Curbside Consult with Dr. Jayne 6/23/25

You really don’t know how much you rely on certain technologies until they’re not available.

At one of our local hospitals, a PACS upgrade during daytime hours threw quite a few clinicians for a loop. I don’t think the IT teams really understood how important muscle memory is for clinicians who are trying to work efficiently in the EHR while seeing patients. Although a workaround was provided, it required physicians to go to a different part of the EHR to view images.

It sounds like some users had security issues and weren’t able to do their work from the new location, which caused frustration that was made worse by long wait times when they called the help desk. Even for those who were able to use the new link to access images, there were complaints that it took half the shift to get used to the new workflow. Later in the evening, it reverted back, which required another shift.

I’ve done plenty of upgrades in my career and I’m not sure what would be happening behind the scenes that would justify doing an upgrade during daytime hours. Most of the upgrades I’ve been involved in were conducted overnight so that they caused minimal impact to clinical workflows.

Based on the fact that nearly all of the IT decisions I’m seeing lately are made with significant attention to cost, I can hypothesize that it likely played a role. Still, I wonder if the people looking at that cost-benefit equation looked beyond the IT resources to include the cost for clinician inefficiency and the risk of clinical quality issues.

A colleague shared the downtime notification with me because they knew I wouldn’t believe it otherwise. I was surprised to see that it included mention of another clinical system that was being taken down from midnight to 2 a.m. the following weekend, so I’m sure there was some reason that this one was being done during peak hours.

If I had been on the leadership team that approved the communication, I would have recommended a mention of why we were doing the upgrade during the day. Users would at least understand that we had thought about them and were forced by extreme circumstances to do it that way.

I also was a fan of running our communications past people in different settings before finalizing them — including academic physicians, hospitalists, and community physicians — to make sure that we were covering all perspectives.

Just out of curiosity, I looked back through some communications from one of my hospitals to see if I could identify patterns from the biweekly newsletters. I was surprised to see that the newsletter had the same top blurb over a six-week period without any changes, which to me would create a risk for people ignoring the newsletter because they may have felt like they had already seen the materials.

I also noticed that over the last six months, the newsletter had become a compilation of unrelated blurbs rather than a more cohesive document. In the current version, each entry had different font and color schemes, including color choices that don’t meet accessibility guidelines for colorblindness. It also looks like it’s in a different order every time, with no standard formatting.

I would think that adding a framework to it might be useful so that people can quickly identify the items that are important to their work. Maybe start with a section for global updates that impact everyone, then move to updates by specialty, care setting, or a host of other categories that would keep people from having to wade through tons of irrelevant information.

I thought about offering some feedback (after all, I’m still a dues-paying member of the medical staff) but there wasn’t any information in the newsletter about who to contact if you have questions. I’ll just stay in the back row with my “Courtesy/Non-Admitting” privileges and hope I don’t have to look at any patient charts any time soon.

I have several major presentations coming up. For once, my week wasn’t completely full of back-to-back meetings. I decided to do some personal development while I was creating the slide decks and see what AI has to offer.

I try to make my slides as non-wordy as possible, often choosing images that tell a story, or images that prompt me to talk about certain content rather than having too many formal text elements on the slide. I always create an outline-style summary first, so it seemed ideal to be able to take that outline and hit it with some AI and maybe save a little time. I tend to be a little stuck in my ways about backgrounds and formatting, so I was looking forward to spicing things up a little bit.

Unfortunately, what my AI friend came up with was entirely unusable. Not only did it just drop the outline into slides in a somewhat disjointed fashion, but the backgrounds it selected bloated a 25-slide deck up to over 80 MB in size. I could see that being possible if I were incorporating high-resolution radiology images or something like that, but this was just from backgrounds and non-critical design elements.

I guess I’m back to creating my presentations in the old-school way, at least until I have time to research whether there is some other way to use the tools differently, or until one of the savvy college interns agrees to give me a quick tutorial on how to not wind up in that place again. When I finished that slide deck in my usual way, it ended up well below 2 MB, so I’m still not sure what happened the first time around.

One of the presentations I was creating was for first-year medical students, introducing them to clinical informatics and explaining the kind of work done by physicians in this space. The incoming students are coming into an educational environment that’s so different from where I trained, and I have to say that I envy them a little bit. Here’s to hoping that I don’t wind up being talked about as someone who was out of touch or uninteresting. Fortunately, my session is a lunchtime one with free food, so I don’t think attendance will be a problem.

If you could go back in time to when you were first learning in your field, what do you wish you had done differently? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Modernizing Healthcare’s Third-Party Risk Approach

Modernizing Healthcare’s Third-Party Risk Approach
By Ryan Redman, JD

Ryan Redman, JD is product manager of marketing at Onspring.

Oracle Health’s announcement of its second data cyber incident in March of this year shocked healthcare providers and customers. Even more alarming was the specific data was impacted that is housed in its legacy cloud infrastructure.

According to publicly available information, approximately 6 million records containing protected health information (PHI) were likely compromised despite Oracle’s attempts to downplay the severity of the potential compromise. The repercussions left hospitals struggling to identify exposed data as the incident reminded compliance officers of the challenge of considering all data outside of centralized oversight, including legacy infrastructures, when accounting for third-party risk.

Many of these healthcare compliance professionals must rely on third-party risk strategies with limited visibility into the many networks of contractors, partners, and hosted environments that they are tasked with managing. Beyond compromising legacy infrastructure data, Oracle’s cyber incidents exposed the damaging compliance gap in how healthcare organizations manage third-party relationships. Healthcare compliance teams must adopt real-time, integrated GRC tools that boost visibility, reduce manual work, and enable proactive risk response to close this gap and protect their data.

The Hidden Dangers of Legacy Infrastructure and Outdated Third-Party Risk Strategies

It’s easy for legacy systems to fall by the wayside within healthcare’s intricate network of active systems that span internal platforms, external platforms, and cloud-hosted data. Using third parties only heightens critical risks. In Oracle’s case, the servers had not yet fully migrated to the company’s new environment, leading attackers to exploit compromised credentials to access those systems. Teams overlooked what appeared to be outdated, dormant infrastructures. Bad actors accessed sensitive data, and traditional assessment methods were unable to detect this risk.

Healthcare organizations face serious compliance consequences when third parties fail to safeguard patient data, whether due to misconfigured access, missed vulnerabilities, or neglected systems. In 2024, the healthcare sector emerged as the most targeted industry for data breaches, proving that third-party risk assessments are not cutting it. Often only conducted periodically and involving emailed surveys, spreadsheets, and disconnected records, these assessments result in hours of manual work and provide a limited, static view of risk. Outdated methods fail to catch emerging vulnerabilities in legacy systems over time. Risks often materialize by the time the next scheduled compliance review comes, meaning sensitive data has already been exposed.

Five Essential Steps to Improve Compliance Oversight

Healthcare organizations must take action to strengthen their third-party risk posture, and the following actions can help turn policy into practice.

• Create a single source of truth for evidence and documentation. A secure, centralized repository ensures that materials that are relevant to organizational compliance are version-controlled and always accessible.
• Track and classify third-party integrations and engagements. Different use cases with the same third parties can carry varying levels of risk. A clear inventory with engagement-level context supports more accurate classification and visibility.
• Automate risk scoring and review cycles. Configurable scoring models based on regulatory frameworks allow compliance professionals to consistently assess third-party risk without manual intake processes.
• Move from periodic reviews to continuous oversight. Periodic reviews leave critical gaps in risk oversight. Real-time alerts through continuous monitoring flag when risk scores increase with new findings.
• Develop response plans for third-party risk. Organizations must regularly test even the most comprehensive risk programs through tabletop exercises or simulations.

Ultimately, maintaining trust is vital to compliance, and losing it comes at too high a cost.

Readers Write: Beyond Self-Scheduling: Analysis Shines Spotlight on The Future of Patient-Driven Access

Beyond Self-Scheduling: Analysis Shines Spotlight on The Future of Patient-Driven Access
By David Dyke

David Dyke is chief product officer at Relatient.

“Access to care” has become a central theme in healthcare leadership discussions. While the term “access” can mean many different things in healthcare, it begins with the patient.

A new nationwide analysis of self-scheduling tool usage underscores a shift occurring in the industry that provider organizations must acknowledge and act on to stay relevant: patient-driven access. Findings across more than 150 million patient bookings reveal a 30% year-over-year uptick in patients who booked appointments through digital self-scheduling options from 2023 to 2024.

Patient interest in self-scheduling is likewise driving adoption from healthcare organizations. The analysis further revealed a 53% increase in implementations of self-scheduling tools across a wide variety of healthcare organizations and specialties.

Self-scheduling has evolved into an essential access tool for today’s practices that are striving to meet rising patient expectations. The key is making the right investments upfront to ensure that organizations reap the full benefits of patient-driven access. Early adopters stand to not only delight patients, but also to realize significant operational value and bottom-line impact – such as 24/7 patient access and new patient acquisition — faster.

Understanding Increased Adoption of Self-Scheduling

Patients increasingly prefer digital self-scheduling options, with an overwhelming desire for improved digital self-service. As the first touchpoint in the patient journey, scheduling has a critical impact on overall patient experience.

Consumerism trends point to the need for greater convenience and empowerment. This means manual processes that require having to call multiple times or wait on the phone to schedule an appointment are quickly being replaced with digital solutions by today’s healthcare organizations.

Healthcare leaders value the patient experience advantages of self-scheduling. They also gain operational efficiencies and greater revenue opportunities. Data uncovered from the analysis revealed:

• A 50% decrease in no-show rates for self-scheduled appointments.
• A 21% reduction in cancellations when self-scheduling is used. The reduction was 30% for established patients.
• Two-thirds of appointments that are booked through online self-scheduling are for new patients.

These numbers significantly highlight ongoing industry opportunities to improve no-show rates and appointment cancellations.

Expanding the Impact of Self-Scheduling

Putting patients in the driver’s seat is a start, but the future of self-scheduling optimization relies on more intelligence and integration across the entire patient journey. Organizations can expand the impact of these tools by:

• Integrating full-service scheduling APIs to meet patients where they are. These open scheduling APIs provide flexibility for healthcare organizations to scale access points across diverse channels, automating key scheduling functions across a variety of new and existing patient touchpoints, including virtual agents, AI-assisted chatbots, third-party apps, financial clearance processes, and virtual care platforms. By supporting a self-service, multi-touch model, these tools empower patients to take control of their care journey. Many organizations struggle to deliver this model due to disconnected systems, but tightly linked, multi-channel functionality allows patients to bypass long phone queues and enjoy a more seamless experience, while providers gain better system interoperability and operational efficiency.
• Transforming staff and patient experiences by automating common appointment management tasks with AI-driven voice solutions. New Voice AI tools integrate seamlessly with existing scheduling systems, taking on repetitive, high-volume inquiries, such as appointment rescheduling and cancellations, so that staff can focus on more complex patient needs. By deflecting calls and reducing hold times, these tools not only ease operational strain, but also enhance the patient experience with immediate, conversational support that is available 24/7.
• Driving action and education with integrated scheduling across the patient journey. Digital patient communication should not only inform —  it should drive action. By embedding scheduling functionality into key communication touchpoints, such as appointment reminders, referral activation, and rescheduling workflows, organizations can support patients with timely next steps. This creates a more seamless and scalable access model.

Whether booking a single primary care visit or managing ongoing specialty care, patients benefit from convenience and autonomy, while providers see increased appointment adherence and streamlined operations. Consequently, providers should think beyond traditional scheduling within the call center by embracing self-scheduling and the scalable infrastructures that are needed to support success for the long-term.

As the future of patient access continues to unfold, with more and more power placed in hands of the patient, a single self-service touchpoint won’t be enough. Savvy patients will come to expect a seamless, interconnected experience at every step of the way.

Expanding patient self-service functionality now allows organizations not just to keep up, but to actively fulfill the future of patient access, leading the pack in both patient access performance and operational efficiency.

Morning Headlines 6/23/25

Insurers Pledge to Ease Controversial Prior Approvals for Medical Care

Major US health insurers pledge to improve prior authorization practices, noting that they are aiming for 80% real-time decisions by 2027.

NM Vintage Fund Invests in Electronic Caregiver to Strengthen Expansion of Leading Virtual Care Ecosystem

New Mexico Vintage Fund invests in New Mexico-based Electronic Caregiver, which specializes in virtual care and remote patient monitoring technologies.

Enhancing the provider search experience through Smart Choice

UnitedHealthcare announces AI-powered provider search for members.

Monday Morning Update 6/23/25

Top News

Major US health insurers pledge to improve prior authorization practices. They aim for 80% real-time decisions by 2027, fewer procedures that require approval, and 90-day care continuity for patients who switch plans.

Insurer trade group AHIP says that it understands patient frustration. It did not mention mounting regulatory and political pressure.

Insurers blame half of PA delays on providers who submit requests via mail, phone, or fax. They say that they will help those providers transition to electronic submissions.

Reader Comments

From Frank: “Re: AI. Is a vendor’s platform AI-enabled just because the junior PR person used ChatGPT to write the press release?” AI-crafted announcements and lengthy punditry articles on social media – which are easily recognizable, by the way – are starting to get annoying. The AI versions are just a bit too polished, soulless, and peppered with em dashes and overly dramatic recitation of background facts that often contain hallucinations.

HIStalk Announcements and Requests

Few poll respondents think more highly of Oracle Health now than in the pre-acquisition days when it was Cerner. I ran this same poll one year ago and the numbers were identical, so at least they’re holding steady. It has been three years since EVP Mike Sicilia promised the Senate Committee on Veterans’ Affairs that it would “start over” in rewriting Cerner’s pharmacy module in 6-9 months.

New poll to your right or here: How concerned are you that AI will diminish or eliminate your job within five years? The poll results may be tricky to interpret. People who are convinced that their role requires their unique insight, nuance, or relationship skills are possibly like medical transcriptionists in failing to see what’s coming. I might get more objective responses if I instead asked if AI could eliminate the job of co-workers or direct reports. I’ll predict with admittedly superficial insight that the first health tech jobs to be affected will be prior authorization specialists, records retrieval and chart abstracting folks, RCM coders, marketing staff, and call center / help desk people.

The onset of summer means that we offer incentives for companies who can take their minds off vacations and beach weekends and make the decision to sponsor HIStalk. I don’t discount normal sponsorship cost because that wouldn’t be fair to existing sponsors, but we will usually offer one-time extra months, webinar exposure, or email messages, not to mention special offers for startups or former sponsors who rejoin the fold. Contact Lorre.

Sponsored Events and Resources

None scheduled soon. Contact Lorre to have your resource listed.

Acquisitions, Funding, Business, and Stock

Business Insider describes the “New Mountain special” for VC firms, as private equity firm New Mountain Capital is acquiring and rolling up health tech AI companies that are unlikely to IPO or be acquired. The firm operates more like a venture studio, targeting higher-risk innovation with larger investments, minimal debt, and a focus on long-term value creation. Some of its big deals involve Datavant from its acquisition of Ciox Health and its recent combination of Access Healthcare, SmarterDx, and Thoughtful AI to create RCM technology vendor Smarter Technologies.

Ohio’s attorney general conditionally approves the $485 million acquisition of Akron-based Summa Health by a business venture that is owned by VC firm General Catalyst.

Non-profit, money-losing Ascension will acquire Amsurg, which runs 250 ambulatory surgery centers in 34 states, for $3.9 billion. Bring on those facility fees.

People

SmarterDx hires Kit Kieling, MD (Orderly Health) as CMIO. He is an Air Force veteran and US Air Force Academy graduate who volunteered to serve as a pediatric ICU director for host-national children in combat field hospitals in Iraq and Afghanistan with the 332nd Expeditionary Medical Operations Squadron.

Dan Phippen (R1 RCM) joins Evergreen Healthcare Partners as chief growth officer.

AdventHealth hires Erica Williams, MBA (Ascension) as VP/divisional CIO.

Announcements and Implementations

UnitedHealthcare announces AI-powered provider search for members.

Epic summarizes some of the main points it made in its response to HHS’s RFI on health tech interoperability and infrastructure.

Humanate Digital pilots its AI front desk receptionist. The assistant checks patients in for clinic visits and adjusts its tone based on patient facial expressions. Other versions handle medical records requests and billing.

Government and Politics

Every newborn in England will have DNA screening within 10 years to allow NHS to predict and prevent disease and personalize treatment.

Other

Hartford HealthCare installs an OnMed CareStation in Bradley International Airport, the first such device to be placed in a US airport. The health system hopes to attract six patients per day to the CareStation, which accepts insurance and cash payments.

Sponsor Updates

• Healthcare IT Leaders staff volunteer at Children’s Healthcare of Atlanta.
• Capital Rx releases a new e-book titled “Why Savings Don’t Materialize: The Truth About Pharmacy Benefit Procurement.”
• Optimum Healthcare IT releases a new episode of its “Visionary Voices” podcast featuring Mike Mosquito.
• Rhapsody offers a new white paper titled “The 5 Most Common Interoperability Missteps—and How to Avoid Them.”

Blog Posts

• Why Healthcare Needs a Different Kind of SOC (Fortified Health Security)
• Rethinking the EHR: Behavioral Health at the Center of FQHC Technology (Netsmart)
• ProFee vs. Facility Coding: Key Differences, Challenges, and the Autonomous Solution (Nym)
• Reflections from Databricks Data + AI Summit 2025 (Redox)
• 5 Ways Improving Care Access for Members Is a Force Multiplier for Engagement and Outcomes (ReferWell)
• The Ultimate Guide to Cloud Payments: Features, Benefits & Real-World Applications (TrustCommerce, a Sphere company)
• What is a CVO? A Step-by-Step Guide for Successful Credentialing (Symplr)
• Tegria at the IPMI Healthcare IT Institute: Insights on Cloud-Enabled Digital Evolution (Tegria)
• SIIM 2025 | Visage’s Top Five (Visage Imaging)
• Harnessing tech to combat drug diversion (Wolters Kluwer Health)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Follow on X, Bluesky, and LinkedIn.
Sponsorship information.
Contact us.

Morning Headlines 6/20/25

Commure Raises $200 Million in Growth Financing from General Catalyst’s CVF to Accelerate AI-Powered RCM Platform

Commure raises $200 million in growth financing to advance its RCM, ambient documentation, and practice management tools.

Hoppr Secures $31.5M Series A to Scale AI Infrastructure for Medical Imaging

Hoppr, which offers a platform for developing medical AI imaging applications, raises $31.5 million in a Series A funding round.

Overland Park digital health startup closes $2.5M seed round with local, national investors

AI healthcare copilot developer CarePilot raises $2.5 million in seed funding.

News 6/20/25

Top News

Commure raises $200 million in growth financing to advance its RCM, ambient documentation, and practice management tools.

The company now calls itself “the fast-growing enterprise AI healthcare technology company,” which is a phrasing shift from previous press releases that described it more generically as “a leading healthcare technology company” or “a leader in healthcare technology innovation.”

Reader Comments

From Significant: “Re: Commure. A $200 million investment to build what, exactly? RCM, ambient notes, and practice tools aren’t exactly underrepresented in health tech. Maybe Commure can use the cash to invent a fourth buzzword.” The company’s current website is at the top of the page, while the year-ago, AI-absent version that vaguely described the company’s product as a “healthtech operating system” is directly above. This was prior to its late 2024 acquisitions of Memora Health (care navigation) and Augmedix (AI-powered medical scribing). Certainly the current website is more specific about what the company actually sells, which was difficult to determine not long ago. The company launched as a FHIR-native developer platform in 2020.

Sponsored Events and Resources

None scheduled soon. Contact Lorre to have your resource listed.

Acquisitions, Funding, Business, and Stock

Patient referral technology vendor Tennr raises $101 million in a Series C funding round.

Hoppr, which offers a platform for developing medical AI imaging applications, raises $31.5 million in a Series A funding round. Founder, CEO, and board chair Khan Siddiqui, MBBS spent executive time at Microsoft and Higi.

Consulting firm Huron will acquire Eclipse Insights, which offers revenue cycle consulting services.

People

Abby Polich, MBA (TridentCare) joins Health Data Movers as SVP of client services.

Announcements and Implementations

Oracle announces GA of Oracle Health Community Care, a cloud-based mobile extension of the Oracle Health Foundation EHR that can be operated offline.

Willis Knighton Health goes live with Meditech Expanse in its 132 clinics.

This may have healthcare implications and will almost certainly kill some competing apps. OpenAI announces ChatGPT Record, which records speech in real time (including from multiple speakers), creates a transcript, generates a summary, and allows rewriting into an email or project plan. A “reference record history” option allows ChatGPT to look back on previous transcripts to improve its responses and to recall previously shared information. The Record option is available only for paid users who run MacOS for now.

Government and Politics

I wrote back in the dark COVID days of early 2021 about Anosh Ahmed, MD, the COO of Chicago’s 122-bed Loretto Hospital who resigned after getting caught diverting scarce vaccine doses to his cronies. He’s back in the news for filing $900 million in bogus COVID testing claims, which netted him and his co-codefendants an astounding $300 million. Ahmed allegedly stole patient data from the hospital to bill the federal government for performing COVID tests on uninsured people who never actually received them. Beyond the $300 million, he also is accused of pocketing $147 million in kickbacks from a lab company. He put his $9 million Houston house on the market after the first round of charges, for which he generously threw in one of his Rolls Royces. He now lives in Dubai as a “wealth management strategist” and operates a charity whose books might warrant review. Kudos to Kelly Bauer of Block Club Chicago for originally breaking the story and chasing it aferward

Epic files a motion to move the CureIS lawsuit against it to a different venue, arguing that the Northern District of California doesn’t make sense given that both companies are based in the Midwest. CureIS’s lawsuit accuses Epic of anticompetitive behavior, requiring customers to use its own products instead of those of CureIS, blocking integration, stealing trade secrets, and violating Cures Act information blocking provisions. Epic says in the motion that the lawsuit contains “seven kitchen-sink causes of action” that “read like a bad spy novel.” In its motion, Epic argues that:

• CureIS blames Epic for its stalled growth and fading customer relationships instead of looking inward.
• Epic doesn’t need to steal IP given that its thousands of developers ship new software constantly.
• CureIS cites information blocking rules that weren’t in effect at the time.
• CureIS should win on merit, not in court, and its job is to prove to customers that its products are better than Epic’s.
• CureIS wants to limit Epic’s ability to improve its offerings and inform its customers about what’s coming, which is “both absurd and antithetical to how competition works in the United States.”
• This isn’t the first time a smaller company has tried to shift blame to a dominant competitor.

Privacy and Security

A late January ransomware attack on medical coding and risk adjustment firm Episource exposed the information of 5.4 million people.

Other

MIT researchers say that ChatGPT makes its users dumber, with brain scans of essay writers suggesting that they incur “cognitive debt” that dulls critical thinking, reduces creativity, and makes them more susceptible to manipulation. They found that 83% of the subjects couldn’t recall anything from the essays they had asked ChatGPT to write.

Sponsor Updates

• Clearwater sponsors the Tennessee HIMSS Chapter Golf Tournament.
• Black Book Research reveals the most promising European health IT firms selected by investors for their growth potential, regulatory preparedness, and ability to scale.
• KLAS features Clearsense in its latest Emerging Insights case study titled “Clearsense Data Platform as a Service 2025: Reducing Costs & Increasing Efficiency Through Accelerated Data Archiving.”
• Capital Rx releases a new episode of “The Astonishing Healthcare Podcast” titled “Inside Capital Rx’s Acquisition of Amino Health: Creating the Health Benefits Platform of the Future, Today.”
• Netsmart announces that its MyUnity EHR platform has received the Community Health Accreditation Partner Verification for Home Health.
• Ellkay will exhibit at Health Choice Network’s Annual Board Educational Conference June 20-22 on Marco Island, FL.
• First Databank names Jessica Durm clinical informatics pharmacist, Ryan Cornell security operations engineer, and Keiron Jerome cloud operations engineer.
• Linus Health receives Silver in the Connected Digital Health, Clinical Decision Support Tools category at the 2025 Spring Digital Health Awards.

Blog Posts

• Findhelp + MHK: Streamline Your SDoH Workflows and Improve Member Outcomes (Findhelp)
• Why Tactics Matter in Cybersecurity: Rethinking the Way Healthcare Defends (Fortified Health Security)
• Behind the Scenes of Better Care: South Florida Psychiatry’s Revenue Cycle Transformation (Inovalon)
• Henry County Hospital’s 6 steps to improving physician satisfaction (Meditech)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Follow on X, Bluesky, and LinkedIn.
Sponsorship information.
Contact us.

EPtalk by Dr. Jayne 6/19/25

As a consultant working with care delivery organizations, I see many of them using “access” as some kind of a performance mantra. Whether it’s access to book a visit with a physician in an office or access to the emergency department, there is constant pressure to make sure patients are formally scheduled for some kind of revenue-generating service with the organization.

I was recently part of a discussion with other physicians who were talking about how access is being conflated with value. One example was the push for patients to book a visit with a provider, without giving full consideration to whether the provider had the correct experience and knowledge to actually treat the patient. It doesn’t matter if you get the patient in quickly, but to the wrong office since you’re ultimately going to have to book a second appointment elsewhere to meet their needs.

Another example was the boom in patient portal messages. Patients can reach their physicians quickly, but that’s not helpful when it causes providers to be burned out and creates risk that patients won’t receive the correct treatments because someone is trying to read between the lines of a series of message exchanges to create a diagnosis and treatment plan rather than having a direct conversation with a patient (either in person or via virtual care).

Another physician mentioned secure texting, which creates a staff access problem “where it’s easy to just fling messages out there rather than thinking through what you’re really asking. It seems like people formulated their questions better when they knew they had to make a phone call.” There may have been cocktails involved in this discussion, leading one of my colleagues to ponder the fact that that “patients have access to their notes, but they’re useless when the notes suck.”

We often look at ways to use technology to create more access, but these comments remind us that there might be “good” kinds of access along with those that are less desirable. I’m hoping that someone might read this and think it through the next time they’re in a meeting pushing for increased access. It’s not just about getting bodies through the door, messages to the provider, or notes to the patient. We need to get to a point where greater access is providing greater value and driving patient outcomes. Otherwise, it’s just a buzzword.

From Navy Fan: “Re: remote work. I’ve enjoyed being a remote worker for 15 years now and I hate seeing people mess it up for the rest of us. Did you see the story about Sentara Health, where remote workers accessed patient information using false identities?” I hadn’t seen it before a reader highlighted it, which reminds me how much we appreciate our readers when they bring us a good story. Apparently, the system hired remote workers to manage lab requisitions, but eventually discovered that they were not based in the US and may have been misrepresenting their identities. The situation impacted patients who had lab tests performed between January and April of this year. The bad actors had access to plenty of protected health information, including names, dates of birth, and Social Security numbers. A manager became concerned in early April when they noticed that the workers attending virtual department meetings did not match the photos that were submitted during hiring. Sentara Health is offering free credit monitoring and identity protection services.

I wanted to add my two cents to some of Mr. H’s comments earlier this week about virtual care prescribing of ADHD medications. He mentioned a study done at Massachusetts General Hospital that showed that at least with their virtual care model, there was not an increased risk of addiction in patients receiving stimulant medications. Mr. H noted that the findings don’t necessarily apply to freestanding telehealth companies that have been accused of cranking out prescriptions, especially those that are investor-backed startups where clinicians are paid on a per-visit basis.

Although I haven’t treated ADHD via telehealth, I’ve worked for several different freestanding telehealth companies and the pressure to prescribe is real. Large percentages of providers working for some of the big firms are 1099 contractors and some of them are trying to complete visits every three or four minutes, which means they’re not doing a detailed visit with the patient. Some of the companies are focused on patient satisfaction metrics, which means that if you don’t give the patients exactly what they request, you’re going to receive scrutiny due to your perceived poor performance. Some in-person organizations are hype- focused on the same metrics and place similar pressure on their physicians, but the risk is much lower with in-person care because you can do an actual examination and can leverage your care team to ensure you have a more comprehensive history from the patient.

Bad news for those of us that like a good nap: a recent research article showed that certain kinds of daytime napping are tied to an increased risk of death in middle- to older-aged adults. The study looked at 86,000 non-shift workers. Those who took longer naps, had high variability in the duration of their naps, and who took more naps around noon or early afternoon were those most impacted. One of the takeaways from the study is that physicians should be asking not only about sleep habits, but specifically about daytime napping. Given all the other data-driven recommendations, I don’t see this one being added to the formal recommendation set anytime soon.

My best time for napping is around 3 or 4 p.m. when my energy is fading and I just need a break. Conference calls during those times are the worst, but sometimes they’re unavoidable for me since I work in all of the US time zones. Based on the data, I should be able to mitigate my risk somewhat by taking consistent short naps in the late afternoon. That seems like a much more enjoyable option than some of the other things I can do to reduce my risk of all-cause mortality, especially since I’m already doing most of them.

What’s your favorite time and place for a nap? Do you like a hammock on the beach, or are you one of the folks I spotted catching a few winks on a park bench after leaving the local winery? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/19/25

Healthcare referrals are where patients get lost. Tennr raises $101M to bring the visibility our system desperately needs

Referral optimization company Tennr raises $101 million in a Series C funding round, bringing its total raised to $160 million.

Vestar Capital puts Quest Analytics up for sale

Vestar Capital reportedly prepares to sell Quest Analytics, which offers management solutions for provider networks.

Huron to Acquire Revenue Cycle Consulting Firm Eclipse Insights

Professional services firm Huron acquires revenue cycle consulting business Eclipse Insights.

RevelAi Health Secures $3.1 Million Seed Funding to Scale Artificial Intelligence Care Coordination for Musculoskeletal Health

AI-powered musculoskeletal care software startup RevelAi raises $3.1 million in seed funding.

Healthcare AI News 6/18/25

News

Lee Health (FL) launches Leah, an AI-powered conversational engagement platform that helps patients with hip, knee, and shoulder pain navigate the system’s services and receive guidance and education.

CONCERN EWS, an AI-powered early warning system that is powered by nurse observations and developed at CU Anschutz, analyzes nurses’ documentation patterns to predict patient deterioration up to 42 hours earlier than standard methods, reducing mortality and hospital stays while improving ICU transfers.

Abstractive Health launches Clinical Time Machine, an AI-powered game that lets users explore structured charts that are generated from centuries-old handwritten medical records. The company, which describes the tool as “a Microsoft Flight Simulator for Medicine,” says that fewer than 1% of physicians have ever seen a full AI-generated medical record summary.

SAS launches Health Cost of Care Analytics, a tool that analyzes claims data to build episodes of care, helping identify cost, quality, and outcome drivers to inform protocols and provider contracts.

Business

Abridge releases Inside for Inpatient, which converts bedside conversations into structured Epic notes. The company is also piloting integration of outpatient orders into Epic.

Hamilton Health Sciences is piloting an AI-powered phone receptionist that was developed by two local doctors and a software engineer. The system, which is being commercialized as Strello Health, books appointments, manages prescription refills, and answers questions. The company says it saves four hours per day and ensures that no caller is ever put on hold or sent to voicemail.

Intermountain Health will implement Layer Health’s AI-powered chart abstraction system for chart review and will invest in the company.

Other

Aidoc releases an open-source, expert-authored framework that it developed with Nvidia and 17 healthcare organizations that guides safe, scalable, trust‑focused deployment of clinical AI across technical, regulatory, operational, and monitoring domains.

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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This Week in Health Tech 6/18/25

Morning Headlines 6/18/25

Nabla Raises $70M Series C to Deliver Agentic AI to the Heart of Clinical Workflows, Bringing Total Funding to $120M

Ambient scribe technology vendor Nabla raises $70 million in a Series C funding round, increasing its total to $120 million.

Glytec Secures $36 Million Growth Investment to Accelerate AI-Powered Diabetes Technology Platform Innovation

Diabetes management software vendor Glytec announces $36 million in new funding.

Sword Health nabs $40M at $4B valuation, pushes IPO plans to at least 2028

Sword Health, a digital health startup specializing in virtual physical therapy, pelvic healthcare, and mental healthcare, raises $40 million.

News 6/18/25

Top News

Ambient scribe technology vendor Nabla raises $70 million in a Series C funding round, increasing its total to $120 million.

The company will use the money to develop an agentic AI platform that will include real-time coding support, smarter documentation, EHR command execution, and nursing capabilities.

Reader Comments

From Skrill: “Re: virtual ADHD prescriptions. A new study out of Massachusetts General Hospital says that remote prescribing doesn’t increase someone’s chances of becoming addicted to drugs like Adderall. Doesn’t this fly in the face of the federal scrutiny (and fines) faced by Cerebral, Truepill, Ahead, etc. several years ago?” Reasons this study’s findings don’t necessarily vindicate for-profit telehealth providers who were cranking out prescriptions for stimulants:

• It looked at MGH patients who were treated for ADHD from March 2020 to August 2023. Most of them had at least one in-person visit before COVID moved their care to virtual. They were evaluated in person and managed by doctors in traditional academic medical center practice.
• I would trust MGH doctors who started seeing patients virtually to follow the proper prescribing guidelines, as compared to an investor-backed startup that contracts with doctors who are paid for each Adderall prescription they generate.
• The study looked at substance use disorder as an endpoint, but that doesn’t necessarily prove the absence of overuse or even misuse in general. Patients could have been selling or sharing their meds or using them for purposes other than as prescribed.
• The researchers had no way to measure diversion or inappropriate prescribing.

Sponsored Events and Resources

Live Webinar: June 18 (Wednesday) noon ET. “Fireside Chat: Closing the Gaps in Medication Adherence.” Sponsor: DrFirst. Presenters: Ben G. Long, MD, director of hospital medicine, Magnolia Regional Health Center; Wes Blakeslee, PhD, vice president of clinical data strategies, DrFirst; Colin Banas, MD, MHA, chief medical officer, DrFirst. Magnolia Regional Health Center will describe how its Nurse Navigator program used real-time prescription fill data from DrFirst to identify therapy gaps and engage patients through timely, personalized outreach. The effort led to a 19% increase in prescription fills and a 6% drop in 30-day readmissions among participating patients. Attendees will learn why prescribing price transparency is key to adherence, how real-time data helps care teams support patients between visits, and how Magnolia aligned its approach with value-based care and population health goals.

Contact Lorre to have your resource listed.

Acquisitions, Funding, Business, and Stock

Parkview Health (IN) launches UpVia Health, a management services company that is focused on independent hospitals and provider groups. UpVia will initially offer services for virtual care, EHR sharing, revenue cycle, and group purchasing as well as pharmacy management and supply chain management.

Diabetes management software vendor Glytec announces $36 million in new funding.

Sales

• VA San Antonio expands its CliniComp EHR system to its post-anesthesia care environments.
• Ochsner Health (LA) selects clinical AI software from Latent Health.
• Erlanger (TN) will implement surgical operations automation software from Qventus.

People

CereCore names Matt Dearborn (Pivot Point Consulting) regional VP.

Eyecare EHR/PM vendor Sightview hires Tycene Fritcher (Outcomes) as CEO.

Announcements and Implementations

St. Mary’s Health and Clearwater Valley Health in Idaho implement a shared Meditech Expanse EHR system.

Stanford Health Care (CA) uses virtual pulmonary rehabilitation services from Kivo Health as part of its home-based care program for COPD patients.

Veterans Memorial Hospital (IA) goes live on Epic through a collaboration with University of Iowa Hospitals and Clinics.

Med Tech Solutions begins offering personalized NextGen Healthcare and EClinicalWorks EHR utilization training through its new ProviderCare program.

Altera Digital Health announces GA of Sunrise 25.1.

Government and Politics

The FDA issues its most serious level of recall on select Zyno Medical Z-800 infusion pumps, citing software that has not undergone verification or validation testing.

VA Deputy Secretary Paul Lawrence, PhD stresses that progress is being made on preparing facilities in Indiana, Michigan, and Ohio to go live on its Oracle Health-based EHR in 2026. Implementation activities are also set to begin this month at care sites in Anchorage and Cleveland. Thirteen facilities are scheduled to go live on the software next year.

Privacy and Security

Population health management platform vendor HealthEC and four of its customers will pay a combined $5.48 million to settle a proposed class action lawsuit that stemmed from a 2023 breach that affected the data of 4.6 million people.

Other

A local news outlet questions the University of Mississippi Medical Center’s decision to add a “citizenship” field to Epic, noting that hospitals are not required to collect the information and patients are not obligated to answer.

Sponsor Updates

• Capital Rx supports the annual NYCFC/NYCSI Community Cup in Queens.
• Arcadia announces a strategic integration partnership with Quest Analytics.
• Black Book Research’s latest survey ranks Inovalon as the top-rated vendor for the End-to-End Medicare Advantage Risk Adjustment Lifecycle.
• Waystar appoints Aashima Gupta and Michael Roman to its Board of Directors.
• Altera Digital Health announces that customer Bolton NHS Foundation Trust has become the first trust in Greater Manchester to implement district nurse referrals in its Sunrise EPR system.
• Clearwater founder and Executive Chairman Bob Chaput leads a cyber risk management course at The University of Texas at Austin.
• Consensus Cloud Solutions will exhibit at the HIMSS Central & North Florida Chapter Conference June 19 in Tampa, FL.

Blog Posts

• 5 Care Coordination Challenges Netsmart Solves (Netsmart)
• What Is ICD-11? Key Differences from ICD-10 and How AI Can Help (Nym)
• 5 Ways Improving Care Access for Members Is a Force Multiplier for Engagement and Outcomes (ReferWell)
• The Panoramic View for Health Plans and Care Managers (Surescripts)
• From Inspiration to Action—How to Instigate Change after the 2025 MUSE Inspire Conference (CereCore)
• The silent advocate: How AI can alleviate mental health struggles in nurses (Altera Digital Health)
• Transforming How Healthcare Organizations Use Data (Dimensional Insight)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Follow on X, Bluesky, and LinkedIn.
Sponsorship information.
Contact us.

Morning Headlines 6/17/25

Parkview launches Upvia Health to empower independent hospitals and physicians with trusted management solutions

Parkview Health (IN) launches Upvia Health, a management services company focused on independent hospitals and provider groups.

Cosentus Expands National Reach with Strategic Acquisition of Utah based Alta Management Solutions

Ambulatory health IT company Cosentus Holdings acquires practice consulting and RCM vendor Alta Management Solutions.

Infusion Pump Recall: Zyno Medical Removes Certain Z-800 Series Infusion Pumps due to Software Issue

The FDA issues its most serious level of recall on select Zyno Medical Z-800 infusion pumps, citing software that has not undergone verification or validation testing.

Curbside Consult with Dr. Jayne 6/16/25

Healthcare isn’t the only industry grappling with how AI should, or should not, fit into our daily work.

Some friends who are teachers sent me the transcript of a recent discussion about how AI is impacting the ability of humans to think and whether it will alter our abilities for critical thinking. The discussion linked to an article “AI Tools in Society: Impacts on Cognitive Offloading and the Future of Critical Thinking” that was a great read. The author set out to examine how AI tool use relates to critical thinking skills and focused on the concept of cognitive offloading as a potential mediating factor. Cognitive offloading happens when thought processes are outsourced to technology instead of being developed independently.

The study found that higher AI tool use had a negative impact on critical thinking abilities. Younger study participants (ages 17-25) were more dependent on AI tools and had lower critical thinking scores compared to those study participants who were older than 46 years. It also noted that regardless of AI usage, better critical thinking skills were associated with higher educational attainment, which should be important to anyone who has a stake in ensuring a well-educated population. The study found that higher educated people maintained those critical thinking skills even when using AI, which supports the idea that how we are using AI is more important than whether we’re using it or not. The study also found that AI use encourages passive learning, where students consume information rather than creating it.

The study had multiple hypotheses about the role of cognitive offloading, including one that suggested that moving thinking tasks to external tools would reduce the cognitive burden on individuals. Instead, they found that the reduced cognitive load can lead to reduced critical engagement and cognitive analysis. According to the author, this phenomenon has been described as the “Google effect,” where being able to easily find information online leads to reduced memory retention and problem solving skills.

That would seem to go along with what many of us already think, which is that the internet is making us dumber. Although to truly explore that statement, you would also have to look at the proliferation of TikTok videos and the nonsense seen all over social media on a daily basis.

I had the chance to speak to a couple of teachers who were blissfully enjoying their summer vacation, so I figured I would ask about their thoughts around AI and their thoughts about how it was impacting education, beyond the obvious concerns about AI-generated work.

One said that plagiarism has always been an issue, and taking from AI sources isn’t a lot different than taking from other authors, although AI might be easier to catch because of stilted language that would have been caught by editors of more traditional sources. She also noted that she’s applying some of her existing “how to spot fake news” lesson plan content to AI, encouraging students to be skeptical about what AI is telling them, to ask about bias, and to consult multiple sources to ensure accuracy. She recommends that students do their best to answer questions in more traditional ways first, then use AI to validate their findings.

The other teacher felt that better education is needed on how AI works and the risks of using it. He likened it to when GPS units first came out, and there were reports of people driving off the edges of roads that were closed because they were blindly following the GPS and not paying appropriate attention to their surroundings. He also noted that although there are certainly concerns about AI use interfering with academic rigor, he is more worried about his teenage students being emotionally harmed by AI-generated content, such as deepfake photos or videos.

He noted, “When I was in school, people spread rumors, but now you can have altered videos going around that are a lot more difficult to combat.” As a proud member of Generation X, I don’t envy the students growing up in this environment. Still, I’m grateful for teachers that recognize these challenges and work to prepare students not only to be ready for the future but to protect their own mental health.

The use of AI by medical students and residents has been a hot topic for my colleagues who are working in academic settings. There are concerns that students have become used to looking up facts and aren’t memorizing information the way they used to, which places them at risk when resources aren’t readily available. Whether it’s a downtime event or a rapidly evolving clinical situation, I know I’m glad that I have certain pathways memorized to the point where they just happen naturally in my thought process.

Of course, I’ve allowed some things to go by the wayside and I would have to look them up if I ever needed them. (Cockcroft-Gault equation, I salute you.) One faculty member said his school is using AI within its case-based learning modules for medical students in hopes that the approach will build diagnostic reasoning skills rather than sabotage their development.

The faculty physicians I spoke with had different thoughts about the use of AI by resident physicians, since they’ve graduated from medical school and have the MD or DO behind their name and are therefore able to treat patients with some degree of independence even if they may not be fully licensed. Universally, they had concerns about using non-medical AI solutions due to the risk of hallucinations and the safety risks to patients. They were also concerned about students using those resources to learn procedures and algorithms, since students wouldn’t be aware if what they were reading was incorrect compared to what they might learn reading a more authoritative resource such as a medical textbook or journal articles.

All but one said they conduct their teaching rounds in an AI-free environment where participants are expected to contribute to the discussion without the benefit of external resources.

That conversation was limited to faculty in my immediate area. I suspect that attitudes might be different in parts of the country that are more apt to adopt new technologies more aggressively. I would be interested to hear from informaticists that work with medical schools or graduate medical education programs on how your institutions are approaching AI and what best practices are being developed.

Is AI really going to make healthcare better, or is it another shiny object that will eventually lose our admiration? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: “The Illusion of Thinking”: Implications for Healthcare

“The Illusion of Thinking”: Implications for Healthcare
By Vikas Chowdhry

Vikas Chowdhry, MS, MBA is founder and CEO of TraumaCare.ai.

If you are even moderately interested in AI, I am sure you have by now at least seen various comments and responses in social media to Apple’s paper titled “The Illusion of Thinking.” But in case you have been under the AI rock, here’s a brief summary.

In this paper, the authors show that today’s large reasoning models (LRMs such as OpenAI o3-mini, DeepSeek-R1, Claude 3.7 Sonnet-Thinking) — systems that explicitly generate long chains-of-thought — really do think more, but not necessarily better. On carefully designed puzzle tasks, they beat ordinary LLMs only in a narrow middle band of difficulty and then collapse outright as problems grow harder.

As expected, the comments span the gamut, from “the sky is falling” to “not a big deal, they will figure out a way to overcome or fix this.” While I am not in the “sky is falling” camp, I do think that this paper raises some important questions with special implications for healthcare. Any healthcare organization (or vendor) that is using or developing a product that is based on LLMs/LRMs will need to think deeply about these issues and have a strategy to run their own similar evaluations and hopefully share them publicly.

Here are four key findings from the paper and my take on the implication of each finding for healthcare.

#1. Impact of complexity on reasoning performance

The authors identify three performance regimes as problem complexity rises:

• Low complexity: standard LLMs are more accurate and efficient than LRMs.
• Medium complexity: LRMs pull ahead.
• High complexity: both collapse to zero.

Performance of LRMs (solid lines) and LLMs (dotted lines) across low, medium and high complexity puzzles (figure from the Apple paper).

Healthcare implications:

• How will you define complexity thresholds in your workflow?
• Does your system dynamically choose between an LLM and an LRM based on a case’s difficulty?
• Can it detect when a case crosses a threshold and alert the clinician instead of forging ahead with low-quality output?

#2. Token-effort collapse

LRMs spend more tokens as tasks get more complex until a critical point, after which, they give up and begin to reduce their reasoning effort despite increasing problem difficulty. This behavior suggests a fundamental scaling limitation in the thinking capabilities of current reasoning models relative to problem complexity.

Healthcare implications:

Let’s say your product helps detect malignant tumors, or, transcribes ambient conversations using LLMs/LRMs.

• In operational mode, does it have mechanisms to detect that the case has crossed a complexity threshold and that it is giving up, and that at that point, humans need to stop using it for that case?
• What happens if the AI product was sold as a tool to make your apps take on more primary care responsibilities, and now that the product has given up, what’s your recommendation for the NP who was relying on your product?
• What if your product doesn’t even have the awareness that it has given up and the NP continues to rely on its output? Who owns the risk for a misdiagnosis?

#3. Over-thinking & self-correction limits

For simpler problems, reasoning models often find the correct solution early in thinking, but then continue exploring incorrect solutions (overthinking). As problems become moderately more complex, this trend reverses: correct answers appear only late. For hard tasks they never appear (“collapse” as discussed earlier).

Healthcare implications:

• Over-thinking wastes compute and drives up cost.
• Yet aggressively pruning the chain of thought might remove the only path to a correct answer on tougher cases.
• Your system therefore needs complexity-aware throttling, not a one-size-fits-all token limit.

#4. No benefit from explicit algorithms

Prompting with a known algorithm to solve the problem does not improve the performance. This indicates weaknesses in faithfully executing step-by-step logic, not just in discovering it.

Healthcare implications:

A healthcare organization may have explicit clinical guidelines for certain use cases and would want the AI product to follow them when those guidelines are met. However, the results of this paper show that an LLM/LRM based on AI product may not be able to execute an algorithm based on those guidelines even when explicitly programmed into the system.

• Embedding clinical guidelines verbatim is not enough.
• You must verify that the model can faithfully execute those step-by-step protocols under real-world complexity.

Final Thoughts

AI progress is breathtaking, yet deploying it in high-risk domains like healthcare demands transparent, domain-specific safety testing. This paper is a timely reminder that such work takes time, expertise, and openness. Sharing evaluation results will accelerate safe adoption for the entire industry.

Readers Write: The Future of Member Support: How Intelligent Search Can Transform VAB Delivery

The Future of Member Support: How Intelligent Search Can Transform VAB Delivery
By  Andi Gillentine

Andi Gillentine, MS is VP of national accounts at Findhelp.

Value-added benefits (VABs) are services that are offered by Medicaid managed care plans above and beyond required Medicaid state plan services. They are extremely popular –  Medicaid plans in at least 48 states offer VABs — and historically poorly promoted and utilized.

How do we ensure improved utilization of VABs, which have the power to impact quality measures, quality of care, and overall health? By maximizing intelligent searching via closed-loop referral systems to surface the right programs to the right person at the right time, for both care managers navigating on a member’s behalf and members who are self-navigating.

About VABs 

While VABs are typically non-medical, they are often related to member wellbeing. Examples of VABs are car seats and bike helmets for children, extended dental and vision services, over-the-counter medication funding, and carpet cleaning. More and more commonly, these services are used to address health-related social needs (HRSNs).

In Ohio, for example, VABs are allowed for dental, vision, transportation, health and wellness programs (includes housing supports and medical meals), incentives to strengthen health and wellbeing (includes rewards for seeking preventative care), prenatal and postpartum incentives, application services, telehealth, and 24-hour medical advice lines. Each of the seven Medicaid plans in Ohio offers at least 30 VABs, with one plan offering nearly 50.

This wealth of benefits can help Medicaid members achieve improved health outcomes and quality of care that is measurable in HEDIS and other health quality measures, if the members are aware of the benefit and know how to access it, and if administering it is easy on the health plan. Unfortunately, this is often not the case.

Improving VABs Access and Awareness

Today, in most states, a Medicaid member seeking support would have to spend hours researching their health plan website or reading their plan’s member handbook. As any health plan member can attest, this is a challenging, time-consuming task, frequently made more challenging by engaging solely through a smart phone. Accessing VABs usually requires a call to a customer service representative, with potentially long wait times, and then a waiting period to receive the goods or services.

This high administrative effort to find and access benefits results in high costs for health plans. Many Medicaid members miss important preventive care appointments due to transportation issues, use the ED for non-emergent needs because they can’t afford medications, or lose housing or utilities. VABs can provide the resources and support to prevent these occurrences, but it’s not enough for support to just be available. Members need relevant recommendations and easy access.

In an ideal world, a Medicaid member would be able to go to one place, validate their insurance coverage, search for services that address their needs, and receive intelligent results that provide resources tailored to their specific situation, with the ability to self-refer to access these goods and services. This intelligent search needs to include all available resources from their community, county, state, and health plan’s VABs. No more hunting through multiple sites or staying on the phone for long periods of time just to put food on the table, get a ride to an appointment, or find a car seat.

Intelligent Search is the Answer

There are no technological hurdles to solving this problem. We have already solved it. We simply need to integrate these workflows at the right time and in the right place for navigators and Medicaid members, using interoperable social care platforms with intelligent search capabilities. Where a patient can walk in the doors of a safety net hospital and, because of the integrated social care information in their medical chart, tailored recommendations, including VABs, are automatically presented to  care teams. The care team may refer or recommend some of these resources to the patient and encourage the patient to self-navigate for additional benefits and support. Or where a health plan care manager, engaging with a chronically-ill, dual-eligible member, can assess need and eligibility for VABs and other integrated social care support and, with consent, directly refer the member to services.

One personalized, intelligent search for all services, in easy-to-access workflows for navigators and members. The future is already here. Let’s make the most of it.