Month: December 2023

Digital Health at the Turn of 2024

Posted on by Jason Barry

Rock Health is wrapping up the year in style by sharing the trends it believes are most likely to move the needle in 2024, based on where they stand along its “innovation maturity curve.”

The top trends were plotted along the curve to reflect their funding momentum, research volume, and partnership activity, revealing insights into which innovations are ready to make the leap from hype to impact.

  • Food as Medicine (Maturity Score: Nascent) – Nutritional recommendation platforms are moving beyond their historically narrow set of use cases (“niche” support for type 2 diabetes) to a variety of conditions ranging from mental health to cancer. Keep an eye on: As legislation and reimbursement pathways continue to expand in 2024, more providers will start using food as medicine to differentiate their care delivery models.
  • Digital Obesity Care (Maturity Score: Nascent) – Although GLP-1s were one of this year’s hottest topics, weight management support services like remote monitoring and behavioral coaching are also coming along for the ride. Keep an eye on: Supply chain and accessibility challenges will continue to constrain GLP-1s, and payors could push for more precise triage to determine who gets priority for medication-based programs.
  • AI in Healthcare (Maturity Score: Developing) – AI startups were one of the only groups spared from the venture funding slowdown, raising nearly $2.8B across 101 rounds through Q3. Keep an eye on: Providers and payors will be solidifying their approach to AI governance and thoroughly assessing the tradeoffs between platform-level integrations (EHR plugins) and best-in-breed solutions (built for specific features).
  • Value-Based Care Enablement (Maturity Score: Developing) – With the most partnership growth in the analysis, VBC enablement is gaining commercial traction and moving closer to maturity. Keep an eye on: As health systems continue to consolidate, VBC solutions might be pushed toward platform-ization to address more needs, especially in areas where they’re easiest to adopt (solidified, attributable care pathways).
  • Data Interoperability (Maturity Score: Calibrating) – Interoperability infrastructure is still under construction, with the ONC only recently onboarding the first cohort of QHINs, but commercial partnerships are picking up as regulations stabilize. Keep an eye on: Data will be increasingly important as more powerful analytics tools become available, and disruptive solutions will need built-in insights capabilities as a value-driver.

The Takeaway

If 2023 was digital health’s transition year, Rock Health expects 2024 to be its recalibration year. Major innovations have begun their trek along the maturity curve, and it’s now time to build the strategies that will give them the staying power to keep progressing.

Medallion Sets Sights On Tackling Administrative Burden

Posted on by Jason Barry

Healthcare costs are climbing, burnout is at an all-time high, and new data arrives on a daily basis highlighting the heavy toll that administrative burdens are placing on the workers making care delivery possible. Each of those issues is wildly complex, which is why Medallion is setting out to automate away the cumbersome operational processes at the core of the complexity.

CMS’ just-released 2022 National Health Expenditures helps set the stage by wrapping some numbers around the size of these challenges:

  • US healthcare spending grew 4.1% last year to reach $4.5 trillion, outpacing the 3.2% increase seen in 2021. The two largest slices of that pie belong to hospital care (30% share) and physician services (20%), largely due to the massive amount of administrative and operational overhead that goes into care delivery.
  • That same administrative overhead is placing a huge weight on providers and operations teams, with CDC figures now showing that 46% of healthcare workers are struggling with burnout (up from 32% in 2018).

Medallion tackles this administrative burden with an end-to-end provider network management platform, which streamlines time consuming and repetitive tasks like credentialing, licensing, and payor contracting and enrollment.

  • The credentialing solution automatically performs primary source verifications, checks state licenses and board certifications, and provides alerts on provider eligibility changes to eliminate manual reviews and ensure regulatory compliance.
  • The licensing solution simplifies cross-state licensing and license renewals to help keep up with ever-evolving state requirements, as well as continuing education tracking in all 50 states.
  • The payor contracting and enrollment solution allows organizations to offload the payor negotiation process from start to finish, then solves the problem of getting providers in-network with enrollment services for any commercial and government payor.
  • All of that information is housed in a provider data management dashboard that serves as a centralized view of the provider network, improving oversight and slashing operations task time.

The Takeaway

The healthcare industry has its work cut out for it reigning in administrative costs and burnout, but platforms like Medallion help make sure that the work filling the plates of providers and digital health companies is actually advancing their mission instead of distracting from it. Make sure to schedule a demo here to check out Medallion in action.

CVS Overhauls Drug Costs, Healthspire Rebrand

Posted on by Jason Barry

CVS Health’s recent investor day brought an avalanche of announcements that buried a strong performance update with major overhauls to its pharmacy and services segments.

The CVS CostVantage drug pricing model stole the show, with CVS making the shift away from complex pricing formulas to a “cost plus” markup that’s far more transparent.

  • Credit where credit’s due, Mark Cuban’s Cost Plus Drug Company put a ton of attention on the opaque pricing models used by most PBMs, prompting others like Cigna and CVS to reconsider their strategies (not to mention MCCPDC beat out CVS for Blue Shield of California back in August).
  • We’ll now have to wait and see how much CVS CostVantage actually helps consumers, but given that CVS is vertically integrated with 9k+ retail pharmacies and the nation’s largest PBM in Caremark, the early verdict is that it might just reshuffle where revenue ends up. “It’s squeezing the balloon in one place and it gets bigger in another.”

The launch of the CVS Healthspire brand was a close runner-up, and the new moniker now encompasses the entire health services business that includes MinuteClinic, Caremark, Oak Street Health, Signify Health, and its recently formed biosimilar company Cordavis.

  • The rebranding was probably overdue given CVS’ recent acquisition spree, and follows the lead of payor competitors with separate services arms like UnitedHealth Group (Optum), Cigna (Evernorth), and Elevance (Carelon).
  • Expect CVS’ future investor presentations to have more cohesive reporting between the Healthspire businesses and Aetna, currently the third largest payor in the US with over 25M health plan members.

An upcoming smartphone app was also teased as a way to give patients a central hub for CVS services, such as prescription refills, information on deductibles, and MinuteClinic appointment scheduling. This well-narrated hype video has the quick overview.

The Takeaway

CVS is going all-in on unlocking the synergies between its core care delivery, pharmacy, and payor businesses. Given the sheer size of its footprint and breadth of its assets, CVS has plenty of ability to cross-promote services and increase the lifetime value of its customers. The question now is execution, but CVS’ grand plan seems to be gaining momentum following a full year of major moves.

Hospitals Don’t Know If Patients Are Dead

Posted on by Jason Barry

An interesting research letter in JAMA Internal Medicine highlighted a grim trend in health system record keeping: EHRs frequently overlook patient deaths.

That’s a major issue for plenty of reasons, which UCLA Health researchers laid out after analyzing roughly 11,700 seriously ill primary care patients across 41 clinics (2020-2022).

Almost 700 patients whose medical records showed them as alive were actually deceased according to California public health filings, nearly 20% of the entire cohort. 

The discrepancy led to hundreds of unnecessary interactions such as prescription refills and appointment reminders, needlessly straining resources and staff bandwidth.

Of the patients found to be deceased:

  • 310 had an active appointment on the calendar
  • 541 had an appointment still pending
  • 221 received 920 letters about preventative care such as flu shots or screenings
  • 166 received 226 mailed correspondence
  • 158 had 184 orders placed for vaccines and other care
  • 88 medications were authorized 

That’s a serious amount of wasted outreach for healthcare workers that don’t exactly have extra slack in their workflows, and the authors point out that addressing just this issue would provide immediate benefit to staff (at least at one California academic health system).

It’s worth noting that California prohibits death file information from being shared with any party except for financial institutions, so the issue varies state to state.

The Takeaway

Not knowing which patients are dead isn’t ideal for provider operations, hindering everything from effective rev cycle processes to quality improvement programs. We’ve covered countless studies related to burnout caused by administrative tasks, but this is the first research we’ve seen that suggests a decent chunk of that burden could be alleviated by simply knowing which patients are still alive.

GPT-4 Capable of Diagnosing Complex Cases

Posted on by Jason Barry

The New England Journal of Medicine is adding to its library of top tier publications with the launch of a new journal focused on artificial intelligence – NEJM AI – and it’s gearing up for the January debut with a sneak peek at a few early-release articles.

Use of GPT-4 to Diagnose Complex Clinical Cases was a standout study from the preview, finding that GPT-4 correctly diagnosed over half of complex clinical cases.

Researchers asked GPT-4 to provide a diagnosis for 38 clinical case challenges that each included a medical history along with six multiple choice options. The most common diagnoses included 15 cases related to infectious disease (39.5%), five cases in endocrinology (13.1%), and four cases in rheumatology (10.5%).

  • GPT-4 was given the plain unedited text from each case, and solved each one five times to evaluate reproducibility.
  • Those answers were compared to over 248k answers from online medical-journal readers, which were used to simulate 10k complete sets of human answers.

GPT-4 correctly diagnosed an average of 21.8 cases (57%), while the medical-journal readers correctly diagnosed an average of 13.7 cases (36%). Not too shabby considering the LLM could only leverage the case text and not the included graphics.

  • Based on the simulation, GPT-4 also performed better than 99.98% of all medical-journal readers, with high reproducibility across all five tests (lowest score was 55.3%).

A couple caveats to consider are that medical-journal readers aren’t licensed physicians, and that real-world medicine doesn’t provide convenient multiple choice options. That said, a separate study found that GPT-4 performed well even without answer options (44% accuracy), and these models will only grow more precise as multimodal data gets incorporated.

The Takeaway

The race to bring AI to healthcare is on, and it’s generating a stampede of new research investigating the boundaries of the tech’s potential. As the hype of the first lap starts to give way to more measured progress, NEJM AI will most likely be one of the best places to keep up with the latest advances.

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