Subcontracting Opportunities

Carenodes contracts with physicians, facilities and other health care professionals to form our provider networks, which are essential for delivering quality, accessible and cost-effective health care services. In partnership with providers (medical and non-medical, behavioral, primary, substance abuse, and others), we have developed (and are growing) community-wide coalition efforts geared towards addressing larger systemic health, infrastructure or social determinant issues with a large impact on health.

Carenodes contracts with physicians, facilities and other health care professionals to form our provider networks, which are essential for delivering quality, accessible and cost-effective health care services. In partnership with providers (medical and non-medical, behavioral, primary, substance abuse, and others), we have developed (and are growing) community-wide coalition efforts geared towards addressing larger systemic health, infrastructure or social determinant issues with a large impact on health.

WORKFORCE MOBILIZATION INITIATIVE

Did you know that locating and securing subcontracting opportunities can be just as, if not more valuable, than administering direct contract awards? There are multiple ways to partner with other contractors to maximize your chances of securing contracts through Carenodes Opportunity Network and Workforce Mobilization Initiative.

  1. Workforce of the future,
  2. Second acts,
  3. Rural resurgence.
  4. A marketplace of healthcare providers
  5. An ecosystem of healthcare consultants
  6. Clinical executives

Our Workforce Mobilization Initiative calls for increasing opportunities for mid-career workers to get the upskilling they need to continue in their current jobs and have access to new jobs. This Program encourages state governments to improve infrastructure, such as broadband, in rural areas to allow workers to work remotely and remain in their communities if they choose.

TYPES OF OPPORTUNITIES

Non-Schedules Based Contracts

These procurements require a response to an RFP or RFQ. Check back or sign up for new opportunities.

Subcontracting and Other Partnerships

Subcontracting and other partnerships involve working with other contractors in order to implement a master agreement, project segments, joint ventures, and/or other specified engagement frameworks across the United States.

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Subcontractor Interest 

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TRICARE

Effective August 31, 2020

The U.S. Department of Labor’s (DOL’s or Department’s) Office of Federal Contract Compliance Programs (OFCCP) publishes this final rule to amend its regulations pertaining to its authority over TRICARE health care providers. The final rule is intended to increase access to care for uniformed service members and veterans and to provide certainty for health care providers who serve TRICARE beneficiaries. It is also anticipated that this final rule will result in cost savings for TRICARE providers. In a reconsideration of its legal position, the final rule provides that OFCCP lacks authority over Federal health care providers who participate in TRICARE. In the alternative, the final rule establishes a national interest exemption from Executive Order 11246, Section 503 of the Rehabilitation Act of 1973, and the Vietnam Era Veterans’ Readjustment Assistance Act of 1974 for health care providers with agreements to furnish medical services and supplies to individuals participating in TRICARE. Thus, even if OFCCP had authority over Federal health care providers who participate in TRICARE (which this rule clarifies it does not), OFCCP has determined that special circumstances in the national interest justify granting the exemption as it would improve uniformed service members’ and veterans’ access to medical care, more efficiently allocate OFCCP’s limited resources for enforcement activities, and provide greater uniformity, certainty, and notice for health care providers participating in TRICARE. Under the final rule, OFCCP will retain authority over health care providers participating in TRICARE if they hold a separate covered Federal contract or subcontract that is not for providing health care services under TRICARE. TRICARE providers that fall outside of OFCCP’s authority under this final rule remain subject to all other Federal, state, and local laws prohibiting discrimination and providing for equal employment opportunity. This regulation is effective August 31, 2020.

Subcontracted Carenodes Advisory Services (Consulting Agreements)

ADVISORY SERVICES Subcontracted Carenodes Advisory Services (Consulting Agreements)

This agreement (“AGREEMENT”) establishes the terms under which the parties hereto agree that the consultant, who has already provided his or her corporate name (if any) and address (hereinafter, referred to as the “CONSULTANT”) will perform consulting work for a client of CARENODES, Inc. (the “CLIENT”), CARENODES’s offices are located at 3415 S Sepulveda Blvd 10th floor, Los Angeles, CA 90034, (“CARENODES”).  CARENODES and CONSULTANT may be individually referred to herein as a “PARTY” and collectively referred to herein as “PARTIES”.  CLIENT is an intended third-party beneficiary of this AGREEMENT, and CLIENT will be entitled to the rights and benefits enumerated below.

  1. Field of Consultation.  CARENODES wishes to engage CONSULTANT, as an expert in the field provided to CARENODES in the course of the on-line sign-up process, to consult with CLIENT regarding CLIENT’s work in the field(s) also provided in the sign-up process.
  • Term of Consultation.  The period of consultation will be as agreed between CARENODES and CONSULTANT beginning on the first day of the project with the CLIENT, and will continue until the project is complete, as determined by CLIENT in its sole discretion.  Consultation will take place during the term of this Agreement at times and places mutually agreed upon by CONSULTANT and CARENODES.
  • Fee.  CONSULTANT will receive the fees that have been specified separately by CARENODES, and which CONSULTANT agrees constitutes valid consideration for this AGREEMENT.
  • Termination.  CARENODES will have the right to terminate this AGREEMENT upon thirty (30) days written notice to CONSULTANT.
  • IRS Form 1099.  It is understood and acknowledged that the IRS Form 1099 that CONSULTANT will receive from CARENODES will indicate the total dollar amount that CARENODES will have paid CONSULTANT for the calendar year.  It will be CONSULTANT’s responsibility to file a Schedule C to deduct expense reimbursement so that these payments are not taxed.  CONSULTANT understands and acknowledges that this will require CONSULTANT to keep records that designate fee income versus expense reimbursements, including maintaining original receipts.  Note: For those contractors that are incorporated, this provision will not apply.
  • No Conflict.  CARENODES understands that CONSULTANT is available to perform the consulting services as provided herein for CARENODES.  CONSULTANT therefore warrants that this consultation will not cause CONSULTANT to breach any agreement or obligation CONSULTANT may have undertaken with others and that all consulting services to be performed by CONSULTANT under this AGREEMENT are fully consistent with the rules and regulations of his or her employer, if any.  All consulting services to be performed by CONSULTANT for CLIENT will be on CONSULTANT’s own time and without the support or use of the facilities of CONSULTANT’s employer.
  • No Third Party Confidential Information.  It is not CLIENT’s desire to be afforded access to, or to receive any information from CONSULTANT, which is confidential or in any way proprietary to any third party, nor to receive any information the receipt of which implies any obligations of confidentiality upon CLIENT.  CONSULTANT understands that any information provided by CONSULTANT can be freely disclosed and used for any CLIENT purpose including, for example, as incident to activities before the Food & Drug Administration, Federal Trade Commission, and U.S. Patent & Trademark Office.  CONSULTANT warrants that no other party, e.g. any employer, has any right, title or interest to or in any information, ideas, developments and inventions which may be submitted to CLIENT by CONSULTANT in CONSULTANT’s capacity as a consultant to CLIENT.  
  • Obligation of Confidentiality.  During CONSULTANT’s engagement as a consultant, it may be appropriate and necessary for CONSULTANT to have access to certain of CLIENT’s technical and business information and materials.  CONSULTANT agrees to consider as confidential all information disclosed to CONSULTANT and materials given to CONSULTANT by CLIENT during the period of this AGREEMENT, and any technical or business information CONSULTANT may learn, observe, or otherwise obtain concerning CLIENT incident to CONSULTANT’s performance under this AGREEMENT, including the fact that CLIENT may have interest in specific materials or areas of business, all of which is referred to as “INFORMATION”.  CONSULTANT agrees to take all reasonable precautions to prevent disclosure of INFORMATION or materials to third parties and not to use INFORMATION or materials without CLIENT’s express written consent.  These obligations of confidentiality and nonuse will continue beyond the term of this AGREEMENT, but will cease to apply as to any specific portion of CLIENT’s information or material which becomes available to the public. 
  • Term of Obligation of Confidentiality.  These obligations of confidentiality and non-use set forth in the section entitled “Obligation of Confidentiality” and all subsections thereof, will survive the termination of this AGREEMENT and any extensions thereof.
  • Disclosures Incident to On-Site Services.  If consulting is performed by CONSULTANT at a CLIENT facility, the obligations of confidentiality and non-use as set forth in the section entitled “Obligation of Confidentiality” and all subsections thereof, will extend to any and all confidential and proprietary information belonging to CLIENT and acquired by CONSULTANT as incident to performing such onsite services.  This information may include, for example, plant size, crew shifts, number of lines, product shipments, new product development testing, and the like.
  • Publication.  CLIENT will retain the results of CONSULTANT’s consulting work for CLIENT as confidential information.  Therefore, CONSULTANT will not publish or otherwise disclose the results of such work or other information concerning such work, without the express written consent of CLIENT.  In the event that work resulting from CONSULTANT’s consulting is published in the scientific literature, acknowledgement will be made to CONSULTANT in the accepted style, as appropriate.  CARENODES may share information collected from CONSULTANT with CLIENT, business partners, advertising companies, and other third parties.  CONSULTANT will not use CLIENT’s name without CLIENT’s concurrence.
  • Independent Contractor.  CONSULTANT understands and acknowledges that CONSULTANT is an independent contractor and not an employee of CARENODES or CLIENT.  As such CONSULTANT will not be considered an eligible participant in any CARENODES or CLIENT benefit plan other than benefits CONSULTANT was entitled to prior to the execution of this AGREEMENT.  Moreover, CONSULTANT disclaims all other disability programs and unemployment compensation programs in connection with CONSULTANT’s work with CARENODES or CLIENT.  In light of CONSULTANT’s status as a consultant, CONSULTANT understands that it is CONSULTANT’s personal responsibility to report CONSULTANT’s earnings under this AGREEMENT to both the Federal and any appropriate State or Local Governments.  Under some circumstances, however, CARENODES may be required to report payments made to CONSULTANT and/or withhold Income and/or Social Security taxes.  It is further understood and agreed that CONSULTANT is not a partner or joint venturer with CARENODES or CLIENT and has no authority to bind CARENODES or CLIENT to any contract with third parties. 
  • Inventions.  CONSULTANT agrees to disclose promptly and fully to an authorized representative of CLIENT all information, discoveries, works of authorship, designs, software, and inventions, whether or not patentable, conceived or reduced to practice by CONSULTANT as a result of CONSULTANT’s performance under this AGREEMENT (“INVENTIONS”).  All INVENTIONS will be the property of CLIENT.  Accordingly, CONSULTANT will assign outright to CLIENT the entire right, title and interest, both in the United States and abroad, to INVENTIONS, without payment other than that herein provided.  CONSULTANT will execute any documents which CLIENT deems reasonably necessary to secure its proprietary rights as set forth herein, such as to obtain patents, worldwide, or other protection covering INVENTIONS and to fully cooperate as requested to do so in the prosecution of such patents or other applications.  CLIENT will have the above-mentioned documents drafted at its own expense, as will also be the case with any patent or other applications which are filed, and with the prosecution and maintenance thereof.  CONSULTANT warrants that CONSULTANT has appropriate ownership rights in INVENTIONS to carry out CONSULTANT’s obligations under this paragraph.
  • Work for Hire.  Work done by CONSULTANT for CLIENT of a custom design and custom tailored nature will be considered work for hire.  Any materials, such as worksheets, exercises, case studies and videos, created by CONSULTANT for CLIENT as part of such custom design and/or custom tailored work, will be wholly owned by CLIENT, with all copyrights being obtained and retained by CLIENT.  
  • Personally Identifiable Information. CONSULTANT warrants that CONSULTANT will not be collecting or handling any personally identifiable information (“PII”) as a result of CONSULTANT’s consultations performed under this AGREEMENT.  PII means any information relating to a person that is sufficient to cause that person to be identified, directly or indirectly, in particular by reference to an identification number or to one or more factors specific to physical, physiological, mental, economic, cultural, or social identity.  If the scope of consultations under this AGREEMENT changes such that the collecting or handling of PII becomes necessary, CONSULTANT will promptly notify CLIENT in writing regarding such change. 
  • Indemnification.  CONSULTANT will indemnify, hold harmless and defend CLIENT and its AFFILIATES and CLIENTS’s officers, directors, shareholders, employees and agents from and against any and all claims, liabilities, losses, expenses (including, without limitation, fines, forfeitures, reasonable attorney’s fees, disbursements and administrative or court costs), penalties or damages (collectively, the “LIABILITIES”) from any third party claim arising from a breach of CONSULTANT’s privacy representations and warranties provided in the article entitled “Personally Identifiable Information”.
  • Compliance with Applicable Government Laws and Regulations. CONSULTANT will fully comply with all applicable governmental, legal, regulatory and professional requirements, including but not limited to anti-corruption and anti-bribery laws, such as the Foreign Corrupt Practices Act (collectively “LAWS”).   If CONSULTANT has operations physically located in the territorial United States which are involved in CONSULTANT’s performance under this AGREEMENT, then CONSULTANT will fully comply with the employee notice requirements set forth in 29 CFR Part 471, Appendix A to Subpart A and any applicable equal opportunity laws including the provisions in 41 CFR § 60-1.4 (a) (1)-(7), 41 CFR § 60-741.5(a), and 41 CFR § 60-250.5.  CONSULTANT will promptly notify CARENODES and CLIENT if CONSULTANT receives any notice, demand, summons or complaint from any governmental or regulatory authority, agency or other body relating to the subject matter of this AGREEMENT, and will take all steps, at CONSULTANT’s expense, to resolve any issues as promptly as practicable.
  • Anti-Corruption Compliance.  In addition to any other measures necessary to comply with LAWS as described above, CONSULTANT will not, and will ensure that any person or entity acting on its behalf will neither (i) offer to pay, pay, promise to pay, or authorize the payment of money or anything of value nor (ii) give or offer any “facilitating” or “grease” payments (i.e. payments given or offered in order to expedite or secure the performance of a routine government action) whether or not those payments may be considered lawful under the applicable anti-bribery laws to any (a) officer, employee or any person acting in an official capacity for or on behalf of a government or an entity owned or controlled by a government, or of a public international organization; or (b) political party or their officials; (c) candidate for a political office (“PUBLIC OFFICIAL”) in order to influence any act or decision of the PUBLIC OFFICIAL in his or her official capacity or to secure any other improper advantage in order to obtain or retain business or obtain any other business advantage.
  • AFFILIATES.  As used herein, the term “AFFILIATES” refers to any corporation, association, or other entity that directly or indirectly owns, is owned by, or is under common ownership with CLIENT, either currently or during the term of this AGREEMENT.  As used in this definition, the terms “owns”, “owned”, or “ownership” mean the direct or indirect possession of more than fifty percent (50%) of the voting securities, income interest, or a comparable equity in such business entity.
  • Entire Agreement.  This AGREEMENT constitutes the entire understanding between the PARTIES with respect to the subject matter contained herein and supersedes all prior agreements, understandings and arrangements whether oral or written between the PARTIES relating to the subject matter hereof, except as expressly set forth herein.  Nothing in this AGREEMENT may be changed or modified, nor may anything be added to this AGREEMENT, except as may be specifically agreed to in a subsequent writing executed with the same formalities as this AGREEMENT.  For their convenience, the PARTIES may use, from time to time, their standard purchase orders, invoices, or other similar preprinted forms.  The terms of this AGREEMENT shall take precedence over any standard Terms and Conditions language set forth in those forms.
  • Governing Law.  This AGREEMENT will be governed and construed in accordance with the laws of the State of California, United States of America.
  • Headings.  The headings or titles of articles, sections or paragraphs appearing in this AGREEMENT are provided for convenience and are not to be used in construing this AGREEMENT.
  • Notices.  All notices, authorizations, etc. relevant to this AGREEMENT may be personally served or sent by first class mail, postage pre-paid, to the respective PARTIES at the addresses provided and/or via email.
HEALTHCARE SERVICES: Provider / Healthcare Organizations

Carenodes contracts with physicians, facilities and other health care professionals to form our provider networks, which are essential for delivering quality, accessible and cost-effective health care services.

In partnership with providers (medical and non-medical, behavioral, primary, substance abuse, and others), we have developed (and are growing) community-wide coalition efforts geared towards addressing larger systemic health, infrastructure or social determinant issues with a large impact on health.

Click here to learn more about joining Carenodes Network.

Digital Therapeutics and Healthcare Reimbursement

Many digital therapeutics (DTx) providers are working to obtain reimbursement from U.S. payers. The following post discusses stategy for reaching patients and partnerships. A reputable DTx company will have a strategy for reaching patients considering whether the therapeutic is curative or designed for chronic care.

  • Digital therapeutics (DTx) represent a novel approach to delivering improved clinical outcomes, but the unstructured nature of today’s DTx access process has presented a major hurdle to broader uptake
  • Payers are still at very different stages in their acceptance of DTx, and in contrast with traditional pharmaceuticals, buy-in from senior leadership will be an essential part of the top-down decision-making process for DTx prioritization
  • Pharmacy benefit managers (PBMs) have taken a leadership role in facilitating a pathway for digital therapeutics adoption, and they are likely to remain the optimal entry point for DTx coverage and reimbursement in the near term
  • Employer groups are likely to be early advocates for the benefits of DTx after running individual pilot programs, whereas managed care organizations (MCOs) may be less receptive to covering DTx until a national body of real-world evidence becomes available
  • Ultimately, payers still have limited willingness to pay for DTx that lack clear impact on plan expenditures, and they will expect to see risk-sharing contracts on the table that can address these uncertainties

PAYER REIMBURSEMENT

More developed DTx companies are coming to discover that payer acceptance and reimbursement is key to market viability and that preparations to engage payer support need to be made in the development stage. Typically, companies partner with pharma companies to leverage traditional insurance reimbursement and distribution pathways, as in the case of Pear Therapeutics benefiting from its partnership with Sandoz. However, are seeking alternative payer reimbursement pathways, looking instead to pharmacy benefit management plans or distributing directly to patients through employers as additional benefit programs.

PHYSICIAN ADOPTION
As the oldest of the DTx have begun to mature, physician adoption is the final hurdle to consumer adoption. There are three major approaches to gaining physician adoption. Pear Therapeutics is using the pharmaceutical model, leveraging pharmaceutical distribution partnerships to make physicians aware of and willing to prescribe the product. Better Therapeutics, which develops a product for insomnia, is partnering with a pharmacy benefit plan that specifically offers a digital dispensary – effectively curating benefit-covered products in a single platform that physicians can use when making therapeutic recommendations. Kaia Health is taking a less traditional approach – the company has been targeting physicians as part of a marketing campaign, but the app is on the App Store and offers three subscription packages for patients.

Healthcare Flow of Funds explained: Healthcare Entrepreneur Bootcamp

Agenda Managed Care 101 for healthcare entrepreneurs seeking to do business in the California market.

Healthcare flow of funds explained. Managed Care 101 for healthcare entrepreneurs seeking to do business in the California market. Session led by Alex Yarijanian, CEO Carenodes. The aim: providing healthcare entrepreneurs with a framework within which they will find their place in the business value chain.

No business doing business in healthcare.

No business doing business in healthcare if you don’t know healthcare business. With that said, you shouldn’t limit yourself because you might have value to contribute. But it should worry you because you don’t have the time necessary to gain tribal, on-the-job, healthcare know-how and work experience.

This session challenges the idea that, just because you don’t have healthcare experience, you can’t learn if knowledge is transmitted in uniquely effective styles and methods.

Providing healthcare entrepreneurs with a framework within which they will find their place in the healthcare business value-chain.

Crossing the Chasm of Healthcare Startups: Reduce go-to-market time by understanding your leverqage points vis a vie industry meta-dynamics and insider insight. Bend the learning curve that surprises, paralyzes, and discourages many health technology startups.

Session Notes

A PILOT

Crossing the Chasm of Healthcare Startups: Reduce go-to-market time by understanding your leverage points vis a vie industry meta-dynamics and insider insight. Bend the learning curve that surprises, paralyzes, and discourages many health technology startups.

Managed Care Boot-camp for Healthcare Entrepreneurs, was a ‘pilot’ session designed to impart otherwise difficult to synthesize knowledge. Given its ‘pilot’ nature, please excuse instances where your experience might be interrupted by factors such as difficulty in whiteboard visibility, etc.

BOOTCAMP SESSION EXPERIENCE & OUTCOMES

Everyone should be able to walk out of this session feeling empowered by having learned the basic flow of funds (starting at the payer) and reimbursement structures along the healthcare delivery value chain. 

Managed Care Boot-camp for Healthcare Entrepreneurs, a ‘pilot’ session designed to impart otherwise difficult to synthesize knowledge with the following objectives:

1. Bend the learning curve of entrepreneurs in healthcare
2. Provide a framework to contextualize health tech business models (aim: to help provide a framework within which you will find your place in the business value chain).

You should be able to better refine your understanding of what ‘buckets’, and mechanisms, of funding you should pursue and trigger so as to index your business accordingly. Trends, current industry practices, and changes set to be effective in the future will be weaved into the session so as to contextualize the material. 

For an outline of topics covered, Managed Care 101 for healthcare entrepreneurs seeking to do business in the California market, see below.

to help healthcare entrepreneurs by providing a framework within which they will find their place in the business value chain.

otherwise, how else would you know how to price your deals and products?

Topics covered in this session are as follows:

I. Essential concepts
  • Crash course on 6 functional areas in any healthcare organization
    1. Operations: anything that hits P&Ls
    2. Compliance
    3. Network/Contracting
    4. Health Services: clinical services, medical director’s wheelhouse
    5. Quality: outcomes, QA/QI
    6. Engagement: outreach, customer services, etc.
  • Understanding Volume-to-Value drivers in payment
    • Business models for health technology companies
II. Managed Care Mindset: How to think like your customer.
  • Managed care: ‘utilization management’
  • Payment: Volume shift to value
  • Quality (‘value’) measured
    • Patient experience
    • Clinical outcomes
III. Lines of Business aka ‘LOB’ (funding source)
  • Medicare (Traditional Medicare and Medicare Advantage, Parts ABCD)
    Medicaid (managed Medicaid, state / federal, Medi-Cal)
  • Duals (Medicare and Medicaid beneficiaries)
  • Commercial (on exchange, off exchange)
IV. Products (benefit designs)
  • The spectrum of products: HMO, PPO, POS, EPO, FFS
  • Business ramifications
V. Difference between ‘LOB’ vs ‘product’
  • Difference between ‘LOB‘ (Medicare, commercial, etc) vs ‘product‘ (HMO, PPO, etc.)
VI. Main Reimbursement structures (payer/provider agreements)
  • Fee for service (FFS)
  • Value-based payment: upside, upside/downside
  • Predominate California Market Structure, determine who is at risk
    • Capitation
    • Delegation
  • Risk-based deals
    • Capitations and delegation of functions by the health plan to a third party
    • Global-risk, shared risk, dual risk.

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