Ed Marx

🎥 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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An interesting new service for accelerating time to market for digital health products and embedding them properly in pathways. Palantir's recent CEO statement is also very revealing. While focused on their defence work, it can be equally read as a rather blunt critique on where much (but not all!) of the digital health industry is at right now: "A premium was placed on developing software products whose principal purpose was to sell themselves. And a perception of value became more important than value itself....... Those companies, however, are now being swept to the side. They attempted to seize the cultural and moral high ground at the expense of anything resembling a commitment to outcomes. And society, not to mention customers, have grown disinterested in their theater." Ouch. https://lnkd.in/e8iVd9wV

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Strategies for Success in the Face of Medicare Advantage Challenges As the Medicare Advantage landscape becomes increasingly complex, with regulatory changes, high utilization trends, and funding stagnation, it is essential to identify and implement effective strategies to ensure success. **1. Membership Shifts and Pricing/Benefits Adjustments:** Anticipate shifts in membership and proactively adjust pricing and benefits to cater to the changing needs of the target population. **2. Synergistic Approach to Coding, Quality, Engagement, and Network Management:** Break down silos and establish a collaborative process that integrates coding, quality, engagement, and network management to optimize performance. **3. Utilization Management and Total Cost of Care Control:** Implement strategies to manage utilization and control the total cost of care, including exploring digital, virtual, and alternative forms of care to enhance affordability and accessibility. For further insights and a more detailed discussion, please feel free to reach out directly. #medicareadvantage #affordability #totalcostofcare #healthcareinnovation #optum #utilizationmanagement

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Amazing results happening in the CGT space especially with Sickle Cell and Duchenne Muscular Dystrophy. Patients are getting cured! Lots of work to do to bring this tech to more common genetic disorders at much more affordable price points but it is coming according to the manufacturers #CellandGeneTherapy #AI #PredictiveAnalytics

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Direct Pediatric Care and the other derivatives of direct care are becoming mainstream. Agree, it is not just a fad, or a fringe model, or one only for patients with disposable income. Direct care models are part of the solution to our broken fee-for-service medical care. It is about prevention, not repair. It is about relationships, not throughput. It is about doing what is right for the patient, not the industry. I love seeing the rapid progress and attention in the market place. https://lnkd.in/gHHKSwBd

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HealththinkPost#37 We are feeling increasingly bullish on 2025 healthcare PE deal flow activity. Likely not 2021 levels, but an uptick--nonetheless. Key drivers will be reduced cost of capital, pent up demand--significant dry powder, and valuation resets. Spaces we believe will see increased activity include--ASCs; HCIT; RCM; specialty pharmacy; ambulatory infusion; hospice; behavioral health; CROs; and clinical trial sites, among others. We are looking forward to supporting buy and sell-side M&A activity! We can feel and see it coming. #Cicero #MGT #Healthcare

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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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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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Which founders fit the mold for success in healthcare? I spoke with Anne DeGheest, Founder and Managing Director at HealthTech Capital, about the key characteristics of successful #healthtech entrepreneurs. Listen to the full conversation here: https://lnkd.in/eqwUCkPx

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As a digital health executive (and a consumer of healthcare) I've been reflecting on the significant rise in average U.S. family health insurance premiums over the years: 2000: $6k 2003: $9k 2006: $11k 2009: $13k 2012: $16k 2015: $18k 2018: $20k 2021: $22k 2024: $26k (projected) This marks a staggering 342% increase since 2000, averaging 6.1% per year, compared to the U.S. CPI inflation rate of 2.5% per year. When electronic health records (EHRs) were introduced, many of us (myself included) were optimistic about their potential to reduce costs. The ability to share lab results electronically, alert for drug interactions, and improve coordination of care seemed like a promising path toward lower healthcare expenditures. However, the anticipated outcomes haven't materialized as expected. As we now look toward AI for solutions, I find myself questioning whether it will truly address these escalating costs. Several factors may contribute to this issue: - The rising rates of obesity since 2000 has tripled. - An aging population with longer lifespans - Provider shortages and increasing burnout - Challenges with interoperability - Market dynamics and regulatory environments - Instances of fraud and abuse I'm interested to hear your thoughts: What do you believe are the primary drivers behind the rising costs. Did EHRs fail us? Can AI fix this?

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At Spring Street Exchange, we've been talking about alternative revenue paths for regional and community-based healthcare organizations for some time now. The 'Middle Path' model outlined in this Harvard Business Review article by Regina Herzlinger, Duke Rohlen, Ben Creo, and Will Kynes is intriguing and adds a framework and structure to some of the ideas we've been exploring. This model would look different for a community-based health plan or provider, but could be valuable to expand thinking. "We’ve shown how the growth driver model can kickstart growth in a stable industry. But it can also be a survival strategy for incumbents facing a disruptive challenge." Interested in your thoughts! #innovation #strategy #secretsauce #differentiation #innovation #communitybasedhealthcare #wholepersonhealth https://lnkd.in/ewu2svCh

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When the music stops we find out which emperor has no clothes. (That’s not how the saying goes is it?) Anyway, here’s the most basic way to look at private equity investments in healthcare (disclaimer: not all are bad!) Healthcare entity sells a piece of itself to an investment group. Let’s say it’s sells 50% for $100 bucks. Investment group (doesn’t matter which one, just choose a color and an object from nature and add Capital or Equity at the end 🤣) puts up $20 dollars and borrows $80 dollars, saddling the healthcare entity with crushing debt. (Works great when interest rates are low, not great when they skyrocket like they have the last couple of years.) Investment group needs to show a return. Easiest way to increase revenue: Raise prices. Don’t pay people what they’re worth. Squeeze them. Cut staff and services. Now you have overworked, underpaid healthcare workers who think they don’t have another option. Let’s say investment group manages to sell their piece for $120 bucks in the usual 3-7 year hold period for private equity. (Remember they only put up $20 and borrowed $80.) Returns the money they borrowed, and keeps the profit. In this scenario it’s basically 100% return on investment. Investment group gets rich. Healthcare entity owners get rich. Patients and healthcare workers suffer. Anyway, Dr. Hal Inc is also a healthcare consulting firm. Follow me for more tips and tricks on what NOT to do in healthcare! (Shameless plug!)

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A great set of insights from Sachin H. Jain, MD, MBA on how health systems can excel in contracts with Medicare Advantage payers -- My top 3 highlights from the interview published today in Becker's Healthcare (link in comments): * Health systems need to be willing to change to succeed in M.A. contracts. * The greatest opportunity is unlocked when health systems enter into value-based contracts with plans. This means the hospital system "assumes full risk for a population of patients and focuses on keeping them healthy rather than managing them when they're sick." * Whether or not a full risk contract is in place, Dr. Jain recommends two focus areas for health systems to quickly succeed: (1) work with plans to optimize performance in the M.A. stars program and (2) ensure appropriate coding. More than half of seniors are in M.A. plans. Seniors with challenges like low income, lack of transportation, housing instability, and food insecurity are more likely to choose M.A. plans over traditional Medicare. If health systems can excel at working with M.A. plans, they will do a better job of helping their most vulnerable patients.

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Strong partnerships are essential to tackling these foundational levers effectively. By aligning goals and working collaboratively (with trust), we can create sustainable strategies (and comp models) that not only lift the tide but also empower everyone to succeed together. Bringing all back to the partnership!

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Still trying to make sense of Walmart pulling back from healthcare delivery? 3 quick thoughts: 🏥 Healthcare delivery is hard, even for companies where it's a primary focus. Navigating reimbursement and competition is extremely challenging. 💸 The patient may be a customer, but they are never the payer. 📊 No matter a company's stature, cooperation and reimbursement from health plans—both nationally and locally—are still critical for building profitable businesses. For a deeper dive, check out our full analysis here: https://lnkd.in/eXTeugKD

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Imagine swallowing the competition whole. That's what many players in tech do via roll-up strategies, gobbling up smaller firms to deliver richer solutions and amass greater market share. Where else are roll-up strategies common? // HEALTHCARE Picture being a patient at a medical practice that’s been part of a roll-up in Healthcare Services. It's an industry ripe for roll-ups due to its fragmented nature and potential for greater efficiency. // CONSUMER SERVICES Or let's say you needed your HVAC serviced, and notice your local repairman is now part of a bigger Consumer Services entity? Centralized management and scale economy turn these localized businesses into roll-up targets. // FINANCIAL SERVICES Think about your insurance agent or wealth management advisor. They're working in complex, highly regulated environments. In the Financial Services sector, roll-ups offer an effective way to consolidate expertise, streamline operations, and enhance customer offerings. // MANUFACTURING Now, imagine driving past factories under a new name — the result of Manufacturing and Industrial Services roll-ups. Bulk purchasing reduces costs, enhances production capabilities, and expands geographical footprints. // REAL ESTATE Lastly, envision your real estate brokerage firm. The industry sees roll-ups as a strategic move to increase market penetration, enhance service offerings, and hike up portfolio value. Roll-ups play a huge role in most industries, rather like a snowball rolling downhill, gaining momentum, and size. Are you seeing roll-ups in your sector or considering M&A?

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Peter Birch from Talking HealthTech and I get down to the nitty-gritty of why 2025 might be the year of healthcare #interoperability.

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