Donna K. Lencki

My latest article in Crain Currency delves into the intersection of HNWI's and Health, Wealth, and Overspending on Healthcare. Exploring the concept that "Healthcare is Wealthcare." #HNWI #Healthcare #Wealthcare

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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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As part of our #M3P solution in JUDI®, the report dashboard gives Medicare Part D #plansponsors insights into payment activity. With all this data at your fingertips, available to slice and dice as you see fit, you can easily visualize and keep track of payment trends. Want to see Ryan Kelly (Chief Technology Officer) run through a live demo of our M3P solution? Check out the replay of our webinar here: https://okt.to/9ZTsSW

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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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With the volume of employers converting to ICHRA plans growing by the hour, here are some thoughts on what to consider as you make your funding decisions.

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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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Smart move by Allegheny Health Network - and likely one that others will follow. #GenerativeAI systems are so powerful and effective in conveying information that not only will businesses and organizations of all types fill follow. And as developing #ChatGPT-style systems become easier, its likely we will each have our own personal #AI. #aiinnovation https://lnkd.in/eaqAZCFT

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We just released our H1 2024 New York Healthcare Innovation Report, and it's generating lots of buzz. Why? Funding is up: 56 companies raised $2.2B in H12024, about 35% greater than the same period last year. There's lots of positive momentum within the NY #digitalhealth community heading into the second half of the year. Download the Digital Health New York report : https://go.dhny.co/h1-2024

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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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Here’s your recap of last week’s healthcare technology news 🗞️ 👇 🤖 AI Clinician Assistant • Carle Health is beginning a full-scale adoption of Nabla through their Epic integration.    • UVM Health Network signed an enterprise-wide agreement with Abridge.    • Regard closed a $61M Series B with an investment from Cedars-Sinai Health Ventures among others.    • Mass General Brigham published a Q&A discussing the results of its initial AI ambient scribe pilot and plans to roll out a wider implementation.    🔁 RCM • Greenway Health released a patient payment solution that integrates cost estimates, patient payments, and payment plans.    💼 Provider and Practice Administration • Kontakt.io released a new wearable tag that aims to enable understanding of patient journey, estimated wait times, room availability, physician time with patient, and more.    📋 Patient Administration • Cone Health is partnering with Lirio on an AI-driven intervention for patients with diabetes.    • SAIGroup acquired Get Well, giving it access to the firm’s AI platform. 🍎 VBC • P3 Health Partners is partnering with Innovaccer to leverage its physician engagement solution as well as its AI-driven analytics.    • HSBlox, Inc released an update to its CureAlign platform that includes tooling for improved care coordination and patient outreach.    • GrayHawk Health is implementing Innovaccer to optimize operations and improve efficiency. 🧠 Food for Thought • We’ve covered numerous studies in our newsletter highlighting the impact of tech on reducing physician burnout. It appears we’re finally seeing signs of widespread impact from these workflow and workload interventions: physician burnout dropped below 50% for the first time since 2020, according to the AMA. https://lnkd.in/eWhj94NB    • ONC released the new, proposed rule HTI-2 to advance interoperability and patient information access and sharing. We're looking forward to more expert takes in the coming days—feel free to send any good ones our way! https://lnkd.in/eyM7eDyq --- Reminder: you can sign up for the Elion Briefing to get the latest healthcare tech news delivered to your inbox each week 📬 👉 https://lnkd.in/e2UJ3ckP

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How to Pay for the #BrainSee Program? 1) Out-of-Pocket (OOP): Pay the full cost directly. 2) Medicare Insurance: Your copay is 20%. 3) C4C (care for a caregiver): If you don’t have Medicare and can't afford to pay OOP, don’t worry. You can contribute to Darmiyan 's mission by caring for a caregiver. The cost of an entire #BrainSee program is 15 C4C. A caregiver is anyone who routinely cares for a patient with dementia. Caregivers need the most support — often more than the patients they look after. Each C4C unit is one hour of volunteer work benefiting a caregiver, with mutual consent. This can involve helping with laundry, shopping, housework, teaching something new, inspiring, being a soundboard, facilitating social activities, introduction to support communities, taking them out for a walk, reorganizing the house, or fixing broken items. The aim is to offer practical and meaningful help that takes some burden off a caregiver's shoulders, shows them they're not alone, and brings a smile to their face. Email us at [email protected] to learn more.

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I always read Rock Health's digital health reports as they give a nice pulse feel for what is happening in the digital health funding space. Good to see funds raised in H1 2024 suggest funding in the sector seems to have stabilized at 2023 levels. Its no surprise the report emphasis the buzz around AI and healthcare. There have been clear winners in the AI healthcare space in the area of process and cost optimization and the R&D space. The impact of AI in care and treatment delivery is so far much more muted. One area I never though to look at AI was in its ability to bring together multiple healthcare pathways and digital point solutions into a more holistic seamless experience for the patient. There is a clear trend away from using stand alone digital health point solutions, and could AI address this challenge by facilitating the efficient integration of disparate processes and technology into unified care programs. I can see this happening with digital health products but this will be more tricky to do with physical care programs involving clinicians and HCPs. “AI is helping us combine multiple parts of the care journey, across all care experiences. In the future, benefits navigation, clinical guidance, and care delivery won’t be delivered by separate companies or point solutions within the healthcare ecosystem. They’ll be features that work in concert within products, and they’ll happen in under 90 seconds for a seamless patient experience.” – Glen Tullman, CEO, Transcarent and Managing Partner, 7wireVentures

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🌟 Unlock Your Financial Freedom with Hive by Metis Health Technologies! 🌟 Designed for clinicians who want to take charge of their financial future, Hive software empowers you to maximize your time, revenue, and practice growth with powerful tools tailored to your needs: ✅ Hive Dashboard: Access all your essential metrics in one place. Quickly get the full picture of your practice’s health without digging through mounds of data. ✅ Revenue Recognition: Discover unpaid claims and identify potential payment delays. By focusing on these missed payments, you’ll unlock more revenue and boost your bottom line. ✅ Fee Schedule Check: Ensure you’re charging at the highest allowable rates by optimizing your fee schedules. Earn what you deserve with strategic, data-driven pricing adjustments. With Hive, clinicians can step away from financial guesswork and focus on what truly matters: delivering compassionate, high-quality care. Unlock your financial freedom and take control of your practice’s growth with Hive! 🌐 Visit our website today: https://lnkd.in/emV8SYbY #MetisHealthTechnologies #HiveSoftware #FinancialFreedom #HealthcareInnovation #PracticeGrowth

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LinkedIn Community & Colleagues: I'm on the hunt for a few vendor solutions ready to support highly-regulated #MedicareAdvantage plan needs to accelerate modern #StarRatings success...looking for friends to connect me with possible sources for: 1. AI-driven MTM CMR creation tools (where AI-powers draft CMRs for clinicians to review/hone/finalize). 2. AI-driven tools to identify high-impact clinical events ripe for clinical intervention real-time (using robust, real-time digital data collected via #dQM/ #ECDS ready tools). Please share any sources and ideas you know of. I'm ready to chase some rabbit holes! TYIA!

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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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Quarterly Q&As are out! These are mini refreshers or clarifiers for everyone in the home health industry! Question 1 is GOLD for businesses like ours. Question 1: A third-party external auditor consistently states that our OASIS functional status items are “underscored” and recommends changing the responses to the OASIS items. Is the assessing clinician required to accept the auditor’s recommendations? Answer 1: While a home health agency may use third party external auditors to review OASIS coding and make recommendations, the assessing clinician is responsible for determining OASIS coding based on their assessment. We often get clinicians who don’t understand the reasoning or rationale. The longer or more detailed it is— consider it unread. That is NOT compliance. Truth be told, most of the clinicians are reviewing these changes in the field or at home after a 10 hour home health shift. Their brains are at capacity for receiving more info. I should know, I was one of those clinicians. Family time is now met with 6 inch long “yellow sticky notes”. That’s why most of these clinicians have my personal email and phone number. I thrive on educating and so I always encourage them to “call me with questions”. You’ll usually find me at 9pm explaining why M2020 is likely marked as 3 if M1860 is stating patient requires assistance or supervision of another person at ALL times during ambulation. What’s your consultant team doing to bridge the gap between making clinicians aware of changes made and EDUCATING on changes being made? Contact me for more info on how C&C Strategic Consulting can assist your agency!

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🤔 What do you know about healthcare administration? 🤔 #claimsadjudication #thirdpartyadministration #specialtyinsurance... :) Andrew Munroe, Senior Vice President of Operations, Pharma, and Payor Partners at NexgenRx Inc. joined us on the latest episode of the Health Tech Horizons Podcast to share industry insights, and the latest trends shaping the future of healthcare administration. Join us as we explore the intersection of insurance related technology, innovation, and healthcare with NexgenRx Inc. and Andrew Munroe. ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ 📲 CHECK OUT the VIDEO 📺 ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ ⚡ ⚡

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