Chad Turner

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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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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There is a misconception emerging that AI agents will lead to immediate reductions in healthcare labor costs. While AI agents can automate end-to-end workflows such as booking appointments, answering basic patient questions, and performing form completion for prior authorizations, automating a single task is not equivalent to automating an entire job. Nurses are a prime example. Certain nursing tasks, such as care coordination and patient documentation, are highly automatable by AI agents; however, there is a tremendous amount of work nurses perform on the ground that cannot be fully automated with current technologies such as direct patient care, physical examinations, medication administration, wound care, patient support, and clinical assessments. These nuances make full role elimination less likely with current technologies. When articulating the ROI of an AI agent, we need to be both precise and accurate. Automating a task is more often not automating an entire profession. For roles that encompass many functions, such as nursing, AI agents can be invaluable tools for unburdening staff, increasing efficiency, and boosting throughput—benefits that are particularly valuable given current healthcare staffing and resource shortages. The most promising job candidates for full role elimination through AI remain positions with monolithic task structures, of which there are relatively few in healthcare today—scribes, medical coders, and data entry specialists for example. It is therefore unsurprising then that the most progress has been made in these categories.

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The power of one question from Jeremy Bikman: "What workflow do you solve that is absolutely essential and not provided by any other vendor in your healthcare market?" I had a great catch up with the always insightful Jeremy Bikman and we shared ideas around AI. Jeremy got at something that has been bothering me - how do you think about what would make for a successful AI application or, maybe even more broadly, any healthcare software innovation. The conversation was far ranging, but in some ways boiled down to the one question above. Truly, the power of one question!

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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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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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So simple, even I could do it…🤣 •Expand #patient engagement •Reduce #clinical team workload •Optimize #operations •Increase #revenue Are you #valuebasedready? Dillon McClernon & Christian Kete Sellu are here to support your next #techstack evolution. Connect today to discover more! GRO🌱 by ERPHealth the market leader in #behavioralhealth #outcomes #technology

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There is a blueprint for success and MDisrupt has the experts to deliver it!

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HLTH continues to be a great networking event - for startups, health systems, investors and industry giants... between meetings and the exhibit floor. I do wonder how much people are getting out of the speakers/content here (or at any of the big meetings anymore). I usually am happy if I can hear 1 great nugget that changes how I think or design... This article gives some thought to the big trends.. and a few summaries from leaders who attended.

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Today, we reported strong Q2 2024 earnings results as we met or exceeded all four key metrics – total revenue, membership, adjusted EBITDA and adjusted gross profit. Specifically for Q2:   • Total revenue was $681 million, up 47% year over year • Health plan membership growth once again outpaced the industry – increasing 56% year over year to approximately 175,100 members • Adjusted gross profit was $77 million, hitting the high-end of our guidance and producing a consolidated MBR of 88.7%   Following this strong quarterly performance, we are raising our outlook on both membership and revenue for the year and reiterating our full-year adjusted gross profit and adjusted EBITDA guidance.   Amid all the changes in MA and the broader health care sector, I’m proud of the Alignment Health team in staying focused on our work, and in our mission in serving our seniors. Our platform is the model for the future of Medicare Advantage done right, built for sustained, profitable growth.   #growth #earnings #medicareadvantage #healthcare #breakoutyear  

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Couldn't make it to our #webinar today with our VP of Product Management, Kevin Sundquist)? No problem -- we've got the replay ready for you! Check it out to learn what happens behind-the-scenes to take a #pharmacyclaim from your doctor's office to your #pharmacist, and how a modern platform like JUDI® makes this process more efficient, accurate, and #transparent for everyone involved. Check out the full webinar here: https://okt.to/MYZDF3

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It's so tough to maintain accurate provider data . . . that's why Veda is here! We take a unique approach: #astrophysicists + #supervisedAI + patented (x5!) ML models Check it out - let us help you move beyond ALL of the manual effort you're currently using to *try* and manage your provider data 🤓

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Prepping for Fall Conferences and curious if the trend of less is more is across the board for SaaS or more prevalent for startups. Conversations with industry leaders reveal a growing consensus: the era of sending an army of 50 people to man a gargantuan booth seems to be gone. Nowadays, a more strategic approach is far more effective. Smaller events provide a chance for intimate interactions and meaningful conversations. Brand Building vs. Pipeline Generation: Large national conferences are great for making a splash and boosting brand visibility. Smaller, niche events offer a better opportunity to dive deep with a targeted audience. Elevate Your GTM Strategy with strategic meetings, set up one-on-one meetings with key prospects and customers. Host exclusive dinners, happy hours, or networking events. Meet with Customers and gather feedback, discuss their evolving needs, and explore upsell opportunities in a relaxed, face-to-face setting. Measure and Optimize: Evaluate your success based on your goals. For brand-building, keep an eye on media exposure and social buzz. For pipeline generation, focus on the quality of leads and conversion rates. Use these insights to refine your strategy and make every interaction count. What’s your strategy for navigating conferences? #SaaS #ConferenceStrategy #BrandBuilding #LeadGeneration #Networking #FallConferences #GTMStrategy #MarketTrends

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Looking ahead to the H2 2024 & 2025 and beyond …. While focusing on the last week of Q2 to finish strong. Reflecting on what’s working (partnerships, referrals, community) and what’s not to pivot ( current ABM). Get disciplined and iterate every quarter. Document the process, inspect the data, and coach your team. Happy Monday from Vegas and #hfma annual conference. What are you focusing on this week? #randispeaks

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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  

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Prior auth is about to change dramatically, and adapting will cost health insurers $16.2B. Yesterday, we explored the history of prior auth and how we ended up with the frustrating system we have today. Now, let's look at the imminent regulatory changes. Here's what you need to know and how you can brace for impact: → There’s broad bi-partisan support for radically restricting insurers’ ability to conduct prior auths 1. The House of Representatives has passed bipartisan legislation demanding sweeping prior authorization reform. [1] 2. Texas, Michigan, and Louisiana have already enacted similar laws. 3. 30 more states are in the process of drafting their own legislation. → The financial impact The Congressional Budget Office estimates that complying with these new laws will cost insurers $16.2 billion. Insurers will be required to: 1. Universally adopt electronic prior authorization (ePA) 2. Maintain 24-hour response times 3. Publicly release data on all prior authorization metrics 4. Implement gold carding programs for certain providers 5. And a slew of other restrictions The industry response? Major insurers like UnitedHealthcare, Aetna, and Cigna are already preparing. They're proactively slashing their prior authorization requirements and racing to implement universal electronic prior authorization. 𝗧𝗵𝗲 $𝟭𝟲𝗕 𝗾𝘂𝗲𝘀𝘁𝗶𝗼𝗻: 𝗛𝗼𝘄 𝗰𝗮𝗻 𝗶𝗻𝘀𝘂𝗿𝗮𝗻𝗰𝗲 𝗰𝗼𝗺𝗽𝗮𝗻𝗶𝗲𝘀 𝗽𝗿𝗲𝗽𝗮𝗿𝗲? It’s going to cost a lot. There’s no getting around it. But by centralizing your prior authorization data, you can avoid the worst of it. Here's why: - Public data releases require a centralized repository of all your prior auth metrics. - Universal ePA adoption needs a centralized system to manage incoming requests. - Gold card programs require centralized tracking of provider performance. - Ensuring 24-hour response times necessitates centralized monitoring. Once you centralize your data, you unlock a world of possibilities. The big one? Automation. McKinsey estimates that with today's technology, 75% of prior auth can be automated. [2] Here’s what this will unlock for insurers facing these new laws: → Responses in minutes, not days → Public data releases with a click of a button → Gold Card programs that run themselves → Vast majority of auth requests handled without human intervention The pendulum is swinging back towards providers, but payers can adapt and thrive with the right approach. By centralizing data and embracing automation, you can slash costs, ensure compliance, and emerge stronger.

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Why does Big Tech fail in health care? This podcast shead some light on this question. Here is my 5 cents. Healthcare is not governed by the rules of economic scale - cost reductions and efficiencies various technologies offer other sectors have only very slowly been adopted. Listen to the reason why here. My 5 cents in the comments. Luba Greenwood, J.D.

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If we build any Value Based program off of current primary care payment levels I think we miss the key opportunity that is present. We also need to be very parsimonious with administrative requirements -- and for me that includes inter-operability. Primary care is a lean environment with significant downstream potential, but not all primary care decreases utilization - some investment is required to prime the pump and create sustainability. Carefully developed expectations for each subpopulation need to be established and clinical risk adjustment alone will not be sufficient. Averages obscure the underlying realities and the overall goal has to be better care, better access and at the population level lower use of avoidable services. Payers need to Trust and keep their eyes on the big picture and that is not where immediate primary care results matter.

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It's a great day at Noom! I'm so happy to announce two new solutions today at the HLTH conference -- each expanding access to GLP-1s. ** Solution 1: Noom Med with SmartRx, in partnership with Waltz Health, drives 4.1x more ROI for employers who seek to cover GLP-1s versus the most common alternative, based on a recent third-party actuarial analysis. ** Solution 2: Noom Weight with GLP-1Rx is a workforce-friendly, budget-conscious solution for employers who do not cover GLP-1s today but would like to provide an effective obesity solution while enabling access to low-cost, non-branded GLP-1s. After spending months and months learning from the market, we have put together two programs that will finally help employers and payers with GLP-1s. Read the full coverage at Fierce Healthcare. https://lnkd.in/gUrvtDJG

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