On this episode, we talk with  Matt Hollingsworth, CEO of   Carta Healthcare, about ChatGPT.  If you've been reading the headlines, and maybe even experimenting with Chat GPT yourself, but don't quite grasp what's going on, then this episode is for you. Mat gives a not-too-technical, high-level explanation of what's going on under the hood so that you have proper context for the discussion. Then, Matt outlines the potential benefits, and potential harms, of applying ChatGPT in healthcare. Finally, Matt shares his experience launching Carta Healthcare, including how he convinced VCs that software plus services could scale better than a pure SaaS offering in this space.  This is a good one. I'm honestly not sure in which part of this conversation I learned more.

ChatGPT: Where (and Where Not) to Apply it in Healthcare

Medicaid Transformation. 1115 waivers. Delivery System Reform Incentive Payment (DSRIP) programs. Expansion. Contraction. We’ve been at this for a long time. Why isn’t Medicaid transformed already? Well… it turns out that this is really difficult work. First off, there are complex political and ideological issues. Even if we all agree that we want the best healthcare for every American – a conceptually easy outcome to rally behind – we don’t all agree on what that looks like, how to get there, or how to pay for it. Second, it takes a long time for policy levers to play out in the real world. That makes it exceedingly difficult to measure the success of our programs, which further exacerbates the first issue. Add in a bunch of multi-billion-dollar entrenched institutions, technology hurdles, and social determinants of health, and you are still just scratching the surface of the many issues that need to be addressed and aligned to “succeed”. But all is not lost. We’ve learned a lot over the past 30-40 years, and we’ve made progress in many areas. There are approaches and mental models that have led to certain levels of success. And today’s guest has been participating in and observing many of them over the past few decades. Today we talk with Alan Weil, Editor-in-Chief of Health Affairs, the nation’s leading health policy journal.  Alan takes us through the history of Medicaid Transformation from the early 1980s on. We discuss the approaches taken, the thinking behind them, and the many factors that influenced their success. We explore the conflicts and hurdles, the friction and confounders, not to define a path forward, but to give the listener a more productive framing from which to build. This is admittedly a bit more of a philosophical discussion than what we usually have on this show. However, I feel we’ve taken a practical approach to the philosophical exploration and yielded actionable advice on how to adjust your frame. Please do let us know what you think!   For full show notes and links, visit: https://thehcbiz.com And of course, find everything from Health Affairs at: https://www.healthaffairs.org/

Medicaid Transformation: Past, Present, and Future with Alan Weil of Health Affairs

Cleveland Clinic recently announced that they would begin charging for certain patient-initiated messages. This flies in the face of everything the industry is talking about when it comes to patient engagement and value-based care. At the same time, it is quite unreasonable to think that a doctor should be available for questions at any time, for free. How can we protect the clinicians' time AND provide the patients with the care and attention they need?  And why are we moving away from value-based care?  Craig Joseph, MD, Chief Medical Officer of Nordic Consulting Partners, and Matt Lambert, MD, Chief Medical Officer for Curation Health join Don Lee to share their take.  Craig's article that led to this episode: To charge or not to charge  For full show notes and links, visit https://thehcbiz.com

Should Patients Be Charged for Messages to their Doctors?

Don and Shahid discuss NCQA's Health Innovation Summit (November 2022) and FHIR Dev Days (June 2022). They explore these events as examples of how to interpret what you hear at conferences, in industry media, and even on podcasts like this.  The discussion covers a lot of ground including:  What is NCQA? What is HEDIS? What does it mean to move from Electronic Clinical Quality measures (ECQM) to Digital Quality Measures (DQM)? Can FHIR really do all that!? Specified, but not implemented (this is important) Why is it hard to innovate and sell innovations in the quality measure space? How are health equity and social determinants of health factoring into quality measurement?  It's a fun conversation, but... take it with a grain of salt. 

Take it All With a Grain of Salt

On this episode, we talk with Ray Dogum, MS, MBA about the state of blockchain and web3 technology in healthcare. Ray is the producer and host of the Health Unchained podcast where he discusses blockchain developments in healthcare with industry experts. There was quite a hype cycle around blockchain in healthcare that has died, but there is still real development being done and plenty of opportunity to create value in the future. We’ll break down the pockets of success that are happening today and talk about where things could be headed in the future. For complete show notes and links visit: https://TheHCBiz.com

The State of Blockchain and Web3 in Healthcare with Ray Dogum

Some people tell doctors that anything more than a cup of coffee is a conflict of interest. What about executives? Is it ok to take them out to lunch? What about a trip to the Super Bowl? Is there a line? Where is it? On this episode, Don and Shahid discuss a recent LinkedIn discussion where a healthcare executive called shenanigans on himself and his colleagues for accepting gifts. The gift is a symptom... not the underlying issue.  Tune in to find out what the issue is and how to fix it. Plus, learn why Don hates RFPs and how we can do those better too.

Can I Buy You Lunch (and tell you about my product)?

There's no business case for doing the right thing in healthcare. Fortunately, being patient-first is the right thing to do and can be good for business too. Today we talk with Brian Sanderson, national healthcare management leader at Crowe LLP and author of the new book, The Patient-First Revolution.  In it, Brian provides a blueprint for hospitals to skyrocket net revenue by boosting patient experience (#HCBiz listeners can grab a free copy of the book  here). Brian explains it's important to think about more than short-term financials. Yes... you need to operate efficiently and run a sound business… those are table stakes. The hospitals and health systems that take it to the next level will do so by playing the long game and being patient-first. This conversation continues our ongoing exploration of the Healthcare Delivery Organization Innovation Lifecycle Ontology (HDO-ILO). Brian helps us understand how to make the case for prioritizing patient-first practices and how to set and manage expectations within the organization. This, of course, is a critical early step for any healthcare innovation effort.  For full show notes and links, visit https://thehcbiz.com

The Business Case for Being Patient-First with Brian Sanderson

It's easy to experiment with new tech and produce products that look and sound innovative. It's much harder to tie your innovation efforts to strategic objectives with measurable outcomes and then scale the solution across your organization. The former leads to "death by pilot". The latter makes a difference in people's lives. We need a more disciplined approach to innovation if we want to make a difference. In this episode (Ep. 201) we introduce the concept of the Healthcare Delivery Organization Innovation Lifecycle Ontology or HDO-ILO. That's a fancy way of saying that we are attempting to codify what we've learned over the past 200 episodes and through our decades of Health IT / Digital Health innovation experience. You can find the current draft here:   Healthcare Delivery Organization Innovation Lifecycle Ontology (HDO-ILO) Our goal is to help the industry move from a haphazard way of innovation to one that is more thoughtful, deliberate, targeted, measurable, and repeatable. And we need your help! There are several asks for the community throughout this episode. Please send us your ideas and experiences. We'll bring you on to share them with the #HCBiz community and we'll incorporate them (with credit) into the HDO-ILO. Let's innovate on purpose, and with purpose. Together... Find more at:  https://thehcbiz.com/201-building-an-innovation-lifecycle-ontology/ Watch this episode on YouTube

Building an Innovation Lifecycle Ontology

On this episode, Don Lee and Shahid Shah celebrate 200 episodes of The #HCBiz Show! We discuss what we've done over the past 6 years and tell you where we're headed next. In a nutshell, we're going to work to codify what we've learned about innovation in healthcare over the past 200 episodes and in our decades of deploying digital health solutions.   We're steering the effort, but we need your help. There will be plenty of ways to get involved. Thanks for learning with us over the past 200 episodes. Here's to 200 more! Oh... and we're on YouTube now too if you prefer the visuals: The #HCBiz Show! - YouTube   Learn more at https://TheHCBiz.com

Episode 200!!! What's Next for the show?

There’s no shortage of development when it comes to AI and ML in healthcare. The technology is already powerful and continues to advance. The challenge, as always, is getting things into the clinical workflow. And doing so at scale. Nuance has a plan to help innovators and health delivery organizations find alignment and get the right tools integrated into the clinical workflow quickly. Nuance started with ambient intelligence in the sensory realm. In computing, ambient intelligence (AmI) refers to electronic environments that are sensitive and responsive to the presence of people. Today, Nuance’s Dragon Ambient eXperience (DAX) can capture and code the natural conversation as it occurs between doctors and patients. Soon, ambient sensor tools will be able to see what’s going on in the exam room too. Building on the sensory tools, Nuance’s somatic ambient intelligence will allow AI to help doctors understand what’s happening inside the body too. And that starts with imaging. The  Nuance Precision Imaging Network (PIN) is designed to integrate imaging insights into the broader healthcare ecosystem and facilitate the use of AI to inform precision diagnostics and therapeutics.  In short, Nuance is allowing innovators to deploy their models on top of existing infrastructure in healthcare delivery organizations across the country. And in doing so, they are making it much easier for healthcare delivery organizations to experiment with these models. A real win-win that could accelerate the integration of ambient intelligence into the clinical workflow. On this episode, we talk with Peter Durlach, Executive Vice President, and Chief Strategy Officer at Nuance, about the technology, the strategy, and the roadmap. Plus, we discuss the  AI Collaborative Nuance launched with The Health Management Academy.   Full show notes and links: https://thehcbiz.com/199-ambient-intelligence-peter-durlach/

Putting Ambient Intelligence into the Clinical Workflow at Scale with Peter Durlach

It is now widely accepted that socioeconomic issues like food, housing, transportation, and more, directly drive health outcomes in the U.S. These issues hinder access to quality healthcare, and create obstacles to education and stable employment. In the former context, they are often referred to as the Social Determinants of Health. In the latter context, we might consider them the Social Determinants of Success. One organization that sees it this way is Ultimate Medical Academy (UMA) – a nonprofit healthcare educational institution based in Clearwater, Florida. UMA has instituted what it calls a “culture of care”. That means they are fully committed to addressing the socioeconomic issues that make it difficult for students to apply, attend, and learn at their schools. UMA is committed to providing the support its students need to thrive inside and outside of school. The culture of care is grounded in a commitment to diversity, community development, and a lifetime of support pledge to every student.   They do this, of course, because it is the right thing to do. But it is also perfect for business! Good for their business as the word of mouth from past students becomes a powerful recruiting tool. And good for the business of health care too. After all, their students will know firsthand the value of receiving this type of support and they will bring it into the healthcare workforce with them. Who better to fix our SDOH issues than those who have already overcome them? We discuss this, and much more with Rebecca Sarlo, Associate Vice President, and Director of Ultimate Medical Academy’s Clearwater Campus where she oversees both the academic and operational functions at the campus. For full show notes and links, visit https://TheHCBiz.com.

Care Pays Back: Addressing the Social Determinants of Success in Healthcare Education with Dr. Rebecca Sarlo

There are many areas where customer service is lacking in healthcare, but few are more egregious than the medical records request process. It’s frustratingly slow, needlessly opaque, and contributes to patient safety issues and staff burnout. And it’s making most of our health systems look bad. Today’s guest is not just calling for a better customer service experience in the medical records request process… she is creating the tool to help get it done. Grace Cordovano is a board-certified patient advocate who knows the medical records process inside and out. She’s helped countless patients navigate the health system and has felt the needless pain of the medical requests process firsthand. Over and over and over again. Now, she’s teamed up with our own Shahid Shah to build Unblock Health. Unblock Health is a comprehensive suite of patient advocacy services designed for patients and consumers who are determined to be empowered in their health care journey and are no longer willing to accept traditional barriers to their information. And it will help Health Information Management (HIM) professionals track medical record requests and process them more efficiently too. This is one of the lowest hanging fruits in healthcare transformation. And one that could immediately, and drastically improve the patient experience.   For full show notes and links visit: https://thehcbiz.com/197-medical-records-requests-as-critical-customer-service-issue-with-grace-cordovano/.

It’s Time We Treat Medical Records Requests as a Critical Customer Service Issue with Grace Cordovano

Last year we learned how Nayya was  using data to help employees pick the best health plan. Founder and CTO, Akash Magoon told us that they were “restacking the financial odds in favor of American Families.” We loved that mission, and apparently, the market did too. Nayya has grown tremendously since we spoke and recently  raised $55M in Series C financing. Now that Nayya has helped us pick our plans, they are taking the next logical step to help Use them. On this episode, we talk with Satvik Gadamsetty, Engineering Manager for the Use squad at Nayya. Satvik helps us to understand why this step is important, how they are approaching it in a data-driven way, and how their engineering approach maintains focus on the consumer as their north star. In addition to getting to know more about the Use product, you’ll learn about the engineering principles that are being applied to make it a reality.  We discuss telemetry, deployment, prioritization, and much more.   For full show notes and links, visit: https://thehcbiz.com/196-engineering-to-your-north-star-satvik-gadamsetty/  

Engineering to Your North Star with Satvik Gadamsetty

It's natural to reach for advanced analytics, machine learning, and other potentially transformational technologies in healthcare. That’s especially true in oncology where speed to diagnosis and speed to care are critical. However, there are fundamental data needs that must be mastered if we are going to be successful. Today we talk with C.K. Wang, Chief Medical Officer at COTA about these fundamentals:  A surprising number of physicians and health delivery organizations still do not fully grasp the importance of data nor how to use it to enhance care delivery Many provider organizations cling to a disabling view of HIPAA and other privacy laws that make them slow to share critical data when it's needed most Data completeness and data fidelity issues continue to fly under the radar due to issues 1 and 2  Bottom line: You cannot hope to succeed in risk-based models until you stop putting all your patients into the same bucket. And you can’t do that until you’ve mastered these data fundamentals. Learn how COTA helps its customers overcome these issues and puts them on a path to succeed in value-based care. Plus, we take a look at how  COTA is helping the Miami Cancer Institute explore racial and ethnic disparities in the diagnosis and treatment of cancer.   For full show notes and links, visit: https://thehcbiz.com/195-the-data-fundamentals-that-enable-value-based-care-c-k-wang/

The Data Fundamentals that Enable Value-Based Care with C.K. Wang

MedTech and Life Sciences commercialization expert, John Giantsidis of CyberActa, assesses the current regulatory environment around Medical Devices, the Internet of Medical Things (IoMT), and wearables. John shares best practices on how to gain regulatory approval and how to make compliance part of your company’s culture. Plus, he provides actionable advice on how to generate evidence and provide your prospects with quantifiable proof of value.   If you’re developing a new medical device, IoMT, or wearable solution, then this episode is for you.   The Summit on Embedding Privacy in Digital Health Register: https://ain.events/privacydigitalhealth/    For full show notes and links:  https://thehcbiz.com/194-privacy-and-security-by-design-john-giantsidis/

Privacy and Security by Design with John Giantsidis

There is a lot of attention being paid to the patient experience, and rightly so. However, we haven’t paid enough attention to our clinicians and caregivers and what they need to guide our patients thru that experience. Providers struggle to keep up with the increased touchpoints and questions without the proper tools. That increases stress and deepens the crisis of burnout amongst clinicians. Worse yet, it leads to unanswered questions and missed opportunities to meet our patients where they are. It turns out that doing this job halfway is worse than not doing it at all. On this episode, we talk with Omar Nagji, Chief Commercial Officer at Memora Health, about how to close the gap and provide clinicians with the tools and support they need. Memora Health was founded on the idea that you must support the workforce in any attempt to improve the patient experience. Omar walks us through their approach to doing just that. This includes digitizing care journeys, deploying chatbots to automate the “easy stuff”, and escalating to clinicians at the right time. Listen in to hear best practices on digitizing patient journeys, reducing friction in communication between patients and providers, and how to tie it all together in a meaningful way. Full show notes and links:  https://thehcbiz.com/193-empower-the-care-team-to-empower-the-patient-with-omar-nagji/

Empower the Care Team to Empower the Patient with Omar Nagji

Digitization means taking paper charts and putting them into EHRs. Digital transformation means leveraging the digital asset to do something we never could before. Applying AI/ML in healthcare will be one of the primary ways we carry out that digital transformation.  Today we discuss all of this with Prashant Natarajan, VP of Strategy and Products at H20.AI and co-author of the new book Demystifying AI for the Enterprise. Prashant tells us our goal for digital transformation is to "help the humans of healthcare achieve better outcomes". That means better experiences and outcomes for patients, providers, administrators, and more. And if we want to achieve that goal, we'll need to combine the best of AI and ML with the best of the humans and the best of our organizations to create symbiotic intelligence. For full show notes and links, visit:  https://thehcbiz.com/192-applying-ai-ml-to-help-the-humans-of-healthcare-achieve-better-outcomes-prashant-natarajan/

Applying AI and ML to Help the Humans of Healthcare Achieve Better Outcomes - Prashant Natarajan

Most health systems don’t understand their own referral networks or patient flows. From an overall fiscal standpoint, they may know who their best and worst physicians are but there’s little clarity on what’s happening in the middle. Where are patients going for procedures? Who is sending them there? And what’s the financial impact to the health system? Not knowing makes it difficult to make sound strategic decisions. The good news is that the data exist. The bad news is that few health systems have figured out how to harness it. Today we talk with Ray Deiotte and Sean O’Malley, co-founders of Monocle Insights. They’ve pulled together industry data that allows them to map provider referral patterns and customer journeys. Their mission is to help health systems, entrepreneurial physicians, and anyone else who manages a network of physicians shed light on their network’s behavior. These insights help drive better decisions around incentives, alignment, M&A, contracting, and more.   Targeted learning: Health systems, clinicians, and network managers will learn:  That data and methods exist to examine referral patterns and customer journeys When properly harnessed, this information can provide a significant strategic advantage    Startups and entrepreneurs will learn:  That the first objection is often a lie designed to make you go away How to design a low friction sales process that allows for a quick “proof of value”    For full show notes and links: https://thehcbiz.com/

Do You Know Where Your Patients (and Money) Are Going? with Ray Deiotte and Sean O'Malley

We've been training medical personnel in the same way for decades, Virtual Reality (VR) and Augmented Reality (AR) are poised to change that. We talk with Dr. Ryan Ribeira, founder and CEO of SimX, about the opportunity to modernize and expand our approach to medical training. We discuss how that is already happening at many of the major medical institutions in the U.S., the opportunities to expand access to training and to cover more nuanced situations that are difficult to replicate using traditional simulation techniques. That said, VR/AR training is young and far from a silver bullet. Accordingly, we explore the areas where AR/VR is not the answer. At least not yet. This episode will get you up-to-speed on the status of VR/AR medical training in the field, educate you on its strengths and weaknesses, and put you in a position to continue to explore this emerging technology. For full show notes and links visit:  https://thehcbiz.com/190-modernizing-medical-training-with-vr-ar-dr-ryan-ribeira/

Modernizing Medical Training with VR and AR - Dr. Ryan Ribeira

The recent  dust-up over Direct Contracting and its ultimate rebranding as the ACO REACH model may have led some to believe that our path forward is unclear. That couldn't be further from the truth. On this episode, we talk with François de Brantes, Senior Vice President of Episodes of Care at Signify Health, about where we are on the pathway to escaping the tyranny of Fee-For-Service healthcare. It's tyranny because it prevents us from delivering care the way we want to and need to. Advanced Alternative Payment Models like ACO Reach allow organizations to separate payment from delivery, stop focusing their efforts on top-line revenue, and begin to operate like typical P & L driven companies. The promise, of course, is that this will change the way healthcare is delivered in the U.S., improve outcomes and lower costs. We discuss: - Has utilization and payment returned to pre-pandemic norms? - Why are commercial carriers lagging behind Medicare and Medicaid in launching Advanced Alternative Payment Models? - Will the shift to value and consumer-centric delivery methods like telemedicine diminish uncompensated care? - Is it possible to be proactive and patient-centric in Fee-for-service? - Are provider systems ready for AAPMs? - Can employers band together to create enough demand for AAPMs in the under-65 commercial market? - What were the arguments against the Direct Contracting Model? - Did they have merit? - What changes were made to Direct Contracting as part of the rebrand to ACO Reach? - How does this dust-up over Direct Contracting confirm we are on a bi-partisan, unwavering march toward value and never going back? - Why did Signify Health acquire Caravan Health?   For full show notes and links:  https://thehcbiz.com/189-escaping-the-tyranny-of-fee-for-service-healthcare-francois-de-brantes/

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