In brief: AAH pushes for follow up, StateServ buys PBM, ADS builds C-suite 

WASHINGTON – The U.S. House of Representatives passed a short-term spending bill on Jan. 18 to keep the government funded until the beginning of March, AAHomecare reports, but the bill does not contain various health care extender measures, including the industry’s provision to extend the 75/25 blended Medicare reimbursement rates in non-rural areas. 

“We are continuing to work with our champions, as well as influential legislators and committee staff, to pass our legislation in the next funding package, which would need to be passed by March 1, and are emphasizing to members of the House and Senate that the cuts have now gone into effect and are impacting suppliers,” the association stated in a bulletin. 

As currently structured, the funding for different government agencies would need to be approved by March 1 and March 8, according to AAHomecare. 

The association is pushing stakeholders to “keep the volume up” on extending the 75/25 blended reimbursement rates through 2024. 

“The impacts of losing this relief will be keenly felt by a large segment of the supplier community, and we must communicate the urgency of restoring the 75/25 blended rate to legislators,” AAHomecare stated. “In discussions with Congressional offices, our lobbyists report that legislators and staff continue to hear from our industry and that this grassroots advocacy makes a difference.  Please follow up with your legislators next week to share the urgency of ensuring this relief is part of the next funding package.” 

Stakeholders can send a pre-drafted message to their senators and representatives using AAHomecare’s Voter Voice advocacy tool. The association has updated the draft text to reflect the current state of the budget legislation. 

StateServ buys pharmacy PBM 

PHOENIX and PITTSBURGH – StateServ, a provider of DME benefit management solutions to the post-acute care market in the U.S., has acquired Delta Care Dx, a provider of integrated pharmacy benefit management, mail order prescription, sterile/non-sterile compounding and clinical pharmacist consulting to the hospice and palliative care markets, in a move that forms the industry's first scaled DME and pharmacy solution. 

The companies say their unique combination forms a leading care-at-home data, technology and service platform, supporting improved quality of care and operational efficiencies by managing DME and pharmacy together, consolidating workflows and reporting, and unlocking a new era of care-at-home innovation for the benefit of customers, network partners and patients. 

"We are thrilled to welcome the Delta Care team's pharmaceutical expertise to StateServ,” said Paul DiCosmo, CEO and Co-Founder of StateServ. “For many years, Delta Care has prioritized quality, reliability and transparency throughout its organization, delivering innovative solutions to its loyal client base. This is an important milestone for StateServ and for the entire industry. Our vision of the combined solution will include a significant investment in new technology to automate and streamline workflows, enabling better quality service and efficiency for our customers.” 

Delta Care's CEO Mary Mihalyo, PharmD, and President Drew Mihalyo, PharmD, will stay on as StateServ's chief clinical officer and president of pharmacy services, respectively, along with the entire Delta Care leadership team. 

Terms of the transaction were not disclosed. TripleTree acted as the financial advisor to StateServ. McDermott Will & Emery LLP acted as legal advisor to StateServ and Much Shelist, P.C. acted as legal advisor to Delta Care. 

New data book provides dual-eligible landscape 

WASHINGTON – People who are dually eligible for Medicare and Medicaid account for a disproportionate share of spending in both programs, according to an updated data book from MedPAC and MACPAC. 

Dual-eligible beneficiaries totalled 19% of the Medicare population in 2021 but accounted for 35% of Medicare spending. Similarly, dual-eligible beneficiaries accounted for 13% of all Medicaid beneficiaries but 27% of Medicaid spending. 

“The existence of separate Medicaid and Medicare funding streams can create barriers to coordination of care for dual-eligible beneficiaries, which in turn can lead to increased costs and poor health outcomes,” the agencies state. “These issues are of particular concern given the high health needs of many dual-eligible beneficiaries and the fact that this relatively small group accounts for a disproportionate share of both Medicare and Medicaid spending.” 

The data book, “Beneficiaries Dually Eligible for Medicare and Medicaid,” describes the dual-eligible population’s composition, service use and spending in calendar year 2021, as well as, new this year, the overlap in Medicaid and Medicare managed care enrollment. 

Other key findings in the data book: 

• There were 12.8 million people who were dually eligible for Medicare and Medicaid for at least one month in 2021 (exhibit 1). 

• Reflecting the continued shift from fee-for-service (FFS) to managed care in Medicare and Medicaid, less than half of dual-eligible beneficiaries (42%) were enrolled only in Medicare FFS in 2021, 46% were in managed care only, and 13% spent part of the year in FFS and part of the year in managed care (exhibit 11). For Medicaid services, 42% of dual-eligible beneficiaries had at least one month of comprehensive managed care enrollment (exhibit 12). 

• One-quarter (25%) of all dual-eligible beneficiaries had at least one month in which they were simultaneously enrolled in a Medicare managed care plan and a comprehensive Medicaid managed care plan. Another 48% of all dual-eligible beneficiaries had some enrollment in Medicare managed care and/or comprehensive Medicaid managed care but not simultaneously (exhibit 13). 

Advanced Diabetes Supply builds out C-suite 

CARLSBAD, Calif. - Advanced Diabetes Supply, a distributor of specialized diabetes devices under the ADS and USMED brands, has made three new C-suite appointments. 

The company has named Sean Muiz as chief supply chain officer, Melanie Montero as revenue cycle leader and Walt Meffert as chief transformation officer. 

“We are pleased to welcome these seasoned leaders to the ADS executive team,” said Bill Mixon, who was named ADS CEO last year. “Their experience, expertise and commitment to excellence will be invaluable as we navigate a future of transformational growth. It is an exciting time in our company as we expand to provide new and innovative ways to serve the diabetic community.” 

• Muiz will be responsible for the direction and leadership of the company’s operational, financial, programmatic and personnel supply chain activities. He will work closely with ADS strategic partners and suppliers to maximize value and optimize the supply chain processes. He brings 12 years of supply chain management and health care logistics experience to the role, most recently serving as the chief service officer for Joerns Healthcare. 

• Montero will be responsible for leading the company’s revenue cycle management operations. She was most recently senior vice president, payer relations, for Women’s Care and held previous roles as executive director, revenue cycle, for Miami Jewish Health and vice president, revenue cycle and payer relations, for VITAS Healthcare. Montero replaces Clydall Bobb, who will now support CFO Bart Witteveen and the broader finance team. 

• Meffert will lead the integration of business systems supporting the company’s ongoing rapid growth. He brings more than 20 years of experience as a leader in information technology, business and digital transformations and process improvement, serving most recently as managing director of Altezas and as chief information and digital officer for ModivCare. Meffert replaces Bill Monast, who remains on the ADS board of directors. 

Prodigy Care Services increases transparency 

AUSTIN, Texas – Prodigy Care Services has launched PACparency, a post-acute care solution that provides workers’ compensation payers full financial transparency on the company’s post-acute care and bill review services. PACparency reports financial metrics, including client savings for each referral; Prodigy’s retained savings; health care provider total billed charges and final reimbursement; and accurate jurisdictional fee schedule determination. “Prodigy’s complete transparency allows clients to easily determine the full savings impact of our PAC solution," said Prodigy Co-Founder and President Matthew Imes. "As a result, clients are realizing better savings than with previous vendors. The old model of companies hiding portions of the financial transaction needs to end." PACparency provides services nationwide through network and out-of-network provider agreements. Providers span the entire post-acute care continuum from long-term acute care and rehabilitation hospitals, residential brain injury/spinal cord injury centers, skilled nursing facilities, and assisted living facilities to home health, complex rehab technology, and durable medical equipment providers. Based in Austin, Texas, and founded in 2020, Prodigy Care Services says it is a health care services technology company dedicated to positively impacting the lives of workers’ compensation patients by delivering outcomes-driven care solutions and increasing payer efficiency across the continuum of care. 

OPGA, Össur open application period for grants 

WATERLOO, Iowa – The Orthotic Prosthetic Group of America (OPGA) and Össur have opened the application period for two grants available to U.S.-based O&P professionals. The two grants: The Russell Walker CP, LP Emerging Leader Grant, now in its third year, is designed to pay tribute to Russell (Rusty) Walker, a practitioner who was passionate about mentoring the next generation of O&P leaders; and the Todd Eagen Advocacy in Action Memorial Grant, now in its second year, is named after Todd Eagen, the former president of OPGA, who passed unexpectedly on June 4, 2022, and was an important leader in the O&P profession. “Both Rusty Walker and Todd Eagen will always be remembered for their commitment to helping others and making the O&P profession the best it can be,” said Adam Miller, president, OPGA. “That is why Össur and OPGA are privileged to honor both of these amazing men by providing these grants.” Both annual grants are designed to provide funding to a current O&P resident and certified orthotist or prosthetist (or both), respectively, that will allow them to attend and participate in two non-clinical events that are highly important to the O&P profession and the patients it serves. Kaleigh Neely was selected as the 2023 recipient of the Russell Walker CP, LP Emerging Leader Grant, and Abbey Senczyszyn, CPO, was selected as the 2023 recipient of the Todd Eagen Advocacy in Action Memorial Grant. To apply for the Russell Walker CP, LP Emerging Leader Grant, click here. To apply for the Todd Eagen Advocacy in Action Memorial Grant, click here. The application period closes Feb. 9, 2024. 

HOMELINK names VP of sales 

WATERLOO, Iowa – HOMELINK has hired Gale Vogler, who brings more than 25 years of experience in the workers’ compensation industry, including senior-level roles at leading national insurance companies, as vice president of sales. “We’re thrilled to have Gale join us; he brings a wealth of experience to round out our sales team and provide critical leadership as we continue to grow the business,” said Matt Waller, president of HOMELINK. “His deep background as a buyer of ancillary care services will position us well to continue to provide value in our business development efforts.” Before joining HOMELINK, Vogler held positions of increase responsibility in risk management, managed care strategies and strategic business initiatives. He brings an extensive knowledge of insurance operations from his previous roles, where he led numerous projects focused on claims efficiency and cost containment measures, product offering expansion and business development. In his most recent role, Vogler was responsible for leading and developing a medical management program, including the integration of acquired programs and provider networks. “HOMELINK has a great team in place, and I’m excited to take on this new challenge of partnering with them to take a consultative approach to business development, through proactive engagement and collaboration,” he said. “And I’m thrilled to be joining an employee-owned company that is known for its high commitment to exceptional customer service and satisfaction.” 

Belluscura announces increased offer 

LONDON and PLANO, Texas – The boards of Belluscura and TMT Acquisition have announced the terms of a recommended share offer to be made by Belluscura for the whole of the issued and to be issued share capital of TMT Acquisition. Having regard to the Belluscura share price in recent weeks, the companies have agreed on an increase in the number of new Belluscura shares to be offered in exchange for TMT acquisition shares. The value of a TMT acquisition share under the offer, based on the closing price per Belluscura share of 30.5 pence on Oct. 2, 2023 (the latest practicable date prior to the commencement of the offer period), is 30.5 pence, representing a premium of approximately 79% to the closing price of 17.0 pence per TMT acquisition share on Oct. 2 2023 (being the latest practicable date prior to the commencement of the offer period). Belluscura announced in October that it had reached an agreement with TMT Acquisitions, a London-based acquisition vehicle in the technology, media and telecommunications sector, on the key terms of a possible share-for-share offer for the company, in a deal that would be valued at EUR 6 million. 

Apnimed makes critical additions to C-suite 

CAMBRIDGE, Mass. – Apnimed, a clinical-stage pharmaceutical company focused on developing oral pharmacological therapies for the treatment of obstructive sleep apnea and related disorders, has named Graham Goodrich as chief commercial officer and Ted Harding as chief human resources officer. The company says the additions to the C-suite are critical as the company prepares to launch AD109, a potential nighttime oral treatment currently in Phase 3. “We are thrilled to have attracted two senior executive leaders with the ability to drive and manage change as we build our commercial capabilities for AD109,” said Dr. Larry Miller, CEO of Apnimed. 

• Recently, as a member of the commercial leadership team and senior vice president of Migraine Market at Biohaven, Goodrich led a team that developed a novel brand strategy, go-to-market model and promotion plan to launch Nurtec ODT during the COVID-19 pandemic. After a successful launch and achieving category leadership, Pfizer acquired the Biohaven Migraine franchise assets and capabilities in October 2022 for $11.6 billion. 

• Harding is a senior executive leader who has guided and built the culture and human resources infrastructure at biotech companies that have included Jounce Therapeutics and Enobia Pharma. He has been the head of human resources for 10 companies on either a full-time or interim basis, and has prior experience in the electric utility, telecommunications, and clean energy sectors.