Vicente Armendariz

California Bill Would Require State Review of Private Equity Deals in Healthcare — Consumer advocates and labor unions are enthusiastic about the plans, but hospitals are not A bill pending in California's legislature to ratchet up oversight of private equity investments in healthcare is receiving enthusiastic backing from consumer advocates, labor unions, and the California Medical Association, but drawing heavy fire from hospitals concerned about losing a potential funding source. Hopefully, more states will initiate the same approach to keeping close tabs on private equity buying healthcare-related entities. Private equity firms raise money from institutional investors such as pension funds and typically acquire companies they believe can be run more profitably. Then they look to boost earnings and sell the assets for multiples of what they paid for them Critics say the profit-first approach isn't good for healthcare. Look to Stewart Health Care where the CEO and C suite lined their pockets while driving the health system into the ground. "Almost all of the most distressed U.S. healthcare companies are owned by private equity firms." Time to rein in private equity vultures out there in healthcare trying to make a quick profit, raising the costs of healthcare in their quest to generate profits. #privateequity, #runningthehospitalintotheground, #vulturecapitalist, #forprofithealthcare https://lnkd.in/ea3pFz43

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The shifting landscape of physician practice management (PPM) requires a strategic pivot for private equity (PE) firms. - Reimbursement models are moving toward value-based care (VBC), necessitating the integration of clinical services with operational efficiencies. - Enhancing collaboration and streamlining administrative functions is crucial for unlocking synergies. - Targeting fragmented specialties with growth potential, like ENT and pediatric therapy, can lead to successful tuck-in acquisitions. - Navigating regulatory complexities and fostering innovation in care delivery is essential for sustainable profitability. - PE firms must position for future exits amidst rising scrutiny and market volatility. I personally believe that the healthcare industry needs to adapt to the evolving landscape, and absolutely, VBC, cross-functional collaboration and specialization are among the main areas to look at. #privateequity #valuebasedcare #healthcare

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CVS Health appoints Steve Nelson, former head of insurance at UnitedHealth, to lead Aetna as the company grapples with rising medical costs and investor pressure. This leadership change comes in the wake of CVS's Q3 earnings miss, with Aetna's unexpected healthcare spending causing a significant drop in profits. As CVS focuses on streamlining operations and improving profitability, Nelson’s experience in healthcare could be key to navigating these challenges. With investor optimism and strategic leadership updates, CVS is positioning itself for a strong future. Read more: https://lnkd.in/egBXXQhm #NKDAdvisory #CVSHealth #Aetna #Leadership #Healthcare #CostManagement #ExecutiveChanges #CVSNews #HealthcareIndustry #Investors #BusinessStrategy #HealthInsurance #Profitability

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Great breakdown from McKinsey & Company here on current Medicare Advantage dynamics. TL;DR they have some levers but margins are as thin as they've been in recent memory in 2024. McKinsey called out the following as challenges for MA players moving forward: -Little to no rate increases from CMS -Broker commissions changes -V28 changes -Star ratings (the biggest near-term lever) -Utilization trends -Part D and other regulatory changes Source: https://lnkd.in/g9U4h2Gp

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Patients today say they want a “customer-like experience” in healthcare. So why do so many organizations struggle to offer it? McKinsey pins the blame on a familiar culprit – siloed systems, channels and data. The solution is end-to-end customer healthcare journeys delivered through an integrated technology stack… so easy to say, so difficult to offer! It makes me proud that Delta Dental of Arizona continues to invest in science and technology to elevate the experience of our members! https://lnkd.in/gPQ-Vymt

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"Consumers are more motivated than ever to choose healthcare options that offer a better experience, higher quality of care, and greater value. As the shift to consumerism continues, organizations that embrace it most successfully will emerge as leaders of the healthcare ecosystem. In the near term—beyond benefits to consumer experience and care—developing a distinctive consumer experience could translate to financial gains through increased acquisition, retention, and share of engagement; reduced administrative costs; and improved Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Medicare Advantage Star ratings.” https://lnkd.in/gQBAzSWM

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The FDA has warned about compounded #GLP1s, again. This one is a bit different from last time, so it is worth a read and a share to make sure this information gets out there! Pharmacist compounding of medications is a safe practice that is vital. However, when compounding is done in mass, for opportunist reasons, unintended consequences seem to happen more often. Patients are not getting these compounds from trusted providers or their local pharmacies, so education is lacking. 💉 Patients lack experience with self-injections. 💉 Patients are using the wrong syringes leading to overdoses. 💉 Instructions are not being given in patient friendly terms. In addition, providers are making medical errors in their dosing leading to much higher than maximum doses. These are all less common when using the FDA approved devices that come with these agents when the non-compounded agents are being used. Patients are being hospitalized because of these errors. It is vital to share these warnings and ensure those discussing compounded GLPs are aware of these safety risks. https://lnkd.in/gqZsBTJH #Pharmacists #Pharmacybenefits #MedicationSafety #GLP1 #Compounds

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Great opportunity for plans (and benefit consultants/brokers) to help #FixInsurance by unraveling conflicts of interest that prioritize plan revenue optimization over effective patient care management. Improving customer health outcomes and employer/government premium dollar value should be their priority.

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The CMS Health Equity Index is helping make health equity a priority for Payers. This new Stars rating calculation could change current ratings. To learn what payers should be doing now, watch this on-demand webinar at https://splr.io/6047WMPn1 #HealthEquity #Payers

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Americans’ experience with the health care system continues to be defined by access and affordability challenges, and specifically, insurer- and PBM-imposed hurdles, the fifth and newest Patient Experience Survey (PES) reports. Conducted by PhRMA and Ipsos, the latest PES highlights how and why patients demand greater urgency in making meaningful strides toward affordable health care. Key findings include: - Four in 10 (41%) insured Americans taking a prescription medicine have experienced insurer- and PBM-imposed barriers to care. - A third of insured Americans (33%) say their health care out-of-pocket costs for health care services have increased over the past year; about 4 in 10 (38%) of Rx insured patients report an increase in prescription medicine out-of-pocket costs. - Most insured Americans (90%) support cracking down on abusive insurer and PBM practices that can limit patient access to medicines. Dive deeper into the data today, which include robust findings across patient populations, demographics and geographic areas: https://lnkd.in/eKRVF-gq

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💡 The Real Problem with PBM Spread Pricing: It's not just the dollars; it's the deception. 💸 Many PBMs claim spread pricing is a tool to "manage costs," but in reality, it’s often a mechanism to maximize their profits at the expense of self-insured employers and plan members. The result? Inflated costs, lack of transparency, and compromised trust. If you're a Director of Benefits, PBM consultant, or benefit broker, this blog is a must-read to understand how spread pricing works against your organization—and how fiduciary PBMs can eliminate it entirely. 🎯 Take control of your pharmacy benefits by partnering with a PBM that puts your interests first. 👉 Read the full blog here: https://lnkd.in/gMgX4yqN 📢 Let’s talk about how fiduciary PBMs can transform your pharmacy benefits strategy. Drop a comment or DM to start the conversation! #PBM #EmployeeBenefits #TransparentRx #FiduciaryPBM #CostSavings #BenefitsManagement

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#M3P has Medicare Part D #plansponsors considering what the best path forward is. When we talked with Jessin Joseph, PharmD, MBA (Sr. Director, PBA Services) on the Astonishing Healthcare #podcast, he mentioned something everyone should keep in mind: "Centers for Medicare & Medicaid Services will learn from this." In other words, M3P will evolve, and changes will come as a result. Learn more about Capital Rx's M3P solution here: https://okt.to/N1bCJn Listen to the entire podcast episode here: https://okt.to/ixrKws"

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A whirlwind of activity last week at the America's Physician Groups conference. Lots of solid insights shared by health system leaders. Some notable thoughts: +++ Artificial intelligence is intelligent in different ways: By now, we all know ai has a diverse set of use cases, incorporated in different applications and tools. But there are fundamental differences in how the intelligence itself is brought to life. Examples include: - Predictive AI, used to forecast future outcomes by leveraging historical data. Shout out to UCLA’s CKD/ESRD early intervention protocol (Joycee Berin) and Diagnostic Robotics’ intelligence care post-dicharge journeys (Kira Radinsky) - Protocolized AI, used to automating a user’s administrative load by using a set of detailed, pre-defined rule sets. Thanks to ARC for sharing their experience using Elaborate 's automated outpatient lab summaries (Manish Naik) - Generative AI, used to create new content. Great overview of ambient documentation at MGB as well as Cedars’ Sinai talking through its medical ontology model powering acute triage (Caroline Goldzweig) Across system leaders and experts, there was clear agreement that the first step to implementing intelligence intelligently is defining the ‘jobs to be done’. That way, internal and external stakeholders are clear on what they're solving for when they architect the solution.  +++ Scaling AI takes time and rigorous observation: Market leaders describe a phased pilot approach that allows clinicians to build confidence and system leaders to measure ROI before deploying systemwide. Loved hearing Rebecca Mishuris outline MGB’s novel approach of piloting two solutions against one another, to pressure test implementation, workflow, and value creation. +++ Proving ROI continues to be challenging: Lots of vendors using lots of different metrics to prove value, but the majority of leaders agreed that estimating the ROI of these new tools today is part science, part art. Demonstrating the ROI of the “soft” metrics around provider burnout and retention seemed to be a big opportunity, especially for investment in more efficient primary care and PCP wellbeing. After all, PCPs drive referrals to specialty-level care (and higher reimbursements) for health systems. Appreciated Anurang Revri's overview of how working team setup can also impact ROI estimates. +++ Value-based care = tools + humanity: VBC will require not only implementing tools to support clinical documentation, risk capture, upcoding, etc, but also humanizing interactions to engage patients. Countless examples, but one that made me smile was a depression focused chat bot responding in the following interaction: - Context: post-discharge check in Bot: Hi Freida, how are you feeling today after your surgery?  Patient: I’m having a tough time, am in a lot of pain.  Bot: Well, it can’t be that bad, I’m sure it will get better with a positive mindset!    🤣 🤣 🤣 Can't wait for next go-around!

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Blue Health Intelligence, a data analytics and software company, undertook an evaluation of almost 170,000 unique GLP-1 users for weight loss, notes less than half of those prescribed stay on the medication for 12 weeks or more. Younger adults were less likely to continue the drug, whereas those who were prescribed the medication by an endocrinologist or obesity medicine specialist were more likely to continue for longer. Indeed, this data states 30% of patients dropped out of treatment after the first four weeks, and 58% at 12 weeks. Those who dropped out are unlikely to achieve clinically meaningful weight loss.  The likelihood of continuance was further exacerbated for those with health inequities or who lived in underserved health regions. The data comes from Blue Cross Blue Shield Association members participating in Plans that provided coverage of these products, from 2014 through to end of 2023. Razia Hashmi, vice president for clinical affairs at Blue Cross Blue Shield wants to ‘…paint a clearer picture of what makes somebody successful.’ The missing piece here is why the patients stopped – side effects, failure to achieve initial weight loss, stigma and discrimination, or coverage issues related to cost and access. My longtime friend, colleague and bariatric surgeon at Stanford University, Dr. Dan Azagury rightly states ‘…The goal is for patients to stay on this for a significant amount of time. Most likely… beyond 12 weeks.’ https://lnkd.in/ediQskQx

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The 9/9 Healthcare Labyrinth Blog is now live. Click below to read. Management consulting firm Oliver Wyman is telling MA plans to not make the mistakes their counterparts did back in the Medicare+Choice days. I tell you why the firm is right. #healthcare #healthcarereform #healthinsurance The Healthcare Labyrinth Marc S. Ryan 🇺🇦 https://lnkd.in/ewrMBEHT

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Running clinical trials? NFP, an Aon company recently launched a first-of-its-kind insurance product that will indemnify you up to the cost of the trial if there has been a measurable failure to achieve the trial parameters. Reach out to learn more about this Clinical Trial Failure solution. #clinicaltrials #insurance #trialfailure #indemnify

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I've been at the forefront of the fight against Multiplan and similar cost containment companies for more than a decade. These entities, including Multiplan, redirect revenue from healthcare providers to payors, reaping significant profits. Unfortunately, such actions lead to a decrease in in-network rates, forcing independent providers and facilities to close, ultimately limiting patient access to essential care. Learn more about it here: [Link to the article](https://lnkd.in/e-xJzedK)

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Have y’all ever watched someone pour water in a cup so fast that it overflows? That’s where I think we are in US #healthcare right now, and according to an article by Yahoo Finance, I’m spot on: US Healthcare spending rose to $4.8 Trillion in 2023, an estimated 17.6% of US GDP. Now I’ve worked in roles across #publichealth, #healthcare and #pharma, but admittedy never quite understood the economic jargon of comparing US healthcare spending to gross domestic product (GDP). So here’s my attempt at explaining this in plain language. ✨ GDP is the total value of all goods produced in a country during a time period; it’s a measure of the size and health of an economy. ✨ Healthcare spending refers to all money spent on healthcare services and products in a country— i.e- hospitals, doctors, medications, insurance… ✨ Why do we compare the two? When we compare healthcare spending to GDP it helps us understand how much of our economic resources are being used for health related expenses. ✨What does this headline mean? U.S. healthcare spending grew faster than the economy *overall* last year—and is expected to do so through 2032. Think of it like this: if we pour water in a cup too quickly, it will overflow. This is like healthcare costs rising faster than the economy can sustain. ✨What’s driving the increase in cost? 1) Insurance coverage has hit historic highs, 2) Medicare is projected to have the highest spending growth, 3) Hospital spending is soaring… Here are a few additional thoughts I had… 💡 How will the rapid uptake of #AI in healthcare, impact these projections? 💡 I wonder how projected healthcare workforce shortages will impact this? 💡*This* is what we mean when we say everyone should care about #healthequity, because inequities are costing all of us. What do y’all think about future drivers of cost or solutions? Drop me a line in the comments! #healthcareonlinkedin

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