Empowered Patient Podcast

Gretchen Case, Managing Partner at The Wilshire Group a boutique healthcare revenue cycle consulting company that helps healthcare clients streamline workflows and processes. They work with hospitals, physician groups, and other providers to optimize their investment in technology and improve patient outcomes. Gretchen points out the various aspects of revenue cycle management, which include insurance benefit verification, explanation of costs, and identification of financial support. The middle revenue cycle includes the codification of clinical data and coordination with insurance companies and electronic health records. The third phase is the billing and payment. Gretchen elaborates, "Some of the automation I've seen over the last several years has been designed to query the documentation and come up with suggested codes, called computer-assisted coding. And there is a lot of that in play. I think it expedites things and it makes things more efficient. I don't know of anybody who's just flipped that button and left it behind and not continued to monitor and manage it." "There's also movement right now around what we call a single path. That's just one way of saying it, but it's about coding the professional and the technical at the same time. What does that mean? The physician's procedure charge and the technical is what the hospital is going for that technical component of the services. And a lot of times, we share codes. So, if you're going to be coding the physicians and getting her bill out the door correctly, you might as well be coding the hospital one at the same time. So there are definitely developments there, but I haven't seen anything. Just completely automate it and step away." #TheWilshireGroup #RevenueCycleManagment #RCM #Hospitals thewilshiregroup.net Download the transcript here

Lynn Carroll, the Chief Operating Officer at HSBlox, focuses on payer-provider collaboration to mitigate risks related to the transition from a fee-for-service model to value-based care. Care coordination is critical to this model to reduce duplicative and unnecessary services and low-value providers by effectively sharing patient data. They are seeing an emphasis on high-cost categories, diagnostics, and disease management to rein in costs and improve patient outcomes. Lynn explains, "At HSBlox, we have built a platform for payer and provider collaboration around these types of arrangements, particularly for onboarding different types of alternative payment model contracts, bringing together the care continuum to align primary care with specialty care because primary care can't go alone in achieving success under value-based programs. A significant amount of spend, particularly under the total cost of care programs, is driven by specialty utilization." "We have built a platform that allows for multi-participant programs that enable the sharing of data and the movement of funds across these different alternative payment models. The purpose of the platform was to provide the infrastructure that would allow these programs to flourish and accelerate the pace of the end game for value-based administration." #alternativepaymentmodels #carecoordination #contractmodeling #healthoutcomes #patientengagement #permissioneddataexchange #populationhealth #referralmanagement #reinbursementmodels #riskbearingproviders #ValuebasedCare #VBC HSBlox.com Download the transcript here

Dave Kerwar is the CEO and Co-Founder of Inbound Health, a hospital-at-home organization that offers an advanced primary care model for patients who would typically go to the emergency department and a secondary care model for post-acute patients who would typically go to a skilled nursing facility. With virtual care enhanced by data analytics, remote sensors, and on-site visits, Inbound Health's model has shown lower readmission rates than traditional facility-based care. Dave explains, "We help health systems launch and scale advanced care models delivered from the home. So our flagship care model is a hospital-at-home model where we're typically taking patients who are presenting in the emergency department or have been inpatient for less than 24 hours and who could otherwise receive the totality of their hospital stay from the comfort of their home. In that model, what we do is we bring forward the care model, so basically, the care pathways for how to care for those patients." "We bring forward a technology and analytics platform to remotely care for those patients, monitor those patients, and manage all the logistics around the care that needs to be delivered. We bring forward the virtual care team, which is made up of virtual nurses and physicians who provide the care and oversee the patient 24/7 and the in-home care. Nurses, therapists, and community paramedics go into the home." "We have to manage a lot of the supply chain in these models. We bring forward durable medical equipment, home-based labs, home-based imaging, home infusion, transportation, and things like that. We manage the ability to provide that supply chain into home-managed care services. Often, these models are not a standard reimbursement structure with the payers, so we create that reimbursement structure with the payers on behalf of our health systems." #InboundHealth #HospitalatHome #Medtech #DigitalHealth inboundhealth.com Download the transcript here

Michelle Clavecilla-Chan, Director of Behavioral Health at MVP Health Care, and Amanda Conway, Chief Growth Officer at Aptihealth, have partnered to expand access to mental health services for MVP customers. Aptihealth provides virtual behavioral health services that connect patients to comprehensive mental health and substance abuse support. Through their digital platform and behavioral health provider network, MVP customers have options for integrated care that remove traditional access barriers and provide virtual visits to engage this high-need population. The partnership focuses on serving complex patient populations with conditions such as psychosis, bipolar disorder, ADHD, and personality disorders with personalized care plans. Michelle explains, "MVP provides coverage for all lines of business, including commercial Medicare, Medicaid, Child Health Plus, and Essential Plan enrollees. We provide all of the healthcare needs of our customers, and our mission is to improve our customers' health and provide peace of mind to our customers by helping them access quality healthcare that meets their needs. Our mission is also to create healthier communities through innovation and collaboration, which is why we're excited to partner with Aptihealth." Amanda elaborates, "Aptihealth is a virtual behavioral health provider. We work with payers in value-based care arrangements to provide comprehensive services for behavioral health patients. We focus primarily on complex, high-acuity patient populations, which is unique to our virtual model, and we integrate within the communities that we serve to be a key stakeholder in the overall care of the patients we treat." #MVPHealthCare #Aptihealth #MentalHealth #DigitalHealth #AccessToCare MVPHealthCare.com Aptihealth.com Download the transcript here

Martin Pytela is a functional medicine expert, metabolic typing coach, and fellow podcaster. He discusses the principles of functional medicine and its focus on finding the root causes of health issues rather than just treating symptoms. Understanding metabolic behavior and how it can affect emotional well-being and overall health highlights the need to better understand the connection between diet and health conditions. Martin emphasizes the need to personalize approaches to health based on individual genetics and endocrine dominance. Martin elaborates, "Functional medicine is a moniker developed to distinguish it from allopathic medicine in the sense that functionals are looking for root causes of things. In the typical medical setting, you are just looking at a symptom, and you address the symptom with some chemicals and let the patient manage or cope with life as is. With functional medicine, you try to find the cause of it and restore health. So, rather than treating symptoms alone, you're trying to heal the patient." "Early on, they were checking venous blood pH. These days, we can get the same results just by putting forward a questionnaire with 120 multiple-choice questions. And at the end of it, we're able to tell you what your endocrine dominance is and what your metabolic dominance is. The endocrine dominance, which we identify as the thyroid, adrenal, pituitary, or ovaries in women, will drive how a person will gain weight or lose weight primarily. And then the metabolic dominance, of which we have either the autonomic or the oxidizer, one is the lipo-oxidative the other one is carbo-oxidative dominances. With that we'll figure out how the pH of the internal body terrain is responding to the food combinations." #MartinPytela #FunctionalMedicine #MetabolicTyping #EndocrineDominance #HolisticHealth #ThePainManifesto Life-Enthusiast.com Download the transcript here

Patty Hayward, general manager for healthcare and life sciences at Talkdesk, talks about transforming the traditional call center into one that uses AI and large language models to make it easier for patients to get help and free up call center staff to focus on value-added tasks. The technology supports call center agents in their conversations with patients and helps avoid escalations. Outbound messaging prompts patients to take action, reinforcing conversations with call centers to improve patient outcomes. Patty explains, "Because AI has been around for a long time, we've had AI infused in our platform for many years. But these large language models that have come speeding into the market have enhanced how we use AI in such a great way and allowed us to more easily support patients and agents in their journeys. We in healthcare do not make these journeys easy. They're very complex. There are a lot of things going on, and quite frankly, deployment and training of these models can be really difficult. So these large language models have helped democratize a lot of this AI so that you don't have to have a full IT staff devoted to doing this, which I think has been great." "Then there are things you need a human for. A human in the loop is really important in healthcare because of the complexity we discussed. So, being able to support the agents, listening to the conversation, and bringing out things like the next best actions. What should that patient be doing next? How does that go without having to read articles or have tons of tabs behind your call center product or sticky notes all over the screen? I've seen this in numerous call centers to help coach those agents to make sure that they're answering calls correctly. Also, the first time the patient calls, she gets what she needs and is not transferred needlessly." #Talkdesk #GenAI #AI #ArtificialIntelligence #ContactCenter #CallCenter #ValueBasedCare #VBC #PatientExperience #MemberExperience #CustomerExperience #Providers #Payers talkdesk.com Download the transcript here

AJ Tesler, an award-winning producer and director who, along with his wife Jenny, is launching Magnolia's Guide to Adventuring, a new documentary video series created with support from Acadia Pharmaceuticals, inspired by their daughter Magnolia's experience with the rare genetic neurodevelopmental disease Rett syndrome. We're also joined by Dr. Cary Fu, a pediatric neurologist at Vanderbilt University Medical Center, who emphasizes the need for early diagnosis. The video series highlights the adventures children with Rett syndrome can engage in. While Cary emphasizes the importance of safety and consulting with specialists before pursuing an adventure, AJ and Cary encourage people to recognize the capabilities of children with Rett and focus on what they can do. AJ explains, "We made a documentary about that experience and those initial steps that we took called Magnolia's Hope, which is available on iTunes and Amazon streaming, as well as a bunch of other places. And in that documentary, my wife so sagely presents it as we want to make sure that when there's a cure, she'll have stories to tell. That's an inspiring way to think about all of this. Her story does not just have to be about Rett syndrome. It doesn't have to be about all the things that she can't do. It can be about all the things that you can do." "Beyond that, it was also about finding families to come along on these adventures with us. Some of the families are adventurous and have tried these things before. Some of them have never done any of these things before. That was part of the creative vision for the entire thing, which was to show that no matter what your disability is, no matter where on the spectrum you are, as long as a doctor says that it's okay to do these things, then, by all means, there are organizations that can help you do these things." Cary elaborates, "I wouldn't say it's necessarily unusual, but I do think that what AJ and Jenny have done with their family is very inspiring. I think families come in all sorts of shapes and sizes. I think the important thing is I encourage all of my families with Rett syndrome to make sure not to allow the diagnosis to define them. To make sure that whatever expectations they had as a family before the diagnosis was made and before they realized that there would be potential limitations and need to make modifications, they should feel free to pursue those things that they wanted, the hopes that they wanted for their child." #RettSyndrome #MagnoliasGuideToAdventuring" #AdventuringWithMagnolia #RettRevealed #AdaptiveSports #AdaptiveAdventures #RareDisease RettRevealed.com Download the transcript here

David Mazzo, President and CEO of Lisata Therapeutics, has a lead program focused on metastatic pancreatic ductal adenocarcinoma. The Lisata CendR Platform and drug certepetide efficiently augment the effects of chemotherapy and immunotherapies in the tumor microenvironment. Based on early findings, the future of cancer treatment may involve combining existing therapies with certepetide to personalize treatment for most solid tumors. David explains, "At Lisata, we're developing therapies to combat a challenging problem in the medical field today, which is the effective treatment of solid tumors. Solid tumors are very difficult to treat for two very simple reasons. On the one hand, these tumors generate a layer of cells around them that acts as a physical barrier. It's called the tumor stroma, and it prevents the penetration of many anti-cancer medicines into the tumor, which is why you often don't get the kind of results that one would expect." "The other obstacle these tumors present is that they generate or express a tumor microenvironment that is immunosuppressive, which helps the tumor hide from your innate immune system. It helps it not respond very well to externally administered immunotherapies. When you combine these two challenges, you end up with a set of diseases that remains an enigma in medical science today." "So our therapy at Lisata called certepetide, our lead product, actually combines the ability to target and penetrate tumors more effectively for co-administered anti-cancer drugs with the ability to modify the tumor microenvironment, making it more immunoreceptive and therefore more likely to respond to your immune system and immunotherapies." #Lisata #Oncology #Cancer #SolidTumors #Immunotherapies #TumorMicroEnvironment lisata.com Download the transcript here

John Incledon, President and CEO of Hisamitsu America, the makers of Salonpas, has seen enormous growth in the acceptance of over-the-counter topical pain management options since introducing the Salonpas analgesic patch in the US market 37 years ago. This growth is partly due to television ads featuring doctors touting the benefits of Salonpas for mild to moderate nerve-related and muscle-related pain and the sampling program that aims to get doctors and patients to try out the products. John explains, "Topical medications have only been around since the 1960s, with the introduction of the first OTC monograph by the FDA. Salonpas itself was formally introduced to the United States in 1987, so we've been around some 37 years or so as a brand in this country. And so, it's been a challenge. I'll give you a couple of fun facts: 85% of US households have a pill form of an OTC pain reliever in their house, and 30% have a topical analgesic of any sort, a cream, a roll-on, or a patch. So, there's a great disparity there. Pills remain a modality, topicals are up and coming, and I think the horizon for them is excellent." "Topicals work locally, at least OTC topical analgesics. You can wear patches and things intended to be systemic, but in this category and the products we're talking about, they're not. They're intended basically just to work below the surface of the skin. There are pain receptors that certain actives will trigger to help minimize the pain. However, they're not intended to get into the bloodstream, so by working locally and acting locally, they're generally safer than systemic analgesics." "We have basically two mechanisms of action in our products. One is anesthetic-based and uses lidocaine, and lidocaine is going to be most appropriate to the extent that you can diagnose this if your source of pain is from aggravated nerves. So if your lower back pain is tending to move outward, say, from the spine, you want to use an anesthetic to treat that, and so, a lidocaine-based product would be best." "If it's purely muscle-related, then you're better off with our alternative formulas, which include menthol, methyl salicylate, and camphor. Methyl salicylate is an aspirin derivative, so it's categorized as a non-steroidal anti-inflammatory but topically applied, as opposed to systemically." #Salonpas #Hisamitsu #GoodMedicine #ItsGoodMedicine #PainManagement #OTC #OvertheCounterDrugs #TopicalAnalgesics us.hisamitsu Download the transcript here

Dr. Doug Newton is the Chief Medical Officer at Rula Health, a tech-enabled provider group that offers therapy, psychiatry, care coordination, and other supportive behavioral health services with a whole-person approach. Mental health disorders are diagnosed and managed using a combination of sound clinical judgment and measurement-informed care, which involves using patient-reported data and other objective measures. Normalizing mental health and using objective measures can help doctors bring up the topic with people of all ages to develop a personalized plan to maintain good physical and psychological health. Doug explains, "We do know that the behavioral health crisis was exacerbated by COVID. Still, unfortunately, for most demographic groupings, it was already starting before the pandemic hit. Using adolescents as an example, because I'm a child, adolescent, and adult psychiatrist by training, I saw this trend, so I looked at the data. We saw that was already a problem for kids, adolescents, and adults, where the rates of depression and anxiety were going up, as well as despair, as well as suicidal ideation - and, unfortunately, completion - were going up prior to COVID. It went up even further with COVID. We're seeing, unfortunately, either continued or slightly increased in the years post-COVID as well." "The next component is, okay, great, let's get people to equitable and quick quality care. That's been harder. And so I do think that telehealth has allowed us to do that. I think it's allowed more equitable care across rural and urban areas. It's allowed providers and patients to find one another in a way we haven't been able to before. And that's great. I think the next frontier is making sure that we are providing the right care, and we can measure ways of providing the right care to that person. Highly personalized outcomes-based care is the frontier that we're going into next, and that's going to be critical." #RulaHealth #BehavioralHealth #MentalHealth #YouthMentalHealth #MentalHealthAwareness #MeasurementInformedCare #COVID Rula.com Download the transcript here