Addressing social determinants of health? Consider artificial intelligence and machine learning

Healthcare Finance | January 30, 2019

"Social determinants of health" is one of the hot buzz-phrases in healthcare these days, and for good reason. SDOH refers to outside factors that may impact a patient's health, such as employment status and access to education, and providers can improve efficiency and curb costs by addressing these factors. Technology is often utilized to do so effectively -- and lately that means artificial intelligence and machine learning. Automation, and technology that learns as it goes, is one way providers can make sense of the glut of SDOH data, and make informed decisions based on it. These technologies aren't new, exactly, but they're still maturing. That doesn't mean it's too early to jump onboard. Embracing new approaches can be one way to ensure that SDOH are addressed in a timely and efficient manner.

Spotlight

This paper examines the transformations and trends in the healthcare industry as it seeks to meet pressing challenges, including escalating health care costs, an aging population, the future shortage of physicians, geographical inequities in the payer mix, and patient demand shifting to a consumer-driven model. The paper analyzes the key factors driving the changes and how they are impacting the way services are delivered, where they are delivered, and the potential future implications.


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MEDICAL DEVICES

Anthem Announces Subsidiary Brands Under Elevance Health

Elevance Health, Inc | June 20, 2022

As Anthem, Inc. moves closer to rebranding to Elevance Health, Inc. later this month, the company announced the launch of healthcare services brand Carelon and health plan brand Wellpoint to join the company’s family of brands that includes Anthem Blue Cross and Blue Shield. The move will optimize and streamline the company’s brand portfolio, reduce complexities, and further underscore its evolution to deliver solutions beyond traditional health insurance, simplify the healthcare experience, and advance health beyond healthcare. “An important part of being a lifetime, trusted health partner is grounded in our ability to ensure consumers have access to services that will meet their whole health needs across their entire healthcare journey. The addition of our new brands to our family of companies will bring together services and products within their respective brands that further integrate our business and health expertise across the industry to solve complex challenges and improve consumers lives.” Gail K. Boudreaux, President and CEO Anthem, Inc Blending a powerful suite of solutions to solve complex healthcare challenges Bringing together decades of experience, the company introduces its new healthcare services brand Carelon to consolidate the company’s existing broad portfolio of capabilities and services businesses under one brand to address the most complex healthcare challenges and support clients and consumers across the entire healthcare continuum. Derived from the word ‘care’ and suffix ‘lon’ meaning full and complete, the name Carelon stands for the importance of providing full and complete care. Carelon will serve one in three people in the U.S. With services ranging from research to integrated whole person care delivery, pharmacy, behavioral health to digital platform and technology services, Carelon will build better care for people and enhance efficiencies systemwide. Through partnerships across healthcare, Carelon will improve outcomes and reduce total cost of care through digitally enabled solutions to improve whole person health. The company expects to fully transition its capabilities and services under the Carelon brand over the next two years. This change further helps to streamline the end-to-end experiences for providers, clients and consumers. “Carelon makes connected care possible for everyone by putting people at the center of what we do and delivering the right balance of care, technology, data-driven insights and expertise to solve complex challenges and help consumers lead healthier lives,” said Pete Haytaian, Executive Vice President of Anthem, and President of Carelon. “Bringing together these solutions will help deliver our strategy, drive growth, and exceed expectations for care providers, consumers, and our other partners.” Launching a brand focused on improving the health of individuals and communities at all stages of life. The company will also launch the Wellpoint brand to unify its Medicare, Medicaid, and commercial health plans in select markets, simplifying interactions that consumers have with these health plans. Wellpoint’s suite of products and services are designed for consumers at any stage of life seeking to make the right care decisions and will offer access to simple, supportive health solutions that will help foster independence, confidence, and whole person health for consumers. ​The company plans to make this transition over the next few years. This change will not impact the company’s affiliated Anthem Blue Cross and Blue Shield and Anthem Blue Cross health plans. “Unifying many of our non-Blue Medicare, Medicaid, and commercial health plans under one brand helps consumers, care providers, and the healthcare industry better understand how our organization works together to deliver our distinct set of products and services that address the health and wellbeing of those we serve,” added Boudreaux. “Our Wellpoint health plans will continue to address consumer needs at a personal level, removing barriers and creating more meaningful connections across a lifetime of milestones and experiences.” This step in the company’s rebranding is a continuation of its bold and ambitious purpose to improve the health of humanity by serving people across their entire health journey; connecting them to care, support and resources; and simplifying every step of the healthcare journey to make health more equitable and accessible. On June 28, Anthem will become Elevance Health and will commemorate its official rebranding by ringing the opening bell at the New York Stock Exchange (NYSE). Shares of the company’s common stock will begin trading under the new ticker symbol ELV as of that morning. About Anthem, Inc. Anthem, which will become Elevance Health on June 28, 2022, is a leading health company dedicated to improving lives and communities, and making healthcare simpler. Through its affiliated companies, Anthem serves approximately 118 million people, including nearly 47 million within its family of health plans. Delivering health beyond healthcare, Anthem is expanding from being a partner in health benefits to a lifetime, trusted health partner.

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DIGITAL HEALTHCARE

Nemaura Medical Launches Metabolic Health Program for Employers and Insurers

Nemaura Medical, Inc | January 14, 2022

Nemaura Medical, Inc.(“Nemaura” or the “Company”), a medical technology company focused on developing and commercializing non-invasive wearable diagnostic devices and supporting personalized lifestyle coaching programs, announces the launch for employers and insurers of Miboko, a new metabolic health program using a non-invasive glucose sensor along with an AI mobile application. The Company’s goal is to achieve broad adoption of Miboko as a form of preventative medicine for a wide user base through these commercial channels and is aligned with the general trend in consumer digital healthcare. “Introducing Miboko to the population at-large through employers and insurers will allow Nemaura to reach a much wider audience in much faster fashion than solely relying on a direct-to-consumer campaign, and in the Western world, these institutions are the most reliable gateway toward wider adoption of preventative health maintenance practices. Being aware of one’s metabolic health and how the body uniquely regulates sugar is key to one’s health. Patients, of course, want to be as informed as possible about their health, and employers and insurers are also aligned with patients in that regard, given the massive productivity losses and healthcare costs at stake on a larger scale across their employee and insured base, respectively. Miboko can help address this substantial market opportunity through our non-invasive, revolutionary approach to healthcare.” Nemaura CEO Dr. Faz Chowdhury Nemaura has also submitted a Premarket Approval (PMA) to the United States Food and Drug Administration (FDA) for approval of its glucose monitoring device as a Class 3 medical device. The Company’s PMA was the subject an on-site FDA bioresearch monitoring (BIMO) audit that generated a single Form 483 observation, for which the Company has committed to a full response this quarter. A follow-up BIMO audit of the clinical investigator site has also been scheduled for the current financial quarter. Miboko has been in development for nearly two years and addresses a significant mass market opportunity that the Company believes could benefit roughly a third to half of the population by using a non-invasive glucose sensor to measure and monitor a user’s metabolic health score, which is based on glucose tolerance or insulin resistance. Those with prediabetes or obesity concerns -- or even those looking to maintain better health through more careful glucose control -- may benefit from such a metabolic health program. How one’s body metabolizes sugar is the main influencer of one’s appetite, weight, sleep quality, and energy and mood levels and even plays a critical factor in chronic diseases (beyond just diabetes), such as heart disease and dementia. At the heart of the Miboko offering is Nemaura’s non-invasive glucose sensor that is designed to measure insulin resistance, reported as a metabolic health score, and priced to be highly affordable with the program running for an initial two-year period. The program also uses a mobile app to provide users with personalized information by tracking their metabolism. A user can find out how well their body responds to sugar through their metabolic health score — and how what they eat and what they do every day uniquely affects their metabolic health. Along with the capability to follow metabolic health progress on the app, Miboko users receive weekly and monthly reports that show and explain their body’s unique metabolic health score and a breakdown of how each of their habits are impacting their overall health and wellbeing. Suggestions for small, manageable changes to daily routines, such as eating more or less of a certain kind of food or exercising at a different time of day to coincide with peak energy levels, provide Miboko users with personalized, usable data. About Nemaura Medical, Inc. Nemaura Medical Inc. is a medical technology company developing and commercializing non-invasive wearable diagnostic devices. The company is currently commercializing sugarBEAT® and proBEAT™. sugarBEAT®, a CE mark approved Class IIb medical device, is a non-invasive and flexible continuous glucose monitor (CGM) providing actionable insights derived from real time glucose measurements and daily glucose trend data, which may help people with diabetes and pre-diabetes to better manage, reverse, and prevent the onset of diabetes. Nemaura has submitted a PMA (Premarket Approval Application) for sugarBEAT® to the U.S. FDA. proBEAT™ combines non-invasive glucose data processed using artificial intelligence and a digital healthcare subscription service and has been launched in the U.S. as a general wellness product as part of its BEAT®diabetes program that is currently undergoing pilot studies. Additionally, Nemaura has launched Miboko, a new metabolic health and well-being program using a non-invasive glucose sensor along with an AI mobile application that helps a user understand how certain foods and lifestyle habits can impact one’s overall metabolic health and well-being. Nemaura believes that up to half the population could benefit from a sensor and program that monitors metabolic health and well-being. The Company sits at the intersection of the global Type 2 diabetes market that is expected to reach nearly $59 billion by 2025, the $50+ billion pre-diabetic market, and the wearable health-tech sector for weight loss and wellness applications that is estimated to reach $60 billion by 2023.

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FUTURE OF HEALTHCARE

Ensemble Health Partners, in Partnership with Caduceus Capital Partners, Leads Series A Round for Janus Health

Ensemble Health Partners | December 15, 2021

Ensemble Health Partners, in partnership with Caduceus Capital Partners, led the $8 million Series A capital raise for Janus Health, a revenue cycle automation and decision support platform. Billions of dollars are left uncollected annually by healthcare providers due to poor methods and inconsistent human decision making in the revenue cycle process. Janus Health studies end-user behavior within the revenue cycle and uses advanced AI to determine the optimal path for each workflow. Janus then automates processes and end-to-end workflows using its scalable platform and delivers real-time predictive recommendations to guide human worker performance. “I invest in people first. I’ve known Brendan for a long time, and he has assembled an incredible team who are experts in the field. We see a lot of technology fads in healthcare, but I am always most concerned with delivering value and creating a meaningful impact for our clients and associates. As someone deeply entrenched in the revenue cycle world, I see tremendous potential for Janus to deliver on both fronts.” Judson Ivy, Founder, President and CEO, Ensemble Health Partners “Several factors, including labor shortages, shrinking reimbursements and more stable IT environments, are creating a ripe opportunity to transform the revenue cycle with artificial intelligence and automation,” said Brendan Downing, co-founder and CEO of Janus Health. “Janus Health offers a timely service that can have a significant impact for health systems struggling with these rising costs-to-collect and reimbursement challenges.” Health systems continue to struggle with a workforce shortage and lack of resources. A recent McKinsey & Company study showed that $180 billion could be saved in healthcare administration and finance costs with automated technology. Many health systems do not currently have revenue cycle automation, but plan to implement this technology in the next year. With Janus Health, managers and executives receive actionable insights into people, productivity and practices, allowing them to optimally allocate and manage resources. “The revenue cycle in healthcare is notoriously challenging. Billing and collections are especially complicated when you consider the various payors and parties involved in a transaction,” said Dave Vreeland, senior managing partner at Caduceus Capital Partners. “This area is one of the most labor-intensive in healthcare, and there is a huge opportunity for Janus to make a difference in the industry.” Jim Gaffney, EVP, strategy and corporate development at Ensemble Health Partners and Sue Tyler, venture partner at Caduceus Capital Partners will serve on the Janus Health board of directors. About Ensemble Health Partners Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. The company offers end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. About Caduceus Capital Partners, LLC Caduceus Capital Partners is a venture capital and private equity company focused on early-stage digital health investments. The Caduceus Capital Partners investment model actively supports portfolio companies from the first check to the exit phase with operational expertise and network access to potential customers and partners. About Janus Health Technologies Janus Health is leapfrogging the automation solutions of today by developing the only end-to-end process improvement platform that studies a revenue cycle operation to determine the optimal path of each workflow and rapidly builds intelligent automation and decision support with a single-click.

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FUTURE OF HEALTHCARE

WELL Health Enters into Automatic Share Purchase Plan

WELL Health Technologies Corp. | June 16, 2022

WELL Health Technologies Corp.ca company focused on positively impacting health outcomes by leveraging technology to empower practitioners and their patients globally, announced today that it has entered into an automatic share purchase plancwith a broker in order to facilitate repurchases of the Company's common shares under its previously announced normal course issuer bid. WELL previously announced that it had received approval from the Toronto Stock Exchange to, during the 12-month period commencing June 1, 2022 and terminating May 31, 2023, purchase up to 5,555,386 Common Shares, representing approximately 2.5% of the 222,215,443 Common Shares issued and outstanding as of May 30, 2022, by way of a NCIB on the TSX or through alternative trading systems or by such other means as may be permitted under applicable law. During the effective period of WELL's ASPP, WELL's broker may purchase Common Shares at times when WELL would not be active in the market due to insider trading rules and its own internal trading blackout periods. Purchases will be made by WELL's broker based upon parameters set by WELL when it is not in possession of any undisclosed material information about itself and its securities, and in accordance with the terms of the ASPP. Outside of the effective period of the ASPP, Common Shares may continue to be purchased in accordance with WELL's discretion, subject to applicable law. The ASPP has been entered into in accordance with the requirements of applicable Canadian securities laws. About WELL Health Technologies Corp. WELL is a practitioner focused digital healthcare company whose overarching objective is to positively impact health outcomes to empower and support healthcare practitioners and their patients. WELL has built an innovative practitioner enablement platform that includes comprehensive end to end practice management tools inclusive of virtual care and digital patient engagement capabilities as well as Electronic Medical Records (EMR), Revenue Cycle Management (RCM) and data protection services. WELL uses this platform to power healthcare practitioners both inside and outside of WELL's own omni-channel patient services offerings. As such, WELL owns and operates Canada's largest network of outpatient medical clinics serving primary and specialized healthcare services and is the provider of a leading multinational, multi-disciplinary telehealth offering. WELL is publicly traded on the Toronto Stock Exchange under the symbol "WELL" and is part of the TSX Composite Index. The Company also trades on the OTCQX Markets under the symbol "WHTCF".

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Spotlight

This paper examines the transformations and trends in the healthcare industry as it seeks to meet pressing challenges, including escalating health care costs, an aging population, the future shortage of physicians, geographical inequities in the payer mix, and patient demand shifting to a consumer-driven model. The paper analyzes the key factors driving the changes and how they are impacting the way services are delivered, where they are delivered, and the potential future implications.

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