Though AI has successfully been utilized in healthcare for decades, a Pew Research Center survey revealed that 60% are uncomfortable with their provider relying on AI for their own healthcare. 

This dichotomy is therefore likely due in part to a lack of awareness and understanding around the technology. Before the public is forced to understand complex, revolutionary, future-state technological developments in healthcare, they must understand how the technology is safely used today.  Examples of this technology in motion include: 

• The pulse oximeter, also called a plethysmograph or pleth, uses AI to calculate blood oxygen saturation based on the difference in transmission of red and infrared light in pulsating blood. It was developed in 1972 and widely adopted in clinical practice in the 1980s and 1990s.
• The MRI (magnetic resonance imaging) scanner has been widely used and incorporated AI since the 1980s to detect conditions including brain tumors, multiple sclerosis, strokes, and infections. Modern AI applications for MRI can improve the speed and quality of scans and help with interpretation and diagnosis.
• The echocardiography machine, widely used with AI since the 1980s, uses sound waves to show how blood flows through the heart to search for heart conditions. According to this article in the Journal of Imaging, “Artificial intelligence can use raw echocardiography images/videos to automatically provide structural or functional measurements but also to identify disease states. This ability is based on AI’s capacity to automatically analyze features from images that may be too subtle to be detected by the human eye.”
• AI also can accurately identify normal and abnormal chest X-rays, according to this article and this study. 
• Other recent studies show that AI has a 100% success rate in spotting melanomas and a 20% better success rate than human radiologists in detecting breast cancer.

These are just a few of the many AI applications present in medical devices today. Each is an assistive technology that provides accurate measurements to health professionals, enabling them to chart the next steps more effectively. None of the technologies mentioned replace human jobs, but instead, enable healthcare professionals to be more accurate and efficient at their jobs, ensuring the best level of patient care possible. 

Beyond using AI for measurements and image interpretation, the next frontiers of AI in healthcare include information systems, some patient interaction, and even possibly robotic surgery. Here are some guidelines to help ensure accurate and safe AI deployments in new applications:

Start With The Back Office

In addition to developing patient-care applications, there is much that AI can do to help with time-consuming back-office administrative tasks that also improve patient care. These include:

• Clinical data abstraction: AI can be used as an assistive technology to automate painstaking and time-consuming data entry, with a required human in the loop to verify accuracy. This enables healthcare professionals to spend more time on patient care, and less on repetitive manual data entry. AI can also mine the hyperscale data sets of clinical registries and share anonymized treatment approaches including comorbidities and medical histories. This can help improve outcomes for current patients with similar conditions to those successfully treated in the past. 
• Drafts of clinical summaries: Generative AI systems such as GPT can save time by instantly creating drafts of clinical summaries, also called patient-visit or after-visit summaries, based on physicians’ notes. Generative AI correspondence is also a possibility, but like any AI application in healthcare, should never be sent directly to patients without human review, due to the possibility of inaccuracies or hallucinations.

Only Develop AI Applications That Can Access Sufficient Supporting Data

AI requires statistically significant data to operate; small data sets are insufficient for AI algorithms to be accurate. A condition or procedure that involves only 50 patients per year across the United States won’t provide enough data for AI to evaluate, compute a patient pathway or indicate whether, for example, a treatment is a normal or abnormal practice for the population with that condition. AI applications should operate on vast data sets and as wide a sample of the population as possible.

AI Applications for Patient Care Require Many Trials.

AI applications for patient care should not be immediately dismissed as too risky so that progress is not hampered. There are, however, potential quicker wins with back-office applications versus patient care applications (which generally require many trials before being put into practice). All patient-care AI applications should help clinical professionals do their job, as they are not equipped (and never will be) to replace them. Accuracy is paramount, and a human in the loop is essential to operate and interpret AI applications for patient care.

AI Is Not New

Although AI may be perceived as generally new, it was invented in the 1950s and has been included in software for medical devices since the 1970s. Almost all medical devices include AI software, except purely analog devices such as analog stethoscopes and hypodermic needles. If the public were more aware of facts like these, it is likely that some of the concerns regarding AI use in healthcare may subside. 

There currently is an explosion of interest and investment in AI, which is now featured in the marketing materials of most healthcare technology vendors. Before this “AI mania,” which was partially fueled by the launch of ChatGPT in November 2022, AI was usually simply called “software.”

About Matt Hollingsworth

Matt Hollingsworth is the co-founder of Carta Healthcare. His passion for improving patient care developed while helping his mother, a five-time cancer survivor, navigate the U.S. healthcare system and communicate her conditions to providers.

In 2017, Matt Hollingsworth founded Carta Healthcare, dedicated to creating a healthier future by advancing the technology surrounding data practices in healthcare. Today, Carta Healthcare is a leader in delivering improved data-gathering solutions to healthcare systems related to a patient’s diagnosis, treatment, and outcomes. Carta Healthcare’s solutions have revolutionized the processes surrounding registry databases, resulting in markedly faster data collection, superior quality of data, and considerable cost savings for healthcare providers.

Matt holds an MBA from Stanford University, where he also worked in the Systems Utilization Research for Stanford Medicine (SURF Stanford Medicine) lab, researching methods for using information technology to reduce equipment waste and improve patient care. It was through his work at Stanford that he and colleagues founded Carta Healthcare. Before receiving his MBA and founding Carta Healthcare, he was a researcher at CERN (Conseil Européen pour la Recherche Nucléaire) and a member of the team that discovered the Higgs boson, an important discovery in particle physics. Matt received bachelor’s and master’s degrees in physics from the University of Tennessee, Knoxville.

About Dr. Andrew Shin

Andrew Shin, MD, is an Associate Professor in the Division of Cardiology at Lucile Packard Children’s Hospital at Stanford University and the Executive Medical Director, Innovations & Clinical Effectiveness for Stanford Children’s Health. His research has leveraged microsystems, improvement science and high-reliability to better understand the intersection between the quality and efficiency of healthcare delivery. As the Medical Director for Systems Design for Utilization Research for Stanford (SURF MEDICINE), Dr. Shin translates his research to continuously improve the value of healthcare utilizing high-throughput advanced analytics such as machine learning and artificial intelligence. He completed his pediatric residency, along with a dual fellowship in pediatric cardiology and pediatric critical care at Boston Children’s Hospital. Dr. Shin is the Associate Medical Director for Cardiovascular Intensive Care Services and serves as a board member for Pediatric Congenital Heart Association, Carta Healthcare and as liaison for the American Heart Association’s Leadership Committee of the Council on Quality of Care and Outcomes Research.

What You Should Know:

–              Today Truveta announced the availability of expanded concepts from clinical notes — including family history, medication details reported to providers, and complex concepts for a wide range of therapeutic areas from cardiology to rare disease and more – and millions of de-identified medical images for scientifically rigorous research.

–              Truveta delivers the most complete, timely, and clean electronic health record (EHR) data from more than 100 million patients across more than 30 US health systems, empowering researchers with regulatory-grade data across all diseases, drugs, and devices.

Truveta: Revolutionizing Healthcare Data Integration and Insights

“Access to complex concepts captured in clinician notes or medical images has been limited by manual processes, impeding the ability to study large, representative, and diverse populations in depth,” said Michael Simonov, MD, vice president of product, Truveta. “With the most advanced AI, trained by clinical experts, Truveta delivers complex clinical concepts – as well as de-identified medical images and their associated metadata – for study integrated with the most complete, timely, and clean EHR data.”

Truveta Data Overview

Truveta Data offers a comprehensive representation of both inpatient and outpatient care, sourced from over 800 hospitals and 20,000 clinics nationwide. This expansive dataset facilitates a holistic understanding of the patient journey, empowering researchers to enhance therapy adoption, clinical trials, and patient care.

Advanced Insights from Clinical Notes

Unlocking critical patient health information from unstructured clinical notes has long posed a challenge in medical research. Truveta addresses this by capturing a variety of clinical notes, such as progress notes, nursing evaluations, and laboratory reports, and utilizing advanced AI technology to extract and clean this data. The recent addition of new concepts, including medication details and family history, enriches Truveta’s dataset, enhancing its utility across various therapeutic areas.

Unparalleled Medical Imaging Dataset

Truveta introduces a groundbreaking capability by integrating millions of de-identified medical images with patient electronic health record (EHR) data. This vast imaging dataset covers diverse modalities, including MRI, CT, X-ray, ultrasound, mammogram, and nuclear medicine. With over 85 million imaging studies available, researchers gain insights into symptoms, diagnoses, and disease progression, further facilitated by complete image metadata.

Bridging Evidence Gaps with Truveta

By seamlessly integrating imaging and pixel data with comprehensive patient medical records, Truveta fills crucial evidence gaps and amplifies patient insights. This integration not only facilitates point-of-care diagnoses and accelerates clinical research but also drives improved patient outcomes. Additionally, Truveta Studio offers a user-friendly interface for researchers to visualize, annotate, and analyze medical images, fostering scientifically rigorous research endeavors.

What You Should Know: 

 – Firstsource Solutions Limited (FSL), a leading global provider of Business Process Management (BPM) services, announced the acquisition of Quintessence Business Solutions & Services Private Limited (QBSS). 

– The strategic acquisition strengthens Firstsource’s position in the healthcare revenue cycle management (RCM) market, particularly in the United States. Financial details of the acquisition were not disclosed. 

Enhanced RCM Solutions for US Healthcare Providers

The acquisition of QBSS, a leader in outsourced RCM services and technology, allows Firstsource to offer a more comprehensive suite of solutions to US healthcare providers. These solutions leverage artificial intelligence (AI) to optimize revenue capture, improve efficiency, and boost overall productivity.

Meeting the Needs of a Changing Healthcare Landscape

The US healthcare market faces a unique challenge – navigating a post-pandemic environment with workforce changes and evolving patient care models. This acquisition allows Firstsource to cater to these evolving needs by:

• End-to-End RCM Services: Offering hospitals, physician practices, and integrated health systems a complete RCM solution.
• Proven Experience and Industry Expertise: Leveraging the combined experience of both companies in the RCM field.
• Streamlined and Personalized Care: Helping healthcare providers deliver high-quality care while managing their finances effectively.

“We are excited to be part of Firstsource, an enterprise with considerable depth and reach in complimentary market segments. The possibilities of deploying combined solutions, shared workflows, and opportunities to implement technology driven solutions to the larger healthcare market is enticing. We see a cultural fit that will be the key driver for working to enhance the competitiveness of our customer base, providing innovative solutions to the marketplace as well as enriching the roles of our employees,” saidNirmal Kumar Rajachandran, CEO, Quintessence. 

What You Should Know:

– Contexture and Quality Health Network (QHN) announced today their official affiliation, creating a unified force for health information exchange (HIE) across Colorado. 

– The strategic move strengthens collaboration and expands resources for healthcare providers in the state.

Combining Expertise for Enhanced HIE

This affiliation brings together staff, technology, and operations of both organizations under the Contexture umbrella. Contexture, already the largest HIE in the western US (spanning Arizona and Colorado), gains valuable expertise from QHN, particularly in serving rural areas with unique healthcare needs.

Building on a History of Collaboration

Contexture and QHN have a history of successful collaboration, including data sharing initiatives and joint program development. This formal affiliation streamlines these efforts, allowing for more efficient expansion of HIE services.

Benefits for Healthcare Providers

The combined organization offers several advantages to healthcare providers in Colorado:

• Enhanced HIE Capabilities: Providers will benefit from a more robust HIE infrastructure, facilitating seamless data exchange across the state.
• Expanded Support for Rural Providers: QHN’s expertise in rural healthcare will ensure that providers in these areas have the resources they need.
• Positioning for National Opportunities: The affiliation strengthens the organization’s position to compete for national HIE initiatives and adapt to federal policy changes.

Timeline and Next Steps

The exploration of an affiliation began in August 2023. Following a thorough due diligence process, both boards approved the move in late April. Contexture and QHN will keep participants and stakeholders informed as the integration process unfolds.

“Affiliating with Contexture is an important step forward for QHN’s participants as we work to provide the best possible HIE services, putting data into the hands of care providers when they need it,” said Marc Lassaux, QHN Executive Director and CEO. “Our team is excited to provide enhanced services tailored to the needs of the medical, behavioral and social service providers we serve.”

What You Should Know:

– Intermountain Health, a leading healthcare system serving the Intermountain West, announced today the enterprise-wide deployment of Nuance Communications‘ Dragon® Ambient eXperience™ (DAX™) Copilot, a generative AI solution aimed at improving clinical documentation efficiency and reducing administrative burdens.

– Intermountain Health emphasizes the responsible development and application of AI technology. DAX Copilot incorporates Microsoft’s responsible AI principles, ensuring ethical and trustworthy implementation within the healthcare setting.

Addressing Urgent Challenges in Healthcare

This move reflects Intermountain Health’s commitment to tackling the critical issues facing healthcare systems nationwide. Clinician burnout, staff shortages, and operational complexities are placing a significant strain on healthcare delivery. DAX Copilot offers a powerful solution to these challenges.

Expanding Access to Care Through AI

By automating clinical documentation and administrative tasks, DAX Copilot frees up valuable clinician time, allowing them to focus on patient interaction and expand access to care across Intermountain Health’s service area, spanning seven states. This is particularly crucial considering the alarming rise in physician practice departures each year.

Reducing Documentation Burden with Conversational AI

The American Medical Association reports that physicians dedicate nearly two hours of administrative and documentation tasks for every hour spent with patients. DAX Copilot leverages conversational, ambient, and generative AI to automatically generate clinical documentation during patient visits, saving physicians significant time and reducing burnout.

“We are deploying DAX Copilot to physicians and APPs across our system to help automate and streamline documentation and other time-consuming tasks, so they have more high-quality, personalized time with patients and less time following up on documentation following their daily medical shift,” said Rob Allen, Intermountain Health president and CEO. “We’re pleased to collaborate with Microsoft in developing next-generation solutions to empower our teams with tools that best support our nurses and other caregivers and to transform healthcare experiences for the patients and communities we serve for years to come.”

What You Should Know:

– Avel eCare, the nation’s leading provider of clinician-to-clinician telemedicine services, continues its aggressive growth strategy with the acquisition of Horizon Virtual, a Minnesota-based virtual hospitalist services provider. 

– This acquisition builds upon Avel’s previous expansion, including the January 2023 acquisition of remote pharmacy services provider NightWatch. Today, Avel serves hundreds of customers across the country with a comprehensive suite of telemedicine solutions and care delivery models.

Strengthening Hospitalist Expertise

Dr. David Willardsen, former CEO of Horizon Virtual, will join Avel as Vice President of Provider Relations and Strategic Partnerships. He will play a key role in developing strategies for market expansion and forging new partnerships. Dr. Todd Severnak, formerly with Horizon Virtual, will serve as Avel’s Medical Director for the combined Hospitalist service. He will lead a team of experienced hospitalists, delivering 24/7 care to hospitals nationwide.

“This is a great strategic fit for Horizon Virtual. After more than seven years of working with critical access hospitals and medical facilities in Minnesota to help address staffing challenges and provide the appropriate physician coverage in their hospitalist areas, we can now offer our customers solutions that address multiple areas within their hospitals while continuing to provide the same world-class virtual care. It has been an honor and will continue to be my desire to serve our customers and help alleviate staffing shortages and physician burnout as it has enabled more patients to remain in their local communities near friends and family support,” says Darin Willardsen, the CEO of Horizon Virtual. 

Expanding Nationwide Reach

Horizon Virtual’s highly skilled team of internal medicine hospitalists significantly enhances Avel’s robust network of clinicians. This acquisition builds upon Avel’s previous purchases of Fident Health (September 2023) and NightWatch (January 2023), further expanding its service offerings and geographic reach.

Elevating Patient Care with 24/7 Support

Avel eCare provides hospitals across the U.S. with access to a dedicated team of board-certified hospitalists and registered nurses, available 24/7. Avel’s virtual clinicians seamlessly integrate into local medical teams, collaborating with on-site staff to deliver and coordinate high-quality patient care. Avel’s proprietary software platform simplifies communication and ensures efficient care delivery.

Avel’s Comprehensive Telemedicine Solutions

With this acquisition, Avel eCare continues to position itself as a one-stop shop for telemedicine solutions. The company now serves hundreds of customers nationwide, offering a variety of services and care delivery models to meet the evolving needs of the healthcare industry.

What You Should Know:

–              Intuity Medical, Inc., a medical technology company committed to making it easier to live with diabetes, announced today that its POGO Automatic® Blood Glucose Monitoring (ABGM) system, featuring one-step testing, is now covered by Medicare Part B. This decision expands access to the innovative monitor for the 16.5 million seniors age 65 and up living with diabetes.

–              The Centers for Medicare and Medicaid Services (CMS) created two new coverage codes specifically for POGO Automatic, recognizing this new and significantly different technology compared to traditional blood glucose meters (BGMs). POGO Automatic features an all-in-one design that integrates testing supplies into a 10-test cartridge.

Advancing Diabetes Management: POGO Automatic Blood Glucose Monitoring System

POGO Automatic, the pioneering and sole FDA-cleared automatic blood glucose monitoring (ABGM) system available, revolutionizes diabetes management. It enables people with diabetes (PWD) to effortlessly test their glucose levels without disrupting their daily routines. This one-step process automates the multi-step glucose monitoring associated with traditional BGMs, particularly aiding seniors in checking their blood glucose more easily.

Endorsed as the optimal solution for numerous diabetes patients by Rosemarie Lajara, MD, an endocrinologist at Southern Endocrinology & Diabetes Associates, P.A. in Plano, Texas, POGO Automatic is recognized by healthcare professionals for its user-friendly design, which can enhance testing compliance. Dr. Lajara emphasizes the significance of such innovation for diabetes patients, especially within the Medicare population, which often includes individuals facing dexterity, visual, or physical challenges hindering traditional self-monitoring blood glucose (SMBG) meters.

Automating blood glucose testing steps addresses an unmet need for many patients who struggle with handling traditional blood glucose meters, test strips, lancets, and lancing devices. The introduction of new coverage codes—Healthcare Common Procedure Coding System (HCPCS) codes E2104 for the monitor for use with integrated lancing/blood sample testing cartridge and A4271 for the integrated lancing and blood sample testing cartridges—enables Medicare beneficiaries, who previously lacked access to this new technology, to acquire POGO Automatic under their Medicare Part B coverage.

Intuity Medical, Inc., founded with the mission of simplifying life for people with diabetes, introduced the FDA-cleared POGO Automatic® Blood Glucose Monitoring System. This innovative system streamlines testing with its all-in-one design, eliminating the need for separate strips and lancets. Manufactured in the U.S., POGO Automatic cartridges are produced at the company’s headquarters in Fremont, California.

What You Should Know:

– Security researchers at Nozomi Networks Labs identified three vulnerabilities in the Merge DICOM Toolkit C/C++ SDK (versions prior to v5.18). 

– These vulnerabilities could be exploited by attackers to crash medical imaging systems through seemingly harmless actions like opening a DICOM file or processing network data.

The Importance of the Merge DICOM Toolkit

In the world of medical imaging, the Merge DICOM Toolkit plays a vital role. This software library ensures seamless handling of medical images (like X-rays and MRIs) by allowing them to be stored, shared, and accessed across various healthcare systems. It’s a critical piece of technology for accurate diagnoses and timely treatments.

Potential Impact on Hospitals

A compromised medical imaging system could have serious consequences. It could disrupt workflows, delay diagnoses, and even impact patient care. In a hospital setting, where every second counts, such disruptions can be critical.

How Attackers Could Exploit These Vulnerabilities

These vulnerabilities could be exploited by attackers to disrupt critical healthcare systems:

• CVE-2024-23912 & CVE-2024-23913: These vulnerabilities allow attackers to crash DICOM viewers by sending them malformed DICOM files. This could potentially delay diagnoses and treatment.
• CVE-2024-23914: This vulnerability could enable attackers to exploit weaknesses in the network communication protocol used by DICOM-enabled devices (like ultrasound or CT machines). A successful attack could crash these devices, hindering their ability to function.

Patching and Remediation

Fortunately, Merge by Merative has addressed these vulnerabilities in the latest release of the Merge DICOM Toolkit C/C++ SDK (v5.18). Here’s what you can do:

• Healthcare providers: Urgently check if any of your medical imaging software uses a vulnerable version (prior to v5.18) of the Merge DICOM Toolkit. If so, update to the latest version (v5.18) immediately.
• Software developers: If you develop healthcare software that utilizes the Merge DICOM Toolkit, ensure you are using the latest patched version (v5.18) to protect your users from these vulnerabilities.

The Importance of Software Supply Chain Security

This incident highlights the importance of software supply chain security in the healthcare industry. Vulnerabilities in widely used libraries like the Merge DICOM Toolkit can create significant security risks for healthcare systems. By working together, software developers, healthcare providers, and security researchers can ensure the safety and security of critical medical technologies.

It’s a perfect storm of financial pressures facing healthcare provider organizations – from rising costs to labor shortages to constrained capacity – that stymies revenue growth. Growing challenges with payer payments only exacerbate these issues. According to a Kaufman Hall report, 73% of leaders surveyed said claims denials, which was the top revenue cycle issue in 2022, had increased in 2023.

The cost of denials is staggering. A recent data analysis revealed that providers spent nearly $20 billion in 2022 on efforts to resolve delays and denials across payers. More than half of the total – about $10.6 billion – came from denied claims that were appealed and ultimately paid. 

The traditional approach for providers has been to rely on medical professionals, including physicians and nurses, to help capture revenue at risk in denied claims by writing appeals. The need to hire clinical expertise to pursue such claims further adds to already substantial costs. The average cost to challenge a $43.84 denied claim will increase by $13.23 for a general inpatient stay and $51.20 for inpatient surgery. With an average of three rounds of appeals, providers are often waiting up to six months after care is delivered to receive payment, which can impact the ability for providers to maintain operational balance sheets. 

Moreover, there is a cascading effect on patients, increasing stress and detracting from the patient experience. For example, if a patient undergoes an outpatient procedure, such as a knee replacement, but then experiences complications that result in an overnight stay, the patient may not even realize their stay could be at issue. Even though the overnight stay was necessary to address complications and prevent deterioration, if the claim is denied, balances may become the patient’s responsibility, and the steps in the process are often confusing for patients. 

Prevent denials upfront

Providers now have the option to apply modern technology – including analytics, automation, and AI – to help improve their claims management processes to not only prevent denials upfront but also identify improvements to continuously hone processes, and efficiently resolve denials that can be overturned. Throughout the process, AI augments human expertise to reduce denials, reduce AR days and improve financial performance.  One method in which AI technologies can help organizations is with coding accuracy and compliance, so claims can be submitted along with appropriate documentation, resulting in fewer denials. 

The typical process for appealing a clinical denial is time-intensive, often requiring multiple rounds, resulting in long payment delays. Using AI technology to ingest, parse, and summarize text portions of the patient record can speed up and improve the entire process. AI-enabled analytics can pinpoint likely denials as well as identify trends by payer, clinical indication, etc. Providers can then focus more attention on those denied claims that are most likely to be successfully overturned. 

AI technologies also equip organizations with valuable data. Leveraging advanced analytics tools, organizations can identify areas for improvement to continuously optimize claims processes from start to finish. With a focus on preventing delays and denials, insights gained from both successful and unsuccessful appeals can be applied to better substantiate each claim upfront in the ever-changing payer landscape. 

Resolve denials accurately and efficiently

For each appeal, a clinician must formulate a strategy by reviewing a patient’s chart – potentially hundreds of pages of history, notes, and summaries – to assess the patient’s situation, treatment, existing conditions, and comorbidities. In minutes, AI can review the patient record and summarize all pertinent information for the type of appeal required, including the key identifiers, an accurate clinical summary, and the clinical argument to substantiate the claim. 

In addition, with manual chart reviews, people may miss key details or overlook important trends. Today’s AI technologies can efficiently and accurately go through the entire patient record in minutes to identify the points critical to depicting the complexity of the patient case. AI doesn’t get tired or experience stress – it can consistently and reliably pull together the data points needed for an effective appeal. 

Using AI in this way makes clinicians appeal editors rather than appealing authors. Instead of reading hundreds of pages and writing from scratch, clinicians review and fine tune the appeal drafted by AI to ensure it presents a compelling, accurate case to the payer. By integrating people services and technology capabilities, the time to resubmit claims can be reduced from hours to minutes – upwards of 75% in time savings. Such time savings on administrative and medical staff offers the added and critical benefit of enabling clinicians to focus on applying their expertise at the top of their license, which reduces their burden, relieves burnout, and improves job satisfaction and staff retention. 

Overcome AI adoption challenges 

Provider organizations evaluating AI solutions for the revenue cycle need to consider governance, change management, as well as policies and procedures to overcome common adoption challenges, including:

• Concern that AI will replace jobs: The best approach – proven by AI’s successful use by leading health systems today – is for AI to support, not replace, human decision-making. Providers should involve end users and other stakeholders right from the start to understand the most pertinent issues, build a solution that truly benefits end users, and gain buy-in along the journey. 
• Compliance and patient privacy: Publicly available solutions, such as ChatGPT, can put organizations at risk. However, adopting a robust framework and a closed environment enables providers to build upon their policies and procedures to productively manage patient privacy and compliance. 

Transform processes for sustainable growth

Healthcare organizations that adopt AI for high-value, high-cost administrative processes, such as clinical claims denials, will be better equipped to navigate today’s healthcare challenges. AI-enabled technologies can help organizations improve efficiency and clinician job satisfaction, more successfully resolve denied claims and apply their success to prevent future claim denials. In addition, AI can make the process more seamless for payers by making appeals more consistent and accurate, requiring fewer iterations. Most importantly, healthcare providers spend more time treating patients, and those patients receive better experiences – from care to cost. All told the resulting increases in revenue and cash flow can put healthcare organizations on stronger footing for sustainable growth, supporting better outcomes for all. 

About Steve Albert

Steve Albert is Executive Vice President and Chief Product Officer for R1. He joined R1 following the acquisition of Cloudmed where he also served as Chief Product Officer. Steve has over two decades of leadership experience in new market development and product innovation for enterprise-scale data management and analytics organizations. He leads R1’s product vision and roadmap, drives product innovation, and helps grow the company through expansion into new markets. Prior to joining Cloudmed, Steve held product and market development leadership roles at 1010data, Mastercard, Equifax, and GeoPhy. He has extensive experience leading and scaling go-to-market, product, and data science teams that delivered product-led revenue growth.

What You Should Know: 

– Aledade, the nation’s leading network of independent primary care practices, announced today the acquisition of Michigan-based Medical Advantage. 

– This strategic acquisition further solidifies Aledade’s position as the preeminent Accountable Care Organization (ACO) network and a driving force in value-based care.

Expanding Physician Partnerships in Michigan

The acquisition significantly expands Aledade’s network in Michigan, bringing the number of partnered physicians from 35 to roughly 700. This strengthens Aledade’s ability to deliver high-quality, value-based care to a wider patient population across the state.

Preserving Physician Choice and Value-Based Opportunities

Importantly, Aledade will maintain Medical Advantage’s standing as a physician organization, allowing it to participate in value-based care arrangements with various payers, including the prominent Blue Cross Blue Shield of Michigan. This ensures continued flexibility and choice for both physicians and patients.

“This is the merger of two organizations dedicated to doing what’s good for patients, practices and society,” said Farzad Mostashari, M.D., co-founder and CEO of Aledade. “Working together, we can help more independent primary care practices in Michigan not only to participate, but succeed, in value-based care. This partnership means more Michigan primary care physicians will have support in doing what they do best – keeping Michiganders healthy.”

What You Should Know:

·      Navina, the AI-driven primary care platform revolutionizing the interpretation of intricate patient data into actionable guidance during care encounters, has unveiled the initial outcomes of its collaboration with Upperline Health. Upperline Health stands as the nation’s largest network committed to value-based specialty care and pioneers of their own ACO REACH. This partnership aims to refine the accuracy of patients’ comprehensive health evaluations and optimize clinical processes to maximize meaningful patient interaction time.

·      Previously, Upperline Health’s specialists in podiatry, vascular care, chronic care management, and preventative health grappled with incomplete patient medical histories dispersed across disparate systems and modalities, particularly as the Medicare beneficiary population seeking specialist care burgeoned. However, within just a month of integrating Navina, specialists embraced its AI-generated insights for 97% of patient encounters. This utilization empowered them to precisely assess patients’ health statuses and significantly bolstered their capacity to deliver comprehensive care.

Revolutionizing Specialty Care: Navina & Upperline Health Partnership Enhances Patient Health Assessment and Clinical Workflows

Before joining forces with Navina, Upperline Health specialists encountered formidable obstacles due to fragmented health records and outdated paper-based workflows. Navina’s introduction streamlined access to precise and timely data, alleviating administrative burdens and allowing clinicians to prioritize accountable care.

Navina seamlessly integrates with Upperline Health’s diverse data infrastructure, encompassing their Athenahealth electronic health record (EHR), health information exchanges (HIEs), claims, and third-party systems housing unstructured notes and scanned documents. Leveraging advanced AI and natural language processing (NLP), Navina harmonizes data from various sources to furnish the most current and precise patient information, alongside offering recommendations during care encounters, even highlighting suspected conditions previously undocumented.

Each insight provided by Navina is traceable to its original clinical source, nurturing clinician confidence and empowering them to make informed, data-driven care decisions. On average, Upperline Health specialists concur with over 80% of Navina’s clinical insights, underscoring its efficacy and value in enhancing patient care delivery.

“Navina closely aligns with our holistic approach to specialty care, enabling us to offer better patient care, and improve outcomes.” said David Thorpe, CEO of Upperline Health. “In a matter of days, Navina’s AI platform achieved high provider engagement and satisfaction across our clinics, a testament to AI’s immense potential to support the clinical workflow and promote proactive, efficient value-based care.”

What You Should Know:

– Baton Health has launched its Universal Primary Source, revolutionizing healthcare credentialing by granting access to hundreds of primary source databases instantly.

– The platform has garnered over 30 organizations as clients and early adopters, showcasing its potential to transform healthcare credentialing and reduce verification times from hours or days to mere seconds.

– Baton Health’s state-of-the-art platform eliminates manual data entry and provides instant, accurate access to comprehensive data from state, federal, and specialty databases, resulting in significant cost and time reductions for various stakeholders in the healthcare industry.

– The company’s pioneering efforts are evident through collaborations with leading entities such as Mocingbird, The Clinic by Cleveland Clinic, Amwell, and Brevard Health Alliance, offering a National Credentialing Directory attracting over 350 users with a streamlined, error-free approach to credential verification.

What You Should Know: 

– Walmart announced today the difficult decision to close all 51 Walmart Health centers and discontinue its virtual care offering. This comes after five years of operation for the health centers.

– The company cited a “challenging reimbursement environment and escalating operating costs” as reasons for the closure. This highlights the difficulty of establishing a profitable healthcare business model, especially in the current environment.

Priority Shift on Profitable Existing Strengths: Pharmacies and Vision Centers

Despite closing the health centers, Walmart remains committed to providing healthcare services through its extensive network of nearly 4,600 pharmacies and over 3,000 vision centers. These established businesses offer a range of services, including:

• Immunizations
• Testing and treatment services
• Specialty pharmacy medication and care
• Medication therapy management
• Health screenings

The company emphasizes the importance of pharmacies, particularly in medically underserved areas where they often serve as the primary point of healthcare access for many communities.

Innovation Continues in Other Healthcare Services

Walmart highlights its ongoing commitment to healthcare innovation through initiatives like:

• The Walmart Healthcare Research Institute
• Development of new health programs
• Expansion of fresh food and OTC (over-the-counter) offerings

Supporting Patients and Employees During Transition

The company assures a smooth transition for patients with ongoing care needs and offers support to impacted associates:

• Patients: Continuity of care will be ensured.
• Associates: All associates will be offered the opportunity to transfer to another Walmart or Sam’s Club location. Those who choose not to transfer will receive 90 days of pay and potentially severance benefits.
• Providers: Partnering providers will continue to serve patients during the closure period and receive compensation for 90 days.

“Today we are sharing the difficult decision to close Walmart Health and Walmart Health Virtual Care. Through our experience managing Walmart Health centers and Walmart Health Virtual Care, we determined there is not a sustainable business model for us to continue,” in an official statement.

What You Should Know:

–              Innovaccer, a leading healthcare technology company, today announced its collaboration with Kaiser Permanente, America’s leading healthcare provider and nonprofit health plan.

–              Kaiser Permanente will implement Innovaccer’s Healthcare AI Platform to support value-based care initiatives. 

Empowering Healthcare Innovation: Innovaccer’s Expansion into Kaiser Permanente and California PHM Initiative

The integration of Innovaccer into Kaiser Permanente’s integrated healthcare system is commencing with its Washington market. This initial rollout is scheduled for completion this summer, with plans for potential expansion into other Kaiser Permanente markets and subsidiaries thereafter. This collaboration involves implementing Innovaccer’s Healthcare AI Platform alongside its population health management solutions within Kaiser Permanente’s Washington market, which serves approximately 650,000 members.

Additionally, Innovaccer has been recently chosen as the preferred platform to support the California PHM Initiative. This initiative, a joint effort between Community Health Centers, Regional Associations of California, California Primary Care Association, Department of Health Care Services, and Kaiser Permanente, is utilizing Innovaccer’s AI platform for healthcare to consolidate and standardize data for improved health equity and community well-being.

Innovaccer serves as the foundational data platform driving healthcare innovation through advanced AI technologies. Its AI-powered healthcare platform seamlessly integrates patient data from various systems and care settings, empowering healthcare organizations with modern, scalable applications that enhance clinical, financial, operational, and experiential outcomes.

“Kaiser Permanente has had incredible success with its value-based care delivery model through its best-in-class operating practices,” said Abhinav Shashank, cofounder and CEO of Innovaccer. “With Innovaccer’s AI platform, Kaiser Permanente will be able to provide an EHR- and payer-agnostic platform to advance their value-based care expertise, technology, and services.”

What You Should Know: 

– Philips and Nicklaus Children’s Health System, a leader in pediatric care, announced a groundbreaking 10-year collaboration focused on enhancing patient and staff experiences, improving outcomes, and driving innovation in pediatric care.

– As part of the partnership, Nicklaus Children’s will be the first to adopt the virtually helium-free Philips Ambition X MR scanner. This innovative technology eliminates the need for ongoing helium refills, a significant advantage for hospitals managing this precious resource. 

– Additionally, the EasySwitch solution allows for a smooth and swift discharge or re-energization of the magnet, minimizing disruptions for patients.

Focus on Faster Diagnosis and Reduced Stress

Philips’ AI-enabled radiology workflow solutions will be implemented to reduce exam times and the need for rescans, leading to faster diagnoses and treatment plans for young patients. Furthermore, Nicklaus Children’s will leverage Philips’ suite of patient experience technologies:

• Philips Ambient Experience: Creates a calming environment with dynamic lighting, video projections, and soothing sounds.
• Kitten Scanner: A child-sized MRI replica that allows kids to explore how the scanner works in a non-threatening way.
• Scan Buddy App: Provides educational games and playful characters to help children understand the MRI procedure beforehand, potentially reducing anxiety and the need for sedation.

Streamlining Workflow and Empowering Staff

Advanced SmartWorkflow and SmartSpeed MR technologies will automate exam setup and accelerate exam times by up to 65%, allowing staff to focus on delivering exceptional care.

Enhancing Cardiac Care with AI-powered Ultrasound

Nicklaus Children’s will also implement Philips’ EPIQ CVx and Compact 5500CV AI-enabled ultrasound systems. These advanced systems automate measurements and strain quantification, leading to:

• Reduced quantification time by 51%
• 20% faster 2D imaging exams
• Improved diagnostic confidence through TrueVue imaging technology

“Philips shares our commitment to innovation, and patient safety and quality, and has taken the time to understand our care goals and the unique Nicklaus Children's experience we work to deliver,” said Matthew A. Love, president, and CEO of Nicklaus Children’s Health System. “This means understanding that you cannot just make a smaller version of an adult radiology solution for our patients, and that sick kids don’t necessarily stay still for studies. More importantly, if we can make things fun and give each child confidence about the procedure, we can alleviate some of the stress they and their families may be feeling as part of the treatment process.”