Dr. Carolyn Brown, DDS, MA

Remember to tune in to Blue Shield of California's webinar on primary care delivery in California today at 12 PM PT. Learn from our CEO, Khanh Gia Nguyen, and other industry leaders on steps being taken to improve primary care service delivery in California and the launch of a value-based payment pilot. Register here: https://lnkd.in/eqwr4RH6 #primarycare #valuebasedcare #healthcareinnovation

14

#fraud, #healthcare, #The Wall Street Journal WHAT A SHAME - Insurers Pocketed $50 Billion From Medicare for Diseases No Doctor Treated https://lnkd.in/dRKitYtW Private insurers involved in the government’s Medicare Advantage program made hundreds of thousands of questionable diagnoses that triggered extra taxpayer-funded payments from 2018 to 2021, including outright wrong ones like Lee’s, a Wall Street Journal analysis of billions of Medicare records found. The questionable diagnoses included some for potentially deadly illnesses, such as AIDS, for which patients received no subsequent care, and for conditions people couldn’t possibly have, the analysis showed. Often, neither the patients nor their doctors had any idea. Medicare Advantage, the $450-billion-a-year system in which private insurers oversee Medicare benefits, grew out of the idea that the private sector could provide healthcare more economically. It has swelled over the last two decades to cover more than half of the 67 million seniors and disabled people on Medicare. Instead of saving taxpayers money, Medicare Advantage has added tens of billions of dollars in costs, researchers and some government officials have said. One reason is that insurers can add diagnoses to ones that patients’ own doctors submit. Medicare gave insurers that option so they could catch conditions that doctors neglected to record. The Journal’s analysis, however, found many diagnoses were added for which patients received no treatment, or that contradicted their doctors’ views. ...Insurer-driven diagnoses by UnitedHealth for diseases that no doctor treated generated $8.7 billion in 2021 payments to the company, the Journal’s analysis showed. UnitedHealth’s net income that year was about $17 billion. ...Humana disputed the Journal’s calculation that the company had received $2.2 billion in 2021 payments from insurer-driven diagnoses, saying that total didn’t reflect chart reviews that lowered payments by removing diagnoses.

1

Check out our latest podcast episode!

2

Good Morning Health Professionals, Telemedicine is reshaping healthcare delivery, yet many patients are still hesitant due to misconceptions. My latest article, Telemedicine's Most Tenacious Myths and Truths, addresses these concerns and prepares patients for confident participation in telemedicine visits. Discover how this resource can help dispel myths and encourage your patients to embrace telemedicine with confidence. #Telemedicine #HealthcareInnovation #PatientBetter https://lnkd.in/gXGFKpE7

1

Many thoughts as Medicare Advantage continues to come under scrutiny. - MA has features of a value-based program, but most of the current "value" is being delivered through diagnosis capture and complexity payments. Ironically, much like FFS, it pays more to keep people sick (or make them look sick). Don't think that's anyone's definition of value. - To be fair, most doctors (especially specialists) don't do a great job of capturing diagnosis and patient complexity beyond their immediate area of expertise. (We're especially bad at this in MSK). We should have accurate representation of a patient's health in the medical record. Complexity and co-morbidities affect treatments and outcomes. We don't yet have a good way to account for this complexity -- and it's becoming clear the MA system isn't it. - EMRs make all of this worse. It's both too easy and too hard to record, change, or resolve diagnoses. EMRs should facilitate accurate complexity capture and treatment personalization. The goal shouldn't be to increase billing, it should be to increase sophistication and precision. - As MA scrutiny grows, the business model of many alternative care models (especially in primary care) will be challenged (potentially dealing another blow to retail healthcare). - CVS' purchase of Signify health is put into full context by this article. - It boggles the mind that CMS can develop and administer a program that nets billions for inscos (at the expense of taxpayers) while reducing physician reimbursement yearly and rolling out ineffective VBC programs for providers. CMMI should have an open-door policy for anyone delivering care and working on true value-based models. Ears, eyes, and minds should be wide open. h/t Mahek Shah MD, MBA Moby Parsons, MD #medicine #healthcare #vbc #valuebasedcare #health

25

11 Comments

CVS Health’s Dr. Mohamed Diab, MBA talks about the efforts #ACOs are taking to accelerate the adoption of value-based care --- 1) Empowering healthcare organizations by providing actionable data to make informed care delivery decisions  2) Addressing SDoH factors that create barriers to care (transportation issues as well as food security issues) 3) Helping physicians and clinicians to improve co-ordinated care delivery outcomes #vbc, #vbaforvbc, #vba , #valuebasedcare, #alternativepayments, #wholepersoncare, #contractbuilder, #valuebasedinfrastructure, #dataengineering, #datascience, #interoperability, #fhir , #hl7 , #edi , #unstructureddata Rahul Sharma, Lynn Carroll, Deepti Sharma ,CPC CMHP, Mohan Badkundri, Karthik Kanakaraj, Kimberly Shepard, Eric D. Young, John Layne, Carl King, Amol Bapat, MD, FACC, Michael Roach https://lnkd.in/eJwY2vwA

15

I'm thrilled that today, we announced a significant milestone for Clover Health: the launch of Counterpart Health. Our innovative Clover Assistant (CA) platform is now available to all Medicare Advantage payors and providers under the new brand name Counterpart Assistant. Why am I so excited about this? This move is a strategic leap forward in our mission to improve healthcare for everyone. With Counterpart Assistant, we're not just expanding our reach—we're leveraging cutting-edge AI and machine learning capabilities that have already proven to make a real difference in patient care. The healthcare landscape is evolving rapidly, and the need for advanced, data-driven tools has never been greater. Medicare Advantage plans, in particular, are under pressure to improve patient outcomes while managing costs. That’s where Counterpart Assistant comes in. By bringing our technology to more providers, we're empowering clinicians with the tools they need to deliver high-quality, personalized care. What makes Counterpart Assistant special? First, we’re broadening our impact by allowing providers outside of Clover Health's Medicare Advantage plan to benefit from our technology. Our hybrid SaaS and shared-savings model aligns financial incentives with health outcomes, ensuring flexibility and scalability. CA’s AI-driven insights enhance clinical decision-making, and are associated with earlier diagnosis and better management of chronic diseases. Plus, we've built a robust support system to ensure seamless integration and ongoing assistance for all users. Clinicians using CA have seen significant improvements in Medical Cost Ratios and patient outcomes. The timing couldn't be better. The healthcare industry is ripe for transformation, and our technology is poised to lead the way. By expanding the use of Counterpart Assistant, we’re not just keeping up with the changes—we’re driving them. Join us on this exciting journey. Visit our website for more details. Thank you for your continued support as we strive to bring high-quality healthcare to everyone on Medicare. #HealthcareInnovation #AI #MedicareAdvantage #ValueBasedCare #CloverHealth

557

35 Comments

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

40

2 Comments

I appreciate Becker's Healthcare Mariah Muhammad for allowing me to contribute to the current convergence of clinical, operational efficiency, and digital health domains. This vertical integration aims to enhance patient outcomes, increase operational efficiency, and tailor care experiences to individual requirements. Examples include the integration of digital health tools for personalized care experiences, emphasis on digital transformation to optimize healthcare delivery, consumerization of healthcare for enhanced accessibility and convenience, and utilization of digital tools to improve clinical performance and operational efficiency. These trends collectively signify a progressive shift towards a more effective, patient-centered healthcare environment propelled by innovation, technology, and a dedication to enhancing healthcare outcomes. The full article link:

12

I recently had the privilege of conversing with Joe Kiani, a trailblazer in the healthcare industry and a visionary leader. Our discussion centered around his innovative approach to making healthcare more accessible and efficient for everyone. Joe Kiani emphasized the importance of leveraging technology to provide high-quality care  -- including in the comfort of patients' homes. This not only improves patient outcomes but also reduces the burden on our healthcare system. His work is a testament to how technological advancements can bridge gaps in care delivery and bring about transformative change. One key takeaway from our conversation was Joe's commitment to patient-centered care. By focusing on continuous monitoring and early intervention, we can significantly enhance patient experiences and outcomes. His vision aligns perfectly with the growing trend of personalized medicine and the need for more flexible healthcare solutions – including when it comes to addiction. I love talking to leaders – especially in healthcare – and learning more about their style. Take a listen to how he talks about microfixing and his need to tackle big problems, while at the same time, speaking up when he sees injustice. Let's keep pushing the boundaries and working towards a more inclusive and efficient healthcare system! #HealthcareInnovation #HomeBasedCare #PatientCenteredCare #TechInHealthcare #HealthcareLeaders #Inspiration

25

14 Comments

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?

2

Main Point of Value-Based Care Value-based care is a healthcare model that ties the amount providers earn to the quality and cost-effectiveness of the care they deliver to patients. Unlike the traditional fee-for-service system where providers are paid for each service rendered regardless of outcome--value-based care rewards providers for improving patient outcomes while keeping costs down.

2

AccendoWave - A Pain #Data Company More recently, the federal government has begun using the QIS program and QRS parameters to advance health equity. Federal rules now require all marketplace insurers to adopt a strategy for reducing health disparities and to stratify certain clinical data by race and ethnicity. While state-based marketplaces (SBMs) have authority to supplement these federal minimum QIS and QRS standards with state-specific quality rules, most have hewed closely to the federal default approach. California and Washington are notable exceptions. Each has implemented a customized QIS program and robust data collection standards to identify and reduce racial and ethnic health disparities. Time to Focus on - #Pain not being Believed. A Root Cause Health Equity Problem. A Top 4 Global Health Equity Solution and Top 15 Global Remote Monitoring Company, AccendoWave, benchmarks objective brain wave pain data (specialty, gender, age) and has nine #pain databases: Emergency Department, Maternal Health, Oncology, MSK, Medical Surgical, ICU, #Women, Adults, #Seniors to eliminate bias, improve outcomes and reduce health care costs. If desired, AccendoWave can also create customized pain databases for partners that can be accessed on the Datavant platform.

5

Unlike fee-for-service models, which prioritize quantity of services rendered, value-based care emphasizes actual outcomes, aligning incentives to improve patient health and reduce costs. As VBC models grow, with predictions showing a market increase from $12.2 billion in 2023 to $43.4 billion by 2031, healthcare will require a more collaborative, efficient, and patient-centric system. This will require adapting from providers, however, to navigate the complexities and succeed financially. #VBC #ValueBasedCare #Healthcare #GoodCareMonth

14

2 Comments

Great synopsis here with some detail on health system ACO participation and “sentiment”. 56% of ACO participating hospitals considering “leaving” the ACO is I think a massive opportunity for the ACO enablement ecosystem companies.

2

Embracing the Future of Telemedicine: The Path Toward Integrated and AI-Enhanced Care I fully concur with Spencer Dorn's recent post with a balanced perspective on the evolution and current limitations of telemedicine. While telemedicine has indeed not lived up to the initial sky-high expectations, its integration into our healthcare system still holds vast potential. Here are some additional points to consider: ·     Care needs to be multimodal: Effective healthcare should seamlessly blend in-person visits, telemedicine, and other forms of digital communication. This integration will cater to different patient needs and scenarios, enhancing accessibility and effectiveness. ·     Technology needs to evolve further to provide better comprehensive solutions: The current telemedicine platforms must evolve to offer more holistic healthcare solutions that are not only technologically advanced but also user-friendly for both patients and healthcare providers. ·     Adoption needs to happen: For telemedicine to truly become an integral part of healthcare, widespread adoption is necessary. This means not only by patients but also by healthcare providers who must embrace these new tools as part of their everyday practice. ·     Reimbursements need to improve: One of the major hurdles to the adoption of telemedicine has been the lack of adequate reimbursement models. As these improve, it will encourage both healthcare providers and patients to utilize telemedicine more extensively. ·     Future generations will likely be more attuned and comfortable receiving digital care: As digital natives age into needing more medical care, their familiarity and comfort with technology will lead to greater adoption of Telehealth services. Conclusion: The evolution of telemedicine is inevitable, though perhaps not immediate. With rapid technological advancements, particularly in AI, the future of integrated telehealth is promising and might arrive sooner than we think. The journey towards a technologically enhanced healthcare system is on its horizon, and it's only a matter of time before it becomes a new standard of care. That's why Idrees Mohammed and I @The Cloud Intelligence Inc are working tirelessly to bring solutions that not only foster change in our current healthcare landscape but will truly revolutionize it. #HealthcareEvolution #Telemedicine #HealthTech #DigitalHealth #AI

4

🚀 Telehealth’s Rocky Road: Beyond the Pandemic Boom 🚀 Telehealth companies like Teladoc, Amwell, Hims & Hers, and 1Life have experienced a brutal year, with stock prices plummeting 40-80%. This begs the question: what went wrong? 📉 🏬 The Retail Approach’s Fall 🏬 Telehealth initially mimicked the retail industry, prioritizing convenience over building strong patient-physician relationships. This lack of trust and loyalty proved detrimental. 😔 🔄 Continuity Conundrum 🔄 Telehealth often falls short in providing continuity of care. While some offer virtual primary care, this message hasn’t resonated with patients who perceive telehealth as solely for minor, urgent needs. 🏥 🩹 Beyond Band-Aids 🩹 Telehealth primarily addressed low-hanging fruit, focusing on minor issues that could often be ignored or handled by a regular physician. Traditional telehealth hasn’t equipped itself to handle complex diagnoses or common problems requiring thorough workups. 🌱 📚 Lessons Learned 📚 The failures stem from flawed business models, not a lack of patient interest in telehealth. So, what can we learn? 🤔 🤝 Human-Centric Healthcare 🤝 Building trust and loyalty through a strong physician-patient bond is crucial for long-term success. This translates to convenient access for patients and efficient workflows for physicians, potentially using AI tools for administrative tasks. Seamless data exchange with other healthcare systems through Health Information Exchanges is also vital. 🌐 🌟 Expanding Capabilities 🌟 Moving beyond basic video visits is essential. Integrating capabilities like pulmonary function tests, EKGs, and home-based testing for common illnesses can significantly enhance telehealth’s value proposition. Additionally, offering home visits from qualified nurses for specific cases can further improve patient care. 🌈 By addressing these critical shortcomings and focusing on a human-centric, comprehensive approach, telehealth can still thrive in the long run. 🌿 Feel free to ask if you’d like to explore more! 🙌 #healthcare, #telehealth, #investment, #patientadvocacy

12

7 Comments

Excited that Becker's Healthcare will air its “CEO + CFO Virtual Forum tomorrow and our panel’s discussion titled, “Hospital Financial Strategy Reboot: How to Proceed as Healthcare Exits the Hospital.” As I noted, UC Davis Health is optimizing the most effective and wise ways to balance care for inpatient, outpatient and at-home contexts, while always putting our patients at the center of everything we do.   https://lnkd.in/ebbkH4Ws

19