In brief: CMS presses MA plans, Tomorrow Health builds growth team 

WASHINGTON – CMS has finalized policies that it says will continue to strengthen protections and guardrails to ensure Medicare Advantage and Medicare Part D prescription drug plans best meet the needs of enrollees. 

The Contract Year 2025 Medicare Advantage and Part D final rule will: 

• Establish a set amount a plan can compensate an agent or broker to protect Medicare Advantage and Part D plan enrollees and prospective enrollees from anti-competitive steering. 

• Require that Medicare Advantage plans include an expert in health equity on their utilization management committees and conduct an annual health equity analysis of their prior authorization policies and procedures. 

• Finalize new guardrails for certain types of supplemental benefits, available only to chronically ill enrollees, to ensure they meet the health needs of enrollees and are supported by evidence and require plans to send a mid-year, personalized communication to their enrollees about accessing unused supplemental benefits. 

“CMS is continuing its commitment to ensuring that Medicare Advantage and Part D prescription drug plans remain strong, stable, and affordable for people with Medicare,” said CMS Administrator Chiquita Brooks-LaSure. “This final rule builds on Biden-Harris Administration efforts to strengthen consumer protections so that people with Medicare can more easily choose the Medicare coverage options that are right for them.” 

• View a fact sheet on the final rule here. 
• CMS also recently released the Calendar Year 2025 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies, which outlined a 3.7% increase in payments to Medicare Advantage plans – worth more than $16 billion – from 2024 to 2025. 
• Additionally, CMS reminds the public to consider submitting comments to the Medicare Advantage Data Request for Information (RFI) announced in January. Comments are due on May 29, 2024.  

Tomorrow Health builds growth team 

NEW YORK – Tomorrow Health has hired Gabriela Perez as chief growth officer, Craig Thompson as general manager and senior vice president of sales and Peter Saul as director of provider growth. "The expansion of our growth team comes as we aim to capitalize on significant demand from enterprise partners to enable high-quality home-based care," said Vijay Kedar, founder and CEO of Tomorrow Health. "Having Gabriela at the helm of a dynamic, relentless team – alongside Craig and Peter — will allow us to accelerate partnership with health plans, providers, and suppliers to deliver high-quality care to the patients who need it most." 

• Perez has more than 20 years of health care and startup leadership experience, including at Best Doctors, where she built new markets and partnerships, and added more than $110 million in top-line revenue. Most recently, she served as chief commercial officer for Big Health, where she built out the company’s commercial strategy. At Tomorrow Health, Perez will lead the growth and scale of the company’s home-based technology to reach more patients across the country. 

• Thompson has 20 years of experience as a sales leader, most recently as chief commercial officer at Getlabs. At Tomorrow Health, he will lead the company’s referring provider and supplier growth teams, taking on ownership of growth and engagement with provider groups, health systems and suppliers. 

• Saul has more than 12 years of health system partnership experience, most recently at Butterly Network. At Tomorrow Health, he will develop and executive strategic partnerships between the company and referring providers, especially health systems. 

Last year, Tomorrow Health exited the HME supply business to focus on its platform for supplier partners. 

PE firm invests in Rebound Medical 

DANBURY, Conn. – Private equity firm Castleford Capital has announced a growth investment in Rebound Medical Systems, a provider of DME to patients recovering from orthopedic and vascular surgical procedures. "We will use this new capital to invest in our team and drive growth in our service territories, which build upon our dedication to physicians and their patients,” said Todd Piatnik, founder of Rebound. “The entire Rebound team is excited by this new partnership. I am thankful to our employees and business partners for their years of dedication. I am very appreciative of our physician and practice clients, who have positioned us for this transformational growth opportunity.” Rebound is a provider of DME and services to patients of orthopedic, vascular, podiatry, pain management and spine physicians. Its offerings include pneumatic compression devices, electrical stimulus devices, wraps, garments and other accessories that facilitate recovery from surgery and manage chronic conditions. The company administers the entire process, including patient insurance verification, patient education and communication, delivery of equipment, accurately and efficiently processing claims, and provider communication management.   

Dominique Sedlezky joins VGM Canada 

BURLINGTON, Ontario – VGM Group Services LTD (Canada) has added Dominique Sedlezky as associate director of supplier and member relations. In this role, she will become an additional contact for current and prospective suppliers and members to continue building a strong relationship with VGM Canada’s partners. “We are thrilled to have Dominique joining our team,” said Dave Davies, president of VGM Canada. “With her extensive background in marketing and operations, she is poised to deliver unparalleled value to our members and suppliers alike. Her track record of success promises to enhance our collaborative efforts and drive innovation within our industry." Sedlezky, who has almost 20 years of experience in the medical devices industry, most recently served as senior director of operations and funding at Sunrise Medical Canada. 

ACHC publishes ‘Redesigning Accreditation’ 

CARY, N.C. – The Accreditation Commission for Health Care has published an annual report showcasing milestones and other highlights from 2023, including the introduction of a cloud-based platform that integrates the customer experience with tools used by the company’s surveyors and staff. The platform is set to launch in 2025. In “Redesigning Accreditation,” ACHC also lists as highlights from the year: Breaking ground on an extended corporate campus in Cary, N.C., and holding its largest Academy education event to date, with five tracks, 14 exhibitors, 73 sessions and two keynotes. Read the annual report here. 

Signifier’s CPAP alternative greenlighted by SC Medicaid 

BOSTON – Signifier Medical Technologies has announced that its eXciteOSA therapy for sleep-disordered breathing is now covered by South Carolina’s Health Connections Medicaid program. This coverage opens new doors for patients 18 and older who have previously had limited access to advanced treatments for obstructive sleep apnea. "We are thrilled that eXciteOSA is now covered by Medicaid in South Carolina," states Akhil Tripathi, director and co-founder of Signifier. "This achievement represents a significant milestone in our mission to make high-quality sleep apnea care accessible to all individuals. We look forward to continuing to collaborate with Medicaid and healthcare providers to improve sleep health outcomes for patients across the state and the country." Signifier says its non-invasive daytime therapy has shown greater than 80% adherence, demonstrating the positive impact on the lives of those suffering from OSA by offering an alternative to traditional night-time devices. eXciteOSA uses NMES to “exercise” the upper airway muscles, working the intrinsic and extrinsic tongue muscles to improve endurance and prevent airway collapse during sleep. It is the first commercially available devices used while awake. 

VGM welcomes two new board members 

WATERLOO, Iowa – VGM Group has two new board members: Steve Ryan, senior vice president of client services at GreatBanc in Chicago; and Dr. Rebecca Ehretsman, president of Wartburg College in Waverly, Iowa. They replace VGM co-founders John Deery, Jr., who resigned from his position on the board at the end of 2023, and the late Jim Walsh, who passed away in 2023. “We are fortunate to add two exceptional leaders to our board of directors,” said Mike Mallaro, who serves as the VGM executive chairman of the board. “VGM Group has become an increasingly sophisticated organization and a leader in the industries it serves. I’m excited to welcome their insights as we move the company forward.” Ehretsman, who is the first woman elected to VGM’s board, brings leadership development and succession planning expertise to the role. She became president of Wartburg College in 2022, the first woman president in the school’s history. Ryan, in his role at GreatBanc, specializes in serving employee-owned companies like VGM Group. He also serves as chairman of the ESOP Committee of Private Directors Association, a national organization for professionals serving on boards.  

Product launches: Pride Mobility, Fisher & Paykel 

Pride Mobility Products has launched the Go Go Elite Traveller 2 4-Wheel, a scooter that it says has the tightest turning radius of any four-wheel scooter on the market. The scooter features iTurn Technology, offering four-wheel stability with three-wheel maneuverability. It also features interchangeable red and black shrouds that come standard with six additional colors available, two battery options and a weight capacity of 300 pounds and a top speed of 4 mph. FMI: https://www.pridemobility.com/go-go-travel-mobility/go-go-elite-traveller-2-4-wheel/. 

Fisher & Paykel has launched the F&P Nova Micro nasal pillows mask in New Zealand for the treatment of obstructive sleep apnea. Weighing less than 40 grams, the new compact mask features minimal, easy adjusting headgear and a soft MicroPillows cushion, providing stability and freedom of movement. F&P has started selling the Nova Micro in New Zealand and will begin selling it in Canada in the coming months. Launches in the United States, Australia and Europe will follow later in the year.