Morning Headlines 6/28/22

PicnicHealth raises a $60m Series C to expand patient-centered real-world data

PicnicHealth, which uses patient-reported data to build datasets for research, raises $60 million in a Series C investment round that brings its total funding to over $100 million.

Nomad Health Raises $105 Million to Expand to New Specialties and Address Healthcare Staffing Crisis

Nomad Health will use $105 million in new funding to expand its online healthcare jobs marketplace beyond travel nursing to include physical therapists, and laboratory and ultrasound technicians.

Siemens to buy U.S. software company Brightly in $1.58 bln deal

Siemens will acquire maintenance asset management software Brightly, whose solutions are used in hospitals, offices, schools, and factories, for $1.6 billion.

Cue Health to Lay Off 170 People

App-enabled at-home and point-of-care testing company Cue Health, which went public last year at a nearly $2.5 billion valuation, will reportedly lay off 170 employees.

Readers Write: Payers Are Approaching a Moment of Reckoning on Fraud, Waste, and Abuse

Payers Are Approaching a Moment of Reckoning on Fraud, Waste, and Abuse
By Ketan Patel, MD

Ketan Patel, MD is chief medical officer of SyTrue of Stateline, NV.

Payers are poised to face a new operating environment with significantly more scrutiny over fraud, waste, and abuse (FWA) in the wake of COVID-19.

Two years ago, the federal government created the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program to beef up audits of MA insurers. For 2022, CMS also doubled its budget for fraud, waste, and abuse (FWA) investigations, and the Department of Justice just announced charges against 21 defendants accused of various healthcare fraud schemes involving the COVID-19 pandemic. Meanwhile, payers are working to reconcile billions of dollars in COVID-related medical expenses and correctly identify risk for the surging number of long COVID patients.

These factors have converged to generate significant potential headwinds for payers and will create the following two new realities:

• Payers will be forced to sift through increasingly huge volumes of clinical records to identify potential fraud and waste, as well as confirm bill accuracy to properly compensate providers.
• At the same time, as we head into the third year of the pandemic, payers will uncover an unprecedented amount of FWA related to COVID-19.

How successfully payers manage these challenges will be determined by their ability to replace time-consuming and expensive manual processes with artificial-intelligence-based tools that comb patient records to identify potential fraud, assess patient and population risk, and confirm payment accuracy.

In the past, payers depended on expensive and time-consuming chart reviews to find and extract key unstructured data from patient records, such as information that reveals the need (or lack thereof) for a patient to undergo various COVID-related tests. More recently, though, payers have turned to natural language processing (NLP) as an alternative to manual chart reviews. NLP is an AI-based technology that enables computers to “read” and understand text by simulating humans’ ability to interpret language, but without the limitations of human bias and fatigue.

With NLP, payers can retrospectively analyze longitudinal health data to find a particular piece of clinical information about a single patient or identify subsets within populations that require further exploration. Given today’s environment of increased FWA scrutiny, NLP is poised to play an increasingly important part in helping payers pinpoint instances of FWA.

The following are three ways payers can leverage NLP to improve FWA detection:

1. Detect patterns. In cases of FWA, there is often a pattern of repeatability in the data, such as a large number of patients meeting the same prior authorization requirements. NLP helps payers detect these patterns that lack the natural variability found in legitimate patient records.
2. Identify outliers. In the same respect, NLP can help payers spot unusual data that may be representative of fraud, such as expensive tests for which there is no medical necessity. With its ability to accurately analyze unstructured data to identify anomalies within records, NLP can quickly verify the presence, or lack of, critical data.
3. Improve scale. While even the most hard-working humans possess limitations on their ability to perform a high amount of chart reviews in a narrow timeframe, NLP automates the process, enabling substantial improvements in scalability. Because some complex medical records may consist of thousands of pages, NLP can drive significant savings in time and money in reviews.

For payers, the time to prepare for increased FWA scrutiny is now.

HIStalk Interviews Jeff Brandes, CEO, Azara Healthcare

Jeff Brandes is president and CEO of Azara Healthcare of Burlington, MA.

Tell me about yourself and the company.

I am a serial entrepreneur who has dabbled in all sorts of areas of technology. About 10 years ago, I came upon an opportunity in healthcare. At the time, I truly didn’t know the difference between Medicare and Medicaid, but I was heavily schooled by our initial partners as we started Azara. Here we are 12 years later and I can speak the lingo and I actually think I might even have a bit of credibility. Azara provides population health, primarily to safety net clinics, Federally Qualified Health Centers, and others who are serving the underserved.

The argument could be made that value-based care is the superior healthcare delivery model, yet patients are usually part of a federally supported program who are seen as underserved or disadvantaged. What are we learning about value-based care that can change the healthcare system?

The Federally Qualified Health Centers in general, depending of course on the state that they reside in, have mostly been fee-for-service with some shared savings and some upside. But because they are held accountable for quality metrics and improvements to maintain their status with HRSA, they have started to place an infrastructure that looks just like what is needed for value-based care into place. Looking at quality. Looking at high-cost events like readmissions. With both the cost aspect in mind, but clearly if someone’s going back to the hospital, they need more care or they need different kinds of care and it’s all in the effort of improving the patient’s health.

How is technology being used to identify those patients who need the most specific care?

We have learned a lot over the past few years. We started by automating things that we were doing already, in particular, billing. US-based EHRs are all centered around billing for services. But through that, we have collected a vast amount of data on our patients and are now just starting to find ways to unlock that data and make sense of it.

But as we do it, what we are learning is that it doesn’t matter how good the reports are and how good the information on the reports is if you can’t get that information to the right point in the workflow of the clinician or the provider where it’s easy for them to see and digest. You can’t make an impact on the patient. What we are starting to see, and what we will see in the years going forward, is more and more emphasis into how to get the right information that we already have to the right place at the right time.

There’s a significant amount of patient responsibility involved in participating in these programs since they need to be engaged, receptive, and perhaps educated about the concept. Does technology help in that way as well?

Technology helps us identify which patients are complying and are engaging a lot sooner potentially than waiting until they come in their next visit and they’ve gained 10 pounds and say they only take their meds once in a while. Using technology, we can at least identify some of those things. If they’re not picking up their prescriptions, it’s unlikely that they’re taking them. We can use things like that to get a bit ahead of the problem instead of waiting six months or a year, or for an emergency room visit, to realize that the patient is not engaging the way we had hoped or the way we had talked to them about.

They may be skipping doses because they can’t afford the prescription. How do you draw a line around delivering value-based care versus the social services that may be required for the patient to do what they need to do?

There are technology aspects and programmatic aspects of it. Of course, there’s just being in tune with it. The vast majority of our clients, the ones who are in the safety net, are very in tune with the patient’s social needs, screening for those and finding their patients affordable means to get the medications and other services that they need. First is identifying the need and then having access to the programs that can fulfill that need. Definitely medications is an obvious example, and there are programs to get medications in the hands of those who can’t afford it.

But when you start to expand the scope of those needs around housing and access to quality food in caring for patients, all of a sudden you need programs like Medicaid and Medicare to be a little more flexible in how those benefits can be delivered. Because it may not be a drug they need, but enough money to buy high-quality fruits and vegetables instead of processed food. Definitely we are hearing and we are seeing our clients look more and more for that flexibility in caring for the total patient in order to address their medical needs.

Capturing social determinants of health is becoming common, but what is the role of providers to help address them?

My perspective is a little biased because I believe that my customers in the safety net are a good bit ahead on this, but it doesn’t just affect patients at Federally Qualified Health Centers. My first experience with how being in tune with social factors and social determinants of health was an interesting one. In talking to a clinician, they talked about having a flag to tell them that the patient had unstable housing or was homeless. The patient presents themself with a run of the mill tonsillitis or some type of infection that requires antibiotics. Just by knowing and recognizing that that patient is homeless, you’re going to look at the available meds, antibiotics in this case, that you could prescribe. If you know they are homeless, you’re going to choose the one that doesn’t require refrigeration. Even though the refrigerated one may be the best one, you’re going to choose one that you know the patient is capable of hanging onto and taking effectively to cure that infection, versus something if it required refrigeration would get thrown away or likely not provide the intended effect. That was my first experience at how recognizing these factors and working with them could really change the way the clinician and the care team delivered their care to be more effective.

What are the constraints in recommending and arranging those services?

The majority of our customers are in the safety net. They are community health centers, and many of them function in the true nature of the word “community,” where they provide the medical care, but they have long established relationships with food banks, shelters, and social service agencies that can help fill these gaps. Do new challenges present themselves every day? Of course, they do. But I think they’re pretty adept at handling it.

I think what they’re optimistic about is that now that the broader world is recognizing the social factors and some of the disparities and starting to put funding and services in that direction, they are well positioned to be able to align their patients to take advantage of those services better today than they were yesterday.

What is the role of text messaging?

In our experience and with our clients, text messaging is extremely effective in the populations that our clients are serving. I’ll speak for myself. Getting text messages for my doctor is quite effective, and in some cases, maybe a little too effective, where I want to turn them off because there’s so many of them. But when I go back to the kind of programs we run and with our clients using texting, there are a lot of ways you can configure a texting campaign, especially around childhood well visits, immunizations, and cancer screenings that you’re automatically due for when you hit a certain age.

We wanted to work with our partners and our customers to make these things really, really simple to execute. From our perspective as a population health company, we know magically when you turn 45 and you’re due for a colorectal cancer screen. We don’t need someone to generate that list. We can build that list every week of who turned 45 and is due. We can see the record. We can kick off that campaign to message them to schedule an appointment. A week later, we can look and see if they’ve taken that action. If they’ve not, we can send them a second, gentle reminder. In fact, a week later, we can send them a third reminder and ask them if they care to schedule an appointment or if they are going to ignore this, etc. We can get some feedback through texting.

All of this runs in the background. No human has to go pull these lists every week look at who took the action and who didn’t. Every new week there’s a new group of patients that turn 45 and are due. It’s combining the text messaging with effective patient identification and automation to make this stuff just happen in the background so that no one at the practice has to handle it day in and day out.

What impact did the pandemic have on your clients?

I think the number one thing they walked away with, besides the confidence that they know how to treat patients even under some of the worst circumstances and keep things moving forward, is the importance of data and information. We had been in this business long before the pandemic hit, but all of a sudden that need for accurate data and the accuracy of it just bubbled up to the executive suite fast and loudly. We had clients for years whose quality staff and operational staff were engaged with Azara and all all of a sudden we were hearing from executive directors.

We were watching a lot of the disparities that we’ve read about in the pandemic, or as the pandemic unfolded. We were watching it in real data how it disproportionally affected those that were black and brown, and how that compared to the population within the practices that we were already serving. As these practices rolled out telehealth, we saw who had access to telehealth, who took advantage of it, and what those disparities were. It’s one thing to go with anecdotes, whether it’s to the state house, the Feds, or to your payers. It’s another thing to go with real numbers and fact. To come back to your question, it heightened the need for accurate and easily available information.

What will be important to the company over the next few years?

To us, the most important thing is to support our clients on their journey to value-based care. They are in different states and in different spots along that journey. Everyone is concerned about improving quality and making the patient better, and we should never forget that there’s a patient behind every number. No matter how good the data is, if there’s not someone out there to take action with it, it doesn’t make an impact. But getting the data, making it available for that journey, whether it’s quality, cost, or risk utilization. All of them play a part. More and more, the requirements are going to be how to get it to the right place at the right time in the workflow so it’s very easy for that provider to know what to do when they’re with the patient, whatever type of provider it is.

Curbside Consult with Dr. Jayne 6/27/22

It’s that time of year, when I typically take a week off to volunteer at one of the nation’s premier summer camps. It’s always an adventure. I’m hoping that despite COVID surges in the area that we have what we previously would have considered a “normal” summer camp experience. Of course, there will be masks indoors when we are in close quarters, but there will be plenty of time to run around in the great outdoors and for the campers to have fun with their friends.

It’s been a scorcher across large parts of the US over the last couple of weeks. I’m hoping for at least a little break so that I don’t have to spend the week treating heat exhaustion, headaches, and dehydration. I’d much rather be teaching fire building, knots, lashings, and wilderness survival skills.

Although the camp offers most of the traditional activities like fishing, swimming, canoeing, kayaking, archery, and various other shooting sports, it also offers some great STEM (science, technology, engineering, and math) options. Welding is available, as are programs in movie making, game design, electronics, and geocaching. There is something for everyone. Usually the best part of the day is dinner, where an adult sits with each table of campers and gets to ask questions about their day and what they liked best.

I always get some interesting questions about what I do in my real life. The staff knows I’m a physician, but they also know I do something with computers on the side. Almost every adult has used a patient portal by this point, so I use that as a way of explaining the kind of work I do and how we help physicians make better use of information and that we help patients have a better experience. There are usually a lot of questions about what kinds of things we can do as telehealth physicians.

Although this camp is old school as far as facilities, I’ve worked with camps in the past that have remote examination setups that really deliver as far as telehealth infrastructure. Given the fact that this particular property is about 30 minutes from a very capable rural hospital, I’m not surprised that they opt to send campers into town if they need more than what we can offer on site.

Since I’m in the middle of a major project, I’ve got my wi-fi hotspot at the ready in case I need to join any calls (courtesy of my public library, which lets you check them out for a couple of weeks at a time). However, for the first time in a long time, I’m working with an extremely capable team, and I would be surprised if I hear from them. There might be something that they need that requires a physician credential to accomplish, but it’s nice to know that they’ve got my back and I can actually take time off without worrying that I’ll walk into a disaster when I return.

I’m sure that some of the people on the team think I’m a little loopy to do this kind of thing for fun, but at least one of my co-workers has made me promise to take pictures of a couple of things I’ve talked about, so I hope I can deliver. I’m just hoping this year is better than the experience I had a couple of years ago, when I ended up with a squirrel leaping from a tree to my head when I least expected it. Honestly, not having a squirrel in your hair seems a low bar when you think about it.

As a consultant, some of my major areas of work included change leadership and teambuilding. I have to say, although I have had plenty of formal training in those disciplines, some of the best training I have had has been in outdoor programs like this one. A very wise man once said, “A week of camp life is worth six months of theoretical teaching in the meeting room.” Having done this for many years, I have to agree. It’s extremely gratifying to see young people learn new skills and discover that they are more capable than they ever thought. This generation of campers has had a couple of summers of COVID-related modifications, and many of these experiences will be new to them. They will be challenged to try things outside of their comfort zones and will be allowed to fail in a safe and supportive environment. They will also probably get sunburned and get lots of mosquito bites because they’re pre-teens and teens and they won’t heed our warnings, but those too will be growth experiences.

For some of the oldest campers who come back year after year, I’ve worked with them since 5th grade and they’re now high school seniors. They’ve had phenomenal growth emotionally and mentally (and also physically, since most of the eldest tower above me). It’s been a pleasure seeing them take leadership roles and I enjoy seeing how the youngest campers look up to them and start to envision what they might look like in a few years. Many of last year’s graduating class headed into tech fields, and one of my older campers from many years ago is now applying to medical school. I hope that as they head to college and into the real world that they take the problem-solving skills that they learned at summer camp with them and figure out how to apply them, not only to the challenges of today, but to what we might run into tomorrow.

If there’s anything we’ve learned since 2020, it’s that life can always throw you a curve ball and we have to figure out how to rise to the occasion. Although I’m looking forward to a week relatively off the grid, I know I’ll come back energized and ready to get back to work (even though my body will be tired). Being around young people with so much potential and so much eagerness to learn always delivers a spark.

Who’s ready for some basketry, rock climbing, and whittling? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/27/22

Biden signs VA health record modernization transparency act into law

The White House signs the VA Electronic Health Record Transparency Act of 2021, which requires the VA to report the costs of its EHR modernization project to congressional committees each quarter.

Myriad Genetics Teams Up with Epic to Make Genetic Testing Accessible to More Patients with Electronic Health Record (EHR) Integration

Myriad Genetics will integrate its provider genetic test ordering and resulting program with Epic.

Hybrid-care Physical Therapy Platform Kins Announces $7.2M in Total Seed Funding to Accelerate Innovation in Care Delivery

Virtual and in-home physical therapy provider Kins raises $4 million in seed funding from W Health Ventures.

Monday Morning Update 6/27/22

Top News

The White House signs the VA Electronic Health Record Transparency Act of 2021, which requires the VA to report the costs of its EHR modernization project to congressional committees each quarter. The report will also include a breakout of project funding sources.

The VA must also submit quality, performance, safety, and value metrics, along with a list of patient safety reports, incidents, alerts, or disclosures.

HIStalk Announcements and Requests

Poll respondents are skeptical that Oracle’s acquisition of Cerner will improve cost or quality.

New poll to your right or here: How important to you personally is telehealth today versus in 2019? I realized while posing the question is that it hasn’t changed for me – I’ve yet to have a telehealth visit, although I wouldn’t be opposed to it as an alternative to the physician office visits that I rarely require.

I’m surprised to see pundits who confidently state that Larry Ellison is CEO of Oracle, a position he hasn’t held since 2014.

The need is evident.

Webinars

July 12 (Tuesday) 1 ET. “Digital Data Stewardship for Trusted, High-Quality Data Exchange.” Sponsor: Clinical Architecture. Presenter: Carol Graham, MS, RN, product manager, Clinical Architecture. Organizations face challenges in ensuring that the patient data they received and send is consistent, accurate, and usable. Use cases include receiving multi-source data across health information networks with variation in formats and content; merging and de-duplicating provider, payer, and research data; uplifting legacy data for current use cases and formats; and normalizing and formatting data for public health surveillance, quality measure reporting, and providing directly to the patient. This webinar will cover Pivot, a comprehensive Digital Data Steward solution that orchestrates format harmonization, content (vocabulary) normalization, de-duplication, and data quality validation into a single solution.

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

Acquisitions, Funding, Business, and Stock

Myriad Genetics will integrate its provider genetic test ordering and resulting program with Epic.

Healthcare Triangle launches a digital front door app for users of Epic’s MyChart.

Sales

• Altus Neighbors Emergency Centers will use the billing system of Sphere-owned Health IPass.
• Lutheran Health Network, Flowers Hospital, and North Knoxville Medical Center implement the PeriWatch Vigilance maternal-fetal early warning system.
• Health Alliance launches a remote patient monitoring program powered by CareSignal.

People

Healthcare Growth Partners hires Brooks McElveen, MS (New Capital Partners) as VP.

Announcements and Implementations

Microsoft will collaborate with Volpara Health Technologies on AI-powered detection and quantification of breast arterial calcification.

PerfectServe will further develop its cloud-based call center solution.

Baker Tilly and MedeAnalytics develop Service Line Data Signs, an easy-to-use analytics solution for supply and pharmacy expenses.

Other

CHOP SVP/CIO Shakeeb Akhter recaps the health system’s recent conversion from Ascom phones to Epic communications, including secure messaging, Voalte voice calling, and Rover alerts and alarms.

Sponsor Updates

• OptimizeRx extends the reach of its omni-channel medication adherence platform through a partnership with pharma marketing technology company Equals 5.
• Pivot Point Consulting promotes Nicole Gerten to senior operations specialist.
• Protenus has received the highest overall performance score for its drug diversion surveillance solution in the recent KLAS Drug Diversion Monitoring report.
• Symplr announces the winners of its 2022 Lean Human Capital Elite Honor Roll program.
• Premier has named Henry Ford Health the winner of the 2022 Premier Alliance Excellence Award.
• TigerConnect and its Critical Alert business have announced that Mount Nittany Health nurse Jodie McClure, RN has won its Nurses at the Heart of Healthcare contest.
• VisiQuate expands its Payer Action Center to help providers reclaim millions in unpaid claims.
• The following HIStalk Sponsors will exhibit at HFMA through June 29 in Denver: AGS Health, Arrive Health, Availity, Change Healthcare, Experian Health, Iodine Software, Nym Health, Olive, Optum, Oracle Cerner, Premier, Tegria, VisiQuate.

Blog Posts

• What Will the Future of Healthcare Look Like? (Experity)
• Healthcare data standards 101: HL7, FHIR and more (Olive)
• Why is it Important to Reduce Hospital Admissions? (PatientBond)
• Breakthroughs Bulletin: Spotlight on Our Innovation Showcase Suppliers (Premier)
• Key Takeaways from the 2022 APG Annual Conference: ACO REACH and Health Equity (RCxRules)
• 6 best practices to know before implementing a cloud contact center solution (Talkdesk)
• The Unexpected Drivers of PT Patient Success (WebPT)
• 7 Patient Engagement Strategies to Improve Outcomes (Well Health)
• Top 3 Things to Look for in a Healthcare Integration Service Provider (Zen Healthcare IT)

Contacts

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

Morning Headlines 6/24/22

Asimily Announces Strategic Investment from MemorialCare Innovation Fund to Further its Innovation in IoT Device Security and Risk Management

MemorialCare’s innovation fund makes an unspecified investment in IoT security vendor Asimily.

Digital health startup Ro just slashed 18% of its staff months after hitting a $7 billion valuation. We got the CEO’s full note explaining the layoffs.

Ro, which offers telehealth visits for ED, hair loss, skin care, and fertility, reportedly lays off 18% of its headcount on Thursday, four months after reaching a paper valuation of $7 billion.

Medallion Raises $35 Million in Series C Funding Fueled by Significant Revenue Growth Over Past Six Months

Provider licensing and credentialing software company Medallion raises $35 million in a Series C investment round, bringing its total funding to $85 million.

News 6/24/22

Top News

MemorialCare’s innovation fund makes an unspecified investment in IoT security vendor Asimily.

Reader Comments

From Pointy Solution: “Re: Cures Act vendor requirements. NextGen, at least, is reaching out to customers about their responsibilities.” NextGen reminds its customers via email that the Cures Act prohibits EHR vendors from enforcing “gag clauses” and reiterates that its customers are free to communicate about system usability, interoperability, security, and user experience regardless of what their contracts do or don’t say (the company says it does not believe that any of its agreements contain gag clauses). I’m not sure if such customer communication is required, but regardless, nice job by NextGen.

Webinars

July 12 (Tuesday) 1 ET. “Digital Data Stewardship for Trusted, High-Quality Data Exchange.” Sponsor: Clinical Architecture. Presenter: Carol Graham, MS, RN, product manager, Clinical Architecture. Organizations face challenges in ensuring that the patient data they received and send is consistent, accurate, and usable. Use cases include receiving multi-source data across health information networks with variation in formats and content; merging and de-duplicating provider, payer, and research data; uplifting legacy data for current use cases and formats; and normalizing and formatting data for public health surveillance, quality measure reporting, and providing directly to the patient. This webinar will cover Pivot, a comprehensive Digital Data Steward solution that orchestrates format harmonization, content (vocabulary) normalization, de-duplication, and data quality validation into a single solution.

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

Acquisitions, Funding, Business, and Stock

Ro, which offers telehealth visits for ED, hair loss, skin care, and fertility, joins an ever-lengthening list of formerly high-valuation digital health startups that are laying off employees. Business Insider reports that the company laid off 18% of its headcount on Thursday, four months after reaching a paper valuation of $7 billion.

Sales

• Intermountain Healthcare goes live on Gyant’s asynchronous e-visit system Async, which provides AI-powered clinical assessment within the health system’s My Health+ app and routes patients to an asynchronous visit when appropriate.
• Urgent care provider Innovative Care goes live on Nym Health’s medical coding technology for revenue cycle management.

People

Signify Health hires Paymon Farazi, MBA (Tausight) as chief product officer.

InstaMed, a JP Morgan Company, promotes Jeff Lin to president.

Announcements and Implementations

Global Healthcare Exchange launches a digital solution to support health systems capture, review, and report vaccination information.

Change Healthcare releases a patient engagement solution that incorporates its revenue cycle management capabilities with Luma Health’s patient engagement software.

Wolters Kluwer, Health and Laerdal Medical launch a VSim for Nursing simulation training course area for advanced medical-surgical and critical care scenarios.

Optum develops a laboratory benefit solution to reduce unnecessary lab testing, which it saves could save health plans $3 billion per year.

WellSky-owned CarePort expands its care coordination data connections to 17 HIES and data sources.

KLAS says that Oracle Cerner’s go-forward RCM product RevElate won’t necessarily solve the company’s high-profile revenue cycle problems, as customer experience with implementation and training of its underlying Soarian Financials product has been mixed. Customers say that Soarian Financials is a solid system that drives good outcomes despite usability issues, but requires more add-on products than expected, has exposed customers to more nickel-and-diming since Cerner acquired the product in 2015, and won’t solve Oracle Cerner’s challenges of hiring and keeping employees who can facilitate successful outcomes.  

Other

North Carolina’s state treasurer says that pandemic-related federal hospital funding was a “huge wealth transfer to wealthy hospital systems,” noting that the state’s seven dominant health systems saw profits swell to $5.3 billion last year. Treasurer Dale Folwell – who notes that Atrium Health collected $719 million in provider relieve funds and then merged with a competitor, while Duke Health’s profit margin jumped from 11% in 2019 to 41% last year – says that big health systems “have turned into stock market, private equity, and real estate development firms” that “disguise themselves as non-profits.”

A KHN article ponders whether a small town is better off with a bad hospital than having none at all, describing two rural Missouri hospitals that were bought by a private equity-backed firm that collected federal relief money, hired directors with little hospital experience, stopped paying their bills, missed paychecks, ran out of supplies, and racked up a long list of CMS deficiencies before closing the hospitals 18 months after buying them. Noble Health Corporation, which operated Audrain Community Hospital and Callaway Community Hospitals, announced on March 18 that it would limit services and divert ambulances temporarily because of an unspecified IT issue with RCM and EHR systems that it said was causing cash flow problems, then locked the doors for good six days later.

Sponsor Updates

• The Health Information Resource Center recognizes Healthwise with seven Digital Health Awards for its medical illustrations and health education videos.
• FDB hires Christopher Marks (State Farm) as information security officer.
• Jinuper Networks publishes an information sheet titled “Revolutionize the Network for Modern Healthcare.”
• CarePort, a WellSky company, has expanded its data connections to 17 HIEs and data sources across the country to provide enhanced visibility into a growing number of providers and increased care coordination capabilities.
• LexisNexis Risk Solutions publishes a new interoperability report, “Assessing the Evolution of Health Data Exchange.”
• Medicomp Systems releases a new Tell Me Where It Hurts Podcast, “On Innovation with Dr. Nick van Terheyden.”

Blog Posts

• HHS Updates Guidance for HIPAA-Compliant Audio-Only Telehealth (EVisit)
• Healthcare data: the value of historical patient data (Experian Health)
• Why Crisis Management Preparedness Matters (Everbridge)
• How to Prioritize the Patient in a Digital-First Experience (Get Well)
• 3 Ways to take your Healthcare IT Service Desk to the next level (The HCI Group)
• Embracing Health at Home – Key Strategies to Optimize Health Outcomes (HCTec)
• Strengthen your security posture with identity governance and privileged access management (Imprivata)
• 6 factors to consider when calculating real EHR downtime costs (Interbit Data)
• IMO asks: What’s next for the CMIO? (Intelligent Medical Objects)
• 3 Reasons Your Healthcare Facility Should Offer Online Bill Pay (Medhost)
• How to reduce prescription abandonment and improve medication adherence (Meditech)
• 5 Inspiring Physical Therapy Innovations (MWTherapy)
• Fantastic First Impressions Set the Foundation for Future Rehab Therapy Referrals (Net Health)
• What is ambient clinical intelligence – and how is it transforming healthcare? (Nuance)
• Autonomous Coding vs. Computer-assisted Coding – Part 1: The Evolution of Medical Coding (Nym)
• The big squeeze: Navigating the confluence of post-COVID challenges (Nordic)

Contacts

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

EPtalk by Dr. Jayne 6/23/22

I wrote recently about hospital shootings and the other unsafe situations that healthcare workers are encountering with greater frequency. We can add another hazard to the list. Earlier in the week, batteries exploded in a Milwaukee hospital parking garage, injuring two people. The incident, which occurred at Aurora St. Luke’s Medical Center, is attributed to an acid spill in a container that was holding recycled batteries. Unanticipated combustion is a thing, and it just goes to show that regardless of how well you think you’ve planned or prepared, there’s always something that has the potential to surprise you.

I’ve read a lot of articles about how physicians should manage their social media profiles, but I haven’t seen too much on how they should manage their non-work-related TV appearances. Amar Shere MD, a cardiology fellow at Saint Louis University School of Medicine, was selected to complete on the NBC show “Dancing With Myself.” Shere appeared in his white coat, but was cut after the fourth round. He has used TikTok to share his dance skills along with patient education and eating tips. He’s also a fitness instructor with an interested in promoting heart health in the community. Kudos to Dr. Shere for putting himself out there, and I hope his patients enjoy his care as much as it sounds like he enjoys delivering it.

Many physicians are watching carefully to see what happens to telehealth provider Cerebral as it has come under fire for deceptive business practices and poor patient care. I’ve seen a number of patients in the brick-and-mortar urgent care world who were trying to get refills on their prescriptions after being denied ongoing treatment due to billing disputes. Cerebral is accused of pushing patients to take controlled substances in an effort to increase patient loyalty. The company used flexibility in telehealth rules to prescribe highly regulated medications without any in-person care. Pharmacies were seeing so many prescriptions they stopped filling orders from the company and flagged its business practices for scrutiny.

Cerebral is no longer starting new courses of therapy with controlled substances and patients who are already under treatment have to transition to other drugs or different providers by mid- October. Given the severe shortage of physicians willing to take over these prescriptions, my clinical employers included, it’s going to be rough for patients who are trying to figure out how to continue treatment. The company has been removed from insurance networks and patients are left holding the bag while they go on waitlists for psychiatrists and call from urgent care to urgent care looking for anyone willing to give a 30-day prescription.

Speaking of brick-and-mortar urgent care practices, I’ve been receiving harassing emails and phone calls from a particular insurance company as they try to recredential me to deliver care at an organization where I haven’t practiced for more than a year. Apparently, their calls and emails to my former employers weren’t managed in a timely fashion (not surprising given the overall turnover in the organization), so they decided to contact me personally. They tracked down personal email addresses that I never would have used on a credentialing application and also used several emails associated with the LLC that I use for my consulting business (but never for clinical care). I finally convinced someone to understand that I don’t want to be recredentialed so they can stop trying, but it took several phone calls and quite a bit of frustration. Supposedly they’ve been trying to reach me for months to see if I wanted to remain on the plan. You’d think they’d be able to look at their own claims data and see that I haven’t submitted anything in a year, but that would require coordination within the organization. I’m less than thrilled that they spent patients’ premium dollars exploring my personal websites, but I guess they consider it trying to be engaged with their providers.

Monkeypox has arrived in my state and medical misinformation is running rampant. I’ve seen comments on local news articles suggesting that transmission is limited to certain sexual behaviors, complete with links to bogus articles blaming this “scourge” on immorality. News flash from infectious disease specialists – monkeypox is spread through contact with body fluids, monkeypox sores, contaminated clothing or bedding items, and through respiratory droplets. It’s been a long two and a half years dealing with patients who have decided that social media is more believable than their own physicians, and I sure wish we could mandate public health and hygiene classes in schools. The World Health Organization plans to rename the disease to reduce stigma and racism, but unfortunately people’s attitudes aren’t going to be easy to adjust.

I just finished reading the novel “Hamnet” by Maggie O’Farrell. It’s a fictionalized account of the life of William Shakespeare’s son, who died at age 11 at 1596. The book’s subtitle clearly says it’s “A Novel of the Plague” and there’s an underlying story about the child’s mother being a healer and her encounters with the medical establishment of the times as the bubonic plague reaches her family. My book club has a way of selecting less-than-cheery readings at times, but I enjoyed the book and found it to be a relatively quick read. Within a day or two of finishing it, I came across an article that summarizes findings about the origin of the Black Death, which ravaged Europe for hundreds of years. Researchers propose that the Black Death began in the late 1330s in North Kyrgyzstan, based on analysis of DNA extracted from skeletons found in the region.

I wonder what historians in the future will say about our current pandemic when they’re looking back at us. They’ll probably think we were similar to what modern medicine thinks about medieval “plague doctors” who wore bird-beaked masks stuffed with herbs as a way to ward off disease. Hopefully, our next book club selection is a little lighter read, but I’m always looking for summer reading suggestions whether I have the ability to make them truly a beach read or not.

What’s on your summer reading list? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/23/22

Health Tech Start-up Spry Secures New Investment to Further Strengthen Its Omnichannel Patient Management Platform for Physical Therapists

Physical therapy-focused practice management software startup Spry raises $7 million in a funding round led by Eight Roads Ventures.

VA secretary responds to revelations Cerner system harmed Spokane veterans as Risch calls for July launch in Boise to be halted

VA Secretary Denis McDonough says his confidence in the agency’s new Cerner system is shaken after an OIG report identifies 148 cases of patient harm that resulted from a flaw in the EHR.

Linden Announces Agreement to Acquire Majority Stake in Aspirion from Aquiline Capital Partners

Linden Capital Partners will acquire RCM technology vendor Aspirion for an undisclosed sum.

DOD confident electronic health record platform deployment remains on schedule

After the VA’s decision to postpone further Cerner roll-outs until 2023, the DoD confirms its MHS Genesis timeline remains unchanged, with remaining sites expected to go live by the end of next year.

Morning Headlines 6/22/22

SteadyMD Acquires BlocHealth to Bolster Its Clinician Licensing and Credentialing Capabilities

Telehealth infrastructure provider SteadyMD acquires BlocHealth, which offers a clinician licensing, credentialing, and payer enrollment platform.

Queensland gov sinks another $300m into e-health record system rollout

In Australia, the Queensland government will allocate an additional $200 million USD for the continued implementation of its enterprise Cerner EHR project over the next five years.

InductiveHealth Informatics Announces Growth Investment Partnership With Diversis

InductiveHealth, an Atlanta-based company specializing in public health reporting and analytics, secures an undisclosed amount of funding from Diversis.

News 6/22/22

Top News

An NBC News article notes the reduced availability of telehealth visits as state-level pandemic emergency health orders expire, reinstating more restrictive practice requirements.

Patients are being forced to change doctors, drive to in-person treatment locations, or answer questions about where they will be physically located during their appointment to comply with individual state laws that regulate cross-border provider practice.

Only 12 states still have telehealth waivers and some of those expire soon.

Additional challenges will be introduced when the federal pandemic order expires and Medicare’s telehealth and payment waivers will end.

Webinars

July 12 (Tuesday) 1 ET. “Digital Data Stewardship for Trusted, High-Quality Data Exchange.” Sponsor: Clinical Architecture. Presenter: Carol Graham, MS, RN, product manager, Clinical Architecture. Organizations face challenges in ensuring that the patient data they received and send is consistent, accurate, and usable. Use cases include receiving multi-source data across health information networks with variation in formats and content; merging and de-duplicating provider, payer, and research data; uplifting legacy data for current use cases and formats; and normalizing and formatting data for public health surveillance, quality measure reporting, and providing directly to the patient. This webinar will cover Pivot, a comprehensive Digital Data Steward solution that orchestrates format harmonization, content (vocabulary) normalization, de-duplication, and data quality validation into a single solution.

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

Acquisitions, Funding, Business, and Stock

Telehealth infrastructure provider SteadyMD acquires BlocHealth, which offers a clinician licensing, credentialing, and payer enrollment platform.

Sales

• Union General Health System (GA) selects digital patient intake technology from Qure4U.
• Mount Sinai Health System (NY) will implement MphrX’s Minerva clinical data-sharing software.
• Valley Health System will install EVideon’s Vibe Health smart room technology at its new hospital in New Jersey next year.
• Appalachian Regional Healthcare (KY) will use virtual care and AI-based predictive analytics technology from Biofourmis as part of its new Rural Home Hospital project.
• Pfizer will use real-world, de-identified pharma safety evidence from Truveta, which represents 20 health system members.

People

Former ConnectiveRx and Surescripts executive Rick Ratliff (CAQH) joins Australian medication management app company MedAdvisor as its US-based CEO and general manager.

Kris Bhambhani (Columbia University Irving Medical Center) joins Amazon Web Services as global head of healthcare compliance.

Pinkrose Hamilton (Hackensack Meridian Health) joins University of Iowa Health Care as chief data analytics officer.

Rich Steinle (Innovista Health Solutions) joins Carium as CEO, replacing co-founder Scott Pradels upon his transition to COO.

Orion Health names Craig White (Concerto HealthAI) chief data officer and Grant Anthony (Verisure) CISO.

Joe Cabralm MS (Press Ganey) joins Prolucent Health as chief growth officer.

Industry long-timer Pete Mounts, partner with Himformatics and former executive with McKesson and Eclipsys, has died.

Announcements and Implementations

CloudWave announces that seven healthcare facilities, including Doctors Hospital (the Bahamas), Franciscan Hospital for Children (MA), Blythedale Children’s Hospital (NY), and Wooster Community Hospital (OH), have implemented its OpSus Cloud Services.

RxRevu, whose platform delivers patient-specific cost and insurance coverage information within provider decision-making workflows, renames itself to Arrive Health.

Chicago-based WellBe Senior Medical implements Bluestream Health’s virtual care platform-as-a-service.

GE Healthcare announces GA of Portrait Mobile, wireless vitals monitoring technology for hospital patients.

Government and Politics

In Australia, the Queensland government will allocate an additional $200 million USD for the continued implementation of its enterprise Cerner EHR project over the next five years. Sixteen of a hoped-for 27 hospitals have gone live to some degree on the new system. Originally launched in 2011 with a budget of $288 million, the IEMR project ballooned to an estimated completion cost of $840 million. An audit in 2018 found the scheme to be 40% over budget. Further problems, including outages in 2019, physician complaints, and the departure of the director-general have hampered go-live timelines.

The VA seeks bids for its $650 million Accelerating VA Innovation and Learning contract, which will focus on five innovation task areas – personalized care, data transformation, digital care, immersive technology, and care and service delivery models. Offers are due June 30.

The 49th Medical Group at Holloman Air Force Base in New Mexico celebrates the launch of MHS Genesis.

Privacy and Security

Baptist Health System notifies over 1 million patients in Texas of a data breach after noticing that an unauthorized entity installed a line of malicious code on the back-end of its website in late March, gaining access to its computer network for several weeks.

Sponsor Updates

• AdvancedMD recognizes Product Developer Kylie Jensen with a FIT Award.
• CTG publishes a case study titled “VCU Health Partners with CTG for Successful Epic Go-Live.”
• Baker Tilly will sponsor and present at the Chief Patient Officer Summit July 19-20 in Boston.
• Nordic posts DoctTalk Ep. 106, “Redefining health for a new era of care.”
• CareMesh welcomes Elle Scott as a sales and account intern.
• Executives from Ascension, CVS, and Cognetivity Neurosciences will keynote the InterSystems Health Leadership Conference June 23 in Seattle.
• CloudWave sponsors the 2022 HIMSS Colorado Golf Classic in Littleton.
• Encompass Health implements Cerner at its 150^th post-acute inpatient rehab hospital.

Blog Posts

• How to save time and money with internal interoperability (Ability Network)
• Agfa HealthCare celebrates another User Conference! (Agfa HealthCare)
• Real-world data IRL: Accelerate your research with new FDA guidelines (Arcadia)
• Connecting DRVS to Your HIE: A High-Value Proposition (Azara Healthcare)
• Ask These Questions Before You Pursue an M&A Transaction (BDO)
• Going Beyond the Firewall: How to Prepare and Plan for a Cyberattack (Philips Capsule)
• Epic Hyperdrive: How You Can Prepare for the Transition (CereCore)
• How EHR Data and Survey Responses Mitigate Clinical Research Bias (ChartLogic)
• Creating Opportunities to Connect is CHIME’s Secret Sauce (CHIME)
• A Holistic Approach to Cyber Risk Management (Clearwater)
• ‘I Just Tried to Be Inventive:’ One Patient’s Plan for Medical Bills (CoverMyMeds)
• 4 Ways to Align Test Automation and Agile Development (CTG)
• Beside the Bed and Behind the Screen: Experienced Nurses are Finding New Energy in Hybrid Care (Current Health)
• Disease Explorer: Effectiveness Through Cohorts (EClinicalWorks)
• Payer COVID-19 Screening Policies and Boosting Your Online Security (Experity)

Sponsor Spotlight

RxRevu, the nation’s leading provider of integrated cost and coverage data, has renamed itself Arrive Health in an effort to better reflect the company’s mission to improve patient access to care, reduce friction in provider workflows, and increase awareness of affordable care options. In conjunction with the renaming, Arrive Health has launched a new corporate website and new product offerings to better serve providers, care teams, and patients. Arrive Health will be exhibiting at the upcoming HFMA Annual Conference in Denver, from June 26-29.

Contacts

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

Morning Headlines 6/21/22

Orion Health’s 30th Birthday Marks New Era Of Profitability And Team

Health information exchange software company Orion Health marks its 30th anniversary with global revenue growth and several leadership appointments.

Patient records from UNC Lenoir Health Care hacked

UNC Lenoir Health Care (NC) notifies nearly 5,000 patients of a potential data breach after business affiliate and clinical support services company MCG Health notifies it of a ransomware attack.

State by state, some patients are losing telehealth access to doctors

Telemedicine availability dwindles as pandemic-related emergency health orders expire, limiting patient access to virtual visits with physicians across state lines.

Readers Write: How One ACO Used Analytics to Promote Health Equity: Lessons for the ACO REACH Model

How One ACO Used Analytics to Promote Health Equity: Lessons for the ACO REACH Model
By Michael Meucci

Michael Meucci is chief operating officer of Arcadia of Boston, MA.

A greater focus on promoting health equity is at the heart of changes CMS recently made to its direct contract model, now labeled as the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model.

While an emphasis on health equity is long overdue, this shift creates challenges for ACOs in measuring, monitoring, and improving health equity – something that can’t happen without leveraging advanced analytics to account for those factors impacting a patient’s ability to effectively manage their health, otherwise known as social determinants of health (SDoH).

A CMS Direct Contracting Entity, Massachusetts-based Community Care Cooperative (C3) incorporated advanced analytics and tight partnership with community agencies into its health equity program under the MassHealth Medicaid ACO program, driving significant improvement in the health of its diabetes patient population, in addition to a reduction in its total cost of care, positioning C3 for eventual success under the new model.

The US Centers for Medicare and Medicaid Services (CMS) launched the ACO REACH model in February, highlighting the organization’s commitment to “promoting value-based care that improves the healthcare experience of people with Medicare, Medicaid, and Marketplace coverage.” To that end, CMS requires all model participants to develop and implement “robust” health equity plans to identify underserved communities, in addition to implementing initiatives that “measurably” reduce health disparities within their patient populations.

Next, CMS placed a high priority on ensuring that medical providers play a prominent role in ACO REACH participating organizations, requiring that at least 75% control of each ACO’s governing body must be held by participating providers or their designated representatives. That number is a significant jump from the 25% requirement held by the ACO REACH model’s predecessor, which was known as the Global and Professional Direct Contracting Model.

Additionally, the new ACO REACH model is designed to deliver better protection to patients through more ACO participant vetting, monitoring, and greater transparency. CMS will look to accomplish that by asking for more information on applicants’ ownership, leadership, and governing boards to gain better visibility into ownership interests to ensure participants’ interests align with CMS’ vision.

The new model’s first performance year begins on January 1, 2023, with the model planned to run for four performance years through 2026. Applications to participate in the first year were due near the end of April 2022.

For patients, the promise of the model is better care, but with a greater focus on addressing SDoH, such as barriers to transportation, nutrition, and healthcare. For providers, the ACO REACH model offers the potential of a more predictable revenue stream and the ability to use those funds more flexibly to meet their patients’ needs.

Community Care Cooperative is an ACO that formed when the state of Massachusetts launched the MassHealth ACO program. MassHealth, which combines the state’s Medicaid and the Children’s Health Insurance programs, has emphasized engaging with community partners to help treat the whole patient, including addressing social needs that are barriers to care. C3 was created by a network of Federally Qualified Health Centers (FQHCs) to better serve their communities by providing more opportunities for individuals to receive coordinated, holistic, and culturally appropriate care in the communities where they live and work.

Incorporated in 2016, C3 serves over 170,000 MassHealth members with a total cost-of-care budget of $1 billion at 18 statewide health centers. In early 2020, inspired by the national conversation around equity, C3 launched a health equity program aimed at addressing physical and behavioral health needs, in addition to SDoH such as nutrition and housing. Earlier this year, C3 submitted its application to CMS to become a REACH ACO.

C3 started its health equity initiative in 2020 by collecting self-reported SDoH data from members, including race, ethnicity, and language information. While self-reported data may not be perfect, it is a good starting point to begin understanding the challenges facing a population of patients.

Next, C3 formed a diversity, equity, and racial justice committee to examine its patient data to investigate areas for improvement, in addition to thinking about ways to most effectively use the data in its possession. For example, the committee investigated whether the racial and ethnic makeup of patients referred to outside social services agencies was representative of the group’s overall patient population, in addition to the racial breakdown of immunization rates for two-year-olds.

To promote greater transparency, C3 has established a scorecard of key metrics pertaining to not just the usual operational numbers such as cost and utilization, but also data pertaining to health equity, such as comparisons of hypertension control by patients’ race and ethnicity. At each leadership meeting, these scorecards are posted for each of C3’s 18 health centers, prompting discussions of how to improve the metrics.

Perhaps most importantly, the attention to detail around data has led C3 to establish several experimental “flex” programs under Medicaid that are also known as “Section 1115 Demonstrations,” in which C3 partners with various social-services organizations (SSOs) that specialize in addressing SDoH, such as helping patients obtain housing or groceries.

For example, in one demonstration, C3 partnered with an SSO that delivered nutritious meals to patients’ homes. The program yielded impressive results: 68% of members with diabetes who received home-delivered meals had lower HbA1c scores in their post-enrollment tests compared with their pre-enrollment tests. Similarly, the percentage of diabetes patients with HbA1c scores that indicate their diseases are well-controlled grew significantly as a result of the home-delivery program, from 38% prior to the program to 71% after.

Additionally, the home-meal delivery program led to a substantial drop in the cost of care. In the six months after enrollment, total healthcare costs for the 456 patients enrolled in the program dropped by an average of more than 30%, from $17,902 to $12,349, compared to the six months prior.

C3’s experience with using analytics to improve health equity offers an example that ACO REACH participants can emulate. In the future, C3 looks to leverage the cost savings its programs generate to launch expanded initiatives that promote greater health equity.

Christina Severin, president and CEO of Community Care Cooperative, contributed to this article.

Curbside Consult with Dr. Jayne 6/20/22

I get my news from HIStalk just like everyone else, so I was very interested to read about US hospitals sending patient information to Facebook. Involved websites include a third of those listed as Newsweek’s “Top 100 US Hospitals.” Using the Meta Pixel tracker, Facebook is receiving the IP address of patients who scheduled appointments online, as well as the physician’s name and the search-term used to locate them. Investigative reporters also found that multiple high-profile hospitals have installed the tracker on their respective patient portals.

Of course, the major concern is that these organizations may have violated HIPAA by sharing patient health information with a third party without obtaining appropriate consent. During the investigation, one of the scenarios used was as follows. On the website of University Hospitals Cleveland Medical Center, for example, clicking the “Schedule Online” button on a doctor’s page prompted the Meta Pixel to send Facebook the text of the button, the doctor’s name, and the search term used to find her: “pregnancy termination.”

The data being sent from within hospital patient portals is even more concerning. The Pixel Hunt project is a crowd-sourced effort to locate places where the Meta Pixel tracker is installed. Five real patient participants in the project had sensitive data sent, including names of medications, allergic reactions, and details about pending medical visits. The hospitals in question denied having contracts in place that would have permitted the release of this data, and investigators found no evidence that the hospitals were appropriately obtaining patient consent. Multiple organizations have since removed the tracker from their websites and patient portals, but the fact that it was there in the first place is highly concerning.

It’s unclear what Facebook has been doing with the data, and whether it’s using it for marketing or other for-profit purposes. As a patient, I find it horrifying that a health system would willingly put this kind of tracker on a patient-facing site and would want to understand why they would do that. The short answer is that those who do install it have access to analytics about ads they may have placed on Facebook and Instagram as well as access to additional marketing tools. In my opinion, neither of those reasons is enough to justify why my personal information should be sent outside of the healthcare organization. Even worse, the article notes that “if a patient is logged into Facebook when they visit a hospital’s website where a Meta Pixel is installed, some browsers will attach third-party cookies – another tracking mechanism – that allow Meta to link pixel data to specific Facebook accounts.”

As a physician who was previously employed by a health system, we know how much health systems profit from the labors of the clinicians that work under their banner. Data from 2016, which is the most recent year I could find, shows that primary care physicians generate $1.4 million in revenue each year. Some specialists, such as cardiologists and orthopedic surgeons, can generate $2.4 to $2.7 million annually. We’ve come to terms with our participation in that equation, but I doubt that physicians think favorably about health systems profiting from confidential patient information that we have worked hard to protect.

Putting on my clinical informaticist hat, the IP address is one of 18 HIPAA Identifiers that are considered personally identifiable information. I remember memorizing these for my last clinical informatics board exam because there were several questions on the topic on practice tests. When you take a piece of personally identifiable information and combine it with clinical data, it is considered Protected Health Information. When investigators were on the Scripps Memorial Hospital physician website, clicking the “Finish Booking” button sent Facebook the physician’s name and specialty as well as the patient’s full name, email address, telephone number, city, and ZIP code. The hospital removed the Meta Pixel from the final stages of the appointment scheduling flow after they were made aware of the investigators’ findings. The article contains a host of other examples of other private information elements that were shared, including patient comments about their medications and information on sexual orientation.

For every patient who has been told they can’t have a copy of their own records, or who has difficult sending records to a consulting physician due to an organization’s misapplication of HIPAA, this is particularly offensive. Glenn Cohen, faculty director of Harvard Law School’s Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics notes, “Almost any patient would be shocked to find out that Facebook is being provided an easy way to associate their prescriptions with their name… Even if perhaps there’s something in the legal architecture that permits this to be lawful, it’s totally outside the expectations of what patients think the health privacy laws are doing for them.” I’ve been privy to dozens of complex legal agreements over the years as well as numerous health systems’ Terms of Use documents for their websites and Conditions of Care documents that they make patients sign. I could see someone nesting language in those documents that might permit a number of things that if spelled out would make patients cringe.

Of course, that assumes that the health system knows what they’re doing and deliberately includes that provision. Maybe we need a law that requires language around data sharing to be in 14-point font at a sixth-grade reading level so that patients can understand, or that requires organizations to present this information in line-item veto format for patients to better identify their wishes. I don’t think the majority of patients would answer “Do you want us to share your medical information with Facebook?” in the affirmative, but then again, you never know. However, from the health system responses cited in the article, it seems that perhaps some of them didn’t fully understand the ramifications of installing the Meta Pixel tracker or what it was actually doing. Others indicated that they have confidence in Facebook’s ability to filter out patient information, and I think the majority of us would suggest that confidence is misplaced.

Since healthcare is going to an increasingly online, patient self-service model, this issue isn’t going to go away. However, I don’t see legislators or regulators dealing with it proactively since they can’t deal with other high-profile issues that dramatically impact our population. I’d love to see a flurry of complaints filed for HIPAA violations and watch Facebook burn money trying to defend itself. Needless to say, it will be a while before we see how this plays out.

If there’s anything that shows how slow the wheels of justice grind, it’s the marking of the Juneteenth holiday, which commemorates the day in 1865 when Major General Gordon Granger delivered the Emancipation Proclamation to enslaved people in Texas – more than two years after it was issued. This is the first year I’m working for an organization that observes the day and it’s a good opportunity to reflect on ways that we can do better as we work to care for all people.

What do you think about the Meta Pixel tracker and its use by healthcare organizations? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Todd Cozzens, Managing Partner, Transformation Capital

Todd Cozzens is co-founder and managing partner of Transformation Capital of Boston, MA.

Tell me about yourself and what you do.

I built two companies in what we now call the digital health space, which we called healthcare IT back then. Marquette Medical offered cardiology software and the first vestiges of patient monitoring, the first vestiges of the electronic medical record. We bootstrapped that company since we didn’t know any better in those days, built it up, and I took the company public with the founder. We had a great run as a public company, then sold it to GE in the late 1990s, where it became GE’s cardiology software division and remains so to this day. I just went to the founder’s funeral a couple weeks ago, Mike Cudahy out of Milwaukee. He was an incredible inspiration and mentor to me.

Picis was the electronic medical record for high-acuity care — operating room, intensive care unit, and emergency room. We started Picis after the Marquette Medical exit and built it up over the years. We had 2,000 hospitals in 23 countries. We were going to take it public in 2010. Then the Affordable Care Act hit and UnitedHealth Group, at that time, was looking at the ACA with a lot of trepidation, thinking about things like medical loss ratio that could challenge their managed care business. As we all know, United made more money than ever in the ensuing years, but at the time, they were worried about that.

United was basically a rollup of 108 health plans. Every time they acquired a health plan, they got a technology piece, like a claims engine or analytics, and they used to roll that up into the division called Health Services. With the Affordable Care Act, they decided to monetize that group of assets and do a string of pearls in acquisitions. They acquired Picis under the idea that hospitals would just become high-acuity centers and low-acuity services would move out of the hospital into the ambulatory areas. They didn’t want to buy bricks and mortar hospitals, but they wanted to engage in the enabling technologies to make hospitals run more efficiently.

I stayed on after that acquisition and did a couple of things for United. Basically I was on the founding team of what became Optum, which was very exciting at the time because it was just a canvas to paint the future of healthcare with the company with the largest momentum and asset base to be able to build something big. Strategizing on how that would shake out was a really exciting time for those of us that participated in that founding. I ran the first value-based care division, which was dedicated to helping hospitals take on risk. This was early on in the value-based care spectrum and it was interesting figuring out what would work and what wouldn’t. My last job there was mapping out strategy and M&A and helping figure out what their next $3 billion of acquisitions would be.

I left there not long after that and joined Sequoia Capital, which was probably the most successful investment firm in the history of the planet. I was really excited to join them and help them with their emerging healthcare focus. They had not done a lot of healthcare in the past, so they needed someone that knew payer, provider, et cetera. I came on to help co-lead the healthcare investing with a guy named Mike Dixon, a young guy that they had hired who, at the age of 26, got them into MedExpress, the urgent care company, Health Catalyst, et cetera. I went on a couple of those boards. ZirMed, which is now Waystar. Little known fact — we were the first institutional investor in Epic, which is a long story, but interesting.

We had a great run there. My only issue with Sequoia was that healthcare was destined to be about 10 to 15% of what they did. I had the chance to start my own fund in 2016 with Leerink, the largest healthcare-focused investment bank. Leerink wanted to get into more on the tech side, and like many investment banks, wanted to start an asset management principle investing wing of the firm. The first fund that they wanted to do was growth equity digital health, so that fit with me.

I’ve known Jeff Leerink for 10 years and I was able to pull Jared Kesselheim, who’s a doc and MBA from the Harvard Mass General system, but more importantly, eight years very successful digital health investing with Bain Capital Ventures. I was able to pull him out of there. He was leading their healthcare investing at the time. Digital health was just starting to boom and the electronic medical record with the HITECH Act was proliferating, generating a whole bunch of data that caused thousands and thousands of companies to be formed. We were at the beginning of the digital health boom and off and running with a $350 million fund, invested in 15 companies across payer, provider, self-insured employer, and pharma, from a tech perspective. We don’t do therapeutics or diagnostics, but pharma is increasingly using this data to bring products to market quicker, et cetera. Virtual clinical trials, what have you. Self-insured employers were starting to directly try to manage conditions of their employees, not getting what they wanted from their brokers and their third-party administrators. The fifth area was the consumer. When I joined the workforce, there were no co-pays, no deductibles, and now families can be spending $6-7,000 on a deductible before they even touch the insurance, so people are going directly online to take control of their healthcare.

Those are the end user bases that our companies sell to. We were able to raise Fund Two during the pandemic, $500 million. My former partner from Sequoia, Mike Dixon, joined us as our third managing partner, built out the team of people that are just totally focused and experienced in this area with either the clinicians operators or long experience investing in this space. Healthcare is very complex, and to understand the intricacies of the reimbursement system and the labyrinthic payment system, in addition to all the nuances of sales cycles, et cetera, generalist firms generally have a tough time really understanding the space. We felt our focus would be an advantage. We invested in 16 more companies in Fund Two, and then we just raised Fund Three at $800 million and closed that in January of this year. We were heavily oversubscribed and ready to go. I’m glad we raised that when we did. Now we have lots of dry powder as we face this very uncertain future here.

How would you describe, to someone whose memory isn’t long enough to have seen it before, this market in which companies contract, valuations drop, and IPO activity dries up?

We are facing very uncertain times, but all indications are — and they are compiling every day — that we are going to enter into a extended period of inflation. Every time you’ve had full employment and this level of inflation creeping up, the economy has gone into a recession. The likelihood of us going into some sort of recession is high, and geopolitical factors like Ukraine are only adding to that prognosis. In uncertain times, you’ve got to be extremely aware of your circumstances — where your company is in its cycle, where you’re spending, and where you’re going to get revenue. The end result of that is you’re going to need cash runway to be able to survive these uncertain times. This will hit different areas of healthcare in different ways.

I’ve been through four of these in my career. Most of the millennials that we see as founders of companies today from 2010/2011 onward have never seen a down market, have never seen a contraction, have never seen a deep recession. Healthcare can be resilient because people still get sick and still need care, but other factors may not make that as viable as has been in the past. For example, I was on the phone yesterday with the CEO of a pretty large health system. He said, “This is the most challenging time I’ve ever seen in healthcare. We can’t find people to staff our hospitals. We have incredible shortage of caregivers right now. It’s not only the great resignation. The average ICU nurse is something like 48 years old. We already had a shortage of caregivers going into this and now that’s just been exacerbated.” He told me he was $50 million variance to budget on staffing costs already, year to date. Closed 10 ORs in the main hospital, the most revenue-generating part of the hospital.

I don’t think providers are going to escape this. Self-insured employers are going to start analyzing what’s nice to have, what’s got to have. In other words, is this point solution I have for diabetes or hypertension really going to save me money? Musculoskeletal is an area that has huge ROI, if you can help employees avoid surgery and get rehab. Getting into understanding the financial benefit, in terms of return on investment of your product, is going to be absolutely key here. The consumer will have less discretionary money to spend on some of these applications that they’re going directly online to engage in. Payers, maybe with a lower utilization, will continue to be profitable. Maybe they’re the winners in this. Yet to be told. Pharma is investing more and more in analytics to get their products to market quicker. Maybe they keep that spend going, because time-to-market will be essential here for them to keep their revenue streams going.

There will be winners and losers, but overall, we’re cautioning our founder who have not been through this before that if they just avoid all the mistakes I’ve made, they will probably do great. We went through financial downturns, such as when the Clintons first wanted to go to a single payer and healthcare was just frozen for a couple years. Obviously the dot com bubble, that wasn’t really the dot com bubble, and it wasn’t HIPAA or Y2K around the Year 2000. It was the Balanced Budget Act, where hospitals were bleeding money and they would engage these consultants like the Hunter Group that would help them just slash their budgets. Then obviously the 2009 Great Recession was significant because hospitals had put their monies in these mortgage-backed securities and couldn’t get liquidity in the assets that they had.

It’s really a time to hunker down and make sure you’ve got cash runway. I’m telling companies that they have 48 months. You should never be raising money again unless you’ve got 12 months of cash runway, because it will take that long and investors get spooked when you’re running out of cash, and they come in like sharks. Really hunker down on your expenses, watch your spend across the board, and keep your team motivated and focused. Those are some of the things we’re cautioning our companies on right now.

How will the M&A picture look in a situation where companies that either can’t turn quickly from growth to profitability or can’t establish a place in the market find themselves looking for a fire-sale buyer?

M&A will continue to be a big area of focus for some of the bigger companies. Some stuff will be cheap compared to the totally inflated prices over the last couple of years. We were definitely in a bubble. The multiples of forward anticipated revenue were crazy and off the charts, and now it’s time to get back to reality. What’s the real steady state of this business? What’s its gross margin? When does this company get to cash flow break even?

The multiples are already coming way down. They’ve come down on the public companies and we’re starting to see that creep into the later-stage growth companies. That’s going to start to affect all companies. There’s usually a lag there for sure. But still, in order to be acquired, you’re going to have to be a company that has line of sight on cash flow, break even, and profitability because these public companies have to acquire you and have to merge your profitability, or lack of profitability, into theirs and affect their earnings per share. Good businesses will still be acquired for reasonable multiples and there’s probably going to be a ton of fire sales out there, for sure.

Health systems are going beyond spinning companies off into actually creating startups and running their own investment firms. What effect will that have on the market?

It’s a mixed bag on those strategic entities. When I started Picis, there were 6,000 hospitals, and very few of them were in integrated delivery networks. Now there’s basically 500 health systems out there, so the number of customers that you can sell to in the hospital area has gone down to 500 decision makers versus 6,000. They have consolidated, and to their credit, they have strengthened their balance sheets through that consolidation, and that has generated pretty good cash flow for most of them. Many of them went off and set up these strategic venture funds.

Some of them are integrated into the strategy of the health system, where the C-suite and the chief digital officer are completely aligned on what they should be investing in or participating in. Some of them are kind of off on their own, investing in early stage companies that can’t scale for the health system. I think there’s going to be a culling of those. The ones that have been successful over the years and bringing great returns, like Ascension Ventures and Providence, will continue to see funding. The ones that are less integrated, kind of afterthoughts as in, “Hey, this doctor’s really smart and he’s got an MBA – let’s let him go set a venture fund up” are going to go by the wayside. We’ve already seen a few of them not get their next funding round.

How do you see the next few years playing out?

At the end of the day, we still have a incredibly broken health system, which is extremely inefficient. Yes, you may have a staffing issue, you may have fewer nurses than used to have, but you’ve got to make them more efficient and make them spend less time on tedious tasks and more time on automation. I’m still very bullish on the market and I’m happy with reasonable multiples from historic times.

When I sold Picis to United, four times forward revenue was a fantastic number. We did OK for ourselves back then. We don’t have to be 20 times. We don’t need 20X investments to return to our limited partners. We need reasonable exits in great companies.

I’m still very bullish. The need is there, the market is there. We are still in the early innings of this digitization of healthcare. I think it will take 15 years before we’re anywhere near digitized as other industries. We’re definitely more scrutinizing about the spots we pick, the companies we go after, the founders that we want to work with and who get it. We’re not going to be perfect. We’re not going to always pick the outstanding winners. But I think we’ll pick enough of them that hopefully we’ll be successful.

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