Andy Mychkovsky

One key reason why healthcare technologies like AI, telemedicine, and software haven't structurally lowered costs or broadened access for the entire system after decades of experimentation (excluding pure financial engineering of payer contracts) is the limited reimagining of care delivery itself, with asynchronous telemedicine as a notable exception. In the same way that digitizing physical paper failed to exploit the capabilities of a new computing medium for word processing, hosting physician-patient conversations over video does not transform the actual delivery of care. In telemedicine, many of the inputs (e.g., clinician time) and therefore cost structures of in-person care persist, which is why we often see fee-for-service telemedicine companies struggle to achieve economies of scale (i.e., growing revenues non-linearly while growing costs linearly). Until we deconstruct the components of a medical appointment – from intake and triage, to chart review, history gathering, physical examination, diagnosis, treatment, and follow-up – we will continue to be underwhelmed by the disconnect between the transformative potential of these technologies and real-world patient/system impact. I’m optimistic that the emergence of reliable and performant medical AI agents will urge us to perform this deconstruction and redesign the fundamental building blocks of a “medical appointment.”

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As we move through 2024, the digital health landscape is undergoing a remarkable transformation. Here are the top trends that are defining the industry, and how Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) technologies are driving these changes: 1️⃣ : AGI's Advancements in Healthcare • AGI plays a key role in drug development to cost optimization. • RPM and CCM leverage AI/ML to process patient data • AI governance in CCM ensures transparency and addresses ethical concerns. 2️⃣ : Accelerating Data Interoperability • RPM and CCM enable unified patient records and advanced analytics. • Supports data exchange and meaningful insights across systems. 3️⃣ : Retailers as Healthcare Providers • Retail clinics are expanding into chronic disease management. • RPM and telehealth extend retailers' reach as healthcare providers. • CCM platforms integrate care pathways across settings. 4️⃣ : Digital Obesity Care and Personalization • RPM monitors lifestyle factors for a holistic obesity care approach. • CCM integrates personalized behavioral interventions for weight management. 5️⃣ : Nutritional Interventions in Healthcare • RPM tracks nutritional habits, providing insights for food-as-medicine. • CCM incorporates personalized dietary plans into care plans. 6️⃣ : Mental Health and Well-Being Solutions • RPM enables remote monitoring of mental health, enabling timely interventions. • CCM seamlessly integrates mental health support into chronic care. 7️⃣ : Women's Health Takes Center Stage • CCM allows personalized care plans and data-driven insights for women's health. • RPM provides valuable data to support women's healthcare decision-making. 8️⃣ : GenAI's Growing Role Across Healthcare - RPM and CCM facilitate GenAI integration, from diagnostics to treatment. - GenAI algorithms enhance clinical decision support. 9️⃣ : Convergence of Wearables and At-Home Devices - RPM enables continuous monitoring of vitals and chronic conditions through wearables. - RPM fosters increased patient engagement and active participation in care. Are you ready to transform your connected care offerings and stay ahead of the digital health curve? DM us now!!

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Should you sell your practice to a VC-Backed MSO Startup? tldr: - new VC-backed startups are forming MSOs to roll up independent practices - The pitch is physicians receive early liquidity from the roll up and are granted ESOP shares that can be used for retirement - Problem is the use of ESOPs with independent practices is not a new concept and has been used with large group practices since the 70's - ESOPs do not grant full ownership and in order for the shares to be valuable for retirement, the practice needs to run the same if not better post roll up - With VC-backed startups being primarily operated by non-physicians with zero clinical or medical practice experience, the likelihood of this happening is extremely low making the entire concept high risk However, there is a viable path for continued ownership + liquidity for independent practices. Check out the article to learn more. ⤵ https://lnkd.in/gmGvTYwP

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Investing in companies that fill needs for health systems is a growth opportunity for both delivery organizations and start ups. Some systems are jumping in on their own, while others are partnering with like minded systems or with established VC firms. While this is a relatively new trend for systems, health plans have been making similar bets for many years. The benefits of becoming a health system portfolio company can be significant. Data, access to beta populations and real world coaching can be extremely beneficial. Start ups get mentoring and systems have to ability to leverage outside resources to solve relevant business problems. I predict a booming business!

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Here’s your recap of last week’s health IT news 🗞️ 👇 💼 Administrative • Pager + League: The care orchestration solution will be embedded into the patient engagement platform for maternity care.    • Veradigm®: The ambulatory care solutions vendor has announced that it is exploring a merger, sale, or other transaction.    • Kyruus Health: The provider search and scheduling solution said it would add MEDITECH to its list of EHR partners which already includes Epic , Oracle (Cerner), athenahealth , and others.   🥼 Clinical • Clover Health: The physician enablement technology company launched its previously internal-facing clinical decision support tool via its subsidiary Counterpart Health as a standalone solution for external Medicare-focused payers and providers.    • Children's Minnesota + ShiftMed: The pediatric health system is partnering with the on-demand workforce tech platform. 🤝 VBC • Innovaccer: The VBC data & analytics company launched its quality management and reporting platform for health plans. 🤖 AI • Plenful: The AI workflow automation company focused on streamlining pharmacy operations announced a $17M Series A.    • SamaCare: The AI prior auth platform announced a $17M Series B. 💡 Things We Found Interesting • In our view, there’s not enough discussion about why technology pilots in health systems fail. So we appreciated this perspective from Justin R. Brueck at Endeavor Health, on three of the most common reasons he sees things go awry. https://lnkd.in/eKBZ_g2N    • We’re continuing to see stories illustrating both the promise and perils of leveraging generative AI in the practice of clinical medicine. Given the pace of progress, it seems clear that AI will play a significant role in clinical care sooner than later. Lots of thorny questions to work through in a short amount of time. (Here are a couple examples from Yudara Kularathne MD, FAMS(EM) and Graham Walker, MD we appreciated: https://lnkd.in/ePUr2SgE, https://lnkd.in/ej9UpfYg)    • On that note, we’re always interested to read the latest research on how AI solutions are performing in the field. One recent study published in JAMA found that AI scribes significantly reduced time spent in the EHR. Researchers of another, however, cautioned that providers must remain vigilant when using GenAI, based on the fact that Chat-GPT produced different outputs when asked to simplify radiology reports for patients of different races. https://lnkd.in/emNi-_Ai, https://lnkd.in/ejH4KHsq  

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Q1 2024 was big for Digital Health, with $1.1B in VC funding. A large portion came from major deals like $126M for Transcarent and $108.8M for Rightway. Despite some challenges in digital therapeutics and telehealth, investments in general care ($213.4M) and health benefits navigation ($140.7M) are promising. Read what’s driving the shift from direct-to-consumer to enterprise telehealth models here: https://ow.ly/uNYs50SpXGh

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I always read Rock Health's digital health reports as they give a nice pulse feel for what is happening in the digital health funding space. Good to see funds raised in H1 2024 suggest funding in the sector seems to have stabilized at 2023 levels. Its no surprise the report emphasis the buzz around AI and healthcare. There have been clear winners in the AI healthcare space in the area of process and cost optimization and the R&D space. The impact of AI in care and treatment delivery is so far much more muted. One area I never though to look at AI was in its ability to bring together multiple healthcare pathways and digital point solutions into a more holistic seamless experience for the patient. There is a clear trend away from using stand alone digital health point solutions, and could AI address this challenge by facilitating the efficient integration of disparate processes and technology into unified care programs. I can see this happening with digital health products but this will be more tricky to do with physical care programs involving clinicians and HCPs. “AI is helping us combine multiple parts of the care journey, across all care experiences. In the future, benefits navigation, clinical guidance, and care delivery won’t be delivered by separate companies or point solutions within the healthcare ecosystem. They’ll be features that work in concert within products, and they’ll happen in under 90 seconds for a seamless patient experience.” – Glen Tullman, CEO, Transcarent and Managing Partner, 7wireVentures

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What is one of the country's leading safety net health systems focused on right now? Gabriel M. Cohen MD, CMIO for Population Health at NYC Health + Hospitals shared his perspective with us in this week's 𝘌𝘹𝘦𝘤𝘶𝘵𝘪𝘷𝘦 𝘐𝘯𝘴𝘪𝘨𝘩𝘵𝘴: 𝗪𝗵𝗮𝘁 𝗮𝗿𝗲 𝘆𝗼𝘂𝗿 𝘀𝘁𝗿𝗮𝘁𝗲𝗴𝗶𝗰 𝗽𝗿𝗶𝗼𝗿𝗶𝘁𝗶𝗲𝘀 𝗳𝗼𝗿 𝟮𝟬𝟮𝟰? 1️⃣ Patient engagement – leveraging omnichannel communication to efficiently close care gaps 2️⃣ Interoperability – putting usable data in front of our clinicians at the point of care to support care gap closure 3️⃣ Care coordination – building the tech infrastructure for our social workers, community health workers, and care managers 4️⃣ Care infrastructure for asylum-seeking and incarcerated patient populations – multiple initiatives, with a particular focus on providing housing for homeless populations 𝗪𝗵𝗮𝘁’𝘀 𝗮 𝗿𝗲𝗰𝗲𝗻𝘁 𝘃𝗲𝗻𝗱𝗼𝗿 𝘀𝘂𝗰𝗰𝗲𝘀𝘀 𝘀𝘁𝗼𝗿𝘆? Our partnership with Findhelp. Addressing health-related social needs is a critical priority for NYC H+H Our organization already has a high penetration of social needs screening, so our focus today is connecting patients with the right resources to address the identified disparities. Findhelp helps us with this by: • Ingesting the health-related social needs screening data • Identifying those patients who have a need • Locating the best local resource(s) for that patient • Connecting the patient to the resource(s) • Facilitating end-to-end communication, including informing the physician and care team whether the patient accessed the resource(s) Key to this initiative's success has been its tight integration with our current workflows in Epic, to the point that it should largely feel seamless for our clinicians. 𝗪𝗵𝗮𝘁 𝗮𝗿𝗲 𝘆𝗼𝘂 𝗳𝗼𝗰𝘂𝘀𝗲𝗱 𝗼𝗻 𝘄𝗶𝘁𝗵 𝗿𝗲𝗴𝗮𝗿𝗱 𝘁𝗼 𝗔𝗜? As a safety net health system, NYC H+H’s priority is to ensure that the AI tools and models we employ can sufficiently manage potential bias. We’re currently prioritizing governance-related workstreams (e.g. governance councils, frameworks, and processes) that will drive a safety net health system playbook for appropriately evaluating and managing AI. The specific AI use cases we're currently prioritizing include: • Chart summarization • Inbasket management Other future areas of exploration: billing automation and radiology automation — For more insight from leading health IT execs, as well as Elion's latest research and can’t miss industry news, subscribe to our newsletter 📬 👉 https://bit.ly/49z6AUW

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Healthcare technology is in trouble. After the relative boom time we experienced through during the pandemic, the fervor to innovate in health systems and payers seems to have dried up. While organizations continue to post stellar earnings, they also continue to lay off experienced health technology people en masse. Why? I think it's time for a bit of honest reflection. 70% of all enterprise healthcare technology projects fail. 17% of of all large scale IT projects go so badly that they threaten the very existence of the company itself. Bridging Business & IT, LLC For projects with a total price tag of over $1MM, that failure rate jumps to over 90%. And the ever prescient Clayton Christensen believed that the failure rate for all new product introductions is 95%. This is not new information. What is new is the most recent E&Y Pulse Survey that has health system CIOs believing that 7 in 10 of their healthcare IT projects have had no discernible #ROI. None. And this is for the projects that didn't fail. https://lnkd.in/gRgVt_Xs This is an existential crisis that health technology must face honestly and soberly. Lack of planning and poor communication are the core culprits. Clunky and outdated Waterfall project methodologies can be blamed for many of these failures. And frankly Agile disciples could use a bit more planning before they start iterating so they know what they're building. There are, however, some problem actors and business models that need to be called out. The historically biggest culprits, in my humble opinion, are large, institutional, enterprise software vendors and their server-based architectures. For decades they feasted on seven figure licensing deals, sometimes humble-bragging to potential implementation partners about 5:1 or 7:1 implementation cost to license cost ratios. Companies just went along with it, because no one gets fired for buying IBM, right? But the failures in this segment are legendary. And many have indeed been a key cause in the parent company failure. As for the ROI, there was a bright spot in the E&Y Pulse Survey. Despite not having established a demonstrable ROI, 96% of them still wanted to move forward with the projects, believed the investment was worth it. So the issue isn't necessarily that the projects aren't generating value, the issue is that the organizations (and their vendors) didn't do a good job up front validating agreed upon ROI metrics and measures. They don’t fully understand the value it is (or isn't) creating. This is our collective job to be better at this. So what can we do to reduce the failure rate and get health systems and payers back into investing in #innovation? #ROI #startups #valueengineering #goldenpath #LCNC #opensource

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“I think it’s important that the person running the organization understands the core thing that the company does.” - Ben Horowitz, GP at a16z. Totally agree, but we actually see the opposite in healthcare. As care delivery businesses are mostly run by people who have no prior knowledge of how to deliver care. The ACA actually prohibits doctors from even owning hospitals. Which completely enables MBAs and other non-clinical administrators to influence how patients receive care. Call me old fashioned but shouldn’t the people trained and licensed to provide care delivery services be the ones running businesses where care services are delivered? 🤷🏽‍♂️ —— Hi, I'm Dr. Mario Amaro, Founder and CEO Ease and I talk about all things starting, running, and growing a private practice with AI. Follow me, if you are planning to start one or are currently figuring out creative ways to grow one. #PrivatePractice #SelfEmployment #HealthcareOnLinkedin #HeyEase #IndependentTogether

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Investing in preventative health tech platforms requires a strategic approach that balances potential returns to improve public health outcomes. One key consideration is the platform's scalability, as scalable technology can serve large populations, achieve widespread impact, and maximize financial returns. This also makes scalable platforms more attractive to healthcare providers and payers seeking cost-effective preventative measures on a broad scale. To learn more about investing in scalable health tech platforms, read the full article. https://buff.ly/3wswQ67 #healthtech #investing #AIwellness #digitalhealth #ecommerce #investmentstrategies #wellnessindustry #AItechnology Subscribe to the Evolving HealthTech newsletter here: https://buff.ly/44pGPE0

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There is an easy way and there is a right way to tackle Direct to Patient / Consumer platforms. Many companies developed, on top of their core offer (e.g. Pharmacy, Telehealth / Virtual Care) an out of the box solution. Companies tend to use these solutions to test the waters, like "is this actually used by patients?" They are but missing a critical point: Patient Engagement is a use-case based job, custom tailored and well monitored for changes. The OOTB solutions do not offer easy customization, nor do they meaningful distinguish between medical use cases. That is the very reason Medlify stays on "pre fabricated modules" which give a fast-access foundation and integrations to a lot of top tier providers in the market, yet offer a fully customizable design system and user flow.

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The defining factor isn't the size of the company or startup, but the vision behind it. Take OpenAI, for instance. Until last year, unless you were deeply embedded in the ML world as a computer scientist/researcher, or enthusiast, you might not have heard of OpenAI. Meanwhile, a giant like Google was dominating the scene. However, a few years back, OpenAI was just another small startup. Now, it's rapidly evolving into a major player in big tech. Why and how? It comes down to having a long-term vision, a clear roadmap, patience, and solid execution (i.e., talents). Even in the context of healthcare AI, where (small) startups face many challenges (including the ones mentioned), the principles of vision and strategy apply. While merging with big tech might seem like an option for some, if a startup truly believes in its vision and has a well-defined path to achieve it, it should forge ahead independently. The landscape is evolving, and like OpenAI, today’s small startups with clear, visionary goals could be tomorrow's industry leaders. #starup #founders #openai #google #healthcare

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The Morisky Medication Adherence Scale-8 (MMAS-8) is an ideal barometric measure for assessing medication adherence among patients due to its reliability and consistency over time. Connect with me for more information and if you want to integrate this tool within your own EHR or digital platform for RPM, telehealth or DTx. Your patients deserve to know their adherence score and an opportunity to improve it over time. 1. Validity and Reliability: The MMAS-8 has been extensively validated in various patient populations and healthcare settings, demonstrating strong psychometric properties. Its reliability makes it a dependable tool for consistently measuring medication adherence among patients over time. Healthcare providers can trust the accuracy and consistency of MMAS-8 scores when assessing adherence levels. 2. Comprehensive Assessment: The MMAS-8 assesses multiple dimensions of medication adherence, including forgetfulness, carelessness, and intentional non-adherence. By capturing these various aspects of adherence behavior, the scale provides a comprehensive understanding of patients' medication-taking patterns. This comprehensive assessment enables healthcare providers to identify specific barriers to adherence and tailor interventions accordingly. 3. Easy Administration and Interpretation: The MMAS-8 is very easy to administer and interpret, making it practical for use in clinical practice. The scale consists of eight simple questions that patients can quickly respond to, minimizing burden on both patients and healthcare professionals. Scoring and interpreting MMAS-8 results are straightforward, allowing for efficient assessment of medication adherence during routine clinical visits. 4. Longitudinal Monitoring: Due to its reliability over time, the MMAS-8 can be used for longitudinal monitoring of medication adherence among patients with chronic conditions. By administering the scale at multiple time points, healthcare providers can track changes in adherence behavior, evaluate the effectiveness of adherence interventions, and identify trends or patterns that may require intervention adjustment. This longitudinal approach facilitates proactive management of adherence-related issues and supports continuity of care. 5. Predictive Value: Research has shown that MMAS-8 scores are predictive of various clinical outcomes, including treatment response, disease progression, and healthcare utilization. Patients with high MMAS-8 scores (indicating good adherence) are more likely to achieve therapeutic goals and experience positive health outcomes compared to those with low scores. By using the MMAS-8 as a barometric measure, healthcare providers can identify patients at risk of poor outcomes early on and intervene to improve adherence and prevent complications.

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The Delusion of Scale in Healthcare Healthcare doesn’t scale - period. In fact, the only companies that have successfully scaled healthcare are the large insurance companies, and these do this through inter-company accounting transactions, medical loss ratios, rationing healthcare services from authoritative vertical integration. You don’t have to believe me, I only worked on more than several buy-side transactions for the two largest heath insurance companies. This is also why you had very few successful roll-ups of PE healthcare platforms - the majority failed. Here’s why: The cost of healthcare does not decrease with more volume. One provider can only serve X amount of patients, and then you must hire a new provider. Same with a location there is a capacity and then a new one must be added. True “fixed” costs are almost non-existent in healthcare, especially since most providers expect a compensation based on a percentage of cash collections (hopefully wRVUs but that’s for a different day). In healthcare it is just as important to understand your cost at the service/claim level as it is to understand your revenue cycle. Understand the cost and risk of your patient population and control expenses accordingly - that is a surer path to profitability than the delusion of “scale” ever will be.

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90% of startups fail. So why do healthcare initiatives at large corporations fail at about the same rate? Many of these were launched with great fanfare but announced closures a few short years lateer. A few reasons might be: 1. Mission but no strategy: it's not enough to have a mission to treat a specific population or group of employees, you have to be in it for the long haul with a strategy that will evolve over time. 2. Misunderstanding of healthcare complexity: many executives believe they understand the problem and use tools from other industries to solve healthcare issues. You can't always bring things that work in banking, finance, retail for example. 3. Execution: rarely does leadership hire people who have a track record of execution in healthcare. I'm talking about people who have been able to gut through the losses. This is probably the biggest misstep. You agree with these reasons? What would you add to these? #healthcare #failures https://lnkd.in/etzZywnK

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AI is changing the game in healthcare. A quarter of VC investments in healthcare tech are projected to be AI-related solutions; plus, the US AI healthcare market is projected to receive $11.1 billion in 2024, up from $7.2 billion in 2023. AI isn't just a trend; it's transforming efficiency, boosting patient outcomes, and aiding drug discovery. The stats back it up. 84% of global healthcare leaders believe AI-driven automation can save clinicians' time by reducing administrative burdens, while 88% think it can help alleviate workforce shortages. The convergence of AI and healthcare is not just a promising development; it is essential for the future of value-based care. The potential impact on patient journeys, cost reduction, and overall healthcare delivery could be profound. #HealthcareInnovation #AI #DigitalHealth

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