Is Your Healthcare Organization Ready to Implement AI? Presented by Nordic

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Featured Story   How to Make Drugs More Affordable and More Accessible The news Consumers have choice and competition for most of their purchasing decisions, but not so much for drugs. Alternatives are emerging for some products through direct-to-patient channels, but these channels only cover certain products. And for rare diseases treated by cell and gene therapies, therapy selection is handled by a doctor and there isn’t much choice at all. These problems were discussed during a drug costs panel discussion at MedCity News’ Bullseye conference in Chicago. Why this matters The amount of money that Americans spend on drugs continues to grow but many patients still don’t get the drugs they need. High prices are just one factor. Pharmacy deserts abound throughout the country, and not just in rural areas. High prices and lack of access are among the reasons patients skip or ration medications. That has implications for patients and payers. Soundbite “The science is making unbelievable leaps and bounds in terms of what we can deliver to patients, but when it actually comes to paying for these things and supporting the patients in the way that they need to get these therapies, that’s, where we have the biggest gap today,” said Annie Collins, co-founder and chief commercial officer of Aradigm Health. —By Frank Vinluan Sponsored   Is Your Healthcare Organization Ready to Implement AI? Presented by Nordic There is an abundance of enthusiasm for the potential of AI applications to transform healthcare. But even when a pilot succeeds, the challenging task of advancing the technology to implementation varies at each institution. This report from Nordic, highlights the findings of its AI readiness survey, produced in collaboration with Modern Healthcare. Download it today! Top Stories   What Health Tech Investors Love in Founders — and What They Can't Stand The skinny Digital health investors have heard nearly every founder pitch imaginable, including many that start along the lines of "healthcare is broken, and I'm the one who's going to fix it." During a panel this week at MedCity News’ Bullseye event in Chicago three healthcare investors made it clear that this kind of certainty is often a warning sign, not a selling point. What they're actually looking for is closer to its opposite — founders who are confident enough to have conviction, but self-aware enough to know what they don't know. “We love a pivot” Anna Fagin, a partner at Town Hall Ventures, said her firm has come to actively favor entrepreneurs who've pivoted before, or even failed outright. In a sector where both regulation and technology are moving faster than they used to, she said that kind of adaptability represents something more valuable than a founder who has never had to change course. “It's very brave to be an entrepreneur but be open-minded simultaneously — sort of recognizing that every decision they make isn’t going to be the right one. So we love a pivot these days,” Fagin declared. Discipline is key… Another panelist — Dana Watt, a partner at Breakout Ventures — noted that in the current startup environment, adaptability must also be balanced against discipline. With AI tools lowering the barrier to trying a little bit of everything, Watt said too many founders end up spreading themselves thin instead of building true advantage. What she looks for instead is a founder with a "crystal clear understanding" of where their strengths lie, along with the resolve to treat that strength as a moat worth defending. …And humility is king Lisa Carmel, chair of business development at Mayo Clinic, agreed that self-awareness is often the deciding factor, especially for founders who haven't built a company before. "That incredibly valuable skill of being self-aware and recognizing their blind spots," Carmel said, is what separates founders worth backing from those who aren’t. She pointed to Vitestro, a robotic phlebotomy startup in Mayo's portfolio, as an example. Its first-time CEO recognized early on that the company lacked a U.S. presence, and brought on a former Solstice Capital partner specifically to fill that gap. That proactive gap-filling gave Mayo confidence in a founder tackling an especially difficult technical and regulatory challenge, Carmel explained. — By Katie Adams Priority Health Launches 2 Cancer Support Solutions with Color Health, Grail The news Priority Health, a Michigan-based insurer, announced Wednesday that it has launched two new cancer support solutions for employers in partnership with Color Health and Grail. The partnership The insurer serves more than 1.4 million members in Michigan, Indiana, Ohio and Wisconsin. The new cancer support solutions are available for large self-funded employers starting January 1. With the new solutions, Priority Health’s employer customers can offer cancer navigation, support and screening through Color Health’s virtual cancer clinic, as well as early cancer detection through Grail’s blood test. Employers can choose to offer one or both solutions. Color Health has a 50-state medical group. The company offers at-home cancer screening and testing, 24/7 access to clinical care and a care team focused on cancer. It provides support for diagnosis, treatment and survivorship, and its clinic is certified by the American Society of Clinical Oncology. Meanwhile, Grail’s blood test, called Galleri, screens for over 50 types of cancer in one test, including breast, colon, melanoma and stomach. — By Marissa Plescia The Cost Crisis in Women’s Healthcare Delayed, duplicated, unnecessary For a long time, women’s health has been looked at through a narrow lens of maternity, fertility and family planning. And while important, women’s health is not a one-time event. More than 60 percent of women in midlife are managing chronic conditions that require regular monitoring, treatment and care. However, in today’s fee-for-service healthcare system, women are bounced between specialists based on isolated symptoms, rather than looking at the full clinical picture and then determining the best treatment path. This results in delayed treatment, duplicate testing, unnecessary labs and imaging procedures, as well as a longstanding bias towards surgery/invasive procedures driving up costs. It also drives up costs for employers, health insurers and perhaps most importantly, patients. An immediate opportunity For employers and payers, this represents an immediate opportunity to bend the cost curve and improve care experiences and health outcomes for their members and employees. However, realizing that opportunity requires a fundamental shift in how we view, deliver and pay for care. Below are a few key building blocks that are essential to success: Look at women’s health as a unified cost category rather than a series of disconnected and episodic events. For payers and employers, this requires collaboration with health economics, claims/billing and data teams to create a comprehensive view of women’s health spend. Create a business case to get leadership buy-in. By creating a unified view of how women’s health costs accumulate over time, we can identify the true drivers and scale of cost, creating a clear mandate for action. Shift from reactive and episodic care to comprehensive, longitudinal care models. Many women’s health conditions require integrated, long-term support, but our care delivery model still treats the episodes like isolated events and symptoms, leading to duplicate imaging and testing. Prioritize strategic partners that take an integrated, whole person approach to address causes, not just the symptoms. Align incentives around the total cost of care and outcomes. Fee-for-service reimbursement rewards more visits, tests, and procedures, regardless of the outcome. Value-based care models create greater accountability across the care continuum, while delivering better outcomes and patient satisfaction, while lowering the overall total cost of care. Invest in partners that deliver clear, measurable ROI with value-based, longitudinal care models. — By MedCity Influencers Chevon Rariy and Kara Ellinger Video   Video: What did UHC CEO say in unprecedented meeting with reporters? Debunked: UnitedHealthcare invited reporters and influencers to their Minnesota HQ. Why? Hear the exchange between MedCity editor and the UnitedHealthcare CEO.

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Healthcare's Next Source of Alpha Is Moving Upstream The question is no longer whether healthcare innovation is accelerating. The question is where investors gain access to generate the strongest returns.

White Paper   Moving Beyond Reactive Healthcare: 5 Traits of Successful Healthcare Organizations Sponsored by League This new white paper highlights how healthcare organizations are transforming the way they manage untenable healthcare costs with innovative tech collaborations, from maternal health to improving the way they care for high-risk patients to developing AI tools in-house targeting internal needs.  View Now

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