Medically Home CEO Rami Karjian

Digital Health

A Hospital Sector Under Siege

Flare Capital’s Michael Greeley and Dr. Gary Gottlieb published a stellar breakdown of the current challenges barraging US hospitals, unpacking how the convergence of cost pressures and workforce issues is creating a perfect storm of financial distress.

It’s a thorough overview to say the least, but most of the issues fit into a few main buckets that are worth considering when mapping out how to best partner to help tackle them:

• The median debt-to-EBITDA ratio for US hospitals stands at approximately 3.9x (up from 2.5x in 2021), and 60 health systems have seen their debt ratings downgraded this year. The looming restructuring negotiations are going to be painful.

• CMS hospital star ratings for 2023, which measure performance along five key areas (mortality, safety of care, readmission, patient experience, timely/effective care), showed slight declines across the board. That directly translates to worse reimbursement.

• Over 600 of the country’s 1,800 rural hospitals are at risk of closing, and mostly in states with a large number of disenrolled Medicaid members. The upcoming spike in disenrolled patients that no longer have health coverage could be the tipping point for many of these hospitals due to increased bad debt and charity cases.

One “promising shiny penny” for avoiding hospital closures has been the broader adoption of technology to reduce clinical and administrative costs.

• This Health System AI Startup Market Map was definitely a highlight, and gives a solid look at the emerging vendors in the space.

• In today’s environment, hospitals need a clear ROI from their vendors. The writeup makes the case that a more patient-centric care delivery system might sound seductive, but could also actually increase a provider’s overall cost structure. That might give solutions that directly drive better star ratings an edge in the current market.

The Takeaway

Hospitals are a customer base that’s under siege from a ton of angles. It’s tough to solve these problems without first identifying their root causes, and this article is a great tool for honing in on those underlying issues.

Creating an Exceptional Engagement Experience

With a surge in experience‑oriented disruptors entering the healthcare industry, patient engagement is becoming a crucial competitive differentiator. Get your copy of Nuance’s guide to  delivering intelligent interactions and a better experience at every touchpoint.

Successful RPM Through End-to-End Support

From needs assessments and program deployment to security enhancements and call center monitoring, Clear Arch Health offers fully customizable support services to help you get the most from your RPM solution.

The Benefits of Faster Licensing Processes

Provider operations are undergoing a sea of change. While the need for speed and near-perfect quality scores isn’t new, the tech automating these workflows certainly is. Tune in to this recording of Medallion’s recent webinar to see how to automate licensing processes to enhance provider satisfaction, reduce administrative burden, and promote organizational longevity.

The Wire

• Lilly’s Zepbound Obesity Approval: Eli Lilly’s blockbuster drug tirzepatide – marketed as Mounjaro for type 2 diabetes – is now FDA approved to treat obesity, giving overweight patients in the US a second (on-label) option beyond Novo Nordisk’s Wegovy. The newly approved drug, which will go by Zepbound in the obesity market, uniquely activates both GIP and GLP-1 hormone receptors, and led to a massive 26% weight loss in trial participants. That spells fierce competition for Wegovy, which might have a first-to-market advantage, but only achieved about 15% weight reduction in trials.

• Medicare Advantage 2024 Spotlight: The average Medicare beneficiary will have 43 Medicare Advantage plans to choose from in 2024, according to a new KFF report. Although that’s the same number as last year, it’s more than double the 20 plans that were available in 2018. That provides plenty of options to compare coverage, but might add to the challenge of deciphering important differences between plans. One-third of Medicare beneficiaries now live in a county with over 50 MA plans in 2024, while less than 1% live in a county with less than than four options. 

• Akili Revenue Up 6x Since Pivot: Akili Interactive just held its first investor call since pivoting from prescription-only digital therapeutics for ADHD to a direct-to-consumer model, and the revenue numbers speak for themselves: Q3 revenue was up 6x to $702k in a single quarter. Despite the top line growth, Akili is throwing a ton of weight behind its D2C marketing efforts since the strategy shift, contributing to a net loss of $15.9M in during the third quarter (compared to $11.8M in Q2). 

• Vida Health Closes $28.5M: Vida Health landed $28.5M in funding to advance its chronic condition management platform that connects users with personal health coaches that tailor individual programs based on data from the member’s labs, pharmacy, and wearable devices. Current focus areas include diabetes management, mental health support, and weight loss, with Vida specifically mentioning plans to push deeper into the GLP-1 market given its ability to combine the prescriptions with behavior change.

• Hospital At Home Waiver Success: A research letter in JAMA Health Forum looked at the initial findings from the first 16 months of CMS’ Acute Hospital Care at Home initiative, which eased requirements for providing inpatient-level care in the home (e.g. 24-hour onsite nursing was reduced to a minimum of two in-person visits per day). The main takeaway was that the AHCAH initiative appears to have been a success, with only 38 of 11,159 hospital-at-home patients across 123 participating systems suffering unexpected deaths, and only 7.2% requiring readmission.

• Artera and Hyro Launch AI Assistant: Patient communication platform Artera is teaming up with Hyro to launch Artera Care Assist, an AI-powered virtual assistant that can be easily embedded into provider websites to answer common patient questions. Artera Care Assist instantly surfaces information already available on the website, such as office hours or parking information, with the goal of streamlining navigation without creating additional workload for staff.

• CancerX Publishes First Resources: CancerX put out a trio of great resources stemming from its inaugural project on improving equity and reducing financial toxicity for cancer patients. The Core Competencies Guide is an interactive tool to help healthcare leaders design a digital strategy for improving access to cancer care. The Financial Navigation Guide equips patient navigation teams with digital solutions for reducing OOP costs. The Solutions Catalog features 14 fit-for-purpose tools to support the implementation of digital cancer care strategies.

• Sheryl Sandberg-Backed Cercle Debut: AI-enabled women’s health startup Cercle launched with $4.2M in funding led by former Meta COO Sheryl Sandberg. Cercle’s platform organizes unstructured data such as medical records and test results into a standardized format to help clinicians develop personalized fertility plans and accelerate research. As an example, if a patient wants to freeze her eggs, her doctor can use Cercle to compare de-identified data from similar patients who also had their eggs frozen to see the types of treatments that were most effective.

• Cigna Explores Shedding MA Business: Reuters broke the news that Cigna is exploring the possibility of offloading its Medicare Advantage business. Cigna entered the MA market in 2011 through its $3.8B acquisition of HealthSpring, and has since grown its MA presence to 29 states. Sources told Reuters that the discussions won’t necessarily result in a transaction, but that Cigna is keeping its options open due to the fact that changes to the reimbursement model and star rating system will likely impact next year’s MA performance.

• Jury Rules Against Johns Hopkins: In a major legal defeat for Johns Hopkins All Children’s Hospital, a jury ruled that the St. Petersburg hospital engaged in “extreme and outrageous” conduct in its treatment of Maya Kowalski after a 2016 ED visit. The girl’s mother, Beata Kowalski, took her own life after Maya was removed by the state and falsely imprisoned at All Children’s for three months. The story was also the subject of the popular Netflix documentary “Take Care of Maya,” and All Children’s is now looking at over $260M in total damages.

The Best Partner for Sustainable Staffing

Delivering the best care requires a partner who understands the current staffing challenges. See how connectRN empowers its partners to deliver sustainable staffing through tools and resources designed to enable the best care possible.

Selecting Your Drug Database and CDS Solution

Do your providers need easy access to real-time drug knowledge and clinical decision support? Explore Synapse Medicine’s complete guide to drug database advantages, use cases, challenges, and factors to consider when selecting the right solution for your organization.

Glooko Outcomes Using Real-World Data

Modern diabetes management requires personalized, always-on, and connected care. Explore Glooko’s latest clinical studies to see how remote patient monitoring is making real-word improvements across multiple glycemic outcomes.