Sat, 04 Nov 2023 05:52:33 +0000 en-US hourly 1 Videra Health Launches AI Digital Health Companion Fri, 03 Nov 2023 16:48:00 +0000 ... Read More]]>

What You Should Know:

Videra Health has introduced Ava, an AI-powered digital health companion designed to improve patient engagement and care delivery for healthcare providers and payers.

– Videra Health’s AI digital health companion aims to enhance patient compliance, awareness, and involvement in their own care, ultimately improving patient outcomes.

Ava: AI-Powered Digital Health Companion

The digital health companion utilizes large language models and machine learning algorithms to tailor its questions and interact with patients, providing a seamless and personalized approach to collecting patient information. The technology’s real-time interaction with patients allows for the early detection of subtle changes in their health, potentially leading to the earlier detection of developing complications.

Ava can be seamlessly integrated into care management clinical workflows, enabling prompt escalation to in-person clinical care when patient responses indicate potential serious issues. “Red alert” responses and high assessment scores trigger immediate calls from care navigators or provide instructions for patients to seek emergency care when necessary.

“We are thrilled to introduce our new digital health companion known as Ava, which takes our video assessments to the next level,” says Dr. Brett Talbot, CCO of Videra Health. “The chats are personalized to each individual and aim to enhance the interactions between patients and their providers while also making it easier to gather crucial data. This allows for early detection of potential health issues and more proactive intervention, ultimately leading to improved patient outcomes and reduced healthcare costs.”

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The Realistic Future of ChatGPT/AI in Healthcare Fri, 03 Nov 2023 07:00:00 +0000 ... Read More]]>
Matt Cohen, Director of AI, Loyal

As the buzz around ChatGPT and generative-AI continues, it’s important for health leaders to look past their excitement around these new tools and remain committed to ensuring patient trust is a top priority. Consider that six out of every ten patients are reportedly uncomfortable with providers relying solely on AI for specific healthcare needs, and while ChatGPT may appear to provide impressive responses, there’s still room for error and data misinformation, which can result in patient dissatisfaction and overall negative healthcare outcomes. 

To ensure patient information is utilized in a proper, secure manner, a cautious approach is needed when implementing generative-AI solutions. Though useful, these tools won’t solve all of healthcare’s problems. Instead, implementing a healthy mix of human touch and precautionary measures, like strengthened AI regulations around patient data, is a safer way to create significant improvements throughout the entire healthcare ecosystem. 

Acknowledging existing limitations within generative-AI tools like ChatGPT 

Currently, AI-models like ChatGPT primarily possess the ability to reference specific data they’re trained on; at the same time, they lack some of the cognition to understand meaning. One survey found that of the ChatGPT-generated responses used to develop medical content, 47% were fabricated, 46% were authentic with inaccuracies, and only 7% of responses proved completely authentic and accurate.

AI-models like ChatGPT also face a multitude of other complications when it comes to language and meaning, which must be addressed in order to avoid negative consequences. When these models are asked a question with complex and specific word choices, the response may lack both true reasoning power and accuracy, proving potentially detrimental to a patient’s health. Only 38% of U.S. adults feel utilizing AI like ChatGPT to diagnose diseases and recommend treatments would lead to better health outcomes, with 33% feeling the tool would result in worsened healthcare outcomes. For example, if someone is looking for answers about a rare condition that is not within the ChatGPT’s data training wheelhouse, its responses could result in a misdiagnosis, negatively impacting the patient’s health condition.

Adopting caution to improve overall patient outcomes 

Patient trust is paramount, and right now, that trust is lacking. Reportedly, 50% of patients are not fully sold on the medical advice provided to them through AI, but they are open to a combination of the tool with guided human input, striking a cautionary balance between utility and safety when it comes to handling a patient’s personal healthcare information. Providers can use their medical training and background, as well as their innate understanding of humans, to weed out inaccuracies provided by ChatGPT responses. The right combination of AI and human interaction can potentially improve a patient’s overall healthcare journey. 

Another way to improve a patient’s experience and outcome when working with these tools is by molding generative-AI models, like chatbots, to fit a specific health system’s need. This combination is a win-win for patients and providers, reducing administrative burden by improving simple tasks like appointment scheduling, pre-and post-visit intake forms, billing and statements, etc., and providing patients with a seamless way to access non-urgent healthcare questions in a timely manner. 

Current regulation landscape 

There are still gaps across the industry when it comes to regulating generative-AI, like ChatGPT, in healthcare, which can be detrimental to a patient and potentially risk breached data and public exposure of private, sensitive healthcare information, protected by HIPAA laws. There are existing ways of utilizing this tool in a HIPAA-compliant manner to properly secure patients’ personal data and provide an added barrier of security and peace of mind.

While there is still much to be learned about generative-AI models, these tools can be useful to healthcare workers if introduced and utilized properly. Through a careful combination of providers practicing caution when using these tools, including looking for any data errors or misinformation, we can begin to see an improvement in overall patient healthcare outcomes and satisfaction.  

About Matt Cohen
Matt Cohen, Director of AI at Loyal, is passionate about improving the healthcare experience through intelligent software. Before Matt joined Loyal, he spent several years performing research in areas that include machine learning, speech, signal and audio signal processing at MIT Lincoln Laboratory and the University of Maryland, College Park. He worked as a software engineer and application support engineer at MathWorks, with a focus on machine learning, and was initially hired as a Software Engineer, Applied Machine Learning, at Loyal. As the Director of AI, Matt oversees the company’s machine learning strategy and the AI team, finding new ways to “…provide technology that guides individualized healthcare actions at scale, and creates efficiency within operations.”

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XRHealth Sends VR Headsets for Mental Health to Treat Astronauts in Space Fri, 03 Nov 2023 06:54:30 +0000 ... Read More]]>

What You Should Know:

  • XRHealth, the leading healthcare platform in Spatial computing, announces today that for the first time ever, a virtual reality headset will be sent to space to treat astronauts for mental health conditions during their next space mission targeted for launch on November 5th.
  • XRHealth partnered with Nord-Space Aps and HTC VIVE to configure the VIVE Focus 3 headset to be compatible with the microgravity conditions of space.

Virtual Assistance Driven Mental Health Initiative for Astronauts in Space Missions

While on a space mission, astronauts live in isolation and in non-stimulating and highly stressful environments that could potentially lead to mental health conditions. To address this, Nord-Space Aps created a virtual assistance mental balance initiative aimed to address astronauts’ specific needs to maintain mental health while in orbit. Danish astronaut Andreas Mogensen will be the first astronaut in space to use the VR headset for preventative care during his 6-8 month mission with NASA Crew-7.

“Astronauts are essentially isolated during their missions for months and years at a time and are confined to small spaces with limited contact with friends and family,” says Per Lundahl Thomsen, Chief Technology Officer at Nord-Space Aps. “Creating a virtual platform that addresses their mental health needs while in isolation is imperative for them to maintain a healthy lifestyle when they return. We partnered with companies that provide the most advanced technologies that could be adapted fo

The VR therapy will occur using the HTC VIVE Focus 3 headset equipped with a custom simulator mode designed to function effectively in a microgravity environment. Historically, employing a VR headset in such conditions presented significant challenges related to tracking and orientation. This was due to the constant jittering, rolling, and drifting of the content, leading to motion sickness and rendering the content in the headset unreadable for astronauts. In a microgravity setting, there are no natural gravity vectors to establish orientation, resulting in a gradual drift that rendered the VR headset both unusable and unstable. Previous ventures with different VR headsets encountered issues with losing tracking within just a few minutes of use. Collaboratively, Nord-Space Aps, HTC, and XRHealth undertook the task of engineering a VR platform capable of functioning in space by implementing a simulator mode and a specialized tracking methodology via the controllers.

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Redox CEO Steps Down, Appoints Trip Hofer as New CEO Fri, 03 Nov 2023 05:43:10 +0000 ... Read More]]>
Trip Hofer, CEO at Redox

What You Should Know: 

Redox CEO and Co-Founder, Luke Bonney announced that he is stepping down as CEO and appointing Trip Hofer as the new CEO of Redox to lead the new phase of growth. Prior to joining Redox, Hofer most recently served as CEO of OptumHealth Behavioral Health Solutions and is the former CEO at AbleTo Inc. 

– Bonney stated that the next phase of Redox would be better served by a new CEO with experience in the next stage of the company scaling. Additionally, he stated his family is a significant reason for the transition.

– As part of the transition, Bonney will shift to that of an advisor to the new CEO, with the primary objective of supporting the new CEO and ensuring their success.

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SubjectWell Acquires PatientCentra, Expanding Ability to Recruit for Rare Disease/Oncology Indications Fri, 03 Nov 2023 05:36:50 +0000 ... Read More]]> SubjectWell Acquires PatientCentra, Expanding Ability to Recruit for Rare Disease/Oncology Indications

What You Should Know: 

SubjectWell, a patient access marketplace connecting individuals with chronic health conditions to healthcare options, has acquired PatientCentra, a company specializing in global patient recruitment and personalized recruitment journeys. Financial details of the acquisition were not disclosed. 

– This strategic acquisition enhances SubjectWell’s capacity to serve patient recruitment needs for international clinical studies and further extends its capabilities to recruit for rare diseases and oncology-related research.

– The combined capabilities of SubjectWell and PatientCentra enable customers to rely on a single company for end-to-end, global patient recruitment support for a range of studies, including vaccine trials, chronic conditions, rare diseases, and oncology research. 

PatientCentra Background

PatientCentra, located in Waltham, MA, offers full-service, global patient recruitment capabilities and an in-house agency for developing tailored, patient-centric recruitment journeys. PatientCentra brings 15 years of experience in delivering digitally enabled patient recruitment programs on five continents, adding to SubjectWell’s strengths in North America.

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Generative AI Revolutionizing Digital Health Investment Strategies Fri, 03 Nov 2023 05:31:14 +0000 ... Read More]]> Generative AI Revolutionizing Digital Health Investment Strategies

What You Should Know: 

– A significant 87% of digital health investors stated that generative AI solutions have influenced their investment strategies, with nearly 1 out of 5 respondents indicating that it is significantly affecting their strategy,  according to the results of an online survey from GSR Ventures

– GSR Ventures, an early-stage digital health investment firm with over $3.5B in assets under management, conducted an online poll in September 2023 with over 40 participants from leading firms in the investment community. The survey covered topics such as deal volume, valuations, industry opportunities, and sectors of opportunity for startups.

Key Findings of the report include: 

– Investment Trends: About 62.5% of investors expect to make the same number or more tech investments for the rest of 2023 compared to 2022.

– Lower Valuation Expectations: Most investors anticipate lower valuations for seed stage, Series A, and Series B companies, with decreases of 20% or more compared to 2022. The majority expect this trend to continue for the remainder of 2023.

– Promising Sectors: According to 55% of investors, the oncology specialty holds the most promise for startups, followed by cardiovascular care (37.5%). However, ophthalmology is seen as offering the least opportunity by nearly one-third (31%) of investors.

– Challenges and Opportunities: The shortage and burnout crisis among healthcare providers are seen as the most significant problem-solving opportunity for startup companies by 50% of investors, followed by changing reimbursement models at 26.3%.

“We expected that generative AI innovations had impacted the digital health investment community and our poll results certainly confirmed it, with nearly 1 out of 5 respondents attesting that it is ‘significantly’ influencing their strategy,” said Justin Norden, MD, MBA, a partner at GSR Ventures and adjunct professor at Stanford Medicine where he teaches courses on the subject to medical students. “It will be exciting to witness over the remainder of 2023 into 2024 the many new generative AI healthcare startups that enter the market. Hopefully, investor enthusiasm drives greater adoption of such technologies across an industry that would massively benefit from greater automation and efficiency.”

To review the full survey results, click here.

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Labor Remains Top Challenges for Hospitals/Health System Exec, Report Finds Fri, 03 Nov 2023 05:16:40 +0000 ... Read More]]> Labor Remains Top Challenges for Hospitals/Health System Exec, Report Finds

What You Should Know: 

– Hospitals’ financial performance declined slightly in September compared to the previous month, according to the latest National Hospital Flash Report from Kaufman Hall. Across the board, there was a decrease in patient volume during this period compared to 2022. 

– The latest Physician Flash Report reveals the need for organizations to be more strategic about how they utilize and retain providers and support staff.  Physicians are operating at record-high levels of productivity compared to recent years; however, physicians are receiving less pay per unit of work, indicating a discrepancy in compensation for their increased productivity.

Challenges for Hospitals

– Labor Costs Challenge: While overall expenses may be softening as volume decreases, labor costs remain a significant challenge for hospitals and health systems.

– Support Staff Ratio: The ratio of support staff to providers has decreased as healthcare teams strive to keep up with increased productivity.

– Strategic Staffing and Retention: Organizations are advised to examine their staffing mix and be strategic about deploying support staff to support their most productive providers. In a competitive labor market, retaining support staff is important, and this can be achieved by establishing career paths and advancement opportunities.

Report Data Backround/Methodology

The reports draw on data from Syntellis Performance Solutions, which is based on information from over 1,300 hospitals and more than 200,000 providers. The methodology of the Physician Flash Report has been updated to allow for better comparison against benchmarks. The change involves using rolling 12-month figures instead of annualized quarterly figures, and expressing differences in metrics as the median change rather than the change in median.

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Healthcare Staffing Shortages Take Toll on Revenue Cycle Management & Patient Engagement Fri, 03 Nov 2023 05:10:56 +0000 ... Read More]]> Healthcare Staffing Crisis Takes Toll on Revenue Cycle Management & Patient Engagement

What You Should Know: 

100 percent of hospital and health system respondents stated that staffing shortages have significantly affected revenue cycle management (RCM) and patient engagement efforts, according to a new survey by Experian Health

– A significant 69 percent of the surveyed healthcare executives responsible for RCM staffing foresee ongoing challenges in the long term.

Challenges Present Urgent Need for Solutions

The findings highlight the urgent need for healthcare organizations to find solutions to address staffing shortages and stabilize their operations for the long term. While staffing challenges persist, the majority of respondents prefer to shore up human resource approaches rather than leveraging technology such as automation and artificial intelligence to address staffing issues. The biggest challenges identified include finding candidates skilled in RCM and addressing staff burnout.

High Turnover Rates

The survey revealed that 9 out of 10 respondents reported turnover rates for administrative roles related to patient access, RCM, and the patient experience in the double digits, with nearly half reporting turnover rates of more than 25 percent, significantly higher than the U.S. average turnover rate. Many healthcare organizations are addressing retention issues through traditional means, including increasing salaries (46%), cross-training (44%), and boosting incentives (42%).

Patient Experience Impact

Eight out of 10 survey respondents reported that staffing shortages have worsened the patient experience. Areas significantly impacted include patient arrival and registration, appointment scheduling, prior authorization approval, insurance coverage confirmation, and patient estimates. Delays in patient care were identified as the most significant consequence of staffing shortages (40%).

AI Adoption

Only a quarter of respondents are considering consolidating workstreams across processes, and just 27 percent are exploring the use of integrated artificial intelligence (AI) to improve efficiency.

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What Is Considered a False Claim? Fri, 03 Nov 2023 04:00:00 +0000 ... Read More]]>

Even the most honest organizations with good-intentioned owners can inadvertently run afoul of the False Claims Act, often due to employee actions or a misinterpretation of government contract obligations. Regardless of the innocence of the mistake, such allegations can tarnish your company’s image. They can also expose you and your enterprise to suspension and debarment, escalating expenses, and pose the risk of civil and criminal penalties. 

Complaints under the False Claims Act can be lodged by either the Department of Justice or individuals with information about the fraudulent activity. These are recognized as qui tam claims, incentivizing the submission of False Claims Act complaints by offering the individual up to 30% of the Government’s recovery. 

Consequently, businesses should always be ready to handle fraud reports, regardless of their merit. Here are straightforward measures to minimize the likelihood of False Claims Act filings, and to effectively manage any accusations.

Carry Out Compliance Training 

Having the best policies and procedures is futile if employees lack the knowledge to integrate them into their daily tasks. While employees might not deliberately breach the False Claims Act, unawareness is no shield against qui tam legal actions. Consequently, alongside establishing a robust policy, your institution should also facilitate frequent compliance education.

The induction of new employees at every level of the organization should involve FCA compliance. It should also be a recurrent feature in retraining sessions, especially given the constant changes in FCA laws and standards.

The training should encompass policies and procedures, billing prerequisites, and patient care. If feasible, it should incorporate real-life examples to enable employees to understand how these laws and policies are relevant to their duties.

To ensure your organization aligns with the False Claims Act and prevents qui tam lawsuits, engage legal experts throughout the entire process. Talk to a whistleblower attorney like Oberheiden for legal advice. They can perform risk analyses to highlight possible points of concern. Attorneys experienced in false claims legislation can assist in creating strong policies and educational materials. They also have the capacity to probe controversial claims and provide counsel on challenging issues that surface.

Clear Policies

Your company’s policies play a crucial role in fostering an environment of integrity, fairness, and equality. An open-door policy that promotes the early disclosure of concerns and cultivates a sense of trust is beneficial whenever feasible. Hiring a law firm with expertise in employment law to annually review your personnel policies ensures they are equitable and adhere to the most recent federal, state, and local regulations. 

In case your organization faces allegations of unlawful conduct, being able to reference your policy and compulsory training can demonstrate your efforts to comply with the law. If a supposed whistleblower was indeed dismissed for rightful reasons and not as a retaliation for unveiling fraudulent activities, your written policy against such unacceptable behavior serves as critical evidence in your defense against the retaliation allegations. 

Overseeing and Managing Violation Reports and Concerns

Many FCA lawsuits stem from dissatisfied employees, both present and past. The Human Resources department should foster an environment where employees feel safe to voice their concerns or report any infractions. These reports and concerns must be investigated and treated with utmost seriousness. 

HR should ensure no punitive actions are taken against employees who report issues, which could lead to a separate legal case against the school. The reporting employee should be updated about the progress of the investigation as much as possible; this is to reaffirm that their concerns are being addressed seriously. Ignoring such concerns could potentially push the employee towards becoming a whistleblower and filing an FCA lawsuit.


The False Claims Act empowers the government and certain third parties to penalize businesses for deceitful and fraudulent operations. If healthcare providers and systems establish precise and responsible billing methods, they can prevent FCA claims. Upon identifying a billing discrepancy, it should be resolved promptly and openly to evade any complications.

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Vivante Health Inks National Distribution Contract with UnitedHealthcare: Expanding Access to Digestive Health Solutions Thu, 02 Nov 2023 21:42:08 +0000 ... Read More]]>

What You Should Know: 

Vivante Health, the provider of GIThrive digital digestive health solution, has entered into a national distribution contract with United Healthcare (UHC), the largest health insurance company in the United States.

– The national distribution partnership allows Vivante Health to offer its digestive health solution to UHC customers, including large self-funded employers aiming to enhance their benefits programs. 

– The agreement marks GIThrive as the first digestive health solution on the UHC Hub, a curated network of vendors simplifying the selection, purchase, and management of healthcare benefits.

Prevalence of Digestive Disorders

The partnership reflects a growing awareness of the prevalence of digestive disorders, which impact the quality of life, work productivity, and medical costs. Digestive issues affect nearly one in four Americans and are among the top healthcare expenses for many companies. As part of the UHC Hub, GIThrive aims to provide real-time care and personalized support to individuals suffering from digestive diseases, helping them regain their quality of life.  GIThrive offers a range of virtual tools, including: 

– food and symptom logs

– educational content

– evidence-based digital therapeutics

– 24/7 support from registered dietitians, health coaches, and nurses

Improvements In Their Digestive Symptoms

More than 90% of GIThrive users report improvements in their digestive symptoms, feeling 70% better on average after two to three months. Organizations offering GIThrive as an employee benefit report reduced digestive-related medical spend, increased medication adherence, and behavior modification, leading to fewer emergency room visits and inpatient admissions.

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9amHealth Expands Into Health Plans With EternalHealth Thu, 02 Nov 2023 18:02:38 +0000 ... Read More]]>

What You Should Know:

  •  9amHealth, the first-of-its-kind virtual cardiometabolic care clinic, is proud to announce its expansion into the health plan sector with a forward-looking partnership with Medicare Advantage plan, eternalHealth.
  • This venture marks a significant milestone for 9amHealth as it brings its innovative and comprehensive care approach to the Medicare Advantage sector for the first time.

Enabling Improved Virtual Care Accessibility

The partnership with eternalHealth will enable its plan members to enjoy a seamless experience, eliminating the burden of coordinating a doctor’s office visit or a trip to the pharmacy or lab. 9amHealth offers at-home virtual care with unlimited access to an expert Care Team of physicians, pharmacists, nutritionists, and health coaches specializing in treating and preventing diabetes, hypertension, hyperlipidemia, and obesity. Members can connect with their Care Team through their preferred method and at their schedule–via text, chat, or video. 

They also benefit from convenient at-home labs, connected medical devices, personalized care plans, and streamlined medication management with home delivery. Additionally, 9amHealth facilitates the sharing of clinical information, such as lab reports, with existing primary care physicians for a truly integrated experience. 

“Today’s announcement is a testament to 9amHealth’s dedication to redefining healthcare accessibility for our senior community,” says 9amHealth’s Co-CEO Anton Kittelberger. “We are excited to join forces with eternalHealth to provide their members with easy access to specialized care right from the comfort of their homes.”

With 9amHealth’s comprehensive care strategy, members can access specialized care regardless of their location. By aligning with plan formularies and providing alternative medication options, 9amHealth delivers the most affordable, clinically relevant treatment option. This combined approach positively impacts business-critical quality metrics like medication adherence and reducing acute instances that could otherwise lead to hospitalizations.

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M&A: Viome Acquires Naring Health Thu, 02 Nov 2023 17:54:51 +0000 ... Read More]]>

What You Should Know:

  • Viome Life Sciences, a longevity company committed to translating scientific advancements into actionable and individualized health solutions, today announced the acquisition of Naring Health, a digital health and wellness company providing access to individualized clinical and molecular data to empower informed decisions.
  • Under Naring Health, Viome will also be acquiring DiscernDX, a company making regular health monitoring, early disease detection, and personalized care a reality for every individual, and Foodome, a company that identifies all bioactive compounds in every food and uses network science to understand the connection between diet, genetic pathways, and diseases. 

Increasing Accessibility to Individualised Clinical and Molecular Data

“We’re entering a groundbreaking era of precision health, an era where every individual has the power to manage their unique nutritional needs effectively,” stated Viome founder & CEO Naveen Jain. “By acquiring entities whose visions align and complement ours, such as Naring Health, we’re advancing our commitment to making unprecedented health insights and actionable solutions increasingly attainable to all and with greater accuracy. We are driven by the goal to transform the paradigm of health through personalized nutrition, unveiling extraordinary insights that hold the key to preventing and reversing chronic diseases using food as medicine. 

By combining resources, including key patents and intellectual property, Viome has the ability to further enhance its suite of personalized health solutions with even more precise food and supplement recommendations. As two leaders in the health industry, the strategic acquisition is helping usher in a new age of personalized nutrition. It will grant customers access to the most comprehensive insights into what is going on in their bodies and how they can address issues at the root cause with personalized and precise nutrition. 

Both Viome and Naring Health share a common goal of providing personalized wellness tools that enable food to be used as medicine. While their strengths lie in slightly different areas – Viome focusing on the microbiome and Naring Health on multi-omics – they now unite under a shared vision of transforming healthcare through advanced, personalized solutions that are backed by data and science.

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NorthShore – Edward-Elmhurst Health Signs Largest VBC Deal in 5 Years Thu, 02 Nov 2023 07:08:39 +0000 ... Read More]]>

What You Should Know:

Edward-Elmhurst Health (NS-EEH) has announced a significant, long-term partnership with Lumeris, a pioneer in value-based care (VBC). This partnership is a major development in the healthcare industry, representing the largest VBC provider deal since 2018.

– With rising expenses outpacing reimbursement rates, health systems and physician organizations are increasingly turning to value-based care to avoid layoffs and service cuts. NS-EEH, the third largest healthcare delivery system in Illinois, comprises nine hospitals, 25,000 team members, and 300 local offices, serving over 4.2 million residents.

Collaboration aims to drive coordinated care and improve quality while reducing costs

NS-EEH will strengthen its clinically integrated network (CIN) by incorporating Lumeris’ population health data platform into its value-based care strategy. The two organizations also plan to deliver joint services, supporting the CIN’s healthcare providers in care management, pharmacy management, patient engagement and other key areas. NS-EEH’s CIN includes more than 3,000 system-employed physicians, affiliated physicians and advanced practice providers, and nine hospitals across Chicagoland.

In collaboration with Lumeris, the organizations will manage joint risk arrangements, leveraging AI as a central component of their technology and approach. Lumeris stands out as the only value-based care enablement company with experience working across various patient populations, including those covered by Medicare Advantage, CMMI programs, commercial insurance, and Medicaid. This partnership aims to enhance collaboration among patients, physicians, and care teams, ultimately leading to improved clinical outcomes, a better experience for both patients and providers, and more efficient management of healthcare costs.

Formation of New ACO Models

Furthermore, NS-EEH and Lumeris will work together to address healthcare disparities in underserved communities by establishing new models of care under the accountable care organization (ACO) framework. Initially, NS-EEH and Lumeris will focus on the opportunity to participate in the Centers for Medicare & Medicaid Services’ (CMS) ACO Realizing Equity, Access, and Community Health (ACO REACH) model. This advanced value-based care model seeks to streamline care coordination and improve health outcomes for traditional Medicare patients. In the future, the partner organizations will expand their focus to include other types of accountable care and population health models to serve our diverse communities.

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Understaffed RCM Payment Teams Need a New Way Forward Thu, 02 Nov 2023 05:30:00 +0000 ... Read More]]>
Shantanu Gangal, CEO, Prodigal

Last year, only 8% of healthcare executives said their RCM or billing departments were adequately staffed, and a stunning 48% said the employee shortage was “severe,” according to a survey cited in MedCityNews.

RCM teams are the engine that allows the machinery of healthcare organizations to run. Without effective billing and payment processes that deliver positive patient financial experiences, everything grinds to a halt.

These staffing woes can’t continue. The cascade of problems that can develop from overworked RCM payments teams includes errors, loss of revenue, patients contesting bills, and organization-wide revenue shortfalls that affect care.

Frantic hiring and retention efforts haven’t delivered. It’s time for a new strategy.

The good news: if this employment crisis had happened even five years ago, we’d be in serious trouble. But we’re at exactly the right moment to meet the challenge thanks to the power of artificial intelligence (AI).

Since the launch of ChatGPT, there’s been a lot of buzz about the effect AI will have on jobs, coupled with a fear that machines will rob people of their employment.

A better way to think of it is how AI will shift our jobs, and in the case of healthcare RCM workflows, it’s shifts we would be celebrating even if there weren’t an ongoing staffing shortage.

In terms of satisfaction on both ends of the payments equation – RCM team members and patients – AI is positioned to ease any number of pain points. 

Anything you are doing several times a day or that you spend several hours in a month doing is something you should figure out how you can automate.

For patient financial representatives, positive aspects of the job can be overshadowed by rote administrative responsibilities. But repetitive, predictable tasks are exactly what machines excel at. Looking for opportunities to hand those dull but necessary workflows over to AI can transform a representative’s workday.

Take, for example, post-interaction notes. During a conversation with a patient about billing and payments, representatives are frequently simultaneously documenting the details, a task they finish before connecting with the next patient.

So they’re distracted during the conversation and then have to spend non-patient time typing up summaries.

Imagine that same interaction if the representative didn’t have to multitask. 

Imagine the patient experience if the representative could focus solely on empathizing and explaining. 

Imagine representatives’ reduced stress levels if they are able to focus on one issue at a time.

Today’s generative AI can deliver that improvement. Automated call notes, produced in real time, remove a tedious task from the representative, freeing them up to do what people do best – connect, problem-solve, explain, empathize – making their job more engaging, which can drive retention, and the patient’s experience more valuable.

And without that additional responsibility, average handle time goes down, allowing representatives to connect with more patients.

As a bonus, because AI works on rules, the notes are standardized, consistent, and clear, allowing a representative to get up to speed quickly during the next interaction with that same patient, and opening the door for managers to research, look for opportunities to train representatives and patterns to improve processes.

That’s just one small task that, when handed over to AI, delivers enormous benefits at multiple touchpoints. The same is true of tasks like automating QA and compliance, delivering training opportunities and improvement metrics, patient self-service opportunities, and decreasing new representative ramp time.

We’ve already seen the impact of AI-powered solutions on coding and billing, which has eased the staffing shortage on that end of the RCM process, allowing for increased productivity and decreased simple data entry to more challenging work.

So it’s time to give ourselves the same gift throughout the RCM process. Let’s consider all the ways we can use AI throughout the process to increase productivity without demanding employees “do more with less,” further increasing their stress and the odds that they will leave for another job, or even another field.

A Becker’s roundup of 63 health system executives’ 2023 investment plans showed that the first issue on many of their minds was people. Investment in recruitment and retention is vital to keep healthcare moving forward.

The same issues of burnout and understaffing affecting clinical care teams have also hit RCM teams – hard. Investing in the right AI is one way to cure RCM payment pains so teams can keep powering the healthcare engine.

About Shantanu Gangal

Shantanu Gangal is the CEO and co-founder of Prodigal, which uses artificial intelligence to illuminate conversations across borrowing, lending, and repayment, including banking, healthcare RCM, and more. Prodigal’s solutions turn analysis into action with quality and compliance automation, business insights for process improvement, real-time agent assistance, and automated notes.

He has an MBA from Wharton and is a Computer Science gold medalist from IIT Bombay. Shantanu has spent years innovating at the intersection of lending and data. Prior to co-founding Prodigal, he led data teams at Fundbox and worked with various banks during his time at Boston Consulting Group and Blackstone.

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Waystar Postpones U.S. IPO in Response to Market Turbulence Thu, 02 Nov 2023 05:21:23 +0000 ... Read More]]>

What You Should Know:

Waystar, a healthcare payments company, has decided to postpone its initial public offering (IPO) due to the ongoing market turmoil in the United States, according to a confidential source. Reuters first reports the company plans to revive its IPO efforts, but it is likely to wait until December at the earliest or possibly until 2024.

–  The decision to delay the IPO was made in response to the volatility in the broader market. Despite receiving positive feedback from investors during the testing phase, Waystar has opted to wait for more stable market conditions.

– Waystar was reportedly considering an IPO that could value the company at up to $8B, including debt. The company had made its IPO filing public in October and expressed its intention to list on the Nasdaq.

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