Kraig Brown

This is quite incredible to see. Very few #CMMI demonstrations can point to any savings at all. And “…MSSP savings go further than savings generated by Medicare Advantage…” #ACO #VBP #Primarycare #MSSP #healthcareinnovation

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https://lnkd.in/gB_-yi-f Sharing a few thoughts on our Computational Care thesis, with a particular focus on the importance of clinical validation in building empathetic software solutions in a complicated environment. Based on the quality of conversations with founders and CEOs recently at HLTH and in the wild, now is a great time to build, deploy, and scale great software against hard problems in healthcare. We are seeing real progress, and we want to see even more bravery.

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Despite the "less conclusive quality and cost findings" shown by Hospital-at-home AHCAH programs for Medicare, participants in the program (both patients and clinicians) give it a thumbs-up. Big proponent of moving appropriate acute/post-acute care into the homes, however, a lot of these programs were not well executed and many were not appropriately resourced. It's not surprising that the overall data on quality and cost is underwhelming. Hopefully, the 2 yr extension (currently legislation due) should allow for this picture to become clearer. #HaH #AHCAH #Hospitalathome #Homehealth

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Let's keep hospice focused first and foremost on the PATIENT. After all, we only get one chance to do it right... "There are six primary trends that are influencing consolidation and professional practices: regulatory complexity. technology and integration, private equity ownership. demographics, economies of scale and consumer expectations,” Henderson said. “So many of these things that we see that are influencing health care consolidation need to be pointing toward the patient." #patientsfirst #hospicecare #youonlygetoneshot https://lnkd.in/gbbgV-YF

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Alot of bad actors and a few good actors. $2.5T HC capital raised & $1T invested by PE in last decade. $31B in 2013 vs. $217B in 2021. We know the story. Misaligned incentives - unrealistic multiples, short-term profit focus, aggressive cost-cutting, unrealistic scaling, misunderstood market dynamics, just to name a few. However, our industry needs money. But our industry is more infrastructure asset class than tech start-up (James Nicholls gave me that epiphany). Mic drop on the lyrical genius of Alex Fair of MedStartr Ventures as he literally gives the whole story poetic justice as he reads HIS POEM on this "On The Road at VIVE" episode of The Reverse Mullet Healthcare Podcast w/BP2 Health. This is the perfect episode for a Friday afternoon! He and Paulo J Machado donned the actual reverse mullets and joined us back in February at #VIVE2024 to talk about the need for REAL change in healthcare, startup focus and investor expectations. It was one to remember and one that is in desperate need of a full-length follow-up episode. Give us a like and a watch or a listen https://lnkd.in/e4w4mjkv https://lnkd.in/egmK3kMB

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Cofounders Capital Fund II is on a roll! Another huge announcement, this time from Pattern Health on its merger with Greenlight Health Data Solutions, Inc.

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Exciting times at 4C Digital Health! Wilmington, Delaware - 4C Digital Health (4C), the preeminent organization delivering independent financial oversight and control solutions for self-funded employee health plans, recently announced the strategic expansion of its services into the Commonwealth of Kentucky. In late 2023, 4C successfully competed for an initial award issued by Kentucky’s Department of Employee Insurance, and Kentucky has since extended the initial contract to allow 4C to continue its important work on behalf of the Commonwealth, its employees, and its taxpayers. The Kentucky Employee Health Plan (KEHP) serves more than 288,000 members, which amounts to 1 in 16 Kentuckians. In addition, KEHP spends over $1.8 billion dollars in total healthcare benefits on behalf of its members per year and covers over 8.2 million claims per year. KEHP objectives include “improving employee health and well-being” and “providing state-of-the-art benefits while maintaining reasonable premiums.” Recognizing its important fiduciary responsibilities to its employees and its state health plan, the Commonwealth of Kentucky enacted Senate Bill 42 (2023) introduced by Senator Stephen Meredith for the purpose of ensuring that critical health plan dollars are being spent properly on behalf of state employees. The legislation requires that 4C analyze 100% of medical claims submitted for payment to KEHP; identify erroneous overpayments; and identify inappropriate or erroneous fees imposed by KEHP’s third-party administrator. Ron Templeton CEO of 4C Digital Health stated: “4C Digital Health is grateful to the Commonwealth of Kentucky for recognizing the fiduciary responsibility that state and local governments have to their employee health plans and for the opportunity to provide our services in support of this mission. We appreciate Kentucky’s goal of using 4C’s expertise and innovative solutions to improve healthcare outcomes and reduce healthcare costs for the Commonwealth, its employees, and its taxpayers.” About 4C Digital Health: 4C Digital Health (https://lnkd.in/eB-fJg4X) is a healthcare data analytics company that was founded for the purpose of developing a disruptive technology targeted at bringing transparency and honesty to the healthcare marketplace.

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Taking stock of primary care today and looking ahead.... Increasing presence, market share for non-traditional providers - payers, advanced primary care providers, primary care enablers. Question marks over retail's presence in primary care and what care models and patient populations they might need to focus on to be a force. #VBC #populationhealth #primarycare #caremodels

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For all the talk about value-based care, progress still is very slow. Advisory Board data shows the small amount of progress made from 2017 to 2022, which varies drastically by line of business. Medicare Advantage is the primary segment driving VBC, mainly due to aligned incentives where plans and providers could get paid more through upcoding (or "appropriate coding") of patients to drive more revenue & margin through the entire system. That drove penetration of VBC in MA, and CMS has paid attention, releasing significant headwinds (v28, RADV, Stars) aimed at reducing these perceived overpayments. In other segments, VBC has been very slow to grow. Commercial VBC arrangements were essentially stagnant. Anecdotally, this is starting to change. Plan sponsors (employers) -- especially large, sophisticated ones -- are demanding more from their carriers. They want to see network arrangements that impact quality & cost. Will that be enough to drive VBC activity in the commercial space? We'll see. Employers -- the customers -- will be the ones who will drive VBC forward here. TPAs alone don't have the incentive to make changes. I remain hopeful, but skeptical. #valuebasedcare #healthtech #digitalhealth

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🙋‍♂️ 🙋‍♀️ How is Health Connect South impacting the Healthcare & Life Sciences ecosystem? I had the pleasure of interviewing Mike Mosquito, CHCIO, MBA, PMP, CDH-E, Bradley Dick , Kelsey Mayo , Khan Siddiqui, MD , and Andy Miller on this topic. Check out what they had to say! Thanks Russ Lipari for a great event!

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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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What I learned this week in the real world of HC vs Vegas Money money money, it's a rich man's world and AI reigns supreme, despite the controversy clinical deployments of it are being funded not just admin burden reduction. Devin Carty announced Martin Ventures completed Series B funding for OncoLens - AI to support clinical care for cancer. Devin glad we finally ran into each other. Feby Abraham and Memorial Hermann Health System are part of the Infinitus Systems, Inc. $51.5M Series C (AI workflows). Daryl Tol announced Commure Care & Commure Perform & HCA Healthcare ambient AI across HCA. Brendan Keeler shared an important new rule (1033) by CFPB enabling consumer access to their data interesting precedent for other industries. Its earnings season and high medical costs across all segments and in Medicare Advantage combined w/ revenue shortfalls (pesky HCC v28 risk code - which btw still isn’t fully phased in!) wreaking MLR havoc. Yet we still don’t address the root cause of health. Loved Chris Deacon's "carrier speak" interpretation of Elevance Health's Q3 results below expectations driven by Medicaid costs but noted their BCBSNC & State of NC award (Chris' translation - "We are giving a full court press on state leadership and politicians to increase our rates, … it will never be enough!"). Centene was the opposite of the dumpster fire of CVS Health beating & surprising the street driven primarily due to 11% YOY revenue growth - side note their MLR degraded markedly to 89.2% Jeffrey DelVerne. Molina with 43% MA & 49% ACA growth (Bright Health acquisiton), revenue up 21% but MLR degraded to 89.6% (from 84.9%) on MA and 0.5% overall Jared Strock who also shared United reported 85.2% MLR the highest in years. Mario Schlosser of Oscar Health announced an aggresive expansion plan. super curious what is under the hood - novel or innovative? I knew GLP-1s were hot but have I been living under a rock?! In my seemingly endless travels, I flipped the TV on and in a span of 4 min had not 1, not 2 but THREE GLP-1 commercials. GLP-1s ARE here. Again what if we paired them with nutritionally dense food?! WSJ shared 42% of GLP-1 weight loss users reported eating more fresh fruits / vegetables Ron Stout MD MPH. Ashley Capoot reported a new study shows they may significantly curb addictive behaviors while Michael Albert MD “GLP-1 and the Inconvenient Truth" in Medium. This will be a tsunami to food, esp CPGs & grocery and the sickcare system good and bad. Carter Williams Katie Stebbins Erin W. Martin Speaking of advertising, Dave Chase, reported that major hip-hop artists are using their voices to tackle America's healthcare crisis. As for HLTH, once I sit in a dark, quiet room for a few days, I'll share my thoughts. But first The Reverse Mullet Healthcare Podcast and BP2 Health will be at American College of Lifestyle Medicine conference this week - medicine that actually addresses the root cause!

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This 👂 podcast episode and insight’s from a16z Bio + Health's Julie Yoo spoke so clearly to the fundamental challenge facing both 🩺 clinicians and 🏥 healthcare systems.  There is a huge disconnect between supply, in the availability of clinicians, and demand, in the increasing volume and complexity of healthcare needs. -     36% of physicians plan to reduce their hours next year according to the AMA -     48% of physicians reported feeling burned out in a 2024 Medscape survey At the same time, the demographic baby boomer bubble and steady increase in the prevalence of major chronic disease, which consumes up to 90% of healthcare expenditures according to some estimates, is driving demand. With this context, Yoo points to a major opportunity for AI adoption in healthcare in 2025. Yeah, a VC hyping a wave of new AI companies that will replace the decades of training and experience of clinicians, the skeptic would say.  But Yoo is thoughtful in pointing to the role AI can play, and is already playing, through solutions such as ambient, autonomous scribe solutions (of which local star Abridge is leading the pack) in not replacing, but freeing up productivity for clinicians. There is so much unstructured context in both the complexity of disease and treatment options and the social/emotional considerations that we shouldn't be looking for AI to *replace* clinicians. But companies are getting better at finding the structured, repetitive and time-consuming places where AI tools can *help* clinicians. Nearly two-thirds of doctors cited bureaucratic tasks as the leading contributor to burnout. Rigorously trained-AI driven solutions can be a force multiplier for clinicians, and I’ve seen several interviews where nurses and doctors go as far as to say some of these solutions are ”restoring their joy in practicing medicine”. Our health is precious; and we rightly want any technology engaging with it to be developed thoughtfully and thoroughly tested. This requires top AI talent and diverse and realistic training data. Pittsburgh’s strengths in both areas is why we are an emerging hub for data-driven healthcare. #AIinhealthcare #clinicianburnout #healthinnovation #digitalhealth

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Lee Shapiro with 7wireVentures and I are both passionate about driving more investment in integrated care. For Healthcare Business Today, we shared our thoughts about why including oral health in overall health care technology and investment is integral to creating more unified care and achieving better patient outcomes. Read more of our perspectives on the importance of increased investment for integrative care solutions, and why we believe the time is now for digital health investors to jump on the medical-dental care bandwagon. #oralhealthVC #digitalhealthinvesting

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There are plenty of ways we rely on interoperability in our daily lives – and we never think twice about it. Like sending a text message that is received by your daughter – that shows up exactly the way you sent it. We only think about interoperability when it doesn’t work and creates frustration for users – like the green bubble versus blue bubble text message debate. It’s no big deal when the photo of your dog is pixelated when it makes it to your friend. But when it comes to the exchange of your health information between your doctor, pharmacist and insurance provider – the consequence of incomplete information risks the safety and quality of your care. We’ve come a long way in healthcare interoperability – but we’re not there yet. Hope you’ll check out my recent article for Forbes Business Council on what we must continue doing as an industry so we can forget about interoperability in healthcare and restore the focus back on patient care. https://lnkd.in/ehi6YRTE   #healthcareonLinkedIn #interoperability Surescripts

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Join me on a panel along with healthcare leaders at the #ATANexus Conference in Phoenix, May 7th! AI, Administrative Burden, and Consumer Demands in the Patient Journey. Use ATA24SPKNET for an exclusive offer!

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Another large funding round in the virtual behavioral health space. It's interesting to note Talkiatry's focus on a physician-centric care model with W-2 providers, as opposed to most of the other players who are delivering care with 1099 mid-level therapists. However, it's still not clear to me how they are measuring care quality and outcomes, which is the foundation of true value-based care.

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