Empowered Patient Podcast

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

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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

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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

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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

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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

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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

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Tina Liedtky, President of Transplant Diagnostics at Thermo Fisher Scientific, identifies the significant challenges in the US organ transplant system that must be addressed to meet the demand for organs. Patient access to transplant care is hindered by geography, the need to match donors and recipients, and the threat of organ rejection. Living donations, particularly of kidneys and livers, are a solution to address the organ shortage, as organs from living donors often lead to better outcomes and can be scheduled to avoid damage caused by organ transportation.

Tina explains, "So first of all, I would say that organ transplantation saves thousands of lives a year and gives patients with end-stage organ disease the ability to extend their lives meaningfully for many years. However, the organ transplant system in the US is not perfect, and it faces several real challenges. The most pressing challenge is a persistent imbalance between organ supply and demand, in that far more patients are in need of a lifesaving transplant than there are available organs, which leaves many patients waiting too long for a compatible organ or perhaps will never receive a compatible match. And unfortunately, for those patients left waiting, many get sicker, and often patients die while waiting on the wait list. So this gap in supply and demand is real, and it underscores the importance of living donation, which can help expand the pool of available organs and give patients a chance at the timely care that they need."

"Another significant challenge is patient access to organ transplant care. For instance, in the weeks leading up to the transplant procedure and after the procedure, patients are often required to be living or situated near the hospital or the transplant center where the surgery is performed. This can pose a challenge to those who simply don't reside in areas where there are major transplant centers or who can't afford temporary housing. And that creates a socioeconomic inequity when it comes to access."

#ThermoFisherScientific #Transplantation #OrganDonors #LivingDonation #HeartTransplant #OrganTransplants

thermofisher.com

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Tina Liedtky, President of Transplant Diagnostics at Thermo Fisher Scientific, identifies the significant challenges in the US organ transplant system that must be addressed to meet the demand for organs. Patient access to transplant care is hindered by geography, the need to match donors and recipients, and the threat of organ rejection. Living donations, particularly of kidneys and livers, are a solution to address the organ shortage, as organs from living donors often lead to better outcomes and can be scheduled to avoid damage caused by organ transportation.

Tina explains, "So first of all, I would say that organ transplantation saves thousands of lives a year and gives patients with end-stage organ disease the ability to extend their lives meaningfully for many years. However, the organ transplant system in the US is not perfect, and it faces several real challenges. The most pressing challenge is a persistent imbalance between organ supply and demand, in that far more patients are in need of a lifesaving transplant than there are available organs, which leaves many patients waiting too long for a compatible organ or perhaps will never receive a compatible match. And unfortunately, for those patients left waiting, many get sicker, and often patients die while waiting on the wait list. So this gap in supply and demand is real, and it underscores the importance of living donation, which can help expand the pool of available organs and give patients a chance at the timely care that they need."

"Another significant challenge is patient access to organ transplant care. For instance, in the weeks leading up to the transplant procedure and after the procedure, patients are often required to be living or situated near the hospital or the transplant center where the surgery is performed. This can pose a challenge to those who simply don't reside in areas where there are major transplant centers or who can't afford temporary housing. And that creates a socioeconomic inequity when it comes to access."

#ThermoFisherScientific #Transplantation #OrganDonors #LivingDonation #HeartTransplant #OrganTransplants

thermofisher.com

Download the transcript here

Dr. Sev MacLaughlin, the CEO of DeLorean AI, has developed an AI platform to identify at-risk patients, including those with renal disease, cardiovascular disease, and mental health conditions. Serving smaller and mid-sized provider clinics, this approach supports the shift to value-based care by predicting adverse events, recommending preventive measures, and reducing hospitalizations and healthcare costs. By analyzing entire populations instead of samples, the platform avoids biases and overlooked subgroups inherent in traditional analytical methods.

Sev explains, "So I think there's an opportunity to not only give better care at the point of care, but also aid in the discovery or assist in the diagnosis of unknown diseases that people may have in the chronic format. That may be identifying chronic kidney disease patients five years earlier, so they can have a different treatment modality and directionality in their lives, or hypertension or cardiovascular disease."

"We're very strong in renal. So both chronic kidney disease and end-stage renal failure, or patients on dialysis. And then the two comorbidities that most that are huge influences for that are cardiovascular disease, cardiovascular system, and diabetes. In addition to that, we do CD and pulmonary. And then we were asked by one of our largest clients, United Healthcare, to look at mental health. And I have to say another surprise to me is how important mental health is to the other disease states, so that mental health needs to be taken care of to ensure that those individuals are medically adherent, they're going to their appointments, they're taking their medications, they're taking their health seriously. And that is something that I learned was most important and needed to be treated in parallel with the primary care diagnosis."

#DeLoreanAI #PreventativeCare #RenalCare #MedAI #Diagnostics #PopulationHealth #RiskStratification

DeLoreanai.com

Listen to the podcast here

Dr. Sev MacLaughlin, the CEO of DeLorean AI, has developed an AI platform to identify at-risk patients, including those with renal disease, cardiovascular disease, and mental health conditions. Serving smaller and mid-sized provider clinics, this approach supports the shift to value-based care by predicting adverse events, recommending preventive measures, and reducing hospitalizations and healthcare costs. By analyzing entire populations instead of samples, the platform avoids biases and overlooked subgroups inherent in traditional analytical methods.

Sev explains, "So I think there's an opportunity to not only give better care at the point of care, but also aid in the discovery or assist in the diagnosis of unknown diseases that people may have in the chronic format. That may be identifying chronic kidney disease patients five years earlier, so they can have a different treatment modality and directionality in their lives, or hypertension or cardiovascular disease."

"We're very strong in renal. So both chronic kidney disease and end-stage renal failure, or patients on dialysis. And then the two comorbidities that most that are huge influences for that are cardiovascular disease, cardiovascular system, and diabetes. In addition to that, we do CD and pulmonary. And then we were asked by one of our largest clients, United Healthcare, to look at mental health. And I have to say another surprise to me is how important mental health is to the other disease states, so that mental health needs to be taken care of to ensure that those individuals are medically adherent, they're going to their appointments, they're taking their medications, they're taking their health seriously. And that is something that I learned was most important and needed to be treated in parallel with the primary care diagnosis."

#DeLoreanAI #PreventativeCare #RenalCare #MedAI #Diagnostics #PopulationHealth #RiskStratification

DeLoreanai.com

Download the transcript here