John Criswell

To meet CMS’ commitment to have all #Medicare beneficiaries in value-based payments (VBP) by 2030, payers have to dig deeper into #VBP design flaws and explore new strategies like: •Creating a coordinated set of VBP model designs to cut wasteful or inefficient spending without asking one participant to forgo all the revenue. •Introducing real savings requirements for shared savings, or implementing a risk-score growth cap to encourage better care practices. •Leaning into mandatory participation in new VBP programs to help ALL types of Medicare beneficiaries – not just larger-scale organizations. Read more about how these solutions can help accelerate VBP adoption in a recent Health Affairs article I wrote with Amol S Navathe and Daniel Shenfeld (linked in comments) #HealthcareonLinkedIn

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Oracle Health announced plans to launch a next-generation EHR platform in 2025, incorporating advanced cloud and AI capabilities. This new EHR will feature Oracle's clinical AI agent, voice-activated navigation, and Health Data Intelligence, which integrates patient data from over 300 sources to enhance clinical workflows and improve patient outcomes. The platform aims to replace traditional EHRs, which often dictate rigid workflows, with a more dynamic system that allows for personalized care plans. Oracle Health emphasizes that the new EHR is a complete reinvention rather than an upgrade of the previous Cerner system. Additionally, Oracle plans to become a Qualified Health Information Network to facilitate standardized data sharing across the healthcare ecosystem. Executives at Oracle also unveiled new cloud applications to improve patient management and streamline front-office operations, reinforcing the company's commitment to enhancing healthcare accessibility and data utility while addressing interoperability challenges in the industry.

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Predictions for the Healthcare Analytics Space in 2025 Increased Integration Across Data Ecosystems As value-based care models continue to expand, seamless data integration across clinical, claims, and social determinants of health (SDOH) sources will become critical. Organizations will prioritize interoperability through networks like QHINs, Carequality, and CommonWell to create a unified patient view. Interoperability Will Become Non-Negotiable Regulatory and operational pressures will force healthcare organizations to embrace true interoperability, with frameworks like TEFCA, QHINs, and platforms like Carequality/CommonWell gaining momentum. Seamless data exchange will shift from a competitive edge to a baseline requirement. Shift from Retrospective to Predictive Analytics Organizations will move away from merely reporting past events and toward anticipating future risks, costs, and care needs. Predictive models will guide both operational efficiencies and patient care interventions. Demand for Transparent ROI Healthcare organizations will increasingly demand clear ROI from analytics investments, driven by financial pressures and accountability in value-based contracts. Solutions must demonstrate tangible outcomes like cost savings, care improvements, and enhanced risk stratification. Rise of Decentralized and Multi-Tenant Data Repositories As data ownership and governance become central, healthcare providers will adopt multi-tenant architectures to securely store and access aggregated data while maintaining control over proprietary information. AI and Machine Learning in Care Pathways(*) The use of AI to identify care gaps, optimize workflows, and automate routine tasks will grow exponentially. Providers will seek analytics solutions incorporating explainable AI to maintain trust and compliance. (*) Steep adoption curve Focus on SDOH for Equitable Healthcare Delivery Payers and providers will deepen their focus on SDOH to address health inequities. Analytics platforms will need to integrate SDOH data into actionable strategies for population health management. Emergence of Modular and Workflow-Specific Tools Comprehensive dashboards will give way to modular, workflow-specific tools that empower users to interact directly with data. These tools will emphasize usability and decision-making at the point of need. Partnerships Over Proprietary Solutions Collaboration between analytics providers and adjacent industries (e.g., tech, pharma, and public health) will drive innovation and adoption. Open ecosystems will gain traction over closed, proprietary platforms.

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There’s no question that AI is transforming healthcare, and understanding where industry leaders perceive opportunities is important. The latest research report from Arcadia is revealing. 63% of healthcare leaders say AI can analyze large patient data sets to identify trends and create population health intervention strategies 58% say AI can analyze individual patient data to identify opportunities to improve health outcomes 47% say AI can optimize the management and analysis of electronic health records Dive into the report to gain insights from top tech leaders and see where the industry is headed! https://lnkd.in/gf_wkWij

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🚨New #JAMA Viewpoint 🚨 “Misaligned Pharmacy Incentives in Value-Based Care” The authors discuss how rising #prescription drug spending has been particularly challenging in the context of value-based contracts between payers and providers. This is partly due to confidential #rebates, which create misaligned incentives between payers/PBMs and hospital administrators. Read more below: 🔗 https://lnkd.in/dwzBT4WD #marketaccess #pbm #access #pricing #payer #valuebased #valuebasedcare #patientjourney #patientaccess #pharmacy #managedcare #pharma

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Unlocking Healthcare Interoperability: Overcoming EMR Barriers for Operational Excellence The healthcare industry is at a pivotal crossroads. Recent developments in EMR interoperability—such as the widespread adoption of the FHIR (Fast Healthcare Interoperability Resources) standards and the implementation of the 21st Century Cures Act's interoperability and information blocking rules—are setting the stage for a more connected and efficient healthcare ecosystem. However, significant roadblocks remain. Some of the largest EMR vendors have built proprietary systems that limit seamless data exchange. These closed platforms and lack of standardized APIs not only stifle innovation but also hinder healthcare providers from accessing comprehensive patient information. This fragmentation leads to increased administrative burdens and can adversely affect patient care. For healthcare tech-enabled service providers like #Neolytix, improving autonomous processing of operations is a core mission. Interoperability is not just a technical challenge for us—it's a fundamental requirement to enhance operational efficiency, reduce costs, and improve patient outcomes. Autonomous processing relies heavily on the ability to access and integrate data from various sources effortlessly. When data is siloed, the potential for automation and innovation is significantly diminished. The importance of breaking down these barriers cannot be overstated. By advocating for open standards and interoperability, we can: - Enhance Patient Care: Provide healthcare professionals with complete and accurate patient information, leading to better diagnosis and treatment. - Reduce Administrative Burdens: Streamline operations by automating routine tasks, allowing staff to focus more on patient care. - Foster Innovation: Enable new technologies and services to integrate seamlessly, driving the industry forward. At Neolytix, we're committed to navigating these challenges by leveraging cutting-edge technology and pushing for greater transparency and collaboration in the industry. We're working diligently to improve autonomous processing in healthcare operations, ensuring that the benefits of interoperability are fully realized. It's time for all stakeholders—EMR vendors, healthcare providers, policymakers, and tech innovators—to come together to overcome these obstacles. By doing so, we can unlock the full potential of healthcare interoperability and build a system that truly serves everyone's best interests. Join us in advocating for a more connected and efficient healthcare future. Let's work together to break down the barriers to interoperability and drive meaningful change in the industry. #HealthcareLeadership #HealthcareCFO #HealthcareCOO #HealthcareCEO #HealthcareOperations #HealthcareInteroperability #HealthTech #HealthcareInnovation #Neolytix

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Interesting perspective on #TechnologicalDebt in health care by Dave Lamar focused on the provider market, but we seem the same issues within state depts and payers. While good data governance practices are key, there must be a better way to solve this common - if not universal - challenge in health care, if only by offloading some of the administrative responsibilities that require the individual management and administration of no-value-add administrative functions. #healthdata

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An interesting article that highlights the importance of aligning strategies with value-based care #VBC goals to enhance patient outcomes and operational efficiency. One critical aspect is #datadrivencare management. Utilizing analytics platforms to aggregate and analyze data from sources like electronic health records #EHRs allows for population health analysis, risk stratification, and tracking quality metrics, all of which contribute to improving care quality. Additionally, placing proactive #preventivecare at the center of your strategy is essential. Implementing wellness visits, chronic disease management, and timely immunizations can boost overall health while reducing long-term costs. Another vital factor is enhancing #carecoordination. Developing care transition protocols, streamlining provider communication, and creating multidisciplinary care teams help ensure a seamless patient journey and better outcomes. Furthermore, increasing #patientengagement and education plays a crucial role. Addressing #socialdeterminants of health is also key. Screening for social challenges, building a community resource database, and ensuring proper referrals and follow-ups are necessary steps to support overall patient well-being. Finally, building #partnerships and aligning incentives with payers, community organizations, and technology vendors is essential. Collaborative efforts to align goals, share data, and explore innovative solutions lead to better patient care and organizational performance. By integrating these strategies into your healthcare business approach, you can effectively align with VBC goals and enhance #patientcare. #healthcarestrategy #resourceoptimization #performanceincentives #stafftraining #healthcareinnovation #hbr #leadership #strategy #lifelonglearner #digitaltransformation #innovations

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As 2024 concludes, healthcare leaders have gained critical insights amidst rapid advancements and challenges. Here's a glimpse of the year's key lessons: 🔍 Data as a Strategic Ally: Harnessing real-time analytics transforms operations and patient care. 💻 Telehealth’s New Era: Virtual care isn't just an option—it's expected. 🩺 Workforce Resilience: Supporting staff well-being is pivotal for quality care. 💡 Personalized Patient-Centered Care: Building trust through tailored approaches ensures loyalty and satisfaction. 📜 Adapting to Regulations: Proactive compliance safeguards growth and quality. 🚀 Tech Integration: Innovations like AI show promise but demand careful execution. 💰 Value-Based Care's Rise: Aligning rewards with patient outcomes reshapes operations. As we step into 2025, the focus remains on resilience, innovation, and care. These takeaways set the stage for a robust and adaptable future. What 2024 lessons resonate most with your healthcare journey? Let’s connect and discuss! #HealthcareLeadership #InnovationInCare #2024Lessons #FutureOfHealthcare

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I’ve been given advice that the fastest way to monetize HER Heard without charging the end user (woman) is trackers and selling data. Instead, I’d like to build something more trustworthy. I don’t want to be in a headline like this. If you are not paying, then you are the product (you/your data are being sold). There are newer ways to deindentify data or even to aggregate things women search for that can be of interest to various stakeholders. In theory that could be okay to sell, but in a post-Roe world with laws encouraging bounty hunting, I am vetting the choices ahead. I am all for moving fast, without breaking things.

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If health systems master the art of delivering a world-class consumer experience in urgent care, they can replicate this success across their entire operation, becoming market leaders and thriving in the long term. This is the core thesis of what we do at UCP Merchant Medicine. For nine years, UCP Merchant Medicine has partnered with 68 healthcare operators, most of whom are health systems, to create internal capabilities that allow them to thrive in consumer experience excellence. This isn’t just about having a world-class urgent care platform, this is about owning the future and the capabilities to expand these experiences across the broader health system. As healthcare shifts towards a consumer-driven model, the need for health systems to adapt is more critical than ever. Patients now have unprecedented freedom to choose their care providers, with 45% researching providers and costs before choosing a health plan, and 44% before making an appointment, according to McKinsey’s consumer Health Insights Survey. These improvements are not just numbers; they're about real people getting better access to the care they need when they need it in a way that they will love. This is what we stand for at UCP Merchant Medicine. Join us as we continue to innovate and lead the way in making healthcare more responsive, efficient, and patient-centric. Together, we can transform the future of healthcare! #HealthcareInnovation #PatientCare #UrgentCare #HealthcareLeadership #UCPMerchantMedicine Intellivisit Solutions

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🌟 Generative AI and Healthcare Transformation: A New Era of Innovation 🌟 I am constantly asked about #AI applications for healthcare transformation. I continue to take people back to the pain points or problems being solved. The healthcare industry is undergoing a significant transformation, driven by the integration of generative AI. This revolutionary technology is currently reshaping the way we approach care management, early disease detection, and administrative tasks. Early Benefits of Generative AI: Enhanced Care Management: AI serves as a "co-pilot" for healthcare professionals, assisting in managing patient care more efficiently and accurately. This leads to improved patient outcomes and more personalized care plans. Early Disease Detection: AI's ability to analyze vast amounts of unstructured data enables early identification of diseases, potentially saving lives and reducing healthcare costs. It's a game-changer in preventive healthcare. Reducing Clinician Burnout: By automating repetitive administrative tasks, AI allows clinicians to focus more on patient care. This not only improves job satisfaction but also enhances the quality of care provided. Affordability and Efficiency: AI-driven processes streamline operations, making healthcare more affordable and accessible. From optimizing workflows to reducing operational costs, AI is paving the way for a more sustainable healthcare system. Challenges and Considerations: Ethical and Legal Frameworks: Ensuring AI is used responsibly requires robust ethical, legal, and policy frameworks. Trustworthy AI adoption is crucial for patient safety and health equity. Technology Infrastructure: Organizations need to update their technology infrastructure, including cloud capabilities, to fully support AI implementation. As we embrace these advancements, it's essential to stay informed and engaged in the conversation about how AI can continue to transform healthcare for the better. #HealthcareTransformation #GenerativeAI #HealthTech #Innovation #AIinHealthcare Thanks to sources McKinsey & Company (https://lnkd.in/g7HZHEST) and MedCity News (https://lnkd.in/gi95t4qJ)

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Healthcare has made improvements but there's still a long way to go to become truly digital-first. While we've seen advancements in telemedicine, electronic health records, and AI-driven diagnostics, the journey to fully integrate these technologies into everyday practice is far from complete. And the “door” to care – patient navigation – needs a lot of work. If we don't evolve, patient's will find others who do! https://lnkd.in/eSJKiHSR #patientcentricity #digitalfirst #digitaltransformation #patientnavigation

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🏥✨ For many years, technology investments made by health organizations were rarely a driving force behind strategic #transactions. Explore in my latest article with Sam Prescott how #generativeAI has changed the game for Health CIOs. A must-read for leaders at the forefront of change! https://lnkd.in/gRWmi5AH

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Looking forward to sharing recent KLAS Research insights at the upcoming The Millennium Alliance Assembly and learning from attendees their expectations in #digitalhealth for 2025. 🔎 What are the investment priorities of 100 healthcare provider executives and 50 payer executives over the next 2 years? 🔎 How do provider priorities compare to patient expectations? 🔎 What are the current digital health problems that you are trying to solve? 🔎 What digital tools do you plan to add, consolidate, or eliminate? 📢 CHALLENGE FOR THE LINKEDIN COMMUNITY Using 5 words 'What digital health trends do you expect to see in 2025? ' Fun fact: we are about to be 40 years since Marty McFly got in the DeLorean.

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What does the future hold for retail medicine and virtual care? Walmart is the latest to announce their health center closure. https://lnkd.in/geZpMTkS. This following Optum news, VillageMD closing in Nevada, Teladoc Health problems, etc. What comes next? This is another in a long line of examples that technology and even consumer willingness are not enough when the reimbursement environment does not support particular care models. Are we getting ready to lose all the lessons painfully learned during the pandemic? Or will new virtual care models emerge following this round of closures?

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Recent projections from Jefferies indicate a significant shake-up for insurers: - Humana: Faces the largest hit, with an expected $2.5 billion reduction in EBITDA and a staggering $16.37 EPS drop, marking an 83% decline compared to 2025 projections. - UnitedHealthcare: Set to lose $1.6 billion in EBITDA, alongside a $1.39 EPS decline (4%). - CVS/Aetna: A relatively modest gain of $100 million in EBITDA and a $0.05 EPS bump (1%). - Elevance: A $100 million reduction in EBITDA with a $0.30 EPS decline (1%). - Centene: A positive outlier, expected to increase EBITDA by $100 million and boost EPS by $0.10 (1%).

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Here’s your recap of last week’s health IT news 🏥 💻 🗞️ 👇 Product updates 👩🏼‍💻 • Augmedix announced public availability of Augmedix Go, their gen AI documentation product, for Emergency Departments.    • Forcura released AI referral summaries for the post-acute market.    • UTM Healthcare and FirstHx are teaming up to provide more robust medical histories.    • AI phone call tech company, Standard Practice, relaunched after pivoting from Nibble Health.    • Revenue cycle management platform, Ensemble Health Partners, is leveraging Microsoft Azure GenAI to enhance their service.    • MRO is extending its clinical data access tool to cover automatic retrieval of continuity of care requests.    • DrFirst, Inc. is partnering with PatchRx to improve medication adherence data. Notable partnerships 🤝 • Brigham and Women's Hospital partnered with FeelBetter to launch a study on the impact of their AI-based population health platform on polypharmacy patient management.    • Community Health Network selected Biofourmis for virtual and at-home care.    • Humana is extending its current use of prior authorizations platform, Cohere Health.    • Louisianan Community Health System deployed Retrieve Medical's Retrieve Dx Smart App to enhance documentation.    • Anne Arundel Dermatology will expand its current partnership with Relatient, adding Dash Schedule. Posts we enjoyed 👏 • Spencer Dorn’s reminder that more mature tech + good process is in many cases the better option than gen AI. (https://lnkd.in/eiK2DNfw) • Graham Walker, MD’s homegrown demo exploring the combination of clinically-informed text search + retrieval augmented generation (RAG) to enable better EHR note summaries. (https://lnkd.in/eDaqCh5H) --- Want to stay in the loop? Sign up for the Elion Briefing to get all of the latest healthcare tech news delivered to your inbox 📬 👉 https://bit.ly/49z6AUW

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