Empowered Patient Podcast

Fawad Butt, Co-Founder and CEO of Penguin AI, is addressing the workflow challenges faced by healthcare payers and providers, particularly in prior authorizations and claims adjudications. These processes are inefficient and often yield inconsistent results because human reviewers interpret rules differently, and patients are denied care due to minor administrative errors. Penguin AI is bringing consistency and speed to adjudication, breaking down data silos and handling non-clinical administrative work, enabling agents to address patient-specific problems and ensure accuracy and safety. Fawad explains, "When you look at the healthcare ecosystem, there are obviously the pharma side, the payer side, the provider side, and the PBN side. So there are lots of areas where opportunities exist. We think payers and providers are especially challenged, and I think the area where they struggle is in the administrative workflow. And these are things like prior authorization and risk adjustment, claims adjudication, and payment integrity on the payer side." "There are things like scheduling and patient 360, or onboarding and referrals, as well as some risk adjustment for entities that are risk-bearing, and ultimately, all the functions around revenue cycle management for providers. I think the payers and providers have a tremendous amount of technology and resourcing support, but these functions have not really been what I would say reimagined in over a decade. And I think with AI, there is a real opportunity to come back and try to optimize." #PenguinAI #HealthAI #HealthcareAdministration penguinai.co Download the transcript here

Alexander Tsiaras, CEO and Founder of StoryMD, is addressing the critical problem of the fragmented health information landscape. The StoryMD platform unifies a patient's health history, including clinical records, wearable data, and personal diary entries, along with relevant data from a vast validated medical library of text and strong visualizations. This provides a coherent narrative about the patient that informs the patient, their healthcare providers, and caregivers, enabling more informed decisions and better outcomes. Alexander explains, "So one of the huge problems that we have in healthcare is that when people go through a health journey, they have to cobble information together from so many disparate sources. You get a PDF here, you get a URL there, you get a screenshot somewhere else. And fundamentally, what happens is that you're trying to cobble the story of your journey together, and it's totally fragmented. You get fragmented medical records, you get fragmented information, and you share fragmented information with other sources. So really the story is constantly evolving, and you're trying to figure it out, and it's problematic." "What we have now built is the largest coded medical library in the world, where we can take all of the information using HL7 codes. Now, HL7 is Health Level Seven International, which basically is the way that your medical records are coded. And we have mapped a piece of information using AI to your medical records. So when we see a lab report, we tell you a beautiful story about what your labs mean, and this way, we can actually keep longitudinal stories going, giving you insights into what's going on in your biomarkers." #StoryMD #HealthTech #DigitalHealth #HealthAI #HealthJourney storymd.com Download the transcript here

Seth Cohen, President of Cedar, is addressing the affordability of health care by shifting the emphasis from billing functionality to patient financial navigation by using technology to connect patients to underutilized financial resources. The Cedar Cover platform is designed to identify and enroll eligible uninsured or underinsured patients into Medicaid, ACA, available pharmaceutical copay subsidies, and untapped Health Savings Accounts, which can be used retrospectively to cover previous medical and ongoing bills, benefiting the patient and providers. An AI agent handles patient service calls to help patients navigate the challenges of connecting to these resources and identifying new coverage options in these uncertain times. Seth explains, "Cedar is the largest independent solution focused entirely on the patient financial experience in healthcare. As you probably know, in the revenue cycle space, there are lots of vendors out there selling solutions up and down the revenue cycle, mostly with an emphasis on insurance reimbursement. We are the only one that we're aware of that is really driving at scale a better patient experience, so fully focused there. And so what that means is we are the entity responsible for sending bills to patients and helping those patients navigate their financial obligations to large hospitals, health systems, and large physician groups." "But that word advocacy, I think, is very relevant now because what we've discovered and a huge, huge shift over the last decade is that most patients cannot afford the bills they're receiving. We're really in an affordability crisis. And so it's less about sending a bill with good billing functionality. It's more about helping the patient navigate how to manage that bill. And so there is a lot of advocacy in that." #Cedar #FinancialSupport #MedicalBills cedar.com Download the transcript here

Jim Foote, Co-Founder and CEO of First Ascent Biomedical, is changing the standard of care for cancer treatment from 'try and hope' to 'test and treat'. The First Ascent platform combines functional drug testing of fresh biopsies, genomic sequencing, and an AI engine to assess a large panel of drugs and identify the most likely to be effective. Clinical data show a high correlation between how cancer cells respond in the lab test and how patients respond to the same drug, and is seen as a treatment guide for refractory cancer patients to identify novel drug combinations. Jim explains, "Fundamentally speaking, if we look at everybody on this planet from a DNA and RNA perspective, there are 8 billion people, and each one of us is different from the others due to our DNA and RNA. So if we acknowledge that biologically we're all different, then the problem that we're trying to solve is if we're all different, why are we treating each patient with the same standard of care? A process that has existed for a hundred years, and again, they've made substantial advancements, but functional precision medicine is really an opportunity to move away from a standard that's based on the laws of averages and really treat people based on an individual level, developed by results that come from their individual biology." "In oncology, these practices and standards have been developed over decades. And in some situations, some of these cancer protocols haven't been updated in decades. There had been continual advancements in things like immunotherapy. What I'll say is that in oncology, they're always looking for the silver bullet. It's in the genome, it's in a biomarker, it's in immuno-oncology, it's in an organoid, it's in all of those types of things. So they have always tried to find that silver bullet. Fundamentally, what we do in First Ascent is that we believe that we have enough bullets, per se. We have enough drugs, per se. We're just not using them in the right ways. " #FirstAscentBiomedical #Cancer #Oncology firstascentbiomedical.com Download the transcript here

Deb Nevins, Director of Product Strategy at POCN, emphasizes the expanding role and importance of Nurse Practitioners and Physician Associates in the American healthcare system. These professionals have evolved from being an extension of the physician to becoming autonomous clinicians who handle a wide range of patient care, including diagnosing, prescribing, and creating treatment plans for a significant portion of the patient population. In many cases, NPs and PAs are filling care gaps in rural and underserved areas and applying a more holistic approach to healthcare in an increasingly virtual healthcare environment. Deb explains, "POCN is an organization that has been around for over 10 years now. It started really with the mission to support nurse practitioners and physician associates and help them practice at the top of their license. And we do that multiple ways, but specifically we like to say it's a learn, earn, care, and connect model. So we provide educational insights to them. We allow them to connect with each other on our platforms, and we also bring them forward to pharmaceutical companies to help them better understand the role that they play in patient care today." "Well, it's really interesting because both nurse practitioners and physician associates have really stepped up their responsibilities and roles since the timeframe when COVID started, where there was such a backlog. So they used to be thought of as more physician extenders or as mid-levels, but we can no longer say that. So nurse practitioners, physicians, and associates will handle everything with patient care from the initial intake, counseling, diagnosing, creating the treatment plan, prescribing medications, doing the follow-up, and ensuring that they're managing during side effects or anything like that that might happen. They support the patient with access challenges as they try to get their medications. So they basically do almost everything that a physician, an MD or a DO would do, except that they're not doing surgery or they're not doing super complex cases, but they have autonomy." #ElevatingCare #VoicesInCare #PatientsFirstCare #POCN #WomenInHealthcare #VisibilityMatters #HealthcareLeadership #AmplifyNPs #AmplifyPAs pocn.com Download the transcript here

Jill Eubank, Division President of Professional Talent Solutions at Randstad USA, shares key findings from the Randstad Work Monitor Pulse Survey on the current landscape in the medical and healthcare industry. Noted is the significant shift from prioritizing remote work to job security, alignment with leadership values, and how AI is being used to improve job efficiency. In an environment facing a scarcity of qualified employees, retention drivers include pay increases that keep pace with inflation, flexible scheduling, and strong manager support. Jill explains, "We're the largest staffing and workforce solution provider in the country and really in the world. We offer recruiting, staffing, HR services, whether it's on a temporary contingent basis or even all the way up to executive search and permanent placement. In healthcare specifically, our co consultants specialize in recruiting for those essential roles in the healthcare industry. Think medical, dental, and pharmaceutical sectors. We have a large, extensive network of not only clients in healthcare, but also candidates and a pool of talent in the market." "I think during COVID, we saw, especially in the healthcare industry, people wanting to find a way to work remotely for a lot of various reasons. What you're finding is that it's now shifting to employability versus working remotely. And in order to stay in a role for, let's say, five years or more, what we're finding is healthcare workers are saying that the top three retention drivers are an annual pay increase that keeps up with inflation or above inflation, followed by manager support, which was something we hadn't seen as frequently in the healthcare space. And then obviously, something that has evolved over the last couple of years is alignment with leadership values. A lot of very interesting key takeaways, but things you're starting to see evolve with the market and what's happening just with the workforce in general." #RandstadUSA #TalentStrategy #WorkforceInsights #FutureofWork #HealthcareJobs #TalenRetention #WorkplaceTrends #HealthcareLeadership #EmployeeWellbeing #FutureofWork randstadusa.com Download the transcript here

David Bates, CEO and Co-Founder of Linus Health, highlights the need to monitor brain health to identify the earliest signs of cognitive decline. The Linus Health AI-powered platform enables primary care providers to quickly screen for, diagnose, and help manage cognitive issues for an expanding population. Striving to overcome stigma and bias, this approach to early detection is crucial because many underlying causes of cognitive decline are treatable or reversible. David explains, "In brain health, especially, I'll talk first about cognitive health. There are up to 15 million Americans right now who have mild cognitive impairment, which is a precursor to dementia, and they do not know it. So, it's believed that up to 92% of mild cognitive impairment is undiagnosed, and up to 60% of dementia is undiagnosed. So we have this massive need to identify these folks and help them, empower them to get the resources to manage the condition, to optimize quality of life for themselves and their family and their loved ones. On the preventative side, empower folks to prevent dementia as much as possible, and maybe even half of dementia cases could be prevented through lifestyle modification." "Furthermore, if it's found early, there's a lot that can be done both to prepare for the advancement of the disease and to delay the advancement of the disease, and to empower people to live the highest quality of life in their circumstances. Furthermore, not all mild cognitive impairment or dementia is due to Alzheimer's disease. There are some things that, especially in the mild cognitive impairment stage, can be done, like changing medications, diagnosing depression, dealing with sleep apnea, vitamin deficiencies, and so on and so forth, that can actually reverse the course or at least slow the progression." #LinusHealth #BrainHealth #AI #Healthcare #EarlyDetection #CognitiveHealth #HealthTech #Innovation linushealth.com Download the transcript here

Mike Hoxter, CTO of Lightbeam Health Solutions, is focused on applying AI to population health management by using predictive models to enhance risk stratification for organizations with value-based care contracts. He emphasizes the importance of integrating social determinants of health along with clinical data to create more accurate predictive scores for patient outcomes, such as reducing hospital readmissions. AI enables a model to incorporate diverse data to derive more fine-tuned, actionable predictions. Mike explains, "We're really all for optimization in value-based care plans and care management. That's really our bread and butter, which is a pretty wide net. So we have a lot of large provider organizations in either CMS MSSP, ACO REACH, or a wide range of value-based care contracts with a lot of the commercial players. The Blues, Humana, Cigna, and Aetna all have value-based care plans that they have contracts with providers. So, optimizing for performance in those contracts. Anybody who works within those is our main clientele. We also have payers that are administering value-based care plans and some hospital systems as well." "If you're good at preventative healthcare, you prevent a lot of unnecessary healthcare. And so risk stratification is something that we do a lot of, and we use a lot of the standard models out there. We have Johns Hopkins embedded into our application. We have all of the different HCC models for Medicare Advantage, CDPs for Medicaid, but then also we have a suite of internal machine-learning-based models, which, I think, is funny - we've gotten to a point where there's such a thing as traditional AI, which is what it's called." #LightbeamHealthSolutions #PopulationHealth #ValueBasedCare #VBC #VBCEnablement #AI #SDOH #RemotePatientMonitoring #Providers #Payers #ACO lightbeamhealth.com Download the transcript here

Adam David, CEO of Doctors House Calls, has identified a gap in healthcare for homebound, high-acuity patients who lack a primary care physician, which often leads to frequent hospital admissions. This service operates primarily for Medicare patients by deploying physicians, PAs, and nurse practitioners to provide comprehensive care in patients' homes. Technology, such as connected devices, AI, and portable diagnostic equipment, enables efficient and effective visits to provide proactive care, extending the range of services available to this population. Adam explains, "I put together Doctors House Calls, not to compete in the business of treating patients in assisted living facilities, which seems to be very popular among independent physicians looking to be more mobile and not wanting to work within four walls." "And so they see facility-based type of care as a way to sort of get out and be mobile and have flexibility, but they're only servicing patients that are in facilities. I would say there are probably more patients who need this type of help who are still living in independent homes than who are actually in facilities. A lot of it's due to their socioeconomic needs. They just don't have the support around them to help guide them. They don't have social services that are in place to tell them what their options are. And so they're sort of just left at home by themselves." "What I've done is over the course of about eight years, I've been working on building a group of nurse practitioners, physician associates, and physicians who are really willing to drive way out of their way at times and drive many miles just to see one patient to make sure that they're receiving the care they need." #DoctorsHouseCalls #HomeHealthcare #MobileMedicine #AccessibleCare #CareContinuity doctorshousecalls.com Download the transcript here

Linda Schatz, Director of AKASA, explains the role of Clinical Documentation Integrity (CDI) specialists in ensuring accurate coding and bridging the gap between clinical documentation and specific, accurate codes to ensure proper reimbursement. The complexity of medical coding often leads to errors, which can be nearly eliminated by using AI to review 100% of patient encounters to identify inconsistencies and help CDI and coding professionals process more accurate claims quickly. Accurate documentation is important for hospital revenue, patient care quality, and perception of the hospital's performance. Linda explains, "Well, the old adage, if it isn't documented, it wasn't done. If the doctor uses incorrect or perfectly acceptable medical terminology, it doesn't translate into an appropriate code. You've heard the term UIs, this is years ago, right? Grandma had UTIs and died. In the coding world, that used to code for a simple UTI. So the hospitals are getting paid for a patient that took care of a UTI, when in reality that patient was septic. To the outside world, it looks like Grandma came to the hospital, something that could have been treated outpatient, and she died. So the public perception of quality is less. So not only is it revenue, it's quality, but ultimately it's delivering patient care." "I'm an old nurse. I've been in this field for over 40 years. I've worked across the NICU, PICU, and adult ICU. I've worked in access hospitals to large academics and all the way through hospice. That's pretty unique as a nurse to have that big of a background. Then I became a CDS, or clinical documentation specialist, or integrity specialist, and learned the documentation and coding aspect." "Then I moved into the consulting role and worked with organizations and physicians all across this nation, helping them learn how to do this. And so you've got the clinical background, the coding background, and now I understand how generative AI works. And so while you're a new nurse, you're a horse, right? When we hear a heartbeat, we think of a horse, and after years, you earn your stripes and you become a zebra, and then you add all of these multiple areas of expertise, you become uniquely valuable as a pink zebra." #AKASA #GenAI #CDI #RevenueCycleManagement akasa.com Download the transcript here