Mario Amaro, MD

In this week's episode of What in the Hot Hell is Happening in Healthcare: Northwell is now an entertainment studio Ummmm, say what now? Let's check the financials: FY 2023 $16.9B revenue $198M op income $1.3B cash from ops Hope none of the $156M in CARES and FEMA funding are going to the studio Maybe just some of this? $11.8B total assets exl. PPE and op leases $6.2B unrestricted cash $7.5B current assets $7.2B net assets I don't know, could be some of this... $140M grants and contracts $35M rental income $31M GPO revenue Could be the $7.9M parking income New York parking is expensive after all Probably just using it's $422M endowment Definitely not using its $774M invested in hedge funds and private equity And definitely not taking away from the 19% increase in General and Admin salary (while health care services salary increased 7%) Glad to see tax dollars going to good use Northwell is tax-exempt after all And generates about 50% of it's revenue from Medicare and Medicaid Can't wait to see the movies they make It's going to be awesome P.S. If you liked this little breakdown, you'll love The Healthcare Breakdown, where we look at numbers and stuff so you can get an idea for what makes healthcare so bananas Check it out here: https://lnkd.in/gVRtQGZN See you out there!

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Bigger isn't always better in healthcare. Just look at the graphic below. Some of the largest health systems in the country are underperforming. They've entered (or operate in) bad markets, hold bloated cost structures, and struggle to hold leverage against payors. As it turns out, and as I'm often reminded, market performance matters. It doesn't matter that you're just big and can absorb a vast swath of overhead. As a health system, the way you throw your weight around in markets is more important than ever. This is the key concept of density and having the right assets in the right markets. CVS, HCA, Tenet, and others all have mentioned the importance of market density in 2024. Density - and being dense in attractive markets - is primarily what separates -3.9% from 10%+ operating margins. I should have paid attention in physics!! PS: if you like graphics and analysis like this, subscribe to my newsletter Hospitalogy here with 34k+ others: https://lnkd.in/gniNmHvz

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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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🤔 How do (US) hospitals spend money 101? Salaries, Wages, Benefits: 45-55% Professional Services: 12-22% Supplies: 12-18% Depreciation/Amortization: 3-6% Other Expenses: 5-20% 8 key insights: n°1. Hospitals consume 31% of US healthcare spending: Despite being the largest spending category, many hospitals struggle with low operating margins, often below 2%. n°2. Labor costs dominate hospital expenses: Salaries, wages, and benefits account for 45-55% of a hospital’s expenditures, with front-line staff making up 75-82% of the workforce. n°3. Contract labor adds significant costs: Hospitals often resort to staffing agencies due to labor shortages, paying 2-3 times more for contract workers compared to employed staff. n°4. Supplies account for 12-18% of expenses: This includes medical equipment, drugs, and personal protective equipment. n°5. For-profit vs. non-profit hospitals: For-profit hospitals tend to manage costs more efficiently, keeping salaries and expenses lower, but often at the expense of services like Medicaid or charity care. n°6. Economies of scale in larger health systems: Larger systems benefit from negotiating better prices for supplies and services. n°7. Rural hospitals face unique challenges: Limited access to talent and capital means rural hospitals must rely more heavily on expensive outsourced labor and struggle to offer high-margin services. n°8. Staffing shortages remain a key issue: Despite financial recovery post-COVID for many hospitals, staffing shortages continue, driving hospitals to explore different revenue models and operational changes to sustain profitability.​ Great post by the Out-Of-Pocket team Nikhil Krishnan & Ben Chao #healthcare

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Here's another fundraising roundup spotted in the healthcare wilds 👀 🍃 ✅ Sword Health raised $130M (new valuation: $3B). ✅ Better Health raised $14M to deploy expanded payer partnerships. ✅ Alzheon, Inc. | Preserving Future Memories raised $100M Series E to advance development & commercialization of its Alzheimer’s treatment. ✅ CinRx Pharma raised $73M to continue its ‘Hub and Spoke’ model of startup formation. ✅ Eko Health raised $41M to scale AI-driven heart and lung disease detection. ✅ Anterior (formerly Co:Helm) secured a $20M Series A to unlock admin efficiencies for healthcare payers. ✅ SamaCare raised a $17M Series B to scale specialty drug prior authorization platform. ✅ Plenful secured a $17M Series A to streamline pharmacy operations with AI-powered workflow automation. ✅ Grayce raised a $10.4M Series A led by Maveron amid a caregiving crisis. ✅ Stitch Employment Services Inc PEO raised $8.75M in seed to support independent medical practices. ✅ Posterity Health secured $6M to fund expansion and technology acceleration. ✅ Sware raised $6M to accelerate life sciences innovation by automating FDA-mandated software validation. ✅ Keragon raised $3M, as announced in @Conno Christou’s LinkedIn post. As always, if I missed you, let me know! Each week I'm spotlighting an innovative healthcare startup. I just ask for a bit more transparency. All submissions are confidential; submit yours here 👇 https://lnkd.in/gF4DrAvJ Looking for more fundraising roundups, alongside healthcare industry news and analysis? Subscribe to Hospitalogy, my 2x/week newsletter. Join 33K+ other investors, executives, and healthcare professionals: https://lnkd.in/g-nfRqW6

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Alot of bad actors and a few good actors. $2.5T HC capital raised & $1T invested by PE in last decade. $31B in 2013 vs. $217B in 2021. We know the story. Misaligned incentives - unrealistic multiples, short-term profit focus, aggressive cost-cutting, unrealistic scaling, misunderstood market dynamics, just to name a few. However, our industry needs money. But our industry is more infrastructure asset class than tech start-up (James Nicholls gave me that epiphany). Mic drop on the lyrical genius of Alex Fair of MedStartr Ventures as he literally gives the whole story poetic justice as he reads HIS POEM on this "On The Road at VIVE" episode of The Reverse Mullet Healthcare Podcast w/BP2 Health. This is the perfect episode for a Friday afternoon! He and Paulo J Machado donned the actual reverse mullets and joined us back in February at #VIVE2024 to talk about the need for REAL change in healthcare, startup focus and investor expectations. It was one to remember and one that is in desperate need of a full-length follow-up episode. Give us a like and a watch or a listen https://lnkd.in/e4w4mjkv https://lnkd.in/egmK3kMB

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🇨🇦 Why the "Any Willing Provider" (AWP) Proposal Won't Solve the PPN Problem—It's Just Another Way for Healthcare Professionals to Get Taken Advantage Of! Warning, This post has a lot of inside baseball terms! Pharmacists, and other healthcare professionals are Honest Brokers, they don't assume the real world is as nasty as a movie. Yet if they were watching a movie they would be shouting at the screen when a proposal would allow "any willing provider" to enter into low cost services in a PPN. The "Any Willing Provider" (AWP) proposal may seem like a step in the right direction for tackling Preferred Provider Networks (PPNs), but it falls short of solving the real problem. While AWP creates the appearance of fairness by allowing any provider to join a network, it opens the door to nefarious strategies that favour large corporate entities over independent healthcare professionals. AWP is a Trojan Horse! One key issue is the practice of bundling regulated services with unregulated services—a strategy that large corporations can easily use to dominate the market. In these cases, corporate chains can offer regulated healthcare services, like physiotherapy or pharmacy care, at lower prices by bundling them with unregulated services. This approach allows them to provide loss-leading services within the AWP framework, driving smaller, independent providers out of the market because they can’t afford to operate at a loss. The result? Market dominance by corporate chains, fewer choices for patients, and a healthcare landscape that prioritizes control over quality care. Independent providers, who are focused on delivering personalized, patient-centred care, are forced to compete against large corporations that manipulate the market by offloading costs onto the public healthcare system whenever possible. It’s important to remember that PPNs aren’t about cost savings—they’re about control. Large corporations use PPNs, and now want the AWP model, to consolidate power and reduce competition. They aim to offload expenses onto the public system, creating an illusion of efficiency while undermining the integrity of healthcare delivery. This shifts the burden to the public sector and ultimately limits the quality of care patients receive. AWP, rather than fixing the issue, opens the door for more corporate control. Independent healthcare professionals, who operate with integrity and fairness, are left vulnerable. True reform requires addressing the core issue: the need to prevent market manipulation and ensure that healthcare remains focused on patient well-being, not corporate profit. We need legislation that protects the future of independent healthcare providers and ensures that the healthcare system remains patient-centred. Patient Centred care is the most efficient care. Ontario Pharmacists Association Ontario Physiotherapy Association Ontario Finance | Ontario Finances Ontario Health | Santé Ontario

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Companies need help with the hard s***. They don’t need more conferences, networking opportunities or talking heads ************* Why do we use build, prove, launch to structure everything we do?  We started by organizing Manos Health around the biggest problems healthcare tech companies face. - Companies build things no one wants - Regulations in health can be confusing - Products still lack evidence - Healthtech is terrible at sales From there, we designed solutions for each, from product research, to regulatory and clinical trial support, to go-to-market offerings. Companies need help with the hard s***. They don’t need more conferences, networking opportunities or talking heads.  Our solutions naturally fit across the lifecycle of development with each addressing the BIGGEST challenge associated with solving problems in Healthcare.    The phases represent that lifecycle with clear milestones associated with each. > Have you built something worth yours, and our, time?  > Do you know the PRIMARY THING you need to prove?  > Does anyone know about you yet? The result? Using a clear and simple structure to organize everything we do - our life purpose.  Build, Prove, Launch

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I’m worried about the state of venture capital and direct-to-consumer (DTC) healthcare startups. Hims & Hers is the poster child for DTC healthcare at $1.2B proj 2024 revenue and a $3.6B valuation. By most accounts, they have been an outlier success for DTC since bottoming out in May 2022. So why is this bad news for DTC healthcare? Because the market leader (Hims) trades at a 3x forward revenue multiple. And the category leader typically gets a higher valuation multiple than smaller startups. We see this phenomenon in private equity. They “roll up” smaller companies within the same category at a lower multiples just to create one larger platform that trades at higher multiples. Now back to DTC healthcare startups. If Hims commands a 3x revenue multiple, it’s not unrealistic that smaller, unprofitable startups may be valued 1-2x revenue at exit. At 2x revenue, a startup must generate $500M to produce a $1B exit in today’s market (depending on growth and profitability). Series A/B venture capitalists must see a pathway to $1B outcomes. And if the growth-stage investors with billions under management are less interested in DTC healthcare, the future funding rounds necessary for fueling growth are not guaranteed. Juxtapose this against 2017-2022 where DTC could raise Series B-E funding. Let’s take a DTC startup doing $25M after 3-4 years of operations and has already raised a Series A. By most accounts, it would be a phenomenal accomplishment. But today, investors will question the chances of that same company scaling from $25M to $500M revenue in the next 3-4 years with unknown future funding sources from Series B and beyond. You're stuck in VC-funding purgatory. Some of these companies will shut down. Some may sell for 1-3x revenue. And some may try to transition to profitable, cash-flowing businesses. All of which are certainly not the venture-backed goal the founders, investors, and employees often had in mind when first taking capital. I say this all with friends working at or starting DTC healthcare companies, I feel bad for them. I also feel bad for the patients who enjoy those products or services. To caveat (b/c I know people will object), there will be other DTC brands that exit for $1B+ (i.e., Ro). However, they were forged and scaled during a different time period where seemingly endless venture capital was available for DTC healthcare. Now we're in a different time with no end in sight. Thoughts?

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Should you sell your practice to a VC-Backed MSO Startup? tldr: - new VC-backed startups are forming MSOs to roll up independent practices - The pitch is physicians receive early liquidity from the roll up and are granted ESOP shares that can be used for retirement - Problem is the use of ESOPs with independent practices is not a new concept and has been used with large group practices since the 70's - ESOPs do not grant full ownership and in order for the shares to be valuable for retirement, the practice needs to run the same if not better post roll up - With VC-backed startups being primarily operated by non-physicians with zero clinical or medical practice experience, the likelihood of this happening is extremely low making the entire concept high risk However, there is a viable path for continued ownership + liquidity for independent practices. Check out the article to learn more. ⤵ https://lnkd.in/gmGvTYwP

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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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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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Despite the "less conclusive quality and cost findings" shown by Hospital-at-home AHCAH programs for Medicare, participants in the program (both patients and clinicians) give it a thumbs-up. Big proponent of moving appropriate acute/post-acute care into the homes, however, a lot of these programs were not well executed and many were not appropriately resourced. It's not surprising that the overall data on quality and cost is underwhelming. Hopefully, the 2 yr extension (currently legislation due) should allow for this picture to become clearer. #HaH #AHCAH #Hospitalathome #Homehealth

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CareMax and Steward Health Care are besties What is CareMax you ask? But of course a value based care provider that went public via SPAC in 2021 $297 open price at IPO $487 high price post IPO $3.00 current trading price Notably, CareMaxbought Steward's Medicare VBC business in 2022 for $135M As part of that transaction, double yacht owning Ralph de la Torre became a board member of CareMax Solid foreshadowing Here's what CareMax recently said in it's 10-Q related to its business: "These conditions raise substantial doubt regarding the Company’s ability to continue as a going concern..." Meaning, it may file for bankruptcy if it can't turn things around Some numbers from the quarter: $156M current assets $507M current liabilities $232M revenue ($21.7M) op loss ($23.8M) cash from ops 1:30 reverse stock split recently issued Translation, you had 30 shares and now you have 1 Some more numbers: 55 centers 218,000 covered members 99% under VBC arrangements And last interesting bit of info: "Our principal sources of liquidity have been cash generated by our centers and MSO operations, and borrowings under our credit facilities." When your third key source of liquidity is borrowing, that's an issue Sorry, sorry, one more thing... Apparently, after the acquisition of Steward's VBC business, Steward doctors continued to serve these patients, though they would then be paid from CareMax... which didn't happen What's going on at CareMax? P.S. If you liked this mystery breakdown, you'll love The Healthcare Breakdown, where I breakdown the business of healthcare and all these wheelings and dealings so you can see what's really going on Check it out here: https://buff.ly/47NeASx See you out there!

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Thank you Saul Marquez for being on "This Week in Pharmacy" --TWIRx In this insightful episode, we sit down with Saul Marquez, veteran of Medtronic and the visionary founder and CEO of Outcomes Rocket, a #podcast and company dedicated to improving healthcare outcomes and driving business success. Outcomes Rocket is a unique shared knowledge hub that brings together healthcare leaders, non-healthcare operators, and investors to discuss and solve pressing healthcare challenges. Key Discussion Points: About Outcomes Rocket: Saul explains how Outcomes Rocket started as a podcast and evolved into a company with a mission to connect healthcare leaders, share best practices, and break down industry silos. By focusing on collaboration and knowledge-sharing, Outcomes Rocket aims to transform healthcare into a more efficient and patient-centered industry. The Power of Connection: Saul dives into how Outcomes Rocket connects healthcare silos, enabling leaders to share knowledge and improve outcomes. By fostering collaboration across the industry, Outcomes Rocket helps bridge gaps and drive positive change in healthcare delivery. Join us as we explore how Saul Marquez and Outcomes Rocket are making a significant impact in the healthcare landscape by fostering a community of leaders committed to improving care and business success. Whether you're a healthcare professional, investor, or entrepreneur, this episode will provide valuable insights into the power of connection and collaboration in healthcare. YouTube Interview here: https://lnkd.in/eEXXRyTz

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Weekly lessons learned - Where did that $200 Billion of acute care revenue go? Hospital C-suites, Carter Williams and I did quick math >$200 BILLION in acute I/P revenue will evaporate if just 25% of those w/1 chronic condition take a GLP-1 and 50% of those avoid 1 hospitalization. This aligns w/Yubin Park, PhD recent data on ACR which would only add to this estimate. And hims & hers is showing this revenue shift real time with a 70% YOY increase Matthew Holt. Even 23andMe is making a comeback play w/Lemonaid Health (part of 23andMe) Sergei Polevikov, ABD, MBA, MS, MA 🇮🇱🇺🇦 Sticking w/"meanwhile an entirely new healthcare ecosystem is being built and we are still focused on heads in beds" 🙄 Superpower and Max Marchione went live with their beta and a video that liteally compares him to Steve Jobs, Bill Gates, Elon Musk and Jeff Bezos in 0:38 sec., well alrighty then. As of now it's a marketplace w/diagnostic testing akin to Function Health (on steroids) comingsoon. Josh Erndt-Marino 😉 One of my favorites Michael Muntner at Crestview Partners announced Cardinal Health has added a GI MSO and Advanced Diabetes Supply to its portfolio 😉 Thatch Chris Ellis is partnering with Quickbooks (hello 1 million small businesses) to bring ICHRA to the masses, hope POTUS doesn't kill it - Brad O’Neill Brendan Keeler was on fire pointing out that AI is actually live on Epic, TEFCA vetting process update and a substack piece for the ages chronically Epic's battle scars and brokedown AI w/impacts, Patrick McGill, MD MBA calls copilots a game changer and Christina Farr added to this by asking - Is AI "time savings" going to mean doctors and care teams get more time with their existing patients than the 6m visit? or have to do more... When will we learn our bricks and mortar lesson?! Forward Health literally imploded in a matter of months after burning $100M largely on pods Guy Culpepper, MD In food news 🥕 Dear health systems you have better choices than Sodexo! Matriark Foods (Anna Hammond) is now a Vizient, Inc #environmentallypreferredsupplier - you can impact your Scope 3 emissions goals AND provide healthy delicious foods to patients 🥑 If you don't know Clancy Harrison and The Food Dignity Movement you should If Robert F. Kennedy can steer clear of reversing vaccines, maybe he really can help "Making America Healthy" - #foodishealth vs. #pharmaisking. Graham Walker, MD Andy Mychkovsky Erin W. Martin Billy Wynne did a great piece in Health Affairs about what the election could mean for HC and Andrew Schwab continues to share great post election intel and Sachin H. Jain, MD, MBA weighed in on MA impacts For my next rabbit hole this week - the report for Accountable Health Communities Model is out Darshak Sanghavi along w/2023 ACO REACH 2023 results next week. $1.6B program savings results which Chris Deacon pointed out could in fact be losses via evaluation findings - I'm conflicted - after working with so many ACOs I know they create true value.

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Here’s your recap of last week’s health IT news 🗞️ 👇 🖊️ AI Ambient Scribes • CHRISTUS Health + Abridge: The 15,000 provider Texas health system adopted the ambient scribe enterprise-wide.    • Tampa General Hospital + Nuance Communications DAX Copilot: Over 500 providers at the health system will begin utilizing the AI ambient scribe.    • Texas Oncology + DeepScribe: The statewide oncology practice adopted the AI ambient medical scribe. (ed. note: scribes continue to be hot!) ☎️ AI Contact Center • Clearstep: The AI conversational chat vendor launched a new feature allowing patients to self-schedule specialist visits. 📊 Data & Analytics • InterSystems + CLEAR: The cloud-based patient data service is integrating the identity technology to expedite access to patient records.    • WakeMed + Bamboo Health: The health system is adopting the data interoperability and encounter notification service. 🥼 Clinical Decision Support • University Hospitals + Aidoc: The Cleveland-based health system is implementing the AI clinical decision support platform across 13 of its hospitals and additional outpatient locations. 🧑‍💻 Virtual and At-Home Care • University of South Carolina School of Medicine + Rimidi: The hospital group and an affiliated multispecialty clinic are adopting the remote patient monitoring platform to reduce complications from postpartum hypertension.    • Mount Sinai Health System + HealthSnap: The medical center announced a new remote patient monitoring and chronic care management program in partnership with the virtual care management platform.    • Wheel: The telehealth company released a new AI-driven virtual care platform designed to enhance the patient experience and offer resources to help partners scale their virtual care services. 💬 Patient Engagement • CipherHealth: The patient engagement solution focused on patient rounding released a new AI summary tool.    • DexCare: The care orchestration platform completed a $75M series C funding round 🩼 Durable Medical Equipment • Better Health: The medical device and peer support network completed a $14M funding round. 🧠 Food for Thought: • Silicon Valley Bank released an interesting report on the state of investment in AI in healthcare, including stats on AI usage at healthcare organizations and the impact of leveraging AI on startup valuation. https://lnkd.in/em7AfivT    • The journal Critical Care Medicine published an editorial on an “in clinico” evaluation of a machine learning-based early warning system to predict in-hospital deterioration. We found it to be an interesting look at the actual impact of a model’s deployment on care processes and patient outcomes in a critical care setting. https://lnkd.in/eQhZbVKu

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