Taylor Stull

A whirlwind of activity last week at the America's Physician Groups conference. Lots of solid insights shared by health system leaders. Some notable thoughts: +++ Artificial intelligence is intelligent in different ways: By now, we all know ai has a diverse set of use cases, incorporated in different applications and tools. But there are fundamental differences in how the intelligence itself is brought to life. Examples include: - Predictive AI, used to forecast future outcomes by leveraging historical data. Shout out to UCLA’s CKD/ESRD early intervention protocol (Joycee Berin) and Diagnostic Robotics’ intelligence care post-dicharge journeys (Kira Radinsky) - Protocolized AI, used to automating a user’s administrative load by using a set of detailed, pre-defined rule sets. Thanks to ARC for sharing their experience using Elaborate 's automated outpatient lab summaries (Manish Naik) - Generative AI, used to create new content. Great overview of ambient documentation at MGB as well as Cedars’ Sinai talking through its medical ontology model powering acute triage (Caroline Goldzweig) Across system leaders and experts, there was clear agreement that the first step to implementing intelligence intelligently is defining the ‘jobs to be done’. That way, internal and external stakeholders are clear on what they're solving for when they architect the solution.  +++ Scaling AI takes time and rigorous observation: Market leaders describe a phased pilot approach that allows clinicians to build confidence and system leaders to measure ROI before deploying systemwide. Loved hearing Rebecca Mishuris outline MGB’s novel approach of piloting two solutions against one another, to pressure test implementation, workflow, and value creation. +++ Proving ROI continues to be challenging: Lots of vendors using lots of different metrics to prove value, but the majority of leaders agreed that estimating the ROI of these new tools today is part science, part art. Demonstrating the ROI of the “soft” metrics around provider burnout and retention seemed to be a big opportunity, especially for investment in more efficient primary care and PCP wellbeing. After all, PCPs drive referrals to specialty-level care (and higher reimbursements) for health systems. Appreciated Anurang Revri's overview of how working team setup can also impact ROI estimates. +++ Value-based care = tools + humanity: VBC will require not only implementing tools to support clinical documentation, risk capture, upcoding, etc, but also humanizing interactions to engage patients. Countless examples, but one that made me smile was a depression focused chat bot responding in the following interaction: - Context: post-discharge check in Bot: Hi Freida, how are you feeling today after your surgery?  Patient: I’m having a tough time, am in a lot of pain.  Bot: Well, it can’t be that bad, I’m sure it will get better with a positive mindset!    🤣 🤣 🤣 Can't wait for next go-around!

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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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As part of our #M3P solution in JUDI®, the report dashboard gives Medicare Part D #plansponsors insights into payment activity. With all this data at your fingertips, available to slice and dice as you see fit, you can easily visualize and keep track of payment trends. Want to see Ryan Kelly (Chief Technology Officer) run through a live demo of our M3P solution? Check out the replay of our webinar here: https://okt.to/9ZTsSW

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Walmart is exiting healthcare. This doesn’t surprise me. Walmart was never designed for healthcare, it was designed for retail. Everyone wants a piece of the $4T pie, but it’s a pie full of indigestible ingredients that would make the biggest companies choke. Especially companies that were never built for healthcare. - fee-for-service doesn’t work, especially with very low fees - relying on legacy payors doesn’t work - using insurance for primary care doesn’t work - not paying providers enough doesn’t work - having a clinic next to gardening supplies doesn’t work Throwing millions at healthcare doesn’t automatically work with a large base that comes to you for something else. I believe a properly built and well-executed healthcare startup that “thinks differently”, will eventually move the needle on improving the American healthcare experience. It’s coming, and will surprise everyone.

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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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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

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Walmart closing 51 Health Centers over “Lack of Profitability!” Walmart Health Virtual Care (telemedicine) offerings will also end. Article by Daniella Alessandra Genovese Fox Business Network April 30, 2024 MY TAKE: · What does ‘lack of Profitability” really MEAN? o Is it meant that this service line is losing money – financially upside down? o Or does it mean that the line is not producing the “EXCESS PROFITS” that were envisioned - and that corporate leaders and shareholders demand?   ·    Healthcare delivery is NOT a simple business model, though increasingly we see corporate entities entering this arena, often envisioning large profits or - in the case of private equity - valuable ASSETS whose value can be accelerated over short periods - or at least sold off as value-added components.   ·    It has been said that the LURE of ‘excess profit’ invariably leads to GREED, and that in healthcare - greed invariable leads to worsening conditions within healthcare workplaces and worsening outcomes for patients! American Medical Association American Hospital Association American College of Emergency Physicians U.S. Senate Committee on Health, Education, Labor, & Pensions Tennessee Medical Association Jesse Pines Chadd Kraus Lara Vanyo Rita Manfredi TENNESSEE COLLEGE OF EMERGENCY PHYSICIANS Timothy Wilson Ryan Stanton Gabe Kelen, Deidre McPhillips Mollie Pillman Alison Haddock, MD, FACEP Susan Morse mor Chelsea Torres Amy Feldman Jesse Ehrenfeld MD MPH Mel Cortez Larry Bucshon, M.D. Peter Stavros Fox article link - https://lnkd.in/gynsbScT

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🤔 What do you know about healthcare administration? 🤔 #claimsadjudication #thirdpartyadministration #specialtyinsurance... :) Andrew Munroe, Senior Vice President of Operations, Pharma, and Payor Partners at NexgenRx Inc. joined us on the latest episode of the Health Tech Horizons Podcast to share industry insights, and the latest trends shaping the future of healthcare administration. Join us as we explore the intersection of insurance related technology, innovation, and healthcare with NexgenRx Inc. and Andrew Munroe. ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ 📲 CHECK OUT the VIDEO 📺 ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ ⚡

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Commons Clinic holds a simple goal: kill the health system. Easier said than done, but they make a compelling case. Commons Clinic is creating a vertically-integrated enablement player in the orthopedics space to disrupt the health system via a 5-step playbook👇 #1: Win Physician Hearts, Minds, and Checks Commons Clinic offers orthopedists equity and control, fostering wealth-building opportunities outside of a traditional PE rollup, or hospital employment. The current productivity based comp model lends itself to overwork and burnout. We need new pathways for physicians to find agency and good partners, but also to reform physician compensation to drive the right behaviors. #2: Rethink the Facility Stack Commons Clinic is redefining episodic specialty care with a streamlined vertical system that fosters ownership of the entire patient experience and processes (enhancing care quality, patient coordination, and appealing to payors & employers with high margins). By leveraging high-quality outpatient assets, Commons Clinic can operate efficiently without legacy health system overhead...which is how they can gain an edge in orthopedic care. #3: Put a Price on it (Bundles) Commons Clinic offers bundled orthopedic care, generating savings and nice margins for both Commons and physicians. If you can optimize for every part of the facility stack with today’s tech and best practices outside of a legacy hospital expense structure...AND ALSO leverage that artificially high pricing to negotiate your bundle, you can start generating material value. The economics work here as long as you can deliver. #4: Rinse & Repeat As Commons Clinic evolves, it plans to tap into other specialties and procedures suitable for bundled care, deploying quality standards and demonstrating bundled offerings' value to payors across diverse markets. #5: Win the Brand War Commons Clinic prioritizes trust and transparency, adopting a patient-centric approach akin to One Medical's ethos. In healthcare, trust is hard-won and easily lost. Prioritizing quality, Commons Clinic rejects rapid expansion in favor of sustainable growth that prioritizes customer lifetime value. Now of course, there's plenty of execution risk involved at every step of the playbook, but we're seeing more and more competition facing health systems. Adapt or die! I had a ton of fun writing this one with major help from Nick Aubin-thanks to the whole Commons Clinic team for the insights and access! For more on The Commons Clinic, check out my recent newsletter here: https://lnkd.in/gVyeZQgw Looking for even more healthcare industry news and analysis? Subscribe to Hospitalogy, my 2x/week newsletter. Join 30K+ other investors, executives, and healthcare pros: https://lnkd.in/gbUGMuPF

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This is an excellent summary and a structure that I have implemented at all of my companies. Seperating revenue from account management seems foreign to so many, but it is a key element to success IMHO. As always Eric Bricker, MD makes the complex seem so simple!

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At TPN.health we are a mission-first company. Our goal is to improve patient outcomes.That means, every decision, every piece of code, and every product we launch is rooted in answering these questions: How does this serve our mission? How does what we're building improve behavioral health outcomes? How can we positively impact and create change in our industry?

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Privia Health had a solid start to 2024 with continued growth and execution. One notable trend is Privia's pullback on capitation. Privia wants to be thoughtful about taking full risk - in markets and scenarios where it makes sense (and it's profitable of course). Flexibility is built into Privia's operating model, and you can see the levers being pulled in Q1 and in 2024 given significant MA headwinds. You can see the pullback in value-based care revenue in Q1 2024 in a chart below. By the way - what do you guys think of the new one-pager format?? If you like these, you'll love my newsletter. Subscribe here! https://lnkd.in/gniNmHvz

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Yep, it takes lots of hard work as well as perseverance and persistence combined with great talent and luck to have a chance to be successful in the healthcare space. Not the least being spot on timing. Today’s healthcare scene is fraught with ever increasing demand and dwindling supply. I spent 50 years in both the tech sector and services sector with some very good outcomes and some marginal ones. I have enormous respect for those in management and those financial sponsors willing to take pretty significant risks. For as expensive as healthcare spend is today it’s only get worse and not better but with very marginal returns. The fact that a company the size and magnitude of Walmart shut down its healthcare speaks volumes. I for one expected a much different outcome but their departure puts a definite marker on just how challenging this healthcare industry is today. My answer to solving it is pretty straightforward, change, sacrifice and move quickly on any front where progress isn’t inevitable.

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Mandatory bundles in surgery are a bi-partisan objective, and (in)ability to optimize cost/quality will dramatically impact hospital P&L. Regular insights from granular data , and AI-based decision support are the only way to systemically reduce unwanted variability and be both profitable and high quality.

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Investing in preventative health tech platforms requires a strategic approach that balances potential returns to improve public health outcomes. One key consideration is the platform's scalability, as scalable technology can serve large populations, achieve widespread impact, and maximize financial returns. This also makes scalable platforms more attractive to healthcare providers and payers seeking cost-effective preventative measures on a broad scale. To learn more about investing in scalable health tech platforms, read the full article. https://buff.ly/3wswQ67 #healthtech #investing #AIwellness #digitalhealth #ecommerce #investmentstrategies #wellnessindustry #AItechnology Subscribe to the Evolving HealthTech newsletter here: https://buff.ly/44pGPE0

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The benefits of DROPPING BlueCross BlueShield as a payer.... One of our clinics at StrataPT was seeing 3,000 BCBS visits. Here's the result if they dropped them right now - Save $300,000 - Drop 1.2 full-time employees - Downsize clinic size - Pay less rent - Profit margin goes from 9-12% to 20-25% Now if they successfully negotiate their BCBS contract up even $10 it's a totally different story. The point is you MUST evaluate the pros and cons of dropping a payer...even if it's a big one like BCBS. Agree or disagree? #physicaltherapy #healthcare #healthcaretechnology #occupationaltherapy

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💯agree with Dr. Mehta and to quote her: Healthcare is broken, and those that are in it understand why. Patients need - and deserve - quality health care. This requires safe staffing practices, skilled clinicians who can feel good about what they do, and insurance companies that pay their bills. We can’t have a system where insurance companies can get away with record profits while finding more and more reasons not to pay for care and eroding away at the heart of healthcare. You cannot scale your way out of America’s healthcare problem. You actually need to fix the incentives, regulate insurance companies, pay clinicians appropriately, prioritize clinician well being and retention, and focus on the patient. The days of paying lip service to physicians leaving medicine and physician burnout are numbered. Supply and demand forces will necessitate real solutions that move the needle.

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Quarterly Q&As are out! These are mini refreshers or clarifiers for everyone in the home health industry! Question 1 is GOLD for businesses like ours. Question 1: A third-party external auditor consistently states that our OASIS functional status items are “underscored” and recommends changing the responses to the OASIS items. Is the assessing clinician required to accept the auditor’s recommendations? Answer 1: While a home health agency may use third party external auditors to review OASIS coding and make recommendations, the assessing clinician is responsible for determining OASIS coding based on their assessment. We often get clinicians who don’t understand the reasoning or rationale. The longer or more detailed it is— consider it unread. That is NOT compliance. Truth be told, most of the clinicians are reviewing these changes in the field or at home after a 10 hour home health shift. Their brains are at capacity for receiving more info. I should know, I was one of those clinicians. Family time is now met with 6 inch long “yellow sticky notes”. That’s why most of these clinicians have my personal email and phone number. I thrive on educating and so I always encourage them to “call me with questions”. You’ll usually find me at 9pm explaining why M2020 is likely marked as 3 if M1860 is stating patient requires assistance or supervision of another person at ALL times during ambulation. What’s your consultant team doing to bridge the gap between making clinicians aware of changes made and EDUCATING on changes being made? Contact me for more info on how C&C Strategic Consulting can assist your agency!

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