Medicaid Tech Strategy: From Data Collection to Value-Based Care [Video] Presented by Sellers Dorsey

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Featured Story   Are Hospitals Ready for Epic's Agent Factory? The skinny Last week at the HIMSS conference in Las Vegas, Epic announced its new "agent factory" — a drag-and-drop platform which lets health systems build and deploy their own AI agents inside Epic. The goal The new agent factory is meant to orchestrate workflows across the entire health system and make it easier to develop cross-system AI agents. It's designed for rapid experimentation, with new tools sometimes going from concept to deployment in just days or weeks, noted Phil Lindemann, Epic's vice president of data and research. "It's for the customer who says, 'I've got new ideas' — they're at the bleeding edge, they've got these great new care models they want to implement. Factory basically gives them a standardized way to do that, with the existing guardrails and controls for them to deploy agentic workflows across the entire system," he remarked. Jackie Gerhart, Epic's chief medical officer, added that the factory puts hospitals "in the driver's seat" by allowing them to design tools and implement changes based on the problems they're trying to solve. Rather than vendors dictating solutions, providers themselves can shape their own workflows and innovations. Are providers prepared enough? Another leader in the EHR space, Adam Farren, CEO of Canvas Medical, applauds what Epic is doing and thinks the company is taking the right approach — but said that he doesn't think hospitals are ready to take advantage of the platform yet. He believes providers have to first demonstrate early wins with "narrow agents" that solve specific problems before attempting broader workflows. He also urged healthcare organizations to embrace the fact that unlike earlier versions of automation, agentic AI can ingest and interpret context. That context includes the patient's medical record, the hospital's protocols and standing orders, and the history of similar clinical encounters. Farren thinks hospitals will need to start with narrow, high-impact agents, as well as fully leverage patient and organizational context, in order to make agentic AI truly useful and safe. — By Katie Adams Sponsored   Medicaid Tech Strategy: From Data Collection to Value-Based Care [Video] Presented by Sellers Dorsey Sellers Dorsey CTO Richard Queen talked about how advanced AI tech can be used to reduce operational pressures with Medicaid. He said it's not the algorithms that have changed so much as the ability to scale them. Watch Now! Top Stories   A Drug Approval Without a Clinical Trial The news The FDA expanded the label of the generic drug leucovorin to include the treatment of cerebral folate deficiency, an inherited disorder that leads to developmental delays. It's the first approved therapy for this ultra-rare disease. Leucovorin, which was initially marketed by GSK under the brand name Wellcovorin, was first approved for reducing side effects from cancer treatment. The drug Leucovorin is a small molecule designed to serve as an analog for folate. GSK no longer makes this medication, which remains available from generic drug manufacturers. Why it matters Last September, the FDA said it was looking to make leucovorin available for treating autism based on its review of published literature in cerebral folate deficiency. The agency said those with this deficiency have been observed to have developmental delays with autistic features. Even though GSK no longer makes leucovorin, the FDA needed the company to submit an application seeking to expand the drug's label to a new indication. There were no new clinical data for the drug. The FDA review spanned only published literature, which ultimately proved insufficient to support a broader label that includes autism. Soundbite "The approval of leucovorin for FOLR1-related cerebral folate transport deficiency (CFD- FOLR1) demonstrates the FDA's commitment to rapidly identifying effective treatments for ultra rare diseases while maintaining the same evidentiary standards for approval," said Tracy Beth Hoeg, acting director of the FDA's Center for Drug Evaluation and Research. "It also provides a good example of how observational or 'real world' evidence can lead to an FDA approval when the product is shown to provide clear clinical benefit compared with what is seen with the natural history of the disease." —By Frank Vinluan Isaac Health Introduces New Virtual Program to Reduce Dementia Risk The news Isaac Health, a virtual memory clinic, unveiled a new eight-week virtual group series on Wednesday to reduce the risk of dementia. The program The new program — called the Lifestyle Medicine and Better Brain Health program — is intended for those proactively seeking to reduce dementia risk or slow cognitive decline, particularly those prone to dementia and their caregivers. The weekly sessions are led by clinicians and are available in individual, couple or family formats. They're focused on a variety of strategies for brain health, including sleep, nutrition, physical activity, cognitive engagement, vascular risk factor reduction and stress management. The program can be covered by most insurers but depends on individual plan benefits. Soundbite "Growing clinical research shows lifestyle interventions, particularly as part of a structured program, can meaningfully support cognitive function," Dr. Joel Salinas, co-founder and chief medical officer at Isaac Health, told MedCity News. "Isaac Health's own patients were asking for more proactive, medically grounded guidance. Since brain disease-related changes can begin decades before symptoms appear, there's a critical intervention window the current standard of care isn't addressing." — By Marissa Plescia Mark Cuban and eMed CEO Throw Some Shade On Those "Marketing Companies" "They start with R's and H's, a couple of H's" Linda Yaccarino, CEO of eMed Population Health, and Mark Cuban, co-founder of Cost Plus Drugs, were at SXSW talking about their new collaboration, where they drew a contrast between their approach to GLP-1 drugs and some unnamed companies. Both Cuban and Yaccarino hinted at the companies without naming them, but there was no doubt that the companies being referred to were Ro and Hims and Hers. The contrast, according to Yaccarino, is largely around a high-touch approach with regular supervision of people taking these medications, and asking accountability from them, too. Another point of contrast was in marketing expense or the lack of it, Cuban said.  The two committed to bringing these medications to "as many people as possible at the cheapest price." Through a collaboration, Cost Plus Drugs will become  one of eMed's distribution partners. Some news left out While the two highlighted their offerings as the more salient approach, combining affordability, care, and community for employees on GLP-1 drugs, Yaccarino in particular provided commentary on the frenzy around compounded GLP-1 drugs that didn't need FDA approval. These drugs were in use during the branded GLP-1 shortage and could be accessed very easily with little oversight. That world has changed since the shortages have receded, with branded drugmakers working to expand coverage and lowering their prices. There are also lawsuits against compounded pharmacies to rein them in. However, some are choosing to kiss and make up — Novo Nordisk dropped its lawsuit against Hims and Hers for its GLP-1 practices and announced a collaboration instead. The changing world wasn't acknowledged on the panel.   Pivot Podcast Tackles Men's Health and Testosterone Replacement Therapy Why is Testosterone Therapy Regulated? Shalin Shah, CEO of Marius Pharmaceuticals, explains that a doping scandal in the Olympics led Congress to regulate the use of testosterone as a controlled substance. In fact, concerns about the use of steroids allowed Congress to pass the Anabolic Steroids Control Act of 1990, lumping in testosterone with steroids. This act classified testosterone as a Schedule III controlled substance. Marius Pharmaceuticals makes an FDA-approved oral drug that is approved to treat adult men with low or no testosterone levels due to certain medical conditions. Currently testosterone is regulated as if it were an opioid, Shah said. Why did the FDA hold a hearing about Testosterone Replacement Therapy? Shah, who testified at the hearings, said the concerns about the drug are overblown and in reality, TRT therapy for men who produce low or no testosterone, has numerous benefits. He said studies have shown the benefits on TRT around diabetes therapy and the prevention of diabetes or the remission of diabetes.  Meanwhile, testosterone's potential for increasing cardiovascular risk is not backed by evidence. Shah pointed to the Traverse study, which was the largest randomized placebo controlled trial ever done on testosterone therapy, which showed there is no cardiovascular risk tied to testosterone therapy. Results were published in the NEJM in June of 2023. So the FDA wants to hear the science and gather the evidence to perhaps make a decision to deschedule the drug. The Trump administration was the one to change the recommendations on hormone replacement therapy for women after many women avoided HRT because of a perceived cancer risk due to the 2002 Women's Health Initiative study. Soundbite "WHI was a flawed study. From the get go, it basically caused hysteria around female hormones, and two decades of females have lost out on hormone therapy because of the flawed headlines that came out of there. Any other administration could have changed this. But this one did for the benefit of the female population," Shah said.  Video   What Will Happen Inside the Nvidia-Lilly Innovation Lab? What won't happen in the Nvidia-Lilly Building in South San Francisco? If you think AI drug discovery, you may be wrong.

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The Lethal Cost of Regulatory Perfection in Rare Disease Congress has already granted the FDA flexibility in evaluating therapies for rare diseases, including the use of real-world evidence and natural history data when traditional large-scale trials are not feasible. The question before the FDA now is not if those tools can be applied – they can – but if the agency has the courage to use them before more patients lose their autonomy, and ultimately, their lives, to rare disease. How Moneyball Economics in Healthcare is Taking Shape with AI     Full schedules and broad outreach look productive, but they are a mirage. Real value comes from using data to hunt for the patients who matter most: the ones whose care drives stronger outcomes and higher margins. Debunked Episode 24: PBM Reform Brainstorm, Elevance Faces CMS Penalty Risk, Hims & Hers' Eucalyptus Deal Takeaways In the latest episode of the Debunked Podcast, the discussion revolved around the Break Up Big Medicine legislation to rein in healthcare giants and ways to introduce meaningful PBM reform.

Podcast   Debunked Episode 24: PBM Reform Brainstorm, Elevance Faces CMS Penalty Risk, Hims & Hers' Eucalyptus Deal Takeaways In the latest episode of the Debunked Podcast, the discussion revolved around the Break Up Big Medicine legislation to rein in healthcare giants and ways to introduce meaningful PBM reform. View Now

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