The New York City-based health system was fined $4.75 million after a federal investigation found that a former employee and stolen patient data from the EHR.
Montefiore Medical Center has agreed to pay a $4.75 million fine for failing to secure patient data.
According to the HHS, Montefiore received a tip in 2015 from federal officials about a data breach. An investigation by health system officials found that since 2013 a former employee had been accessing the data of more than 12,000 patients through the health system’s electronic medical record system. The data included names, addresses, social security numbers, and confidential medical records.
Montefiore filed a breach report with HHS, prompting the federal investigation.
Investigators found that the health system failed to “analyze and identify potential risks and vulnerabilities to protected health information, to monitor and safeguard its health information systems’ activity, and to implement policies and procedures that record and examine activity in information systems containing or using protected health information.”
By failing to properly monitor its EHR, the investigation reported, Montefiore was unable to stop the cyberattack or even detect it until years later.
Since the investigation and arrest of the former employee, who was charged with three felonies, Montefiore officials say they have taken steps to improve security and protect patient data. This includes expanding monitoring capabilities around patient information and implementing additional technical safeguards to protect all electronic records.
A Montefiore spokesperson told HealthLeaders in an e-mail that they have also increased training and outreach to staff to reinforce privacy and security standards, reminding staff that patient privacy is a basic right.
“With healthcare systems across the country continuing to be targets for data breaches and other malicious cyberattacks, we take our responsibility to protect patient information very seriously and remain committed to ensuring safety protocols and cybersecurity safeguards are always maintained to protect our patients' privacy,” the spokesperson said.
Cybersecurity attacks on healthcare systems are becoming more common. According to HHS, from 2018-2022 there was a 93% increase in large data breaches reported to OCR, and a 287% increase in large breaches using ransomware. In 2023 alone two new records were set: the most reported data breaches (725) and the most breached records (133 million).
“Unfortunately, we are living in a time where cyberattacks from malicious insiders are not uncommon,” OCR Director Melanie Fontes Rainer said in the HHS press release on the Montefiore investigation. “Now more than ever, the risks to patient protected health information cannot be overlooked and must be addressed swiftly and diligently.”
“This investigation and settlement with Montefiore are an example of how the health care sector can be severely targeted by cyber criminals and thieves—even within their own walls,” she added. “Cyber-attacks do not discriminate based on organization size or stature, and it’s incumbent that our health care systems follow the law to protect patient records.”
In March 2023 the Biden Administration released a National Cybersecurity Strategy, and HHS followed this with a healthcare-specific plan indicating that the agency would play a more active role in helping health systems become more secure.
The plan highlights four main guidelines that HHS will follow to help ensure the security of health systems. The agency plans to:
Establish voluntary cybersecurity performance goals for the healthcare sector;
Provide resources to incentivize and implement these cybersecurity practices;
Implement an HHS-wide strategy to support greater enforcement and accountability; and
Expand and mature the one-stop shop within HHS for healthcare sector cybersecurity.
Medicare Advantage has seen a lot of turbulence recently.
With everything happening in the Medicare space there are bound to be a few items that will shake up the scene for payers this year. With questions floating around like ‘is the Medicare gold rush slowing down?’, some insurers may be questioning whether or not MA is as profitable as it used to be. There are important factors to consider when looking at how MA will progress over the next two years, here are three that are bound to shake up the Medicare Advantage space soon.
What the $3.7 billion dollar deal means for each company.
The deal is just about sealed. Cigna is ditching its Medicare business in a sale to Health Care Service Corporation (HCSC) for around $3.7B, set to close in early 2025.
HCSC will acquire Cigna’s Medicare Advantage, Part D, Supplemental Benefits, and CareAllies businesses, which in total currently provide about $7.9B in revenue for the giant. Cigna’s Medicare business currently serves 3.6 million members, with close to 600,000 members in MA plans, over 450,000 on Medicare Supplement plans, and 2.5 million with Medicare Part D. Its CareAllies business serves approximately 450,000 patients. As part of the deal, Cigna’s Evernorth Health Services subsidiary entered into a four-year agreement with customer-owned health insurer HCSC to continue to provide pharmacy services to Medicare plans if the deal officially closes.
Did We Expect This?
There were rumors of Cigna mulling the sale back in November, and we even saw Elevance enter into somewhat of a bidding war with HCSC for Cigna’s Medicare businesses in December. We all knew this acquisition was in the cards, but did we expect HCSC to prevail over Elevance? Looking just at size and revenue, Elevance is raking in over triple that of HCSC, $170B (2023) vs $54B (2022), and it seemed Elevance would take the pot. HCSC is also not publicly traded like Elevance, limiting it to a cash-only offer. Perhaps a quick cash offer is what Cigna was looking for in this deal; the sale comes at a time when government scrutiny of Medicare is high. Cigna pushed through with this sale despite their failed merger with Humana in December.
What It Means For HCSC
This acquisition marks a big transformational step in HCSC’s growth, taking it from a regional to a national insurer. With license to provide BCBS plans in five states, HCSC employs over 27,000 people and serves 18.6 million members.
In a press release HCSC CEO Maurice Smith said that this sale will allow the insurer not only to quickly scale, but also evolve its product portfolio.
"This acquisition supplements our growth strategy in the large and growing Medicare marketplace and will bring many opportunities to HCSC and its members—including a wider range of product offerings, robust clinical programs, and a larger geographic reach," Smith said.
What It Means For Cigna
Cigna seems to be making particularly strategic moves with this sale. The insurer acquired its Medicare sector in a $3.8B acquisition of HealthSpring back in 2011. But the majority of Cigna’s revenue doesn’t stem from their Medicare business, but rather their commercial and pharmacy benefits divisions where it spent $52B in a purchase of Express Scripts in 2018.
CEO David Cordani of The Cigna Group said that this HCSC sale will allow the company to focus on growth targets.
"This decision is aligned with our highly disciplined approach to managing our portfolio and allocating resources toward growth opportunities in our Evernorth Health Services and Cigna Healthcare portfolios," Cordani said in the press release. "While we continue to believe the overall Medicare space is an attractive segment of the healthcare market, our Medicare businesses require sustained investment, focus, and dedicated resources disproportionate to their size within The Cigna Group's portfolio."
While this is a big move for HCSC’s expansion and portfolio evolution, will the company be able to retain all of Cigna’s Medicare members? Going forward in the current Medicare landscape is uncertain, and the “Medicare Gold Rush” we saw at the start of last year has teetered off. HCSC serves more than 22 million members across the country and will be adding 3.6 million more if the sizable deal goes through.
A record 20 million Americans signed up for marketplace health insurance, and that number is expected to grow.
Affordable Care Act (ACA) signups have blown up since open enrollment began on December 15th, marking the third year of increasing sign ups for ACA under the Biden Administration.
Signups have already surpassed last year’s numbers by 4 million and more are expected as the January 16th deadline approaches. Some states have also extended the open enrollment deadline through the end of January. Roughly 3.7 million of these signups, representing about one-fifth of the total, are new members.
KFF Health News surmised that much of this high enrollment comes from the disenrollment of many consumers from Medicaid programs. During the COVID-19 pandemic, states were not allowed to disenroll people from Medicaid, but since April 2023, disenrollments have been allowed to resume. As a result, over 14 millionpeople were disenrolled from their Medicaid plan last year.
In the midst of the Iowa Caucus when Americans are carefully watching to select a Republican nominee, access to healthcare is a big issue on the table. Back in November of last year, former President Donald Trump revived his push to roll back the ACA, also known as Obamacare. At the 2022 midterm elections, the calls to eliminate the law failed and were abandoned by Republicans, but Trump could bring it back in 2024.
Meanwhile, the Biden Administration has argued for the law and the coverage it has provided to millions of Americans. An increase in consumer outreach from the Biden Administration has also played a part in new signups.
A press release from HHS services explained how the administration's use of ‘navigators’ also helped to increase signups:
“For this past enrollment cycle, the administration issued almost $100 million in Navigator Awards, allowing organizations to hire staff who are trained to help consumers find affordable, comprehensive health coverage. Navigators, as they are known, have been key to helping consumers enroll in quality health insurance plans in every Marketplace state.”
Enhanced subsidies for the program have also driven enrollment this season. With the Biden Administration adding enhanced subsidies in the American Rescue Plan Act and the Inflation Reduction Act, coverage has become more affordable for enrollees.
KFF Health News reported that 45 states saw an increase in their ACA enrollment compared to last year. Some Republican states specifically saw an uptick in signups, including Louisiana and West Virginia; both states saw a 63% increase in enrollment year-over-year.
KFF also pointed out this unusual mid-year growth in market enrollment. Unlike previous years, 2023 saw a boom in mid-year growth from April 2023 to September 2023, outside of the open enrollment window. Usually, the number of people leaving the program exceeds the number of people signing up for it, mainly due to limited qualification opportunities. 2021 was one other exception where mid-growth was apparent, when Biden first rolled out the enhanced subsidies in the American Rescue Plan Act and most state-based marketplaces saw more opportunities for mid-year enrollment.
No organization is immune to cyberattacks, and last year they ran rampant for healthcare systems.
Following the Biden Administration’s March 2023 National Cybersecurity Strategy, the Health and Human Services Department released a multi-page healthcare specific plan that cited how the agency will play a more active role in keeping healthcare cyber systems safe. The new strategy includes specific guidelines issued through CMS and HIPAA for health systems to follow.
Check out this infographic that highlights the four main guidelines that HHS will follow to ensure a secure cyber system.
For the full story, including the HHS incentives for struggling hospitals who need help improving their defenses, read Eric Wicklund’s article here.
The multi-million-dollar project marks the start of a multiyear partnership.
Silicon Valley startup Cerebras Systems just secured itself a big partner, the Mayo Clinic. The two have teamed up to develop large scale AI models to implement in the healthcare system.
Cerebras will provide the Mayo Clinic with clinical use computing chips and specialized systems to utilize decades of anonymized medical records and patient data, including diagnostics, treatments, outcomes, imaging, and molecular research to develop its own AI models.
“To create the first truly patient-centric healthcare AI, Mayo Clinic selected Cerebras for its proven experience in designing and training large-scale, domain-specific generative AI models,” the company wrote on its LinkedIn page. “Together, Cerebras and Mayo Clinic seek to combine AI and domain expertise to produce better patient outcomes.”
According to a report from Reuters, Matthew Callstrom, medical director for strategy and chair of its radiology department at the Mayo Clinic, said that these new models will be able to summarize important parts of extensive medical records; others will be trained to look for patterns over thousands of medical images or analyze genome data. However, Mayo made it clear that human doctors will still be the ones making all medical decisions.
Cerebras CEO and co-founder Andrew Feldman said on the Cerebras Systems website: “[...] we are uniquely positioned to combine AI and medicine. The state-of-the-art AI models we are developing together will work alongside doctors to help with patient diagnosis, treatment planning, and outcome estimation.”
Cerebras grew to fame for their giant wafer-scale chips. With 2.6 trillion transistors, its Wafer Scale Engine 2 is the largest semiconductor in the world.
Dhiraj Mallick, Cerebras Systems Chief Operating Officer, wrote on the company’s LinkedIn about the new team’s first project: “The first deliverable of the partnership is a Rheumatoid Arthritis diagnostic model, which will combine data from patient records, DNA and drug molecules to help match RA patients with the best therapeutics to manage their disease.”
Mallick went on to say that Mayo and Cerebras plan to develop a similar model for pancreatic cancer, which is the fourth leading cause of cancer death in both men and women, taking nearly a half million lives globally in 2020.
This isn’t Cerebras Systems first (healthcare) rodeo either.
In May of 2022, Cerebras CS-2 system was used by biopharmaceutical company AbbVie to train biomedical natural language processing models. The company is one of several AI chip startups looking to challenge market leader Nvidia (NVDA.O). Cerebras will provide the Mayo Clinic with both hardware and software under the new deal.
Cerebras is one of few AI hardware startups to secure large customers like the Mayo Clinic. The company is set to generate something close to a billion dollars in revenue.
As for the cost, Callstrom said the Mayo Clinic is undecided on how much it will charge for the new technology. However, multiple outlets have reported that this is a multi-million-dollar partnership.
In an effort to increase margins, improve clinical care, and rise to competitors, some health systems are looking to expand their pharmacy services.
If you build it, will they come?
From big pharmacies to retail giants, health systems are facing competition left and right. Searching for a one-stop experience for patients, some are looking to add pharmacy services.
In an effort to keep their patients within their healthcare network, pharmacies are being built as stand-alone facilities or are co-located beside existing clinics. Through the 340B Drug Pricing Program, health systems can be reimbursed through Medicaid for outpatient drugs sold to uninsured and low-income patients.
But with several major criteria to consider, expansion might not be a simple fix for all. Check out the big ticket items to consider when deciding if pharmacy expansion is right for your health system.
These expansion guidelines come from Nicole Faucher, MS, president of Clearway Health, a Massachusetts-based company spun out of Boston Medical Center that partners with health systems and hospitals to strengthen their specialty pharmacy programs.
Mental healthcare is finding its place in health systems. Here’s what three executives are tackling to make mental healthcare more accessible.
While mental healthcare integration remains a challenge, innovation is on the horizon.
Three executives: Gabbriella Gold, Director of Network Strategy and Innovation, CareFirst BlueCross BlueShield; Dr. Greg Harris, Senior Medical Director, BlueCross BlueShield of Massachusetts; and Dr. Tim Law, Chief Medical Officer, Highmark, Inc. share their strategies for incorporating a functional, beneficial system for mental health.
From paving an accessible path to care, to utilizing tech tools that extend value-based care coordination, check out what these three executives are implementing in their health systems. Read the full story by Laura Beerman here.
Medicare Advantage has gained substantial popularity over recent years, but its growth may prove to not be the best trajectory for consumers.
Medicare Advantage (MA) already holds about 30 million beneficiaries, and that number is only expected to grow. A new report by the New England Journal of Medicine is raising some concerning questions about the quality of care, cost considerations, and general strain of an overpopulated program.
The study shows that since 2010 MA has been slowly catching up to traditional Medicare enrollment numbers and is now on track to surpass it in 2024.
Why the Growth?
The attraction of MA plans stems from a few items. Beneficiaries consistently cite that these plans have lower cost-sharing, support generous supplemental benefits, and put limits on out-of-pocket spending. Another attraction is the increasing rebates, as well as the supplemental benefits they fund, which are also expected to grow over the next decade.
But outside of the attractive benefits and costs, aggressive broker marketing is also at play here, and it is prone to abuse. Brokers are offered higher commissions and other financial incentives by insurers to enroll consumers in MA plans, versus private insurance plans that supplement traditional Medicare.
Another reason? The simplicity in the plan. While traditional Medicare forces patients to split up their plan in various different parts to receive comprehensive coverage, MA plans keep it short and sweet with one comprehensive plan and one deductible.
The Current and Rising Issues
The Cost
The issues the system is seeing emanate from its overpopulation and costs. Can Medicare afford MA?
According to the Medicare Payment Advisory Commission (MedPAC), MA plans will cost Medicare approximately $27 billion more for 2023 than for the same patients in traditional Medicare. The program costs the Federal Government 6% more per enrollee, and that’s before we even account for the general favorability of MA. This hike in cost results in higher federal expenditures and deficits and higher costs to all beneficiaries.
Solutions? There’s the option to trim Medicare benefits and increase federal taxes, but these aren’t exactly favorable discussions. Problems will inevitably arise.
The Quality
While the quality of MA plans seems to be neck and neck with traditional Medicare, there are a few areas of concern, the NEJM study said. On the whole, in some parts of the country MA has shown less disparities in quality, but the quality of care for some medical services may be poorer than traditional Medicare. However, the data here is limited.
Concerns have also arisen about provider networks, specifically for top tier providers of cancer care. Evidence shows that accessibility to behavioral and mental health is also an issue for both MA and traditional Medicare, many psychiatrists will opt out of traditional Medicare and very few remain in networks of MA plans.
Although MA beneficiaries seem to be using fewer services and running into fewer costs, care quality is somewhat unclear. The NEJM study reported, “[...] recent evidence suggests that beneficiaries in Medicare Advantage plans who use postacute services have less favorable outcomes than those in traditional Medicare.”
Keep in mind this data is limited, unclear, and shows that quality of care is an area that will need to be further examined for comparison.
The Road Ahead
MA has presented a few major problems for an important national program, and working to change them may not be the easiest path. MA holds a massive number of older voters that might make it politically difficult to change the course of the program.
However, as the study suggests, as the program continues to grow, federal authorities and MA plan stakeholders must rise to the challenge of creating a program that is affordable, high-quality, free-of-abuse, meets the needs of consumers, and truly benefits them.
An AI driven tool used by Mercy and called the Chen Chemotherapy model is helping patients steer clear of complications after chemotherapy
With the potential to reduce workloads, streamline services, and aid in patient care quality, AI is rapidly becoming a popular tool in healthcare.
The technology has now entered the cancer care unit. The Mercy healthcare system is using AI to help cancer patients - by texting them.
Often, chemotherapy patients find themselves struggling with side effects such as general pain, fever, diarrhea, fatigue, and vomiting; these are red flags that frequently lead to hospitalizations. According to a study by the National Institutes of Health, “of 18,486 patients who received chemotherapy for metastatic cancer, 92% were hospitalized at least once for any reason, including 51% hospitalized for a likely toxicity.”
Care units need a way to track these symptoms before they lead to patient hospitalization. Enter the Chen Chemotherapy model.
Named after lead data scientist Jiajing Chen, who lost their own battle with cancer in 2023, the model notifies doctors before these symptoms become severe, keeping patients out of the hospital.
The program works by creating a risk score for non-leukemia chemotherapy patients over 18 years old. As the program learns, it’s able to predict how likely it is that a patient who is experiencing symptoms will be hospitalized within 30 days after their chemotherapy treatment.
Once patients are opted into the smart texting platform, they will receive a text each day for seven days, minus weekends and holidays, to monitor their symptoms. When a patient selects a symptom, they rate it and, based on their answers, the information may be sent to their provider.
Prior to this model, providers were oblivious as to which patients were experiencing problems until patients called or showed up at the emergency room.
This tool allows providers to be more involved in the process of chemotherapy recovery.
“The Chen Chemotherapy Model and smart texting allows us to proactively manage these patients and identify when they are having problems earlier in the journey,” Jay Carlson, DO, medical director of Mercy oncology service line, said in a press release. “This means they may be able to be treated in the office, recover faster and feel better overall.”
The success of AI in cancer care has led to the development of several other tools by different creators. Last year a neurobiology and human genetics professor at the University of Utah, along with a 20 person team, created an AI algorithm to help identify more than 200 ‘micro-symptoms’ for cancer patients, such as behavior, speech, and vocal patterns. These range from abnormal neurological phenotypes and eye movements to sadness in the vocal tone. A clinical trial of the tool is scheduled to start in January 2024 at the Moffitt Cancer Center. Identifying these small changes can help assess how patients are handling the treatment and can even predict changes in future symptoms.
Healthcare providers have also been using AI to improve breast cancer screenings. According to The Lancet Oncology, a recent survey of 80,000 women in Sweden found that, when put up against two experienced radiologists, AI-enabled breast cancer screenings outperformed their standard readings.
Cancer is the second leading cause of death in the U.S., compelling the need for new innovations and screening technology. In recent years the U.S. Food and Drug Administration has approved more than 500 AI and machine learning-enabled medical devices, ranging from imaging software to remote cardiac monitoring devices.
%20(2).jpg)
.jpg)
.jpg)
