In brief: Allina Health partnership, TRICARE appeal, DME scams

MINNEAPOLIS – Allina Health has partnered with venture capital firm Flare Capital Partners to launch Inbound Health, a new company that enables health systems and health plans to offer hospital-at-home and skilled nursing-at-home programs. 

Allina Health and Flare Capital are leading a $20 million fundraising round for Inbound Health to scale successful acute care-at-home programs nationally through their unique partnership model, they say. 

“The home hospital programs that we’ve scaled to thousands of patients here in Minnesota are rooted in our Population Health drivers of delivering safe, high quality, affordable care that’s timely and convenient to access,” said Lisa Shannon, president and CEO of Allina Health, which has more than 90 clinics, 12 hospitals and 14 retail pharmacies. “We are excited for Inbound Health to leverage the capabilities and know-how that power these programs to scale similar at-home programs across the nation.” 

To date, more than 4,200 patients across 185 primary diagnoses have been cared for through Inbound Health, which has been operational in Allina Health’s service area since May 2020. The program combines biometric monitoring, digital surveillance, in-home nursing and therapy, virtual visits with hospitalists and geriatricians, and a comprehensive supply chain. 

Inbound Health, which will be led by CEO Dave Kerwar, formerly of Mount Sinai Health System, says it lowers total-cost-of-care by 30% to 40% on a risk-adjusted basis, while achieving similar or improved clinical outcomes when compared to traditional facility-based care. These outcomes have enabled Inbound Health and Allina to develop unique episodic-based payer contracts with multiple commercial and Medicare Advantage payers in Minnesota, a model that the company plans on replicating with partners in other markets. 

“We are proud to be backed by one of the most prestigious health systems and one of the largest dedicated health care technology venture capital firms in the country in our pursuit to revolutionize this new level of care,” said Kerwar. “Inbound Health will leverage the clinical, operational and technology assets that we’ve developed alongside Allina Health to enable our customers nationwide to safely offer facility-level care in the home, at a lower cost and with an elevated patient and caregiver experience.” 

NCPA appeals to DOD 

ALEXANDRIA, Va. – A recent decision by Express Scripts to eliminate the option for TRICARE beneficiaries to obtain their prescriptions at their pharmacy of choice should be rectified to ensure continued access to needed medications, the National Community Pharmacists Association stated in a letter to U.S. Defense Secretary Lloyd Austin. 

Express Scripts, the Cigna-owned pharmacy benefit manager that administers the TRICARE benefit on behalf of the DOD, recently announced changes effective Oct. 24 that would shrink its retail pharmacy network by 15,000 pharmacies, mostly independent community pharmacies located in underserved rural and urban areas. The change impacts 400,000 beneficiaries, according to the NCPA. 

“TRICARE patients earned their benefits, and it is imperative that they retain convenient access to their health care providers,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA, in his letter to Austin. “With a vast majority of independent pharmacies out of the network, along with large chains such as Kroger and Walmart, it is difficult to see how Cigna/Express Scripts is meeting even the reduced access standards in its new contract with DOD. We, therefore, urge you to take steps to ensure all pharmacies that were included in the 2022 Tricare network remain in the 2023 network at the 2022 terms and conditions. Without this action, access to needed medications for Tricare beneficiaries is in peril.”  

The appeal follows significant outreach from NCPA to DOD officials to address how the agency intends to take care of the medication needs of TRICARE beneficiaries, to inform them of what community pharmacy owners are reporting on these issues, and to work with them to protect pharmacy access for those who serve or have served in the armed forces.  

NCPA has been engaged on this issue with legislators, as well, which has resulted in several members of Congress demanding answers on TRICARE pharmacy contracts and the consequences for their constituents. 

For a one-pager from the NCAP with more information on the changes and what they will mean for patients and small-business pharmacies, click here. 

BCBS of Massachusetts warns against DME scams 

BOSTON – Blue Cross Blue Shield of Massachusetts is warning members to be vigilant, as scams offering free DME and pharmacy products are on the rise. Medicare beneficiaries and patients who've had a recent injury or surgery are often targeted by scammers, it says. In many cases, the perpetrators solicit physicians to sign off on unnecessary orders or prescriptions, such as back braces or pain cream, which are then improperly billed to a patient's health insurer. "While these types of scams have been around for years, the uptick in telemedicine usage during the COVID-19 pandemic is causing a resurgence in fraud," said Jennifer Stewart, senior director for fraud investigation and prevention at Blue Cross Blue Shield of Massachusetts. "Members should treat their medical information like their credit card number and if they're unsure, they should call their clinician to confirm if a service or product is necessary.” Blue Cross members who suspect, experience or witness health care fraud should report the information by calling the number on the back of their member identification card. Consumers who are not Blue Cross members can call the company's fraud reporting hotline at 1-877-327-BLUE (2583).  

Alan Morris returns to VGM 

WATERLOO, Iowa – Alan Morris has re-joined the VGM Government Relations team as director of research and strategy. Morris previously worked for VGM from 2007-14. “I am excited to be coming back to VGM and seeing all of the ways the VGM has adapted and changed during my time away,” Morris said. “Additionally, I am excited to be placed in a position where I will be able to bring knowledge of regulations, analytics, and consulting to help navigate the ever-changing industry.” Prior to re-joining VGM, Morris led a team of internal consultants and analysts at a large midwestern health system. In his new role at VGM, he will focus on industry trends and advising providers on the impact of certain industry regulations. “We are thrilled to have Alan back with the VGM family,” said Mike Isaacson, SVP of Operations, VGM & Associates. “His knowledge of healthcare systems and strategy are part of our efforts to continue to be on the forefront of industry trends. Alan’s insights and expertise will bring even more opportunities to our members and industry partners.”  

 IHCS receives award for outcomes platform 

MIRAMAR, Fla. – Integrated Home Care Services, an independent administrator of home health, DME and home infusion benefits, has announced that its MedTrac Home Insights and Outcomes Platform has received the silver award for the Home Care Innovator of the Year as part of the 2022 McKnight’s Excellence in Technology Awards program. The annual program celebrates outstanding innovation by skilled nursing, senior living and home care providers. "We developed MedTrac to better support our mission of providing the highest quality home care services to patients, providers and health plans,” said Christopher Bradbury, CEO of IHCS. "The web-based utilization management tracking system provides real-time transparency through every step of a patient's journey, enhancing and streamlining care management and ensuring our health plan partners, patients, and our network providers have access to accurate, up-to-date and critical insights.” The MedTrac platform includes numerous supporting modules that enhance communication and integration across IHCS's provider network, provide real-time access and documentation to its health plan partners, and enhance data accuracy and interoperability. With MedTrac, IHCS has been able to optimize authorization workflows, having more than 23 million home care authorizations delivered within their DME and home health services lines as of the end of March 2022. 

AOPA names first recipient of Professor Hans Georg Näder Digital O&P Care Award 

ALEXANDRIA, Va. – The American Orthotic and Prosthetic Association is pleased to announce David Boone, PhD, MPH, as the recipient of the first Professor Hans Georg Näder Digital O&P Care Award. The award was established this year by a gift from Ottobock Healthcare in honor of Professor Hans Georg Näder and his many contributions to the field of orthotics and prosthetics worldwide. The purpose of the award is to prepare the O&P profession for the future as digital care and innovations in technology continue to lead the direction of patient care. “Dr. Boone has spent decades contributing to research in the digital space,” said David McGill, president, AOPA. “He has been involved with CAD development, microprocessor component development, outcomes data collection, management, and much more.” The award was presented to Dr. Boone in conjunction with the 2022 AOPA National Assembly in San Antonio. 

NCPA files brief defending Oklahoma PBM law 

ALEXANDRIA, Va. – The National Community Pharmacists Association, the American Pharmacists Association and the National Association of Chain Drug Stores, along with American Pharmacies and the Oklahoma Pharmacists Association, have filed an amicus curiae brief defending the rights of states to pass and enforce laws protecting patients and community pharmacies from pharmacy benefit manager practices. In 2019, the Oklahoma legislature passed the Patient’s Right to Pharmacy Choice Act to protect access to pharmacy providers and protect those pharmacies from PBMs. The new law was soon challenged in court by the Pharmaceutical Care Management Association. In early April, the U.S. District Court for the Western District of Oklahoma ruled largely in favor of the state of Oklahoma and Insurance Commissioner Glen Mulready, upholding most of the Oklahoma statute against a federal preemption challenge. PCMA appealed that decision to the U.S. Court of Appeals for the Tenth Circuit, asserting that only four of the provisions are preempted by ERISA and Medicare Part D. The joint amicus brief notes that, “The law at issue here, the Oklahoma Patient’s Right to Pharmacy Choice Act, addresses a subset of the business practices of PBMs that have inhibited safe, cost-effective and convenient access to pharmacy care.” 

Soleo Health ranks eighth among fastest-growing companies 

FRISCO, Texas – Soleo Health, a national provider of complex specialty pharmacy services, has ranked eighth on Dallas Business Journal’s eighth annual list of the 50 Fastest-Growing Middle Market Companies across the Dallas-Fort Worth area. “Soleo Health earned a spot in the top 10 based on our organic growth; geographic expansion; increases in therapeutic programs; and the forging of new relationships with pharmaceutical manufacturers, health insurance plans and health systems, prescribers and patient advocacy groups,” said Drew Walk, CEO. “Overall, for the 2021 ranking, Soleo Health saw a 110% growth in three-year annual revenue and continued double-digit growth in patient census. The commitment of our entire team played a role in Soleo Health’s inclusion again.” This marks Soleo’s fifth consecutive year appearing in the list of top 10 fastest growing companies in North Texas, one of the country’s largest metropolitan growth areas and highly competitive marketplaces. The list was based on revenue growth over the three-year period spanning 2019, 2020 and 2021. 

TwelveStone expands access to home infusion 

MURFREESBORO, Tenn. – TwelveStone Health Partners has announced that its TwelveStone Infusion Support CON application was approved on Sept. 28 for 90 counties in Tennessee. The CON allows the company to provide nursing care for their patients when other home health options aren’t available. "Obtaining this CON further equips TwelveStone to deliver on the promise of a positive and convenient experience for patients who need a higher-level of care," says Shane Reeves, CEO, TwelveStone Health Partners. "This is another way TwelveStone Health Partners is differentiated from other specialty pharmacies in regard to offering the highest level of care to those with chronic and complex conditions." With CON approval, TwelveStone patients will have greater access to receive their medications in their home, complementing infusion services sites currently located in Murfreesboro, Spring Hill, Knoxville and Chattanooga, with more planned in Davidson County. This will benefit the company’s specialist referral partners in all markets, allowing them to provide care in a convenient infusion center located near home or directly in the home for even great convenience.   

OIG recommends increased focus on Medicaid managed care 

WASHINGTON – The U.S. Office of Inspector General recommends that CMS implement a plan to increase Medicaid program integrity activities by the UPICs. The OIG found that UPICs conducted substantially more program integrity work for Medicare FFS than Medicaid in 2019. It also found they conducted only minimal activities related to Medicaid managed care, even though most Medicaid enrollees receive services through managed care. The OIG found that UPICs reported no data analysis projects related to Medicaid managed care and they reported only one fraud referral for Medicaid managed care. “Overall, UPICs conducted disproportionately fewer Medicaid activities compared to the levels of funding they received from CMS for Medicaid program integrity activities,” the OIG stated. The OIG acknowledged that the UPICs faced several challenges that could have contributed to the lower levels of activity in Medicaid, including problems with data availability and quality, and differences across state policies and regulations. At the same time, the OIG found CMS and the UPICs have laid a foundation for improvements, including the development of collaborative processes, analytical codes and new technologies across the UPICs, like the United Case Management system and Major Case Coordination initiative. The OIG recommends CMS make improvements to the UCM system, implement a plan to help ensure the success of MCC for Medicaid referrals and identify the reasons for the unexplained variation in program integrity activities across UPICs. CMS concurred with all recommendations. 

https://oig.hhs.gov/oei/reports/OEI-03-20-00330.asp 

Therapy Choice grows home mods business 

PHILADELPHIA – Therapy Choice, a Medicare Part B provider that specializes in in-home physical and occupational therapy, has enhanced its home modification program through new partnerships with managed care organizations. Under the new partnerships, the company now works with MCOs in Pennsylvania to deliver home evaluations in a timely and thorough manner. “The program makes a difference,” said Michael Gasiewski, OT, co-owner of Therapy Choice. “Our client-reported outcomes are more than 95% positive for helping to improve safety and independence. In addition, partnering with leading health care providers that have a broad adult community brings Therapy Choice new opportunities to provide the best value to our new clients.” Therapy Choice has been a provider for Veterans Affairs for more than 20 years, serving veterans in Pennsylvania and New Jersey. The company has on staff experienced, certified and trained clinicians who have a strong understanding of disease processes and the functional limitations of their clients. They work with elderly and disabled clients to make recommended changes to their homes to overcome barriers, increase safety and reduce the risk of falling, while improving overall function at home. 

USA Wheelchair Rugby Team: ‘We will get better’ 

VEJLE, Denmark – The USA Wheelchair Rugby Team took silver at the 2022 WWR World Championships on Oct. 16, losing to Australia in the gold medal match. It was the first time in 10 years that the USA team advanced to the gold medal match. “We kept our podium streak intact, which is important for our program,” said coach Joe Delagrave. “We pride ourselves on being a podium team, which is so, so hard to do given the level of rugby that was played this week here in Viejle. We came into this World Championship wanting to establish a new culture, a new way to play the game; tonight, we did not play well. We will get better; we have 22 months till Paris and that’s time to build our identity and trust the process.  It is amazing what we have achieved in 11 months. I can’t imagine what we will be able to do in double that time.” If you missed any of the rugby action from Viejle, visit https://worldwheelchair.rugby/2022/10/09/watch-the-2022-wheelchair-rugby-world-championships/ and check in for all the stats and highlights at usawr.org. In addition to the silver medal, Lee Fredette (East Moriches, N.Y.) was named best in class 1.0; Josh Wheeler (Tucson, Ariz.) best in class 2.5 and Chuck Aoki (Minneapolis) best 3.0. 

Apnimed looks forward to Phase 3 studies 

CAMBRIDGE, Mass. – Apnimed, a clinical-stage pharmaceutical company focused on developing oral pharmacologic therapies to treat obstructive sleep apnea (OSA) and related disorders, has announced positive topline results from the MARIPOSA Phase 2b trial – an efficacy, safety and dose-finding study of one-month duration. The results were positive for the company’s lead candidate for OSA, AD109 (atomoxetine + aroxybutynin). The primary endpoint showed a statistically significant reduction in the apnea-hypopnea index (AHI), the standard measure of OSA severity and nighttime breathing, for both doses studied (p<0.001 vs. placebo). Results from the MARIPOSA trial also demonstrated that AD109 improved daytime symptoms caused by OSA and was safe and well-tolerated. Results from this study support dose and endpoint selection for Apnimed’s Phase 3 studies of AD109, anticipated to start in the first half of 2023, following discussions with the U.S. Food and Drug Administration. 

Direct Supply joins AAHomecare’s corporate roster 

WASHINGTON – Direct Supply is AAHomecare’s newest corporate partner. Founded in 1985, the Milwaukee-based, 100% employee-owned company and their 1,300 employees are dedicated to offering world-class solutions and helping health providers thrive. Direct Supply Brands has successfully been supporting the home health industry for the past few years as a manufacturer providing oxygen concentrators, wheelchairs, mattresses, nebulizers, aspirators, walkers and cushions. Most recently Direct Supply partner Nick Bush joined the AAHomecare board of directors. He currently serves as director, business development, for the company. 
  
Axxess receives ACHC product accreditation  

DALLAS – Axxess, a provider of home health, home care and hospice software solutions, has earned ACHC Product Certification from the Accreditation Commission for Health Care. Accreditation is awarded based on a comprehensive evaluation of the product’s ability to meet ACHC standards in administration, operations, fiscal management, human resources, provision of care, quality assurance/performance improvement and risk management. To earn ACHC Product Certification, Axxess participated in a rigorous survey similar to the surveys that agencies experience. The survey evaluated Axxess Home Health, Axxess Home Care and Axxess Hospice for their ability to meet software requirements for each ACHC standard. “By achieving certification of its software, Axxess has demonstrated its commitment to serving home health, home care and hospice providers with high-quality solutions,” said Matthew Hughes, ACHC vice president of corporate strategy.