Jonathan Bush

Still trying to make sense of Walmart pulling back from healthcare delivery? 3 quick thoughts: 🏥 Healthcare delivery is hard, even for companies where it's a primary focus. Navigating reimbursement and competition is extremely challenging. 💸 The patient may be a customer, but they are never the payer. 📊 No matter a company's stature, cooperation and reimbursement from health plans—both nationally and locally—are still critical for building profitable businesses. For a deeper dive, check out our full analysis here: https://lnkd.in/eXTeugKD

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Smart move by Allegheny Health Network - and likely one that others will follow. #GenerativeAI systems are so powerful and effective in conveying information that not only will businesses and organizations of all types fill follow. And as developing #ChatGPT-style systems become easier, its likely we will each have our own personal #AI. #aiinnovation https://lnkd.in/eaqAZCFT

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I'm thrilled that today, we announced a significant milestone for Clover Health: the launch of Counterpart Health. Our innovative Clover Assistant (CA) platform is now available to all Medicare Advantage payors and providers under the new brand name Counterpart Assistant. Why am I so excited about this? This move is a strategic leap forward in our mission to improve healthcare for everyone. With Counterpart Assistant, we're not just expanding our reach—we're leveraging cutting-edge AI and machine learning capabilities that have already proven to make a real difference in patient care. The healthcare landscape is evolving rapidly, and the need for advanced, data-driven tools has never been greater. Medicare Advantage plans, in particular, are under pressure to improve patient outcomes while managing costs. That’s where Counterpart Assistant comes in. By bringing our technology to more providers, we're empowering clinicians with the tools they need to deliver high-quality, personalized care. What makes Counterpart Assistant special? First, we’re broadening our impact by allowing providers outside of Clover Health's Medicare Advantage plan to benefit from our technology. Our hybrid SaaS and shared-savings model aligns financial incentives with health outcomes, ensuring flexibility and scalability. CA’s AI-driven insights enhance clinical decision-making, and are associated with earlier diagnosis and better management of chronic diseases. Plus, we've built a robust support system to ensure seamless integration and ongoing assistance for all users. Clinicians using CA have seen significant improvements in Medical Cost Ratios and patient outcomes. The timing couldn't be better. The healthcare industry is ripe for transformation, and our technology is poised to lead the way. By expanding the use of Counterpart Assistant, we’re not just keeping up with the changes—we’re driving them. Join us on this exciting journey. Visit our website for more details. Thank you for your continued support as we strive to bring high-quality healthcare to everyone on Medicare. #HealthcareInnovation #AI #MedicareAdvantage #ValueBasedCare #CloverHealth

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AccendoWave - A Pain #Data Company More recently, the federal government has begun using the QIS program and QRS parameters to advance health equity. Federal rules now require all marketplace insurers to adopt a strategy for reducing health disparities and to stratify certain clinical data by race and ethnicity. While state-based marketplaces (SBMs) have authority to supplement these federal minimum QIS and QRS standards with state-specific quality rules, most have hewed closely to the federal default approach. California and Washington are notable exceptions. Each has implemented a customized QIS program and robust data collection standards to identify and reduce racial and ethnic health disparities. Time to Focus on - #Pain not being Believed. A Root Cause Health Equity Problem. A Top 4 Global Health Equity Solution and Top 15 Global Remote Monitoring Company, AccendoWave, benchmarks objective brain wave pain data (specialty, gender, age) and has nine #pain databases: Emergency Department, Maternal Health, Oncology, MSK, Medical Surgical, ICU, #Women, Adults, #Seniors to eliminate bias, improve outcomes and reduce health care costs. If desired, AccendoWave can also create customized pain databases for partners that can be accessed on the Datavant platform.

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Oshi Health: Insights to Scale a Specialty Care Model… It is hard to stomach the fact that there are an estimated 60 – 70 million Americans who suffer from gastrointestinal (“GI”) conditions, costing the U.S. healthcare system approximately $140 billion annually, according to the National Institute of Diabetes and Digestive and Kidney Diseases. BCC Research tallied the costs of just the therapeutics and associated diagnostic procedures were $86 billion last year, increasing to more than $123 billion by 2028. There are now more than 100 million GI ambulatory care visits each year and GI conditions are thought to be one of the four most expensive diseases.   In part as a function of the pandemic when the healthcare system had to become virtual/on-demand/predictive/always-on overnight, there was a dramatic influx of capital in 2021 of nearly $30 billion invested in healthcare technology companies, much of which went to launch virtual specialty care models across many diseases.    As we now appear to be in an “emerging winners” phase of the market, some observations on what it takes to scale virtual specialty care models into substantial businesses. https://lnkd.in/eTJeAFBu Flare Capital Partners #digitalhealth

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Here’s your recap of last week’s health IT news 🗞️ 👇 💼 Administrative • Pager + League: The care orchestration solution will be embedded into the patient engagement platform for maternity care.    • Veradigm®: The ambulatory care solutions vendor has announced that it is exploring a merger, sale, or other transaction.    • Kyruus Health: The provider search and scheduling solution said it would add MEDITECH to its list of EHR partners which already includes Epic , Oracle (Cerner), athenahealth , and others.   🥼 Clinical • Clover Health: The physician enablement technology company launched its previously internal-facing clinical decision support tool via its subsidiary Counterpart Health as a standalone solution for external Medicare-focused payers and providers.    • Children's Minnesota + ShiftMed: The pediatric health system is partnering with the on-demand workforce tech platform. 🤝 VBC • Innovaccer: The VBC data & analytics company launched its quality management and reporting platform for health plans. 🤖 AI • Plenful: The AI workflow automation company focused on streamlining pharmacy operations announced a $17M Series A.    • SamaCare: The AI prior auth platform announced a $17M Series B. 💡 Things We Found Interesting • In our view, there’s not enough discussion about why technology pilots in health systems fail. So we appreciated this perspective from Justin R. Brueck at Endeavor Health, on three of the most common reasons he sees things go awry. https://lnkd.in/eKBZ_g2N    • We’re continuing to see stories illustrating both the promise and perils of leveraging generative AI in the practice of clinical medicine. Given the pace of progress, it seems clear that AI will play a significant role in clinical care sooner than later. Lots of thorny questions to work through in a short amount of time. (Here are a couple examples from Yudara Kularathne MD, FAMS(EM) and Graham Walker, MD we appreciated: https://lnkd.in/ePUr2SgE, https://lnkd.in/ej9UpfYg)    • On that note, we’re always interested to read the latest research on how AI solutions are performing in the field. One recent study published in JAMA found that AI scribes significantly reduced time spent in the EHR. Researchers of another, however, cautioned that providers must remain vigilant when using GenAI, based on the fact that Chat-GPT produced different outputs when asked to simplify radiology reports for patients of different races. https://lnkd.in/emNi-_Ai, https://lnkd.in/ejH4KHsq  

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Technology in its current state is worsening the physician crisis. There seems to be a new referral pathway every month with unlimited check boxes and data for us to input. Each often requiring a new log in and at times two factor authentication. It seems with every new tech in healthcare we spend more time interacting with the tech and less time interacting with our patients. The solution is simple, if the tech in question results in decreased physician-patient time then it shouldn’t be rolled out. The one thing to keep in mind is say you’re rolling out a new patient intake form for referrals for MRIs to better triage patients. It’s important to think about the downstream effects of who will fill out this form and the time needed to do so. As a front line physician every new referral intake pathway increases my admin burden and endpoint burnout. In an ideal world I simple type “MRI lumbar spine” in my EMR and all the data is auto populated. Sadly this almost never happens. #primarycare #healthcare #familyphysician

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We’re all too familiar with one of digital health’s most “popular” sore spots: point solution fatigue. I’ve even written about this for the Forbes Business Council (https://buff.ly/43ADMKt) With the rising demand for GLP-1s, buyers are looking for yet another solution to help mitigate rising costs. But have they considered taking a closer look at current vendors they may have to treat chronic or cardiometabolic conditions? For example, Omada Health has been working with members taking GLP-1s since 2019 at the launch of its diabetes program - and now has a GLP-1 Care Track available across its full cardiometabolic suite, which includes diabetes prevention, diabetes, and hypertension. Buyers should provide a program that takes more than just weight loss into account. They should consider MSK support, and sustainable outcomes (i.e. long-term support should members discontinue the drugs). We’re not here for a quick money grab, but to support members for long-term weight health. Learn more about Omada’s approach to GLP-1s: https://lnkd.in/gm77rfWk

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The landscape of healthcare interoperability is finally beginning to change. The HITECH Act's passage in the early 2000s incentivized the adoption of electronic health records across the industry. New regulations enhance accessibility to APIs and open seamless data exchange between healthcare providers, pharmacies, payers, and patients. This encourages collaboration to improve patient care, optimize outcomes, and lower costs. Prioritizing safe and secure data sharing via APIs empowers patients to access their health data. How do pharmacies continue to drive progress in healthcare interoperability? #Healthcare #HealthData #Pharmacies #PatientCare Video Edits by GrowthMatch

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A must-read article. You might not agree with it, but it certainly makes the case we make which is understanding what AI can and can't do, and knowing how critical the underlying data and how that is organized and handled, is mission critical.

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If health systems master the art of delivering a world-class consumer experience in urgent care, they can replicate this success across their entire operation, becoming market leaders and thriving in the long term. This is the core thesis of what we do at UCP Merchant Medicine. For nine years, UCP Merchant Medicine has partnered with 68 healthcare operators, most of whom are health systems, to create internal capabilities that allow them to thrive in consumer experience excellence. This isn’t just about having a world-class urgent care platform, this is about owning the future and the capabilities to expand these experiences across the broader health system. As healthcare shifts towards a consumer-driven model, the need for health systems to adapt is more critical than ever. Patients now have unprecedented freedom to choose their care providers, with 45% researching providers and costs before choosing a health plan, and 44% before making an appointment, according to McKinsey’s consumer Health Insights Survey. These improvements are not just numbers; they're about real people getting better access to the care they need when they need it in a way that they will love. This is what we stand for at UCP Merchant Medicine. Join us as we continue to innovate and lead the way in making healthcare more responsive, efficient, and patient-centric. Together, we can transform the future of healthcare! #HealthcareInnovation #PatientCare #UrgentCare #HealthcareLeadership #UCPMerchantMedicine Intellivisit Solutions

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Here's a shocker -- the AHA and the FAH are pushing back against Medicare's mandatory hospital-based bundled payment program. The hospital associations are asking for more time to get ready for a program that will start in 19 months.... It's laughable, of course, but what else should we expect from the agents of the status quo? For those who hadn't kept up, Medicare announced the Transforming Episode Accountability Model several months ago and it's finally going through the end of the rulemaking process. So what's TEAM? A slimmed down version of the Medicare Bundled Payment Model (BPCI and its successor BPCIA) that has been in place for over a decade. There's nothing new about TEAM except that it only covers a handful of inpatient stays and the accountability is reduced to 30 days post discharge instead of 90. Four years ago a dozen or so highly respected leaders in the industry recommended that CMS institute a "DRG+30" across the board. Not just for five DRGs, but all DRGs. And here we are, four years later, and TEAM is set to start in 2026....yes, 2026, not 2025. The first cohort of the original program launched in April 2013, more than 11 years ago. By the time TEAM starts it will have been close to 13 years. Isn't that enough time to get ready Chip Kahn???? All of the published analyses on the Medicare Bundled Payment program showed the same source of savings -- post-acute care. And the savings never negatively impacted outcomes. So it's logical that Medicare makes this mandatory. What's not logical is that it's taken so much time to get to this decision. So let's just get on with it because the taxpayers deserve it and so do Medicare beneficiaries. #TEAM, #BundledPayments, #CMMI

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Embracing the Future of Telemedicine: The Path Toward Integrated and AI-Enhanced Care I fully concur with Spencer Dorn's recent post with a balanced perspective on the evolution and current limitations of telemedicine. While telemedicine has indeed not lived up to the initial sky-high expectations, its integration into our healthcare system still holds vast potential. Here are some additional points to consider: ·     Care needs to be multimodal: Effective healthcare should seamlessly blend in-person visits, telemedicine, and other forms of digital communication. This integration will cater to different patient needs and scenarios, enhancing accessibility and effectiveness. ·     Technology needs to evolve further to provide better comprehensive solutions: The current telemedicine platforms must evolve to offer more holistic healthcare solutions that are not only technologically advanced but also user-friendly for both patients and healthcare providers. ·     Adoption needs to happen: For telemedicine to truly become an integral part of healthcare, widespread adoption is necessary. This means not only by patients but also by healthcare providers who must embrace these new tools as part of their everyday practice. ·     Reimbursements need to improve: One of the major hurdles to the adoption of telemedicine has been the lack of adequate reimbursement models. As these improve, it will encourage both healthcare providers and patients to utilize telemedicine more extensively. ·     Future generations will likely be more attuned and comfortable receiving digital care: As digital natives age into needing more medical care, their familiarity and comfort with technology will lead to greater adoption of Telehealth services. Conclusion: The evolution of telemedicine is inevitable, though perhaps not immediate. With rapid technological advancements, particularly in AI, the future of integrated telehealth is promising and might arrive sooner than we think. The journey towards a technologically enhanced healthcare system is on its horizon, and it's only a matter of time before it becomes a new standard of care. That's why Idrees Mohammed and I @The Cloud Intelligence Inc are working tirelessly to bring solutions that not only foster change in our current healthcare landscape but will truly revolutionize it. #HealthcareEvolution #Telemedicine #HealthTech #DigitalHealth #AI

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Interesting, if seems to make sense that when companies merge there are efficiencies driven from scale etc. That does not seem to be the case when health systems merge. Check out this article, post mergers pricing seems to increase and that is bad for local employees as unemployment follows. What do you think https://lnkd.in/gCpGSG9t

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I believe every #healthcare organization—#hospital, provider group, #pharmaceutical, managed care, startup—should aim to be at least 10% better every year. If we can each be 10% better— 10% more timely. 10% more effective. 10% more efficient. 10% more equitable. 10% more patient-centered. 10% less costly. And be 10% better every single year— Over time—the compounding improvement will lead to the real transformation we seek. Ten percent does not sound like a lot and improving the first 10% won’t be hard. Because we all know we have some easy opportunities in our sight. But the next 10 and the next 10 and the next 10 will test our ingenuity and our guile. Unlocking that extra 10% is going to require an improvement mindset. Obsession with detail: with getting the big and small things right 100% of the time. Humility: the ability to call your business ugly. Flexibility: the willingness to try new approaches or introduce new talent Perseverance: the ability to keep going even when things are hard. and most of all Accountability: the ability to take responsibility for outcomes and lead. Too many of us are preoccupied with defending the status quo when we *know* we can be better. Time to change our tune—and industry culture. #leadership #motivation #saudi #uae #saudiarabia #uaehealthcare #medicine #patientcare NMC Healthcare Cleveland Clinic Johns Hopkins Aramco Healthcare (JHAH) #apollohospitals #fortishealthcare #asterdmhealthcare #manipalhospitals

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🚨🚨 Thoughtful Analysis Alert 🚨🚨 Why are we seeing significant pullbacks in healthcare services from major retailers like Walmart and Walgreens. This strategic shift underscores the real challenges in healthcare delivery today. Our latest blog post talks about why these pullbacks are happening, the implications, and more. #HealthcareInnovation #RetailHealthcare #StrategicInsights #HealthcareTrends https://lnkd.in/gfW5aX3n

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🔎 Senators See Possible Conflicts of Interest in Health Care Pricing Tools The chairmen of two Senate committees overseeing health policy, Ron Wyden of Oregon and Bernie Sanders of Vermont, are looking into the practices of data analytics firm MultiPlan. Concerned about companies prioritizing their own profits over patient well-being, the senators are investigating MultiPlan's business model, which recommends lower payments to medical providers. This model could lead to a conflict of interest, as MultiPlan and insurers can collect higher fees when payouts are lower. The senators have called on MultiPlan to discuss their investigation and address concerns raised by a recent New York Times article. Read the full article here: Senators See Possible Conflicts of Interest in Health Care Pricing Tools MultiPlan has stated that they are working with the Senate committees to explain the complexities patients face when choosing high-priced care outside their networks, emphasizing their commitment to making healthcare transparent, fair, and affordable for all. This inquiry reflects the growing scrutiny of MultiPlan, which has faced allegations of anticompetitive behavior and collusion with insurers to fix prices. The Department of Labor also has ongoing investigations into the type of pricing services provided by MultiPlan. The attention on MultiPlan highlights the importance of employer-based health insurance, which is the most common way Americans receive coverage. Employers are increasingly looking into the cost of administering their plans and are frustrated by limited access to claims data. Legislation has been introduced to address this issue, requiring insurers to provide employers with claims data. As the investigation unfolds, it remains to be seen how MultiPlan and insurers will address concerns and ensure that patient well-being is prioritized over profits. #HealthCarePricing #PatientAdvocacy #HealthInsurance #DataAnalytics #SenateCommittees

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“We envision a future where every child receives personalized, high-quality care. To make this vision a reality, we must overcome the challenges of #carecoordination,” said Dr. Amanda Furr, VP of #PopulationHealth at Pediatrics Associates Inc. “We understand the value of #dataanalytics, risk adjustment, quality gap closure and empowering #pediatric clinicians to improve outcomes. As our organization continues to grow, it’s imperative for us to scale our #PHM capabilities. The #Innovaccer platform enhances our understanding of patient populations and helps us make accurate diagnoses, establish and automate TCM protocols, and bridge care gaps. This holistic approach helps us to deliver a seamless, comprehensive #healthcare experience for our patients and families.” “We have an established relationship with the #PediatricsAssociates team, and we are excited to be working with them again as we are setting a new standard for #healthcare, where #technology and compassion converge to enrich the lives of children and their families,” said Abhinav Shashank, cofounder and CEO at Innovaccer. “Pediatric Associates has an impressive track record in managing over 1.5 million lives across Medicaid and commercial contracts. Innovaccer’s AI-powered, scalable PHM platform will help them effectively manage patient populations to meet their goal of managing over 1 million covered lives in the next two years. We look forward to supporting Pediatric Associates in its mission to launch a new era of pediatric care that is both proactive and profoundly impactful.” https://lnkd.in/gvUD-sm4

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Let's keep hospice focused first and foremost on the PATIENT. After all, we only get one chance to do it right... "There are six primary trends that are influencing consolidation and professional practices: regulatory complexity. technology and integration, private equity ownership. demographics, economies of scale and consumer expectations,” Henderson said. “So many of these things that we see that are influencing health care consolidation need to be pointing toward the patient." #patientsfirst #hospicecare #youonlygetoneshot https://lnkd.in/gbbgV-YF

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