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Health technology company Seqster is focused on helping patients bring all their health information into one place.

The San Diego-based company, which launched in 2016, announced Thursday it secured backing from Japanese pharmaceutical giant Takeda Pharmaceutical. 

The companies did not disclose the funding amount.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

The funds will be used to accelerate the adoption of the company’s interoperability technology for enhancing clinical trials, patient engagement and outcomes, the company said.

“Seqster’s technology is a very unique platform that addresses interoperability on not only a nationwide scale but also globally. Interoperability is one of the biggest barriers to applying precision medicine to clinical trials and patient engagement,” Bruce Meadows, head of investments at Takeda Digital Ventures, said in a statement.

Seqster’s platform retrieves, parses and harmonizes multidimensional data sets to help accelerate the entire drug development process and provides clinical trial participants a platform to share their data with investigators in real time creating a longitudinal health record, according to the company.

Before the Takeda investment, the company raised at least $4 million in seed funding.

The company’s name, Seqster (pronounced seekster), comes from the idea that everyone is “seeking” health data, company CEO and co-founder Ardy Arianpour told FierceHealthcare during Health Datapalooza this week.

Arianpour said he was motivated to launch the startup as a result of his mother’s experience as a cancer patient and the challenge of aggregating health data from multiple providers and hospitals.

As a health technology entrepreneur, Arianpour has a background in genomics and big data. Prior to starting Seqster, he helped bring next-generation DNA sequencing to the clinic as chief strategy officer of Pathway Genomics as well as senior vice president of Ambry Genetics, which Konica acquired for $1 billion in 2017.

Seqster aims to provide “person-centric interoperability,” he said.

“When I started on this journey I didn’t know what interoperability was,” he said. “Recently a former executive from a large EHR vendor came to us and said: ‘You cracked interoperability.”

The platform is designed to pull together episodic clinical electronic health record (EHR) data, baseline genetic DNA results and continuous fitness/wearable device data all in one place. The company’s technology standardizes and harmonizes different data sources on the back end and then organizes and visualizes those health data in an easily accessible format.

Arianpour compares the platform to the personal finance management platform Mint.com, which was designed to be a platform that brought all of an individual’s financial information together to a single place.

Seqster is not a consumer-facing platform, but licenses it to enterprise customers such as providers and payers. The platform currently connects users to more than 3,600 healthcare providers and over 150,000 hospitals and clinics nationwide.

Other companies taking a stab at aggregating patient records include Picnic Health, which collects and digitizes health records, and PatientBank, which offers online medical record sharing. Apple also launched its Health Records feature that is now supported by hundreds of hospitals, medical clinics and specialty practices.

One distinction from Apple Health Records is that Seqster is platform-agnostic, the company says. It also enables families to aggregate health data to form a multigenerational health record, an idea that has raised privacy concerns. 

In January, the company added new interoperability features it says will help its customers more easily share longitudinal health information across various sources. Seqster improved its connectivity to providers by adopting the Fast Healthcare Interoperability Resources (FHIR) standard through the FHIR application programming interface, the company said.

The company says the new platform can help healthcare providers and health plans come into compliance with upcoming federal interoperability regulations to be released by the Office of the National Coordinator for Health IT and the Centers for Medicare & Medicaid Services.

Small physician-led Accountable Care Organizations (ACOs) have shown success in reducing costs while improving quality. But they need more support to continue down that road, according to a new report.

Those ACOs would benefit from more guidance and support from the Centers for Medicare & Medicaid Services (CMS), private insurers and other sources as they take on greater financial risk and move farther away from traditional fee-for-service payments, according to a new report (PDF) from the Duke-Margolis Center for Health Policy.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

“ACOs, especially smaller ones and those in more resource-deprived settings, need additional support in building the organizational competencies (such as clinical care redesign and forecasting costs) to take on increased risk,” authors of the report, who conducted interviews with ACO leaders, concluded.

ACO leaders interviewed by researchers have concerns about meeting the new requirements of Medicare’s “Pathways to Success” program that shifts financial risk from CMS to ACOs more quickly, the report indicated. 

“By asking physician-led ACOs to take on more financial risk, CMS is trying to encourage better care at a lower cost,” said Robert Saunders, research director for payment and delivery reform at Duke-Margolis. “Transitioning to new payment models is always challenging, and CMS should do all it can to support smaller physician groups in joining effective ACOs at this pivotal time or risk their longer-term sustainability.”

Some of the challenges faced by small physician-led ACOS in taking on more risk include the structure of their ACO contracts—including the cost benchmark they are expected to improve on, their limited capital reserves and their need for advance investment and technical assistance, the report said.

The report noted that many small physician-led ACOs are partnering with third-party companies, what they called “ACO enablers,” such as Aledade, Caravan, Evolent and others, to access needed upfront capital and additional services to help them participate in risk-bearing models.

Others have dropped out of ACO programs at high rates in recent years, the report said.

CMS is pushing ACOs to more quickly transition to downside risk under its Medicare Shared Savings Program, or in new ACO-type programs, such as the Direct Contracting program or complementary programs, such as the Primary Care First program.

The report, which was prepared with funding from the Robert Wood Johnson Foundation, recommended three steps CMS can take to assist these ACOs:

  • Reduce regulatory burdens. For instance, ACO leaders interviewed by researchers said that regulations such as the Stark Law and Anti-Kickback Statutes limited their ability to coordinate and manage care effectively. CMS has proposed changes to both rules to provide greater flexibility for organizations in value-based payment arrangements
     
  • Provide more support for ACOs to develop technical capabilities. The report said CMS can identify and share successful strategies used by ACOs to improve the cost and quality of healthcare.
     
  • Simplify program rules. ACO leaders expressed difficulty keeping up with changing policies and priorities, the report said. Smaller organizations will be more likely to participate in new tracks or programs when the rules are certain and simpler to understand.

Small physician-led Accountable Care Organizations (ACOs) have shown success in reducing costs while improving quality. But they need more support to continue down that road, according to a new report.

Those ACOs would benefit from more guidance and support from the Centers for Medicare & Medicaid Services (CMS), private insurers and other sources as they take on greater financial risk and move farther away from traditional fee-for-service payments, according to a new report (PDF) from the Duke-Margolis Center for Health Policy.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

“ACOs, especially smaller ones and those in more resource-deprived settings, need additional support in building the organizational competencies (such as clinical care redesign and forecasting costs) to take on increased risk,” authors of the report, who conducted interviews with ACO leaders, concluded.

ACO leaders interviewed by researchers have concerns about meeting the new requirements of Medicare’s “Pathways to Success” program that shifts financial risk from CMS to ACOs more quickly, the report indicated. 

“By asking physician-led ACOs to take on more financial risk, CMS is trying to encourage better care at a lower cost,” said Robert Saunders, research director for payment and delivery reform at Duke-Margolis. “Transitioning to new payment models is always challenging, and CMS should do all it can to support smaller physician groups in joining effective ACOs at this pivotal time or risk their longer-term sustainability.”

Some of the challenges faced by small physician-led ACOS in taking on more risk include the structure of their ACO contracts—including the cost benchmark they are expected to improve on, their limited capital reserves and their need for advance investment and technical assistance, the report said.

The report noted that many small physician-led ACOs are partnering with third-party companies, what they called “ACO enablers,” such as Aledade, Caravan, Evolent and others, to access needed upfront capital and additional services to help them participate in risk-bearing models.

Others have dropped out of ACO programs at high rates in recent years, the report said.

CMS is pushing ACOs to more quickly transition to downside risk under its Medicare Shared Savings Program, or in new ACO-type programs, such as the Direct Contracting program or complementary programs, such as the Primary Care First program.

The report, which was prepared with funding from the Robert Wood Johnson Foundation, recommended three steps CMS can take to assist these ACOs:

  • Reduce regulatory burdens. For instance, ACO leaders interviewed by researchers said that regulations such as the Stark Law and Anti-Kickback Statutes limited their ability to coordinate and manage care effectively. CMS has proposed changes to both rules to provide greater flexibility for organizations in value-based payment arrangements
     
  • Provide more support for ACOs to develop technical capabilities. The report said CMS can identify and share successful strategies used by ACOs to improve the cost and quality of healthcare.
     
  • Simplify program rules. ACO leaders expressed difficulty keeping up with changing policies and priorities, the report said. Smaller organizations will be more likely to participate in new tracks or programs when the rules are certain and simpler to understand.

Sepsis hospitalizations cost Medicare $41.8 billion in 2018 alone, a new study from the Department of Health and Human Services (HHS) shows. 

The rate of Medicare beneficiaries hospitalized with sepsis has increased by 40% over the past seven years, the HHS study found. The researchers analyzed more than 9.5 million inpatient admissions between 2012 and 2018, making for one of the largest studies into the impact of sepsis. 

The growing sepsis infection rate isn’t related to ballooning Medicare enrollment, the study says, as enrollment grew by 22% even as infection rates grew by 40%. 

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

“Sepsis is a lethal and costly health threat affecting Americans’ lives and our economy, yet many Americans may never have heard of it,” Robert Kadlec, M.D., HHS assistant secretary for preparedness and response, said in a statement. 

“Any infection can lead to sepsis, including infections caused by influenza or emerging diseases like coronaviruses, which makes sepsis a significant concern in public health emergencies,” Kadlec said. 

A study released last month by the University of Pittsburgh estimates that sepsis is responsible for one in every five deaths worldwide, double previous projections. And while high-income countries have plenty of work to do to address sepsis rates, middle- and low-income countries disproportionately bear the burden of the disease, the Pitt study found.

HHS’ analysis dug into sepsis’ impact on outcomes for Medicare beneficiaries and found that 10% of those with non-severe sepsis died while hospitalized or within a week of discharge, and 60% died within three years of contracting the infection. 

Of those diagnosed with severe sepsis, or septic shock, 40% died in the hospital or within a week of discharge, and 75% died within three years, according to the study. 

Mortality risks were highest among beneficiaries with comorbid chronic conditions, HHS said. 

Medicare patients were more likely to arrive at the hospital with the infection rather than contracting it while hospitalized, the study found. However, two-thirds had a medical encounter in the week before their hospitalization, emphasizing the need for earlier detection. 

The study suggests the cost burden of sepsis isn’t likely to decrease anytime soon. HHS projects that in 2019 the cost for inpatient and skilled nursing care related to sepsis could exceed $69 billion. 

Costs increased by 12% to 14% every two years, the study found. 

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said in a statement that the study highlights the “urgent need” for continued action to mitigate sepsis and said the agency is moving full speed ahead with efforts to eliminate regulatory hurdles that can inhibit access to lifesaving drugs. 

“This groundbreaking study sheds light on the sepsis-related challenges faced by patients, providers, and taxpayers alike,” Verma said. 

“CMS continues to clear away regulatory obstacles and financial disincentives that have long inhibited the development of life-saving antibiotics capable of treating sepsis patients,” she added. “Patients suffering from sepsis deserve to see America’s full innovative potential mobilized to address this devastating condition.” 

A Miami woman sentenced to serve 35 years in prison for Medicare fraud had her sentenced commuted by President Donald Trump.

Judith Negron, 48, was among the 11 federal inmates Trump announced pardons and commutations for Tuesday, according to the Tampa Bay Times.

Negron was sent to prison for her part in a $205 million fraud case in what was then the country’s biggest mental health billing scheme, according to the report.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

Negron, the owner of a Miami mental health care company, American Therapeutic Corporation, was the only defendant in the case who refused a plea deal and went to trial. A federal jury convicted her in August 2011 on 24 counts of conspiracy, fraud, paying kickbacks and money laundering.

Prosecutors said the company submitted more than $205 million in fraudulent claims to Medicare.

Negron served eight years of her 35-year sentence at a federal prison in central Florida. Her family told the Associated Press they were waiting to hear when she would be released from the Coleman Federal Correctional Complex.

Negron’s husband, Hector Negron, told the AP a clemency advocate put his wife’s case on Trump’s radar, and she was among the high-profile cases whose sentences were commuted Tuesday.

Federal prosecutors said Judith Negron and two co-defendants paid bribes and kickbacks to owners and operators of assisted living facilities and halfway houses, as well as patient brokers, in exchange for sending ineligible patients to their mental health facilities.

Throughout her trial, Negron maintained she was unaware of the billing scheme. “She has steadfastly insisted on her own integrity,” Bill Norris, the attorney who had tried unsuccessfully to appeal her sentence, told the Tampa Bay Times. “Integrity is a little more complicated than innocence or guilt.”

Co-owners of American Therapeutic Corporation, Lawrence Duran and Marianella Valera, pleaded guilty to the charges against them and were sentenced to 50 years and 35 years in prison, respectively.

The Trump administration wants to keep a hip and knee replacement bundled payment model going for another three years.

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule Thursday that calls for a three-year extension to the Comprehensive Care for Joint Replacement Model, which is set to end after this year. The agency is also floating a major change to cover outpatient replacements, as the model currently only covers inpatient procedures.

The goal is to address changes to facilities that can now “allow for total knee and hip replacements to be treated in the outpatient setting,” CMS said in a fact sheet on Thursday.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

CMS is also proposing changes for how it will reconcile payments made under the model. Participating hospitals can get a bundled payment to cover an entire episode of care for a hip or knee replacement.

The episode begins when the patient is admitted and encompasses all care provided for 90 days following patient discharge. The goal of the model, which was created in 2016, was to improve care coordination between the initial admission and through recovery.

Currently, a hospital gets two chances to reconcile its bundled payments: at two and 14 months after the close of a performance year. But CMS is proposing to have one reconciliation period instead at six months after the close of each performance year.

The agency also wants to update how payments are calculated to better account for changes in Medicare’s payments.

The first two years of the model generated a modest reduction in spending per hip and knee replacement episode, according to a study in the New England Journal of Medicine.

CMS’ decision to propose an extension for the joint replacement model comes as other models await word of their fate. Chief among them is the Next Generation Accountable Care Organization program, which also sunsets after this year. 

Federal regulators have listened to physicians’ complaints about health IT burdens and they have some solutions.

The Department of Health and Human Services (HHS) released Friday a final version of an overarching strategy to reduce clinician burden revolving around entering information into the electronic health records (EHRs), meeting regulatory requirements and improving EHR ease of use.

The new report (PDF), which includes 43 recommendations around clinical documentation and health IT usability, is a follow-up to a draft strategy released in November 2018.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

The overall goal is to improve patient care by enabling physicians to spend more time focused on them instead of their keyboards, HHS officials said.

“Physicians and other healthcare providers have long identified regulatory and administrative burdens as a key contributor to the many challenges they face. They also note these burdens weigh down the overall healthcare delivery system as well. Clinicians have pointed to an ever-increasing and poorly coordinated set of requirements they must meet to deliver and receive payment for patient care,” senior officials with the Office of the National Coordinator for Health IT (ONC) wrote in a blog post Friday.

The clinical community frequently links the increased burden of meeting these requirements with the tasks and use of health IT, such as EHRs, Andrew Gettinger, chief clinical officer for ONC, and Thomas Mason, ONC’s chief medical officer, wrote.

The report targets burdens tied to regulatory and administrative requirements that the federal government can directly impact through the rule-making process.

When looking at the steps HHS could take to mitigate EHR-related burden for healthcare providers, ONC and the Centers for Medicare & Medicaid Services (CMS) focused on strategies that are achievable within the near to medium term, roughly a three- to five-year window, according to the report.

And HHS is looking at strategies it can implement through existing or easily expanded authority.

EHR burdens have been a near-constant complaint from physicians that see the technology as an impediment to their relationship with patients. Numerous studies have documented the time suck of the technology.

The finalized strategy, required under the 21st Century Cures Act, reflects feedback from industry stakeholders and healthcare groups, including 200 comments submitted to the draft strategy, HHS said.

In several recommendations, the agency vowed to continue its work stripping down regulations and working with the industry to find solutions to growing problems. 

CMS already has taken some steps to reduce administrative burden such as changes to the more-than-two-decades-old E/M documentation and coding framework that clinicians use to bill Medicare for common office visits. 

HHS also wants to see health IT vendors doing more to improve technology usability. EHR vendors need to work with clinicians when designing systems or new features and should consult with experts in user-centered design during development, HHS officials said.

Specifically, EHR vendors should take the lead in developing health IT-specific user interface best practices and should collaborate to develop a shared repository of EHR usability practices.

This collaboration would help provide better consistency with user interface best practices while still enabling EHRs to compete with each other, HHS said in the report.

HHS also wants an EHR vendor’s user-centered design process to be highlighted on the ONC Certified Health IT Product List so potential EHR customers can see the efforts that went into the products they are considering acquiring.

“A shift from check-box interface elements to intelligent features that extract needed data from routine clinical workflows would provide a substantial reduction in usability-related clinician burdens,” HHS officials wrote in the report.

HHS’ recommendations represent the “best next steps” to address the growing problem of clinician burden related to their use of health IT and EHRs, ONC chief Donald Rucker, M.D., said in the report.

As part of its ongoing strategy, ONC plans to work to enable further automation in healthcare, with a focus on prior authorization and quality reporting.

“Through this HHS strategy, we look forward to advancing the premise of how to accurately model and support the clinical cognitive process in the EHR—a shift away from a strictly linear, logic-based model to a more sophisticated design that supports the complex pattern recognition inherent in the diagnostic and treatment process,” Rucker said in the report.

“We envision a time when clinicians will use the medical record not as an encounter-based document to support billing, but rather as a tool to fulfill its original intention: supporting the best possible care for the patient.”

The first deadline for the Trump administration’s new direct contracting value-based care payment model is right around the corner. But potential applicants are worried about key missing details.

For instance: How will they get paid?

Feb. 25 is the deadline to apply to be part of the implementation year for direct contracting. But the application period for the first performance year that starts in 2021 is three months away, and value-based care organizations are demanding the Centers for Medicare & Medicaid Services (CMS) fill in the holes in the program. During the implementation period, which runs through 2020, organizations will not have to take on any financial risk.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

Here are three major questions organizations have:

How much will we get paid?

Under direct contracting, an organization would get capitated payments from CMS. The organization would then contract with providers and dole out value-based payments. At the end of each performance year, CMS will compare actual spending by the organization against a benchmark and see whether the organization saved or lost money.  

But what that benchmark is remains a mystery.

CMS intends to put out an adjusted rate book used traditionally by Medicare Advantage (MA), which lists the rates for separate regions and dictates the capitated payment amounts for MA plans.

CMS intends to use a modified version of that rate book for the capitated payments under direct contracting.

“The rate book will tell you how much you get paid per person,” said Joshua Traylor, a director for the Health Care Transformation Task Force, which is composed of payers and providers in value-based payment arrangements.

Without the rate book, value-based care organizations can’t plug information into their own analyses and see how they would perform in the model.

“Let’s say you have a low-risk patient get $50 per patient per month, but high-risk patients $500 per person per month,” Taylor said. “You can go back to look at data and say how much high and low-risk people I have and that will see how many I can get per month.”

When will we get more information?

Value-based care provider groups are getting restless and want to know when more information will be released on the model. CMS told FierceHealthcare last month that it plans to release more information this spring. 

CMS also told interested organizations on a webinar that the rate book will be out by the end of the second quarter of this year, said Clare Pierce-Wrobel, senior director of the task force.

NAACOS said many accountable care organizations (ACOs) and provider groups will likely apply for both the Medicare Shared Savings Program and direct contracting and then make an “educated decision once they have the necessary information,” according to a letter the group sent to the Centers for Medicare & Medicaid Innovation, which is overseeing the model.

“Not providing more information upfront creates more administrative burden for providers and the agency,” the group added.

A value-based care provider group can put together the model and adjust it when more details become available. However, if the details come “too late then folks aren’t going to have time to get comfortable with the program,” said Greg Scrine, senior vice president of advisory solutions for consulting firm Lumeris.

Others questioned whether CMS would delay the implementation performance year.

Pierce-Wrobel noted that CMS pushed off the start date for the Bundled Payments for Care Improvement initiative, comprising four care models, to “allow for participants to change their participation arrangements. Considering how much is left unknown would CMS consider delaying implementation.”

Can CMS ease an administrative burden?

Direct contracting is composed of three tracks: a standard track for organizations that have experience with value-based care programs such as ACOs, a new entrant track for organizations that haven’t served Medicare fee-for-service patients and a high-need track for organizations caring for patients with complex needs.

Right now, an organization must be either in standard or high-need direct contracting and cannot blend the two.

“If you are a standard direct contracting entity and 5% of your population are high-need, and you want to get paid the high-need capitation rate for them then you need to create a separate tax ID and a separate entity and apply as high-need direct contracting entity for that 5%,” said Pierce-Wrobel.

That creates an administrative burden for organizations and can hinder efforts to coordinate care among patient populations, she added.

“The other issue is that it is not clear how CMS will identify that high-need patient,” Pierce-Wrobel said.