Brad Hively

Today’s healthcare policymakers are focused on their favorite boogeymen: physician compensation, biopharma, and new medical technologies. The real villains are ‘benefit managers’ and administrators’ who lurk in the shadows extracting 25 cents of every healthcare dollar. The reality is, in fact, in plain view if you look: administrators have grown 3200% while physicians have grown 200% over the last two decades; physician compensation is down, net of inflation. Admin comp is up, way up. PBM (pharmacy ‘benefit’ ‘management’) revenue has outstripped Pharma revenue growth in the last 20 years. Pharma extends life and improves quality of life, and extends working lives of taxpayers. PBMs - who knows… People grasp onto things they understand like doctors and drug companies. ‘Administrators’, ACOs, VBC, VBC, PBMs, spread pricing are more challenging to grasp and are allowed to obsfucate people about what they do from the shadows. America’s healthcare landscape is burdened by ‘administrators’ and ‘managers’ who extract rents from an otherwise highly innovative system. https://lnkd.in/gK3mCme4 https://lnkd.in/gPC9vKB9 DocVader puts it aptly: ‘thoughts and prayers’ https://lnkd.in/gUfnSXGV Technology is one answer. Physician and nurse leaders are another. If your company is about literally decimating administrative costs in the back office or front office of healthcare, I applaud you. As Americans we need this. Return care to the people and shrink administration and management bloat across the system. Medicare deserves this and so do the commercially ‘insured’.

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In the last 4 years, we've seen dramatic surges and falls in healthcare private equity deals and volumes. PE investments can revitalize existing healthcare organizations and breathe life into new, innovative approaches. Read more from my colleague Troy Keach on the top PE trends emerging in 2024.

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Ironically enough, cost savings and improved access to care aren't outcomes that happen very often with healthcare M&A. #healthcare #mergers #acquisitions #consolidation #rollup #privateequity #venturecapital #pe #vc #hospitals #clinics Clay Allen https://lnkd.in/gMxFdKEt

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When the music stops we find out which emperor has no clothes. (That’s not how the saying goes is it?) Anyway, here’s the most basic way to look at private equity investments in healthcare (disclaimer: not all are bad!) Healthcare entity sells a piece of itself to an investment group. Let’s say it’s sells 50% for $100 bucks. Investment group (doesn’t matter which one, just choose a color and an object from nature and add Capital or Equity at the end 🤣) puts up $20 dollars and borrows $80 dollars, saddling the healthcare entity with crushing debt. (Works great when interest rates are low, not great when they skyrocket like they have the last couple of years.) Investment group needs to show a return. Easiest way to increase revenue: Raise prices. Don’t pay people what they’re worth. Squeeze them. Cut staff and services. Now you have overworked, underpaid healthcare workers who think they don’t have another option. Let’s say investment group manages to sell their piece for $120 bucks in the usual 3-7 year hold period for private equity. (Remember they only put up $20 and borrowed $80.) Returns the money they borrowed, and keeps the profit. In this scenario it’s basically 100% return on investment. Investment group gets rich. Healthcare entity owners get rich. Patients and healthcare workers suffer. Anyway, Dr. Hal Inc is also a healthcare consulting firm. Follow me for more tips and tricks on what NOT to do in healthcare! (Shameless plug!)

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Direct Pediatric Care and the other derivatives of direct care are becoming mainstream. Agree, it is not just a fad, or a fringe model, or one only for patients with disposable income. Direct care models are part of the solution to our broken fee-for-service medical care. It is about prevention, not repair. It is about relationships, not throughput. It is about doing what is right for the patient, not the industry. I love seeing the rapid progress and attention in the market place. https://lnkd.in/gHHKSwBd

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I had the honor of moderating a panel of three hospital Presidents/CEOs at Laudio's inaugural Leadership Innovation Exchange (LINE) conference. We discussed “Future-Proofing Health Systems” and what is required for the next generation of hospital leadership to effectively manage the healthcare workforce. We didn’t have a crystal ball, but we had the next best thing -- insights from these three impressive leaders. Quick takes: 💡 Mark Slyter, DSc, FACHE of Dignity Health: High reliability organizations are the way of the future. When implemented correctly, retention is the output and not the goal. 💡 Bill Santulli, FACHE formerly of Advocate Health: When looking for his successors, he looked for leaders who are effective at change management…it’s ultimately all about culture. 💡 Joseph Mitchell of Franciscan Children’s: It took a strong arsenal of leaders who were resilient to complete the integration with Boston Children’s and ultimately to bring attrition down from 35% to 18%. Heard throughout the day were these fascinating tidbits from C-level leaders on what is improving their workforce culture and satisfaction: 🐕 Geisinger: ‘Paws to Reflect’ program that brought in dogs for healthcare workforce, not for patients 🤖 El Camino: Robots for patient wayfinding – an idea that stemmed from their nurses when they saw the robots delivering specimen 💻 Stanford: Being discerning about not automating processes that are terrible, but only the ones that are deserving Hats off to the Russ Richmond, CJ Floros, Emma Smith, Ashley N. and the whole Laudio team on this fantastic LINE-up!

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Imagine swallowing the competition whole. That's what many players in tech do via roll-up strategies, gobbling up smaller firms to deliver richer solutions and amass greater market share. Where else are roll-up strategies common? // HEALTHCARE Picture being a patient at a medical practice that’s been part of a roll-up in Healthcare Services. It's an industry ripe for roll-ups due to its fragmented nature and potential for greater efficiency. // CONSUMER SERVICES Or let's say you needed your HVAC serviced, and notice your local repairman is now part of a bigger Consumer Services entity? Centralized management and scale economy turn these localized businesses into roll-up targets. // FINANCIAL SERVICES Think about your insurance agent or wealth management advisor. They're working in complex, highly regulated environments. In the Financial Services sector, roll-ups offer an effective way to consolidate expertise, streamline operations, and enhance customer offerings. // MANUFACTURING Now, imagine driving past factories under a new name — the result of Manufacturing and Industrial Services roll-ups. Bulk purchasing reduces costs, enhances production capabilities, and expands geographical footprints. // REAL ESTATE Lastly, envision your real estate brokerage firm. The industry sees roll-ups as a strategic move to increase market penetration, enhance service offerings, and hike up portfolio value. Roll-ups play a huge role in most industries, rather like a snowball rolling downhill, gaining momentum, and size. Are you seeing roll-ups in your sector or considering M&A?

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CareMax and Steward Health Care are besties What is CareMax you ask? But of course a value based care provider that went public via SPAC in 2021 $297 open price at IPO $487 high price post IPO $3.00 current trading price Notably, CareMaxbought Steward's Medicare VBC business in 2022 for $135M As part of that transaction, double yacht owning Ralph de la Torre became a board member of CareMax Solid foreshadowing Here's what CareMax recently said in it's 10-Q related to its business: "These conditions raise substantial doubt regarding the Company’s ability to continue as a going concern..." Meaning, it may file for bankruptcy if it can't turn things around Some numbers from the quarter: $156M current assets $507M current liabilities $232M revenue ($21.7M) op loss ($23.8M) cash from ops 1:30 reverse stock split recently issued Translation, you had 30 shares and now you have 1 Some more numbers: 55 centers 218,000 covered members 99% under VBC arrangements And last interesting bit of info: "Our principal sources of liquidity have been cash generated by our centers and MSO operations, and borrowings under our credit facilities." When your third key source of liquidity is borrowing, that's an issue Sorry, sorry, one more thing... Apparently, after the acquisition of Steward's VBC business, Steward doctors continued to serve these patients, though they would then be paid from CareMax... which didn't happen What's going on at CareMax? P.S. If you liked this mystery breakdown, you'll love The Healthcare Breakdown, where I breakdown the business of healthcare and all these wheelings and dealings so you can see what's really going on Check it out here: https://buff.ly/47NeASx See you out there!

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Another gem of wisdom from our CDO Brian Hamilton at Allied OMS. We believe when you bring together successful investing experience and real-world operating experience, you can share a deeper connection with your doctor shareholders, empowering significantly better outcomes. Want to learn more about how to put Doctor Equity ™ or Entrepreneur Equity ™ to work for you? Let's start a conversation. https://lnkd.in/g_hHBwDD Allied OMS Aviva Aesthetics BGS Alliance LifeFlow Partners Phase 1 Equity

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AI and Med Tech in Focus   Implantable Device Reverses Opioid Overdoses Researchers at MIT and Brigham and Women’s Hospital have developed an implantable device that detects and reverses opioid overdoses by autonomously administering a dose of naloxone. Naloxone is a drug that binds to opioid receptors and blocks the effects of heroin, fentanyl and other opioids. Called iSOS, the device has sensors that continuously monitors a user’s respiratory rate, heart rate, body temperature and blood oxygen saturation and uses machine learning algorithms that are trained to recognize the signs of overdose using the cardiorespiratory data collected by the sensors. When the device detects a suspected overdose, the device buzzes and sends an alert to a user’s phone. If the alert is not cancelled, iSOS administers a rapid shot of naloxone.  The device is about the size of a stick of gum and implanted under local anesthesia. It has a wireless rechargeable battery that lasts 14 days and a 10-milligram refillable drug reservoir. ISOS has been shown to be effective in reversing the effects of overdose 96% of the time and could help people who are at the highest risk of re-overdose. Because the naloxone dose is automatically delivered in a “closed loop” survival is not predicated by timely intervention of a first responder or a bystander Further research is being done to miniaturize the size and optimize battery life. VC Investors are always adjusting their "Play Book" with a variety of options for investing. Mikal Ventures is one of those alternatives, offering curated solutions to real world problems. Reach out if you have questions on how we can be of assistance and bookmark https://mikalventures.com/ for additional insights and information.

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Recently, I had the opportunity to listen to a podcast featuring the CEO's of Prime Therapeutics and Cap Rx. Investing time to learn what I can has always been crucial to my growth, and this podcast hit the mark for me. I was able to uncover some nuggets of wisdom that I can use to educate myself further. It's always exciting to learn from industry leaders and gain insights that can help me excel in my field. https://lnkd.in/eZTMUmiu

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As we officially kick off fall with the fall equinox, The “Goldilocks thaw” of the capital markets (not too hot not to cold but colder than we like) is seen with the billion dollar deals and select venture raises. We are less than 45 days to the election and a marginally surprising 50 basis point cut by the fed has helped accelerate this thaw and many executives and owners to explore options and alternatives. Cardinal Health announces a $1.1b acquisition of Integrated Oncology Network while venture studio Hashed Health spinoff SubPop Health, Inc. gets acquired by MedeAnalytics. Watch for our exclusive Healthcare Venture Studio report, the only research on this alternative asset class with more unicorns than any other group. #healthcareinnovation #venturestudio #healthcaredeals #fallequinox

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Our micro-hospitals provide a patient-centered experience that focuses on convenience, efficiency and personalized care. For patients who don't want to face long waits for non-life-threatening conditions, which often happens at large hospital ERs, we offer a clear alternative. Quicker check-ins, faster treatment and convenient locations are a few of the reasons to visit our emergency departments. But consider this, too: The smaller size of our state-of-the-art facilities allows our expert healthcare providers to spend more time with each patient, offering a more personalized, attentive care experience. This can lead to better communication and more thorough explanations of diagnoses and treatment options in a calmer, less stressful environment. You don't have to accept long waits, overcrowding and an impersonal atmosphere during your healing journey. Altus Community Healthcare provides a better patient experience – the kind you deserve. #PatientExperience #FastService

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Q2 2024 saw a resurgence in home-based care M&A, driven by strategic acquisitions and a cautious yet optimistic private equity landscape. Based on the Q2 2024 Home-Based Care M&A Report from Mertz Taggart, here are the top three trends that I see: 1. Increased Deal Activity: After a slow first quarter, M&A activity picked up significantly, particularly in home health and hospice sectors. 2. Private Equity Influence: Private equity’s role in M&A was smaller than usual due to tightened credit markets, but optimism is rising for more deals in the latter half of 2024. 3. Strategic Acquisitions: Companies like Addus and Amedisys made strategic moves to expand their market share, signaling continued consolidation in the industry. As deal activity heats up, how will these trends shape the future of home care? You can read the full report here - https://hubs.ly/Q02KY4r90 #HomeCare #MergersAndAcquisitions #HealthcareTrends

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SPACs are increasingly used to take private healthcare companies public, offering an alternative to traditional IPOs. This trend has been growing, especially between 2012 and 2021. SPACs provide a pathway to public markets for companies that may not meet traditional IPO financial performance targets. They also typically incur lower underwriting fees and are less likely to face shareholder lawsuits. 👉 SPACs could lead to higher prices for healthcare services and products due to increased consolidation and vertical integration .... ultimately raising costs for employers, insurers, and patients. 👉 Corporatization of healthcare through SPACs may result in adverse clinical events, as seen with previous private equity acquisitions. 👉 The need for regulatory compliance and transparency may present challenges. 👉 SPACs can be risky investments, as they often merge with companies that have not yet achieved profitability. 💡 Financial engineering and creating value in the healthcare value chain are two distinct pursuits. #SPACs #SVP #HealthcareIPO #Digitalhealth

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Healthcare is highly suited for AI automation, with many opportunities to improve accessibility, affordability, and outcomes. AI can drive efficiencies across various functions, though it will inevitably reduce the need for some human roles. #higherorder #ai #automation #healthcare #healthtech

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AI and Med Tech in Focus   Implantable Device Reverses Opioid Overdoses Researchers at MIT and Brigham and Women’s Hospital have developed an implantable device that detects and reverses opioid overdoses by autonomously administering a dose of naloxone. Naloxone is a drug that binds to opioid receptors and blocks the effects of heroin, fentanyl and other opioids. Called iSOS, the device has sensors that continuously monitors a user’s respiratory rate, heart rate, body temperature and blood oxygen saturation and uses machine learning algorithms that are trained to recognize the signs of overdose using the cardiorespiratory data collected by the sensors. When the device detects a suspected overdose, the device buzzes and sends an alert to a user’s phone. If the alert is not cancelled, iSOS administers a rapid shot of naloxone.  The device is about the size of a stick of gum and implanted under local anesthesia. It has a wireless rechargeable battery that lasts 14 days and a 10-milligram refillable drug reservoir. ISOS has been shown to be effective in reversing the effects of overdose 96% of the time and could help people who are at the highest risk of re-overdose. Because the naloxone dose is automatically delivered in a “closed loop” survival is not predicated by timely intervention of a first responder or a bystander Further research is being done to miniaturize the size and optimize battery life. VC Investors are always adjusting their "Play Book" with a variety of options for investing. Mikal Ventures is one of those alternatives, offering curated solutions to real world problems. Reach out if you have questions on how we can be of assistance and bookmark https://mikalventures.com/ for additional insights and information.

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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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