In brief: Cyberattack update, PBM reform, Medicaid hearing

MINNEAPOLIS – Change Healthcare says it has made “strong progress” restoring services impacted by a cyberattack in February. 

In the April 22 update, Change Healthcare said that medical claims across the U.S. health system are moving at near-normal levels, as systems come back online or providers switch to other methods of submission. The company said it realizes there are a small number of providers who continue to be adversely impacted and it is working with them to find alternative submission solutions and will continue to provide financial support as needed. 

Change Healthcare also cited other areas of progress: 

• Payment processing by Change Healthcare, which represents approximately 6% of all payments in the U.S health care system, is at approximately 86% of pre-incident levels and is increasing as additional functionality is restored. 

• Other Change Healthcare services, including eligibility software and analytical tools, are being restored on a rolling basis with the active reconnection of our customers now the priority. To date, approximately 80% of functionality has been restored on the major platforms and products, and the company expects full restoration of other systems to be completed in the coming weeks. 

• Pharmacy services are now back to near-normal levels, with 99% of pre-incident pharmacies able to process claims. 

Parent company UnitedHealth Group has also announced support for people concerned about their personal data potentially being impacted based on preliminary findings from the ongoing investigation and review of the data involved in the cyberattack. 

Based on initial targeted data sampling to date, the company has found files containing protected health information (PHI) or personally identifiable information (PII), which could cover a substantial proportion of people in America. To date, the company has not seen evidence of exfiltration of materials such as doctors’ charts or full medical histories among the data. 

“We know this attack has caused concern and been disruptive for consumers and providers and we are committed to doing everything possible to help and provide support to anyone who may need it,” said Andrew Witty, CEO of UnitedHealth Group.   

People can visit a dedicated website at http://changecybersupport.com/ to get more information and details on these resources. A dedicated call center has also been established to offer free credit monitoring and identity theft protections for two years to anyone impacted. 

Related stories: 

• HME industry under strain 
• Cyberattack: ‘This just might be the final straw’ 
• Change Healthcare outage has ‘scary’ impact on HME 
• Blog: Change after Change 

NCPA fly-in turns up heat on PBM reform 

WASHINGTON – Hundreds of community pharmacists from 40 states and the District of Columbia visited more than 250 congressional offices to press for PBM reforms during the National Community Pharmacists Association’s Congressional Pharmacy Fly-In April 17-18.  

Rep. Buddy Carter, R-Ga., offered attendees insights into what’s happening with PBM reform and how community pharmacists could best press policymakers for progress during their meetings on Capitol Hill. 

“Low reimbursements from PBM-insurers, the ‘DIR hangover’ and other pressures are pushing some pharmacy owners ever closer to a breaking point,” said Lea Wolsoncroft, NCPA president. “Many in Congress understand that, in theory, but this year’s fly-in was our opportunity to impress upon them what’s really at stake for their constituents if their local pharmacy shuts its doors and why PBM reform is needed now. Community pharmacy showed out in force, fighting for the future of our businesses and pushing Congress to finish doing its job for the patients we serve.”    

Attendees urged Congress to act swiftly to finalize and pass PBM reform legislation that includes the Drug Price Transparency in Medicaid Act (H.R. 1613/S. 1038) and the Neighborhood Options for Patients Buying Medicines (NO PBMs) Act (H.R. 5400/S. 2436). These efforts are aimed at increasing congressional support for transparency into PBM-insurers, fair and transparent Medicaid managed care pharmacy payments, and requiring “reasonable and relevant” Medicare Part D contract terms. 

Promotions: Encore Health, CCS 

LIVINGSTONE, Tenn. – Encore Healthcare has promoted Carrie Proffitt, RRT, to senior vice president of operations. Over the last few years, her role has evolved from clinical operations to overall operations of Encore’s software and service business lines. In her previous role as vice president of clinical operations, Proffitt demonstrated exceptional leadership, dedication and a deep commitment to Encore's mission, the company says. 

Dallas-based CCS has named Scott Streator as its new senior vice president of enterprise solutions. Streator brings deep payer and pharmacy experience that includes sales and management leadership roles at Outcomes, Cardinal Health, OhioHealth, MedImpact Healthcare Systems and CareSource. In his new role, Streator will own a comprehensive payor market strategy and lead the enterprise solutions team, working closely with cross-functional teams to ensure successful solution implementation for the benefit of the patients CCS serves. 

Reps. Rodgers, Guthrie put Medicaid under spotlight 

WASHINGTON – House Energy and Commerce Committee Chair Cathy McMorris Rodgers, R-Wash., and Subcommittee on Health Chair Brett Guthrie, R-Ky., will hold a legislative hearing on April 30 to discuss legislative proposals that will strengthen the Medicaid program for individuals most in need. “Medicaid is indispensable to millions of Americans, particularly those with disabilities who rely on long-term services and supports,” they said in an announcement. “It’s critical that we work to bolster access to those services while also improving the integrity of the program to ensure that states can continue to offer care for years to come. We thank the members who have led on these proposals—many of which are bipartisan—and look forward to hearing from Deputy Administrator (Daniel) Tsai on how we can strengthen Medicaid for those it was designed to assist.” Tsai, deputy administrator and director of the Center for Medicaid and CHIP Services for CMS, will testify. For a list of the legislation being discussed, including the “Ensuring Seniors’ Access to Quality Care Act,” go here. 

F&P launches AutoFit segment 

IRVINE, Calif. – Fisher & Paykel Healthcare hosted a webinar this week to highlight the launch of its F&P Solo Nasal mask in the U.S. The company says the AutoFit mask is the first to allow users to stretch it onto their face and adjust it with one touch. “F&P Solo Nasal marks the creation of our AutoFit segment, and our teams have delivered a significant leap in mask innovation, driven by the unwavering commitment to enhance patient outcomes,” said Justin Callahan, vice president of sales and marketing for F&P Healthcare. “The simplified setup and fit process makes it a valuable addition to our product lineup.” The mask features an AutoLock technology that allows the mask to stay in place with minimal force and that responds to sleep movement and pressure. F&P says the mask is supported by positive clinical trial results that show 95% of users can set themselves up on the mask without assistance; and 93% of patients rated their experience with the mask as simple or very simple. 

Forcura releases AI-based referral feature 

JACKSONVILLE, Fla. – Forcura, a health care workflow management company, has released a new feature that uses HIPAA-compliant generative artificial intelligence to transform the intake process, instantly summarizing a patient referral packet and presenting essential criteria in a concise, shareable format. Users can manage all referrals from a single, digital inbox and efficiently move through a workflow that automates data capture with the company’s Referral IQ product, which also now includes a referral summary featurethat presents all the most pertinent referral information in a consumable format. “GenAI has tremendous implications on improving patient care transitions and coordination,” said Craig Mandeville, founder and CEO. “It will empower our clients to make faster, better decisions about accepting patients into their care.” Typically, referral packets are delivered to home-based care agencies and other post-acute organizations via disparate, paper-based methods, which staff must manually identify and aggregate vital patient information, frequently creating a bottleneck. 

Sunknowledge celebrates 10-year partnership 

NEW YORK – Sunknowledge, a provider of health care outsourcing solutions, has marked a 10-year partnership with a leading DME provider in New York. Through advanced technology experience and a dedicated team of professionals for all kinds of DME billing needs, Sunknowledge has effectively streamlined the billing processes for the DME company, ensuring maximum reimbursement and compliance with regulatory standards. “We are thrilled to commemorate 10 years of collaboration with one of New York’s premier DME companies,” said Ronnie Hastings, director of business development at Sunknowledge. “Our partnership exemplifies our shared commitment to excellence and innovation in health care revenue cycle management. We are proud of the impact we have made together and look forward to continuing to exceed expectations in the years to come.” Sunknowledge’s services include eligibility verification, claims submission and processing, coding, denial management, accounts receivable follow-up and more.  

Wearable Health Solutions turns to Amazon 

NEW YORK – Wearable Health Solutions, a provider of age-tech solutions, has established an official Amazon account, with an Amazon store to follow, to expand its market presence and offer its medical alerts to a wider audience. The company says the move underscores its commitment to accessibility and convenience for customers seeking its products. In addition to setting up the Amazon store, Wearable Health Solutions is currently in talks with seasoned marketing and sales management teams to optimize its presence on the platform. The company says it recognizes the importance of effective marketing and sales strategies in driving visibility, engagement and sales growth.