Optimizing Wellness Visits by Optimizing Workflows

Americans aren’t getting any younger, but a pair of new studies in the Annals of Family Medicine offer a deceptively simple way for providers to stay afloat in the Silver Tsunami: optimize the workflows hiding in plain sight.

In case anyone’s new here, the U.S. doesn’t have enough physicians to meet today’s patient demand, let alone the needs of a Medicare population that’s adding 10k seniors every day.

  • New tech and AI-driven efficiencies might eventually balance the equation, but small changes at scale can still make a noticeable difference in the meantime.

Optimizing care means optimizing visits. Immediate concerns frequently overshadow preventive care, and that’s easy to see during Medicare annual wellness visits. The first study tested a straightforward solution by combining wellness visits with problem-based visits – and extending them from 20 to 40 minutes – at a five-office family medicine department.

  • Completion rates for annual wellness visits skyrocketed 6x over nine months (8.4% to 50.8%), and the combined appointments had nearly half as many no-shows as traditional wellness visits (11.9% vs. 19.6%).
  • Giving providers extra time to address new issues without derailing the agenda also boosted screenings across the board – depression, hemoglobin A1c, and a long list of cancers.

Pre-visit preparation pays off. The second study out of Mayo Clinic focused on getting more out of existing appointments with pre-visit test ordering.

  • Researchers sent automated portal messages to 3,500 Medicare patients listing the tests they were due for in the next six months, along with a self-scheduling link and a nudge to review results in a wellness visit.
  • About 27% of patients followed through on the message. Physicians appreciated being able to order follow-ups ahead of time, and patients loved discussing results during their regular visit.

The Takeaway

Combined appointments and pre-visit testing won’t stop a Silver Tsunami, but these studies show that they’re practical changes that might at least make some decent floaties.

Wolters Kluwer Jumps in the GenAI Ring With UpToDate Expert AI

Right when you think Wolters Kluwer might just let everyone else have all the AI fun, it debuted UpToDate Expert AI to give the world’s most widely used clinical decision support tool a much-needed AI overhaul.

Wolters Kluwer took its time with the launch. The incumbent CDS juggernaut is used by 3M doctors worldwide, so it had plenty of users to disappoint with a hasty roll out.

  • That said, nimble competition has been gaining ground pretty much as fast as it takes to download OpenEvidence from the App Store.
  • The good news is that WK made the most of the extra development time.

Here’s what sets UpToDate Expert AI apart. Unlike general-purpose chatbots, the AI-enhanced version of UpToDate is built exclusively on WK’s peer-reviewed content library.

  • It draws on 30+ years of evidence-based research authored by 7,600 experts, rather than the open web or selective journals.
  • That allows it to quickly answer complex clinical questions, while surfacing all of its sources, assumptions, and step-by-step reasoning directly in the response. Probably safe to assume that also helps with hallucinations.
  • Those answers still manage to be easy to scan at the bedside and will look extremely familiar to any doctor that’s ever read an UpToDate article (or one that’s been reading them for a decade).

The extra time in the oven means that more features are baked in. Wolters Kluwer knows its audience, and UpToDate Expert AI’s biggest leg up on the competition is its fine-tuning for health systems.

  • Enterprise-grade governance, compliance, and workflow integration are all standard out-of-the-box, giving UpToDate Expert AI an advantage for a system-wide implementation over OpenEvidence or Doximity.

The Takeaway

It turns out that the 800-pound clinical support gorilla wasn’t going to let the newcomers eat its lunch forever, and UpToDate Expert AI gives health systems plenty of reasons to keep rolling with Wolters Kluwer.

Co-Creating Confidence: Inside Amigo’s Approach to Building Trustworthy AI Agents

AI moves fast, but trust moves slow. That’s why Digital Health Wire is launching a new series to spotlight the companies taking AI from promise to practice.

First up: Amigo.

No matter how many medical licensing exams and curated case vignettes the latest models conquer, they’ll still need to make it through the proving ground of real clinical practice to get doctors on board.

The biggest challenge for AI in healthcare isn’t building agents that can handle a task, it’s building agents that clinicians can trust to handle those tasks safely – every time, guaranteed.

There’s a massive gap between textbook performance and real-world reliability, and Amigo is giving providers the infrastructure to bridge that gap.

Earning trust takes more than technology. Amigo’s process is just as important as its platform for enabling healthcare orgs to safely design, test, and monitor agents that they can genuinely depend on for their unique clinical and administrative workflows.

Amigo’s approach to building trust stands on four core pillars:

  • Controllability – Clinical teams can define and adjust agent behavior.
  • Performance Validation – High-fidelity patient simulations stress-test readiness.
  • Real-time Observability – There’s full transparency into decision-making.
  • Continuous Alignment – Agents adapt to changing protocols and priorities.

“Good enough” isn’t enough in healthcare. Most industries can get away with using the 80/20 rule to fine-tune their products. If they can improve the experience for 80% of their users, it justifies any shortcomings for the other 20%. Traditional benchmarks might work for customer service, but not when that 20% includes life or death situations.

  • When AI developers chase benchmark scores but ignore outcomes, they miss the actual point of care delivery: making patients healthier. A perfect medical licensing exam is great, but it’s not the same thing as a perfect clinician – or a trustworthy AI agent.
  • Strong benchmark scores can also lure providers into a false sense of security, and it’s tough to notice when performance starts to drift if nobody is on the lookout.

Drift is inevitable, and the current is strong. Even if an AI agent works on day one, there will always be a tendency for performance to slip over time. Clinical guidelines change. New drugs enter the market. Populations evolve. 

Amigo safeguards against this drift with a three-layer framework:

  • The Problem Model – Customers define their specific needs and the “operable neighborhood,” which is basically the set of scenarios that the agent can help with.
  • The Judge – Customers establish their own success criteria, as well as the verification measures to keep track of them. That includes both safety metrics like accuracy and handoff reliability, plus experience metrics like empathy and response time.
  • The Agent – Amigo spins up an agent that can safely tackle the problem at hand, then continuously monitors it against the “success scorecard” to minimize drift and intervene well before it impacts patient care.

How can performance be guaranteed? Simulating success ahead of time. Amigo swaps generic benchmarks for millions of simulated patient conversations to make sure each of its agents are 100% operationally ready before they’re actually deployed.

  • The simulations reflect the real-world scenarios and demographics of each customer’s unique patient population. The goal is to stress-test the agents to their breaking point in a controlled environment, then refine them until they perform reliably under pressure.
  • Amigo intentionally oversamples rare scenarios – like patients with unusual drug interactions – to ensure edge cases don’t slip through. This not only helps keep the agents consistent at scale but also means that they frequently perform better in real practice.

It’s a proven blueprint. Amigo’s strategy for building trust in AI resembles the playbook used in another area with similarly high stakes, high variance, and high skepticism: self-driving cars.

  • Waymo defines the well-charted terrain where its autonomous vehicles (AVs) are designed to operate safely. Amigo maps specific clinical neighborhoods.
  • Waymo simulates edge cases that might take years to encounter in the field before its AVs see any actual street time. Amigo puts its agents to the same test.
  • Waymo’s initial rollout includes safety drivers that can take control when needed. Amigo works with clinicians to refine the accuracy of the Judge.
  • Waymo removes safety drivers as its AVs prove themselves on real trips. Amigo reduces human oversight once clinicians are confident the Judge is calibrated correctly.
  • Waymo moves to similar neighborhoods only after success is consistently demonstrated. Amigo can expand to adjacent use cases where its agents can inherit validated behaviors and guardrails.

Adoption follows confidence. When clinicians co-create the solution to their problems, they’re more comfortable putting it in front of patients. 

  • That confidence usually means leveraging Amigo to automate the workflows that have been weighing them down the most, such as around-the-clock support and care navigation.
  • The agents go beyond providing advice. They can perform actions like ordering tests, updating the EHR, and looping in care teams for complex workflows like triage and medication management.

AI still has a lot to prove. Medicine is complicated, edge cases are everywhere, and lawsuits ain’t cheap. Getting doctors to toss an agent the keys to complex workflows is a tall order, but that’s exactly why Amigo designed its entire platform around getting that buy-in with verifiable evidence every step of the way.

The Takeaway

Clinical AI has the potential to transform healthcare. Fine-tuned AI agents can help eliminate medical errors, keep patients engaged with their care, and allow providers to start carving out competitive moats through their own clinical differentiation.

Doctors aren’t going to arrive at that future by taking a leap of faith. Trust is gained slowly, and can shatter instantly. AI agents will have to earn credibility one workflow at a time, and could lose it all with a single misstep. 

That said, it’s a future worth striving for, and Amigo’s safety-first approach to building trustworthy AI agents is one of the best roadmaps we’ve seen for how to get there.

Nothing gets the magic across better than Amigo’s live walkthrough. Make sure to check out the agents in action by booking a demo on their website.

Innovaccer Acquires Story Health for Agentic Care Augmentation

Innovaccer kicked off a shopping spree instead of chasing an IPO, and virtual specialty care platform Story Health just became the latest startup to get crossed off the acquisition list.

Innovaccer’s been busy. It spent years building the technical infrastructure to make healthcare actually work, and it’s now acquiring the pieces to show what’s possible with that foundation.

  • That includes picking up Humbi AI (actuarial intelligence), Cured (healthcare marketing/CRM), and Pharmacy Quality Solutions (pharma-payor performance tech).
  • It also means equipping more healthcare orgs with its new solutions like Gravity (connects nearly every data input into a single source of truth to scale AI adoption) and Comet (an AI-powered access center with a name so good that Epic had to steal it).

Here come the agents. Story’s cardiovascular health platform is designed to shift care from episodic visits to continuous management that can move the needle on value-based outcomes. 

  • The platform combines AI-driven clinical pathways, advanced medication workflows, and human-led coaching to deliver industry-leading results across heart failure and other chronic conditions. 
  • Innovaccer will be using Story as its first scaffolding to “pioneer agentic care augmentation,” where EHR-integrated AI agents will help specialty care teams with non-clinical tasks and engage patients between visits. 

There’s more on the way. Innovaccer recently revealed that it has “two to three additional acquisitions planned in the coming months,” and that hospital administration and revenue cycle management are both major focus areas.

  • Although Hinge and Omada helped crack open the digital health IPO window, Innovaccer’s business is quickly evolving, and it still has the freedom to make longer-term plays in the private markets.
  • Answering to public shareholders wouldn’t exactly offer Innovaccer any more freedom, and it’s using its unrestricted range of motion to take advantage of private markets that “have never had the kind of depth they have today.”

The Takeaway

We love to see a good crossover story. Innovaccer didn’t just acquire Story to improve outcomes for its patients, it acquired it to scale those outcomes to patients everywhere – and we shouldn’t have to wait long to see another chapter that takes the same playbook to a new specialty.

Penguin Ai Raises $30M to Arm the AI Agent War

Payors and providers are in an AI arms race, and Penguin Ai just raised $30M to supply both sides with agents to outcompete each other.

Penguin goes far beyond point solutions. The enterprise AI platform combines proprietary LLMs with AI tooling that both payors and providers can use to configure custom agents for their own back-office processes. 

  • The platform enables customers to prep their data for AI, use pre-built LLMs via APIs, or start with a ready-made agent for medical coding, prior auths, claims adjudication, appeals management, risk adjustment, medical chart summarization, or payment integrity.
  • The ultimate goal is streamline high-volume workflows and cut down on the billions of dollars of administrative waste that the healthcare industry generates every year.

The agent wars have begun. Payors and providers across the country are racing to enlist AI agents to fight for an advantage in a system that’s historically been plagued by inefficiencies and headbutting.

  • Providers vs. Payors: Doctors and hospitals are leveraging agents to fight back against billing denials – filing floods of appeals and automating responses faster than any human could manage alone.
  • Payors vs. Providers: Health plans are rolling out agents to instantly review claims, prior auths, and appeals requests – enabling mass, automatic care decisions that overwhelm providers.

Penguin CEO Fawad Butt has been in the buyer seat. He spent his career serving as the chief data officer at some of the biggest names in the industry: UnitedHealthcare, Kaiser Permanente, and Optum.

  • He founded Penguin to build the platform he saw was missing, and that adds a lot of credibility as Penguin takes on incumbent admin agent dealers like Innovaccer and Autonomize AI.

The Takeaway

The agent wars are in full swing, and Penguin is bringing a comprehensive platform to a battlefield full of point solutions. 

Doctors Who Use AI Are Viewed Worse by Peers

The research headline of the week belongs to a study out of Johns Hopkins University that found “doctors who use AI are viewed negatively by their peers.”

Clickbait from afar, but far from clickbait. The investigation in npj Digital Medicine surfaced interesting takeaways after randomizing 276 practicing clinicians to evaluate one of three vignettes depicting a physician: using no GenAI (the control), using GenAI as a primary decision-making tool, or using GenAI as a verification tool.

  • Participants rated the clinical skill of the physician using GenAI as a primary decision-making tool as significantly lower than the physician who didn’t use it (3.79 vs. 5.93 control on a 7-point scale). 
  • Framing GenAI as a “second opinion” or verification tool improved the negative perception of clinical skill, but didn’t fully eliminate it (4.99 vs. 5.93 control). 
  • Ironically, while an overreliance on GenAI was viewed as a weakness, the clinicians also recognized AI as beneficial for enhancing medical decision-making. Riddle us that.

Patients seem to agree. A separate study in JAMA Network Open took a look at the patient perspective by randomizing 1.3k adults into four groups that were shown fake ads for family doctors, with one key difference: no mention of AI use (the control), or a reference to the doctors using AI for administrative, diagnostic, or therapeutic purposes (Supplement 1 has all the ads).  

For every AI use case, the doctors were perceived significantly worse on a 5-point scale:

  • less competent – control: 3.85, admin AI: 3.71; diagnostic AI: 3.66; therapeutic AI: 3.58
  • less trustworthy – control: 3.88; admin AI: 3.66; diagnostic AI: 3.62; therapeutic AI: 3.61
  • less empathic – control: 4.00 ; admin AI: 3.80; diagnostic AI: 3.82; therapeutic AI: 3.72

Where’s that leave us? Despite pressure on clinicians to be early AI adopters, using it clearly comes with skepticism from both peers and patients. In other words, AI adoption is getting throttled by not only technological barriers, but also some less-discussed social barriers.

The Takeaway

Medical AI moves at the speed of trust, and these studies highlight the social stigmas that still need to be overcome for patient care to improve as fast as the underlying tech.

Particle vs Epic: The Lawsuit Moves Forward

For the first time in history, Epic will have to face antitrust claims in court after it failed to dismiss Particle Health’s allegations that the EHR giant has been wielding its monopoly power to stifle competition.

Here’s the overly-simplified version. Particle combines health data from 270M+ patients’ medical records by aggregating “thousands of sources”… sources like Carequality.

  • Carequality is effectively one of the largest health information networks, facilitating data exchange between network members (like Particle) who agree to only query patient data for “Permitted Purposes” such as Treatment, Health Operations, or Public Health Activities.
  • The problem at the heart of the lawsuit arises due to the fact that Treatment is the only purpose that organizations like Epic are actually required to respond to, causing all sorts of companies to warp their true purposes to Treatment-shaped requests.

Particle vs. Epic. Particle’s case alleges that Epic used its EHR monopoly to hamstring competition in the market for “payor platforms,” which allow payors to retrieve patient data to make decisions about care and coverage.

  • Last spring, Epic said that Particle was allowing its customers to inappropriately label their Carequality data requests as Treatment, then proceeded to stop responding to EHR requests from 34 Particle customers.
  • Particle’s lawsuit alleged that Epic trumped up the Carequality accusations in order to block it from serving its payor platform customers.

Epic filed to dismiss all nine of Particle’s claims. On Friday, the judge sided with Epic on five of the nine claims, dismissing the allegations that Epic maintained a conspiracy to uphold its market dominance, as well as claims of defamation and trade libel.

  • However, the court declined to throw out all three of Particle’s federal monopolization claims, as well as a state claim that Epic had interfered with a business contract.
  • Those claims will move forward into discovery, and Epic will now have to turn over documents that can shed light on whether its practices withstand legal scrutiny.

The Takeaway

Get the popcorn ready. Epic’s motion to dismiss was only partially successful, meaning it will now have to actually admit, deny, or qualify Particle’s remaining allegations. That deadline is quickly approaching on September 16th – then the real legal fireworks can get started.

CMS Reports Record MSSP Performance in 2024

CMS just dropped its 2024 performance data for the Medicare Shared Savings Program, and the debate over the program’s true effectiveness rages on despite another record year. 

MSSP saved Medicare $2.4B in 2024, the eighth consecutive year of savings and the highest total since the program’s inception in 2012.

  • The program generates savings by working with accountable care organizations to cut down on avoidable utilization, eliminate duplicative care, and minimize costly medical errors.
  • The ACOs that effectively improve care quality and reduce total spend share in the success, and last year saw 75% of participating ACOs earn $4.1B in performance incentives, a new all-time-high.

Accountable care delivers. MSSP ACOs lifted hypertension control rates to 79.5% in 2024 (up from 77.8% in 2023), while trimming the share of patients with poor hemoglobin A1c control to 9.4% (from 9.8%).

  • Low revenue ACOs (typically physician-led) continue to outperform high revenue ACOs (typically hospital-led), generating $316 in net per capita savings (vs. $175).
  • Most ACOs also performed better than comparable physician groups on quality measures, such as screening for depression and creating follow-up plans (53.5% vs. 44.4%).

There’s always a catch. Although at first glance 2024 was one of MSSP’s best years to-date, it’s worth noting that total Medicare spending also reached a staggering $847B.

  • That means that MSSP, the crown jewel of CMS value-based care programs that includes 476 ACOs equipped with some of the best care delivery tools in the industry, delivered an overall savings of just 0.28%.
  • $2.4B is nothing to scoff at, and the program is moving the needle, but it’s nowhere near fast enough to keep pace with Medicare’s runaway growth.

The Takeaway

MSSP had a great 2024 by almost every metric, and its ACOs are the tip of the spear for CMS’s push toward value-based care. That said, it’s a long journey to lower overall Medicare spending even with $2.4B steps, and there’s still plenty of work to be done to help get there faster.

Justifying Healthcare AI Valuations

A stellar report from Flare Capital Partners suggests that there’s some surprisingly sound justifications for the sky-high valuations we’re seeing with healthcare AI companies.

Numbers talk. The report – based on an analysis of 4,500 digital health VC rounds and an exec survey – found that a record 58% of deals involved AI companies in H1 [Chart: AI Funding].

  • Over 10 healthcare AI startups joined the unicorn club in the last year, and the investor enthusiasm only kept surging after five exits over $1B: SmarterDx, Iodine Software, Machinify Health, Office Ally, and Tempus AI.
  • That’s resulted in AI-focused companies commanding valuations 50% higher than the healthcare industry average [Chart: Valuations]. 

What’s fueling the fire? Companies that handle administrative tasks like revenue cycle management and contact center operations are leading the pack, at least for now.

  • Administrative AI companies are shining by having LLMs help turn messy data into measurable ROI, but clinical support based on structured sources (ex. OpenEvidence) continues picking up steam [Chart: Category Adoption]. 
  • One of the best charts unpacks the DNA of market leaders, and it turns out quick deployments and immediate ROI work well regardless of category [Chart: Leaders]. 

It’s not just FOMO. Flare’s exec survey found that half are already carving out over 10% of their IT budget for AI, and 83% plan to dial that percentage up going forward.

  • There’s a meaningful level of product-led “pull” driving AI adoption, especially compared to the “push” that drove past cycles like EHRs.
  • There’s also a high amount of confidence that AI startups will push into new areas (ex. scribing to RCM), and investors are giving them a lot of credit for unrealized growth based on what customers are saying about future budgets and expansion plans.

The Takeaway

Healthcare AI has moved from experimentation to execution, with wider adoption, bigger budgets, and value concentrating around market leaders. Flare doesn’t necessarily believe that justifies billion-dollar valuations for companies that are years away from profitability, but it at least sheds light on why the top players are blasting into orbit.

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