In brief: Carelon buys CareBridge, 20 reps sign letter, OIG adds reviews

INDIANAPOLIS – Carelon, a division of Elevance Health, recently entered into an agreement to acquire CareBridge, a value-based manager of home and community-based services for chronic and complex members that will serve as the foundation for its home health business, company officials announced during a conference call to discuss its third quarter 2024 financial results. 

"We're excited to continue to serve all its customers and members,” said Gail Koziara Boudreaux, president, CEO and director during the call. “Carelon Services is expanding its capabilities to manage a growing proportion of health care spending, supporting the long-term growth of the business and by extension, the value it creates for health plan customers.” 

Nashville, Tenn.-based CareBridge serves Medicaid and dually eligible patients with physical, intellectual and developmental disabilities by providing 24/7 access to an interdisciplinary clinical team of physicians, nurses, pharmacists and social workers. It provides patients with a tablet so that they, their families and their caregivers can access video visits from the company's clinical team 24 hours a day, seven days a week. 

In 2023, CareBridge took the No. 1 spot on Inc. Magazine's Inc. 5000 list of the fastest growing, privately owned companies in America. The company had grown nearly 5x, expanding from serving about 25,000 patients in July 2022 to serving about 115,000 patients in 2023. 

Currently, CareBridge, which was founded in 2019 by former Center for Medicare and Medication Innovation Director Brad Smith and former Sen. Bill Frist, serves patients in 17 states and the District of Columbia.  

• Related: Earlier this year, Elevance Health and private equity firm Clayton, Dubilier & Rice formed a strategic partnership to bring together certain care delivery and enablement assets of Elevance Health’s business unit Carelon Health and CD&R’s portfolio companies aspree health and Millenium Physician Group.   

Reimbursement relief: Keep pushing for signatures 

WASHINGTON – So far, more than 20 members of the House of Representatives have joined a sign-on letter requesting that CMS re-establish 75-25 blended rates in non-rural, non-competitive bidding areas, according to AAHomecare. 

“Given that Congress is currently out of session and House members are in the final weeks of campaign season, this is a promising start,” the association stated in a bulletin. 

AAHomecare urges stakeholders to continue reaching out to representatives and their staff to ask them to join the sign-on letter, noting that those offices should contact the offices of Rep. Mariannette Miller-Meeks if they’re Republican or Rep. Paul Tonko if they’re Democrat. 

The association says it’s best to use personally drafted emails, but it has provided a template letter here. 

• Related: Why stakeholders need to stay motivated on reimbursement relief. 

Survey: More work needs to be done to support pumping in workplace 

ASHEVILLE, N.C. – Eighty-two percent of working mothers say their workplace could provide more support for breast pumping, according to a new survey from Aeroflow Breastpumps. 

Aeroflow Breastpumps surveyed 667 mothers who have had children within the past two years and are working while breast pumping. 

Improved access to private pumping rooms, better maternity leave policies, and an increased acceptance of pumping at work would enable moms to more easily meet and exceed their breastfeeding goals, while simultaneously continuing in their professional development, according to survey respondents. 

Notable survey results include: 

• Despite 75% of working mothers having a private pumping space at work, almost half (44%) have had negative interactions with their coworkers about pumping and breastfeeding. 

• Even though the PUMP Act of 2022, which expanded the legal right to ample breaks and private pumping space, has now been in effect for more than a year, 83% of working mothers state there is still a stigma attached to moms who breast pump at work. 

• While there have been significant improvements in providing space and resources for working mothers to breastfeed, 59% stated they are concerned that breastfeeding/pumping could impact their career growth. 

• More than 54% say that their employer’s pumping policies have made them consider a job/career change. 

Aeroflow Breastpumps conducted a similar survey in 2018. The number of women who feel there is a stigma attached to pumping at work has increased from 63% in 2018 to 83% in 2024. While there has been an increase in the number of employers who have a pumping policy at work (from 49% to 69%), more women today stated their employer’s pumping policies have made them consider a career change. 

“These survey results from 2018 and 2024 show that despite small gains for pumping mothers over the past few years and the abundance of information we have around the benefits of breastfeeding, there is still a lot of room for improvement in societal acceptance of breastfeeding mothers from employers,” said Dr. Jessica Madden, medical director of Aeroflow Breastpumps. “The need for employers to provide sufficient physical space, time, resources, and emotional support to nursing employees is still paramount. Until we are able to provide adequate maternity leave policies to working mothers in our country, employers must provide ample support to breastfeeding moms when they return to work and are separated from their infants.” 

To view the full findings of the survey, please click here. 

COPD Foundation to honor COPD Awareness Month 

MIAMI – The COPD Foundation and its community have a full month of activities planned for November in honor of COPD Awareness Month. The COPD Foundation’s activities aim to raise awareness of COPD and to emphasize the need for increased research, funding and support for people impacted by chronic lung disease. “This November, we join lung health champions around the world to raise awareness of COPD,” said Jean Wright, M.D., MBA, CEO of the COPD Foundation. “COPD affects millions of people, yet many are unaware of the disease and its symptoms. By increasing awareness through initiatives like Lace Up for Lungs, social media sharing and lighting landmarks, we can collaborate toward better understanding and management of COPD to help people live longer, healthier lives.” 

COPD Awareness Month activities include: 

• Get active with Lace Up for Lungs: Get moving for 30 minutes every day in November. Start a Facebook fundraiser, invite your friends to donate and join, and post about your daily activity progress in the Facebook group. 

• Share on social media: A social media toolkit includes pre-written posts and images for easy sharing, as well as information on other ways people can raise awareness of COPD. 

• Light the Night Orange for COPD: Lung health champions across the nation are asking their city halls, bridges and other local official buildings to light up orange during the month of November.  

• World COPD Day: Nov. 20 is World COPD Day. People are encouraged to wear orange to represent COPD awareness.   

The Lace Up for Lungs Awareness Campaign is supported by Cipla Limited, Insmed Incorporated, Theravance Biopharma, Inc., and Viatris Inc. For more information, visit copdfoundation.org. 

OIG adds reviews for wheelchair repairs, oxygen 

WASHINGTON – The Office of Inspector General added wheelchair repairs and oxygen and oxygen equipment to its work plan in October. For wheelchair repairs, the OIG will examine suppliers who provide these services and will consider the duration of repairs, their implementation of selected quality standards, and their identification of deficiencies related to wheelchair repairs. It will review documentation from wheelchair suppliers and accreditation organizations and conduct interviews with CMS, accreditation organizations and Medicare enrollees. For oxygen and oxygen equipment, the OIG will determine whether Medicare paid suppliers for oxygen and oxygen equipment according to Medicare requirements. It noted that for calendar year 2023, Medicare paid more than $674 million for oxygen and oxygen equipment and that CMS has consistently identified high rates of improper payment for oxygen and oxygen equipment through its Comprehensive Error Rate Testing program. For both reviews, the OIG expects to issue a report in 2026. 

Physician sentenced in kickback case 

DALLAS – Daniel R. Canchola, M.D., has been sentences to 10 years and one month in prison and ordered to pay more than $34 million in restitution for his role in a scheme to defraud Medicare by prescribing durable medical equipment and cancer genetic testing without seeing, speaking to or otherwise treating patients. According to court documents, Canchola, of Flower Mound, Texas, agreed to electronically sign doctor’s orders for DME and cancer genetic testing that he knew were used to submit false and fraudulent claims to Medicare. From August 2018 through April 2019, Canchola received approximately $30 in exchange for each doctor’s order he signed authorizing DME and cancer genetic test orders that were not legitimately prescribed, not needed, or not used — totaling more than $466,000 in kickbacks. The doctor’s orders Canchola signed were used to submit more than $54 million in false and fraudulent claims to Medicare. According to court filings, the Medicare beneficiaries for whom Canchola prescribed DME and cancer genetic testing were targeted by telemarketing campaigns and at health fairs, and they were induced to submit to the cancer genetic testing and to receive the DME regardless of medical necessity. In October 2022, Canchola pleaded guilty to a conspiracy to commit wire fraud. 

Beta Bionics integrates with Libre 3 Plus 

IRVINE, Calif. – Beta Bionics has launched the integration of its flagship iLet Bionic Pancreas with Abbott’s FreeStyle Libre 3 Plus sensor. The iLet Bionic Pancreas is an autonomous insulin delivery system that streamlines diabetes management and is the first insulin delivery system in the United States to connect to Abbott’s FreeStyle Libre 3 Plus sensor, whose readings every minute will help iLet calculate insulin doses. “Beta Bionics continues to move at lightning speed to bring these enhancements to our userbase,” said Sean Saint, CEO of Beta Bionics. “With our recent launch of the Bionic Circle remote monitoring app, our latest updates to the iLet app, and today’s launch of the iLet integration with Abbott’s FreeStyle Libre 3 Plus sensor, we are focused on providing major product enhancements to make diabetes management even easier for our users and their families.” With both Beta Bionics’ and FreeStyle Libre’s ability to sell products through the pharmacy channel, users of the integrated platform can benefit from the ease of obtaining supplies with an innovative pay-as-you-go model. The iLet and FreeStyle Libre 3 Plus sensor are also available through durable medical equipment providers. By simply updating the iLet app and software, iLet users will have a choice of iCGMs (FreeStyle Libre 3 Plus sensor or Dexcom CGMs) when they set up a new sensor. 

EnsoData, Happy Health partner on sleep monitoring 

MADISON, Wis. - EnsoData and Happy Health, which makes the Happy Ring, have announced a partnership to meet the need for simple, clinical grade nightly sleep monitoring in the home. Happy Health’s platform, Happy Sleep, now allows patients to directly receive an FDA-approved sleep test powered by EnsoData PPG, see a board-certified sleep doctor and begin personalized care – all from the comfort of their homes and all in just three days, the companies say. “In the world of health care, harmonizing medical accuracy with consumer wearability has always been a challenge for medical devices,” said Dr. Dustin Freckleton, MD founder and CEO of Happy Health. “If they’re not comfortable, people won’t wear them, if they're not accurate, the data is useless. With this collaboration with EnsoData, Happy Ring is setting a new standard for home sleep testing.” Cleared by the FDA in October 2024, the Happy Ring is a wearable medical device that combines medical accuracy with all-day comfort, collecting missions of clinical grade individual data points each night, the company says. That data is shared with EnsoData over the cloud and EnsoData PPG provides an accurate sleep diagnosis and customized sleep report for physicians. “We are excited to see the Happy Health team grow with the adoption of EnsoSleep PPG to expand the diagnostic capability of Happy Ring sleep data,” said Justin Mortara, PhD, CEO and president, EnsoData. “As care moves increasingly to the home, patients need wearable form factors designed with long term use in mind and physicians need a trusted AI partner to analyze the growing amount of data collected.” 

FDA says OK to leave FreeStyle Libre CGMs on for imaging 

ABBOTT PARK, Ill. – Users of the FreeStyle Libre 2 and 3 continuous glucose monitoring systems from Abbott no longer need to remove and discard the devices for imaging procedures, such as X-rays, CT scans and MRIs. The U.S. Food and Drug Administration has cleared the removal of the imaging contraindication, making Abbott’s systems the first and only patient-applied CGM sensors approved for these screenings. "For people with diabetes, especially those using insulin, removing a CGM sensor for long periods can be problematic," said Carol Wysham, M.D., clinical professor of medicine at the University of Washington School of Medicine and section head of the department of diabetes and endocrinology at Rockwood Clinic in Spokane. "Previously, patients had to remove their sensors during these procedures, resulting in several hours without critical data, especially if they didn’t have a replacement sensor. The removal of the imaging contraindication from Abbott’s FreeStyle Libre 2 and 3 systems is a big win for patients, allowing them to keep their sensors on and avoid lost data." 

CMS: Shared Savings Program reaps savings 

WASHINGTON – CMS says the Medicare Shared Savings Program yielded more than $2.1 billion in net savings in 2023 — the largest savings in the program’s history. “Accountable Care Organizations in the Medicare Shared Savings Program continue to deliver high-quality health care for people with Medicare and meaningful savings for the Medicare program,” said CMS Administrator Chiquita Brooks-LaSure. “CMS continues to improve the Medicare Shared Savings Program for the future so that providers in Accountable Care Organizations are able to deliver coordinated, high-quality, affordable, equitable, person-centered care to people with Medicare.” In 2023, ACOs in the Shared Savings Program earned shared savings payments (also known as performance payments) totaling $3.1 billion, the highest since the program’s inception more than 10 years ago.  In addition, ACOs scored better on many quality measures than other types of physician groups and continued to demonstrate quality improvement. ACOs led by primary care clinicians had significantly higher net per capita savings than ACOs with a smaller proportion of primary care clinicians.  

Home Oxygen Company passes TPE review 

MODESTO, Calif. – Noridian Healthcare Solutions has notified Home Oxygen Company that the provider had successfully completed Round 1 of the Targeted Probe & Education Audit process with zero claims reviewed containing errors. As a result, the audit file has been “closed and no further audit rounds required,” the company says. “I am very proud of the effort between our TBO intake & billing teams resulting in compliant files,” said Andrea Ewert, CEO of Home Oxygen Company. “We decided long ago to keep everything under our control, and this continues to pay dividends.” After earning an audit reprieve in 2017, 2018 & 2019 from both oxygen and sleep audits, Noridian this year selected Home Oxygen Company for the Targeted Probe & Education Audit for sleep-related files. The claims pulled up for review included products billed under E1390, E1392, E0424 & E0431 between June and September 2024. Home Oxygen Company continually trains personnel on the need to be vigilant when preparing patient charts for billing. “We definitely feel confident in our ability to process orders and get paid” said Ewert.