Latest Twentyeight Health News
May 11, 2021
The nation's accountable care organizations sent a letter last week to the Centers for Medicare and Medicaid Services, urging the agency to delay certain changes to quality reporting requirements for value-based payments. Backed by large, national medical groups, the letter warned that rushed implementation of these changes could deter new organizations from joining the shared-savings program or even cause organizations to leave it. Accountable care organizations are groups of hospitals, physicians and health centers that work to improve health outcomes while reducing cost. Organizations that achieve savings are entitled to share them with CMS, and those that incur losses have to chip in. In December the federal agency published new rules on how accountable care organizations report health quality outcomes. "While many are aimed at simplifying the reporting process, some measures need more clarity, and others might have unintended negative effects on certain ACOs," said Dr. Robert Fields, chief population officer at Mount Sinai Health System and board chairman of the National Association of ACOs. The previous system measured the health outcomes of Medicare patients treated by a physician who was part of an accountable care organization. However, the reporting overhaul would assess all patients treated by the physician, even if the patient is not assigned to the organization. Assessing an organization for patients it is not accountable for would muddy true quality metrics, said Matt Siegler, senior vice president of managed care and patient growth for NYC Health + Hospitals and CEO of HHC Accountable Care Organization, its affiliated arm. Expanding this requirement would disproportionately affect federally qualified health centers that have a larger Medicare and Medicaid mix, Fields said. Organizations comprising these centers, which tend to serve lower-income communities, inherently face more barriers in access to care, and they will pale in comparison to organizations that have a bigger private insurance payer mix, he said. There currently aren't reporting measures that would account for the social determinants of health or offset the negative impacts of this expansion, Siegler noted. "Those serving lower-income communities will have a harder time achieving the results of those with more private insurance, even if they are all delivering the same quality of care," Fields said. There are a notable number of ACOs downstate centered around such community health centers, he said. As of January, there were 477 accountable care organizations nationally, of which there were nearly 30 in New York. Additionally, as accountable care organizations' assessments are publicly reported, it might cast a pall on how patients view their quality of care, Fields added. Another contentious overhaul was the implementation of mandatory reporting using electronic clinical quality measures, derived from electronic medical records. "While, in theory, reporting measures using an electronic system should be easier and more accurate, that's not the case," Fields said. In the past year vendors had not standardized how their electronic medical record systems collected information and put out reports. "Not only is there variability from system to system; there is also variability from doctor to doctor on how they enter data," Fields said. This variability can under- or over-report certain measures. "Rushing this system with this much uncertainty makes it hard for ACOs to function, especially following the pandemic, when balancing costs and quality is hard enough already," Fields said. There is hope that CMS will heed the letter's advice, especially when it's backed by big organizations such as the American Medical Association, the American Academy of Family Physicians and the American College of Physicians, Fields said. The agency last month, at the advice of various medical groups and organizations, held off changes intended for implementation under the Trump administration, he said. Siegler is optimistic for positive change. "The ACO program is incredibly important to New York, and I'm sure the Biden administration will act in the best interest of the program," he said. —Shuan Sim Exclusive: Brooklyn reproductive telehealth startup expands Dumbo-based telemedicine startup Twentyeight Health will bring its birth control prescription and delivery services to seven new states, it shared exclusively with Crain's. The reproductive and sexual health company is entering Alabama, Colorado, Georgia, Kentucky, Nebraska, Tennessee and Virginia. With the expansion, its services will be available in 20 states. It launched in New York and New Jersey in 2018. The expansion means Twentyeight Health's services will be available to nearly 70% of reproductive-age women in the United States, co-founder Amy Fan said. Named for the typical length of a woman's menstrual cycle, Twentyeight Health offers birth control pills, patches, rings and shots, and emergency contraception like Plan B. Patients pay $20 a year out of pocket for a medical consultation and ongoing communication with the company's dozens of providers. The company takes private insurance or Medicaid or charges $16 out of pocket for birth control and $30 for emergency contraception. Co-founder Bruno Van Tuykom said changes in state telehealth regulations and an infusion of seed funding made the expansion possible. Some states required real-time virtual visits before the pandemic but now allow asynchronous communication, which means patients and doctors do not have to be present at the same time. The company has raised $6.6 million in seed funding, including a $5.1 million round that closed in October. Third Prime led that round, with participation from Town Hall Ventures, SteelSky Ventures, Aglaé Ventures, GingerBread Capital, Rucker Park Capital, Predictive VC and AVG. Van Tuykom declined to share the company's annual revenue but said it grew seven times last year. Twentyeight Health has tens of thousands of users, Fan said, 30% of whom make less than the federal poverty level of $15,000 a year. Through a partnership with Bedsider's Contraceptive Access Fund, it has provided free birth control to hundreds of women. —Maya Kaufman Bushwick digital pharmacy opens Harlem location Brooklyn's Medly Pharmacy last week announced it has opened a location in East Harlem. The 1,700-square-feet space is meant to help meet growing demand in northern Manhattan, the Bronx, Westchester County and Long Island. The full-service digital pharmacy company is based in Bushwick, from which it was unable to efficiently reach those other regions, said Chirag Kulkarni, co-founder and chief marketing officer. "During the pandemic, we saw massive growth, especially from the Medicaid and Medicare population as well as patients over age 65," Kulkarni said. The new site accepts walk-ins picking up prescriptions and serves as a delivery distribution hub. The facility launched with 20 employees and is expected to process about 300 prescriptions per day, Kulkarni said. As it ramps up, it could add over 50 drivers for same-day delivery. The Bushwick and Harlem pharmacies will deliver within a radius of up to 70 miles each, he added. Construction of the Harlem pharmacy took about four months, and its costs were not disclosed. It was funded by a $100 million Series B round raised in July. There are no plans for additional locations in the city at this time, Kulkarni said. "With this current model, we don't have to open a ton of brick-and-mortar locations," he said. Medly was founded in 2017, and its 2020 revenue was about $200 million. Besides the city, it serves Florida, Maryland, New Jersey, North Carolina and Pennsylvania. —S.S. Mother Cabrini awards $20M to nonprofits for Covid efforts The Mother Cabrini Health Foundation announced last week that it has provided $20 million in funding to 25 nonprofit organizations in the state to aid their efforts to vaccinate and treat New Yorkers. Grants ranged from $200,000 to $2.5 million. Locally, the Greater New York Hospital Foundation, affiliated with the Greater New York Hospital Association, received $2.5 million to support safety-net hospitals in treating Covid-19 patients. "We see light at the end of the tunnel of this pandemic, but we know there are still plenty of issues to address," said Deborah Konopko, chief programs and grants officer at Mother Cabrini. The main focuses of this round of grants are improving access to vaccines, providing personal protective equipment and testing to frontline workers, giving emergency financial assistance to those who lost their jobs and addressing food insecurity. The grants will fund activities throughout this calendar year. Other notable local recipients include Catholic Charities in the Diocese of Brooklyn ($1.5 million); Foundation for Long Term Care, an affiliate of LeadingAge New York (about $1.3 million); ArchCare ($1 million); and the Community Health Care Association of New York State ($750,000). This is the foundation's third Covid-related round of aid. Mother Cabrini provided $50 million in funding over two rounds last year, Konopko said, adding that there are no current plans for a second effort this year. "Even with vaccines, Covid-19 has laid bare its impact on the poorest among us, and many have difficulty with access," Konopko said. "In the coming months we'll continue to play a role in helping New Yorkers get vaccinated." The Mother Cabrini Health Foundation, based in Midtown, was founded in 1880. It gave out $165 million to over 650 health care organizations and programs last year. —S.S. AT A GLANCE WHO'S NEWS: Dr. Maxim Shulimovich was named chief of hematology and medical oncology for the Brooklyn Cancer Center, a partnership between New York Cancer & Blood Specialists and the Brooklyn Hospital Center. Shulimovich previously worked as chief of hematology and oncology at Richmond University Medical Center. VACCINE AUTHORIZATION: The U.S. Food and Drug Administration expanded the Pfizer-BioNTech Covid-19 vaccine's emergency-use authorization to include adolescents ages 12 to 15, the agency announced Monday. Previously Pfizer's vaccine was authorized only for those 16 and older. HEALTH GRANTS: The New York State Health Foundation on Monday announced it has awarded grants totaling $1 million to five organizations to address health equity issues. The five city-based recipients will develop projects that will benefit people of color statewide on racism, bias and communication gaps in health care.