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Key Takeaways | Putting Employee Wellness Programs to Work

During this session, panelists discussed the unique opportunities and challenges of digital-health wellness programs that partner with employers and health plans in considering, adopting and operationalizing wellness programs across their employee populations. The panelists discussed a wide range of challenges and opportunities, including accessibility to employees, navigating the health plan regulatory landscape, and being mindful of budgetary constraints and the reality of rising health carecosts.

Session panelists:

  • Denise Bloch, Vice President and Associate General Counsel, Regulatory and Compliance, SWORD Health
  • Tsion Lencho, Co-Chief Executive Officer, Cleo
  • Emily Taylor, Chief Financial Officer, Wondr Health
  • Sarah Raaii, Partner, McDermott Will & Emery
  • Moderator: Scott Weinstein, Partner, McDermott Will & Emery

Top takeaways included:

  1. Trends in employee health include looking for ways to drive healthcare costs down, which often involves adoption of employee wellness solutions, particularly digital-health wellness solutions.
  2. Employers are balancing the desire to find and adopt a “full-scale” solution that meets the unique needs of their workforce, while also considering budgetary constraints, the likelihood of employee utilization and the costs of implementing new benefits solutions.
  3. When implementing wellness programs, employers should be aware that they may be subject to the Employment Retirement Income Security Act (ERISA), the Health Insurance Portability and Accountability Act (HIPAA), or other laws and regulations governing health plans (e.g., the Consolidated Omnibus Budget Reconciliation Cat (COBRA)) if the program involves the provision of medical care to employees. Employers and/or health plans may request compliance assistance from their digital-health wellness programs, and digital-health companies should tread carefully to avoid liability for such compliance.



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Top Takeaways | Successfully Deploying Digital Health in Value-Based Care

In this session, McDermott Will & Emery Partner Lisa Mazur moderated a panel that explored how digital health tools can support financial and clinical success under value-based care arrangements. Panelists also looked at how digital health companies can successfully demonstrate value within the value-based care framework and make themselves attractive partners to value-based care companies. The panel showcased perspectives from executives at digital health companies and companies participating in value-based care models that have successfully leveraged digital health tools.

Session panelists included:

  • Jessica Beegle, Chief Innovation Officer, LifePoint
  • Jamie Colbert, MD, MBA, Senior Vice President of Care Delivery, Memora Healt
  • Ashul Govil, MD, MBA, Co-Founder and Chief Medical Officer, Story Health
  • Maulik Majmudar, MD, Chief Medical Officer and Co-Founder, Biofourmis
  • Kelsey P. Mellard, Founder and Chief Executive Officer, Sitka

Top takeaways included:

  1. Behind-the-scenes role. What do many successful digital health companies in the value-based care space have in common? They are operating behind the scenes, facilitating patient’s care with a trusted healthcare provider. The patient does not know they are interacting with a separate brand—rather, the companies position themselves as an extension of the local care team. This allows digital health companies to leverage the trust patients have with their physicians, increasing patient engagement as a result.
  2. Achieving provider buy-in. The panelists discussed several ways to achieve provider buy-in for digital health tools. A key theme was the ability of a digital health tool to integrate with providers’ existing systems and workflows. Clinicians do not want another portal to log into or another widget they are required to use. Rather, successful tools are those that are able to integrate into providers’ existing workflows and that improve those workflows as a result. Such integration requires a deep understanding of a provider’s operations and patient populations; the ability to leverage clinicians’ expertise; and engaging clinicians early during the design process and launch. The most successful digital health companies are those that are seen as a partner to providers, rather than simply being another vendor. Panelists also discussed how digital health companies need to be able to demonstrate value. While there are numerous ideas for digital health tools, successful tools will be those that deliver demonstrable outcomes.
  3. Successfully bridging the current fee-for-service world with value-based care. Successful digital health tools are those that can demonstrate value in both the fee-for-service (FFS) and value-based care models. Digital health companies must understand that for providers, the reality of the current system is organized around FFS. Successful companies are those that can meet providers where their systems are today, and work together towards value-based care. Panelists reflected that this requires a long view, flexible contracting models, and establishing progressive outcomes that can continue to be built upon.
  4. Value-based care: why now. The large penetration of Medicare Advantage (MA) is quickly changing the landscape. It provides digital health companies a large target audience that companies can meet, innovate around and innovate for, allowing companies to test their theses and adjust their models. Other accelerants [...]

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Top Takeaways | Successfully Deploying Digital Health in Value-Based Care

In this session from the Value-Based Care Symposium 2023, McDermott Will & Emery Partner Lisa Mazur moderated a panel that explored how digital health tools can support financial and clinical success under value-based care arrangements. Panelists also looked at how digital health companies can successfully demonstrate value within the value-based care framework and make themselves attractive partners to value-based care companies. The panel showcased perspectives from executives at digital health companies and companies participating in value-based care models that have successfully leveraged digital health tools.

Access the full takeaway here.




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Identity Requirements for Telehealth Encounters – What does Your State Require?


Verifying the identity of a patient prior to delivering telehealth services is important to prevent a range of potential risks, including the creation of fake accounts, insurance fraud and drug abuse/diversion. A growing number of states and health plans require the verification of a patient’s identity. This verification activity has become a standard practice in the telehealth industry and is expected to continue.

For the complete state-by-state requirements, click here to download the full report.




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APTA Pushes Digital Health Companies to Use “Physical Therapy” in Marketing Materials Only When the Care is Directed by Licensed Physical Therapists

On December 2, 2022, the American Physical Therapy Association (APTA) published a statement concerning a recent decision from UnitedHealthcare and its contractor, Kaia Health, to stop marketing Kaia Health’s services as “physical therapy” given that Kaia Health’s program does not consistently involve licensed physical therapists. As a result, digital health companies that market themselves as providing physical therapy should evaluate their marketing and customer communications to determine whether any revisions are required pursuant to the APTA’s guidance.

BACKGROUND
The APTA and APTA North Carolina sent a letter to UnitedHealthcare, along with a complaint filed with the North Carolina Board of Physical Therapy Examiners, identifying that the services provided through Kaia Health’s application were not overseen by a licensed physical therapist. UnitedHealthcare subsequently acknowledged that Kaia Health and United Healthcare’s benefits manager, Optum, utilized the phrase “physical therapy” in its marketing materials and that all materials would be revised to remove reference to physical therapy.

WHY IT MATTERS
The APTA has consistently held that physical therapy, either in person or digitally, must be “performed or directed only by licensed physical therapists.” The APTA has requested that physical therapy providers sign a pledge, which in part acknowledges that the “physical therapist examination, evaluation, diagnosis, development of a management plan, and intervention shall be represented and reimbursed as ‘physical therapy’ only when performed by a physical therapist or when selected interventions are performed by a physical therapist assistant under the direction and supervision of a physical therapist.” Several digital healthcare companies have signed onto the APTA’s pledge.

The complaint filed with the North Carolina Board of Physical Therapy Examiners, along with the APTA’s letter to UnitedHealthcare, are strong indicators that state boards of physical therapy and industry groups are reviewing the marketing and the scope of services offered by virtual physical therapy companies, as well as companies who partner with virtual physical therapy companies.

Businesses offering digital or virtual physical therapy or musculoskeletal services should review their service descriptions and marketing materials and assess whether any updating is required—a task our healthcare team can help with. For assistance or questions, please reach out to your regular McDermott lawyer or contact any of the authors of this article.




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Final Episode | Markets Under Pressure Strategies for Restructuring and Risk Management

In this new video series, McDermott’s digital health team shares timely insights and strategies to help your organization stay ahead of the curve, addressing critical areas of workforce management, financing and the potential for restructuring.

Today’s market pressures increase the potential for broken financial covenants. In this episode, McDermott partners Dale Van Demark and Felicia Perlman discuss steps that digital health companies can take now to prepare for the possibility of restructuring and mitigate associated risks.


Explore the full series and their takeaways here.





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Episode Two | Managing Capitalization Structures and Investor Relationships in Today’s Digital Health Market

In this new video series, McDermott’s digital health team shares timely insights and strategies to help your organization stay ahead of the curve, addressing critical areas of workforce management, financing and the potential for restructuring.

In episode two, McDermott partner and digital practice co-head Lisa Mazur joins fellow partner Brian Gordon to review important considerations for navigating today’s market realities.


Explore the full series and their takeaways here.





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Episode One | Workforce Management Solutions in an Uncertain Economic Environment

In this new video series, McDermott’s digital health team shares timely insights and strategies to help your organization stay ahead of the curve, addressing critical areas of workforce management, financing and the potential for restructuring.

In episode one, Stephen Bernstein talks with McDermott partner Ellen Bronchetti about timely employment considerations for digital health companies.


Explore the full series and their takeaways here.





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Navigating Volatile Markets in the Digital Health Ecosystem | Introduction – What to Consider

In this new video series, McDermott’s digital health team shares timely insights and strategies to help your organization stay ahead of the curve, addressing critical areas of workforce management, financing and the potential for restructuring.

Watch the introduction where Stephen Bernstein, Co-Head of the Digital Health Practice, kicks off the series discussing what companies should be considering as they navigate today’s complex digital health ecosystem.

Explore the full series and their takeaways here.





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2021 Digital Health Year in Review


The continuation of the COVID-19 public health emergency (PHE) and consumer demand for digitally delivered healthcare not only necessitated the shift from in-person to virtual care, but also continued to drive interest, adoption, investment and transactions in digital health in 2021. Digital health funding in 2021 far surpassed 2020’s totals, with no signs of slowing down in 2022, and the potential permanence of some regulatory flexibilities beyond the PHE are charting a course for continued digital health growth in 2022 and beyond.

Access the report.




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