Readers Write: Social Care Help Shouldn’t Come at Social Cost: Why Dignity and Ease Should Be at the Heart of Modernizing America’s Safety Net

Social Care Help Shouldn’t Come at Social Cost: Why Dignity and Ease Should Be at the Heart of Modernizing America’s Safety Net
By Jaffer Traish

Jaffer Traish is COO of Findhelp of Austin, TX.

The Safety Net

Social safety nets are different in each country. Some focus on poverty alleviation, economic mobility, or disaster relief. The World Bank has estimated that safety net programs have helped 36% of the poorest in the world escape extreme poverty.

In the US, we have seen federal administrations strengthen and weaken safety net funding over decades. The history of social safety nets in the US has been shaped by voluntarism, the notion that the voluntary actions and agreements undertaken by private charity and industry are preferable to state-mandated social welfare programs.

Nonetheless, the US has tens of millions of vulnerable people looking for services. 

This is a breakdown of healthcare specific needs after analyzing 10% of searches from a population of 16 million Americans. 

COVID-19 placed a spotlight on the vast array of needs. Our public benefit data mirrors what we heard and saw of the struggle for individuals and families.

Policy Winds

With the increasing awareness of social disparities and impact on health, we now see many major policy changes:

• ACO REACH Model. This model began on January 1 and includes focus areas on equity, access, and community health. There are reimbursement calculations and withholdings related to the area deprivation index (API) and SDoH quality measures.
• Joint Commission. New rules in effect January 1 include identifying a system leader who is accountable to address disparities in the patient population, as well as social needs screening and the sharing of community resources.
• NCQA. They released new HEDIS measures, including the SNS-E measure related to assistance for plan members needing food, housing, and transportation.
• CMS guidance letter. CMS issued a guidance letter on January 4 to state Medicaid Directors related to ILOS (In Lieu of Services) for Medicaid Managed Care, which relates to the Cal-AIM California waiver and many future waivers. The guidance strongly emphasizes the importance of measuring utilization and impact of non-traditional services such as social supports.

Private Company Technology is Accelerating Modernization

With any emerging market, we’ll see some companies taking advantage for short-term profit, multi-million dollar software costs, and a story of hype that fades post contract signature.  We will see others that aim to maximize funding going to communities, to capacity building, and to community health worker staffing. Government and private sector buyers must be well educated to avoid the expensive shiny object that doesn’t deliver.

The good news is that healthcare leaders have long had a vision for what’s possible, including Judy Faulkner and Epic, where social services digitization is found in her original business plan.

SDoH is in the spotlight, with 80 bills proposed in Congress and $90 million of requested funding by states related to social care. Requests fall into several categories,including Medicaid waivers and federal match money.

We have the opportunity to build private-public partnerships that align on key principles. Education of key stakeholders is essential.

Influence 

People go to helpers to get help. Those helpers might be a librarian, a pastor, or a neighbor. Those helpers may also be care coordinators, social workers, and hospital discharge planners.

State government can heavily influence the funding for services. Medicaid directors, Health and Human Services secretaries, commissioners, and deputies control how money is spent through Medicaid waivers, MCO contracting, non-profit capacity grants, and more. There are tough decisions to make, and there is incredible respect for people in these roles who are lobbied heavily by industry.

A large influence on these decisions is improving overall health and driving down the cost of healthcare. We all know over the last two decades of electronic health record implementations that technology alone is not the answer. Technology enables us to work more efficiently and more collaboratively, though it doesn’t solve governance, community engagement, or equitable service delivery.

State agencies want to understand the needs of their populations, where people are going to receive help, the services delivered, and when possible, the correlations with healthcare cost and clinical outcomes.

Some vendors promise a panacea of results via a top-down monopoly that goes something like this:

• Mandate use of a specific, single technology system.
• Force communities to use one system.
• Force non-profits into a contract.
• Force a per-user license model so the vendor makes more money with every user whether they adopt or not.
• Force a one-time consent so the vendor owns data sharing.
• Restrict federal dollars being used outside of this system.

This sounds like a good way to make a vendor rich and to skirt consumer privacy, interoperability, and non-profit autonomy.

The Choice

Procure one technology system with a hand in the face of private sector procurement or empower the community and health systems to choose the tools that make the most sense for them. Require that they report the data using standards and even certifications as the Office of National Coordinator (ONC) has supported for years.

Dignity and Ease

At the heart of this work is privacy. Imagine that you signed a single consent form for your healthcare provider to put your information into a system to facilitate a referral to a local food pantry or domestic violence shelter. But with that one action, you’ve granted more than 120 non-profit organizations the ability to access all of the personal financial, social, and medical data you reported. This is happening today because social care privacy standards haven’t kept pace with healthcare. People expect that their sensitive information will only be visible to the organizations and people they choose. Too many are blindly forced into one-time, all-in consent models in exchange for getting the help they so desperately need.

Healthcare, government, and non-profit leaders must improve safeguarding personal information by building a consumer-directed privacy approach to social care technology. Last year, the State of New Hampshire adopted a first-in-the-nation privacy protection law that established a policy framework to prioritize a person’s right to informed consent when seeking social services.

The Future of the Safety Net

• Imagine a future where applying for state benefits is a dignified, fast, digital process, not a paper process with a custom system.
• Imagine a future where a person in need can log in to a patient portal and see covered benefits, whether value-added, supplemental, community bank funded, or other non-profit led.
• Imagine a future where payers can see member needs and where their member has received help (with permission) anywhere in the country, and (with permission), intervene to prevent costly chronic or other clinical adverse events.
• Imagine a future where social workers, discharge planners, and other helpers simply use their EHR or care management system to make referrals and orders without worrying about which vendor is powering the SDoH network, a true API network model.

This is all possible. We should not be asking governments to pick winners and then learning too late about the risks to privacy and dignity taking place behind a curtain.

With network effects, community engagement, and trust building, the outcomes that we all want to see are possible. We can enact policies that do not create data silos or create monopolies with false promise. The right interoperability policies will create innovation in health and human services that are ubiquitous in every other sector.

Readers Write: What Health IT Companies Can Expect in 2023

What Health IT Companies Can Expect in 2023
By Jodi Amendola

Jodi Amendola is founder and CEO of Amendola Communications of Scottsdale, AZ.

My crystal ball says tighter budgets, LinkedIn, and more targeted, integrated campaigns.

The beginning of a new year provides an irresistible temptation to make predictions. Unlike the ancient Romans, we don’t look to the flight patterns of birds to foretell the future, but base our predictions on what we see in the industry and the economy, what we hear from clients, technological developments, etc. Here are my predictions for what to expect this year in healthcare/health IT.

A tumultuous economy

Economists have been arguing for months about whether the US is headed toward a recession and, if so, how severe it will be. I don’t pretend to know the answer, but I do expect 2023 to be challenging for the healthcare and health IT industry given the challenges faced by providers and payers. Hospitals are still recovering from the COVID-19 pandemic and coping with rising expenses, ongoing staffing shortages, and continuing capacity constraints. In response, health systems have restricted services, laid off employees, closed departments, and even shut down entire hospitals.

However, systems are also investing in new digital technologies that allow them to operate more efficiently and expand care models, such as remote and virtual care, in the face of these challenges. The vendors who sell these products and others that support the digitization of healthcare are ramping up marketing and PR efforts to position themselves as the solutions to help systems clear these barriers.

To best reach their target audiences, what I am seeing for healthcare and health IT companies are budget considerations, such as whether to invest heavily in trade show marketing or if those dollars should be reallocated to more targeted account-based marketing (ABM), digital marketing, or integrated marketing programs.

Twitter down, LinkedIn up

I think 2023 will be a critical year for Twitter as an advertising vehicle and, quite possibly, as a viable social media platform. The uncertainty over Elon Musk’s takeover, the departure of so many staff, and Musk’s controversial decision to largely stop moderating tweets and to welcome back accounts that had been banned for misleading or false content has made brands understandably wary of being associated with Twitter.

According to a recent Media Matters report, half of Twitter’s top 100 advertisers have stopped promoting on the platform, brands which have accounted for nearly $2 billion in advertising since 2020. Some publicly announced their break with Twitter, while others have quietly stepped away. And Musk’s myopic claim that companies who choose not to advertise on Twitter are somehow engaging in censorship or violating free speech principles is not the way to woo them back. Brands have every right to avoid unnecessary and unwelcome controversy when choosing where to advertise.

By contrast, we’re seeing heightened interest among clients in LinkedIn as a marketing and advertising platform. The oldest of the social media platforms, LinkedIn has evolved from a glorified jobs board to a place where companies — including healthcare providers and payers — research vendors, network, and promote themselves.

LinkedIn content is becoming richer and more interesting as well. Yes, there are still plenty of photos of people sitting in hotel ballrooms captioned: “Excited to be attending the annual Widget Trade Show in Walla Walla,”, but creative brands are using it to tell stories and connect with target audiences on a deeper level. To encourage this, LinkedIn is adding content-friendly features, such as Creator Mode, Auto Embed, and image templates.

As LinkedIn becomes more important and versatile, brands would be wise to re-evaluate their approach to the platform with an eye toward expanding their content to engage target audiences beyond what they’ve traditionally posted.

Marketing and PR integration

It’s long been a good idea to integrate PR and marketing, but at many health IT companies, they are still separate silos. With tight budgets for both likely in 2023, it’s never been more important that they work closely together to achieve shared goals, measured using agreed upon performance metrics.

Comprehensive, integrated marketing programs that include webinars, events, digital marketing, and account-based marketing, in addition to media relations, social media, and thought leadership activities, will deliver better returns than separate, disjointed campaigns and help rise above the noise.

That also supports another 2023 trend: companies focusing more on strategic messaging and marketing to reach specific prospects. In a tough economy, it makes sense for businesses to focus on satisfying their most important accounts and landing the whales that could make the difference in a difficult year. Making the best use of tight resources and budgets through integrated marketing and PR campaigns can make all the difference.

Marketing resolutions

January is a great time for making resolutions, as well as predictions. In anticipation of what is likely to happen this year, here’s what healthcare and health IT companies should do:

• Look for new ideas and partnerships that work within their budgets while continuing to deliver great ROI.
• Integrate marketing and PR. Synchronizing efforts delivers a greater punch than pursuing separate tracks. If 2023 does prove to be a difficult year economically, it’s even more important to deliver a strong, coordinated message.
• Take creative risks. One of the great things about marketing and PR is that it’s not static; there’s always a new medium, platform or strategy to explore. This is going to be a good year to go exploring.

Whatever your resolutions, I hope you achieve them. Here’s to a happy and fulfilling new year.

HIStalk Interviews Michael O’Neil, CEO, Get Well

Michael O’Neil, JD, MBA is founder and CEO of Get Well of Bethesda, MD.

Tell me about yourself and the company.

I started GetWellNetwork 22 years ago following a personal cancer experience while I was in school getting a JD/MBA degree at Georgetown. I started the company with a simple mission to make it better for the next person. I had spent way too much time going through surgeries, chemotherapy, and coming in and out of hospital beds and clinics. I thought that these amazing people who were delivering my clinical care needed some help in delivering the kind of patient and family experience that could enhance not only my attitude, but also my outcome. I started the company to help hospitals leverage technology to engage patients and families more effectively in their care, and in turn, help clinicians and improve outcomes.

The original concept was somewhat limited, focusing on in-room patient entertainment and education. How did you broaden the company’s reach to include everything from pre-acute to post-care and even remote monitoring?

I look at this as two acts to a play with an intermission in the middle. Act I was long, 15 years of trying to improve a two-day, four-day or 12-day hospital stay. We met a patient at admission and we said goodbye to them at discharge. We we were in many ways proud of transforming the hospital experience at the point of care for the patient, family, and nurse.

A bit before COVID – and COVID certainly accelerated this — we began to invest, both in organic R&D and in some acquisitions. We knew that the impact that we could have on both our customers and people and their health journey, which had become nine or 10 million people in a year. Their journey was not just that two, four or 12 days – it was a lifelong journey, a 30-day journey, a surgery, or what have you.

We had this intermission period where we doubled down on investing in R&D. We bought a couple of companies and that helped us accelerate to build Act II for the last 18 to 24 months. That involves enterprise engagement, navigation, and retention. We have a chance to help organizations wrap their digital arms around either members or patients at scale, but do it with intimacy that is required in healthcare. We are excited about today and what lies ahead.

Patient engagement seemed to align well with value-based care, which has had perhaps less impact than everybody expected on health systems, and now the imperative involves patient recruitment and retention. What are the primary motivators of health systems to improve patient engagement?

It’s actually straightforward , and there is a triple purpose on this. The industry is littered with tiny niche consumer engagement solutions. It doesn’t have many true platforms at scale. When we talk to health systems, payers, and managed care organizations, we are talking about what we would call Get Well Anywhere. The value proposition is threefold. They need to drive their business because these organizations have been through the grinder the last three years. If you can’t claim, stand behind, and share risk in the ability of your consumer engagement solutions to drive business, we don’t think you can do a lot of business in today’s health system world.

Number One is these AI-driven outreach tools that we have now, the ability to navigate people back into their primary care, to help them navigate into a mammogram or a care gap or something like that. It is driving direct revenue when it comes to fee-for-service organizations. But a lot of times, those same organizations also have value-based pockets. They have taken on full inpatient risk in a certain market.

The powerful thing is that the same platform, the same workflows, the same what we call Get Well Navigators — who have been trained to help people in vulnerable moments leverage technology and then pick them up when they can — these same things work to make sure that we are guiding patients to the appropriate and oftentimes lower-cost point of care, or doing self-care. The number one value prop and number one driver of people investing in this now is business, whether you are in fee-for-service or you’re in risk.

The second reason, and I don’t say this lightly, is that loyalty and patient love are more important than ever. We have an internal Slack channel at Get Well called Call Patient Love, and all day long our navigators are streaming comments from our thousands of patients every day who have interacted with one of our navigators, who interacted with a nurse, or who interacted with a physician who has touched them in a certain way. It matters. This kind of patient loyalty and patient love is the second piece. It’s a little softer in its ROI approach but it’s not unimportant.

The third thing is that workforce challenges are everywhere. This isn’t a temporary thing. This has been going on for a long time. How can you leverage the power of the patient and their family caregivers to help drive efficiency of your incredibly precious workforce?

That is our three-part value prop. I will tell you pretty bluntly that we are driving at Number One. We are going at a lot of risk for this. If you have 800,000 dormant patients, we know we can convert them back to activated. They need care, and that care will also drive revenue. Let’s share in the risk of that. Let’s make sure they get the care they need. That allows us to then make other investments alongside of our partners in things that they want to do.

Insurers are making significant inroads into becoming providers, while providers are sometimes taking on the role of payvider. How does this affect your business?

On the payvider side, a lot of our large complex health systems have partnered fairly meaningfully and financially with local, regional or national payers. In those partnerships where they are taking on risk, they of course are terrific partners for us. We are doing a lot of innovative stuff. You are managing 12,000 mothers on Medicaid and you are responsible for their full cost, so we are running a Mothers on Medicaid navigation program that was a feature at the White House last December. We think there’s a way to really help these incredibly important people in our communities have the very best care and have a healthy pregnancy. In that case, you have an aligned payer and provider delivering great care and the solutions match that way.

In a world where you have payers who are starting to invest in direct care as you alluded to, they also need tools. You know from using your employer’s portals and digital tools that nobody uses them. The trust relationship and the navigation is light. We are partnering more and more these days with some folks on the managed care side, because we now have 20 years of data on when people are in this vulnerable spot, what are the interactions? How frequently should we be interacting with them? How can we recruit and hire local navigators who are in market who understand the communities, understand the local vernacular? How do you build trust on behalf of a health system or a payer? Those managed care companies have struggled for a long time with that, and we think we can help. We have shown some data to be able to help that as well.

How did your business change with the pandemic?

In all transparency — as you have built your entire organization around directness and transparency, which those of us who get to read it love — it was challenging. The most challenging thing for us was we lost touch with the clients that we work with day in, day out, month in, month out, quarter in, quarter out. We work closely with chief nurses, chief experience officers, CIOs, and nurse directors on an ortho unit that is doing a certain pathway for post-knee replacement patients and how they are going to navigate through their discharge. This is work that we do all the time. We have a lot of clinicians in the company. That changed. We had to figure out how to support them without being able to be with them, and that’s a difficult challenge.

On the other side, it tested the dynamism of our solutions and platforms. We gave a solution called GetWell Loop. It’s a library of 300 digital care plans. I was at a fellowship in Colorado when COVID broke out. When I got home, w4e met as a team. Within three weeks, we had built five COVID loops. We deployed them over the next six weeks in 200 command centers across the US at no cost to our provider partners. We ended up touching and helping over a million patients stay safe at home, and helped ER beds free up so they would stay available for the sickest people. It challenged folks to support our clinicians in a way that we are typically supporting them.

Thirdly, ironically enough, it gave us a little bit of room to double down on R&D and transformation. We contracted with this amazing firm in the UK to design a completely new consumer-grade UX that we just launched late last year. We built a BYOD version of our inpatient solution that we are deploying now across lots of hospitals without capital investment. We acquired a business that does AI outreach and navigation, which has been amazing.

We doubled down on our government investment. We spent quite a bit of time and resources on getting FedRAMP approval for our cloud-based solutions in the government. We do a lot of work across 70 or so VA medical centers and now we are able to bring our loops and our navigation stuff into those communities for our vets. That is a source of pride and drive for the company as well.

The interest in AI tools such as ChatGPT has been unprecedented. How will AI technology be applied to patient engagement?

We have a front row seat. We were admittedly a little bit slow on the organic R&D in AI. We just didn’t have the bandwidth to get ahead of it. We acquired a company whose foundation is in AI and chat. One of the elegant things that we liked about this was that it has an ability to interject AI and live chat simultaneously. You are building real-time profiles of patients and how they are interacting with the content and our people.

As an example, we are working on a large project in California, where we had close to a million dormant patients. We were given a file from their EHR company. They had not been in to see a primary care physician in over 18 months because of the pandemic. We used our AI to reach out to them. To give you a sense of this, you’re talking about 2.6 million AI-driven, text-based bidirectional interactions coupled with 40,000 supplemental live interactions from our navigators.

The good news is that we are seeing the AI work and people respond to it. But we also would tell you that the realization in healthcare is to think that this stuff will be done exclusively without people. We believe that human interactions in your biggest state of vulnerability will require people to make sure they are monitoring, looking, and attaching in highly personal, delicate, and intimate ways in times of need. We have combined AI with a high-touch approach as well. We are seeing some great results that we are excited about.

How do the areas of patient engagement and patient-reported outcome measures overlap?

This is where things get fairly complicated among the EHR and its capabilities; a large CRM platform and its capabilities; and tools, solutions and platforms like ours.

We are seeing that a large health system will often default to the large enterprise EHR or CRM. We don’t fight against those platforms at Get Well. We spend as much time on programs as we do on platforms, meaning that these platforms are only as good as highly discreet programs that help an individual or a micro population of people navigate through their incredibly individual journey.

It sounds cliché, but you had better be able to integrate into core EHRs in a deep, API-driven, and oftentimes more so these days, FHIR kind of fashion and have SMART apps and things like that. You had better be able to pick up on a broader campaign from a CRM outreach. But in our world, you had better be able to put on top of those two platforms some individualized and personalized programs. Because if not, we are going to see engagement rates just like we saw the portal for 20 years. That’s not good enough. People need help.

How does the company’s history of acquisitions and funding activities change with the current business environment?

It’s been crazy. At HLTH, the buzz wasn’t just patient engagement and health equity, but also the cash burn of companies that have spent a lot of money on marketing knowing that their solutions are fairly niche and are not scaled. I don’t envy being in that kind of startup, early stage, cash-burning mode.

Get Well was not an overnight success. This stuff takes a long time to get  right and to get to scale. But we are fortunate. We have a lot of customers. We have positive cash flow. We are able to invest our own money in things that we actually want to pursue. We will be working this year on an important youth mental health project in Mississippi. We can take our own money, which we actually make, and invest in things that we think are projects of purpose.

The funding environment has changed dramatically, literally over 90 days, because there was a lag. The private markets stayed relatively hot until August and September and then they started to cool. That has been a significant change.

As a company that has been around for a while that has some scale, these are opportunities for us. We are thinking about our strategy. We are thinking about how we might accelerate our own R&D efforts with other companies that might be willing and excited about partnering with us to do something bigger together versus smaller on our respective owns. We spend a bunch of time talking to the ecosystem and staying connected. Honestly, I’m rooting for all of them. Everyone that is doing good work in patient engagement means that somebody on the patient end is impacted.

I hope they all succeed, but they won’t. It’s tougher because there are fewer buyers out there, as health systems consolidate and become fewer and fewer prospects. It is difficult not only that there are so many vendors, but so few customers. It’s a double whammy for the small niche players. Fewer customers, and those fewer customers have a hard time adopting, integrating, and implementing tiny projects that don’t have the security measures and integration depth that these multi-billion dollar, multi-state organizations expect. You have pressure on that side to work with larger, more stable, more comprehensive solutions. Secondly, there’s a big movement at the CIO level to consolidate suppliers.They can’t manage 14 different consumer-facing tools or whatever.

This is not to say that I don’t believe in innovation. Our industry always needs people who have identified a pain point and are going after it in a creative, innovative, new way. However, these entrepreneurs need to spend as much time honing their business models as they are honing their elegant solutions, because too often these amazing solutions can’t get scale on the revenue side, and there’s not a lot of forgiveness out in the market right now for that.

What will be important to the company in the next three or four years?

One is what I will call Get Well Anywhere. That is, finding our way into relationships where we become that third core solution. You have an EHR, you’ve got a CRM, and you have an engagement, navigation, and retention platform with the depth, the credibility, and the security to make sure that they can deal with these two behemoth solutions while also having the rare ability to deliver digital intimacy that those big platforms lack. We want to find our way into more of these Get Well Anywhere partnerships that are large, where we are sharing risk, and where we can drive business, patient love, and workforce efficiency at scale. We are excited about the progress there.

The second thing for us is that we will continue our work and we are doubling down in the government space. We have had such success in impacting US veterans. We are doing more work these days as well in active duty military clinics and facilities. We are excited about the impact that consumer engagement and navigators can do with the folks that we cherish. We have 30 or 40 veterans on our  cohesive, amazing, and focused team. We are doubling down on their success to make sure that we can impact veterans in active duty military moving forward.

The third thing is that we have primarily been dealing with health systems for 20 years. There are school systems, payers, and other organizations that have a vested interest in engaging constituencies in their health. We need to get outside our comfort zone and help populations do food as medicine, navigating to treatments, and doing self-care. These are the kinds of things that give us great purpose and that we are excited about.

Curbside Consult with Dr. Jayne 1/16/23

As a CMIO, one of my primary responsibilities is to make sure the EHR is configured in a way that makes it easy for clinicians to do the right thing. This involves everything from determining the content and display order of an order set to creating documentation templates and workflows that make sense for a given specialty, subspecialty, or particular type of visit.

In a large healthcare organization, managing this content can be complex. It can seem like we never have enough money, time, or personnel to do everything we want to do. We have to juggle priorities and manage conflicting requests from teams that might be in conflict with organizational priorities. Some days are easier than others, but when the going gets tough I’m glad that I have my “village” of fellow CMIOs that I can reach out to for advice.

During a recent call, one of them brought up this study that was recently published in the Journal of the American Medical Informatics Association. The title was eye-catching: “Behavioral ‘nudges’ in the electronic health record to reduce waste and misuse: 3 interventions.” The authors, working with the EHR team at an academic medical center, identified three workflows that might be driving users towards medical errors, waste, and misuse. They modified the system to try to nudge providers towards high-quality outcomes. but with varying degrees of success.

They had a couple of strategies for how they updated the EHR. “By changing the direction of these nudges – in one case, via making the less appropriate order more difficult to find and use; in the second case, by making the more frequently desired imaging easier to find; and in the final case, by presenting an easy to find alternative – we attempted to nudge providers toward reduced waste and misuse.”

The first situation dealt with a blood test. There were several variations of the test available and having an alphabetical order display that placed the least-desirable option higher on the list was likely contributing to erroneous orders. The modification removed the less-appropriate option, replacing it with an order panel that included educational content to help the provider make a better choice, including pre-checking the more desired test.

The second situation addressed the issue of providers erroneously ordering a CT scan of the abdomen when it was more likely that they wanted to order a CT of the abdomen and pelvis. The researchers assumed that alphabetical placement was an issue here as well. They reordered the list to place the more desired option higher in the list.

In the third situation, the authors looked at prescriptions of benzodiazepines that are given to help patients with anxiety during medical procedures. Prior to the intervention, the default quantity for the medication order in the EHR was what one would prescribe for a patient who was taking the medication on a routine basis rather than just taking it before a procedure. This led to prescriptions for more pills than would be appropriate for the situation. The team created a new order that made it clear that the intent was for pre-procedure use. It dispenses two pills with no refills and includes an additional comment that it is to be used as needed for anxiety prior to a procedure.

The authors noted some challenges in determining how effective the nudges were. For the anxiety prescription, there was a very short baseline, so it was difficult to determine the level of improvement. They also commented that the benefits of changes to the system have to be balanced against the cost of implementing them. There was a fairly dramatic difference in the time needed to create each solution: six hours for the blood test, three hours for the imaging order, and 16 hours for the anxiety medication order.

The changes were presented to end users as part of general educational guidance that is released with monthly EHR updates. In my experience the uptake of monthly update documentation can be variable, so there’s a good chance that some users simply stumbled upon the changes in the system. It would be interesting to look at how different specialties interacted with the new orders. For example, whether they made more of a difference among physicians in a specialty that interacted with the orders at a higher frequency than those who ordered the tests less frequently.

In the article’s discussion, I was interested to learn that “as compared to interruptive alerts, nudges in the EHR literature have not been as well described.” That’s an interesting point, because alerts that interrupt the workflow have become general annoyances for many clinicians, where nudges can be embedded in the design to the point where users might not even perceive them as having been deliberately placed. I wasn’t aware of the “Nudge” group at the University of Pennsylvania, but I’ll definitely be keeping an eye out for writeups of their work.

I also hadn’t thought of some of the work I recently incorporated into my own EHR as being nudges, but in hindsight, they are. I got the idea from a presentation I saw from one of the nation’s premier children’s hospitals and extrapolated a piece of it to the work that our clinicians do. It hasn’t been live long enough for me to know how well it’s been received, but I’m looking forward to finding out.

Another interesting dynamic to explore would be whether there were any specific complaints from end users about the incorporation of the nudges. For items that appear in a list, changing the order or removing an item can interfere with muscle memory and will feel bothersome to those who had adapted to finding the right choice in the list in their own way. It can take time for those users to re-adapt to the new presentation. For items that appear as part of a search, changing those can be less bothersome.

Since the study was done at University of California, San Francisco (UCSF) Health, I’d be interested to hear from anyone who was on the team responsible for the changes or from end users who experienced it.

What user-facing nudges or interventions are you working on for 2023? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 1/16/23

GAO rules Booz Allen has no conflict in $860M VA award

The Government Accountability Office rejects bid protests involving the VA’s selection of Booz Allen to continue managing its Oracle Cerner implementation for another five years.

Definitive Healthcare lays off 6% of staff despite revenue growth

Healthcare market intelligence company Definitive Healthcare, which went public in 2021, will lay off 55 employees as it struggles to balance hiring and expenses with revenue.

Owensboro Health and Optum Launch Comprehensive Partnership to Enhance Patient Care and Experience in Western Kentucky and Southern Indiana

Owensboro Health (KY) outsources revenue cycle management and IT to Optum, which will take on 575 health system employees.

Monday Morning Update 1/16/23

Top News

The Government Accountability Office rejects bid protests involving the VA’s selection of Booz Allen to continue managing its Oracle Cerner implementation for another five years.

Unsuccessful bidders Cognosante and Pro Sphere Tech said that Booz Allen has an organization conflict of interest because the $860 million contract will allow it to steer work under a different VA task order to its subsidiary Liberty IT Solutions, which it acquired in June 2021 for $725 million.

GAO dismissed a similar year-ago protest by a Liberty IT Solutions competitor, determining that Liberty and Booz Allen are performing different kinds of work that is managed by different VA offices.

Reader Comments

From Cron: “Re: disruptors. Does any company actually disrupt anything?” Rarely in healthcare, since those companies that would be disrupted are usually entrenched, well funded, and politically connected. Expectations are misplaced that scrappy startups will somehow fix our healthcare non-system for us since politicians won’t. The job of a startup is to survive, grow, and make money, and tangling with huge insurers, health systems, and vendors isn’t a great way to do that.

HIStalk Announcements and Requests

Poll respondents are mixed on assigning responsibility to the VA’s struggling rollout of Oracle Cerner.

New poll to your right or here: Which social media service have you used in the past seven days?

Several folks have reached out about the death of industry long-timer Frank Pecaitis. His family has started a GoFundMe to establish a scholarship in his name.

Welcome to new HIStalk Platinum Sponsor RxLightning. The New Albany, IN-based company enables physicians to accelerate patient access to their preferred specialty therapies. Its MedAccess platform was designed for physicians and their clinical team to re-imagine the entire specialty medication experience without paper forms or fax machines, supporting over 1,200 specialty medications across all therapeutic specialties. Ninety-four percent of patients get access in less than one hour and 99% in less than one day. Its proven approach simplifies the historically cumbersome process of specialty medication access by providing visibility into the entire patient journey through a digital platform, which acts as a single source of truth for all stakeholders. This MedAccess Ecosystem optimizes the patient journey from enrollment to fulfillment and makes the disconnected, connected. Thanks to RxLightning for supporting HIStalk.

Thanks to these companies that recently supported HIStalk. Click a logo for more information.

January 19 (Thursday) 2 ET. “Supercharge Your Clinical Data Searches.” Sponsor: Particle Health. Presenter: Paul Robbins, MSMBA, VP of product, Particle. Particle’s team will preview the exciting results of Specialty Search, a new condition-specific record locator service. This webinar will review how to collect patient records from top Centers of Excellence across the entire country; how healthcare organizations of all types are benefiting from Specialty Search capabilities, using Particle’s simple API; and why a focused search of chronic condition data — in oncology, cardiology, endocrinology, orthopedics, and more — has an outsized impact on care outcomes.

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

Acquisitions, Funding, Business, and Stock

Not directly healthcare related, but interesting. JP Morgan Chase sues Charlie Javice, the 30-year-old founder of student loan signup platform vendor Frank, which it acquired for $175 million in September 2021 and has since shut down. Executives of Frank allegedly hired a data science professor to create 4.25 million phony user accounts versus its actual 300,000 users who used the service to apply for school loans. The company came under Congressional scrutiny in 2020 on suspicions that it was misleading students and  selling their personal information to advertisers. JP Morgan discovered discrepancies when it asked for a customer list so it could begin marketing its own offerings to students, then found that three-fourths of test emails were undeliverable and only 1% were opened.

Jingyun Fan, MS, founder and CEO of app-based insomnia coaching startup Shuni, lists the lessons she learned that resulted in shutting the company down after three years:

1. Founders must manage their egos in balancing the many naysayers while still listening to legitimate feedback.
2. First-time founders focus on “build it and they will come” instead of the real challenge of distribution. They should learn about marketing and sales and split their time equally between product and growth.
3. Operational excellence is easily copied and just doing something better isn’t enough to provide the returns that venture capital seeks.
4. Startups should not focus on building a services business, which is operational excellence that incumbents can copy given their capital and reputation.
5. Don’t try to sell platform technology into healthcare since better technology is a nice-to-have that may never result in a sale, and it’s hard to disrupt Epic or Oracle Cerner.
6. For behavioral health offerings, focus on direct-to-consumer growth rather than pursuing academia-grade outcomes data that would interest only employers and insurers.
7. Cost-of-acquisition is high in behavioral health and marketing strategies should focus on long-form content written by authentic personalities as brand representatives, making YouTube as the primary channel because you can speak directly to target clients, has good discoverability, and is good for search engine optimization.
8. Make sure as a founder that the problem you are addressing is worth dedicating a major part of your life to.
9. Venture capital isn’t right for every business. Capital comes with timeline expectations and what startups need is time.
10. Ignore these lessons. People do the impossible all the time, doing meaningful work and transforming their own lives.

Sales

• Two hospitals on the border between France and Belgium choose Sectra for digital pathology in a joint project.
• Owensboro Health (KY) outsources revenue cycle management and IT to Optum, which will take on 575 health system employees.

Government and Politics

ONC publishes Draft Version 4 of USCDI.

Sponsor Updates

• Current Health publishes a new case study, “UMass Memorial Health Builds Leading Hospital at Home Program.”
• EClinicalWorks releases a new customer success story, “Value-Based Care Achieved Through PCMH and HEDIS.”
• Relatient publishes a new case study featuring One Pediatrics, “Activating Patients Through Targeted Messaging and Segmentation.”
• West Monroe appoints TED Conferences CEO Jay Herratti to its board.

Blog Posts

• Are You Compliant? New CURES Act Rules in Effect (Pivot Point Consulting)
• How Bedside Manner Improves Patient Recovery (PerfectServe)
• How The Bellevue Hospital is Transforming their Supply Chain – and Maximizing Savings (Premier)
• Your guide to the average speed of answer in a call center (Talkdesk)
• 2023 Top Healthcare Cybersecurity Threats (TigerConnect)
• Upfront Healthcare 2022 Year in Review (Upfront Healthcare)
• 4 Tips to Boost Physical Therapy Documentation Training in Your Clinic (WebPT)
• The Cost of Doing Nothing (VisiQuate)
• Carequality & EHealth Exchange Annual Meeting Highlights (Zen Healthcare IT)

Contacts

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

Morning Headlines 1/13/23

Censinet Secures $9M in New Funding to Accelerate Third Party Risk Management in Healthcare

Healthcare risk management company Censinet raises $9 million in new funding, bringing its total raised to $22 million.

Talent Group Acquires Queen Consulting Group

IT staffing company Talent Group acquires Queen Consulting Group, which specializes in pharma and healthcare IT, including EHR implementations.

Alpine Investors Announces Partnership with Leading Revenue Cycle Management Provider, Medusind

Alpine Investors acquires RCM, practice management, and analytics company Medusind from HIG Capital.

News 1/13/23

Top News

Alphabet’s Verily health sciences unit will lay off 240 employees, 15% of its workforce, as the company tries to bolster its financials to reduce reliance on its parent.

The company will end early-stage projects that involved remote patient monitoring and microneedles for drug delivery.

Reader Comments

From High Vibration Go On: “Re: J.P. Morgan Healthcare Conference. You should ask your readers for their assessment and any zingers, predictions, etc.” Readers who attended JPM, what thoughts do you have?

HIStalk Announcements and Requests

The migration to the new, more powerful server overnight went mostly OK, with a few errors due to permissions, security certificates, and the “contact us” online forms (still working on those). Let me know if you see anything that is irritatingly broken.

Webinars

January 19 (Thursday) 2 ET. “Supercharge Your Clinical Data Searches.” Sponsor: Particle Health. Presenter: Paul Robbins, MSMBA, VP of product, Particle. Particle’s team will preview the exciting results of Specialty Search, a new condition-specific record locator service. This webinar will review how to collect patient records from top Centers of Excellence across the entire country; how healthcare organizations of all types are benefiting from Specialty Search capabilities, using Particle’s simple API; and why a focused search of chronic condition data — in oncology, cardiology, endocrinology, orthopedics, and more — has an outsized impact on care outcomes.

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

Acquisitions, Funding, Business, and Stock

Censinet raises $9 million in new funding.

Talent Group acquires Queen Consulting Group.

Sales

• C By Precision Care chooses EClinicalWorks, Healow, and PRISMA.
• Meditech UK chooses CloudWave’s OpSus Cloud Services to deploy its cloud-based Meditech Expanse implementation at two NHS trusts.
• Eye Health America will implement NextGen Patient Experience Platform and NextGen Pay powered by InstaMed.
• Jefferson County Human Services (WI) chooses Eleos Health’s natural language understanding technology to interpret behavioral health conversations and reduce documentation time.
• Transcarent will offer expert second opinions from specialists at The Clinic by Cleveland Clinic, which is a joint venture between Cleveland Clinic and Amwell.
• Nicklaus Children’s Hospital will implement the ActX Genomic Decision Support platform.

People

Life sciences medical intelligence company Dr. Evidence hires Rose Higgins, RN, MPM (HealthMyne) as CEO.

DrFirst promotes G. Cameron Deemer to CEO. He replaces founder James Chen, MS, who moves to executive chairman of the board. The company also promotes Anthony Brooke to chief technology and innovation officer.

ModMed hires Jody Beaverson (Change Healthcare) as chief people officer.

Industry long-timer Frank Pecaitis — who held executive roles at QuadraMed, Medsphere, GE Healthcare, PatientSafe Solutions, Agfa HealthCare, and most recently at Philips in a 30-year career — died December 24 at 59.

Announcements and Implementations

A trigger method adverse event study of 11 hospitals in Massachusetts finds that nearly one-fourth of admissions included an adverse event, of which about 1% were both serious and preventable. The most common type of events involved drugs (39%), surgeries or procedures (30%), nursing care (15%), and healthcare-associated infections (12%).

Northwell Health releases a pregnancy chatbot for its patients that offers education and triage with escalation.

Sponsor Updates

• Nordic posts a new episode of DocTalk titled “The two sides of digital health.”
• Healthjump earns Validated Data Stream designation in the new NCQA Data Aggregator Validation Program.
• EClinicalWorks customer Children First Pediatrics reports successful process automation, increased patient compliance, and general cost savings using the company’s Healthcare Effectiveness Data and Information Set (HEDIS).
• Ellkay hosts a virtual blood drive through the Red Cross in support of National Blood Donor Month.
• Fortified Health Security names Ayinde Mitchell (Cognoa) regional sales director.
• HCTec sponsors five families as part of Operation Stand Down Tennessee’s holiday program.
• Impact Advisors announces that is has been recognized as one of the top leaders in Canada in the KLAS Canada EMR Consulting Services 2023 report.
• Kyruus reports a landmark year in 2022, serving over 100 health systems, 500 independent medical groups, and 100 health plan brands.

Blog Posts

• Customer-Centric Healthcare Tech Commercialization (Get-to-Market Health)
• Digital Innovations Behind the Future of Life Sciences Industry (Healthcare Triangle)
• How Technology is Affecting Hospitals From the Top Down: The Role of Today’s CIO (HealthTech Resources)
• How Patient Education Can Increase Compassion in Healthcare (Healthwise)
• Unlocking the power of digital healthcare solutions in three steps (InterSystems)
• A history of home healthcare payment models (Intelligent Medical Objects)
• Meltdown: Why Resiliency Programs Alone Can’t Reverse Physician Burnout (Medhost)
• 4 essential factors to a successful, multi-year, phased implementation project (Meditech)
• How NeuroFlow Prioritizes User Experience to Improve Digital Mental Health (NeuroFlow)
• An In-Depth Q&A with Cathy Thomas Hess, Chief Clinical Officer of Wound Care (Net Health)

Contacts

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

EPtalk by Dr. Jayne 1/12/23

I volunteer with a couple of community organizations. Although I find the work gratifying, it can also be frustrating for those of us who are used to workplaces where time is seen as precious and communication is key.

One of my organizations keeps sending out “friendly reminder” emails telling recipients that “if you haven’t taken care of XYZ yet, please do so, but if you have already done it, disregard this message.” I’ve certainly seen this approach in business situations as well, so those who are guilty should be on notice. For those of us in fast-paced situations who tend to juggle way too many balls, it can be difficult to know if you did it or not – especially if the original request was some time ago. Sending the email only to the people who actually need to take action would be more useful and would avoid wasting other people’s time.

From Jimmy the Greek: “Re: telehealth. Check out this company that will set you up with a video chat with a doctor, and then sell you a bunch of prescription meds to keep on hand  ‘just in case.‘” Duration Health describes itself as “a mission-driven organization with a deep belief in patient autonomy.” Following a consultation, they prepare a customized kit from their list of 60 medications so that you can have the good stuff on hand in the event of trouble in the backcountry, natural disaster, or all civil unrest. They note that their formulary “contains the medications most prescribed at urgent cares for acute, non-emergent conditions, along with a select set of potentially life-saving medications for emergent scenarios where help is limited.” The list includes such favorites as antibiotics, antifungals, antimalarials, steroids, epinephrine, antihistamines, laxatives, altitude sickness treatments, emergency contraception, and anti-nerve gas agents. They focus their sales on those who anticipate traveling outside the US, into the backcountry, to an area at risk for natural disasters, or to a medically underserved area as defined by HRSA. Their OFFGRID promo will net you a hefty discount if you’re interested.

Here’s some good news for those of us who spend a lot of time at our desks. A recent study published in Nature Medicine shows that even short bursts of vigorous activity as part of daily life can help reduce the risk of death. Activities might include climbing stairs, brisk walks during a commute, and more. Participants wore wrist-based accelerometers that helped measure the amount of vigorous intermittent lifestyle physical activity (VILPA). More than 25,000 people aged 40 to 69 years participated in the study and wore the devices more than 16 hours a day for at least three days during a weeklong period. The “nonexerciser” group said they didn’t exercise during leisure time and they didn’t walk more than once weekly for recreation. The researchers compared mortality rates between those nonexercisers who did and did not have spurts of VILPA recorded by their devices. They also looked at data from another 62,000 research subjects who self-reported that they exercised regularly. The subjects’ health outcomes were tracked for approximately seven years.

The study found that even in nonexercisers, having engaged in bursts of vigorous activity was associated with a nearly 50% decrease in mortality from cardiovascular disease. Although the study can’t show causality, it’s hopefully interesting enough to help set a framework for additional investigations. The authors noted some limitations of the study. Only about 6% of people invited to participate actually accepted, so the subjects might not represent the general population. Additionally, some bursts of activity such as carrying something heavy like a shopping bag might not have been accurately captured by wrist-based devices.

It looks like every bit of movement during the day counts, so I’ll keep that in mind when I’m racing to the laundry room to rotate a load of towels in between conference calls or scurrying down the driveway to bring the recycle bin in before one of my neighbors calls the city inspector for leaving it out past dusk.

Of no surprise to anyone: MyChart message volumes decreased at UCSF Health after the organization began billing for them, even though the number of messages that actually generated charges were small. A research letter published in the Journal of the American Medical Association found that although charges occurred about 2% of the time, the overall number of messages declined from 59,648 to 57,925. The authors propose that the decline was likely due to “awareness of the possibility of being billed.” Interestingly, they found no significant changes in the numbers of scheduled visits or unscheduled telephone calls. They note that “future research should investigate overall costs under different payment models and the effect of billing for messaging on outcomes, health equity, and patient and clinician satisfaction.”

In speaking with my peers around the virtual water cooler, it doesn’t seem like patients understand the burdens that primary care physicians are facing including the deluge of messages that has happened since COVID appeared. Patients are unaware that a majority of primary care physicians are taking work home with them and continuing to manage phone messages, insurance preauthorizations, and visit notes well into the evenings. As I coach physicians on trying to make documentation more efficient, I keep hearing themes about not only lack of office staff, but lack of highly qualified staff, which pushes more work onto the physicians.

One physician I spoke with recently has had to perform all patient care tasks in his office, including patient intake (history updates, vital signs, etc.) because his medical assistant is on medical leave and the health system employer claims they can’t find anyone to serve as a temporary replacement. He’s thinking about resigning because he can’t get caught up and other physicians in the practice are unwilling to share their staffing capacity. I know that my former clinical employer still has a percentage of its locations closed because it can’t staff them, so I’m not surprised about any hiring crises I hear about.

Is your organization charging for messages, and how are patients receiving the change? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 1/12/23

Array Behavioral Care Secures $25 Million from CVS Health to Help Address National Mental Health Crisis through Virtual Care

Telepsychiatry provider Array Behavioral Care raises $25 million in a Series C funding round led by CVS Health, which will look for ways in which Array’s capabilities can complement its own healthcare delivery services.

OpenLoop Acquires Reliant.MD Practice Group, Expanding Services and Strengthening Position in Insured Care Market

OpenLoop, a white label telehealth services company focused on payers and employers, acquires Reliant.MD’s practice group.

Alphabet to cut staff of health sciences unit Verily by 15%

Verily will lay off 240 employees and shutter several product lines, including remote patient monitoring for heart failure, in an effort to streamline operations and achieve financial independence from parent company Alphabet.

Morning Headlines 1/11/23

LeanTaaS Acquires Hospital IQ to Create AI Innovator for Hospital Operations Optimization

Capacity management and patient flow software vendor LeanTaaS acquires Hospital IQ, which offers hospital automation solutions.

Avel eCare Announces the Acquisition of NightWatch to Expand Pharmacy Telemedicine Services

National telemedicine provider Avel ECare acquires after-hours remote pharmacy service NightWatch.

20 Ontario Hospitals Transition to Meditech Expanse as Members of the ONE Shared Service Organization

In Canada, 23 hospitals form a shared services IT organization as they implement a shared instance of Meditech Expanse.

News 1/11/23

Top News

Capacity management and patient flow software vendor LeanTaaS acquires Hospital IQ, which offers hospital automation solutions.

Webinars

January 19 (Thursday) 2 ET. “Supercharge Your Clinical Data Searches.” Sponsor: Particle Health. Presenter: Paul Robbins, MSMBA, VP of product, Particle. Particle’s team will preview the exciting results of Specialty Search, a new condition-specific record locator service. This webinar will review how to collect patient records from top Centers of Excellence across the entire country; how healthcare organizations of all types are benefiting from Specialty Search capabilities, using Particle’s simple API; and why a focused search of chronic condition data — in oncology, cardiology, endocrinology, orthopedics, and more — has an outsized impact on care outcomes.

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

Acquisitions, Funding, Business, and Stock

Kaufman Hall will acquire six-employee advisory firm and media publisher Gist Healthcare.

Behavioral health clinical database company Holmusk raises $45 million in a Series B funding round led by Veradigm, which will incorporate segments of its behavioral health and related de-identified patient data into Holmusk’s NeuroBlu Database.

CVS Health is reportedly interested in acquiring senior-focused primary care provider Oak Street Health in a deal that could be worth $10 billion. The retail pharmacy chain is in the midst of an $8 billion acquisition of home healthcare company Signify Health. Chicago-based Oak Street, which went public in 2020, operates 170 clinics across the country.

Tech-enabled kidney care company Monogram Health raises $375 million, bringing its total to $547 million.

Carbon Health announces a $100 million investment from CVS Health Ventures less than a week after announcing layoffs and the shuttering of several business lines. CVS will pilot the primary and urgent care company’s operating model and software within several of its CVS Health locations.

Wolters Kluwer Health acquires nursing education and training company NurseTim.

National telemedicine provider Avel ECare acquires after-hours remote pharmacy service NightWatch. Avel ECare got its start at South Dakota health system Avera Health before it was sold to private equity buyers and renamed in 2021.

Microsoft is in talks to invest $10 billion in ChatGPT owner OpenAI at a valuation of $29 billion

Sales

• Connecticut Children’s Care Network will offer nursing mothers Nest Collaborative’s virtual lactation consultation service.
• The VA will integrate Renalytix’s KidneyIntelX kidney disease assessment and management software with its EHR.
• Bon Secours Mercy Health (OH), Adventist Health (CA), Northside Hospital (GA), Duly Health and Care (IL), and Onsite Women’s Health (TN) select Volpara Health’s breast cancer screening and detection software.
• Meditech UK will use CloudWave’s OpSus Cloud Services to power its Expanse EPR at East Cheshire NHS Trust and Mid Cheshire Hospitals NHS Foundation Trust.

People

Retired Army Colonel Bobby Saxon, MS (CMS) joins Leidos as a VP focused on customer advocacy.

Curve Health names Matthew Michela, MBA (Life Image) CEO.

R1 RCM promotes Kyle Hicok, MBA to chief commercial officer.

Nordic Consulting promotes Terri LeFort, RN, MBA to president of Nordic International and hires Kieran Hughes (Tegria) as president of its markets in Europe and the Middle East and Thomas O’Shaughnessy, MSc (Deloitte) as president of its Canada-based subsidiary Healthtech.

Ventra Health hires Steven Huddleston (Pelitas) as CEO.

Consulting firm Brightwork Health IT hires Eliza Corrigan (Tasman Global) as chief sales officer.

Divurgent promotes Hannah Ellerbee, MBA to chief customer officer.

Colin Ashby (Talkdesk) joins Healthmap Solutions as VP of sales for healthcare systems.

Announcements and Implementations

Ardent Health Services (TN) will implement remote patient monitoring and virtual care services from Cadence as part of its remote care programs for patients with chronic conditions.

In Canada, 23 hospitals form a shared services IT organization as they implement a shared instance of Meditech Expanse.

Other

The Bermuda Hospitals Board provides a breakdown of costs and timelines associated with the rollout of its Oracle Cerner-based PEARL system, noting that its staff had to work through several COVID waves and a hurricane as its October 29 go-live approached. The board saved $1.3 million by hosting planning meetings remotely, though it spent $1.7 million to feed and house 160 extra support staff at the Hamilton Princess & Beach Club. The net cost of the project is expected to be $30 million paid over 10 years.

The Better Business Bureau alerts consumers to the shady business practices of North Texas-based telemedicine company Doctor Alexa. The bureau revoked the company’s accreditation last June after it failed to address 24 of the 46 consumer complaints filed on the BBB’s website. Complaints related to paying for services never rendered, chronic lack of communication, and failure to send prescriptions to pharmacies after virtual consults. The BBB received over 300 complaints related to telemedicine between 2019 and 2021.

Sponsor Updates

• AdvancedMD announces that it has been awarded 21^st Century Cures Act Certification from ONC.
• Baker Tilly releases a new BuzzHouse Podcast, “Fostering healthcare and housing through relationships as a community investment.”
• ChartSpan welcomes Lauren Wyatt (Change Healthcare) as client success director and Shelby Statom (Everly Health) as implementation project manager.
• Netsmart’s MyUnity earns ONC’s Cures Update certification, the first post-acute EHR to do so.
• CHIME releases a new Leader2Leader Podcast featuring Symplr Chief Product Officer Brian Fugere.
• Diameter Health again achieves the Certified Partner designation in NCQA’s Data Aggregator Validation program.

Blog Posts

• What does Experity do? (Experity)
• Improving Business Development at Your Medical Practice (AdvancedMD)
• The Role of RCM in Health Equity (AGS Health)
• CMS National Healthcare Directory RFI Blog Series: Provider Response (CareMesh)
• The Secret to One Hospital’s $115k Savings in EHR Build Costs (CereCore)
• Content Roundup: Top 5 Blog Posts of 2022  (Optimum Healthcare IT)
• Talking Cyber Resilience and Business Risk to Your Board and Executives (Clearwater)
• 3 Tips for Optimizing Your Cloud Costs (CTG)
• The Right Analytics Solution Involves More Than Data Alone (Dimensional Insight)
• A Renewed Focus on Employee Engagement (Direct Recruiters)

Contacts

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

Morning Headlines 1/10/23

Carbon Health Secures Series D Investment to Drive Primary and Urgent Care Expansion

Carbon Health announces a $100 million investment from CVS Health Ventures as part of a Series D funding round, and that CVS will pilot the primary care company’s operating model and software within several of its CVS Health locations.

Veradigm Announces Strategic Investment in Holmusk

Behavioral health clinical database company Holmusk raises $45 million in a Series B funding round led by Veradigm.

Monogram Health Closes $375M Growth Capital Raise to Support Continued Expansion of Innovative In-Home Kidney and Polychronic Care Model

Tech-enabled kidney care company Monogram Health raises $375 million, bringing its total raised to $547 million.

CVS Is Exploring a $10 Billion-Plus Acquisition of Oak Street Health

Bloomberg reports that CVS Health may acquire senior-focused primary care provider Oak Street Health in a deal that could be worth $10 billion.

Curbside Consult with Dr. Jayne 1/9/23

I read a number of articles this week that addressed various hot topics about how people spend their time and how employees should be treated.

It was quite ironic that the best thing I saw on Facebook this week was a link to a piece in The Atlantic titled “The Age of Social Media Is Ending.” I have a love/hate relationship with social media depending on how much I feel like I’m being forced to use it versus how much I’m electively using it to keep up with things I care about. I despise it when community organizations (including our local schools) decide that Facebook is the best way to communicate important information. They don’t seem to understand that Facebook isn’t a static place you go to view things, like a bulletin board. The algorithm serves up different things to different people at different times and depending on your settings it’s possible to miss information unless you’re stalking a particular group or page on the daily.

I also dislike the fact that social media posts from individuals have become newsworthy. Outlets like MSN are constantly posting stories about things that people share on TikTok. Often, these stories are about happenings that we’re supposed to find outrageous, but I can’t take any more earnest-appearing people complaining about things that aren’t really that outrageous. I enjoy social media when I see updates from friends I don’t often see or use various groups or forums to get advice about my hobbies. Rather than broadcast to the entire universe on Twitter or Facebook or Instagram, I prefer to be part of smaller platforms that let me connect in a deeper way with my actual friends, like private workspaces on Slack or chats on GroupMe. I still can’t figure out why Twitter thinks I want to see most of the tweets it recommends for me, or what behaviors to exhibit to see content I would actually read.

The piece from The Atlantic talks about the evolution of social media from the early days of collecting friends to the recent explosion of its use as a “latent broadcast channel” where “all at once, billions of people saw themselves as celebrities, pundits, and tastemakers.” Social media has certainly made it more difficult for primary care physicians to do our jobs, with the constant barrage of headlines touting so-called “things your doctor doesn’t want you to know about” and the proliferation of people trying to make a buck with pseudo-medical “wellness” offerings that physicians have to spend time debunking.

The author notes that “as the original name suggested, social networking involved connecting, not publishing.” The evolution to “social media” happened around 2009, according to the article, “between the introduction of the smartphone and the launch of Instagram. Instead of connection – forging latent ties to people and organizations we would mostly ignore – social media offered platforms through with people could publish content as widely as possible, well beyond their networks of immediate contacts.”

The piece notes that the 2006 introduction of Twitter “amounted to a giant, asynchronous chat room for the world.” It goes on to discuss “the data-driven advertising profits that the attention-driven content economy created,” including the influencer economy, where people are essentially paid for sharing marketing messages or for product placements, creating the idea that becoming an influencer “became an aspirational role, especially for young people for whom Instagram fame seemed more achievable than traditional celebrity – or perhaps employment of any kind.”

It talks about the potential decline of social media given the current state of things, and what a remodeling might look like – drawing an analogy from the cultural changes needed to drive a decline in smoking across several decades. The idea that social media could play a smaller role in our lives is an interesting one. Many people check their accounts, feeds, and streams compulsively and I wonder what they would do with all the time they might get back.

Speaking of time, I also enjoyed this read from Forbes: “Companies Fret About Time Theft – But Who’s Taking From Whom?” Time theft has traditionally been defined as the hours when employees do things like managing personal business while on the company clock, or otherwise wasting time that is seen as belonging to their employers. With the rise of remote work, employers have taken to doing things like monitoring laptop use, the time spent in various applications, or the calendars of employees.

The article looks at the idea that time theft can go both ways. It talks about employers who demand work outside of normal working hours, but who don’t provide additional compensation or mandating unpaid training. It notes that “this kind of time theft more often affects marginalized people who are asked to go the extra mile and work harder than others to be considered for advancement opportunities.”

The author describes the pathway by which people who are constantly battling additional demands “grow weary of their work time encroaching so insidiously on their personal time…They lose their desire to shine and they focus on self-preservation instead.” I’ve worked in plenty of organizations like this, including one health system where the IT team was constantly expected to deliver the impossible. The teams sacrificed themselves on the altar of this principal and what resulted was global burnout and the departure of key leaders and high performers from the organization.

The author notes that “Workers shouldn’t feel that their private time can be snatched from them at a moment’s notice for questionable reasons, and that if they balk at putting in those additional hours their chances of advancing in the organization will be compromised.” In my experience, healthcare IT organizations are particularly at risk for this due to the 24×7 nature of our work. When someone has to be on call, it’s easy to reach out to them as opposed to thinking carefully about whether the situation needs to be addressed immediately or whether it can wait until the next business day.

Also in my reading, I came across a number of articles about the proposed end to non-compete clauses. Companies seem to love them, workers hate them, and states have done variable jobs regulating them. Most physicians are subject to non-compete clauses.

When I left the medical practice that I had built from the ground up (literally it was a slab when I started), one of the things the health system used to sweeten the deal was voiding my non-compete clause. I’m not a fan of them, especially in medicine, because they jeopardize the patient-physician relationship. They force employees to decide between uprooting their families and preserving their livelihoods and I’ve seen them hasten the demise of numerous relationships. Employees who feel handcuffed aren’t going to be as productive or successful as those who feel they’re remaining at their employer by choice. The best way to keep an employee from leaving to go work for the competition is to treat them with respect, pay them fairly, and support them.

Those concepts were among the topics at the most recent session of my leadership intensive. The theme of one of the presentations was “What fills your bucket?” We were asked to visualize our psychological bucket and the things that fill or drain it. Your bucket might be filled by support from co-workers, knowledge of a job well done, or completion of a difficult task. It might be drained by an overly demanding boss, stressful working conditions, or a chaotic environment. When people feel forced to remain in situations where they can’t fill their bucket, letting them leave might be the best option for all parties. There are plenty of other things that can fill or drain our buckets, including our own habits. When thinking about social media or time theft or a number of different things, it’s useful to determine the impact they have on our buckets.

What has filled your bucket lately, and what has drained it? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 1/9/23

Carbon Health to cut more than 200 jobs, narrow focus

Primary and urgent care company Carbon Health lays off 200 employees and will end its initiatives in public health, remote patient monitoring, and chronic care.

Walgreens Boots Alliance (WBA) Q1 2023 Earnings Call Transcript

Walgreens says during its most recent earnings call that it will pause M&A activities short term and will eventually consider smaller acquisitions that advance its core business, stressing that it won’t “go out and do a $2 billion or $3 billion acquisition on a health tech company.”

Codex IT Acquires Utah Managed Services Provider

Healthcare IT consulting and managed services company Codex IT acquires competitor Intranet Consulting.

Morning Headlines 1/6/23

KeyCare Completes $27M Series A Investment Round to Expand Adoption and Grow Capabilities of its Epic-based Virtual Care Platform

Epic-integrated virtual care platform vendor KeyCare completes its $27 million Series A funding round.

Onc.AI Raises $25 Million Series A Financing Co-Led by MassMutual and Action Potential Venture Capital

Onc.AI, which offers a medical oncologist clinical decision-making platform, raises $25 million in Series A funding.

Porter Raises $5.4M in Seed Funding

Porter, a Miami-based software and services startup specializing in care coordination and quality optimization, raises $5 million in seed funding.

Careficient Acquires Home Health, Hospice, Home Care, Palliative and RCM Solutions and Services from Net Health

Home health, hospice, and home care management company Careficient acquires Net Health’s HealthWyse, Hospicesoft, and RCM division.

News 1/6/23

Top News

Allscripts changes its company name to Veradigm.

The company sold many of its health IT assets in the past two years. It says it has now consolidated its remaining portfolio of EHR, PM, and patient communication systems into the Veradigm Network.

Shares will continue to trade under the MDRX ticker symbol. They are down 8% in the past 12 months versus the Nasdaq’s 34% drop.

Reader Comments

From Publius: “Re: non-competes. This would significantly impact Epic, which would have a mass exodus of employees. I assume they would fight it in court.” The Federal Trade Commission proposes banning the use of non-compete clauses that prevent employees from taking jobs with competitors or starting their own businesses. FTC says the clauses are exploitative, affect one in five American workers, and are sometimes imposed by companies on low-earning employees who don’t have significant company knowledge. Previous studies have shown that non-compete agreements protect established companies from startups, reduce competition, and limit the ability of companies to hire the best-suited workers. FTC says the change would provide new opportunities for 30 million Americans and raise wages by $300 billion per year. The proposed change would not affect non-disclosure agreements, but those could be subject to FTC review if they interfere with workers changing jobs. Among the companies named in FTC’s complaints are two Michigan-based security companies that prevented low-wage security guards from working within a 100-mile radius for two years after leaving.

From Pure Energy: “Re: M&A in a down market. Predictions?” Previously overvalued but cash-burning startups that have no obvious path to profitability will find themselves selling out to larger competitors – assuming any are interested in attaching new weights to their corporate ankles – at barely more than asset value as being ‘disruptive” and “innovative” without making money causes newly focused eyes to roll. Modestly or selectively successful companies will shed non-core business in hopes of generating quick cash from carve-outs. Companies that went public during the recent boom, especially those that took the sketchy SPAC route, will have to figure out how to continue operating (or not) based on trashed share price with zero chance of obtaining favorable funding. This is healthy and necessary, just like thinning and pruning deadwood, and survivors will emerge stronger. Also important is that the profitable aspects of the entire hospital and health system market may be consolidated into a couple of dozen big provider and provider-insurer players over the next 10 years, so it will be feast or famine for companies who sell into that market whose participants are focused on decreasing their vendor count.

HIStalk Announcements and Requests

I’ll be migrating HIStalk to a new server shortly, which includes a lot of changes to the underlying programming and databases, so expect the usual (hopefully minor and short-lived) glitches.

Webinars

January 19 (Thursday) 2 ET. “Supercharge Your Clinical Data Searches.” Sponsor: Particle Health. Presenter: Paul Robbins, MSMBA, VP of product, Particle. Particle’s team will preview the exciting results of Specialty Search, a new condition-specific record locator service. This webinar will review how to collect patient records from top Centers of Excellence across the entire country; how healthcare organizations of all types are benefiting from Specialty Search capabilities, using Particle’s simple API; and why a focused search of chronic condition data — in oncology, cardiology, endocrinology, orthopedics, and more — has an outsized impact on care outcomes.

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

Acquisitions, Funding, Business, and Stock

Salesforce will reduce its workforce by 10%, about 7,000 jobs, and will close offices in some markets, reductions the company blames on reduced customer spending and its own excessive hiring during the pandemic’s boom times. It not break out how many of the job cuts were related to healthcare. The company’s market value has dropped more than half to $134 billion from its late-2021 high.

Shares of GE spinoff GE HealthCare begin trading on the Nasdaq under the GEHC ticker. Shares closed their first day of trading Wednesday up 8%.

Epic-integrated virtual care platform vendor KeyCare completes its $27 million Series A funding round.

Onc.AI, which offers a medical oncologist clinical decision-making platform, raises $25 million in Series A funding.

Sales

• East Tennessee HIN chooses 4medica’s patient matching system.

People

Ardent Health Services hires Brad Hoyt, MD (Utica Park Clinic) as CMIO.

Acadia Healthcare Company hires Laura Groschen (Medtronic) as CIO.

Experity promotes Brian Berning, MS to CFO.

Curve Health hires Matt Michela, MBA (Life Image) as CEO.

Nicholas Anderson (G2o) joins Olah Healthcare Technology as VP of product management.

Announcements and Implementations

EHNAC publishes new versions of its program criteria for its accreditation programs.

The new quarterly market report of Pivot Point Consulting, A Vaco Company makes these points:

• Amazon’s acquisition of One Medical gives the company partnerships with big health systems and a business that has off-the-charts member satisfaction, 90% retention, and 300% member growth over five years, plus a growing Medicare and Medicare Advantage business via its Iora Health.
• Amazon’s relaunched virtual service of Amazon Clinic will be challenged to attract both consumers and providers to its platform, with modest synergies with its pharmacy business but little impact on expensive chronic condition spending.
• CVS Health gained 10,000 contracted clinicians with its September 2022 acquisition of Signify Health, which also gives it a Medicare presence with its Caravan marketplace.
• The acquisition of Summit Health by Walgreens-controlled VillageMD, which closed Thursday will double the company’s PCP count to 2,800 working in 680 locations.
• Walmart made no healthcare acquisitions in 2022, but expanded its telehealth and Medicare preventive care markets using its 4,000-stores footprint.
• Pivot Point recommends that providers start with the digital front door to enhance patient and staff experience, use data to innovate, and build partnerships with payers since the big retailers have shown little interest in hospital care.

An EpicShare article describes how University of Michigan Health – West uses Nuance’s DAX to reduce physician time spent writing notes, with some doctors reporting a total daily effort of 10 minutes to review the results. The organization says the cost can be high and DAX works better in primary care than with specialties, but notes got better and faster over time, more prior authorization requests were approved on the first try, and patients say they enjoy seeing their own words in the doctor’s notes in MyChart.

Withings announces U-Scan, a toilet bowl device that takes daily biomarker readings. The device, which is pending US FDA clearance, will debut in Europe with consumer health cartridges for women’s cycle tracking and hydration.

Government and Politics

A JAMA Network opinion piece warns that clinical algorithms may be found to violate antidiscrimination laws under the Affordable Care Act or may be regulated by FDA as medical devices, both of which the authors urge the federal government to avoid for lower-risk algorithms and until discrimination aspects are better defined. 

Other

Amy Abernethy, MD, PhD, who runs Verily’s life sciences clinical studies platforms, discusses the state of clinical trials in a brief Politico interview:

• Clinical trials will move to using existing data from EHRs and claims, along with sensor data, although data quality mismatches need to be resolved.
• Clinical trials need to involve a low burden for participants to generate representative participation.
• Clinical trials recruitment needs to include digital marketing, call centers, and extra service.
• Future clinical trials will involve long-term following of participants, which will require new ways of thinking about keeping people enrolled.

This is an interesting observation by Will Weider, although perhaps less relevant than it seems to healthcare since ordering is the focus at Amazon and most of us have done it many times. I don’t mind a chat bot as long as it doesn’t hog the screen, make sounds, or pop up on every new page after I’ve already dismissed it. I always renew my car registration online and DMV’s chat bot is like a nicer, field-prompting version of an online form. At least even the dumbest chat bot is smarter than the smartest telephone auto attendant.

Sponsor Updates

• Availity associates volunteer at the 24th annual Make-a-Wish Request-a-Thon.
• Medicomp Systems releases a new Tell Me Where IT Hurts Podcast featuring National Coordinator Micky Tripathi.
• Wolters Kluwer Health marks the 30th anniversary of its UpToDate clinical decision support solution by announcing that it has donated over 100,000 subscriptions to UpToDate to caregivers and organizations in 159 countries.
• EClinicalWorks publishes a new customer success story featuring Orthopaedic Institute of Ohio, “Prisma: How Better Data Improves Care and Reduces Costs.”
• Everbridge appoints RSA CEO Rohit Gai and Blackbaud EVP David Benjamin to its Board of Directors.
• Nordic launches a new podcast series titled “In Network.”
• The Empowered Patient Podcast features First Databank VP of Product Management Virginia Halsey, “Improving Access for Pharmacists to Appropriate Drug Interaction and Dosing Data.”
• Get Well offers a digital inclusivity toolkit to help healthcare teams address workplace violence.
• InterSystems announces it has been positioned in the Visionaries Quadrant of the recently published Gartner Magic Quadrant for Cloud Database Management Systems.
• Juniper Networks announces it has been named a leader in the 2022 Gartner Magic Quadrant for Enterprise Wired and Wireless LAN Infrastructure for the third consecutive year.
• Meditech publishes a new case study, “Frederick Health Aligns Workflows Across Care Settings with Meditech Professional Services.”

Blog Posts

• 5 Modern Must-Have Features in Urgent Care Technology (Experity)
• Top Trends Transforming the Future of Healthcare in 2023 and Beyond (Healthcare Triangle)
• Top 5 Challenges in Value-Based Care (and How to Solve Them) (Healthjump)
• More Than Two Years Into the Pandemic, Hospital Budgets Are Beginning to Crack (HealthTech Resources)
• Telehealth Finance Variables and Successful Business Models (Impact Advisors)
• 5 things to know about the 2023 CPT code updates (Intelligent Medical Objects)
• When it Comes to Wired & Wireless Access, Juniper Mist is in the Driver’s Seat (Juniper Networks)
• Voices from the Frontlines: Key 2022 Consumer and Provider Research Findings (Kyruus)
• Redefining Productivity to Assist with the Healthcare Staffing Crisis (Lumeon)
• Five Crucial Topics for Healthcare Leaders in 2023 (Medhost)
• How Volunteer Attorneys are Helping Patients Overcome the “Financial Toxicity” of a Cancer Diagnosis (Myndshft)
• Don’t Be Forgotten: Reduce Rehab Therapy No-Shows by Addressing the ‘Whys’ Behind Missed Visits (Net Health)
• Rebuilding Trust to Empower the Future of Healthcare (Nuance)

Contacts

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