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thelastairbender135-blog · 6 years ago

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How We Handle Our Healthcare In 2018

If you cancel within your first 30 days, canada pharmacies online prescriptions the membership fee will be refunded. The plan also must ensure that there is a sufficient mix of PCPs and specialists to meet membership needs. There are two basic types of POS plans: the open-ended HMO and the gatekeeper PPO. Americans are welcomed at the many fetes that occur throughout the year. Reports are also available for hospitals and nursing homes. Stage 3 includes the requirement for hospitals to include complete patient contact information in 30% of reports. Robin Raiford from Allscripts created a Quick Guide to the recommendations, making it easy to compare Stage 1, 2 and 3 in a single PDF. If you’re considering a healthcare sharing ministry, I urge you to compare Liberty with the other options out there. There are divers online Canada pharmacies which provide consumers the skilfulness to purchase branded and generic drugs as antidote to a lesser price than what is serviceable in conventional pharmacies. Employees are allowed to make loans and withdrawals from their accumulated cash values, but for administrative reasons the frequency of loans and withdrawals may be limited. In my case, I make it easy for me to exercise. Scammers may want you to click a link to download malware or adware, or bring you to a convincing looking phishing page in order to trick you into providing your login credentials for a website. Trinidad's most notable contribution to world culture, however, may be the steel drum ("pan"). Instead of merely submitting a list of URLs each month, FDA requests that sponsors who choose to use such forums submit screenshots of the interactions that occur. ] OSHA has decided to retain this item on the first aid list and to add the lancing of blisters as well. Well ANY age, really.. Along with reducing traffic and saving Coloradans money, our state can dramatically improve the quality of life for citizens with limited transit options. Group universal life insurance products are being marketed primarily as supplemental life insurance plans, either to replace existing supplemental group term life insurance plans or as additional supplemental plans. Of all the different brands and products that I tried, the best (and most expensive) was the one that came from the Statewide Collective in California. The fastest and most cost-effective transportation system is one that reduces our need to travel and provides us the freedom to travel easily when we do. The charcoal is made into a poultice and held onto the area in need with an ace bandage or cohesive tape to draw out poison and toxins, reduce swelling and relieve pain. Premiums are increasing, insurers are pulling out of the marketplace, and people across the country are feeling the pinch. While surveys show members are generally satisfied with managed care, satisfaction rates will vary among different managed care plans. Online sales are permitted 24 hours a day, seven days a week. 2 each per week. Mind you I will just be reporting what they said for your information only because you have to consult the professionals before making any changes. If the law is overturned, the "donut-hole" will remain open. Employer and employee satisfaction of managed care will be largely affected by the ability of the managed care company to follow through on commitments and meet the objectives of the plan sponsor. An increasing number of large employers now require managed care plans to either have received NCQA accreditation or have an established plan towards gaining accreditation in order to be offered to plan members. There was little federal health care legislation during Clinton's second term, at least partially due to a Congressional majority of a different political party from the President. Read the majority of this flyer painstakingly before you begin taking this drug. Or stick a couple of moth balls in your ginch but dont get pepermint oil near that area cause you wont be able to tell if your freezing or on fire. Now create a bunch of marble sized balls and dump them near any rat infested areas in your house or on your property. Thirty states now recognize NCQA accreditation as meeting regulatory and licensing requirements for health plan. There is definitely a gray area here. Under a block of individual insurance contracts, the desirable situation for an insurance company is to have a spread of risks throughout a range of acceptable insureds. I have set electronic traps which kill a few, but not all. Fires in London, Chicago, Baltimore, and San Francisco resulted in insurance company bankruptcies and loss of confidence in the industry. And do not be concerned too much about weight loss. They tried to tell me that the reason I did not receive the medication was because I had neglected to include the word "Avenue" after my street name. Poor public transportation makes a personal car necessary in Port of Spain. Before the advent of the glucose meter, it was the only way the diabetics can feel a sense of control over the blood sugar levels. CBD oil has clearly proven itself as a therapeutic substance to help a variety of ailments, and it can also play a role in helping anxiety and depression. Between Front and Reid Streets, with entrances from both, a shopping center, with a variety of small shops in a courtyard and 2-floor setting.

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itssashasharma · 4 years ago

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Ambulatory Surgical Centers Market To Reach USD 7.2 Billion By 2025 – Increasing Investment In Supply Chain Management

What This Report Will Provide?

The study involved four major activities in estimating the size of the Ambulatory Surgical Centers market. Exhaustive secondary research was done to collect information on the adoption of different technologies and their regional adoption trends. Industry experts further validated the data obtained through secondary research through primary research.

Furthermore, the market size estimates and forecast provided in this study are derived through a mix of the bottom-up approach (country-level data for outpatient surgical procedures) and top-down approach (assessment of utilization/adoption/penetration trends, by product and services, components, and specialty type). After that, market breakdown and data triangulation methods were used to estimate the market size of segments and subsegments.

Expected Revenue Growth :

[176 Pages Report] The Ambulatory surgical centers market is projected to reach USD 7.2 billion by 2025 from 2.1 billion in 2020, at a CAGR of 27.6% during the forecast period.

Major Growth Boosters :

Market growth can be attributed to the growing need to curtail escalating healthcare costs, shift from inpatient to outpatient surgical procedures, and growing demand for IT solutions such as mhealth, telehealth, and remote patient monitoring for better management.

However, high deployment costs and reluctance among end users to adopt new methods are expected to restrain the overall market growth to a certain extent during the forecast period.

Download PDF Brochure: https://www.marketsandmarkets.com/pdfdownloadNew.asp?id=182183086

Recent Developments

In 2019, NextGen Healthcare launched NextGen Health Data Hub

In 2019, GE Healthcare launched Edison Datalogue and my. Cryochain software

In 2019, MEDITECH collaborated with Google to offer EHR data through the Google Cloud Platform. This helped to securely deliver patient data, enhance scalability, and facilitate interoperability.

In 2019, Epic Systems partnered with Teledoc Health to integrate Teledoc Health’s virtual care platform to Epic’s App Orchard that would help the company conduct telehealth video visits.

Key Questions Addressed in The Report:

Who are the top 10 players operating in the global Ambulatory surgical centers market?

What covers the drivers, restraints, opportunities, and challenges in the Ambulatory surgical centers market?

What are the new technological advancements in the Ambulatory surgical centers market?

What are the growth trends in the Ambulatory surgical centers market at the segmental and overall market levels?

Request Sample Report: https://www.marketsandmarkets.com/requestsampleNew.asp?id=182183086

By-products and services, the clinical solutions segment accounted for the largest share of the Ambulatory surgical centers market in 2019

Based on products and services, the Ambulatory surgical centers market is segmented into clinical solutions, non-clinical solutions, and HCIT outsourcing services. In 2019, the clinical solutions segment accounted for the largest share of the Ambulatory surgical centers market. The need to control the increasing healthcare costs and improve the efficiency of healthcare services by reducing medical errors are a major driver that propels the demand for healthcare provider solutions.

Regional Growth Analysis:

North America accounted for the largest share of the Ambulatory surgical centers market, followed by Europe. The large share of this region can be attributed to the high adoption of Ambulatory surgical centers for reducing the soaring healthcare costs, increasing volume of surgical procedures performed, and the presence of significant market players, such as Epic Systems Corporation (US), Cerner Corporation (US), McKesson Corporation (US), Philips Healthcare (Netherlands), and Allscripts Healthcare Solutions, Inc. (US).

#Ambulatory Surgical Centers Market

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georgettebaker4569 · 6 years ago

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The Rise of BigTech in Healthcare | Blog

A couple of weeks ago, my colleague and partner-in-crime, Abhishek Singh recapped his healthcare IT’s annual jamboree.

Now, I want to expand on one of them – how BigTech firms are homing in on healthcare (got to love almost-alliteration). Here are my key observations on how different BigTech firms are approaching the business of healthcare, based on what I saw and heard at HIMSS.

Google

The focus for the Mountain View-based company has been to develop a secure and compliant cloud platform, which has tools unique to the healthcare industry. It claims that the Google Cloud Healthcare API has significant momentum in the industry to really bring silos of data together. It has enabled FHIR integration as well. The general release of the platform is still sometime away though. On a lighter note, while Google is using AI to solve complex and messy problems in a range of industries, its HIMSS booth had a demo to help address the much dreaded fax plague in healthcare, allowing users to fax medical information to Google Drive, the company’s cloud storage service (as someone on Twitter pointed out), following Eric Schmidt’s observation that healthcare is still in the “stone age.”

Microsoft

The company, reinvigorated under Nadella’s leadership, is taking a smart approach to healthcare across two levers:

Utilizing broader technology bets with healthcare-specific use cases. It launched a service to help healthcare firms move large sets of patient data to its cloud (Azure) and connect with other systems. This is one of several attempts to connect patient health records in the cloud. It announced the availability of its healthcare chatbot in the Azure marketplace, as well as the launch of an API for FHIR in Azure

Leveraging a partner ecosystem. Microsoft is taking an ecosystem-based approach to accelerate healthcare adoption, using partners such as CitiusTech, DXC Technology, and Philips, to develop more cases on its technology offerings.

Oracle Health Sciences

Oracle is taking a dual approach – doubling down on a focused play in healthcare data and analytics, as well connecting with its life sciences focus – as the ecosystem converges. It announced integration between Quorum’s institutional review board (IRB) and goBalto, its recent acquisition focused on clinical trial site selection and activation. And it introduced Connected Care, a telehealth and remote patient monitoring tool initially aimed at improving stroke outcomes. Its other big focus was on Oracle ERP Cloud as the single stop solution to help unify a health system’s enterprise systems (HR, financial, supply chain) on an integrated platform.

Salesforce

Salesforce has bet big on verticalizing its CRM strengths to help deliver personalized patient experiences (CRM as the gateway to digital transformation.) It already has a bunch of use cases across the care lifecycle. Its focus is now on leveraging a partner network and adding more healthcare-centric functionality to its core set of products. For instance, it launched a feature to add social determinants of health information to patient profiles to improve outcomes. It also announced Fairview Health Services as a client deploying Health Cloud, Marketing Cloud, Heroku, and MuleSoft to centralize and manage patient touchpoints. Building from its progress at HIMSS18, where it collaborated with Cerner, Salesforce also announced new healthcare solutions using Health Cloud, built by consulting partners such as Accenture, Deloitte Consulting LLP’s Deloitte Digital, Huron, IQVIA, Silverline, Simplus and Torrent Consulting.

Uber and Lyft

Both ride sharing companies had a presence on the exhibition floor, and Lyft made a major splash and co-sponsored the opening reception as well. The common use cases they’re both addressing are around social determinants of health. An example is Lyft’s partnership with Allscripts (Lyft Concierge) to help patients get to appointments and lead healthier lives.

Ever since Amazon formally announced its move to shake things up in healthcare, the industry has been abuzz with an equal mix of anticipation and trepidation. While many are fixated on the idea that Amazon will take a Customer Experience (CX) route to healthcare, similar to its ecommerce disruption, I think this belief is misplaced. Why?

As we noted in our earlier analysis, Amazon is best placed to solve more messy problems in healthcare. Not many people realize how Amazon is already playing a role in reshaping healthcare’s supply issues. For instance, more than half of the products available on the Amazon Business platform are medical commodities such as syringes, IV bags, forceps, etc. It is targeting healthcare organization’s tail spend (typically 20 percent), which is focused on purchasing, pricing, suppliers, etc. This plays into its deep strengths in warehousing, distribution, and logistics.

At the end of the day, Amazon is just one of the growing number of technology companies looking to tap into the $3.4 trillion U.S. healthcare market. If HIMSS19 was any indication, BigTech is only going to accelerate its focus on solving key issues, with an ecosystem-driven approach. My bet for HIMSS20 is for someone showcasing curated Netflix content for improving mental health. One can always dream!

The post The Rise of BigTech in Healthcare | Blog appeared first on Everest Group.

from pesonivt2a https://www.everestgrp.com/2019-03-the-rise-of-bigtech-in-healthcare-blog-49280.html/ via http://www.rssmix.com/

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randybenedict · 6 years ago

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Insulet taps former Medtronic finance exec McMillan as CFO | Personnel Moves – January 8, 2019

Insulet (NSDQ:PODD) said yesterday that it tapped former Medtronic minimally invasive therapies CFO and finance VP Wayde McMillan as its new chief financial officer, replacing Michael Levitz.

The Acton, Mass.-based diabetes-focused medtech company said that McMillan will join the company in February and that Levitz will continue as an advisor for a period following the succession to ensure a smooth transition. McMillan will officially take the role of CFO on March 1.

Prior to joining Insulet, McMillan held executive roles in finance at Medtronic, having come to the company during its acquisition of Covidien in 2015. After the acquisition, McMillan helped reorganize the new acquisition into the Medtronic Group structure, the company said.

“We are excited to welcome a leader of Wayde’s caliber to Insulet as the company transitions to profitability, expands internationally, and enters its next phase of rapid growth. Wayde has significant expertise scaling large organizations and a thorough understanding of the strategies we are pursuing globally to accelerate growth and build on our strong foundation. We look forward to benefitting from Wayde’s experience as we continue to position the company for long-term success and solidify our leadership in the global management of diabetes. On behalf of the board of directors and the entire company, I want to thank Mike Levitz for his numerous contributions, as well as his support during this transition period. Over the last four years, Mike has helped develop and execute our strategic imperatives, strengthen our infrastructure and capabilities in support of future growth, and generate exceptional value for shareholders. We wish Mike all the best in his future endeavors,” prez & CEO Shacey Petrovic said in a prepared statement.

“I am honored to join the team at Insulet, a company with a strong mission dedicated to improving the lives of people impacted by diabetes. I look forward to working alongside the Insulet leadership team and contributing to the company’s initiatives to drive growth, profitability and value creation for shareholders,” McMillan said in a press release.

Senseonics appoints Isaacson as CFO

Senseonics (NYSE:SENS) said yesterday that it named Jon Isaacson as its new chief financial officer, replacing R. Don Elsey.

Elsey will remain on with the Germanton, Md.-based company in an advisory role to support the transition and to assist in preparation of the company’s annual report filings for the previous fiscal year. Elsey is slated to stay on until his planned retirement date of February 28, or a later date if another agreement is made.

Prior to joining Senseonics, Isaacson acted as CFO of Edelman Financial Services from November 2017 to December 2018, and as managing director of private equity firm American Capital, the company said.

Livongo names Shapiro as CFO

Livongo said last week that it appointed board member and audit committee chair Lee Shapiro as its new chief financial officer, effective on February 1.

Shapiro currently serves as a member of the board and audit committee for Medidata Solutions and as the audit committee chair of Tivity Health, Mountain View, Calif.-based Livongo said. He also served at Allscripts Healthcare Solutions as president from 2001 to 2012, the company added.

“I couldn’t be more excited about working with Lee. His intimate knowledge of Livongo, his close working relationships with the leadership team, and his connections across the industry, including virtually every analyst in the healthcare and technology space, will allow us to rapidly accelerate our business and better serve our members and clients,” CEO Zane Burke said in a press release.

“Lee’s experience in scaling companies is a perfect fit for Livongo as the company moves to the next level. I speak for the entire team in sharing my enthusiasm in gaining Lee’s experience in building great companies for Livongo,” exec chair Glen Tullman said in prepared remarks.

“I have been impressed with what the Livongo team has accomplished in such a short time. As the company continues its rapid acceleration, my hope is to contribute in both financial and strategic ways to serve Livongo’s mission of empowering more people with chronic conditions to live better and healthier lives,” Shapiro said in a prepared statement.

Reva Medical lifts Elkolli to CFO

Reva Medical (ASX:RVA) said last week that it promoted Leigh Elkolli to the office of chief financial officer and corporate secretary, replacing Brandi Roberts who resigned, effective January 4.

Elkolli joined San Diego-based Reva Medical in August 2017 as finance senior director and corporate controller, the company said. Elkolli previously worked with privately held biotech company Avidity Biosciences, serving as finance director.

Wright Medical shuffles the exec roster

Wright Medical (NSDQ:WMGI) yesterday announced a number of internal organizational changes, including lifting current prez Kevin Cordell to the position of chief global commercial officer and exec VP and promoting senior VP and CFO Lance Berry to the newly created position of chief financial and operations officer and exec VP.

Cordell joined Wright in 2014, and has helped integrate the U.S. commercial teams of Tornier after the companies merged, Wright said. In conjunction with his promotion, current int’l prez Peter Cooke will assume the role of president of emerging markets, Australia and Japan and current upper extremities marketing VP Steve Wallace was promoted to int’l prez, the company said.

In his new role, Amsterdam-based Wright Medical said that Berry will be responsible for global finance and accounting, operations, quality, regulatory, information technology, strategy and corporate development.

“Wright Medical is quickly becoming a $1 billion high-growth medtech company that is built to win in the fast-growing Extremities and Biologics markets. As we continue to grow and progress, there is a need to better align our team to support long-term revenue growth, profitability and day-to-day execution. At the same time, we must stay strategically focused to maintain our technology differentiation and leadership positions. It is with these goals in mind that I am creating two new executive vice president positions, reporting to me, to advance our global commercial focus and to further transform our global business processes. With significant opportunities ahead, these organizational changes will allow for further alignment of our cross functional organizations with a stronger and sharper focus on long-term growth and profitability, including a greater emphasis on the emerging market opportunity. I am looking forward to working with Kevin and Lance in their new leadership roles and am confident that these appointments, along with our other organizational changes, will further bolster our ability to capitalize on the growth opportunities in front of us and accelerate our market performance,” prez & CEO Robert Palmisano said in a prepared statement.

Flow control co. Circo taps Smith & Nephew ex-US CFO Chahine as SVP, CFO

Pressao Medical taps Pak as new CEO

TAE Life Sciences adds Hill as COO

Quanta Dialysis Tech names Komenda as chief med officer

Bonesupport appoints Vikner as global marketing & communications exec VP

Cerus Corp taps Moore as manufacturing operations and supply chain senior VP

AxoGen names Crisman as US sales VP

GI Dynamics appoints Linhares as clinical & regulatory affairs VP

The post Insulet taps former Medtronic finance exec McMillan as CFO | Personnel Moves – January 8, 2019 appeared first on MassDevice.

from MassDevice http://bit.ly/2FfE9BS

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your-daiku-blog · 7 years ago

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Vidyoと米Allscripts、患者エンゲージメントポータル”Follow My Health”上で対面の遠隔診療機能を提供開始

[VidyoJapan] [画像1: https://prtimes.jp/i/24911/8/resize/d24911-8-157082-1.jpg ]

Allscripts社のGeneral Managerであるキム・サウス氏は次のように述べています。「Allscriptsは、患者が能動的に関与できる充実したプラ… Source: PR TIMES

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greggsdiabetes-blog · 8 years ago

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Five predictions for health tech and services in 2017

New Post has been published on http://www.greggsdiabetes.com/predictions-health-tech-services-2017/

Five predictions for health tech and services in 2017

1. The 21st Century Cures Act makes “Real World Evidence” a buzzword in pharma and payer circles, and justifiably so

For the uninitiated, “Real World Evidence” (RWE) is a term that has received much and attention and debate as a core component of the 21st Century Cures Act: a bill that received much press coverage in Q4 2016. The term refers to health care information about the use of a drug after it has been approved by the FDA and prescribed to patients in the “real world.” This data is usually derived from electronic health records, claims databases, and patient-reported registries. Given the several ramifications of the Cures Act, 2017 will see pharma and payers clamor to acquire solutions to harness the power of RWE, creating new revenue opportunities for incumbents and early stage companies.

Amongst its many regulations, the Cures Act speeds up the FDA New Drug Approval process while earmarking short term funding for other health related programs like NIH research, mental health, and Joe Biden’s cancer “Moonshot” initiative. The Act passed in overwhelmingly bipartisan fashionwith a 295 – 14 vote in the house. Perhaps the most subtle, yet profound component of the law allows Pharma companies to do post-market launch research around “real world use” (read: off-label) of drug products. If data suggests positive outcomes of off label use, this evidence can be used to expand the indications of use for that drug. This game changer will allow biopharma companies to save tens to hundreds of millions of dollars as the previous standard practice of expanding indications required re-running costly randomized control trials.

In addition to expanding indications, there are a host of other biopharma use cases for RWE highlighted in the below QuintilesIMS schematic where the case is made for a Billion dollar opportunity per pharma client.

From a payer perspective, the impact of expanding indications will be immediate, but the looming hazard is the sheer volume of high cost, specialty drugs and biosimilars coming to market sooner than ever before. To mitigate the uncertainty of the value of new, high-cost drugs, Payers are turning to value based contracts powered by RWE. A great example is my former employer, Harvard Pilgrim Health Plan and their CMO Michael Sherman, who has pioneered a series of value based contracts for high cost cholesterol and congestive heart failure drugs.

Given the above catalysts, there is a clamoring in both biopharma and payer circles for solutions to harness the power of RWE. Answering this call are a score of companies who are focusing on “value based” therapeutics analyses. One exciting company with significant market traction focused exclusively on RWE is NYC based Aetion (Arrivi, Lakestar). The company, founded by Harvard pharmacoepidemiologists and Wall Street data scientists, is pioneering the concept of “Rapid Cycle Analytics” in healthcare. On behalf of its pharma and payer customers, the multidisciplinary team performs real-time simulated studies drawing on terabytes of distributed international data sets. With statistical precision, the company can perform comparative effectiveness studies and reproduce the results of large scale clinical trials with 10x the speed of traditional methods of database programming, statistical modeling, and analysis.

There are a handful of health tech analytics companies previously focused on biopharma market access, reimbursement, and R&D efficiency that are now reorienting around the RWE use case. Some notable early stage tech companies here are GNS Healthcare (Cambia/Echo, Alexandria) and Truveris(Canaan, New Leaf, First Round). In addition to these early stage companies, the Large HCIT Conglomerates (QuintilesIMS, Optum, Truven/IBM, Inovalon) and traditional consulting firms (Avalere, ZS Associates, Decisions Resources Group) are starting to devote significant resources to this emerging opportunity in RWE and are likely acquirers in this space.

Special mention in this category goes to Flare Portfolio company, Health Verity. The company is led by successful serial entrepreneur Andrew Kress, who sold his last health data start up SDI to QuintilesIMS in 2011. Health Verity is pioneering new ways for large healthcare enterprises to buy and sell rich healthcare data. By liberating, enriching, and marketing previously siloed patient data, Health Verity is on pace to become a market leading supplier of the RWE mentioned above.

2. Clinical Decision Support moves into the world of Prescriptive Analytics and finally takes root

The delivery of scalable, patient centered, evidence based clinical decision support (CDS) to entire populations has been viewed as one of the “Holy Grails” of health tech. This promise has led to a score of CDS companies being built on the way to creating a $500M market for CDS solutions. But given the universal appeal for CDS in the addressable market of providers and payers, some would argue that the opportunity has been largely undershot. In the following paragraphs, I’ll attempt to make the case for why 2017 is the year that CDS solutions begin to overcome their previous barriers and finally take root in the market through incorporation of big data and cognitive commutive resources.

It is estimated that up to 50 percent of medical care for chronic conditions does not adhere to evidence-based medicine/guidelines (EBM). This statistic is compounded by the fact that 86 percent of all US healthcare costs are a result of complications of chronic disease. When analyzing the high prevalence of non-EBM in chronic conditions such as cardiac disease, diabetes, and renal disease, its generally accepted that systematic adoption of patient centered EBM portends improved outcomes and potential cost savings.

CDS 1.0 saw the health tech industry simply digitize long lists of clinical guidelines into workflow tools. A common tech manifestation of this trend was the “order set.” Order sets are essentially checklists or protocols that direct a clinician to order certain tests and medicines when they encounter a patient with a certain clinical condition (e.g. A CHF or COPD order set). A notable company from this era was Zynx Health, co-founded by CDS Veteran and Cedars Sinai Chief Clinical Transformation Officer Dr. Scott Weingarten. Zynx was ultimately bought and sold twice, first by Cerner, and then subsequently to Hearst Media. Criticisms of this first wave of CDS companies was a lack of patient-centeredness. The guideline-based recommendations did not change from unique patient to the next, which led to providers decrying one-size fits all “Cookbook” medicine.

I would contend we are starting to see CDS 2.0 with early stage companies pioneering the relative new trend of Prescriptive Analytics. These new entrants are combining predictive population health analytics with that of evidence based guidelines and compiling these data sets to make patient-centric recommended interventions pertinent to a patient’s current condition. This new wave of CDS companies are using virtual data warehousing, natural language processing, and Cognitive computing to incorporate disparate data sets, determine causative factors and predict outcomes.

There are a handful of next generation CDS companies that are attacking varying elements of the care spectrum using the prescriptive analytics strategy. In the Care Management space, an exciting early entrant is the stealthy, NYC-based HealthReveal, founded by Dr. Lonny Reisman. Prior to seeding and starting HealthReveal, Lonny served as chief medical officer of Aetna after his start-up Active Healthwas acquired by Aetna for $400M. HealthReveal is predicated on the ability to identify individuals in a population who are not receiving evidence-based care, then recommending evidence-based interventions, called “Reveals,” to the responsible clinician or care manager. Two other notable players in the care management space are venture-backed Lumiata (Khosla, Intel, Sandbox) and Atlanta based Jvion (Eastside). Led by CEO Ash Damle, an MIT trained data scientist, Lumiata company is pioneering the use of AI to identify populations that are at highest risk of adverse clinical outcomes, and directing care management through the codification of the world of clinical evidence. Jvion is harnessing their cognitive clinical success machine to serve a variety of use cases from preventing readmissions to driving success in value-based payments.

Two companies that are exclusively focused on CDS at the patient bedside through integration with Providers’ EHR and ordering systems are Stanson Health and PeraHealth. Stanson Health (Cedars Sinai), co-founded by previously mentioned Scott Weingarten is a continuation of his work at Zynx. Stanson attempts to reduce low value and unnecessary care by pinging clinicians with context-driven alerts and prompts at the point of care. PeraHealth (Mainsail) provides real-time CDS tools that are based on the Rothman Index: a validated clinical measure of patient condition/stability based on 26 independent variables. With an installed base of 80 hospitals, PeraHealth helps clinicians better predict and anticipate transitions in care, readmissions, and morality.

There are a host of large legacy players who will continue to speak to the opportunity in clinical decision support, most notably the large EHR Vendors (EPIC, Cerner, Allscripts, Athenahealth) as well as HCIT stalwarts (IBM/Watson, Optum). Given the platform nature of these companies, it is likely that they will be acquirers of these next gen CDS models that will continue to come to market in 2017.

3. MACRA spells the end of the standalone primary care provider and health tech looks to fill the void

In late 2016, CMS overrode the way Medicare physicians received payment with the passage of MACRA (Medicare Access and CHIP Reauthorization Act). The legacy approach to physician payment, known as the Sustainable Growth Rate (or “doc fix”), was based on a fee for service backbone. MACRA details how physician payment and its adjustment over time will occur after 2018. These payment adjustments will be based on two value-based criteria: involvement in Alternative Payment Models (APM – such as ACOs and CMMI demonstration projects) and a Merit-based Incentive Payment System (MIPS). With MACRA reporting to begin in 2018, I predict that 2017 will see increased market adoption of health tech solutions to manage and automate primary care operations.

Prognosticators familiar with nominated HHS Secretary Dr. Tom Price’s preferences predict that MACRA will remain unchanged in the new administration given its broad bipartisan support. What may change though, is shifting of mandatory APM rollouts such as the CJR (Complete Joint Replacement) demonstration project and cardiovascular bundles to optional/voluntary participation. This switch to voluntary participation is possible because the APM component of MACRA is a bonus payment until 2026, when it then becomes a requirement and a lion’s share of the payment adjustment schedule. The below chart shows the dollar flows in typical APM structure for the average PCP.

For the next 10 years, MIPS (Merit Based Incentive Payment System) will become the required, default system of clinician payment adjustment. The MIPS adjustments start at a (+/-) adjustment of 4 percent of Medicare revenue, but ultimately grow to (+/-) 9 percent by 2022. Said another way, a clinician can stand to gain a bonus or a dock in pay equal to the adjustment figure in a given year. The MIPS system is based on four components of reporting of care of varying significance: quality, value-based payment practices, meaningful EHR use, and clinician improvement activities.

Compliance with MIPS reporting and achieving success in target measures creates a significant burden requiring dedicated infrastructure. Independent primary care groups will understandably struggle to comply and succeed in a post-MACRA world. Even large integrated practices will require new workflows given the potential 10-plus percent swings in Medicare revenue. Given the need for new infrastructure, I predict we will see the continued trend of consolidation of independent practices and entry by health tech/service start-ups offering MACRA compliance and optimization services.

The last five years have seen emergence of a spectrum of primary care practice management/value based care enablement offerings in the market. Three well-funded leaders in this space are Aledade(Venrock, GV, Biomatics), Village MD (Oak HC/FT), and Lightbeam Health (Hearst, 7 Wire). Y Combinator alum Able Health and Greenville based Chartspan (Iron Yard), represent new entrant, pure play MACRA enablement solutions. There are a host of start-ups who have pioneered Chronic Care Management (CCM) reimbursement code submission that are also well positioned to power MACRA compliance. Two notable players in this space are CareSync (Greycroft, Harbert, Merck GHI) and MD Revolution (Jump). I predict that this is just the tip of the iceberg, and venture investors will see a flood of new entrants combining aspects of the above business models to serve the growing need of primary care practices in a post-MACRA world.

4. Start-ups develop a “high risk” appetite and target “node” conditions in high risk populations such as Medicare Advantage and Dual Eligibles

Some would consider that the “First Act” of Digital Health innovation (2011 – 2015) was heavy on hype and light on substance. Quantified self was the battle cry with a focus on the “worried well” population who have relatively low average annual healthcare expenses of $4,400. Many entrepreneurs and investors bought in, with decidedly mixed results. Veterans from this era have learned that tech in healthcare requires a more utilitarian approach: there must be a valuable “use case” or core costly problem being solved to generate a willingness to pay (WTP). A great example of this WTP is care management in the high cost populations of Medicare Advantage and Dual Eligibles. By the sheer number of medical conditions in these populations, management is problematic with average total medical expense ranging from $10,000 to $30,000 per year. I predict that 2017 and the “Second Act” of digital health will see a continued trend of entrepreneurs gravitating towards the sickest and highest cost members of our population, delivering valuable tech enabled solutions for “node” conditions that drive costs for individual patients.

An interesting phenomenon that is emerging amongst many successful start-ups targeting high-risk populations is the focus on what I’m calling a “node” condition. These “node” conditions (e.g. a terminal illness, end stage renal disease, chronic pain, behavioral health, and frailty) are the most advanced in a patient’s medical history and serve as the cost driver condition for a patient. Because of this centrality, the specialty care team responsible for the “node” condition can best manage the total cost of care for the patient. This is the concept behind the “specialty medical home,” a model being piloted across the country. Many spectators have doubts as to whether specialist physicians can truly manage the total cost of care of patients, and entrepreneurs are rushing in. Early stage companies are designing full stack, tech-enabled services to manage these “node” conditions, and then inking contracts with payers/providers that allow start-ups to “go at risk” and participate on the upside of potential savings realized.

Two notable early stage companies managing care in patients with terminal illness are Landmark Health (Francisco Partners) led by former Accretive Investor Adam Boehler, and Nashville based Aspire Health (GV, Oak, Sandbox), co-founded by Senator Bill Frist. With the end of life period being the costliest period of all, these companies are providing palliative care services that dramatically lower costs as they aid patients and families transition from chronic illness to palliation.

An interesting early stage company attacking the high cost node condition of end stage kidney disease is Cricket Health (First Round, Boxgroup). Co-founded by former LinkedIn exec Arvind Rajan and Aberdare Partner Vince Kim, the company’s HOPE platform identifies patients at risk for advanced kidney disease and delivers a navigation service that educates and attempts to lower the cost of care for these patients.

Two additional node conditions that are often connected and have a high prevalence in these high-risk populations are chronic pain and mental illness. It’s well documented that patients with chronic pain have healthcare costs that are two to three times that of the general population. Two companies that are focused on delivering tech enabled management solutions to this population are MOBE and Axial. MOBE provides a unique solution for payers that identifies patients with chronic pain and delivers comprehensive CBT and coaching to improve health outcomes. Venture-backed Axial Healthcare (Oak, Sandbox, 406) is developing comprehensive analytic solutions that monitor prescriber and patient behavior to help navigate high-risk patients to receive care at centers of pain excellence (COPE). I’ve written extensively about behavioral health tech companies that are delivering much needed, cost saving solutions to these high-risk populations.

A final special mention is in the emerging awareness of the node condition of frailty. Although seen as a natural progression of aging, there is a medical diagnosis that corresponds to frailty known as failure to thrive. Many start-ups are now rushing into the frailty space to provide services to delay this gradual decline and in turn, preventing high cost complications. Two special early stage mentions in this category are Welbe Health and Attuned Care. Bay Area based Welbe (F-Prime) is implementing the much-acclaimed PACE program which provides Medicare reimbursement for delivering common activities of daily living such as meals, transportation, and home care assistance. Chicago-based Attuned Care is providing comprehensive care services for the high needs populations of Assisted Living communities.

I predict start-ups in 2017 will continue to hone in on node conditions, and will be rewarded as payers and at-risk providers look to the market to deliver best in breed solutions to their populations

5. Health tech industry innovation will not waver over the next 4 years, it will subscribe to republican orthodoxy and free market forces

Most of the preceding predictions will be impacted by the election of a Donald Trump administration, and perhaps more importantly, a systematic republican transfer of power. Post the 2016 election, Republicans have the majority in both houses of congress: Senate (R – 52, D – 46, I – 2) and House (R – 241, D – 194). On a state level, there is a predominance of republican governors (R – 33, D – 16, I – 1)and republican controlled state legislatures (32 states – accounting for 61 percent of the population). This is important given that a likely GOP ACA replacement plan would leave much fine-tuning of policy to the states. It should be no surprise then that traditional republican policy will prevail, and prudent entrepreneurs and investors should prepare for that.

For the next four years, we should expect legislative reforms that reflect traditional republican principles, specifically: deregulation and less federal government oversight of industry, privatization of federal programs, and re-appropriation of funds from entitlement programs. We should expect a very active climate of legislation as both the legislative (Congress) and executive (Health and Human Services) branches of government promise to enact healthcare reform. The key representatives of both branches have made attempts to replace Obamacare and are on record regarding their wish lists. Representing the legislative branch, Speaker Paul Ryan has spearheaded a concerted effort on behalf of his congressional caucus and think tank groups to author his “A Better Way” series for his vision on the elements of a repeal plan. Representing the executive branch, HHS nominee Dr. Price has previously submitted his version of a replacement plan — Empowering Patients First Act, HR 2519— four times in four different congresses. Finally, the last republican congress actually passed an ACA repeal bill – Restoring American Healthcare Freedom Reconciliation Act of 2015, HR 3762 — that was ultimately vetoed by President Obama. Ultimately the details of the ACA replacement plan will become clear in the months to come, but the essential elements of the plan will be held in the plans noted above.

And as expected, in joining my brethren of investor health tech bloggers, I am compelled to include my guesses at what replaces the ACA. Sticking with the trends approach, I’ve selected key items that will face either headwinds or tailwinds in the new congress. I’ve also included the sources that led to these predictions.

Overall, our team at Flare Capital is very bullish about continued value creation in the healthcare sector through traditional free market forces. Whereas the last eight years have seen healthcare innovation driven by the federal government, we believe the market will now become the leading driver of change. We predict that enterprises will attempt to improve their bottom line, gain market share, and achieve differentiation through continued adoption of innovative health tech and services. We believe that many big businesses will be built by providing solutions to this end for the multi-trillion dollar US healthcare market. We hope that this market-driven lens, combined with the preceding sector specific predictions, provides all participants a guide to navigating dramatic change in the coming year.

By Dan Gebremedhin MD, MBA

January 27, 2017

About the author: @DanGebremedhin is a Principal at Flare Capital Partners, an early stage Health Technology and Services focused VC Firm. He is a practicing physician at the Massachusetts General Hospital, and previously served as an Associate Medical Director at the Harvard Pilgrim Health Plan, and spent five years as an entrepreneur in the Health IT Industry.

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