Eating disorders often start at a younger age, but they don’t solely affect this population. Recognizing this, virtual eating disorder support company Equip announced Tuesday that it is now treating adults as well as adolescents. The company also announced an investment from General Catalyst, which helped expand its platform to adults. The amount was not disclosed.
“There is a very pervasive, really dense stereotype that eating disorders only affect 15- to 25-year-old thin, White girls,” said Dr. Erin Parks, chief clinical officer and co-founder of Equip, in an interview. “That is true, it does affect them. But it is not only them.”
She added that because so few people have access to treatment, many older adults have had their eating disorder for a very long time and need support.
San Diego-based Equip, which was founded in 2019, previously focused on those ages 6 to 24. The startup is now expanding to serve people of all ages. The virtual company operates in all 50 states and is in-network with several insurance companies, including Aetna, Elevance, Optum, Cigna and UnitedHealthcare. It connects patients with a care team that includes a therapist, dietitian, physician and peer and family mentor.
Different ages require different kinds of treatment, according to Parks. With its younger patients, the company uses family-based treatment, in which the family is brought in to help care for the patient. For adults, the company is using a method called enhanced cognitive behavioral therapy, which is a highly individualized treatment that addresses thoughts, feelings and behaviors affecting the patient’s eating disorder.
Parks said that when it comes to adults, individual treatment is often the best way to go because they may not have a support group. Sometimes when adults have been sick for a long time, they’ve “pushed away” a lot of their family and peers, or they may be too busy with work to build that support group.
There are other virtual solutions for eating disorders as well, including Arise and Within. Arise offers coaching with a care advocate who has lived experience with an eating disorder, therapy, nutrition counseling, group support and psychiatry. Within provides access to a care team that includes dietitians, therapists, nurses and peers.
The expansion to adults was powered by a recent investment by General Catalyst. In total, Equip has raised more than $75 million. With the funding, the company brought on a new president, Nikia Bergan. It also updated its technology and trained its providers in treating adults. In addition, it’s planning to use the funding to gain more Medicaid contracts, Parks said.
Equip considers itself an alternative to brick-and-mortar eating disorder treatments, which often require patients to stay at the treatment facility for a certain period. Parks said the benefit of a virtual program is that patients can be treated as they live their normal lives.
“[If you take] someone out of their life and give them a bunch of skills, then all of the sudden they plop back into their life and have all these triggers that they aren’t equipped to deal with,” Parks argued. “One of the great things about getting treatment while still being able to go to school, still being able to go to your job, still being able to parent your kids, is that you get to work with your providers on your real-life triggers as they come up.”
Parks is likely looking to replicate the positive results it claims to have achieved in the adolescent population in this new, adult population. In its annual outcomes report published earlier this year, the company cited that 81% of its adolescent patients reached or maintained their target weight within one year.
Photo credit: Bohdan Skrypnyk, Getty Images
The commercial market has been slower to adopt value-based care than the public market, but there are ways to move the process along successfully, executives said Monday.
During a panel at the Oliver Wyman Health Innovation Summit 2023 held in Chicago, healthcare leaders discussed the challenges and opportunities in advancing value-based care in commercial health plans. The panelists were Mark Hansberry, senior vice president and chief marketing officer of HealthPartners; Ellen Kelsay, president and CEO of Business Group on Health; and Tiffany Albert, senior vice president of health plan business at Blue Cross Blue Shield of Michigan.
Bloomington, Minnesota-based HealthPartners, which is an integrated healthcare organization serving more than 1.8 million members, has had some success with value-based care in the commercial space, Hansberry claimed. He shared five rules for scaling value-based care in the commercial market:
1. Payers and providers in a value-based arrangement need to have a shared understanding of what value is for patients, Hansberry said.
“You have to have a universal definition of what value means so that when clinicians look at you as a payer … they need to acknowledge that what you’re saying a clinical outcome is is actually a good clinical outcome, a good measure of performance,” he stated.
2. It’s important to ensure that the providers in the value-based arrangement are able to and willing to take the risk associated with value-based care.
“Most care systems weren’t built to actually manage risk,” Hansberry said. “That wasn’t their job. Their job was to take care of sick people. Now we’re asking them to do something else. How do you actually support those individuals on that journey?”
3. Payers need to support providers engaging in value-based care with “real-time, actionable data and consultation,” Hansberry said.
“It’s not just a data dump or a big Excel file that you pass over and you say good luck with it,” he stated. “Because, by the way, if they perform well in those value-based contracts, you do too as a payer. You want them to perform well. So you want to provide them with good, insightful, actionable data that’s risk-adjusted, that is connected to their practice — not just an amorphous health system — but to their practice so they can take action on those insights. But then you also want to supplement that with that consultation along the way.”
4. The incentives in the value-based contract must be aligned to “enable that [provider] to reap the benefits of the value that they’re creating for those members,” according to Hansberry.
5. Ultimately, a value-based contract comes down to trust between all the parties. But Hansberry noted that this is easier for HealthPartners as an integrated health system.
“We’re fortunate because we’re both a health plan and a care system,” he said.
He added that success in value-based care doesn’t happen overnight, which is partially why it’s difficult to scale.
“It takes time to build trust,” Hansberry stated.
Photo: atibodyphoto, Getty Images
By Chris Zarpas, Zenger News
Commercial real estate investors face a lot of headwinds these days — remote work emptying downtown offices, ravaging inflation, rising interest rates, shrinking family sizes — but they may not be hedging for another “Great Migration.Of course, commercial estate investors see their business as cyclical, managing costs as markets bottom and bullishly chasing them when they climb. Real estate markets crash at varying velocities, and return, often with even greater vigor than before, as if by some natural law. But another “Great Migration” would be outside the natural swing of real estate markets.
A rapid decline in quality-of-life is draining American cities of its people and bleeding the revenue of both governments and investors. There are many reasons to leave major U.S. cities: surging violent crime, failing schools, climbing taxes, soaring housing costs, a sidewalk-occupying army of homeless.
The pandemic opened the door for remote work, which got many office workers asking “Why do I have to live within commuting distance?” Brooklynites have discovered that when they move to the Hudson Valley that they no longer have to pay New York City income tax, Manhattanites have discovered that sheltering in a Bucks County farmhouse means that honking horns no longer burst through their bedroom windows. Many more have discovered Florida, where they can trade away snow and state income taxes for humidity and hurricanes.
All of these revelations have produced the greatest exodus from America’s declining “super-cities” in more than 50 years. Fifty-four of the 88 largest-population U.S. cities reported population losses between 2020 and 2021, according to Brookings Institution data. By the end of 2022 only 37 of the largest cities reported ongoing losses, but among them were Los Angeles, Portland (Oregon), Seattle, and every major Northeast city — from Philadelphia to Boston, according to the Economic Innovation Group. City centers have hollowed out, with half-vacant hotels and acres of empty offices and storefronts. Offices now lead the distressed property category, surpassing even enclosed malls and suburban hotels. A new “Great Migration” is now underway.
Investors and mayors can debate who should worry more. Hundreds of billions in property value is being lost, as is tens of billions in tax revenue as city assessments are recalculated downward. Experienced investors, foreseeing this calamity, have amassed billions of dollars earmarked for acquiring mortgage notes secured by these declining properties. It’s a dangerous game because no one knows where the market’s bottom is, but fortunes can be made by the bold.
Some scholars refer to the “urban doom loop.” That’s when declining property and income tax revenue leads to reductions in city services — fire, police, water, sewers, and schools — which prompt a new wave of departures, further squeezing city revenues, starting the cycle again. At the end of the road is Detroit, 1989.
Cities lost some $360 billion due to lost tax revenues from 2020 to 2022, according to the National League of Cities. If the exodus of wealth continues, lower municipal bond ratings could escalate financial pressure on major cities, leading to default, according to credit analyst Merrit Research Services.
Consider the last “Great Migration.” Almost 30 million poor, rural — black and white — citizens from 1910 to 1970 fled the segregationist South and rural Appalachia to Northern industrial cities in search of a better life. That plentiful pool of labor fueled unprecedented prosperity for decades after World War II, much of which was concentrated in the Northeast and the midwestern heartland. As people moved, the fortunes of regions flourished or withered.
Now, in an ironic reversal, over two million Americans have relocated to the Southern U.S, most from the North, according to data from the U.S. Census Bureau, and the Economic Innovation Group. The Internal Revenue Service reviews tax returns annually to determine when and where taxpayers move. From 2020-2021 alone, Northeast states lost $60 billion in income tax revenue, while Florida, Texas, Georgia, the Carolinas, and Tennessee, gained $100 billion according to recent Internal Revenue Service wealth migration data. New York State alone lost 468,200 people, $24.4 billion, and one seat in Congress.
While some commercial real estate investors are betting on legacy city recovery, busily acquiring distressed assets, others are looking South for new opportunities. Of the top ten markets attracting the most commercial real-estate investment, eight are in Florida, Texas, Georgia, North Carolina, and Tennessee, according to Urban Land Institute and Price Waterhouse Cooper.
For the first time ever, in 2022, the GDP of those six southeastern states (23.8 percent) exceeded that of Washington, D.C. and all northeastern states from Maryland to Maine (22.4%).
Notably, three of those southern states- Florida, Texas, and Tennessee – have no state income tax, and all six have less burdensome regulatory environments than those up North.
Corporations have followed. Since 2020, Texas has gained more relocations than any other state except Florida, landing Tesla, Oracle, Caterpillar, and Hewlett Packard. Their workers who can do the math are eager to go. The standard of living that requires a $250,000 salary in New York City, requires only $94,603 in Houston according to financial services marketplace, NerdWallet.com.
For those who dismiss the idea of an urban doom loop caused by another “Great Migration” as pop culture nonsense, remember the urban doom loop has happened before. As the post-war American service economy grew, there began a slow-motion collapse of American manufacturing from 1950 to 1980, and urban devastation ensued. Between 1970 and 1980, New York City and Its suburbs lost 1.6 million people, 10% its population. The other cities of the Northeast corridor from DC to Boston, saw similar declines. Or, from another perspective, the seeming prosperity of Northeastern cities from 1990 to 2020 was an aberration and now those cities are returning to the earlier trend line.
Urban consultant Bruce Schaller recalls that period of urban decline from 1970 to 1980 when drugs, violent crime and poverty emptied city centers of those with the resources to flee, in a recent report titled “Boom Times or Doom Loop – America’s Future Post- Pandemic.” By 1974, New York City’s annual deficit had reached $487 million, its outstanding debt topped $13 billion, and the city was on the verge of bankruptcy. Every single day between 1970 and 1980, an average of 6 people were murdered and almost 250 assaulted and robbed, a rate 500% higher than that in 2022. If those crime rates return, cities would empty and investors would lose.
During that dark period, commercial real estate values collapsed. Thousands of owners of urban apartments, offices and retail spaces were wiped out. In the Bronx, perhaps the most devastated urban landscape in America, some landlords set fire to their properties to collect insurance money. Seven census tracts in the Bronx, between 1970 and 1980, lost more than 97 percent of their buildings to fire and abandonment, Schaller writes.
The hoped for “full return to work” has failed to materialize, The result has been devastating. A report by researchers at NYU and Columbia– “Work From Home and the Office Real Estate Apocalypse;” sums up the damage. Soon after the pandemic began in 2020, office occupancy collapsed to 20% in major office markets. Occupancy has slowly recovered but is now stalled at 49.9%. Decreased daytime population coincided with increased crime. Compulsory pandemic face masks enabled a crime wave of shoplifting, carjacking, armed robbery, and burglary that is ongoing. In Metro DC, 1000 people were carjacked in 2022, a rate of almost three per day.
Brazen, organized gangs of shoplifters led essential retailers like CVS, Target, Walgreens, and Walmart to shutter stores, and lock up laundry detergent, toiletries and even ice cream.
Cities including DC, Philadelphia and New York have no cash bail policies that return recidivist criminals to the streets hours after an arrest, demoralizing shrunken police forces. The lawful became fearful, the lawless, fearless.
A 2021 study by Howard Chernick, at City University of New York’s Hunter College calculated the commercial real estate tax revenue of eight major cities. Including Atlanta, Chicago, Los Angeles, New York and San Francisco. In these cities, commercial real estate accounts for an average of 37% of these property taxes ranging from 26% in Los Angeles to 56% in Atlanta.
The future of America’s largest cities depends on the tax revenue paid, directly and indirectly, by commercial real estate investors. If those investors decide to invest more in the Sun Belt, the future of Northeastern cities will go south too.
It’s no secret that hospitals and health systems have been facing severe financial woes in the past couple years. These money problems have forced many providers to make what they likely felt were tough but necessary choices — such as shuttering underperforming service lines, laying off staff and using debt collection agencies to obtain payment from patients.
Some of these tactics have even invited negative scrutiny
. However, a new report argued that commercial payers should shoulder some of the blame when it comes to how hospitals are managing their dire financial circumstances.
Compared to government payers, commercial payers take significantly longer to pay hospitals and deny claims at a higher frequency — often without a justifiable reason to do so — according to the report published by consulting firm Crowe. These delays mean that hospitals are waiting longer than they need to receive commercial payments — during a time when they need cash flow to be expedited, not needlessly delayed, the report said.
Crowe analyzed data from the more than 1,800 hospitals that use its revenue cycle analytics platform and found that about 45% of a typical hospital’s patient population is covered by a commercial health insurance carrier.
Commercially insured patients have conventionally been thought of as hospitals’ preferred population. This is because hospitals can negotiate prices with commercial payers, and these payers usually pay higher rates than government payers like Medicare and Medicaid. For the average net revenue per inpatient case, commercial plans pay $18,156.50 compared to $14,887.10 from Medicare. For outpatients, commercial plans pay $1,606.86 for the average patient case, compared to $707.30 paid by Medicare.
Reimbursement rates may be higher among commercial payers, but getting them to pay in a timely manner is an entirely different story, per the report. During the first quarter of this year, commercial payers initially denied 15.1% of inpatient and outpatient claims compared to 3.9% for Medicare over the same period, according to the report.
Crowe analyzed the claim denial category of prior authorization and precertification denials. These occur when a payer denies a claim based on their decision that a provider did not get prior approval for care before it was delivered or that the care rendered wasn’t necessary based on the patient’s medical diagnosis.
Last year, the prior authorization/precertification denial rate for inpatient claims among commercial payers was 2.8%, up from 2.4% in 2021. This rate increased to 3% during the first three months of 2023, but the denial rate for traditional Medicare was just 0.2% during the same period.
Another claim denial category that the report examined is the request for information (RFI). RFI denials happen when a payer decides not to process a claim because it is missing some type of required documentation, such as a signature or copy of the medical record. In this category, commercial payers’ denial rate is 12 times higher than Medicare, the report found.
Most of the claims that commercial payers deny eventually get paid. However, the administrative effort required for hospitals to turn an initially-denied claim into a payment costs a good deal of time and money — two things in short supply at hospitals
To obtain payment from a denied claim, a provider must investigate the claim, determine what they have to do to rectify the problem and resubmit the claim — a process that can take weeks — said Colleen Hall, the managing principal for Crowe’s healthcare consulting group, in a recent interview. This process creates “an aging accounts receivable situation” for the provider and delays them from receiving much-needed cash.
“There certainly are several for-profit insurers out there. I won’t name names, but I think that those for-profit entities are in direct conflict with the nonprofit hospitals. I don’t know what goes on in the for-profit payer side of things, but could there be actions that they’re deploying to delay payments? Potentially. There have certainly been denials that our clients, as providers, have to manage only to find were denied for no reason,” Hall declared.
In the first quarter of this year, about a third of the claims that providers submitted to commercial payers took more than three months to get paid, the report found.
It’s difficult for hospitals to gain steady financial footing when the payers that have the best reimbursement rates are holding onto a third of their claims payments for more than 90 days, Hall pointed out.
Photo: santima.studio, Getty Images
The first quarter is in the books, and no real surprises. As things slowed last summer under the weight of “spiraling mortgages rates,” we reached the dizzying heights of 6.5-7% for 30-year mortgage rates.
I assured my colleagues that come Q1 of 2023, there would be three types of buyers in the market. First, those who retreated from the market to wait for the return of the days of 3-4% rates. Best of luck! Second, those who were in the market last August and smelled opportunity coming and thought they would figure out the mortgage piece. Third, new buyers who would enter the market without the baggage of longing for what used to be.
This week, I had the opportunity to meet with sellers who had bought their homes on the Hill in 1992-94. Then, there was a buyer’s market for those bold enough to seize it. Many of our friends were fleeing to the ‘burbs with their young families. Many with professional moves could not sell and were forced to rent their homes here on the Hill. Our local government was a mess and showing no hope. Crime was hitting all-time highs. And if you bought in 1989, you probably could not get out whole until 2000-02.
I can’t tell you how many settlements I attended in those days when the seller was bringing more money to the settlement table than their buyers!
A home is a long-term investment. It’s a place to live and to build wealth over time. Timing has nothing to do with long-term objectives. It’s more about dumb luck in the short term. Those who were buying in the early 90s were using double-digit 30-year mortgage rates or less expensive adjustables. They would have killed for a 6.5%, 30 year fixed-rate mortgage. With all of these factors, they were clearly taking risks at the time. In hindsight they were making one of the most significant financial decisions in their lives.
No one who bought then and still owns the property will be bringing money to the settlement table (unless they treated their home like a piggy bank), and they will see doubling, tripling or quadrupling of their original purchase price. Not the cash they put down but the gross value of the property.
So Where Are We Now?
It looks more like 2007-08, when financial markets and institutional lenders were in the tank and some residential marketplaces were devastated. Not here in DC and not on Capitol Hill. Our market slowed a little. Prices vacillated somewhat. Basically, we took a break from the sizzling market we had experienced for the preceding six or seven years. Once things settled down a little, we were off and running for another decade, with that pandemic.
Inventories today remain tight and that is holding property values at a stable level. Some homes may be selling for a little less than a year ago, but not many. More are on par with levels of a year ago and some higher ‒ stunning to see the strength in the market between $750,000 and $1,500,000. The drop in median price in the chart is more a reflection of the strength in the lower-priced part of the market than any decrease in value anywhere.
A Few Tips To Keep In Mind:
1. If you are thinking of selling in the next year or so, and your rental unit becomes vacant, DO NOT RE-RENT IT.
2. If your spouse were to die, have a legitimate professional appraisal done to establish the property value at the time of death. There could be significant tax implications when you sell. Consult with your accountant.
3. If you are approached by a friend or a neighbor or some nice young man who knocked on your door, and they want to buy your house without a realtor, and the price sounds fair, don’t sell unless you consult with a known local realtor or pay for that professional appraisal. What you pay in a real estate commission or appraisal fees might be a pittance compared to underselling your home for many tens of thousands of dollars. Put your property into our local multiple listing service and let the market speak!
Keep these things in mind and consult with a professional realtor from a reliable firm.
Don Denton, an associate broker with Coldwell Banker Realty, has lived and sold properties on Capitol Hill for more than 40 years. He can be reached at email@example.com.
Oshi Health — a virtual care provider for patients with digestive disorders — announced its first contract with a commercial insurer on Thursday. The New York-based company has entered into a value-based contract that provides Aetna members with in-network access to its specialized treatment.
Founded in 2019, Oshi built a virtual-first care platform designed to help patients achieve lasting control over chronic digestive conditions. The company hires gastroenterologists, nurse practitioners, dieticians and GI-specialized behavioral healthcare providers to quickly reach a diagnosis and guide individualized treatment. Patients are also assigned a care coordinator, who can help them find in-network providers if they need services like a colonoscopy or endoscopy.
The startup prides itself on providing whole-person care, which includes often-neglected dietary and psychosocial interventions, Oshi CEO Sam Holliday said in a recent interview.
“Over the past decade, there’s been a recognition that many gastrointestinal disorders are actually triggered by the signaling between your gut and your brain. A whole class of GI conditions has actually been renamed as disorders of the gut-brain interaction, or DGBIs,” he explained. “Things like gut-directed cognitive behavioral therapy can really reframe patients’ thought patterns and dampen the brain signaling that causes their symptoms, making symptoms feel less severe.”
Dietary interventions and behavioral therapy are proven methods to alleviate GI patients’ symptoms, and they’re often more effective than medication, Holliday pointed out. But these services are rarely available to GI patients because they haven’t been reimbursed historically, he added.
That’s why these interventions are a core part of the care patients receive under Oshi’s new contract with Aetna.
“One of the challenges in GI is that there aren’t very good quality measures. Really, the main things we focus on as a country is getting people screened for colorectal cancer, But we don’t really have measures for what matters to patients, who are the people suffering. What we think is the best measure to use is symptom control,” Holliday explained.
The root cause of GI symptoms usually stems from dietary or behavioral health reasons, and traditional, medication-centric GI care does not address those underlying causes, he declared. Patients end up continually seeking care — and driving costs up — because their symptoms are still bothering them. Through Oshi’s value-based contract with Aetna, “the value aspect being measured is Oshi’s ability to reduce that utilization downstream,” Holliday said.
Oshi will measure its care teams’ ability to sustainably control patients’ symptoms through a mix of medication, dietary adjustments and gut-brain psychology interventions. The company will track metrics such as reductions in emergency department visits and patients’ reported symptoms.
“We get paid a certain amount as we’re providing the care. Then, if we’ve gotten to a good level of patient satisfaction, symptom control and reduced utilization at the end of the measurement period, we have a bonus opportunity. And if we don’t achieve certain levels, there is a downside,” Holliday explained.
Aetna shares in the upside if Oshi hits its goals, but the payer is protected against potential downside. If Oshi doesn’t achieve as good outcomes as the partners had hoped, Aetna won’t have to pay the startup the full amount for care, Holliday declared.
The partnership is in its first phase, meaning Aetna members can access Oshi’s services in the following six states: Florida, Maine, Massachusetts, Ohio, Pennsylvania and Texas.
Photo: TLFurrer, Getty Images
Paragonix Technologies — a company that launched in 2010 as a response to the lack of innovation in the donor organ preservation and transport process — closed a Series B funding round on Tuesday. The $24 million round was led by Signet Healthcare Partners.
The Cambridge, Massachusetts-based company provides transplant centers and organ procurement organizations (OPOs) with medical devices designed for the preservation and transportation of donor organs.
The traditional method of preservation requires the organ to be transported in a cooler of crushed ice. Due to unstable temperatures, many facilities that receive organs preserved in this manner report that they arrive frozen and damaged, said Paragonix CEO Lisa Anderson.
“Paragonix determined there was an opportunity for a more scientifically reproducible, measurable and reliable solution to transporting an organ from a donor to recipient,” she said. “We set out to create a new standard for organ preservation and transport that would provide the care and quality of handling commensurate with transporting such a valuable gift and improve patient outcomes worldwide.”
Paragonix’s devices are made from a series of interconnected systems that work together to provide a cool and sterile environment within a consistent range of 4-8° Celsius. The company sells three devices, each designed for a different organ (heart, lung and liver). All have been cleared by the Food and Drug Administration.
Each device works slightly differently based on specific user needs related to the organ type, Anderson said. For example, the heart preservation device has pouches filled with proprietary cooling solutions that keep the organ at optimal temperatures during transport. The heart is contained within a nested canister and is then housed in a wheeled shipper container that works to protect and insulate the inner contents.
All of Paragonix’s devices display the organ’s temperature while it is being transported. They also use bluetooth monitoring and tracking technology to allow surgeons to track the organ’s exact location throughout its journey, even in flight, Anderson pointed out.
Paragonix markets and sells its devices to transplant centers and OPOs across the U.S. and Europe. Last year, over one in five thoracic donor organs transplanted in the U.S. were preserved using a Paragonix device, Anderson declared. She also said that 19 out of the 30 largest U.S. heart transplant programs rely on Paragonix devices to safely preserve, track and transport organs to their intended recipients.
“Most other organ preservation devices are extremely complicated, labor intensive and require special personal or extensive training, while Paragonix’s devices are lightweight, user friendly, and a user can be trained in less than an hour,” she declared.
Anderson explained that her company’s main competition is the legacy way of transporting organs, as many organizations still receive damaged organs that were transported using the over-ice method. The medical industry needs to move away from this method of organ preservation because devices like the ones that Paragonix sells are clinically proven to improve patient outcomes and reduce the risk of post-surgical complications, she declared.
Picture: Getty Images, ThomasVogel
Husch Blackwell is pleased to announce leaders for its Real Estate, Development and Construction business unit and its Tax and Commercial Litigation practice groups.
Jon Giokas will head up the firm’s Real Estate, Development and Construction business unit. Michael Hargens has been named as the leader of the Commercial Litigation team, and Robert Romashko has been named the practice leader of the firm’s Tax group. These changes are effective January 1, 2023.
Giokas, based in the firm’s St. Louis office, has been with Husch Blackwell since 2003 and counsels investors, institutions, companies and public entities with respect to real estate and finance matters, with a particular focus on transactions utilizing public and private capital sources. He succeeds Carrie Hermeling, who served as the head of the firm’s Real Estate, Development and Construction business unit for the past 10 years.
“Our real estate practice has grown tremendously over the past decade, earning national rankings and expanding our depth in key markets across our footprint,” said Giokas. “I look forward to capitalizing on all of the positive momentum that Carrie’s leadership has generated and to continue building on the esteem our lawyers have earned in the marketplace.”
Based in the firm’s Kansas City office, Hargens has served as the co-lead of Husch Blackwell’s Commercial Litigation practice group since 2020 and will take over the leadership of the team as JoAnn Sandifer steps down after 10 years leading or co-leading the group.
Romashko takes over leadership of the firm’s Tax group, succeeding Joe Pickart, who had led the team since 2017. He recently relocated to the firm’s Washington office from Chicago.
“Each of these partners has been promoted to their new roles because they share a set of core values that match our firm’s strategic vision when it comes to our clients and our colleagues,” said Paul Eberle, Husch Blackwell’s Chief Executive. “These individuals successfully collaborate with and develop those around them, support and share our One Firm Vision, and are stalwart champions in our desire to integrate Diversity, Equity and Inclusion into everything we do here.”
Defined contribution (DC) pension scheme members’ ‘digital journeys’ must be “vastly improved” to offer savers what they need as they approach the point of making decumulation decisions, Hymans Robertson has said.
The pensions consultancy stated that there are product design opportunities and technical solutions that providers should be utilising in their digital products to help give consumers much needed financial support.
In particular, Hymans Robertson stated that providers “must” use technology and enable savers to use a range of different products, including pension drawdown, annuity, savings vehicles and property, to meet savers’ needs through retirement.
Hymans Robertson also suggested that, by implementing smarter digital journeys, providers can help individuals to better navigate the complex decision-making process of using their pensions and other assets to meet their needs and manage risks in a holistic way.
According to the consultancy, personalised digital retirement journeys would enable many members to easily engage with their retirement decisions through a non-advised channel, supplementing the advised route for those who have more complex needs and access to advice.
The call for better support follows on from Hymans Robertson’s recent report, The Decumulation Market: Opportunities for Providers, which found a “raft” of issues that pensions providers need to consider if members who are reliant on DC pensions as their main source of income are to minimise future retirement funding risks.
Hymans Robertson head of digital wealth, Paul Waters, commented: “Consumers need the right support, guidance and protection today; they cannot wait until the future.
“As an industry that is responsible for delivering good outcomes, a slow evolution in the sophistication of products and support available for individuals to manage their retirement income needs is not enough.
“There are key opportunities for providers to help individuals improve outcomes through retirement.
“Firstly, by taking a more holistic approach to retirement planning and helping individuals understand how their various assets could be used to help them achieve their retirement plans.
“Secondly, by providing guidance on sustainable income drawdown levels on an ongoing basis through an individual’s retirement, reflecting both their personal circumstances and changing market conditions.
“Finally, once pensions dashboards are fully operational, building in the ability to have all pension pots in one place allowing for easier assessment of their overall position and a smoother consolidation process.”
The American Hospital Association (AHA) survey, released Wednesday, found that 78% of hospitals and health systems said their relationship with commercial insurers is getting worse. Less than 1% said their relationship is improving and the rest said it has stayed the same.
The survey included 304 respondents representing 772 hospitals. All of the respondents are members of AHA.
One of the main culprits behind the worsening relationship appears to be certain practices of commercial insurers, such as prior authorization. The report found that 95% of hospitals and health systems said staff time spent seeking prior authorization approval is increasing. Meanwhile, 62% of prior authorization denials are eventually overturned, the report found.
Aside from time spent on administrative procedures, costs may also be a factor in the relationship souring. A whopping 84% said the cost of complying with insurer policies is also increasing.
“Misuse of utilization management tools like prior authorization has several negative implications for patients and the health care system,” AHA said in the report. “Prior authorization denials can result in delays of necessary treatment for patients and ultimately lead to unexpected medical bills. The extensive approval process that doctors and nurses must go through adds wasted dollars to the health care system through overuse of prior authorization, inefficient submission processes, excessive requests for unnecessary documentation and the need to reprocess inappropriate payment and coverage denials.”
AHA also takes issue with claims denials, stating that commercial health insurers are “increasingly delaying and denying coverage of medically necessary care.” However, 50% of claims denials that are appealed are overturned, AHA said.
There are financial consequences to these delays and denials, AHA stated. The survey found that 50% of hospitals have more than $100 million in accounts receivable for claims that are older than six months, totaling $6.4 billion in delayed or potentially unpaid claims among the 772 hospitals in the survey. Another 35% of respondents said they’ve lost $50 million or more in revenue because of denied claims.
“These payment delays and denials for medically necessary care have serious implications for the financial stability of health care providers and compound fiscal challenges plaguing our health care system,” AHA said.
The report also provided several policy recommendations, including streamlining the prior authorization process and increasing oversight on insurers. Additionally, the organization sent a letter to the Department of Health and Human Services and the Department of Labor, calling for action against commercial payers.
“Health care coverage must work better for patients and the providers who care for them. We urge you to take additional steps to ensure adequate oversight of commercial health plans, including those offering Medicare Advantage plans, this open enrollment season,” the letter stated. “Individuals and families should feel assured that the plan they choose during open enrollment will actually be there for them when they need care.”
America’s Health Insurance Plans (AHIP) declined to comment publicly on AHA’s survey, but previously told MedCity News that commercial insurers’ practices are needed to reduce expenses for patients.
“Health insurance providers advocate for the people they serve by ensuring that the right care is delivered at the right time in the right setting — and covered at a cost that patients can afford. Prior authorization prevents waste and improves affordability for patients, consumers, and employers,” Kristine Grow, AHIP spokesperson, previously said. “Health insurance providers have a comprehensive view of the health care system and each patient’s medical claims history and work to ensure that medications or treatments prescribed by clinicians are safe, effective, and affordable for patients. This results in better outcomes and lower costs for patients.”
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