Chris Henry

NuvemRx Acquired par80 from R1 RCM By: John Santilli https://lnkd.in/eDwAg7e3   NuvemRx, a leading tech-enabled pharmacy solutions company for community health providers, announced it has acquired the 340B referral capture business formerly known as par8o, from R1 RCM. par8o is an innovative healthcare technology company specializing in 340B referral capture with expansive integrations with the nation’s major pharmacy partners. The acquisition expands NuvemRx’s ability to help covered entities more effectively capture specialty referrals, retain patients within their networks, comply with ongoing rebate and reimbursement changes, and grow eligible prescription savings. NuvemRx began as three organizations—340Basics, Apovia, and Louvir—each dedicated to improving access, care, and visibility. In 2024, the company united its expertise into one commitment: to help health centers simplify complexity, strengthen pharmacy programs, and keep patients at the focus of every decision. With par8o’s network added to its suite of services, NuvemRx will now support more than 800 covered entities nationwide. The expanded network of customers leveraging these services represents more than 70 million cumulative patients being served. 26Health, a Central Florida-based family health center committed to providing comprehensive care to underserved communities, recently announced plans to open its first entity-owned pharmacy in Orlando. This initiative is being made possible through an expansion of the health center’s partnership with NuvemRx.   #NuvemRx #par80 #RI RCM #coveredentities 340B #340B referral Access Market Intelligence https://lnkd.in/eDwAg7e3

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MARKET NEWS: CMS’ LEAD Announcement Yesterday: What Payers, Stakeholders and Investors Might Be Watching Yesterday, Centers for Medicare & Medicaid Services rolled out the Long-term Enhanced ACO Design (LEAD) Model, a 10-year initiative aimed at expanding accountable care participation. LEAD targets tailwinds for smaller, independent, and especially rural providers. This is where change MUST happen. Why might LEAD be different? CMS has clearly learned: 1) Upside-only doesn’t drive durable change 2) Companies will bail on full risk 3) Rural providers were left behind...again 4) Short timelines discourage long-term investment LEAD attempts to address all four. The details are worth a read. If this sounds familiar, that’s because #CMS has been here before. A quick look back: Medical Homes (2005–2010): Tested shared savings. High reporting burden, no downside risk. MSSP (2012–present): Drove broad participation, but upside-only tracks delivered small savings churn. Pioneer ACOs (2012–2016): Aggressive risk/reward worked for some—but downside risk scared away big money. Next Gen ACOs (2016–2021): Better tools and incentives, but complexity limited rural adoption. Direct Contracting / ACO REACH (2021–present): Faster accountability, more capital, more scrutiny. Bottom line: CMS has been trying to scale ACOs for 20 years. #AccountableCare is here to stay, right? Who may see tailwinds? UnitedHealth Group: UnitedHealthcare plus Optum’s value-based and provider integration capabilities. Elevance Health: Massive managed care footprint positioned to benefit if adoption broadens. CVS Health: Oak Street Health and Signify Health strengthen value-oriented primary care exposure. What non-health plans may be poised for growth? 1) Evolent Health 2) Privia Health 3) Health Catalyst If demand increases for analytics, care management, and population health infrastructure, these firms could benefit. What do Payers need to watch out for? LEAD likely means more products, more variants, and faster change cycles. Spreadsheet management won’t scale. Documentation risk goes way up. ASO and employer conversations get harder. Clarity and consistency matter. As LEAD enrollment and performance data happen, regulatory ripple effects—including downstream impacts on Stars. There is never a dull moment in healthcare. But if these models work, they move us closer to a system where access to care doesn’t compete with food, housing, or basic security.

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Livmor AI and Health Insurance Plan News (HIPN) | Healthcare BizDev | HCBD HIPN Autopilot Announce Strategic Partnership to Expand Reach Across #MedicareAdvantage Plans Nationwide. This partnership combines Livmor AI’s market intelligence and engagement tools with HIPN Autopilot’s strategic access to plan executives, laying the groundwork for scalable growth and deeper industry impact. Eric Weber David Kohel

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Excited to announce our partnership with Michigan Rise! Authsnap is proud to partner with Michigan Rise, an organization deeply committed to helping innovative companies scale and make measurable impact across Michigan and beyond. Their support strengthens our ability to: • Expand our hospital partnerships across the Midwest • Accelerate validation of our AI-driven denial automation platform • Build strategic relationships that amplify our mission to help healthcare teams focus on patient care, not paperwork We’re grateful for this partnership and for the shared belief that meaningful innovation can start — and scale — right here in Michigan. #Authsnap #MichiganRise #HealthcareInnovation #AI

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2027 Star Ratings are going to separate strategy from noise. We’re working closely with our customers to focus on what actually drives performance and turning complexity into a clear, executable path forward. This is where strong partnerships matter most.

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$71.3B in Insurer Profits as Patients Delay Care: What’s Broken? As patients face higher out-of-pocket costs, delayed care, and growing medical debt, providers are managing increasing administrative complexity and reimbursement pressure across the care continuum. Against that backdrop, the nation’s largest health insurers reported a combined $71.3 billion in profits in 2024, marking the most profitable year in the industry’s history. The contrast is striking. Hospitals and health systems are navigating tighter utilization controls, expanding prior authorization requirements, and rising denial volumes, all while working to preserve access and clinical quality. Patients, meanwhile, are paying more for coverage that often comes with narrower networks and greater financial exposure at the point of care. These results raise important questions about alignment in today’s healthcare system. When financial performance improves at the top of the value chain while access and affordability decline downstream, it’s worth examining how incentives are structured, and whether they support sustainable care delivery for both patients and providers over the long term. https://lnkd.in/ePBiiwUb

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The pressure is unrelenting: rising demand, no added capacity/staff/space, and siloed legacy systems cracking under strain. Clinicians drown in manual documentation instead of patient care. Silos trap info. Throughput stalls. Access outside hospital walls feels out of reach. Workforce gaps are permanent. AI isn’t optional - it’s foundational for connected, efficient operations. Core Mobile delivers Foundational AI for connected healthcare: • Seamless EHR/device/system integration → one real-time view from bedside to command center. • Ambient AI automation → cuts documentation time up to 50%, freeing clinicians for patients. • Automated scheduling, reminders, integrated telehealth → reduces no-shows/delays/cancellations up to 40%. • Scales across hospitals, clinics, counties, rural & community care—connecting the full continuum without added complexity. Care extends beyond walls. Economics demand smarter ops. Fragmentation loses; coordination wins. Full ATO, FISMA, HIPAA, and in use since 2019 with U.S. VA Hospital execs, CIOs, CMIOs, ops leaders: What’s your biggest fragmentation headache right now? DM me to discuss - happy to share how we’re helping similar systems. #HealthcareAI #DigitalHealth #HealthIT #ConnectedCare #HealthTech #HealthcareInnovation #HIMSS #HIMSS26 https://lnkd.in/e9nNTQju

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A VP of a large MSO told me last month they spent $2M on a 'patient engagement platform' that mostly sends appointment reminders. Meanwhile, 35% of their scheduled patients no-show because nobody coordinated their pre-visit labs or answered their insurance questions. That's the gap Gartner's new Healthcare CRM report exposes: most systems communicate with patients. Very few actually guide them to completion. The difference? Healthcare organizations with true coordination platforms see 25%+ revenue growth and 30-40% cost reductions—not from more touchpoints, but from completed care journeys. Here's what Gartner got right (and what they missed) → https://lnkd.in/eBZY7eGC

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💡 Revenue integrity isn’t just technical — it’s the alignment of clinical services, coding, pricing, and billing to ensure accurate reimbursement. And at the end of the day? It all comes back to patient experience. 🎙️ We dig into it in this week’s episode of For the Love of Revenue Cycle — plus, I recorded a bonus debrief with some key takeaways and reflections. 👉 Catch the full episode (and debrief) here: https://lnkd.in/gvVrVxR8 #RevenueCycle #HealthcareFinance #PatientExperience #RCM

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If Network A's discounts are 5% better than Network B's, does that mean switching to A will save 5%? Maybe. Stranger things have happened. The problem is that does not even mean Network A has better prices. Network B's weighted pricing as a % of Medicare can be better, but still have lower discounts. One carrier executive told me they like disclosing discounts because it provides the "right" amount of information. Buyer beware. If you want to know which network prices are better based on where your employees live, that's what Deerhold Ltd.'s #PRIZM Networks is for.

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Q4 is strategy season. 2024 Medicare Shared Savings results are out. Digital health companies are planning 2026 market expansion. ACOs are evaluating contract performance. The pattern: Organizations that built systematic payment intelligence this year are planning growth. Those that hoped for better outcomes without changing operations are scrambling. Three areas where 90-day consulting partnerships create measurable impact: 1️⃣ Product Counsel for digital health platforms scaling payment operations – recent client moved from 47% to 100% first-pass approval rates 💡 2️⃣ Shared Savings Optimization for aggregators missing quality thresholds – ACO network reduced administrative burden 25% through unified reporting 📈 3️⃣ Staff Revenue Alignment for independent practices capturing full value – family practice discovered $73K in unworked claims 🎯 The difference: Organizations that engineer fair payment vs. those that hope payers will treat them fairly. What is your top 2026 priority? 🤔

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Day 1 at ViVE and the conversations are exactly why we show up. Health systems aren’t asking about point solutions anymore … they’re asking how to standardize a platform across inpatient rooms, operating rooms, and enterprise operations. They want scale. They want Epic-native workflows. They want measurable ROI. That’s where our AI-enabled sensor platform changes the conversation. From virtual nursing and sitting, to OR milestone automation, to bedside TV and throughput.. it’s one fabric, not five vendors stitched together. If you’re here, stop by. If you’re not, tell me what problem you’re trying to solve in 2026 … I’ll share what we’re seeing across the market. #ViVE #SmartHospital #VirtualCare #AIinHealthcare #HealthSystemLeadership

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Billingparadise highlights how administrative inefficiencies significantly damage financial margins within the healthcare industry. Current data suggests that a large portion of revenue cycle laborfails to yield financial results, often leading to permanent revenue loss from unrecovered claim denials. To combat these issues, the source proposes moving away from outdated metrics in favor of touch-based benchmarks that track specific human intervention. By aiming for a high zero-touch rate and minimizing avoidable staff interactions, organizations can better connect daily work efforts with actual cash realization. This operational shift focuses on identifying front-end breakdowns to streamline the billing process and maximize profitability. This strategy addresses gaps left by standard electronic health record systems through precise performance monitoring.

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