Andrew Wint

This is a cautionary tale that points to the crux of bringing virtual care and telehealth to primary care: do you have a clear, efficient, scalable reimbursement model for your tech or do you not? While having a reimbursement strategy at the core of any digital health business model is a make or break criteria, defining reimbursement pathways is often overseen or assumed to be a self fulfilling prophecy once the tech hits the market. It is not. You can have the best tech in the world (throw as much AI into the mix as you want) and even with a bullet proof value proposition, clinical studies, consumer centric service design, a pressing client need and deep pockets: if your reimbursement strategy does not work, the business won’t work. It’s not easy to get reimbursement strategies right: within specific markets conditions can change (today you might have a reimbursement code, tomorrow you might not - and vice Versa) and things get extremely complicated when scaling across multiple markets, jurisdictions and geographies. https://lnkd.in/gXFRzJXQ

39

5 Comments

Smart move by Allegheny Health Network - and likely one that others will follow. #GenerativeAI systems are so powerful and effective in conveying information that not only will businesses and organizations of all types fill follow. And as developing #ChatGPT-style systems become easier, its likely we will each have our own personal #AI. #aiinnovation https://lnkd.in/eaqAZCFT

7

🍕 Glue pizza, anyone? We've been monitoring the changes Google has been making to its Search Engine Results Page (SERP) over the last few months and have been taking notes on the changes its been making to its search results - especially as they've introduced Search Generative Experience (SGE) results. Now that they've converted the SGE results to AI Overviews, the world is going to get weird... 🙄 Google's roll-out of AI Overviews hasn't been without some issues (one AI Overview told users to add glue to pizza to make it taste better). But, despite some missteps, Google continues to incrementally launch AI Overviews in the US and healthcare organizations need to know what to expect now and how to prepare for the future. Have no doubt, your organic strategy will definitely need to change. I'm really excited to be hosting a webinar with two authorities in this space -- Aaron Watkins from Johns Hopkins Medicine and Jason Hamrick from Phase2 -- where we'll be talking about everything we know and answering top questions we've been getting about how to think differently about how to connect with patients and consumers digitaly now and in the future. If you haven't RSVP'd yet, we'd love to have you join on Thursday, June 6 at 11am ET. You can find more information here: https://lnkd.in/ewj8mcR5

23

1 Comment

Assuming the chart is accurate, or close. Let's realize that insurance provides no treatment and other than paying the bills does exactly nothing for health. They like to call themselves health plans, so we don't call them bill payers. Then there are many other forms of intermediary that also do not provide any care or health. The system has converted from transactions to financially support caregiving, into caregivers and patients supporting profit taking transactions. This is upside down.

3

2 Comments

Moving healthcare services into the future requires a bold approach to whole-person care. That’s what attracted me to Carelon: the potential to improve healthcare service delivery. By taking a unique approach to achieving exceptional and equitable patient-centered care we can stay on top of evolving needs. Learn more about how Carelon's capabilities help us improve care experiences in this video. #healthcareinnovation #movinghealthcareforward #Productmanagement  

111

4 Comments

Manatt, Phelps & Phillips, LLP's take got me: "CMS is recognizing the role of digitally enabled care in improving access and outcomes." They also propose these new models "present health tech companies with opportunities to target new markets" because of the new/extra funding—such as viewing state Medicaid offices as new partner opportunities, which I've been seeing a lot of talk about recently in my feed. What do you think? I guess being in New Mexico, where almost half of our state is covered by Medicaid, Medicaid and MCOs have been a primary strategic partner/target market for 15+ years, and a somewhat omnipotent source driving most investment and initiatives. ------------------ More about the models: The Transforming Maternal Health (TMaH) model will issue agreements to up to 15 state Medicaid agencies to develop and implement a whole-person approach to pregnancy, childbirth, and postpartum care. The Innovation in Behavioral Health (IBH) model will develop and implement state-administered approaches which integrate behavioral, physical, and social supports to coordinate and manage care for Medicare and Medicaid beneficiaries with moderate-to-severe mental health conditions or substance-use disorders (SUD). I thought to myself, "wait, aren't we already doing that?" But they clarified: through the new models, CMS is encouraging states and providers to invest in technology and supporting infrastructure. ------------------ 🎉 What I'm excited about: Continued support for entities to get connected and the continued case for HIEs to expand their capabilities. Specifically, EHRs, HIEs, and remote patient monitoring (RPM). AND.... 🎉 "Additionally, CMS will support states with implementing data infrastructure to enable collection of Health-Related Social Needs (HRSN) data and referral to support resources." ------------------ 🤯 What I didn't realize: "It is estimated that only 6% of behavioral health facilities and 29% of substance use disorder treatment centers in the U.S. utilize EHRs, whereas nearly 4 in 5 office-based physicians (78%) leverage an EHR platform today 🤯 I'm having a hard time following along with all the new models coming out of CMMI, though 😉 Interesting piece all around, good info.

3

Our partnership with Oracle Health will include advances in artificial intelligence (AI) and other technologies that hold the potential to revolutionize patient care and outcomes while dramatically reducing the non-productive administrative burden on our providers and caregivers. #VISION2030 #RemarkableReimagined #AcceleratingTransformation

31

The recent EY Health Pulse Survey reveals that technology advancements are enhancing member engagement and access to health care services. The increased engagement is translating into tangible improvements in care. Executives report that members are expressing a heightened sense of control over their health management, encountering fewer obstacles when seeking health information, experiencing lower nonpayment rates and expressing greater overall satisfaction with their health care. - Health insurance executives report that digital health care technologies, such as wearables, remote monitoring and telehealth, are beginning to yield significant benefits. - As these technologies continue to evolve, so should cybersecurity innovation measures despite the rising costs. #digitalhealth #payer #innovation https://lnkd.in/eWReasJN

21

4 Comments

Walmart Exits Healthcare Market: RPM Steps Up to Fill the Gap... Walmart's departure from the healthcare market, including its virtual health care services, will leave a void in care services for underserved communities. While hospitals and primary care providers (PCPs) remain the backbone of our healthcare ecosystem, their resilience is rooted in the trust relationships they've built with patients. This trust is a cornerstone of effective care, and RPM can help hospitals and PCPs extend their reach. RPM uses digital technologies to monitor patients' vital signs, health data, and other relevant information remotely, enabling healthcare providers to deliver timely interventions and preventive care. By leveraging RPM, we can: - Increase access to care for underserved communities - Detect health issues early, preventing complications - Deliver personalized care plans - Reduce healthcare costs - Empower patients to take a more active role in their healthcare As we move forward, RPM can help address the disparities in healthcare access and ensure that everyone has access to quality care, regardless of their zip code or background. Let's harness the power of RPM to create a more equitable and accessible healthcare ecosystem! #RemotePatientMonitoring #Telehealth #DigitalHealth #HealthcareAccess https://lnkd.in/eD7CcaEm

31

5 Comments

I've often shared my excitement about AI in healthcare, foreseeing its value while acknowledging the need for trust. AI, particularly generative AI, is advancing rapidly. Wolters Kluwer reports that 54% of Americans believe it will be fully integrated in doctor interactions by 2028. However, trust is key for consumers. 86% want to know medical specialists were involved in creating GenAI source content, and 81% seek a reputable healthcare track record from GenAI companies. Validating source content and AI outputs against care standards is crucial, considering evolving medical practices. Applications using generative AI will need to adapt with new discoveries. It will take time to put the required processes and governance in place to make sure that happens, but it’s yet another reason that physicians should be involved in all AI-related initiatives in. It is imperative that AI be viewed as a #healthcare tool, not simply a new technology. https://bit.ly/44yCz6G

4

As has been re-iterated by multiple presenters at the CMS Health Equity conference today, "it takes all of us" to improve health equity. I'm proud to play a small part in this national effort and work for a company that is making an impact. Learn more about how Nymbl's program addresses health disparities related to older adult mobility: Read Nymbl’s White Paper on Health Equity Impact https://lnkd.in/gnbHuxVG What's inspiring you today from #HealthEquityCon24?

7

Providing a measurement of fidelity to a therapy protocol at scale is a difference maker for three main reasons: 1. to date measurement feedback of fidelity has been labor intensive, subject to bias - therefore NOT scalable 2. To actually, truly, literally say you are doing evidence based care delivery you MUST measure against protocols 3. the measurement provides feedback that can be used to improve delivery to the model Lyssn is one of those unique tools that enables us the ability to connect theory to practice.

5

Last week, Elion covered the AI prior auth space for providers. This week we're looking at it from the payer side. For payers, prior authorization (PA) is a necessary burden: important for utilization management (UM) and financial planning, but a nightmare to manage. After PA requests are sent in, payers have to process the request from various channels into a case, match it with clinical criteria, validate required information, review and make the PA determination, then respond and iterate through any appeals. As payers update their procedures with new clinical evidence guidelines and new diagnostics and treatments, managing policies and creating decision trees for PA decisions requires enormous effort. Payer-facing AI prior authorization platforms have a huge opportunity to streamline these workflows by: 📒 Improving rules-engine generation and updates from unstructured policy documents and PDFs 📤 Automatically processing PA requests across all channels ✅ Matching the case to the right clinical criteria, validating data completeness, and determining if policies have been met through machine learning models and generative AI 📬 Generating decision documents and automating appeals correspondence with providers Several vendors are already making strides in AI-enabled PA for payers. Banjo Health offers tooling both for the PA request and clinical decision policy creation workflows for health plans, TPAs, and pharmacy benefit managers. basys.ai uses LLMs to offer rapid ingestion of policy documents for fast integration and up-to-date policies. Cohere Health is one of the more mature vendors in the space, and offers a variety of products for UM. Co:Helm is a generative AI platform for payers, with initial use cases around enabling UM nurses to make complex PA decisions more quickly. Finally, GenHealth.ai has built their own large medical foundation model and is using it to enable both rapid policy ingestion and PA review. We see PA as the first place where payers will incorporate advanced clinical AI. Although PA denials should never be fully automated, vendors that can drive efficiency here stand to become a core part of payers’ clinical decision-making process. --- We received a number of interesting responses last week regarding the AI prior auth space. We're continuing to dive deep here, so please reach out if you're currently investigating it and would like to discuss.

28

👉 If you're a clinician or HealthTech employee that's recently been laid off, I'm here to help you. 😥 The darker side of healthcare and startups - large companies sometimes choose to shed employees to pivot, or balance the books. Small companies and startups often are born, grow, and die within the same year. 😖 This happens in both the clinical world and the non-clinical world (though, much more frequently in the non-clinical world.) 🌤 The good news? There are still tons of great jobs out there if you can find them. 👏 Fellow Next Degree users have referred nearly 100 recently laid off peers to us in the last two weeks to request access to our job search - our tribe is banding together to support each other. 🤝 We stand with you. They stand for you. We've made the decision to accelerate onboarding from our waitlist to get access to our 2200+ jobs across the healthcare ecosystem. ❤️ Let's shape the future of healthcare, together. #healthcare #layoffs #weareinittogether PS: Looking for some coaching? Here are a few of our clinical colleagues around the ecosystem supporting our clinical community: Kylie Cicero, MS, OTR/L Lauren Sheehan Brandy Wilkins, DPT, CPHQ, CSSGB

53

9 Comments

Looking forward to our discussion later today on "Cutting-edge Care: AI and ML Transformations in Digital Health and MedTech" together with Vishal Gulati, Natalie Pankova, Shahid Bobat and Meri Beckwith as part of #LondonTechWeek. It's such an exciting time to be innovating in healthcare: 20 years of developments in #machinelearning and #AI have got us to the point where technology will be transformative. And #mentalhealth is top of the list when it comes to using new language generation capabilities (#NLP) to address one of the biggest global healthcare challenges. But how can we do this in a way that is safe, effective and equitable? I will be talking about the importance of #ResponsibleInnovation and the key role for #LivedExperience as we seek to provide scalable, clinical-grade care to the millions of people around the globe who are struggling with their mental health. At ieso we've worked hard to invite challenge from outside voices to ensure that we're pushing the boundaries of what is possible while holding ourselves to account in terms of #patient #trust, #clinician buy-in and research #ethics. https://lnkd.in/eCavvxuX

13

We talk a lot about the impact of prior auth on payers, but what are the impacts on providers? Itiliti Health CEO outlines the provider impact in this clip from a recent webinar, alongside how the newly finalized CMS rule will create impactful change. #priorauthorization #priorauth #healthtech #healthcare #AIinHealthcare #AIinhealthtech

2

Nurses in Tech: Building Solutions That Make a Difference As nurses, we have a wealth of clinical experience across various settings. We've seen firsthand the disparities in patient outcomes.   Michael Loomis, MBA, BSN, RNC-OB, C-EFM chats with Nurses In Tech about the importance of harnessing our expertise to build innovative technology solutions that truly make a difference - whether it's for healthcare administration, nursing workflows, or direct patient care. Too often, healthcare technology is developed without sufficient input from the end users - nurses who will actually be using these tools day in and day out to deliver care. It's crucial to have nurses intimately involved in the tech development process from the ground up. Nurses need a strong voice to ensure the solutions are practical, intuitive, and designed around real clinical workflows. Legacy EHR systems like Epic and Cerner were built on generic paradigms that don't always fit smoothly into a nurse's workflow as they're caring for patients.   With more tech-savvy nurses entering the field than ever before, there's a huge opportunity to rethink how these systems are designed and implemented. It's past time for nurses to be included! And until then, we have a responsibility to create the solutions our patients need! Why? Because we are the solutions! Schedule some time to find out what we are up to at Nurses In Tech. Link in the comments. nursesintech #healthcareinnovation #digitalhealth #nursinginformatics

38

10 Comments

🆕 Episode: Continuing our recap of HIMSS 24, host Angelo Kastroulis sat down with Nicholas Stepro of Arcadia. In this clip, they touch on the topics of value-based care, social determinants, and AI in the healthcare setting. You can catch the full podcast with this link 👇 or on any major platform. https://lnkd.in/eYt2suhf #healthcare #data #analytics #sdoh #ai #himss24

13

2 Comments

📡 What’s ambient signal, and how can it help address social determinants of health? Arcadia’s Chief Product and Technology Officer, Nicholas Stepro, explains in this episode of the Counting Sand Podcast. 🎙️ Give it a listen to learn how: ➡ Data and analytics provide an understanding of performance and identify areas for improvement in healthcare ➡ Artificial intelligence can be used to enhance healthcare efficiency and effectiveness ➡ Trust and transparency can lead to the adoption of AI in healthcare

5