Royce Brunson

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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There’s a category we believe is getting too little attention when it comes to AI in healthcare: AI Clinical Documentation Integrity (CDI) While AI ambient scribes and autonomous medical coding solutions have gotten most of the headlines, we’d argue AI CDI is equally impactful when it comes to quality care and accurate billing. For those not familiar, CDI ensures that clinical documentation accurately reflects the patient’s medical condition and the provided care. Historically, CDI was a manual slog, with dedicated CDI specialists, nurses, and physicians painstakingly reviewing patient charts to ensure documentation supported the care delivered. Today, AI is reshaping this landscape. While it’s still early days, we’re seeing three primary approaches to applying AI when it comes to CDI: 1️⃣ CDI + ambient scribing—an AI ambient scribe and AI CDI assistant operate simultaneously, generating comprehensive notes and surfacing codes for physicians to review at the point of care. (Example: Ambience Healthcare’s AutoCDI) 2️⃣ CDI via real-time diagnosis support—diagnoses are suggested at the point of care based on clinical data in the EHR, with auto-generated documentation and audit trails. (Example: Regard) 3️⃣ CDI via an AI-driven post-coding / pre-billing review—the entire patient record is ingested and analyzed against what is coded, surfacing suggestions for revenue and quality opportunities. (Example: SmarterDx) To date, AI in healthcare has focused primarily on administrative use cases. With the increasing adoption of AI CDI solutions, we’re now taking a step closer to clinical workflows. As clinicians get used to AI-suggested diagnoses in the CDI context, it will be interesting to see if this increases their comfort with AI playing a role in clinical care. Here's our working list of AI CDI vendors. Anyone else we should add? • Ambience Healthcare • Brellium • Iodine Software • Regard • Semantic Health • SmarterDx   

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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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Healthcare is highly suited for AI automation, with many opportunities to improve accessibility, affordability, and outcomes. AI can drive efficiencies across various functions, though it will inevitably reduce the need for some human roles. #higherorder #ai #automation #healthcare #healthtech

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Mandatory bundles in surgery are a bi-partisan objective, and (in)ability to optimize cost/quality will dramatically impact hospital P&L. Regular insights from granular data , and AI-based decision support are the only way to systemically reduce unwanted variability and be both profitable and high quality.

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I am grateful to Medical Economics for inviting me to explore the important topic of whether healthcare is shifting toward viewing the patient in the same light as a consumer. This conversation is crucial as we witness a significant evolution in the healthcare industry, where patient-centric approaches are becoming the norm. I am proud of the work we are doing at OneStep for the team's relentless focus on patient centricity. Healthcare is increasingly focusing on empowering patients, making health tech solutions more accessible and relevant. This shift not only improves patient outcomes and satisfaction but also fosters stronger engagement between patients and healthcare providers. By prioritizing patient needs, we are setting the stage for a more efficient and patient-focused future. #healthcare #healthtech #healthcareinnovation #patientcare #patientcentered #patientsatisfaction

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We’re all too familiar with one of digital health’s most “popular” sore spots: point solution fatigue. I’ve even written about this for the Forbes Business Council (https://buff.ly/43ADMKt) With the rising demand for GLP-1s, buyers are looking for yet another solution to help mitigate rising costs. But have they considered taking a closer look at current vendors they may have to treat chronic or cardiometabolic conditions? For example, Omada Health has been working with members taking GLP-1s since 2019 at the launch of its diabetes program - and now has a GLP-1 Care Track available across its full cardiometabolic suite, which includes diabetes prevention, diabetes, and hypertension. Buyers should provide a program that takes more than just weight loss into account. They should consider MSK support, and sustainable outcomes (i.e. long-term support should members discontinue the drugs). We’re not here for a quick money grab, but to support members for long-term weight health. Learn more about Omada’s approach to GLP-1s: https://lnkd.in/gm77rfWk

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I’m worried about the state of venture capital and direct-to-consumer (DTC) healthcare startups. Hims & Hers is the poster child for DTC healthcare at $1.2B proj 2024 revenue and a $3.6B valuation. By most accounts, they have been an outlier success for DTC since bottoming out in May 2022. So why is this bad news for DTC healthcare? Because the market leader (Hims) trades at a 3x forward revenue multiple. And the category leader typically gets a higher valuation multiple than smaller startups. We see this phenomenon in private equity. They “roll up” smaller companies within the same category at a lower multiples just to create one larger platform that trades at higher multiples. Now back to DTC healthcare startups. If Hims commands a 3x revenue multiple, it’s not unrealistic that smaller, unprofitable startups may be valued 1-2x revenue at exit. At 2x revenue, a startup must generate $500M to produce a $1B exit in today’s market (depending on growth and profitability). Series A/B venture capitalists must see a pathway to $1B outcomes. And if the growth-stage investors with billions under management are less interested in DTC healthcare, the future funding rounds necessary for fueling growth are not guaranteed. Juxtapose this against 2017-2022 where DTC could raise Series B-E funding. Let’s take a DTC startup doing $25M after 3-4 years of operations and has already raised a Series A. By most accounts, it would be a phenomenal accomplishment. But today, investors will question the chances of that same company scaling from $25M to $500M revenue in the next 3-4 years with unknown future funding sources from Series B and beyond. You're stuck in VC-funding purgatory. Some of these companies will shut down. Some may sell for 1-3x revenue. And some may try to transition to profitable, cash-flowing businesses. All of which are certainly not the venture-backed goal the founders, investors, and employees often had in mind when first taking capital. I say this all with friends working at or starting DTC healthcare companies, I feel bad for them. I also feel bad for the patients who enjoy those products or services. To caveat (b/c I know people will object), there will be other DTC brands that exit for $1B+ (i.e., Ro). However, they were forged and scaled during a different time period where seemingly endless venture capital was available for DTC healthcare. Now we're in a different time with no end in sight. Thoughts?

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I had the honor of participating in an Oxford style debate this week at the Oliver Wyman Health Innovation Summit: “Consumers Know Best, Or Do They?” As healthcare continues to evolve, the rise of consumer point solutions has promised greater convenience and affordability, allowing patients to access care in new ways. It’s exciting to see so many innovations aimed at improving the healthcare experience. However, the question posed was this: Do the convenience and affordability of these solutions deliver better access and health? Or, does an integrated approach—driven by health systems—ultimately drive better outcomes? I believe that healthcare is not just about transactions and convenience; it’s also about long-term, coordinated care for the whole person across the continuum. Consumers need partners to support them in understanding their choices. Integrated systems, like Fairview Health Services, are partners in care. And while technology plays a crucial role, there’s no substitute for the integrated systems that ensure every doctor, every specialist, and every caregiver is on the same page when it comes to the health and well-being of the people we serve. I’d like to thank my fellow debater, Laura Jensen from Amazon Pharmacy, for a thoughtful and insightful discussion on the role of consumer-driven care. There’s no doubt that together, we can find a way to merge the best of both worlds—leveraging innovation while ensuring that the human element of healthcare remains at the forefront.

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Understanding the distinct perspectives and strategies of providers and payers is crucial for effective negotiation and risk management. These insights can help providers and payers avoid common pitfalls, as well as highlight the importance of alignment between them. Looking forward to more insights from you and your team Joseph Rafferty. Teaming up with Michael McCabe is a smart move.

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Apologies for the long post, but its LinkedIn so hopefully you are used to it. I’m grateful to share that I’m building a fractional product management practice aimed at supporting modern healthcare companies during pivotal growth phases. Whether it’s launching B2B partnerships, expanding nationally, introducing new services, or breaking into new markets, I’m here to help bridge the gap between commercial strategy and technical capabilities. Reflecting on my career, the central theme has always been about expanding access to innovative clinical solutions. I’ve had the privilege of working at the intersection of healthcare, technology, and finance, crafting products that make a real difference. Recently, I transitioned to an advisory role at Brightline, where we launched BrightLife Kids (https://lnkd.in/gzASHwU8), a joint effort with the State of California to provide free mental health support to 6.3 million children and their families in California. It’s inspiring to see innovative healthcare companies like Selia (https://lnkd.in/gMrJCHbK) and Synapticure (https://lnkd.in/gdZ6ywae) targeting underserved populations and higher acuity patients. As an advisor to these companies, I’m continually motivated by their dedication to addressing these critical challenges, which is why I remain passionate about working in healthcare despite its complexities. As I dive deeper into this new chapter, I’m particularly curious about how we can leverage AI agents in healthcare enterprises to accelerate the growth of clinical solutions. The potential here is immense, and I’m eager to explore it further. Thank you to everyone who has been part of this journey so far. Your support means the world to me. If you’re working on something exciting in the healthcare space or just want to catch up (bonus point for meeting in person), feel free to reach out. Let’s continue to innovate and make a difference together!

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M7 Health is scaling, and we are growing our team! Two years ago, Eric Gruskin and I had just incorporated M7. We had no team and most days we were working off of a folding table in the (truly) empty NYC apartment that my husband and I had just moved to.   We were cold-calling nurse managers around the country to give us feedback on our MVP. We didn't even have software - we serviced our first clients with elaborate spreadsheet models. Two years later, a lot has changed.   🚀 We have a fully functioning product that has evolved far beyond schedule balancing.   🚀 Nurses depend on our software every single shift.   🚀 We have 8 (and counting!) mission-driven employees on the team.   🚀 We've more than tripled our customer base since January. 🚀 We raised a $4M seed round to step on the gas. The vibe at M7 is electric. We're doing what we set out to do.   We are actively hiring across engineering, operations, and analytics.   If you or anyone you know is interested in joining a mission-driven startup making waves to support the nursing workforce, please send them my way! #hiring #opentohire #openroles

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Eye Opening! As noted by Matthew Holt below, Doximity promotes itself as “The Professional Medical Network for Physicians” with a mission to “help clinicians be more productive so they can provide better care for their patients.” Sounds simple enough, a community built for doctors—a space where they can connect, share insights, and access tools to support their work. Their main source of revenue, subscriptions. Of course, you'd think the subscribers would be the doctors using this valuable platform and its tools, like video calls, hiring services, and various apps, platforms. But look a little deeper at their financials? Yuck. Doximity’s revenue doesn’t come from clinicians at all. The“subscriptions” (main source of revenue) are actually sold to pharmaceutical and other industry players that want access to docs and the powerful (and profitable) prescription pads they wield. These “Marketing Solutions” subscriptions allow advertisers to push tailored content directly into doctors' "news" feeds, with pricing set according to the type and number of doctors targeted. In effect, the platform sells access to doctors to those looking to drive up utilization of their products. Doximity’s real revenue engine (which is pretty amazing, see post below) lies in its advertisers. Life sciences companies and the highest bidders pay for the privilege of influencing what doctors see in their feeds—not just ads, but entire modules and news updates. What seems like a physician’s trusted source of industry news and updates is, in reality, a curated stream designed to serve business interests. This brings us to the key question: when doctors use Doximity as their “news feed” and source of the latest research, are we comfortable knowing their information stream is largely influenced by advertising dollars? When we scroll through platforms like Instagram or Facebook, we’re well aware of how advertising shapes our experience. Mention a skincare product in a text, and suddenly, your feed is filled with face cream ads. We know this, we accept it, and we view each ad with a healthy dose of skepticism. But are we okay with doctors facing the same experience? Are we comfortable with Doximity’s advertisers shaping the content doctors see, especially when they rely on this platform for up-to-date clinical research and product information? Let's hope our docs approach these tools with the same skepticism I do when I'm promised younger looking skin:). Jessica DaMassaPreston AlexanderDutch RojasPatient Rights Advocate Marilyn BartlettDave Chase, Health Rosetta-discovering archaeologistAnn LewandowskiJeffrey HoganDavid Contorno Stacey RichterLee Lewis Shawn GremmingerAndré WENCKER Renzo Luzzatti

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Proud to announce a strategic partnership between Salient Health and Revelar Analytics that is set to transform the landscape of healthcare pricing transparency! 💡 By combining Revelar's innovative approach to price transparency with Salient's core competency in turning complex data into actionable intelligence, we're unlocking new levels of value and efficiency for healthcare organizations. Our mission? Empowering providers, payers, and patients alike to make more informed, data-driven decisions that improve care quality while controlling costs. This collaboration is about more than just technology – it’s about creating a sustainable impact on the healthcare industry by delivering insights that matter, driving efficiency, and advancing patient outcomes. 🎯 Stay tuned as we continue to push the boundaries of what's possible in healthcare innovation! #Healthcare #Analytics #PriceTransparency #Innovation #SalientHealth #RevelarAnalytics #ValueBasedCare #DataDriven #Efficiency #HealthcareTransformation

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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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Value-based care (VBC) is reshaping healthcare by emphasizing outcomes and cost efficiency over volume. Originating from managed care models in the 1980s, VBC has evolved with a strong focus on refining payment models, enhancing care coordination, and improving patient outcomes. Key players, including clinical data registries, ACOs, and payers, are crucial to this transformation. By collaborating, sharing data, and aligning incentives, these stakeholders drive advancements in care quality and efficiency. Learn more about how these collaborations can enhance VBC in this Health IT Answers article. https://lnkd.in/gxSPZAgM

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Exciting news from Monica Chopra, Jeffrey De Flavio, MD, Samantha Adelberg, and the rest of the Auxa Health team as they officially announce their $5.2M Seed round. The team's deep industry expertise and drive for change have led them to solve critical infrastructural friction to providing quality healthcare and adoption of value-based care. Auxa's AI benefit navigation platform is simplifying the complexities of healthcare by streamlining all of the fragmented and siloed data and information to make it actionable in real-time for healthcare organizations. For the 70% of Americans who aren't getting access to the health and social care benefits they deserve, Auxa's solution will be pivotal in enabling equitable care. We're thrilled to partner with co-investors Zeal Capital Partners, AlleyCorp, Laconia, and Chaac Ventures on this journey and look to share many more milestones ahead. Cc K50 Ventures, Ryan Bloomer, Daniel Vásquez, Nick Talwar, Stefanie Ng https://lnkd.in/dPDY7-Db

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For the healthcare nerds 🏥 🤓 Kaufman Hall just released its latest (September) Hospital Flash report. As always, the data is amazing. While 2024 performance shows improvement over 2023, recovery lags pre-2020 levels for many organizations. Here are some highlights across all hospitals: ▶️ EBITDA Margins are up 11% comparing YTD 24 vs. YTD 23 but down -15% when comparing YTD 24 vs. YTD 21. ▶️ Operating Margins are up 17% when comparing YTD 24 vs. YTD 23 ▶️ Both Inpatient and Outpatient Revenue are up 9% per calendar day comparing YTD 24 vs. YTD 23. Outpatient is up 31% per day when comparing YTD 24 vs. YTD 21 ▶️ Current YTD Operating Margin across all hospitals/geographies is at 4.3%. Up from 2.3% in Oct '23, but down from 4.9% in April. Holding steady since January ▶️ Total Expenses are up 19% comparing YTD 24 vs. YTD 21 but showing "just a" 6% increase when comparing YTD 24 vs. YTD 23 Beyond the numbers, here are a couple of big trends: 🏥 Large national players have been reevaluating their portfolio of assets. Many are divesting underperforming hospital sites and shifting investment to ambulatory settings (clinics, ACS, outpatient centers, etc.) within more profitable geographies. 💪 Providers are seeing a combination of solid volume growth, favorable payer mix shifts (results from redetermination), higher commercial reimbursements, increased acuity for inpatient admissions, and greater cost control over contract labor and professional fees (contract labor down 30% from its height). 🙏 25M Americans have lost Medicaid coverage due to redetermination. Many of these lives have been moving to the Exchange, which is a significantly better payer than Medicaid, thereby improving the payer mix within health systems.

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