Daniel Cawood

Here's my 2024 LinkedIn Rewind: For too long, DME companies have been treading water with outdated, legacy systems— that acted more like anchors than accelerators. At NikoHealth, we’ve been leading the charge, helping providers break free from the constraints of outdated software. But in 2024, the momentum hit a new level, here's how NikoHealth transformed the landscape: → Strategic Partnerships: Secured game-changing partnership with RedSail Technologies, expanding our reach to help more providers modernize their operations. As Josh Howland from RedSail noted: "NikoHealth offers next-generation, cloud-based HME systems with robust features that have garnered excellent customer feedback." https://lnkd.in/eFUpgyKm → Crisis Resilience: When the Change Healthcare disruption hit, we didn't just survive—we ensured our clients thrived. By quickly partnering with Availity, we kept providers billing and operational when others were paralyzed. https://lnkd.in/eMyRAhNh → Provider Success Story: Take Eastern MedTech, a New England provider serving communities since 1986. By switching to NikoHealth, they transformed from a cluttered, inefficient operation to a streamlined, modern business—cutting costs, reducing errors, and empowering their team. https://lnkd.in/enCj9TVv Beyond the numbers, 2024 was about proving that technology isn't just about features—it's about giving DME providers the freedom to focus on what truly matters: patient care. In 2025, we're not just continuing our mission—we're accelerating it. More integrations, more automation, more opportunities for providers to break free from the status quo!

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🥊 A Tough Quarter for CVS – What's Next? 🚨 💊 CVS was the final "Big Six Payor" to reports earnings last Wednesday and I was able to dive into CVS's latest earnings report, and it's clear that the healthcare giant is facing some significant challenges. From Medicare Advantage headwinds to Medicaid acuity issues, CVS is navigating a complex landscape that’s testing Karen Lynch as she has moved to actively manage Aetna. 🗞 In this article, I break down: - The driving forces behind CVS’s Q2 performance and loss of free cash flow along with expanding expenses - Insights into their Medicare Advantage and Medicaid strategies headed into 2025 - The impact of the retail pharmacy contraction and biosimilar partnerships for Cordavis as they look to control the potentially 100 billion dollar market against Cigna and UNH If you’re following the healthcare industry, especially the dynamics among the “Big Six Payors,” subscribe below. CVS Reports Q2 Earnings jeffdelverne.substack.com I'd love to hear your thoughts on CVS’s current trajectory. Do you think they can successfully integrate Aetna, Signify, Oak Street, and Cordavis to turn things around? #healthcare #pharmacy

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More interesting #news today on #carecoordination and transitions of care, this time specific to bundled payments for hospitals and the #TEAM model. #CMS #Healthcare #reimbursement

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Excited to share Waystar's groundbreaking advancements in AI + GenAI! With the comprehensive AI capabilities from Waystar AltitudeAI™, healthcare providers will be able to recover more payments associated with denied claims, while improving accuracy and efficiency throughout the revenue cycle. Check out the announcement for more details: https://gag.gl/zH29kt #AI #GenAI #Software #Innovation

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I frequently chat with healthcare tech companies about their US product strategy, business model, and go-to-market (#GTM) strategy. Below and attached are the core tenets of the conversation and my advice. I haven't changed these slides in 5+ years, so let me know if you see anything that needs updating. To be successful in #healthcare technology business development and product development, you must understand what drives your client's #economic motives. For example, too often, companies are building products, messaging, and selling as if "reducing costs and improving outcomes" is a fundamental motive in all provider organizations. In reality, it's a tiny subset of the market. Morally, almost everyone nods their head in agreement. Economically, they don't. There are ~10 different behavioral economic environments in US healthcare.

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Flexpa operates the largest payer #FHIR network and we've served more individual patients than anyone else. We learned lessons about CMS-9115 patient access the hard way. I spoke about some of those challenges at FHIR DevDays 2024 last year, and I've compiled them into a list of 9 Challenges. Here are the first three: 𝗖𝗵𝗮𝗹𝗹𝗲𝗻𝗴𝗲 𝟭: 𝗧𝗵𝗲 𝗣𝗮𝘁𝗶𝗲𝗻𝘁 $𝗲𝘃𝗲𝗿𝘆𝘁𝗵𝗶𝗻𝗴 𝗢𝗽𝗲𝗿𝗮𝘁𝗶𝗼𝗻 𝗜𝘀𝗻'𝘁 𝗘𝘃𝗲𝗿𝘆𝘁𝗵𝗶𝗻𝗴 According to Flexpa's own State of the Payer Patient Access API Report (https://lnkd.in/gZFEDh2R), only a third of CMS-9115 implementing payers provide a Patient $everything operation. But even when they do, they aren't performant. 𝗖𝗵𝗮𝗹𝗹𝗲𝗻𝗴𝗲 𝟮: 𝗕𝗮𝘁𝗰𝗵 𝗧𝗿𝗮𝗻𝘀𝗮𝗰𝘁𝗶𝗼𝗻 𝗟𝗶𝗺𝗶𝘁𝗮𝘁𝗶𝗼𝗻𝘀 FHIR allows batch transactions with read and search operations, which seems like another elegant solution. However, this feature is rarely supported by patient access APIs. 𝗖𝗵𝗮𝗹𝗹𝗲𝗻𝗴𝗲 𝟯: 𝗖𝗮𝗽𝗮𝗯𝗶𝗹𝗶𝘁𝘆 𝗦𝘁𝗮𝘁𝗲𝗺𝗲𝗻𝘁 𝗨𝗻𝗿𝗲𝗹𝗶𝗮𝗯𝗶𝗹𝗶𝘁𝘆 When falling back to individual search operations, we discovered that capability statements aren't always trustworthy. They can: under-advertise supported resources, fail to fully disclose search parameters, and lack information about maximum count limits for search results. Find the rest of the 9 challenges below!

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Here’s your recap of last week’s health IT news 🗞️ 👇 🤖 AI Clinician Assistant • Commure announced it will acquire Augmedix in a take-private deal. • Suki announced a partnership with Federally Qualified Health Centers and Community Health Centers, including Utah Navajo Health System, Inc., CenterPlace Health , and Access Health Louisiana. • OneHealth is partnering with healthPrecision / Medical Brain to support the former’s Modern Primary Care platform. 📈 Data & Analytics • Huma announced a $80M Series D that included pharma investors AstraZeneca and Leaps by Bayer, as well as the launch of its Huma Cloud Platform, a service that promises to help digital health products scale and launch their products more efficiently. • Intermountain Health partnered with NeuroFlow to better understand its Colorado patients’ behavioral health risks. 🔁 RCM • Medmetrix acquired HRSI - Healthcare Receivable Specialists Inc., accelerating development of its end-to-end solutions. • Thoughtful AI launched new “human-capable” AI agents for claims processing, patient eligibility verification, and payment posting and announced a $20M Series A. 📋 Patient Administration • XO Health Inc. is partnering with Kyruus Health to integrate its price transparency and directory tools. 💼 Provider and Practice Administration • West Tennessee Healthcare is implementing Qventus, Inc. 📱 Patient Support and Communications • Vizient, Inc has contracted with Mytonomy on behalf of its hospital and health system customers. • Tendo added FlyteHealth to its marketplace. • Epic offers a new integration with United Language Group allowing providers to dial-in an interpreter directly from the patient care workflow. ⚙️ Clinical Operations • Wolters Kluwer Health released an update to its UpToDate Pro software designed to support PCPs in prescribing, switching, and titrating antidepressant prescriptions. • Fullscript released two new studies demonstrating higher engagement and improved patient labs. 🍎 VBC • Guidehealth is now offering Story Health to its partner health systems. • Astrana Health is partnering with Elation Health to offer its EHR platform and billing technology to its customers. • Thyme Care closed a $95M series C, including healthcare funds such as CVS Health Ventures, Concord Health Partners, and more. 🧠 Food For Thought • A recent study found that Chat GPT-written patient portal messages were comparable in quality (and better on measures of empathy and communication style) to those drafted by healthcare professionals, according to PCP reviewers. We’re always interested to see physicians’ responses to GenAI solutions, as the tide turns toward greater acceptance of the technology. https://lnkd.in/gMX7ATX2 --- Want the latest healthcare tech news delivered to your inbox each week? Sign up here 📬 👉 https://lnkd.in/e2UJ3ckP

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Managing PT/OT cases shouldn’t feel like a constant chase for missing information.   Yet, when key details like Medicare cap amount or authorization requirements are missing from clearinghouse responses, it creates unnecessary delays and administrative headaches.   That’s why we’ve introduced a new enhancement to Infinx Patient Access Plus. It now automatically pulls this critical data based on the type of insurance—no more relying solely on incomplete clearinghouse information.   With this enhancement, you can:   ✅ Get the right information upfront, improving case accuracy. ✅ Speed up authorizations and reduce denials. ✅ Free up more time to focus on patient care, not paperwork.   Automation is no longer optional if you want to stay competitive and ensure smoother operations.   Ask yourself: How much revenue is lost when cases are delayed due to missing information?

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Over the last two+ years, Photon Health has managed to become the second-largest prescription network in the United States, a feat that no one has been able to achieve in the last two+ decades. We did it by having a bold vision and unwavering desire to affect change, by listening to customers and consumers about what their problems were, and by empowering the team at Photon Health to build products that actually solve problems. There is a dearth of great products in healthcare—we're setting a new standard—technology first, experience is critical, design matters, outcomes are greater than outputs. I'm proud that we've been able to achieve what we have without sacrificing our values. We're bringing consumer-grade experiences to broader healthcare—this is the new standard, and it's overdue. We've also ushered in a new era at Photon, maturing into a first-class organization to set ourselves up for growth—we've brought on Diya Shah as Chief of Staff, Sophie Maarleveld to lead operations, Jomi Cubol to lead design, Scott Bowerman as our first sales hire. I'm humbled to work with these ambitious, critical, and curious folks, and the whole team of product-minded engineers and scrappy operations folks that keep us moving—we're out here proving that playing long-term games with long-term people results in a fundamental change in a broken system. Big ups to my cofounders Otto Sipe and Sam Kotlove, and shout out to our lead investors Nicholas Chirls at Notation Capital and Parth Desai at Flare Capital Partners. Wouldn't be possible without these folks. Hit me up if you're looking for a role—we've got plenty. 🍄

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Since '21 Nishon Jones has helped lead the shift in how UC Davis evaluates and reviews pharmacy purchase data. "I can pull any data I need from the platform. There’s no need for downloading and running and rerunning data, loading new NDCs, or manually looking up prices." Stay tuned for more on Nishon. In the meantime, read more about UC Davis, Nishon, and their team's success here

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One of the biggest challenges practices face in scaling isn’t just adding physicians or providers— it’s doing so without adding extra admin or operational staff. When budgets are tight, scaling can put pressure on admin staff, who quickly become overloaded with the additional prior authorizations and uptick in managing denials. The result? Less than expected money comes in and physicians and providers are asked to more patients. This cycle often leads to burnout, reduced quality of care, and a breakdown of the solid systems they once had. One solution: Implement billing and operational automation software before growth. Train your admin and ops staff on these tools. With the right systems in place, practices can add physicians and providers while keeping admin workloads manageable. This means reimbursements stay consistent (or increase), providers and physicians avoid productivity pressures, and teams can focus on actually delivering quality care.

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🎥 Exciting update: I recently joined Jody Tropeano Greene to discuss the DiMe Seal, a milestone in building trust and accountability in digital health. Check out our conversation here: https://lnkd.in/epMHYU5x 🌟 Launched at HLTH 2024, the DiMe Seal recognizes high-quality, trustworthy digital health software products. Since its debut, we’ve seen incredible momentum: 🏥 Healthcare systems and payers across the US are looking to the DiMe Seal to help de-risk their digital health software purchases 🌍 Digital health software developers across the world are recognizing the value of the DiMe Seal to distinguish their products in a crowded market 👉 Are you a developer of digital health software products? Pursue the DiMe Seal and join the leaders setting the standard for quality and trust in healthcare innovation. Register today and use the code HLTH25 for a 25% discount https://lnkd.in/eTb6rRbj Let’s continue to raise the bar for digital health together! 🚀 #DigitalHealth #DiMeSeal #HLTH2024 #Innovation #TrustInHealth

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Attending RISE? Stop by! 🚀 Value-Based Care in 2024: Pivotal Changes and Trends As we navigate through 2024, the healthcare industry is embracing transformative changes with an increased focus on value-based care (VBC). Here are the key developments: 1.    Quality and Outcomes Over Volume: Shifting from fee-for-service to value-based models emphasizes patient outcomes and quality care. Regulatory changes continue to support this trend, enhancing the focus on social determinants of health. 2.    Technological Innovations: Advanced technology and data integration are crucial. AI is revolutionizing predictive care models and reducing administrative burdens, significantly improving care efficiency and quality. 3.    Financial Incentives and Risk-Based Contracts: The rise of risk-based contracts and alternative payment models is reshaping financial incentives, aligning provider interests with patient health outcomes. 4.    Emergence of Non-Traditional Players: Community pharmacies and home care providers are increasingly pivotal, filling gaps left by traditional care models and enhancing integrated service delivery. 5.    Integration of Specialty Care: Specialty care is being more meaningfully incorporated into VBC models, driven by increased utilization and federal initiatives to integrate these services more fully into care plans. 6.    Ethical AI Utilization: With AI's growing role, ethical considerations are paramount to ensure equity and avoid biases in healthcare delivery or impact the member's well-being. These trends underscore a collective move towards a more integrated, technology-driven, and patient-focused healthcare system. Let's discuss how these changes are influencing your strategies and operations in 2024! #HealthcareInnovation #ValueBasedCare #DigitalHealth #HealthTech #AIinHealthcare

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While driving up to Boston yesterday, I heard an ad from the Optum- Atrius Health ACO that mentioned their ACO offering commercial premium rates 12% than their competitors on the radio. First time I’ve ever seen or heard a major provider/insurer explicitly advertising their cheaper rates as the key part of a commercial ad. Curious to see if others start to follow suit with their similiar ACO/narrow network commercial products. #healthinsurance #aco #premium

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Stop it! Stop managing patient eligibility and authorizations on spreadsheets and (GASP!) sticky notes! My team at HealthRev Partners has been working on a solution and it is here! As someone who's been involved in developing Velocity's E&A platform, I can't express how thrilled I am to see it launch. This isn't just another tech solution – it's a game-changer for home health and hospice care. Why am I so passionate about this? Because predictable revenue isn't just about numbers – it's about ensuring continuity of care for those who need it most. Every efficiency we gain means more resources for patient care, more stability for caregivers, and more sustainability for services. This platform represents countless hours of collaboration, problem-solving, and a shared vision for better healthcare. It's personal for me because I know the real-world impact it will have – from reducing stress for administrative staff (because we're all stressed, right?) to ultimately improving patient outcomes. To my colleagues in home health and hospice: Velocity is here to support your mission. Let's embrace this technology and work together to create a future where exceptional care is always within reach, regardless of financial constraints. Creating predictable revenue is the only way to circumvent those financial constraints. I wanted to share a quick video of how it works: https://lnkd.in/g4X82SmK #HealthcareInnovation #HomeHealth #Hospice #PredictableRevenue #QualityCare #predictablerevenue

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A big thank you to William Fleming, PharmD, Stacey Finster, Chris Caudill, Fabio Baglioni, Lorena Neibaur, and Jay Finster for the incredible opportunity to collaborate on such a transformative vision for healthcare. Together, we’re tackling some of the biggest challenges facing patients and providers, with Healthyr leading the charge to simplify and enhance the care experience. The healthcare system often feels fragmented, making it hard for patients to connect with providers and access the care they need seamlessly. Healthyr is addressing this with interoperability, connecting EMRs, wearables, and self-reported data, so critical information flows smoothly. The future of healthcare isn’t only about advanced technology; it’s about making compassionate, seamless experiences the norm. We’re making this happen at Healthyr, one innovative step at a time, with a commitment to personalized care, patient-centered insights, and improved health outcomes. We’re shaping a future where healthcare is simplified and personalized.

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It's hard to define adequate access to healthcare. On a recent expert call, I heard "pretty much all macro numbers in healthcare are just best guess or completely made up," and that's the way this number feels to me: "83M Americans live without access to primary care." Utah has more healthcare supply than most states, but a quick look at ZocDoc shows 73 primary care providers open to taking new patients this week. Anyone aware of specialties with exceptionally long wait times? Some interesting federal data if anyone wanted to look more into it: - Provider shortage tracker (https://lnkd.in/g3ZfMyAn) - Drug shortage data (https://lnkd.in/gu_62HE3)

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