40% & Counting

By Monica E Oss, Chief Executive Officer

The proportion of U.S. health care reimbursement dollars paid in advanced value-based reimbursement (VBR) models—contracts with shared savings, downside financial risk, and/or population-based payments—just passed 40%. The slow adoption of VBR with financial gain sharing and downside risk sharing—along with the unique challenges to specialty provider organizations in participating in these arrangements—may cause executive teams to think there isn’t much movement. But this development is glacial—slow but changing the landscape along the way.

In addition to the national snapshot of reimbursement patterns, the recent survey by the Health Care Payment Learning & Action Network (see APM Measurement Methodology And Results Report  and The 2020 LAN APM Measurement Effort), also reported that the reimbursement model that health plan executive think will grow the most in the next year were arrangements with both shared savings and downside financial risk. This includes reimbursement with fee-for-service-based shared-risk and procedure-based bundled/episode payments

This trend is reflected in some current market developments. In a recent earnings report, Wyatt Decker, M.D., CEO of Optum Health, said that the company had exceeded their projections for value-based reimbursement. Optum Health has raised its projects of consumers in VBR arrangements from 500,000 new consumers to 600,000 (see Optum Health Has Raised Its Expectations For Value-Based Care Participation. Here’s Why). The increase was attributed to changes in provider reimbursement for dual special needs consumers with high acuity who need care across the continuum and wrap-around services in the home.

In other news, the federal Department of Health and Human Services (HHS) proposed testing models that use value-based payments in Medicare Part B to link payment with a medication’s clinical value (see HHS Proposes Testing Value-Based Payments For Medicare Part B Drugs). This plan also includes testing total-cost-of-care models to assess whether the models result in changes to drug utilization, reductions in total spending, and improvements in beneficiary health outcomes. And in January the Colorado Department of Health Care Policy & Financing (HCPF) launched its first two value-based contracts for the Colorado Medicaid pharmacy program—two Medicaid value-based contracts with drug manufacturer Novartis (see Colorado Medicaid Implements Two Pharmacy Value-Based Contracts With Novartis). Both contracts hold Novartis financially accountable for meeting the clinical outcomes demonstrated in clinical trials.

And in February, the U.S. Centers for Medicare and Medicaid Services (CMS) announced it will increase performance measurements and the use of value-based reimbursement for nursing homes (see CMS Planning New Staffing Requirements & Value-Based Reimbursement Plans For Nursing Homes). This will include an effort to reduce unnecessary medications, staffing, and the inappropriate use of antipsychotic medications, and strengthen the skilled nursing facility (SNF) value-based purchasing (VBP) program with incentive funding to facilities based on quality performance.

Among specialty provider organizations, 45% are participating in some form of VBR. But only 9% have more than 20% of revenue coming from VBR contracts (see The OPEN MINDS 2022 Survey On Value-Based Reimbursement In Specialty And Primary Care).

From our recent discussions with health plan executives, the challenge for specialty provider organizations in participating in robust VBR arrangements is attribution of consumer care coordination and financial management responsibilities. (For more on this, see my articles on the presentations by Dr. Indira Paharia, Chief Operating Officer, Behavioral Health, Centene Corporation, Eric Bailly, LPC, LADC Business Solutions Director, Behavioral Health Clinical Strategy, Anthem, Inc. at The 2022 OPEN MINDS Performance Management Institute—Collaborative Care At Scale – More Important Than Ever and The Choppy Road To Better Value.) My takeaway is that specialty provider organizations have two possible approaches for moving ‘upstream’ in risk arrangements with health plans—specialty service programs or health home/medical homes with primary care.

The question for executive teams of specialty and primary care provider organizations is how to navigate this change in the market and maintain (and grow) revenue. For an answer to that question, I recently spoke with my colleague and OPEN MINDS Senior Associate, Paul Duck. His observation—executive teams need to think less about volume and more about value. “They need to understand the ‘value’ of their services to consumers and payers—and develop models to get paid for that value.”

“Most provider organization executive teams have not adequately prepared their infrastructure for arrangements with downside financial risk—their data systems, their clinical delivery systems, and their culture,” explained Mr. Duck. “While many professionals service consumers with behavioral and cognitive disorders have traditionally had a mindset that therapies are more of an art form than science, the science has grown over the past decade and payers want to reimburse on this emerging new science and the performance it will bring.”

“Executive teams need to retool for the four major market shifts that are top-of-mind for payers—“integrated” care coordination models, ‘hybrid’ service delivery models, and a push for lower costs and value with financial alignment with risk sharing reimbursement.”

To test how prepared your organization is for reimbursement arrangements with risk sharing, check out the got an error message when trying to link to this on PRC OPEN MINDS Value-Based Reimbursement Readiness Assessment. And for more on the changing health and human service reimbursement landscape, check out these resources in The OPEN MINDS Circle Library:

And for even more, join us on June 16 at The 2022 OPEN MINDS Strategy & Innovation Institute for the session, Metrics Matter – Utilizing Quality Measures & Key Outcomes As Performance Drivers, featuring Isamu Pant, Director of Business Intelligence, Aurora Mental Health Center; Dominick DiSalvo, Corporate Director of Clinical Services, KidsPeace; and Tammy Pearson, Senior Associate Director, Marshall Center of Excellence for Recovery, Marshall University.

VBR Marches On – A Trend Driving 2022 Strategy

By Monica E. Oss, Chief Executive Officer

We started the year with the release of new reports on the continued movement away from fee-for-service reimbursement to alternate, value-based reimbursement (VBR) models. Over half of health systems are planning to move to “payvider” market positioning in 2022 (see Nearly 60% Of Health Systems Aim To Become ‘Payviders’ In 2022). These ‘payvider plans’ include many arrangements – provider-sponsored health plans; direct contracting with health plans; joint ventures with health plans; and risk-based contracting. In addition, a new survey found 56% of health plans and pharmacy benefit managers (PBMs) report using outcome-based, non-fee-for-service provider reimbursement. However, when it comes to mental health reimbursement, only 22% reported having outcomes-based contract (OBC) (see 56% Of Payers Had Outcomes-Based Provider Reimbursement In Place As Of September 2021).

This disparity between the use of VBR for reimbursement for behavioral health services and other areas of health care is not new. Our survey, The 2021 OPEN MINDS Performance Management Executive Survey: Where Are We On The Road To Value, reported 53% of specialty provider organizations serving consumers with chronic and complex conditions are participating in VBR, compared to 74% of primary care organizations. And, 12% of specialty provider organizations reported 20% or more of their revenue was tied to VBR, compared to 32% of primary care organizations.

There are several reasons for this disparity. Many specialty provider organization executives report difficulties securing VBR contracts. Health plan executives express concerns about balancing choice and access with value-based contracts for behavioral health. In addition, when it comes to behavioral health reimbursement, health plans have issues with linking behavioral health provider compensation to total cost of care in systems with capitation of primary care services; with data sharing and systems interoperability; and with making necessary system changes.

Executive teams of specialty provider organizations need to get ahead of this curve and develop a strategy to “fit” in established value-based relationships. That will involve understanding the dominant health plans in their market areas – and how they prefer to contract for delivering services to consumers living with behavioral health and cognitive conditions. With that market information, executive teams can decide if new partnerships, a merger, or an investment in a different service delivery and management capacity is the best strategy.

Many executive teams are skeptical of participating in the new alternative payment methodologies because the options are limited. Fee-for-service rates for undifferentiated services have been flat for a number of years (on the decline, on an inflation-adjusted basis). To maintain margins, executive teams need to build a plan for creating “value-added services” that get above-market reimbursement. Or, the other options for margins is VBR.

In 2021, there were some great perspectives on future health plan strategy from our keynote speakers at our institutes and summits. To watch any of those presentations, check out:

For the VBR year in review, check out these 2021 resources in the OPEN MINDS Industry Library:

And for even more, join OPEN MINDS on February 10 for The 2022 OPEN MINDS Performance Management Institute, where OPEN MINDS Chief Marketing Officer, Timothy Snyder and OPEN MINDS Senior Associate, Casey Zanetti, will present the executive seminar Maximizing Revenue, Aligning Internal Growth Strategy & Succeeding In Value-Based Care.

Who Should Do What? Scope of Practice; Treatment Tech Shift Clinical Best Practices

By Monica E. Oss, Chief Executive Officer

There has been a long debate about the scope of health care practices. What type of licensed clinical professionals can perform particular functions? Should psychologists and/or pharmacists prescribe psychotropic medications? What supervision do nurse practitioners and physician assistants need? (Should ‘physician assistants’ be renamed ‘physician associates’?)

Psychologists can prescribe in five states: Louisiana, New Mexico, Illinois, Iowa, and Idaho (see Can Psychologists Prescribe Medications?). The scope of pharmacists’ practices is state-dependent and varies widely from state-to-state (see Mapping U.S. Statewide Protocols For Pharmacist Prescriptive Authority). Pharmacists may or may not give injections and immunizations and prescribe everything from naloxone, tobacco cession aids, travel medications, and more. Physician Assistants are licensed to practice in all 50 states, the District of Columbia, all US territories, and the uniformed services. Physician Assistants are authorized to prescribe medications in all jurisdictions where they are licensed, except Puerto Rico (see PA Prescribing and Assessing Scope of Practice in Health Care Delivery: Critical Questions in Assuring Public Access and Safety).

Executives of health and human service organizations need to plan to leverage the ‘value’ of their clinical team members by developing systems where they can work at the ‘top of their practice’—with most of their time going to the services that require their specific level of training. But that is easy to say and much harder to accomplish in practice. This type of service specialization is an essential part of the specialization needed to achieve maximum operational efficiency—and the highest value.

But there are two factors that complicate plans for specialization to increase value. The first is that in systems that are increasingly rewarded for a ‘whole person’ approach to care—which runs contrary to specialization. The second is that health care treatment technologies are reaching a level of sophistication that they can be a replacement for some of the work of licensed clinical professionals. The key for executive teams is using technology to address both of these issues. The first is ‘virtual integration’—creating a singular consumer data set that is available to all health care professionals. The second is to use data—both small data and big data—to develop algorithms that curate the recommendation of treatment services for specific consumers—both treatment technology and the most appropriate clinical professional. These are essentials to sustainability—building organizational efficiencies that result in competitive advantage.

For more on our coverage of efficiency and effectiveness in staffing models—and in emerging treatment technology, check out these resources in the OPEN MINDS Industry Library.

Scope of Practice Issues

Digital Treatment Trends & Strategy

Digital Treatment Developments

For more on managing and practicing at the top of your team’s skillsets, join me for The 2022 OPEN MIND Management Best Practices Institute in Newport Beach, California from August 30 to September 1, 2022.

The Opportunities & Challenges Of VBR – Making It Work On The Ground

By Monica E. Oss, Chief Executive Officer

Despite significant movement, behavioral health is trailing the rest of health care domains in value-based reimbursement contracting. Forty-five percent of specialty provider organizations have some value-based reimbursement (VBR)—compared to 72% of primary care organizations (for more, see, The OPEN MINDS 2022 Survey On Value-Based Reimbursement In Specialty And Primary Care). And at the health plan level, 22% of plans report having some form of VBR for mental health services in 2021, compared to 79% in the cardiovascular services and 54% in respiratory services (see 56% Of Payers Had Outcomes-Based Provider Reimbursement In Place As Of September 2021).

This gap is due to a combination of factors. Some are due to the structure of financing and reimbursement in health plans. (For more on key opportunities for specialty provider organization value-based contracting, see Treatment Transformation Ahead and The Sustainability Challenge – Capitalizing On Emerging Market Opportunities In Behavioral Health.) Others are due to issues as diverse as consumer choice and provider organization readiness.

How can executives of provider organizations and health plans work together to make this happen in the behavioral health space? Getting to the answer for that question was central to the recent 2022 OPEN MINDS Health Plan Partnership Summit session, “Looking For Quality Outcomes? It Starts With Innovative Value-Based Contracting,” delivered by Monica Collins, senior director, system transformation, Magellan Behavioral Health of Pennsylvania, and Charlotte Chew, vice president, outpatient operations, Pyramid Healthcare.

In January of 2018, the Pennsylvania Medicaid program implemented new requirements for the value-based purchasing (VBP) initiative for the behavioral health HealthChoices program. The state’s goal was to have an increasing percentage of total medical expenses paid through VBP over a three year period (for more, see Pennsylvania Medicaid Moving To Value-Based Reimbursement For Behavioral Health and Pennsylvania Medicaid Managed Care Contracts). Pennsylvania’s value-based strategies requirements fall along a continuum. There are fee-for-service payments linked to performance (low risk), supplemental payments attached to shared savings and risk (medium risk), bundled payment arrangements (medium risk), and global payments based on quality measures (high risk). Eventually, 30% of total medical cost must be in VBR arrangements by year five (originally set for 2022). Pennsylvania originally set staggered targets, beginning with 5% in year one, and increasing to 10% each year.

While the pandemic has slowed the implementation timeframe, Ms. Chew and Ms. Collins discussed the planned value-based relationship between Magellan and Pyramid Healthcare—and the steps required to make it work. In the model, there are limited shared savings models based on spending targets that encourage coordination of behavioral health care. The model also requires addressing social determinants of health (SDOH) issues.

But challenges to getting this up and running are substantial. There are multiple provider organizations among consumers and across episodes of care, which makes it harder to coordinate care. There also exists a lack of medication assisted treatment (MAT) services available and resources for follow up care. The speakers offered two pieces of advice—develop a collaborative model to solve problems and engage at a ‘grassroots’ level to assure success.

Work together to solve hurdles. Operationalizing value-based models has a number of hurdles to overcome—including attribution, managing care transitions, and having the right staff in place. Much of the time well spent involves connecting consumers through various points of care transitions from inpatient to outpatient community models. It’s also difficult to define what ‘value’ is and what drives outcomes—from reduced emergency room visits, medication adherence, better nutrition, less comorbidities, etc. To maximize effectiveness, the whole care delivery system needs to work together to attribute consumer outcomes back to the providers that serve them (see Specialty Primary Care As A Growth Strategy). Magellan and Pyramid Healthcare recommend having weekly touchpoints to examine data, discuss successes and opportunities, and share information among teams to clinically shape what happens next.

Get to the grassroots level. For both payer and provider organization management teams, this requires a cultural shift, centered around the consumer experience, utilizing peers, and making sure all the right information gets to provider organizations (see Nimble Applies To Information Too). Ms. Chew explained how “much of the work has to happen at a local level in different pockets or pilots, balancing expectations and taking the best parts of certain programs and models and adapting and integrating them into others.” One strategy that Pyramid Healthcare introduced is an alumni program, where consumer peers can continue to be involved and integrated into the community, with certified training, job placement assistance, and linkages to wellness programs.

Specialty provider organization executive teams need to renew their focus on getting in ‘first-position’ with health plans by creating opportunities for financial alignment—and for increasing revenues through achieving superior outcomes. In a health care landscape where fee-for-service reimbursement is not keeping pace with inflation (even before this year of hyper-inflation), this shift is a key to sustainability.

For an assessment of organizational preparedness for value-based reimbursement, take the OPEN MINDS Value-Based Reimbursement Readiness Assessment. For more information on value-based reimbursement strategies and partnerships, checkout these resources in the OPEN MINDS Industry Library:

And for more discussion on value-based payment and strategies, join me for the following executive seminars at The 2022 OPEN MINDS Management and Best Practices Institute in Newport Beach, California on August 30: How To Build Value-Based Payer Partnerships: An OPEN MINDS Executive Seminar On Best Practices In Marketing, Negotiating & Contracting With Health Plans.

Qualifacts + Credible Named 2022 Best In Klas: Software & Services

GETTYSBURG, Pa. (February 20, 2022) — Qualifacts + Credible, a leading provider of electronic health record (EHR) platforms for behavioral health and human services organizations, today announced the Credible platform has ranked No. 1 in the 2022 Best in KLAS: Software and Services report.

Additionally, Qualifacts + Credible’s CareLogic EHR platform is ranked No. 2 in the 2022 Best in KLAS: Software and Services report.

The Best in KLAS report recognizes software and services companies who excel in helping healthcare professionals improve patient care. All rankings are a direct result of the feedback of thousands of providers over the last year. A Best in KLAS award signifies to the healthcare IT industry the commitment and partnership that the top vendors should provide.

“We are honored by the trust our partners place in us every day, and their success is our highest priority. This recognition from KLAS is a great validation of the remarkable work our teams have done in support of our mission to be an innovative and trusted technology and solutions partner, said Paul Ricci, chief executive officer at Qualifacts + Credible.

“Each year, thousands of healthcare professionals across the globe take the time to share their voice with KLAS. They know that sharing their perspective helps vendors to improve and helps their peers make better decisions. These conversations are a constant reminder to me of how necessary accurate, honest, and impartial reporting is in the healthcare industry. The Best in KLAS report and the awards it contains set the standard of excellence for software and services firms. Vendors who win the title of Best in KLAS should celebrate and remember that providers now accept only the best from their products and services. The Best in KLAS award serves as a signal to provider and payer organizations that they should expect excellence from the winning vendors,” said KLAS CEO Adam Gale.

About Qualifacts + Credible   
Qualifacts + Credible is one of the largest behavioral health and human services EHR vendors in the country. Its mission is to partner with customers to support and extend their ability to deliver quality care and improve the lives of the clients they serve. With more than 20 years of experience its products and services help customers achieve interoperability goals, optimize efficiency, improve productivity, and maximize reimbursement. The company offers several EHRs – CareLogic, Credible and InSync – while collaborating to build an even brighter future for partner agencies and their clients.

About KLAS
KLAS has been providing accurate, honest, and impartial insights for the healthcare IT (HIT) industry since 1996. The KLAS mission is to improve the world’s healthcare by amplifying the voice of providers and payers. The scope of our research is constantly expanding to best-fit market needs as technology becomes increasingly sophisticated. KLAS finds the hard-to-get HIT data by building strong relationships with our payer and provider friends in the industry. Learn more at klasresearch.com.

Qualifacts + Credible Acquires InSync Healthcare Solutions

GETTYSBURG, Pa. (January 9, 2022) – Qualifacts + Credible, a leading provider of electronic health record platforms for behavioral health and human services organizations, today announced it has acquired InSync Healthcare Solutions.

InSync Healthcare Solutions is a leading provider of EHR and practice management software plus revenue cycle management services for behavioral, medical and rehabilitative professionals.

Qualifacts + Credible is adding InSync’s highly configurable, clean and intuitive platform to their portfolio of EHR solutions.

“The acquisition allows the combined organization to deliver innovation, technology, customer support, and complementary solutions to a broader behavioral health and human services market,” said Paul Ricci, chief executive officer of Qualifacts + Credible. ”It also better positions us for long-term growth by expanding our ability to serve small to medium-sized practices and agencies.”

Demand for behavioral health is on the rise, according to data from the Kaiser Family Foundation. As of January 2021, approximately four in 10 U.S. adults reported symptoms of anxiety or depression compared to one in 10 from January–June of 2019.

About 40% of behavioral providers work in smaller behavioral health organizations with fewer than 50 full time employees.

The company will continue to support all three platforms, with CareLogic and the Credible platforms remaining primarily focused on enterprise accounts.

InSync’s flexible and easy to use solutions for small to medium-sized practices and agencies will be enhanced by Qualifacts + Credible’s innovation and advanced technology capabilities.

“We’re excited to be part of an organization that is also focused on providing technology that empowers behavioral health providers to deliver the best care,” said Roland Therriault, executive vice president and general manager of InSync Healthcare Solutions.

Qualifacts + Credible currently has over 900 customers across 43 states making it one of the largest behavioral health EHR vendors in the country. The addition of InSync doubles the size of the organization’s customer count and it will serve over 10 million patients in all 50 states.

ABOUT QUALIFACTS + CREDIBLE    

Qualifacts + Credible is one of the largest behavioral health and human services EHR vendors in the country. Its mission is to partner with customers to support and extend their ability to deliver quality care and improve the lives of the clients they serve. With more than 20 years of experience and two of the highest rated platforms, its products and services help customers achieve interoperability goals, optimize efficiency, improve productivity, and maximize reimbursement.

ABOUT WARBURG PINCUS 
Qualifacts + Credible is a portfolio company of private equity firm Warburg Pincus LLC.

This leading global growth investor has more than $67 billion in private equity assets under management. The firm’s active portfolio of more than 215 companies is highly diversified by stage, sector, and geography. Warburg Pincus is an experienced partner to management teams seeking to build durable companies with sustainable value.

ABOUT INSYNC HEALTHCARE SOLUTIONS    
InSync Healthcare Solutions is a leading provider of EHR and practice management software plus revenue cycle management services for behavioral, medical and rehabilitative professionals. InSync leverages advanced technology, best-in-class partnerships and proven business processes to provide services and solutions that translate into better efficiency for healthcare organizations.

CMS Designates Connecticut Health Plan’s Episodes-Of-Care Payment Model As One Of TheFirst Commercial Plan Other Payer Advanced Alternative Payment Model

On October 7, 2021, the Centers for Medicare & Medicaid Services (CMS) approved a new payment model—the Episodes of Care program—between the State of Connecticut Health Plan for state employees and several provider organizations as an Other Payer Advanced Alternative Payment Model (A-APM). This Other Payer A-APM designation is one of the first earned by a commercial health plan, which starting in 2022 allows the Connecticut Health Plan network professionals to earn credit for participating in value-based care for the Medicare Quality Payment Program (QPP). The Connecticut Health Plan Episodes of Care program is for covered state employees and retirees, as well as members of the Connecticut Partnership Plan, which offers health care coverage to municipal employees.

The State of Connecticut’s commercial employee and retiree health plans, as well as the Connecticut Partnership Plan, launched the Episodes of Care program in October 2020. The Connecticut Health Plan covers state and certain municipal workers, retirees, and their dependents, totaling about 260,000 covered lives, and 210,000 are covered by the episode program. The remaining 50,000 are in a group Medicare Advantage plan in which the episode program does not apply.

The Episodes of Care program sets fixed episode prices covering evaluation through recovery for over 40 common health episodes that may be delivered by multiple provider organizations or professionals across multiple sites. The services included in the episodes account for up to 60% of the average health plan spending. The episodes include knee replacement, colonoscopy, cataract surgery, care related to pregnancy, and a comprehensive spine episode. The full list can be viewed online at https://www.careinnovationinstitute.com/episodes-summaries/ (accessed October 27, 2021).

The Connecticut State Health Plan episode-of care-model establishes a target episode price with each participating provider organization based upon the provider organization’s past performance. The episodes are retrospective, meaning that episode performance against the benchmark is calculated after the completion of the episode by aggregating the cost of all the claims associated with the baseline episode. Episodes are reconciled on a quarterly basis. The risk level of the participating provider organization groups varies based upon the financial ability of each to take on risk and their risk tolerance.

The Connecticut Office of the State Comptroller partnered with Signify Health during 2020 to create a new “Network of Distinction” program. The network includes hospitals, health systems, and physician groups. Each has low rates of complications and below-average episode prices. Since its inception last year,1,400 physicians have committed to the state’s quality and cost standards through their participation in the Network of Distinction. Additional provider organization groups are still eligible to join.

The hospitals, health systems, and physician groups selected into the Network of Distinction all have low rates of complications and below-average episode prices. Signify Health is supporting the Connecticut Episodes of Care program by identifying, contracting with, and supporting participating provider organizations with services, technology, and analytics, as well as securing fixed, episodes-of-care pricing with high-value network provider organizations participating in the Network of Distinction.

The QPP was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which restructured how Medicare pays clinical professionals. MACRA repealed the Medicare sustainable growth rate; established permanent statutory payment updates; and created incentive payments for participants in A-APMs. An A-APM must meet three criteria: require clinical professionals to use certified electronic health records (EHRs); tie payments to quality measures; and require eligible clinical professionals to bear nominal financial risk. Eligible Medicare professionals must participate in an A-APM or the merit-based incentive payment system (MIPS). Non-exempt eligible clinical professionals who fail to participate in an A-APM or MIPS are subject to lower Medicare reimbursements for the following year. Those who do participate are eligible for QPP bonus payments.

Signify Health is a health care platform that leverages advanced analytics, technology, and nationwide health care provider networks to create and power value-based payment programs. Its mission is to transform how care is paid for and delivered. Its solutions support value-based payment programs by aligning financial incentives around outcomes, providing tools to health plans and health care provider organizations designed to assess and manage risk and identify actionable opportunities for improved consumer outcomes, coordination, and cost-savings.

For more information, contact:

Massachusetts FQHC Centers Surpass One Million Telehealth Visits

The Massachusetts Federally Qualified Health Center (FQHC) Telehealth Consortium’s 35 community health center members have conducted more than one million telemedicine visits since the start of coronavirus disease 2019 (COVID-19) in March of 2020. This achievement comes at the same time the Consortium has passed the halfway mark of its Phase II $12 million fundraising goal – thanks to a major grant from the Gordon and Betty Moore Foundation – to attain sustainable telehealth capacity at health centers and address health disparities in the communities served by them.

Consortium data measuring telehealth use between May 2020 and May 2021 show that telemedicine visits have provided safe and convenient access to primary care for communities of color, which have been disproportionately impacted by COVID-19. Of the 767, 234 Massachusetts health center consumers who accessed primary care via telemedicine visits during that year-long period, more than 52% were white, nearly 21% were Black/African American, more than 6% identified as more than one race, more than 5% were Asian/Pacific Islander, and 1% were Native American. Of those identified by ethnicity, nearly 31% were Latinx/Hispanic.

According to the data, the same held true for behavioral health care services. Of the total number of consumers taking part in behavioral health telehealth visits during the same one-year period, nearly 56% were white, more than 23% were Black/African American, more than 5% were of more than one race, 4.65% were Asian/Pacific islander, and less than 1% were Native American. By ethnicity, 31% again identified as Latinx/Hispanic.

Phase II of the Consortium’s campaign is focused on ensuring that FQHCs have what they need to fully develop, deploy, sustain, and integrate telehealth modalities into primary and behavioral care, while also addressing the digital divide in their communities. This includes providing better access to broadband and remote monitoring equipment, increased digital literacy training, peer learning, outreach in communities that health centers serve, and online dissemination of best practices.

Phase II of the campaign launched in the fall of 2020 with $1,040,000 received from an anonymous donor to create skilled bandwidth at nine pilot sites required to integrate advanced, durable, and mature telehealth capabilities into member FQHCs. Another $3.1 million grant awarded by the U.S. Federal Communications Commission (FCC) in January as part of the FCC Connected Care Pilot Program is providing equipment and hot spots for consumer broadband access. The grant from the Gordon and Betty Moore Foundation ($878,000) is designed to increase the number of consumers with controlled hypertension, particularly for African American/Black consumers, and to test the additional value of telehealth navigators and clinical intervention over federal funding of remote monitoring.

The Consortium is a partnership of Community Care Cooperative (C3), the accountable care organization (ACO) that advances community-based care for MassHealth members, and the Massachusetts League of Community Health Centers, the state-based association of health centers.

Community Care Cooperative (C3) is a not-for-profit ACO that leverages the proven best practices of ACOs throughout the country and is the only ACO in Massachusetts founded and governed by Federally Qualified Health Centers (FQHC) and exclusively focused on advancing integrated and coordinated community-based care for MassHealth members. C3 works with its 18 member FQHCs to strengthen health centers across the state, and continued growth enables C3 to better serve MassHealth members across the Commonwealth. To view a list of C3 health centers, click here.

The Massachusetts League of Community Health Centers (the League) is a not-for-profit membership organization supporting and representing the Commonwealth’s 52 community health centers, which offer primary and preventive care to more than one million residents. The League serves as an information resource on community-based primary care to policymakers, opinion leaders, and the media. It provides a wide range of technical assistance to its health center members, including advocacy on health policy issues, support for workforce development, clinical care and technology initiatives, and guidance to state leaders and community-based organizations seeking to open health centers.

The Gordon and Betty Moore Foundation fosters path-breaking scientific discovery, environmental conservation, consumer care improvements, and preservation of the special character of the Bay Area.

This was reported by The Massachusetts FQHC Telehealth Consortium on August 24, 2021.

Contact information: Abby Akoury, Chief of Staff, Community Care Cooperative, 75 Federal Street, 7th Floor, Boston, Massachusetts 02110; 857-302-4261; Email: aakoury@c3aco.org; Website: https://www.communitycarecooperative.org/

Contact information: The Massachusetts League of Community Health Centers, 40 Court Street, 10th Floor, Boston, Massachusetts 02108; 617-426-2225; Email: massleague@massleague.org; Website: https://massleague.org/

Contact information: The Gordon and Betty Moore Foundation, 1661 Page Mill Rd, Palo Alto, CA 94304; 650-213-3000; Email: communications@moore.org; Website: https://www.moore.org/

Babylon, A World Leading, Digital-First, Value-Based Care Company, Announces Plans To Become A Public Company Via $4.2 Billion Merger With Alkuri Global Acquisition Corp.

Babylon Holdings Limited (Babylon), a world leading, digital-first value-based care company, and Alkuri Global Acquisition Corp. (Alkuri Global), a special purpose acquisition company, announced that they have entered into a definitive merger agreement. Upon closing of the transaction, the combined company will operate as Babylon and plans to trade on Nasdaq under the new symbol “BBLN”. The transaction reflects an initial pro forma equity value of approximately $4.2 billion. The transaction is expected to close in the second half of 2021.

Babylon was founded in 2013, with the mission to put accessible and affordable quality healthcare in the hands of every person on Earth. Babylon is poised to re-engineer the $10 trillion global healthcare market to better align systemwide incentives and shift the focus from reactive sick care to preventative healthcare, resulting in better member health, improved member experience and reduced costs. Babylon helps consumers through two primary channels — Babylon 360, its digital-first value-based care service; and Babylon Cloud Services, a suite of digital self-care tools that enables consumers and primary care professionals to gain insights and information either through Babylon directly or through Babylon’s roster of top-tier partners. Combined, those services cover 24 million people across the United States, Canada, Europe, Africa and 13 countries in Asia. In 2020, the company had approximately 6 million consumer interactions. Moreover, Babylon has a 95% user retention rate and a 5-star rating from more than 90% of its users.

Supported by capital raised through the transaction, Babylon will continue to expand its services both with existing and new consumers. Babylon has achieved strong traction in the U.S. market and is focused on building on this momentum by rapidly scaling its operations.

The transaction is expected to deliver up to $575 million of gross proceeds to fund Babylon’s pro forma balance sheet, including the contribution of up to $345 million of cash held in Alkuri Global’s trust account assuming no redemptions. The combination is further supported by a $230 million private placement (the PIPE) – funded over 85% from new, external institutional investors including AMF Pensionsförsäkring, Sectoral Asset Management and Swedbank Robur with strategic investor Palantir – at $10.00 per share. There is additional participation from Ali Parsa, Alkuri Sponsor LLC and existing Babylon investors Kinnevik and VNV Global. In addition, Babylon previously acquired an option to purchase Higi, a consumer health engagement company, and intends to acquire the remaining Higi equity stake it does not already own. The major investors in Higi, including 7wire Ventures, Flare Capital Partners and William Wrigley, Jr., have agreed to accept shares in lieu of a portion of cash consideration if Babylon exercises its option. This agreement is expected to reduce Babylon’s cash needs by approximately $40 million.

Assuming no redemptions, taking existing cash and transaction fees into account, Babylon is expected to have approximately $540 million net cash on its balance sheet following the transaction, which will be used to pursue organic growth strategies as well as attractive and opportunistic acquisitions. The transaction reflects an initial pro forma equity value of approximately $4.2 billion and enterprise value of approximately $3.6 billion. Existing Babylon shareholders will roll 100% of their equity into the combined company and will own approximately 84% of the pro forma company at closing.

The transaction, which has been unanimously approved by the Boards of Directors of both Babylon and Alkuri Global, is expected to close in the second half of 2021, subject to approval by Alkuri Global’s stockholders and other customary closing conditions, including any applicable regulatory approvals. Following the closing of the proposed business combination, Babylon will retain its experienced management team. Dr. Parsa will continue to serve as Chief Executive Officer and Chairman of the Board. An Alkuri Global representative will join the Babylon Board of Directors.

Ardea Partners LP is serving as financial advisor, Citi is serving as financial and capital markets advisor, and Wilson Sonsini Goodrich & Rosati, P.C., Allen & Overy LLP and Walkers (Jersey) LLP are serving as legal counsel to Babylon. Jefferies is serving as exclusive financial advisor and Winston & Strawn LLP is serving as legal counsel to Alkuri Global. Jefferies, Citi, and Pareto Securities AB served as placement agents on the PIPE.

Babylon is a world leading, digital-first, value-based care company whose mission is to make high-quality healthcare accessible and affordable for everyone on Earth. Babylon is re-engineering healthcare, shifting the focus from sick care to preventative healthcare so that consumers experience better health, and reduced costs. This is achieved by leveraging a highly scalable, digital-first platform combined with high quality, virtual clinical operations to provide all-in-one, personalized healthcare. Babylon endeavors to keep consumers at the peak of health and get them back on their feet as quickly as possible, all from their devices, with the aim to promote longer and healthier lives. When sick, Babylon provides assistance to navigate the health system, connecting consumers digitally to the right primary care professional 24/7, at no additional cost. Founded in 2013, Babylon has since delivered millions of clinical consultations and AI interactions, with c.2m clinical consultations and c.3.9m AI interactions in 2020 alone. Babylon works with governments, health provider organizations and insurers across the globe, and support healthcare facilities from small local practices to large hospitals.

Babylon 360 is Babylon’s digital-first value-based care service. Babylon 360 combines cutting-edge AI-powered technology with human medical expertise to help members stay out of the hospital and remain in control of their health. Using a combination of Babylon’s primary care professionals’ expertise and data, Babylon 360 gives members actionable insights and information about their wellbeing, and – by helping members to understand their specific needs – helps them set personalized health goals. If there’s a problem, Babylon 360 gives 24/7 access to a dedicated Personal Care Team, so that consumers can receive the most appropriate care, medication and treatment. A recent survey among Babylon 360 members identified that more than 40% of consultations had resulted in consumers avoiding the emergency room or urgent care visits, generating significant cost savings.

Babylon Cloud Services provides a suite of digital self-care tools that enables consumers and primary care professionals to gain insights and information either through Babylon directly or through Babylon’s roster of top-tier partners. The tools include Babylon’s AI symptom checker, which provides a 24/7 source of health information to consumers when they need it, and Babylon’s Healthcheck, which offers a comprehensive, digital-first health assessment that identifies at-risk conditions and actionable next steps members can take which aim to improve overall health and decrease future risk of disease.

Alkuri Global Acquisition Corp. is a blank check company formed for the purpose of effecting a merger, stock exchange, asset acquisition, stock purchase, reorganization, or similar business combination with one or more businesses or entities. Alkuri Global intends to favor next-generation technology businesses led by visionary founders and teams leveraging data and artificial intelligence in the areas of Consumer Internet and Marketplaces, Healthtech, Fintech and Mobility.

This was reported by Babylon Health on June 3, 2021.

Contact information: Ali Parsa, Ph.D., Chief Executive Officer, Babylon Health, 60 Sloane Avenue, London United Kingdom; SW3 3DD; +44 (0)20 7100 0762; Email: support@babylonhealth.com; Website: https://www.babylonhealth.com/

Contact information: Alkuri Global Acquisition Corp., 4235 Hillsboro Pike, Suite 300 Nashville, TN 37215; 615-632-0303; Website: https://www.alkuri.com/


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Eleanor Health Announces $20 Million Series B Financing To Address The Growing Need For Value-Based Addiction & Mental Health Treatment

Eleanor Health, the first outpatient addiction and mental health provider organization delivering convenient and comprehensive care through a population and value-based payment structure, announced it has closed an oversubscribed $20 million Series B financing round. The company received significant participation from all existing investors including Town Hall Ventures, Echo Health Ventures, and Mosaic Health Solutions, as well as new participation from Warburg Pincus, a global private equity firm which has invested more than $90 billion in over 930 companies.

Eleanor Health will use the capital to meet increased need from communities and demand from payers for population, value-based, whole-person care for individuals with drug addiction and mental health needs. By 2022, Eleanor Health anticipates managing more than 50,000 members under its innovative population-based partnership models.

Within the past two years, the company has shown the following results throughout its physical and virtual footprint:

  • 84% reduction in emergency department and inpatient stays.
  • 70% report improvement in depression and anxiety.
  • 84% improvement in drug addiction.
  • 76% report improvement in social drivers of health.

To date, Eleanor Health operates 18 clinics and a fully virtual model statewide across Louisiana, Massachusetts, New Jersey, North Carolina, Ohio, and Washington, delivering care through population and value-based partnerships with Medicare, Medicaid, and employers. The company plans to scale the business by going deeper in existing markets by executing additional payer contracts to manage new populations and further developing its proprietary analytics and technology platform that will support identification, engagement, and treatment.

Eleanor Health was created in the Oxeon Venture Studio, together with Town Hall Ventures and Mosaic. It remains dedicated to:

  • Providing treatment where most convenient for community members, including in-person care in clinics, community-based care in homes, and a 100% virtual model available from the safety and convenience of home;
  • Delivering comprehensive services including medications for drug addiction, psychiatric evaluation, treatment of co-occurring psychiatric conditions, individual and group therapy, nurse care management, support to address social determinants of health, and peer recovery coaching;
  • Operating on a payment structure that includes accountability to positive health outcomes achieved, including reducing total health care costs, providing unmatched access, and achieving high consumer satisfaction;
  • Employing diverse teams of medical practitioners, nurses, addiction professionals and peer recovery coaches with personal lived experience, to engage and support individuals in achieving their recovery goals;
  • And coordinating care across the health care and social services continuum to improve the consumer journey and increase long-term recovery rates and overall health outcomes for individuals.

This was reported by Eleanor Health on May 17, 2021.

Contact information: Alex Piersiak, Eleanor Health, 155 Federal Street, Suite 700, Boston, MA 02110; 617-909-5022; Email: alexandra.piersiak@eleanorhealth.com; Website: https://www.eleanorhealth.com/