Empowered Patient Podcast

Mike Esworthy, Chief Strategy Officer at EnableComp, understands the challenges that health systems face when dealing with complex health claims such as workers' compensation, Veterans Administration, motor vehicle accidents, Medicaid, and out-of-state claims. These exception-based claims require deep subject matter expertise to identify the right payer and process the claims correctly. Using AI-driven technology, EnableComp helps hospitals manage complex claims, minimize the number of denials, optimize revenue, and allow them to focus on their core commercial claims.

Mike explains, "I think the easiest example to provide in that context, if you look at a worker's comp claim, more often than not, when a patient comes into the hospital, they don't know who their company's workers' comp provider is, and so often they hand over the commercial insurance card. If that doesn't get caught early, the commercial insurance gets billed, it results in a denial, and the claim sits out there in the ether for 30, 45 days before it comes back to the provider to go figure out who is the right payer class for this. So that's the big picture of the challenges. And then each of those claim types has unique nuances that make this challenging."

"I think there are a lot of good things happening in the VA that are, in theory, improving access for veterans, and that's a great thing. From a claim standpoint, though, I think all of the core challenges still remain. And so I know that many of the EMRs have been putting a focus on interoperability, and all of that is great from a treatment care coordination, getting veterans seen in hospitals, and getting them through the door."

"But once they've been treated, all of the same challenges that were prevalent before, all of these announcements are still out there. And I think the complexity still exists in terms of not being a normal payer pathway for providers and not knowing all the specific rules. One such example is that you were only allowed one appeal level within the veteran's claims, which means you have to get it right the first time. And so there's a really important component of knowing how to process the claim, getting it done correctly, and ensuring that you're maximizing the yield and the outcome of the claim itself."

#EnableComp #VeteranCare #HealthcareInnovation #ComplexRCM

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Dr. Neal Kassell, Founder and Chairman of the Focused Ultrasound Foundation, is working to raise awareness and drive the utilization of focused ultrasound to treat a wide range of medical conditions. This non-invasive technology uses medical imaging to precisely target and treat tissue deep in the body. Focused ultrasound has multiple mechanisms of action and can be used for destroying tumors, modulating neural activity, delivering drugs, and stimulating the immune system.

Neal explains, "So focused ultrasound is a new, totally non-invasive therapeutic technology, and it's the intersection of medical imaging, which is either ultrasound or MR imaging, which is used to identify the portion of the body that we want to treat to plan the treatment, and then to guide the treatment. Then, the focused ultrasound technology delivers the energy that treats the tissue. The way it works is analogous to using a magnifying glass to focus beams of light and burn a hole in a leaf."

"But at that focal point where all the beams converge, we now understand 30 ways ultrasound can affect tissue. That's in contrast to, for instance, radiation therapy, which is only one mechanism of action. Or a surgical robot, which is one mechanism of action. Focused Ultrasound has at least 30 mechanisms of action, including destroying tissue at that focal point by a variety of mechanisms, stimulating or blocking neural activity in the brain called neuromodulation, and delivering drugs or other therapeutic agents precisely to a point in the body where they are needed. This increases both the effectiveness and decreases the systemic side effects, stimulates the body's immune response to tumor, and to the effectiveness of cancer immunotherapy agents."

"The point in the body where the ultrasound is targeted is, as I said, previously guided and controlled by medical imaging, either ultrasound or MR imaging. Now, the fact that there are so many different mechanisms of action creates the opportunity to treat a wide variety of medical disorders. Today, around the world, there are more than 180 clinical indications or diseases in various stages of research and development in commercialization. Ten years ago or so, there were only three. That's how rapidly the field is growing."

#FocusedUltrasoundFoundation #FUSFoundation #FocusedUltrasound #Glioblastoma #ClinicalTrials #NeuroOncology #Innovation #Healthcare #MedTech #Oncology #Neurology

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Dr. Neal Kassell, Founder and Chairman of the Focused Ultrasound Foundation, is working to raise awareness and drive the utilization of focused ultrasound to treat a wide range of medical conditions. This non-invasive technology uses medical imaging to precisely target and treat tissue deep in the body. Focused ultrasound has multiple mechanisms of action and can be used for destroying tumors, modulating neural activity, delivering drugs, and stimulating the immune system.

Neal explains, "So focused ultrasound is a new, totally non-invasive therapeutic technology, and it's the intersection of medical imaging, which is either ultrasound or MR imaging, which is used to identify the portion of the body that we want to treat to plan the treatment, and then to guide the treatment. Then, the focused ultrasound technology delivers the energy that treats the tissue. The way it works is analogous to using a magnifying glass to focus beams of light and burn a hole in a leaf."

"But at that focal point where all the beams converge, we now understand 30 ways ultrasound can affect tissue. That's in contrast to, for instance, radiation therapy, which is only one mechanism of action. Or a surgical robot, which is one mechanism of action. Focused Ultrasound has at least 30 mechanisms of action, including destroying tissue at that focal point by a variety of mechanisms, stimulating or blocking neural activity in the brain called neuromodulation, and delivering drugs or other therapeutic agents precisely to a point in the body where they are needed. This increases both the effectiveness and decreases the systemic side effects, stimulates the body's immune response to tumor, and to the effectiveness of cancer immunotherapy agents."

"The point in the body where the ultrasound is targeted is, as I said, previously guided and controlled by medical imaging, either ultrasound or MR imaging. Now, the fact that there are so many different mechanisms of action creates the opportunity to treat a wide variety of medical disorders. Today, around the world, there are more than 180 clinical indications or diseases in various stages of research and development in commercialization. Ten years ago or so, there were only three. That's how rapidly the field is growing."

#FocusedUltrasoundFoundation #FUSFoundation #FocusedUltrasound #Glioblastoma #ClinicalTrials #NeuroOncology #Innovation #Healthcare #MedTech #Oncology #Neurology

fusfoundation.org

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Bryan Mazlish is CEO of Surf Bio, a company focused on novel subcutaneous formulations of biologics to enable patients to self-administer these treatments at home. The limitations of subcutaneous administration have historically made time-consuming IV infusions necessary for many biologics. The growing number of biologics and biosimilars in development will further strain the capacity of infusion centers, making subcutaneous administration a way to increase access, reduce healthcare costs, and improve patient adherence.

Bryan explains, "Surf Bio is focused on enhancing the ability for patients to take a lot of the innovative and novel biologics that are currently on the market and in development. The vast majority of these historically have required a trip to the infusion center at the hospital, which is quite burdensome and takes a lot of time and resources from the patients and the healthcare system. We focus on creating novel formulations of those same drugs. These biologics can be self-administered at home in seconds instead of requiring a patient to spend the better part of the day commuting to and from an infusion center and sitting in a chair."

"When you formulate biologics, they typically are formulated in water and concentrated to very high levels. They become extremely viscous and, consequently, not injectable. So, the ability to inject very high-concentration biologics subcutaneously is limited by the volume that can be administered and the concentration of the biologic that can be squeezed into that volume. As a consequence of this, historically, a large quantity of drug has been diluted at great levels and then dripped into your bloodstream through the intravenous route, which can typically take an hour or, in some cases, multiple hours."

#SurfBio #BiologicsDelivery #SubcutaneousInnovation #HealthcareEfficiency

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Bryan Mazlish is CEO of Surf Bio, a company focused on novel subcutaneous formulations of biologics to enable patients to self-administer these treatments at home. The limitations of subcutaneous administration have historically made time-consuming IV infusions necessary for many biologics. The growing number of biologics and biosimilars in development will further strain the capacity of infusion centers, making subcutaneous administration a way to increase access, reduce healthcare costs, and improve patient adherence.

Bryan explains, "Surf Bio is focused on enhancing the ability for patients to take a lot of the innovative and novel biologics that are currently on the market and in development. The vast majority of these historically have required a trip to the infusion center at the hospital, which is quite burdensome and takes a lot of time and resources from the patients and the healthcare system. We focus on creating novel formulations of those same drugs. These biologics can be self-administered at home in seconds instead of requiring a patient to spend the better part of the day commuting to and from an infusion center and sitting in a chair."

"When you formulate biologics, they typically are formulated in water and concentrated to very high levels. They become extremely viscous and, consequently, not injectable. So, the ability to inject very high-concentration biologics subcutaneously is limited by the volume that can be administered and the concentration of the biologic that can be squeezed into that volume. As a consequence of this, historically, a large quantity of drug has been diluted at great levels and then dripped into your bloodstream through the intravenous route, which can typically take an hour or, in some cases, multiple hours."

#SurfBio #BiologicsDelivery #SubcutaneousInnovation #HealthcareEfficiency

surf.bio

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Mark Newman, CEO of Nomi Health, focuses on building an operating system for self-insured healthcare to lower costs, remove friction, and simplify the transaction process for employers and providers. Nomi emphasizes holistic preventative healthcare by eliminating barriers like deductibles and copays to encourage the utilization of primary care, mental health, and other services. The company leverages technology, AI, and asynchronous care to improve access to diverse communities, including Spanish-speaking and low-income workers.

Mark explains, "Our model, starting from scratch and starting from a blank sheet of paper, is focused on getting providers out of the collection business so they can focus on the care business. Simplifying the entire transaction of buying and paying for healthcare has been a revolutionary way for our customers to cut their healthcare costs by 20% to 30%. And someday, I think we can hit 50%."

"Last time I checked the cost curve in American healthcare has not slowed down and has done nothing but accelerate. So, in my book, I think value-based care has pretty much failed and has been more of a pipe dream versus reality. Our world is how do we take the same doctors, same care and cut 25% of the cost out of it by removing all the friction and pain points and ambiguity and noise as it relates to what an employer pays for healthcare and what a provider collects for delivering that healthcare. We're betting on our model and hope for the best on things like value-based care or other models, but we haven't seen the results delivered yet."

#NomiHealth #HealthcareIndustry #HealthInsurance #Healthcare #HealthcareCEO

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Mark Newman, CEO of Nomi Health, focuses on building an operating system for self-insured healthcare to lower costs, remove friction, and simplify the transaction process for employers and providers. Nomi emphasizes holistic preventative healthcare by eliminating barriers like deductibles and copays to encourage the utilization of primary care, mental health, and other services. The company leverages technology, AI, and asynchronous care to improve access to diverse communities, including Spanish-speaking and low-income workers.

Mark explains, "Our model, starting from scratch and starting from a blank sheet of paper, is focused on getting providers out of the collection business so they can focus on the care business. Simplifying the entire transaction of buying and paying for healthcare has been a revolutionary way for our customers to cut their healthcare costs by 20% to 30%. And someday, I think we can hit 50%."

"Last time I checked the cost curve in American healthcare has not slowed down and has done nothing but accelerate. So, in my book, I think value-based care has pretty much failed and has been more of a pipe dream versus reality. Our world is how do we take the same doctors, same care and cut 25% of the cost out of it by removing all the friction and pain points and ambiguity and noise as it relates to what an employer pays for healthcare and what a provider collects for delivering that healthcare. We're betting on our model and hope for the best on things like value-based care or other models, but we haven't seen the results delivered yet."

#NomiHealth #HealthcareIndustry #HealthInsurance #Healthcare #HealthcareCEO

nomihealth.com

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Maureen McBeth, Senior Medical Affairs Liaison for ImpediMed, a company that develops bio-impedance spectroscopy technology for the early detection and monitoring of lymphedema. This swelling, a common side effect of breast cancer surgery, is often overlooked until it impacts the quality of life of the patient. Using this advanced diagnostic technology, objective data on the risk and progression enables personalized intervention at the mild stage to prevent progression to severe, irreversible stages.

Maureen explains, "Breast cancer-related lymphedema is an underappreciated side effect. Most people think that it's not an issue anymore because we do sentinel node biopsy. Still, we know that any time lymph nodes are removed, damaged, or radiated, they can cause problems with the plumbing system in that area of the body. And inflammation starts, and that's the first thing. People don't feel that, but over time, it starts to impact the lymphatic vessels, and those lymphatic vessels don't pump as well, and a fluid buildup starts to occur. Finally, a patient may start to have symptoms like an aching or a fullness, or they notice things don't fit right, and by the time they notice it, they're likely well into stage one lymphedema, which has noticeable symptoms."

"And 20 years ago, when we didn't have these methods to detect it early, we often didn't see patients even with that at stage one. We wouldn't see them until the arm got really big and noticeable. If you can imagine, the guidelines said that the arm had to be 10% larger than the other side before we would diagnose it with lymphedema. Imagine your arm being 10% bigger on one side."

"One of the important things about our technology is that it's about a 30-second test. In terms of non-invasive, the patient doesn't feel it. It gives us this L-Dex score, and we can get other things like body composition. And so, at the start of someone's treatment, it can be used not only for surveillance of lymphedema but also for other side effects of cancer treatment."

#ImpediMed #EarlyDetectionMatters #LymphedemaAwarenessMonth #Survivorship #SurvivorshipCare #PatientEmpowerment

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Maureen McBeth, Senior Medical Affairs Liaison for ImpediMed, a company that develops bio-impedance spectroscopy technology for the early detection and monitoring of lymphedema. This swelling, a common side effect of breast cancer surgery, is often overlooked until it impacts the quality of life of the patient. Using this advanced diagnostic technology, objective data on the risk and progression enables personalized intervention at the mild stage to prevent progression to severe, irreversible stages.

Maureen explains, "Breast cancer-related lymphedema is an underappreciated side effect. Most people think that it's not an issue anymore because we do sentinel node biopsy. Still, we know that any time lymph nodes are removed, damaged, or radiated, they can cause problems with the plumbing system in that area of the body. And inflammation starts, and that's the first thing. People don't feel that, but over time, it starts to impact the lymphatic vessels, and those lymphatic vessels don't pump as well, and a fluid buildup starts to occur. Finally, a patient may start to have symptoms like an aching or a fullness, or they notice things don't fit right, and by the time they notice it, they're likely well into stage one lymphedema, which has noticeable symptoms."

"And 20 years ago, when we didn't have these methods to detect it early, we often didn't see patients even with that at stage one. We wouldn't see them until the arm got really big and noticeable. If you can imagine, the guidelines said that the arm had to be 10% larger than the other side before we would diagnose it with lymphedema. Imagine your arm being 10% bigger on one side."

"One of the important things about our technology is that it's about a 30-second test. In terms of non-invasive, the patient doesn't feel it. It gives us this L-Dex score, and we can get other things like body composition. And so, at the start of someone's treatment, it can be used not only for surveillance of lymphedema but also for other side effects of cancer treatment."

#ImpediMed #EarlyDetectionMatters #LymphedemaAwarenessMonth #Survivorship #SurvivorshipCare #PatientEmpowerment

impedimed.com

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Dr. Sam Clark, Founder and CEO of Terran Biosciences, is developing a long-acting once-daily formulation of a new class of antipsychotic drugs to treat schizophrenia. The use of a prodrug approach to modify the new drug Cobenfy allows for improved bioavailability and has been shown to have fewer side effects than traditional antipsychotics. This novel class of antipsychotic drugs targets the muscarinic receptor system, which is a different mechanism of action compared to existing treatments.

Sam explains, "Schizophrenia is a very severe disease. It has both hallucinations and delusions. It also has a set of symptoms called negative symptoms, which encompass social withdrawal and symptoms that can resemble depressive symptoms, cognitive dysfunction, and memory issues. So, with this patient population, there are a number of drugs that are approved to treat schizophrenia called antipsychotics. But until now, there hasn't been a new drug approved with a new mechanism. So, all drugs have the same mechanism to treat the disease since the 1950s."

"But we just got, right now in the space, a new drug approved from Bristol Myers. It just got approved, and Cobenfy is the first new mechanism to treat schizophrenia since the 1950s. But there are some downsides to that drug in that it's dosed twice daily as an oral drug, and there's currently no long-acting injectable. And so, twice daily can be difficult for patients with schizophrenia to take. The space is moving towards long-acting injectables, which can last just one injection for several months."

"Now, that strategy has been used with other anti-psychotics on the market, such as Invega, to improve their bioavailability and make long-acting forms. So we took that same approach and created the long-acting prodrugs of Cobenfy, which are TerXT, those long-acting prodrugs. We believe that that will enable a once-daily form and a long-acting injectable that can go multiple months from a single injection and thus improve options for patients with schizophrenia."

#TerranBio #Prodrug #Antipsychotic #Schizophrenia #MentalHealth

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