Jason Lineen

Nice sum up on the #privateequity investments in #healthcareservices “healthcare services are increasingly integrating technology into workflows and becoming more attractive to tech investors” - Dan Shoenholz Private Equity Leader at EY-Parthenon. Technology has immense potential to amp up the quality of care, access and bridge gaps created by labor shortages through AI, automation and richer data science prediction tools.

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Value analysis is transforming partnerships between health systems and suppliers in health care. In a recent article from The Journal Of Healthcare Contracting, insights from the IDN Insights West panel featuring Cheryl Smith Anderson, DNP, MBA, RN, BSN, system director of Value Analysis at Steward Health Care, and Jimmy Chung, MD, MBA, FACS, FABQAURP, CPE, CMRP, chief medical officer at Advantus Health Partners, sheds light on the pivotal role of value analysis. Cheryl and Dr. Chung discuss their approaches to value analysis and the key components of successful partnerships. From prioritizing patient care outcomes to fostering transparent communication, their insights show the importance of collaboration in driving value for both healthcare organizations and their patients. Read more about how strategic partnerships in value analysis are reshaping the healthcare supply chain landscape: https://lnkd.in/gB7NgJF3

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Health plan strategist and executive coach Dominick Bizzarro believes that an agile approach to strategic planning can help turn regulations like the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) from something done TO you to something done FOR you. #Interoperability #digitalhealthinnovation

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Equitable healthcare stands as the paramount goal for the industry, especially in an era where patient demands outpace available resources. While advancements have propelled healthcare to unprecedented heights, the widening gap between patient needs and resource availability poses a daunting challenge. However, AI emerges as a powerful ally in bridging this disparity. Here’s how: #Healthcare #AI #PatientCare

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PE is particularly poised for growth in 2025... with $2 trillion in available funds and pressure to deploy capital. CEOs are encouraged to stay prepared, align leadership, and focus on integration to navigate a competitive and evolving deal-making landscape. Hot sectors include: ✅Life Sciences ✅Energy ✅Infrastructure ✅Tech and AI driving transformative opportunities

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Interesting perspective on #TechnologicalDebt in health care by Dave Lamar focused on the provider market, but we seem the same issues within state depts and payers. While good data governance practices are key, there must be a better way to solve this common - if not universal - challenge in health care, if only by offloading some of the administrative responsibilities that require the individual management and administration of no-value-add administrative functions. #healthdata

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Key Strategic Insights = A Successful OP CDI Program The challenge of value-based care starts with a collaborative approach, when launching an Outpatient Clinical Documentation Integrity (OP CDI) program. Here are some key strategic insights to success: 1. Engage with Population Health Understand Pain Points: Begin by understanding the specific challenges faced. This fosters collaboration. Tailored Questions: Use customized questions to facilitate productive discussions and ensure alignment with needs. 2. Effective Software Implementation Manage Patient (Pt.) Volumes: Implement software solutions to efficiently handle pt. volumes. OP CDI Calculator: Utilize a calculator to determine Full-Time Equivalent (FTE) needs. Data Analytics and Reporting: Emphasize the importance of continuous improvement via data analytics. 3. Workflow Creation Establish Robust Workflows: Create strong workflows before integrating reviewers. 4. Collaboration & Communication Promote Strong Collaboration: Encourage robust communication between key stakeholders. Leverage Software: Use technology to reduce physician burnout & streamline communication. 5. Patient-Centered Approach Address social determinants of health (SDOH) & ensure accurate documentation of conditions and care plans. Patient Outcomes: Keep patient care at the center of all doc. & workflow processes. 6. Regulatory Compliance Adhere to Guidelines: Follow regulatory requirements such as CMS guidelines on Hierarchical Condition Categories (HCC) coding to avoid penalties and enhance credibility. 7. Measurable Outcomes Set Clear Goals: Aim for measurable outcomes like improved HCC recapture rates, enhanced RAF scores, better HEDIS measures, and addressing SDOH needs. 8. Stakeholder Engagement Involve All Stakeholders: Ensure that executives, clinicians, and other relevant parties are involved in planning and implementation process. Success Stories Recently, I helped several CDI directors validate their cases for OP CDI programs within Accountable Care Organizations (ACOs). By engaging with population health leadership, we identified key issues such as RAF gaps and HEDIS measures, and tailored processes to address them. For instance, a CDI director I guided successfully identified HCC and HEDIS recapture as their biggest pain points. With strategic solutions in place, they are now ready to implement the project for the 2025 budget yr., aiming to improve their HCC recapture rate by 20%, leveraging data analytics for outcomes and improvement needs. Benefits of Implementing These Strategies Align Risk Stratification: Properly align risk stratification with chronic conditions and healthcare needs. Quality Measures: Improve quality measures and address SDOH. Collaborative Team: Ensure success with a collaborative team supported by technology. Overall, these strategic actions will enhance patient care and operational efficiency. #Healthcare #Leadership #CDI #PatientCare #ValueBasedCare #HealthcareInnovation

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I had the pleasure of contributing to this book, Digital Health, Telemedicine and Beyond. It has a broad list of topics including the basics of services, reimbursement, and regulations. I wrote the "Coding for Telehealth/CMS guidelines" chapter. I still don't believe this myself, but my most interesting and impactful work has been on reimbursement and regulation. Here I describe some of it based on the behemoth that is #CMS. Edited by Dipu Patel, DMSc, MPAS, ABAIM, PA-C as she describes it: "With a strong focus on case studies and patient outcomes, this title provides an overview of digital medicine, terms, concepts, and applications for the multidisciplinary clinical practitioner. Chapters provide a concise, yet comprehensive understanding of digital health, including telemedicine, mHealth, EHRs, and the benefits and challenges of each. The book gives insights on risks and benefits associated with storing and transmitting patient information via digital tools and educates clinicians in the correct questions to ask for advocacy regarding state laws, scope of practice, and medicolegal implications." I'm joined with a number of incredible authors. Link below to pick up a copy: Harvey | Amit | Susan | Sonia | Jeremy | Derek | Kathryn | Nathan | Tom | Lisa | Marty | John | Dr Stefan #ai #rpm #rtm #dtx #telehealth #telemedicine #digitalhealth #digitalmedicine #aiinmedicine #healthcare

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S&P: Medicare Advantage's growth a bad omen for hospitals - n8: and Many Health Systems Continue to Participate Under the Terms Dictated by the MA plans, Enabling this Abuse “Even beyond rates, MA adds more administrative and liquidity hurdles for providers. S&P pointed to MA plans’ “key strategy” of prior authorization requirements, which force providers to absorb associated refiling costs and sometimes keep patients locked in a longer hospital stay. That burden is exacerbated by insurers’ generally “high” denial rates, S&P wrote, which have led to instances where smaller providers without the resources to fight claim denials terminate their MA plan contracts and become more vulnerable to closure…. The report also notes that many MA plans have longer pay cycles than traditional Medicare. Combined with claims denials and payment uncertainty, the delayed reimbursement “can hurt cash flow and liquidity,” according to the report.” https://lnkd.in/g3-drT-S So it goes n8 #healthsystems #hospitals #valuebasedcare #medicareadvantage #valuebasedscam

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Two new proposed rules could be a game changer for health data interoperability... In early July (published in Federal Register August 5), ASTP/ONC released all 1,067 pages of its proposed HTI-2 rule, in which it proposed expanding its Certification Program to complement CMS' FHIR APIs. This included creating criteria impacting payers and public health IT. It reminded me of a line of questioning from ONC's electronic prior authorization RFI from January 2022, where the agency asked nearly ten questions about what certification criteria should look like to facilitate electronic prior authorization processes. The thought then, and even at the publication of HTI-2, was that certified modules wouldn't help payers much because payers are not the ones implementing modules. The vendors who provide the administrative platforms are. As it stands, there are only disincentives to certifying under the program for payer health IT vendors (i.e., bringing them under the information blocking rule), so payers are really at the mercy of their vendors. This is in stark contrast to the impact the program has on EHR developers. That was until HHS' ASFR and ASTP/ONC released another proposed rule on August 9 that would require all providers and health plans (that means you, MA plans) that receive HHS funding to use certified health IT or adhere to ONC standards at a minimum. So, what does this mean? Payers who receive HHS funding could now have the regulatory support to require their vendors to be certified... If passed as written, payer health IT vendors that want to maintain their contracts with federally funded plans would not be able to "unreasonably limit" the exchange, access, or use of electronic health information - including charging an unreasonable fee. They could be penalized up to $1M per violation if they do. This is a huge deal. Luckily, the team at Maverick Health Policy summarized both proposals (linked below). If you need help navigating these changes, we're here to help. HTI-2: https://lnkd.in/g4McbwMy Acquisition Regulation: https://lnkd.in/gWY--VPb

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Also don’t outsource your hospital’s core services to a GPO ran by foreign PE… I do find it so odd that Vizient’s own contracts couldn’t stand on their own so they had to create a aggregation group with Mayo Clinic called Capits. (https://lnkd.in/gpiVDKvn) Which by the way Mayo Clinic is being sued because not only does Mayo control pricing on supply chain contracts for Vizient, but guess who controls pricing on their self insured insurance plan. (https://lnkd.in/guvx5mqr) Oh and as of November of last year Mayo Clinic lead their state in adverse healthcare events. (https://lnkd.in/gXsPi2sw) Should I go on or have I made my point clear on why Oklahoma hospitals should not blindly follow Vizient, Captis, and the Mayo Clinic?

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Key trends and takeaways from HLTH 2024: 1. AI's Evolving Role: AI dominated discussions, with executives acknowledging its potential while also recognizing challenges in accuracy and clinician trust. There's a shift towards focusing on the practical applications of AI, with a call for partnerships to ensure reliable testing and implementation. 2. Infrastructure Focus: Beyond the glitzy AI tools, there's a growing emphasis on the "picks and shovels" needed for healthcare data accessibility, including infrastructure, compliance, and interoperability. Executives believe that improving data flow will facilitate the effective use of AI. 3. Middlemen Under Scrutiny: Pharmacy benefits managers (PBMs) faced criticism for their role in rising drug costs, with discussions highlighting misaligned incentives and the need for transparency in healthcare pricing. 4. Women's Health Spotlight: Women's health initiatives gained attention, particularly following government funding announcements and personal stories shared by advocates. However, investment in women's health remains minimal compared to overall healthcare funding. 5. Interest in Psychedelic Medicine: The potential of psychedelics for treating mental health conditions garnered significant interest, with discussions about funding and research moving forward, especially within the Veterans Affairs system. Executive Takeaways: Leaders from various sectors emphasized the importance of consumer-focused strategies, collaboration, and the need for responsible AI usage. There was a consensus on the critical role of addressing healthcare accessibility, improving patient experiences, and fostering innovations that genuinely enhance care delivery.

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Oracle Health announced plans to launch a next-generation EHR platform in 2025, incorporating advanced cloud and AI capabilities. This new EHR will feature Oracle's clinical AI agent, voice-activated navigation, and Health Data Intelligence, which integrates patient data from over 300 sources to enhance clinical workflows and improve patient outcomes. The platform aims to replace traditional EHRs, which often dictate rigid workflows, with a more dynamic system that allows for personalized care plans. Oracle Health emphasizes that the new EHR is a complete reinvention rather than an upgrade of the previous Cerner system. Additionally, Oracle plans to become a Qualified Health Information Network to facilitate standardized data sharing across the healthcare ecosystem. Executives at Oracle also unveiled new cloud applications to improve patient management and streamline front-office operations, reinforcing the company's commitment to enhancing healthcare accessibility and data utility while addressing interoperability challenges in the industry.

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How can we leverage Patient Experiences to Drive Health and Care Outcomes? What is "Authentic" Value-Based Care? In our recent Health Data Management article, Rachel Biblow and I discuss transforming health and care delivery by prioritizing “authentic” value, which emphasizes patient experiences and health outcomes (in relationship to financial results). This approach requires healthcare providers to focus on what matters most to patients. Read the full article: https://lnkd.in/e7fQihgw Initial Steps to Drive Authentic Value: 🌟 Adopt a human-centered culture by prioritizing individual health needs and goals >> Partner with individuals across the health and care continuum to support progress toward achieving goals. Operationalize experiences that enable better outcomes. 🌟 Develop an integrated data strategy and utilization plan >> Implement tools to capture patient perspectives on health status and healthcare experiences, ensuring that care aligns with patient needs. Integrate data for continuous improvement through collection, analysis, and intentional change to transform experience and health outcomes. 🌟 Leverage technology innovations >> Adopt relevant digital tools, including, AI for personalized care, improved communication, and operational efficiency. Determine pragmatic applications of technology that enable outcomes that matter to patients. By focusing on these elements, health and care organizations can earn trust, strengthen partnerships, enhance health outcomes, and achieve a more sustainable system. ************ SIGN-UP: Free monthly digest:  “Transforming Health and Care Experiences with Research and Actionable-Insights" https://lnkd.in/eWG5XSEd ************ ATTEND: Patient Experience Symposium, Boston, Sept 16-18, 2024 https://lnkd.in/eNKSpJ8G ************ PUBLISH: in the Special Collection on "Exploring the Relationship between Patient Experience, Health Outcomes, and Value-based Care" https://lnkd.in/ew4gEgz7 (A Collaboration between Journal of Patient Experience and International Consortium for Health Outcomes Measurement (ICHOM) ************ #PatientExperience #PatientReportedOutcomes #PatientEngagement #HealthCareExperience #ClinicianEngagement #PREMs #PROMs #VBC #VBHC #ValueBasedHealthCare #ValueBasedCare

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🤔Private Equity and Healthcare seem to have a complicated relationship. A recent PitchBook report reveals some intriguing insights about PE investments in healthcare. Despite the buzz, PE investment in healthcare providers remains a small slice of the pie, making up less than 4% of the U.S. healthcare provider market by revenue. Interestingly, the growth in PE-backed providers has significantly slowed over the past six years. 📉 The numbers tell a compelling story: year-over-year growth in the number of PE-backed healthcare companies has plummeted from nearly 25% in 2018 to under 1% in the first quarter of this year. In response, PE firms are pivoting from traditional provider investments to areas like healthcare IT and pharmaceutical services. 💡 While PE investments continue to face scrutiny regarding their impact on care quality and costs, it's clear that firms are innovating and finding new ways to contribute to the healthcare sector. For more detailed insights, read the full report here: https://lnkd.in/dmQkzMzh #HealthcareInvestment #PrivateEquity #HealthTech #HealthcareTrends #PitchBook Bjoern von Siemens Dennis Kogan Matt Krueger Amel Mokrani Bois Etienne Bauer Gargee Kashyap Emre kamil Özkan

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With the elimination of non-compete agreements (temporary?), there has been rampant forecasting and debate about its implications in healthcare. Frankly, healthcare often is a negative catalyst industry, meaning it needs a negatively disruptive event to motivate innovation adoption (look no further than Covid or the IRA). As a healthcare business builder and investor, I am eager to collaborate with with founders in both vertical solutions as well as horizontal technologies. By horizontal, I mean solutions that every payor/provider/manufacturer must perform frequently/daily. A lot of the new AI companies focused on healthcare have taken aim here. I find vertical solutions just as compelling. By this, I mean healthcare solutions that these healthcare nodes don't NEED to own because the node does not need full utilization of the asset or even the base load demand required to economically justify the investment. But historically, for reasons not entirely quantitatively driven, these nodes choose to invest in the product or service. I forecast that the elimination of non-competes will stop or at least substantially curtail this negative ROI practice. Case in point, my good friend, Dr. Sina Haeri, MD, MHSA is building Ouma Health (note, I'm not an investor here). Sina is one of the leading clinicians in Maternal-Fetal Medicine. This is a relatively small but life saving practice area. Ask any mother that has faced a high risk birth. NIH indicates there are only 1355 MFM docs in the US, with a significant concentration in six states. Given the scarce skillset, maintaining MFM capability is extraordinarily expensive for any one hospital system. At Ouma, leveraging the combination of expertise and tech, Sina and his team are making the service available to all hospital systems/payors/self-insured employers on a semi-variable priced basis. Brilliant - a win/win for everyone, and clinician uptime is maximized! And now, Ouma's customers (aka providers) aren't forced to figure out how to maintain/pay the fixed cost for sub-optimal utilization of their MFM practitioners. Economically, this is the necessary business model. And as we look out over the next 2-5 years, given their expertise and accumulated data, models like Ouma will further distance themselves because they can build and augment with AI assistants for further capacity in a non-linear expense framework. Exciting times!

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