The No Surprises Act intends to prevent patients from getting burned with huge, unexpected bills for medical services. It is a needed law – medical bills are the #1 cause of bankruptcy in the U.S. And it’s certainly noble in its intentions. However, the healthcare machine works in unexpected and unintuitive ways. It has a way of moving surprises when we try to eliminate them. In this case, we may exchange surprise bills for new health access and health equity issues. And we will certainly create...
Dec 01, 2021•57 min•Ep. 178
The Centers for Medicare & Medicaid Services (CMS) released the 2022 Medicare Physician Fee Schedule and Quality Payment Program final rule on November 2 , and there are big changes to physician payments. In particular, the Medicare conversion factor, which forms the basis for payments to clinicians, will be lowered by 3.7%. There’s nuance in calculating the payments, but you can sum this up as most doctors will take a pay cut in 2022. And since the final rule goes into effect on January 1, ...
Nov 23, 2021•55 min•Ep. 177
We planned to discuss quality measures but shifted to address a very important piece of listener feedback after the preview and Episode 1 . The comments came from a doctor in the audience and I know there are many more doctors and healthcare administrators who feel the same way. The feedback, in short, is that we’ve been hearing about the move to value for 10 years. We’ve invested in it through several evolutions and it still hasn’t come to fruition. The key is to rebuild trust between the gover...
Nov 19, 2021•35 min•Ep. 176
There’s a lot of unknowns as we head into 2022, but one thing is certain: Health Equity will be a major focus for CMS and CMMI. Gail Zahtz, CEO of PropHealth , tells us that “value-based payment models have failed to deliver on the promise of health equity” and that is a major reason why CMMI paused so many models earlier this year. When the next iteration of value-based payment arrives, you can bet that health equity will be front and center. And for that, we prepare. “Fee-for-service says you ...
Nov 04, 2021•1 hr•Ep. 175
What is going on with Value-based payment models in healthcare? We’ve been talking about it for years and despite all the chatter and investment, uptake has been slow. Now, the CMS Innovation Center (CMMI) has put many of its models on hold including the Direct Contracting Geo model that we covered earlier this year. Does this mean we are moving away from value-based payment models? Absolutely not! In fact, things are going to start moving much more quickly towards value in 2022. The #HCBiz Show...
Oct 22, 2021•29 min•Ep. 174
We're less rational, less logical, and less deliberate than we like to believe. We have biases and regularly use heuristics, or mental shortcuts, to make our decisions. Most of the time we aren't even aware it's happening. Every actor in healthcare has these tendencies. Health systems have biases that influence doctors. Doctors have biases that influence patients. And of course, patients have biases too. These compounding biases create challenges when presenting information, defining care pathwa...
Oct 01, 2021•57 min•Ep. 173
There are many ways to innovate within an existing organization. However, it can be difficult to move as fast as you’d like within the constructs of an established business model and culture. For one, it’s difficult for your team to innovate on top of their “day job”. Second, it can be difficult to hire and incentivize the right people to drive the innovation within your existing constructs. These are the types of issues that the folks at Cleveland Clinic identified as reasons for not innovating...
Sep 10, 2021•45 min•Ep. 172
On this edition of #HCBiz Office Hours, Don and Shahid talk with Yuma Nambu, Chief Strategy Officer (CSO) at CROSS SYNC. CROSS SYNC is a Japanese startup whose medical data analytics software, “iBSEN”, enables hospital ICU’s to automate the monitoring of patient vitals and motions continuously to assist healthcare professionals in identifying acute deterioration as early as possible. The platform relies on multimodal AI capabilities that combine time-series vital analytics from physiological mon...
Aug 11, 2021•1 hr 4 min•Ep. 171
We spend a lot of time talking about how to align your startup’s vision with the realities of the business of healthcare. You can have the best idea in the world, but if you don’t properly validate your offering with customers, clearly and concisely explain the value it will bring them, close deals, and deliver on your promises then it will amount to nothing. Each of these steps is critical to your success. However, you can get many of them right and still fail. The best way to prevent this fate...
Jul 16, 2021•1 hr 1 min•Ep. 170
Just about every health system has an innovation program, but how do they know if it’s making a difference? That’s the question we set out to explore with the team from Houston Methodist Center for Innovation. On this episode we talk with: Michelle Stansbury, Vice President of IT Innovation Brad Shaink, Administrative Director of Digital Innovation Josh Sol, Administrative Director of Ambulatory Innovation They walk us through: Innovation Expectations: How do you set expected goals, OKRs, KPIs, ...
Jul 09, 2021•44 min•Ep. 169
Early in the pandemic, Amazon Web Services (AWS) launched the Diagnostic Development Initiative (DDI) to help organizations around the world accelerate diagnostics research and development. In the first phase of the initiative, AWS awarded $8 million in computing credits and technical support to 87 organizations in 17 countries. Some of the highlights include: Stanford University School of Medicine’s smartwatch app that detects early signs of COVID-19 Ilumina’s identification of viral mutations ...
Jul 02, 2021•41 min•Ep. 168
A major driver of health disparities is that the system does not typically account for the differences in the culture, language, and experience of the patients it is charged to serve. Today we talk with Abner Mason, Founder, and CEO of ConsejoSano about the importance of customizing engagement to match the multicultural realities of your patients. Abner tells us that it’s not about translating, but “creating content based on culture; based on deeper factors than language”. And it’s effective. Co...
Jun 28, 2021•43 min•Ep. 167
Price transparency and healthcare consumerism are top of mind for many operators and observers of the healthcare industry. On the surface, these topics sound great. Of course, we want to enable patients to be good consumers of healthcare. However, as we’ve seen so often on this show, aligning the obvious with the realities of the business of healthcare is no small feat. Today we’re talking with Dr. Steve Ambrose about healthcare costs, pricing, and consumerism. We discuss what these terms mean a...
Jun 09, 2021•1 hr 15 min•Ep. 166
Poor oral health has a direct link to high risk of chronic diseases like diabetes and heart disease. It contributes to depression, poor maternal health outcomes, and death. Research shows that it increased the risk associated with COVID-19. Yet we treat oral health as being separate from “healthcare”. 65 million Americans lack dental coverage and even Medicare provides no oral health benefits to our seniors. Worse yet, this lack of coverage contributes to healthcare disparities as black adults a...
May 28, 2021•46 min•Ep. 165
When it comes to billing codes there are many processes and solutions that focus on the backend. They support the coders and help ensure the codes are “bill ready”. However, as today’s guest points out, there are very few solutions that exist solely to help providers put those codes in the EHR accurately and efficiently in the first place. Abboud Chaballout created Diagnoss to untether the clinician from a clunky EHR interface when it comes to coding. Chaballout describes it as a provider assist...
May 24, 2021•48 min•Ep. 164
95% of innovations that are brought to market fail to reach an adequate level of customer adoption or financial ROI. It sounds scary, but it doesn’t have to be this way. Today we’re talking with healthcare commercialization strategist and digital health advisor Dr. Roxie Mooney, about the steps innovators can take to dramatically increase their chances of being in the other 5%. Why you need an early adopter strategy that focuses on the specifics needs, goals, and desires of the customers who are...
May 11, 2021•53 min•Ep. 163
IBM Watson Health came on the scene with swagger and promises. They were going to revolutionize healthcare! And now the unit may be for sale . We don't yet know what's really going on there, but the commentary surrounding this rumor provides some interesting points for discussion. What is the state of AI in healthcare? Is the industry ready for it? Will doctors use it? Is it going to kill us if it's not perfect? There's a lot to explore. On this episode, Paddy Padmanabhan joins us to hash it all...
Apr 29, 2021•46 min•Ep. 162
Picking a health plan can be the biggest crapshoot of anyone’s year. It’s confusing and tedious to compare the plan benefits, the provider directories are unreliable, and even if you can figure it out, there’s no way to know how much you’ll pay for a given service from one plan to the next. So, we cross our fingers, pick the one that seems like a fit, and hope for the best. Today’s guest is trying to change all of that. Akash Magoon is Co-founder and CTO at Nayya – a company that offers personal...
Apr 14, 2021•46 min•Ep. 161
What is the role of a doctor at a digital health startup? Why are they needed? What jobs will they do? How do you find one? And how can you tell if they will be a fit for your team? If you’re a doctor considering this move, you may have similar questions in reverse. What will it be like to be a “digital doctor”? How can I find opportunities? What new skills will I need to develop? How can I tell if the digital health startup I’m looking at has a shot? On this episode we talk with Sven Jungmann ....
Mar 31, 2021•53 min•Ep. 160
Machine Learning in healthcare (and Artificial Intelligence in the broader sense) is real and is being used today. The problem is, it’s difficult to sort out what’s real and what’s hype. Opinions on the matter range from “it’s all hype and BS” to “AI is revolutionizing healthcare and replacing doctors”. The truth, of course, lies somewhere in between. Today we talk with Josh Miramant, CEO and Founder of Blue Orange Digital , to help you sort this out. After listening you’ll have clarity on what ...
Mar 19, 2021•1 hr 1 min•Ep. 159
Direct Contracting is a new model from the Center for Medicare & Medicaid Innovation (CMMI, or the CMS Innovation Center) aimed at reducing expenditures and preserving or enhancing quality of care for beneficiaries in Medicare fee-for-service (FFS). At a minimum, it’s an opportunity for providers to change the way they care for Medicare FFS patients. And if the Geographic Direct Contracting Model is launched ( it’s currently under review by CMS ), it will be a sea change in the 10 targeted “...
Mar 07, 2021•43 min•Ep. 158
As of 2015 the Office of the National Coordinator for Health IT had awarded $548 million in grants to states to establish health information exchanges (HIE) . I have no doubt hundreds of millions of dollars more have been invested in various ways since then. So, when faced with one of the most daunting healthcare data challenges of our time in the COVID-19 vaccine rollout, surely, we turned to the HIEs first. Right? Not so much, according to today’s guest. Niam Yaraghi , assistant professor of B...
Feb 26, 2021•50 min•Ep. 157
CMS Direct Contracting is coming fast, is very nuanced, and full of grey. In a nutshell, 50% of Medicare patients are in Medicare Advantage (i.e., value-based care) and 50% are still Medicare fee-for-service (FFS). Direct Contracting is CMS’ bold play to quickly move many of the remaining Medicare fee-for-service (FFS) patients into value-based care. If you’re a doctor who takes care of Medicare fee-for-service (FFS) patients, then it is going to affect you whether you’re paying attention or not...
Feb 10, 2021•1 hr 8 min•Ep. 156
The pandemic has exposed many weaknesses in our healthcare and public health systems, and our disjointed public health data infrastructure is certainly one of them. Like much of our healthcare data, public health data tends to be manually compiled, Excel-reliant, and lacking in critical detail needed to make good decisions. Today we talk with Prashant Natarajan, VP of Healthcare Life Sciences and Health Insurance at H2O.ai about reimagining the collection and use of public health data. Public He...
Jan 29, 2021•1 hr 18 min•Ep. 155
The pandemic has had a tremendous impact on the business of healthcare. With states canceling elective procedures and people deferring care for fear of being exposed to the virus, hospital and medical practice revenue is down. On the flip side, many health plans are sitting on a mountain of premiums that aren’t being spent because of this deferred care, possibly leading to rebates in some cases and a ton of uncertainty in pretty much all cases. One less obvious outcome of all of this may fall on...
Jan 22, 2021•49 min•Ep. 154
The CMS Patient Access Rules are coming. And they’re easy to cheer for. We’re giving patients their data and that’s a huge win! We all love that! But what we don’t love is when FraudulentHealthcareApp.com collects patient data and sells it to the highest bidder to support targeted marketing, or whatever other nefarious act they can come up with. Well, the health plans don’t get to pick and choose which apps they connect to. What if their member wants to use FraudulentHealthcareApp.com? What’s th...
Jan 15, 2021•47 min•Ep. 153
This podcast features the Selling to Health Plans panel discussion at the Digital Health Growth Summit , moderated by our very own Shahid Shah, with panelists Vijay Bhatt, Deputy CTO, Harvard Pilgrim Health Care , and Bill Friedman, Vice President of Sales, Zipari . The panel covers some of the most important digital health technologies that health plans are interested in and how digital health startups can get health plan executives to buy the technologies they’re building. One of my favorite p...
Jan 07, 2021•39 min•Ep. 152
The business of healthcare is consensus-driven and permissions-based. As we’ve seen time and again on this show, this culture slows innovation , stretches sales cycles , and inspires institution-first thinking. Ultimately, it’s responsible for the high costs and lousy user-experiences we’re all trying to fix. What if healthcare went from a culture of consensus and permission to one of openness and experimentation? That’s what we’re going to explore today. Our guest, Paul Jones, “grew up” in a la...
Dec 11, 2020•1 hr 1 min•Ep. 151
Many digital health startups rely on sales prospecting to generate new leads. That works to a point but doesn’t scale because each deal takes a long time, and good healthcare salespeople are hard to find. Today we’re talking with Bryan Loomis , a Digital Health Growth expert and mentor, about how to design, build and execute a growth plan that generates leads in a more sustainable way. We discuss: Bryan’s PAGE Methodology (Purpose, Audience, Gospel, and Experimentation) for growth The importance...
Dec 03, 2020•47 min•Ep. 150
Get ready for a cold dose of reality. On this episode, we’re talking with Neil Carpenter , VP of Strategic Planning at Array Advisors and former health system Chief Strategy Officer, about how health systems think. This behind the scenes look at health system strategy, decision-making, and purchasing tells you much of what you need to know as a startup/vendor trying to sell into this market. You won’t like everything you learn, but it’ll give you a much more productive way to look at your produc...
Nov 24, 2020•59 min•Ep. 149
