George M. Aloth

👍 In the first half of 2024, U.S. digital health startups secured $5.7 billion across 266 deals, showing a strong rebound after years of slowed investment, according to Rock Health. With early-stage deals driving the momentum, the sector is on track to surpass funding totals from 2019 and 2023. https://bit.ly/4cCRy2W Via Healthcare Dive #digitalhealth #digitalhealthfunding

10

1 Comment

The California Office of Health Care Affordability has recently approved a requirement that all healthcare providers report their annual operating expenses. If those expenses increase more than 3.5% (eventually lowering to 3%) in a year, that provider will be fined, ironically increasing their expenses. The state claims this regulation is aimed at protecting consumers from high healthcare costs. This is the same State of California that recently raised all healthcare workers' minimum wage to $25 per hour (up from $15.50).  For our health system, that results in a $30 million annual cost increase and a 7.5% increase in our salary costs. This is also the same state that passed an unfunded mandate that requires our system to spend about $1 billion to replace a hospital building that they feel is at risk from damage in an earthquake. And it’s also the same state that increased the cap on medical malpractice lawsuits…and has authorized utility companies to raise their rates 15% per year.  So, with all of these unfunded requirements and policies that dramatically increase providers' costs beyond their control, how exactly does the state suggest that we limit our expense growth to 3% per year?  Healthcare cost inflation has already been running at more than 5% before any of these new requirements took effect. Perhaps if California wants to get serious about reducing the cost of healthcare they might look at the managed care plans. The most recent data I could find from the California Health Care Foundation indicates that California managed care companies made $222 billion in 2020. What direct value did these companies provide to the health of our communities? Meanwhile, hospitals and physicians are providing direct patient care and struggling to survive- especially systems like Kaweah Health that serve a high percentage of Medi-Cal (Medicaid) and Medicare patients.  On a side note, the governor did sign a new managed care organization tax into law this year, which was promised to increase Medi-Cal reimbursements to providers, but all signs suggest that he now intends to use those proceeds (nearly $7 billion) to fill holes in his budget's general fund deficit and will not be providing Medi-Cal rate increases. I would humbly suggest that if the state is genuinely concerned about its residents' cost of living, they might look at the state income tax (highest in the country), its gas prices (highest in the country), the essentially unaffordable housing costs, or countless other factors that will have a larger impact on individuals' pockets than beating up healthcare providers with laws that don't make any sense. #hospitals #california #healthcare

106

19 Comments

Doing M&A in healthcare is now going to cost more, in time and money, to comply with the pre-merger filing final rule requirements. The FTC wants its info. I'm not sure if this added friction is a good thing or a bad thing... #healthcare #mergers #acquisitions #investing #venturecapital #vc #pe #privateequity #strategy Federal Trade Commission https://lnkd.in/gGw-ZF7X

3

The Centers for Medicare & Medicaid Services recently announced the first states to participate in their new #PopulationHealth-focused payment model. The States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model is a voluntary, state total cost of care (TCOC) model designed to address population health in specific regions, reduce health disparities and lower #healthcare costs. States participating in this model will be responsible for the quality, coordination and cost of healthcare while receiving funding and additional tools to address current payment and equity challenges in their state. 💡 My thoughts: It's exciting to see how we continue evolving our thinking around value and innovation, looking across payers, states and state agencies to push some of these practices forward. Not only that, but the timeline of these models has also been extended from 3 years to 10 years – allowing us a longer period to gather more comprehensive learnings and understand if these interventions are having a true impact. Efforts like these help us more accurately assess if the current work we’re doing is making a difference. I look forward to following the development of this model and seeing how it plays out with the first cohort (Maryland and Vermont) in 2026! 

17

2 Comments

Attention Founders! Wondering how to structure market based relationships with MA payers? Here are the plan groupings that align with H numbers. This is why there are times that payers ask you to work with plans in seemingly disparate markets. There is a method to the madness. Thanks Yubin Park, PhD for sharing your work.

7

💡 Knowledge Is Power in Healthcare Data 💡 If you're a plan sponsor looking to improve population health or steer members toward high-quality care, you need data—and not just claims data, but the EHR data behind it. In the latest episode of Relentless Health Value Podcast, we dive into the Particle v Epic EHR lawsuit with Brendan Keeler. What does this legal battle mean for data access? Could it create more data liquidity for plan sponsors, or will it make accessing essential health data even harder? Join us as we unpack the implications of this case and what it could mean for the future of healthcare data access. #HealthData #PlanSponsors #EHR #DataAccess #PopulationHealth #HealthcareInnovation 🎧 Listen Now: https://cc-lnk.com/EP454 Also mentioned in this #healthcarepodcast: Brendan Keeler; HTD Health; Pryce Ancona; Lisa B., MBA, MPH; Health Tech Nerds; Tom Nash

46

8 Comments

What does the future hold for retail medicine and virtual care? Walmart is the latest to announce their health center closure. https://lnkd.in/geZpMTkS. This following Optum news, VillageMD closing in Nevada, Teladoc Health problems, etc. What comes next? This is another in a long line of examples that technology and even consumer willingness are not enough when the reimbursement environment does not support particular care models. Are we getting ready to lose all the lessons painfully learned during the pandemic? Or will new virtual care models emerge following this round of closures?

2

Today I've been reflecting on where the healthcare industry was when we launched Wheel, and the incredible advancements in care delivery and access that we've seen in just a matter of years. I believe this news is really about innovation, and underscores why organizations partner with companies like Wheel. When providing care is not a core competency, experienced teams play a vital role in helping drive integrated care strategies, rather than a stand alone approach. Those who deliver holistic models — centered on trust, loyalty, and great experiences — will be the transformative forces driving healthcare consumer adoption. Ultimately this is about the players who will drive transformation, and the types of companies that can and will power the next generation of care.

49

3 Comments

Unlike fee-for-service models, which prioritize quantity of services rendered, value-based care emphasizes actual outcomes, aligning incentives to improve patient health and reduce costs. As VBC models grow, with predictions showing a market increase from $12.2 billion in 2023 to $43.4 billion by 2031, healthcare will require a more collaborative, efficient, and patient-centric system. This will require adapting from providers, however, to navigate the complexities and succeed financially. #VBC #ValueBasedCare #Healthcare #GoodCareMonth

14

2 Comments

CVS Health is grappling with significant internal challenges and growing investor pressure. The latest sign of this tension is Glenview Capital Management's involvement, led by Larry Robbins, who is set to meet with CVS executives to propose strategic changes. Robbins, known for his activism in healthcare companies like Tenet Healthcare, where his push for board changes resulted in leadership resignations, has a history of driving "transformation." His recent stake in CVS suggests he sees untapped potential, but the bigger question is: What kind of change will this bring? For those of us focused on healthcare reform, this situation demands close attention. CVS, like many healthcare giants, has been struggling with deeper systemic issues—its Medicare business has seen setbacks, and its pharmacy-benefit arm, CVS Caremark, is under FTC scrutiny for inflating drug prices. While Robbins’ influence often steers companies toward financial improvement, what does that mean for patients, transparency, and accountability? Should we expect cost-cutting measures that improve shareholder returns, or will there be a genuine focus on improving healthcare delivery? Will the involvement of hedge funds like Glenview in shaping the future of healthcare companies lead to sustainable, patient-centered reforms, or reinforce profit-driven strategies that prioritize financial returns over care quality and access? I think not. I'm not passing judgment yet —but it's a moment to pay close attention. The future direction of companies like CVS has wide-reaching impacts on our healthcare system. As these dynamics play out, we need to ensure that any changes ultimately serve the needs of patients and communities, not just the bottom line.

53

22 Comments

I recently came across an insightful article from Becker's Hospital Review discussing the inpatient and outpatient services that incur the most financial losses. It’s a thought-provoking read that underscores the critical challenges faced by healthcare providers today. https://lnkd.in/gZNnyyx4 One key issue highlighted is the significant financial burden posed by wound care management. As we navigate these complex times, it's clear that addressing workforce shortages is paramount to improving patient outcomes and reducing costs. This is where innovative tools and technologies come into play.  At Truss Health, we're dedicated to developing solutions that tackle these challenges head-on. #HealthcareInnovation #WoundCare #AI #HealthTech #PatientSafety #WorkforceSolutions #TrussHealth

25

I've enjoyed seeing everyone's reflections on this year's HLTH USA and wanted to share some of my own. First off, big shout out to my co-panelists William Porteous Elizabeth Mitchell Laura (Gilligan) Walmsley and moderator Christina Farr for a really great discussion on the high bar for selling to employers today.   Beyond the panel, here are a few of my top takeaways:   - Employers are becoming more prescriptive when it comes to employee health. We’ve been seeing it, but it was clear our colleagues across the industry are seeing it, too. Employers are narrowing options for employees as a way of driving down costs. It’s a huge opportunity for those of us who can help them on this while still delivering on outcomes and experience.   - The rate of cost increases for specialty care is at the top of priority lists for employers. Arundhati Parmar and I discussed how unsustainably high costs are impacting access to care at every level, particularly for specialty care. The issues remain the same – MSK, weight management, and cancer – so solutions stand out through their efficacy.   - In healthcare, we need to be bold and focused. My main takeaway from the conference was: there’s a lot of noise out there. Zeroing in on high cost, high acuity moments is an effective route to cutting back on costs while maintaining high-quality care; it’s one dimension where we can truly make a significant difference for both employers and employees.   Curious to hear what others think!

97

2 Comments

Happy to share my thoughts with HLTH about their HLTH and Vive events - and how Medicomp Systems, Inc. is able to share the latest related to our clinical intelligence engine with EHR vendors and other health systems. #HealthIT #Vive2024 #EHR #AI #ClinicalAI #Quippe

15

You may have seen my post last week about the HHS final rule prohibiting algorithmic discrimination by providers, payers and other covered entities. The rule applies whether the provider or payer builds its own algorithm, or buys it from a vendor. The rule requires that they be vigilant for possible discrimination and take steps to mitigate the risk. Please join us on May 20 when we discuss the nuances of the rule. Organizations have 300 days to comply.

19

1 Comment

PE acquisitions of healthcare providers organizations has slowed this year. I think this is just a pause to take a deep breath before the next plunge. Look for activity to start to spike again later in the year. #healthcare #hospitals #clinics #healthsystems #pe #privateequity #venturecapital #mergers #acquisitions #consolidation

5

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  

34

5 Comments

New Expectations The cost of healthcare collections continues to rise despite significant technological investments by providers and payers alike. Healthcare is the only industry where the payer and the provider have little understanding of how a transaction is priced as well as how rules are used to determine the price of an episode of care. A recent implementation of CALIBRATE demonstrated that over 16% of claims were mispriced from the provider's contract. Imagine any industry with a 16% error rate! Should we have new expectations of this decades old problem? We believe that we should reimagine the cost of collection between payers and providers with new metrics and expectations that truly define the life of a claim. - 99% of medical claims are priced according to the provider's contract terms. - Pricing variances are identified within three days of the payment posting process and resolved by the payer within ten days from payment receipt. - Pricing variances are resolved PRIOR to traditional claim appeals processes. - Payer Administrative guidelines are identified, codified, and priced into the provider contract. - Claim denials are resolved through specific provider workflows. - Claim appeals are reduced by 50%. By unlocking the historical "payer's black box", CALIBRATE creates new expectations for managed care and revenue cycle leadership to reach new levels of perfection for providers and payers alike.

40

1 Comment