Morning Headlines 10/11/23

Commons Clinic Announces $19.5M Series A Financing to Unseat Specialty Care Incumbents With its New Model for Spinal Care, Orthopedics, and Pain Management

Los Angeles-based Commons Clinic, which offers value-based specialty care for orthopedics, raises $19.5 million in a Series A round.

Leading Remote Health Care Company Optimize Health Completes $18 Million Series B Financing

Remote patient monitoring and chronic care management vendor Optimize Health raises $18 million in a Series B funding round.

Sutter Health Announces Cutting-Edge Innovation Center to Revolutionize Patient Care & Elevate the Healthcare Experience

Sutter Health (CA) will open an innovation center by the end of 2024 that will offer collaborative space for technology partners to incubate new products and services.

News 10/11/23

Top News

Private equity firm General Catalyst launches Health Assurance Transformation Corp., which will work with the firm’s 20-plus health system partners to test new care delivery and workflow optimization technologies developed by companies within its portfolio.

HATco will also eventually seek to purchase a health system through which it can pilot additional concepts.

General Catalyst’s portfolio includes Athelas, which recently acquired Commure; Aidoc; Imprivata; and Transcarent.

Former Intermountain Health CEO Marc Harrison, MD, MMM will serve as CEO of HATco.

Webinars

October 25 (Wednesday) 2 ET. “AMA: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is your healthcare organization looking to drive profitability and scale quickly? Our experts will explore how comprehensive clinical data can revolutionize the health tech landscape. This engaging discussion will cover trending topics such as leveraging AI and data innovation to enhance patient care and outcomes, real-world examples of organizations leading the charge in data-driven healthcare, overcoming challenges in data completeness and interoperability, and visionary perspectives on the future of care delivery.

Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.

Acquisitions, Funding, Business, and Stock

The cycle of de-listing warnings, extensions, and appeals for failing to file financial reports continues for Veradigm, for which Nasdaq has granted a temporary de-listing stay pending a November 16 hearing.

Walmart will offer no-charge virtual primary care from Included Health to 1 million people who are covered by its employee health insurance plan. Walmart’s pilot project with the company saw an 11% reduction in total cost with only 10% of those treated moving to an in-person care setting. One-third of the visits related to chronic or preventative care.

Commons Clinic, which offers value-based specialty care for orthopedics from two Los Angeles area clinics, raises $19.5 million in a Series A round. The company vows to disrupt the “stagnant hospital-centric model” in favor of conservative treatment, digital-first services, and use of surgery centers for procedures.

Sales

• Citizens Medical Center (TX) will implement Meditech Expanse.
• Clemson Rural Health (SC) selects health information exchange and storage capabilities from Sync.MD.
• Intermountain Health will use Clearsense’s 1Clearsense data archival service to consolidate data from its legacy systems.

People

Ashlee DesJardins (StayWell) joins Cordea Consulting as regional VP of sales.

University of Cincinnati College of Medicine names biomedical informatics professor Rodrigo Deliberato, MD, PhD chief research information officer.

Munson Healthcare (MI) names Michael Saad, MBA (University of Tennessee Medical Center) CIO.

Mike Heckman, MBA (Rockcreek Way) joins Beterra Health as president.

Announcements and Implementations

Healthwise announces GA of Health Compass, a service that delivers educational healthcare content in any format to any digital channel.

In England, King’s College Hospital and Guy’s and St Thomas’ NHS Foundation Trusts go live on Epic, which Epic says is the largest single go-live in the world with 51,000 users involved.

Cedars-Sinai launches a virtual healthcare app for patients in California using technology from K Health.

Care.ai equips its Smart Care Facility Platform with Google Cloud’s generative AI and data analytics.

Northern California HIE SacValley MedShare works with Konza National Network to develop behavioral health analytics dashboards.

Orlando Health rolls out AndorHealth’s ThinkAndor Virtual Hospital technology.

Verato will incorporate Clear’s consumer-facing identity verification technology into its healthcare master data management solution.

Main Street Health, which provides an in-house care coordination navigator in each of its 900 mostly small and rural practices in 18 states to support value-based care, raises $315 million in new capital. Investors in the round include the five largest Medicare Advantage plans in the US. One of the company’s investors and builders is Russell Street Ventures, which also backs CareBridge, a provider of remote care to Medicaid patients who prefer at-home care to nursing home admission. That company is named as the fastest-growing in the US by Inc. 5000, with a 157,000% revenue increase last year to $873 million.

Government and Politics

The DEA extends a COVID-initiated rule allowing providers to prescribe select controlled substances via telemedicine through the end of 2024.

The Oklahoma Fraternal Order of Police sues Oklahoma Health Care Authority, claiming that its HIE is unconstitutional because it requires providers who treat Medicaid patients to submit details about the encounter. The plaintiff’s lawyer says the HIE is “the most dangerous attack on Oklahomans’ privacy in the history of the state” and questions its authority to mandate participation or to impose fees that should instead be appropriated by the legislature.

Privacy and Security

The state insurer of the Philippines, which has warned its 36 million members that a ransomware attacked has exposed their information, admits that it didn’t renew its antivirus software agreement in May before the incident because of new government procurement rules. PhilHealth has since asked the antivirus vendor for a 30-day trial of new software.

Other

Advocate Health will send 100 of its Epic experts to England, where they will help seven London hospitals transition to Epic.

Best Buy will partner with virtual care provider Wheel and pharmacy technology vendor HealthDyne to sell prescription continuous glucose monitors from its website. The retailer plans to allow customers to upload CGM prescriptions from their own physicians to their Best Buy health profile.

Sponsor Updates

• Ascom staffers raise $5,000 by riding 10,000 miles in the Great Cycle Challenge to help fight pediatric cancer.
• Nym expands its suite of outpatient solutions for RCM automation to include outpatient surgery and visits.
• Veradigm becomes the first major EHR to join FDB’s Vela e-prescribing network.
• Nuance ranks as the leading vendor for mid-RCM healthcare providers, according to a recent Black Book Research survey.
• Baker Tilly publishes its “Healthcare M&A Update: H1 2023.”
• Censinet releases a new Risk Never Sleep Podcast featuring Skip Sorrels.
• CloudWave wins the Managed Security Solution of the Year Award in the 2023 Cybersecurity Breakthrough Awards program.
• CereCore releases a new podcast, “Vision and Value-Driven EHR Optimization: A Leadership Interview.”
• Current Health publishes a new case study, “The Geek Squad Effect.”
• Surrey and Sussex Healthcare NHS Trust in England roll out Sectra’s enterprise imaging technology to a sixth trust.

Blog Posts

• Implementing a Revenue Cycle Maturity Framework: Best Practices (AGS Health)
• Data on FHIR: Interoperability standards for whole-person care (Arcadia)
• Are You Struggling with Interoperability Challenges? You’re Not Alone (AdvancedMD)
• Screen, stream, support: The tech-driven future of mental health (Nordic)
• Best Practices for Centralized Virtual Sitting (AvaSure)
• Building New Data Connections Helps Brands Lower Adherence Barriers (ConnectiveRx)

Contacts

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

Morning Headlines 10/10/23

Main Street Health Announces $315M Financing Round to Expand Into 26 States

Main Street Health, a practice management company focused on helping rural primary care providers transition to value-based care, announces $315 million in funding and expansion into eight additional states.

Venture capital firm General Catalyst wants to buy a health system

General Catalyst launches Health Assurance Transformation Corp. to acquire health systems that will serve as testing grounds for new care delivery and workflow optimization technologies.

UC Davis Health, NODE.health, and Leading Health Systems launch VALID AI

University of California health systems and partners including hospitals, payers, nonprofits, and vendors launch the VALID AI collaborative to promote best practices for generative AI in healthcare.

Curbside Consult with Dr. Jayne 10/9/23

Hitting the road over the last couple of weeks, I had to really strip down the essentials of what I needed to get my work done. It’s definitely a shocker to go from having either multiple monitors or one ridiculously large monitor to a single laptop screen. I know there are portable second monitor setups out there, but I wanted to see if I could manage the laptop life for more than the week that I usually travel at a time.

My travel companion is in the process of relocating, so I was a bit limited on the overall space in the car due to the household goods crammed into every square inch. I’m the kind of person who has lived in a tent for the better part of a month, so I figured I could find a way to make it work.

It got me thinking about the things I use every day in my home office and how that setup compares to when I used to work in a corporate office and when I go on site for consulting engagements. The home office is always my first choice because it has exactly what I need and I can leave out the things I use often and store the things that are more occasional-use items. The corporate office was similar, although I didn’t have anything on my desk that I’d be sad about in the event it disappeared. We had a standard set of corporate-issued supplies, like a stapler, three-hole punch, and tape dispenser that I don’t really remember using since the whole point of our project was to be paperless. I had an inordinate number of push pins, though, since our cube walls were secretly fabric-covered bulletin boards and I certainly took advantage of that as a way to hang pictures, flyers, and other bits of decoration.

When I travel for consulting engagements, I’ve been fortunate that most of my clients provide nice “hotel” space that includes a multiple monitor setup with docking station and ethernet cable. I had one client whose idea of a productive workspace was an L-shaped bank of bar-height countertops that faced a wall on one side and a set of floor-to-ceiling glass windows on the other. We had to vacate our station at the end of every day, so I ended up carting everything around all the time. If you came in later than others, you were stuck in front of the windows with their never-ending glare.

The stools that they had at these “desks” weren’t exactly the right height, either, and their lack of a footrest meant that your feet ended up dangling. The other option was a cushy armchair with a folding desk on one of the arms that was barely big enough to hold your laptop and definitely wasn’t large enough to accommodate a mouse. In either setup, the idea of a second monitor was a figment of my imagination. I can’t say that I was sad when the engagement ended.

As employers demand that people return to the office, it’s going to be important to create the kind of spaces that make people actually want to come to the office. Will they have a designated space that they will share with one or two other people, or will it be a free-for-all every day to see who works where? Will they have the amenities needed to be productive, such as dual monitors? Will there be company-provided snacks or drinks beyond the stereotypical burned coffee? Many of us have become content in our home office hideaways, and it’s going to take time to reorient us to office rules, such as making sure to take our containers out of the refrigerator before clean-out day and to avoid bringing allergens to the office that might negatively impact our colleagues.

As people go back and forth in a hybrid situation, it will be more important than ever to make sure accounts sync seamlessly between the corporate office and the home office. People also need to figure out what the must-haves are for each office environment and whether they will need to bring things from place to place to feel they have what they need.

I ran across an article recently that talked about dealing with digital clutter, which might be a contributing factor for anxiety and frustration. The author specifically calls out things like photos, old presentations, expense receipts, and other digital artifacts that might be rarely seen but are always present. Then there are the physical objects, including charging cables, old phones, the keyboard that your company shipped to you that you don’t like but will need to possibly return some day, and more.

The author offers some strategies for decluttering. On the topic of power cables, the recommendation is to toss anything that doesn’t have an identified device that it goes with. If there are extra cables, one shouldn’t keep more than two of each version. Further recommendations include discarding anything that hasn’t been used in six months, although we’re reminded to be sure to discard it responsibly. I’m lucky that my city does an electronic recycling event every other month, but not every community is that fortunate.

For cables that are used regularly, the article recommends organizing them as much as possible, including attaching them to desk legs or bundling them for neatness. I’ll admit, I have a pile of twist ties on my desk. I’m always meaning to do some cable management, but I never get around to it. I wonder what that subconsciously indicates about me.

The author goes on to talk about “digital hoarding” and managing obsolete data. They recommend getting rid of files that haven’t been opened in years, purging smartphone apps that aren’t used, and cleaning up photo libraries. Quick decluttering can involve removing duplicates or photos where our technique was less than ideal, or just organizing images into folders. More extensive decluttering involves curation where we determine if particular photos are something we want to see again in the future.

Honestly, if I tried to get into that, I know I’d have an acute case of analysis paralysis, so I’m going to take a pass on that suggestion. It’s definitely easier to clean up data, at least for me. Deciding to purge client files after a certain number of years or months seems cleaner than trying to make a value judgment about whether I think I will want to look at it in the future.

At least for the foreseeable future, I’ve stripped my needs down to what can fit in a business-style backpack and a 40-liter duffel. My traveling companion doesn’t care if I’m wearing the same two pair of Columbia pants all the time, and we are intentionally not going anywhere that requires a fancier level of dress. I’ve got my laptop and a small travel mouse, although I do wish I had brought my full-size one, but I’m sure I’ll eventually get used to the tiny one. I’ve adapted from my ever-present stack of sticky notes and my trusty whiteboard to their digital counterparts, and it was fun to remember that’s how I used to do it back in the day when I traveled every other week, since I had forgotten. Of course, I’ll probably feel different about this when I get back to my bank of monitors, but at least for now it’s fun to rough it a little bit.

What are the office essentials that you absolutely must have, whether at home or in a company facility? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/9/23

VA to share health info with private-sector medical systems

The VA and 13 health systems pledge to share data to improve veteran healthcare.

LGI Healthcare Solutions Acquires Boston Software Systems.

Canada-based health IT company LGI Healthcare Solutions acquires healthcare automation vendor Boston Software Systems.

DEA extends pandemic telehealth rules for prescribing controlled substances

The DEA will continue to allow providers to prescribe select controlled substances via telemedicine through the end of next year.

New Generative AI-Native Health Company RhythmX AI Announces Precision Care Platform for Doctors to Deliver Hyper-Personalized Care to the Right Patient at the Right Time

Investment firm SAIGroup funds and launches RhythmX AI, which analyzes longitudinal data to make recommendations to doctors.

Monday Morning Update 10/9/23

Top News

The VA and 13 health systems pledge to share data to improve veteran healthcare via three objectives:

• Accurately identify veterans when they seek care from community providers.
• Connect veterans with resources that promote health and healthcare, especially with those VA services that lower their out-of-pocket expenses.
• Coordinate care and exchange information about care requested and provided, regardless whether they are enrolled in VA health benefits.

Reader Comments

From Supplicant: “Re: health system announcement forthcoming. Don’t run this until you hear it from another source because it might out me.” Sorry to be vague in avoiding exposing the reader’s identity. If you’re privy to details of an upcoming health system’s product switch that I haven’t mentioned, which includes some interesting hosting choices, email me. I’ll keep everyone anonymous while making sure it’s not just easily identified insiders who know.

HIStalk Announcements and Requests

Poll respondents attribute different factors to the success of Epic. Some offered other choices:

• A demonstrated, take-charge implementation process.
• Software architecture that allows Epic to enhance and develop faster.
• Trying to do the right thing, even in the absence of financial reward.
• Connectivity among Epic sites.
• Being led by a founder instead of flipping owners or going public.
• Hiring smart people and motivating them to work hard for customers.
• Being the safe choice for health system C-level executives.
• Marketing in the “invite your friends” sort of way, like an exclusive club where clients want to connect to each other.

New poll to your right or here, featuring a question I ask every few years: Which annual conference would you attend if limited to one and paying your own way?

Topping my current list of annoying business terms: “unlock,” when vendors offer to sell the “key” to snatching some elusive business benefit if you just sign on the line which is dotted. Honorable mention goes to replacing the single-syllable and perfectly descriptive “use” with the bloviatory “utilize” or “leverage.” I’ll also nominate “currently” for superfluity – “I am currently working” adds nothing except three syllables to “I am working,” although maybe it’s an improvement over “at this point in time.”

Webinars

October 25 (Wednesday) 2 ET. “AMA: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is your healthcare organization looking to drive profitability and scale quickly? Our experts will explore how comprehensive clinical data can revolutionize the health tech landscape. This engaging discussion will cover trending topics such as leveraging AI and data innovation to enhance patient care and outcomes, real-world examples of organizations leading the charge in data-driven healthcare, overcoming challenges in data completeness and interoperability, and visionary perspectives on the future of care delivery.

Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.

Acquisitions, Funding, Business, and Stock

Canada-based health IT solutions provider LGI Healthcare Solutions acquires healthcare automation solutions vendor Boston Software Systems. 

Virtual rheumatology provider Remission Medical will offer services through KeyCare and coordinating patient care with Epic-using health systems.

Investment firm SAIGroup funds and launches RhythmX AI, which analyzes longitudinal data to make recommendations to doctors.

Announcements and Implementations

Black Book announces the top-performing vendors among HIM users surveyed in the areas of computer-assisted coding, clinical documentation improvement, speech recognition, transcription, and outsourced coding services.

Government and Politics

Cigna will pay $172 million to settle False Claims Act charges that it assigned diagnosis coders review patient medical records to find additional billable codes after its Medicare Advantage plan had already been paid. The Department of Justice says Cigna hired third-party vendors to send nurse practitioners into member homes to find additional billing opportunities, but did not allow them to perform diagnostic tests to support their conclusions or to treat the conditions they supposedly found. DoJ says Cigna inappropriately assigned diagnosis codes for morbid obesity, congestive heart failure, chronic kidney disease, and other chronic conditions without supporting documentation and failed to refund taxpayer money when it was caught.

Doctors push back on CMS’s Merit-Based Incentive Payment System (MIPS) as quality standards toughen as was originally designed, pushing more doctors into penalties rather than rewards.

Privacy and Security

Hackers claim to have acquired user data from the 23andMe genetic service and are selling it online. This data was accessed through the website’s feature that allows users to share information with potential DNA-matched relatives. The hacker alleges that CEO Anne Wojcicki was aware of the breach two months prior and chose not to disclose it, claiming that her family members were shorting company shares in anticipation of a stock price slide.

Other

KFF Health News looks at Dollar General’s test of offering mobile healthcare services from the parking lots of its small-town stores. The company is partnering with New York-based DocGo, which is is being investigated by the New York attorney general after complaints about its treatment of asylum-seekers under a $432 million no-bid contract under which it providers housing and busing. DocGo CEO Anthony Capone resigned last month after a New York newspaper found that he lied about earning a graduate a degree in computational learning theory in pursuing a multi-billion dollar contract with US Customers and Border Protection. Publicly traded DocGo’s market cap is $623 million after shares dropped 44% in the past 12 months. I’m wondering if the van has a restroom for the nurse (and potentially patients) and how safe it is for a nurse to be sitting in the parking lot of stores whose headlines often involve OSHA fines and customer violence. I would not be comfortable welcoming some parking lot rando into the van for an exam.

Central Maine Medical Center settles a malpractice lawsuit that was brought by a patient who claimed that doctors ignored his elevated PSA results, allowing his prostate cancer to spread untreated. The lawsuit says that a computer system upgrade failed to import some lab results into the dashboard of the new system.

Stanford’s medical school dean says that AI will be medicine’s most important development since antibiotics, predicting that it will break down access barriers, improve quality and consistency, increase the efficiency and speed of clinical trials, and reduce rote memorization in medical education. He predicts that responsible AI deployment will create societal benefits and earn patient acceptance in 10 years.

California regulators find that Adventist Health Simi Valley’s administration of two doses of the blood thinner Lovenox within two hours probably caused the brain bleed death of an 81-year-old patient 18 hours later. The original Lovenox order was discontinued after one dose, causing it to disappear from the active profile and to be missed by a second doctor who ordered another dose. The orders were approved by separate pharmacies that didn’t communicate with each other, an Adventist corporate pharmacy and another that is local to the hospital.

The VA finds that a four-hour VistA downtime at the Kansas City VA was caused by a network technician’s keyboard-surfing cat, whose keystrokes deleted a server cluster configuration.

Sponsor Updates

• Black Book’s survey of VC and tech investors reveals the top 50 rising stars in healthcare IT’s ecosystem of startups.
• MRO will present and exhibit at AHIMA 2023 October 8-10 in Nashville.
• Nordic releases a new Designing for Health Podcast, “Interview with Evan Heigert.”
• Wolters Kluwer will add generative AI capabilities to UpToDate.

Blog Posts

• Introducing two new Conversation AI Services (Nuance)
• 6 Communication Channels for EHR Implementations (Optimum Healthcare IT)
• Pharmacists, You Are Appreciated. (OmniSys)
• Nurses of Note 2023: The Regional Practice Administrator Celebrates 30 Years in the Field (PerfectServe)
• The State of Play: What Prescribing Trends Say About the Future of Primary Care (Surescripts)
• Do Family Caregiving Benefits Exist for Employees? (Trualta)
• Revenue cycle 101: prior authorization + referrals (Waystar)
• October 2023 Interoperability Monthly Update: TEFCA, QHINs, ONC’s Latest News (Zen Healthcare IT)

Contacts

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

Morning Headlines 10/6/23

Alpha II, LLC Announces Strategic Acquisition of RCxRules

RCM technology vendor Alpha II acquires RCxRules, which provides revenue cycle automation.

US mental health startup Headway raises $125 million at $1 billion valuation

Headway, which connects patients to in-network therapists, raises $125 million a Series C round that values the company at $1 billion.

Nonprofit service provider Blackbaud settles data breach case for $49.5M with states

Blackbaud will pay $49.5 million to settle claims brought by 50 attorneys general pertaining to a 2020 ransomware attack affecting 13,000 nonprofits including hospitals, universities, and religious organizations.

Netsmart Advances Substance Use Disorder Solution Offerings Through Acquisition of Netalytics

Behavioral health IT vendor Netsmart will acquire Netalytics, an addiction treatment and practice management company based in South Carolina.

News 10/6/23

Top News

Workflow automation vendor Athelas acquires Commure and announces a $70 million investment from General Catalyst that values the combined company at $6 billion. The business will operate under the Commure name.

Commure offers analytics workflow tools and the PatientKeeper EHR, which it bought from HCA two years ago.

Athelas co-founder and CEO Tanay Tandon will continue as CEO of Commure. The 25-year-old started Athelas when he was 17, offering a malaria test kit for smartphones.

Commure CEO Ashwini Zenooz, MD will move to a non-executive role on the company’s board. The acquisition brings together 300 employees from Commure and 500 from Athelas.

Reader Comments

From Winky: “Re: insurance company IT issues. Anybody having lick getting them to fix their problems? Things are pretty bleak at just one insurer, just as the healthcare industry tries to automate revenue cycle.”

HIStalk Announcements and Requests

Going to HLTH? So are my sponsors Best Buy Health, Biofourmis, Five9, Get-to-Market Health, Healthcare Growth Partners, Medicomp Systems, and Trust Commerce. They describe their activities in my HLTH 2023 guide.

I hadn’t use Skype for years, but it was the best choice for my video-tutoring a Ukraine woman in conversational English as a volunteer with ENGin (Ukraine has one of the lowest rates of speaking English in all of Europe, which limits its post-war market participation). Using the free, Microsoft-owned Skype was a better experience than I expected.

Webinars

October 25 (Wednesday) 2 ET. “AMA: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is your healthcare organization looking to drive profitability and scale quickly? Our experts will explore how comprehensive clinical data can revolutionize the health tech landscape. This engaging discussion will cover trending topics such as leveraging AI and data innovation to enhance patient care and outcomes, real-world examples of organizations leading the charge in data-driven healthcare, overcoming challenges in data completeness and interoperability, and visionary perspectives on the future of care delivery.

Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.

Acquisitions, Funding, Business, and Stock

RCM technology vendor Alpha II acquires RCxRules, which provides revenue cycle automation.

Autism provider company Cortica raises $40 million in a Series D extension, completing the round at $115 million.

A Black Book survey of venture capital and technology investors finds the 50 top-rated emerging health IT vendors for 2023.

The $217 million growth and opportunity fund of 7wireVentures – whose founders and managing partners are industry long-timers Glen Tullman and Lee Shapiro – closes its capital raise and will use its assets to move the firm’s high-potential investments to later states and to invest in other Series B and C companies. The fund has already invested in NOCD (obsessive compulsive disorder), Folx Health (a virtual healthcare platform for LGBTQUA+),  and Parsley Health (virtual chronic care).

Headway, which connects patients to in-network therapists, raises $125 million a Series C round that values the company at $1 billion.

Sales

• Four-hospital Wisconsin health system ProHealth Care outsources revenue cycle management, IT, informatics, analytics, and inpatient care management to Optum, which will take on the 800 employees who are involved.
• Fraser chooses Netsmart CareFabric to support its transition to a Certified Community Behavioral Health Clinic.

Announcements and Implementations

Medicomp Systems announces that its MEDCIN clinical relevancy engine features mapping of 10 million clinical codes and concepts across 12 terminologies.

PayZen offers PayZen Care Card with partners Geisinger and UTMB, which offers patients a zero-interest payment plan for outstanding balances in the form of an upfront debit card that pays providers immediately on use.

Elation Health announces GA of a unified EHR and billing solution for high-value primary care.

University Hospitals of Cleveland completes its transition from the former Allscripts Sunrise suite to Epic.

ChatGPT can now analyze images, as evidenced by this inquiry I made by posting a HIMSS conference exhibit hall photo. It proved to be more irony-aware than many humans, and more capable of explaining than I, when I asked why the HIStalk logo features a doctor who is smoking:

The image portrays a stylized and somewhat whimsical character. The pipe-smoking doctor might be an artistic choice to evoke a certain image, possibly hinting at an older, “classic” or “traditional” stereotype of a learned or scholarly individual. In literature and older media, a pipe has often been associated with contemplation, wisdom, or intellect. However, given the modern understanding of the health risks of smoking, such a depiction in a healthcare-related setting is likely intended to be ironic or tongue-in-cheek. It’s a design decision by the creators of the image and may be intended to make the character more memorable or to convey a specific tone or mood.

Government and Politics

CMS will restrict the use of predictive AI tools by Medicare Advantage plans to make coverage decisions. Patients and providers complained that MA plan operator UnitedHealthcare – which uses an algorithm developed by NavHealth, which it acquired in 2020 for a reported $2.5 billion – was using its predicted discharge date to cut off coverage without considering individual patient needs as traditional Medicare would have done. NaviHealth says its algorithm was designed to personalize post-acute charge discharge planning, not to drive coverage decisions. The new federal rules, which take effect in January, will allow such software to be used only if it takes individual patient circumstances into consideration.

HHS’s ARPA-H designates up to $50 million for funding for six contract awards for developing advanced technologies to secure healthcare data. The DIGIHEALS awardees submitted these projects:

• Develop an automated medical device patching system.
• Create a cognitive health assistant.
• Develop clinician-focused tools and techniques for use during ransomware attacks.
• Identify legacy medical device vulnerabilities.
• Discover and report parsing bugs in EHRs.
• Automate cybersecurity risk assessment for medical devices.

Other

UVM Medical Center’s tells a US House cyberthreat committee that managing its 2020 ransomware attack was “much harder than the pandemic by far” as the hospital lost internet, phones, and access to the EHR for 28 days at a cost of $65 million.

A ProPublica investigation finds that pharma giant GSK developed a vaccine for TB – which kills 1.6 million mostly poor people each year – then put it on the back burner to focus on the world’s most profitable market of the US, where higher incomes and insurers can afford products such as the company’s Shingrix vaccine that has generated $14 billion in five years. The TB vaccine was developed under contract with the US Army, after which GSK patented the active ingredient, took charge of the global ingredient supply, and accepted government and non-profit funding to develop the commercial product that won’t be widely available until 2028, 10 years after it was developed, and only then because the Gates Foundation is funding it. The vaccine’s co-inventor, who originally took his idea to GSK in hopes of getting the injections to people who desperately need them, says in criticizing how Big Pharma co-opts public health research, “You get a big company to take it forward? Bullshit. That model is gone. It’s failed. It’s dead. We have to create a new one.”

The problem-plagued EClinicalWorks EHR of Hawaii’s prison system may cause a deceased inmate’s malpractice lawsuit to be dropped because the state hasn’t been able to produce his medical records 18 months into the allowed 24 month discovery period. Hawaii’s Department of Public Safety admits that the system was down for two months in one stretch, broke down again two weeks after it was restored, and is still plagued by bugs and corrupted tables. The state says it is looking for a replacement system.

Marginally health IT related, but fascinating to me, is this description of Epic’s new audio production system. Epic uses an SSL C100 HD digital audio console to broadcast software introductions – including sound effects and musical cues — to 15 countries, also producing related media in an attached “live room.” Audio engineer Paul Micksch is a former musician who started with Epic in 2006 as a software trainer. You just know that Epic Deep Space Auditorium is loaded with cool behind-the-scenes stuff.

Sponsor Updates

• Surescripts publishes a new data brief, “Pharmacy Availability & Prescribing Patterns Hint at the Future of Primary Care.”
• Robbins Dermatology experiences streamlined payment collections and processing using Healow Payment Services from EClinicalWorks.
• Medicomp Systems directly maps over 10 million clinical codes and concepts across more than 12 terminologies to its Medcin clinical relevancy engine.
• First Databank names Steve Fite regional manager, Jessica Landis commercial operations manager, and Courtney Kessler digital customer success manager.
• Rhapsody announces the availability of Corepoint Integration Engine version 7.6.
• Nordic releases a new episode of DocTalk, “DocTalk Ep. 210 | Optimizing value from EHR investments.”

Blog Posts

• How to Deal with Angry Patients in Urgent Care (Experity)
• Data’s Crucial Role in Combatting the “Tripledemic” (Dimensional Insight)
• Navigating AI Adoption: Insights from UNC Health’s Chief Analytics Officer (Divurgent)
• Essential Checklist for Starting a Weight Loss Clinic or Medical Spa (EClinicalWorks)
• Meeting the Social Care Needs of Medicaid Beneficiaries (Findhelp)
• The Current Healthcare Landscape: A Paradigm Shift Driven by Technology (InterSystems)
• From brain injury to dementia: the evolution of the clock drawing test (Linus Health)
• Trending Cybersecurity Topics for 2024 (Medhost)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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EPtalk by Dr. Jayne 10/5/23

Registration is open and agendas have been published for the 2023 ONC Annual Meeting, to be held December 14-15 in Washington, DC. Hot topics include artificial intelligence in healthcare, public health standards, policymaking, and of course information blocking. Mainstage sessions will be livestreamed on HealthIT.gov, but breakouts and other sessions will be in-person only.

I’ve never been to an ONC annual meeting, but it looks like there will be some good sessions covering racial bias in health care artificial intelligence. Given the fact that my state recently gave up some federal money because of antiquated public health systems, I’m particularly interested in the Thursday session on “Public Health Data Modernization at the Local, State, and Federal Level.”

The conference is free and the room block rate for hotel accommodation is $188 per night, which isn’t terrible compared to other venues, but be sure to budget an extra $55 per night for parking if you’re driving in. My conference budget this year doesn’t permit me to go, but if anyone wants to send me the scoop from that public health session, I’d be eager to hear what strategies are discussed.

I visited a family member in the hospital recently and took a moment to reflect on how much the technology in the patient rooms has improved since I was a trainee at the same institution. The chart carts and racks have given way to ergonomic workstations in each patient room. The IV pumps have become smarter and more connected, and the in-room patient education is a vast improvement from the crummy printouts we used to give to patients on the day of discharge. It made me think about whether any of our current technologies will still be in service in the future.

I was musing about this with a fellow astronomy and space afficionado, who mentioned an event that took place with the Voyager 2 spacecraft earlier this summer. Apparently it’s still alive and kicking at the tender age of 46 years, although it had gone quiet for a bit. Like parents who have to yell at teenagers from across the house, NASA engineers sent an interstellar “shout” across 12 billion miles of space to get Voyager to turn its antenna back toward Earth. The idea of a piece of equipment from that era still functioning today is pretty impressive. It will be interesting to see which healthcare technologies stand the test of time.

Planning for the American Medical Informatics Association AMIA 2024 Clinical Informatics Conference is underway, and its Scientific Program Committee leadership is seeking interest from those interested in joining the Committee. Members will review submissions and help define the content of the conference. Submissions are being accepted through October 13.

One of the hot topics around the virtual physician water cooler this week was the entry of Costco into the world of telehealth. Essentially, the retail giant is partnering with Sesame to offer discounted virtual primary care and mental health services. Even though I’m not in a traditional primary care practice anymore, I struggle with the transactional nature of some of these offerings, Amazon’s most recent one included. Use of on-demand services like this can fragment care, and I’ve experienced how hard it can be it from the telehealth provider side.

One venture capital leader hit the nail on the head: “From what I can tell, neither Sesame nor Costco have ambitions around a longitudinal relationship with the patient, and definitely no intentions of assuming risk, as it’s a cash pay offering. This is really a story around convenience and incremental growth.” Most patients probably don’t understand this, however. Certainly few of the ones who flocked to the independent urgent care where I worked understood what it means to get care from a third-party provider who doesn’t have access to your records. For the most part, they assumed that all doctors are connected and that I would know everything about them. Magnify that by patients chasing the cheapest visit and moving from provider to provider and it’s going to get messy.

From Off the Grid: “Re: remote work. I enjoyed your recent Curbside Consult on the topic, especially with the true stories from the trenches. I’ve also worked at companies that have handled this well, and also at those who are doing it badly. It seems like a lot of new leaders forget that companies have done this for years and have done it successfully. Check out this article on managing remote teams. I think it has good advice for newbies who are struggling to navigate these waters, which are less uncharted than they think.” The piece has a lot of good advice, including how to make sure that remote teams don’t experience burnout through having regular conversations about how people are doing but “without a string of action items.” It also discusses the need to have clear goals and objectives. I would add that those goals should be set not by management in a top-down fashion, but collaboratively. I still run across leaders that don’t understand how to create reasonable and/or achievable goals, and instead saddle their teams with either shifting targets or ones that simply cannot be accomplished.

I particularly like the article’s advice to “use technology, but wisely,” especially when it discusses communication hierarchies. Some of the most productive teams I have worked with have clear communication matrix documents that explain what should be communicated, by what means, and to whom. This avoids spamming or interrupting people who don’t need to be party to an issue and making sure that items that need attention get the focus they deserve.

My favorite self-organizing team had guidelines around how to communicate based on time sensitivity. For example, anything that needed attention in fewer than three business days required a phone call. Otherwise, an email could be sent, but with the assumption that the recipient had three business days to handle it.

In hindsight, that was luxurious compared to the noisy world of texts, Slack, Teams, various other messenger apps, and general chaos that I live in with my consulting clients. For groups using Slack, Teams, or similar platforms, encourage people to set their status accordingly so people don’t think they’re available when they’re actually busy with someone else and not checking messages. And for those organizations that expect people to be instantly available at all times – good luck, because if you think your teams aren’t using mouse jigglers or other strategies to look active, you’re deluding yourself.

Speaking of remote work, I’m currently on a project that involves mostly heads down work and very few meetings, so I’m taking advantage of the opportunity to do some travel with a friend. For the next few weeks, we’ll be seeing the USA in our Chevrolet, so here’s your “Where in the world is Dr. Jayne?” moment for the week.

What’s the most unusual roadside attraction you’ve visited? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/5/23

Athelas + Commure: Merging to Create a $6B Healthcare Infrastructure Company

Remote patient monitoring and RCM vendor Athelas acquires Commure, parent company of PatientKeeper, and announces an undisclosed amount of funding from General Catalyst.

ProHealth Care and Optum Launch Strategic Relationship to Enhance the Health Care Experience for ProHealth Patients

Optum will take over the RCM, IT, informatics, analytics, and inpatient care management operations of ProHealth Care in Wisconsin.

Cortica Closes $40 Million Series D Extension Led by CVS Health Ventures, LRVHealth, and Other Strategic Investors, Bringing Round Total to $115 Million

Tech-enabled autism and neurodivergent care company Cortica raises $115 million in an extended Series D funding round led by CVS Health Ventures.

Healthcare AI News 10/4/23

News

Augmedix offers early access to Go, which uses generative AI to create a draft medical note after each visit.

CloudWave releases an AI security and privacy policy template that guides AI implementation and management in healthcare, including risk assessment, audit and compliance procedures, ethical considerations, and review and revision procedures. 

Zoom extends its AI Companion summarization capabilities to healthcare customers. They include whiteboard idea generation, fast meeting review and catch-up via highlights and smart chapters, and drafting quick messages based on team chats.

Sentara Health expands its implementation of Regard’s AI clinical documentation solution to all 12 of its hospitals.

Virtual provider HealthTap launches Dr. AI, a pre-appointment patient interview that uses GPT-4 to collect the patient’s information, then present it concisely to the physician.

HeHealth launches its AI-powered sexual health app in the US, offering to “help all penis owners” who suspect they have a sexually transmitted infection. Users scan and submit photos to receive an initial AI report that is followed by physician review. The service, which costs $10, allows users to remain anonymous. Co-founder and CEO Yudara Kularathne, MBBS is a Singapore-based ED physician 

Business

Health Data Analytics Institute raises $31 million in a Series C funding round. The company’s AI-optimized platform quantities patient and population risks and identifies clinical improvement opportunities.

Research

A Spanish hospital is conducting trials of Cordio Medical’s HearO app, which hopes to detect early signs of congestive heart failure by analyzing a patient’s speech patterns, specifically those indicative of lung fluid buildup.

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
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Morning Headlines 10/4/23

UC San Diego Awarded $9.5 Million to Enhance Cybersecurity in Health Care

University of California San Diego School of Medicine researchers will use a $9.5 million award from the HHS-affiliated Advanced Research Projects Agency for Health to develop protocols and solutions that can prevent or reduce the severity of ransomware attacks.

Automated healthcare? Plenful emerges from stealth with $9M to streamline medical admin

Pharmacy-focused workflow automation startup Plenful launches with $9 million in funding.

AHIMA Acquires HCPro

The nonprofit American Health Information Management Association acquires for-profit HCPro, which offers educational and compliance-related RCM resources for healthcare professionals.

News 10/4/23

Top News

Providence launches Praia Health, which uses identity-driven personalization of consumer profiles for “digital flywheel” ongoing engagement between care episodes.

Leading the company is Justin Dearborn, who previously ran Merge Healthcare, Tribune Publishing, and PatientBond.

Reader Comments

From Barney Ruble: “Re: 3M Health Information Systems. Laid off 100-120 people as part of a corporate cutback. The HIS group that is being spun off is cutting back some teams and products due to slow sales.” Unverified.

HIStalk Announcements and Requests

I don’t use Twitter much and rarely venture from the useful “Following” feed to the crazy “For you” clickbait version, but I can say that despite my endless muting and flagging of posts as “not interested,” I’m stilled buried in tweets about (and by) Elon Musk, TSLA stock pumpers, and fanboys salivating about the still-unreleased Cybertruck. Musk had complained that the algorithms weren’t giving him the audience he deserved, so programmers have obviously devised an ego-stroking enhancement.

Listening: Scotland-based rockers Stiltskin, which hit pretty hard in grunge circles 30 years ago. Trivia: the band’s singer Ray Wilson was selected in 1996 at the age of 27 to lead Genesis, the former five-member group that was down to Mike Rutherford and Tony Banks following the departure of Phil Collins. They gave Wilson limited creative influence over their lackluster “Calling All Stations” album, which largely resembled Rutherford’s Mike and the Mechanics trying to sound progressive. Audiences snoozed and Genesis had to downsize and then cancel a planned US tour in a major hit to their egos. Years later, Rutherford, Banks, and Collins erased Wilson from their revisionist history books, omitting him from a BBC Genesis documentary and on streaming platforms. Wilson finally got to attend his first Genesis concert as an audience member later, where he watched Collins cover the songs he had recorded.

Webinars

October 25 (Wednesday) 2 ET. “AMA: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is your healthcare organization looking to drive profitability and scale quickly? Our experts will explore how comprehensive clinical data can revolutionize the health tech landscape. This engaging discussion will cover trending topics such as leveraging AI and data innovation to enhance patient care and outcomes, real-world examples of organizations leading the charge in data-driven healthcare, overcoming challenges in data completeness and interoperability, and visionary perspectives on the future of care delivery.

Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.

Acquisitions, Funding, Business, and Stock

Health Data Analytics Institute raises $31 million in a Series C funding round, bringing its total raised to nearly $50 million. The company offers AI-powered predictive risk and care optimization software.

Heywood Healthcare (MA) files for Chapter 11 bankruptcy, citing operational and business challenges that have included a “costly and lengthy” EHR implementation and low reimbursement rates, as well as economic reverberations from the pandemic. The two-hospital system went live on Meditech Expanse in 2021.

Walgreens CIO Hsiao Wang leaves the company after a year on the job. Walgreens continues recruiting for a new CEO and CFO as well.

Sales

• HealtHIE Nevada selects health data aggregation and sharing software from Holon Solutions.
• La Paz Regional Hospital (AZ), Russell Medical Center (AL), and Memorial Hospital and Manor (GA) select CareCloud’s MedSR division as their Meditech implementation partner.

People

Emtelligent hires Jennifer Canfield, MBA (Kantar) as EVP of sales.

Announcements and Implementations

Doctors Hospital Health System in the Bahamas implements Meditech Expanse with assistance from CareCloud’s MedSR division.

OCHIN offers EpicCare Inpatient software and implementation services to rural hospitals.

A Symplr survey of health system IT leaders finds that working with disparate IT systems is their top challenge, while clinicians name their top issues as nurse retention and satisfaction, optimizing technology efficiency, and the need to streamline workflows.

I interviewed Trilliant Health healthcare economist Sanjula Jain, PhD 18 months ago and found her really interesting, so I perked up at the company’s new trends report when I saw her name on it. It is brilliant, and names 10 trends:

1. The number of commercially insured Americans is declining steadily as declining birth rate fails to offset the aging into Medicare, and migration to Florida, Texas, and Utah will shift healthcare demand.
2. The physical and mental health of Americans has taken a hard turn downward, with higher under-40 mortality, rising cancer mortality, and rates of forgone care rise due to cost.
3. Most newly approved drugs target genetic diseases and cancer.
4. Utilization of care in all settings declined except for the ED, with the 2021 rebound mostly caused by testing and treatment of COVID-19. The relationship between the number of comoribidities and consumption of healthcare services is not linear.
5. The public’s dissatisfaction with healthcare is growing and younger patients are behaving more like consumers in seeking care from retail pharmacies and other non-traditional sources. Virtual care is being offered more widely, but demand is tapering, half of telehealth users have used it just once, and physicians perceive its quality as inferior to in-person care.
6. More consumers are using transactional delivery models such as urgent care, retail, and ambulatory surgery centers. Retailers are using low-acuity care as a loss leader.
7. Physician supply is constrained, as “payviders” Optum and Kaiser Permanente employee nearly 10% of US doctors and organizations compete to hire more doctors as supply drops. Nursing supply rebounded in 2022 and the number of allied health providers is increasing to help meet physician shortages. The number of primary care providers would need to increase by 218,000.
8. Some healthcare markets have a price problem, but all have a cost problem. Rates are often lower in monopoly markets. Spending on lobbying is increasing to influence federal policy on M&A. The federal measure of market concentration is limited to inpatient usage, which may not be reflective, and market concentration is not a clear driver of quality or price.
9. Employers are paying more for less as costs rise, with a growing rate of self-insurance. Employer-sponsored insurance leaves employees being financially responsible for 10% and more of their overall incomes.
10. US healthcare spending is unsustainable and value-based payments don’t equal value for money. Site-neutral payments could reduce Medicare payments by over $1 billion for one office procedure alone – lumbar epidurals. Procedures cost multiples when performed in hospitals rather than in an outpatient setting.

Government and Politics

An analysis of NHS Trusts in England finds that the government has spent over $1 billion on storing paper records over the last five years. NHS England digital lead Joe Harrison says that while some hospitals have become digital health trailblazers, others are working with “carrier pigeons and pen and paper.”

CMS says that 500,000 people in 29 states have regained Medicaid benefits after state computer systems failed to automatically re-enroll them once pandemic-related restrictions on terminating coverage were lifted.

Privacy and Security

McLaren Health Care (MI) confirms that it was the victim of a ransomware attack several weeks ago. It is now working to determine if any stolen data has been posted to the dark web, as the Black Cat/AlphV ransomware group claims. The attack impacted billing and EHR functionality at 14 facilities for nearly six weeks.

Other

Texas Tech University Health Sciences Center uses $10 million in state funding to launch the Institute of Telehealth and Digital Innovation, which aims to serve rural patients by improving access to telehealth and remote patient monitoring services through community and academic partnerships.

Sponsor Updates

• AdvancedMD staff volunteer at The Green Urban Lunchbox, Encircle, St. Vincent De Paul Dining Hall, and The Road Home during the company’s day of service.
• The Toledo Clinic in Ohio successfully leverages RCM optimization services from EClinicalWorks.
• CrossWinds Counseling & Wellness (KS) adds NetSmart’s CareFabric technology, including the MyEvolv EHR.
• Symplr publishes its 2023 Compass Report, “From Imminent to Urgent: Aligning Clinicians & IT is Critical to Streamlining Healthcare Operations.”
• Aridhia publishes a new case study, “Leveraging Aridhia TRE for Identifying Pupils at Risk of Being Not in Education, Employment or Training (NEET).”
• The AWS Health Innovation Podcast features Artera co-founder and CEO Guillaume de Zwirek.
• SteadPoint Insurance will offer its clients Bardavon’s Injury Prevention suite of products.
• Care.ai releases a new Smart from the Start Podcast featuring Houston Methodist EVP and Chief Innovation Officer Roberta Schwartz.
• Nordic publishes a new episode of its “In Network” podcast titled “Designing for Health: Interview with Evan Heigert.”
• Censinet releases a new Risk Never Sleeps Podcast featuring Paul Connelly.
• CloudWave announces its commitment to cybersecurity education by participating in the 20^th Cybersecurity Awareness Month.

Blog Posts

• Realizing the Opportunities for a Clinical Service Desk (CereCore)
• RSNA 2023 – See imaging without barriers from Agfa HealthCare (Agfa HealthCare)
• Preparing for the FY2024 ICD-10-CM Code Updates (AGS Health)
• How data platforms help healthcare organizations leverage their massive data asset (Arcadia)
• Ascom Workflow Solutions Tested Hack-Proof at MISI Cybersecurity Conference (Ascom)
• Five Things to Consider when Selecting a Musculoskeletal Injury Prevention Partner (Bardavon)
• How Data + Research Will Drive Healthcare Forward (Clearsense)

Contacts

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

HIStalk’s Guide to HLTH 2023

Best Buy Health

Booth 4230

Contact: Donna Breault, senior manager of event marketing
donna.breault@bestbuy.com
You may pre-book a meeting with our team.

Best Buy Health is on a mission to enable care at home for everyone. Learn how we’re combining best-in-class retail strengths with an enterprise care-at-home platform to transform patient experiences and outcomes. Come meet our team and experience live demonstrations of our solution at our booth. Also, don’t miss, “Retail and Health, Sitting in a Tree” on Sunday, October 8, at 2:40 p.m. PT. Best Buy Health’s COO, Chemu Lang’at, joins a panel discussing how healthcare is embracing consumerization, mirroring disruptive models like Airbnb and Uber. This shift prioritizes personalization, convenience, transparency, and user experience, meeting the expectations of today’s digital-savvy consumer.

Biofourmis

Booth 3035

Contact: Tara Stultz, chief strategy officer, Amendola Communications
tstultz@acmarketingpr.com

Did you check out the coolest booth with the best coffee at ViVE? Biofourmis is at HLTH, showcasing their tech-enabled care delivery solutions and demonstrating how data to outpace disease for care at home solutions and clinical trials. Come for the coffee and stay for the experience – new solutions for Care in the Home, Digital Clinical Trials, and Remote Care Coordination.

Five9

Booth V-2943

Contact: Roni Jamesmeyer, senior healthcare marketing manager
roni.jamesmeyer@five9.com
972.768.6554

If you are moving your old, on-premise call center to the cloud, you want to visit the Five9 booth!  Five9 offers a HIPAA-compliant healthcare cloud contact center solution that empowers you to seamlessly monitor and report call volumes in real-time across critical areas such as patient access, scheduling, prescription refills, and revenue cycle management, enhancing your staff’s efficiency. The Five9 Intelligent Cloud Contact Center seamlessly integrates with various back-end systems, including electronic health records, serving as a central hub to facilitate digital engagement, provide comprehensive analytics, optimize workforce performance, and leverage AI for improved outcomes and measurable business success. Come see us!

Get-to-Market Health

Contact: Steve Shihadeh, CEO and founder
steve@gettomarkethealth.net
610.613.4074

Get-to-Market Health helps healthcare technology leaders’ market, sell, and create sustainable, long-term relationships with their customers.

Healthcare Growth Partners

Contact: Chris McCord, managing director
chris@hgp.com
713.955.7935

Healthcare Growth Partners is an investment bank exclusively focused on the health IT market. We’ve advised 140 companies across the health IT landscape through M&A and capital transactions since our founding in 2006. We’re intentional, dedicated, and tenacious in all that we do in serving our clients. Excited to get out there and see some long-time contacts and friends and meet some new folks. I (Chris) am attending the show and happy to connect.

Medicomp Systems

Contact: James Aita, director of strategy and business development
jaita@medicomp.com
647.207.0080

Medicomp will showcase innovations in clinical usability and documentation workflow improvement, using clinical intelligence for EHRs to mirror the way clinicians think. Reach out to see how Medicomp is powering AI tools like ChatGPT for healthcare, along with enhanced FHIR/interoperability tools to make sense of incoming data by problem in health systems, breakthroughs in speech and NLP, taking freetext to structured data, and improvements in real-time compliance at the point of care.

We will not have a booth at HLTH, but email James for meetings.

TrustCommerce, a Sphere Company

Contact: Ryne Natzke, chief revenue officer
rynen@spherecommerce.com
657.383.7967

TrustCommerce, a Sphere company, is the leading financial technology company trusted by the nation’s largest health systems. The TrustCommerce integrated payment platform facilitates secure, compliant patient payments. Using TrustCommerce to enhance the patient financial experience and untangle payment workflows, clients can securely process payments anytime, anywhere and be connected with core software including EHRs like Epic, Veradigm, and athenaIDX. Our team is attending HLTH and will be available to meet with you and introduce you to our solutions. You can reach Ryne Natzke and Senior Director of Strategic Partnerships Sunil Shah at HLTH.

Morning Headlines 10/3/23

Health Data Analytics Institute (HDAI) Announces $31 Million Funding Round to Scale Predictive Risk Platform

Health Data Analytics Institute raises $31 million in a Series C funding round, bringing its total raised to nearly $50 million.

‘Restructuring historical financial obligations’: Heywood Hospital files for bankruptcy

Heywood Healthcare (MA) files for Chapter 11, citing operational and business challenges that have included a “costly and lengthy” EHR implementation.

Providence Unveils Praia Health, Its Fourth Incubated Technology

Providence’s Digital Innovation Group announces GA of its Praia Health patient identity and engagement software.

Readers Write: It’s Time to Hold Payers Accountable For Their Games

It’s Time to Hold Payers Accountable For Their Games
By Matt Seefeld

Matt Seefeld is EVP of MedEvolve of Little Rock, AR.

Payer, provider, and patient alignment — it’s the holy grail of healthcare’s focus on value to ensure the best care is delivered at the lowest cost. And while industry stakeholders have the best intentions to achieve this critical big-picture goal, the average healthcare organization sinking in denials management knows that we still have a long way to go.

A report issued by the Kaiser Family Foundation in 2022 reveals the continuation of year-over-year trends of high rates of claims denials. The report found that approximately 18% of in-network claims were denied on average during the reporting period, but some plans reached as high as 80%. This reality equates to increased burdens on revenue cycle teams and delayed reimbursements, two challenges today’s healthcare organizations must mitigate amid burnout, staffing challenges, and tight operational margins.

While provider organizations are wise to implement infrastructures and automation to ensure clean claims are delivered to payers on the first try, they should also consider how to improve reimbursement through the lens of payer accountability. For instance, understanding payer mix and where an organization is getting the most bang for its buck can provide a foundation for better negotiating power.

Jumpstarting a payer accountability strategy starts with visibility into key payer trends and data, or the ability to maintain a payer scorecard.

Payer Scorecard: Laying the Foundation for Payer Accountability

Improving operational margin is imperative for today’s physician practices. As shifting reimbursement models place more financial responsibility on patients, healthcare organizations must have a holistic strategy that proactively addresses the full lifecycle of billing processes to maximize use of limited and expensive internal resources.

Effectively negotiating with payers is a key part of this strategy, yet few provider organizations understand where they are getting the most ROI against work effort with their health plan partners. For example, can your executive team answer the following questions?

• How many claims touches did it take to get paid from Payer A compared to Payer B?
• What is the ratio of zero-touch rate (claims paid without humans getting involved), denials, and work effort between Payer A and Payer B?
• How does at-risk AR, collection effectiveness, and work effort stack up between payers?
• What is your denial overturn rate and associated work effort to achieve this result?
• Which health plans are having the greatest impact on gross collection rate (GCR) and net collection rate (NCR)?

When providers can identify payers that are creating the most internal revenue cycle havoc or have poor ROI when compared to work effort, they are empowered to confront issues head on. For example, it’s fair to ask why reimbursement from Payer A appears in 14 days while Payer B takes 28 days on average. Or why my organization is getting 60 cents on the dollar from one managed care contract and 70 cents on the dollar for another. In either case, maybe it’s time to stop seeing a particular carrier’s patients and opt for better contracts and partnerships.

Increasing Zero-Touch Rates Through Payer Accountability

The goal for any healthcare organization’s revenue cycle is to achieve the highest zero-touch rate possible. Not surprisingly, this measure reflects claims that are processed and paid without any human involvement. When that happens, work effort and cost to collect automatically goes down, and revenue cycle teams operate more efficiently.

A 26-location, 75-provider orthopedics and neurosurgery group set a course to improve its zero-touch rate with payer accountability as a key part of the strategy. To do this, they needed visibility into the daily work of every staff member and a way to track payer interactions. Because EMR and practice management systems do not have the analytics capabilities to produce the level of granularity and visibility to answer key questions, the organization deployed a framework of effective intelligence to identify where breakdowns were occurring along the revenue cycle that required human intervention.

They created a dashboard to measure zero touch visits against claims edits, refiles, denials, and actions required by the billing team to get paid. This strategy complemented other payer accountability use cases that compared work effort against at-risk AR as well as how each payer was impacting net collection rates (NCR). In essence, the team developed and maintained an ongoing payer scorecard.

Since implementing this dashboard, the organization has been able to improve its payer contract negotiations and refocus efforts around the greatest ROI. Early results have been promising:

• 98% NCR, above industry benchmark of 97%.
• 77% increase in production from redesigned processes.
• 62% zero-touch rate.

At a time when insurance companies are reporting billion-dollar profit margins and providers are finding it increasingly difficult to stay independent (or in business), it’s important that healthcare organizations have proactive visibility into payer insights. Payer accountability must become a strategic part of broader revenue cycle processes to maximize bottom-line impact and position for a viable future.

Readers Write: Accelerating Redetermination: Social Drivers of Health and 1115 Waivers

Accelerating Redetermination: Social Drivers of Health and 1115 Waivers
By Jaffer Traish

Jaffer Traish is COO of Findhelp of Austin, TX.

Medicaid Redetermination

Medicaid continues to be the largest healthcare funding vehicle in the United States. From February 2020 to April 2023, Medicaid and the Children’s Health Insurance Plan (CHIP) enrollees increased 33% to 94 million individuals.

The declaration of the public health emergency (PHE) by Congress in March 2020 enacted a “continuous coverage” requirement, where Medicaid agencies couldn’t disenroll anyone unless they asked, moved out of state, or passed away. Traditionally, there is a churn or loss of enrollees due to non-responsiveness to forms requests, regular eligibility reviews, income changes, and so forth. When the PHE ended on May 11, 2023, state Medicaid agencies were given 12 months to initiate renewals and 14 months to complete them. For many states, unwinding from the PHE will last well into 2024.

Redetermination processing is an enormous undertaking. States are under pressure from the Centers for Medicare and Medicaid Services (CMS) which can track call center metrics and procedural terminations (for example, if the person couldn’t be reached). CMS could even request corrective action plans and implement financial penalties in the event of missed unwinding reporting as required by the Consolidated Appropriations Act.

Being a Medicaid director is a critical yet unenviable position for PHE unwinding, and some states have requested waivers to use simplified criteria to process redeterminations. It has been estimated by Kaiser Family Foundation that a staggering eight to 24 million enrollees may lose Medicaid coverage.

Innovating with CMS Waivers

One approach available to states, and growing in popularity, is the 1115 Waiver. The Secretary of Health and Human Services (HHS) can approve a waiver for a pilot or demonstration project that federal rules would normally not allow, including changes to eligibility, benefits, and provider payments.

As of August 2023, there are 68 approved 1115 waivers across 48 states. Interestingly, 19 of these have social drivers of health provisions. There are 33 more waivers pending approval, and 12 of these also include social drivers of health provisions.

Beneficiary Stability

By investing in non-traditional case management, housing, and nutrition, states are adding stability for enrollees with specific health-related social needs and anticipate a positive impact on redetermination. New York, for example, is awaiting approval on a several billion dollar waiver proposal to invest in creating major social care network structures.

Amanda Lothrop, COO of Medicaid for New York State, shared the significant role social care networks will play in the 3.5 year demonstration waiver to a large group of NY stakeholders on September 27.

Centene, UnitedHealth Group, Elevance Health, Molina, and Aetna control about half of the Medicaid Managed Care market across 40 states. They receive requests from states for both updated enrollee contact information to better process redetermination and to meet requirements for social care provider networks and claim processing as part of their benefit administration.

Three Themes: Understanding the Evolving Medicaid Population

In discussing these challenges with managed care organizations, government, schools, hospital systems, and community organizations, we hear three consistent themes:

• States are in the dark about the non-medical risks of enrollees and how this is impacting churn and cost. In particular, MCOs need early notification about the clinical and social risks of both adults and children. Not only to work to address them, but to conduct benefit eligibility determinations and proactive engagement.
• Hospital systems need to adapt to new Medicaid-led financial incentives to assess needs and initiate interventions. States may take for granted the community engagement (trust-building), network contracting, and technology implementation that is required for successful non-medical services delivery.
• A single care coordination technology mandate does not substitute for community interoperability. Care coordination is cross-sector and collaboration goes far beyond traditional healthcare. All industries should look to United States Core Data for Interoperability (USCDI) standards and follow rules such as the Michigan Health Information Network (MiHIN) interoperability pledge.

The Future of Redetermination

To stay rooted in reality, waivers come and go, as do the officials that approve them. In the long term, states should invest in enhancing their member engagement channels to reduce procedural termination, updating their public health analytics to include social risk, and reducing paper friction in the state benefit eligibility processing.

The Kaiser Family Foundation estimates that more than 4 million people have lost Medicaid coverage so far. States do not have to make redetermination data public, so the full scope is unknown until federal numbers are published later this year.

Imagine if:

• The MCO could retrieve current member contact information and social risk through hospital electronic health record (EHR) connectivity to contact members for redetermination and support. Epic Payer Platform and SchoolCare are two examples of vendors supporting these efforts.
• The acute and post-acute care providers could order waiver-approved social services based on automatic benefit authorization. CalAIM is an example of this enhanced care management.
• The community social service provider could document services and reimbursement codes would automatically associate in the system for claims. MassHealth supports codified services in this approach.
• States aggregate anonymized social risk, supply, and demand to inform future capacity investments and waiver services to expand or retract. CRISP HIE in Washington, DC is leading efforts in aggregated social services management.

The large redetermination effort nationwide and the requests by states to fund social services for beneficiary stability are fueling a renewed look at antiquated state benefit eligibility systems and processing. One prediction – we will start seeing API-based application submissions that enable fast determination and financial disbursements for state benefits.

We will be watching (and supporting) waiver implementations closely along with private sector investments in social drivers of health to better understand public benefit needs, direct service delivery, and accelerated redetermination.