Healthcare Strategies

Health insurers face a couple of key obstacles as they implement digital health solutions, such as the lack of payer alignment around digital quality measures and the slow development of interoperability. Peter Long, executive vice president of strategy and health solutions at Blue Shield of California and co-author of a National Academy of Medicine article on digital health, explains how payers can refine their digital health efforts and how an integrated health record can overcome digital health barriers.

In 2023, leaders in health IT analytics, mHealth, EHR, and health IT security will see innovation around healthcare consumerism and provider burden. Experts from HITRUST, Surescripts, Mass General Brigham Health System, and Mayo Clinic Platform share their projections for the new year. Multimedia Manager's Note (1/17/2023): This is an updated version of the podcast episode that went live on January 16, 2023. The original version misattributed some of the guests. The guests in order of appearance are: - Frank Harvey, chief executive officer of Surescripts, - John Halamka, MD, president of Mayo Clinic Platform - Lee Schwamm, MD, vice president of digital patient experience at Mass General Brigham Health System - Robert Booker, chief strategy officer and executive vice president of the center of excellence at HITRUST

In 2023, payers, providers, revenue cycle, life sciences leaders will face extreme financial pressures that will shape their decisionmaking but that may also open their eyes to new opportunities in value-based care and other areas of healthcare. Healthcare leaders from Blue Shield of California, Cook Medical, Forrester Research, and Providence Health & Services – Washington share their projections for the new year.

Gender-affirming care, including social, psychological, behavioral, and medical interventions, is supportive healthcare that affirms a person's gender identity when it conflicts with their assigned birth gender. Though proven to result in overwhelmingly positive outcomes, such as reducing suicide ideation and attempts, gender-affirming care access can be hard to come by, especially in primary care settings. In this episode, Kate Steinle, nurse practitioner, chief clinical officer at FOLX Health, and former Planned Parenthood employee, discusses ways to break down the barriers to gender-affirming care and expand access to patients.

Seniors in the LGBTQ+ community today are aging in a country that is much more open to conversation about LGBTQ+ care and wellness than when they were young, but they still face barriers to care and coverage. Sachin Jain, MD, president and chief executive officer of SCAN Group and SCAN Health Plan, and Jill Selby, senior vice president of product development, marketing, and market expansion for SCAN Health Plan, share how the health insurance industry can facilitate coverage and cultural change to reduce barriers to care for LGBTQ+ seniors.

Because the effects of fertility treatment such as in vitro fertilization can often be traumatic and taxing, patients see many disruptions in their daily lives and have rated the stress of undergoing this procedure as more stressful than or almost as stressful as any other major life event, including the death of a family member or divorce. In this episode, Dr. Maria Costantini-Ferrando, clinical director and reproductive endocrinologist with Reproductive Medicine Associates of New Jersey and a licensed clinical psychologist, shares how in vitro fertilization impacts patients personally, financially, and emotionally and how healthcare providers can lend support.

Third-party health apps can help patients manage chronic diseases, log vital signs, and take charge of their health. But these apps often fall outside of HIPAA's purview, leaving them in a regulatory gray area. Tina Grande, executive vice president for policy at the Healthcare Leadership Council and chair of the Confidentiality Coalition, Robert Tennant, vice president of federal affairs at the WEDI, and Marilyn Zigmund Luke, vice president at AHIP, discuss third-party health app privacy and security risks.

Supporting care coordination for incarcerated individuals is challenging due to fragmented care systems and data sharing barriers. Kim Dong, DrPH, RD, assistant professor in the Department of Public Health and Community Medicine at Tufts University School of Medicine, and Lynda Rowe, senior advisor of value-based systems at InterSystems, share findings from a study evaluating HIV care transition processes at a Massachusetts jail.

In the second part of a two-part series on specialty pharmacies, Shaunte Law Rhames, RN, BSN, an infusion care nurse supervisor working in inpatient management services, and Nichol Marrero Nieves, PharmD CSP, a patient management service pharmacist who specializes in neurology, behavioral health, and chronic inflammatory diseases at AllianceRx Walgreens Pharmacy, one of the nation's largest home delivery and specialty pharmacies for patients with rare and chronic diseases, share how pharmacy team members can purposefully support patients manage and prevent chronic diseases.

Considering specialty pharmacies provide highly accessible healthcare to patients, pharmacies have the chance to extend their role by advocating for better patient outcomes and supporting patients in navigating the complexities of dealing with a chronic disease. Shaunte Law Rhames, RN, BSN, an infusion care nurse supervisor working in inpatient management services, and Nichol Marrero Nieves, PharmD CSP, a patient management service pharmacist who specializes in neurology, behavioral health, and chronic inflammatory diseases at AllianceRx Walgreens Pharmacy, one of the nation's largest home delivery and specialty pharmacies for patients with rare and chronic diseases, share how the pharmaceutical community can purposefully empower patients and prevent future illnesses.

The nation's progress toward value-based care is impeded by the siloed nature of the healthcare industry. Joe Castiglione, principal program manager of Industry Initiatives at Blue Shield of California, shares how Blue Shield implemented an industry collaboration team to increase momentum in value-based care progress.

To meet the needs of an increasingly independent senior population, primary care organization Heal leverages in-person and virtual care services to provide care in the home. Justin Zaghi, MD, Heal's chief medical officer, joined the podcast to discuss Heal's model, how it uses telehealth and RPM to supplement in-person care, and how care in the home can support value-based care delivery.

Global capitation models are the most high-risk form of advanced payment model that a health system could adopt, but they have proven advantageous for promoting alignment around value-based care. Michael Weiss, MD, vice president of population health for Children's Hospital of Orange County (CHOC), shares how his health system moved toward global capitation and offers recommendations for other organizations hoping to do the same.

The accountable care organizations (ACO) model is one of the greatest tools in the value-based care toolbox, with ACOs in the Medicare Shared Savings Program producing savings five years in a row. Sam Starbuck, VP and GM at Privia Quality Network, shares how physician engagement, patient access, and data transparency are all key to savings and quality improvements.

One of the key challenges in value-based care is achieving collaboration between healthcare stakeholders who would normal be in competition with each other. Crystal Eubanks, senior director of care redesign at the Purchaser Business Group on Health (PBGH), shares how the California Quality Collaborative programs pursued effective collaboration on value-based care.

From the patient's perspective, physical and behavioral healthcare are already integrated in their wellness experience, but the healthcare industry has a long way to go in matching this reality in patients' treatment journeys. Ewa Matuszewski, chief executive officer and co-founder of MedNetOne Health Solutions, explains how healthcare stakeholders can work toward a more integrated behavioral-physical healthcare experience within the value-based care framework.

Artificial intelligence and machine learning are increasingly integral to value-based care models, which rely heavily on data and data analytics. However, these resources can also work against value-based care if they introduce or perpetuate negative biases. Marzyeh Ghassemi, a principal investigator at MIT's Jameel Clinic, shares how to avoid negative biases in artificial intelligence and machine learning in the value-based care context.

Cancer treatment is full of challenges for patients and their families. A lack of patient-centered care can amplify these existing challenges and introduce new ones. André Dahinden, managing director at Accenture, shares how healthcare providers can make their oncology treatment processes more patient-centered in order to facilitate better patient experience and improve outcomes.

To support business growth and promote the shift to patient-centric care, health system CEOs are implementing digital tools and diversifying their workforce. Jiban Khuntia, PhD, director of the University of Colorado, Denver's Health Administration Research Consortium, shares the results of a health system CEO survey highlighting these trends and discusses how they support the digital transformation journey in healthcare.

Artificial intelligence has a variety of useful applications in healthcare. But algorithmic bias, along with data privacy and security concerns, have prompted significant ethical and legal concerns. Linda Malek, partner at Moses & Singer and chair of the firm's healthcare, privacy, and cybersecurity practice group, discusses the risks associated with AI in healthcare.

Many unknowns surround Alzheimer's Disease prevention and management, but blood testing might pave a way forward. Michael Racke, MD, Medical Director of Neurology at Quest Diagnostics, shares how a new type of diagnostic testing might help identify Alzheimer's Disease early and change the healthcare system's approach to the disease.

Investing in primary care services can be key to the success of organizations' value-based care and health equity efforts. Vivek Garg, MD, chief medical officer for Humana's Primary Care Organization, shares how organizations can invest strategically to support primary care, from investing in more sustainable EHRs to aligning around health equity.

Amid evolving telehealth policy and regulations, federal agencies are working to prevent fraud and abuse. In part two of a two-part series on telehealth, Jacob Harper, an associate with law firm Morgan, Lewis & Bockius, Christa Natoli, executive director of the Center for Telehealth and E-Health Law (CTeL), and Ben Steinhafel, policy director of CTeL, discuss fraud enforcement actions related to telehealth and why providers must remain vigilant.

In part one of a two-part series on telehealth, to ensure access to telehealth after the public health emergency has ended will require lawmakers to pass new legislation extending or making permanent regulatory flexibilities enacted during the pandemic. Jacob Harper, an associate with law firm Morgan, Lewis & Bockius, Christa Natoli, executive director of the Center for Telehealth and E-Health Law (CTeL), and Ben Steinhafel, policy director of CTeL, discuss the bills currently introduced in Congress and trends in state telehealth legislation.

By bringing primary care services into the home through in-home primary care, providers can improve patient satisfaction while lowering healthcare costs. Chris Dodd, MD, chief medical officer at Emcara Health, sheds light on how in-home advanced primary care interacts with the rest of the healthcare system to lower costs and boost patient experience.

Access to comprehensive patient health data at the point of care is critical for care coordination. Holly Miller, MD, chief medical officer of MedAllies, shares how 360X specifications can help healthcare organizations streamline data sharing to support patient-centered care during care transitions.

Broader uptake of virtual care has broken down many of the geographic- and stigma-related barriers of the past, but has also erected new barriers in their stead. Adam Hornung, executive director of telehealth operations at Intermountain Healthcare, shares how his organization has tackled barriers to virtual care access and involved patients in the solution.

Pharmacogenomics and precision medicine are evolving fields that are full of opportunities for advancement and improving patient outcomes, but seizing these opportunities may require a concerted effort from healthcare stakeholders. Cynthia Yu, PharmD, director of precision medicine at The Profero Team, and Scott Betzelos, MD, chief medical officer and vice president of HMO strategy and affordability at Blue Care Network, offer their perspectives on the challenges and opportunities of precision medicine and pharmacogenomics and its future.

Since chronic disease management has a significant impact on patient outcomes and spending, it is often a central focus of healthcare stakeholders' value-based care efforts. Hayden Schmidt, assistant editorial researcher of Insights at Xtelligent Healthcare Media, dives into the recent Insights report which sheds light on value-based care efforts related to chronic disease. To access the report, visit our corporate website: https://www.xtelligentmedia.com/insights.

The new DOJ Civil Cyber-Fraud Initiative includes provisions related to whistleblowers and may change the way that healthcare providers are viewed in cybersecurity cases. Lisa Rivera, a member of the law firm Bass Berry & Sims, and co-chair of the firm's compliance and government investigations practice group, delves into how the initiative might impact the healthcare industry.

Despite the high demand for healthcare workers during a years-long workforce shortage and the demonstrated benefits of workforce diversity, large disparities exist between women and men in the medical field including leadership transitions and promotions. Shikha Jain, MD, a hematologist and oncologist at UIC Cancer Center and the founder of Women in Medicine (WIM), and Eve Bloomgarden, MD, an endocrinologist and chief development officer for WIM, shared their nonprofit's goals and efforts to reverse gender gaps in the healthcare workforce.

Electronic medical records (EMRs) and electronic health records (EHRs) are essential tools that allow the storage and maintenance of protected health information (PHI). Unfortunately, PHI is also extremely valuable to threat actors. Salwa Rafee, global managing director for healthcare security at Accenture Security, discusses EMR security risk factors and the pros and cons of in-house and cloud-based EMR systems.

In part two of this introduction to the life sciences, Alivia Kaylor, senior editor of LifeSciencesIntelligence, addresses the other three categories of life sciences: medical devices, medical imaging, and reproductive health. Each of these categories is prime for growth and presents many opportunities and challenges to the healthcare industry as a whole.

Life sciences is a broad field of study, but it has significant implications for stakeholders across the healthcare industry. Alivia Kaylor, senior editor of LifeSciencesIntelligence, explains how being knowledgeable about biotechnology, genetics, genomics, and other aspects of the life sciences can be valuable for healthcare professionals.

Predictive analytics covers a broad range of functions and tools. Tom Selva, chief medical information officer of University of Missouri Health Care, shares how his healthcare system implemented a a predictive analytics-powered early intervention tool for sepsis and what the future of predictive analytics could hold. Thanks to our sponsor: Lark utilizes proprietary A.I technology to simplify the prevention and management of chronic illnesses. Its expanding platform provides users 24/7 access to a virtual care coach through an engaging and personalized text-like interface. Lark currently works with 2 of the 3 largest health plans.

Providers know that preventive care services are critical to achieving positive patient outcomes, but how do they educate patients about the need for preventive care and encourage patients to follow through on preventive care appointments? Sara Heath, managing editor at Xtelligent Healthcare Media, covers how healthcare organizations have been improving their patient engagement strategies around preventive care services.

We are celebrating 100 episodes of Healthcare Strategies with 100 seconds capturing a couple of highlights. Thank you to all of our guests, hosts, sponsors, and--of course--a big thank you to you, our listeners, for making this possible!

When hospitals and healthcare systems require an EHR enterprise solution that will meet a variety of unique needs, EHR vendor solutions may fall short. Jessica Cox, director of product solutions at Holy Name Medical Center, explains how Holy Name Medical Center designed and implemented a customized EHR enterprise solution, offering lessons learned from this experience.

The legal debate around the coronavirus vaccine mandate that CMS issued in November 2021 has surfaced many questions around workforce management and drew attention to the nation's clinician labor shortage. Sarah Coyne, partner at Quarles and Brady and adjunct professor at the University of Wisconsin-Madison School of Law, and Jon Kammerzelt, partner at Quarles and Brady and Chair of the Health and Life Sciences Group in the Firm's Madison Office, share their insights into the legal proceedings and the impact that this debate could have on the healthcare workforce.

As the healthcare industry seeks to improve health equity and reduce care disparities, Healthfirst has introduced seven principles for orienting an organization around health equity. Susan Beane, executive medical director of partnerships for medical outcomes at Healthfirst, and her colleagues Rashi Kumar, director research and policy in partnerships for medical outcomes, and Tom Wang, manager of research and evaluation in partnerships for medical outcomes, share the ADVANCE principles and how they guide Healthfirst's health equity efforts.

What responsibility do employers have to address social determinants of health among their employees and how should they act on that responsibility? Mike Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions (National Alliance), and Christa-Marie Singleton, chief medical officer of the Office of the Associate Director for Policy and Strategy at the Centers for Disease Control and Prevention (CDC), share how employers can use demographic data to better address employees' social risks. Thanks to our sponsor: Lark utilizes proprietary AI technology to simplify the prevention and management of chronic illnesses. Its expanding platform provides users 24/7 access to a virtual care coach through an engaging and personalized text-like interface. Lark currently works with 2 of the 3 largest health plans.

When a crisis disrupts claims volume and payments processes, what can payers and providers do to adjust? April Todd, senior vice president of CORE and explorations for CAQH, explores the coronavirus pandemic's impact on administrative transactions and how the past two years can inform healthcare stakeholders' reactions to future crises.

The coronavirus pandemic has sparked an increase in substance abuse, but many Americans who struggle with substance abuse do not seek out mental healthcare support. Jasleen Chhatwal, MD, chief medical officer at Sierra Tucson, shares the findings of Sierra Tucson's survey on substance abuse in the US and dives into how those results can inform healthcare professionals at the patient engagement level and the strategic level.

As ransomware attacks continue to overwhelm the healthcare sector, organizations will have to decide whether to pay the ransom or potentially risk patient safety. Erik Weinick, a seasoned litigator and co-founder of Manhattan-based law firm Otterbourg's privacy and cybersecurity practice, discusses the consequences of paying or not paying the ransom in the event of a healthcare cyberattack, and how organizations can mitigate risk.

As the national conversation around interoperability moves forward, it is time to progress beyond defining what interoperability is and instead make sure that all of the impacted stakeholders' voices are represented, including patients' and payers' perspectives. Alan Swenson, executive director for Carequality, shares how to better engage payers and patients in discussions around health data exchange.

After a couple of years of rapid healthcare technology innovation and uptake, healthcare professionals want to know what 2022 might have in store. Executives from the HIT security space, legal advisors, leaders in digital and artificial intelligence strategy, and HIT consultants share their perspectives on key 2022 trends in telehealth, remote patient monitoring, security, and more so that healthcare professionals can prepare for the new year.

2020 and 2021 highlighted the critical need for more consumer-centered strategies. Health insurance plan leaders, healthcare nonprofit founders, and industry consultants share how healthcare organizations will rally around the consumer in 2022, both independently and across sectors.

As the number of urgent care clinics around the country continues to grow, their role in helping communities access care perpetually evolves. Jackie McDevitt, PA-C, lead advanced practitioner at Northwell Health-GoHealth Urgent Care, explains how urgent care clinics help patients navigate the healthcare system and utilize appropriate care at a lower cost.

As stakeholders strive to prepare for surprise billing regulation compliance—building off of interoperability progress—one thing is clear: payers and providers alike will need to find a common approach. Erin Weber, director of the Committee on Operating Rules for Information Exchange (CORE) at the Council for Affordable Quality Healthcare (CAQH), shared how the healthcare industry can standardize its approach to surprise billing.

As healthcare systems move toward greater interoperability, they have leveraged various strategies including cloud-based technology implementation and stakeholder partnerships. Nevertheless, they continue to confront barriers in their efforts. Kristian Feterik, medical director of interoperability and clinical associate professor of medicine at University of Pittsburgh Medical Center (UPMC), explains how widespread adoption of FHIR would advance the healthcare industry's interoperability--and intraoperability--goals as well as how cloud-based technologies factor into this effort.

Medical device security vulnerabilities have the potential to impact patient safety and serve as an open door to hackers. Elizabeth Butwin Mann, Americas Life Sciences and Health Cybersecurity Leader at EY, explains what makes medical devices so susceptible to security vulnerabilities, and what healthcare organizations can do to mitigate risk.