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October 10, 2024 News 4 Comments

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Carequality issues its final resolution on the Particle Health versus Epic dispute.

Particle is suing Epic, charging it with antitrust behavior for shutting off data to Particle customers to suppress competition in the payer software market. Epic countered by claiming that it caught Particle customers extracting data for non-treatment purposes, such as researching malpractice lawsuits, in violation of Carequality’s policies. Particle’s lawsuit remains active.

A summary of the resolution, which both companies accepted:

  • Carequality found that two of Particle’s customers were accessing data for non-treatment purposes and is investigating the third company that Epic questioned. Particle had already ended its agreements with the two companies and Carequality banned them from network participation for 12 months. The company names were redacted in the published version of the resolution.
  • Particle should require prospective customers to document their relationship with providers, such as copies of their business associate agreements.
  • Particle had vetted the three questionable customers but failed to discover the inaccurate information that those customers had provided to it. Particle agreed to a six-month corrective action plan in which will send Carequality a list of new customers with their application documentation.
  • Carequality reaffirmed that Epic can shut off data access for questionable users and determined that, contrary to Particle’s claims, it did not treat Particle any differently than other Implementers. Epic agreed to use consistent, objective criteria when it denies service and to share its Phonebook Policy and the outcomes of each entry that it reviews every month for the next 6 months. UPDATE: I originally referred to this as a corrective action plan, which it is not.
  • The resolution sided with Particle on the technical issue of whether requests should be tagged as originating from Particle or should instead indicate the individual Particle customer’s ID. Epic had claimed that Particle was intentionally hiding the origina of the data requests.

Both companies declared that Carequality’s resolution was favorable to their organizations. Particle says that the resolution invalidates Epic’s original dispute filing and requires Epic to be more open and transparent. Epic says that the three Particle customers that it claimed were violating the treatment-only provision were verified by Carequality as indeed doing so and have either lost their access or face further actions.

Carequality will tighten its documentation process for new Implementers that relates to Applicant Business Rules and documentation of any claimed provider relationships.


Webinars

October 15 (Tuesday) noon ET. “AI in Practice: How Privia Health Empowers Doctors to Win at Value-Based Care.” Sponsors: Navina and Athenahealth. Presenters: Dana McCalley, MBA, VP of value-based care, Navina; Michael McDonnell, strategic account executive, Navina; Francheska Feliciano, director of risk adjustment, Privia Health. The panelists will share practical insight from Privia Health’s experience that are applicable for users of any EHR, focusing on strategies to improve collaboration between clinical teams and coders, reduce administrative burden, and ensure accurate HCC capture at the point of care. The presenters will offer strategies for streamlining value-based workflows across clinical and coding teams, reducing friction and administrative burden, and improving value-based performance and risk adjustment accuracy by empowering clinicians with AI at the point of care.

October 24 (Thursday) noon ET. “Preparing for HTI-2 Compliance: What EHR and Health IT Vendors Need to Know.” Sponsor: DrFirst. Presenters: Nick Barger, PharmD, VP of product, DrFirst; Tyler Higgins, senior director of product management, DrFirst. Failure to meet ASTP’s mandatory HTI-2 certification  and compliance standards could impose financial consequences on clients. The presenters will discuss the content and timelines of this key policy update, which includes NCPDP Script upgrades, mandatory support for electronic prior authorization, and real-time prescription benefit. They will offer insight into the impact on “Base EHR” qualifications and provide practical advice on aligning development roadmaps with these changes.

Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.


Acquisitions, Funding, Business, and Stock

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Diabetes digital health vendor Glooko raises $100 million in a Series F funding round. The company also announced that it has replaced CEO Russ Johannesson with medical device executive Mike Alvarez, MBA.

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Ambient documentation software vendor Suki raises $70 million in a Series D funding round that values the company at $500 million.

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Laudio publishes a book titled “Leader Inspired Work: Insights and Tools by and for Healthcare Managers,” which was authored by Laudio co-founder Tim Darling.

Nutritional supplement ordering technology vendor Fullscript acquires Rupa, which offers a specialty lab ordering system.


Sales

  • Griffin Health (CT) will implement EHR-integrated personalized patient experience software from Vyne Medical.

People

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Healthmonix promotes Michael Lewis, MBA to VP of customer success.

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TeleTracking Technologies promotes Anita Dressel, MS to president, replacing Nigel Ohrenstein.

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Anthony Leon (Trove Health) joins B.well Connected Health as RVP of sales.


Announcements and Implementations

Elsevier Health expands access to its ClinicalKey AI decision support tool to individual medical residents and physicians.

Duke Health will collaborate with NTT Data to create a technology-drive home care model that includes a virtual agent, automation, device interoperability, remote patient monitoring, and a patient app and portal.

Microsoft announces healthcare-related AI enhancements:

  • Multimodal AI models that integrate medical imaging, genomics, and clinical records.
  • Healthcare data solutions for Microsoft Fabric: conversational data integration, social determinants of health (SDOH) public dataset transformation, care management analytics, CMS  claim and claim line feed (CCLF) data ingestion, and data discovery and cohorting.
  • A public preview of healthcare agent service in Copilot Studio to build Copilot agents for appointment scheduling, clinical trial matching, and patient triaging.

Sponsor Updates

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  • Findhelp customer and community success teams donate supplies to the little free food pantry at an elementary school in Austin, TX.
  • Wolters Kluwer Health celebrates a decade of bringing VSim for Nursing virtual nursing education and innovation to students.
  • Ellkay will sponsor the CommonWell Health Alliance Fall Summit November 4-5 in Nashville.
  • Five9 publishes a new case study, “VSP Delivers Self-Service to 12M with Five9 IVA.”
  • WellSky’s annual “Evolution of Care” report finds that hospitals are struggling to find post-acute care options for their patients.
  • The Healthcare Market Matrix Podcast features Healthcare Growth Partners Managing Director Christoper McCord, “Navigating a Health IT Market in Flux: Key Insights as We Head Into Q4.”
  • Healthmonix will exhibit at the NAACOS Fall 2024 Conference October 16-18 in Washington, DC.
  • Impact Advisors will present at the OR Manager Conference October 29 in Las Vegas.
  • Laudio publishes a new book, “Leader Inspired Work: Insights and Tools by and for Healthcare Managers” by Laudio co-founder and Laudio Insights President Tim Darling.
  • Medicomp Systems announces the re-architecture of its Quippe Solutions to the W3C web component standard.
  • Meditech staff take part in hands-on development and testing of FHIR during the HL7 International 38th Annual Plenary, WGM+, and HL7 FHIR Connectathon in Atlanta.

Blog Posts


Contacts

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Currently there are "4 comments" on this Article:

  1. Regarding Carequality/Particle/Epic… have the patients been notified of the HIPAA violation? And… who should those patients sue?

    I forecast a class-action lawsuit with three defendants.

    • A class action lawsuit because a Particle customer was mining for reasons to file class action lawsuits….

    • I expect, and would expect, CMS to be filing the first round of fines. Followed by a class action.

      Love the Anonymous quote.

  2. “Particle says that the resolution invalidates Epic’s original dispute filing” – Particle’s lawyers were later seen limping after straining themselves on that stretch.

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