ChilCast: Healthcare Tech Talks – April Industry Update

by | May 12, 2023

The Chilcast is back with the second installment of our monthly recap series! Join the team as we touch on topics ranging from our personal experiences at HIMSS, generative AI, Epic’s GPT-4 integration, Google – Med-PaLM 2 rollout, MEDITECH partnership, and more!

HIMSS has wrapped up, and it was an extraordinary event. 35,000+ attendees from around the world gathered in Chicago to connect with like-minded individuals and discuss the latest trends in the industry. The conference was jam-packed with enlightening sessions, exciting panel discussions, and opportunities to catch up with old industry friends.

Did you miss us at HIMSS? No worries, please be sure to reach out to J3 or Colin to get something on the books as soon as possible.

Stream this latest episode of the podcast below or find it on your favorite podcast app via this link:

Check out our analysts post-HIMSS recaps here: 

Show notes and citations:

STAT+ article cited re: Kaiser-Geisinger (Kaisinger?) / Risant Health deal. More recent coverage since we recorded the episode:

CommonWell Health Alliance celebrates 10-year anniversary

New 405(d) Program: “[A] collaborative effort between industry and the federal government to align healthcare industry security practices to develop consensus-based guidelines, practices, and methodologies to strengthen the healthcare and public health (HPH) sector’s cybersecurity posture against cyber threats.” Learn more on the HHS site.

HHS Proposes New Rule to Further Implement the 21st Century Cures Act 

  • ONC Offers an Overview of HTI-1 Proposed Rule Expectations
  • ONC’s Proposed Rule Updates to the 21st Century Cures Act Regulations

Particle Health Releases API for Interoperability w/ 3 National HIE’s:

  • CommonWell Health Alliance
  • Carequality
  • eHealth Exchange

Responsible AI and Generative AI observations: STAT report on AI in Medicine 

Health equity, fact or fiction: Nuance/MS ambient AI


Prior auth process challenges and how to implement them

Providers and health plans connect to fast track prior auth, claims, and quality reporting

Transcript Below:

John Moore III: [00:00:14] Welcome back to the Chilmark Monthly Industry update, where in our team reviews some of the biggest news in health care from the last month and share our thoughts on what these events portend for the industry. Today we’ll be starting with a group discussion, sharing our takeaways from the annual HIMSS conference that took place in Chicago a couple of weeks ago at the time of recording. Then we’ll jump into each team members individual perspectives on the last month’s key activities and events. So to start off, I will have everybody just give a quick summary of what you’ll be discussing. We will start with Jodi. Sure.

Jody Ranck: [00:00:45] So I’ll be talking about AI of course, that’s the area that I cover for Chilmark. And and it’s been the area of tremendous amount of marketing hype due to chatgpt and generative AI. So definitely going to be talking quite a bit about that and some news that happened post hymns on that front in the last 24 hours prior to our recording. And then I’ve been on health equity at hims in light of some of the proclamations from ViVE before HIMSS around trying to create a coalition around equity. So that’s what I’ll be talking about.

John Moore III: [00:01:21] Thank you, Jody.

Fatma Niang: [00:01:22] So today I’ll be discussing a new rule that was released by the ONC on April 11th, as well as Particle Health’s new partnership with Commonwealth Health Alliance Care Quality and eHealth Exchange.

John Moore III: [00:01:35] That’s fantastic. And then I will be covering what I saw at the Oracle Analyst Summit last week, as well as the guys, the Kaiser Geisinger acquisition and the new Rising Health ACO Program or Accountable care and value based care entity that the two of them are propping up. Is Kaiser Geisinger actually going to be the largest health system in the country if they are allowed to go through with this? Do you know?

Jody Ranck: [00:02:04] I don’t know. I don’t know. It’s interesting, you know, because I’m from the Geisinger Catchment area, all of my parents, you know, the elderly folks there were chatting about it on Facebook over the weekend. There was a lot of worry about. In fact, it’s interesting, they were posting articles about from NPR on the impact of private equity on access to rural hospitals and saying, look at what Kaiser is going to do to us. And I’d say, well, Kaiser is not a private equity entity. You’re comparing apples and oranges, but to give you a level like I mean, there’s paranoia, rightfully so. If you’re a rural American, that’s you’re just used to getting screwed.

John Moore III: [00:02:48] But there’s a big difference between a financial organization taking over.

Jody Ranck: [00:02:51] Yeah, there’s taking over. There’s no understanding. There’s just all one big monster out to eat up your health care system and close down shut down the E.R. because that’s what they’ve seen. That’s that’s their experience. Everything gets shut down and your access gets worse and worse and worse all the time. But I tried to intervene and educate a little bit, but they just go and repost the same shit the next day.

John Moore III: [00:03:18] Didn’t want to hear it.

Elena Iakovleva: [00:03:21] So today, mainly I’ll be talking about news from hims and some stuff about my upcoming report on payor provider platforms. This also was my primary focus at hims on top of my current hospital at home reports. So we’ll be great to start a discussion on all those payer provider communication and how it’s going to look like moving forward.

John Moore III: [00:03:49] Thank you, Elena. So jumping into the group part of the conversation where we discuss our various hims takeaways, I just want to lead off by saying it was a great first hims for me to be leading a team there as opposed to kind of taking the second seat to my father. It was very nerve wracking having that pressure on me going into the event. But you guys all delivered. I heard great things from everybody that you met with and your support of me, as well as the community support as I start to transition to leading this business was tantamount to having a great experience at Hims this year. So I really want to thank everyone that played a role in that, both on the team as well as externally. We had a lot of great meetings, had a lot of really good kind of personal interactions as well as more business focused ones. So feeling very strong and optimistic After attending Hims this year, One of my big takeaways from the event was just the maturity of the interoperability discussion seems to have kind of picked up finally, as everyone agrees, that there really does need to be more data flow for everyone to capitalize on all this information that’s being digitized so we can actually start teasing out the insights from the data that’s been aggregated. So if everybody wants to just quickly go around the horn and kind of share any of their key takeaways or if you guys want to discuss anything about hims, we can jump into that.

Jody Ranck: [00:05:10] Sure. Well, I’ll jump in. You know, obviously everyone heard a lot about generative AI chatgpt the announcements from Nuance, Microsoft, Epic and so forth and the demos along the way on on that front, it was interesting to see how everybody’s talking about doing generative AI and AI in general in a responsible way, but without any details or transparency on what that means. And it sort of brings me back to AI discussions at large beyond healthcare a couple of years ago, where when the ethical AI discourse first appeared and then soon there was a lot of talk about ethics washing. And so I think without really getting into the details of what they mean by responsible AI and the concrete steps they’re taking, there’s going to be a there’s a big risk of generating a lot of distrust unless there’s transparency around what responsible AI means. So we saw some really flashy demos from Epic and the ambient AI with Nuance and and so forth. When the Wi-Fi was working, it was really impressive. But, you know, these were demos, so understanding kind of how they perform over a longer time frame. And, you know, I hate the term hallucinations, but basically misinformation that they generate.

Jody Ranck: [00:06:48] Let’s be real. That’s what it is. It’s not a hallucination. It’s bad information, mal information, misinformation, disinformation, everything but a hallucination. So we got to talk about that aspect. And then the other thing that I was interested in going into hims was following the discussions on Vive. And a couple of weeks before when Vive announced this equity Coalition. And so I’m really quite interested in this whole notion of health equity in regards to technology and not that satisfied with the industry in general in terms of concrete capabilities and functionality that contributes to health equity. And it’s all fine and good to make announcements at Vive, but you know, show us the data. And however, I did talk to a couple companies, Light beam and Health Catalyst in general that seemed to be really serious about it and were looking forward to some ongoing conversations with them to get dive into more of the details on that front. So I think there are a couple of bright spots, but a lot of marketing talk without, you know, all dressed up in no place to go essentially around equity and health equity, so forth. So those are my first general observations about hims.

John Moore III: [00:08:16] Yeah, I definitely agree that health equity people have been talking to it for a number of years now. And it’s obviously with the ACO Reach program and some of the other things that have been really brought to the fore since the pandemic highlighted just how bad health equity is in this country. It’s still hard to know how much of this is lip service and like you said, kind of the ethics washing versus actual substantive change in the way that care is being delivered to disadvantaged and vulnerable populations are actually getting their needs met. So I’m definitely very curious to see what your research shows us on that front as we continue to follow that area. Fatma, how about you? What were your kind of key takeaways and experiences at Hims this year? I know this is your first big event, so it’s probably a lot to take in.

Fatma Niang: [00:08:59] Yeah, for sure. I had a great time at hims. There were times where I would just stop and really conceptualize the fact that there were over 35,000 people in this one central location. But overall, I got to have a lot of great meetings, visit a lot of booths, and I met a lot of interesting people, including potential collaborators and mentors. As I continue to move forward in the industry, I think the biggest takeaway for me for sure was regarding Tefca and just kind of seeing where it’s at for face value, especially when we got to meet with Paul Wilder and learn that Cubans weren’t really Cubans. I wrote in my post that it’s kind of similar to medical students when they’re getting their white coat, like the ONC is designating these Cubans with their white coat. But that doesn’t necessarily mean that they’re able to just go out and practice just yet. They have a lot to prove.

John Moore III: [00:09:48] So yeah, I had a lot of fun with that meeting with Paul. He’s always a great guy to meet up with. And then the Commonwealth ten anniversary, 10th Anniversary party was a lot of fun. Ran into a lot of our friends because as you’re well aware, interoperability in the space was really one of the first areas that Chilmark Research got known for. So a lot of people there we’ve had some relationships with for a very long time and it was nice to see everyone get together to celebrate Commonwealth’s success over ten years. And Elena, how about you? What were your kind of key takeaways or interesting conversations that you had at Hims?

Elena Iakovleva: [00:10:22] Oh God. John Yes, this year hims was just fantastic. I was so happy I went actually, I, I wrote a full blog post on LinkedIn and on Marc’s website. So for those who are interested in my more specific takeaways from Hims 2023, please go read the post. Um, also I would just like to highlight a few things. You know, like we all were kind of in mixed feelings about Vive and Hims and all this competition, how it’s going to play out, but it seems like Hims is very much alive. I had and just dozens and dozens of excellent networking opportunities and just amazing conversations. I also was very glad to have an opportunity to actually see where the market is going. So obviously we are right now in somewhat recession times, even though it’s not reflected that clearly in numbers. But people are talking about that. And I was wondering where the spending going to shift to, like what are providers willing to spend on right now? And it seems like RCM, as always, is one of the main points of interest. And yeah, so I had a number of great conversations around authorizations and how complicated the space is. One of the companies here, they do have an interesting solution about the episode of care authorization process that actually really caught my my eye. Another one was ability. I had just amazing conversations with Bobby. She was very into what’s going to be going in the space over the next two, three years. And she was talking about the partnership strategies in this particular space and how many, many blogs make actually the competition and the whole strategy much more complicated than it actually should be.

John Moore III: [00:12:38] You saw the telehealth at hims was also on an uptick again. You know, after what I saw at Meta this year.

Elena Iakovleva: [00:12:44] Yeah, last year was really bad. Oh my God. I don’t think I’ve ever seen such a conference in my life. People were barely networking. I saw some vendors, they were leaving early and so on. You know, part of it, I think, in telehealth that we are dealing with a huge effect of COVID still, because during COVID we had such a high demand for telehealth that is kind of started to slow down quicker than people expected. So I think these like up and down effect mainly mainly is dependent on the COVID curve that we all experienced.

John Moore III: [00:13:28] Yeah, I think a lot of what we saw in 2022 was all the hype from the lockdowns and all of the, you know, dramatically increased usage, substantially overinflated the valuations of a lot of these companies in the telehealth space. And you know that just once people saw that the numbers were declining, when they could go back into the office, people got a little spooked and it made the industry nervous. And with all the SPAC IPOs in the space, they were very sensitive to any kind of market movement in general. And so I think that what you’re seeing makes a lot of sense given the fact that things seem to have balanced out now, there seems to be a kind of more of a plateau or like a baseline level of increased telehealth use from pre-pandemic levels. And so we are at an inflection point where this is becoming more of a social norm outside of the public health emergency. And we are starting to get a much better idea of what the consumer actually wants to gravitate towards to utilize these remote care options. And, you know, where these things really fit into the care ecosystem because they’re not going to be a full replacement like people were kind of projecting during the lockdowns. That’s not going to happen. And so we’re really seeing what the true equilibrium starts to look like between virtual and in-person care, I think. Would you agree?

Elena Iakovleva: [00:14:42] Very true, Yes. So, indeed, when we did not have many options besides telehealth during COVID, I feel like, you know, a big part of the population, they have formed a new patient’s behavior and that’s pretty much a new norm. You know, just to call your provider. And for some people it just so much more convenient.

Jody Ranck: [00:15:07] But, you know, I’m going to put on a little health services researcher hat here because there are studies coming up I see every week on its to talk less about it in these generalities in terms of norms and so forth for the general population. And instead look at there are going to be cohorts either by age, by disease condition and so forth, that it works really well for and others. It doesn’t work very well for. Same with providers. They’re going to be some providers, some providers for some conditions. They really need to see the person in person and and so forth. So I think we’re beginning to, you know, now that we have a couple of years and, you know, going forward, we’re probably going to see a lot more research into where it works really well, where it doesn’t, where it needs some work and have more kind of nuanced discussions. Once we have some of that data. That’ll be pretty interesting to see. And, you know, like I said, we’re beginning to see some studies come in here and there about the different cohorts.

Elena Iakovleva: [00:16:20] Yeah, Jodi, Without a doubt. I totally agree. I personally do know providers and patient groups that use telehealth for some conditions and they are not using telehealth for other conditions. And also, I think big part of it depends on the relations between patient and provider, how well provider knows the patient. And you know, obviously like some specialties, they just cannot take advantage of telehealth.

John Moore III: [00:16:52] All right. Well, thank you both for digging into that a little bit more. So I’ll go a little bit deeper into what my actual impressions and takeaways from the event were beyond the interoperability piece. I want to give everyone else a chance to share their thoughts first. So obviously, like I said, interoperability seems to have matured as a conversation. It’s people are really trying to figure out how to get quality data, not just structured data into clinical notes and transmitting between different systems so that you can actually compute some of those hidden insights that are in doctor’s notes and things like that. As two meetings that I had that really left an impression, I want to start off by just commenting on how impressed I was by the data robot demo. I’ve been listening to Jodi preach about how to do ethical AI and responsible AI development for months now, if not years, and seeing basically everything that he talks about in a live demo without any prior conversation with the company really drove home that they got they seem to be approaching this from the right angle. They really seem to have a good sense of how to ethically and responsibly deploy these types of solutions. They you know, they provide you this tool that you can upload your data set to tell it what your intended predictive outcome is, and then you can run it against a number of different models. It spits out which model is best, and then you can dig into that model for any potential bias issues.

John Moore III: [00:18:17] And it actually breaks down the different things that you would want to be looking for with bias, whether that be socioeconomic status, race, age, gender, whatever the case may be. So I thought that. Is fascinating. And then it will generate it has the option to generate a 20 page, roughly regulatory report that shows how it got to those recommendations. Why that model is a good fit. Et cetera. Another great call I had was with someone from the office of the CSO at Google Health or at Google in general, and we were specifically talking about the absurdity of so many companies relying on their cloud service providers to be really their only security element and how a lot of these companies that do cloud deployments of their IT don’t really plan to make their own systems secure by default, secure by design. And this is something that a new legislative act is trying to change. There’s this 405 D, you can find out more about it at 405 D HHS.GOV But it’s all about this new cyber safety element of how to actually keep patients safe from malicious attacks. And I hadn’t heard about 4 or 5 D myself. We’re just starting to delve into the impact of cyber on all the areas that we cover. So as I get learning about these different approaches to both the regulatory aspect of trying to push regulation onto companies that are going to be developing for health care, as well as just kind of an opt in best practices piece. I’m really curious to see how these things play out.

John Moore III: [00:19:47] One of the things that this executive told me was to just go around and ask the different vendors on the floor what their security plan was and how much they were relying on their cloud provider. And to be fair, I didn’t follow through on this, but we were all pretty confident in the meeting that most companies were just going to say that they leave that to their cloud provider and that’s why they use cloud and that’s just, you know, burying your head in the sand. You’ve got to have a better plan than that to make sure that your systems are secure and you’re reducing as many vulnerabilities and attack vectors as you can. Finally, you know, to be fair, I had a lot of great meetings, met with Point Cloud Care. They’re doing fantastic work. It was great to get a check in with Orion Health, you know, health Catalyst. They’ve been a client of ours for years. It was nice to see what they’re doing and get an update from them like Jodi was saying about the piece. Anyway, So one of the really good meetings that I had that kind of came out of the blue when we had announced our upcoming Real World Data report, someone from a company called Invite reached out, and I personally didn’t know Glen, but apparently he’s known my father for years. He was a co founder of Axolotl, so way back again in our ag days. And so Glen and I met up and he showed me a really cool demo of how the citizen product that invitae one of the larger clinical genomics companies in the country, they acquired Citizen to help with clinical trial recruitment.

John Moore III: [00:21:08] And I thought what they were doing with the citizen platform was fantastic because it actually allows patients to give them permission to go out, collect all the records, aggregate their full medical history, and then normalize their medical history into a research compatible format so that anybody conducting decentralized clinical trials can recruit people from around the country, from around the world, eventually into clinical trials. And the they actually kick some of that pay back to the patient. So there’s certain clinical trials where you can get paid for participating, but a lot of them, if you’re already sick, you don’t see any of that revenue that goes directly to the unit or the group that’s, you know, hosting the clinical trial and running the experiments. But what Invitae does is they actually give you a percentage as a patient when you’re recruited, you get a cut of that payment, which I thought was really cool too. It seems to be a new standard potentially for how patient data rights are approached and how the medical industry and the pharmaceutical industry can actually incentivize patients to opt in to sharing their medical histories as opposed to all of these data cartels just aggregating and selling our data without our knowledge. All right. So I will pass this to Fatma to share some of what she’s been covering over the last month. Outside of the Hims coverage.

Fatma Niang: [00:22:23] On April 18th, the ONC published the one proposed rule expectations aim to facilitate the secure and efficient exchange of health information across different health systems and networks. The main objective of this rule would be to enhance interoperability and improve patient access to health information while addressing privacy and security concerns. One of the key requirements of this rule are for health. Oh, let me start over. Okay. On April 18th, the ONC published the one proposed rule expectations to facilitate the secure and efficient exchange of health information across different health systems and networks. The main objective of this rule would be to enhance interoperability and improve patient access to health information while addressing privacy and security concerns. One of the key requirements of this rule is for health care providers and developers to implement standardized APIs that would enable patients to access and share their health information easily and as they please, the rule currently under its 60 day. Review and comments period calls for significant updates to EHR certification criteria and builds on the information blocking regulations that were set back in October of 2022. It also aims to improve the ability of patients to request restrictions on the use and disclosure of their PHI. So while many of the proposed revisions are highly technical and geared towards health IT developers, this proposed rule aims to further Onc’s goal of advancing health information, exchange and interoperability as a whole. It’s interesting, as I mentioned earlier, interoperability is a really hot topic. A lot of people have mentioned the resurgence of interoperability, even though it never left while we were at Hims. So the 21st Century Cures Act continues to expand on this concept with high hopes to make seamless interoperability a reality.

John Moore III: [00:24:17] Fantastic. Thank you, Fatma. When you save for those who require it. What kind of organizations are you talking about? All organizations. Or. I know that one of Jodi’s big talking points recently has been the issues around the accessibility of data and the data equity story there. So is this something that will help make access to data more democratic?

Fatma Niang: [00:24:36] Recently, Particle Health announced a partnership with Commonwell Health Alliance Care Quality and eHealth Exchange to facilitate patient health data sharing across different health systems and EHRs coined as particle for platforms. This collaboration will leverage Particle Health’s API based platform to enable the exchange of health information between different his and EHRs. Achieving interoperability by providing a gateway to the three partners mentioned, as well as additional resources and hopes that this will ultimately promote care coordination of and improve patient outcomes. This partnership is noteworthy because it symbolizes a significant step towards promoting interoperability. By leveraging these APIs, health care providers can overcome the barriers to health information exchange while enabling seamless data sharing. In addition to this news, Particle Health has recently appointed Dr. Carolyn Ward as the director of clinical strategy.

John Moore III: [00:25:34] It’s fantastic. Thank you, Fatma. Joe, do you want to go next? Sure.

Jody Ranck: [00:25:39] One piece of news I plan to write about here in the near future is a couple of days before hims, the ONC proposed a new rule for certification criteria for clinical decision support algorithms. The EHR, in an attempt to give providers more information about these clinical decision support tools and AI tools that are connecting into the EHR. So we’ll have more on that in the near future. But that’s an interesting development because with the rapid growth of AI, all of a sudden I think there’s a great potential for a lot of confusion and messiness involved. So it’s good to see at least one of the regulators step in and start moving forward a bit in the U. There’s been some movement as well around their AI regulations. And then just in the last 24 hours, there’s been an interesting development in just the AI front in general that’s making a big splash. And I want to have a little back to the future quote here about this. So Geoffrey Hinton, one of the who’s widely quoted as the godfather of deep learning, he resigned from Google the day before we recorded this podcast. And the stated reason for his resignation was his concerns about misinformation and the harm that these generative AI models might produce. But I want to take people back to 2016. And a quote from said Mr. Hinton when this quote is rather interesting because it’s a health care related quote. And he said, I think if you work as a radiologist, you’re like the coyote that’s already over the edge of the cliff but hasn’t yet looked down. People should stop training radiologists.

Jody Ranck: [00:27:49] Now it’s just completely obvious. Within five years, deep learning is going to do better than radiologists. It might be ten years, but we’ve got plenty of radiologists already. So the the amount of press attention just within 24 hours that his resignation from Google is getting is pretty impressive. But they haven’t looked to the past where quotes like this have not actually been helpful for the adoption of AI in health care. And often this hype machine in the way AI is framed, even when they’re talking, they’re criticizing it. They give it more power than it’s than it’s worthy of. In some ways. So that that in and of itself is an ethical problem. So I think we need to ask a lot of questions and not just celebrate Hinton’s resignation as on on face value. There’s there’s more going on to it than we think. And there’s a long history behind it that, you know, it’s great when you cash in and then resign. But the younger female folks that were trying to clean up the messes years ago got fired. That’s an equity issue in in itself in the data science world in terms of big tech and AI. So I’ll just, you know, and as an addendum globally, there’s a shortage of radiologists that Dr. Hinton should have taken note of, that these tools are there augmented intelligence for radiologists? There are tools for radiologists, but they’re not replacing radiologists. Any time soon, even if it’s real. So he said maybe ten years. So that would make it 20, 26. Yeah. Go back to the drawing board. On prognostications from prominent AI scientists.

John Moore III: [00:29:53] Jodi This week you also shared with us a stat article about this. The title of the article is A Research Team Airs The Messy Truth about AI and Medicine and gives hospitals a guide to fix it. You shared this internally. I want to get your thoughts to just share with everyone else, since this seems pretty relevant to what you’re talking about.

Jody Ranck: [00:30:11] Well, you know, the the talk that we often hear just about AI in general beyond medicine and health care is you often hear from technologists this narrative of the seamlessness of adoption. And then and even when it’s adoption is rather slow, you rarely have sort of nuanced. Sociological anthropological takes of the day to day adoption and resistance to technologies that happen. And so I really like this. This article in the approach, I think is done by folks at Duke looking at the real concrete practices. When we get to responsible AI, you know, some level we have these principles that are out there around fairness, bias, auditing and all of that that companies need to do. But then translating that down to the everyday practice of data science and business decisions, that’s where the rubber hits the road. And it’s really important to have social scientists as part of these teams working to look at how these tools are adopted and adapted, because often there are lots of trade offs. It’s not like bias is always a black or white issue or fairness is a black or white. You’re either fair or you’re not. There are often trade offs that people have to make around accuracy. The best sensitivity and specificity of a model which biases matter most and contribute to inaccuracies in that. And then fairness is very context dependent. So when you start digging into any context where AI is being applied, people have really hard decisions to make. And and often when we look at the the sort of grand ethical discourse done by philosophers, you know, it’s looking like ethical AI is going to be the Equal Opportunity Employment Act for philosophers with backgrounds in ethics.

Jody Ranck: [00:32:21] But I’m going to take a different take that we need more of the social scientists. And then in in health care, you know, public health folks that that have a different take from the ethicists the embodied ethics is that’s what really matters I think even beyond these grand principles. And so I think that the piece in stat that we’ll put in our show notes, it’s really worth looking at. And some of these there’s a lot of good work coming out on the ethics of automation or social sociology of automation and so forth, where it’s talked about in very different ways from the data scientists. And those voices are going to be really important going forward to get things right and to understand what does digital transformation mean beyond a slogan, beyond a marketing trope, what does it mean for the people using the tools and really having some empathy for the challenges they face in adopting these tools? There are going to be lots of cases where it makes their jobs easier and so forth, but in many cases it requires a lot of extra work. There are some previous work done at Duke on the sepsis algorithm that’s largely viewed as a that Duke created itself that’s viewed as a very successful youth use of AI. But then when data and society social scientists took a look at it, they saw that the work of disruption fell disproportionately on nurses. So that’s where these more fine grained, sociological, anthropological studies, I think are going to be really valuable to put teeth on responsible AI and looking at actually existing responsible AI practices. That’s my TED Talk.

Elena Iakovleva: [00:34:21] Judy, that’s fantastic. You know, every single time when I hear you talking on responsible AI, it gives me hope that actually people will start using it more carefully. I was actually you know, I was wondering how did we manage not to mention Chatgpt for the whole time we were talking because I want to hymns and I was hearing Chatgpt from every single fly on the wall. I called it.

Jody Ranck: [00:34:54] Generative AI when I was talking. That’s what I was referring to. They’re the same thing.

Elena Iakovleva: [00:34:59] Thank you, Judy. That was such a nice twist. So was charged. But, you know, I was like talking to my folks and I talked to a number of EHR vendors and I was like, let me.

Jody Ranck: [00:35:14] Guess, they had a problem in Chatgpt was the answer to Down.

Elena Iakovleva: [00:35:20] So they actually they all announced Chatgpt how they implemented Chatgpt and so on and so on. And I am not being an expert in AI, obviously, right? Like I’m focused on RCM mainly. And I was just like walking around talking to people and wondering how do they live with chatgpt all the security issues that Chatgpt brought to the industry that are well documented and known and how are they doing it? Like, how did that happen? Like where are we sleeping while they were implementing Chatgpt?

Jody Ranck: [00:35:57] Now, this is what I was talking about. And maybe you missed the the my recap of hymns was everybody said, yeah, chatgpt And we’re doing it responsibly. Well, show me your work is our math teacher said in grade school, Show me your work. You know what what does responsible I mean, beyond kind of a you know, there’s a market of virtue out there. And this is the dangerous part of any ethical discourse on technology, where it rapidly becomes a marketing slogan devoid of content. And so I think it’s time we start looking, asking folks to show us their work. What what steps in responsible AI did you implement? What what are the metrics and and then down further downstream, you know, there will definitely be the KPIs. But what does it it means anything and nothing currently. And you know, I think we need you know, this is an area where I think Chilmark we should do can make a big difference in terms of, you know, reaching out to companies that say they’re doing this and, you know, talking to them about the granular practices that they’re employing to guarantee safety and ethical application of AI. And there needs to be transparency on that. We will not have technology that people can trust if it it this stuff is not transparent and and discussed openly. You can know we no longer live in a world where you can just say, trust me, it’s responsible.

Elena Iakovleva: [00:37:43] That That is actually I think it’s very true in Judy. Never again. I’ll miss your summary, I promise you that. You know, it just it’s fascinating with AI and stuff. So I keep on seeing more and more vendors relying on AI so heavily and especially like with diagnostics, right? Like what you were talking about, radiology and so on. And I’m I’ve, I’ve talked to a number of new vendors that just trying to climb this scene. And for example, one of them was detecting early dementia. And it just like to me, I can definitely see the value. But what you’re saying, the trust, I think we still need to work so much more to actually establish this trust between patient and technology. And this applies to every single part of digital health. And anywhere I look, I’m just like, Guys, why are you not using it? It’s so much easier. And people would go, Well, you know what? My friend or my aunt or my relative had this kind of experience or We’ve heard this and we’ve heard that. And yeah, sometimes it simplifies the life and actually sometimes it helps. It serves as a, you know, extra pair of hands or eyes to a physician. But just sometimes the technology from a security perspective and from accuracy perspective is in the place that we cannot quite say go for it and trust it fully. That’s definitely a huge, huge.

Jody Ranck: [00:39:24] Problem in AI. Models are notoriously difficult. They’re not the portability of them. When you move from one population to another, it’s still really challenging. I mean, we shouldn’t underestimate how hard it is to do AI in health care, and there’s no magic wand. And but we do need transparency about how they’re doing it.

John Moore III: [00:39:53] Quite true. Elena, do you want to talk about some of your news items? Next.

Elena Iakovleva: [00:39:58] Sure. So I’m mostly excited for my new upcoming Hospital at Home Report. It’s almost done. It’s going to be released in the next few weeks, I hope. And I just want to thank all of you guys and vendors and industry professionals and providers who actually helped me with the with the research and gave me a lot of insights and expertise. So thank you so much for making it happen. And also, I just want to say a few words about my upcoming report, which is going to be on payor provider platforms. And as I was saying previously, the focus on RCM is huge and for a good reason, right? So like a lot of provider organizations, they are losing revenue. They are not in the best financial shape. So obviously, like with this in mind, they all want to see some. Uncut edge technologies in Arkham. And in my opinion, one of the biggest trends I see in our world right now is when payers and providers, they are willing to cooperate more and more. So previously we all were talking about this problem that payers were not willing to actually make that step and to release more information and to be more open to work with providers directly. So right now I feel like it’s changing and more and more payers actually opening their doors and saying, we’re open, we’re here to help you and that is awesome. I actually see a lot of benefit in it and an ultimate benefit receiver is going to be the patient and I cannot be happier. So that’s what my next report is going to be on. I’ll be looking on all those technologies that enabling this communication between patients excuse me, between provider and the payer and also what are other services involved? Like how do they communicate in terms of population management? How do they make sure that all the financial transactions they go smoothly? Also, I will be looking into auditing processes and some others.

Elena Iakovleva: [00:42:20] So that is my biggest news. I’m announcing my new report and I’ll be actively searching for vendors for this report. So please reach out if you think you should be on this report. Another big update I got actually partially from him, partially from just following the news. I saw Epic and Oracle demos on their platforms and oh, my God, I seriously I feel like we just got to see a new horizon in our world. It looks very ambitious. It looks, um, it just looks like a totally new creature. So I’m very happy that Cerner is moving, is moving very quick. And actually after the acquisition, we all were kind of like worried how the company is going to look like, but I think that they got the best out of it. And also Epic, just hands down. I mean, their project on what’s going to be doing with RTM. It just looks fantastic. Um, it covers a lot of areas and obviously, you know, like Epic is one of those vendors that brings its very own vision into overall market expectations. So let’s see how it’s going to play out. So far we have a roadmap until 2025 and we’ll be following up closely on every single release that Epic does. So hold on to your seats. We’ll be posting on that soon.

John Moore III: [00:44:03] Well, thank you, Elena. Definitely looking forward to seeing what your research that you’re about to embark upon starts to look like as that shapes up and see what’s new there. Because as you’re aware, we only just recently started covering RTM because it was always a bit dry and too administrative for us to really see the impact that it has on patient care and access. But with some of the new models of care delivery and some of the new economics around how patients are actually getting their care, I think that this piece does become a lot more important to the accessibility problem in particular, and obviously physician burnout is a big part of this. So the less documentation that physicians have to be doing to get paid what they’re owed, the better and the better care they can provide. Um, all right. So thanks a lot, everyone, for sharing your thoughts about what’s happened in the last month. And I will close this out today with a quick overview of the Kaiser Geisinger Ryzen Health new entity. As most of you are probably well aware, it’d be hard not to have seen this in the news, considering that it’s one of the biggest events that’s happened in hospital mergers in a few years. Kaiser announced plans to acquire Geisinger Health and invest $5 beyond that into a new entity called Ryzen Health that helps nonprofit health care systems shift to value based care models. Now, this may at a high level, seem like a good thing, given that Kaiser has done a really good job of proving out value based care in a large system.

John Moore III: [00:45:30] But Kaiser has not been without its own issues and its own problems. I have one anecdote that I personally know that I think is well documented is my cousin. He got into a bike accident. He’s an avid mountain biker and he broke his collar bone in his arm in a fall going off a cliff kind of thing. And he had a Kaiser, I mean, a Kaiser Health Plan in Denver area, but he was outside of the Denver service area and had to get emergency treatment at a non Kaiser hospital and basically had to cover all the expenses out of pocket. It took my aunt a very long time to get Kaiser to cover any of the cost of treatment because he didn’t go to an in-network provider. And so as you think about Kaiser continuing to grow at a national level, they typically only service the core. Um, urban areas where there’s high population density. And so it’s a fairly limited accessibility to the network in general. And if they make it so that you can only use providers in their network, it’s very limiting for the actual patients on the other end. So definitely hoping that they don’t push that through everyone else that they work with. On the rising side of things, I know that Stat plus did a much deeper dive into some of the kind of practical implications of this and some of the potential downfalls of Kaiser going even broader than they already are.

John Moore III: [00:46:57] The new system would be one of the largest in the country. It’s kind of hard to know exactly how to quantify what the largest system is. Some. Barometers use the number of hospital beds. Some of them use the number of just hospital facilities or clinics. So there’s a bunch of different metrics that you can look at. But by patient revenues and sheer size, Kaiser was already one of the biggest systems in the country. It was definitely within the top 20, if not top ten. And now by acquiring Geisinger and making this announcement, they’re going to be bringing more nonprofit health systems into their fold. They’re definitely going to be one of the largest second only probably to maybe an HCA or someone at that level or others. So we have yet to see what that amounts to. We have yet to see if it will even be approved by regulators because it could obviously set up a lot of anti-competitive dynamics within the catchment areas for these different systems. And it could also create a lot of monopolistic power around negotiating rates with physicians and kind of trapping them into these narrow networks that Kaiser is known for. So we have yet to see how that will all shake out and whether or not regulators will actually approve it, especially given that they’ve been a bit more heavy handed recently with blocking more hospital mergers in areas where there’s very few services being provided in particular. All right. So the other big event or the big news item for us was I got to attend my first Oracle Analyst summit in my new role as the managing partner for Chilmark.

John Moore III: [00:48:28] In the past, it was usually my father that would go to Oracle events and just be him. He’s had a relationship with Oracle from well before he even founded Chilmark Research because he got his you know, he cut his teeth in the analyst business in the ERP space, which is one of the big things that Oracle is known for way back in the day when he was more focused on manufacturing. And so it was interesting seeing how Oracle has really doubled down on their healthcare investments and their health care vision. Obviously, any of these big enterprise companies were always pretty skeptical of them coming into healthcare if they don’t have deep experience there already, as we have learned time and again, if a product was developed outside of the health care ecosystem, generally speaking, the product will fail. If it was being kind of retrofitted to fit into healthcare as opposed to being purpose built initially. We’ve seen that with Google, Amazon, I mean Amazon shuttered all three of their main Amazon kind of health care products as of a couple of months ago. So we just see these big enterprises continually struggling in health care. But it seems like Oracle has a really good perspective on this. At the meeting, they kept hyping how much they are embedding health care experts into every unit of Oracle to make sure that as they develop new functionality, the health care needs and use cases are being met, which I thought was very interesting and a much better approach than what I’ve seen from a lot of other large organizations that try to just create a health care unit segment that often the rest of the organization and have them kind of try to make recommendations to the rest of the organization who’s all operating independently.

John Moore III: [00:50:03] So the fully integrated approach, I think would be really useful, especially as you think about the benefits that the Oracle supply chain and health and human capital platforms both provide. So obviously, Cerner was just the system of record for Oracle to buy to get a foothold, a much deeper foothold into the health care space. They cited that Cerner was the largest in the world. That’s why they went and acquired them. That and because Epic couldn’t be acquired, they actually noted that explicitly that the way that Epic is structured as a trust, they weren’t an acquisition target in general. So basically they were looking at Epic or Cerner and Cerner. I mean, an epic was an adoption. So Cerner was the obvious winner there. And so with all that penetration, all that data that they’re collecting, they see a lot of synergies with some of the core functionality that the Oracle Group is known for. There were a couple of things that they kept really pushing at the Analyst Summit. One of them was the NetSuite integration to all of their industry verticals side of their products.

John Moore III: [00:51:09] So basically every industry that they look at is going to have net suite products that are kind of fine tuned for that industry. They talked a lot about their supply chain management offerings, specifically looking at how they can or discussing how they can be providing a more access to kind of GPO level rates without being a GPO themselves. And so they were talking about how they can enable smaller providers, smaller healthcare clinics to have similar buying powers with a much larger organizations do by using the Oracle supply chain tools. Obviously we keep talking about how scheduling and just workforce management is a huge problem. They touched upon that a bit with their human capital management integration. They didn’t talk too much about that, but they did kind of speak to just the fact that they have all these tools already built for other enterprises. And so now they have it for health care to help with smart scheduling and things like. And then they were also talking a lot about their Redwood app development ecosystem, which I don’t know how new that is, but it definitely sounded like it’s a relatively new deployment that they’ve released. So basically it’s this whole thing for building on the OCI, the Oracle cloud infrastructure, and it has tools built in. It kind of has the framework already there for you to very easily and with a limited amount of code, be able to start building out apps that tap into the OCI kind of base. So it’s the idea is that enterprises can build their own apps as well as new new companies can very easily spin up a new application that can leverage all the benefits of what the OCI brings to bear.

John Moore III: [00:52:49] And that was the other thing that they talked about a lot, is the Oracle cloud infrastructure. So OCI is they refer to it as this acronym and. By June this year, they are going to be pushing all new clients to OCI. They are no longer going to be allowing clients to do on prem Oracle servers. So entirely virtual, entirely cloud based going forward, which we’ll see how that shakes out. We’ll see how some enterprises feel about that. But I thought it was a particularly interesting approach to just force everybody to go cloud or nothing. We’ll see how that plays out for them in the long run. So that’s really my key takeaways from the last month. This has been a really good podcast. Everyone. Thank you all for bringing your thoughts to bear. Before we break, I just want to do a quick call out with Jody and Elena. They are both in the process of starting a new research project and as part of that, we will be looking for interview guests for this podcast because we will still be doing specific interviews, more concrete topics in addition to these monthly podcasts that we’re releasing. So Jody, do you want to just share what kind of experts and people you might want to be interviewing as part of your upcoming research around the RPA?

Jody Ranck: [00:54:10] Yes. So I’m midway through an RPA Robotic Process Automation report looking at some of the key vendors across mostly administrative tasks. Some may reach a little bit into clinical. So I’ve reached out to quite a few vendors and done some demos, but if you’re in that space, you’d like to be part of the report. If you have a substantial offering, please feel free to to reach out. And then we’re also this responsible AI generative AI thing. We’re kicking around some ideas on that front as well. So if you’re, um, if you have something you want to show off on the responsible AI with respect to generative AI, I’d love to talk just to do some pre research on that as well.

John Moore III: [00:55:00] Perfect. And Elena, you want to share any thoughts about who you’re looking to talk to right now, whether it be for a podcast or for your research purposes, to help you frame out this payer provider solutions.

Elena Iakovleva: [00:55:10] Sure. So I’m starting my new report on payer provider platforms, and I am looking for industry professionals and leaders to speak more about the solutions that are available on the market today and also solution users who actually do have personal experience in using technologies, enabling payer provider communication. We’re also going to have a podcast, so I am definitely interested in learning more about your experience in payer provider platform space. Please reach out if you want to join our podcast on that. And just in general, if you would like to share your experience and insight or you a vendor operating in this space, please just send me a note. I’m always happy to talk and maybe we can actually develop a relationship further. And your profile going to show up on my new report.

John Moore III: [00:56:10] Fantastic. Well, thank you, everyone, for another great podcast. And I hope the market and our community sees the value in what we’re bringing with these. I definitely enjoy having a chance to kind of touch base with everyone, just hear what has got you excited and what you’re seeing over the last month. So I definitely get value out of us just gathering and talking like this. It’s a good prompt.


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