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Payers

On the heels of a coordinated care agreement with Anthem, St. Louis-based Mercy is partnering with another health insurer.

On Thursday, the health system announced it was entering into an agreement with Louisville, Kentucky-based Humana to expand patient access to virtual health resources.

Per the new agreement, Humana’s Medicare Advantage members who are patients at Mercy facilities and physician practices will gain in-network access to Mercy Virtual. Staffed with more than 300 clinicians, Mercy Virtual offers 24/7 telehealth services, including virtual primary care at home.

In addition, the agreement links provider reimbursement to quality of care, shifting the payment model for Mercy physicians from fee-for-service to value-based compensation.

“Mercy is committed to working with our communities to improve healthcare while also reducing the total cost of care,” said Shannon Sock, Mercy’s executive vice president, chief strategist and CFO, in a news release. “Strong payer relationships, like this one with Humana, will help in our long-term journey to provide more seamless care for our patients. Together we can make a real difference for patients, which is especially critical during this pandemic.”

The new agreement brings together an insurer with a sizeable membership and a vast healthcare organization.

Mercy includes more than 40 acute care, managed and specialty hospitals, urgent care locations, imaging centers and pharmacies, as well as 4,000 primary and specialty care clinicians in Arkansas, Kansas, Missouri and Oklahoma. And, as of January, Humana’s Medicare Advantage membership totaled more than 4.8 million.

“This agreement unites two organizations striving to offer care that is more accessible, personalized and coordinated — a commitment that is more important than ever right now,” said Jeremy Gaskill, Humana regional Medicare president, in a news release.

The news of the partnership between Humana and Mercy comes just a few weeks after the health system entered into a cooperative care agreement with Anthem. That partnership includes a closer alignment between clinical care and reimbursement as well as increased data flow between Mercy and Anthem.

As the healthcare industry moves toward value-based care, provider-payer partnerships that aim to improve care quality have become more popular.

For example, at the end of last year, Salt Lake City-based Intermountain Healthcare and UnitedHealthcare established an accountable care organization with the goal of improving care coordination and health outcomes for the payer’s Medicare Advantage members. In another instance, Butler Hospital, a mental health facility, partnered with Blue Cross & Blue Shield of Rhode Island to reduce hospital readmissions.

“If either a payer or provider is looking to fill a gap and expand optionality of services for partners or members, these types of innovative partnerships are beneficial because they provide both parties an opportunity to quickly refine and build versus recreating the wheel,” said Nick Donkar, PricewaterhouseCoopers’ health services deals leader. “This strategy enables a win-win solution in short order.”

Provider-payer partnerships will likely continue into the future to help both entities fill gaps as they think about improving care in a virtual environment, he said.

Photo: Gerasimov174, Getty Images

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health insurance, Obamacare

A rise in insurer participation in the Affordable Care Act individual marketplace indicates that payers are anticipating a fruitful year ahead. The installation of a new president and ongoing Covid-19 pandemic appear to be driving this trend.

Over the past year, insurer participation in the ACA individual marketplace has grown and benchmark premiums have declined, according to a new analysis by the Robert Wood Johnson Foundation. The total number of insurance offerings sold on the marketplace is now 9,144, which is about 75% of the 2015 record high.

This suggests that insurers are anticipating increased enrollment as a result of federal policy changes and the impact of the Covid-19 pandemic, said Katherine Hempstead, senior policy adviser at RWJF and author of the analysis, in an email.

“The Biden administration has been emphatic about its commitment to the ACA marketplace,” she said. In particular, the administration has committed to preserving and expanding health coverage to help Americans during the pandemic.

In his American Rescue Plan, President Joe Biden called on Congress to subsidize continuation health coverage through the end of September and to expand and increase the value of the Premium Tax Credit. The latter move will help lower or eliminate health insurance premiums and ensure enrollees will not pay more than 8.5% of their income for coverage.

Further, Biden recently reopened the HealthCare.gov insurance markets for three months to enable Americans to sign up for coverage amid the ongoing pandemic.

Though these policy changes are temporary, there is a commitment on the part of the administration to try to make them permanent, Hempstead said.

Drilling down into participation among major insurers, Hempstead found that Anthem, UnitedHealth and Cigna currently comprise about two-thirds of the national commercial offerings on the individual marketplace. Centene, which dominates the Medicaid managed care organizations category, made its largest single-year increase, nearly doubling its marketplace offerings from 2020 to 2021.

In addition, participation by newcomers like Oscar and Bright Health has grown steadily. Bright Health is now in 10 states, and Oscar is in 19.

Another key analysis finding is that states that have yet to expand Medicaid saw increases in insurer participation. Increased participation in the ACA individual marketplace was particularly focused in Florida, Georgia, North Carolina and Texas, where the number of offerings increased by almost 50% in the last year.

“This is where the greatest number of uninsured people live, so it is the biggest opportunity for membership growth,” Hempstead said.

Looking ahead, it is clear that insurers are hopeful that a significant expansion in healthcare coverage is due, and they see the ACA marketplace as an increasingly important part of the coverage landscape, according to the analysis.

Photo: BrianAJackson, Getty Images

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Humana and IBM Watson Health are collaborating to provide the insurer’s Employer Group members with access to a conversational AI solution.

The solution, called the IBM Watson Assistant for Health Benefits, is an AI-enabled, cloud-based virtual assistant. The AI assistant gives users information about member benefits, coverage, claims, referrals and healthcare cost estimates, said an IBM Watson Health spokeswomen, who declined to be named, in an email.

The solution will be made available to all members of the Louisville, Kentucky-based payer’s Employer Group, which includes 1.3 million medical and 1.8 million dental members.

IBM is not the only tech giant that is using AI chatbot technology to make inroads in healthcare. Microsoft, for example, has been popular among insurers and providers alike, launching triage chatbots and other AI technology. For IBM, it also affords the chance to prove its value in offering AI services dedicated to healthcare — it stumbled in 2017 in its loftier vision to use the technology to one day revolutionize cancer care and more recently in 2019 when it abandoned the AI product meant to speed up drug discovery.

But Humana believes that IBM Watson Health’s AI assistant will provide several benefits to health plan members, said a spokesman for the insurer, who declined to be named, in an email. Specifically, it will provide personalized answers to questions from members.

“Customers want us to make it easy, meet on their terms, and save them time,” he said. “The Watson [Assistant for Health Benefits] offers immediate answers to the majority of customer questions without [them] having to call in for help.”

In addition, the solution can aid in the move toward price transparency, which is now a part of federal regulations for insurers. Beginning Jan. 1, 2023, insurers must disclose negotiated rates and provide estimates of patient out-of-pocket costs for 500 services and items per a federal rule finalized in October. Payers must make that information publicly available for all items and services starting Jan. 1, 2024.

The IBM AI assistant’s cost transparency tool, which uses historical claims and provider data to calculate cost estimates for members, will help the insurer comply with the federal rule.

This is not the first time Humana and Armonk, New York-based IBM Watson Health have partnered on AI technology. The companies developed the Provider Services Conversational Voice Agent with Watson, which was made available to healthcare providers in 2019.

“Given the success, both parties see considerable value in investing in the co-creation of a new, cloud-native, healthcare-specific product,” said the Humana spokesman. “IBM has the technical experience to optimize the AI platform and Humana has the business expertise to bring forward the desired customer experiences.”

The collaboration between the payer and technology company is coming as the use of AI chatbots is soaring.

Though interest in AI-powered digital assistants was growing prior to 2020, the Covid-19 pandemic accelerated its use. Companies, like chatbot and voice bot company Syllable, found themselves overwhelmed by demand, and health systems like Cincinnati Children’s Hospital Medical Center and Springfield, Illinois-based Memorial Health System quickly developed and deployed the technology.

AI-powered chatbot use is expected to grow and continue to shape healthcare in 2021.

Photo: Gerasimov174, Getty Images

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Insightin Health, a company that offers payers a personalized member engagement platform, has raised $12 million in a Series A funding round.

The round was co-led by the Blue Venture Fund — a collaboration between Blue Cross Blue Shield companies, the Blue Cross Blue Shield Association and Sandbox — and healthcare growth equity fund Blue Heron Capital.

Insightin Health plans to use the new funds to scale its proprietary inGAGE platform, which is designed to help payers retain and engage their members, said Enam Noor, CEO of Insightin Health, in an email.

The platform applies natural language processing to clinical information and social determinants of health and then generates an algorithm for care management and retention for each member, he explained.

“The AI-driven approach and machine learning algorithm connects the dots for all of the data sources and aggregates the trends for predictive outcomes,” he said. “[The platform makes] recommendations for every touchpoint of member communications and activities.”

Currently, the platform has aggregated data for more than 5 million people.

Scaling the inGAGE platform will allow Insightin Health to bring in new clients and provide new tools within the platform for existing customers.

“[Blue Venture Fund is] committed as an organization to improve the health system, and we feel a solution like Insightin Health takes great strides in getting us there,” said Binoy Bhansali, managing director of the Blue Venture Fund, in a news release. “Their ability to leverage data strategically elevates Medicare Advantage and Managed Medicaid plans’ abilities to improve quality, reduce costs, and drive growth and retention by better engaging members.”

Other investors in the funding round included Health Catalyst Capital, Revolution’s Rise of the Rest fund and SaaS Ventures.

The market for personalized consumer engagement platforms is crowded, with companies like Zipari, Welltok and Health Mine all jostling for market share. In addition, large enterprise companies are moving into the healthcare space, such as SalesForce and Microsoft, Noor said.

But Insightin Health sets itself apart by being the only single platform that is able to aggregate all data points for both structured and unstructured data into one ecosystem, he added.

In contrast to many companies that have suffered amid the Covid-19 pandemic, Insightin Health has fared well.

Though Noor declined to share the company’s current valuation, he said Insightin Health experienced 170% revenue growth year-over-year from 2019 to 2020. The company is aiming for similar growth this year.

The company’s growth during the pandemic is partly due to the fact that Insightin Health developed tools focused on the senior population in March 2020, Noor said. These tools gather data on Medicare and Medicaid beneficiaries and then use machine learning to help payers determine patient risk factors.

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UPMC Enterprises, the innovation and commercialization arm of Pittsburgh-based UPMC, launched Astrata. The company has developed natural language processing technologies that aim to improve the quality of care.

Astrata’s technologies help payers and providers assess care delivery in accordance with quality measures, like the National Committee for Quality Assurance’s Healthcare Effectiveness Data and Information Set (HEDIS). These measures aim to ensure the delivery of high-quality care and mitigate gaps.

Increasingly, the government and private payers are tying provider compensation to quality measures amid the move toward value-based care.

The company’s technologies can comb through hundreds of millions of clinical notes, and by applying natural language processing, can identify whether a patient has received care that is compliant with quality measures, said Dr. Rebecca Jacobson, president of Astrata, in a phone interview.

“[The platform] is really evaluating all the text across one member or one patient and [then it] says, yes this person is in the denominator, that is, the measure applies to them,” she explained.

Once the platform has determined whether a measure applies to a patient, it then assesses whether the care they received is compliant with that measure.

For example, there is a HEDIS measure that focuses on older women with bone fractures who have not yet received appropriate imaging and treatment. Astrata’s platform is able to analyze clinical notes and pinpoint those patients.

“That’s a true gap,” said Jacobson. “That is someone that the health plan and the provider want to know about because they want to intervene quickly so that they can prevent subsequent morbidity and mortality.”

Further, the platform allows healthcare organizations to conduct year-round monitoring and quality improvement efforts as opposed to the current system, where quality rates for many HEDIS measures can only be determined once a year via a manual process.

Astrata partnered with UPMC Health Plan to develop and validate its technologies. The platform has been used by UPMC and UPMC Health plan for several years.

“Over the last two years, UPMC Health Plan abstractors found they can work up to 38 times faster with the implementation of Astrata’s NLP-assisted tools,” said Diane Holder, president and CEO of UPMC Health Plan, in a news release. “This partnership facilitates a more rapid and accurate flow of thorough, meaningful data between our quality team and our providers.”

With the launch of the spinout, Astrata’s tools are now available in the U.S. market.

The company also plans to increase its workforce by 30% in 2021.

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interoperability

Every year at this time, it feels like the movie Groundhog’s Day for many in the payer community. New members, that can run into the tens of thousands, are onboarded. For those in care management, it’s a mad scramble to obtain patient medical histories. The amount of time, energy, and resources spent on largely manual processes continues to be exasperating.

Take Medicare, for example, where more than 840,000 baby boomers aged into the system and enrolled between 2019 and 2020. When these new members are onboarded, care management teams have a very challenging time attempting to close gaps in care. Common questions such as, “when was the last time a member had a mammogram, and what were those results?” are often difficult to answer because of healthcare’s infamous data silos that ensure patient information remains trapped.

Chronic fatigue syndrome
Payers employ teams of people whose full-time job is calling a doctor’s office, requesting information, and waiting weeks for the data to be mailed in hard copy or other physical media such as CDs —or being required to physically drive to the provider location to pick up records. The onus of collecting patient records doesn’t stop with care management.

During reporting periods for HEDIS/STARS measures or risk adjustment evaluations to set rates for plans, administrative teams must chase down records. This Herculean task often requires extra help from outside firms during the January to April crunch time. Many providers find multiple people from multiple departments from the same payer organization requesting the same type of information over and over again in a single year. The result is extraordinary expense and unnecessary fatigue in a records collection process that repeats itself every year.

Interoperability struggles
2020 was supposed to be The Year that would kick health data interoperability into high gear. The Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid (CMS) issued their highly anticipated rules that are intended to improve data interoperability and to prevent information blocking. The rules specify the interoperable data and technology standards for sharing medical records between patients, doctors and payers. The goals are to give patients greater access and control over their medical information to make better healthcare decisions and to spur the type of consumer innovation that is seen in almost every other industry except healthcare.

Those rules have been delayed twice due to difficulties with payers and providers implementing the standards; and then there was also the pandemic. While it remains to be seen if April 2021 will indeed be the effective date for compliance, and many companies are actively advocating for additional delays, one thing we do know is that neither payers nor providers are completely ready for it.

According to a recent survey by Accenture, fewer than one in five (18%) of the executives surveyed in key leadership positions at U.S. healthcare companies said they are “very familiar” with the new regulations, while 17% said they are completely unaware of it. In another survey by the eHealth Initiative, 64% of payers said their top concern is their ability to implement and maintain the application programming interfaces (APIs) that are required for patient access. This concern dwarfs the results of the next top issue by a large margin which is compliance with the rules where only 14% of payer executives said they were concerned about their ability to adhere to the interoperability laws.

This is not especially surprising given that payers have built compliance capabilities to follow the letter of the law in a heavily regulated health insurance industry. However, interactions with patients are centered around the administration of benefits while they are members. Payers have not traditionally dedicated IT resources to building and maintaining technology to directly engage patients, collect and share health information across their care journey geographically and through time longitudinally. Therefore, it’s also not especially surprising that 79% of payers said they definitely would or probably would use vendor solutions to help meet required deadlines.

Working with a Vendor
If the preferred route is to work with a health IT vendor, and all indications are that payers will need to seek outside help with at least some aspects of interoperability and patient access, here are three important things to consider:

  • Can the vendor handle advanced data? As interoperability increases, more complicated data types will be required as part of the essential health information (EHI) of a patient. Already, the newly defined U.S. Core Data for Interoperability standard expands the criteria for clinical data from its more simplistic forms such as claims data. Patients have the right to ask for and receive more advanced data such as medical imaging and digital pathology. Advanced data contains clinical data of significant value that are crucial to care delivery, chronic and complex disease management, and treatment innovation.
  • Is it a mature solution? Common concerns that I often hear is trepidation in dealing with startups without a track record on reliability, scalability, security and credibility. How do you trust that patient data is being handled with care? That is why it’s important to look for vendors with a mature solution and a track record. As an industry, we need to innovate, but we also need to be measured in our choices and not be fooled or distracted by promises of the next disruptive technology that may never be delivered. With no time to waste, the healthcare industry should rely on proven scale capabilities, even if they are not perfect, and build upon them systematically.
  • Look for “off the shelf” API tools that you can use to access medical networks such as Health Information Exchanges (HIEs) and other data networks that support common standard such as HL7 and FHIR. Payers can then plug and play these API tools to access a broad variety of clinical data such as EHR data, labs and imaging. Vendors providing tools should also provide support services for integration into your enterprise systems. Robust service agreements should provide you with comfort knowing that you have a partner to work with you throughout your data interoperability journey.

We all know the upcoming road is going to be tough and will challenge the healthcare industry to share and collaborate in a way it is unaccustomed to. One of the important lessons from Covid-19 is that, paradoxically, the long-awaited and delayed interoperability rules have proven exactly why we need better data sharing.

Photo: DrAfter123, Getty Images

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Blue Cross and Blue Shield of Kansas City expanded its partnership with HealthMine, a technology company providing member engagement solutions, to build a rewards program for the payer’s individual and family Affordable Care Act members.

The Missouri-based payer, also known as Blue KC, has an existing partnership with HealthMine to offer a rewards program for its Medicare Advantage plan members. The program focuses on encouraging preventive health actions, such as annual wellness visits, flu shots and breast cancer screenings, by offering the ability to earn rewards in the form of gift cards to national and local retailers, Jenn Ader, senior director of client services at HealthMine said in an email.

“The program has also continued to evolve to provide additional features, including a digital health risk assessment delivered through the program application to help Blue KC better understand their members’ health status and risks,” she said.

Members interact with the program through a mobile app, web portal and live customer service support, she added.

Through the expanded partnership, HealthMine will build an incentive and rewards program for the insurer’s ACA members similar to the one for its Medicare Advantage members, giving the ACA members incentives to complete health actions and digital health risk assessments.

“The rewards program helps our MA members engage with their healthcare decisions and develop an ongoing relationship with their primary care providers,” said Lori Rund, vice president of government programs at Blue KC, via email. “We expect it will do the same for our ACA members, ultimately giving them the tools they need to successfully navigate the healthcare system and reach their long-term health goals.”

Creating incentive programs for ACA plan members is especially important, because these members tend not to seek routine medical care as they previously may not have had health insurance coverage, James Haskins, HealthMine’s director of government programs, said in an email.

These programs, “by rewarding preventive visits, encourage members to establish a relationship with a provider — this relationship is a launching point for the member on a journey of engagement in managing their health,” he said.

Engaging plan members in preventive healthcare has become even more challenging amid the Covid-19 pandemic, as the fear of contracting the deadly new coronavirus has kept people from routine care visits. By June 30, an estimated 41% of U.S. adults had delayed or avoided medical care due to concerns about Covid-19, according to data from the Centers for Disease Prevention and Control.

“There are ways to minimize the effects of Covid-19 on preventive care by providing a solution that seamlessly connects members to the care they need and incentivizes them to get needed care — that’s where rewards programs can come in,” Haskins said.

In addition, as the Covid-19 vaccine becomes more widely available, health plans need to be able to communicate with its members, especially the younger and healthier members that tend to have ACA plans, to give them information about vaccine availability and safety, he said.

“Offering an associated reward helps increase member interest and move those who may not have sought this vaccine otherwise,” he added.

Photo credit: ljubaphoto, Getty Images

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interoperability, rope, braid

Back in 2019, the Proposed Interoperability rules were released from ONC and CMS, and the final version of these rules were published in March 2020. While there were some changes implemented based on comments received, largely the new rules kept a lot of the original requirements along with the timelines for implementation. Some of those timelines have been pushed out due to the coronavirus pandemic, but the first payer deadline will be upon the industry before we know it.

Payers have their work cut out for them, although many have hired consultants and partnered with vendors to help implement the first phase of the rule: Patient Access Application Programming Interface (APIs) and Provider Directory. With a relatively short implementation window of January 2021 (with a 6-month grace period on enforcement), that’s not a lot of time to get ready for compliance.

Based on conversations with customers, prospects and industry organizations, there is still ambiguity in the interpretation of the rules, and operational impacts that payers may not be ready to address.  Here are five bumps on the road ahead to implementing the CMS Rules, effective Jan. 1, and some ways health plans can mitigate those uncertainties.

Implementation Guides – Still in Flight
Although not required by CMS, use of the referenced Implementation Guides on the CMS web site is encouraged. The challenge here is that some of those implementation guides are still not finalized. For example, the CARIN Blue Button and CPCDS Implementation Guide still needs to reconcile comments to Standard for Trial Use ballots (STU1). Additionally, the HL7 Da Vinci Formulary and Provider Directory implementation guides (IGs) are likewise in the process of final updates. Both CARIN and Da Vinci are moving quickly, but it’s hard to implement when the target may still move. As such, it is critical that payers and their vendor partners participate in these workgroups and follow the updates to make sure that they have the latest technical specifications.

Clinical Data – What Counts
CMS finally has provided guidance on this, and the news is good for payers. Only clinical data elements listed in the United States Core Data for Interoperability (USCDI) that are structured data need to be shared for the Patient Access API. So, USCDI clinical data elements embedded in a fax or PDF don’t need to be shared. For payer-to-payer exchange, if data in a PDF sent to a payer contains USCDI, they do need to send it along to the next payer. Here’s the link to answers to some common questions from CMS:

Despite this reprieve,  payers need to be aware they have plenty of structured clinical data that they manage, so locating that data and bringing it all together might be a challenge. Consider sources such as lab data, diagnosis and procedure codes contained in a claim, data entered into a case management system or disease management registry; they will count. Not to mention data that might come in through an Abstract Data Type (ADT) or a Consolidated Clinical Document Architecture (CCDA) directly from a provider. To avoid bumps, payers must ensure they’re working with a vendor that can easily ingest data, no matter what the source format.

Clean Data – Does it Matter What Payers Send to Members?
Not only does it matter what payers share, but also how payers share it. A lot of clinical data captured by a payer is not “clean data”.  This means it might not be in the required coding, there may be multiple copies of the same data (i.e. lab results) stored or data might be in the wrong field when ingested. Cleaning that data before sharing it should be a key consideration. If members don’t understand what they are seeing, and can’t make sense of it, then the member service line might be ringing off the hook. The more payers can curate that clinical data, the easier it will be for third party applications to use and display it to members in a meaningful way. Having aggregated, normalized, and deduplicated data is key to enabling the ability to payers pass clean data to an API vendor.

Provenance
It is important that members know the origin of their data. As part of the new USCDI standard, data provenance needs to be part of the data shared. Similarly, knowing the source of that data could help educate members about who to call when the data doesn’t look right. For example, if a medication that a patient is no longer taking appears in the application, knowing the source of that data can help the member follow up with their provider, not their health plan, to make the correction. Health plans need to make sure that they, or their vendor partners, capture and share the provenance data with the third-party apps. There should also be education on the payers’ website and as part of its member portal that provides clear information on what members should do if their information isn’t correct.

API Application Vendor Vetting
The CARIN Alliance is doing a lot of work to create framework and reference documents that help payers assure that the third-party apps are “vetted” prior to connecting to the payer’s infrastructure. Although a payer cannot deny access to an application, they can make sure that the vendor is who they say they are and that they are handing off credentials to a reputable app vendor. [Editor’s note: The author’s employers is a member of the CARIN Alliance.]

CARIN has also created a Code of Conduct, where app vendors can voluntarily attest to the Code. App vendors that have agreed to the code state that they plan to respect patient privacy and only use the data for member benefit. It’s important for payers to let their members know that third-party apps will not be sharing the data in ways the member didn’t intend (often because of language in the app End User Agreement).

While the new regulations come with many challenges, the end result of improved interoperability and providing members greater access to their health data makes it all worth it. For payers, it’s as important to focus on the operational impacts of the CMS rules as it is on the technology used to comply with them. To do this, payers should continue to monitor both feedback from CMS, chatter from the CARIN Alliance and the HL7 Da Vinci project as well as feedback from customers and prospects. By focusing on these non-technical considerations as they move to implementation, the process will become much more seamless.

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venture capital,money,business,Investor

Diameter Health, a company focused on health data optimization and interoperability, has raised $18 million in a Series B funding round. Managed care organization Centene Corp. led the new financing round.

Diameter Health cleans and enriches health data, Eric Rosow, CEO of the company, said in an email. The company’s technology automatically ingests raw health information — that is, poorly formed, unstructured or incorrectly coded data — from EHRs and other data systems which it then normalizes, enriches, reorganizes and summarizes. It also takes out duplicate data.

“The [normalized] data can be used for clinical care, quality reporting, population health, risk adjustment and many other use cases,” Rosow added.

The recently raised funds will be invested in product development. The company plans to expand its Fast Healthcare Interoperability Resources-enabled integration solution, called Fusion, to accept and ingest all health messages, standards and data sources. Diameter Health also plans to add new artificial intelligence and machine learning capabilities to the Fusion system.

Further, the company will use the new funding to expand its network of direct connections between EHR systems, health information exchanges and other healthcare data sources.

“We invested in Diameter Health because their ability to automatically integrate and normalize clinical data will play an important role as we look to accelerate innovation and digitization across our company,” said Mark Brooks, Centene’s executive vice president and chief information officer, in a press release.

In addition to Centene, the latest funding round included participation from existing investors Optum Ventures, LRVHealth, Connecticut Innovations and Activate Venture Partners. After raising $9.6 million in a Series A-1 funding round in April 2019, Diameter Health’s total funding now stands at $30 million.

The investment comes as efforts to advance interoperability and curb information blocking accelerate in the U.S. Two rules that implement the interoperability and patient access provisions of the 21st Century Cures Act were released by the Department of Health and Human Services earlier this year, and they require providers, payers and EHR vendors to share data more widely than ever before, both amongst themselves and with patients.

Interoperability requires standardized data that can be seamlessly shared. With several companies, like Verinovum and Innovaccer, also focusing on health data optimization, competition in the market is fierce.

But, for Diameter Health, its biggest competitors are “the companies using general purpose software, spreadsheets and expensive labor to ‘do it themselves’ — creating error prone, one-off solutions which do not scale, to meet the demands for real-time decisioning,” Rosow said.

“Diameter Health is unique because [our] best-of-breed technology is purpose-built to optimize health data at scale,” he added.

Photo credit: claudenakagawa, Getty Images

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UnitedHealthcare is providing members of its Motion program access to Apple Fitness+ workout classes, powered by Apple Watch, for at least six months and at no additional cost.

UnitedHealthcare Motion is a well-being program that enables people to earn over $1,000 per year by meeting certain daily activity goals, Rebecca Madsen, UnitedHealthcare’s chief consumer officer, said in an email. People in the program have access to several wearables, including Apple Watches, at no additional cost and as buy-up options.

Beginning Jan. 1, UnitedHealthcare Motion enrollees with Apple Watches will have access to Apple Fitness+, which provides a variety of studio-style workouts, including high-intensity interval training, yoga, dance and cycling.

“UnitedHealthcare and Apple share a joint mission to help people live healthier lives,” Madsen said via email. “By making Apple Fitness+ accessible to UnitedHealthcare Motion members with Apple Watch, we are helping achieve that goal. Plus, with interest in at-home fitness resources surging amid Covid-19, this collaboration is another way to support our members on their journeys toward health.”

Eligible members will gain free access to Apple Fitness+ workouts for six months, after which they will be able to buy a six-month subscription using program earnings, a credit card or a combination of both.

Providing access to Apple Fitness+ is a part of the insurer’s broader effort to offer people digital resources and financial incentives that can help them better manage their health, especially their chronic conditions, Madsen said.

“UnitedHealthcare is dedicated to creating seamless, integrated health programs and resources that empower people to take charge of their health, more easily navigate the health system and help make care more affordable for all Americans,” she added. “We are helping accomplish those goals with UnitedHealthcare Motion and the new collaboration with Apple.”

A recent study, which followed 44,370 men and women for 4 to 14.5 years, showed that people who spent more time being sedentary faced a higher risk of death as compared to people who spent more time being physically active.

UnitedHealthcare Motion enables members to earn financial incentives based on reaching daily fitness targets, which include completing 300 steps within five minutes, six times per day, at least an hour apart.

Since the launch of the program, UnitedHealthcare Motion participants have collectively walked more than 511 billion steps and earned $60 million in rewards, Madsen said.

Photo credit: martin-dm, Getty Images

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