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Florida-based AdventHealth plans to replace its Cerner electronic health record (EHR) system with rival Epic’s.

One of the largest faith-based health systems in the country, AdventHealth operates 50 hospital campuses across a dozen states. The health system employs more than 80,000 people who serve more than 5 million patients annually and reports nearly $20 billion in annual revenue.

The health system first signed a deal with Cerner in 2002 when it was known as Adventist Health System.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

AdventHealth will begin the transition in March and will eventually roll Epic’s EHR out to 1,200 care sites. The work is expected to be completed in about three years, the health system said.

In a press release issued Tuesday, AdventHealth said it plans to install a single, integrated Epic EHR and revenue cycle management system across all of its acute care, physician practice, ambulatory, urgent care, home health and hospice facilities.

Epic’s Community Connect program will also allow AdventHealth to extend its EHR system to affiliated providers as part of the integrated platform, according to AdventHealth.

“Our journey to become a consumer-focused clinical company requires a fully connected network throughout our entire enterprise,” Terry Shaw, president and CEO for AdventHealth, said in a statement. “Connecting our network with a robust, integrated health record platform will give our caregivers access to the clinical information they need at the point of care and ultimately advance our consumer promises through a more seamless experience for those we serve.”

In an emailed statement, Cerner confirmed the changeover. “AdventHealth has made the business decision to transition over the next few years management of its EHR and revenue cycle management system to another supplier. The shift is expected to take up to five years and Cerner is committed to working closely with AdventHealth to continue delivering superior health care technology solutions throughout the transition,” the company said.

Anonymous Reddit posters predicted the change months ago, saying that the health system was frustrated with integration issues with Cerner’s ambulatory solution and revenue cycle functionalities. HIStalk first reported the Reddit posts regarding Cerner and AdventHealth.

One Reddit user said AdventHealth staff felt the health system was on the “back burner” since Cerner signed massive projects with the departments of Defense and Veterans Affairs.

It’s unclear what the loss of a big EHR client will mean for health IT company Cerner’s annual revenue or earnings.

The company continues efforts to turn its financial picture around and improve its operating performance.

Almost a year ago, activist investor Starboard Value stepped in, and Cerner reached a settlement with the hedge fund to add new directors to its board and buy back more of its shares. Cerner also agreed to take steps to improve operations and committed to hitting certain operating targets.

The new agreement between Cerner and Starboard Value, which has a 1.2% stake in the company, was seen as welcome news by many financial analysts as a plan to increase the company’s profitability.

Cerner’s full-year 2019 bookings were down 11% compared to 2018 bookings, from $6.72 billion to $5.99 billion. Company executives said during their full-year and fourth-quarter earnings call that the decline in bookings was primarily driven by the company being more selective in the types of contracts it pursues, which led to fewer large, long-term outsourcing contracts.

Health technology company Seqster is focused on helping patients bring all their health information into one place.

The San Diego-based company, which launched in 2016, announced Thursday it secured backing from Japanese pharmaceutical giant Takeda Pharmaceutical. 

The companies did not disclose the funding amount.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

The funds will be used to accelerate the adoption of the company’s interoperability technology for enhancing clinical trials, patient engagement and outcomes, the company said.

“Seqster’s technology is a very unique platform that addresses interoperability on not only a nationwide scale but also globally. Interoperability is one of the biggest barriers to applying precision medicine to clinical trials and patient engagement,” Bruce Meadows, head of investments at Takeda Digital Ventures, said in a statement.

Seqster’s platform retrieves, parses and harmonizes multidimensional data sets to help accelerate the entire drug development process and provides clinical trial participants a platform to share their data with investigators in real time creating a longitudinal health record, according to the company.

Before the Takeda investment, the company raised at least $4 million in seed funding.

The company’s name, Seqster (pronounced seekster), comes from the idea that everyone is “seeking” health data, company CEO and co-founder Ardy Arianpour told FierceHealthcare during Health Datapalooza this week.

Arianpour said he was motivated to launch the startup as a result of his mother’s experience as a cancer patient and the challenge of aggregating health data from multiple providers and hospitals.

As a health technology entrepreneur, Arianpour has a background in genomics and big data. Prior to starting Seqster, he helped bring next-generation DNA sequencing to the clinic as chief strategy officer of Pathway Genomics as well as senior vice president of Ambry Genetics, which Konica acquired for $1 billion in 2017.

Seqster aims to provide “person-centric interoperability,” he said.

“When I started on this journey I didn’t know what interoperability was,” he said. “Recently a former executive from a large EHR vendor came to us and said: ‘You cracked interoperability.”

The platform is designed to pull together episodic clinical electronic health record (EHR) data, baseline genetic DNA results and continuous fitness/wearable device data all in one place. The company’s technology standardizes and harmonizes different data sources on the back end and then organizes and visualizes those health data in an easily accessible format.

Arianpour compares the platform to the personal finance management platform Mint.com, which was designed to be a platform that brought all of an individual’s financial information together to a single place.

Seqster is not a consumer-facing platform, but licenses it to enterprise customers such as providers and payers. The platform currently connects users to more than 3,600 healthcare providers and over 150,000 hospitals and clinics nationwide.

Other companies taking a stab at aggregating patient records include Picnic Health, which collects and digitizes health records, and PatientBank, which offers online medical record sharing. Apple also launched its Health Records feature that is now supported by hundreds of hospitals, medical clinics and specialty practices.

One distinction from Apple Health Records is that Seqster is platform-agnostic, the company says. It also enables families to aggregate health data to form a multigenerational health record, an idea that has raised privacy concerns. 

In January, the company added new interoperability features it says will help its customers more easily share longitudinal health information across various sources. Seqster improved its connectivity to providers by adopting the Fast Healthcare Interoperability Resources (FHIR) standard through the FHIR application programming interface, the company said.

The company says the new platform can help healthcare providers and health plans come into compliance with upcoming federal interoperability regulations to be released by the Office of the National Coordinator for Health IT and the Centers for Medicare & Medicaid Services.

When Carol Pak-Teng, M.D., an emergency room doctor in New Jersey, hosted a fundraiser in December for Democratic freshman Rep. Tom Malinowski, her guests, mostly doctors, were pleased when she steered the conversation to surprise medical bills.

This was a chance to send a message to Washington that any surprise billing legislation should protect doctors’ incomes in their battle over payments with insurers. Lawmakers are grappling over several approaches to curtail the practice, which can leave patients on the hook for huge medical bills, even if they have insurance.

As Congress begins its 2020 legislative session, there is evidence the doctors’ message has been received: The bills with the most momentum are making more and more concessions to physicians.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

As surprise medical billing has emerged as a hot-button issue for voters, doctors, hospitals and insurers have been lobbying to protect their own money flows. All that lobbying meant nothing got passed last year.

Television and internet ads are the most visible manifestation of the battle. But in taking their cause to politicians, doctors like Pak-Teng have waged an extraordinary on-the-ground stealth campaign to win over members of Congress. Their professional credentials give them a kind of gravitas compared with other lobbyists, who are merely hired guns.

Ending the practice of billing patients for the amount of their treatment not covered by insurance—sometimes triggered by unwittingly seeing a doctor out of network—is ultimately a fight between doctors and insurers over rate-setting and reimbursement. But as more patients balk at surprise bills—or suffer the enormous financial strain—lawmakers are under pressure to protect patients. In turn, powerful lobbying forces have activated to protect doctors and insurers who don’t want to pay the price for a fix.

The main message physicians are using to bring lawmakers into their corner? “We just want to be paid a fair amount for the services rendered,” Pak-Teng said.

Her congressman, Malinowski, has not endorsed any surprise billing legislation. In congressional testimony in July, he cited the “extra $420 million” in medical debt patients in New Jersey reckon with each year.

“There are many things that Republicans and Democrats sincerely disagree about in this body,” he said. “I don’t think that this is one of them. I don’t see any philosophical difference amongst us about whether people should be stuck with massive surprise medical bills.”

Doctors say they are taking the brunt of the criticism.

But little has been as powerful in shaping surprise billing legislation as the clout of hospitals and their doctors, many of whom are, in fact, employed by private equity-backed companies and armed with years of experience shaping surprise billing legislation at the state level.

 

They are throwing in a lot of money, too, funneling millions to lawmakers ahead of the 2020 elections. Four physician organizations that have heavily lobbied on surprise medical bills and have private equity ties—the American College of Emergency Physicians, Envision Healthcare, US Acute Care Solutions and U.S. Anesthesia Partners—gave roughly $1.1 million in 2019 to members of Congress, according to a Kaiser Health News analysis of Federal Election Commission records.

The biggest recipients, from all four PACs combined, were Reps. Donna Shalala and Stephanie Murphy, Florida Democrats who got $26,000 each. Sen. Thom Tillis (R-N.C.) took in $25,500, Senate Majority Leader Mitch McConnell got $25,000, and Rep. Brett Guthrie (R-Ky.) received $22,500.

That was in tandem with a ground game led by local doctors. ER doctors, anesthesiologists, radiologists and other specialists who most often charge out-of-network prices—and also are among the highest-compensated practitioners—fanned out to shape legislation in a way that maintains their pay, and to voice their concern to lawmakers that insurance companies would have too much leverage to control their compensation.

“We by necessity place a tremendous amount of trust in our physicians,” said Zack Cooper, an assistant professor at Yale University who has extensively researched surprise medical bills. “Frankly, they have an easier time lobbying members [of Congress] than the folks who are affected by surprise billing.”

Arguing over the fix

Lawmakers in both parties appear unified on the need to resolve the problem of surprise billing. But as was clear when all the air blew out of legislative proposals on the table at year’s end, that is largely where the agreement ends.

Fixing the problem comes down to settling on a system for deciding how much to pay for a disputed bill. One approach is to set up an outside arbitration process, in which doctors and insurance companies would negotiate payment—this is the model preferred by doctors, who contend it puts them on better footing against insurance companies. Another option would be to resolve surprise billing disputes by having insurance companies pay doctors based on the median in-network rate for the service, an approach known as benchmarking. Large employers, labor unions and insurance companies prefer this.

The failure to get legislation through Congress set up a potentially explosive battle in an election year. Republicans and Democrats who have vowed to do something about healthcare costs must reckon with powerful industry groups whose influence transcends party lines.

Meanwhile, physicians and hospitals have made their case in Washington and back home through in-person meetings and phone calls with lawmakers and congressional staff. They’ve hosted dinners and fundraisers and organized fly-ins to swarm Capitol Hill with in-person meetings. They’ve even led tours of their emergency rooms.

Pak-Teng is among them, coming to Washington this month with other physicians to petition lawmakers. She is employed by Envision, a physician staffing company backed by private equity firm KKR. She’s also on the board of the American Academy of Emergency Medicine, a trade organization representing ER doctors.

“There is a lot of anti-physician rhetoric out there,” said Pak-Teng, who is pushing her physician colleagues to be more active in shaping public policy by sharing stories about the reality of caring for patients.

The lobbying by hospitals and physicians trying to protect their reimbursements has divided key lawmakers, compounding disagreements among senior House Democrats over the policy details of a bill and turf wars in Congress. Three House committees have now unveiled legislation to ban surprise medical bills, each with different details.

“We are not trying to stop legislation. We are trying to stop bad legislation,” said Anthony Cirillo, M.D., an emergency medicine physician who describes a “bad” bill as one that favors insurance companies over doctors.

Cirillo is also a lobbyist for US Acute Care Solutions, a physician staffing company backed by private equity firm Welsh, Carson, Anderson & Stowe. WCAS, which manages $27 billion in assets and is focused on healthcare and technology investments, is based in New York City and co-founded US Acute Care Solutions in 2015.

In an interview, Cirillo said he met with lawmakers and their aides about “10 to 12 times” in Washington last year. Financial disclosures show he spent $340,000 between July and September lobbying on surprise billing on behalf of US Acute Care Solutions. USACS’ political committee also contributed $134,500 to lawmakers in 2019, according to FEC records.

Tilt toward doctors

Before the private equity-fueled dark-money group Doctor Patient Unity started running ads warning of the dangers of government price controls as an argument against legislation, surprise billing legislation being drafted in one of Congress’ most powerful healthcare committees was already tilting to be more favorable to doctors.

“People on the Hill are very sympathetic to hospitals and physicians because they’re actually providing the care itself,” said one Democratic aide, speaking on the condition of anonymity to candidly describe sensitive political dynamics. “Nobody wants to defend the insurers.”

In May, a House Energy and Commerce Committee draft proposal included no mention of outside arbitration. The same was true for a bill the Senate Health, Education, Labor and Pensions Committee approved in June. Instead, under those proposals, surprise billing disputes would be resolved by insurance companies paying doctors based on similar rates in that area.

By mid-July, though—roughly a week before Doctor Patient Unity registered as a business in Virginia—the Energy and Commerce legislation was amended to allow doctors to appeal to an independent arbiter if their payments exceed $1,250. The revision was pushed by two physicians on the committee—Democrat Raul Ruiz, M.D., of California and Republican Larry Bucshon, M.D., of Indiana—and was a moment Sherif Zaafran, M.D., a Texas anesthesiologist, describes as a “turning point” in negotiations over the bill.

“It’s all about fairness,” said Zaafran, who works for private equity-backed U.S. Anesthesia Partners. He has been involved for a decade in surprise billing fights in Texas, which enacted a new law with an arbitration process last year. U.S. Anesthesia Partners gave $197,900 in campaign contributions to members of Congress last year.

Zaafran chaired another coalition of medical specialists, Physicians for Fair Coverage, in 2019, and pressured Congress to pursue a surprise billing approach modeled on a New York law under which insurers and providers rely on arbitration. Under that process, if there is a payment dispute between doctors and insurers, the two sides submit a proposed dollar amount to an independent mediator, who then selects one.

In New York, the mediators were told to base their decisions on the 80th percentile of the prices set by the hospital or physician. Research has suggested that the model is broadly making healthcare more expensive for state residents because of higher payments to doctors, according to findings from the USC-Brookings Schaeffer Initiative for Health Policy.

Still, on Capitol Hill, doctors complained that many procedures would fail to cost enough to qualify for arbitration as proposed in the Energy and Commerce bill, bolstered by data ER doctors presented to lawmakers showing that prices mainly fall below $1,250.

“It’s largely out of reach,” said Laura Wooster, a lobbyist with the American College of Emergency Physicians, whose political action committee contributed $708,000 to lawmakers in 2019. “The problem with a threshold is, you just have one threshold. It’s going to impact different specialties so differently.”

By December, House Energy and Commerce Committee leaders and Sen. Lamar Alexander, a Republican who chairs the Senate HELP Committee, agreed to lower the arbitration threshold to $750 as part of a bipartisan agreement on a bill. Notably, several hospital lobbying organizations, such as the American Hospital Association and the Greater New York Hospital Association—the latter a strong financial backer of Senate Minority Leader Chuck Schumer—refused to back the deal.

Pak-Teng and other physicians also say that arbitration threshold is still too high. The House Education and Labor Committee has unveiled surprise billing legislation with a similar framework.

“I’m open to listening to all sides on this,” Rep. Greg Walden of Oregon, the top Republican on the House Energy and Commerce Committee, said in an interview. “We want to make sure doctors are adequately compensated.”

Walden had harsh words for private equity firms that have attacked the Energy and Commerce legislation in a series of TV and internet ads, saying they were “misleading and scaring people” and just made lawmakers dig in deeper. The ads prompted a bipartisan probe from Walden and committee Chairman Frank Pallone (D-N.J.) into how the companies have influenced surprise billing practices.

“I’m not trying to hurtle a rock at them, but they’ve been throwing a few my way,” he said.

What’s coming

Arvind Venkat, M.D., a Pittsburgh emergency physician employed by US Acute Care Solutions, traveled to Washington multiple times last year to meet with congressional offices representing Pennsylvania. But he also made sure to bring up surprise bills on his home turf, giving his congressman, freshman Democrat Conor Lamb, a tour of the emergency room at Allegheny General Hospital last summer.

“There are two issues here,” said Venkat, who leads the Pennsylvania chapter of the American College of Emergency Physicians and has practiced at Allegheny General for 12 years. “Patients need to be protected, [and] we need to avoid anything that disrupts in-network relationships between insurers and clinicians.”

The call seems to have been heard: Legislation is likely to change further this year as the House Ways and Means Committee pushes an approach that is friendlier to hospitals and doctors. It builds off a one-page document committee leaders issued Dec. 11 that blunted momentum for a bipartisan deal that was to be included in a December spending bill.

The latest proposal from the committee includes an arbitration process to resolve payment disputes, with no minimum dollar amount needed to trigger it, and doesn’t ban surprise billing from air ambulance companies—a win for yet another special-interest lobbying group. The patient protections would not take effect until 2022.

Richard Neal, a Massachusetts Democrat who chairs the committee, remains an ally of Massachusetts hospitals. He released the brief December surprise billing document two days after the Massachusetts Medical Society and Massachusetts Hospital Association wrote a joint op-ed in The Boston Globe arguing that benchmarking physician payments—as the Senate HELP and Energy and Commerce deal would do—would wreck the state’s healthcare system.

“The heavy hand of government would create an unfair imbalance in the healthcare marketplace and insurers would have no incentive to engage physicians in building robust healthcare networks. The connected system of care we have all been working toward in Massachusetts would immediately become fragmented and disjointed,” the two groups wrote in The Boston Globe.

“They weren’t asking for favorable treatment. They were asking for fair treatment, and there’s a big difference,” Neal said in an interview. “I don’t want to rule anything out, but I think that the momentum right now is arbitration.”

“We need to get a little bit more balance,” added Shalala, who endorsed the Ways and Means legislation unveiled earlier this month.

Shalala has at least two hospitals in her Miami-area district that rely on private equity-supported physician staffing companies.

“I’m worried about the hospitals,” she said. “And the providers obviously include the docs.”

Victoria Knight contributed to this story.

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

New research suggests that hospitals with strong financial results could do more to help patients in need of charity care.

According to a research letter published in JAMA Internal Medicine, hospitals that produce high net income spend proportionally less than their peers on charity care for both insured and uninsured patients.

For every $100 of net income earned in 2017, hospitals ranked in the top quartile for net income provided $11.50 in charity care for uninsured patients and $5.10 for insured patients.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

In comparison, the third quartile of hospitals provided $72.30 for uninsured patients and $40.90 for insured patients.

While the top quartile of hospitals generated more than 100% of total overall net income measured in the study, those same hospitals provided only a little more than half of total charity care.

Hospitals in the bottom quartile supported more than 17% of total charity care provided, despite incurring substantial net losses.

Researchers also looked at the difference between charity provided to insured and uninsured patients to get a better sense of how much of charitable care provided by hospitals amounts to discretionary spending, according to lead author Ge Bai, Ph.D., CPA, an associate professor at Johns Hopkins Bloomberg School of Public Health.

Where uninsured patients receive charity care in the form of a full or partial discount on their bills, hospitals tend to waive deductible and coinsurance payments for insured patients. The study noted a decrease in the amount of charity care provided by hospitals in states that expanded Medicaid as compared to those that did not.

“Charity care provision to uninsured patients is sensitive to the number of uninsured patients,” Bai told FierceHealthcare by email. “States that adopted Medicaid expansion have a lower proportion of uninsured patients than other states, and thus it is expected that hospitals in the former states would provide less charity care to uninsured patients than hospitals in the latter states. In contrast, charity care provision to insured patients is not subject to the same constraint, and thus is more discretionary.”

While it’s likely that lower demand for charity among uninsured patients produced some part of the decrease in charity spending in states that expanded Medicaid, it’s unclear whether the policy shift had an effect on charity spending for insured patients. Bai indicated a look at pre- and post-Medicaid expansion spending across those categories would be ripe for future research.

The study notes that the healthcare system’s current legal and regulatory framework gives nonprofit hospitals broad discretion in how they draw up their financial assistance policies. The authors recommend that hospitals consider reexamining their eligibility criteria to provide greater financial assistance to both uninsured and underinsured patients.

Providing more assistance voluntarily would likely be better for all parties involved than waiting for policymakers or government regulators to act, according to Bai.

“It’s very challenging to regulate charitable actions, which are directly linked to the financial viability of the entity,” she says. “The cure could be worse than the disease.”

Ascension’s net income reached $1 billion in its most recent quarter ending Dec. 31, the health system reported in a recently released financial statement.

That was up from losses of more than $982 million on $6.5 billion during the same quarter in 2018, due in part to investment returns. The health system saw a return for the six months ended Dec. 31 of $755.7 million.

However, the St. Louis-based Catholic health giant said its bottom line for the most recent six months only reached $795 million on $13.1 billion in revenue, citing a drop in its income from operations. 

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

The health system reported losses of $568 million for the same six-month period in 2018 on $12.6 billion in revenue.

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Overall, officials said they saw increases in patient volumes, higher acuity of patients served and expansion of service lines and sites of care in addition to the favorable investments in the last six months. 

Ascension reported 408,676 admissions in the six months ended Dec. 31, up just slightly from 408,142 in the same six-month period a year earlier. The health system reported its emergency room visits also increased to 1.67 million from 1.66 million, and its surgery visits—both inpatient and outpatient—increased to 329,571 from 325,435. Its case mix index rose 3.1% to 1.72 from 1.67 in the same six months a year earlier. 

Still, its growth in expenses outpaced its revenue growth. The health system reported a jump in its expenses of $528 million, or 4.2%, saying the increase was primarily due to increased volumes, expanding service lines and sites of care as well as continued transition toward standardized revenue cycle services. 

For example, supply costs increased 5.2%—or by $96.4 million—compared to the same period a year earlier due to an increase in acuity of patient care. Total salaries, wages and benefits increased $120 million, or nearly 2%, compared to the same period in the prior year.

Ascension reported it provided $376 million in charity care in the period ending Dec. 31, up from $266 million in the same six months a year earlier. That $100.6 million jump was due to a new process aimed at better identifying patients qualifying for charity in certain markets, officials said. In all, Ascension said it provided approximately $1.2 billion in community benefit.

Executives are bullish on the potential of artificial intelligence to improve healthcare. But they say adoption is not happening quickly enough due to a lack of workforce training, high costs, and privacy risks, according to a survey by audit, tax, and advisory services firm KPMG.

KPMG’s survey of healthcare leaders was part of a larger study of how executives across five industries view the future of AI in their sectors, and the steps they are taking to maximize its benefits and mitigate its challenges.

“The pace with which hospital systems have adopted AI and automation programs has dramatically increased since 2017. Virtually all major healthcare providers are moving ahead with pilots or programs in these areas. The medical literature is showing support of AI’s power as a tool to help clinicians,” Melissa Edwards, managing director, digital enablement, KPMG, said in the report.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

An overwhelming majority of healthcare respondents (89%) think AI is already creating efficiencies in their systems, and 91% believe it is increasing patient access to care.

Many of the AI-related services and solutions being advanced in healthcare today are largely in the clinical, patient-facing space.

“Basic forms of automation are proving to be the ‘gateway drug’ to advanced forms of AI—such as scanning documents to determine the urgency of a referral. Applying AI to make earlier diagnoses of critical illnesses is a key area,” Edwards said.

  • Nine out of 10 healthcare executives are confident that AI will improve the patient experience with the greatest impacts being found on diagnostics, electronic records management and incorporating robotics into tasks.
     
  • More than two-thirds of healthcare stakeholders (68%) are confident AI will eventually be effective in diagnosing patient illnesses and conditions, and close to half (47%) believe that diagnostics will have a significant impact soon—within the next two years.
     
  • Healthcare executives also anticipate gains in process automation, with 40% seeing X-rays and CT scans being handled robotically.

Recent findings indicate that function may be close to reality. Google Health reported that an AI model developed and deployed by its DeepMind subsidiary was more effective in screening patients for breast cancer than human doctors using recent X-rays only, despite having access to patients’ previous records.

But the pace of progress is too slow, according to one-third of executives, citing barriers such as a lack of workforce talent and the high cost of implementing AI tools.

To date, only 44% of healthcare insiders say their employees are prepared for AI adoption, which is substantially lower than some of the other industries surveyed. Less than half of healthcare organizations (47%) offer AI training courses to employees.

Just 67% of healthcare insiders say their employees support AI adoption, the lowest ranking of any industry, according to KPMG.

Many healthcare institutions lack a breadth of individuals who “speak” the language of AI, Edwards said.

“Comprehending the full range of AI technology, and how best to apply it in a healthcare setting, is a learned skill that grows out of pilots and tests. Building an AI-ready workforce requires a wholesale change in the approach to training and how to acquire talent. Having people who understand how AI can solve big, complex problems is critical,” she said.

Health systems have already made significant capital investments to meet electronic health records (EHR) requirements. To get AI off the ground requires even more of an investment, and, as a result, some health systems are slower to allocate full funding for AI.

More than half of executives (54%) believe that AI to date has actually increased rather than decreased the overall cost of healthcare. Decision-makers are struggling to determine where to place their AI best bets.

“The question is, ‘Where do I put my AI efforts to get the greatest gain for the business?’ Trying to assess what ROI will look like is a very relevant point as they embark on their AI journey,” Edwards said.

Healthcare executives also are concerned that AI could threaten the security and privacy of patient data. Relatedly, 86% say their organizations are taking care to protect patient privacy as it implements AI.

Women and family health startup Maven landed $45 million in series C funding with some high-profile backers.

The funding round was led by Icon Ventures with participation from existing investors Sequoia, Oak HC/FT, Spring Mountain Capital, Female Founders Fund and Harmony Partners.

Individual strategic investors include Reese Witherspoon, Natalie Portman, Mindy Kaling and 23andMe CEO Anne Wojcicki.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

Over the last 12 months, Maven has expanded rapidly, driven by the adoption of its family benefits platform among individuals, employers and health plans seeking better solutions for women’s health, family planning and diversity in the workforce, the company said.

The latest round of funding will be used to support Maven’s growth, deepen investment in its core digital programs across fertility, maternity, return-to-work and pediatrics and expand into adjacent areas.

Ten women’s health digital startups brought in $177 million in funding through the third quarter of 2019, and funding for women’s health companies has risen 812% from 2014 to 2018, according to Rock Health. But only a few women’s health startups have made it to a series C round.

Founded in 2014 by Katherine Ryder, Maven has raised $88 million to date.

The company was initially started as an app but grew into a business that helped employers offer benefits to support their workers with maternity and fertility costs. The product was designed to offer women “end-to-end” support in areas including preconception, egg freezing, IVF/IUI, adoption, surrogacy, pregnancy, postpartum, early pediatrics, return-to-work and breast milk shipping.

Maven was among FierceHealthcare’s 2020 class of Fierce 15 winners.

Ryder told FierceHealthcare in December that she started the company because she saw major gaps when it came to offerings for women, who make up the dominant customer base in healthcare. And that was particularly the case when it came to the biggest healthcare decision of their lives: starting a family.

The company recently launched Maven Wallet, a new feature designed to help members better manage receipts and expenses associated with fertility, egg freezing, adoption and surrogacy reimbursement.

“We believe that women’s and family health is not just a vertical, but the core of a functional healthcare system. With this latest round of funding, Maven will continue to double down and invest in the long term to drive meaningful, sustained change,” Ryder said.

“Maven is addressing critical gaps in care by offering the largest digital health network of women’s and family health providers,” Tom Mawhinney, lead investor from Icon Ventures, said. “With its virtual care and services, Maven is changing how global employers support working families by focusing on improving maternal outcomes, reducing medical costs, retaining more women in the workplace, and ultimately supporting every pathway to parenthood.”

Mawhinney will join the Maven board of directors.

Last year, the company tripled in size to offer care to 5 million women and families. Maven’s women’s and family telehealth network has expanded to include 1,700 providers across more than 20 specialties.

Community Health Systems narrowed its losses to $675 million in 2019 as it continued aggressively cutting the size of its portfolio of hospitals throughout the year.

That loss was improved 14% after CHS reported it was $788 million in the red the prior year.

The Franklin, Tennessee-based health system giant reported a loss of $373 million in the quarter ending Dec. 31, or $3.27 per share, compared to a net loss of $328 million, of $2.91 per share, for the same period in 2018. The company posted revenue of $3.3 billion in the fourth quarter, down from $3.5 billion in the same quarter a year earlier. 

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

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For the year, CHS had revenues of $13.2 billion in 2019, down from $14.2 billion in 2018. 

Wayne Smith, chairman and CEO of CHS, called it a “strong finish” for the year.

“Our successful divestiture program, along with strategic growth initiatives in our core portfolio of markets, has driven better results, including improved same-store volume and net revenue growth in 2019,” Smith said in a statement. “As we enter 2020, we expect to deliver incremental growth, driven by a combination of continued same-store net revenue performance and execution across our strategic margin improvement programs.”

CommonSpirit Health posted $40 million in operating income in the second quarter of fiscal 2020 (PDF), its first operating gain since the health system was formed through the merger of Catholic Health Initiatives and Dignity Health last year.

The Chicago-based health system—the largest nonprofit health system in the country by revenue—cited a revenue jump to $7.5 billion, up 3.2% from $7.2 billion during the same quarter the prior year. The health system reported its total net income was $579 million, up from a loss of $724 million in the same quarter a year earlier.

In its first consolidated financial report last year after merging, the health system reported a net loss of $290 million on revenue of almost $29 billion, down from $1.1 billion in earnings on $29 billion in revenue in fiscal 2019. The health system’s operating loss was much higher when taking into account special charges and merger-related costs.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

CommonSpirit operates 137 hospitals and hundreds of additional facilities in 21 states.

The health system has called diversifying and increasing revenue from non-acute care settings “a strategic priority.” They reported a 4.1% increase in outpatient services. CommonSpirit’s home care and hospice care business grew 10.5% in the first half of the fiscal year compared to the previous year. Barely 30% of the company’s revenue came from value-based agreements with payers, employers and government programs, officials said.

“These results demonstrate that we are gaining traction with the strategy and operating model we’ve put in place,” said Daniel Morissette, CommonSpirit’s senior executive vice president and chief financial officer, in a statement.

“A year into our new organization we have a clear vision and well-defined strategy, we are growing in key markets and service lines, and we are keeping our expenses in check,” he said. “We still have significant work to do to realize our ambitious growth and savings goals, but there is no question that these results represent a step in the right direction.”