Monday Morning Update 1/6/25

Top News

The Wall Street Journal reports that UnitedHealth Group has significantly increased its Medicare Advantage payments by electronically prompting its employed and affiliated doctors to add new diagnoses.

Patient sickness scores rose by 55% among those patients who switched from traditional Medicare to UHG’s Medicare Advantage plan, boosting UnitedHealth’s revenue by $5 billion over three years.

UnitedHealth disputes the findings, asserting that it complies with Medicare payment rules and that its patients are sicker. Doctors have pointed out that the company’s motivations are likely non-clinical since it does not suggest additional diagnoses for traditional Medicare patients, as doing so would raise its costs without increasing revenue.

A previous WSJ analysis revealed that Medicare Advantage insurers collected $50 billion over three years by adding diagnoses for which doctors performed no treatment. One example is a bruising condition that generated an additional $1,900 per year per patient, which was diagnosed 28 times more often in MA patients versus traditional Medicare, with one doctor saying that the diagnosis is pointless since all she can do is tell affected patients, “Wear some sunscreen. Maybe stop bumping the wall.”

HIStalk Announcements and Requests

Two-thirds of poll respondents think that health AI has reached Gartner’s Peak of Inflated Expectations, which is defined as generating a lot of excitement and widespread adoption attempts that fizzle when the technology’s limitations are discovered.

New poll to your right or here: Which of your local care providers has earned your most positive brand perception? I ran this poll a few years ago and a hospital / health system was the winner, but that outcome may have been influenced by respondent demographics.

I’ve played so much R.E.M. during the slow last week that I created a playlist of similar bands from all eras (mostly old by definition) that play alternative, guitar-heavy, melodic indy pop. My research turned up these and a bunch of others, all of which I’m enjoying: The Lemonheads, Bob Mould (I notice that the video includes former Superchunk drummer Jon Wurster), The Connells, Michael Penn, Matthew Sweet, Teenage Fanclub, The Posies (I recognized co-founder Ken Stringfellow because he played keyboards and bass on several R.E.M. tours), Urge Overkill, and The Auteurs. I pasted the list into ChatGPT and asked for similar bands, which gave me another few dozen to investigate.

Pundits are cranking out their annual attention-seeking lists of safely vague predictions for 2025, which hopefully will prove to be more accurate than the ones from previous years. Here is my one and only: the new administration and its replacement of Federal Trade Commission Chair Lina Khan, JD will allow private equity firms and big companies (including big health systems and their vendors) more leeway in acquiring, merging, and engaging in potentially anti-consumer behavior. Beyond that, FTC has been directly involved in the Health Breach Notification Rule, the proposed (but failed so far) banning of non-compete clauses, the requirement to disclose pay-for-play social media product reviews, the distribution of potentially biased AI algorithms, the use of consumer data by health app vendors, drug company and pharmacy benefits manager pricing, healthcare price transparency, and health-related advertising.

If I was forced to make a second prediction, it would be that major health systems will turn over some of their specialty-specific chronic care management and care coordination functions to AI tools, which will test FDA’s willingness to give its OK to such systems under the new administration. The good news is that (a) even mediocre AI is probably better than the best current efforts; (b) those new systems don’t need to connect to external data that could cause hallucinations; and (c) the scope of this work focuses on specific conditions and clinical rules. The unknown is the extent of payer willingness to give hospitals money for performing those functions, whether AI or manual.

OK, one more. My aspirational #3 prediction is that doctors will finally reassert their autonomy and push back against their undervalued role as compliant rubber stampers of patient-unfriendly corporate decisions that are imposed by insurers, health systems, and private equity owners. However, I doubt that disunited physicians can effectively challenge the status quo, as they fail to recognize the collective power they could wield if they overcame divisions based on specialty, employer type, geography, and fears of being displaced by non-physician clinical providers. The lack of cohesive leadership compounds the issue, particularly given that so few practicing physicians—especially younger ones—are AMA members and don’t agree with its business-friendly, revenue-generating positions, which leaves basically no other group or individual to lead the charge.

Welcome to new HIStalk Platinum Sponsor Censinet. The company is the leading collaborative risk network for healthcare organizations and vendors. Censinet RiskOps is the first and only cloud-based integrated platform that consolidates enterprise risk management and operations capabilities across critical business areas: clinical, regulatory, cybersecurity, research, and supply chain. This includes the company’s foundational success with third-party risk management (TPRM) for healthcare and transforms enterprise risk by making data and insight actionable. Thanks to Censinet for supporting HIStalk.

I found this video that describes how Northwell Health converted its TPRM programs and processes to Censinet.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.

Acquisitions, Funding, Business, and Stock

Siemens questions whether its 75% ownership of Siemens Healthineers justifies its $47 billion investment, advising investors that it will make a decision about its involvement by the end of the year.

A Financial Times opinion piece says that investors aren’t realizing a substantial return on the $100 billion they put into digital health companies from 2020 to 2022. Factors include stiff competition, low consumer switching costs, high user acquisition costs, and the introduction of competing products from big tech companies such as Amazon.

Veradigm extends the six-month contract of interim CFO Leland Westerfield for the second time. The company fired its CEO and CFO in December 2023 for failing to comply with financial reporting. Original interim CEO Shih-Yin Ho, MD, MBA stepped down in May 2024 and was replaced as interim by Tom Langan, who remains in that role. MDRX was delisted from the Nasdaq in February 2024 for not filing its annual report for 2022.

People

ChristianaCare hires Rob Hartmann, MBA (Tegria) as VP of EHR transformation, where he will oversee its Oracle Health to Epic project.

Justin Mooneyhan, MBA (Amsurg) joins IVX Health as VP of IT / CISO.

Charlie Gibbs, who founded early hospital IT software companies Gibbs Computer Systems and First Coast Systems, died December 30. He was 84. Long-timers may want to search Vince Ciotti’s HIS-tory for his name to get a fuller picture of Jacksonville-based FCS.

Announcements and Implementations

A Department of Defense crowdsourced test identifies 800 vulnerabilities in using AI to summarize clinical notes and for powering a consumer medical chatbot. DoD will use its findings to evaluate future vendors and to develops its best practices and policies. The study was conducted by the non-profit Humane Intelligence, which gives AI model evaluators a platform for auditing and performing impact assessments. Co-founder and CEO Rumman Chowdhury PhD, MS has done similar work at Twitter and Parity, the latter of which she founded.

Black Book reports its top EHRs for specialty practices for 2025, also naming as top innovation leaders ModMed, NextGen Healthcare, Netsmart, ClinicMind, Epic, and RXNT.

DirectTrust announces updated versions of its 26 accreditation programs that took effect on January 1.

Sponsor Updates

• HCTec offers holiday support to an elderly care facility in Hohenwald, TN, and Operation Stand Down Tennessee.
• First Databank will present at the ASAP 2025 Annual Conference January 16 at Amelia Island, FL.
• Goliath Technologies publishes a new client success story, “Maimonides Medical Center Quickly Troubleshoots ‘Citrix is Slow’ Complaints.”
• Black Book Research highlights Australia’s digital health transformation in its “2025 Global Healthcare IT Rankings” report.
• QGenda publishes a new case study, “Children’s Nebraska Improves Clinical Capacity Management.”
• The “DGTL Voices with Ed Marx” pPodcast features SmartSense by Digi President Guy Yehiav, “SmartSense Disruption in Healthcare & Simple Hacks to Become a CEO.”
• TruBridge names Merideth Wilson (Experian) financial health general manager.
• Clearwater releases a new “Clear Perspective” podcast, “The Truth About EDR Killers.”
• The Philadelphia Business Journal recognizes Crossings Healthcare Solutions parent company UHS CEO Marc Miller as one of the region’s Most Admired CEOs.
• Direct Recruiters recognizes its Healthcare IT Team as a top producing team in 2024.
• EClinicalWorks announces that Indiana University Student Health Center has integrated Sunoh.ai’s AI-powered ambient listening solution with its EHR.
• Ellkay supports the Pajama Program, an initiative providing children with new pajamas and storybooks to foster a comforting and safe bedtime routine.

Blog Posts

• Transforming primary care: Inside the Making Care Primary (MCP) model (Healthmonix)
• CMS 2026 Proposed Rules: Key Takeaways for Quality and Stars Managers (Inovalon)
• Meditech Expanse: It’s Electric (Meditech)
• MRO is Advancing Quality Control Solutions for Release of Information (MRO)
• 2025 Healthcare Forecast: The Convergence of Behavioral Health, Technology, and Measurable Impact (NeuroFlow)
• 5 Ways AI is Revolutionizing IDD Care (Netsmart)
• The Power of More Data: AI’s Wheelhouse (Rhapsody)
• The Ultimate Guide to Choosing the Right QHIN: 5 Questions Every Healthcare Leader Should Ask Themselves (Surescripts)
• Key Insights From 2024: Our Experts Share Their Best Takeaways From Leading Healthcare Events (Tegria)
• Nearly 70% of the Private Practices We Surveyed Lack a Comprehensive Patient Engagement Strategy (AdvancedMD)
• Current Procedural Terminology® 2025: Key Changes and Updates (AGS Health)
• Future-forward healthcare data platform considerations (Arcadia)
• RCM Strategies: Shift Left to Prevent Denials Before They Start (Availity)
• Top 5 Ways IT and Clinical Leaders Can Collaborate on Virtual Care Programs (AvaSure)
• Pharmacy Benefits 101: The Importance of the Network (Capital Rx)
• Predictions and Prerequisites for Healthcare IT in 2025 and After (CereCore)
• How Electronic Prior Authorizations Cut Through Complexities of Specialty Medication Access (DrFirst)
• 2025 – The Year of AI Validation and Human-Centered Innovation (Medicomp Systems)
• The Unbeatable eClinicalWorks Experience (EClinicalWorks)
• Gundersen Health System Makes 15,000 Referrals in 3 Years (Findhelp)
• Why is Revenue Cycle Management Important in Healthcare? (FinThrive)
• Forget 2025 — Here Are My Top Predictions for CX in 2030 (Five9)
• A Legacy of Connection: Transforming Healthcare Through Innovation and Care (Fortified Health Security)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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