Jason Taylor

Now that our HIT industry has spent nearly 40 years figuring out how to effectively pass data between sites, settings, and institutions of care (and while that journey isn't completely over, we're well on our way), we can finally turn and look farther down the road and consider what's next. In my view, advancing process consistency, agility, and change is that horizon. The BPM community is focused on that challenge, and having recently transitioned into HL7 as HL7 BPM, is squarely trying to take this on. With today's press release, HL7 is truly open-for-business in this space. Thanks to the OMG for nurturing this work along and for HL7 for having made our next home for this effort. So much to do! https://lnkd.in/dAF96g3n

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Cognizant conference will reveal trailblazing product strategy   The 2024 Cognizant Health Sciences Conference will center on unifying experiences, a broad effort to align the best stakeholder experiences across a converging healthcare industry value chain. At the conference, we’re excited to be presenting the 2024 TriZetto Healthcare Products strategy, which aligns with the goal of unifying experiences. A few key themes outline this strategy: 1.     Advanced technology drives our approach to products, particularly how AI and gen AI are enabling digital transformation in healthcare relative to the cloud and to data interoperability. 2.     Healthcare organizations prefer SaaS, and we’re implementing it, which provides our clients with a faster time to value and the ability to focus on higher value work in their business of delivering and administering healthcare. 3.     Our payer-provider collaboration solutions focus on the adoption of new interoperable standards, reducing friction in healthcare workflows and streamlining actions between payers and providers. 4.     New modular solutions provide options for clients who are expanding their business models into adjacent markets and want to both leverage and protect their existing investments, while growing. Our strategy aims to enable a more interoperable and transparent healthcare ecosystem for stakeholders. Learn more about our product strategy at the mainstage session on Tuesday, June 11th directly following the keynote: https://lnkd.in/gRT6-ykT #Strategy #Innovation #Healthcare #HealthSciences #Conference TriZetto Healthcare Products Cognizant

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The future of telehealth is poised to transform the healthcare landscape through an omnichannel approach to care, integrating digital and traditional modalities for a seamless patient experience. As technology continues to evolve, telehealth will expand beyond virtual consultations to include remote patient monitoring, AI-driven diagnostics, and personalized treatment plans. This holistic model aims to bridge the gap between in-person and virtual care, offering patients greater flexibility, accessibility, and continuity of care. By leveraging multiple channels—such as mobile apps, wearable devices, and telehealth platforms—healthcare providers can deliver more efficient, patient-centric services. This is a worthwhile listen from Ayla Ellison and Emma Beavins. #Telehealth #Healthcare #PatientExperience #AI #Transformation

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I'm thrilled that today, we announced a significant milestone for Clover Health: the launch of Counterpart Health. Our innovative Clover Assistant (CA) platform is now available to all Medicare Advantage payors and providers under the new brand name Counterpart Assistant. Why am I so excited about this? This move is a strategic leap forward in our mission to improve healthcare for everyone. With Counterpart Assistant, we're not just expanding our reach—we're leveraging cutting-edge AI and machine learning capabilities that have already proven to make a real difference in patient care. The healthcare landscape is evolving rapidly, and the need for advanced, data-driven tools has never been greater. Medicare Advantage plans, in particular, are under pressure to improve patient outcomes while managing costs. That’s where Counterpart Assistant comes in. By bringing our technology to more providers, we're empowering clinicians with the tools they need to deliver high-quality, personalized care. What makes Counterpart Assistant special? First, we’re broadening our impact by allowing providers outside of Clover Health's Medicare Advantage plan to benefit from our technology. Our hybrid SaaS and shared-savings model aligns financial incentives with health outcomes, ensuring flexibility and scalability. CA’s AI-driven insights enhance clinical decision-making, and are associated with earlier diagnosis and better management of chronic diseases. Plus, we've built a robust support system to ensure seamless integration and ongoing assistance for all users. Clinicians using CA have seen significant improvements in Medical Cost Ratios and patient outcomes. The timing couldn't be better. The healthcare industry is ripe for transformation, and our technology is poised to lead the way. By expanding the use of Counterpart Assistant, we’re not just keeping up with the changes—we’re driving them. Join us on this exciting journey. Visit our website for more details. Thank you for your continued support as we strive to bring high-quality healthcare to everyone on Medicare. #HealthcareInnovation #AI #MedicareAdvantage #ValueBasedCare #CloverHealth

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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.

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This is an interesting article because EHR companies, like Epic and Oracle's Cerner, have made siloing data a major part of their business model. Overall, I like EPIC’s ability to review records from other EPIC shops. It also has a nod to interoperability with its “Care Everywhere“ feature. However, this is often a disorganized and outdated collection of information. Using it requires a ninja level of both tech expertise and medical knowledge possessed mainly by younger physicians and chief residents. I am a fan (and advisor) of companies like Zus Health focused on user-friendly, comprehensive, and up-to-date interoperable health care data tools.

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💡 Insightful article about #telehealth 💡 With all the recent #telehealth companies making #headlines, Joseph Kvedar does a great job outlining some of the #obstacles for making #telehealth an #imperative instead of an option. He sets out a roadmap that identifies ways to overcome the #obstacles to wider and consistent #adoption. https://lnkd.in/ersZAzvH #innovation #healthcare #patientexperience #providers #patientoutcomes

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Here is a healthcare centric lens on the recent piece I wrote for Forbes Technology Council on how AI should dramatically change how we select solutions in the enterprise. For hospitals, which have been behind the curve, its a chance to "skip the landlines" but it requires taking some concrete steps in a different direction. #hospitals #AI #SelectionIsStrategy

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Years ago, CMS forced health systems and ambulatory providers to ONC-Certified EHR technology through Meaningful Use (but also paid for it). Post-Acute and Behavioral Health Providers were not included in this. Today, through payment models being released into the industries (such as GUIDE), CMS is forcing the adoption of Certified EHR technology by requiring it for these models. This is so that organizations can share information and collaborate on patient care in payment models that reward them for doing so. This trend continues for home health with Transforming Episode Accountability Model (TEAM), which provides a new model of care for home health organizations to participate in for 5 of the most expensive surgical procedures that require post-acute care (launches in 2026). From a technology standpoint, an EHR's Certification is only the first step. There are clinical scales, tools, and content to be licensed plus built. Changes to billing functionality. Reporting on measures to create workflows and analytics around the capture on numerators and denominators. Make sure any vendor partners you work with has actually prepared for these things, on top of certification, in the models of care you're pursuing. GUIDE has a profound impact for hospice/palliative care providers by allowing them to be properly reimbursed for taking care of some of nation's most elderly and vulnerable populations. Proud that Netsmart has taken multiple providers on this list LIVE in the last two weeks on the model, operationalizing GUIDE through all of the above in a way that takes care of one of our most vulnerable populations.

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This potential application of CLEAR technology to healthcare is interesting but will it have the intended effect? Will it eliminate multiple entries of the same health data by patients? Will it actually speed the process? Will it make patients happier and improve clinic productivity? The answers to these, like any transformation work, lies in whether or not the health system invests in understanding the patients, people and processes. Then investing in change management and process redesign just like an EMR Implementation. But will they? The technology alone will not be enough. https://lnkd.in/d6vjGPBp HCT Consulting Group

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🔍Is your behavioral health treatment strategy reactive or proactive? Starting May 7th, providers and patients can proactively measure treatment and gain insights into symptom severity with our new Behavioral Vital Signs™ report. As a provider, you'll get a comprehensive PDF report via secure message or right in your EHR. This includes trends for clinically validated surveys, actionable self-report data, and even intelligent passive sensing insights for the last 30 days. As a patient you will receive the same report in the Health Rhythms app, where you can share it with your wider care team and securely review them month over month. It's time to improve our mental health measurement capabilities to enhance treatment strategies and improve outcomes. #DigitalHealth #MentalHealthCare #HealthcareInnovation #PatientCare #healthrhythms #bvs #behavioralvitalsigns

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Value add networks and digital solutions will continue to outpace the need for human capital in healthcare… find the optimal partner

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The California Office of Health Care Affordability has recently approved a requirement that all healthcare providers report their annual operating expenses. If those expenses increase more than 3.5% (eventually lowering to 3%) in a year, that provider will be fined, ironically increasing their expenses. The state claims this regulation is aimed at protecting consumers from high healthcare costs. This is the same State of California that recently raised all healthcare workers' minimum wage to $25 per hour (up from $15.50).  For our health system, that results in a $30 million annual cost increase and a 7.5% increase in our salary costs. This is also the same state that passed an unfunded mandate that requires our system to spend about $1 billion to replace a hospital building that they feel is at risk from damage in an earthquake. And it’s also the same state that increased the cap on medical malpractice lawsuits…and has authorized utility companies to raise their rates 15% per year.  So, with all of these unfunded requirements and policies that dramatically increase providers' costs beyond their control, how exactly does the state suggest that we limit our expense growth to 3% per year?  Healthcare cost inflation has already been running at more than 5% before any of these new requirements took effect. Perhaps if California wants to get serious about reducing the cost of healthcare they might look at the managed care plans. The most recent data I could find from the California Health Care Foundation indicates that California managed care companies made $222 billion in 2020. What direct value did these companies provide to the health of our communities? Meanwhile, hospitals and physicians are providing direct patient care and struggling to survive- especially systems like Kaweah Health that serve a high percentage of Medi-Cal (Medicaid) and Medicare patients.  On a side note, the governor did sign a new managed care organization tax into law this year, which was promised to increase Medi-Cal reimbursements to providers, but all signs suggest that he now intends to use those proceeds (nearly $7 billion) to fill holes in his budget's general fund deficit and will not be providing Medi-Cal rate increases. I would humbly suggest that if the state is genuinely concerned about its residents' cost of living, they might look at the state income tax (highest in the country), its gas prices (highest in the country), the essentially unaffordable housing costs, or countless other factors that will have a larger impact on individuals' pockets than beating up healthcare providers with laws that don't make any sense. #hospitals #california #healthcare

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Join Teresa Younkin as she explores the exciting new features of ChatGPT 4o and its implications for healthcare. Discover how the latest advancements can transform patient interactions and healthcare strategies. - Overview of the new ChatGPT 4o including its ability to understand context and hold conversations. - Demonstration of ChatGPT 4o’s new features, including generating images and providing healthcare advice. - Discussion on how ChatGPT 4o can address common healthcare questions using AI, and its impact on future healthcare consultations. - Insight into the integration of this technology on multiple platforms, enhancing user experience across devices. - Preview of the next episode focusing on a deeper dive into AI features and upcoming announcements from Gemini related to healthcare. Discover the power of AI for your company and embrace the future of healthcare. Get in touch with me today to learn more about how we can work together in creating the strategy and roadmap for your AI efforts. Reach out and let’s talk! https://lnkd.in/efAdNDzd #HealthcareInnovation #Interoperability #DecisionSupport #HealthTech #DataTransparency #HealthcareData #HealthcareCompliance #HealthcareEvolution #PatientCare #healthtech #DataGovernance

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Healthcare CFO Panel Hot 🥵 Topic kicked it off— 🤖 AI—oversight & governance committee, partnerships to help drive innovation & productivity, reviewing use cases Clinical adoption - still a ways to go( ie. ambient listening) Business adoption- going faster but need to ensure it’s reducing costs long term Be methodical and look at incremental gains with focus on sustainability and improving margins overall. This is not a silver bullet but a lever to pull. The future is here now. How are you using AI personally or professionally? Personally, I use it for account research and GTM strategy. #healthcare #hfmaannual #randispeaks

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Healthcare software pricing models: For many health systems, being charged by bed count seems outdated. How does that work for users in non-acute settings? What are some of the preferred models in today's market? Per provider? Net Patient Revenue? Per user of the software? Something else? Hoping to hear discussion from health system members as well as HIT vendors.

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Join Teresa Younkin as she explores the exciting new features of ChatGPT 4o and its implications for healthcare. Discover how the latest advancements can transform patient interactions and healthcare strategies. 👉 Overview of the new ChatGPT 4o including its ability to understand context and hold conversations. 👉 Demonstration of ChatGPT 4o’s new features, including generating images and providing healthcare advice. 👉 Discussion on how ChatGPT 4o can address common healthcare questions using AI, and its impact on future healthcare consultations. 👉 Insight into the integration of this technology on multiple platforms, enhancing user experience across devices. 👉 Preview of the next episode focusing on a deeper dive into AI features and upcoming announcements from Gemini related to healthcare. 🎧 Tune in here for a sneak preview... then go catch the full #replay! Discover the power of AI for your company and embrace the future of healthcare. Get in touch with me today to learn more about how we can work together in creating the strategy and roadmap for your AI efforts. Reach out and let’s talk! https://buff.ly/4a1Oqwf #HealthcareInnovation #Interoperability #DecisionSupport #HealthTech #DataTransparency #HealthcareData #HealthcareCompliance #HealthcareEvolution #PatientCare #healthtech #DataGovernance

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