Mikael Öhman

One key reason why healthcare technologies like AI, telemedicine, and software haven't structurally lowered costs or broadened access for the entire system after decades of experimentation (excluding pure financial engineering of payer contracts) is the limited reimagining of care delivery itself, with asynchronous telemedicine as a notable exception. In the same way that digitizing physical paper failed to exploit the capabilities of a new computing medium for word processing, hosting physician-patient conversations over video does not transform the actual delivery of care. In telemedicine, many of the inputs (e.g., clinician time) and therefore cost structures of in-person care persist, which is why we often see fee-for-service telemedicine companies struggle to achieve economies of scale (i.e., growing revenues non-linearly while growing costs linearly). Until we deconstruct the components of a medical appointment – from intake and triage, to chart review, history gathering, physical examination, diagnosis, treatment, and follow-up – we will continue to be underwhelmed by the disconnect between the transformative potential of these technologies and real-world patient/system impact. I’m optimistic that the emergence of reliable and performant medical AI agents will urge us to perform this deconstruction and redesign the fundamental building blocks of a “medical appointment.”

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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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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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Thank you to our wonderful participants this afternoon in the HCT Consulting Group Healthcare Transformation Executive Roundtable. Brian D. Washburn, DHA, MHA, FACHE, FACMPE, CHFP, PMP Chris Saxman Elizabeth Crawford Restat Elya Prystowsky, MS, PhD Mark Korth. I was encouraged by several insights from this amazing group: 👉 #Transformation - we know it when we see it! 👉 #Valuebasedcare - we know it when we don't! 👉 #Valuebasedcare means different things to #patients and #providers but we should not lose sight that like or not, we have to play by the language and definitions being proposed by the Centers for Medicare & Medicaid Services 👉 #Transformation towards #VBC should be keeping healthcare simple, local and well-coordinated - what 99% of people are trying to do today. Organizing to stop the despicable 1% is adding 30% of costs to everyone - especially #ruralhealth 👉 #EMR Transformation has put some hospitals out of business and in some communities, when the hospital closes, the whole community shuts down 👉 #Transformation this group sees on the horizon includes demand for change only intensifying, doing more with fewer providers, addressing #documentation challenges, #AI should focus on removing the hassle of the little things 👉 MAJOR RISK AHEAD - Will #transformation defined by CMS + #BigTech lead to a loss of simplifying the provider-patient experience? Will documentation to meet #VBC demands only escalate due to the 'potential' of what technology offers? And therefore, will health disparities only expand due to the inability of #ruralhealth to keep up? Ultimately - will we eventually have to unwind many of the current technology investments to one day return to a simpler provider-to-patient connection? Thanks again to our amazing participants. DM me if you'd like to be on our roster to participate in the next one!

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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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Epic Systems’ recent move to back the TEFCA medical records exchange is interesting. On the surface, it’s all about creating a seamless flow of patient data across hospitals, QHINs, and all relevant stakeholders. But let’s be real—data is the oil of the new economy, and interoperability is the pipeline that delivers this precious resource to all the right stakeholders. By aligning with TEFCA, Epic might just be positioning itself as the refinery. All in all, this is a welcoming move by Epic Systems—especially if it really is as straightforward as they make it sound. But given the lack of details, one has to wonder if there are any hidden catches. After all, when it comes to something as valuable as healthcare data, it’s wise to look out for the fine print. Let’s hope this is genuinely about improving patient care. https://lnkd.in/gDdDCcmj

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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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It's wild to think in 2024 we're FIRST seeing the DOJ accuse telemedicine conglomerates of criminal drug distribution. How long have we known about these practices in brick and mortar care...? Answer: decades! Take it from someone who prescribed stimulants and other psychotropics to kids over the years - painstakingly measuring and documenting the need and impact - these appalling abuses by Done and Cerebral mean we need more calls for thoughtful pause when it comes to working with startups. Particularly about funding's role - my favorite topic! 🤑 How did we end up with venture capital and PE financing in healthcare that risk the safety of kids in the name of exorbitant returns? Not that all VC or PE dollars are bad, of course, but they're certainly key drivers who shouldn't be in that seat. Did we underestimate these funders as 'barbarians at the gate', much like the pharma reps of the 90's and early 2000's heyday? Have we not learned from Purdue Pharma's aggressive and deadly Oxoycontin marketing? Purdue pleaded guilty to criminal charges and paid $600 million in fines in 2007. Or TAP Pharmaceutical Products's Lupron kickback scheme for the prostate cancer drug? TAP also pleaded guilty to criminal charges and paid $875 million in fines in 2001. Or Pfizer marketing Neurontin, an anti-seizure drug, for off-label uses, such as treating pain and bipolar disorder, even though the drug was not approved for these purposes, and paying physicians kickbacks. In 2004, Pfizer pleaded guilty to criminal charges and paid $430 million in fines. Cerebral and Done's playbooks were practically the same thing, just with a modern mid-pandemic, low-regulatory scrutiny, digital-platform twist. Will appropriate regulation ever outpace American venture greed? Is it even possible to ensure patient safety AHEAD of tragedies driven by the intersection of innovation and venture funding? If you're keeping score, healthcare regulatory reactivity: 1 million. Healthcare ounces of smartly preventive policy: 3. Blech. 😖 When will we finally own that prevention in-house? #healthcare #overdoseprevention #suicideprevention

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In today’s healthcare landscape, where every dollar matters , operating margins are under significant pressure (look at the publicly traded payer and hospital system stocks for reference). Rising costs, regulatory challenges, and inefficiencies in both clinical and administrative processes are squeezing margins. Here’s how CFOs can leverage AI platforms to improve margins: 1. Automate Administrative Tasks: Streamlining repetitive processes like claims processing, prior authorizations, and medical coding can significantly reduce labor costs and errors. AI can do these tasks faster and with greater accuracy, freeing up resources and reducing overhead. 2. Enhance Revenue Cycle Management: Especially for providers, Ai can reduce claims denials, expedite payments, and improve billing accuracy, leading to faster collections and better cash flow. We can even forecast which claims are at risk of being denied before they’re submitted. 3. Predict Better: We can identify high-risk members or costly interventions before they escalate, enabling preventative care that reduce unnecessary hospitalizations and expensive treatments. 4. Improve Outcomes: AI driven decision-making can improve everything from patient diagnoses to treatment plans, reducing unnecessary procedures and improving care quality, which in turn, decreases readmissions and penalties. CFOs can lead the charge in creating a more financially resilient healthcare organization while improving overall patient care and operational efficiency by using Ai platforms. But, are healthcare CFOs even thinking about this? Are they aware of the impact Ai can have, or do they think that Ai's another buzz word like Cloud or Data? #HealthcareAI #CFO #HealthcareFinance #OperatingMargins #DigitalTransformation #AIinHealthcare #healthcare #RCM

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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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As AI becomes more embedded in healthcare decisions, ensuring traceability from algorithmic decisions back to clear guidelines and submitted clinical evidence is critical. Recent findings on companies like EviCore reveal a disturbing gap where AI and algorithms drive treatment denials, often with little transparency. When decisions about patient care are delegated to AI, every outcome should be fully accountable—linking directly back to both the clinical guidelines and the evidence provided by the physician. For AI-driven decisions, transparency is not a nice-to-have; it’s essential. This traceability not only fosters trust among healthcare providers and patients but also ensures that cost savings don’t come at the expense of patient care or quality. As we advance AI in healthcare, let’s prioritize clear, traceable pathways that support both efficiency and patient-centered care. https://lnkd.in/gV-AP8j9 #HealthcareInnovation #AIEthics #PatientAdvocacy #HealthcareTransparency #PenguinAi #Healthcare #PriorAuth #Denials ProPublica Missy Krasner Peter Longo Kishore Ayyadevara

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Now that our HIT industry has spent nearly 40 years figuring out how to effectively pass data between sites, settings, and institutions of care (and while that journey isn't completely over, we're well on our way), we can finally turn and look farther down the road and consider what's next. In my view, advancing process consistency, agility, and change is that horizon. The BPM community is focused on that challenge, and having recently transitioned into HL7 as HL7 BPM, is squarely trying to take this on. With today's press release, HL7 is truly open-for-business in this space. Thanks to the OMG for nurturing this work along and for HL7 for having made our next home for this effort. So much to do! https://lnkd.in/dAF96g3n

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Understanding the distinct perspectives and strategies of providers and payers is crucial for effective negotiation and risk management. These insights can help providers and payers avoid common pitfalls, as well as highlight the importance of alignment between them. Looking forward to more insights from you and your team Joseph Rafferty. Teaming up with Michael McCabe is a smart move.

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Radiologists are achieving payments 500% above the Qualified Payment Amount (QPA) in surprise billing disputes, thanks to the No Surprises Act. This figure is staggering and highlights an important reality: many providers might not realize the tremendous potential of this opportunity. When the No Surprises Act (NSA) was enacted in 2022, the rates at which providers were reimbursed took a major hit, often cut in half. Payors exploited the QPA to justify lower payments, essentially giving themselves the green light to underpay claims. If a provider disagreed with the payment, they had to navigate the cumbersome claims process to recover what they deserved. But here’s the good news: By participating in the IDR process, radiologists are claiming up to 5 times their initial payments. This result is a powerful incentive for payers to engage in a meaningful negotiation and ensure fair compensation. Providers should leverage the NSA to their advantage - and capture every dollar they’re owed.

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Great Post Bob ... I have said a few times... "The role of Supply Chain in healthcare is evolving significantly, shifting from a transactional role to a strategic function with a direct impact on financial performance. Supply Chain now has a presence at the C-level, underscoring its importance in driving margins and supporting sustainable financial models. By adopting a holistic approach to expense management and overseeing all non-labor spending, Supply Chain leaders can create substantial value.And its not all created equal. Exmaple: reducing costs by just 5% can yield the same profit impact as increasing revenue by 100%, highlighting the efficiency of cost management over revenue initiatives in improving profitability. This transformation aligns closely with strategic imperatives around delivering higher value with fewer resources, supporting revenue generation, and enhancing competitive advantage. Moving towards clinically integrated, population health-focused, and value-based contracting models is critical for the future."

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If you build it, will they come? I’ve heard countless organizations - #MA plans, #Medicaid plans, risk-bearing providers, vendors, PBMs, and retail players - say “we need to build the capabilities to XX”. Many are looking to vendors for solutions, but few vendors are ready to invest in new capabilities without contracts.  Anyone else sensing this (problematic) new conundrum? Here’s my quick take and a few ideas to break through this barrier. Many sales meetings are often held with functional departments, and often do not include the #MedicareAdvantage #StarRatings, #RiskAdjustment, #HEDIS, IT or P&L owners. We must collaborate to get those departments’ urgent needs integrated into new vendor purchases in order for new activities to meet new and emerging needs, remembering that: 🌟 Vendors are vital to your success.  🌟 Vendors operate in a more volatile environment than plans. 🌟 Vendors have smaller budgets than plans. 🌟 Vendors need signed contracts to make significant investments.   🌟 Vague RFPs waste vendors’ time and resources. Collaboration creates win-win contracts which expand capabilities of both parties. I encourage plans to: ✅ Ask vendors about their roadmap; including timing and certainty of planned enhancements. ✅ Include the #Stars, Risk Adjustment and #PartD teams in new vendor discussions. ✅ Consider adding a vendor's roadmap capabilities to contracts. ✅ Co-create with trustworthy vendors. I encourage vendors to: ✔ Ask about the customer’s unmet needs. ✔ Offer to co-create solutions to new and emerging needs with willing customers. ✔ Offer to accelerate roadmap capabilities with willing customers.   ✔ Articulate the things you would be willing to do if a customer would be willing to contract for it. This is a #MarketMakingMoment as #CMS has thrown down the gauntlet with #NewNeedsOfStars and #NewNeedsOfMA. This is a stellar time for vendors to review current and planned capabilities with a broader lens on new and emerging MA, #Compliance, Stars, #ECDS, #Interoperability, #HealthEquity, Medicaid & #SNP Aligment, and Risk Adjustment needs. If you need help, reach out to us.  #WhatGotYouHereWontGetYouThere  ⭐ ⭐ ⭐ ⭐ ⭐

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I get Dr. Yang's concern about large, wealthier health systems adopting AI sooner than smaller, poorer organizations, but this is actually a good thing...unless your time horizon is myopically short. Big organizations, with much larger budgets and sophisticated IT teams, can afford to take risks, make mistakes, and test out exciting (but still unproven) emerging tech while smaller organizations certainly can't (for the most part). So let the behemoths take all the risk, do the heavy lifting first, and then smaller organizations get to adopt truly proven solutions at lower risks/prices...once these have run the Kaiser, Mayo, Intermountain, etc., gauntlet. It's all part of the plan... #healthcare #startups #startup #ai #generativeai #digitalhealth #emergingtech Kaiser Permanente Cleveland Clinic Mayo Clinic Risant Health Intermountain Health https://lnkd.in/gckgQB_q

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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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The 'payvider' becoming a healthcare delivery niche player. It appears all outpatient...infusion, pharma, home health, urgent care, etc. Seeing more signs of consumers being directed by payers. No real, big box hospital purchases. Are beds being isolated and commoditized? #hospitals #healthcare #business #payers

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