Empowered Patient Podcast

Todd Doze, CEO of Janus Health, specializes in bringing AI to hospitals to connect the hospital revenue cycle management with the overall patient experience. Automating some manual RCM tasks, such as prior authorizations and referrals, has led to significant reductions in claim denials, faster processing times, fewer errors, and better compliance with recent legislation. Challenges remain to ensure the AI model's accuracy and to demonstrate clear ROI and a direct impact on the hospital's revenue. Todd explains, "Today at Janus, we focus on helping providers improve their operational and financial efficiency. We work with about 250 acute care hospitals across the country, servicing some of the largest health systems in the nation by providing automations and AI-driven operational intelligence. This gives management insight into what their revenue cycle folks are doing to ensure they're taking the optimal paths to adjudicate claims and also automating as much of the laborious, tedious work that goes into treating patients in the most optimal manner." "There are a lot of very manual pain points within the rev cycle experience. For example, many of us have been referred by our primary care physician to a specialty provider. A very common example is referring to an imaging center for an MRI or X-ray. And many times, to access an appointment with that specialty provider, the provider may need to submit a prior authorization request to the patient's insurance. And then there's also the communication loop process focused on the referral. And so there are many areas for error, and there are a lot of ways the patient experience can go south very quickly." #JanusHealth #AIinHealthcare #HealthcareAI #HealthTech #HealthcareOperations #RCM janus-ai.com Download the transcript here

Susan Grant, Chief Clinical Officer at symplr, reviews findings from their annual Compass Survey, which revealed the significant challenges hospitals face, driven by financial pressures, clinician burnout, and operational inefficiencies. Fragmented technology systems create significant administrative burdens, and there is growing recognition that unifying healthcare operations and strategically implementing AI are crucial to streamlining workflows. Clinicians' involvement in the design and implementation of new processes and procedures is essential to ensure that patients' real-world needs are properly addressed. Susan explains, "The annual Compass Survey, is actually our fourth survey that we've done here at symplr, and the goal of the survey is to drive awareness around the need for and benefits of streamlining healthcare operations software. So it's a way to get feedback from our customers, clients, and leaders out in the healthcare world." "I've been a Chief Nurse for the last 30 years in different health systems around the country, and we do tend to be a very reactive industry. However, I think it's built and intensified over the last few years because of issues we're seeing that have also intensified, including finances, workplace violence, clinician burnout, and cybersecurity. Those are some of the top issues our healthcare systems are dealing with. So I think that the reactivity of trying to really deal with those various issues has intensified and created this reactivity." #symplr #CompassSurvey #HealthcareIT #HealthcareOperations #symplrOperationsPlatform #HealthcareAI symplr.com Download the transcript here

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

In this engaging discussion, Alexander Tsiaras, Founder and CEO of StoryMD, tackles the chaos of fragmented health records. He reveals how his platform unifies clinical data, wearables, and personal entries into coherent narratives. With insights on the power of visualizations in improving patient understanding, Tsiaras discusses the significant role of AI in transforming data into meaningful stories. He also shares real patient experiences, emphasizing how immediate access to consolidated health information can revolutionize care.

Seth Cohen, President of Cedar, focuses on transforming the healthcare billing landscape into a more patient-friendly financial navigation system. He discusses how Cedar's AI, Cora, connects patients to underused financial resources like Medicaid and Health Savings Accounts. Seth highlights the impact of recent policy changes on patient affordability and explains Cedar's strategy for automated eligibility verification. With an emphasis on advocacy, he shares how technology can alleviate financial burdens for patients while benefiting healthcare providers.

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