Brayden Haws ⚒️

Here’s your recap of last week’s health IT news 🏥 💻 🗞️ 👇 Product updates 👩🏼‍💻 • Augmedix announced public availability of Augmedix Go, their gen AI documentation product, for Emergency Departments.    • Forcura released AI referral summaries for the post-acute market.    • UTM Healthcare and FirstHx are teaming up to provide more robust medical histories.    • AI phone call tech company, Standard Practice, relaunched after pivoting from Nibble Health.    • Revenue cycle management platform, Ensemble Health Partners, is leveraging Microsoft Azure GenAI to enhance their service.    • MRO is extending its clinical data access tool to cover automatic retrieval of continuity of care requests.    • DrFirst, Inc. is partnering with PatchRx to improve medication adherence data. Notable partnerships 🤝 • Brigham and Women's Hospital partnered with FeelBetter to launch a study on the impact of their AI-based population health platform on polypharmacy patient management.    • Community Health Network selected Biofourmis for virtual and at-home care.    • Humana is extending its current use of prior authorizations platform, Cohere Health.    • Louisianan Community Health System deployed Retrieve Medical's Retrieve Dx Smart App to enhance documentation.    • Anne Arundel Dermatology will expand its current partnership with Relatient, adding Dash Schedule. Posts we enjoyed 👏 • Spencer Dorn’s reminder that more mature tech + good process is in many cases the better option than gen AI. (https://lnkd.in/eiK2DNfw) • Graham Walker, MD’s homegrown demo exploring the combination of clinically-informed text search + retrieval augmented generation (RAG) to enable better EHR note summaries. (https://lnkd.in/eDaqCh5H) --- Want to stay in the loop? Sign up for the Elion Briefing to get all of the latest healthcare tech news delivered to your inbox 📬 👉 https://bit.ly/49z6AUW

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Digital health, we need to talk about your ROI claims & reducing overall healthcare costs. Companies often target a specific clinical subset, but then make claims that $x of spending towards the digital health solution yields $x+y savings in overall healthcare spend. When you peel back the onion, a lot of the overall healthcare "savings" is generated by a supposed reduction in emergency department or hospital admissions. Below is a visual breakdown of 2018 Nationwide Emergency Department (ED) Sample (NEDS) that shows the most common reasons for ED visits. For an employer-sponsored population (non-Medicare, non-Medicaid), the reasons for going to the ED are vast and acute. Retrospectively, you can always pick two periods in time where spending was higher at start and lower at the end (i.e., producing savings). But that really doesn't prove it's your instrument or company that generated the savings. Rather, many patients are poly-chronic and/or subject the randomness of disease/injury. Multiple companies treating the same employee may even use the same savings estimates... More sophisticated buyers don't believe you can reliably produce the claims some of your sales team's are making. It's not your fault the savings are difficult to produce, humans just are complicated creatures. I get your sales and marketing teams need to beat up each other, but let's be realistic. Now I do think site of care savings for chronic treatment of disease is the most reliable way to produce savings, but it’s only applicable to those receiving expensive hospital-based care. ---- credit: AHRQ Healthcare Cost and Utilization Project

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One key reason why healthcare technologies like AI, telemedicine, and software haven't structurally lowered costs or broadened access for the entire system after decades of experimentation (excluding pure financial engineering of payer contracts) is the limited reimagining of care delivery itself, with asynchronous telemedicine as a notable exception. In the same way that digitizing physical paper failed to exploit the capabilities of a new computing medium for word processing, hosting physician-patient conversations over video does not transform the actual delivery of care. In telemedicine, many of the inputs (e.g., clinician time) and therefore cost structures of in-person care persist, which is why we often see fee-for-service telemedicine companies struggle to achieve economies of scale (i.e., growing revenues non-linearly while growing costs linearly). Until we deconstruct the components of a medical appointment – from intake and triage, to chart review, history gathering, physical examination, diagnosis, treatment, and follow-up – we will continue to be underwhelmed by the disconnect between the transformative potential of these technologies and real-world patient/system impact. I’m optimistic that the emergence of reliable and performant medical AI agents will urge us to perform this deconstruction and redesign the fundamental building blocks of a “medical appointment.”

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Integrations with the EHR are a must. Take a look at how we go above and beyond

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Let's talk AI with payers and providers—some interesting numbers to consider from the latest research (Sept 2024) (KLAS Research & Bain) Here are four eye-opening takeaways: 1. AI Strategy Surge: • 15% of providers now have an AI strategy, tripling from 5% last year • 25% of payers are leading the pack with established AI strategies • Both sides are bullish on generative AI's potential 2. Tech Spending Spree: • 75% of surveyed orgs boosted IT investments • Top priorities: cybersecurity, clinical workflow optimization, and data platforms • 70% of orgs doubling down on security 3. Payer Priorities: • Focus on care coordination, utilization management, and claims processing • 65% grappling with legacy tech challenges • Trend towards streamlining tech stacks and favoring existing vendors 4. AI Adoption Hurdles: • Regulatory and legal concerns top the list • Cost and accuracy issues (like AI hallucinations) are giving pause • Growing need for robust governance and ethical frameworks The report here: https://lnkd.in/gxjKPUaW Is your organization leading the charge or playing catch-up? #HealthcareAI #TechInnovation #FutureOfHealthcare

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Why struggle with complex EHR systems when TurnCloud makes it simple? In this clip, Josh Nation explains how TurnCloud’s intuitive 'pick up and play' design helps chiropractors get straight to work without dealing with unnecessary complexity. With powerful features like scheduling, appointment reminders, and SOAP notes, TurnCloud focuses on ease of use so you can streamline your practice without being bogged down by features you don’t need. https://www.turncloud.com/

Why struggle with complex EHR systems when TurnCloud makes it simple? In this clip, Josh Nation explains how TurnCloud’s intuitive 'pick up and play' design helps chiropractors get straight to work without dealing with unnecessary complexity. With powerful features like scheduling, appointment reminders, and SOAP notes, TurnCloud focuses on ease of use so you can streamline your practice without being bogged down by features you don’t need. https://www.turncloud.com/

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Why struggle with complex EHR systems when TurnCloud makes it simple? In this clip, Josh Nation explains how TurnCloud’s intuitive 'pick up and play' design helps chiropractors get straight to work without dealing with unnecessary complexity. With powerful features like scheduling, appointment reminders, and SOAP notes, TurnCloud focuses on ease of use so you can streamline your practice without being bogged down by features you don’t need. https://www.turncloud.com/

#IngredientCosts in #prescriptiondrugs - what's the right metric? That's a great question. Let's review. 💊 AWP = I think we can all pretty much agree that AWP is a inaccurate metric for establishing actual acquisition costs of drugs. The joke in the industry is that it stands for "Ain't What's Paid." It's allegedly a markup of 20% on WAC or wholesale acquisition cost. Furthermore, generics can actually be discounted up to 98% the cost of AWP when all on and off invoice discounts and rebates are said and done. 💊 WAC = WAC might be a little better, maybe, at least on brand drugs. But not on generics. Percent off from wholesalers to pharmacies can be widely variable on generics as well. 💊 NADAC = (Full disclosure, I worked on the NADAC in the past.) NADAC is probably better than AWP and WAC, at least with Brands. Brands are usually with NADAC about WAC minus 1-6% (dependent upon class of trade of the pharmacy and/or their size). But again, generics are all over the place, and NADACs can vary widely to actual acquisition costs. There really isn't a great correlation between NADAC on generics and the actual drug price to the pharmacy. Not all pharmacies participate in NADAC, and NADAC pricing does not show off invoice rebates and discounts, so it's not the actual price the pharmacy paid either. Not all drugs have a NADAC, either. 💊 ASP = Average Sales Price. Not terrible, but only is for J code drugs or drugs that can be used in the medical benefit, put out quarterly by CMS. Doesn't really solve the problem of retail community practice actual drug costs for the pharmacy, after discounts, rebates, and all the other jazz. So, what's the BEST solution then? 💊 AAC = Actual Acquisition Cost. It clears out all the smoke and mirrors and clearly states what the pharmacy actually pays for the drug - this is really critical on both generics AND brands too - as reimbursements on brands by big 3 PBMs has been BELOW a pharmacy's actual acquisition cost, and this is what is driving over 2000 independent pharmacies out of business this year alone thus far. What do we use at Mark Cuban Cost Plus Drug Company, PBC? AAC. Yes, what we're showing you is actually what we actually paid for the drug. No off invoice rebates or discounts or any of that jazz. That and we make sure before we put a drug on our drug list that we have it available at our Actual Acquisition Cost to pharmacy team ups, both with Costplusdrugs.com as well as teamcubancard.com. No WAC, AWP or NADAC. Just what we paid, period. It's time to start using actual acquisition cost of drugs and get all the gobbleygook out of the way. (I'll save my opinion on drug rebates for another post and another day....) #pharmacy

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2024 was a big year for Flexpa. Writing it all down in one place was hard - there was too much to cover! But I tried. The big 4: 1⃣️ 𝗡𝗲𝘁𝘄𝗼𝗿𝗸 𝗘𝘅𝗽𝗮𝗻𝘀𝗶𝗼𝗻: We hit 85%+ CMS lives coverage and rolled out the largest network of payer FHIR endpoints in the industry. We support patient-consented claims data for over 215 million people. 2⃣️ 𝗖𝗼𝗻𝘀𝗲𝗻𝘁 𝗜𝗺𝗽𝗿𝗼𝘃𝗲𝗺𝗲𝗻𝘁𝘀: From the new Multiple Use tier to 24-hour access token expirations—our transparent, user-friendly authorization flows put patients in control. 3⃣️ 𝗥𝗲𝗰𝗼𝗿𝗱 𝗣𝗿𝗼𝗰𝗲𝘀𝘀𝗶𝗻𝗴 𝗮𝘁 𝗦𝗰𝗮𝗹𝗲: We processed over 50 million FHIR Resources with 95% of consented data transfers completed in less than 60 seconds, plus added advanced Resource filtering and data standardization. 4⃣️ 𝗔 𝗟𝗼𝗼𝗸 𝗔𝗵𝗲𝗮𝗱: Payer-to-Payer data exchange, new HL7 working group contributions, and even more secure data-sharing—2025 is going to be big! Read the rest: https://lnkd.in/gwrye5Fm A huge thanks to everyone who contributed to our success this year, from our customers to interoperability partners - and especially everyone on the team: Claudio Carbajal III, Amanda McGivern, Angela Liu, Dylan Klein, Larry Ditton, Kyle Tilman, and of course my co-founders Tom Hamilton and Andrew Arruda.

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A health system asked if I could share what SeamlessMD’s secret sauce was for engaging patients… so I’ve decided to open source my response here. They wanted to know what principles and success factors have enabled our customer partners to achieve industry-leading results like: ⬇️ Cost of care by $1,000+ per patient ⬆️ Increased net profit of $1,000+ per patient ⬇️ 1 to 2 days length of stay ⬇️ 89% readmissions reduction by up to 89% ⬇️ 68% ED visit reduction by up to 68% ⬇️ 89% mortality ⬇️ 65% phone calls to providers Here are the main principles and success factors I shared: 1️⃣ It starts with a high touch partnership to ensure success. The People + Process we assign to a health system partnership matter even more than the Technology 2️⃣ Clinical expertise applied to the product matters more than Tech features. Our product’s secret sauce is our world class, pre-built care plan content. 3️⃣ Key elements of our care plan content that drive high patient engagement include: - Brand personalization - Condition-specific patient experiences - Personalization to a patient’s demographics & comorbidities - Condition-specific health status & symptom tracking - Automated self-care guidance for 80%+ of patient issues 4️⃣ Obsession with patient accessibility further optimizes patient engagement. - Gr. 6 reading level - Colour-blind tested - Screenreader friendly - WCAG 2.0 Level AA requirements met and more 5️⃣ Digital care plan implementation is Clinical Change Management. A successful implementation requires a proven playbook and hands-on expertise for: - Achieving care pathway standardization and alignment - while being efficient with clinician time commitment - Embedding digital care journeys into the clinical workflow: What workflows make the most sense for receiving alerts and monitoring dashboards given our limited staff resources? - Having the clinical acumen to going deep into the nitty gritty clinical workflows. E.g. for a pregnancy care journey - how will our solution know if there is an infant loss? How should the care plan change in that case? 6️⃣ Clinicians must be engaged to have a sense of ownership so they promote it to patients We’ve figured ou the optimal time commitment that ensures all clinicians are engaged during implementation (hint: physicians have very limited time!) 7️⃣ Let busy clinicians act as the Editors of Clinical Content. By having a clinical Patient Education team act as proactive Ghost Writers. - The key principles are to (1) earn clinician trust and (2) reduce friction to clinician engagement. 8️⃣ The ideal approach to patient enrollment varies from health system to health system. Sometimes a hybrid approach might even be needed 9️⃣ You must believe that the job’s not done until you achieve business outcomes. We obsess over the data and push our partners to measure ROI. More details in the slides below 👇 *** I’m curious: Which of these resonated most?

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The power of AI consensus…

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The rising tide of claim denials and prior authorization requirements is placing a heavy burden on healthcare providers and their patients. I recently spoke with HIT Consultant Media about why these issues persist and, more importantly, how to address them. Here's how we can start solving these challenges: -  AI and automation can simplify workflows, easing the administrative load and allowing providers to spend more time on patient care. -  Integrated systems make data accessible and accurate, allowing real-time policy alignment and reducing errors that lead to denials. -  Payer-provider partnerships are crucial. For example, making payer adjudication rules and medical policies accessible and easily understandable using AI at the point of care will lower the burden and cognitive load related to claims and prior authorization workflows. Novel solutions like these are applicable beyond these specific challenges. When we apply innovation across the ecosystem, we will start to see scalable change - and help build a healthcare system that’s efficient, affordable, and truly patient-centered. Check out the full interview linked in the comments. 

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In case you missed it last week, we discussed "TEFCA Operations (aka TEFCA for Payers)". Key Topics Covered - Payer Use Cases: Exploration of data exchange use cases and the regulatory landscape (CMS-9115, CMS-0057, HTI-2). - TEFCA Operations Overview: How payers can access data for care coordination, HEDIS reporting, and quality measures. - Comparative Analysis: TEFCA Operations vs. alternatives like Individual Access Services (IAS) and secondary use patterns. - Data Reciprocity: The importance of avoiding asymmetric relationships in health information networks. - Regulatory Integration: Potential integration of TEFCA with CMS-0057 requirements. -Adoption Timeline: Overview of upcoming deadlines and the current state of TEFCA adoption. We had great discussion after the overview presentation, tackling: - Challenges in managing multi-line business organizations and data usage rules - The February 2026 deadline for certain healthcare operations exchange purposes - Industry participation in real-world testing initiatives (e.g., NCQA's Bulk FHIR Quality Coalition) - Integration of TEFCA and CMS-0057 requirements, particularly for provider access API and payer-to-payer API - TEFCA's potential as a foundation for payer-to-payer exchange - The significance of the 10x10 initiative in shaping healthcare interoperability - Proposal for an "11x11" initiative to include health plans working with pharmacies/pharmacists in TEFCA operations Check it out here! https://lnkd.in/gP4ys37W

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Somewhat predictably, the headlines of Epic's UGM were mostly focused on AI. In my mind, the ones to focus on got buried as footnotes. Products leveraging Epic's position as the dominant inpatient EHR and selling differentiated products as a wedge into new markets (mostly under Health Grid) should frighten other healthcare vendors more than the AI arms race (which they'll largely win as the default option): - Payer Platform: A Health Grid product for payers. This was decently well covered, but that's because it's a mature product at this point. A lot of outlets covered it as if it was net new, but it was launched in 2019. The most noteworthy piece is Judy's quote saying they’re investigating submitting claims directly through Epic so you don’t need a clearinghouse - this represents a threat to clearinghouses and could represent the expansion from Payer Platform as a beachhead to attack incumbent SaaS, claims processing systems. - Epic Aura (labs): This is a Health Grid product for labs. This was launched previously. I don't see any announcements, but this is a beachhead for Epic to sell to labs that have or built their own LIS, allowing them to eventually replace it over time (or at least have all major labs as customers). This threatens existing LISes even more than Epic's LIS product, Beaker. They also announced a planned Blood Bank module, which increases their appeal as an all-encompassing LIS in this push. - Epic Aura (medical devices): A new sub-category of Aura (and Health Grid) for expanding into medical devices. I was waiting to see if they'd launch a separate category for medical devices or reuse Aura. First devices are cardiac arrhythmia and CGM. This threatens businesses like Redox to some degree. - Per Healthcare IT today, "Judy said they’re working on better surgical device manufacture planning leveraging the Epic schedule." This sounds like further expansion of Aura/Health Grid to surgical supply manufacturers. - I was surprised to not hear any updates about Discovery, Epic's Health Grid program for pharma. I'm curious what shape that will take. - I thought the use of the state of Washington + the Garden Plot model is a smart distribution play. Garden Plot has existed since at least 2022, but using a state for distribution to get to new markets that Epic struggles to sell to (small clinics, behavioral health clinics, correctional medical facilities and tribal facilities) is again another example of their expansionary mode. Health Grid products will be more impactful than the Vendor Services rat races or AI wars. It's worth paying attention to and taking advantage of: https://lnkd.in/gimisDzZ

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Digital health companies often are looking for a way to "notify" providers, akin to what iOS or Android allow for. EHRs largely don't have a notification paradigm, though. The closest you can generally get is either an inbasket/inbox message (for which there are only rudimentary APIs, if there's anything at all) or CDS Hooks (which only top end EHRs support today). Some newer ones support task management conceptually. What they're looking for is to grab attention and affect behavior change. Both methods have distinct drawbacks to that end. Piling Inbasket messages is a clumsy asynchronous pattern for task management. CDS Hooks are generally interruptive (although Epic supports a passive in-line mode) and therefore resented/ignored by providers if used aggressively and shown frequently. Ultimately maybe it's just that no user really loves being told what to do 😂 EDIT: Notification fatigue is real, which is why task reduction and automation via AI and other tools is so important

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Walmart is selling its #telehealth business to Fabric 💸 Fabric is a #healthtech startup that unifies virtual and in-person care across intake, triage, routing, and treatment while automating workflows for staff. They raised a $60M round earlier this year funded by General Catalyst, Thrive Capital, GV (Google Ventures), and Salesforce Ventures. They also made two other acquisitions, Zipnosis (asynchronous #virtualcare) and GYANT (conversational AI assistant used for #digitalfrontdoor) within the past 18 months. 📈 This acquisition will get Fabric access to the 30,000 employers and 5 million members that Walmart served, expand provider network, add virtual behavioral health, and build on their employer’s and payer’s solutions. #digitalhealth M&A activity continue to be trending this year as we’re seeing more synergies come together when companies join forces and the challenging funding environment. I’m curious to see how Fabric will be able to merge these new acquisitions into their current workflow to improve care management. Any thoughts from you❓

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One of the most underrated aspects of using an #interoperability tool like Metriport is not needing to know where the patient has received care previously 👇 While this may be obvious to providers who have leveraged Health Information Exchanges (HIEs) before, the reality is that so many providers today still need to ask their patient where they’ve received treatment previously (assuming the patient remembers them all), and then needs to call each facility and beg them to send over the records via #fax. This process can take days, if not weeks, and often still results in the provider having an incomplete, partial understanding of their patient's medical history 🤷‍♂️ Through #HIEs, a provider who leverages Metriport simply needs to enter the basic demographic info of their patient (name, DOB, gender, and address) to pull records from all the facilities where their patient has received care previously. Metriport handles this entire process in seconds, without any humans in the loop. This is by far one of the biggest “aha” moments for providers who use Metriport for the first time, after being reliant on manual retrieval methods previously. From initial skepticism, to providers who now can’t live without this, we see these tools as an inevitable part of evolution of modern #healthcare workflows.

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