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Anthem Inc. (NYSE: ANTM) continues to tout its positioning when it comes to home-based care.

The Indianapolis-based insurer acquired myNEXUS — a convener that manages home-based care for payers — earlier this year. Anthem’s focus on how that acquisition improves its overall network since then reflects its home-based commitments.

“We closed on the acquisition of myNEXUS during the second quarter, advancing our strategy to grow and deepen Anthem’s capabilities in Medicare Advantage,” Gail Boudreaux, the CEO of Anthem, said on the company’s Q2 earnings call last week.

On its end, the Brentwood, Tennessee-based myNEXUS is a tech-enabled organization that optimizes home health for over two million Medicare Advantage (MA) members in 20 states. Close to half of those members were already a part of the Anthem network as well, according to the company.

“MyNEXUS improves outcomes by facilitating timely, personalized care for our members in the comfort of their homes, leading to improved continuity of care and reduced hospital admissions, readmissions and ER visits,” Boudreaux said. “In addition to supporting future growth in Medicare Advantage, myNEXUS furthers our diversified business group’s strategy to deliver on its risk contracts to the expansion of home-based care.”

Anthem’s operating revenue for the quarter was $33.3 billion, a 14.1% year-over-year increase from the $29.2 billion it brought in Q2 2020.

Its medical enrollment also increased by 1.9 million lives year over year to 44.3 million members, a 4.4% increase.

“This one hits both parts of our strategy,” Boudreaux said. “Going to the home, virtual and value-based care — those are all of those are critical elements of our cost-of-care strategy. And so having a strong in-home offering, I think, is a really important part, particularly for the senior population.”

Anthem’s in-home strategy is not new. In fact, the insurer has been invested in home-based care capabilities for some time.

In 2018, it acquired the community-based palliative care provider Aspire Health. It has also formed relationships with innovative at-home care organizations such as the senior companionship company Papa and the home-based primary care provider Heal.

Anthem — and a number of its affiliated health plans — additionally was an early adopter of the U.S. Centers for Medicare & Medicaid Services’ (CMS) home-based care-related supplemental benefits for MA plans.

And as it continues to expand home-based care offerings to its members, it’s also trying to gain easier access to the home through virtual offerings.

“We’re starting with, really, our deep data insights, and we’re connecting that with our care provider network, trying to give them the best information across every point in time,” Boudreaux said. “And then we’re using that to enable our value-based care providers, … and virtual is a component of it. And not only virtual, but also at-home care. They all come together.”

Especially over the last year, Anthem has done significant outreach to its members to make sure their non-medical-related needs aren’t going by the wayside.

A major part of that has been enacting those virtual and at-home visits.

“We’re really meeting members where they are and how they feel most comfortable engaging with their care providers,” Felicia Norwood, Anthem’s EVP of government business, said on the earnings call. “Based on our analytics, we feel very good about where we are, and believe that we are on track to help our members’ health risks reflected in our 2020 payments at levels that are similar to 2019.”

(New York, NY) April 29, 2021 – WindRose Health Investors, LLC (“WindRose”), the New York-based healthcare private equity firm, announced that it has completed the sale of myNEXUS, Inc. (“myNEXUS” or the “Company”), to Anthem, Inc. (“Anthem”). Terms of the transaction were not disclosed.

myNEXUS is a post-acute benefits management company helping its payor clients to enable and coordinate care in the home. myNEXUS delivers integrated clinical support services for approximately 1.7 million Medicare Advantage members across 20 states. The Company deploys a user-friendly platform for providers to automate the home visit authorization process, speed time to care, increase provider effectiveness and improve member satisfaction. The digital platform combines an advanced analytic rules engine, with a clinical staff of over 250 clinicians to effectively plan for and to optimize home care. Additionally, myNEXUS has established a nationwide network of high-performing home health providers and nurse agencies including nine of the top ten highest quality national and local providers. WindRose completed its majority investment in myNEXUS in October 2014.

“We are thrilled to have had the opportunity to partner with myNEXUS and its management team,” said Oliver Moses, Managing Partner of WindRose. “The incredible growth myNEXUS achieved over the course of our investment is a testament to the Company’s ability to deliver improved clinical outcomes for home-bound patients, enable high-quality providers and improve the cost of care for its payor customers.”

“WindRose was a tremendous partner to us and we are grateful for their support and commitment to helping us grow our business,” said Juan Vallarino, CEO of myNEXUS. “The myNEXUS team is excited to partner with Anthem to build upon the value we deliver to our customers and their members. The strength of Anthem’s Diversified Business Group platform will allow us to broaden our capabilities as we strive to transform how quality healthcare is delivered to the people we serve.”

Latham & Watkins LLP and Waller Lansden Dortch & Davis, LLP acted as legal advisors for myNEXUS.

About myNEXUS
myNEXUS is a post-acute benefits management company focused on delivering innovative home and community-based product offerings. myNEXUS provides comprehensive management services to health plans and other risk-bearing organizations on an at-risk or fee-for-service basis for total medical expense related to Integrated Home Health, Stars Performance Improvement Program, Social Determinants of Health, Inpatient Avoidance, and Clinical Programs. For further information, please visit  www.mynexuscare.com.

About WindRose
WindRose Health Investors, LLC  makes equity investments in companies that operate within the services sectors of the healthcare industry. We focus on companies with profitable business models and a demonstrated ability to deliver cost-effective solutions.  WindRose manages over $1.2 billion in investments and is currently investing out of its fifth fund. We are based in New York City and invest in companies throughout the United States. For more information, please email WindRose at info@windrose.com.

About Anthem
Anthem is a leading health benefits company dedicated to improving lives and communities and making healthcare simpler. Through its affiliated companies, Anthem serves more than 116 million people, including more than 43 million within its family of health plans. We aim to be the most innovative, valuable, and inclusive partner. For more information, please visit www.antheminc.com or follow @AnthemInc on Twitter.

Media Contact:
Caroline Luz
Lambert & Co.
203-656-2829
cluz@lambert.com

Visit our website at windrose.com.

INDIANAPOLIS–(BUSINESS WIRE)–Mar. 24, 2021– Anthem, Inc. (NYSE: ATNM) today announced that the company has entered into an agreement to acquire myNEXUS, Inc. (“myNEXUS”), a comprehensive home-based nursing management company for payors. myNEXUS delivers integrated clinical support services for approximately 1.7 million Medicare Advantage members across 20 states.

“Providing timely care for members in their homes allows for both excellent personalized care as well as the comfort of being in preferred environments,” said Prakash Patel, M.D., Anthem Executive Vice President, and President, Anthem Diversified Business Group. “Bringing the right level of whole person care into the home has been demonstrated to improve outcomes, reduce readmissions and improve members’ and their family’s experience of wellbeing.”

myNEXUS deploys a user-friendly platform for providers to highly automate the home visit authorization process, speed time to care, increase provider effectiveness and improve member satisfaction. The digital platform combines an advanced analytic rules engine, with a clinical staff of over 250 clinicians to effectively plan for and to optimize home care. Additionally, myNEXUS has established a nationwide network of high performing home health providers and nurse agencies including nine of the top ten highest quality national and local providers.

Juan Vallarino, CEO of myNEXUS, said, “The myNEXUS team is thrilled to be partnering with Anthem to build upon the value we deliver to our customers and their members. The strength of Anthem’s Diversified Business Group platform will allow us to broaden our capabilities as we strive to transform how quality healthcare is delivered to the people we serve.”

This transaction aligns with Anthem’s strategy to manage integrated, whole person multi-site care and support, by providing national, large-scale expertise to manage nursing services in the home and facilitate transitions of care. The myNEXUS solution and network will enhance Anthem’s continued expansion to deliver care for members in a coordinated manner, leveraging both high touch support and technology driven capabilities.

Anthem is acquiring myNEXUS from an investor group led by WindRose Health Investors, a New York-based healthcare private equity firm. The acquisition is expected to close in the second quarter of 2021 subject to customary closing conditions. Upon closing, myNEXUS will operate as a wholly-owned subsidiary of Anthem and will join Anthem’s Diversified Business Group. Financial terms of the transaction were not disclosed. The company’s 2021 EPS guidance remains unchanged as a result of this acquisition. Anthem’s legal advisors are White & Case LLP and Faegre, Biddle, Drinker & Reath LLP. Latham & Watkins LLP and Waller Lansden Dortch & Davis, LLP are acting as legal advisors for myNEXUS.

About Anthem, Inc.

Anthem is a leading health benefits company dedicated to improving lives and communities, and making healthcare simpler. Through its affiliated companies, Anthem serves more than 107 million people, including approximately 43 million within its family of health plans. We aim to be the most innovative, valuable and inclusive partner. For more information, please visit www.antheminc.com or follow @AnthemInc on Twitter.

About myNEXUS, Inc.

myNEXUS is a post-acute benefits management company focused on delivering innovative home and community-based product offerings. myNEXUS provides comprehensive management services to health plans and other risk-bearing organizations on an at-risk or fee-for-service basis for total medical expense related to Integrated Home Health, Stars Performance Improvement Program, Social Determinants of Health, Inpatient Avoidance and Clinical Programs.

Forward-Looking Statements

This document contains certain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements reflect our views about future events and financial performance and are generally not historical facts. Words such as “expect,” “feel,” “believe,” “will,” “may,” “should,” “anticipate,” “intend,” “estimate,” “project,” “forecast,” “plan” and similar expressions are intended to identify forward-looking statements. These statements include, but are not limited to: financial projections and estimates and their underlying assumptions; statements regarding plans, objectives and expectations with respect to future operations, products and services; and statements regarding future performance. Such statements are subject to certain risks and uncertainties, many of which are difficult to predict and generally beyond our control, that could cause actual results to differ materially from those expressed in, or implied or projected by, the forward-looking statements. You are cautioned not to place undue reliance on these forward- looking statements that speak only as of the date hereof. You are also urged to carefully review and consider the various risks and other disclosures discussed in our reports filed with the U.S. Securities and Exchange Commission from time to time, which attempt to advise interested parties of the factors that affect our business. Except to the extent otherwise required by federal securities laws, we do not undertake any obligation to republish revised forward-looking statements to reflect events or circumstances after the date hereof. These risks and uncertainties include, but are not limited to: the impact of large scale medical emergencies, such as public health epidemics and pandemics, including COVID-19, and catastrophes; trends in healthcare costs and utilization rates; our ability to secure sufficient premium rates, including regulatory approval for and implementation of such rates; the impact of federal and state regulation, including ongoing changes in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended (collectively, the “ACA”) and the ultimate outcome of legal challenges to the ACA; changes in economic and market conditions, as well as regulations that may negatively affect our liquidity and investment portfolios; our ability to contract with providers on cost-effective and competitive terms; competitive pressures and our ability to adapt to changes in the industry and develop and implement strategic growth opportunities; reduced enrollment; unauthorized disclosure of member or employee sensitive or confidential information, including the impact and outcome of any investigations, inquiries, claims and litigation related thereto; risks and uncertainties regarding Medicare and Medicaid programs, including those related to non-compliance with the complex regulations imposed thereon; our ability to maintain and achieve improvement in Centers for Medicare and Medicaid Services, or CMS Star ratings and other quality scores and funding risks with respect to revenue received from participation therein; a negative change in our healthcare product mix; costs and other liabilities associated with litigation, government investigations, audits or reviews; the ultimate outcome of litigation between Cigna Corporation and us related to the merger agreement between the parties and the potential for such litigation to cause us to incur substantial additional costs, including potential settlement and judgment costs; risks and uncertainties related to our pharmacy benefit management (“PBM”) business including non-compliance by any party with the PBM services agreement between us and CaremarkPCS Health, L.L.C.; medical malpractice or professional liability claims or other risks related to healthcare and PBM services provided by our subsidiaries; general risks associated with mergers, acquisitions, joint ventures and strategic alliances; possible impairment of the value of our intangible assets if future results do not adequately support goodwill and other intangible assets; possible restrictions in the payment of dividends from our subsidiaries and increases in required minimum levels of capital; our ability to repurchase shares of our common stock and pay dividends on our common stock due to the adequacy of our cash flow and earnings and other considerations; the potential negative effect from our substantial amount of outstanding indebtedness; a downgrade in our financial strength ratings; the effects of any negative publicity related to the health benefits industry in general or us in particular; failure to effectively maintain and modernize our information systems; events that may negatively affect our licenses with the Blue Cross and Blue Shield Association; the impact of international laws and regulations; changes in U.S. tax laws; intense competition to attract and retain employees; and various laws and provisions in our governing documents that may prevent or discourage takeovers and business combinations.

View source version on businesswire.comhttps://www.businesswire.com/news/home/20210324005316/en/

Media Contact:
Michelle Vanstory
Michelle.Vanstory@anthem.com

Investor Relations:
Stephen Tanal
Stephen.Tanal@anthem.com

Source: Anthem, Inc.

myNEXUS has partnered with the American Academy for Home Care Medicine and will be attending the annual conference on October 26th in Chicago.  In partnering with AAHCM myNEXUS will continue its work with home and community-based providers in advancing models of care, technology, and payment that keep people out of the hospital.

“The healthcare ecosystem is rapidly evolving to include new care delivery models to support interventions and treatment in the home, making care more accessible for people who may not need an institutional level of care” reported Scott Vasey, Chief Strategy Officer with myNEXUS. “AAHCM is the leading advocacy organization promoting these models and it is important to connect former silos of care into a fully integrated approach.”

“Home care medicine is one of the most rapidly expanding areas of health care for a good reason—technology is becoming more portable, allowing care in the home to become the most cost-effective and most compassionate form of health care” said Dr. Theresa Soriano president-elect at AAHCM.  “We are thrilled that companies like myNEXUS are working with AAHCM to facilitate better connected care for people in the home.”


Juan Vallarino, Chief Executive Officer
Press Release: myNEXUS Announces Leadership Transition

The myNEXUS Wound Team is comprised of 13 Wound, Ostomy, Continence Nurses (WOCNs), who hold National Certifications through the WOCN Certification Board. Their focus is promoting wound healing and ostomy care through evidence-based practice. These highly trained nurses are members of the Wound, Ostomy, Continence Nurse Society, an “international, professional community dedicated to advancing the practice and delivery of expert healthcare to individuals with wound, ostomy, and continence care needs,” according to the WOCN website.

Two of the myNEXUS WOCNs, Anita Prinz and Laura Shaffer, recently had an abstract published in the Journal of Wound, Ostomy, Continence Nursing (May/June 2018) entitled “The Role of the WOC Nurse in Utilization Management.”  Shaffer, who leads the Wound Team, and Prinz, presented the abstract as a poster at the National WOCN Conference in Philadelphia, PA in June and will present the same at the Southeast Region WOCN conference in Myrtle Beach, SC in September 2018. The purpose of the conference is to bring WOC Nurses together for education on the latest advances in their fields of expertise, networking, and decision-making processes which affect this profession.

The myNEXUS Wound team is currently coordinating with WOCN Society to offer the Wound Treatment Associate (WTA) program to home care nurses in the myNEXUS provider network, in order to promote advanced wound care knowledge among clinical staff serving our clients’ members. This on-line course will be facilitated by the myNEXUS WOCN Team. After completing the 90-day on-line course requirements, participants will travel to the myNEXUS corporate office in Brentwood, TN for hands-on clinical instructions and testing by our wound team. myNEXUS will offer the course once each calendar quarter.

The Wound Team has made a profound impact on our clients and their members.  The successes of this team include a focus on wound healing through the use of clinical pathways, specialized dressings, treatments and improved outcomes.  As a result of the great work our Wound Team has performed, a number of our clients’ members who had been receiving home care for months and even years, are now seeing healing in their wounds and a reduction in, or conclusion of home care services.

For more information on the Wound Ostomy Continence Nurses Society, please go to www.wocn.org.  For more information on myNEXUS, please go to www.mynexuscare.com or submit your inquiry to info@mynexuscare.com.

 

WOCN

Amedisys (NASDAQ:AMED), a leading healthcare at home company, announced today the Company has entered into a collaborative partnership with myNEXUS®, a leading post-acute technology and home-based benefit management company based in Nashville, TN.

This new partnership allows Amedisys to focus on care delivery, leverages the strength of benefit coordination from myNEXUS®, and seeks to maximize the population health needs of our shared payor partners while exploring new ways to share risk.

The goal of the partnership is to jointly serve a limited number of payor population health needs in select states. Together with myNEXUS, Amedisys will pursue new and innovative ways to pair an industry-leading home healthcare provider with coordinated benefit management and strong analytic solutions to further focus on quality, outcomes, and lower total cost of care for Medicare Advantage plans and their members.

“Quality clinical programs, outstanding patient outcomes and a solid value proposition are the cornerstone of our home health care solutions,” said Christy Vitulli, Senior Vice President of Payor Services at Amedisys, Inc. “Quality and affordability are top of mind, and the opportunity with myNEXUS allows us to focus on patient outcomes, increase the predictability of care in the home, and better align payor, provider and patient goals.”

“We’re proud to partner with a national leader in the home healthcare and hospice care arena,” said Jonathan Davis, CFO at myNEXUS. “We share Amedisys’ viewpoint that best-in-class quality, outcomes and value is a shared responsibility, and we’re excited to collaborate on innovative ways to deliver value to both the patients we serve and our payor partners.”

“We look forward to embarking on this exciting journey together with myNEXUS,” Vitulli said.

About Amedisys
Amedisys, Inc. is a leading healthcare at home Company delivering personalized home health, hospice and personal care. Amedisys is focused on delivering the care that is best for our patients, whether that is home-based personal care; recovery and rehabilitation after an operation or injury; care focused on empowering them to manage a chronic disease; or hospice care at the end of life. We partner with 3,000 hospitals and 59,000 physicians nationwide have chosen Amedisys as a partner in post-acute care. Founded in 1982, headquartered in Baton Rouge, LA with an executive office in Nashville, TN, Amedisys is a publicly held company. With more than 16,000 employees, in 432 care centers in 34 states, Amedisys is dedicated to delivering the highest quality of care to the doorsteps of more than 385,000 patients in need every year. For more information about the Company, please visit www.amedisys.com.

About myNEXUS
Founded in 2014, myNEXUS is an innovative, technology-driven care management company focused on serving and keeping clients in their home through intelligent, connected care. myNEXUS partners with Health Insurers and Healthcare Providers to expertly deliver cost effective services that reduce risks, promote independence, and improve quality of life for members and families. myNEXUS provides value to our partners by expertly managing home based services such as Home Health, DME, and IV Infusion through our innovative technology and collaboration with our Providers. For more information regarding myNEXUS and our service offerings, please visit www.mynexuscare.com.

Aspire Health and myNEXUS are pleased to announce a new collaboration focused on providing home health patients with a more comprehensive level of clinical support. Through the partnership, myNEXUS, a technology-driven care and benefit management platform, will help identify patients who may benefit from receiving additional home-based clinical support from Aspire Health’s team of physicians, nurse practitioners, social workers and chaplains. The partnership is designed to help ensure that patients receive the right level of care at the right time in the location of their choosing.

“By partnering together, myNEXUS and Aspire Health will be able to significantly improve the quality of care provided to patients with very complex medical needs,” said McArthur VanOsdale, CEO of myNEXUS. “By leveraging the unique strengths of each organization, we will be able to identify and provide more comprehensive support to patients and families who are facing some of the toughest times in their lives.”

Using a proprietary algorithm jointly developed by Aspire and myNEXUS, myNEXUS will identify patients who are receiving traditional home health services who may benefit from an additional layer of in-home clinical support. The algorithm leverages OASIS clinical data collected on myNEXUS’s proprietary technology platform to identify patients who are at high risk of hospitalization and/or likely to experience significant clinical decline in the coming months. Patients identified by myNEXUS will then be eligible for Aspire’s in-home services.

Patients enrolled on Aspire’s service receive in-home interdisciplinary care from Aspire’s team of specially trained physicians, nurse practitioners, social workers, and chaplains. Aspire’s clinicians are experts in providing patients with relief from the symptoms, pain, and stress of a serious illness, guiding patients and caregivers through difficult and complex treatment choices, and providing emotional and spiritual support to patients and their families. Aspire’s physicians and advanced practice nurses are available to patients 24/7. Patients will remain eligible for traditional home health services while enrolled on Aspire’s service, with Aspire’s clinical team coordinating closely with the home health agency.
“Partnering with myNEXUS will allow us to positively impact the lives of more patients and families,” said Brad Smith, Co-Founder and CEO of Aspire Health. “The post-acute care space is evolving very rapidly across the country, and we believe partnerships like ours with myNEXUS are critical to ensuring that patients receive high-quality, integrated clinical care.”

The myNEXUS and Aspire partnership officially launched in December 2017 and has already identified several hundred patients who qualify for additional clinical support in their home. myNEXUS and Aspire intend to expand their partnership to additional health plans and at-risk provider groups in the coming months.
About Aspire Health
Aspire Health is the nation’s leading community-based palliative care provider, currently operating in 25 states and 67 cities. Aspire specializes in providing an extra layer of in-home support to patients facing a serious illness. Aspire’s clinicians are experts in providing patients with relief from the symptoms, pain, and stress of a serious illness; helping patients and caregivers navigate the healthcare system; guiding patients and caregivers through difficult and complex treatment choices; and providing emotional and spiritual support to patients and their families. Aspire is based in Nashville, Tennessee. Additional information on Aspire Health can be found at www.aspirehealthcare.com.
About myNEXUS
Founded in 2014, myNEXUS is an innovative, technology-driven care management company focused on serving and keeping clients in their home through intelligent, connected care. myNEXUS partners with Health Insurers and Healthcare Providers to expertly deliver cost-effective services that reduce risks, promote independence, and improve quality of life for members and families. myNEXUS provides value to our partners by expertly managing home based services such as Home Health, DME, and IV Infusion through our innovative technology and collaboration with our Providers. For more information regarding myNEXUS and our service offerings, please visit www.mynexuscare.com.
Contacts

NASHVILLE, Tenn. – myNEXUS, the emerging leader in transforming the way care is coordinated within a patient’s home, announced today the appointment of former U.S. Senate Majority Leader Bill Frist, M.D., to its board of directors. “Fragmentation of care sits among the top issues that our Nation must solve, both clinically and economically. myNEXUS is focused on ensuring that care is coordinated within the home setting by using both people and technology,” said Sen. Frist. “We need solutions that embrace practical opportunities for clinicians to share timely and accurate information on an individual patient; with technology to advise the best resource and treatment plans, based on population health data and evidence-based guidelines.” Sen. Frist represented the state of Tennessee for 12 years in the U.S. Senate, including four years as Senate Majority Leader.

Under his leadership, Congress passed the 2003 Medicare Prescription Drug, Improvement and Modernization Act and approved unprecedented levels of funding for the fight against HIV/AIDS. Sen. Frist gained recognition earlier in his career as a world-renowned heart and lung transplant surgeon and founder of the Vanderbilt Multi-Organ Transplant Center. Currently, Dr. Frist serves as an adjunct professor of Cardiac Surgery at Vanderbilt University. “There are very few people in the world that have an understanding of the Global Healthcare ecosystem like Dr.Frist ,” said McArthur VanOsdale, myNEXUS founder and Chief Executive Officer. “His experience as a physician and as Senate Majority Leader lend a broader vision to our team that challenges conventional assumptions about the types of care that can be delivered in the home. Additionally, Dr. Frist’s passion for patients will continue to challenge our team to drive quality through better clinical integration and care coordination beyond the post-acute episode.”

Dr. Frist serves on the boards of publicly-traded companies AECOM, Select Medical Corporation, and Teladoc, as well as on the boards of the Robert Wood Johnson Foundation, The Nature Conservancy, and the Kaiser Family Foundation. In addition, he serves on multiple early- and mid-market health boards. He co-founded Aspire Health, is a founding partner of Frist Cressey Ventures, and is a board member of Devoted Health. myNEXUS, which was launched in 2014 and fueled through a Private Equity backed partnership, with WindRose Health Investors, has rapidly expanded its footprint by collaborating with many of the Nation’s largest Health Insurers. The Company has been a pioneer at lowering total cost of care while improving quality outcomes in the Post-Acute and Home-Based service arena. myNEXUS was most recently recognized by The Brookings Institution for transforming healthcare through innovative care delivery models.