Yolanda ZHANG’s Post

V. Interesting article out this week from the Tony Blair Institute on the pre-requisites of healthcare data to unlock the benefits of AI, specifically the need for a Digital Health Record. The framing of the NHS as a "social insurer" whose aim is to pool risk across the entire population such that any member can use health services as they need is particularly interesting. Also great to see so many projects and case studies referenced that have had AGEM staff playing a core part of their successful delivery. https://lnkd.in/eyNPGS45

The future of Primary Care continues to be a widely discussed topic. With the integration of AI across various sectors of the healthcare industry and the availability of diverse modalities, the appearance of Primary Care in the near future is a subject of speculation. A colleague recently shared a report published by Bain, which proved to be an intriguing read. The report contains numerous statistics, one of which particularly stood out to me. "By 2030, it is projected that "non-traditional" providers could deliver 30% of primary care, with a significant portion of this service provided by payers." https://lnkd.in/grNEY7vH

Healthcare interoperability leaves us at the mercy of our governments to understand the importance of the ability for our health data to flow across the system with the patient to inform those treating us and to ensure that consumers can access their own health data. This is particularly critical with the rise of AI. Clinicians need up to date health data and they need to be able to trust it. Data is what we use to build our AI models and if it’s outdated and disconnected we can’t trust it to make decisions. We need legislation to make it happen. It will drive much needed innovation and efficiency in the way we work and reduce the duplication. So much progress has been made by this government in just one term to connect the system and few would argue that the legislation before parliament is well overdue. We are looking forward to hearing the coalitions policy on Digital Health as it is critical that we continue with the momentum in achieving an interoperable health system. Australasian Institute of Digital Health (AIDH) #connectedcare #sharingbydefault

46% of Americans believe AI will improve healthcare in the next 5 years! 🤔 What do you think? Would you ever consider getting an AI doctor? We recently surveyed 1,007 Americans about their trust in healthcare practitioners and the future of AI in medical services. Some interesting insights were: ✅Idaho leads in trust with the most highly-rated family doctors. ✅39% of Americans would trust their doctor less if they used AI—but 53% of those who’ve experienced AI-assisted care trust the results! ✅Americans are most likely to trust older (44%) and female (37%) healthcare practitioners. ✅Over 1 in 5 Americans (21%) reported receiving an AI-assisted diagnosis or treatment plan, with 53% of these individuals trusting the results. 🔗 Check out the full article for more: https://lnkd.in/gNczr55V #Tebra #PracticeAutomation #HealthcareCommunity #CalendarManagement #HealthcarePractice #HealthcareProfessionals #Tebra #PatientCare #HealthTech #Healthcare #HealthcareMarketing #HealthcareInnovation #PracticeGrowth #DigitalTransformation #HealthcareTech #HealthcareEvolution #PatientCenteredCare #DigitalHealthcare #EHR #ElectronicHealthRecord #ElectronicHealthRecords #IndependentPhysicians #NursePractitioners

New report dropped from Tony Blair Institute for Global Change on 'A Digital Health Record (DHR) for Every Citizen'. I skimmed on my way to Taylor Swift but have had a longer read today. 👨💻 The key takeaway for me is data sharing! ❌ Private healthcare data is siloed at multiple steps of a patient's journey 🤒 A typical young (or younger than me) patient who uses a private GP and private diagnostics for speed of access cannot easily take this data back into the NHS. Private providers cannot access the Summary Care Record and it does not have a direct link to GPs' providers portal, not into a patient portal such as the NHS app. DHRs need to bring those records together and include information from both public and private providers of care. A review of who is the data controller is needed to enable this. 🏥 Private hospitals still face barriers to participation in national registries and audits removed. Having a single source of truth for patient records may go some way to achieve this. https://lnkd.in/eVe3NQ-x

AI-Driven Care Denials Fueling Hospital Administrative Costs, Threatening Patient Access A recent report from the American Hospital Association highlights an alarming trend: administrative costs now make up over 40% of hospitals' total expenses, with a significant portion driven by the increasing number of care denials stemming from the growing use of AI tools by insurers. Between 2022 and 2023, claim denials surged by an average of 20.2% for commercial plans and a staggering 55.7% for Medicare Advantage plans. The AHA attributes this surge, in part, to the increased use of AI technologies like machine learning algorithms. These tools, when poorly implemented, can lead to automatic denials of care without considering individual patient needs or clinician input. While the 2024 Medicare Advantage final rule offers some guidance around payment denials, the AHA emphasizes the ongoing concerns with AI-driven denials. CMS itself has raised alarm bells about the potential for AI to perpetuate discrimination and bias. The increasing scrutiny of AI use by insurers, coupled with ongoing lawsuits against major players like UnitedHealthcare and Humana, underscores the urgency of this issue. As AI continues to evolve, it's imperative that we strike a balance between leveraging its potential for efficiency and ensuring patient-centered care remains at the forefront. The rising administrative costs and the threat of AI-driven denials pose a serious risk to patient access. I am excited for the changes coming over the next 2 years spurred on by the CMS Interoperability and Prior Authorization Final Rule https://lnkd.in/e4zx9NRm and the new HTI-2 Proposed Rule https://lnkd.in/edWgWy4z that will accelerate transparency into prior authorization, allowing us to provide more efficient and effective patient care. #healthcare #AI #patientcare #administrativecosts #insurers #HTI-2

A few years ago, I "accidently" stumbled into a Prior Authorization project and man oh man was I in for a treat of absolute insanity. My team and I were trying to close care gaps and some of my gap closing efforts were triggering prior auths. When I did something in my department it inadvertently impacted another team (this is why administrative healthcare is not that simple). Thus is how I ended up in the referral and prior auths department. I had no idea the complexities that surrounded a simple diabetic exam, colonoscopy, mammo, etc 😮 If Kevin Hart was there, he would have said, "You gonna learn today!" And in fact, I learned a lot over the next several weeks. 1. I have a love hate relationship with Prior Auths, in one aspect, part of me see's the benefit of them, the other side of me thinks they create so much administrative work that its mind numbing. 2. How have health plans not figured out a way to streamline this so its the same process for all patients, same form, same portal, same documentation requirements? Someone help me understand this. 3. What is preventing us from simplifying this process? Do you have a solid process in place that you are happy with? Is it cost effective? Take a look at my latest contribution article alongside Clarissa Riggins, David J. Sand, MD, MBA, Michael Gould, Jay Nakashima, Maxim Abramsky, in Healthcare IT Today: https://lnkd.in/eqcDe78B Follow me for weekly healthcare information: https://lnkd.in/eczw8pfe Navina #PriorAuth #VBC #AI

Exciting news! In 2025, Medicare will introduce new Advanced Primary Care Management (APCM) codes that will transform how healthcare providers deliver and are reimbursed for care. These codes move away from time-based billing, allowing physicians and non-physician practitioners to focus on meeting patients' needs using technology and AI. This shift will help reduce operational burdens and improve patient access to care. The new APCM codes offer a more flexible and patient-centered approach to care management. By bundling elements of existing codes and removing time constraints, healthcare providers can leverage technology to provide comprehensive care and better manage chronic conditions. While there are administrative requirements to meet, the APCM codes present an opportunity for healthcare providers to enhance care management services and improve patient outcomes. Learn more about these exciting changes and how they can benefit your practice: https://lnkd.in/g8dVF62z #Medicare #APCM #healthcare #innovation #patientcare #technology #AI #WelbyHealth

Big big stuff brand new from TBI - here's our #FutureofBritain paper on preparing the NHS for the AI era. The need for NHS reform is pretty undeniable. Elective waiting lists stand at 7 million and 250 people a week are dying prematurely in A&E. There's a huge policy agenda in addressing that, but one crucial element to moving to a sustainable model is digital infrastructure. In this paper we argue that properly designed Digital Health Records will have huge benefits across access to care, continuity of care and prevention of illness. This massive enabler can change the way we all generate health and consume healthcare - better analytics, more targeted prevention, more care in the community and less in hospital…the report sets out many more changes that should be around the corner, and a sensible plan for making them possible. Huge thanks to Tony Blair Institute for Global Change authors Dr Charlotte Refsum, Adam Bradshaw, Oliver Large and Darcy Ward. I should say we're expecting a lot of comments on this one! All responses welcome, but particularly from people who have read the report... https://lnkd.in/gNbATAVU

Monday Morning Update 1/6/25 – HIStalk - HIStalk In this week's HIStalk update, UnitedHealth's Medicare Advantage strategy raises eyebrows, revealing a 55% increase in patient sickness scores linked to new diagnoses, contributing $5 billion in revenue. As healthcare AI approaches Gartner's Peak of Inflated Expectations, the industry anticipates significant shifts in chronic care management and physician autonomy. Predictions suggest that private equity may gain more influence under a new administration, impacting healthcare dynamics. Meanwhile, Censinet emerges as a key player in risk management, while notable personnel changes signal ongoing evolution within healthcare IT. #HealthcareIT #MedicareAdvantage #HealthAI #DigitalHealth #PatientCare #HealthTech #RiskManagement ai.mediformatica.com #histalk #clinical #medicare #patients #doctors #medicareadvantage #news #revenue #unitedhealth #payments #unitedhealthgroup #digitalhealth #healthit #healthtech #healthcaretechnology @MediFormatica (https://buff.ly/4gICR09)