Genevieve D. Caruncho-Simpson

Risant Health, a new entity formed by Kaiser Permanente in 2023, is expanding its value-based care network with a strategic acquisition of Cone Health, a nonprofit healthcare delivery system in North Carolina.    This move echoes Risant Health’s earlier acquisition of Geisinger in April, underscoring its commitment to growing its value-based care network and expanding access to evidence-based healthcare for all populations. Like Geisinger, Cone Health will keep its decision-making autonomy and maintain its brand. As an organization within the portfolio, Cone Health will receive centralized support from Risant Health to enhance its operations and implement best practices that are established for the network.    Despite the need for value-based care, the industry has seen only a targeted shift away from fee-for-service models. Will Risant Health be successful in moving the needle on value-based care? Read our full analysis below and share your thoughts in the comments! #ro3llc #RisantHealth #Geisinger #ConeHealth #Healthcare #ValueBasedCare #MergersandAcquisitions

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Here’s your recap of last week’s health IT news 🗞️ 👇 💼 Administrative • Pager + League: The care orchestration solution will be embedded into the patient engagement platform for maternity care.    • Veradigm®: The ambulatory care solutions vendor has announced that it is exploring a merger, sale, or other transaction.    • Kyruus Health: The provider search and scheduling solution said it would add MEDITECH to its list of EHR partners which already includes Epic , Oracle (Cerner), athenahealth , and others.   🥼 Clinical • Clover Health: The physician enablement technology company launched its previously internal-facing clinical decision support tool via its subsidiary Counterpart Health as a standalone solution for external Medicare-focused payers and providers.    • Children's Minnesota + ShiftMed: The pediatric health system is partnering with the on-demand workforce tech platform. 🤝 VBC • Innovaccer: The VBC data & analytics company launched its quality management and reporting platform for health plans. 🤖 AI • Plenful: The AI workflow automation company focused on streamlining pharmacy operations announced a $17M Series A.    • SamaCare: The AI prior auth platform announced a $17M Series B. 💡 Things We Found Interesting • In our view, there’s not enough discussion about why technology pilots in health systems fail. So we appreciated this perspective from Justin R. Brueck at Endeavor Health, on three of the most common reasons he sees things go awry. https://lnkd.in/eKBZ_g2N    • We’re continuing to see stories illustrating both the promise and perils of leveraging generative AI in the practice of clinical medicine. Given the pace of progress, it seems clear that AI will play a significant role in clinical care sooner than later. Lots of thorny questions to work through in a short amount of time. (Here are a couple examples from Yudara Kularathne MD, FAMS(EM) and Graham Walker, MD we appreciated: https://lnkd.in/ePUr2SgE, https://lnkd.in/ej9UpfYg)    • On that note, we’re always interested to read the latest research on how AI solutions are performing in the field. One recent study published in JAMA found that AI scribes significantly reduced time spent in the EHR. Researchers of another, however, cautioned that providers must remain vigilant when using GenAI, based on the fact that Chat-GPT produced different outputs when asked to simplify radiology reports for patients of different races. https://lnkd.in/emNi-_Ai, https://lnkd.in/ejH4KHsq  

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"Overall, advancing health equity remains a moderate to high priority for most organizations surveyed, with varying levels of investment, leadership, strategic maturity and capabilities to advance identified priorities," the EY 2024 Health Equity Outlook Report says. Significantly, the role of different organizations in health equity prioritization is underscored. Government organizations, especially federal bodies and those with over $1 billion in revenue and more mature health equity strategies are likely to report higher levels of health equity prioritization, highlighting their crucial role in this endeavor. Consistent with last year’s findings, the specific factors and issues prioritized within health equity programs are diverse. Health access and quality remain at the top—44% of organizations ranking it in their top three health equity priorities, up from 34% in 2023. Health equity strategy development was cited by roughly a third (34%), consistent with 2023 (33%). Another top area of focus cited was health outcomes disparity closure (31% of organizations). There was a significant—50%—increase in those citing data, AI, and technology as a priority. At the same time, a reduced focus was observed on healthcare costs and addressing upstream social determinants of health factors such as economic stability and inclusion, neighborhood and built environment, and broadband infrastructure and access. Access the report at https://lnkd.in/g9WhZeTc #Health #Healthequity #Healthdisparities #Publichealth #Healthcare #wellness #healthycommunities #healthequityforum #SDoH

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🚀 Telehealth’s Rocky Road: Beyond the Pandemic Boom 🚀 Telehealth companies like Teladoc, Amwell, Hims & Hers, and 1Life have experienced a brutal year, with stock prices plummeting 40-80%. This begs the question: what went wrong? 📉 🏬 The Retail Approach’s Fall 🏬 Telehealth initially mimicked the retail industry, prioritizing convenience over building strong patient-physician relationships. This lack of trust and loyalty proved detrimental. 😔 🔄 Continuity Conundrum 🔄 Telehealth often falls short in providing continuity of care. While some offer virtual primary care, this message hasn’t resonated with patients who perceive telehealth as solely for minor, urgent needs. 🏥 🩹 Beyond Band-Aids 🩹 Telehealth primarily addressed low-hanging fruit, focusing on minor issues that could often be ignored or handled by a regular physician. Traditional telehealth hasn’t equipped itself to handle complex diagnoses or common problems requiring thorough workups. 🌱 📚 Lessons Learned 📚 The failures stem from flawed business models, not a lack of patient interest in telehealth. So, what can we learn? 🤔 🤝 Human-Centric Healthcare 🤝 Building trust and loyalty through a strong physician-patient bond is crucial for long-term success. This translates to convenient access for patients and efficient workflows for physicians, potentially using AI tools for administrative tasks. Seamless data exchange with other healthcare systems through Health Information Exchanges is also vital. 🌐 🌟 Expanding Capabilities 🌟 Moving beyond basic video visits is essential. Integrating capabilities like pulmonary function tests, EKGs, and home-based testing for common illnesses can significantly enhance telehealth’s value proposition. Additionally, offering home visits from qualified nurses for specific cases can further improve patient care. 🌈 By addressing these critical shortcomings and focusing on a human-centric, comprehensive approach, telehealth can still thrive in the long run. 🌿 Feel free to ask if you’d like to explore more! 🙌 #healthcare, #telehealth, #investment, #patientadvocacy

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Private-Equity in Healthcare As reported by the Wall Street Journal, many state legislatures across the country are enacting laws to limit healthcare acquisitions by PE firms. On the surface this sounds like a much-needed step to slow consolidation and the price gouging that usually follows. What’s the problem? First, these laws are directed almost exclusively at PE firms. There is little attention being paid to the significant healthcare acquisitions of large health insurance carriers. If I was a cynical person, I’d bet that the health insurance lobby was behind the push for more restrictive acquisition rules for PE firms.  Once PE firms are banned from acquisitions in a state, healthcare entities will be less expensive for insurance carriers to buy. A big win for insurance. The second problem with prohibitions on PE acquisitions is that it’s an attempt at solving a problem without addressing the root cause. This is typical with government solutions. Most elected officials are well intentioned, but they frequently address the symptoms without considering the underlying causes. What’s the core problem? Our healthcare system is antagonistic to independent doctors. Need examples: ·      Prohibition on physician owned hospitals ·      Certificate of Need laws across many states ·      Absence of site-neutral reimbursements ·      HSA rules that prohibit direct subscription payments to DPC/DSCs ·      Unchecked consolidation of health insurance carriers, many becoming competitors to independent doctors To be clear, I believe PE acquisitions of healthcare providers deserves more scrutiny. But let’s not give a free pass to large health insurance carriers. Their continued acquisitions of healthcare providers is a significant threat to our healthcare system as well. And if we really want to address the underlying problem of consolidation in healthcare, let’s establish policies that make it easier for independent doctors to remain independent and to thrive. If we don't fix the underlying issues, these well-intended state laws directed only at PE acquisitions are likely to leave us even worse off than before.

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Just announced: WalMart Health shutting down Walmart Health--all 51 health centers and virtual health to close. My colleague and friend Robert Huckman at Harvard Business School just shared this news, and it's unfortunate. As he, Brad Staats, and I wrote about in Harvard Business Review last month, retailers could be strong complements to traditional health care delivery systems if they partnered successfully. The retailers offer accessibility, convenience, and strong consumer behavior insights, while the delivery systems that are involved in risk-bearing value-based contracts could do with the help in preventing unnecessary (re)admissions. Together, the two could do a lot to advance health and, in turn, even reduce costs of care for society. More of our thoughts here: https://lnkd.in/eY3kC2pb https://lnkd.in/eWa5Wk5i

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#Startups - Take note! The blog post from Michael A. Greeley of Flare Capital Partners does an excellent job of highlighting key practices in #scaling a #healthcare startup effectively. Check it out and take what Michael says to heart - or in this case - to stomach. #startupsuccess #innovation #healthcareonLinkedin https://lnkd.in/e7wr2Gry

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Let’s get real about men’s health! Join NBC News Anchor, Tony Perkins, in a candid conversation with Dr. Kwame Akoto and Dr. Kai Li from Kaiser Permanente as they delve into crucial men's health topics. From health tips to screening recommendations, they cover essential information on cardiovascular health, prostate cancer, and more. Watch the insightful discussion here: https://lnkd.in/eqC3-5bR #MensHealth #HealthTips #ProstateCancer #CardiovascularHealth

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How’d the largest for-profit and nonprofit health systems do in Q1? Most large nonprofit health systems have ‘reported’ their Q1 financial and operating updates for bondholders, investors, and stakeholders, so I thought it’d be worthwhile to do a comparative analysis. Let’s take a peek at their operating margin (AKA, total operating revenues minus total operating expenses). The main takeaway below is simple: most large health systems performed better in Q1 2024 when compared to the first quarter of 2023. And if you’ve followed my Hospitalogy writings over the past year, it’s pretty easy to see why: utilization is up, the labor market has stabilized, and dense health system consolidators are staying ahead of the game. The below graphic is Hospitalogy original analysis (also one of my favorite charts in recent memory I’ve made), and it’s sorted by operating margin % profitability. • Any green bar means the system performed better in 2024. • Any red bar = worse performance than a year ago. Several players - including Tenet, Baylor, Mayo, AdventHealth, Providence, and Ascension - saw significant improvement in operating margins between the two periods. Baylor sitting at 8.7% in Q1 is particularly unreal performance. The Dallas-based nonprofit is benefiting from strong Texas markets and strong strategic decision-making within. Outside of 5 systems, the majority (75%) of large regional and academic players saw operating margin expansion in the first quarter of 2024. The remainder of 2024 sets up well for healthcare services, though the waters are muddy beyond this year given an uptick in payor-provider disputes. What sticks out to you in the below graphic? PS - for more original analysis like this subscribe to my newsletter Hospitalogy - https://lnkd.in/gniNmHvz And consider joining my community of strategists, investors, and consultants for even deeper analysis, networking, & resources: https://lnkd.in/gqbbVq_W

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"In today's world, there's a power and financing differential between payers, providers, and patients. Health systems need to find a way to renegotiate and get appropriately reimbursed for providing the kind of care that will naturally result in more appropriate utilization." Great points here. Healthcare needs to find a way to balance the dynamic between payers, providers, and patients to effectively support everyone—the system works best when everyone benefits. #Healthcare #ValueBasedCare #PatientExperience

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🩺💻 The Achilles Heel of Telehealth: Why Walmart and Village MD Stumbled 🩺💻 Walmart’s recent decision to shutter its entire healthcare division, including 51 physical clinics and its virtual care platform, sent shockwaves through the industry. This news, following the closure of Village MD clinics by Walgreens, begs the question: what went wrong with these seemingly promising ventures? 🤔 The Walmart Case: Walmart cited “a challenging reimbursement environment and escalating operating costs” as the reason for its exit. While convenient and affordable, their model struggled to compete with established healthcare providers and navigate the complex insurance landscape. 🏥💰 What Didn’t Work: Lack of Integration: The clinics operated independently, lacking deep integration with existing healthcare systems, which made patient data sharing and continuity of care difficult. 🔄📊 Focus on Price Over Value: While offering low costs, Walmart may have prioritized affordability over building strong patient relationships and personalized care. 💲🤝 Limited Scope of Services: The clinics primarily offered basic primary care, potentially failing to attract patients needing more specialized services. 🏥🔍 Models that Work: While Walmart’s venture faltered, other telehealth models are showing promise: Value-Based Care: Providers focus on preventative care and managing chronic conditions, potentially lowering overall healthcare costs and improving patient outcomes. 🌿🏥 Integrated Telehealth: Seamless integration with existing healthcare systems ensures smooth patient data sharing and a more holistic care experience. 🔄🔗 Specialized Services: Telehealth platforms that connect patients with specialists in specific fields, like mental health or dermatology, are proving successful. 🌟👩‍⚕️👨‍⚕️ Village MD Closure: Walgreens’ closure of 160 Village MD clinics highlights another challenge: ensuring the financial viability of these ventures. While Village MD focused on primary care, the high cost of acquiring and operating clinics might have outweighed the revenue generated. 💼💔 The Takeaway: Telehealth holds immense potential, but its success hinges on overcoming these critical hurdles. Building a sustainable model requires: Strong partnerships with established healthcare providers. 🤝🏥 Focus on value-based care and patient outcomes. 🌟📈 Integration with existing healthcare systems. 🔄🔗 Offering specialized services alongside primary care. 👩‍⚕️🔍 The recent closures serve as a cautionary tale, but they shouldn’t overshadow the potential of telehealth to revolutionize healthcare access and delivery. By learning from these missteps and focusing on sustainable, patient-centered models, the future of telehealth remains bright. 🌐🏥🌟 What are your thoughts? #telehealth #healthcare #technology #medicine #futureofhealthcare

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We all have seen by now that AI holds the promise of reshaping healthcare delivery, and this goes particularly for marginalized communities. Its widespread adoption, however, necessitates careful navigation of potential biases and ethical concerns to ensure equitable outcomes for all! As we embrace AI's transformative potential, we must continue to actively address issues of access, transparency, and workforce readiness in order to promote a future where technology enhances, rather than hinders, health equity initiatives. #HealthEquity #Healthcare #AI

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"The Middle Path to Innovation" (Harvard Business Review, July-August 2024) delineates a new model for how to make health care innovation happen. It explains how both large firms, struggling with sluggish revenue growth and product development, and start-ups, struggling to obtain the resources they need and "not invented here" cold shoulders from the large firms, can work together to achieve their goals. The article is based on the actual results achieved by co-author Duke Rohlen as he implemented this model to quadruple Cordis’s growth rate in two years, with the funding and expertise of PE firms KKR and Hellman & Friedman. We then illustrate how this model has been deployed in the moribund film industry and can be used to increase laggard defense innovation. (Herzlinger, Regina E., Duke Rohlen, Ben Creo, and Will Kynes. "The Middle Path to Innovation." Harvard Business Review 102, no. 4 (July–August 2024): 134–145. https://lnkd.in/d9GBWJJC) #healthcare #innovation #Cordis

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I’m excited to share what we've been obsessing over for the last six months! Introducing Threshold Health, a unique patient engagement platform that puts healthcare operators in the driver's seat of modern care gap closure campaigns. Shockingly, only 1 in 20 US adults is up to date on their recommended preventive care, such as cancer screenings or blood pressure testing. This statistic is paradoxically low, especially given the increasingly direct financial incentives tied to increasing population-level care quality. When my longtime friend and now cofounder, Dr. Doug Murad, and I started exploring why patient engagement is so low, we quickly discovered a recurring pattern. Time and again, we heard from passionate operators across diverse healthcare organizations who struggled to mount effective patient engagement campaigns, often waiting until the last few months of the contract year to close important care gaps in their patient populations. In almost every case, these operators seemed to be building campaigns from scratch, deploying blunt tools like bulk SMS, physical gift cards, and manual call centers, and relying on lagging indicators of success. Unsurprisingly, these efforts were operationally expensive and often fell short of their targets. Dr. Doug and I aim to empower healthcare operators level up their patient engagement with campaigns that are cheaper, better, and faster than building something themselves. To do this, we’re building a self-serve platform that makes it easy for operators to rapidly launch and iterate on modern campaigns that integrate well with their existing care coordination workflows. If we’re successful in this first step, we will have a vehicle to deliver an increasingly sophisticated library of campaign templates and next-generation patient engagement technology. So far, we’ve developed a prototype that allows operators to go from zero integration to a modern deployed campaign in fewer than 10 clicks. We’re excited to run our first pilot in mid-July and continue developing the product with 2-3 launch partners through the rest of this year. There's a lot left to learn -- I plan to post regular updates and lessons here. Reaching this level of conviction took a lot of time—not just from me and Dr. Doug, but from numerous experts across various fields who have been extremely generous in sharing their expertise and feedback. I especially want to thank our network of advisors: Daniel Croymans, MD, MBA, Benjamin (Benny) Axt, Indira Gowda, Ivo Vlaev, Suruchi Kothari, MD, Melissa G., Christian Spier and many others; our investors Jane Wang and Saumitra Thakur at MedMountain Ventures; and our first full-time employee Joe Bonneau. Also, shout-out to Shirley Mao and rvnway for designing and building our new website: https://threshold.health With all that said, we’re open for business! Let’s chat :)

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Today's behavioral healthcare is broken due to misaligned incentives. This is one of the core reasons why we started Integral Health -- to fix the incentives to reorient toward patient outcomes. With technology and data, we can now build outcome-based behavioral health to scale. Integral Health #vbc #outcomebasedcare #behavioralhealth #incentivealignment

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Resource allocation to underserved populations in healthcare is a major issue. Misallocation of resources and disorganized logistics can prevent patients from getting lifesaving care, and can create barriers for entire communities to access the care they need. AI is a potential solution. Healthcare data is a powerful tool. The greater access we have to data, the better healthcare operations management is able to mitigate delays in care, allocate resources equitably, and provide administrative support to on-site physicians. However, accessing and working with data in healthcare can be a challenge due to nonstandardization and high fees. AI is solving this issue. With AI, healthcare organizations are able to provide health facilities with access to, and analytics of, the health data. This can help diagnose patients, support telehealth, and importantly, better allocate resources to areas in need. Through AI, communities in need can be identified and targeted by health initiatives. #AI #healthcare #HealthData

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