Important Industry News

eClinicalWorks and three of its executives are fined $154.9 million for false certification of its EMR software

eCW not only falsely certified its software for meeting government meaningful use, but it also paid kickbacks to influential customers to recommend the company’s products. The company is #6 amongst EMR vendors catering to mid size practices. eCW has $440 million in sales and 125,000 physician clients. The whistle blower, who is getting $30 million of rewards, first filed the lawsuit back in 2015. HHS has set stringent requirements for ongoing monitoring of eCW’s progress. 

Oscar and Centene expand Obamacare presence while others retreat

News headlines are full of insurers that are leaving the ACA marketplace including Aetna, Anthem (partial exit) and Humana. Oscar, a next gen insurer based in NYC, and Centene which is predominately involved in Medicaid and exchange markets, are actually expanding their presence. What refreshing news. There is always room for the contrarians.

Companies that are leaving the ACA exchanges cite the difficulty with shrinking and deteriorating population pools. That may be true but it is only part of the answer. Many of the insurers that are exiting the market have antiquated IT infrastructure, are mostly bureaucratic institutions and have not demonstrated clear leadership in embracing the changing dynamics of the insurance markets. OSCAR lives and dies on its next gen IT platform and its emphasis on prevention vs. cure. Centene has had a long history of catering to the low-income population so they are well adept in dealing with that risk pool.

Rumors of Apple buying athenahealth

Whether the rumors are true or not, lets look at the numbers. Apple has an enterprise value of close to $800 billion and trades at 3.6x sales and 11.4x EBITDA. athena, on the other hand, has an enterprise value of close to $6 billion and trades at 5.4x sales and 53.2x EBITDA. Some of the differential may be  warranted, but what Apple can do with the “content” resident in athena’s EMR can be of enormous value. athena has data on over 65 million patients and has been around for 20 years. If this happens, we are all for it. It will definitely serve as a wakeup call for the entire industry. This is even bigger than Amazon buying Whole Foods! And like Amazon, Apple can afford the bet.

Afsaneh Naimollah

Xen Partners

242 Forest Avenue
Palo Alto, CA 94301
mobile: + 1 (917) 887-4278

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