Geoff Hyatt

In this webinar, Natalie McGroarty and Elizabeth Beringer discuss key challenges in building #trust in #healthcare #marketing. The use of AI for #medical content comes with its own legal compliance and content bias issues. The responsible and privacy-conscious marketing strategies they suggest will be essential to build back trust and connect with healthcare professionals. If you're a healthcare marketer, I highly recommend this listen.

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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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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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I guess #healthcare is not alone when it comes to problems with #pricetransparency. Reading this article by Christopher Beam at The Atlantic makes me think of U-Haul - cheap trucks to get you in the door but all their profits are in the boxes and supplies. Imagine if in healthcare, a hospital instituted surge pricing on their chargemaster for cold/flu season, natural disaster or mass casualty events! The public would rightly lose their minds. We have a lot of problems in healthcare and a lot of work still to be done but maybe we are at least headed in the right direction on things like prices? https://lnkd.in/g8_jfEJz #healthcaretransformation HCT Consulting Group

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MeditSimple is featured in The Innovator by Jennifer Schenker for transforming healthcare with AI! Tomorrow, our wonderful CMO @ Dr. Mathilde Konczynski will speak at the Platform Leaders Conference on digital platforms’ role in solving the healthcare crisis. Read the article: https://lnkd.in/ePfFVg2Y and sign up here to join us: https://lnkd.in/grRAdUk. #HealthcareInnovation #AIinHealthcare”

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

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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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AccendoWave - A Pain #Data Company The global chronic pain market is expected to grow at a CAGR of 4.0% from 2024 to 2034, driven by advancements in pain management therapies and an increasing prevalence of chronic conditions. The market is projected to rise from USD 50,611.1 million in 2024 to USD 74,757.4 million by 2034. North America currently dominates the market, while the Asia-Pacific region is expected to witness the fastest growth due to increasing healthcare expenditure and awareness about pain management therapies. Key drivers of growth include technological advancements, non-opioid treatment options, and a growing geriatric population. https://lnkd.in/gz_QHWki

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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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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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🌟 Exciting News! 🌟 We are integrating Digbi Health's precision biology-based programs into Solera's HALO™ platform to holistically tackle cardiometabolic conditions such as obesity, Type 2 Diabetes (T2D), and gastrointestinal (GI) health. Joining Solera Health's elite network of digital solutions enables us to bridge access gaps and transform the lives of even more people. We are proud to be the first company to offer multi-condition support for #obesity, #T2D, and #digestivehealth. Due to GI-based side effects of #GLP1 medications, this capability has become increasingly relevant for payers, employers, and individuals. Our integrated approach ensures personalized care that effectively addresses these interconnected health issues. Digbi Health's precision biology-based care platform goes beyond traditional behavior change programs by addressing the root causes at the biological level. This leads to more sustainable and impactful health outcomes. The partnership makes it easier for employers and health plans to offer this significant innovation in care as part of comprehensive and flexible health solutions. Together, we are pioneering a future where personalized, biology-driven care empowers individuals to achieve their best health. Working with the fantastic Solera team that made this possible was a pleasure. Ed Liebowitz Byron Crowe, Tom Kostecke, Blake Wetherbee WTW Aon Aetna, a CVS Health Company Dexcom Labcorp LG NOVA #genetics #gutmicorbiome Abbott

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Karel’s HealthTech Chronicles #14 - Controversy of Direct Comparison Dear readers, I am going to be a bit controversial today. I was recently very pushy when I was introducing new tools of digital health to my colleagues. There was so much passive resistance against it. You are right, it did not work. It took me some time to adapt and to find the right way to move on. Things have changed since those times. More and more people started to believe in the future and benefits of digital health. And now comes the promised controversy. I want to share with you some examples of what we could lose without digital health tools. - Vital signs monitoring is provided automatically by devices that transfer data directly into the systems.  Alternative: Nurses have to go to beds with non-connected devices and have to use pen and paper to make evidence and records. - Radiologic interpretation is being processed by machines.  Alternative: Doctors have to be ready to make it 24/7 no matter what, even if there are not enough radiologists. - A doctor meets a patient with a severe diagnosis with non-existing therapy and explains the whole situation in an empathetic, professional, and helpful way, thanks to VR training.  Alternative: A doctor meets such a patient for the first time in their life and faces questions they have never faced before. - I want to arrange a meeting at the doctor’s office. I just open my health app and make that arrangement in seconds.  Alternative: I tried to arrange a meeting via calls, SMS, emails. Yesterday. I am still waiting for the response. - I am on vacation in Sweden. I need some acute treatment. I go to the nearest hospital. A local doctor gets all my electronic health records instantly, thanks to EHDS. They make a short examination and know exactly what to do.  Alternative: I go to the hospital and the doctor does not get anything. They have to perform several different examinations like X-ray, ultrasound, laboratory tests, etc. It will take hours, I will have to wait and undergo examinations I already had recently at home. We are going to lose unnecessary time. I could continue like this much longer. And where do I see the controversy? I see it in this clear, direct comparison of different worlds: a world with or without digital health. I wish to find the way to make that digital health world happen. I greatly appreciate your thoughts. Please, share them with me. #DigitalHealth

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The post discusses three key things to keep an eye on in the market, particularly the negotiated discounts by CMS on a select few drugs. However, it's crucial to pay attention to what will happen to the prices of all the other drugs not included in the CMS negotiated list. Despite our political leaders celebrating and claiming to have saved $6 billion for Medicare, many industry experts believe that pharmaceutical companies will likely offset the negotiated discount by increasing the prices of their other drugs not covered by CMS negotiations. This could result in a mere shell game and political maneuvering that ultimately leads to increased costs for everyone in the commercial and individual markets. Adam FeinStacy MaysAnn M. Richardson, MBAJeffrey HoganDan BurkeStacey RichterLarry BeckerGeorge T Mathew, MD, MBA, FACPGe BaiChris DeaconMichelle T. HayesGeorge Reigeluth, PhD

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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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📣 I HAVE SOME BANDWIDTH FOR A FEW MORE CLIENTS. I AM ALSO AVAILABLE FOR FRACTIONAL ROLES. ❗ 💲 ARE YOU A STARTUP OR EALY STAGE HEALTHCARE COMPANY NEEDING SOME ADDITIONAL RESOURCES? 📌 Attention: 💥 MEDICAL DEVICE COMPANIES ⚕MAYBE YOU WANT TO PLAY IN THE DIGITAL AI SPACE...LET ME HELP YOU NAVIGATE THE LANDSCAPE. THERE ARE ALOT OF COMPANIES OUT THERE AND MANY MORE COMING TO MARKET SOON. DON'T PICK THE FIRST ONE! MAYBE YOU ARE A HOSPITAL 🏥 AND YOU HAVE NO IDEA WHERE TO START ON YOUR JOURNEY TO ADOPT AI. I HAVE A GROUP OF ADVISORS WHO HAVE DEEP EXPERIENCE IN AI (BOTH SCIENTIST AND PHYSICIANS) AND WE WOULD LOVE TO BUILD OUT A CREDENTIALING PROCESS OR ONBOARDING PROCESS ON HOW TO ADOPT OR EVALUATE AI. (Our team can even provide a group of advisors to be your AI committee.) 👨‍⚕️ NOT ALL AI IS THE SAME AND DON'T 🚫 JUST TAKE A COMPANIES WORD FOR IT...SHOP, EVALUATE AND ENSURE IT'S CLINICALLY VALIDATED. www.go2market-ai.com

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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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A whirlwind of activity last week at the America's Physician Groups conference. Lots of solid insights shared by health system leaders. Some notable thoughts: +++ Artificial intelligence is intelligent in different ways: By now, we all know ai has a diverse set of use cases, incorporated in different applications and tools. But there are fundamental differences in how the intelligence itself is brought to life. Examples include: - Predictive AI, used to forecast future outcomes by leveraging historical data. Shout out to UCLA’s CKD/ESRD early intervention protocol (Joycee Berin) and Diagnostic Robotics’ intelligence care post-dicharge journeys (Kira Radinsky) - Protocolized AI, used to automating a user’s administrative load by using a set of detailed, pre-defined rule sets. Thanks to ARC for sharing their experience using Elaborate 's automated outpatient lab summaries (Manish Naik) - Generative AI, used to create new content. Great overview of ambient documentation at MGB as well as Cedars’ Sinai talking through its medical ontology model powering acute triage (Caroline Goldzweig) Across system leaders and experts, there was clear agreement that the first step to implementing intelligence intelligently is defining the ‘jobs to be done’. That way, internal and external stakeholders are clear on what they're solving for when they architect the solution.  +++ Scaling AI takes time and rigorous observation: Market leaders describe a phased pilot approach that allows clinicians to build confidence and system leaders to measure ROI before deploying systemwide. Loved hearing Rebecca Mishuris outline MGB’s novel approach of piloting two solutions against one another, to pressure test implementation, workflow, and value creation. +++ Proving ROI continues to be challenging: Lots of vendors using lots of different metrics to prove value, but the majority of leaders agreed that estimating the ROI of these new tools today is part science, part art. Demonstrating the ROI of the “soft” metrics around provider burnout and retention seemed to be a big opportunity, especially for investment in more efficient primary care and PCP wellbeing. After all, PCPs drive referrals to specialty-level care (and higher reimbursements) for health systems. Appreciated Anurang Revri's overview of how working team setup can also impact ROI estimates. +++ Value-based care = tools + humanity: VBC will require not only implementing tools to support clinical documentation, risk capture, upcoding, etc, but also humanizing interactions to engage patients. Countless examples, but one that made me smile was a depression focused chat bot responding in the following interaction: - Context: post-discharge check in Bot: Hi Freida, how are you feeling today after your surgery?  Patient: I’m having a tough time, am in a lot of pain.  Bot: Well, it can’t be that bad, I’m sure it will get better with a positive mindset!    🤣 🤣 🤣 Can't wait for next go-around!

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I don't think anyone would argue that 2023 / 2024 were rough years for the healthtech sector, however I would say the worst has past with 2025 looking up compared to the last two years. The Q3 earnings report from FierceHealth on the financial performance of 3 healthtech companies also highlights the success cases in the sector, these 'champions' show digital health companies can grow into sustainable ventures. There are a couple of interesting takeaways from these businesses, and I'll focus in on hims & hers, since the team at Peach Health Asia focuses on patient facing digital health products. i) Execution trumps tech: Hims and Hers success doesn't rely on using the most innovative or advanced tech, rather the Company has executed the commericialisation side of their business exceptional well using a digital platform that is fit for purpose. ii) Its hard to work SaaS models in patient facing solutions: Every successful digital health which engages patients directly uses some level of healthcare professional engagement and other human resources to power a commercial model. This might change in a world where AI can replace doctors but we are there yet! iii) Digital health is scalable....in certain areas: Digital health enabled models lend itself to certain areas of the healthcare sector like allied health and primary care settings. Patient facing products that work deep in a clinical setting are still valuable and they can offer a lot of value. However one thing history has show is these are expensive and difficult to scale in any short to medium time scale compared to products that manage patients in a contained ecosystem. iv) Digital health plus: virtual care is good, hybrid care is better from a commercial value angle. Hims and Hers I would argue does the same thing, but provides a hybrid virtual care service plus product model to drive patient engagement and profitability.

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