Optum: Testing Time for an Invisible Empire
By Jeff Goldsmith
Years ago, the largest living thing in the world was thought to be the blue whale. Then someone discovered that the largest living thing in the world was actually the 106 acre, 47 thousand tree Pando aspen grove in central Utah, which genetic testing revealed to be a single organism. With its enormous network of underground roots and symbiotic relationship with a vast ecosystem of fungi, that aspen grove is a great metaphor for UnitedHealth Group. United, whose revenues amount to more than 8% of the US health system, is the largest healthcare enterprise in the world. The root system of UHG is...
Source: The Health Care Blog - April 2, 2024 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Health Tech Jeff Goldsmith Optum PBMs United HealthGroup Source Type: blogs
Will Americans Get PBM Reform in 2024? Maybe, But Many Things Need to Happen In Order to Get There. On the Upside: Insulin Has Opted Out of PBM Sales.
At the core of this post is a YouTube video which can be viewed in the middle of this blog post. The subject is about whether we ' ll get much-needed legislation passed into law to reform corrupt Pharmacy Benefit Managers (PBMs) which we know with absolute certainty were at fault for runaway insulin prices. At least that was true until March 2023, when the three largest insulin manufacturers, starting withLilly, followed byNovo Nordisk and shortly thereafter,Sanofi all announced major insulin list price reductions in the range of 70% to 78%. Think about that for a second: Imagine being able to instantly...
Source: Scott's Web Log - March 17, 2024 Category: Endocrinology Tags: 2024 Congress insulin prices PBM rebates reform Source Type: blogs
Will Americans Get PBM Reform in 2024? Maybe, But Many Things Need to Happen I Order to Get There. On the Upside: Insulin Has Opted Out of PBM Sales.
At the core of this post is a YouTube video which can be viewed in the middle of this blog post. The subject is about whether we ' ll get much-needed legislation passed into law to reform corrupt Pharmacy Benefit Managers (PBMs) which we know with absolute certainty were at fault for runaway insulin prices. At least that was true until March 2023, when the three largest insulin manufacturers, starting withLilly, followed byNovo Nordisk and shortly thereafter,Sanofi all announced major insulin list price reductions in the range of 70% to 78%. Think about that for a second: Imagine being able to instantly...
Source: Scott's Web Log - March 17, 2024 Category: Endocrinology Tags: 2024 Congress insulin prices PBM rebates reform Source Type: blogs
Are AI Clinical Protocols A Dobb-ist Trojan Horse?
By MIKE MAGEE
For most loyalist Americans at the turn of the 19th century, Justice John Marshall Harlan’s decision in Jacobson v. Massachusetts (1905). was a “slam dunk.” In it, he elected to force a reluctant Methodist minister in Massachusetts to undergo Smallpox vaccination during a regional epidemic or pay a fine.
Justice Harlan wrote at the time: “Real liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own, whether in respect of his person or his property, regardless of the injury that may be done to others.”
What could ...
Source: The Health Care Blog - March 1, 2024 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Abortion AI Dobbs Forced Sterilization Mike Magee racial bias SCOTUS Vaccination Source Type: blogs
Bonus Features – January 28, 2024 – 49% of orgs likely to invest in RCM tech in the next 18 months, v2 drafts of TEFCA Common Agreement and QHIN Technical Framework out, plus 27 more stories
This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job.
News and Studies
The Sequoia Project released a bundle of TEFCA draft documents, including v2 drafts of the Common Agreement and QHIN Technical Framework. Interested stakeholders have until February 5 to provide feedback.
About...
Source: EMR and HIPAA - January 28, 2024 Category: Information Technology Authors: Brian Eastwood Tags: Healthcare IT Interoperability Revenue Cycle Management 1upHealth AdhereHealth Aidéo Technologies Anatomy IT Andrea Kowalski Authenticx Clearsense Don Brown eClinicalWorks Emory Healthcare Epic Research Fathom First Health A Source Type: blogs
Uses of AI in Healthcare – 2024 Health IT Predictions
As we kick off 2024, we wanted to start the new year with a series of 2024 Health IT predictions. We asked the Healthcare IT Today community to submit their predictions and we received a wide ranging set of responses that we grouped into a number of themes. In fact, we got so many that we had to narrow them down to just the best and most interesting. Check out our community’s predictions below and be sure to add your own thoughts and/or places you disagree with these predictions in the comments and on social media.
All of this year’s 2024 health IT predictions (updated as they’re shared):
John and ...
Source: EMR and HIPAA - January 17, 2024 Category: Information Technology Authors: John Lynn Tags: Administration AI/Machine Learning Ambulatory C-Suite Leadership Clinical Health IT Company Healthcare IT Hospital - Health System LTPAC 2024 Health IT Predictions 2bPrecise Alexander Nazem Anish Sebastian Arascia Arun Nagdev Source Type: blogs
PursueCare Completes Series B Fundraising Round and Acquires Digital Therapeutics Developed by Pear Therapeutics, Inc.
The Fundraising and Acquisition of Digital Therapeutics for SUD Strengthens PursueCare’s Ability to Provide Care for Individuals with Addiction
PursueCare, a digital addiction treatment provider, today announced the completion of a Series B fundraising round totaling $20 million. The Series B round was led by T.Rx Capital and Yamaha Motor Ventures, with participation from Seyen Capital and OCA Ventures. The proceeds from the financing will support PursueCare’s ongoing collaborative care initiatives with health systems across 11 states, as well as expansion into value-based care with Medicaid managed care and other heal...
Source: EMR and HIPAA - January 5, 2024 Category: Information Technology Authors: Healthcare IT News Tags: Health IT Company Healthcare IT Corey McCann Health IT Acquisitions Healthcare M&A Nicholas Mercadante OCA Ventures Pear Therapeutics PursueCare reSET reSET-O Seyen Capital T.Rx Capital Yamaha Motor Ventures Source Type: blogs
Medicine has become the new McDonald ’ s of health care
I was having a conversation with a colleague about a state-funded Medicaid managed care organization (MCO). She told me that the mental health performance measures used by the state to evaluate the MCO were all “placement and provider issues,” such as the amount of time children spent sleeping on the floors of social services offices
Read more…
Medicine has become the new McDonald’s of health care originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - November 2, 2023 Category: General Medicine Authors: Arthur Lazarus, MD, MBA Tags: Policy Primary Care Public Health & Policy Source Type: blogs
Bonus Features – September 10, 2023 – 77% of clinicians see RPM outpacing traditional inpatient care within five years, Microsoft partnering with Paige on pathology and oncology AI models, and more
This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job.
News
Executives for Healthcare Innovation is transferring its assets to the American Telemedicine Association, and ATA will extend engagement opportunities to current EHI members through its various Special Interest Groups.
More...
Source: EMR and HIPAA - September 11, 2023 Category: Information Technology Authors: Brian Eastwood Tags: Healthcare IT Adrian Agostini Alo American Telemedicine Association Andrea Rowe Anki ATA AVIA Black Book Research Canopy Edifecs Experity Healthcare IT Today Bonus Features HITRUST Ibex Medical Analytics iMerit Inovalon K Source Type: blogs
THCB 20th Birthday Classic: Value-based care – no progress since 1997?
As the 20th Birthday rolls on I thought I’d bring out a more recent piece first published in October 2020, albeit one that relies heavily on 25 year old data to make a point. This is some evidence to back up Jeff Goldsmith’s comment on the original that for all the talk “ ‘Value based” payment is a religious movement, not a business trend’ ” By the way, Humana updated these numbers last year and there’s been basically no change — Matthew Holt
By MATTHEW HOLT
Humana is out with a report saying that its Medicare Advantage members who are covered by value-based care (VBC) ar...
Source: The Health Care Blog - August 24, 2023 Category: Consumer Health News Authors: matthew holt Tags: The Business of Health Care Capitation Humana Medicare Advantage VBC Source Type: blogs
THCB 20th Birthday Classic: As I’ve always suspected, Health Care = Communism + Frappuccinos
By MATTHEW HOLT
Our 20th birthday continues with a few classics coming out. Back in 2005 I was really cutting a lyrical rug, and would never miss a chance to get that Cambridge training in Marxism into use. This essay about whether health care should be a public or private good has always been one of my favorites, even if I’m not sure Starbucks is still making Frappuccinos. And 18 years later the basic point of this essay remains true, even if many of you will not have a clue who Vioxx or Haliburton were or why they mattered back then!
Those of you who think I’m an unreconstructed commie will correctly suspec...
Source: The Health Care Blog - August 15, 2023 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Matthew Holt Communism Frappuccinos Source Type: blogs
Vertical Integration Doesn ’t Work in Healthcare: Time to Move On
Conclusion
Healthcare providers of all stripes must leave the industrial world behind. The value chains in health services are not physical, but rather comprised of human relationships, sustained by trust. Virtual care, the advent of AI in healthcare and consumer demand will require a flexible, 24/7 and care anywhere business model. Those who build the best modern clinical mousetrap will end up with a committed clinical staff and loyal patients. Healthcare isn’t about the building, or the brand, or scale. Surviving and thriving in the future will require engaged clinicians who foster trust on the part o...
Source: The Health Care Blog - August 14, 2023 Category: Consumer Health News Authors: matthew holt Tags: The Business of Health Care Hospitals Jeff Goldsmith Physicians Vertical integration Source Type: blogs
Matthew ’s health care tidbits: Time to get Cynical
Each time I send out the THCB Reader, our newsletter that summarizes the best of THCB (Sign up here!) I include a brief tidbits section. Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt
Plenty of reason to worry about the future of American health care this week. The biggest for-profit hospital chain–HCA–was accused of aggressively pushing patients into hospice care, sometimes in the same room, in order to make their hospitality mortality numbers look better. Most of the leading benefits consulting companies were exposed as taking payments from PB...
Source: The Health Care Blog - June 26, 2023 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Matthew Holt Babylon Health HCA Medicaid Medicaid Work Requirements PBMs UnitedHealth Group VBC Source Type: blogs
Pomelo Care Secures $33M, Partners with Leading Health Plans, Employers and Academic Medical Centers to Deliver Value-Based Care and Improve Maternal and Newborn Health
Backed by Andreessen Horowitz and First Round Capital, Pomelo Care has Built an End-to-End, Value-Based Virtual Maternity Care Platform and is on Track to Cover 2M Lives this Year
Pomelo Care, a virtual medical practice that improves maternal and newborn health outcomes, today announced $33 million in Seed and Series A funding led by Andreessen Horowitz. The capital will fuel Pomelo’s continued partnership expansion with major health plans, including several Medicaid managed care organizations, employers and leading academic medical centers on the front lines of the national maternal health crisis.
Pomelo’s multispeci...
Source: EMR and HIPAA - June 23, 2023 Category: Information Technology Authors: Healthcare IT News Tags: Health IT Company Healthcare IT Adam Boehler Allen & Company LLC Andreessen Horowitz BoxGroup Center for Medicare and Medicaid Innovation CMMI Elevance First Round Capital Health IT Funding Health IT Fundings Health IT Investment Source Type: blogs
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To reverse the maternal health crisis in the U.S., Medicaid managed care must be central to any comprehensive maternal health redesign.
(Source: The Commonwealth Fund: Blog)
Source: The Commonwealth Fund: Blog - May 23, 2023 Category: International Medicine & Public Health Authors: Sara Rosenbaum, Anne Rossier Markus, Caitlin Murphy, Rebecca Morris, Maria Casoni, Kay Johnson Source Type: blogs
