Joel Evans

Read how StoryMD is transforming patient engagement by changing the way patients view their health data, empowering them to understand, engage, and take control.

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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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There is a misconception emerging that AI agents will lead to immediate reductions in healthcare labor costs. While AI agents can automate end-to-end workflows such as booking appointments, answering basic patient questions, and performing form completion for prior authorizations, automating a single task is not equivalent to automating an entire job. Nurses are a prime example. Certain nursing tasks, such as care coordination and patient documentation, are highly automatable by AI agents; however, there is a tremendous amount of work nurses perform on the ground that cannot be fully automated with current technologies such as direct patient care, physical examinations, medication administration, wound care, patient support, and clinical assessments. These nuances make full role elimination less likely with current technologies. When articulating the ROI of an AI agent, we need to be both precise and accurate. Automating a task is more often not automating an entire profession. For roles that encompass many functions, such as nursing, AI agents can be invaluable tools for unburdening staff, increasing efficiency, and boosting throughput—benefits that are particularly valuable given current healthcare staffing and resource shortages. The most promising job candidates for full role elimination through AI remain positions with monolithic task structures, of which there are relatively few in healthcare today—scribes, medical coders, and data entry specialists for example. It is therefore unsurprising then that the most progress has been made in these categories.

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Digital Health Wire 279 is live, and telehealth is back in the hot seat after Trilliant Health pinned virtual visit volume at less than half its initial peak. Although telehealth utilization is still up massively, it was interesting to see that behavioral health now accounts for over two thirds of virtual visits. Other top stories include: > NeuroFlow acquired fellow digital behavioral health company Owl Health to bolster its end-to-end platform for identifying and managing behavioral care needs. >Ardent Health is exploring an IPO at a valuation upwards of $5B. >Anterior (formerly Co:Helm) scored $20M in Series A funding to fund its GenAI co-pilot for prior auth workflows.

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The #NDIS guidelines for assistive technology: Concerns that vendors of assistive technologies have undue influence on the types of devices approved, driven by commercial interests rather than participant needs. Structured funding tiers (low, mid, and high cost) might prioritize budget control over individual needs, suggesting a hidden agenda to cap spending regardless of the participant's actual requirements. Stringent requirements for evidence & the categorization of AT into cost tiers act as #gatekeeping mechanisms. This disproportionately disadvantages those less capable of navigating the bureaucratic process or those without access to professional advocates or occupational therapists who can provide the necessary documentation. Complexity & rigidity of the approval process may strengthen provider power, reducing the participant's ability to influence decisions about their own care & support needs. The system's design nudges participants towards choosing lower-cost AT by making the process for obtaining high-cost technology more cumbersome & time-consuming. Detering participants from pursuing the best solutions for their needs, subtly influencing decisions that prioritize budget considerations over optimal care. Focus on cost-effectiveness & value for money, while economically rational, may conflict with the more human-centric approach of providing the best possible technology to enhance life quality, regardless of price. Detailed & complex guidelines, tiered funding & extensive evidence requirements, might discourage participants from applying for or appealing decisions about AT, a form of dark pattern where the system design dissuades taking action that is in the participant's interest. Language used in the policy claims to support participant empowerment & choice, while the actual practices—through rigorous controls & strict funding tiers—limit these very principles. By making it difficult to access necessary, AT, the guidelines may inadvertently contravene the UNCRPD's principles, particularly those regarding the right to live independently & be included in the community. The one-size-fits-all approach in categorizing and funding AT can lead to inequities, where individuals with the same type of disability but different personal circumstances might receive disparate levels of support. Guidelines overly restrict access to innovative AT, theres a lack of adoption of new technologies that could significantly improve quality of life, leading to technological stagnation. If participants cannot access the AT they need to function independently, this could lead to increased isolation, decreased community participation, and greater dependency on human caregivers, moving away from the goals of the NDIS to empower. NDIS need to continuously engage with participants & care givers to ensure the AT guidelines genuinely reflect & support the diverse needs of all participants, promoting an inclusive, flexible, & participant-centered approach.

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We're underestimating how physicians will build and access software in the future and we're 100% underestimating how this will impact independent practice. By now I'm sure you've seen the Claude 3.5 Sonnet demos and all of the use cases or application non technical folks are building with 1-3 line prompts. Even Jensen Huang, CEO of Nvidia made a controversial comment on the future of coding, “It is our job to create computing technology such that nobody has to program. And that the programming language is human, everybody in the world is now a programmer. This is the miracle of artificial intelligence,” This is absolutely true, and if there's one area where this will have the biggest impact on society, it will be healthcare. The reason for that is that physicians and clinicians have NOT been included in the design of healthcare technology over the last 20ish years, leaving them to practice in systems designed by non-clinical people. Claude 3.5 offers a glimpse into the future of independent practice. Physicians will be able to design, build, and launch AI applications as needed without requiring developer support. In the future, I envision independent practices hiring their own AI Agent developers who can not only build these applications, but also integrate them into their practice operations infrastructure to create the ultimate practice management system. What application would you build if this were possible today? ----- Hi, I'm Dr. Mario Amaro, Founder and CEO Ease, and I talk about all things starting, running, and growing a private practice with AI. Follow me, if you are planning to start one or are currently figuring out creative ways to grow one. #PrivatePractice #SelfEmployment #HealthcareOnLinkedin #HeyEase #IndependentTogether #Fintech #Infrastructure #AIinHealthcare #CareDelivery

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MDS Nurses: The Unsung Heroes of Quality Care in SNFs Digital Scientists has partnered with a large skilled nursing facility (SNF) provider for over five years. Throughout this collaboration, we’ve seen how MDS nurses are the backbone of quality care, ensuring compliance and enhancing patient outcomes. Considering the challenging work environment, we believe in empowering nurses with technology that supports and improves their workflows—not technology that dictates how they do their jobs. Our AI-driven solutions are designed to streamline assessments, optimize reimbursement processes, and ultimately make it easier for MDS nurses to focus on what matters most: delivering exceptional patient care. 🎯 Join us for our upcoming webinar, “Optimizing Reimbursement and Quality Incentives with AI-Driven MDS Assessments,” where we’ll explore how technology can empower nurses and improve their jobs and patient outcomes. #SkilledNursing #MDSNurse #SNF #EmpoweringNurses #AIinHealthcare #PatientCare #HealthcareCompliance

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Long, long, long overdue. YOUR health records are YOUR health records. The barriers created by companies like EPIC to get your records, house them all in one place, and take them "with" you wherever you are, should be illegal. If this lawsuit prevails, it likely will be. I have always said, we should direct our data to be deposited where we would like it to be, not in some EHR/EMR with vertical walls of steel. If you haven't tried EPIC's capabilities to share your records, or combine your multiple instances of EPIC together....give it a try. We found the capabilities to be nearly useless. On top of all of this......a longitudinal, historical health record that shows years of an impending condition, under the lens of great AI algorithms, can prove to be very predictable. But how will that work when your health records are scattered all over in multiple steel walled vaults "owned" by these EHR/EMR's?? The future of precision medicine is at risk based on this. It's time to stop having to beg for your health data...that is yours. #dataprivacy #privacy #healthrecords #trust #ethicaldatause 360ofme https://lnkd.in/gUSFPmnt

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This truly highlights the tension between innovation and market dominance in health tech. Particle Health's challenge against Epic could set a significant precedent for data interoperability and patient rights. As regulatory scrutiny on monopolistic practices intensifies, it will be interesting to see how this unfolds.

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Endeavor Health builds on long history of personalized medicine leadership with polygenic risk score test https://lnkd.in/gMtNRNzG

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Next week we begin releasing our Signals guides, visuals, and analysis of CMS's Kidney Care Choices Program. Results from its first year were published on the CMMI website back in October. The table below is a preview of our interactive guides, featuring the Top/Bottom 10 performing KCEs by monies owed by (to) CMS (just one of *many* ways to look at this dataset). One thing we plan to do differently this year is presenting data in a way you can interact with and learn from. These snapshots make for nice visual references, but we realized there's much more you can do with this information once you have it in front of you. The full database includes: • Entity Type • Affiliated Dialysis/ Care Coordination Organization • Agreement Option • Presence in States • Entity in Aggregation Group (Y/N) & Group Number • Average Risk Score CKD • Average Risk Score ESRD • Average Risk Score (CKD & ESRD) • Beneficiary Count CKD • CKD / Total Benies (%) • Beneficiary Count ESRD • ESRD / Total Benies (%) • Beneficiary Count (CKD & ESRD) • Beneficiary Months CKD • Beneficiary Months ESRD • Beneficiary Months (CKD & ESRD) • Unadjusted CKD Benchmark • Unadjusted ESRD Benchmark • Unadjusted Benchmark (CKD & ESRD) • ESRD Discount (Only Global) • Total Quality Score • Quality Withhold Amount • Earned Quality Withhold • Adjusted CKD Benchmark • Adjusted ESRD Benchmark • Adjusted Benchmark (CKD & ESRD) • Performance Year CKD Expenditure • Performance Year ESRD Expenditure • Performance Year Expenditure (CKD & ESRD) • Gross Shared Savings/Losses CKD • Gross Shared Savings/Losses ESRD • Gross Shared Savings/Losses (CKD & ESRD) • Gross Percentage Savings/Losses (CKD & ESRD) as % of Benchmark • Net Shared Savings/Losses (CKD & ESRD) • Net Percentage Savings/Losses as % of Benchmark • Medicare FFS Claims Zeroed out for CKD QCP • Prospective CKD QCP Payment • Leakage Withhold Balance Amount • Alignment Withhold Balance Amount • Health Professional Shortage Area Bonus • Home Dialysis True Up • High Performers Pool • Extreme and Uncontrollable Circumstance • Total Monies Owed By (To) CMS Sign up to get the guide when it goes out: 📡 trfitzpatrick.com/welcome We'll also add it to the data room: 📊 data.trfitzpatrick.com *** Have feedback or insights to share? We'd love to hear from you! We'll be putting together our thoughts for a full series on Signals From [Space], so don't hesitate to say hello or join us in the Signals Slack channel. Send me a 👋 or tag someone below who should see this, and I'll send over the PY22 results.

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Redesign Health has launched its largest fund to date, securing $175M to support over 20 new healthcare startups. Founded in 2018, the venture builder has previously incubated more than 60 companies, including Scriptology and Vivid Health. The new fund aims to address challenges such as healthy aging, interoperability, and expanding sites of care. This funding underscores investor confidence in tackling the $4T healthcare market's persistent challenges.

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Instead of using a third-party app, consider a license for the validated MMAS scales directly into your EHR. Here’s why: ✅ Simplified Licensing – Fewer terms, less hassle. 💸 Cost-Effective – No hidden software fees. 🔒 Better Data Security – Keep patient data in-house. 💻 Customizable Workflows – use internal Large Language Learning models that you control. Tailored for your clinicians. 🕒 Independence from Vendor Support – Manage updates on your schedule. Think about the benefits of keeping validated tools close to home. Better efficiency for your team, better outcomes for your patients! www.moriskyscale.com #HealthcareInnovation #EHR #PatientCare #HealthcareTech #ClinicalWorkflows #MedicationAdherence

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All the innovation. All the virtual care models. All the value-based care payment incentives. All the breakthrough drugs and technologies. Nothing stops the healthcare spending train as the system currently exists. Better health, not more healthcare, is the solution. https://lnkd.in/gdGGA9KV

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🚨 Senators Question Telehealth Moves by Pharma Giants Eli Lilly & Pfizer 🚨 In October, Senators Durbin, Sanders, Welch, and Warren sent letters to Pfizer and Eli Lilly, raising concerns about their new telehealth DTC platforms. These platforms, which connect patients directly to doctors after reading about medications, could blur the lines between healthcare advice and profit-driven influence. 💊 Key Concerns: - Anti-Kickback Risks: If these platforms pressure doctors to prescribe their medications, Medicare and Medicaid laws may be at risk, specifically the Anti-Kickback Statute. - Potential for Fraud: Referring to a recent HHS alert, these models could create opportunities for fraud if companies incentivize doctors to prescribe certain medications, regardless of medical need. In a broader context, cases like Done Global, Inc., involving Adderall prescriptions, highlight the challenges and risks tied to telehealth and DTC practices, especially as federal agencies continue investigating fraud concerns. #HealthcareEthics #Telehealth #Pharma

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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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