The visits have provided access to primary care for communities of color, which have been disproportionately harmed by the COVID-19 pandemic.
Federally qualified health centers in Massachusetts have logged more than one million telehealth visits since the start of the pandemic in March 2020, the state's consortium of FQHCs announced Tuesday.
Massachusetts FQHC Consortium telehealth data between May 2020 and May 2021 show that telemedicine visits have provided access to primary care for communities of color, which have been disproportionately harmed by the COVID-19 pandemic.
Of the 767, 234 Massachusetts health center patients 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, the consortium said.
Of the total number of patients taking part in behavioral health telehealth visits during the same span, 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.
"While telehealth played an essential role in maintaining continuity of care throughout the pandemic, our health centers see its continued popularity among low-income communities and communities of color, even as in-person visits are now available," said Christina Severin, President and CEO of C3.
"As we pass one million telemedicine visits, the numbers validate what we’ve seen: telehealth provides opportunities for increased access to care and diminishes health inequities faced by Medicaid patients as a result of institutionalized racism in our health care system. We thank our donors who are supporting our efforts in addressing this injustice," she said.
The milestone comes as the consortium passed the halfway mark of its Phase II $12 million fundraising goal – thanks to an $878,000 grant from the Gordon and Betty Moore Foundation – to attain sustainable telehealth capacity at health centers and address health disparities in the communities they serve.
"The digital divide disparately impacts poor communities and communities of color," said Michael Curry, President & CEO of the Massachusetts League of Community Health Centers.
"Access to broadband and other technology is a social determinant of health that must be prioritized in order to avoid the deepening of existing racial health inequities," he said.
The county and the health system will now shift to build a working plan for the partnership, which they hope to launch within the next nine months.
San Joaquin General Hospital and Dignity Health have signed a letter of intent to pursue a long-term affiliation to improve services at the safety net hospital.
Tom Patti, chairman of the San Joaquin County Board of Supervisors, said the partnership "will allow San Joaquin General Hospital to remain viable as a provider of cost-effective quality health care."
"Due to the pandemic and a variety of other fiscal considerations, SJGH will require access to clinical, operational, educational and financial assistance that could only be provided by entering into an agreement with an established, successful health care system," Patti said. "We believe this affiliation will be significantly beneficial to all parties, but especially to patients and staff at SJGH by providing a more financially-secure hospital setting which offers more sustainable care over the long term."
The county and the health system will now shift to build a working plan for the partnership, which they hope to launch within the next nine months.
Under the affiliation, the 619-bed Huntington Hospital will maintain local governance—with its own employees, board of directors and medical staff. In addition, Huntington's fundraising and volunteer program will remain under local control.
Cedars-Sinai will provide additional resources, expertise, and management. The Los Angeles-based health system has also committed to improving IT, expanding ambulatory services, and bolstering physician recruiting and development.
The affiliation was first announced in March 2020, but raised anticompetitive concerns by the California Attorney General's Office. Huntington and Cedars-Sinai filed a lawsuit against the AG in March 2021, claiming that state regulators slapped burdensome and unprecedented conditions on their proposed affiliation.
At issue was the so-called "competitive impact" conditions attached to the affiliation by the AG's office that state regulators said would ensure that the consolidation does not raise prices for consumers in the affected service areas.
Cedars-Sinai officials told HealthLeaders that the suit had been resolved, but they did not elaborate.
Lori J. Morgan, MD, CEO of Huntington, said the hospital chose to move forward with Cedars-Sinai because it "has demonstrated a commitment to build on the strengths of its affiliates to advance clinical quality, provide outstanding patient care and engage with the communities it serves."
"Huntington will be both a strong contributor to this world-renowned, nonprofit system and enjoy the benefits of joining a larger, regional organization to preserve our legacy of compassionate, community-based care well into the future," Morgan said.
Boca Raton, Florida-based MDVIP is one of the nation's largest concierge medicine providers, with a network of more than 1,100 primary care physicians and 357,000 patients.
Goldman Sachs Asset Management and Charlesbank Capital Partners on Thursday announced that they've acquired controlling ownership in concierge care provider MDVIP from Leonard Green & Partners and Summit Partners.
Financial terms were not disclosed for the deal, which is expected to close by year's end.
Founded in 2000, Boca Raton, Florida-based MDVIP is one of the nation's oldest and largest concierge medicine providers, with a national network of more than 1,100 primary care physicians and 357,000 patients.
"This investment by Goldman Sachs and Charlesbank speaks to the strength and resiliency of our business model, and we are excited to partner with them as we embark on our next phase of growth," said MDVIP Chairman and CEO Bret Jorgensen.
MDVIP partners with employers to offer healthcare services to their workers. The company has also expanded its offerings to include incorporating the concierge model in hospitals and developing a women's healthcare program that pairs gynecological services with preventive primary care.
"MDVIP has an impressive track record of delivering business growth to investors and proven healthcare outcomes that benefit patients, physicians and the healthcare system at large," said Jo Natauri, Partner and Global Head of Private Healthcare Investing within Goldman Sachs Asset Management.
"The company's history and ability to adapt to a rapidly changing healthcare environment make it a strong addition to our investment portfolio, and we look forward to partnering with Charlesbank and the MDVIP management team."
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Under the deal, which is expected to close by the end of the year, Evolent will acquire 100% of the outstanding equity interests in Vital Decisions for $85 million, comprised of 50% Evolent Class A common stock and 50% cash, and another $45 million in cash or in a mix of cash and Evolent Class A common stock, tied to metrics at the end of 2022.
"We believe Vital Decisions is a strong strategic fit for Evolent," Evolent Health CEO Seth Blackley said. "We believe this transaction… unlocks patient engagement and telehealth as levers for ensuring patients with complex illness receive high-quality, coordinated care."
When the deal is finalized, Vital Decisions, currently a portfolio company of WindRose Health Investors, will be brought under Evolent's Clinical Solutions subsidiary, and will report to Evolent's management company, New Century Health.
"Cancer and heart disease account for more than 50% of deaths in the United States and drive a substantial portion of health care services at the end of life," New Century Health CEO Dan McCarthy said.
"The addition of Vital Decisions to New Century Health will help ensure that the care plans for these and other individuals facing advanced illness align with their core values and personal preferences, adapting with patients as their needs and goals evolve," he said.
Vital Decisions CEO Leah Puccio said that "up to 35% of costs in the last six months of life are for services that are unwarranted or unwanted—decreasing patient satisfaction and quality while increasing costs to the system."
"Addressing this misalignment of treatment goals between patients and providers requires multiple innovative solutions coming together," Puccio said. "This acquisition will help ensure that the care plans created by our Vital specialists find their way into the hands of the providers responsible for ensuring these individuals receive the care they want as their illness progresses."
TytoCare CEO and Co-Founder Dedi Gilad claims the platform will allow Prisma physicians to "fully replicate an in-person visit."
Prisma Health – South Carolina's largest not-for-profit health system -- is teaming up with telehealth platform TytoCare in a partnership that both organizations say will improve remote diagnostics and treatments.
"At Prisma Health we're committed to improving access to quality, convenient, and affordable care to our patients," said Nick Patel, MD, chief digital officer of Greenville-based Prisma Health. "Through our partnership, we can now reach more patients, decrease costs, and transform the virtual care experience. We look forward to working together with TytoCare to offer our patients clinic-quality, at-home care in this new era of telehealth."
TytoCare's FDA-approved handheld examination kit allows users to perform comprehensive physical exams of the heart, skin, ears, throat, abdomen, and lungs, as well as measure blood oxygen levels, heart rate, and body temperature, which are key for monitoring COVID-19 and many other chronic and acute conditions.
Dedi Gilad, CEO and co-founder of Israel-based TytoCare, said the platform will allow Prisma physicians to "fully replicate an in-person visit."
"TytoCare is enabling Prisma Health to provide the telehealth experience consumers desire in today's on-demand world, allowing for more thorough virtual care when it's most convenient for the patient," Gilad said.
The online, self-paced program examines innovative telehealth models and best practices and provides strategies to help providers overcome nagging hurdles.
The online, self-paced program examines innovative telehealth models and best practices and provides strategies to help providers overcome nagging hurdles such as reimbursement parity, set-up costs, regulatory red tape, and competition from retail clinics and urgent care centers.
"As a physician at one of Pennsylvania's first 100% virtual primary care practices, I can testify to the importance of education in telehealth – and teleprimary care in particular," said Salim Saiyed, MD, CMIO at UPMC in Central Pennsylvania and course director for ABT's teleprimary care program.
"Doctors and care teams need to understand how they can deliver teleprimary care more efficiently and effectively – from the start of the encounter to check out and arranging any follow-up care needed so that patients can access the right specialists, for the right test, or the right procedure," Saiyed said.
The Teleprimary Care Certificate program covers:
Barriers and opportunities of teleprimary care, along with the evolution of telehealth in the primary care setting, and progressive models now in the market;
Operations, workflow and productivity in the ambulatory setting, and how technology can optimize resources and maximize productivity while maintaining care standards;
Legal, regulatory and ethical considerations, with an emphasis on regulatory compliance challenges at the federal and state levels and mitigate risk guidance;
Providing care via a remote medium, examining best practices for hybrid care models, including tips for virtual patient encounters and strategies to promote quality and foster patient trust;
Health equity and social determinants of health, and how to enhance access for underserved populations.
"Teleprimary care is at the forefront of the telemedicine space, but it continues to evolve and expand with the development of new technologies, innovative care models and evolving reimbursement policies," said Whitney Flanagan, RN, director of education for the ABT. "Telehealth training – whether it's on the platform, regulations or webside manners – will be critical to long term success. Primary care teams need specialized skills to meet the growing demand for telemedicine services and ensure the highest quality care possible for patients."
California docs say the latest mandate is part of an ongoing and "common practice for health insurance companies to create new obstacles for patients, in hopes of not having to provide essential health care to those who need it."
The California Medical Association is taking Aetna Inc. to task for what the physicians' association claims is cumbersome new red tape requiring prior authorization for cataract surgeries.
The CMA said the latest mandate, effective July 1, is part of an ongoing and "common practice for health insurance companies to create new obstacles for patients, in hopes of not having to provide essential health care to those who need it."
"Aetna claims the practice will 'help members avoid unnecessary surgery,'" CMA said. "The reality is that this bureaucratic roadblock is not some kind of patient protection measure. It is an effort to deny care and pad the insurance company's bottom line."
The CMA noted that Aetna has seen record profits through the COVID-19 pandemic. Acquired by CVS Health in 2018, Aetna's operating income increase from $1 billion in 2019 to $3 billion in 2020.
A recent American Medical Association survey found that nearly 70% of 1,000 practicing physicians surveyed in Dec. 2020 reported that, amid the COVID-19 pandemic, health insurers had either reverted to past prior authorizations policies or never relaxed these policies in the first place.
More than nine in 10 physicians (94%) reported care delays while waiting for health insurers to authorize necessary care, and nearly four in five physicians (79%) said patients abandon treatment due to authorization struggles with health insurers.
In a statement sent to California Health Facts, Aetna said it notified in March the ophthalmologists in their network and related professional associations about the "precertification policy" on cataracts, explained the rationale, and laid down the guidelines.
"Based on our decades of experience in reducing unnecessary surgeries, a multi-year, multi-state pilot on reducing unnecessary cataract surgeries, and national clinical guidelines and literature on surgeries, we believe up to 20% of all cataract surgeries may be unnecessary," Aetna said. "Our data from July shows that more than 99% of cataract precertification cases were compliant with turnaround time standards, which are based on regulatory and accreditation requirements."
In California, CMA is sponsoring SB 250 by Senator Richard Pan, MD, which would require state regulators to streamline the prior authorization system to ensure patients have access to critical care. That could include copying legislation in Texas that created an audit-based system where prospective prior authorization is waived for clinicians deemed high-performing.
CMA is also supporting federal legislation—HR 3173, the "Improving Seniors' Timely Access to Care Act" sponsored by U.S. Rep. Ami Bera, MD, D-CA. The bill would standardize and streamline prior authorizations for routinely approved services under Medicare Advantage programs.
Cricket claims its "StageSmart™" predictive analytics model can identify patients with chronic kidney disease stages 3b and beyond with 96% accuracy.
Blue Shield of California has partnered with Cigna Ventures and other investors to provide $83.5 million to expand Cricket Health, the San Francisco-based kidney care provider.
"In the year that we have been working with Cricket Health, our members with chronic kidney disease have received comprehensive care from the comfort of their homes, resulting in better health outcomes," said Blue Shield of California Interim CMO Susan Fleischman, MD. "Cricket Health's virtual platform has helped connect patients with clinical and peer support, making them feel more educated about their health and involved in their care plans, allowing them to live their best lives."
Cricket claims its "StageSmart™" predictive analytics model can identify patients with chronic kidney disease stages 3b and beyond with 96% accuracy, which allows the provider to risk stratify patient populations and deliver stage-specific care.
Cricket's "MyCricket™" patient support platform provides access to a multidisciplinary care team, peer support, and educational resources online, by telephone, or in person. Cricket patients in end-stage kidney disease are more likely to be referred for transplants and have access to home dialysis to reduce unnecessary hospitalizations.
The Series B funding round, led by the healthcare private equity firm Valtruis, a portfolio of Welsh, Carson, Anderson & Stowe, also includes existing investors Oak HC/FT, and K2 HealthVentures. With the new funding, Cricket has raised more than $120 million in equity and debt financing.
"Changing the way kidney disease is identified and managed is how we are able to deliver better clinical results," Cricket Health CEO Robert Sepucha said. "By identifying patients earlier and delivering the care they need, we are helping more Americans than ever stay healthy, at home, and out of the hospital. With new partners Welsh Carson and Blue Shield of California and existing partners Oak HC/FT, Cigna, and K2 Health Ventures, we will be able to continue to expand our innovative model of kidney care across the country."
Tom Richards, senior vice president and global lead, strategy and business development at Cigna, said the payer's partnership with Cricket has made kidney disease management more affordable, predictable and simple for beneficiaries.
"Since May 2020, we've seen more than a 50% reduction in hospitalizations and an increase in patient autonomy in a customer's transition to dialysis," he said, "and we look forward to continuing our partnership to help improve our customers’ experience and their health."
The settlement stems from violations of the Mental Health Parity and Addiction Equity Act of 2008.
United Behavioral Health and parent United Healthcare Insurance Co. will pay $15.6 million to settle allegations that the payer unlawfully denied mental health and addiction treatment services to thousands of people.
"United's action violated the Mental Health Parity and Addiction Equity Act of 2008, which prohibits Employee Retirement Income Security Act-covered health plans from imposing treatment limitations on mental health and substance use disorder benefits that are more restrictive than the treatment limitations they impose on medical and surgical benefits," DOL said.
As a result of United's violations, beneficiaries did not get mental health and substance use benefits mandated by their ERISA-covered plans. More than $13 million of the settlement will be paid to those beneficiaries, with the remainder collected as penalties, DOL said.
United also failed to disclose adequate information about these practices to plans and their beneficiaries, and has agreed to stop the violations, improve its disclosures to plan participants and commit to compliance.
"In the shadow of the most devastating year for overdose deaths and in the face of growing mental health concerns due to the pandemic, access to this care is more critical than ever before," New York Attorney General Letitia James said.
"United's denial of these vital services was both unlawful and dangerous – putting millions in harm's way during the darkest of times. There must be no barrier for New Yorkers seeking healthcare of any kind, and I will always fight to protect and expand it."
UnitedHealth Group issued a statement saying it is "committed to ensuring all our members have access to care and to reimbursing providers consistent with the terms of the member's health plan and state and federal rules."
"We are pleased to resolve these issues related to business practices no longer used by the company. As part of our broader commitment to quality care, we continue to support our members with increased access to providers and new ways to get the effective behavioral support they need."
