Brandon Edwards

Exciting times at 4C Digital Health! Wilmington, Delaware - 4C Digital Health (4C), the preeminent organization delivering independent financial oversight and control solutions for self-funded employee health plans, recently announced the strategic expansion of its services into the Commonwealth of Kentucky. In late 2023, 4C successfully competed for an initial award issued by Kentucky’s Department of Employee Insurance, and Kentucky has since extended the initial contract to allow 4C to continue its important work on behalf of the Commonwealth, its employees, and its taxpayers. The Kentucky Employee Health Plan (KEHP) serves more than 288,000 members, which amounts to 1 in 16 Kentuckians. In addition, KEHP spends over $1.8 billion dollars in total healthcare benefits on behalf of its members per year and covers over 8.2 million claims per year. KEHP objectives include “improving employee health and well-being” and “providing state-of-the-art benefits while maintaining reasonable premiums.” Recognizing its important fiduciary responsibilities to its employees and its state health plan, the Commonwealth of Kentucky enacted Senate Bill 42 (2023) introduced by Senator Stephen Meredith for the purpose of ensuring that critical health plan dollars are being spent properly on behalf of state employees. The legislation requires that 4C analyze 100% of medical claims submitted for payment to KEHP; identify erroneous overpayments; and identify inappropriate or erroneous fees imposed by KEHP’s third-party administrator. Ron Templeton CEO of 4C Digital Health stated: “4C Digital Health is grateful to the Commonwealth of Kentucky for recognizing the fiduciary responsibility that state and local governments have to their employee health plans and for the opportunity to provide our services in support of this mission. We appreciate Kentucky’s goal of using 4C’s expertise and innovative solutions to improve healthcare outcomes and reduce healthcare costs for the Commonwealth, its employees, and its taxpayers.” About 4C Digital Health: 4C Digital Health (https://lnkd.in/eB-fJg4X) is a healthcare data analytics company that was founded for the purpose of developing a disruptive technology targeted at bringing transparency and honesty to the healthcare marketplace.

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If I asked you to choose between Trader Joe's or Target, which would you choose? It's a silly question, really. Because both offer unique benefits. As major GPOs shift in the market, exclusive agreements are becoming common. But are they truly driving value for health systems and patients? Exclusive GPO contracts limit choice. It's like forcing someone to choose between Trader Joe’s and Target. At Advantus Health Partners, we offer diverse vendor partnerships and PPI contracts, enhancing both economic benefits and patient care. By rethinking exclusivity, we prioritize patients and empower health systems with choice. Ready to supplement your supply chain with value-added partnerships? Contact Advantus today to learn more about our non-exclusive contracts. https://lnkd.in/deiYRgfE #SupplyChainStrategy #GPOExclusivity

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Employed cardiologists are navigating increasingly difficult challenges in today's healthcare landscape. Our CEO, Jasen Gundersen MD, MBA, and Board Chairman, Jonathan Gavras, MD, shed light on these new realities and offer insights into how to overcome them. Spoiler alert: employment isn't the only option anymore. Plus, they share how private equity partners, like WindRose Health Investors, are bolstering the resources and capital private practice cardiologists need to remain fully independent. 👉 Read More - https://lnkd.in/eSxSySWY

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As the 2025 Medicare Advantage (MA) enrollment season approaches, experts note significant challenges and changes in the landscape. The CMS has adjusted its payment models, impacting how health plans are reimbursed based on patient health conditions. This has led to a noticeable decline in the number of available plans, with major insurers like CVS and Centene cutting over 60 plans each, resulting in fewer carriers and increased plan terminations. Despite these challenges, enrollment in Special Needs Plans (SNPs) has surged, more than doubling since 2019, driven by the growing demand for tailored care for vulnerable populations. SNPs now account for 20% of overall MA enrollment, highlighting a significant shift towards specialized care amid broader market fluctuations.

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In our recent webinar "The Future of Medicare Advantage: How the Election Results Impact the Program," Leavitt Partners Principal Matt Gallivan, MBA, mentioned that he expects changes to prior authorizations as an end-of-year priority, as well as looking at home risk assessments through a budgetary lens. Check out our full conversation here: https://bit.ly/48rmRwa #MedicareAdvantage #Election2024 #HomeRiskAssessments

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🚀 Shaping the Future of Telehealth: Congressional Insights from the CTeL Summit At the CTeL Digital Health Summit, the Congressional Panel shed light on the evolving telehealth policy landscape and the critical steps needed to secure its future. Featuring Jackie Weinrich, MPH, Health Policy Advisor to Congresswoman Doris Matsui (D-CA), and Abbygayle Brewington, M.Ed. Brewington, Legislative Assistant to John Carter U.S. Congressman (R-TX), the session highlighted bipartisan momentum, funding challenges, and the potential inclusion of a two-year telehealth extension in the End-of-Year (EOY) legislative package. 🔑 Key Themes: Mental Health in Focus: Congresswoman Matsui’s office emphasized telehealth's transformative role in mental health care, advocating for the permanent repeal of the six-month in-person visit requirement for Medicare telehealth services. Funding Innovation and Wins: Congressman Carter’s team shared a commitment to ensuring telehealth access nationwide, with funding allocations including $44.5 million for HRSA telehealth services and $13 million for pediatric mental health initiatives. 💡 What’s on the Horizon? The panel revealed optimism about a two-year extension for telehealth services being included in the EOY package. This would provide much-needed certainty for providers and patients while Congress continues working toward permanent solutions. However, questions remain about how these initiatives will be sustainably funded in the long term. 🚧 Current Challenges: *Persistent delays in decision-making are creating operational nightmares for providers and limiting patient access to care, especially in specialties like autism management, where wait times for in-person visits with providers can exceed 18 months. *Concerns about misperceptions of “waste, fraud, and abuse” in telehealth underscore the need for data-driven advocacy to educate policymakers on the facts. 🌟 Takeaway for Telehealth Leaders: This session highlighted that while bipartisan agreement exists on the importance of telehealth, the path to permanency requires strategic advocacy, actionable data, and a focus on targeted wins. With a potential two-year extension on the table, the telehealth community has an opportunity to strengthen its case for lasting policy solutions. 📌 Call to Action: Now is the time to align your organization’s strategies with emerging policy trends, engage policymakers with robust data, and advocate for the permanent integration of telehealth into our healthcare system. Let’s seize this moment to ensure telehealth continues to transform access and care for patients across the nation. #Telehealth #DigitalHealth #PolicyInsights #CTeLSummit

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In the latest episode of the MedTech Talk Podcast, Dr. Liz Kwo MD, MBA, MPH, Chief Commercial Officer at Everly Health Solutions, sat down with Geoff Pardo to discuss navigating the digital transformation of healthcare. Dr. Kwo dives into how AI and data are evolving the consumer experience and what the future of healthcare looks like in the next 20 years. Listen to the full interview: https://bit.ly/4cbnIBF #DigitalHealth #HealthTech #MedTech

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The latest VMG Health report indicates a shift in hospital financials, with the median operating margin increasing from -0.9% in 2022 to 2% in 2023. Leaders from major health systems report a more stable labor market and consistent operational improvements, reflecting a cautiously optimistic outlook for 2024. #CFOs #OperatingMargins #FinancialPerformance https://lnkd.in/efkSZYvV

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With 41 states, including DC, adopting Medicaid expansion, Utah’s #Medicaid overhaul is a standout example of how advanced procurement and implementation strategies can enhance healthcare access and quality.   Medicaid system overhauls are crucial as they directly impact millions of individuals, ensuring they receive the necessary healthcare services. Effective modernization efforts can lead to improved health outcomes, reduced #HealthDisparities, and better resource allocation. Utah Department of Health and Human Services, along with Acentra Health, successfully implemented advanced strategies such as early engagement, precise criteria setting, and rigorous quality assurance testing. These efforts reflect broader trends across the country, where states are working to enhance their Medicaid programs to better serve their populations.   If you're attending #MESC2024, don't miss this opportunity to gain actionable insights and apply best practices to your state’s #Medicaid #modernization efforts. To learn more: 📅 Attend our upcoming session at #MESC2024 – add the session to your calendar here: https://hubs.li/Q02J0mhq0 📊 Sign up for the latest Acentra Health Impact Report for the full Utah Medicaid overhaul success story: https://hubs.li/Q02J0t0F0

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As telehealth continues to see adoption across the Commonwealth, providers are increasingly recognizing its benefits and integrating it into their practice. In fact, 88% of Virginia telehealth users agree that telehealth provides more schedule flexibility according to our 2024 Benchmarking Telehealth Usage in Virginia Survey. Check out the full findings from our survey here: https://lnkd.in/duAuJCt8

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It's been a volatile earnings week for the digital health/upstart health insurance companies we follow here for Endpoints News' Health Tech coverage. Inside today's newsletter edition: - Shelby Livingston breaks down key parts of Alignment Health and Oscar Health's earnings (as well as what's going on with the MA market in her typically expert way) - Ngai Yeung spotted that although Talkspace hit a key profitability metric, its stock still got dinged after warning that employers are dropping mental health benefits + post CVS Health earnings, I got an inside look at how the healthcare giant's PBM managed to catalyze biosimilar traction in the Humira market Take a read and let me know what you think! https://lnkd.in/gi3EAFgp

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My Friday good news celebrates the heroes of value-based care: primary care physicians and teams. The most successful #Medicare ACOs, those delivering value for Medicare and Medicare beneficiaries and sharing in that value, are primary care-centric #ACOs. We know how they do it; the playbook often includes support from enablers like Aledade, Inc.. Dr. Menard and his colleagues didn't give up when success wasn't immediate. How do we grow more primary care-centric ACOs and generate more value for Medicare and more access and quality care for beneficiaries? There are some health system ACOs investing in primary care and integrated teams. But it might take more forceful nudges from Medicare to get big health systems participating in total cost-of-care risk models. Or, we might need payment policies to give primary care more independence to practice comprehensive care. Congress could also consider restructuring the APM bonus to reward primary care "centricity". #primarycare #valuebasedcare Primary Care Collaborative David Raths David Muhlestein AAFP Foundation Thomas Culhane, MD, MMM, MS Darrin Menard, M.D. Stacey Richter https://lnkd.in/dThMvJrQ

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Had the opportunity to attend the 16th annual Merchant Medicine Symposium in Nashville, and I have to say—it was an incredible experience! The speakers were nothing short of inspiring, sharing cutting-edge insights that really show how urgent care is evolving. From discussions about innovation to ways we can better serve our communities, it’s clear that the future of urgent care is brighter than ever. There was a wealth of knowledge on how we can continue to expand our reach, increase access to care, and build a more patient-centered experience. I’m excited to be part of this movement and to bring back fresh ideas to drive change and elevate the care we deliver. The healthcare landscape is always shifting, but what’s certain is our ability to adapt, innovate, and lead with compassion. Looking forward to seeing where this industry is headed—big things are coming! #HealthcareInnovation #UrgentCare #Leadership #CultureGameChanger #HealthcareLeadership #PatientCenteredCare #CommunityCare #UrgentCareGrowth #FutureOfHealthcare #InnovativeCare #MedicalInnovation #MerchantMedicine #HealthcareLeadership #MakingADifference #InspiringHealthcare #LeadersInCare

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Last week on #RadioAdvisory, we broke down what healthcare leaders need to know about 2024 elections results. This week, Advisory Board experts Regina Lohr, Sarah Roller, and Paul Trigonoplos join host Abby Burns to talk three major policy areas of the last year: Medicare drug negotiations, changes to physician employment and payment, and an emerging mandatory bundled payment model called TEAM. Listen now to unpack how these policies are affecting the industry, how the elections outcomes may impact them, and how much you should be paying attention to them moving forward🎧👇 https://lnkd.in/eVp3nz2Z

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From Healthcare Financial Management Association (HFMA), here's coverage of what #hospitals and health systems need to know regarding the #Medicare FY25 final rule for hospital #inpatient care and long-term care hospitals. Hospitals will get only a small bump in Medicare inpatient payments for FY25: https://lnkd.in/gvygJtb5 Mandatory Medicare bundled payments and respiratory disease reporting are on the way for hospitals: https://lnkd.in/gthgPwRW

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#MROExchangePod - On the debut episode of Matt Wildman, Chief Commercial Officer at MRO, interviews #healthcare quality reporting expert James Pelletier. Together they discuss the importance of healthcare quality reporting and more. #RevenueCycleOptimized - Learn how to harness technology to simplify and enhance accuracy and efficiency in coding and revenue cycle management with Infinx Healthcare Senior Revenue Cycle Manager, Christina Harkins. #Healthusiasm - Christophe Jauquet and a panel of experts share their interpretation of this decision and its consequences for Primary Care in general. #AmbulatoryHC - Roy Gill, MD, FAMIA, Vice President of clinical affairs and safety for NextGen Healthcare, and Dr. Dany Domínguez Pérez, NextGen’s vice president of clinical analytics and population health, consider how to leverage data in ways that tangibly benefit your practice and patients. #HCforHumansPod - Raj Sundar and his guests explore the heart-wrenching yet inspiring journeys of Tom, Arnold, Cathy, and Brainze as they navigate the challenges of being LGBTQIA+ individuals in Africa. #asktheeducatorpodcast - Kevin Anderson & Adam speak with fellow Clinical Education Specialist, Seth Hendee, about the ANSI/AAMI ST79 Amendments that were released in 2020, with a specific focus on Amendment 1: “Environmental services/fans/food and drink”. #HealthcareRap - Keenan Wyrobek, Co-Founder and CTO of Zipline, joins the Rap to talk about how drone delivery is changing the way that patients with chronic diseases access care, how it enables health at home, and how consumer-centric can mean getting physical things fast. #DesigningforHealth - Craig Joseph MD, FAAP, FAMIA, invites triple board-certified physician and architect Diana Anderson, MD. They discuss her background in design and architecture, her transition into the healthcare industry, and where her expertise in both has intersected. =  #TheBrainTrustPod - Raj Shah MD MBA, is joined by Susan Frick, MSW, LSW, Social Worker, Rush Alzheimer’s Disease Center, to talk with caregiver Jeanne as she shares her heartrending experience recognizing her husband John’s early signs of Alzheimer’s. #HealthLawHotSpot - Ericka Adler and Roetzel & Andress attorney Christina Kuta delve into the world of buying and selling dental practices. #AMCPListenUp - Fred Goldstein invites Ruchi Gupta, MD, MPH, professor of pediatrics and medicine at Northwestern University - The Feinberg School of Medicine, and the founding director of the Center for Food Allergy and Asthma Research to discuss Food Allergies, their prevalence, new treatments and how payers should look at this area. #TheHandoffPodcast - On the season finale Dr. Joni Watson, DNP, MBA, RN, OCN sits down with Dr. Michael Jones, a regional director at Common Spirit Health and a leader in clinical informatics. Trusted Health https://lnkd.in/ex7HN3Rx

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https://lnkd.in/gMUpgFgC Check out Beterra's latest blog, and check back for more Beterra thoughts on the CMS Proposed Patient Safety Structural Measure (PSSM). #healthcare, #safety, #cms, #pssm

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