CaRessa Hutchinson

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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The Telehealth Time Bomb: How Hims and Ro Are Risking Patient Safety for Profit The telehealth Men's Health industry is booming, with Hims reporting $872 million in revenue for 2023 and projections up to $1.20 billion for 2024​ (Hims)​. However, much of this profit comes from a dangerous loophole allowing online prescriptions for medications like Viagra and Cialis without adequate medical oversight. Hims and Ro use AI-driven questionnaires, bypassing real-time physician interactions, which can lead to severe health risks, misdiagnosis, and adverse reactions. Financial Success at What Cost? These companies capitalize on the convenience of online prescriptions, bypassing crucial steps in the patient-provider relationship, such as: Medical History Review: Vital to understanding potential health risks and medication interactions. Comprehensive Health Evaluations: Necessary for accurate diagnosis of men's health issues. Continuous Monitoring and Follow-Up: Ensures ongoing patient safety and treatment efficacy. The Legal and Ethical Concerns According to § 410.78 Telehealth Services of the U.S. Code of Federal Regulations, telehealth services must involve an interactive telecommunications system that allows real-time, two-way communication between the patient and provider. This regulation ensures a higher standard of care, which is often bypassed by the simple form-filling methods used by some telehealth companies. Hims and Ro often use AI-generated question and answer formats to determine if a prescription should be issued. This method bypasses real-time interaction with a physician, raising significant safety and ethical concerns. Such practices should be illegal and likely will be in the future as adverse reactions or deaths accumulate. Risks to Patient Health Cardiovascular Complications: Dangerous drops in blood pressure for heart patients. Drug Interactions: severe side effects from negative interactions with other medications. Misdiagnosis: ED can be a symptom of conditions like diabetes or hypertension, requiring proper evaluation. Overuse and Dependence: Easy access leads to overuse and psychological dependence. Ensuring Patient Safety at His Health His Health avoids these pitfalls by adhering to rigorous telehealth standards: Comprehensive Evaluations: Detailed medical history reviews and thorough consultations. Patient Education: Providing resources on medication risks and benefits. Ongoing Monitoring: Regular follow-up appointments and support. Legal Compliance: Adherence to all relevant state and federal regulations. Our Unique Approach At His Health, we prioritize patient safety and comprehensive care: Dedicated Telehealth Doctors: Patients are assigned to a specific telehealth doctor responsible for their care, like traditional practices. Secure Communication: Regular communication through our EHR system, including secure messaging, additional appointments, and access to medical records via our patient portal. THE DIFFERENCE IS CLEAR!

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I completely agree with the concerns raised by Dr Gigy Kuruttukulam, which is the current state of EMR systems. Having worked abroad with CISs, EHRs and EMRs as a Registered Nurse and Health Informatics specialist, I’ve seen firsthand the frustrations they can cause. This experience was further reinforced upon my return to South Africa, where I found that our healthcare sector largely reliant on outdated paper systems.📝 🇿🇦 It’s high time healthcare professionals voice their needs. Equally important, we must listen to the patients who often complain that doctors spend more time clicking away at computers than engaging directly with them. At Proto Care (Pty) Ltd, we are committed to addressing these concerns. We are actively developing an EHR system that is responsive to the needs of both healthcare providers and patients. We invite healthcare professionals and patients alike to DM me or the Proto Care team with your thoughts on what should be included in your ideal EHR solution. Your insights are crucial as we strive to enhance the effectiveness and human connection in healthcare. 📢👩‍⚕️👨‍⚕️ #HealthcareInnovation #PatientCare #EMRReform #EHR #HealthTechStartUp

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Revenue does NOT equate to the value of your practice. Clinic owners, make sure you understand the statement below from Dave Kittle - he's spot on. ⬇️ ⬇️ “If a practice is doing a million dollars in revenue, and $250,000 in adjusted EBITDA, that practice could potentially be valued at either $750,000 or a million dollars in that range. If their practice is doing a million dollars in top-line revenue, most of them don’t want to or will not sell if the offer is below a million dollars. Because they’re equating revenue to the value of their practice. But the value of their practice actually starts with your adjusted EBITDA."

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Insights from the 'Tech Tour Growth Health 2024' panel on 'Acquisition – What are PE looking for in healthcare? When do buyers acquire?' Selling to PE is not like an Exit. PE usually does not buy 100%. It's rather a partial acquisition where the management team stays on, working towards a bigger exit. We have return expectations just like other investors. We plan to sell in 3-5 years. A lot of money was raised in 2020 and 2021 and there was great reluctance to invest in the last 24 months. At the same time a lot of the investors that invested money in 2020 and 2021 now need to return money to their investors. Due to these two factors, we will see a lot of activity in the coming quarters. Selling to strategics you usually see acquisitions super early, a molecule, or pretty late stage when the company delivers at scale. Because strategics struggle to take companies from a growth stage to scale. Strategics expect all the boxes to be ticked, all the t's to be crossed and all the i to be dotted: compliance, evidence, regulatory... Strategics want to cover the full patient journey with integrated solutions. That often cannot be done all in-house. You have to partner within an open ecosystem. Sometimes even direct competitors. For startups: When a large company announces a big strategic shift that might be a good moment to reach out to them, because they will want to make progress on that strategy quickly and have an interest to make an acquisition. The market is still fragile. PEs are still super risk averse. At JP Morgan everyone was talking about the coming interest rate cuts. But it has not happened yet. Now they are backed into expectations. Therefore potential further delays are seen as a risk. It is a buyer's market. Some sellers will try to hold out and wait for a better market environment. Think about all three main stakeholders - the three P's: Patients, Providers and Payors. Ideally, you serve all three. Payors are often forgotten about and they are super focussed on cost particularly in this stage of the cycle. US strategy – It's the biggest market and everyone will want to know how you think about it What is the difference between selling to PE and selling to strategics? You have to address them differently and, maybe, even sequentially. It depends on a lot of parameters. An M&A exit to PE requires a certain commercial traction and the management team is crucial. Strategics are sometimes also interested very early (e.g. acquiring a technology). Do's and don'ts in a sales process: - be super transparent. don't try to hide anything. it will come out anyway - be reasonable in terms of expectations (price, timeline) - be prepared (usually you have a single shot) - assess probably the post-acquisition plans - the diligence process should be two-sided (talk to other companies that were acquired by the buyer you are talking to and ask for references) Insights from Luke R Parsons, Vincent Meunier, Joerg Hoelzing, PhD, Tanja Dowe

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We're underestimating how physicians will build and access software in the future and we're 100% underestimating how this will impact independent practice. By now I'm sure you've seen the Claude 3.5 Sonnet demos and all of the use cases or application non technical folks are building with 1-3 line prompts. Even Jensen Huang, CEO of Nvidia made a controversial comment on the future of coding, “It is our job to create computing technology such that nobody has to program. And that the programming language is human, everybody in the world is now a programmer. This is the miracle of artificial intelligence,” This is absolutely true, and if there's one area where this will have the biggest impact on society, it will be healthcare. The reason for that is that physicians and clinicians have NOT been included in the design of healthcare technology over the last 20ish years, leaving them to practice in systems designed by non-clinical people. Claude 3.5 offers a glimpse into the future of independent practice. Physicians will be able to design, build, and launch AI applications as needed without requiring developer support. In the future, I envision independent practices hiring their own AI Agent developers who can not only build these applications, but also integrate them into their practice operations infrastructure to create the ultimate practice management system. What application would you build if this were possible today? ----- Hi, I'm Dr. Mario Amaro, Founder and CEO Ease, and I talk about all things starting, running, and growing a private practice with AI. Follow me, if you are planning to start one or are currently figuring out creative ways to grow one. #PrivatePractice #SelfEmployment #HealthcareOnLinkedin #HeyEase #IndependentTogether #Fintech #Infrastructure #AIinHealthcare #CareDelivery

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Health caregivers suffer a "death by thousand logins and passwords".... A login/ app for EHR A login/ app for Payroll A login/ app for Benefits A login for Scheduling .... The list goes on. By the time is comes for a healthcare services operator to integrate "the next best thing for X", they're faced with adding yet another login/ app to their caregivers' experience. That's why, from Day 0, the Arya team has been focused on integrating into caregivers' existing tech ecosystem and workflow, in stead of adding to it. Arya now supports SAML 1.0, SAML 2.0 and OTP-based authentication, all powering lightweight and "login-less" (but secure) web and mobile experiences for caregivers. Another step towards our vision of powering a "simple, single pane of glass" for the caregiver. Come join us. #digitalhealth #homecare #homecareagencies #homehealth #PostAcuteCare #healthcareworkers #skillednursing #personalcare

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Missed our webinar about the hype surrounding AI and outpatient infusion coding? Watch this snippet from the event to see how having an automated solution can simplify your coding so that you aren't leaving revenue on the table.

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Local focus won't cut it. For regional health plans, scaling means looking beyond community ties and redefining market differentiation. At the HPA Value Visit, one thing became clear ⬇️ Affordability, access, and easy navigation are the new competitive edges. Health plans that lean into data and innovative payment methods—like Softheon’s community lockbox drop-offs—are breaking into traditionally hard-to-reach populations and creating real impact. To stay ahead, you need to rethink your strategy and prioritize these differentiators. Let’s discuss how your plan can leverage these insights for growth. https://bit.ly/3LsXa3F #HealthPlan #HealthcareIT #innovation

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Critical Issues in Healthcare that Everyone Should Know but Are Complicated (Explained as simply as possible) 1. Declining Reimbursements (Even Though the Dollar Amount Payments May Increase)   Declining reimbursements are probably the most urgent problem in healthcare right now. Reimbursements are a more technical term and represent revenue in healthcare (at least in the traditional model where healthcare organizations are being “reimbursed” for services by the insurance carriers) and as reimbursements decline, providers struggle to maintain profitability. Yes, healthcare is a business and without profits the medical practices will not survive.    How can there be “declining” reimbursement and the cash payment for some services still increase year-over-year?   Short answer: CMS (Center for Medicare and Medicaid Services) publish publicly the annual fee schedules (technical term for an organized table of reimbursement rates) that the commercial insurance carriers base their reimbursement rates on.    CMS uses a relative value unit formula to calculate the cash payments for each service. There are three components in the RVU model - Practice Expense RVU, Malpractice Liability Insurance Expense RVU, and Work RVU. The RVUs are adjusted for geographic price factors, essentially to factor in the cost of living differences between different regions, states, cities, etc., and then are multiplied by the Conversion Factor.    The formula: (PE RVU x GPCI) + (MP RVU x GPCI) + (wRVU x GPCI) x Conversion Factor   The Conversion Factor is arguably the most critical component of the formula and has decreased year-over-year for the past 20 years. This is why providers and healthcare experts keep ringing alarm bells on declining reimbursement. However, that does not always mean the actual dollar payment has decreased for each CPT code/service (though, many cash payments have decreased).    This is because CMS analyzes the actual historical revenues and expense of Medicare participating hospitals and medical practices at the CPT code level and assigns RVUs to each service based on these metrics. Overall, healthcare expenses have been increasing and based on the RVU allocations there are services that have still “increased” in total cash payment despite declining conversion factors.   The PROBLEM is at this point Medicare rates are basically breakeven points based on legislation that mandates CMS changes to meet certain federal budget requirements. The components of RVUs are based on expenses - actual expenses, so just because these increase they are just covering rising expenses. The conversion factor is the profitability component of the formula and has been shrinking for over 20 consecutive years.   

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A profitability secret every clinic owner should know ⬇️ You can’t say margins are too thin to succeed while private equity is snapping up PT clinics every month. At a recent event, I sat down with a group of practice owners who all shared a common frustration: reimbursements are down, margins are shrinking, and the grind feels endless. But I had to challenge them: If private equity is actively acquiring PT clinics, it’s because they see the potential many of us overlook. They know this industry has untapped value—because profitability doesn’t come from just working harder or seeing more patients. It comes from running a better business. Here’s how to shift your focus: - Stop chasing volume; focus on optimizing margins. - Take a hard look at payer contracts and drop the ones that drain resources. - Invest in systems that improve efficiency and patient outcomes. - You don’t need to be the biggest clinic around. When you focus on profitability, you position your clinic for long-term success, whether that’s expansion, acquisition, or just enjoying running it every day. H/T: Rafael Salazar

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Nothing will really fix our healthcare system. That is because there are certain entities: hospital systems, pharma, health insurance companies that profit immensely off of it right now. Changing it amounts to affecting their bottom lines. These entities have huge lobby arms and budgets, so they are already in the ear of congress. Getting change on a legislative level will be near impossible. Legislative changes while necessary, are also very slow. One legislative change that would save time and effort and be better for patients would be if health insurance companies had medical liability for their denials. It makes sense that they should have medical liability in that they are making medical decisions which could and often do cause poor outcomes. So they could still deny care if they want to, they will just have to face the consequences if there is as bad outcome. If this law were to ever pass (it wouldn't) then you would see prior authorizations and denials go down dramatically. This would be in the patient's best interest. Right now, health insurance companies can deny all sorts of care and have no negative results from it. They are still collecting premium money and just don't have to pay out. #healthinsurance #healthcare #medicine

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📈 Boost DME Revenue with Real-Time Connectivity DME and remote patient monitoring providers face increasing complexity in operations and reimbursement. Learn how APIs and automation can enhance efficiency, reduce costs, and improve patient care in today’s healthcare landscape. 🔗 Read the full blog: https://hubs.li/Q02Vw05R0 #RemoteMonitoring #HealthcareAPIs #RevenueCycle #DMEProviders #HealthcareTechnology

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Your first 100 "no's" are actually your market research. . When a hospital administrator tells you your idea won't work because of HIPAA, workflow issues, and union regulations – that's not rejection, that's your roadmap. For those starting out: 1. Find one problem so specific it seems trivial 2. Solve it so well it seems like overkill 3. Watch how that solution reveals ten bigger problems you couldn't see before My current board meetings look nothing like my first meeting with my first ever client. Now, when clinics say "So, you think you can fix this?" I answer differently: "No, but I think we can work together to make it better." Happy National Entrepreneurship Day to all the founders passionate enough to think they can change healthcare. You can. Just not in the way you originally planned – and that's the best part. #Founder #StartupLife #NationalEntrepreneurshipDay #HealthTech

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Healthcare is fixed No more misaligned incentives No more price obfuscation No more rising premiums No more price gouging No more out-of-pocket No more deductibles No more middlemen No more carriers No more PBMs Healthcare is affordable But nothing changes 28 million people smoke 100+ million people are obese 38 million people live in poverty 15 million people drink too much 19 million people still live in food deserts 43 million adults are functionally illiterate The leading causes of death are heart disease, stroke, and cancer 80% of heart disease and stroke are preventable 40% of cancer is preventable But even our "fixed" healthcare system still isn't built to prevent Not to mention all the remaining barriers to access So, if we fix the money problem, is it really fixed? Or, do we need to fix the societal problems too?

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**For Sale: Telemedicine Evaluation Company with 4,000+ Stage 3 Wound Patients** Price: $3 Million One of my business partners is selling a highly profitable telemedicine evaluation company that specializes in Medicare patients. This company not only handles over 8,000 Medicare lives but also documents a significant number of stage 3 wounds—currently over 4,000 in their database, with an average of 300 new cases added each month. This documentation occurs naturally through their evaluation process, and with a more strategic approach, there’s potential to uncover even more stage 1 and stage 2 wounds. In the hands of a buyer active in the wound care marketplace, this business could be incredibly valuable. All numbers are guaranteed, backed by a consistent four-year history and solid proof of records. This is a unique opportunity to acquire a thriving business with tremendous potential for growth. NO PATIENT HAS BEEN TREATED FOR WOUNDS YET. This company is profitable on consulting and evaluation for obtaining a wheelchair in rapid speed. Many in-home or other care models could be plugged into this potential Goldmine and harvested far beyond just wound care. Not only have these wounds not been treated. There’s a high probability that they have not been closed yet either due to the nature of needing a wheelchair. There could be more discussions on this. Message me for details. Appreciate any referrals as well.

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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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Bigger isn't always better in healthcare. Just look at the graphic below. Some of the largest health systems in the country are underperforming. They've entered (or operate in) bad markets, hold bloated cost structures, and struggle to hold leverage against payors. As it turns out, and as I'm often reminded, market performance matters. It doesn't matter that you're just big and can absorb a vast swath of overhead. As a health system, the way you throw your weight around in markets is more important than ever. This is the key concept of density and having the right assets in the right markets. CVS, HCA, Tenet, and others all have mentioned the importance of market density in 2024. Density - and being dense in attractive markets - is primarily what separates -3.9% from 10%+ operating margins. I should have paid attention in physics!! PS: if you like graphics and analysis like this, subscribe to my newsletter Hospitalogy here with 34k+ others: https://lnkd.in/gniNmHvz

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