In brief: Sverica Capital, Humana, WellSky, CareBridge

BOSTON – Sverica Capital Management, a private equity investment firm, has made a strategic investment in SG Homecare, a Tustin, Calif.-based provider of DMEPOS to patients throughout the state. 

SG specializes in using capitated contracts, serving a wide range of payers and risk-bearing provider groups, acting as a value-added partner to these organizations as they seek to provide high-quality care for their home-based populations. 

“After an exhaustive search for the right growth partner, I determined that Sverica and SG shared the same values and commitment to patient care,” said Thomas “Randy” Rowley, founder and CEO of SG Homecare. “We look forward to the opportunity to grow and expand our footprint in the health care space.” 

Rowley will continue to lead SG. 

Gregg Osenkowski, partner at Sverica, and Doug Patrican, vice president at Sverica, will join the company’s board of directors as part of the transaction. 

“We were drawn to SG Homecare because of the company’s relentless focus on customer service, breadth of product offering, and leadership in risk-sharing payment models with payors and at-risk physician groups,” Osenkowski said. “As the number of physician groups taking full risk increases nationwide, we believe models such as SG Homecare’s will be an attractive alternative to legacy fee-for-service.” 

Humana expands onehome into Virginia 

LOUISVILLE, Ky. – Humana is bringing its onehome value-based home care model to Virginia, as it continues to build its Home Solutions business. 

onehome, a subsidiary of Humana, will coordinate convenient in-home care services for Humana Medicare Advantage plan members in the state, working closely with existing home care providers in the market. 

“Humana’s acquisition of onehome in 2021 and expansion into Virginia this year further advances the company’s commitment to building our Home Solutions business and value-based offerings,” said Andrew Agwunobi, M.D., MBA, president of Humana’s Home Solutions business. “There is a tremendous need for a care model that provides high quality, fully-integrated care in the home at reduced cost. Humana’s value-based approach aims to deliver on that promise and on our mission of bringing healing home.” 

onehome’s integrated model creates a single point of accountability that takes into account the needs of patients, physicians, hospitals and health plans for home-based patient care, with that care largely delivered through a network of local home care providers. The services onehome coordinates include infusion care, nursing, occupational therapy, physical therapy and DME. 

In Virginia, onehome’s value-based model is first rolling out in Richmond, Roanoke and Southern Virginia counties. Within several months, onehome will be available to coordinate home care services for Humana Medicare Advantage plan members throughout the state, as well as in North Carolina, totaling more than 500,000 people. In the future, these services will be payer agnostic, and onehome will accept Medicare health insurance plans in Virginia and North Carolina other than Humana. 

Within five years, Humana expects 50% of its Medicare Advantage members to have access to the company’s value-based home care model.

WellSky’s CarePort sees ‘record growth’ 

BOSTON – Nearly 2,500 post-acute providers, including HME providers, and 13,000 home- and community-based services organizations joined the CarePort network in 2021, signifying record growth within the platform’s post-acute, home and community client base, the company says. 

CarePort, a care coordination software company powered by WellSky, also launched CarePort Community, a new referral and care coordination platform for post-acute, home- and community-based providers, that added more than 220 clients within the past 12 months. 

“We’ve prioritized the enrichment of CarePort’s provider network by adding more home- and community-based providers such as home health care, transportation services, and dialysis agencies over the last year as care shifts to the home,” said Lissy Hu, M.D., CarePort CEO and founder. “The rapid growth CarePort has experienced in the post-acute, home and community space over the past year demonstrates that our solutions are mission critical to these providers and validates our focus on helping patients recover – whether in a facility, in the home, or in the community.” 

WellSky bought CarePort in 2020 for $1.35 billion. 

CareBridge attracts financing 

NASHVILLE, Tenn. – CareBridge, a value-based care solution for patients receiving home and community-based services, has closed a $140 million financing round, valuing the company at more than $1 billion. 

Over the past 12 months, the company, whose intervention has been shown to reduce emergency room visits, hospitalizations and total costs, has grown more than 17x, expanding from serving about 1,100 full-risk patients in June 2021 to about 19,000 today. 

“CareBridge is revolutionizing care for individuals on Medicaid receiving home and community-based services," said Brad Smith, former director of the Center for Medicare and Medicaid Innovation (CMMI) and executive chairman of CareBridge. "By helping coordinate care and provide 24/7 access to a clinician, CareBridge is helping individuals live healthier, more independent lives while remaining at home." 

CareBridge's 24/7 clinical support solution includes deploying a tablet to the home of high-risk individuals so that those individuals, their family members and their caregivers can contact a CareBridge clinician 24 hours a day, 365 days a year. The clinical team includes physicians, nurse practitioners, social workers, behavioral health specialists and pharmacists.  

CareBridge’s financing was led by Oak HC/FT, joined by four of the nation's largest managed Medicaid plans, which together serve nearly 60% of all Americans receiving home and community-based services. By next year, the company will serve members in 16 states and the District of Columbia.  

"We are excited to have many of the nation's largest Managed Medicaid plans as investors," said Mike Tudeen, CEO of CareBridge. "Their investment speaks to the uniqueness and importance of CareBridge's solution. Our strong growth allows us to impact the lives of more individuals and to influence our nation's system of care around this deserving population." 

The financing will be used to support the company's continued geographic expansion, the ongoing build out of the nation's largest database for home and community-based services, and the expansion of services to patients with Intellectual and Developmental Disabilities (IDD). 

IHCS expands to meet demand 

MIRAMAR, Fla. – Integrated Home Care Services, an independent administrator of home health, DME and home infusion benefits, plans to offer expanded services in 13 states to meet the growing demand for home care. Founded in 2015, IHCS currently serves the home care needs of more than 2.2 million patients through partnerships with managed care organizations and risk-bearing provider organizations across the country. "IHCS was created to better meet the needs of the managed care industry,” said Jorge Pereda, CEO and co-founder. “Our model is replicable, scalable, and offers a single point-of-contact for patients, health plans and providers. By reducing the complexity of a fragmented home care system, we are demonstrating improved patient outcomes and industry-leading patient and client satisfaction." IHCS expects to serve more than 3 million patients under a value-based model by the end of 2023. The company says, by removing unnecessary and historically discriminatory health care challenges for homebound individuals and by embracing value-based contracting, it is creating a new standard of long-term and socially determined care. "We continue to exceed stakeholder expectations by furthering upon our contractual commitments and positively impacting our partners' total cost of patient care,” said Paul Pino, chief development & analytics officer and co-founder. “Our ability to coordinate a multi-faceted home care offering, in an expedited fashion, enables the safe and timely discharge of patients and ensures improved experiences and outcomes.” IHCS adheres to the National Committee for Quality Assurance (NCQA) evidence-based guidelines and all state and federal regulations.  

AMA: Make diapers tax free 

CHICAGO – The American Medical Association is calling for the removal of the sales tax on child and adult diapers, a tax levied in 36 states. The AMA is also calling for the inclusion of child and adult diapers as qualified medical expenses for health savings accounts. “Vulnerable patient populations need affordable access to diapers,” said AMA Trustee Scott Ferguson, M.D. “The fiscal impact is de minimis for states but significant for low-income patients.” Making diapers tax free is only one of numerous policies that the AMA adopted this month as part of its annual meeting. The association is also calling on states and the federal government to develop legislation to protect physicians who report safety and other concerns, as more physicians become employed by non-physician organizations, such as hospitals, corporations or private equity. 

NCPA opens registration 

ALEXANDRIA, Va. – Registration is open for the National Community Pharmacists Association’s 2022 Annual Convention, Oct. 1-4, in Kansas City, Mo. This will be the association’s second in-person convention since the start of the COVID-19 pandemic. NCPA President Michele Belcher says it will be a great opportunity to get together with colleagues and allies at the premier event for neighborhood pharmacy owners and their staff. “This year’s convention will be all about independent pharmacy teams: maintaining strong squads, connecting with other players in the industry, and holding our position as the best of what pharmacy has to offer,” says Belcher, owner of Grants Pass Pharmacy in Grants Pass, Ore. “Our talents were revealed to the world throughout the COVID-19 pandemic. Together at NCPA’s convention, we’ll be working to make the most of this opening and continue changing the pharmacy payment model, the future of pharmacy, and our health care system. I’m looking forward to what is sure to be an action-packed event.” To learn about and register for the convention, click here. The NCPA will add more information on keynote speakers, events and other details as it becomes available.  

Alleged Medicare fraudster arrested on broken down jet ski 

MIAMI – A federal judge in Miami ordered that a Hialeah resident who allegedly submitted more than $4 million in fraudulent health care claims to Medicare be detained pending trial, after he was arrested on board a jet ski headed south from Key West toward Cuba. According to allegations in the criminal complaint, from February through April, 54-year-old Ernesto Cruz Graveran owned Xiko Enterprises, Inc., a Florida corporation that purported to provide DME to eligible Medicare beneficiaries. The complaint alleges that Xiko, in only a two-month period in 2022, submitted approximately $4.2 million in fraudulent health care claims to Medicare for DME that Xiko never provided and that Medicare beneficiaries never requested. As a result, Medicare paid Xiko more than $2.1 million. The government alleged in court that the U.S. Coast Guard and U.S. Customs and Border Protection officers located Graveran aboard a broken-down jet ski in the waters south of Key West, headed in the direction of Cuba, roughly 90 miles away. Graveran was aboard the jet ski along with one other individual, who was known to law enforcement to be an alien smuggler. The jet ski was outfitted with a special fuel cell to allow for long trips and within the compartments of the jet ski, law enforcement discovered a trove of food and water bottles. 

AAH pushes for increased coverage for breastfeeding supplies 

WASHINGTON – AAHomecare’s Breastfeeding Coalition is urging insurance companies and Medicaid plans to increase coverage for breastfeeding supplies, as the baby formula shortage worsens. Insurance companies and Medicaid plans need to cover breastmilk storage bags and breast pump replacement parts to support the increased need to breastfeed and pump during the shortage, the coalition says. “There has never been a more important time for insurance companies, including state Medicaid plans, to support breastfeeding,” said Jason Canzano, co-chair of the AAHomecare Breastfeeding Coalition. “As a coalition of breastfeeding equipment providers, we are seeing a strong increase in demand for breast pumps, replacement parts and breastmilk storage bags.” Last week, infant formula out-of-stock rates climbed to 74% nationally, according to a recent article by Bloomberg press. While the Biden Administration has taken some actions to provide relief, it will likely take months before those actions produce results, the coalition says. In the interim, it is important to consider ways to make sure moms delivering today and tomorrow have access to the resources they need to ensure a successful breastfeeding journey, it says. 

Permobil backs up power assist devices with new white paper 

NASHVILLE, Tenn. – Manual wheelchair users benefit from power assist devices (PADs) across all aspects of their lives, according to a new Permobil white paper. The impact goes beyond relief of repetitive strain and energy conservation to directly and indirectly affecting the activities users can participate in, the environments they can access and navigate, and their independence, the company found. “The evidence around the benefits of PADs in general to relieve the shoulders, energy conservation and on difficult terrains is well-documented and increasingly well understood,” said Carla Nooijen, senior researcher and co-author of the white paper. “A second important conclusion we found was that the different types of PADs meet differing user needs. In other words, we need to match individuals to the right kind of PAD for them.” The white paper is based on a systematic literature review, complemented by a survey Permobil conducted with 125 individuals internationally. In addition, in early 2022, the company conducted interviews with individuals who use various types of PADs. Among the findings in the white paper: One advantage with rear PADs, such as the Permobil SmartDrive, is the compact size doesn’t inhibit access in the workplace or at home and it is easier to transport compared to other PADs; and front-mounted PADs, such as Permobil’s Mototronik, were found to be the most intuitive for people to drive and can provide mobility without any pushes. Permobil will host a series of webinars on June 21 to discuss the purpose and development of PADs and address the variety of solutions currently available.  

ACHC names VP of medical affairs 

CARY, N.C. – The Accreditation Commission for Health Care (ACHC) has hired Gerald Maccioli, MD, MBA, FCCM, FASA, an anesthesiologist and prolific researcher and presenter, to serve as its vice president of medical affairs. Maccioli, who brings extensive experience in quality improvement across a range of settings, will be responsible for developing meaningful integration across ACHC’s clinical programs to ensure accredited organizations foster sound medical practices, achieve quality outcomes and meet personal objectives. “I am both excited and honored to join the ACHC leadership team,” said Dr. Maccioli. “For years I have worked with the AMA, chairing its Committee of Innovators and serving on the Quality Improvement Advisory Committee and the Committee on Practice Sustainability and Professional Satisfaction. My top priority is to use the knowledge gained through these experiences and my roles as a clinician and a Chief Quality Officer to deepen ACHC’s connection to its customers as they seek to improve their organizations.” Maccioli completed his fellowship training in cardiothoracic anesthesiology and critical care medicine at Duke University, following a residency at the University of North Carolina at Chapel Hill and an internal medicine internship at the University of Oklahoma. He continued his education at Auburn University’s Raymond J. Harbert College of Business, earning a master’s in business administration. He has given back to his specialty as director of the American Society of Anesthesiologists for North Carolina, president of the Society of Critical Care Anesthesiologists, and chair of the ASA Section on Education and Research. He has contributed and written more than 50 clinical papers, abstracts, editorials and book chapters and has been invited to speak at more than 70 state and national meetings on diverse topics. 

U.S. Rehab signs Braze Mobility 

WATERLOO, Iowa – U.S. Rehab, a division of VGM & Associates, has signed a partnership agreement with Toronto-based Braze Mobility, making the Braze Blind Spot Sensors for wheelchairs available to its members nationwide. The sensors can be added to any manual or power wheelchair, transforming it into a “smart” wheelchair. “U.S. Rehab is extremely excited about this new partnership,” said Greg Packer, president. “We strive to continually bring partnerships to our members that are beneficial for them and their customers.” The sensors detect obstacles and provide feedback to the user through intuitive lights, sounds and vibrations. They can prevent accidents that can result in property and wheelchair damage, as well as injuries that can lead to hospitalizations. 

RemSleep seeks OTCQB status 

TAMPA, Fla. – RemSleep has officially filed its application for OTCQB status with otcmarkets.com and expects to receive a decision in about three to four weeks. The company believes the move to the OTCQB will provide enhanced investor benefits, including higher reporting standards, greater access to analyst coverage and news outlets, and more comprehensive compliance requirements. The U.S. Securities and Exchange Commission considers the OTCQB an “established public market” for determining the public market price when registering securities for resale with the SEC. "Uplisting to the OTCQB will assist our company in providing greater shareholder value by allowing us to achieve greater market visibility, expand our potential prospective investor pool, greater share price stability, along with increased trading liquidity within the investment community,” said Tom Wood, RemSleep CEO. “We look forward to broadening our company exposure to a larger and more diverse demographic of both domestic and international investors.” OTC Markets Group operates financial markets for 11,000 U.S. and global securities. It organizes these securities into three markets based on the quality and timeliness of information a company provides to investors: the OTCQX Best Market, the OTCQB Venture Market, and the Pink Open Market. 

Medicare bennies are satisfied with Medicare Advantage, survey finds 

SANTA CLARA, Calif. – While Medicare Advantage plans have come under scrutiny by some policy makers and the media, a majority of enrollees are happy with their coverage, according to a survey conducted by eHealth, an online private health insurance marketplace. Nearly nine in 10 (88%) say they are either “very satisfied” (63%) or “somewhat satisfied” (25%) with their plans, according to the survey of more than 2,800 Medicare beneficiaries. A similar number (68%) would recommend Medicare Advantage plans to friends and family. Additional findings: Most of those previously enrolled in Medicare Supplement (Medigap) still prefer Medicare Advantage, most Medicare Advantage enrollees can’t afford the alternatives and most see Medicare Advantage as a prime example of public/private cooperation.   

NCPA drops lawsuit 

ALEXANDRIA, Val. – The National Community Pharmacists Association and the American Pharmacists Association have voluntarily dismissed their lawsuit in the wake of a new CMS rule on Part D that they hope makes it unnecessary. The NCPA filed the lawsuit in the closing days of the Trump administration, after multiple administrations failed to address retroactive pharmacy direct and indirect renumeration (DIR) fees. “We’ve been fighting in Congress for years to end retroactive pharmacy DIR fees and lower prescription costs for seniors and protect small business pharmacies,” said NCPA CEO B. Douglas Hoey. “We’ve been working with HHS and CMS for years on a regulatory solution, and more than a year ago we strategically filed a lawsuit in case the other two roads were blocked. We are cautiously optimistic that the new Part D rule satisfies the goals we had for the lawsuit.” Pharmacy DIR is a catchall term used to describe various price concessions required by pharmacy benefit managers (PBMs) to participate in Medicare Part D. These concessions have grown by more than 107,000% since 2010, according to CMS, inflating the prescription drug costs of seniors, the NCPA says. These concessions are also assessed retroactively, often months after the transaction, making it impossible for pharmacies to keep up with and predict the cost of these transactions, the association says.  

AAH elects officers, members 

WASHINGTON – AAHomecare’s membership re-elected three officers for 2022-23 and approved six board members for three-year terms. The re-elected officers are Bill Guidetti of Apria Healthcare (chair), Josh Marx of Medical Service Company (vice chair) and Seth Johnson of Pride Mobility (secretary). The board members are Robert Blake of Philips Respironics, Matt Mellott of Brightree, Tom Pontzius of React Health, David Siegel of Nationwide Medical, Casey Toomajian of Hometown Healthcare and Todd Walling of Permobil. Blake, Siegel and Toomajian are new to the board, and Mellott, Pontzius and Walling were re-nominated. “I believe there’s great opportunity ahead for the segments of the health care continuum that support seniors and other individuals who benefit from high quality, home-based care,” said Tom Ryan, president and CEO of AAHomecacre. “The contributions of these highly accomplished HME veterans will be critical to realizing our industry’s potential to improve the quality of life for millions of patients and their caregivers.” A complete list of AAHomecare’s officers and board members can be found here.  

ATLAS Technology Group enters Canadian market 

LAS VEGAS – ATLAS Technology Group, which offers four service lines for the complex rehab and HME markets, is now providing services in Canada. The company offers ATLAS Enterprise Software, Telehealth Clinical Evals, ATLAS Clinical Evals Software and ATLAS – FIOS Business Services. “Our mission at ATLAS Technology Group is to support the HME/DME and rehab mobility providers with the tools and services for an enhanced patient experience,” said Bill Paul, CEO of ATLAS Technology Group. “We are very excited to support providers and patients in Canada to receive the correct medical equipment and services in an improved delivery time.” Paul took his background in engineering and education to create a seamless software that combines enterprise resource planning (ERP) and customer relationship management (CRM), along with process management and medical billing software, into a single business tool built specifically for the complex rehab and HME markets.