Outcomes Rocket

Trust and collaboration between payers and providers are crucial for better healthcare outcomes.In this episode of the AHIP 2024 series, Chuck Feerick, VP of Sales for Clarify Health Solutions, discusses the evolving dynamics between payers and providers, with a focus on AI's role and the integration challenges it faces. Chuck explains fee-for-service 2.0, which lets providers act as if they're in a value-based contract, and emphasizes the importance of trust and collaboration in payer-provider relationships, highlighting Clarify's tools for assessing provider performance and improving care quality. He underscores the need for standardized healthcare contracts and data's role in creating opportunities, noting that Clarify aims to reduce friction and improve healthcare flow by combining health plans and provider data. Chuck also talks about how AI in healthcare faces challenges like hallucination and emphasizes the need for accurate data input while also stressing that innovation in healthcare is driven by everyone involved, from providers to payers.Tune in and learn how value-based care is evolving, focusing more on outcomes than processes!Resources:  Watch the entire interview here. Connect and follow Chuck Feerick on LinkedIn. Learn more about Clarify Health Solutions on their LinkedIn and website.

Early and continuous engagement in quality programs can significantly boost health outcomes and ratings.In this episode of the AHIP 2024 series, Ryan Boulier, VP of Business Development at Sprinter Health, shares insights into how his company is enhancing healthcare engagement through in-home services. He explains how Sprinter Health focuses on reaching underserved populations by providing preventive care at home using a skilled workforce known as "sprinters." By employing community-based sprinters who perform various diagnostic services such as A1C tests, blood pressure checks, and diabetic eye exams, Sprinter Health fosters trust and improves patient follow-up. Ryan emphasizes the importance of early and continuous engagement in quality programs to boost health outcomes and ratings while also highlighting the success of their consumer-based outreach methods in engaging patients who often skip visits. Tune in and learn how innovative home-based healthcare solutions can transform patient engagement and outcomes!Resources:  Watch the entire interview here.  Follow and connect with Ryan Boulier on LinkedIn. Learn more about Sprinter Health on their LinkedIn and website. Listen to Sprinter Health’s previous episode on our podcast here. 

AI has the potential to significantly improve prior authorization, payment structures, and patient navigation. In this episode, Brian Urban, Director of Innovations and Emerging Markets at FinThrive, talks about why understanding and utilizing non-clinical data is crucial for addressing social health needs effectively. He explains how FinThrive, a leading revenue cycle management company, is addressing issues like payment integrity, care coordination, and social health needs. Brian emphasizes the importance of AI in reducing remittances and friction and improving provider-payer relations. He also discusses the importance of social determinants of health data and why he believes intrapreneurship within organizations can drive significant advancements in the healthcare sector, underscoring the importance of data literacy for creating a sustainable healthcare system. Tune in and learn how AI and innovation are set to revolutionize the healthcare industry, making it more efficient and equitable!Resources:  Watch the entire interview here.  Connect and follow Brian Urban on LinkedIn. Learn more about FinThrive on their LinkedIn and website. Listen to FinThrive’s podcast, Healthcare Rethink, here.

Navigating healthcare economics, particularly Medicare Advantage, presents challenges but offers learning opportunities.In this episode, Ed Liebowitz, EVP and Chief Strategy Officer at Solera Health, discusses his path from being diagnosed with juvenile diabetes at 26 to getting inspired for a bright career in health tech. Solera Health started by supporting digital diabetes prevention and expanded to cover various health areas, including mental health, weight management, and hypertension.  Ed explains how the company utilizes a pay-for-performance model, ensuring cost-effective, clinically relevant outcomes. Throughout this interview, he shares insights on the complexities of healthcare economics, especially in Medicare Advantage, and the potential of AI in improving healthcare delivery. Ed also emphasizes the importance of innovation, patient care, and leveraging technology to empower individuals and encourages listeners to stay updated on digital health advancements. Tune in and learn about the transformative power of digital health solutions and the future of healthcare innovation!Resources:  Watch the entire interview here.  Connect and follow Ed Liebowitz on LinkedIn. Learn more about Solera Health on their LinkedIn and website. Learn more about Solera Health’s partners:  Sworkit  Kaia Health Sword  Vori Health 9amHealth

True power lies in naivety, creativity, curiosity, and courage, transforming visionary ideas into tangible outcomes.In this episode, Christian Coachman shares insights from his journey from academia to entrepreneurship, emphasizing the essential qualities of naivety, creativity, curiosity, and courage that have fueled his success. He explores the development of Digital Smile Design, the importance of collaboration to enhance patient outcomes, and his philosophy of sharing ideas to foster innovation while addressing challenges in the dental industry, such as clinicians' business acumen and maintaining quality care amidst scalability pressures. Whether you're a dental professional or curious about tech in healthcare, this episode offers insights as Christian Coachman shapes the future of dentistry, one smile at a time.Resources: Connect with and follow Dr. Christian Coachman on LinkedIn and Instagram. Follow Digital Smile Design on LinkedIn and Instagram and explore their website! Watch the entire episode on YouTube and get more details at Think Oral Health.

AI and predictive analytics offer exciting possibilities for improving patient care and operational processes.In this episode, Jonathan Adam Fialkow emphasizes the importance of empathy and support in medical care, personalized and value-based care strategies, and the effective use of technology in cardiology and population health. He highlights the necessity of addressing provider burnout, the benefits of team-based and concierge care, and the rapid development of big data technologies while also covering how digital tools improve patient engagement and streamline care management, leading to better outcomes and physician satisfaction. Tune in and learn how combining empathy, technology, and innovative strategies can transform patient care and healthcare systems!Resources: Connect and follow Jonathan Adam Fialkow on LinkedIn. Follow Baptist Health South Florida on LinkedIn. Discover Baptist Health South Florida’s Website! Listen to the Baptist HealthTalk podcast here! About Memora Health:Memora Health, the leading intelligent care enablement platform, helps clinicians focus on top-of-license practice while proactively engaging patients along complex care journeys. Memora partners with leading health systems, health plans, and digital health companies to transform the care delivery process for care teams and patients. The company’s platform digitizes and automates high-touch clinical workflows, supercharging care teams by intelligently triaging patient-reported concerns and data to appropriate care team members and providing patients with proactive, two-way communication and support.

A holistic approach to healthcare involves engaging members in preventive care rather than waiting for them to become sick.In this episode of the AHIP 2024 series, Nicholas Kraft, Chief Growth Officer at CDPHP, discusses the health plan's dedication to innovation and quality in healthcare. CDPHP, a physician-led nonprofit serving 400,000 members in New York's Capital District, prioritizes community care, challenges high healthcare costs, and promotes collaboration among leaders to improve healthcare access and affordability. Nicholas highlights the potential of fee-for-service 2.0, emphasizing the need for openness and trust among providers, payers, and members, advocating a holistic approach that prioritizes preventive care and early member engagement. He also urges listeners to join their mission to enable patients to spend more time with their families.Tune in and learn how innovative strategies are shaping the future of healthcare!Resources:  Watch the entire interview here.  Connect and follow Nicholas Kraft on LinkedIn. Learn more about CDPHP on their LinkedIn, Instagram, Facebook, and website.

The Clinic by Cleveland Clinic and Amwell’s collaboration bridges geographical gaps in specialist care.In this episode of the AHIP 2024 series, Frank McGillin, CEO of The Clinic by Cleveland Clinic, explores how their joint venture with Amwell is transforming healthcare by providing virtual access to over 3,500 specialists. This innovative platform, available through various channels like direct visits, health plans, and employers, helps users better understand their diagnosis and treatment, significantly reducing the risk of misdiagnosis and saving about $8,700 per second opinion. Throughout this conversation, Frank explains how The Clinic's nurse care managers ensure patients are matched with the right specialists, improving outcomes and maintaining in-network care.  He also highlights the platform's impact on chronic disease management and medication optimization, emphasizing that the service makes it convenient for patients to access top-tier care, whether locally or at Cleveland Clinic.Tune in and learn how this collaboration is making a significant difference in healthcare delivery!Resources:  Watch the entire interview here. Connect and follow Frank McGillin on LinkedIn. Learn more about The Clinic by Cleveland Clinic on their LinkedIn and website. Listen to Frank’s previous episode on our podcast here.

Real-time access to patient data through electronic medical records' APIs is a game-changer for healthcare analytics.In this episode of the AHIP 2024 series, Donald Rucker, the Chief Strategy Officer at 1upHealth, discusses the critical role of modern data representations and FHIR APIs for payers and providers. He highlights the significance of electronic medical records and their APIs for real-time patient data access and analytics, explaining how payers can utilize the Bulk FHIR API for core data and how advancements in JSON and RESTful APIs have made clinical data access smarter and more efficient. Donald emphasizes the importance of building a quality FHIR data pipeline for modern analytics and AI while also delving into the re-architecting of healthcare through data science, stressing the need to involve consumers in the process. He also explains how he and his team are focused on improving industry processes like quality measurement, network design, prior authorization, case management, and payer-to-patient outreach, expressing excitement for the industry's future and involving consumers in healthcare data processes.Tune in and learn how healthcare is evolving with the power of data!Resources:  Watch the entire interview here.  Connect and follow Donald Rucker on LinkedIn. Learn more about 1upHealth on their LinkedIn and website.

The demand for mental health and substance use services is growing, requiring more clinicians and alternative support roles like coaches and peers.In this episode of the AHIP 2024 series, Solome Tibebu, founder and CEO of Behavioral Health Tech, discusses the importance of payer partnerships with digital health innovators in behavioral health. She emphasizes the need for collaboration to ensure members are directed to the right services, particularly for specialized conditions like eating disorders and OCD, while also highlighting the role of technology, health equity, and innovation in expanding access to mental health, substance use, and IDD care. Solome underscores the success of pioneering plans like NovaWell in reaching underserved populations, including young people and people of color, but notes the ongoing challenges with payment codes and reimbursement. She also stresses the need for more clinicians to meet the rising demand for mental health services and suggests that coaches and peers can help fill this gap, though many payers are not yet reimbursing for these roles.Tune in and learn how collaboration and innovation are shaping the future of behavioral health!Resources:  Watch the entire interview here. Follow and connect with Solome Tibebu on LinkedIn. Learn more about Behavioral Health Tech on their LinkedIn and website. Subscribe to the Behavioral Health Tech newsletter here. Book a ticket to the Annual Behavioral Health Conference here.