Latest news with #valuebasedcare
Forbes
4 days ago
- Health
- Forbes
Is AI About To Solve A $55 Billion Healthcare Problem?
Mika Newton is CEO of xCures, using state-of-the-art AI to process all types of medical records, turning data chaos into clinical clarity. Each year, the U.S. loses more than $55 billion due to missed prevention. This includes colonoscopies that were never scheduled, A1c tests that were forgotten and statins that stayed on the pharmacy shelf. In a value-based care environment, these oversights cause avoidable crises, drain shared-savings pools and inflate emergency care costs. Yet today, most health systems still rely on spreadsheets, printed lab reports and manual chart reviews to identify and address lapses. The result is unfortunate and predictable: Care slips through the cracks, and no one notices until it's too late. This so-called 'gap' in care consists of evidence-based actions that haven't occurred. Guideline-setting organizations such as USPSTF, ADA, NCCN and CMS outline thousands of these actions, ranging from mammogram scheduling to the follow-up times after a heart failure discharge. Electronic health records can (and do) help catch some of these lapses before they cause significant damage or affect patients. Still, many are buried in unstructured notes, siloed imaging systems or social risk factors that traditional rules engines can't easily parse. We need fast, precise and proactive tools to improve health outcomes and reduce costs. This is where artificial intelligence is on the cusp of addressing missed prevention. AI systems can read millions of clinical notes. This is a feat unthinkable just a few years ago. In fact, one health AI company, Astrata, reported that its NLP platform accelerated gap-closure efficiency by six to 38 times, depending on the measure. This is a topic I've been passionate about for years. I've worked on applying simulation models of human physiology and health systems to predict clinical outcomes and optimize care delivery. I've helped build AI tools that automate literature review and evidence synthesis, which has taught me valuable knowledge buried in unstructured data. Furthermore, I've observed how often essential details get missed, not because people don't care, but because the systems weren't built to help them catch everything. Because these models continuously learn and evolve, they integrate new guideline releases within days, rather than waiting for the next annual update. Most importantly, AI makes these insights actionable by assigning risk scores to patients, which helps care teams prioritize outreach based on potential benefit. That means resources go where they matter most. We're already seeing this shift take place in the real world. In 2024, AmeriHealth Caritas and Prospect Medical won a KLAS Points of Light award for demonstrating that AI could close HEDIS care gaps more efficiently than manual review. In March 2025, Navina, a company developing an AI copilot for physicians, raised $55 million to scale its work, which is strong evidence that the return on investment for AI in care coordination is already apparent to the market. Meanwhile, the cost of doing nothing continues to climb. Preventable care gaps are estimated to account for 30 cents of every healthcare dollar in the United States. The financial upside of closing these gaps is significant. Fewer unmanaged diabetics means fewer ER visits, which improves shared savings and capitation margins. In Medicare Advantage, every half-star jump in plan ratings can increase revenue by more than 2%. When AI tools help document chronic conditions previously hidden in free-text notes, the accuracy of risk adjustment scores improves, along with the per-member payments tied to them. Across multiple payer case studies, AI gap-closure programs deliver first-year returns of three to one, even before factoring in long-term clinical gains. These systems typically work by ingesting a wide variety of data, including electronic health record (EHR) and claims feeds, pharmacy records, lab results, device data and social-risk indices. AI models then map each patient's status against current guidelines using codified rules or clinical knowledge graphs. Predictive risk models help prioritize which patients should be contacted first, and those alerts are integrated directly into clinicians' existing workflows, avoiding the friction of switching systems or portals. In parallel, real-time dashboards link each closed gap to downstream outcomes, providing visibility into the impact of each intervention. With the ONC's HTI-1 Final Rule expected to take effect this year, AI vendors must disclose the training data attributes and bias mitigation techniques used in their models. This regulatory change adds a layer of transparency that will likely empower buyers to make more informed choices. To see how this all works, consider Maria, a 58-year-old hypothetical diabetic patient who hasn't filled her statin prescription. The AI platform notices her unfilled script, her most recent LDL results and two missed primary care appointments. It recognizes that she lives in a transportation desert. Within seconds, the system sends her a message offering a lower-cost statin alternative and a ride-share voucher. When the pharmacy claim posts, the care gap closes automatically. Multiply that moment across thousands of patients, and it becomes clear how AI can save money while improving population health. To do this right, we need to be clear about the problem. Changing a process is hard, so the best tools earn trust because they help immediately. That's what makes the difference. In healthcare, patient outcomes are paramount. However, tools must also show return on investment (ROI) through increased revenue and ensure user adoption through better workflow. Any tool you vet or develop should make these capabilities immediately apparent. Additionally, make sure you understand bias. It is always there. This phenomenon is natural, but you must understand and quantify the bias. For example, most Polygenic Risk Score (PRS) models for breast cancer, which are used to predict genetic susceptibility, were initially developed using data from individuals of European descent. As a result, these models underperformed in Black, Hispanic and Asian populations. Researchers created ancestry-specific PRS models by training on genomic data from non-European cohorts. This kind of proactive work to address bias is essential in any AI solution you build or buy. The truth is that bending the cost curve isn't possible unless you know where it's broken. Artificial intelligence now allows us to see those cracks as they form and points to who can fix them. The incentives are aligned. The technology is mature. The upside is enormous. The next move is yours. Forbes Technology Council is an invitation-only community for world-class CIOs, CTOs and technology executives. Do I qualify?
Yahoo
4 days ago
- Business
- Yahoo
Aledade Acquires More Michigan Value-Based Care Operations
Strategic deal bolsters Aledade's support for Michigan independent primary care practices BETHESDA, Md., June 24, 2025--(BUSINESS WIRE)--Aledade, the nation's largest network of independent primary care, today announced its acquisition of the Michigan-based value-based care operations of CCA Holding Company, Inc. This acquisition includes an Accountable Care Organization (ACO) and Physician Organization operating in Southeast Michigan and all related employees, further expanding Aledade's existing expertise and presence across the state. Aledade currently supports more than 1,500 physician partners across more than 180 primary care practices and community health centers statewide, reflecting additional growth including last year's acquisition of Medical Advantage, a Michigan-based provider of practice performance improvement and value-based care enablement solutions. "We are excited to welcome these physician-led organizations into Aledade," said Ahmed Haque, chief performance officer at Aledade. "This move further expands value-based care in Michigan, empowering more independent primary care organizations to continue providing high quality care in communities they serve." In the 2023 Medicare Shared Savings Program (MSSP) performance year, Aledade ACOs generated a record $801 million in savings, surpassing all other accountable care partners nationwide, and achieved quality scores higher than average non-Aledade MSSP participants. Aledade's physician-led ACOs were among the top performers in MSSP, with 93% achieving savings compared to under 70% among non-Aledade participants. Since 2014, Aledade and its partners have saved more than $2 billion in health care for U.S. taxpayers. "As part of Aledade, the value-based care operations of CCA Holding Company, Inc. will have the ideal platform to continue successfully serving over 500 independent primary care and specialty offices in Southeast Michigan," said David Klein, Chair of the CCA Holding Company, Inc. About Aledade Aledade, a public benefit corporation, is the largest network of independent primary care in the country, helping independent practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Through its proven, scalable model, which includes cutting-edge data analytics, user-friendly guided workflows, health care policy expertise, strong payer relationships and integrated care solutions, Aledade empowers physicians to succeed financially by keeping people healthy. Together with more than 2,400 practices, federally-qualified health centers and community health centers in 46 states and the District of Columbia, Aledade shares in the risk and reward across more than 200 value-based contracts representing nearly 3.0 million patient lives under management. To learn more, visit or follow on X (Twitter), Facebook or LinkedIn. View source version on Contacts Hiran RatnayakeDirector of External Communications(302) 299-3562Request an Interview Visit our Newsroom Sarah MagazineVice President of Communications(617) 470-6755mediainquiries@
Free Malaysia Today
4 days ago
- Health
- Free Malaysia Today
Joint ministerial committee to tackle rising healthcare costs
Finance minister II Amir Hamzah Azizan (left) and health minister Dzulkefly Ahmad attending the first meeting of the joint ministerial committee on private healthcare costs. (KKM pic) PETALING JAYA : The finance and health ministries have officially established the joint ministerial committee on private healthcare costs (JMCPHC) in a move aimed at ensuring affordable private healthcare in Malaysia. The committee, which held its first meeting today, aims to coordinate a whole-of-nation approach in managing medical inflation and improving transparency and sustainability within the private healthcare sector, said the ministries in a statement. Co-chaired by finance minister II Amir Hamzah Azizan and health minister Dzulkefly Ahmad, the JMCPHC includes representatives from both ministries and Bank Negara Malaysia (BNM). The committee will be supported by a consultative council which brings together private hospitals, healthcare professionals, insurance and takaful providers, consumer advocacy groups, and academics to provide expert input and technical advice to guide the committee's initiatives. 'This joint committee reflects our commitment to building a private healthcare system that is sustainable, transparent, and delivers real value for the rakyat,' said Amir. Dzulkefly said the committee aims to reduce overcrowding in public hospitals and improve access to private healthcare by embracing value-based care and expanding cost-effective options. The committee will also look to improve existing programmes such as Rakan KKM, which offers 'premium economy' services at selected public hospitals for elective outpatient, daycare and inpatient services. The JMCPHC builds upon previous groundwork, including BNM's implementation of co-pay requirements, interim measures to cushion the impact of medical premium adjustments for policyholders affected in 2024-2026, and the RESET framework. The RESET framework covers five strategic thrusts to address medical inflation – revamp medical and health insurance/takaful (MHIT), enhance price transparency, strengthen the digital health ecosystem, expand cost effective options, and transform provider payments. One of the committee's immediate priorities includes the development of a base MHIT product to ensure affordability and sustainability.
Yahoo
18-06-2025
- Business
- Yahoo
Zacks Industry Outlook Highlights CVS Health, BrightSpring Health Services and GeneDx
Chicago, IL – June 17, 2025 – Today, Zacks Equity Research discusses CVS Health CVS, BrightSpring Health Services, Inc. BTSG and GeneDx Holdings Corp. WGS. Link: The Medical Services sector is experiencing significant transformation fueled by advancements in technology, increased adoption of value-based care and focus on patient-centric solutions and precision medicine. Rising demand for remote treatment is accelerating digital healthcare growth, especially in telemedicine and AI-powered analytics. Providers are using these tools to improve diagnostics, streamline operations, and enhance outcomes, while value-based models promote preventive and personalized care. According to a Precedence Research report, the global healthcare analytics market was valued at $53.1 billion in 2024 and is projected to witness a CAGR of 21.4% from 2025 to 2034, benefiting payers, professionals, and patients with advanced insights and services. Stocks like CVS Health, BrightSpring Health Services, Inc. and GeneDx Holdings Corp. are poised to benefit from this shift. Meanwhile, as the U.S. healthcare system faces post-pandemic pressure, shifting payer mix and labor shortages, demand for skilled nursing professionals is surging. A 2024 Mercer report projects a shortfall of over 100,000 healthcare workers by 2028, including 73,000 nursing assistants. This will elevate labor costs, though tech-driven care models are driving new, specialized roles. The Zacks Medical Services industry comprises third-party service providers and caregivers appointed by core healthcare companies for economies of scale. The industry includes pharmacy benefit managers, contract research organizations, wireless MedTech companies, third-party testing labs, surgical facility providers and healthcare workforce solution providers, among others. Over the years, this industry has strategically moved from volume-based to value-based care. The resurgence in medical tourism is further boosting the sector. This changing pattern of care calls for advanced facilities, thus increasing the need to appoint specialized external service providers. With the growing importance of effective healthcare management, the medical service industry has become an integral part of the modern healthcare system. The adoption of digital platforms within the medical device space is gaining prominence in the United States. A 2024 digital health market report by Statista suggests that this market will witness a 9.2% CAGR from 2024 to 2028. The increasing availability of unstructured health data, advanced analytics and the demand for personalized medical services underscore the growing importance of big data in healthcare. According to a Roots Analysis report, the global big data in healthcare market size is estimated to increase from $78 billion in 2024 to $540 billion by 2035, representing a CAGR of 19.20%. Other reports suggest that companies that adopted artificial intelligence technologies witnessed a 50% reduction in treatment costs and experienced more than 50% improvement in patient outcomes. : The lingering impact of COVID-19 as a global health emergency has driven many frontline workers to exit the field. Added to this, a drastic increase in the aging population in recent times (about 10,000 individuals aged 59-77 are joining Medicare plans daily) has made the healthcare staffing shortage more pronounced. According to McKinsey, while the global economy could generate 40 million new healthcare jobs by 2030, a significant gap remains. WHO projects a shortfall of 9.9 million physicians, nurses, and midwives worldwide over the same period, highlighting the urgent need for workforce expansion in health systems. Needless to say, this supply shortage has led to a significant rise in healthcare wages. Going by an HR for Health report, increased labor costs and staffing challenges have resulted in a rise in hospital expenses. Hospitals have experienced a 15.6% increase in labor expenses per adjusted discharge compared to pre-pandemic levels. : In 2025, the role of nurses continues to evolve with advancements in medical technologies and shifts in healthcare delivery models. Telehealth and remote patient monitoring have expanded nurses' reach beyond traditional hospital settings, enabling them to provide care in rural or underserved areas. Specialized nursing roles, such as nurse practitioners, critical care specialists and geriatric nurses, are in high demand due to the growing complexity of patient needs. Going by the Bureau of Labor Statistics, the overall employment of nurse anesthetists, nurse midwives and nurse practitioners is projected to grow 40% from 2023 to 2033, much faster than the average for all occupations. About 31,900 openings for nurse anesthetists, nurse midwives and nurse practitioners are projected each year, on average, over the decade. The Zacks Medical Services industry falls within the broader Zacks Medical sector. It carries a Zacks Industry Rank #67, which places it in the top 27% of 245 Zacks industries. The group's Zacks Industry Rank, which is basically the average of the Zacks Rank of all the member stocks, indicates flourishing near-term prospects. Our research shows that the top 50% of the Zacks-ranked industries outperforms the bottom 50% by a factor of more than 2 to 1. We will present a few stocks that have the potential to outperform the market based on a strong earnings outlook. But it's worth taking a look at the industry's shareholder returns and current valuation first. The Medical Services Industry has underperformed its sector and the S&P 500 over the past year. The stocks in this industry have collectively lost 13.4% during the said time frame compared with the Medical sector's 12% dip and the S&P 500 composite's surge of 10.6%. On the basis of forward 12-month price-to-earnings (P/E), which is commonly used for valuing medical stocks, the industry is currently trading at 14.6X compared with the S&P 500's 21.9X and the sector's 19.3X. Over the last five years, the industry has traded as high as 20.12X, as low as 13.4X, and at the median of 14.6X. Below, we present three stocks from the Medical Services industry that have been witnessing positive earnings estimate revisions and carry a Zacks Rank #1 (Strong Buy) or #2 (Buy) at present. You can see the complete list of today's Zacks #1 Rank stocks here. GeneDx: This genomics company provides genetic testing services. It primarily offers pediatric and rare disease diagnostics with a focus on whole-exome and genome sequencing, as well as data and information services. The company is also developing an AI-based platform for NGS analysis, interpretation, and clinical reporting for rare disease, hereditary risk, and cancer testing. This Zacks Rank #1 stock's 2025 expected earnings growth rate is 336%. The Zacks Consensus Estimate for WGS' 2025 revenues indicates a rise of 22.5% from 2024. CVS: It is a pharmacy innovation company with integrated offerings across the entire spectrum of pharmacy care. CVS Health is investing in advanced technological capabilities to cut down costs and improve customer experience. Improved Medicare Advantage star ratings for the 2025 payment year are a positive development for the company. CVS Health's 2025 and 2026 earnings growth rates are pegged at 12.6% and 14.3%, respectively. CVS has a long-term expected earnings growth rate of 11.4%. The stock holds a Zacks Rank #2 currently. BrightSpring: The company operates as a home and community-based healthcare services platform in the United States. BrightSpring is delivering significant improvements in care quality across its diversified service portfolio, boosting stakeholders' and investors' sentiment. In Home Health, over 80% of branches are now rated 4 stars or higher, with the 60-day hospitalization rate continuing to decline. BrightSpring's 2025 expected earnings growth rate is 82.1%. The Zacks Consensus Estimate for BTSG's 2025 revenues indicates a rise of 9.1% over 2024. The stock carries a Zacks Rank #2 at present. Why Haven't You Looked at Zacks' Top Stocks? Since 2000, our top stock-picking strategies have blown away the S&P's +7.7% average gain per year. Amazingly, they soared with average gains of +48.4%, +50.2% and +56.7% per year. Today you can access their live picks without cost or obligation. See Stocks Free >> Join us on Facebook: Zacks Investment Research is under common control with affiliated entities (including a broker-dealer and an investment adviser), which may engage in transactions involving the foregoing securities for the clients of such affiliates. Media Contact Zacks Investment Research 800-767-3771 ext. 9339 support@ Past performance is no guarantee of future results. Inherent in any investment is the potential for loss. This material is being provided for informational purposes only and nothing herein constitutes investment, legal, accounting or tax advice, or a recommendation to buy, sell or hold a security. No recommendation or advice is being given as to whether any investment is suitable for a particular investor. It should not be assumed that any investments in securities, companies, sectors or markets identified and described were or will be profitable. All information is current as of the date of herein and is subject to change without notice. Any views or opinions expressed may not reflect those of the firm as a whole. Zacks Investment Research does not engage in investment banking, market making or asset management activities of any securities. These returns are from hypothetical portfolios consisting of stocks with Zacks Rank = 1 that were rebalanced monthly with zero transaction costs. These are not the returns of actual portfolios of stocks. The S&P 500 is an unmanaged index. Visit for information about the performance numbers displayed in this press release. Want the latest recommendations from Zacks Investment Research? Today, you can download 7 Best Stocks for the Next 30 Days. Click to get this free report CVS Health Corporation (CVS) : Free Stock Analysis Report GeneDx Holdings Corp. (WGS) : Free Stock Analysis Report BrightSpring Health Services, Inc. (BTSG) : Free Stock Analysis Report This article originally published on Zacks Investment Research ( Zacks Investment Research Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Yahoo
17-06-2025
- Business
- Yahoo
Motive Medical Intelligence Partners with Amendola on Thought Leadership Program
Partnership to elevate awareness of Motive's groundbreaking physician-level performance measures, value-based care leadership SAN FRANCISCO and SCOTTSDALE, Ariz., June 17, 2025 /PRNewswire/ -- Motive Medical Intelligence (Motive), a leading healthcare data and analytics company advancing physician-level performance and value-based care, today announced that it has selected Amendola, part of Supreme Group, to create and lead its integrated public relations and thought leadership program. Amendola will spotlight Motive's Practicing Wisely solution and position the company's experts to expand its reach across the healthcare industry. "At Motive, we're reimagining how evidenced-based healthcare data can empower physicians and transform care delivery," said Jeanne Cohen, CEO and Founder of Motive Medical Intelligence. "To bring that vision to life at scale, we knew we needed a communications partner who shares our passion for innovation and understands the broader impact of value-based care. Amendola stood out for their strategic insight, storytelling excellence, and deep roots in healthcare. Together, we're not just raising awareness—we're building momentum for real change in the industry." Practicing Wisely is the only clinical analytics system designed to evaluate performance and improvements at physician and group levels using Appropriateness of Care, Quality, and Waste measures across 18 specialties as well as primary care and pediatrics. It is widely used by top payers and providers committed to reducing low-value services and advancing value-based care. "Motive is redefining how the healthcare industry understands and improves clinical performance to drive the healthcare ecosystem's commitment to value-based care," said Jodi Amendola, president of Amendola. "The healthcare industry is ripe for broader adoption of the Practicing Wisely system, which is the result of deep clinical and technical expertise." Amendola added, "Now is the time to showcase the Motive team's powerful work, expertise, and thought leadership to guide the industry to the future. Motive is exactly the kind of visionary client we're proud to support." About Practicing WiselyThe proprietary solution is powered by technology that delivers defensible, auditable insights based on clinical guidelines and evidence. Every measure is delivered with clear rationale, supporting materials such as clinical guides and evidence, and engagement strategies to foster physician and group improvement to build payer-provider trust. It is designed to support, not penalize, physicians, while helping all healthcare stakeholders align around shared goals in value-based care. About Motive Medical IntelligenceMotive is redefining healthcare performance analytics with an emphasis on transparency, physician trust, and real-world actionability. With nearly 30 years of experience and no direct competitors matching its scope or precision, Motive is the partner of choice for organizations committed to eliminating low-value care and thriving in value-based care models. Through its proprietary Practicing Wisely solution, Motive is helping the industry eliminate the $390 billion in annual waste in the U.S. health system, advancing the transition to high-value, patient-centered care, and achieving the quadruple aim. Learn more here. About AmendolaAmendola, part of Supreme Group, is an award-winning, insights-driven public relations and marketing firm that integrates media relations, social media, content, and lead gen programs to move healthcare, life sciences/pharma and healthcare IT decision-makers to action. The agency represents some of the industry's best-known brands as well as groundbreaking startups disrupting the status quo. Nearly 90% of its client base represents multi-year clients and/or repeat client executives. Amendola's seasoned team of PR and marketing pros understand the ongoing complexities of the healthcare ecosystem and provide strategic guidance and creative direction to drive positive ROI, boost reputation and increase market share. Making an impact since 2003, Amendola combines traditional and digital media to fuel meaningful and measurable growth. For more information about the industry's "A-Team," visit this website and follow us on LinkedIn. Media Contact: Marcia Rhodes/mrhodes@ View original content to download multimedia: SOURCE Amendola, part of Supreme Group Sign in to access your portfolio
