriers limiting access to care.
INNOVATION TAKING CENTER STAGE AT ATA NEXUS 2024: 12 FINALISTS PRESENTING LIVE AT ATA TELEHEALTH INNOVATORS CHALLENGE
ATA Nexus Annual Conference, May 5-7, Phoenix, AZ
WASHINGTON, DC, MARCH 28, 2024 – The American Telemedicine Association (ATA) today announced the 12 finalists who will be presenting live at the Telehealth Innovators Challenge, where the future of healthcare meets creativity and innovation, at ATA Nexus 2024, May 5-7 in Phoenix, AZ. The ATA Telehealth Innovators Challenge is an exclusive opportunity for early-stage virtual care developers to showcase their novel solutions in front of key stakeholders, investors and decision-makers driving the future of healthcare.
The 12 innovators presenting in the final round of the Telehealth Innovators Challenge will highlight the latest digital health innovations to help eliminate gaps in access to care:
Femtech and Women’s Health:
Leva Pelvic Health System – Axena Health
Nest Collaborative
The Future of Maternal Care – Bloomlife
In-patient Care Solutions:
Oshi Health Virtual GI Center of Excellence
ThinkAndor – Andor Health
DermEngine AI-Powered Care Coordination – MetaOptima Technology, Inc.
The Patient Experience:
Vori Health
The TeleDentists
ThriveLink (formerly Nutrible)
Tools That Deliver Care:
CardioSignal
Alio Remote Monitoring Platform
Strados Labs RESP Biosensor
Meet the Innovators Challenge Judges:
Samir Batra, BAHA Enterprises; HIP; ATA Advisor (Emcee)
Kiran Avancha, PhD, HonorHealth Innovations
Amit Aysola, Create Health Ventures
Joe Brennan, TytoCare
Christine Brocato, CommonSpirit Health
Adam Dakin, Medivation Advisors
Tracy Dooley MD, Avestria Ventures
Charlotte Gabet, Parkview Health
Jon Gabriel, Foley & Lardner
Nancy Green, The SAA Group, LLC
Rick Hall, PhD, Mayo Clinic/ASU MedTech Accelerator
Saira Haque, PhD, Pfizer Medical Affairs
Jennifer Joe, MD, AstraZeneca
Aditi U. Joshi, MD, Digital Health Consultant
Connor McDermott, A1 Health Ventures
Kate Merton, PhD, ChicagoArc
Matt Miller, PhD, Headwater Ventures
Yuriy Oinyskiv, Orlando Health Ventures
Maxim Owen, Wavemaker Three-Sixty Health
Rakesh Patel, MD, Good Samaritan Hospital
Julia Monfrini Peev, PACE Healthcare Capital
Shravan Rai, Teladoc Health
Lygeia Ricciardi, AdaRose
Julianne Roseman, Plug and Play
Matthew Sakumoto, MD, Sutter Health-West Bay Region
Mayank Taneja, OSF Healthcare
Kristen Valdes, b.well
Elliott Wilson, Flying Pig Consulting
Keith Winter, Teal Ventures
Emily Zhen, Zeal Capital Partners
Anthony Zlaket, Tampa General Hospital
Jeff Zucker, Digital Health Entrepreneur/Investor
ATA Nexus features three full days of dynamic content, including new programming formats and interactive sessions that will explore The Next Chapter in Virtual Care, including interactive sessions, collaborative workshops, a bustling exhibit floor and networking and social events that will spark curiosity, foster learning, and ignite transformative discussions, including:
Four Deep Dive sessions on the hottest topics in virtual care, plus NEW! Telehealth 101 Bootcamp
Over 80 Oral and Poster Research Presentations with CME
NEW! System Spotlights featuring leading hospital systems on the forefront
NEW! Curbside Consult sessions, engaging and informal “consults” with clinicians and industry experts
Annual Telehealth Innovators Challenge live pitch competition
NEW! Meet the Experts lounge in the ATA Hub
NEW! Insights Workshop on Virtual Nursing for senior nursing leaders
Plus over 300 speakers, hundreds of sponsors and exhibitors, and an audience packed with telehealth and virtual care stakeholders
GENERAL REGISTRATION: For more information or to register, please visit the ATA Nexus 2024 website for details and easy online registration.
MEDIA REGISTRATION: Register to attend ATA Nexus 2024 hereand use comp code ATA24PRMEDIA to receive complimentary press credentials. Or contact Gina Cella at gcella@americantelemed.org.
About the ATA
As the only organization completely focused on advancing telehealth, the American Telemedicine Association is committed to ensuring that everyone has access to safe, affordable, and appropriate care when and where they need it, enabling the system to do more good for more people. The ATA represents a broad and inclusive member network of leading healthcare delivery systems, academic institutions, technology solution providers and payers, as well as partner organizations and alliances, working to advance industry adoption of telehealth, promote responsible policy, advocate for government and market normalization, and provide education and resources to help integrate virtual care into emerging value-based delivery models.
Average 2023 hourly rate for home health aide increased 5.2%
Hourly per visit nurse rate decreased 1.6% with facility prices mixed
Washington and New Hampshire most expensive states for home health aides
illumifin’s comprehensive study provides insight which empowers consumers, insurers, and providers by benchmarking the prices of senior care.
WOODBURY, Minn., March 27, 2024 /PRNewswire/ — illumifin, the leading insurance administration and claims solution provider for long term care (LTC) insurance, has just released its 2023 Cost of Care study and comprehensive analysis. Now in its tenth year, this longitudinal study includes national, state and regional costs of various care services, spanning skilled nursing, adult day care, home health care and assisted living facilities.
illumifin’s Cost of Care study gathers tens of thousands of data points from care providers nationwide, with results normalized by the company’s in-house actuarial and data science teams. Insurers and financial services providers rely on this data for both forecasting and stakeholder education as well as informing customers and agents about national and regional cost variations. In addition, care providers benefit from understanding the market rates for services in their area. These insights are also accessible via illumifin’s What Care Costs website, which offers interactive maps and projection tools to sort, rank and evaluate average costs of LTC services across the US.
illumifin’s study found that the average hourly rate for a home health aide in 2023 was $30.62, an increase of 5.2 percent over the prior year. Meanwhile, the average per-visit rate for a registered nurse in 2023 was $147.72, a decrease of 1.6 percent over the prior year, potentially reflecting rates beginning to normalize post pandemic.
The research also shows facility prices were mixed. The average assisted living facility rates increased between 0.6 and 3.8 percent in 2023 depending on room type, reversing course from the pandemic where assisted living facility rates had been trending downward. However, skilled nursing facility rates experienced a small decrease in 2023 between 0.4 and 1.0 percent.
The most expensive states for home health aides were Washington and New Hampshire, whereas Mississippi and Louisiana were the least expensive. Meanwhile, the most expensive assisted living rates were found in New Hampshire and New Jersey, while the lowest assisted living prices were found in Alabama and Oklahoma.
“We are proud to leverage our 30 years of experience in senior care to provide actionable data for insurers, consumers, providers and financial institutions,” said Peter Goldstein, illumifin’s President and CEO. “Our focus remains on customer centric initiatives which assist in managing risk and planning for the future. Our Cost of Care survey has proven valuable to not only to our business partners but providing valuable knowledge to consumers and their families as they navigate the maze of service types when making care decisions.”
The study, interactive tool and data are available for use by insurers, providers and financial services firms. For more information regarding illumifin’s Cost of Care Study, please contact Jennifer Frost via email at jenniferfrost@illumifin.com.
About illumifin illumifin provides third party administration and technology services to individual and group insurers. The company, launched in 2021, blends insurance industry knowledge, technology leadership and operational execution to prepare insurers for the digital future. illumifin is a diverse, passionate and empowered team of insurance specialists committed to the growth and success of its customers. With illumifin, there’s a brighter future. Visit www.illumifin.com.
Contact: Chris Tofalli Chris Tofalli Public Relations, LLC 914-834-4334
NEW REPORT FINDS THAT DIGITAL DIABETES MANAGEMENT TOOLS FAIL TO DELIVER MEANINGFUL HEALTH BENEFITS TO PATIENTS WHILE INCREASING SPENDING
Independent evaluation from Peterson Health Technology Institute recommends new directions for digital diabetes solutions
NEW YORK — Peterson Health Technology Institute (PHTI), an independent organization that evaluates healthcare technologies to improve health and lower costs, today released a new evaluation of digital diabetes management tools. These solutions are used by millions of Americans and have been funded by $58 billion of investment and mergers and acquisitions, yet the evidence shows that the technologies do not deliver meaningful clinical benefits, and result in increased healthcare spending.
The analysis, conducted by a team of health technology assessment experts and informed by clinical advisors, evaluated eight widely used digital tools that people with Type 2 diabetes use to track and manage blood glucose using a noncontinuous glucometer.
The report found that people who use these tools achieve only small reductions in hemoglobin A1c (HbA1c) compared to those who do not, and these reductions are not sufficient or sustained enough to change the trajectory of their health, care, or long-term prognosis, including cardiovascular risks. The solutions also result in increased overall healthcare costs. One promising solution, Virta, supports nutritional ketosis to achieve diabetes remission in patients who follow the rigorous diet modifications.
“When these digital diabetes management tools launched more than a decade ago, they promised to improve health outcomes for people with diabetes and deliver savings to payers. Based on the scientific evidence, these solutions have fallen short, and it is time to move toward the next generation of innovation,” said Caroline Pearson, executive director of PHTI. “Patients with diabetes invest time, energy, and resources in these tools, and they deserve to experience meaningful, positive benefits for their health. The healthcare sector as a whole needs transparent, accurate information about the clinical and economic impact of these digital tools that are taking up precious healthcare dollars.”
PHTI’s rigorous analysis incorporated an evidence-based assessment framework and review of more than 1,100 articles, including 120 submitted to PHTI by companies evaluated in the report. PHTI’s ratings are at the category level, including remote patient monitoring solutions that support providers, and behavior and lifestyle modification solutions that engage users to improve their diet, exercise, and self-management.
HbA1c is the standard form of measurement of glycemic control in diabetics. The studies show that these digital tools deliver small reductions in HbA1c of 0.23 to 0.60 percentage points compared to usual care. These results are generally below industry standards for Minimal Clinically Important Difference (MCID) of 0.50 percentage points. Further, the evidence indicates that this small improvement is not durable because the reduction is not sustained over time.
Additionally, PHTI’s analysis did not find evidence to demonstrate that digital diabetes management tools improve other health factors, including weight loss, body mass index, blood pressure, cholesterol, or other common conditions impacting people with diabetes. The analysis also concluded that, despite the disproportionate impact of diabetes on low-income and racially and ethnically diverse communities, these tools are not currently being deployed in ways that improve health equity.
PHTI’s evaluation further determined that these tools increase net healthcare spending. This is due to the fact that price for the solutions exceeds the associated healthcare cost savings, because the minimal clinical benefit does not enable the patient to avoid other care or treatments. For patients using tools in the remote patient monitoring category, annual spending is projected to increase by $2,002 for commercial insurance patients, by $1,011 for Medicare patients, and by $723 for Medicaid patients, as a result of higher provider payments. For patients using tools in the behavior and lifestyle modification category, annual spending is estimated to increase by $484 for commercial insurance patients, by $513 for Medicare patients, and by $574 for Medicaid patients. For all payers, the increased spending associated with virtual diabetes solutions has a significant impact on total spending given how many people are eligible to use the solutions, including 4.3% of those with commercial insurance, 17.0% of those with Medicare, and 4.8% of those with Medicaid.
In addition to its scientific literature review, PHTI proactively engaged the companies included in the report and provided an opportunity for them to share data and product information. Companies in PHTI’s evaluation include DarioHealth, Glooko, Omada, Perry Health, Teladoc (Livongo), Verily (Onduo), Vida, and Virta. The evaluation considered evidence about which populations stand to benefit the most from using the technology, as well as the durability of clinical impacts given the importance of sustained glucose control to achieve health benefits. The economic analysis modeled expected healthcare savings resulting from improved glycemic control for patients using digital diabetes management solutions who are enrolled in Medicare, Medicaid, and commercial insurance.
PHTI identified two potential bright spots for digital diabetes management tools. Initial data showed that Virta users are much more likely to achieve clinically meaningful benefits in glycemic control, including diabetes remission and the ability to reduce or eliminate their diabetes medications, if they can maintain the rigorous dietary requirements of the intervention. The other area of greater potential is among patients with higher starting HbA1c levels who are newly starting insulin. By engaging these patients at an early critical transition point in their care, digital solutions could have more impact by helping establish good self-management habits among these higher-risk patients.
In the United States, about one in seven adults—more than 38 million living in the U.S.—has Type 2 diabetes, which is the eighth leading cause of death. At over $400 billion of total healthcare spending annually, diabetes is the most expensive chronic condition to treat and manage. Given the critical role of patient self-management, investment in digital health tools has surged in recent years.
Throughout the assessment process, PHTI worked with a range of independent evaluation partners, clinical advisors, patients with Type 2 diabetes, and other stakeholders. Report contributors and reviewers included:
Curta: assessed the clinical and economic impact of these technologies using the published ICER-PHTI Assessment Framework for Digital Health Technologies, including the systematic literature review and budget impact assessment
Charm Economics: identified what technologies cost to deliver, how they work, and their impact on patients and purchasers
Institute for Clinical and Economic Review (ICER): co-developed the ICER-PHTI Assessment Framework for Digital Health Technologies, and was consulted to review its implementation in this report
Ami Bhatt, MD, chief innovation officer of the American College of Cardiology
Richard Milani, MD, chief clinical innovation officer, Sutter Health; former innovation lead at Ochner Health System
Karen Rheuban, MD, co-founder and director of the University of Virginia Center for Telehealth
“Managing diabetes is complex and essential to future cardiovascular health. Patients will gain agency and drive better clinical benefit if they direct their time and effort towards effective interventions rather than tools that provide marginal or no benefit,” said report contributor Ami Bhatt, MD, chief innovation officer of the American College of Cardiology.
“New diabetes technologies need to be easier to use, by the people who need them most, at lower cost than standard care, and provide real health benefits,” said report contributor Richard Milani, MD, chief clinical innovation officer at Sutter Health. “This evaluation suggests there is room for new innovations that deliver for patients and address worrying increases in healthcare spending.”
The PHTI report provides recommendations and best practices for innovators, providers, and payers. The next generation of diabetes management solutions should aim for clinically meaningful improvements in glycemic control, potentially integrating continuous glucose monitors and new GLP-1 obesity medications. Solutions should also generate sufficient evidence to support broader adoption, and they should prioritize access for populations who need them most. Providers of diabetes care should have clarity about the performance of these digital solutions when recommending them to their patients. Payers, including health plans and employers, should adapt their contracting approach to require transparency about the solution’s usage and benefits within their covered population and to include financial performance guarantees tied to clinical outcomes.
“PHTI is filling an important role in delivering actionable and market-facing information to digital health purchasers about what solutions will make a meaningful impact on health outcomes for members, making them worth investment,” said Peter Long, PhD, executive vice president, Strategy and Health Solutions at Blue Shield of California and a PHTI Advisory Board member. “Having an organization like PHTI cut through the noise of digital health options helps payers make faster and more effective decisions for members so that we can focus on the big work of transforming the healthcare system.”
PHTI has announced that future assessment areas include virtual physical therapy, blood pressure monitoring, and mental health tools.
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About the Peterson Health Technology Institute
The Peterson Health Technology Institute (PHTI) provides independent evaluations of innovative healthcare technologies to improve health and lower costs. Through its rigorous, evidence-based research, PHTI analyzes the clinical benefits and economic impact of digital health solutions, as well as their effects on health equity, privacy, and security. These evaluations inform decisions for providers, patients, payers, and investors, accelerating the adoption of high-value technology in healthcare. PHTI was founded in 2023 by the Peterson Center on Healthcare. For more information, please visit PHTI.com.
Late on Monday, March 4, the Center for Medicare and Medicaid Innovation (CMMI) announced it plans to formally end the Value-Based Insurance Design (VBID) Medicare Advantage hospice “carve-in” demonstration on December 31, 2024, and that it will not accept applications to the previously released CY 2025 Request for Applications (RFA) for the hospice component of the Model. In its announcement, CMMI stated that it made the decision to terminate the demo “after carefully considering recent feedback about the increasing operational challenges of the Hospice Benefit Component and limited and decreasing participation among MAOs that may impact a thorough evaluation”. CMMI recently solicited input on the carve-in via a public request for information (RFI).
NAHC was pleased to be able to provide detailed comments to the RFI highlighting our members’ ongoing concerns and frustrations with the demonstration and registering our deep skepticism that the model was necessary or appropriate for hospice patients and families. We are pleased to see CMMI has decided to end this particular demo, and we look forward to continuing to work with them to advance innovation in care delivery and payment models for people with serious illness.
Since the carve-in was first announced, NAHC has maintained our strong opposition to the premise that incorporating hospice into the Medicare Advantage was necessary or would lead to positive outcomes. In 2019, NAHC emphasized our “unqualified opposition” to the program when it was first unveiled, and after more details were released in the model’s first request for applications (RFA); We have continued to stress our concerns since model implementation began, working with our hospice members to solicit feedback and translate those experiences into direct advocacy with CMS, CMMI, and members of Congress. As early evaluation data and inputs highlight, the model has been extremely burdensome for both hospices and participating plans, and has had no measurable positive impact on beneficiary or family outcomes, care experiences, or Medicare spending.
In the announcement about the model’s termination at the end of 2024, CMMI stated that the decision is not a result of the demo “not meeting its goals”, and that the agency will continue its evaluations of the hospice component to assess its overall impact. Over the course of the three years of the model, it was clear to NAHC that the demo was not meeting CMMI’s stated goals to drive greater care continuity and higher quality hospice care for beneficiaries and families. We also questioned the premise that a carve-in would save the Medicare program money in the long run. Contrary to what the VBID evaluators found, the seminal 2023 NORC research demonstrated that hospice utilization in the traditional Medicare program saves billions of dollars a year while delivering high-quality care.
CMS also indicated in their notification that later this year, they will issue additional guidance to ensure that “all obligations of any impacted organization may be met in a timely and reasonable manner so that hospice beneficiaries in the Hospice Benefit Component maintain a coordinated, seamless care experience.” NAHC will be following up directly with CMMI to better understand what may be included in this guidance and when it may be released.
Increasing access to hospice care remains NAHC’s primary policy goal. We are committed to working to improve more timely connection to hospice, reducing the percentage of very short stays that make it difficult to benefit fully from the hospice model, and ensuring every provider is capable of delivering high-quality, person-and-family-centered services. We appreciate our engagement with CMMI on the carve-in over the years, and we welcome the opportunity to collaborate with them on new ways to support seriously and terminally-ill people and their families.
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