MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: CVS makes another huge investment into its tech portfolio.

 
 

 
 

 
 

Clipped from: https://www.newswire.com/news/waymark-secures-additional-42m-to-scale-tech-enabled-community-based-22151010

New Funding Will Support Waymark’s Market Expansion and Technology Investments to Continue Improving Access and Outcomes for Medicaid Recipients

 
 

SAN FRANCISCO, October 18, 2023 (Newswire.com) – Waymark, the Medicaid provider enablement company, today announced $42 million in new financing to scale technology-enabled, community-based care for primary care providers and their patients enrolled in Medicaid programs. Existing investor Lux Capital led the oversubscribed round, and CVS Health Ventures, the venture capital arm of CVS Health, joins the company as a new investor. Existing investors Andreessen Horowitz (a16z) and New Enterprise Associates (NEA) also participated in the round. The investment consists of $22 million in equity capital and a $20 million line of credit, bringing Waymark’s total capital raised to date to $87 million. 

“CVS Health Ventures’ investment portfolio is comprised of innovative companies that are at the forefront of transforming care delivery. Waymark’s use of proprietary data science technologies to improve access and quality of care is doing exactly that,” said Vijay Patel, Managing Partner and co-founder, CVS Health Ventures. “We expect this investment will provide Medicaid members expanded access to coordinated and holistic health care.”

Waymark will use its new investment to continue improving healthcare access and outcomes for people enrolled in Medicaid programs. Patients receiving Medicaid benefits often experience challenges accessing care, prescriptions, and social support like housing and food. Waymark hires, trains, and deploys local teams of community health workers, pharmacists, therapists and care coordinators to work directly with primary care practices — at no cost to the practice — and address gaps in care for their patients enrolled in Medicaid. The company’s local teams are supported by Waymark Signal™, a proprietary machine learning technology that has shown industry-leading performance in identifying “rising risk” populations, or patients at risk of avoidable emergency room (ER) and hospital utilization, and helps to direct Waymark teams to the best evidence-based intervention to meet patient goals. The technology is integrated into a care management software built by Waymark specifically for community-based teams, and incorporates data from multiple sources (e.g., local ERs, primary care practices, social services databases, and health plan data) to engage patients who are traditionally hard to reach. 

“Medicaid programs have historically been overlooked and under-innovated, but Waymark’s groundbreaking partnerships demonstrate the positive impact technology-enabled services can have for communities who need it most,” said Deena Shakir, General Partner at Lux Capital. “By aligning business incentives with patient outcomes, Waymark continues to build a uniquely effective approach to advance population health. There is no better team or technology out there to take this challenge on, and we are thrilled to deepen our partnership with the entire Waymark team.”

Waymark is currently supporting approximately 50,000 people enrolled in Medicaid across both Washington state and Virginia. Since launching in January 2023, the company has secured partnerships with several large health systems, a federally qualified health center (FQHC), and independent practices across both markets. Through its evidence-based care pathways, Waymark has shown promising early improvements in quality scores and clinical outcomes — including reduced non-emergent emergency department (ED) visits and hospitalizations.

Providence, one of the largest health systems in the country, is working with Waymark to improve access to care for patients receiving Medicaid. “At Providence, we’re committed to addressing inequities in the communities we care for,” said Dr. Scott Anders, CMO, Value Based Care, Providence Clinical Network, Providence Health & Services. “Waymark provides a disciplined Medicaid population health management approach that improves access to high-value care. Waymark’s use of data science combined with a local, person-centered process is compelling, and we are eager to see how they proactively help patients access the care they need.” 

At community clinics like Country Doctor Community Health Center (CDCHC), a Seattle-based federally qualified health center (FQHC) with roots in the civil rights movement, Waymark is helping to increase provider capacity and deliver whole-person care to patients. “We chose to partner with Waymark because their local, community-based, multidisciplinary care model aligns not only with the evidence of what works in Medicaid, but also our own mission and values,” said Matthew Logalbo, MD and Medical Director, CDCHC. “We have worked hard to develop services tailored to the needs of our patients (e.g., our low-barrier addiction treatment clinic, peer support specialists, re-entry CHWs, and healthcare for the homeless services), but we can’t meet the level of demand that exists alone. Waymark provides us with more capacity outside the clinic setting to engage and support patients, bring them into care, and connect them to our programs and other resources in the community that can address patients’ social determinants of health.”

Waymark enters into risk-based contracts with Medicaid MCOs to deliver community-based care for their rising risk populations and transition primary care practices to value-based arrangements. By building a new community health workforce to support primary care providers (PCPs) — paid for through value-based arrangements with MCOs — Waymark seeks to increase the capacity of its healthcare delivery system and align payment incentives to enable whole-person care.

“We created Waymark because the evidence of what works to improve Medicaid outcomes exists, but the operational capacity, technology and funding is insufficient to scale to the level of need that exists in communities across the country,” said Dr. Rajaie Batniji, co-founder and CEO of Waymark. “This new financing will allow us to continue hiring and training a new community health workforce, expand PCP capacity, and ultimately deliver on our charter to improve access and quality of care for people receiving Medicaid.” 

Source: Waymark

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Gainwell is re-selling state Medicaid data to researchers.

 
 

 
 

Clipped from: https://www.streetinsider.com/Globe+Newswire/Gainwell+Enables+Breakthrough+Southern+Methodist+University+Research+on+Hospital+Readmissions+for+Medicaid+Diabetes+Patients/22282075.html

New model holds key to accurately predicting 30-day patient readmission

IRVING, Texas, Oct. 17, 2023 (GLOBE NEWSWIRE) — Hospital readmission for diabetes patients is an enormous health risk and an expensive problem for the U.S. healthcare system. The question is how do we address it?

Gainwell Technologies (Gainwell), a leading innovator in healthcare technology solutions, partnered with its state Medicaid clients and SMU (Southern Methodist University) to develop an answer.

Diabetes affects roughly 13 percent of the U.S. population. These patients have elevated rates of hospital admission and all-cause mortality. They are also twice as likely to be readmitted within 30 days of discharge as similar patients without diabetes. The estimated cost of hospital readmissions is $20 billion to $25 billion annually.

While predictive hospital readmission models for diabetes exist for Medicare, they do not for Medicaid, which is the single largest source of health insurance in the U.S. This fact helped motivate this research.

SMU determined the first step was to develop a model to predict which Medicaid patients admitted to a hospital for any reason are most likely to be readmitted within 30 days. To develop a predictive model, Gainwell enabled SMU’s research by providing an advanced research platform and de-identified Medicaid claims from its clients in seven states.

SMU used 69,640 claims for the research that focused exclusively on patients who were diabetic, admitted to the hospital for any reason and discharged either to their homes or a non-hospice facility.

Using claims data only, SMU concluded Medicaid patients with diabetes were much more likely to be readmitted to hospitals within 30 days of their release than Medicaid patients without diabetes.

This important research was published in The
American Journal of Managed Care (AJMC), a respected peer-reviewed medical journal.

Some of the most significant findings from the research were:

• Researchers derived and validated a Medicaid claims-only statistical model to predict 30-day readmission for hospitalized Medicaid patients with diabetes.
  
• The model’s accuracy is similar to that of other models that are based on more granular clinical and demographic data. It identifies populations by risk and suggests targets for interventions to improve outcomes.
  
• The model will be of use to insurers, policymakers and health systems as they seek to categorize patients by risk to improve health outcomes and contain readmission costs in Medicaid programs.
  

The research will enable payers and health systems to use a patient’s age, gender and admissions history to predict the likelihood of a readmission.

“This research provides important guidance to clinicians,” said Daniel Heitjan, Ph.D., professor and chair of Statistics and Data Science at SMU. “Our new predictive model is accurate and much simpler to process. That’s a significant advantage when predicting the likelihood of readmission.”

A cost driver in healthcareThirty-day readmissions are widely recognized as a driver of increased healthcare costs. And it is to the benefit of hospitals and health plans to address it.

“These results are important to ensure patients get the care they need for this pervasive and deadly disease. This predictive model will help providers and payers identify Medicaid patients with a higher risk of readmissions. It also enables them to proactively focus on care transitions to improve outcomes and decrease costs,” said Gainwell Chief Medical Officer Dr. Gary Call.

“By identifying high-risk diabetics, clinicians will be better equipped to focus on patients during and after hospitalizations to improve treatment adherence and avoid readmissions. These models can also track high-risk population outcomes, develop care management programs and monitor the effectiveness of existing ones,” Dr. Call said.

He added the research would not have been possible without the foresight of Gainwell’s clients who enabled the company to share the de-identified Medicaid claims for this vital research.

Cooperative researchThis research is one in a series of studies Gainwell has enabled for top universities on issues ranging from hospital readmissions to opioid addiction to the impact of the social determinants of health.

Gainwell facilitated the research data environment for SMU under the umbrella of Australia’s Digital Health CRC (Cooperative Research Centre) to sponsor this study. The DHCRC connects government, academic and industry partners to harness digital technology to address many of the world’s most challenging healthcare issues.

About Gainwell TechnologiesGainwell Technologies is the leading provider of digital and cloud-enabled solutions vital to the administration and operations of health and human services programs. With more than 50 years of proven experience, Gainwell has a reputation for service excellence and unparalleled industry expertise. We offer clients scalable and flexible solutions for their most complex challenges. These capabilities make us a trusted partner for organizations seeking reliability, innovation, and transformational outcomes. Learn more at gainwelltechnologies.com.

About SMUSMU is the nationally ranked global research university in the dynamic city of Dallas. SMU’s alumni, faculty and over 12,000 students in eight degree-granting schools demonstrate an entrepreneurial spirit as they lead change in their professions, communities and the world.

CONTACT: Elizabeth Bonet, Gainwell Technologies972-556-5082 elizabeth.bonet@gainwelltechnologies.com

 
 

Source: Gainwell Technologies LLC

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: The latest casualty in the MOVEit debacle.

 
 

 
 

Clipped from: https://indianacapitalchronicle.com/briefs/breach-exposes-information-of-200000-hoosier-medicaid-members/

 
 

Hoosiers on Medicaid are facing the impacts of a global software breach in late May. (Screenshot from FSSA)

The personal health information of more than 200,000 Hoosiers on Medicaid may have been exposed in a global software breach in late May, the Indiana Family and Social Services Administration (FSSA) announced Friday.

That includes the names, addresses, Social Security numbers, dates of birth, gender, medical conditions, diagnoses, medications, allergies, health conditions, member IDs and plan names of 212,193 Medicaid recipients utilizing Indiana’s services.

Those affected are part of a managed care plan provided by Ohio-based CareSource.

A file transfer software the company was using, called MOVEit, was breached briefly in late May.

CareSource “immediately remediated the breach” and notified FSSA, according to the agency. And the company is contacting those affected with information and credit monitoring options.

It’s part of the same MOVEit hack that, in August, the agency said exposed the names, addresses, case numbers and Medicaid numbers of more than 744,000 Hoosiers on Medicaid. Just four people’s social security numbers were accessed, however.

In that case, the software was being used by Indiana’s health coverage programs enrollment broker, Maximus Health Services.

The breach has impacted an estimated 1,000 organizations and 60 million people worldwide, according to TechCrunch.

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MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Yep. Uber tapped in SNAP funding. That’s a 10-year total addressable market of $1.223Trillion per CBO. Somebody at that disruptive lil’ ole ride share got a promotion on this one.

 
 

 
 

Clipped from: https://thehill.com/changing-america/respect/poverty/4217069-uber-eats-to-accept-snap-benefits-for-grocery-deliveries-in-2024/

Story at a glance

• Starting in 2024, SNAP recipients will be able to buy grocery deliveries through Uber Eats.
  

 
 

• Uber also announced it is working to help support Managed Medicaid and Medicare Advantage plans by accepting FSA cards, Flex cards and waiver payments on Uber for its services.
  

 
 

• Tapping into artificial intelligence, Uber is poised to launch later this year an AI-powered assistant to outline new available dishes and cuisines on the app, sort through deals at popular restaurants and reorder previous meals more quickly, per the release.
  

(KXAN) — Beginning in 2024, Supplemental Nutrition Assistance Program (SNAP) recipients will be able to purchase grocery deliveries through Uber Eats, the company announced Wednesday.

“We know that online food delivery can have a meaningful impact in reducing barriers to fresh groceries, especially for the most vulnerable–including people living in food deserts, seniors, and those facing disabilities or transportation barriers,” company officials wrote in the announcement. “Helping to improve access to quality food is incredibly important to our work at Uber and we’re proud to use Uber’s technology and extensive local delivery networks to offer SNAP recipients the ability to use their benefits to access fresh groceries conveniently from our app in 2024.”

DeSantis vows to revoke funding for COVID vaccines if elected in 2024

Uber also announced it is working to help support Managed Medicaid and Medicare Advantage plans by accepting FSA cards, Flex cards and waiver payments on Uber for its services. Some of those payment methods will be ready and accepted come 2024, per the announcement.

Tapping into artificial intelligence, Uber is poised to launch later this year an AI-powered assistant to outline new available dishes and cuisines on the app, sort through deals at popular restaurants and reorder previous meals more quickly, per the release.

The AI assistant can also be used to denote sales on grocery items or reorder ingredients from recipes previously used. Uber announced its Uber Eats Sales Aisle concept will highlight grocery store promotional deals and sales to help streamline shopping.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: More info on the MOVEit data breach. This one is about the impact in IN, but the overall impact is much larger (and impacts lots of systems and vendors) and we learn more each week.

 
 

 
 

Clipped from: https://indianapolisrecorder.com/data-breach-exposes-personal-information-of-more-than-700000-medicaid-clients-in-indiana/

By FARAH YOUSRY

The personal information of more than 700,000 Medicaid beneficiaries in Indiana has been exposed in a data breach in late May.

The Family and Social Services Administration announced on Aug. 11 afternoon that a third party contractor had experienced a data breach.

“The names, addresses, case numbers and Medicaid numbers of more than 744,000 members of Indiana Medicaid were exposed in the breach,” according to the FSSA’s press release. “Social Security numbers of four additional Medicaid members were impacted.”

The breach occurred in a software called MOVEit used by Maximus Health Services, a third party contractor.

According to the FSSA, the people affected in Indiana are Medicaid beneficiaries who had received a communication from Maximus about the selection of a managed care entity.

Maximus Health Services Inc. has been an Indiana Medicaid enrollment broker since 2007. The company handles the FSSA’s communications with Medicaid clients including for redetermination and open enrollment.

The company is contacting all members affected by the data breach with information and options for credit monitoring.

For questions or additional information, individuals can call 1-833-919-4749 toll-free.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Medicaid is now an app in LA. Cool.

 
 

 
 

Clipped from: https://ldh.la.gov/news/7108

Medicaid cards will be available in the LA Wallet app. The LA Wallet app is available in Apple and GooglePlay stores. Fee-for-Service members and members enrolled with United Healthcare can already use the service. Other managed care organization cards will become available over the next few months.

The planned dates that other cards will become available are:

• Louisiana Healthcare Connections and Healthy Blue Louisiana – July 31
  
• AmeriHealth Caritas and Humana Healthy Horizons – August 31
  
• Aetna Better Health – September 29
  

Members listed as head of household can access the health cards of family members in their household. A member will not be able to access a card for a person who is not in their household or if they are no longer eligible for Medicaid.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: “Passw0rd”

 
 

 
 

 
 

Clipped from: https://www.azfamily.com/2023/06/30/medicaid-security-breach-affects-over-2600-arizonans-agency-says/

 
 

The Arizona Health Care Cost Containment System says 2,632 people are affected by the breach.(MGN)

PHOENIX (3TV/CBS 5) — Over 2,600 Arizona Medicaid recipients may have had their personal information stolen after a breach that happened mid-May.

The state’s Medicaid agency, the Arizona Health Care Cost Containment System (AHCCCS), said in a statement that it is “aware of a breach of personal information on May 11, 2023 affecting 2,632 individuals in Arizona who are enrolled Medicaid members.” The vulnerability would have allowed bad actors to see sensitive details, including first and last names, addresses and the last four digits of Social Security numbers through the Health-e-Arizona Plus website. Upon learning of the error, the HEAplus system toolbar was turned off.

AHCCCS assures that this type of breach would not happen again, the agency said in the statement, and that starting July 3, it will start to notify those affected by the breach. The agency will send out the notifications through the mail.

If you learn that you’re affected by the breach, you can contact one of the three credit reporting agencies to report a fraud alert, which lets the agencies know that any new requests for credit may be fraudulent. You can also ask the agencies for a security freeze that stops agencies from releasing your information without your express permission (you’ll have to do this using certified mail notifying all three agencies).

Consumers are entitled to one free credit report from each of the three agencies: Equifax, Experian and TransUnion. You can learn more at www.annualcreditreport.com or call 1-877-322-8228.

Credit Reporting Agency contact information:

Equifax, 1-888-378-4329 or www.equifax.com/personal or mail to P.O. Box 740241, Atlanta, GA 30374-0241

Experian, 1-888-EXPERIAN (397-3742) or www.experian.com or mail to P.O. Box 9532, Allen, TX, 75013

TransUnion, 1-800-916-8800 or www.transunion.com/annual-credit-report or mail to Fraud Victim Assistance Division, P.O. Box 6790, Fullerton, CA 92834-6790

Other resources:

Report any suspected identity theft to local police and inform AHCCCS of any filed police reports.

Identity Theft Resource Center | www.idtheftcenter.org

1-888-400-5530 (not a toll-free number). Information is available in English and Spanish.

Federal Trade Commission |
www.consumer.ftc.gov/features

1-877-ID-THEFT (1-877-438-4338). Information is available in English and Spanish.

Arizona Attorney General’s Office

For more, www.azag.gov/consumer provides tips on how to guard against identity theft and the misuse of personal information (select Identity Theft from Quick Links menu at top of home page). You may also call 602-542-5025 (Phoenix); 520-628-6504 (Tucson); or toll-free 1-866-742-4911 (outside Maricopa and Pima Counties).

See a spelling or grammatical error in our story? Please click here to report it.

Do you have a photo or video of a breaking news story? Send it to us here with a brief description.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Oh look! Another Private Equity / VC money guy telling us we all need to get bullish on the last remaining untapped market they are pointing portfolio companies at. Seems legit to me!

 
 

 
 

Clipped from: https://medcitynews.com/2023/07/medicaid-startups-innovation-healthcare/

At a recent conference, Yuvo Health CEO Cesar Herrera said he is proud to bring value-based care to Medicaid populations, but he wishes there was more innovation activity dedicated to these beneficiaries. In his view, the main obstacles preventing startups from entering this space are ignorance about how the Medicaid market works and the false belief that they can’t make money in it.

 
 

Growing up in Detroit without health insurance, Cesar Herrera struggled to find access to care — his family’s only saving grace was federally qualified health centers. That’s part of the reason he founded his startup Yuvo Health, which is focused on helping FQHCs participate in value-based payment models.

Yuvo contracts directly with payers — including Medicaid, Medicare and commercial health plans — for various risk arrangements. The startup then partners with FQHCs, wherein these health centers delegate the risk of their attributed patients to Yuvo. As the company’s CEO, Herrera is proud to bring value-based care to Medicaid populations, but he wishes there was more innovation activity dedicated to these beneficiaries, he said Thursday at HITLAB’s Innovators Summit in New York City.

In his view, there are two main obstacles that prevent startups from launching initiatives or partnering in the Medicaid realm. The first is ignorance. Many people in the healthcare field still lack a developed understanding of what the Medicaid population needs and how Medicaid payment structures work, Herrera declared.

Promoted

 
 

PE Investments, Acquisitions Fuel New Stages of Growth for Healthcare and Life Science Companies

In an interview, Nathan Ray, a partner with the healthcare and life practice who oversees M&A/PE related work in that industry for West Monroe, highlighted how his firm works with companies to drive due diligence for clients, and help acquired companies address issues and differentiate during holds.

Stephanie Baum

“Organizations have tried doing things in Medicare and translating that into the Medicaid space. Then they say, ‘This doesn’t work in Medicaid,’ and automatically assume it’s because Medicaid is the problem or the communities that are being served by Medicare are a problem — but these are two vastly different populations. What may work in a Medicare population should not and would ever be applicable to a Medicaid population — you have to do something different,” he explained.

The other obstacle preventing innovation in Medicaid is that people assume they can’t make any money in this space due to the fact that Medicaid has much lower premiums than Medicare. 

Herrera doesn’t think this is true, but he said it’s “really hard to compare” opportunities for profit in Medicare versus Medicaid because of “the relative dearth of precedent in the Medicaid innovation space.” He noted that this lack of activity in the Medicaid market has led some healthcare stakeholders to draw the conclusion that Medicaid populations don’t want to be engaged, but he contended that this is not the truth.

Medicaid and CHIP serve about a third of the U.S. population, so there’s plenty of opportunities in every state to try new payment models and create better pathways to care access, Herrera pointed out.

Promoted

 
 

Strengthening Security: The Importance of Multi-Factor Authentication in Healthcare

Organizations across most industries, especially the technology sector, have adopted Multi-Factor Authentication (MFA) to fortify their security measures. 

Don Kleoppel – Greenway Health

While the Medicare market has a much more established presence in the value-based care world than Medicaid does, Herrera acknowledged that Medicaid innovation has made some strides in recent years.

“We’re seeing lots of states choosing to be much more innovative —whether proactively by choice or because they have no choice. This is because Medicaid is a third of their budget and they’re trying to figure out how to be financially sustainable with their taxpayer dollars. That’s creating a lot of room for different innovation, which we’re not just seeing in blue states. In many heavily red states, we’re seeing a lot of interesting innovation happening with alternative payment models in Medicaid because they have to be sustainable,” Herrera declared.

Other healthcare stakeholders share Herrera’s view that Medicaid is in dire need of innovation. In April, Justin Norden, partner at GSR Ventures, told MedCity News that companies seeking to innovate the Medicaid space face little competition.

He added that there’s also an “incredible need” for startups to focus on this space, as Medicaid beneficiaries often struggle with care access and poor health outcomes.

“There’s been almost $20 billion in startup investment towards Medicare Advantage which has a roughly $300 million annual budget. This is contrasted with Medicaid, an area that generates almost $700 billion per year in terms of spending in the U.S., and only about $1 billion dollars of startup money is invested in that space,” Norden said.

Photo: zimmytws, Getty Images