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Morning Headlines 5/16/24

May 15, 2024 Headlines Comments Off on Morning Headlines 5/16/24

New Orleans Startup Secures $13.6M for Patient Care Coordination

Care coordination software vendor Watershed Health announces $13.6 million in new funding.

Missouri Launches Pioneering Statewide Digital Health Initiative to Transform Crisis Response and Behavioral Health Care

The Missouri Department of Mental Health and Missouri Behavioral Health Council will use technology from Chorus Innovations to develop MOConnect, a digital tool that will help coordinate care between crisis lines, crisis centers, mobile teams, and referral networks.

SmarterDx Raises $50M to Bolster Hospital Revenue Integrity and Quality with Its Clinical AI Solution

SmarterDx, which uses AI to audit and review medical claims, raises $50 million in a Series B funding round.

Comments Off on Morning Headlines 5/16/24

Healthcare AI News 5/15/24

May 15, 2024 Healthcare AI News Comments Off on Healthcare AI News 5/15/24

News

OpenAI releases GPT-4o (the “o” stands for “omni”):

  • All users, including those who use the free plan, will have access to the new version.
  • Users can carry on voice conversations with ChatGPT with faster responses and can interrupt it when it is talking.
  • The system can perform real-time language translation.
  • It can interpret photos, screen shots, and other documents in real time.
  • It can return real-time information from the web.

Google announces enhancements related to Gemini AI:

  • Addition of 1.5 Flash, which is optimized for speed and efficiency with a lighter weight than 1.5 Pro.
  • Adding audio understanding to Gemini 1.5 Pro.
  • Extending Project Astra, the next generation of AI assistants that can understand real-time video and conduct conversations about what it sees, which can be extended to phones or glasses.
  • Adding Gemini-powered AI Overviews to results from Google Search.
  • Enhancing Google Photos with Ask Photos, which can find photos in response to user queries.
  • Enhancing Gmail with generation of summaries and replies, complex search and the ability to analyze attachments.

Google launches AlphaFold3, which offers a 50% improvement in analyzing and predicting molecules for biology-related research and drug discovery.


Business

CLEW Medical’s learning models for predicting patient deterioration receive FDA’s 510(k) clearance

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An Amazon Web Services blog post describes how Japan’s Fujita Health University used Amazon Bedrock’s managed AI service to generate discharge summaries, which it says reduced time requirements by 90 minutes to about 1 minute per patient.

An interesting Forbes article features digital health Investor Glen Tullman:

  • He says that telehealth is dead, declaring that “all of the virtual care we’re doing now is going to move to chat.”
  • His latest venture Transcarent – which has reached a $2.2 billion valuation for its chat-based primary care services —  is creating an AI chatbot that can answer a patient’s questions about their health plan, such as those that are related to deductibles and in-network doctors.
  • Tullman says that Transcarent’s $100 million acquisition of 98point6 in 2023 gave it 1 million doctor-patient chat conversations that it is using for AI validation and testing.
  • He says that Teladoc Health – onto which he unloaded Livongo for $18.5 billion in 2020 – saw its market cap shrink to around $2 billion because of poor leadership and the high cost of conducting video visits.

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Sift Healthcare raises a $20 million Series B funding round to expand its AI tools that tie clinical information to financial outcomes to predict “adverse payment outcomes” and calculate patient responsibility upfront.

SmarterDx, which uses AI to audit and review medical claims, raises $50 million in a Series B funding round.


Other

A Wall Street Journal report on how professionals are using AI profiles a Mass General primary care doctor who says that ambient documentation is “incredibly accurate,” never requires major editing of the notes it creates, and allows her to interact with patients rather than typing.

America in a nutshell: a researcher finds that ChatGPT creates more compelling GoFundMe pitches for donations from strangers to cover catastrophic medical expenses. He notes, however, that sometimes AI creates stories and images that are too polished, which turns off potential donors. A research team used ChatGPT to rewrite the stories of 900 medical crowd-funding projects, where it added emotion and direct calls-to-action to move people to open their wallets.


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

Comments Off on Healthcare AI News 5/15/24

Morning Headlines 5/15/24

May 14, 2024 Headlines Comments Off on Morning Headlines 5/15/24
    Crosby Health will use $2.2 million in pre-seed funding to further develop its automated clinical appeals software.

CareCloud, Inc. (CCLD) Reports Q1 Loss, Misses Revenue Estimates

Ambulatory health IT vendor CareCloud reports Q1 results: revenue down 13%, EPS –$0.02 versus –$0.28, beating earnings expectations but falling short on revenue.

Augmedix Delivers 40% Revenue Growth for First Quarter of 2024

Augmedix, which specializes in AI medical documentation, reports Q1 results: revenue up 40%, EPS –$0.12 versus –$0.14, beating expectations for both.

Comments Off on Morning Headlines 5/15/24

News 5/15/24

May 14, 2024 News Comments Off on News 5/15/24

Top News

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Ascension’s most recent update from Monday evening reaffirms that it will take some time – no timelines were announced — for it to return to normal operation following its May 8 cyberattack.

The update confirms that the attack involved ransomware.

Ascension also added region-specific updates for its patients. It warns that it is unable to accept credit card payments, wait times will be extended, and that some of its retail pharmacies cannot fill prescriptions.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Specialty care coordination company Switchboard Health raises $6.5 million in seed funding. Health IT veteran Derek Baird co-founded the company in 2022.

A Black Book survey of 30,000 physician office leaders and practitioners about their response to the Change Healthcare outage finds that 92% of medical practices are navigating short-term fixes and long-term vendor solutions. Nearly all complained that they first heard about the cyberattack from sources other than Change Healthcare. Black Book also notes that healthcare organizations that are negotiating new clearinghouse contracts should consider the value of the data that is contained in their claims, rights to which may have been signed over to their vendor in their original contracts. The top-rated competitors to Change Healthcare are Veradigm Payerpath, Waystar, Experian, and Availity.

Sturdy Health (MA) implements Notable Health’s AI-powered patient engagement, intake, and payments software.

Adam Selipsky, MBA, CEO of Amazon Web Services, will leave the company after three years. He will be replaced by AWS sales and marketing SVP Matt Garman, MS, MBA.

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CareCloud reports Q1 results: revenue down 13%, EPS –$0.02 versus –$0.28, beating earnings expectations but falling short on revenue, sending shares down sharply and valuing the company at $30 million.

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Augmedix reports Q1 results: revenue up 40%, EPS –$0.12 versus –$0.14, beating expectations for both. Shares dropped 51% as the company announced lowered revenue expectations, which it attributed to providers pausing to evaluate competing AI offerings. The company’s market cap is $56 million.


Sales

  • Elbert Memorial Hospital (GA) selects telehealth services from Equum Medical.
  • Meditech chooses Ellkay to provide interface services, including supporting the technical infrastructure involved in implementing Expanse as Meditech-as-a-Service.

People

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Alpha II promotes Ashley Womack to CEO.

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Censinet names David Woska, PhD (PHD Consulting Services) CISO.

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Justin Jacobson, MBA (Microsoft) joins Symplr as managing director/SVP of its contract and supplier management business.

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Suzanne Delbanco, PhD, MPH, founding CEO of The Leapfrog Group and co-founder and executive director of Catalyst for Payment Reform, has died of cancer.


Announcements and Implementations

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LG Electronics announces Primefocus Health, which offers digital health solutions for in-home care.

Nuffield Health, the UK’s largest healthcare charity, goes live on a new digital booking experience for health assessments with assistance from Lumeon.

Dandelion Health, which offers a real-world data and clinical AI platform, launches a clinical dataset of 200,000 patients who are taking GLP-1 drugs, as extracted from the systems of its non-academic health system partners.

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Researchers that include Eric Topol, MD introduce medical image interpretation dataset MedInterp, which contains 13 million annotated instances across three modalities. It will support the development of the “learnable orchestrator” that they call MedVersa.

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Meta will shut down its enterprise communication system Workplace and is recommending Zoom-owned Workvivo as its replacement.


Government and Politics

HHS offers new funding opportunities for projects related to accelerating the adoption of health IT in behavioral healthcare settings, and to developing novel ways to evaluate and improve the quality of health care data used by AI solutions.

The Idaho Department of Health and Welfare will likely end its contract with the bankrupt Idaho HIE unless the exchange improves transparency over security, financials, and employees. The HIE has spent $94 million of mostly federal tax funds, but a watchdog found that the 10-year-old organization has instituted few accountability measures.


Privacy and Security

Johnson Memorial Hospital (IN) President and CEO David Dunkle, MD says that the hospital is still feeling the effects of the ransomware attack that crippled its computer network in 2021: “We are forced to spend millions on cybersecurity, and we’re still suffering from higher insurance rates because of our attack, and we pay more than our peers, our same size peers do, because we had an attack. We see what Ascension is going through. My heart breaks for them because I’ve been there.”


Other

OpenAI’s newly announced GPT4o includes integration with the Be My Eyes app for the vision impaired. The ability for a blind person to hail a taxi as shown at the 0:35 mark is spectacular.


Sponsor Updates

  • Availity and Waystar rank highest in physician customer satisfaction with clearinghouses during and after the Change Healthcare ransomware attack.
  • CereCore releases a new podcast, “Cybersecurity Expert from Defense Weighs in on Healthcare’s Opportunities.”
  • Consensus Cloud Solutions will sponsor the Colorado HIMSS Spring Conference May 15-16 in Denver.
  • CloudWave will exhibit at the HIMSS New England Spring Conference May 16 in Norwood, MA.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

Comments Off on News 5/15/24

Morning Headlines 5/14/24

May 13, 2024 Headlines Comments Off on Morning Headlines 5/14/24

Switchboard Health Announces $6.5M Series Seed Funding

Specialty care coordination company Switchboard Health raises $6.5 million in seed funding.

HHS Announces LEAP in Health IT Special Emphasis Notice for AI and Behavioral Health Focused Projects in Fiscal Year 2024

HHS offers new funding opportunities for projects related to accelerating the adoption of health IT in behavioral healthcare settings, and to developing novel ways to evaluate and improve the quality of health care data used by AI solutions.

Avel eCare opens renovated headquarters with room to grow

Avel ECare, a telemedicine provider serving patients in 42 states, expands and renovates its headquarters in Sioux Falls, South Dakota.

Comments Off on Morning Headlines 5/14/24

Curbside Consult with Dr. Jayne 5/13/24

May 13, 2024 Dr. Jayne 17 Comments

I have friends who work for Ascension. The concerns coming out of their facilities, which are offline due to a ransomware attack, are quite serious. It sounds like they haven’t done adequate downtime preparation, let alone preparation for a multi-day incident that has taken nearly all of its systems out of commission.

Mr. H reported in the Monday Morning Update about a patient who left one facility because it had been two days and he still hadn’t been seen by a physician. This is completely unconscionable. I hope regulators step in immediately.

Any hospital leaders in any organizations who are not aware of the current ransomware and cyberattack landscape should be removed from their positions of authority immediately. Hospitals need to be drilling for the eventuality on a regular basis. Not annually, but monthly.

I’ve written about this before, but one of the most serious near-misses of my career, which to me will always be a full miss, occurred during an EHR downtime, when the environment in my facility can only be described as chaos. No one knew where the downtime forms were. They were reluctant to engage downtime procedures due to a misplaced fear of “having to fill out a bunch of paperwork” that is required when they formally call a downtime.

I was working in what was essentially a freestanding emergency department at the time, although it was licensed as an urgent care. Due to that licensing, we could have easily stopped taking new patients while we got things sorted. However, the fear of repercussions from management was too great. They continued to bring patients into the exam rooms, leaving the clinical teams scrambling.

Once I found out what was going on and that we were still taking new patients, I called the downtime and demanded we stop bringing in new patients. There’s no need to worry about diversion, EMTALA violations, or turning people away when you’re not licensed as an emergency facility. I’ve been around long enough and practiced in enough challenging environments, including in a tent and out in the field with no support, to know that sometimes you just have to take charge.

Shame on these facilities that are putting patients at risk through lack of planning, lack of leadership, and focusing on the bottom line instead of focusing on the patients who are in front of them. I hope they’re providing counseling for the clinical team members who are experiencing profound moral injury as they are expected to continue to just do their jobs in an untenable situation. One person who reached out to me described it as a “battlefield” situation.

For those of you who are in administrative positions, I urge you to walk to the front lines in various clinical departments in your facility and start asking questions about downtime. It’s not enough to simply trust the reports that are coming out of planning committees and safety assessment committees. My free consulting advice: you need to put your proverbial boots on the ground to find out whether people know what to do or not. It’s not enough to perform phishing tests and to look at the reports that show that people are becoming less likely to click on sketchy links or to visit dodgy websites. People have gotten really good at watching those cybersecurity videos and picking the correct answer on a bland, five-question test.

What you need to know, though, is that when push comes to shove and someone has taken control of your infrastructure, do your employees know how to see patients? Kind of like when you’re drilling for an inspection by The Joint Commission and you expect everyone to be able to explain the PASS acronym for how to use a fire extinguisher (Pull, Aim, Squeeze, and Sweep for those of you who might not be in the know) you need to ensure that everyone knows how to successfully execute a downtime.

Back to PASS, though. Knowing the acronym isn’t enough. Does your team even know where the fire extinguishers are? If a random person came up to them during a time when there was no inspection, could they verbalize where to find them? A downtime is no different. All staff should be able to articulate what are the conditions that require that a downtime be called, how to initiate a downtime, the various roles of the team during downtime, how to find the “downtime box” or whatever supplies they need to use, what the downtime communication plan is, and how to manage critical patient care tasks in the near-term while the entire downtime procedure is put into place. 

Every single healthcare facility needs to know how it will handle a multi-week downtime. News flash: no one is immune to this, and anyone who thinks otherwise needs to seriously reevaluate their leadership readiness. Our facilities need staffing plans to help workers cope with prolonged downtime, including adequate double-checks and safety procedures to account for the loss of systems we’ve all grown to rely on, such as bar code medication administration (BCMA), allergy and interaction checking, and electronic time-out checklists.

At this point, and especially after the Change Healthcare debacle, no one has any excuse for keeping their heads in the sand and thinking, “It couldn’t happen to me.”

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This weekend marked the opportunity to cross something off my bucket list without having to leave my home state to do it. The raging Level 5 geomagnetic storms are the first to hit Earth since October 2003, which was a time when I was knee-deep in building my practice and didn’t know a solar cycle from the citric acid cycle. Being involved in amateur radio for the last several years has taught me quite a bit about the former, and every day that I move farther from medical school has allowed me to forget more details about metabolic cycles than I care to admit.

As a “science person,” I’m happy to see this month’s expanded Northern Lights phenomenon capture the attention of so many people. I personally learned that the aurora comes in all different colors besides the most-often featured green. I hope there are children being inspired by it and considering future careers that involve exploring our universe and all the fantastic phenomena around us. Kudos to my favorite college student for capturing this amazing pic.

Were you able to see the aurora, or do you still have a trip to the northern latitudes on your bucket list? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Interoperability’s Last Mile – Universal Patient Consent and Access is Holding Us Back

May 13, 2024 Readers Write 1 Comment

Interoperability’s Last Mile – Universal Patient Consent and Access is Holding Us Back
By Lew Parker

Lew Parker, MSIS, MBA is chief technology officer of Arrive Health of Denver, CO.

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As always, the latest round of health technology conferences has inspired us with new ideas for the application and value of interoperability in healthcare. The combination of existing and new technology offers tremendous potential to impact patient outcomes and provider experiences. There’s one last mile we’ve yet to cross, however – our business policies haven’t caught up to our technology, and we’ve fallen short on the key step for how true data sharing will work.

Healthcare interoperability is meant to create transparency, giving providers and patients the information that they need to make decisions about all types of things, including diagnoses, treatments, costs, and more. We’ve made great strides in developing technology to standardize how we share data, such as HL7 and FHIR, at a granular level. There are also shining examples of interoperability at work to tackle specific challenges, such as using real-time prescription benefit (RTPB) data to support patient affordability and adherence.

What’s needed to cover interoperability’s last mile is a federated, decentralized way to authenticate, access, and, most importantly, verify consent to that data.

This isn’t an impossible task or pie-in-the-sky recommendation. Think about when you register a website domain. You purchase the domain from a single registrar, point it to your server, and every DNS instantly knows where to route traffic. The registration isn’t centralized, but it is handled in a way that makes the ownership and access, managed by one registrar, available to all for verification and use.

For another example, look at how SSL certificates facilitate secure communications across the internet through a federated registry system, where trust is decentralized yet universally acknowledged. Over 100 trusted certificate authorities are providing this service. By applying a similar federated model to healthcare, we can enable seamless access to data while respecting the autonomy of individual entities within the network. Imagine what our world, and patient experience and outcomes, would look like if we achieved this same level of trust and access.

In a federated model, the focus shifts from establishing a single centralized governing body to an alliance of healthcare entities that agree on shared policies and standards for data use and access. Much work has been done to create these types of alliances, and we should leverage existing organizations if possible. This would:

  • Create a single place for healthcare entities and partners to ping for information once patient consent is given.
  • Streamline access to data, removing firewalls that we experience today because of contract or independent business policies.
  • Foster innovation by providing an easy way to grant data access to trusted partners.
  • Pave the way for patients to access, understand, and plan their healthcare in a single place.

In this future scenario, RTPB data has new potential. RTPB surfaces millions of real-time patient events a day, events like me getting a new prescription or having a prior authorization approved, that others could use to improve care delivery, lower costs, connect me to community resources, and a million things I have not thought of myself.

Without a unified way to provide access to this data, however, these opportunities to make my experience better cannot happen. Instead, to gain access to real-time information, each innovator and partner must establish 1-to-1 relationships and partnerships, each with their own policies, contracts, and requirements. Our systems become complicated and cumbersome as we must codify this variability into our interoperability applications. This ultimately slows down, and in many cases prevents, access to the very data that is needed to drive progress and health outcomes.

I am extremely proud of our industry for our interoperability achievements, and I remain positive about what’s to come. I also believe covering the last mile and achieving true interoperability in healthcare is going to require us to think more broadly and collaboratively about not only how we share data, but how we use it. It remains to be seen if TEFCA can provide the federated model that is required for success.

Readers Write: Unification of Content Will Unlock the Next Phase of Healthcare Innovation

May 13, 2024 Readers Write 1 Comment

Unification of Content Will Unlock the Next Phase of Healthcare Innovation
By Greg Samios

Greg Samios, MBA is president and CEO of clinical effectiveness of Wolters Kluwer Health

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The pressures and challenges in the healthcare environment are numerous, from dealing with financial constraints to coping with severe staffing shortages. The situation is concerning and getting worse: 16.7% of healthcare facilities anticipate critical staffing shortages, one in four nurses plan to exit the profession because of overwork and understaffing, and disruption from cyberattacks has put many healthcare facilities on the brink of closure.

The stark reality is that 60% of physicians’ questions go unanswered daily and more than one in every 20 patients experiences preventable harm, incurring costs that are associated with medication errors of approximately $42 billion USD globally. 

Yet healthcare executives must strive to deliver the best possible patient care amidst continually evolving circumstances. The shape of healthcare has changed with new care delivery models for where and how healthcare is provided, from retail clinics to virtual health. Within this cyclone of change, healthcare enterprises are seeking scalable solutions that can not only improve patient outcomes, but also drive care team efficiencies and reduce care variability.  

Each day, healthcare providers turn to information and technologies to make care decisions and educate patients. Content and data underpin the continual information stream, but too often that content is based on disparate technologies that lack harmony, leading to inconsistent care decisions and inefficiencies that may exacerbate care variability.

In many cases, this disconnect is the result of solutions being added at different times to address different needs while forgetting to consider how they fit into the clinical workflow. For example, as COVID-19 arrived, many healthcare providers pivoted quickly to solutions to support remote and virtual care out of necessity. For many organizations, this resulted in relying on “best for need” vendor solutions to fill in immediate gaps, but not necessarily best address long-term, enterprise level goals. Today, however, like many industries, healthcare is looking for fewer vendors in seeking consistency, efficiency, and cost savings. 

Looking at this issue, the unification of content is a necessary next step for healthcare to facilitate seamless decision-making at the point of care and across the healthcare ecosystem. Harmonized content makes healthcare delivery easier for all members of the healthcare team, who can access the same information for treatment, drug dosing, and patient education to support better care.

Having consistent content also creates a vital underpinning to support and coordinate high quality patient care and eliminate care variability as healthcare adopts innovative technologies such as generative AI. In fact, both physicians and consumers have expressed concerns about the source of the content that is driving GenAI healthcare solutions, making it even more critical that there is a trusted and unified content solution for healthcare.

Unified content and solutions help align care teams and administrators to work together, rather than in disparate workflows, to deliver the best care for patients and position themselves for success in meeting current and emerging health challenges.

Morning Headlines 5/13/24

May 12, 2024 Headlines Comments Off on Morning Headlines 5/13/24

Cybersecurity Event Update

Ascension’s 140 hospitals in 19 states remain offline following a ransomware attack on Thursday.

#StopRansomware: Black Basta

The federal government issues a warning about the Ascension-linked Black Basta ransomware variant.

Senators call for VA to tighten performance standards in new health records contract

Three members of the Senate Veterans’ Affairs Committee call for the VA to take advantage of its recently renegotiated contract with Oracle Health to strengthen accountability and oversight terms.

Sift Healthcare Raises $20M Series B Funding Round to Enhance AI-Powered Payment Solutions

AI-enhanced RCM company Sift Healthcare raises $20 million in a Series B funding round led by B Capital.

Comments Off on Morning Headlines 5/13/24

Monday Morning Update 5/13/24

May 12, 2024 News 5 Comments

Top News

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Ascension’s 140 hospitals in 19 states remain offline following a ransomware attack on Thursday. An unstated number of the facilities are diverting ambulances.

The health system says restoring the systems “will take some time to complete,” adding, “we will be utilizing downtime procedures for some time.”

Ascension advises patients to bring in their own appointment notes and prescription information. A hospital family nurse said, “Patients are getting harmed. No one can tell you otherwise.”

A patient who was hospitalized when the attacked started reports, “It was like 1980. Everyone’s running to get pieces of paper, charts, clipboards. They have no computers whatsoever. It was chaos.” The patient, a colon cancer survivor who was vomiting blood, left the hospital two days after admission because he still hadn’t been seen by a doctor.

CNN reports that the Russia-linked ransomware group Black Basta was responsible for the attack. The federal government issued a warning about its ransomware variant on Friday.


HIStalk Announcements and Requests

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Here are the results from last week’s poll. For me, the convenience of co-locating a medical and dental practice with a big-box store doesn’t hold value since plenty of doctors and dentists have offices in easily accessible locations. Some respondent comments that I’m paraphrasing:

  • Walmart shut it down because they can generate higher margins elsewhere. The company benefits only from bringing in more dollars per square foot, not from supporting “healthier communities.”
  • Health systems know that primary care and pediatrics are loss leaders, but Walmart missed that fact. They can’t sell enough groceries and TV sets to make up the cost.
  • Walmart didn’t differentiate its services. It was just a bigger box with more expensive executives who were disconnected from any kind of healthcare transformation. Still, the company probably isn’t done with healthcare and an acquisition is likely.

New poll to your right or here: Should the federal government issue a national patient identifier?

I was pondering another poll: which platform’s users have the apparent lowest IQ or technical capability, Facebook or Nextdoor?


I always offer a Summer Doldrums Sponsorship Special, which usually involves some free months for the first year. Contact Lorre. Former sponsors also get a deal for returning. All gain visibility with the most influential people in the industry, who read HIStalk quietly but religiously.


Webinars

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


Sales

  • The Centers chooses Netsmart CareFabric, which includes the MyAvatar EHR.

People

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Industry long-timer Dann Lemerand (Navv Systems) joins Otter Products as healthcare vertical lead. Dann created the 4,200-member HIStalk Fan Club on LinkedIn many years ago, of which I can’t cite any specific benefits except to my ego when it gets bruised.


Government and Politics

Three members of the Senate Veterans’ Affairs Committee call for the VA to take advantage of its recently renegotiated contract with Oracle Health – which changed the contract’s five-year term to five, one-year terms – to strengthen accountability and oversight terms. They note that poor service delivery in the previous five-year period resulted in just a few hundred thousands of dollars in credits being extended toward the $10 billion contract.


Sponsor Updates

  • Wolters Kluwer Health publishes a new “UpToDate Point of Care Report: An enterprise approach to unify healthcare.”
  • EVisit announces a business development partnership with digital consulting firm Monsterlab.
  • TruBridge announces Multiview’s cloud-based enterprise resource planning software as its preferred financial management solution for its customers.
  • Nordic releases a new Designing for Health Podcast, “Interview with Farhan Ahmad and Jon Keevil, MD.”
  • PerfectServe honors 150 outstanding nurses in its fourth annual Nurses of Note Awards program.
  • Sonifi Health will exhibit at the HIMSS Texas Regional Conference May 13-16 in Grapevine.
  • Tegria publishes a new case study, “Custom Demo Environment Accelerates EHR Adoption.”

The following HIStalk Sponsors are named MedTech Breakthrough Award winners:

  • Amenities – best online search and scheduling solution
  • Nym – health administration innovation award
  • Bamboo Health – best care orchestration platform
  • Artera- best patient communication solution
  • Elsevier – AI innovation award
  • Symplr – best provider data management platform
  • Inovalon – best data visualization solution
  • Waystar – healthcare payments innovation award

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

Morning Headlines 5/10/24

May 9, 2024 Headlines Comments Off on Morning Headlines 5/10/24

CareCloud Retains Citizens JMP as its Exclusive Capital Structure Advisor

CareCloud hires an investment bank to review its capital structure after it turns down an unsolicited acquisition offer.

DoorSpace secures $2M in seed round

Healthcare workforce management software startup DoorSpace raises $2 million in seed funding.

Guthrie Lourdes Hospital Experiences Communication System Issues

Guthrie Lourdes Hospital (NY) works to recover from a communications system outage that impacted phone lines.

Oracle’s $28 Billion Cerner Health Tech Bet Sputters With Lost Customers and Slipping Sales

Bloomberg reports that the former Cerner business lost at least 12 large clients in 2023.

Comments Off on Morning Headlines 5/10/24

News 5/10/24

May 9, 2024 News 2 Comments

Top News

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Ascension’s 140 hospitals and 2,600 healthcare sites in 19 states divert patients and go back to paper documentation following an unspecified cybersecurity event that forced the health system to take down “select technology network systems” Wednesday morning.

Ascension has urged its business partners to disconnect from its systems, which would suggest a ransomware attack.

Hospital visitors say that they saw younger doctors struggling to use fax machines, pneumatic tube systems, and paper prescription pads for the first time.


Reader Comments

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From Rashaverak: “Re Steward bankruptcy filing. Hoping that the Commonwealth of MA sues Cerberus Capital to recoup some of the nearly $1 billion profit via its fleecing of Steward’s MA hospitals. Steward spun off its MA real estate to a real estate holding company for $1.25 billion in 2016. It appears that none of those dollars went into improving Steward patient care, but more likely to Cerberus’ pockets.” Blame the game, not the player, for employing immoral but not illegal behavior to do what private equity (aka pirate equity) firms do best – buy a company, load it with debt, pay investors all their money back immediately, and then walk away with bro high-fiving when the business is financially starved because it can’t even pay the interest on the loans that were taken out in its behalf. I’m sure that Steward chairman and CEO Ralph de la Torre, MD is anguishing over the plight of patients and communities from his $40 million yacht that operates out of the Galapagos Islands (one of two that he owns). He awarded himself a $100 million bonus when Cerebrus quadrupled its investment by selling the land from under its hospitals, pocketing $800 million.


HIStalk Announcements and Requests

Last chance for HIStalk sponsors to get a free mention in my guide to the MUSE Inspire conference. I have just one response versus the several companies that are exhibiting, so my work will be minimal.


Webinars

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


Acquisitions, Funding, Business, and Stock

CareCloud hires an investment bank to review its capital structure after it turns down an unsolicited acquisition offer. CCLD shares have lost 64% of their value in the past 12 months and are 91% off their all-time high, valuing the company at $17 million.

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A Bloomberg report that is based on interviews with former Cerner clients and employees concludes that the business lost at least 12 large clients in 2023. Bold product ideas have been placed on hold as Oracle’s engineers struggle with moving the Cerner product to the cloud. Internal documents predict that Oracle Health sales will decline 5% this fiscal year due to the VA project’s hold. Insiders say that Larry Ellison’s boasting that most Cerner clients have been moved to the cloud is accurate, but misleading – it’s a bunch of small medical practices, but no huge health systems that are likely to have customized the product.


People

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NextGen Healthcare hires Jacob Sims (Gainwell Technologies) as CTO and Garo Doudian (Moody’s Analytics) as CIO/CISO.

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Nisha Gandhi, RN, MBA (AbleLight) joins KeyCare as chief growth officer.

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Nordic hires Stuart McLean, MBA (Alvarez and Marshal) as interim CEO following the retirement of Jim Costanzo. The company also lists Uyon Johnson, MBA (Bon Secours Mercy Health) as interim chief human resources officer.  


Announcements and Implementations

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Valley Health System (NJ) opens a new “smart hospital” as its flagship in Paramus, which uses Meditech Expanse, in-room monitors to allow patients to review their medical information and manage room environment, RTLS-based display of the names of caregivers who enter the room, and AI-powered fall monitoring.

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Customer experience app vendor Ushur releases a white labeled medication adherence solution for payers and pharmacy benefit managers.


Privacy and Security

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Some systems at Palomar Health Medical Group (CA) remain down after the organization took them offline following suspicious computer activity on Sunday.


Sponsor Updates

  • Symplr launches a new Symplr Workforce mobile app feature to enable healthcare professionals to nominate nurses for a DAISY Award.
  • FinThrive publishes a new case study, “McCurtain Memorial Hospital Cuts Weekly Verification Time by 30 Hours with Real-Time Insurance Discovery.”
  • Arcadia publishes a study that finds that nearly half of all healthcare data is not used in decision-making.
  • HCTec will sponsor the Texas Regional HIMSS Spring Conference May 14-16 in Grapevine.
  • The Medicomp Systems Tell Me Where IT Hurts Podcast earns an honorable mention in the PR News Digital Awards program.
  • Mobile Heartbeat partners with technology consulting firm Signet.

Blog Posts


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Mr. H, Lorre, Jenn, Dr. Jayne.
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EPtalk by Dr. Jayne 5/9/24

May 9, 2024 Dr. Jayne Comments Off on EPtalk by Dr. Jayne 5/9/24

The American Medical Informatics Association is working with the Patient ID Now Coalition to persuade members of Congress to reject language in Section 510 of a 2025 appropriations bill that continues to ban the US Department of Health and Human Services from investing money towards a national unique patient identifier.

Organizations are still using a hodgepodge of matching algorithms that often work, but sometimes don’t. There are particular challenges with pediatric patients when organizations include phone numbers in the algorithm. Infants who might not yet have a Social Security number are also at risk. I’ve seen EHR conversions that inadvertently combined a pair of infant twins due to inadequate matching algorithms, so I would very much like to see a unique patient identifier even if it’s voluntary and patients have to opt in. The risks to patient safety remain great and I want my care teams to have access to all of my data.

Also in Congress, the House Ways and Means Committee is entertaining a two-year extension of Medicare telehealth rules that have improved reimbursement since the COVID-19 pandemic. There are multiple bills under consideration, including the CONNECT for Health Act and the Telehealth Modernization Act. Without an extension, the rules will expire at the end of this year. Primary care docs are leaving my state’s rural areas in droves, and increased coverage would allow patients to have visits with physicians in other areas of the state without driving for multiple hours.

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I’m so used to working in high-reliability organizations that it shocks me when I encounter an organization that probably should be more high-reliability than it is. I was at a large regional post office this morning, and apparently they had experienced a power outage and the electricity had just come back on. There was one customer at the counter and two in line, so the postal employee announced what had happened and asked for our patience as they rebooted the systems. It took a few minutes for her station to come back up, and when the customer was ready to check out, apparently the credit card machine didn’t work. She was sending several registered mail items, so went out to her car to rummage for cash or a checkbook.

The employee suspended her transaction and called me to the window, making an announcement to the dozen or so people that had accumulated in line that the credit/debit machine was down and that they could only take cash or check. Everyone behind me turned and left, and I was grateful that I had my friend Andrew Jackson in my wallet, although I haven’t carried a checkbook in decades. One would think that the US Postal Service would be critical infrastructure and have at least some level of UPS backup (uninterruptible power supply of course, not the competition) with generator backup. They can deliver despite rain, heat, and gloom of night, but a power outage is going to put a dent in things.

I’ve been a panelist for several Women in STEM events and am always on the lookout for ways to increase the number of girls interested in healthcare and technology careers. During a recent talk, one of my co-panelists talked about “The Scully Effect,”  which shows that women who watched “The X-Files” were more likely to pursue careers in STEM-related fields. According to 2017 data, 63% of study respondents who were familiar with the Dana Scully character admitted an increased their beliefs in the importance of STEM.

Many of the young women I work with weren’t alive when Gillian Anderson began playing Dana Scully in 1993, so it will be interesting to see who will be STEM role models for newer generations. Media popularity now seems to be centered on TikTok and various social media influencers, many of whom share unscientific and downright dangerous content. I’d love to see a campaign to raise awareness about the roles available to women in healthcare IT, since I’ve run across multiple medical students who didn’t have a clue that it was a career path.

Federal regulators in the US are taking a greater interest in the issue of organizational consolidation in healthcare. They’ve opened comments looking to understand “the effects of transactions involving health care providers (including providers of home- and community-based services for people with disabilities), facilities, or ancillary products or services, conducted by private equity funds or alternative asset managers, health systems, or private payers.” You can browse the submitted comments (1,400 so far) and see how frustrated patients, physicians, and other providers are with our healthcare non-system. Hot topics in the comments I screened include lack of competition, greed, hospitals requiring pre-operative labs to be done in-house at a higher cost than competitive labs, the negative effects of companies like CVS expanding their scope of business, and compromised patient care. All the talking heads in healthcare should have to understand comments like this one from Lindy:

I am a retired home health caregiver, as well as an American citizen who lives below the poverty line financially. It has been a lifelong struggle for me to access good healthcare, and it is only getting worse. Corporations are by design intended to maximize profit, and in the health care field, this translates into sacrificing the good of a human being for the profits of a corporation. Every human being should be prioritized over profit, failing that is to put money over humanity which degrades us all. How can it be that dollars are more important than a mother, a father, a child who is suffering and in need? It is cruel, heartless, and inhumane on every level. It is time to put the genie back in the bottle, prioritize human beings over dollar signs, and prevent moneychangers from having the ability to dictate who lives or who dies because of money. America must be better than that, and corporations must be kept in line with humanitarian priorities.

It’s National Nurses Week, so here’s a shout-out to all the nurses out there who are caring for patients day in and day out. Special props to my nurse informaticist colleagues, who have taught me so much about thinking about systems from different points of view.

Of course, there are still hospital executives behaving badly as they attempt to show gratitude to the people that make their facilities run. One example of a tone deaf gift choice was sent to me by a nurse in the Midwest. The hospital gave nurses lunch boxes, which felt particularly insulting to night shift workers since the facility removed all hot food service for them. They also require workers to use self-checkout for prepackaged items on the night shift. The only overnight worker is a cook who is doing prep work for daytime workers, who still have full food service, including salad bar.

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It sounds like managers suspected that the gift wasn’t going to be well received and provided these adorable badge reels plus breakfast out of their own pockets.

What’s the most irritating thank you gift you’ve received from leadership? Leave a comment or email me.

Email Dr. Jayne.

Comments Off on EPtalk by Dr. Jayne 5/9/24

Morning Headlines 5/9/24

May 8, 2024 Headlines Comments Off on Morning Headlines 5/9/24

Network Interruption Update

Ascension diverts ambulances, reverts to downtime procedures, and urges business partners to disconnect from its systems after detecting suspicious activity on its network.

In-House Health Raises $4 Million Seed Round, Unveils AI-Powered Scheduling Platform to Combat Nurse Shortage Crisis

In-House Health announces GA of its scheduling and management software for nursing staff and $4 million in seed funding.

Ciba Health Raises $10M in Series A Funding

Ciba Health, which offers digital therapeutics and virtual care, raises $10 million in Series A funding.

Comments Off on Morning Headlines 5/9/24

Healthcare AI News 5/8/24

News

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The American Hospital Association asks Congress to employ flexibility in any decisions to regulate AI in healthcare, proposing use of a sliding scale that is based on risk and the level of human oversight that is involved. AHA says that a one-size-fits-all regulatory approach could stifle innovation, saying that a better model is that of the FDA’s guidelines for defining Software as a Medical Device.

Apple announces the 2024 IPad Pro, the company’s first product to feature the newly announced, AI-optimized M4 chip. Prices start at $999 before trade-in credit for the 11-inch, one-pound model with Ultra Retina XDR display, 256 GB, and 12 MP front and back cameras. The company is speculated to be preparing all of its hardware to run AI without further upgrades, and the Wall Street Journal reports that Apple is working on a chip to run AI software in data centers.


Business

Karius, whose early warning system diagnoses infectious disease by using AI to analyze a form of DNA from blood samples, raises $100 million in Series C funding. The company will use the proceeds to expand beyond its 400 US hospital customers of Karius Test, which can detect 1,000 pathogens from a single blood sample.

Opmed.ai, which uses AI to optimize surgery scheduling and resource allocation, raises $15 million in a Series A round.

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Expion Health, which offers pharmacy and medical cost management solutions for payers, develops an AI-driven tool for responding to RFPs, which increases efficiency and reduces errors in its contracts in which it accepts financial risk.

OpenAI is working on a search feature for ChatGPT that would perform real-time web searches and return detailed information with citations, competing with Google’s search that includes paid ads and SEO-optimized, low-quality sites. Google generates $200 billion in annual search engine revenue, which represents about 80% of its total.


Research

Experts from drug maker Lilly say that AI will soon be able to design new drugs by using its own thinking instead of being trained on human-created datasets. They believe that even AI’s hallucinations will provide value by analyzing non-existent proteins within models.

Ohio State researchers train AI on de-identified medical claims data to predict the impact of available medical interventions on patient outcomes, which could supplement randomized clinical trials and explore new uses for existing drugs.

A UCSF study of emergency room visits finds that AI performed triage based on acuity as accurately as physicians. The authors note that since the commonly used Emergency Severity Index (ESI) is a rules-based triage scoring system that is straightforward for clinicians to calculate, AI might outperform them when making decisions that are based on both ESI score and patient details, such as answering difficult questions such as, “We have two patients and one available resuscitation bed – which one should get it?”


Other

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A Mother Jones article says that AI chatbots not only haven’t eliminated health misinformation, they have made it worse. It says that GPT can’t tell the difference between scientific information and the information it crawls from questionable websites, refers users to sites that sell scientifically unproven health products, and is easily fooled by information that sounds authoritative but isn’t. A science communication professor says that AI, unlike humans, doesn’t have the capacity for critical thinking, applying skepticism, and seeking out facts that disprove inaccurate information. I replicated the authors question to Microsoft Copilot about alternative cancer treatment programs, which included a link to the website of for-profit, cash-only Cancer Center for Healing, whose physician owner sells cancer treatments that have not been FDA approved.


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

HIStalk Interviews Russ Thomas, CEO, Availity

May 8, 2024 Interviews Comments Off on HIStalk Interviews Russ Thomas, CEO, Availity

Russ Thomas, JD is CEO of Availity of Jacksonville, FL.

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Tell me about yourself and the company.

Availity connects health plans and providers for their critical business workflows. Most people would call that a clearinghouse, but we think of it as a 21st century clearinghouse because we add a lot of intelligence around the workflows that we facilitate between providers and payers.

We’ve been doing that for almost 25 years. The company started in 2001. Today, we serve well over 3 million providers around the country. We will process $3.5 trillion of claims through our network this year.

We are big believers in what we call multi-modality. We take providers however we find them. If they are sophisticated providers working in their Epic environment, we love that. We are deeply integrated with Epic with our revenue cycle product. At the same time, we have literally millions of providers who access their payer information through Essentials, our real-time, multi-payer portal. That gives them the vast majority of the information that they need, day in day out, to run their business. It serves all types of providers, not just physicians, but anyone who’s providing healthcare to a patient and getting reimbursed by health plan. Think about Medicaid, which includes atypical providers — ramp builders, transportation companies, or somebody’s aunt or uncle or mom or dad who is getting reimbursed for providing care to them.

What are the most urgent opportunities in improving communication between providers and payers?

The most urgent opportunity is quality of information. We are very good at building and deploying technology to facilitate the exchange of information in a timely way to the right person with the right information that they need. The underlying quality of the content has to continue to improve. Authorization workflow is facilitated today between most health plans and providers. Trying to figure out that translation of provider-speak to payer-speak often involves phone calls and faxes, and wait times for authorization are still long.

In that example, we have found a way to automate that workflow. We acquired a company about a year ago called AuthAI and have implemented that with one payer, with others in process. We are literally creating a real-time exchange of authorization information, facilitating that authorization workflow in under 90 seconds, all the way through a medical necessity determination. It’s a huge provider satisfier and works great for the payers as well, bringing value to both sides of the equation.

Right or wrong, I assume good intent. I assume that providers only want to perform procedures that are appropriate, medically necessary, and good for patient care. I assume that payers want to pay the fair contracted rate for that care. If the administrative workflow is slowing that down, creating obstacles, or getting in the way of good medical practice and good reimbursement practice, it can be more trouble than it’s worth.

We focus on eliminating those administrative workflows that just get in the way and aren’t providing any value. They were put in place with good intentions at some point in the past, but now they are not helping to improve either patient quality or the relationship between providers and payers.

What impact will patients see from federally mandated payer-to-payer APIs?

We have launched that. We have our first cohort of payers implementing now. I think it’s three or four that we’re starting with and our second cohort is right behind it. Transparency, right? Interoperability.

Availity is in Jacksonville, FL. We have been a Florida Blue company for a long time for our health coverage. If we decide to move to somebody else, my data shouldn’t be siloed in the Florida Blue environment. There’s tons of opportunity to improve patient care, to improve transparency, and to make the provider’s job easier by mandating the exchange of that information between payers when either I individually or my company makes a decision to make a switch. It’s freeing up data, which is what I love about it.

What are your biggest takeaways from the Change Healthcare cyberattack?

I anticipated that question, but I still don’t know that I have the best answer to but a couple of things.

Security is paramount. We talk about it in terms of resiliency. Resiliency means that you have a you have a really good Plan A, which is to maintain the highest possible level of information security to protect your network. You’re going to see us advocating for this as a company.

The bar is higher for firms who do what we do. The bar for clearinghouses needs to be higher, for both the level of information security that we maintain and for the resiliency or redundancy of our networks, because the alternative to that is to try to figure out how to protect millions of endpoints. I don’t think that’s a fair burden to put on providers in particular, who are already stressed and trying to run businesses that are financially struggling in some cases.

We have been advocating aggressively in the last couple of months with CMS. Congress has gotten involved and should be focused on hardening the network itself, so that physicians and payers can continue to collaborate effectively.

Information security has to be your Plan A. You have to be world class at it, and it needs to be a culture within your organization. It certainly is for us.

Then, candidly, you need a redundancy plan. Your Plan B that assumes plan A fails at some point. When there is an attack, and when there is an impact from attack, you have to be able to bring the network back to full strength in time periods that are measured in days, if not hours, not in months or quarters.

The takeaway for us is that as good as we think we are from an information security perspective, we have to continue to get better, better, and better. Invest more and bring more resources to bear. Challenge ourselves to think differently about how to protect our network. We have to make sure that our redundancy plan remains strong. We’re doing things today to make sure that we are fully cloud migrated, so that when or if something happens, we are able to move environments really, really quickly and have as little impact on our clients as possible. Those are the key takeaways.

I’m at a large health system today where we extended the Availity Lifeline. Not to brag, but I think we’ve done a really nice job of helping providers get back in business. We’ve stood up 300,000 providers in the last 65 days and moved over $160 billion of claims that would have otherwise been stuck. As you can imagine, that has allowed us to make some really good relationships. One of the things that we are hearing from these providers is that we have to have a backup plan. Being on our own and having one system has worked for a long time, but we really need to think about how to create redundancy in our own network with a solid backup plan. That’s a takeaway not just for Availity, but for a lot of providers.

We were at our annual client conference in Arizona when the cyberattack started on February 21. We took the correct immediate step to disconnect from anything with a “U” in front of it, not just Change, but all of the Optum environments and all the UnitedHealth Group environments that we were connected to. We then said to ourselves, we don’t know how long this is going to last, but there will be providers and payers who need some help. We created this program called Availity Lifeline to bring claims and remits back up. We stripped down our revenue cycle product into a really simple, fundamental version of it that was just claims and remits, which are the lifeblood of the business relationship between a health plan and the provider.

We went out to the market and said, we’ll make this available to anyone who needs it, free and with no strings attached. You can terminate it with five days notice. You never pay us a nickel, but in the short term, this at least will help you as a health system to get claims and remittance flowing again so that you can continue to run your business while you figure out what you want to do. It’s been very successful, with 300,000 providers and 150 or 160 actual systems that have implemented Lifeline. As I mentioned, we have moved $160 billion of otherwise stuck claims between payers and providers.

UnitedHealth Group paid the hacker’s demanded ransom, but was still down for many weeks. Oracle’s Larry Ellison said that they could have come up quickly if they were running Oracle Cloud. Is it harder to recover a complex network than to restore a health system, and does cloud provide a lot of extra recovery benefit or just a head start?

Cloud gives you a ton of extra benefit. If you listen to UHG CEO Andrew Witty’s testimony to Congress, there was a lot of older technology behind the scenes of Change. That created some real challenges, based on what they have said, in terms how the bad guys got into the network and had the ability to root around for a week and half before they actually pulled the lever on the actual ransomware attack.

Being cloud-enabled absolutely is advantageous in getting networks back up faster when there’s an event. I don’t know whether Larry’s right that it would happen in minutes. From the Availity perspective, we are completing our cloud migration. We run two data centers, but we never have them both processing transactions at the same time for that very reason. One is primary and one is redundant.  If we had to move from A to B, we can do that in three to six hours. We also do some other things to protect our core data with things like immutable backups that nobody can touch. It’s a journey, but we are absolutely counting on our cloud migration to give us even further redundancy and resiliency against a cyberattack.

You’ve acquired Diameter Health and the Olive’s utilization management business since we last spoke. How did those acquisition round out your portfolio?

The first thing that we do, even in due diligence, is cyber audits and cyber reviews. Before we close, what do we need to do to bring an acquisition up to our standards for information security? We don’t do anything to combine, from a technical perspective, those kinds of capabilities until we have brought them up to standard if needed.

Diameter was a great acquisition. The best analogy that I can give is that it’s a refinery for clinical data. Unlike administrative data, a lot of clinical data has no structure. There are no standard terminologies that everyone uses. You get a lot of data in, but aren’t able to use it and apply it to business workflows in an automated fashion. Diameter upcycles – we use that term – and refines clinical data from a lot of different sources into consumable data elements that can then be implemented in an automated workflow. We are very happy with that acquisition. It is really core to our broader clinical data, clinical interoperability standard today.

AuthAI, likewise, has been great. We bought it with one client. We’ve now sold it to multiple clients. It is a true delighter. The difference between AuthAI and Diameter is that Diameter is more of an internal technology, while AuthAI has a user experience. We can walk into provider’s office and say, “We we have automated your auth workflows for the vast majority of the ‘ologies’ that you work with. Now you can get a response in 90 seconds, all the way through medical necessity determination.” That’s a difference-maker to a provider.

How will AI affect your business?

AI is going to give us new capability. We are pretty committed to it at this point. AuthAI is built on the premise that analytic AI is a great tool to apply in complex healthcare workflows. We’ve certainly seen that with our AuthAI solution. Internally, we are leveraging AI to simplify both our own workflows and our relationship with our providers and health plans and other customers.

I’ll say one thing as an example. I got demos yesterday from two really cool companies, not startups, but sort of earlier stage. One that is on the provider side is leveraging AI in clinical documentation to help providers by essentially transcribing their clinical conversation into an application, then leveraging AI to create a true clinical note and applying what the AI believes are the proper billing codes, ICD codes, to that note.  Great. That could be a real time saver for providers.

The other demo later in the day was an early-stage AI company that was building what you and I would call, from our experience, fraud, waste, and abuse capabilities for payers. They use AI to look at the pattern of how claims come in and the documentation behind a claim to make sure that the claims are appropriate and medically necessary and therefore should be paid.

If you think about those two conversations individually, on both sides, they are cool, save time, save energy, and drive efficiency. However, you have to make sure that you achieve true transparency and enhanced decision-making to get to the right result. I don’t want to arrive in a year or two at a scenario where payer AI and provider AI are arguing with each other over whether a claim should have been a denied or whether a code should have been paid.

To the extent that AI can be applied like we’ve applied it with AuthAI to automate a workflow, in the end, between a payer and provider, where everybody’s agreeing to the rules of the road and you are leveraging the AI to drive a more efficient, effective process, the promise of that is just spectacular. That gets me really excited.

CMS’s pay-and-chase policies and perhaps its lack of sophisticated technology allow seemingly obvious fraud to take place over years before someone might be brought to justice. Couldn’t technology detect outliers more quickly?

I think there’s a great opportunity there, 100%. We sell our Advanced Editing Services product into Medicare through the MACS. It is built in with as a real-time editing capability so that you can continue to learn where games are being played or where there’s potential for fraud, waste, or abuse. You can build new edits in real time and deploy those prospectively. Why are you paying this and going after it? What you should be doing is applying the rules prospectively to deny the activity or to prevent the activity in the first place. That is 100% where we are focused as a company.

I don’t think that’s just to protect from bad activity. We are focused on it in terms of shifting left. Availity serves as the gateway for payers that are representing well over 100 million covered lives in the US. Generally, all claims and all activity flow through Availity. We believe that through the application of technology, including AI, we can make our gateway smarter, so that by the time we pass a claim onto the payer, It can be screened for nefarious activity, but it can also be screened for clinical appropriateness, proper documentation, and all the things that are required to pay a claim accurately and in a timely fashion.

What are the key points of the company’s strategy over the next five years?

We have a good thing going at Availity. We have a pretty unusual capital structure in that some of my largest customers in our health plans are investors in the company. We have a really good culture at the organization, with people who really believe in our mission. In the next five years, we will continue to do what we’re doing today to drive better collaboration, better partnership, and more transparency of information between payers and providers.

Then, to eliminate some of these lagging, complex, administrative problems that drive hundreds of billions of dollars of inefficiency in healthcare and just piss everybody off. No patient wants to stand at the MRI counter waiting an hour for their auth to be approved or to be told that even though you have a scheduled appointment, you have to come back tomorrow because I can’t get your auth approved.

Good, bad, or otherwise, we have just scratched the surface on some of these super complex challenges in healthcare. Availity has in important role to play over the next five or 10 years in simplifying the process of healthcare.

Comments Off on HIStalk Interviews Russ Thomas, CEO, Availity

Morning Headlines 5/8/24

May 7, 2024 Headlines Comments Off on Morning Headlines 5/8/24

Rad AI Closes $50 Million to Empower Physicians with AI

Rad AI, which offers AI-powered radiology reporting workflow software, raises $50 million in Series B financing.

Blackwell Security raises $13M co-led by General Catalyst and Rally Ventures to empower healthcare cybersecurity operations

Healthcare cybersecurity solutions vendor Blackwell Security raises $13 million in additional funding and hires Geyer Jones (Cylera) as its first CEO.

OptMyCare Secures $3 Million in Series A Funding from Investor Group Led by LiveOak Ventures

AI-powered risk stratification software startup OptMyCare announces $3 million in Series A funding.

Palomar Health Medical Group phones, patient portal offline after ‘suspicious activity’ detected

Palomar Health Medical Group (CA) reverts to downtime procedures after detecting suspicious activity on its computer network.

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