John Kao

Aligned, hybrid primary care payment models that combine capitation alongside some fee-for-service payments are gaining traction in California. However, some key decision-makers have questioned the feasibility of adopting capitation as a payment mechanism among self-funded and flex-funded health coverage arrangements. A new issue brief from IHA and the Purchaser Business Group on Health (PBGH) 's California Quality Collaborative explores how regulatory oversight of health coverage affects opportunities for hybrid primary care payment in self-funded health insurance arrangements in California. The brief examines several topics, including: ✔️Primary care payment alignment and the role of capitation ✔️Regulatory context related to primary care payment in California ✔️Primary care capitation in self-insured plans: allowable conditions, remaining uncertainty Access the full brief here: https://hubs.li/Q02yr2770

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Drex DeFord Advises Simplifying Healthcare for Vendor Risk Reduction: https://lnkd.in/dDvhYsDF First Health Strategic Advisory Board Member & Healthcare Strategist Drex DeFord dives into pressing concerns around the increasingly complex, difficult to manage, and frequently targeted healthcare environment. Drex’s conversations with This Week Health fuel meaningful conversations to spur the change necessary for improving health sector resilience. We’re proud to have such a dedicated member of the healthcare cybersecurity space advising our leaders and ensuring First Health is at the forefront of digital health security innovation. For more insight into First Health’s leadership and board members, visit https://lnkd.in/gQUx5BzD or contact First Health at [email protected]. #CISO #CIO #CTO #CDO #Compliance #HIPAA #HealthcareIT #HealthcareSecurity #CyberRisk #ThirdPartyRisk #RiskAssessment #Cybersecurity #HTM #DigitalHealth #PatientSafety

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"Rarely have the pathologies of the Medicare Physician Fee Schedule portended such poor outcomes for the future of U.S. healthcare as they do now." In a new Healthcare Financial Management Association (HFMA) blog, APG President and CEO Susan Dentzer describes the four main flaws in the Medicare Physician Fee Schedule. "Those of us hoping for a better system for paying physicians should keep pushing for alternative payment models." #valuebasedcare #Medicare #healthcarecosts Read the blog: https://lnkd.in/dGVE8dfM

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Abdel Mahmoud, MD will deliver the Keynote Talk at The Millennium Alliance event this September: 'What does the health plan of the future look like?'. The future of health plans is not just about optimizing operations — it’s about reimagining the entire member experience. The health plan of the future is proactive, personalized, and powered by AI, shifting from reactive administration to anticipatory care.

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"Watershed’s SaaS platform gives providers real-time information, including health status, social determinants of health, location and involved care team members." #care #healthcare #healthtechnology #digitalhealth #saas #postacute

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The new KFF analysis shows that nearly seven in 10 Medicare beneficiaries did not compare their #Medicare coverage with other Medicare options during the program’s annual open enrollment period for coverage in 2022. Enrollees in traditional Medicare were slightly more likely to skip shopping around than those in #MedicareAdvantage plans.

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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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In a recent panel discussion, Sara Pastoor, MD, MHA, FAAFP, Jay Keese & Penny Morris delved into groundbreaking federal policies that will reshape primary care. With a focus on interoperability, innovative payment models, and improved care access, these changes are set to enhance patient outcomes and support providers. What does this mean for you as a Primary Care provider? Understand Your Contracts: Be aware of fee-for-service vs. value-based models to ensure compliance. Leverage Technology: Use Certified EHRs and AI tools to streamline data management and patient care. Stay Informed: Keep updated on evolving regulations to navigate the changing landscape effectively. Ready to dive deeper? Discover how these legislative shifts can impact your practice and equip you to thrive in this transformative era! Read the full blog here: https://ow.ly/QFJf50TGe1S #PrimaryCare #PrimaryCareProvider #HealthcareInnovation #ValueBasedCare #HealthTech #RegulatoryCompliance #EHRs #AIinHealthcare #HealthcarePolicy #MedicalPractice

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HLTH and ENDEAVOR PARTNERSHIP for Masterclasses! Thrilled to be a new Partner and Anchor in the Health HLTH Community. Endeavor will be delivering a series of Masterclasses on a regular basis over the next year on AI and Healthcare in the areas of drug development & discovery, innovation impacting hospitals including electronic healthcare records, radiology, pathology, surgical suite logistics, discharge planning, improving patient fall risks, and addressing nurse and physician burnout. We will be discussing important partnerships in AI and Healthcare between Emerging Companies, Big Tech, Biopharma, Biotech, Bedtech, Healthtech, and Major Academic Medical Centers. As part of our 20 year development of the Endeavor Healthcare Ecosystem, we've established partnerships with Fortune 500 companies and collaborations with major tech firms, including Microsoft, as well as with Big Pharma, including Sinofi, and leading medical centers such as Mount Sinai, Memorial Sloan Kettering, SUNY Downstate, and Mass General Brigham Hospital. Our focus is on fostering collaboration as we look to integrate AI into the healthcare system. Join us on November 13th for a celebration of collaboration at the Endeavor and Mount Sinai Health Systems Healthcare AI and Technology Investor Summit, from 4:00 PM to 10:00 PM at the offices of Goodwin Proctor in NYC. For more information, please contact us at [email protected]. #Artificialintelligence #VentureCapital #Investing #Entrepreneurship #Startup #Healthcare #HealthTech #MedTech #Funds #DrMartinAlexanderGershon #BetterHealth Dr. D. Martin Alexander Gershon, MD, JD, MPH Endeavor Venture Fund & Venture Studio

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The California Office of Health Care Affordability just announced a 15% primary care spending target. That means that by 2034, insurers should allocate 15% of their spending to primary care, a significant increase from the current 7%. This initiative aims to enhance preventive care, improve health outcomes, and reduce long-term costs. It coincides with a recently established 3.5% annual cap on overall health care spending growth. California is one of several states working to make health care more affordable, and improve outcomes, by setting both primary care spending and health care cost growth targets. https://lnkd.in/g6g3rSkP

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Healthcare Deals and News for Week ending September 20th, 2024: · Cardinal Health (NYSE: CAH) to Acquire Integrated Oncology Network for $1.115 Billion, Expanding Community Oncology Services · Northwest Urgent Care, Subsidiary of Community Health Systems, Inc. (NYSE: CYH), Acquires 10 Arizona Urgent Care Centers from Carbon Health, Expanding Tucson Healthcare Network · Encore Clinical Holdings Corp (Encore Wound Care) Expands Wound Care Services in Northeast Ohio with Acquisition of Ohio Wound Care · CentralReach Acquires Behavior Science Technology Inc., Insight Partners and Arc Capital Development, to Enhance ABA Care with AI-Powered Treatment Fidelity Solutions · Vyne Medical Acquires Extract Systems to Enhance Healthcare Automation and Data Management Capabilities via its Financial Sponsors, Health Catalyst Capital (HCC) and TJC · RLDatix Acquires SocialClimb to Enhance Healthcare Operations with Comprehensive Patient Insights and Reputation Management via Nordic Capital, Pantheon International Plc, Torreal, Resolve Growth Partners, Susquehanna Growth Equity (SGE), TA Associates, and Five Arrows Principal Investments · SubjectWell Acquires Trials24 GmbH via WindRose Health Investors · MedeAnalytics Acquires SubPop Health, Inc., a spinout from Hashed Health, via JLL Partners · Blue Matter Acquires Sam Brown Healthcare Communications., via Baird Capital · Panacea Healthcare Solutions Acquires KA Consulting Services a Division of Panacea via its Financial Sponsors Columbia Pacific Capital Partners and The Firmament Group · Agape Care Group Expands Hospice Services with Acquisition of Select Crossroads Hospice Facilities Across Four States via Audax Private Equity, H.I.G. Capital and Ridgemont Equity Partners Other and Venture News · Xvivo Perfusion Acquires FlowHawk Software Platform to Enhance US Transplant Clinical Workflow Automation Healthtech Solutions Inc. · Candid Health Secures $29M in Series B Funding Led by 8VC, Joined by First Round Capital, BoxGroup, and Y Combinator · Scriptology Acquires RxLive, Accelerating Growth with AI-Driven Medication Management Platform · Fabric Expands Virtual Healthcare Network with Acquisition of TeamHealth VirtualCare For more details on these transactions and more: https://lnkd.in/gqPHCCYU Read our recently released BioAstronautics, (Space Health) white paper on the future of space health. https://lnkd.in/gbvyC5j3 Join our bankers at these events: Sept 25 - 26 HFMA Columbus OH Oct 7-9 - Behavioral Health Business Invest Conference Dallas TX Oct 20- 23 HLTH Las Vegas NV Lawrence, Evans & Co. LLC (LECO) is a leading national healthcare financial advisory firm. We specialize in capital raising, mergers and acquisitions, and restructuring for lower middle market private companies, delivering strategic solutions to maximize value and drive long-term growth across healthcare, technology, and business services.

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Confluence Health has roll out its new partnership with KeyCare, a new virtual care option which will allow patients to seamlessly access care 24/7 from their home or while traveling across Washington State while ensuring the visit notes end up in their chart for their care team. “With KeyCare, Confluence Health can now expand our telehealth options for our patients, allowing us to provide on demand virtual visits for routine ailments and minor illnesses,” explained Josh Wood, vice president of digital engagement for Confluence Health. “KeyCare is a virtual care platform based in Epic – the same system we use for our patients’ EHR, or electronic health record, for in-person appointments and other care. It offers video visits for on demand, high-quality, affordable care 365 days a year, 24 hours a day, from anywhere in Washington State.” This option – alongside other new tools like Care Companion, which is a digital option for patients with chronic conditions such as diabetes to help monitor vitals, manage their health, and communicate with their care team – is a part of Confluence Health’s new Patient Digital Engagement initiative. This suite of new tools and processes dovetails with and expands upon the Primary Care Redesign efforts which have already led to improvements across the healthcare system such as the recent launch of DirectCare. "We are excited to add another convenient way for patients to get care when, where, and how it works best for them. Offering on-demand virtual visits grows our ability to meet the care needs of the people of North Central Washington,” added Tracy Corgiat, vice president of primary care. These expanded virtual visit options play an important role in Confluence Health’s overall primary care services. With this change, patients will now be able to receive medical care at home, the office, or anywhere else in Washington State via the internet using MyChart on their computer, tablet, or smartphone. “Rather than having to re-enter healthcare information each time or share medical chart information, KeyCare providers, as well as the patient’s Confluence Health care team, will have access to patients’ health information automatically within the patient’s MyChart account, assuring they receive high-quality care with all their medical history available,” continued Dr. Beth Avena, core medical director for primary care. Our primary goal is to continue delivering exceptional healthcare services while prioritizing patient options, convenience, and safety, all while helping staff and providers to better balance and structure patient caseloads,” remarked Dr. Andrew Jones, CEO for Confluence Health. “With these new and expanded components to our primary care services, we will continue providing local care by and for our community while meeting our patients’ needs in the ever-changing healthcare landscape.”

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PicassoMD and Eventus WholeHealth Announce Partnership to set a new standard in healthcare innovation and patient-centered services for individuals in long-term care settings PicassoMD, Inc., a platform that connects healthcare providers for real-time clinical decision support, referrals, and care coordination, and Eventus WholeHealth, the country’s leading provider of primary care and mental health services for medically vulnerable adults, are proud to announce a new partnership that will enable their strategic clinical care teams to connect with local and remote specialists in real-time. PicassoMD and Eventus WholeHealth share a common goal of making access to healthcare available to those who are medically vulnerable. Co-founded by a cardiologist, PicassoMD has revolutionized the way Primary Care Providers (PCPs) deliver care. The platform enables PCPs to access real-time clinical consultations with specialists across more than 30 specialties in under 30 seconds, significantly improving patient outcomes and reducing costs. Additionally, if a referral is necessary, PicassoMD helps seamlessly transition the patient from the PCP to a local specialist, ensuring continuity of care and enhancing patient satisfaction. This partnership has already shown impressive results for Eventus patients: * 70% of Emergency Department (ED) visits were avoided. * 77% of specialist referrals were avoided. * 70% of cases saw a change in clinical behavior based on real-time specialist input. * The average time to connect with a specialist was just 12 seconds. "Through our strategic partnership, Eventus WholeHealth and PicassoMD are setting a new standard in healthcare innovation for individuals in long-term care," said Dr. Reza Sanai, founder and Co-CEO of PicassoMD. "We are dedicated to enhancing patient outcomes and streamlining care coordination, demonstrating our commitment to transforming healthcare with compassion and excellence." “Eventus’ partnership with PicassoMD has been amazing! It allows our clinicians to securely message specialty providers for consultation about difficult cases. I’ve personally connected with various specialists and within minutes had a plan of care to implement the same day. This app enables real-time patient treatment instead of waiting months for an appointment,” said Cathy Parker, NP, VP of Value Based Care Outcomes at Eventus WholeHealth. “These curbside consults directly affect value-based care by providing real-time solutions, coordinating care, and decreasing ER transfers, leading to better quality and cost-effective care for our patients.”

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#HLTH24Takeaways The recent HLTH24 conference brought together healthcare leaders to discuss critical issues, including the challenges and opportunities in primary care. 🔗 https://lnkd.in/grw47PuD Key Takeaways: 1. Everyone agrees on the vital role of primary care in a functioning healthcare ecosystem and for a healthy population. 2. Early intervention and preventive care are essential for better patient outcomes and reduced healthcare costs. 3. A shift to value-based care is seen as critical to incentivize better patient outcomes. One missing piece: The critical role of care coordination. At Ursamin, we believe that effective care coordination is essential for ensuring seamless communication and collaboration between healthcare providers- enabling better care management and adherence to treatment plans. By avoiding unnecessary tests and procedures, care coordination helps optimize healthcare resource utilization. Let's continue the discussion - share in the comments your thoughts on HLTH USA recap and your thoughts on what is broken in #primarycare. #carecoordination #primarycare #healthcare #ursamin

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Providers and health systems implementing innovative models are rewarded for ensuring #RightCareRightTimeRightSetting. One example is from Health Care Transformation Task Force member, Trinity Health’s MediGold Medicare Advantage a #HealthCareInnovation that results in better patient outcomes. Learn more about the MediGold total cost of care payment model and then Take Action and ask Congress to advance patient-first models: https://lnkd.in/g58BUfDb

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As we all know, the pandemic prompted the rapid adoption of telehealth technology across most health systems in the United States. But there is one significant consideration that many providers didn’t consider at the time: adopting high-quality security measures. The Pandemic and Virtual Care Coverage The pandemic led to increased coverage for telehealth with fewer restrictions, prompting more patients to utilize digital services instead of in-person services. The hopes of this decision were that fewer patients would be entering high-risk facilities and opt for stay-at-home care instead through the duration of the pandemic. Telehealth Cybersecurity Attacks Telehealth vendors that existed for some time before the pandemic already had quality security measures in place – it’s primarily the telehealth solutions that started popping up across the market throughout the pandemic that some providers are encountering issues with. Top virtual care software vendors saw a 30% increase in cybersecurity attacks in the first month of the pandemic. Unsurprisingly, hackers are trying to take advantage of the mass adoption of this technology with malware activity shifting from organization-focused attacks to vendor-focused attacks. Poor security leaves your practice and patients vulnerable to dangerous cybersecurity attacks. This means that your practice data and your patient’s information are at higher risk of getting into the wrong hands, in turn leaving your practice vulnerable to violating compliance and security regulations. So, how do you find the right telehealth vendor? 1. Increased Security The right telehealth vendor has quality security in place. They have years of experience fighting off cybersecurity attacks and know how to keep patients and providers safe. They have a seamless integration process that enables your team to understand how to safely use the software and lower your risk of cyber-attacks or vulnerability. 2. Customer Support Customer support is vital through any transition. If your practice is considering implementing a new telehealth solution, then it would be wise to partner with a vendor that offers quality customer support. This is important for the moments when your team has questions or concerns regarding the technology, enabling your team to run at its most effective pace. 3. Accessible Solution The virtual care solution your practice chooses to implement should also be accessible while offering top security. This means it should be user-friendly, but also HIPAA compliant. With more of your team working from home and on-the-go, an accessible solution can make all the difference. Find a vendor that wants to help your team utilize all that telehealth has to offer without putting you and your practice at risk. Learn more about our quality telehealth solution here: https://ow.ly/eZP350RILoc

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New CMS report: The Medicare Shared Savings Program (MSSP) continues to demonstrate its effectiveness in delivering high-quality care while generating significant cost savings. Key highlights from the report: - MSSP generated $1.8B in savings for Medicare in 2022 - 483 ACOs participated, serving 11 million Medicare beneficiaries - 99% of ACOs successfully reported quality measures - 54% of ACOs earned shared savings payments These outcomes reinforce that VBC can drive care quality while improving financial outcomes for the ACOs who participate. Check it out here: https://lnkd.in/dJDNU6-c #Valuebasedcare #healthcareinnovation #ACOs #Medicare

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🌟New Issue Brief Alert: Calculating Adjustment Factors for Primary Care Capitation Payments in California 🌟 Want to know how to fairly distribute primary care capitation payments to practices with diverse patient populations? Let Onpoint Health Data’s August Issue Brief show you how! Onpoint Principal Health Data Analyst Katharine McGraves-Lloyd explains how Onpoint, in partnership with the Integrated Healthcare Association in California, created a set of adjustment factors that go beyond the typical focus on total cost of care, and instead map the interrelationship between certain patient characteristics – age, sex, health status, and health coverage – and primary care spending. This innovative approach allows payers to scale payments to primary care practices based on the estimated clinical complexity of their patient mix. Onpoint had the opportunity to present the results of this work at AcademyHealth's Annual Research Meeting last month in Baltimore, Maryland. If you missed it in Baltimore, don’t worry—you can read all about it on our website! 👉 https://lnkd.in/ehB4rERu #HealthcareInnovation #PrimaryCare #HealthcareData #HealthEquity #OnpointHealthData

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