Thomas Chamberlain, PharmD

🙏 Cigna ER Analysis Updated - Thank you LinkedIn Network! 💡Split Analysis between Professional vs Institutional Rates 👉Prof = Up to 58 X Medicare, Inst = Up to 95 X Medicare

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In the face of ongoing challenges, such as the recent shortages of FDA-approved GLP-1 medications (eg, Ozempic, etc), compounding pharmacies like Empower Pharmacy are stepping up to fill critical gaps. 💪 Our compounded medications are not only tailored to meet individual needs like allergies and dosage adjustments but also ensure that patients continue to receive essential treatments without interruption. Also, compounded medications are way more affordable. 💰 We're committed to personalizing healthcare solutions. By providing alternative forms and custom dosages, we make sure that everyone has access to the medications they need, exactly how they need them. Learn more about what we do --> https://lnkd.in/g_XRaHcM If you want to chat about it, DM me! #medicationshortage #healthcareinnovations #GLP1s #weightloss #diabetes #healthcaresolutions #houston #integrativehealth #access

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AccendoWave - A Pain #Data Company More recently, the federal government has begun using the QIS program and QRS parameters to advance health equity. Federal rules now require all marketplace insurers to adopt a strategy for reducing health disparities and to stratify certain clinical data by race and ethnicity. While state-based marketplaces (SBMs) have authority to supplement these federal minimum QIS and QRS standards with state-specific quality rules, most have hewed closely to the federal default approach. California and Washington are notable exceptions. Each has implemented a customized QIS program and robust data collection standards to identify and reduce racial and ethnic health disparities. Time to Focus on - #Pain not being Believed. A Root Cause Health Equity Problem. A Top 4 Global Health Equity Solution and Top 15 Global Remote Monitoring Company, AccendoWave, benchmarks objective brain wave pain data (specialty, gender, age) and has nine #pain databases: Emergency Department, Maternal Health, Oncology, MSK, Medical Surgical, ICU, #Women, Adults, #Seniors to eliminate bias, improve outcomes and reduce health care costs. If desired, AccendoWave can also create customized pain databases for partners that can be accessed on the Datavant platform.

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Blue Health Intelligence, a data analytics and software company, undertook an evaluation of almost 170,000 unique GLP-1 users for weight loss, notes less than half of those prescribed stay on the medication for 12 weeks or more. Younger adults were less likely to continue the drug, whereas those who were prescribed the medication by an endocrinologist or obesity medicine specialist were more likely to continue for longer. Indeed, this data states 30% of patients dropped out of treatment after the first four weeks, and 58% at 12 weeks. Those who dropped out are unlikely to achieve clinically meaningful weight loss.  The likelihood of continuance was further exacerbated for those with health inequities or who lived in underserved health regions. The data comes from Blue Cross Blue Shield Association members participating in Plans that provided coverage of these products, from 2014 through to end of 2023. Razia Hashmi, vice president for clinical affairs at Blue Cross Blue Shield wants to ‘…paint a clearer picture of what makes somebody successful.’ The missing piece here is why the patients stopped – side effects, failure to achieve initial weight loss, stigma and discrimination, or coverage issues related to cost and access. My longtime friend, colleague and bariatric surgeon at Stanford University, Dr. Dan Azagury rightly states ‘…The goal is for patients to stay on this for a significant amount of time. Most likely… beyond 12 weeks.’ https://lnkd.in/ediQskQx

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If health systems master the art of delivering a world-class consumer experience in urgent care, they can replicate this success across their entire operation, becoming market leaders and thriving in the long term. This is the core thesis of what we do at UCP Merchant Medicine. For nine years, UCP Merchant Medicine has partnered with 68 healthcare operators, most of whom are health systems, to create internal capabilities that allow them to thrive in consumer experience excellence. This isn’t just about having a world-class urgent care platform, this is about owning the future and the capabilities to expand these experiences across the broader health system. As healthcare shifts towards a consumer-driven model, the need for health systems to adapt is more critical than ever. Patients now have unprecedented freedom to choose their care providers, with 45% researching providers and costs before choosing a health plan, and 44% before making an appointment, according to McKinsey’s consumer Health Insights Survey. These improvements are not just numbers; they're about real people getting better access to the care they need when they need it in a way that they will love. This is what we stand for at UCP Merchant Medicine. Join us as we continue to innovate and lead the way in making healthcare more responsive, efficient, and patient-centric. Together, we can transform the future of healthcare! #HealthcareInnovation #PatientCare #UrgentCare #HealthcareLeadership #UCPMerchantMedicine Intellivisit Solutions

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🌟 Exciting Insights from the Latest Harvard-Inovalon Medicare Study! 🌟 As professionals in the Medicare Advantage space, we’re always on the lookout for data that underscores the efficacy and efficiency of MA plans. A recent study by Harvard and Inovalon has brought some compelling findings to light, showing that Medicare Advantage not only reduces healthcare expenditures but also maintains high levels of care compared to traditional Medicare Fee-for-Service. Here are some key takeaways: - MA enrollees experience over 50% fewer inpatient stays and 22% fewer emergency visits compared to FFS, with no significant reduction in primary care or prescription drug services. - Overall, MA shows a 12% reduction in health expenditures, highlighting its efficiency in managing healthcare resources. At Sonder Health Plans, we're proud to say that we're already implementing many of the strategies that make Medicare Advantage so beneficial. Our focus on care coordination and preventive care isn’t just about keeping costs down—it's about providing a foundation for healthier, happier lives for all our members. This study reinforces the value of the Medicare Advantage program and the potential for more innovative, cost-effective care models. Let’s continue to push forward, driving improvements that matter. #MedicareAdvantage #HealthcareInnovation #SonderHealthPlans

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Also don’t outsource your hospital’s core services to a GPO ran by foreign PE… I do find it so odd that Vizient’s own contracts couldn’t stand on their own so they had to create a aggregation group with Mayo Clinic called Capits. (https://lnkd.in/gpiVDKvn) Which by the way Mayo Clinic is being sued because not only does Mayo control pricing on supply chain contracts for Vizient, but guess who controls pricing on their self insured insurance plan. (https://lnkd.in/guvx5mqr) Oh and as of November of last year Mayo Clinic lead their state in adverse healthcare events. (https://lnkd.in/gXsPi2sw) Should I go on or have I made my point clear on why Oklahoma hospitals should not blindly follow Vizient, Captis, and the Mayo Clinic?

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https://lnkd.in/gTQCC2at Customer experience matters. CVS understands this. There is tremendous burnout on the part of pharmacists, and customers want more out of their interactions. Using AI to take out the administrative burden and enable more human touch between pharmacists and customers is meaningful.

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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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I’ve been given advice that the fastest way to monetize HER Heard without charging the end user (woman) is trackers and selling data. Instead, I’d like to build something more trustworthy. I don’t want to be in a headline like this. If you are not paying, then you are the product (you/your data are being sold). There are newer ways to deindentify data or even to aggregate things women search for that can be of interest to various stakeholders. In theory that could be okay to sell, but in a post-Roe world with laws encouraging bounty hunting, I am vetting the choices ahead. I am all for moving fast, without breaking things.

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Please consider the following. The 340b drug program is a well-intended public policy with unintended consequences. It is a $55 billion net revenue flow to all the intermediaries with little evidence that it is shared with the patients it was designed to benefit. Here are some suggestions for reform by Lown Institute. 8/23 "But there are ways that 340B could be tweaked to optimize the benefit for low-income patients and the hospitals that serve them. In a recent Viewpoint article in JAMA, Dr. Sanjay Kishore at The University of Alabama, Dr. Rahul K. Nayak at the Emory University School of Medicine, and Dr. Aaron S. Kesselheim at Harvard Medical School explore policy solutions to improve oversight and eligibility for the 340B program. Here are a few of their proposals: Alter eligibility requirements for hospitals to redefine “ *safety net” hospitals beyond disproportionate share percentage, to include other criteria such as “measures of uncompensated care and area socioeconomic disadvantage.” *Offer 340B discounts on a sliding scale based on hospitals with the neediest patients, rather than having 340B eligibility be “all or nothing.” *Add more reporting requirements and utilize audits to better understand how 340B hospitals are using their discounts and gain more data around whether these discounts are being passed along to patients. “ Instead of heeding calls to cancel the program amid growth, policymakers should consider reforms that better ensure 340B benefits are targeted toward people with the most need. It is the least patients, clinicians, and health care facilities deserve.” "The 340B contract pharmacy market shows little sign of slowing down. Drug Channels Institute’s exclusive analysis of the 2024 market reveals that: About 33,000 pharmacy locations—more than half of the entire U.S. pharmacy industry—act as contract pharmacies for the hospitals and federal grantees that participate in the 340B program.  Five multi-billion-dollar, for-profit, publicly traded pharmacy chains and pharmacy benefit managers (PBMs)—Cigna (via Express Scripts), CVS Health, UnitedHealth Group (via OptumRx), and Walgreens, Walmart—continue to dominate the 340B contract pharmacy market. Federal grantees are aligned primarily with the vertically intergated organizations' retail pharmacies, while hospitals rely on mail and specialty pharmacies. Over the past four years, manufacturers’ restrictions on 340B contract pharmacies have led hospitals to deepen their relationships with the largest PBMs—even as those PBMs have simultaneously limited hospitals’ direct participation in specialty pharmacy networks." Adam FeinShawn GremmingerStacey RichterJeffrey HoganGe BaiChris DeaconScott Conard, MDRob Marty, DBA, MHADave Chase, Health Rosetta-discovering archaeologistDan BurkeChris SkisakStacy MaysAnn M. Richardson, MBA https://lnkd.in/g_dtN8Mm

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Many will see Walmart’s exit from direct care as yet another indication that #healthcare is an endeavor that requires domain expertise not easily replicated by retail or technology leaders. On some level this of course is true, but I believe another less obvious, but equally important factor must be considered. Effective and highly successful #healthcare organizations and operations build on and draw from, deep community-based provider relationships that are not easily created with a big-box approach. Fierce Healthcare https://bit.ly/4bgfyaS

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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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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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Telehealth is critical to providing access to care and reducing the overall cost of care. It also supports the anytime/anywhere care model. Consumers, in addition, continue to provide feedback that their virtual care experiences are highly valued. It is important that we make the temporary telehealth regulations put into place during the pandemic permanent so that we can continue to improve care and wellness. #virtualcare #telehealth #patientexperience https://lnkd.in/gN9gVtZv

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This post highlights the need to revamp the 340b program to eliminate any misconduct, as mentioned by the original poster. The key findings from the study suggest that public hospitals are the only health systems using excessive profits in a way that aligns with the original intention of Congress, which is to support providing access to services for our most vulnerable populations. Ge BaiAnthony DiGiorgio, DO, MHAStacey RichterScott Conard, MDShawn GremmingerLarry BeckerChris DeaconLee LewisAl Lewis 🇺🇦Jeffrey Hogan Key Points Question  Does the US 340B Drug Pricing Program enable participating hospitals to sustain access to hospital-based services and how does hospital ownership affect the influence of 340B participation on hospital service offerings? Findings  This longitudinal observational study including 2152 general acute care hospitals found that public hospitals were significantly more likely to sustain unprofitable services after 340B participation, but there was not a meaningful association between 340B participation and service offerings at nonprofit hospitals, except for oncologic services. Meaning  These findings suggest that participation in the 340B program enables public but not nonprofit hospitals to sustain unprofitable service lines, such as psychiatric services.

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Primary care providers and CalAIM service providers able to capture data, interpret trends, and translate information to delivery enhancements, quality & social gap closure, and care team feedback loops will be positioned to come out of the CalAIM waiver ahead of the curve. Read this article by COPE Health Solutions expert, Evan King, to learn of key considerations on strategies for provider value and proposition. https://lnkd.in/gxgxFDss #healthcare #valuebasedpayment #CalAIM

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#RevenueCycleManagement in #Healthcare is critical for the long-term wellness of a healthcare organization. Here's my interview with Medhealth Outlook on this important challenge. #Thoughtleadership #Thoughtleader #Leadership #BreakfastLeadership

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