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The #HCBiz Show!
75 minutes | Jun 9, 2021
Healthcare Costs, Pricing, and Consumerism w/ Steve Ambrose
Price transparency and healthcare consumerism are top of mind for many operators and observers of the healthcare industry. On the surface, these topics sound great. Of course, we want to enable patients to be good consumers of healthcare. However, as we’ve seen so often on this show, aligning the obvious with the realities of the business of healthcare is no small feat. Today we’re talking with Dr. Steve Ambrose about healthcare costs, pricing, and consumerism. We discuss what these terms mean and why they are important. Then we dig into examples of companies that are already making an impact on these issues. We discuss: Companies that are helping to lower healthcare prices like ONCOspark (24:22), GoodRX (41:05), Transcarent (48:42), Cedar (53:24), Green Imaging (55:23), and more. What is going on in the retail space with the likes of Walmart, Target, Amazon and others (27:07). And companies working to reduce administrative costs like Olive (1:04:00) and LeanTAAS (1:08:51). This is an exciting space that is full of potholes and false promises. However, it is also a space where good companies are beginning to make progress. And that progress may offer us a glimpse into the future of healthcare. Dr. Steve Ambrose Dr. Steve Ambrose is a healthcare strategist with 25 years in clinical, technology, patient engagement, and consumerism. He is selectively reviewing options to place his talents and passion into his next FT leadership role. Dr. Ambrose may be reached through contact information on his LinkedIn profile. Links and Resources Steve Ambrose on Drug Pricing and GoodRX: https://walktheridge.com/drug-pricing Health Care Spending in the United States and Other High-Income Countries - this is the Ashish Jah study on healthcare prices and costs that Steve mentioned. Walmart acquires telehealth provider MeMD, upping competition in telehealth space Several recent #HCBiz episodes on AI/ML in healthcare administration: Episode 162: What’s up with IBM Watson Health? A Discussion on the State of AI in Healthcare with Paddy Padmanabhan Episode 159: A Practical Look at Machine Learning in Healthcare with Josh Miramant Episode 147: Applying Conversational AI to Reduce Provider Burnout from HealthIMPACT Live’’ The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media. Music by StudioEtar
46 minutes | May 28, 2021
The Moral and Business Case for Oral Health Integration with Dr. Myechia Minter-Jordan
Poor oral health has a direct link to high risk of chronic diseases like diabetes and heart disease. It contributes to depression, poor maternal health outcomes, and death. Research shows that it increased the risk associated with COVID-19. Yet we treat oral health as being separate from “healthcare”. 65 million Americans lack dental coverage and even Medicare provides no oral health benefits to our seniors. Worse yet, this lack of coverage contributes to healthcare disparities as black adults are nearly seven times more likely to have an unmet dental need than white adults. But where there are problems there are opportunities. Today we’re talking with Dr. Myechia Minter-Jordan, an MD, MBA, community health champion, and the President and CEO of the newly formed CareQuest Institute for Oral Health. Myechia shares with us how her role as the head of a Federally Qualified Health Center (FQHC) helped her see the gaps in our system and the extraordinary benefits of integrating oral health into primary care delivery. Better yet, those benefits extend far beyond a moral imperative. There is a clear business case for integrating oral health in a more holistic health delivery system. Myechia breaks it all down for us, plus much more including: Why oral health has been treated separately from healthcare. How oral health integration compares to behavioral health integration (which is already leading to improved outcomes and lower overall costs). The many ways CareQuest Institute is moving the needle including grants, research, innovation, and social impact investing. How entrepreneurs and startups can work with CareQuest Institute and why they will be launching the CareQuest Innovation Partners initiative to drive this. The need for teledentistry. The ways oral health and the COVID crisis have impacted one another. How ACOs, Direct Contracting Entities, and other risk-bearing organizations can benefit from oral health integration. The opportunity for dentists to rethink their own practice and begin to support primary care (and get reimbursed for it). How to foster relationships between dentists and primary care providers. Plus, we discuss The New Commonwealth Racial Equity and Social Justice Fund (NCF). Myechia Minter-Jordan, MD, MBA Myechia Minter-Jordan, MD, MBA, serves as the president and CEO of the CareQuest Institute for Oral Health. A physician and business executive, Myechia leads a dynamic team of professional and clinical experts committed to building a future where every person can reach their full potential through excellent health. Through Myechia’s leadership, CareQuest Institute operates as a catalyst for systems change, bringing forth ideas and solutions to create a more equitable, accessible, and integrated health system for everyone. CareQuest Institute collaborates with a wide range of partners to achieve its mission — to improve the oral health of all — through work in grantmaking, research, health improvement programs, policy and advocacy, and education, as well as leadership in dental benefits, care delivery, and innovation advancements. Myechia also continues to shine a national spotlight on the importance of ending deep social inequity. In 2020, Myechia joined 18 other Black and Brown executives in Massachusetts as a founding leader of The New Commonwealth Racial Equity and Social Justice Fund (NCF) to provide philanthropic support to community groups and coalitions fighting systemic racism and racial inequity in the Commonwealth. Originally seeded with $20 million, the NCF aims to raise $100 million. Before joining CareQuest Institute, Myechia served as chief medical officer and CEO of the Dimock Center, one of the largest community health centers in Massachusetts. During Myechia’s tenure, Dimock was recognized as a national model for comprehensive, integrated health and human services. As CEO, Myechia formed partnerships with world-class institutions to advance person-centered care, including Harvard Medical School, Beth Israel Deaconess Medical Center, and Partners HealthCare. Prior to Dimock, Myechia worked for Johns Hopkins Medicine as an attending physician and instructor of medicine. Myechia also invests personal time in her community, serving on several boards and committees, including BlueShield of California, The Boston Foundation, Harvard School of Dental Medicine, Harvard Pilgrim Health Care, and the Isabella Stewart Gardner Museum. Previously, she held appointed positions for influential agencies, including the Massachusetts Health Planning Council Advisory Committee and the City of Boston Public Health Commission. Myechia earned her doctor of medicine degree from Brown University School of Medicine and a master of business administration degree from the Johns Hopkins University Carey School of Business. She also received honorary doctorates from Northeastern University and Newbury College. About CareQuest Institute for Oral Health CareQuest Institute for Oral Health is a national nonprofit championing a more equitable future where every person can reach their full potential through excellent health. We do this through our work in grantmaking, research, health improvement programs, policy and advocacy, and education as well as our leadership in dental benefits, care delivery, and innovation advancements. We collaborate with thought leaders, health care providers, patients, and local, state, and federal stakeholders to accelerate oral health care transformation and create a system designed for everyone. To learn more, visit carequest.org. Twitter: @CareQuestInst Instagram: carequestinstitute LinkedIn: CareQuest Institute for Oral Health Website: https://www.carequest.org/ Additional Resources and Links Research Report: A Coming Surge in Oral Health Treatment Needs CareQuest Institute is set to release a series of reports in the coming months that provide in-depth analysis of the results of a comprehensive national survey aimed at understanding oral health equity in the US. They released their first report earlier in April that looks specifically at the impacts of the COVID-19 pandemic on our oral health and overall health systems. Key findings: Roughly 6 million adult Americans have lost their dental insurance due to the pandemic Nearly two-thirds of them have a symptom that is frequently linked to oral diseases, such as tooth decay and periodontal disease. Many others have canceled or put off important preventive care in the last year – 28 million people have delayed care because of concerns ranging from cost and lacking insurance to risk of exposure to the virus. The data also reinforces what became very clear early on in the pandemic: low-income individuals, those living in rural areas, and families and communities of color have been disproportionately impacted by this virus. In fact, 60% of Black respondents said they knew someone personally who has died from COVID-19. Across all demographic groups, the higher a respondent’s income level the less likely they were to know someone who has died from COVID-19. Additional statistics on inequities in oral health care Poor oral health has a direct link to higher risks of chronic illnesses, including cardiovascular disease, diabetes, asthma, and more. It also leads to greater instances of depression and other mental health diseases. Over 65 million Americans lack access to dental coverage prior to the pandemic, four times the number of people who are medically uninsured. Americans in poverty are 2.5 times more likely to have an unmet dental need due to lack of insurance. Black adults are 68% more likely to have an unmet dental need than white adults. Nearly 4 in 10 Black and Latino adults reside in 14 states where Medicaid’s adult dental benefits cover no services or emergency-only care. Press Release: New National Nonprofit Will Battle Inequity in Health Care The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media. Music by StudioEtar
48 minutes | May 24, 2021
Using AI to Make the Provider's Job Easier with Abboud Chaballout
When it comes to billing codes there are many processes and solutions that focus on the backend. They support the coders and help ensure the codes are “bill ready”. However, as today’s guest points out, there are very few solutions that exist solely to help providers put those codes in the EHR accurately and efficiently in the first place. Abboud Chaballout created Diagnoss to untether the clinician from a clunky EHR interface when it comes to coding. Chaballout describes it as a provider assistant that reads the free-text clinical narrative as they record it and uses AI to suggest the appropriate codes needed to paint an accurate picture of their patient’s health and the nature of the care they provided. Certainly, this will improve the accuracy of coding and allow for improvements in the overall coding workflow, but that really isn’t the goal. For Abboud, it’s far more important to give the providers some relief from clicking, pecking, and guessing in the EHR. The EHR is one of many contributors to physician burnout, or as Abboud prefers to describe it, moral injury. Simply put, Abboud and Diagnoss are using AI in an attempt to improve providers’ lives. It’s their sole focus. In addition to exploring Diagnoss’ goals and capabilities, we also get into the technical aspects of building this type of startup in healthcare. We discuss: How to decide which EHRs to work with. How to engage with those EHRs and get access to their API. How much variance you see from EHR to EHR when it comes to integration and APIs. How FHIR will impact the EHR integration process in the future. This is a great discussion for anyone trying to do the hard things in healthcare, especially when they require tight integration with many EHRs. Abboud Chaballout Abboud Chaballout is the CEO and founder of Diagnoss, a digital health company on a mission to reduce the administrative burdens of medical providers on the front lines of our healthcare system by building seamless tech. At Diagnoss, he’s taking on medical coding with an AI-based coding assistant that “whispers over a doctor’s shoulders.” Find and connect with him on LinkedIn to talk AI, EHRs, and medical coding. Connect with Abboud on LinkedIn Follow Diagnoss on Twitter Learn more at https://www.diagnoss.com/ Diagnoss Video: https://www.youtube.com/watch?v=6y3zFZ8yHPY Diagnoss Diagnoss supports providers in their most cumbersome EHR tasks so they can spend more quality time with patients. Today, Diagnoss's AI powered EHR assistant helps providers pick medical codes, more quickly and more accurately, saving them time while simultaneously enabling them to capture more revenue. By building the most robust real-time predictive system for clinical teams, Diagnoss transforms the experience of medical providers from one of frustration to one of inspiration. The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media. Music by StudioEtar
53 minutes | May 11, 2021
What’s your Early Adopter Strategy? with Dr. Roxie Mooney
95% of innovations that are brought to market fail to reach an adequate level of customer adoption or financial ROI. It sounds scary, but it doesn’t have to be this way. Today we’re talking with healthcare commercialization strategist and digital health advisor Dr. Roxie Mooney, about the steps innovators can take to dramatically increase their chances of being in the other 5%. Why you need an early adopter strategy that focuses on the specifics needs, goals, and desires of the customers who are looking for something new and novel. How to avoid pilot purgatory by negotiating future sales up-front and ensuring you can get value from the pilot along the way. The risks of falling in love with your idea and skipping the all-important customer discovery and market validation step. And no, your mom is not a good source of feedback on your innovation. The benefits of being strategic with your go-to-market timing (i.e., don’t rush to market; do rush to customer feedback). How to co-create with your clients without building a product that works only for them. When to convert your early-adopter messaging (i.e., new, never been done before, innovative, etc.) to mainstream messaging (i.e., social proof, trustworthy, reliable, ROI, etc.). This is a rich conversation, and whether you’re a startup or innovating within your organization, it's full of things you should be thinking about right now! Dr. Roxie Mooney, DBA Healthcare Commercialization Strategist and Digital Health Advisor Dr. Roxie Mooney helps health tech innovators uncover their most profitable and viable market strategies, from early adoption strategies to pivoting. She transformed 20 years of business practice, 7 years of researching over 500+ peer-reviewed articles, and 160+ interviews with health innovators into a repeatable method to go from an idea to full-scale adoption. She advises startups and emerging healthcare brands and has been involved in three successful exits. She currently serves as the Healthcare Commercialization Strategist and Digital Health Advisor of Legacy DNA. She’s also the international best-selling author of How Health Innovators Maximize Market Success: Strategies to Launch and Commercialize Healthcare Innovations, as well as host of the podcast and video show “Health Innovators.” In addition to her strategist role, Dr. Roxie is a sought out speaker and educator. She’s spoken at HIMSS and the Connected Health Conference, and currently serves as an Associate Professor of Marketing at the Jack Welch Management Institute and an Adjunct Professor of Gender Leadership and Coaching and Consulting at Palm Beach Atlantic University. She’s also a Board Member of One Purse, a nonprofit organization committed to restoring the lives and dreams of sex-trafficking survivors. Dr. Roxie holds a DBA with a Marketing Specialization from Walden University, an MS degree in Organizational Leadership from Palm Beach Atlantic University, and a BA degree in Organizational Communications from Rollins College. She has carried out additional post-graduate studies on Disruptive Strategy under Clayton Christensen at Harvard Business School. To learn more about Dr. Roxie’s personal and professional work, follow her on LinkedIn: www.linkedin.com/in/roxiemooney. Learn about her company Legacy DNA at www.legacy-dna.com. Links and Resources More on selling/getting things done in Healthcare: Episode 150: How to Turn the Growth Engine on in your Digital Health Startup with Bryan Loomis Episode 149: How Health Systems Think with Neil Carpenter Episode 148: Partnering with Payers w/ Andrew-Adrian Karlin of Highmark Episode 103: Selling to Health Systems: Advice for Digital Health Startups (Part 1) Episode 105: Selling to Health Systems: Advice for Digital Health Startups (Part 2) Episode 85: Lessons on Selling in Healthcare w/ Dom Cappuccilli Also mentioned on the show: Clayton Christensen on what Disruptive Innovation really means. Startup books by Steve Blank (and others he recommends) VideoPeel.com – remotely capture video testimonials from your customers in seconds. The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.
46 minutes | Apr 29, 2021
What's up with IBM Watson Health? A Discussion on the State of AI in Healthcare with Paddy Padmanabhan
IBM Watson Health came on the scene with swagger and promises. They were going to revolutionize healthcare! And now the unit may be for sale. We don't yet know what's really going on there, but the commentary surrounding this rumor provides some interesting points for discussion. What is the state of AI in healthcare? Is the industry ready for it? Will doctors use it? Is it going to kill us if it's not perfect? There's a lot to explore. On this episode, Paddy Padmanabhan joins us to hash it all out. Paddy is the Founder and CEO at DAMO Consulting, Host of The Big Unlock podcast, and co-author of the new book Healthcare Digital Transformation: How Consumerism, Technology and Pandemic are Accelerating the Future with Edward Marx. We discuss what's working today (think administrative functions), and what may still be a ways off (think complex cancer diagnostics). Plus we get into the challenges of regulation, ethics, patient safety, messaging, and more. About Paddy Padmanabhan Paddy Padmanabhan is the author of the best-selling book Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future. He is the founder and CEO of Damo Consulting, a digital transformation advisory firm that works with healthcare enterprises and digital health companies. He is the host of The Big Unlock, a widely subscribed podcast focusing on healthcare digital transformation. He is also the author of the book The Big Unlock: Harnessing Data and Growing Digital Health Businesses in a Value-Based Era. About DAMO Consulting Damo Consulting provides digital transformation advisory services to enable healthcare organizations navigate the technology-enabled transition to telehealth and virtual care. We bring deep industry knowledge, market insights and technology skills to help develop and implement enterprise digital roadmaps. We work with healthcare IT and digital health firms to develop and execute market growth strategies. Links: Company Website: www.damoconsulting.net Paddy Twitter: https://twitter.com/PaddyPadmanabha Paddy LinkedIn: https://www.linkedin.com/in/paddypadmanabhan99 Paddy’s latest book on healthcare digital transformation: https://thebigunlock.com/healthcare-digital-transformation-book-by-paddy-padmanabhan-and-edward-w-marx/ Newsletter: https://www.damoconsulting.net/newsletter/ Assessing Digital Maturity: The DigiMTM Digital Maturity Model for Health Systems - Damo Consulting (White paper) Selecting Technology Partners to Execute Digital Strategy - Damo Consulting (white paper) Healthcare Digital transformation Podcast: https://thebigunlock.com/the-big-unlock-podcast/ More on AI and Machine Learning in Healthcare Episode 159: A Practical Look at Machine Learning in Healthcare with Josh Miramant Episode 147: Applying Conversational AI to Reduce Provider Burnout from HealthIMPACT Live Episode 116: Enhancing Diagnostic Accuracy with Art Papier of VisualDx Episode 91: Deep Medicine with Dr. Eric Topol Episode 43: Demystifying Big Data and Machine Learning for Healthcare w/ Prashant Natarajan The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.
46 minutes | Apr 14, 2021
Using Data to Pick the Right Health Plan with Akash Magoon
Picking a health plan can be the biggest crapshoot of anyone’s year. It’s confusing and tedious to compare the plan benefits, the provider directories are unreliable, and even if you can figure it out, there’s no way to know how much you’ll pay for a given service from one plan to the next. So, we cross our fingers, pick the one that seems like a fit, and hope for the best. Today’s guest is trying to change all of that. Akash Magoon is Co-founder and CTO at Nayya – a company that offers personalized enrollment guidance across all employee benefits. Today we talk about how Nayya uses claims and consumer data to help consumers pick the best health plan for their situation. Their goal is to “restack the odds for American families”. That’s something we can all get behind. As a bonus to the startups out there, we talk about Nayya’s rapid growth over the past year. Pre-pandemic it was just Akash and his co-founder, Sina. Now a seed and series A round later, they have expanded to more than 30 employees and have customers in nearly every state. We talk about the key factors that enabled them to find their product-market-fit and show value to their customers. On this episode you’ll learn: How claims and consumer data can be used to help consumers make better decisions about health plans. Why employers and health plans are interested in providing this service to their employees and members. Why it's important to engage consumers throughout the year to help them get the most out of their plans for the least amount of money. How the CMS Patient Data Access Rule creates new opportunities to empower healthcare consumers. How to get feedback early and often when launching a new product, and other advice for finding your product-market-fit. About Nayya At Nayya, we believe there is a better way to choose and use healthcare benefits. A more transparent, less confusing way where consumers feel more confident in their decisions. We focus on decision support and benefits engagement. It’s one of the most stressful and challenging situations consumers face – and we see that as an opportunity to do good. We’re excited to deliver a new experience to consumers – where they choose and use their benefits through our software, data and AI engine. Learn more: Web: https://www.nayya.com/ Nayya Series A Announcement Nayya + Selerix Partnership Nayya + Selerix Video Get connected: LinkedIn: https://www.linkedin.com/company/nayya Twitter: https://twitter.com/Nayya_Inc Facebook: https://www.facebook.com/WeAreNayya Instagram: https://www.instagram.com/nayya_inc/ Links and Resources Episode 153: How Will Patients Securely Connect 3rd Party Apps to Their Data Once Patient Access Rules Kick In? from Health Data Unbound Episode 50: A Blueprint for the Next Generation Health Ecosystem | Dave Chase | The Health Rosetta Episode 27: Health Benefits as a Strategic Opportunity | Chris Skisak | HBCH The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.
53 minutes | Mar 31, 2021
The Role of Doctors at Digital Health Startups with Sven Jungmann
What is the role of a doctor at a digital health startup? Why are they needed? What jobs will they do? How do you find one? And how can you tell if they will be a fit for your team? If you’re a doctor considering this move, you may have similar questions in reverse. What will it be like to be a “digital doctor”? How can I find opportunities? What new skills will I need to develop? How can I tell if the digital health startup I’m looking at has a shot? On this episode we talk with Sven Jungmann. He’s a medical doctor with additional degrees in Public Health, Public Policy, and entrepreneurship. He’s the Chief Medical Officer at FoundersLane in Berlin, Germany, where he advises digital health startups, and helps align other doctors with startups too. I can’t think of anyone more qualified to discuss this topic with! You’ll learn: Why many digital health startups really do need a doctor on their team. What the transition is like when moving from practicing medicine to the startup world. The drawbacks to doing this if you’re a doctor. Six skills that make medical doctors indispensable for startups What a non-clinical founder should do to bring themselves closer to the medical side. That the problems in the U.S healthcare system are not unique when it comes to a lack of prevention and woefully inadequate data sharing. Why Corporate Venture Building is a powerful way to drive innovation. We also discuss Sven’s new book, FightBack NOW: Leveraging your assets to shape the new normal and his work at FoundersLane. About Sven Jungmann Sven Jungmann is a medical doctor with additional degrees in Public Health (Master, LSHTM), Public Policy (Master, Oxford), and entrepreneurship (Postgraduate Diploma, Cambridge). He worked in hospitals for several years. Today, as Chief Medical Officer, he heads the Healthcare Vertical for FoundersLane and advises start-ups in the digital health sector. He’s co-author of FightBack Now. Connect with Sven on: LinkedIn Instagram Twitter About FoundersLane FoundersLane is a Corporate Venture Builder that helps established organizations launch new digital offerings in the healthcare and sustainability space. FoundersLane is formed by serial full-stack entrepreneurs with experience in building tech companies from scratch to scale. Learn more: https://founderslane.com Newsletter: https://founderslane.com/insights Links and Resources Episode 149: How Health Systems Think with Neil Carpenter Episode 103: Selling to Health Systems: Advice for Digital Health Startups (Part 1) Episode 105: Selling to Health Systems: Advice for Digital Health Startups (Part 2) Episode 85: Lessons on Selling in Healthcare w/ Dom Cappuccilli The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.
61 minutes | Mar 19, 2021
A Practical Look at Machine Learning in Healthcare with Josh Miramant
Machine Learning in healthcare (and Artificial Intelligence in the broader sense) is real and is being used today. The problem is, it’s difficult to sort out what’s real and what’s hype. Opinions on the matter range from “it’s all hype and BS” to “AI is revolutionizing healthcare and replacing doctors”. The truth, of course, lies somewhere in between. Today we talk with Josh Miramant, CEO and Founder of Blue Orange Digital, to help you sort this out. After listening you’ll have clarity on what Machine Learning is, an understanding of what’s possible in healthcare today, and a practical expectation of what’s coming next. In this conversation we’ll: Help you understand the terminology. What is Machine Learning? What is Artificial Intelligence? What is everyone talking about!? Take the “magic” out of Machine Learning and help you understand at a basic level what’s happening here. Layout the need for data quality and data fidelity (i.e., the usefulness of data for a purpose). Along with data acquisition, this is the first thing you’ll need to address. Discuss practical applications of Machine Learning that are being used productively in healthcare right now. This is “Applied Machine Learning” and there are many solved problems that add value in healthcare administration, patient acquisition, costs, pricing models, etc. Dig into the research and operational applications of machine learning. These include things like image detection, diagnosis, etc. like we discussed with Eric Topol (Episode 91). These applications are real and they’re improving, but they aren’t replacing doctors anytime soon. Then we touch a bit on the theoretical. Things that are happening in the lab that are incredibly exciting but have a way to go before they have real-world applications. About Josh Miramant Josh Miramant is the CEO and founder of Blue Orange Digital, a top-ranked data science and machine learning agency with offices in New York City and Washington DC. Miramant is a popular speaker, futurist, and a strategic business & technology advisor to enterprise companies and startups. As an example of thought leadership, Miramant has been featured in IBM ThinkLeaders, Dell Technologies, Global Banking & Finance Review, the IoT Council of Europe, among others. Connect with Miramant: LinkedIn: @joshmiramant Email: firstname.lastname@example.org Twitter: @jmiramant About Blue Orange Digital Blue Orange Digital is recognized as a “Top AI Development and Consultant Agency,” by Clutch and YahooFinance, for innovations in predictive analytics, automation, and optimization with machine learning in NYC. They help organizations optimize and automate their businesses, implement data-driven analytic techniques, and understand the implications of new technologies such as artificial intelligence, big data, and the Internet of Things. Whether your goal is to optimize your supply chain, use existing data to decrease operating costs, or customize the patient experience with predictive modeling, Blue Orange Digital can help you meet your challenge. Have a project in mind but need some help implementing it? Contact us, we’d love to discuss how we can work with you to co-develop your AI project. For more on AI and technology trends, see Josh Miramant, CEO of Blue Orange Digital’s data-driven solutions for Supply Chain, Healthcare Document Automation, and more case studies at BlueOrange.Digital. Connect with Blue Orange: LinkedIn: @blueorangedigital Email: email@example.com Twitter: @BlueOrangeData Medium: @blueorangedigital Links and Resources Smartwatches can help detect COVID-19 days before symptoms appear The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.
43 minutes | Mar 7, 2021
Direct Contracting: A Physician's Perspective with Dr. Krishnan Narasimhan
Direct Contracting is a new model from the Center for Medicare & Medicaid Innovation (CMMI, or the CMS Innovation Center) aimed at reducing expenditures and preserving or enhancing quality of care for beneficiaries in Medicare fee-for-service (FFS). At a minimum, it’s an opportunity for providers to change the way they care for Medicare FFS patients. And if the Geographic Direct Contracting Model is launched (it’s currently under review by CMS), it will be a sea change in the 10 targeted “Geo” regions. Either way, it’s worth paying attention to. We covered the Direct Contracting model and options at length in Episode 156 with Gail Zahtz. You should start there if Direct Contracting is new to you. During that conversation, Zahtz identified plenty of areas where the model could benefit doctors and their patients. However, she identified several grey areas that make it difficult for physicians to engage with potential DCEs as the application deadline rapidly approaches (April 1, 2021). The timeline and lack of clarity make it difficult for a physician to evaluate the model and make a sound decision on how, or if to participate. So, that’s our goal of this discussion. I talk with Dr. Krishnan Narasimhan, an academic family medicine physician and an Associate Professor in the Department of Community and Family Medicine at Howard University, about what Direct Contracting means to physicians. What opportunities does Direct Contracting create for physicians? What opportunities does Direct Contracting create for their patients? How does Direct Contracting compare to other value-based payment programs? How might Direct Contracting lead to deeper physician-payer alignment? How does Direct Contracting enable physicians to truly address the Social Determinants of Health (SDOH)? What questions should a physician ask a DCE to determine if they are a fit? What should physicians’ do right now to determine if Direct Contracting is worth pursuing? How can busy physicians fit this in with all their existing priorities during a pandemic? Dr. Krishnan Narasimhan Krishnan Narasimhan M.D., is an academic family physician who has a proven record of driving health system and policy change. Dr. Narasimhan has led grassroots coalitions to move the political and policy debate on health reform, expand access, and to increase primary care infrastructure. He has spoken at the U.S. Capitol, at universities, and with numerous stakeholders on health reform, health disparities, and physician workforce. He serves on the Boards of Doctors for America and the District of Columbia Academy of Family Physicians. Dr. Narasimhan has a decade of experience in undergraduate and graduate medical education with a focus on curricular design, mentorship, and integrated care models. He has a record of consistently increasing primary care workforce capacity. His research on the Economic Impact of Family Physicians has been utilized extensively by the American Academy of Family Physicians. Currently he serves as Associate Professor at Howard University, Director of the Family Medicine Clerkship, as Residency faculty, and takes care of underserved populations. His training includes an M.D. from Jefferson Medical College, residency at University of Connecticut, Primary Care Health Policy Fellowship at Georgetown University, and a Certificate of Health Policy at the Georgetown Public Policy Institute. Dr. Narasimhan is also an advisor to WiseCare, a startup applying to become a Direct Contracting Entity (DCE). LinkedIn: https://www.linkedin.com/in/krishnanmd/ Links and Resources Doctors for America - Doctors for America mobilizes doctors and medical students to be leaders in putting patients over politics on the pressing issues of the day to improve the health of our patients, communities, and nation. District of Columbia Academy of Family Physicians: The District of Columbia Academy of Family Physicians (DCAFP) is a state chapter of the American Academy of Family Physicians. A membership organization for DC Family Physicians, the Academy advocates for Family Physicians and our patients, and conducts continuing medical education for Family Physicians. Episode 156: Direct Contracting: It’s Coming Fast and Will Have a Big Impact on Medicare-fee-for-service w/ Gail Zahtz – you’ll find additional Direct Contracting resources there. WiseCare The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.
50 minutes | Feb 26, 2021
Why Aren’t We Using HIEs to Support Vaccination Efforts (and Everything Else)? w/ Niam Yaraghi
As of 2015 the Office of the National Coordinator for Health IT had awarded $548 million in grants to states to establish health information exchanges (HIE). I have no doubt hundreds of millions of dollars more have been invested in various ways since then. So, when faced with one of the most daunting healthcare data challenges of our time in the COVID-19 vaccine rollout, surely, we turned to the HIEs first. Right? Not so much, according to today’s guest. Niam Yaraghi, assistant professor of Business Technology at Miami Herbert Business School at the University of Miami and a nonresident fellow at the Brookings Institution’s Center for Technology Innovation, recently explored the use of HIEs in vaccination efforts across the country. He tells us that “While the U.S. employed every possible resource to develop the vaccines, we are neglecting to use the best available information technologies to efficiently distribute them”. In Yaraghi’s recent article, co-authored with Brookings Institution colleague Peter Levin, they share that none of the state vaccination plans they reviewed made any mention of using HIEs to support the effort. Further, they found no correlation between a state’s vaccination success and the existence of a robust HIE infrastructure in that state. There are some efforts underway to change this, including ONC’s $20 million investment to help increase data sharing between health information exchanges (HIEs) and immunization information systems. Still, the question remains: why aren’t we using HIEs to their fullest potential to support the vaccine rollout? And why aren’t we turning to the HIEs first whenever we need to move clinical data in general? On this episode, we explore those questions plus: Five ways that health information exchange can help with vaccination efforts. How HIEs can change the conversation when it comes to revenue generation. The opportunity for HIEs to add value and transform data into information through analytics. How might HIEs play a role in reopening the economy? Will HIEs play a role in patient-mediated exchange? Why it’s time for the industry to rethink its views on HIE and make them their first stop for interop. Plus, some novel API ideas for HIEs. Niam Yaraghi Niam Yaraghi is an Assistant Professor of Business Technology at Miami Herbert Business School, and a non-resident Fellow in the Brookings Institution's Center for Technology Innovation. Niam's research is focused on the economics of health information technologies. In particular, Niam studies the business models and policy structures that incentivize interoperability and sharing of health information among patients, providers, payers and regulators. Niam's research has appeared in leading business journals including MIS Quarterly, Information Systems Research, and Production and Operations Management, as well as top-tier health policy and informatics journals including Journal of American Medical Informatics Association, and Milbank Quarterly. He regularly consults with various companies and platforms in the healthcare industry and is a sought-after expert and speaker on issues related to health information technology in media and at industry conferences. Niam has a B.Sc in Industrial Engineering from the Isfahan University of Technology in Iran, and a M.Sc from the Royal Institute of Technology in Sweden. He received his Ph.D. in Management Science & Systems from the State University of New York at Buffalo. Twitter: @niamyaraghi HIE Links and Resources The benefits of health information exchange platforms: Measuring the returns on a half a billion dollar investment Five ways that health information exchange can help with vaccination efforts Episode 140: Getting to Know eHealth Exchange – The Largest Health Information Network in the Country – Jay Nakashima Episode 129: What you need to Know About TEFCA Right Now w/ Mariann Yeager Episode 104: Why HIEs Will Lead the Way on Healthcare Quality Measurement w/ John D’Amore The Regional HIE Should be Your First Stop for Interop Plus 4 more #HCBiz Discussions with Niam Yaraghi The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.
68 minutes | Feb 10, 2021
Direct Contracting: It’s Coming Fast and Will Have a Big Impact on Medicare-fee-for-service w/ Gail Zahtz
CMS Direct Contracting is coming fast, is very nuanced, and full of grey. In a nutshell, 50% of Medicare patients are in Medicare Advantage (i.e., value-based care) and 50% are still Medicare fee-for-service (FFS). Direct Contracting is CMS’ bold play to quickly move many of the remaining Medicare fee-for-service (FFS) patients into value-based care. If you’re a doctor who takes care of Medicare fee-for-service (FFS) patients, then it is going to affect you whether you’re paying attention or not. That’s doubly true if you’re in one of the 10 “Geo” model regions (Atlanta, Dallas, Houston, Los Angeles, Miami, Orlando, Philadelphia, Phoenix, San Diego, Tampa). In those regions, 100% of non-Medicare Advantage beneficiaries will have to align with one of three to seven awarded Direct Contracting Entities (DCE). DCE applications are due April 1, 2021 and all beneficiaries will be re-aligned under this fully capitated plan beginning January 1, 2022. Ya… that fast. “There will no longer be any fee for service for all of Medicare and all of dual eligibles, which is Medicaid and Medicare eligible, in up to 10 regions of our country starting the first of next year.” Gail Zahtz, Founder and CEO, WiseCare Today we’re talking with Gail Zahtz, Founder and Chief Executive Officer at WiseCare, a startup applying to become a Direct Contracting Entity (DCE). Gail helps us to understand the urgency of the situation and walks us through the nuance of the model. And while she acknowledges the hurdles for providers and the risks CMS’ rapid timeline imposes, she also embraces the opportunity that Direct Contracting represents. As a cancer survivor, Gail understands firsthand the difficulty of navigating our healthcare system and she believes Direct Contracting offers a pathway to really make a difference in how care is delivered. It makes new services and care models possible, and it allows doctors to care for patients in the way they dreamed of when they got into medicine. Direct Contracting / Direct Contracting Entity (DCE) Topics Covered What is Direct Contracting and how does it differ from MSSP and Next Gen ACO models? What are the timelines? What are the different types of Direct Contracting Models? How are beneficiaries aligned to DCEs? Do patients have a choice in any of this? How will patients’ benefits and/or costs change? What will happen to doctors who ignore this and let the pieces fall where they may? How do doctors interact with DCEs? How does payment flow through the DCEs? How can doctors find the DCEs in their area who they might partner with? How should providers evaluate DCEs to determine if they are right for their patients and their business? How does quality measurement work in Direct Contracting? Will there be any changes to the model under the Biden Administration? There’s a lot here, and still a lot of open questions on Direct Contracting. We’re going to do our best to unravel this for you in the coming weeks. Drop me a note at firstname.lastname@example.org and let me know what questions you’d like us to cover. Gail Zahtz Founder and Chief Executive Officer, WiseCare Inc. Gail Zahtz has spent her career focusing on the intersection of evidence-based healthcare and user-centric design to honor and empower the doctor-patient relationship. An entrepreneur since the 1990s when she took a health-in-the-workplace property to $100M valuation, she has served as an adviser to healthcare start-up funders, a thought leader and advisor to industry on designing for health outcomes, a consultant to health innovation startups, and the architect of value-base healthcare delivery for NY’s largest post-acute healthcare system. She has won numerous awards for her work at the intersection of health and design, including: Top 100 in Health Info Technology, Top 100 International Influencers in Health, and Top 50 Most Influential Health Leaders. As a survivor of late-stage cancer and domestic violence, Gail is dedicated to sharing her story of how to survive and thrive in the most challenging of circumstance to show young women everywhere a way forward. Twitter: https://twitter.com/GailZahtz LinkedIn: https://www.linkedin.com/in/gailzahtz/ About WiseCare WiseCare is an Integrated Healthcare Collaboration Company, enabling doctors to deliver true wrap-around care to Medicare patients by leveraging the new value-based care models. WiseCare makes thriving within the new capitated models seamless for physician practices and alternate-level-of-care facilities. A partner, not just a payor, we offer the ready-made collaborations and working partnerships across the healthcare continuum that will be the key to success. And we’re expert in helping physicians keep, grow, and better care for their Medicare populations in this fast-changing environment. We lessen administrative burdens, improve financial stability, provide the data physicians need to make strategic care decisions, and deliver benefit enhancements that pay off for patient and caregiver, physician, and the practice. And our CareCoaches support patients and care plans between office visits, providing: condition and wellness education, targeted referrals to medical and social providers, and resolution of issues that stand between your patients and better outcomes. That’s what we call Healthcare Made Well. To learn more about how WiseCare can partner with you, email us at email@example.com. Web: https://www.wisecare.health/ LinkedIn: https://www.linkedin.com/company/wisecare-health/ Links and Resources Notice of DCEs Participating in the Implementation Period of the Direct Contracting Model, Global and Professional Options This is dated, and only covers the Global and Professional options, but is worth a look if you’re trying to figure out what’s happening in your area. CMS Announcement: Geographic Direct Contracting Model (“Geo”) CMS Direct Contracting Model Options Industry Voices—CMMI chief: Direct Contracting Geographic Model a win for all stakeholders ACOs press for halt to Geographic Direct Contracting model due to complexity concerns ACOs Fear Direct Contracting Options Stray Too Far From Providers The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.
78 minutes | Jan 29, 2021
Reimagining Public Health Data w/ Prashant Natarajan
The pandemic has exposed many weaknesses in our healthcare and public health systems, and our disjointed public health data infrastructure is certainly one of them. Like much of our healthcare data, public health data tends to be manually compiled, Excel-reliant, and lacking in critical detail needed to make good decisions. Today we talk with Prashant Natarajan, VP of Healthcare Life Sciences and Health Insurance at H2O.ai about reimagining the collection and use of public health data. Public Health Data Topics Discussed The current state of our public health data infrastructure (12:20) Why data is the lifeblood of our society, and how it can help us make better public health decisions (22:36) How the pandemic has exposed our weaknesses, and how the private sector can help (28:12) The gaps in our public health data and opportunities for improvement (33:19) Enable better decision-making with demographic and socioeconomic data (40:17) The importance of sharing lessons from region to region and country to country (44:54) Applications and use cases for Artificial Intelligence (AI) in public health data (52:01) Converting data to narrative form and the importance of storytelling (1:02:22) This was a fascinating conversation, and Prashant is always a lot of fun. I hope you enjoy it! About Prashant Natarajan Prashant Natarajan is VP of Healthcare Life Sciences and Health Insurance at H2O.ai Award-winning global track record of building successful businesses with solutions and products. Conceptualizing, evangelizing & delivering lasting innovation and business transformation - across multiple geographies and organizations in Healthcare Life Sciences Insurance (Health, Group, Annuities & Life) Financial Services Best-selling author of books that demystify data, analytics, AI-ML, and transformation for business leaders, domain experts, and non-technologists. Keynote speaker. Twitter: @natarpr LinkedIn: https://www.linkedin.com/in/natarpr/ Book: Demystifying Big Data and Machine Learning for Healthcare Book: Multidisciplinary Approach to Head and Neck Cancer About H2O.ai H2O.ai is a leading AI technology company that enables organizations to rapidly build world-class AI models and applications. They continue to reimagine what is possible with artificial intelligence and deliver new platforms and technologies to put responsible AI into the hands of more users. The company vision is to democratize AI by making it easier for individuals to build and access world-class and responsible AI. To achieve this vision, H2O.ai has created a culture of responsible and engaged makers: community, customers, partners, entrepreneurs, and their own “makers,” enabling them with the technology to “make.” H2O is a leading open-source data science and machine learning platform used by nearly half of the Fortune 500 and trusted by over 20,000 organizations and hundreds of thousands of data scientists around the world. Links Episode 43: Demystifying Big Data and Machine Learning for Healthcare w/ Prashant Natarajan Episode 53: What exactly is Precision Medicine? | Prashant Natarajan | H2O.ai Episode 126: Using Opportunity Zones to Drive Substantial Investment in SDOH w John Gorman Episode 143: The Long Fix: Solving America’s Health Care Crisis with Strategies that Work for Everyone w/ Dr. Vivian Lee Episode 146: How Purpose-driven Interoperability and Data Quality Positioned Surescripts to Fill Communication Gaps During the Pandemic – Tom Skelton Why Indonesia is vaccinating its working population first, not elderly Survivorship Bias: See the In the Military section for an explanation and image of where the planes were shot The Hero’s Journey – Joseph Campbell The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media. Music by StudioEtar
49 minutes | Jan 22, 2021
Deferred Care and Lower Risk Scores Could Reduce Medicare Advantage Payments in 2021 w/ Dr. Matt Lambert
The pandemic has had a tremendous impact on the business of healthcare. With states canceling elective procedures and people deferring care for fear of being exposed to the virus, hospital and medical practice revenue is down. On the flip side, many health plans are sitting on a mountain of premiums that aren’t being spent because of this deferred care, possibly leading to rebates in some cases and a ton of uncertainty in pretty much all cases. One less obvious outcome of all of this may fall on Medicare Advantage plans in 2021, and it threatens to lower payments by 4-6% in 2021. Medicare Advantage, of course, is the rapidly growing model that’ll cover more than 24 million Americans this year. According to a recent Avalere report, these plans may be looking at both a sicker population and reduced payments in 2021 because of this deferred utilization. Here to help us understand why, and to share some advice for how Medicare Advantage plans can weather the storm is Dr. Matt Lambert, a practicing ER clinician, and Chief Medical Officer at Curation Health. A few actions Dr. Lambert suggests are: Focus on the long game and be patient. For example, don’t pay out more to shareholders and, instead, place revenue in short-term investments that they can access without penalty. Prioritize virtual care/telemedicine enablement/reimbursement now and moving forward. This will enable more members to access care while avoiding in-person treatment risks. Lead with interventions and the type of claim vs. volume of claims. MA plans will be best served to focus on capturing the key conditions that map specifically to chronic conditions as they drive the most improved outcomes, utilization and costs. There’s a lot of nuance to this story and the way Medicare Advantage payments are calculated. Dr. Lambert breaks it all down for us. Enjoy! Dr. Matt Lambert Dr. Matt Lambert brings more than 20 years of experience as a clinician, CMIO, and change leader in value-based care, ensuring that patients receive more comprehensive care and that payers and providers better capture the value of their services. He is a practicing, board-certified emergency medicine provider who previously founded his own physician staffing company. Dr. Lambert was one of the founding members of Clinovations. During his time there he served as part of the leadership team for several electronic health record implementations at the nation’s largest public health system in New York City, the University of Washington in Seattle, Johns Hopkins, Barnabas Health, Medstar, and Broward Health. He is also the author of two healthcare books: Unrest Insured and Close to Change: Perspectives on Change and Healthcare for a Doctor, a Town, and a Country. firstname.lastname@example.org Curation Health Curation Health was founded by a team of healthcare veterans and clinicians to help providers and health plans effectively navigate the transition from fee-for-service to value-based care. Their advanced clinical decision support platform for value-based care drives more accurate risk adjustment and improved quality program performance by curating relevant insights from disparate sources and delivering them in real time to clinicians and care teams. With Curation Health, clinicians enjoy a streamlined, comprehensive clinical documentation process that enables better clinical and financial outcomes while simultaneously reducing clinical administrative burdens on providers. Curation Health takes pride in combining the flexibility and speed of a startup with decades of leadership experience and know-how from roles in leading companies including Clinovations, Evolent Health, and The Advisory Board Company. Web: curationhealthcare.com. LinkedIn: https://www.linkedin.com/company/curationhealth/ Twitter: https://twitter.com/curationhealth Case Study: https://curationhealthcare.com/a-case-study-on-curation-health-and-a-physician-group-in-the-midwest/ Links and Resources Report: COVID-19 Pandemic May Reduce MA Risk Scores and Payments (Avalere) Unrest Insured by Dr. Matt Lambert Close to Change: Perspectives on Change and Healthcare for a Doctor, a Town, and a Country by DR. Matt Lambert Episode #122: Headwinds Impacting the Shift to Value-Based Care with Kyle Swarts and Dr. Matt Lambert The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media. Music by StudioEtar
47 minutes | Jan 15, 2021
How Will Patients Securely Connect 3rd Party Apps to Their Data Once Patient Access Rules Kick In? from Health Data Unbound
The CMS Patient Access Rules are coming. And they’re easy to cheer for. We’re giving patients their data and that’s a huge win! We all love that! But what we don’t love is when FraudulentHealthcareApp.com collects patient data and sells it to the highest bidder to support targeted marketing, or whatever other nefarious act they can come up with. Well, the health plans don’t get to pick and choose which apps they connect to. What if their member wants to use FraudulentHealthcareApp.com? What’s their recourse? How can they educate and protect their members? On this episode, we’re sharing another of Shahid’s recent panels. This one from Health Data Unbound, and it’s like an #HCBiz super panel as we’ve had all 4 of the panelists on the show in the past. The panel asks the question: “How Will Patients Securely Connect 3rd Party Apps To Their Data Once Patient Access Rules Kick In?” And they will be kicking in on July 1st of this year (2021). Shahid Shah is our moderator, and he’s talking with: Andrew Adrian-Karlin, Director of Business Platform-Product, Highmark Health (Episode #148: Partnering with Payers) Gunjan Siroya, Principal Partner & Sr. Vice President, Netspective (Episode #69: An Open Source Industry Platform for Provider Directory) Ron Urwongse, Director of Strategy and Innovation, CAQH (Episode #13: Are We Asking Providers the Wrong Questions?) They cover this core question and discuss the tools and frameworks health plans can use to protect their members and themselves. And then, as he always does, Shahid asks the most important question. Is this going to make a difference for the patients/members? Will it help them pick a health plan? Will it help them find out if their doctor is covered? Their meds? Will it help them better understand how much things are going to cost them out of pocket? Because if not, what the hell is the point? It’s easy to get caught up in the implementation, especially when you’re dealing with regulatory requirements. Question 1 is naturally… how do we meet the regs so we don’t have a problem? That, as Shahid puts it, is institution first thinking. The smart health plans… the member-centric health plans are asking, how are we going to use this to make things better for our members? It’s a great discussion. You’re going to love it and I’m so happy we get to share it with you. On that note, thank you to Satish Kavirajan, Managing Director at the Actionable Intelligence Network (AIN) for letting us share this with you! Health Data Unbound The Health Data Unbound Virtual Conference: Innovations in Health Data Sharing for the COVID-19 Era and Beyond, hosted by Actionable Intelligence Network, was held on November 10-12, 2020, and is now an on-demand event. While there have been many events on interoperability and data sharing, what’s unique here is the focus on the BUSINESS rationale for health data sharing. The conference focuses on the emergent need for interoperability of all kinds, implementation of appropriate sharing of patient information, high priority use cases, value propositions, and companies with enabling technologies, business models, and strategies. Videos of all presentations from the Health Data Unbound Virtual Conference can be accessed by registering on the Summit website: https://ain.events/hdu/ The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.
39 minutes | Jan 7, 2021
Selling to Health Plans from the Digital Health Growth Summit
This podcast features the Selling to Health Plans panel discussion at the Digital Health Growth Summit, moderated by our very own Shahid Shah, with panelists Vijay Bhatt, Deputy CTO, Harvard Pilgrim Health Care, and Bill Friedman, Vice President of Sales, Zipari. The panel covers some of the most important digital health technologies that health plans are interested in and how digital health startups can get health plan executives to buy the technologies they’re building. One of my favorite points is that you’ve got to de-risk the decision to buy: Start small and build-up Pilots are not bad when done right Show the IT department that you won’t be a pain in their neck Show the finance department a transparent roadmap of the true cost of ownership from implementation thru tangible ROI. Some great advice for anyone trying to sell in healthcare. This panel discussion complements several recent episodes: Episode 145: How Payers Can Master Core Administrative Transactions and Deliver a World-class Experience to their Members and Providers w/ Steve Krupa Episode 148: Partnering with Payers w/ Andrew-Adrian Karlin of Highmark Episode 150: How to Turn the Growth Engine on in your Digital Health Startup with Bryan Loomis – one of the organizers of this event Episode 151: Shifting Healthcare’s Culture Toward Openness and Experimentation with Red Hat’s Paul Jones where we talk about his experience as a buyer at a health plan and how that helps him in his new role as a seller. We focus on selling a lot because you may have the best solution in the world, but nothing happens until someone sells something. The Digital Health Growth Summit The Digital Health Growth Summit, hosted by Actionable Intelligence Network and Viral Healthcare Founders, is an on-demand virtual event. The Summit was held on October 29-30, 2020. This two-day Summit highlights the marketing, sales, and leadership capabilities and strategies that are necessary for digital health startups to grow and scale. Speakers include nationally recognized growth experts and executives from digital health companies, hospitals, health systems, health plans, investors and accelerators. The Summit is designed to meet the information needs of marketing and sales leaders and other senior executives at digital health startups. The program would also be of interest to digital health accelerators, the investment community, consulting firms, and marketing and sales technology companies. Videos of all presentations from the Digital Health Growth Summit can be accessed by registering on the Summit website: https://ain.events/dhgsummit/ Thank you to Satish Kavirajan, Managing Director at the Actionable Intelligence Network (AIN), and Bryan Loomis, Founder at Viral Healthcare Founders for allowing us to share this content with you The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.
61 minutes | Dec 11, 2020
Shifting Healthcare's Culture Toward Openness and Experimentation with Red Hat's Paul Jones
The business of healthcare is consensus-driven and permissions-based. As we’ve seen time and again on this show, this culture slows innovation, stretches sales cycles, and inspires institution-first thinking. Ultimately, it’s responsible for the high costs and lousy user-experiences we’re all trying to fix. What if healthcare went from a culture of consensus and permission to one of openness and experimentation? That’s what we’re going to explore today. Our guest, Paul Jones, “grew up” in a large health plan where he was the prospect and buyer of health IT systems and solutions. Now, as Red Hat’s Healthcare Strategist for the Northeast US, Paul is selling innovative healthcare solutions rooted in Open Source software back into the industry he cut his teeth in. After making this move, Paul didn’t just find open-source software, but an open culture. Looking back on his days at the health plan, this is the first thing he would try to replicate if he went back. We’re going to find out why and explore the hurdles he might face in that endeavor. In addition, we dig into everything Paul learned as a prospect and buyer of health IT systems, and how he’s using that to be a more effective partner as he sells back into the healthcare industry. We round out the conversation with a real-world example of a Sepsis-detection system that has already saved 9,000 lives, a riff on why FHIR may still be the gamechanger the hype has promised, and of course, we get into data governance and data quality. This is a wide-ranging conversation, and it's packed with insights. Enjoy! Paul Jones Paul Jones is Red Hat’s Healthcare Strategist for the Northeast US. He and his teammates drive innovative healthcare solutions rooted in Open Source software. Prior to that Paul was VP, Card-to-Care at HM Health Solutions where he led the Clinical, Provider and Pharmacy Application Delivery domains focused on Value-Based Care and Care Management Solutions to multiple payers. Before that Paul Led Architecture at HM Health Solutions. Paul has had roles in both IT and Business. “Open unlocks the world’s potential.” Email: paul.Jones@redhat.com LinkedIn: https://www.linkedin.com/in/paulejones/ Red Hat Red Hat is the world’s leading provider of open source solutions, using a community-powered approach to deliver reliable and high-performing Linux®, hybrid cloud, container, and Kubernetes technologies. This efficient, focused method outpaces traditional proprietary software development models and enables healthcare customers to customize solutions in areas such as data integration, clinical reasoning, and compliance automation. It’s why 100% of healthcare companies in the Global Fortune 500 rely on Red Hat. Learn more at redhat.com/health Related Episodes Episode #148: Partnering with Payers – Andrew Adrian-Karlin Episode #149: How Health Systems Think with Neil Carpenter And since Paul briefly mentions the topic, check out our Provider Directory series. The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.
47 minutes | Dec 3, 2020
How to Turn on the Growth Engine in Your Digital Health Startup w/ Bryan Loomis
Many digital health startups rely on sales prospecting to generate new leads. That works to a point but doesn’t scale because each deal takes a long time, and good healthcare salespeople are hard to find. Today we’re talking with Bryan Loomis, a Digital Health Growth expert and mentor, about how to design, build and execute a growth plan that generates leads in a more sustainable way. We discuss: Bryan’s PAGE Methodology (Purpose, Audience, Gospel, and Experimentation) for growth The importance of generating marketing qualified leads instead of relying solely on sales prospecting Why email opt-ins are a good indicator your plan is working Useful tools to help you execute your growth strategy The proper way to reach out to prospects on LinkedIn How to use the assets you already have to generate content and “gifts” for your audience You don’t need blind experimentation, but hypothesis-driven experimentation with measures and statistics. And much more Bryan Loomis “I’m Bryan Loomis, digital health growth expert and mentor. I’ve mentored 25+ digital health companies, from ranging a founder with an idea to 200 million in ARR. My proven methodology helps digital health startups grow rapidly in an entrenched industry that’s set up for them to fail. Grow your startup. Change the world.” Learn more, check out the video series VHFcast, and sign up for Bryan’s Slack Community at: https://bryanloomis.com/ Connect with Bryan on LinkedIn Related Episodes & Resources Episode 136: Marketing in a Post-COVID World with Jared Johnson Book: Traction: How Any Startup Can Achieve Explosive Customer Growth by Gabriel Weinberg and Justin Mares – This book breaks down the 19 channels that you can use to build your customer base and helps you identify the best ones for your business. The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.
59 minutes | Nov 24, 2020
How Health Systems Think with Neil Carpenter
Get ready for a cold dose of reality. On this episode, we’re talking with Neil Carpenter, VP of Strategic Planning at Array Advisors and former health system Chief Strategy Officer, about how health systems think. This behind the scenes look at health system strategy, decision-making, and purchasing tells you much of what you need to know as a startup/vendor trying to sell into this market. You won’t like everything you learn, but it’ll give you a much more productive way to look at your product or service and how you fit into the cold-hard reality of health systems. You’ll learn: Health systems are permission oriented and consensus driven. What does that mean and how does it affect your sales strategy? The difference between the big-name systems and their scrappy competitors down the road. What is the role of a Chief Strategy Officer at a health system and how can you work with them to get your foot in the door? Why health systems are so focused on what’s happening right now and struggle to look to the future. That most decisions are driven by personal, and not organizational interests, and how that impacts your ability to make deals How to avoid the common pitfall of focusing on your solution, and not taking the time to truly understand your buyer Why it’s easier for health systems to buy from established players than small shops NOTE: We touched on this in Episode 148: Partnering with Payers too Why health system executive compensation and performance expectations make innovation difficult Why the “local monopoly” strategy is so common for health systems and why telemedicine is so threatening to that model How to get to know health systems you’re trying to sell to What are the two primary power centers within the health system and how to work with each of them? Which solution spaces are overcrowded and should be avoided? Which solution spaces are wide-open and ready for new solutions? Why a good spreadsheet may be your most potent sales tool This one is densely packed and full of fire. You may want to listen twice. Neil Carpenter Neil Carpenter is a health care strategy and innovation consultant– he advises clients from health systems (e.g., on the future of precision medicine, ambulatory planning) to the State of Maryland (e.g., COVID-19 planning). Neil’s thought leadership, where he is the VP of Strategic Planning at Array Advisors modeling the impact of COVID-19 on the US health care sector has been cited by the Wall Street Journal, the Washington Post and several industry publications (e.g., Health Leaders). In his career, Neil has been a system leader and senior advisor to health system leaders and boards. Neil was the Chief Strategy Officer for LifeBridge Health, a $2billion+ integrated health care delivery system in Maryland with over 400 employed providers and assets across the entire continuum of care. In that role, Neil had wide-ranging responsivities, including helping lead the clinically integrated physician network which had one of the highest ACO savings in the country for several years, launched the first in the nation, offshore command center, the first bioincubator inside a community hospital in the country and new patient engagement technologies aimed at some of the most socio-economically patient populations in the country. Neil also spent a decade at leading consulting firms. Neil’s clients included Kaiser Permanente, Sisters of Mercy Health System, Steward, UnityPoint, Trinity, Dana Farber, the Military Health System, Montefiore, and the University of Virginia among many others. Prior to entering consulting after business school, Neil focused on global reengineering, financial analysis and process improvement at GE and American Express. Neil has a Master’s Degree in business from Georgetown University and a Bachelor’s in Business from the University of Massachusetts at Amherst. Neil has served on various state task forces related to Health System planning, taught at John’s Hopkins Carey School of Business and has been published papers on technology transformation in forums such as Digital Biomarkers and AMA Journal of Ethics. LinkedIn: https://www.linkedin.com/in/neil-carpenter-924a40/ Array Advisors We understand that asking the right questions positively affects your Health System’s goals. Our purpose is to ask the questions that turn your goals into tangible realities. Array Advisors has the expertise to help position your organization for success in tomorrow’s uncertain market. As your trusted partners in Strategy Development, Organizational Transformation, and Building Informatics, we can help you solve strategic business problems and develop methods to improve efficiency and utilization. We approach each problem from a unique angle, providing a plan tailored to help you overcome your toughest challenges. Having dedicated our careers to healthcare innovation, our objective viewpoint and industry-wide knowledge provide you the decision support you need. Website: https://array-advisors.com/ COVID-19 Resource Hub: https://info.array-architects.com/en-us/covid-19 Market Disruption Study: https://array-architects.com/press-release/array-models-healthcare-disruption-top-111-markets/ Links and Resources Episode 103: Selling to Health Systems: Advice for Digital Health Startups (Part 1) Episode 105: Selling to Health Systems: Advice for Digital Health Startups (Part 2) Episode 85: Lessons on Selling in Healthcare w/ Dom Cappuccilli The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.
61 minutes | Nov 17, 2020
Partnering with Payers - Andrew Adrian-Karlin
For many healthcare startups and established vendors, partnering with payers is a crucial part of their business plan. And as we know, selling in healthcare is hard. It’s even harder when you don’t understand how these large corporations work. What do they want? How do they set priorities? How do they make purchasing decisions? How long does that process take? The list goes on, and if you’re strategizing without this knowledge you’re going to struggle. That’s where this episode comes in. Today we’re talking with Andrew Adrian-Karlin, Director of Business Platform Product at Highmark Health. Andrew sheds some light on how payers decide what to do and who they decide to do it with. This episode will help you build an effective framework for preparing, approaching, and successfully partnering with payers. You’ll Learn What are “products” from a health insurance point of view? What is the purpose of health insurance? Note: This is the same question we went deep on with Steve Krupa from HealthEdge on Episode 145. Steve’s answer is also worth a listen. What are some things that payers are interested in from a “business processing” perspective? How do payers set priorities? What’s the typical timeline for bringing on a new vendor and what factors contribute to it? What are the challenges, both internally and externally, that need to be managed when bringing on a new vendor? What can/should vendors do to minimize these challenges and shorten the timeline? How do external factors like the CMS Interoperability Rule or the COVID-19 pandemic impact your priorities? And a little bonus here: Why no one – not payer, not vendor, not lawmaker, and not even the regulator – fully understands new regulations and how that creates an early mover advantage. What are the best ways to keep a pulse on what a health plan is trying to do so that you can partner with them? NOTE: For more tactics on this one, Jeff Byers gave us the journalists take on Episode 62. Andrew Adrian-Karlin Andrew Adrian-Karlin helps companies do new things by better applying technology. I’m proud to be transforming healthcare at Highmark Health. As the Director of Business Platform- Product at Highmark Health, Andrew focuses on building cross-functional teams and leading Product Managers. He is accelerating speed to market for new products, reducing the cost to market, and delivering improved experiences to Highmark’s members. Andrew has more than 10 years of experience in Information Technology. Prior work has included diverse areas like data analytics, cybersecurity, post-merger integration, and system development. He holds a BS in Accounting from Case Western Reserve University, an MBA from Carnegie Mellon University, and a number of professional certificates and certifications. LinkedIn: https://www.linkedin.com/in/andrewadriankarlin/ Highmark Health One of America’s leading health insurance organizations and an independent licensee of the Blue Cross Blue Shield Association, Highmark Inc. (the Health Plan) and its affiliated health plans (collectively, the Health Plans) work passionately to create a remarkable health experience for customers. Highmark Inc. and its Blue-branded affiliates proudly cover the insurance needs of 5.6 million members in Pennsylvania, Delaware, and West Virginia. As an industry, health care poses new challenges every day that require deep insights, constant innovation, and new solutions. The Health Plan business has boldly forged ahead with doing things differently, piloting new approaches, and breaking from the pack. Web: https://www.highmarkhealth.org/ Links and Resources Episode 145: How Payers Can Master Core Administrative Transactions and Deliver a World-class Experience to their Members and Providers w/ Steve Krupa Episode 141: The State of Payer Data with Jordan Bazinsky Episode 103: Selling to Health Systems: Advice for Digital Health Startups (Part 1) Episode 105: Selling to Health Systems: Advice for Digital Health Startups (Part 2) Episode 96: The CMS NPRM: Opportunities from the Payer Perspective Episode 85: Lessons on Selling in Healthcare w/ Dom Cappuccilli The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media. Music by StudioEtar
39 minutes | Nov 10, 2020
Applying Conversational AI to Reduce Provider Burnout from HealthIMPACT Live
There’s a lot of talk about addressing physician burnout, but little practical advice about what to do. The path to action lies first in understanding the many sources of burnout, and then separating them into those that we can impact, and those we cannot. There’s a class of burnout factors that are intrinsic to being a physician. Simply put, it’s a hard job, and it's demanding in both a physical and mental sense. But this is part of what they signed up for, and due to their passion and sense of purpose (as we discussed at length with Dr. Vivian Lee on Episode 143), most physicians are willing and able to work through them. That’s good because there’s little we in the tech/entrepreneur community can do to help. The problems arise with the other class of burnout factors – the extrinsic variety. As a society, we have in many ways changed our deal with doctors over the past 10+ years. Under the guise of healthcare transformation, we have piled on to the existing stressors with paperwork, regulations, quality measures, reimbursement cuts, and more. These are burdens that physicians didn’t sign up for, and they are not supported by the same passions we mentioned earlier. The additional layers may be necessary to support our healthcare transformation goals at a systemic level, but they don’t always translate into better care for individual patients, and often undermine the patient/physician relationship. To a physician, this administrative burden feels unnecessary at best, and directly in conflict with their mission at worst. If we really do need these things, and we should confirm that regularly, then we also need to provide the tools and support to make them happen. And that brings us to the point of this episode. Today, we’re sharing a discussion from the HealthIMPACT Live Summer Forum (July 22-24, 2020). In it, our co-host Shahid Shah discusses how to apply conversational AI to reduce physician burnout with Peter Durlach, SVP of Strategy and New Business Development at Nuance. As the setup would indicate, Shahid and Peter discuss the sources of physician burnout and help us to better understand where we in the tech/entrepreneur community should be focusing our efforts if we want to make an impact. Their discussion covers: The sources of physician burnout The difference between intrinsic and extrinsic stressors and why we should focus on the latter How good conversational AI, or dictation, can cut the administrative time by half How ambient conversations, where the AI listens in to the conversation as it happens, can take it to the next level Why we should also be working on nurse burnout How we can help before, during, and after the patient visit How the COVID-19 pandemic is accelerating decision making and innovation in healthcare (as discussed in Episode 137 - The Novation Dynamic: 3 Pillars for Healthcare Innovation Success with Michael Ackerman) Specific advice for entrepreneurs looking to enter healthcare The difference between health systems that get this right and those that spin their wheels I’d like to thank our partners at Purpose Events for allowing us to share this content with you. They run the HealthIMPACT Live series, and our very own Shahid Shah is the HealthIMPACT Forum Chair. Shahid describes it as a “No BS and No PowerPoint” event that’s intended to be more of a conversation than a series of presentations. The goal is to get healthcare leaders together and facilitate a conversation amongst peers about the work they’re doing in the real world. Definitely fitting for a listener of this show. Links and Resources Purpose Events website HealthIMPACT Live page HealthIMPACT Live on YouTube This interview on YouTube Upcoming HealthIMPACT Live Events Episode 144: HealthIMPACT Live Fall Forum Preview plus Tips on Running Virtual Events Episode 90: Healthcare Is Not Quite Digitized w/ Bill DeStefanis of Nuance - how and why paper is still widely used in healthcare, how we can keep it secure, and how we can effectively integrate it into our digital workflows. The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.
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