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Yevgeny (Gene) German serves as Lyric's chief product and technology officer.

AI and prepayment claims editing play a critical role in enhancing payment accuracy and unlocking value for health plans.




A blueprint for the next era in healthcare payment integrity | Viewpoint

By 2050, it's estimated that 139 million people worldwide will have dementia, but by today's standards, 60% will be undiagnosed. It's clear that there's a significant gap in dementia detection and care, but what can your organization do about it?

Get perspectives from clinical leaders and neuroscience experts about the underlying causes and consequences of these gaps, practical opportunities to address them, and a proven roadmap that shows how leading health systems have successfully transformed their dementia screening and care processes.

Closing the Dementia Care Gap: Expert Insights and Proven Strategies for Health Systems

The Health Infrastructure Security and Accountability Act (HISAA), introduced in the U.S. Senate last month, is a big step forward in addressing the monumental cybersecurity challenges the healthcare sector faces. 

While we can debate whether the specific proposals in the bill are the best ones to drive change, it is encouraging to see lawmakers taking action to address the gaps that many healthcare organizations have in their cybersecurity controls and risk management practices.

While certainly there are organizations who are following industry best cybersecurity practices, the reality is that many others are not. Cyberattacks on healthcare organizations include devastating ransomware attacks that create major disruptions in healthcare services and data breaches of highly sensitive electronic protected health information, causing significant harm to patients.

Healthcare providers – and their business associates, including digital health and health IT companies - must ensure they are safeguarding patient information if they plan to create, receive, transmit or store it. Furthermore, if they are relying on technology to deliver services, they must ensure these systems are available and maintain their integrity. 

Creating mechanisms to ensure all healthcare organizations are meeting cybersecurity standards is essential to reduce the number of breaches and ransomware attacks. This bill aims to do just that.

Cybersecurity and risk management issues aren’t confined to one corner of the sector—it's a challenge for the entire system, and it’s about time we all moved in the same direction. As we saw with the Change Healthcare and OneBlood ransomware attacks, a disruption to the supply chain can have a rippling effect on the entire sector.

The Change Healthcare cyberattack affected 100 million Americans

The American Hospital Association has repeatedly argued that much of the challenge in healthcare cybersecurity lies in software vendors shortcomings. HISAA seems to recognize this point, as it would require that business associates covered under HIPAA comply with the same standards that providers must adhere to. HISAA also includes incentives in the form of funding from the government, however, this support is reserved for hospitals.

The bill takes several important steps to strengthen healthcare cybersecurity:

Establishes minimum and enhanced standards

: HISAA sets minimum cybersecurity standards for covered entities and business associates, with enhanced standards for those deemed critical to national security. The standards are also set to be updated at least every two years.

: While healthcare organizations are already required to conduct risk analyses under HIPAA, HISAA expands this to include risks related to business associates, strengthening the entire supply chain.

: Organizations will need to create and stress-test incident response, business continuity, and disaster recovery plans to ensure they can bounce back quickly when (not if) something goes wrong.

: CEOs and CISOs will be held formally accountable by attesting that their organization complies with the security standards—and they’ll have to post this attestation on their website for all to see.

: Organizations will need to bring in third-party auditors to assess compliance with the minimum standards, and certain entities will have to submit those results to HHS annually.

: The bill mandates that HHS audit at least 20 covered entities or business associates per year, keeping everyone on their toes.

Funding for rural and urban safety net hospitals

: HISAA allocates $1.3 billion in funding to help hospitals—particularly smaller, rural, and urban safety net hospitals—implement better cybersecurity practices.

The funding piece is a good start, but let’s be clear—it’s not enough. While $1.3 billion sounds like a lot, it’s still insufficient when you consider the sheer size of the sector and the financial struggles of many organizations, especially non-profits. We need more funding, particularly for those organizations that don’t have the resources to meet even the most basic cybersecurity controls.

One thing that would really move the needle is providing incentives, like we saw with the Meaningful Use/Promoting Interoperability programs, to motivate organizations to invest in cybersecurity. Fines and penalties alone aren't enough to spur the kind of proactive investment we need.

It’s also crucial that smaller healthcare organizations—especially critical access hospitals and rural health centers—get ongoing support. These organizations are vital to our health system, and they simply don’t have the resources to meet the new standards without additional help.

I’m also glad to see the bill includes third-party audits, but we need to make sure these auditors are vetted and certified, much like the Department of Defense’s Cybersecurity Maturity Model Certification (CMMC) program does. Otherwise, we risk inconsistent or subpar assessments.

And it’s good to see there might finally be some accountability at senior levels of the organization, with proposed requirements to have the CEO attest that the organization meets the minimum cybersecurity requirements. 

Just as Sarbanes-Oxley raised the stakes for financial accountability in the early 2000s, this legislation is likely the beginning of a new era of accountability in cybersecurity. When senior executives are held responsible, we can expect to see more organizations take these requirements seriously.

Notably, the bill falls short on providing safe harbor to those organizations who are meeting recognized security standards and meeting HIPAA requirements, such as on-going risk analysis and risk management. 

Healthcare organizations that do everything they can to prevent, detect and stop an attack, and who have strong resiliency plans in place, should not be penalized or face class action lawsuits if they are attacked by criminals, who are often supported or harbored by adversarial nation states. These types of laws already exist in some states, such as in Ohio, which passed the Data Protection Act in 2018.

Healthcare leaders should not wait for this bill to become law in order to act. Threats to healthcare continue to grow in both frequency and severity. 

Healthcare breaches and ransomware attacks are becoming more impactful to operations, revenue, brand reputation and most importantly patient safety. It should not take regulations to implement what is already required under HIPAA and already considered best practice for healthcare organizations. 

As with any patient safety issue, or threat to the business, leaders should ensure that their organizations are protecting themselves and that they have long term strategies in place to assess and mitigate high risks. Unfortunately, while this is obvious to some, others will continue to ignore the issue, or simply not be able to afford to address it. 

Therefore, whether it’s HISAA or some other bill, we need some catalyst to drive change and help our healthcare industry to achieve a more secure, compliant and resilient state.

Chief Healthcare Executive® presents a discussion on cybersecurity in healthcare from three of the top experts in the field. 

Cybersecurity issues aren’t confined to one corner of the sector—it's a challenge for the entire system, and it’s about time we all moved in the same direction.

Topic

New cybersecurity bill is a step in the right direction, but needs more work | Viewpoint

There will be some doctors in the House in the next congressional session.

Several physicians and dentists succeeded in their re-election campaigns. A couple of physicians will be joining the House in the new congressional session.

Here’s a rundown of some congressional races involving physicians where the contests have been called.

Election Day 2024: Hospitals, emergency leaders plan for possibility of unrest

a Texas Republican and a dentist, won re-election in the 36th District, the 

 reported. He has been in the House since 2015.

a California Democrat, was re-elected to the House. Bera represents the 6th Congressional District, which includes Sacramento, and has been in the House since 2013. He’s the longest serving Indian-American in Congress.

 a Georgia Republican, retained his seat in the 1st Congressional District, according to the 

. Carter, who owned a pharmacy for over 30 years, will begin a sixth term in January.

, a Republican, retained his seat in Tennessee’s 4th Congressional District. He will begin his eighth term in January, the 

, a Florida Republican, is returning, the 

 reported. A surgeon for 25 years, he secured a fifth term.

, a Tennessee Republican, held onto his seat in a contest against former Nashville Mayor Megan Barry. An emergency physician, Green has served in the House since 2019.

, a Maryland Republican, won re-election, the 

, a Texas Republican, secured re-election to the House, which was expected since he ran unopposed. Jackson, who served as the White House physician under President Donald Trump’s administration, will begin a third term.

, a Republican from Pennsylvania, won re-election, 

. Joyce will begin his fourth term in January.

, a Georgia Republican, claimed victory in his re-election bid, the 

, a North Carolina Republican, kept his seat in the state’s 3rd congressional district, the Associated Press said. Murphy is a lead sponsor of 

a bill to avert cuts in Medicare payments to doctors

, a California Democrat, was re-elected in the state’s 25th Congressional District. An emergency physician, Ruiz was first elected to the House in 2012.

, a Democrat from Washington state, won re-election in the 8th Congressional District. A pediatrician, she was first elected in 2018. The race was called Thursday.

, R-N.J., won re-election to his seat in the Garden State’s 2nd Congressional district. He’ll begin his fourth term in January.

 a Democrat, captured a House seat representing Oregon’s 3rd Congressional District, which includes part of Portland. A pulmonolgist with Kaiser Permanente, Dexter defeated Republican Joanna Harbour in the contest for an open seat. U.S. Rep. Earl Blumenauer, a Democrat, is retiring.

, a Democrat, defeated Republican Tad Jude to win an open seat in Minnesota’s 3rd Congressional District. An OB-GYN who practiced for more than 20 years, Morrison will take the seat held by Rep. Dean Phillips, who didn’t seek re-election.

, a Democrat and an OB-GYN, lost to Republican Tony Wied in a race for the state’s 8th Congressional District. 

, an Indiana Republican, opted against seeking re-election. He’d been in the House since 2011.

, a Texas Republican, is retiring after serving in the House for 22 years.

., a Georgia Republican, also opted against a bid for re-election. His fourth term will be his last.

, an Ohio Republican and a podiatric physician, opted against seeking another term. He was first elected in 2012.

Four physicians are serving in the U.S. Senate, and they weren’t on the ballot this year. The four doctors in the Senate are U.S. Sens. Roger Marshall (R-Kan.); Bill Cassidy (R-La.); Rand Paul (R-Ky.); and John Barrasso (R-Wyoming).

Several physicians won re-election to new terms in the House of Representatives. And a couple of freshmen physicians will join the House.

Election 2024: Doctors keep seats in the House

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The HLTH conference offered evidence of the growing excitement about artificial intelligence in healthcare, but the conversation is getting more nuanced.

That’s perhaps the key takeaway from the healthcare technology conference in Las Vegas. Thousands of healthcare leaders came for the convention, which started Sunday and ended Wednesday.

Here’s a rundown of some of my key takeaways from the HLTH conference.

I’ll offer a few caveats. There were literally hundreds of sessions, so obviously I didn’t attend each one. And with an estimated 12,000 in attendance, I didn’t talk to everyone.

I did speak with a good number of healthcare leaders in attendance (my dance card was full), some for interviews and others in casual conversations. This rundown reflects insights from the sessions I attended and those I spoke with at the conference.

You can also check out this video recap for more of the sights and scenes from HLTH. (The story continues below.)

The HLTH conferenced featured AI, technology and other key healthcare topics

HLTH 2024 in 2 minutes

some healthcare leaders projected that AI would be the main topic

It’s probably not surprising that AI was the dominant conversation at HLTH, and it was the topic of a host of sessions.

, MD, president and CEO of the Cleveland Clinic, talked about how his health system is utilizing AI in healthcare in one of the featured addresses at HLTH. In the short term, he said AI’s impact on healthcare may be overhyped, but he also said in the long-term, AI’s potential to change the industry could actually be underrated.

“The enthusiasm for the application of AI in healthcare is appropriately high,” he said.

However, there is a little fatigue, and even some frustration, over the constant AI hype. A number of healthcare leaders said there needs to be an understanding that AI is not a magic wand that is going to solve every problem in healthcare.

Others also expressed a little wariness of vendors pushing AI technologies. Some leaders said AI companies need to focus on more than using new technology, and concentrate on developing tools that help solve real issues for healthcare providers.

They also offered advice worth heeding for AI companies: Get some input from clinicians on your AI tools, since they’ll be using them. Another hint: That should include nurses as well as doctors.

Michael Meucci, CEO of Arcadia, said the conversation around AI is evolving from asking "what's possible" to helping clinicians.

"It’s clear that empowering clinicians with tools that integrate seamlessly into existing workflows—without adding burden—is key to enabling faster, better decisions at scale," Meucci said.

Executives continue to see AI offering more immediate benefits in helping streamline administrative tasks and helping to ease burdens on their staff.

While some leaders say AI could help expand access to healthcare, others warned that it could exacerbate disparities. 

 said he sees AI as expanding the divide.

“I’m very worried health systems are using AI honestly to segregate patients into those that are profitable and those that are not,” Califf said.

Kaiser Permanente CEO talks about acquiring more hospital systems | HLTH 2024

Some of the AI discussions are aimed at easing the workload of clinicians, and there is a recognition that doctors, nurses and other caregivers are spending too much time looking for data or filing claims, and that’s contributing to burnout.

Burnout among doctors and nurses is hardly a new phenomenon. The Physicians Foundation reports that 

60% of doctors experience feelings of burnout

. But there seems to be growing understanding that clinicians need more help and that too many are losing their joy for the job.

Healthcare leaders are also talking about reducing time spent on administrative tasks so that clinicians can focus more on their patients and have better conversations and can think more deeply about ways to help them. That’s a concern that was addressed repeatedly over the course of HLTH.

Health leaders also exhibited some restlessness over the state of healthcare.

Even as many talked about AI and other digital tools to improve care, executives noted the glaring problems that persist for many Americans.

Americans have shorter lifespans than those living in other countries, Califf noted. Too many people don’t have a primary care doctor, and too many communities don’t even have family physicians.

Too many can’t afford the care they need, and are grappling with social factors such as homelessness, food insecurity, or simply lacking a full-service grocery store.

Some of the conversations about health equity felt a bit ironic in the Venetian, the lavish site of the conference. But it’s good that there was a recognition of the reality for many Americans beyond the Vegas strip.

Some of the best conversations involved the growing mental health crisis in America.

. As executives of pediatric hospitals have lamented, 

more children are showing up in emergency rooms

Experts on the panel warned against dismissing a child’s depression or anxiety as just a phase. They also said some people aren’t appreciating how much the COVID-19 pandemic disrupted kids and teens.

Disturbingly, the experts said too many kids simply don’t see hope for the future. Akiera Gilbert, CEO of Project HEAL, an organization that helps young people with eating disorders, warned that many kids struggle with isolation.

“We are theoretically living in an age of connection, and we have never been more alone,” Gilbert said.

The HLTH conference gave some welcome attention to women’s health and research.

 announced the awarding of $110 million for research in women’s health research during the closing day of health.

She also urged healthcare leaders to put more attention on women’s issues.

“I know you see these opportunities in your day-to-day work,” Biden said. “Here’s what I also want you to know. The women of America are waiting on you.”

Another high-profile woman made the case for paying more attention to women’s health. 

, the Oscar-winning actress, talked about her advocacy for women’s health and the need to invest more in studies of menopause. Even though all women will go through menopause, Berry noted that there’s been little research. She’s backing a bill to invest more in menopause research and care.

“We need more money, we need more dollars, we need more research, we need more clinical trials,” Berry said.

At least in the sessions I observed, there were a good number of women on the panels, which is also encouraging.

Quite a few HLTH sessions focused on the popularity and potential benefits of anti-obesity medications, or GLP-1 drugs. The demand for those drugs has surged, and leaders at HLTH see little signs that the consumer appetite for GLP-1 drugs is waning.

While used in treatment of diabetes and weight loss, healthcare leaders also expressed interest in more research in their use to treat other conditions.

However, some derided the cost of GLP-1 drugs, which top $1,000 and are out of reach of many Americans. Califf chided drug companies for the high price tags.

“The profit margin, especially in the U.S., is outrageous,” Califf said. “They should be ashamed of themselves for what they’re charging Americans.”

Halle Berry wasn’t the only famous face at HLTH this year. Other celebrities took the stage and offered some perspectives that have some value for healthcare organizations.

Musician John Legend spoke about health equity during an appearance on the main stage Monday. In a conversation with Vanessa Broadhurst, executive vice president of global corporate affairs at Johnson & Johnson, Legend talked about seeing health disparities in his own family. He noted that his grandfather had his leg amputated due to diabetes, and talked about delays in getting the right diagnosis and treatment.

“I’ve seen how health equity and the lack thereof has impacted my own family over the years,” Legend said.

 talked about his work to improve oral health and healthcare more broadly in the Bahamas. He also pointed to a key ingredient in the success of those efforts, and offered a worthwhile lesson for providers.

The clinicians who are working with people in the Bahamas are treating them with respect and not pity, he said.

““It just feels beautiful,” Kravitz said. “You’re giving them their health back, you’re giving them their smile back, their dignity. … they’re so thankful.”

Thousands of people traveled to Las Vegas for the annual event. There’s growing enthusiasm for AI, and a little fatigue over some of the hype.

HLTH 2024: 7 key takeaways from the healthcare technology conference

Healthcare occupations are projected to outpace other industries, adding 2.4 million jobs by 2026. Nurses are in short supply; the U.S. Bureau of Labor Statistics forecasts need for over 200,000 new RNs annually through 2026.

AMN Healthcare conducted research regarding Integrated Talent Solutions (ITS), an enterprise-wide approach to permanent and contingent talent strategies. This research examined industry and talent management trends impacting health organizations, while offering actionable solutions. This eBook summarizes key conclusions from the ITS partnership research.


Complete the form below to download the whitepaper.

Healthcare occupations are projected to outpace other industries, adding 2.4 million jobs by 2026. Nurses are in short supply; the U.S. Bureau of Labor Statistics forecasts need for over 200,000 new RNs annually through 2026.

AMN Healthcare conducted research regarding Integrated Talent Solutions (ITS), an enterprise-wide approach to permanent and contingent talent strategies. This research examined industry and talent management trends impacting health organizations, while offering actionable solutions. This eBook summarizes key conclusions from the ITS partnership research.

Gene German

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