Category: Health

The chief executive officer of UnitedHealth Group appeared in front of two Congressional Committees on Wednesday forced to answer uncomfortable questions on how it handled what is being described as the worst malicious ransomware attack in the history of the healthcare industry — the outage at Change Healthcare that has had ripple effects on providers and patients alike, and for which it had to pay $22 million to the bad actors that hacked its unprotected server. It was striking to see Andrew Witty — the CEO of both the largest insurance company and the largest employer of physicians — to preface almost every answer with the deferential, “Mr Chairman, thank you for that question.” A video of the hearing showed Witty looking every bit the penitent executive hauled to provide testimony on a subject that has garnered bipartisan anger.

Here are the key moments and takeaways from the 2-hour-plus hearing in the Senate Committee on Finance:

“Practically every provider I bump into is waiting to be paid”

In his direct questioning, Senator Ron Wyden (D-Oregon) wasted no time in asking how long providers who had rendered clinical services in February would need to wait to get paid because clearing the backlog would take time. Witty calmly responded that claims flow across the entire country was “broadly back to normal” noting that UnitedHealth was paying claims as quickly as possible but other insurance companies may not be.

Wyden was not willing to make the distinction between whether UnitedHealth is paying in a timely fashion vis-a-vis other insurance companies whose claims they also process and asked Witty to simply hurry up and pay. Witty repeated that he believes claims flow is broadly back to normal but asked Wyden to refer him to any providers in the states that are still waiting.

To which Wyden retorted: “Practically every provider I bump into is waiting to be paid.” He ended that line of questioning by asking Witty to send in writing how he will “meaningfully compensate” providers and insurance plans whose business was disrupted as a result of the Change Healthcare attack and subsequent outage.

Later in the hearing, Senator Marsha Blackburn (R-Tennessee) expressed indignation that it’s taking “nine weeks” for providers to get paid, seriously doubting Witty’s characterization that claims processing was “back to normal.

“We have absolutely been inundated with phone calls since this came back” Blackburn said of Change Healthcare’s system being back online but providers not getting paid. “Things are wildly different than the rosy picture you have painted.”

When Witty was attempting to answer, Blackburn cut him off citing saying how providers are having to pull on a line of credit to remain operational.

“Are you going to pay that interest?” she asked “Are you going to reimburse that?”

Witty responded that UnitedHealth is offering interest free loans, but Blackburn shot back, “I said are you going to pay the interest cost?’

Witty couldn’t answer how many people were impacted by the attack or what data was stolen

Two and a half months after the attack was first detected, Witty couldn’t answer a question — exactly how many people were impacted by the breach. The executive did contend that so far he believes no medical records or medical history was stolen only claims but Wyden wasn’t buying it.

“But you don’t have the logs that would show what data walked out the door because we have been working to get that and we haven’t seen it,” Wyden shot back.

Multiple senators pressed Witty on when patients will be notified saying that he could be in violation of HIPAA rules regarding notification. But he would only say that they are working with regulators to figure it out.

“I think it will be in the next several weeks,” was what Witty allowed every single time the question was posed. Senator Bob Casey Jr. (D-Pennsylvania) noted however, that the company’s website notes that the notification process will take “several months.”

“How in heaven’s name did you not have the necessary redundancies?”

When Senator Michael Crapo (R-Idaho) asked Witty, what steps were being taken to strengthen the system, UnitedHealth’s chief acknowledged that multifactor authentication has now been implemented to all external facing systems across the company. [There was a policy that was there in place to have multifactor authentication, only the policy was not being followed, Wyden later pointed out.] Witty added that the company has also hired third parties to perform “double or treble scanning of our systems” as another layer of protection. Unitedhealth has hired Mandiant Consulting to help understand the nature of the attack and do cybersecurity oversight.

“They have become a board advisor…” Witty said of the cybersecurity consulting firm.

Crapo who took a gentler tone with Witty than Wyden asked whether these approaches and even stronger defenses than the ones that UnitedHealth has adopted since the breach should become the industry standard.

“I would agree with that,” Witty said. “What we saw with Change Healthcare, which was a company which just came into our group a little over a year and a half ago, was a company which was an older company, had older legacy technologies but I think is very typical of many small-to medium-size organizations in our healthcare environment and therefore inevitably there’s going to be a lot of work to be done to upgrade those standards ….”

Of course the question is that if it took an attack of this magnitude to get the deep-pocketed UHC to take the threat of cybersecurity seriously, can anyone hope that smaller businesses will either have the financial resources or the will to invest in stronger systems?

Witty blamed the attack on one server that didn’t have multifactor authentication and on the fact that Change Healthcare had old legacy systems but got repeatedly upbraided by Wyden and other senators for this failure. Senator Blackburn expressed disbelief that the company didn’t have the cybersecurity infrastructure given that UnitedHealth’s revenue is larger than the GDP of some small countries.

“How in heaven’s name did you not have the necessary redundancies so that you did not experience this attack and find yourself so vulnerable?” she asked incredulously.

Witty responded that Change Healthcare has only been part of UnitedHealth Group for a short time and they were in the process of upgrading their systems. He added that one of the reasons it has taken so long to get back online was because UnitedHealth has built a new technical environment from scratch to ensure it was modern and that wasn’t “infected” by the attack.

Another important tidbit: The hackers had broken into the system nine days before UnitedHealth detected the breach.

The $6.5 billion worth of financial assistance just doesn’t cut it

In his opening statement Witty said that the company has extended $6.5 billion worth of financial assistance in the form of accelerated payments and no-interest, no-fee loans to thousands of affected providers.

But Senator Bob Menendez (D-New Jersey) said the backlog of claims is “estimated to be easily over $14 billion” before noting that the actual figure may be “many multiples of that.” He added that the company knows to the penny how much payment an average provider gets on any given day, but Witty pushed back on that stating that UnitedHealth doesn’t know what payments other insurers make to providers in their network and that is why it was slow in getting the proper terms of financial assistance to providers.

Menendez then asked if Witty would commit to not demanding loan repayment from providers until the claims backlog has cleared.

“… we’ve already told providers there is no need to repay these interest-free loans until 45 days after they have concluded they are back to normal,” Witty replied.

“Does messing up United mess up everybody?”

Even though Senator Bill Cassidy (R-Louisiana) praised Witty for his hard work in trying to deal with the fallout of the Change Healthcare cyberattack, he did not shy away from asking about the elephant in the room: Citing a Washington Post article that 5 percent of U.S. GDP flows through UnitedHealth everyday, he declared:

“The fact that you are so big and so dominant poses a special vulnerability. And that yes, you have the deep pockets to address this but the very fact that you are so big means that it had a wide ranging ripple effect that was outsized. And so for us, we would have to ask is the dominant role of United too dominant because it’s into everything and messing up United messes up everybody?”

Witty tried to push back against this line of query by noting that Change Healthcare has the same footprint today as it did prior to being acquired by UnitedHealth but Cassidy said the concern goes beyond just Change Healthcare because a future attack that went beyond Change’s footprint could jeopardize even a larger aspect of healthcare.

Later Senator Elizabeth Warren cast UnitedHealth as a “monopoly on steroids.”

it’s important to note here that the Department of Justice has opened an antitrust investigation of the insurance giant, per a Wall Street Journal article in late February.

We don’t “control” them, they “choose” to work with us

These hearings are fascinating from the perspective of semantics. Warren, known for being a consumer protection warrior and a thorn on the side of big business, began her questioning by describing just how mammoth the Minnesota corporation is. It’s the largest insurer, largest claims processor, the nation’s third largest pharmacy benefits provider, owner of a huge pharmacy chain and the country’s largest employer and controller of physicians numbering at least 90,000.

“That’s one out of every 10 doctors in the country,” Warren said before asking him to confirm that her descriptions were accurate.

Witty responded that UnitedHealth employs “under 10,000” physicians and the rest are “affiliated” to which Warren replied, that’s precisely why she used the term controlled by. Witty then responded with this gem:

“Not controlled. They choose to work with us.”

Whether they are controlled by UnitedHealth or not, there was a fear among several senators that the company would buy even more physicians’ groups. Why? As the company provides no-interest loans to providers, they would get information on each group’s financial status and thereby ample opportunity to buy up more struggling practices.

“I would like to see at a minimum a firewall established so [that] you can’t use the data from these doctors through the loans process to go out and buy up more doctors because that’s the last thing we need in America,” Wyden said. “Will you support that?”

Witty answered that he thought it was a good idea.

Everything is not broadly back to normal

Multiple senators challenged the notion that everything is broadly back to normal as Witty described. Senator Catherine Cortez Masto (D-Nevada) citing the experience of Nevada Health Centers, a FQHC (federally qualified health center) in her state. That center relies on Change Healthcare for real time patient eligibility verification, Cortez Masto said.

“I am hearing despite portals being back online that critical provider and patient information is often missing or mismatched with nearly 50 percent of payer information being inaccurate,” she said asking when these problems will be fixed.

Witty said he didn’t have the information but would get back to her within that day with updated information.

The hearing was about more than just the recent cyberattack

While most of the senators opening comments and questions directed at Witty was about the Change Healthcare cyberattack, some senators took the time to lament the state of healthcare overall and lay some blame at the feet of UnitedHealthcare . Senator James Lankford (R-Oklahoma) talked about inaccurate provider directories burdening patients and how hospitals are no longer accepted Medicare Advantage patients because plans were paying lower than Medicare rates and there were often denials of care.

Senator Sherrod Brown (D-Ohio) explained how local, independent pharmacies were closing in Ohio because of bad PBM practices and declared that reigning in these “corporate middle men” is a priority.

Photo: Screenshot of video recording of May 1 Hearing

Kaiser Permanente announced a significant AI partnership this week aimed at enhancing value-based care. The West Coast-based health system is deploying Innovaccer’s healthcare AI platform and population health management tools — starting with its Washington market and potentially expanding to new markets in the future.

This initial deployment, which will serve about 650,000 Washington patients, is expected to be complete this summer.

“As we continue to build out our unique set of flexible capabilities, tools, and services — developed by clinicians and experts and grounded in evidence and real-world best practices — we are excited at the prospect of assembling advanced technologies and solutions that can help us accelerate our ability to deliver the best value to our patients and our organization,” Paul Minardi, CEO of the KP Medical Foundation said in a statement.

San Francisco-based Innovaccer was founded in 2014. The healthcare technology company specializes in data-driven solutions that help providers enhance patient care and operation efficiency.

Its healthcare AI platform helps simplify patient care by bringing together data from various disparate sources. By combining all this information, the platform provides a complete and detailed view of each patient’s health, explained Innovaccer CEO Abhinav Shashank.

“This helps doctors, nurses and other healthcare professionals get a clearer understanding of each patient’s situation and deliver better care. Therefore, it is not just a point AI application, but a holistic approach to healthcare AI that helps the healthcare ecosystem journey from data to data-driven decisions,” he remarked.

Innovaccer’s population health product is the other solution that Kaiser is deploying in its Washington market. Similarly to its AI product, Innovaccer’s population health platform also consolidates patient data from various sources, including the EHR, lab results and insurance claims.

With this comprehensive view, Innovaccer’s platform then applies algorithms to identify potential health risks, predict future medical costs and measure the quality of care delivered.

“For instance, the platform can evaluate a patient’s likelihood of developing chronic conditions such as diabetes or hypertension, allowing healthcare providers to intervene early and mitigate risks. It can also reveal gaps in care, such as missed screenings or follow-up appointments, which can then be addressed promptly,” Shashank said.

The population health product also provides hospitals with real-time reporting and dashboards, which allow healthcare providers to better monitor the health status of all patients under their care, he added.

With Innovaccer’s technology, Kaiser will be able “to avoid spending billions of dollars to replace or modify its EHR and claims systems,” Shashank declared. Instead, the healthcare AI and population health platforms provide a unified data layer that can integrate with Kaiser’s existing infrastructure, allowing for a standardized approach to healthcare delivery across various locations, he noted.

“This unified approach allows Kaiser to scale its world-class clinical processes throughout the country, ensuring consistency in care delivery regardless of location. The unified health record makes it easier for healthcare professionals to track patient history, treatments and outcomes, facilitating better coordination and more informed decision making,” Shashank said.

Photo: elenabs, Getty Images

In the dynamic realm of life sciences, learning and development (L&D) is an essential strategy for the growth of employees in this space – specifically in developing their knowledge, skills and management and leadership abilities. Because in the end, every company wants to uplevel the skills of their employees and increase their sense of development opportunities and engagement in the organization.

However, there are some key issues. 75% of 1,500 managers surveyed from across 50 organizations were dissatisfied with their company’s L&D function and 70% of employees reported they don’t have mastery of the skills needed to do their jobs. The problem is, training programs in organizations are often ineffective and unstructured. Furthermore, as it pertains to this topic, there are also critical gaps in life science-specific learning. Life sciences can be very technical in many areas and yet most employees have only one area of specialization through their academic studies. Also, companies often don’t measure the impact of their training. McKinsey research finds that only 50 percent of organizations even bother to keep track of participants’ feedback about training programs, let alone do something with the feedback. The effectiveness of the training must be evaluated and actioned in some way to continuously improve the content and methodology to meet the learners needs.

How best to deliver effective L&D programming? Address a broad array of cross-functional capabilities that life sciences organizations and leaders need to be successful. Also, create an engaging and immersive learning experience that inspires employees to embrace a growth mindset. Additionally, cultivate a culture of curiosity and continuous learning, where mistakes are considered opportunities for growth and feedback is seen as a valuable tool for improvement.

Technical areas requiring attention

There are many technical areas that require education related to the life sciences space. Increasing understanding in these areas is beneficial to any company’s progression and advancement of their product pipeline and overall business. However, finding learning solutions in this technical space is often a challenging to impossible feat, and can also be very costly. Some examples of specific topics that should be prioritized among life sciences employees, at all levels, include:

• Clinical operations: Imagine you work for a biotech or pharmaceutical company, and you don’t understand the fundamentals of clinical operations, such as the management of clinical trials. This is a critical area for every employee working in life sciences to comprehend, specifically, insights around the full cycle of this function and its role in designing and executing on clinical studies to successful conclusion.
• Drug development 101: If you are not in a science or development role, helping employees understand the broader context of life sciences’ drug discovery and development is important because it provides a critical overview of the primary function of the business.
• Preparing for an Investigational New Drug (IND): Learning the fundamental requirements for a successful IND, including best practices as well as common challenges, is an essential area to understand, as without an IND, many life sciences organizations (depending on their particular product strategy), cannot work toward commercialization until this critical milestone occurs.
• Ramping up to phase 1, 2 & 3: It’s difficult to work for a biopharma company without grasping how to transition from a Phase 1 to Phase 2 clinical trial – including what’s typically required to be successful and common pitfalls. The same goes for Phase 3 clinical trials, which bring with it a myriad of challenges and learning opportunities. Gaining knowledge about Phase 3 also introduces a variety of other considerations beyond clinical development, such as preparing the rest of the business and organization for a potential product launch.
• Preparing for commercialization: Whether you’re in medical affairs or on the marketing side of the business, it’s important to understand key strategies and steps biopharma organizations need to take in preparation for commercialization/reimbursement strategies/marketing/sales of biopharma products. Even if your organization is several years away from commercializing a product, an understanding regarding what the future may hold and require can help you and your organization make proactive plans.

Additionally, it’s important for companies to prioritize management and leadership development. For example, delivering a successful presentation is often challenging, particularly when the topic is complex and contains a lot of data. Presentation skills training can help not only an individual advance their poise, presence and exposure, but also enhance their organizational knowledge – improving clarity around how best to shape and deliver compelling content and get buy-in from senior leadership. Investing time and energy in this key area continues to prove to be incredibly beneficial – not only to the teams and organizations on the receiving end of this training, but also for positive, strategic, financial and operational bottom-line impact.

 
In the end, it’s essential that an organization harnesses and maximizes its talent. Outcomes are best achieved when business leaders participate in the design and delivery of training programs and connect them to new ways of working. Life sciences companies must have a strong L&D strategy that keeps their employees competitive, competent and engaged. Ultimately, the key to success lies in creating the right mindset and environment for learning and development to thrive.

Photo: CASEZY, Getty Images

Novartis is adding on to its capabilities in radiopharmaceuticals through a deal to acquire Mariana Oncology, a startup with a drug pipeline and technologies that diversify the pharmaceutical giant’s scope in this fast-growing area of cancer drug research.

According to the deal terms announced Thursday, Novartis is paying $1 billion up front. Milestone payments could bring the shareholders Mariana another $750 million.

Novartis is already a leader in radiopharmaceuticals with two commercialized therapies, Lutathera for gastroenteropancreatic neuroendocrine tumors and Pluvicto for prostate cancer. Both products employ the radioisotope lutetium, a beta particle. Beta particles are smaller, making them good at penetrating tissue. But they are less potent than alpha particles.

The research of Watertown, Massachusetts-based Mariana spans both alpha and beta particles. When Mariana emerged from stealth in 2021, co-founder and CEO Simon Read told MedCity News that working with both types of particles enabled the company to select the one best suited for a given cancer. Alpha particles could be used for smaller tumors while beta particles could be used for larger ones.

Mariana says it designs its peptide-based radioligand therapies to maximize tumor penetration while minimizing toxicity. Lead program MC-339, based on the alpha particle actinium, is in development as a treatment for small cell lung cancer. Mariana has not disclosed the target of this radiopharmaceutical.

Novartis’s two commercialized radiopharmaceuticals are from acquisitions: Lutathera came in 2017 followed by Pluvicto in 2018. The Swiss pharma giant’s purchase of Mariana continues a newer streak of radiopharmaceuticals dealmaking by other big pharma layers. Last year, Eli Lilly entered the radiopharmaceuticals space with the $1.4 billion acquisition of Point Biopharma. Bristol Myers Squibb soon followed with its $4.1 billion acquisition of RayzeBio. In March, AstraZeneca agreed to pay $2 billion to buy partner Fusion Pharmaceuticals.

Mariana was formed by the venture capital firms Atlas Ventures, Access Biotechnology, and RA Capital Management, launching in 2021 backed by $75 million in Series A financing. At that time, it was known as Curie Therapeutics. When Mariana closed its $175 million Series B financing last September, the company said it was preparing to advance MC-339 to the clinic in 2024. Besides MC-339, Mariana has not provided details about other programs in its pipeline.

“This acquisition of Mariana Oncology brings to Novartis phenomenal talent and new capabilities in radioligand therapeutic research that complement our wide-ranging internal research and drug discovery efforts, in addition to our translational and clinical development capabilities,” Shiva Malek, global head of oncology for biomedical research at Novartis, said in a prepared statement.

Photo: Sebastien Bozon/AFP, via Getty Images

Data privacy became a significant issue in the healthcare sector in 2023. Many lawsuits were filed, fines and regulations were imposed, and some healthcare websites had to report breaches. Regulatory bodies like The Department of Health and Human Services (HHS) and the Federal Trade Commission (FTC) issued warnings to multiple healthcare organizations that third parties may be unlawfully collecting health data on their websites. 

The focus on data privacy has only intensified in 2024, with new laws adding to the patchwork of regulations already in place. This article explores where we’ve been, where we’re going, and how healthcare organizations can protect themselves from privacy risks caused by the Meta pixel and other third-party trackers.

Review of 2023 – Regulatory actions and lawsuits in healthcare

2023 kicked off with the FTC’s fine to GoodRx for $1.5 million in February. The issue at hand is one that so many healthcare companies have since learned firsthand: GoodRx was sharing personal health information with Meta, Google, and other third parties without the required consumer disclosure and consent from their website visitors. As we have now seen in hundreds of cases, websites usually are not intentionally sharing this data with third parties, but avoiding this sharing on a modern website can be harder than it seems.

Similarly, Betterhelp faced a $7.8 million fine the following month. In July, a joint letter from the FTC and HHS warned 120 hospitals and telehealth systems about using the Meta Pixel, potentially sharing personal health information, and how that could be considered a HIPAA violation. The FTC warned that using third-party pixels could potentially breach the FTC Act, HIPAA Privacy, Security, and Breach Notification Rules, as well as various state and federal laws. 2023 also shed light on the viability of Meta pixel lawsuits, with many hospitals settling lawsuits, including Advocate Aurora Hospital for $12.25 million in August. While the focus on healthcare data was clear, the overall solution was less so, as many healthcare and retails sites came to learn.  

These enforcement actions are catching up to the current state of data sharing that has typically been BAU when building websites. It’s not so much that a company wants to share your data or has ill intentions. Third parties use the data they receive to offer companies the opportunity to target ads or custom content to consumers. That’s where things get sticky with healthcare and other sensitive data.

Here’s the scenario we all want to avoid. When visiting your hospital’s website to check your appointment, you decide to search for various medical conditions for you or a loved one. That information is shared with other trackers, and in turn other trackers and data aggregators, and often ends up with data brokers. The data is then used as criteria for whether or not you see ads for, let’s say, cancer treatment on other websites across the internet. This can lead to some embarrassing moments if you’re screen sharing at work and happen to open up a search bar (think ad for addiction rehab).  

The issue gets considerably more serious when precise location tracking is used and shared. Consider this happening when searching for sensitive conditions like reproductive health care, addiction or mental health treatments, etc. Isn’t this the privacy HIPAA promised to protect?  

2024 – Current privacy landscape & privacy predictions

As we move into 2024, the focus on healthcare continues. Currently, 16 state privacy laws have been signed, with five states (California, Colorado, Virginia, Connecticut, and Utah) already enacted. Additionally, two healthcare-specific laws, one in Nevada and one in Washington, became effective on March 31, 2024. Three more states (Tennessee, Florida, and Oregon) will enact laws on July 31, 2024 followed by Montana on October 1, 2024. With states taking the lead, companies face a complex regulatory landscape, navigating multiple state-specific regulations.

On April 5th, two key members of Congress proposed a draft bipartisan, bicameral federal privacy bill known as the American Privacy Rights Act. Even if this bill is not passed, it shows the urgency and popularity of regulating privacy.

The Washington My Health My Data Act (MHMDA) is particularly noteworthy for several reasons: 

• It broadens the definition of consumer health data to include various personal information linked to a consumer, encompassing medical records, interventions, reproductive health, biometrics, and inferences from non-health data like online browsing histories.
• MHMDA mandates clear, affirmative, informed, and unambiguous opt-in consent for data collection, sharing, and sale, setting a high bar for valid consent.
• The law allows consumers to sue organizations for violating consent and data handling requirements, enhancing enforcement and potentially broadening the law’s interpretation. And with one of the first allowed “private rights of action”, individuals can now initiate lawsuits.

This law marks a significant change in how companies must manage sensitive health data, extending beyond the current HIPAA regulations. It addresses health data collected and shared through tracking tools like the Meta pixel and others. We anticipate more lawsuits and expect more states to enact similar laws in 2024.

Challenges and tools for compliance

While regulations are being passed with increasing frequency, the lack of practical guidance on how to comply remains. Other things that make compliance challenging is the complexity and dynamic nature of the web and the fact that the existing tools that address compliance actually fall short in many instances.

Websites evolve daily, so do trackers on them, but consent tools often struggle to keep up with the daily discovery of new trackers. When it comes to implementing consent tools, there’s often a perception that simply employing a consent management tool equates to automatic compliance. This is NOT the case. Consent tools require a significant amount of manual configuration during initial setup. Additionally, they need manual oversight and updates to remain compliant with the frequent changes to trackers on websites. Other problems with the setup are that they’re often missing from certain pages and don’t pick up different types of data collection mechanisms like pixels and fingerprinters that collect data, meaning your company might not have proper consent.

In summary, most companies want to do right, but the rules are unclear, and the tools often don’t work as they should.

Staying ahead: Protection strategies

Effort and intent to abide by privacy regulations go a long way. To safeguard against unauthorized data collection, companies should:

• Gain visibility and control over all third parties on their websites and apps. Implement real-time scanning and blocking tools to inform you of known and unexpected third parties.
• Know the scope of your data sharing to ensure tools are in place to limit the scope and use of data with all third parties receiving data. Even if a contract is in place, you still want to monitor their data collections practices.
• Scan often to reliably manage the risk of new trackers and tags being added. Because a third party can suddenly permit another third party to collect data on your sites, the scope of third parties can be constantly changing.  
• Obtain explicit user consent to ensure ongoing management and compliance with evolving regulations. They should also regularly audit consent tools to ensure they function properly, gathering consent for all sources of data collection and on all pages.

Regular data audits, training teams on privacy practices, and fostering collaboration between IT and legal departments are crucial. With dynamic technological changes, vigilant monitoring is essential to avoid unintended consequences.

Organizations must prioritize transparency, limit data collection, block unknown third parties, and establish clear processes for navigating the regulatory landscape. It is also crucial to embrace data minimization, implement robust security measures, foster a privacy-first culture, and adapt to ongoing changes.

Photo: LeoWolfert, Getty Images

Everywhere you look today, artificial intelligence (AI) is making an appearance and offering to do something you already do smarter, faster or just a little more efficiently. Or it’s allowing new, exciting ways to look at old problems. Across health care, it’s opening up new opportunities to weigh risks and improve diagnoses, personalize medicine and develop less-invasive medical procedures. 

Indeed, AI is popping up almost everywhere in the healthcare arena, from evaluating patient propensities for genetic mutations to lifespan prognosis. There is no area of specialty research that is not investigating the potential for AI to improve medicine. 

The laggard? Value-based care. Ironically, as we improve the ability to do more with advanced medicine through AI, the organizations charged with improving outcomes, cost, and health equity are left behind and dependent on lesser tools.

While the possibilities across most areas of healthcare are transformative, AI for accountable care organizations (ACOs) remains stuck on the outskirts of value-based care.

The current state of AI in ACOs

The artificial intelligence being implemented in ACOs today consists mostly of patient-checking bots, robotic assistants and Chat GPT patient communications. There’s also a nod to the future of AI in predicting patient utilization. Essentially, most of the AI deployed in ACOs are tools for use in an already predetermined menu for value-based care—a menu focused on limited gains through coordinating care, keeping utilization down and meeting regulatory requirements. 

We’re thinking too small.

ACOs could implement transformational AI that advances clinical improvement in patient outcomes and costs.  Imagine that ACOs could explore and build AI algorithms that identify characteristics of people at risk for acquiring or progressing in disease, for better targeting interventions, rather than depending on retrospective claims data  While these algorithms are not cost-focused per se (because the goals are clinical), cracking the code on risk factors greatly increases the probability that future savings can be reaped by identifying patients at high risk and intervening prior to events like emergencies and inpatient care, and preventing or slowing progression of disease. That’s improved value.

So why aren’t we reaping the benefits of that capability in our value-based care initiatives? 

ACOs need clinical data to achieve their goals—and the promise AI offers 

We will never realize the value of clinical progress in health care outcomes, lower costs or health equity if value-based care and the delivery system don’t operate in tandem.  Likewise, the specialty areas that have created successful algorithms for predicting risk will not be tied into the ACO resources of population health or patient navigation that can change the patient’s future.   

The lack of data collected by ACOs makes it difficult for them to achieve their mission of improving outcomes and keeping costs within a benchmark while ensuring equitable delivery of health care services and a good patient experience. While all ACOs receive claims data from Medicare, many only use claims data for cost management.  That retrospective, rather than forward-thinking approach based on clinical data insights, makes it hard for ACOs to achieve higher levels of savings or significant improvements in patient outcomes.

Because of concerns about costs of data aggregation of various provider systems, ACOs as a group fought against the need to collect electronic health records (EHR) data for quality reporting and continued to only report quality to Medicare on a small sample of patients. There’s no doubt that many ACOs have practices with non-certified EHRs, making it more expensive to aggregate. But ACOs will only have future viability if they can adopt data-driven solutions to improve outcomes, costs, and services to historically marginalized people. 

ACOs that will lead in the future of value-based care must do more, including using predictive tools to avoid preventable admissions and other costs. They must fill the gap between fragmented specialty care and social services and provide a holistic view and plan for each patient. Doing so will require creating a patient-centric value-based-care database, sharing performance analytics, centrally coordinating improvement initiatives, and establishing referral networks to external specialists and social services.

Artificial intelligence solutions are capable of helping to improve patient health—but first ACOs need to create the value-based-care data substrates needed to put those solutions to use. 

Three strategies for creating vibrant value-based care datasets

Here are three strategies for building the datasets needed for ACOs to take advantage of artificial intelligence to manage costs and improve outcomes for all:

• Aggregate data from all provider EHRs in the ACO, including demographic, transactional, and clinical data. Data is the fuel for ACO performance efforts—and data content must be continually improved.
• Build the data substrate to be clinically rich and include scoring from specialty risk algorithms. While ACOs may be short on data, many participating providers are not—and their data that captures more clinical and social data should be included.  Likewise, risk score data from AI-powered algorithms being used by participating groups to identify and score patient risk and refer patients to services should also be part of ACO data collection.
• Share data with providers, including performance data, patient episodes of care, and general patient risk data. Ensure providers can see where their own patients are in episode analytics, in cost variation for every episode and compared to their other patients. 

To thrive long-term, ACOs today must conceptualize how artificial intelligence can be used to bridge health care and value-based care activities. Coupling the capabilities of electronic health records with advances in AI offers ACOs opportunities to share their data to improve patient health outcomes—a win for all.

Photo: Ralf Hiemisch, Getty Images

Improving the patient pre-registration process continues to present a challenge on both sides of the front desk. For patients, dealing with paperwork, struggling to provide the right information, and worrying about payment and insurance coverage make in-person registration feel fraught. Meanwhile, providers are searching for digital solutions to make the patient registration process simpler, more accurate, and more efficient.

How are providers tackling these patient registration challenges? Barb Terry, Product Manager at Experian Health, who oversees Registration Accelerator, a digital pre-registration solution, shares her perspective on the state of the industry and insights from Experian Health’s State of Patient Access 2024, a survey of 200 healthcare executives and more than 1,000 consumers conducted in February, 2024.

Q1: Why is patient registration still so challenging for providers?

“It continues to present challenges for both providers and patients,” says Terry. Despite the growing availability of patient registration software, many providers and their patients still contend with outmoded manual processes and confusion over insurance and the cost of care.

For providers still coping with staffing shortages, manual registration can be time-consuming and error prone. According to the State of Patient Access 2024 survey, 82% of providers who say access is a challenge cite staffing as a reason. Meanwhile, Terry estimates a typical registration process consumes 15 minutes of staff time and 10 minutes for patients: “It’s time that neither the provider nor the patient has,” she points out.

“The manual registration process for most offices requires printing, scanning, faxing, calling the patient a few times, and then manual data entry into the office systems,” Terry explains. “The provider is also under pressure to obtain financial clearance before the appointment. In many cases the provider team is working with reduced or new staff, managing repetitive and manual tasks for registration, all while striving to maintain a positive patient experience.”

Q2: Why is creating a positive registration experience important for patients?

“Patients are evolving into consumers of healthcare, meaning they’re more active in their healthcare decisions,” says Terry. “They have growing expectations of their healthcare experience and expect the same convenience and modernization they find with other industries like retail and financial services.”

To keep up, healthcare providers need to meet patients where they’re used to completing tasks and communicating—namely, on their smartphones. “Patients use their smartphones to complete many everyday tasks at their convenience. Many prefer to be contacted via text rather than with a phone call, since text allows them to answer when they have time.” Terry says.

Helping patients complete registration on their time increasingly means providing mobile solutions. As an example, Registration Accelerator sends patients a pre-registration link they can use to scan in their identity and insurance cards. Patients can locate their cards and scan them in wherever and whenever they prefer. Data is captured accurately and sent automatically to the eCare NEXT platform, where it can be verified and used for billing.

“Compare this process to time-consuming phone calls that must be made and re-made until contact happens,” Terry says, “or trying to collect information at the time of the appointment. Simply put, patients do not want to spend time in a waiting room completing paper forms that could have been completed digitally.”

Q3: How is patient pre-registration important to the revenue cycle?

“The traditional registration process isn’t very efficient,” says Terry. “Manual processes can easily lead to inaccurate patient information. If the registration process does not include real-time insurance verification, there will likely be more denials and a slower revenue cycle process.”

“Waiting until the patient’s appointment to collect insurance information doesn’t give providers much time to verify insurance, or to determine the patient’s financial responsibility for copays, deductibles, and out-of-pocket expenses,” Terry continues. “At the same time, patients don’t have time to prepare for their out-of-pocket costs. In the 2024 survey, 94% of providers said they felt a sense of urgency to implement a faster, more comprehensive review of insurance coverage.”

“We know from past surveys that 40% of providers say registration errors are a primary cause of denied claims,” Terry concludes. “When the provider has patient information early, they can start facilitating an estimate and confirm insurance coverage before the appointment. Obtaining patient registration data before the appointment helps to ensure revenue cycle processes flow efficiently to reduce denials and financial risks.”

Q4: Greater efficiency is better for providers, but how does it help patients?

“The State of Patient Access 2024 survey found that patients expect efficiency as well as convenience,” Terry says. “Here’s an example: 85% of the patients surveyed think they shouldn’t have to fill out paperwork if their information hasn’t changed.” Digital pre-registration solutions that allow providers to re-use valid patient information on file simplify registration all around.

“For the patient, spending less time filling out paperwork in the waiting room contributes to a positive experience and improves their overall satisfaction with their provider, in turn leading to increased consumer loyalty,” says Terry. “Instead of managing forms at the appointment, the staff can focus on addressing any questions or discrepancies, and getting the patient settled in for their appointment. For many reasons, going to the doctor can be stressful for patients. Minimizing the forms they need to complete in the waiting room can alleviate some of that pressure.”

Q5: How are providers improving the patient pre-registration process?

“Providers are presenting additional registration options to their patients, including a modernized and digital process,” says Terry. “In the 2024 survey, 65% of providers agreed that patients prefer digital and self-service pre-registration,” so patient-facing mobile solutions like Registration Accelerator are a clear option for providers to explore. “Patients expect an easy digital experience,” Terry continues, “and, in response, providers should make registration as simple and straightforward as possible.”

Yet, the same tools that make pre-registration better for patients can improve the process for providers as well. “Optical character recognition (OCR) is a great example of a feature that creates mutual benefits,” says Terry. “OCR can be leveraged to read insurance cards and pull out relevant and correct information. Staff members are under less pressure to avoid manual errors, and so are patients, who are relieved of the pressure of having to decipher their own insurance cards.

“A registration solution should streamline the workflow, reuse patient information, keep data private and secure, and reduce manual entry,” Terry concludes. “By putting the registration process in the patient’s hands, the provider is gathering information directly from the source while reducing their operational costs. Once registration data is obtained, it should flow into the front-end revenue cycle processes, so that eligibility is validated and errors are highlighted. This helps the provider ensure they have up-to-date insurance information for billing, leading to faster claims processing and reimbursement.”

Q6: What does the future of pre-registration look like?

“As patient expectations and provider demands grow, providers will increasingly turn to digital solutions,” says Terry. “Our survey found that 42% of providers have already expanded digital/mobile patient communications to reduce intake friction, and that trend is likely to continue.”

“Digital solutions like Registration Accelerator give patients the ability to complete the registration process at their convenience and give providers more consistency in gathering information, less manual data entry errors, and opportunities to integrate with other patient access processes. All these benefits provide much-appreciated efficiencies for providers, and can lead to a better healthcare experience for the patient, so they can focus on their appointment and time with their provider.”

Learn more about Registration Accelerator, a patient-facing mobile solution that lets patients scan in their own insurance and identity cards, captures data accurately, and uploads it automatically into Experian Health’s eCare NEXT® platform, simplifying registration for patients and providers.

The waters have been rough for telehealth providers and retail clinics in the past couple years —  to know that, one has to look no further than the stock prices of Teladoc and Amwell. Yet, amid this tempestuous sea, industry observers did not expect the crew of Walmart to raise the white flag of defeat on its healthcare effort.

If any company could navigate those choppy waters, many thought it would be Walmart, given how successfully the retailer has maintained its presence in so many parts of the American urban and rural hinterlands. However, on Tuesday, the Arkansas-based retail mainstay announced that it is shuttering Walmart Health division because “there is not a sustainable business model” for the venture to continue. The admission only reinforced the tired but potent cliche – healthcare is hard. 

Established in 2019, the division comprises 51 retail primary care clinics across five states and a virtual care business. On Tuesday, Walmart announced that it is shuttering this division because “there is not a sustainable business model” for the venture to continue.

“We understand this change affects lives — the patients who receive care, the associates and providers who deliver care and the communities who supported us along the way. This is a difficult decision, and like others, the challenging reimbursement environment and escalating operating costs create a lack of profitability that make the care business unsustainable for us at this time,” Walmart said in a statement.

Unaffected by this announcement are its nearly 4,600 pharmacies and more than 3,000 vision centers that aren’t part of the Walmart Health division.

Walmart’s decision reflects just how difficult it is to achieve profitability in the primary care and telehealth markets — and how this challenge is being exacerbated by rising healthcare costs, labor shortages and outdated business models.

Will retail entrants ever be successful in their efforts to integrate into healthcare?

Building primary care clinics from scratch has always been a slow and capital-intensive route, pointed out Rebecca Springer, lead private equity analyst at PitchBook.

Looking from a fee-for-service lens, primary care is known to be a low-margin, volume-oriented specialty. If the provider’s goal is to take risk, it requires an “enormous up-front investment” to build a clinic footprint dense enough to really drive down healthcare costs across a population — as well as make sure that the population is large enough to be actuarially sound, Springer explained.

In her view, there are three main questions when it comes to retailers in primary care — the first one being: Will retailers be able to fully integrate and profitably run healthcare assets? 

“The jury’s still out on that one,” she said. “It’s not easy, but CVS and Amazon may succeed.”

That may well be true down the road, but the evidence so far doesn’t inspire confidence in that outcome. Amazon threw in the towel on its hybrid primary and urgent care business nearly two years ago. This year, CVS Health has begun shuttering dozens of its pharmacies in Target stores, and Walgreens announced that it will close 160 of its VillageMD primary clinics.

The second question has to do with retail healthcare settings’ ability to support the kind of longitudinal patient relationships needed to succeed in value-based primary care. So far, we haven’t seen much evidence of this at scale, Springer stated. 

The final question is whether retail healthcare can actually achieve a more holistic view of the patient by leveraging consumer data —  and we’re “nowhere close to answering that one,” according to Springer.

She noted that Walmart’s decision to shutter its healthcare unit aligns with industry trends.

“Scaling back retail care delivery and virtual primary care has become as ‘trendy’ in 2024 as accelerating these offerings was in 2021,” she remarked.

Headwinds can be strong

Healthcare labor costs are increasing drastically, and providers are leaving the industry in droves. These circumstances restrict retailers’ ability to deliver care that is convenient and highly accessible — yet that is their key value proposition for consumers — noted Arielle Trzcinski, a principal analyst at Forrester, in an email sent to MedCity News.

“Administrative burden and costs from health insurers have also increased, with some large health systems dropping major insurers and plans in response,” she added. “Consumers are being left to search for a new provider that is in-network mid-plan year. Retailers that bill insurance are not insulated from these additional issues.”

Additionally, large health systems have more opportunities to unlock profitability in primary care than retailers do. 

Primary care is often a loss leader for health systems — but this category serves a critical role as a feeder of patients to specialty care and surgical service lines. Without those higher revenue opportunities, retailers must achieve high levels of adoption and volume to achieve profitability, Trzcinski explained.

Clearly that didn’t happen at Walmart Health.

Another healthcare analyst — Kate Festle, a partner in West Monroe’s healthcare M&A group — pointed out that retail clinics tend to follow an encounter-centric model where patient interactions with the clinician are confined to the visit. 

That model can work among healthy populations, but it is less effective for chronic condition management that requires higher-touch, asynchronous communication between visits, Festle said.  

“Investment in care coordination technologies is possible but expensive — representing another cost dilemma for retailers focused on margin expansion,” she remarked.

Primary care and telehealth are unforgiving markets

Similarly to the retail healthcare market, the telehealth market hasn’t fared very well this year. Just a week ago, Optum disclosed its plans to shut down its virtual care unit. And two of the country’s largest telehealth providers — Teladoc Health and Amwell — have both enacted major rounds of layoffs this year.

These events, along with the Walmart news, reflect the realities of the total addressable market for telehealth, which is “effectively zero,” said Sanjula Jain, Trilliant Health’s chief research officer.

“Healthcare operators tend to adopt the ‘if we build it, they will come’ mentality but that has not panned out when it comes to telehealth utilization,” she declared.

Companies that want to enter the healthcare delivery market need to know that facilitating access does not guarantee adoption, Jain added. She noted that this false notion is why we continue to see supply exceed demand. 

According to the fundamentals of economics, prices get lower when supply exceeds demand. In some instances, lower prices can create more demand — but that has not proven to be the case in the telehealth market, Jain pointed out.

Old models simply don’t work

Admitting that Walmart’s business model is not sustainable underscores a larger issue plaguing the U.S. healthcare system, said Monica Cepak, CEO of Wisp, a telehealth provider that offers upfront pricing instead of working with insurers.

“Walmart shuttering its in-store clinics and discontinuing its telehealth program emphasizes the challenging reimbursement environment and escalating operating costs many healthcare providers are struggling with today,” she stated. In doing this, Walmart is loudly saying that these existing business models are not profitable.”

Ashok Subramanian — CEO of Centivo, a health plan for self-funded employers — sees things differently.

To him, the main takeaway from Walmart Health’s shutdown is that companies need to stop attempting to layer new solutions on top of the existing system. This approach will never be an effective way to deliver coordinated care or truly improve access, he wrote in an email.

“Walmart highlighted a ‘broken business’ model as the reason for closing its brick-and-mortar and virtual care services. What is actually broken is the entire model of financing uncoordinated, fragmented healthcare services at uneven prices with no correlation to quality,” he explained.

What does this mean for the future of retail healthcare?

Going forward, large retailers will likely start thinking about their role in healthcare in a much more employer-focused manner, predicted Springer of Pitchbook.

Just as retail interest in primary care clinics helped drive investment in the space a few years ago, she thinks there will soon be growing investment in employer-facing solutions for primary care, chronic condition management and benefits navigation.

“[Employers] have national, diverse employee populations, and like all, employers are facing rising healthcare costs. If you can solve it for your employees, maybe you can roll it out to other employers too. This is the direction Amazon seems to be taking, and Walmart also has a nationwide program for its employees with Included Health that has seen some early success,” Springer remarked.

Included Health is a benefits navigation startup that sells its platform to employers. Robin Glass, the company’s president, wrote in an email that she doesn’t think the Walmart news represents a bad moment for telehealth or primary care providers. Instead, she thinks the news is “a clear signal of an appetite to clear the way for a new chapter of modern healthcare.”

Ideally, this new era will be characterized by less commodity solutions and a deeper focus on longitudinal support for patients, Glass wrote.

“This is good news for consumers, clinicians and for companies like us who’ve been building a more robust and holistic modern healthcare experience -— one that goes beyond being convenient and transactional to highly personalized and seamlessly connected to all of healthcare’s highest-quality resources and settings.”

Another healthcare leader — Derek Streat, CEO of DexCare, a startup offering health systems a platform to help them coordinate and manage digital care — noted that the Walmart news is a cautionary tale of the complexities that affect the country’s “fragile” healthcare system. 

This delicate system will be pressure tested as more people live with chronic conditions, physician burnout reaches crisis levels, more Americans reach the age of 65, Streat explained.

To get ahead of these challenges, healthcare providers must move away from a fragmented view of care and toward a predicted model, he declared. This approach must be backed by technology that can manage how, when and where care is accessed, he added.

“The fact that Walmart, atop the Fortune 100, cannot make a buck in healthcare should be a wakeup call for the industry at large. The hurdle is not technology, but changing how we operate,” Streat said.

Photo: ComicSans, Getty Images

Pepper Bio’s drug-hunting efforts have turned up its first clinical-stage drug candidate, but not by discovering a novel molecule in its labs. Instead, the startup’s proprietary technology found another company’s shelved breast and lung cancer drug also shows promise for treating cancer of the liver.

Boston-based Pepper is acquiring rights to the G1 Therapeutics drug, lerociclib, under an agreement announced Wednesday. The deal covers all indications, except for the radioprotective applications that are a focus of Research Triangle Park, North Carolina-based G1.

Lerociclib is a small molecule designed to block the cancer-driving proteins CDK and CD6. G1 has already commercialized a CDK4/6 inhibitor, Cosela. Blocking these proteins has the effect of shielding bone marrow, protecting it from adverse effects that limit the use of chemotherapy. In 2021, the FDA approved Cosela, which is administered intravenously prior to chemotherapy in the treatment of extensive-stage small cell lung cancer.

Lerociclib is an oral CDK4/6 inhibitor that G1 designed to offer potential dosing and safety advantages over currently approved CDK4/6 inhibitors, such as Pfizer’s Ibrance and Novartis’s Kisqali. Under G1, lerociclib generated positive Phase 1/2 clinical data in ER positive, HER2 negative breast cancer. But the company decided against pursuing further development of the molecule and instead looked for a partner to take it on.

In 2020, China-based Genor Biopharma acquired rights to lerociclib in Australia and certain Asian countries. The agreement covers the development of the drug for all indications in those regions. According to G1 regulatory filings, Genor paid G1 $6 million up front. Soon after, G1 reached a separate agreement with EQRx, which paid the company $20 million up front for lerociclib’s rights in most of the rest of the world. But after EQRx was acquired by Revolution Medicines in an all-stock deal last year, EQRx gave G1 notice it would terminate the license agreement.

Pepper Bio has described its platform technology as “a Google maps for drug discovery.” The platform takes in a variety of “-omics” data—genomics, proteomics, phosphoproteomics, and transcriptomics. These “trans-omics” data create a full and comprehensive picture of the biology of disease, which in turn guides the company’s efforts to find drugs to treat it. Pepper Bio said its technology identified CDK4/6 as potentially important targets for treating hepatocellular carcinoma, the most common type of liver cancer. The company said it then tested lerociclib in animals, yielding results that showed superior efficacy over standard liver cancer treatments during and after dosing.

Pepper Bio’s deal with G1 gives the startup all rights to lerociclib, excluding the regions already licensed to Genor. G1 and Pepper Bio said the upfront payments are in the single-digit millions, which is less than EQRx had paid. Pepper Bio’s agreement makes it responsible for a maximum $135 million in milestone payments, depending on the drug’s progress in up to three indications. If Pepper Bio can commercialize the drug, it would owe G1 royalties from sales.

The Pepper Bio pipeline already has a liver cancer drug candidate. PEP001 is in preclinical development for hepatocellular carcinoma driven by the Myc oncogene. Two additional programs are in development for diffuse large B-cell lymphoma. A fourth program is in preclinical development for solid tumors.

“Lerociclib holds tremendous promise as a cornerstone of our oncology portfolio, and we are excited to leverage its potential to bring life-saving treatments to those in need,” Pepper Bio co-founder and CEO Jon Hu said in a prepared statement.

Pepper Bio launched in 2021. Last November, the company announced a $6.5 million seed financing that was led by NFX.

Image by Flickr user Ed Uthman via a Crreative Commons license

Emergency department (ED) overcrowding continues to strain healthcare resources and harm the patient experience. Patients continue to treat the emergency room as a catch-all for their emergent (and some non-emergent) conditions, while in reality, many would be better suited to receive treatment at an urgent care (UC) clinic – where they could also be seen in a fraction of the time. It’s up to urgent care clinics to help patients understand urgent care is a completely viable, likely better option. 

There are many ways to address this through marketing, but success is largely contingent upon reaching different audiences who consume information in different ways. In healthcare, it’s easy to segment by generation and consider how each age group would best be reached. Technology is a crucial asset here, but UC owners and marketers must also consider the varying levels of comfort with tech. 

There is no one-size-fits-all solution to meeting the needs and expectations of today’s patient population, so the urgent care industry can use intel from each generation to reach them, help them understand the best course of action on a case-by-case basis, and improve care delivery. 

Finding an Identity

WD Partners conducted a survey on how 2,600 consumers between 18 and 80 years of age used and perceived primary care practitioners (PCPs), retail clinics, and urgent care. Results showed that Gen Z and Millennials are progressively looking to move away from the PCP’s office and toward more accessible, low-cost options. As for the older consumers, even though 90% prefer PCPs, lack of familiarity was the top reason that Boomers (44%) and the Silent Generation (50%) reported not considering urgent care facilities for services. As healthcare deviates from the classic PCP model, confusion grows about which alternative provider will best suit consumers’ needs. Establishing a firm identity for urgent care by clear up messaging surrounding where to seek care for various symptoms and ailments will ultimately drive revenue growth for the industry. 

Additionally, according to a National Library of Medicine article, an increase in presentations by the elderly is one of the top reasons EDs are struggling. The number of nonurgent and unnecessary visits were also cited, among other factors, emphasizing the missed opportunity for these folks to seek care at an urgent care clinic. This missed opportunity comes down to less-than-sufficient communication and messaging: urgent cares need to find a way to let these patients know they can help with these types of concerns. 

Reaching each generation

What patients want is fairly consistent across the generations (after-hours care, convenience, and accessibility). How patients want to receive information, though, varies – particularly by age group – so to optimize success, urgent cares should build diverse and tailored marketing strategies.

Older generations may not be as tech-savvy as others, but Baby Boomers and the Silent Generation should not be mistaken as tech-incompetent. The biggest hurdle urgent cares have with these groups is their loyalty based on familiarity. To redirect this patient population to urgent cares, messaging should focus on how UC can provide services that they cannot get with their PCP and highlight that they don’t need to waste time and money in the ED.

Gen X, on the other hand, is particularly skeptical of healthcare claims, so there is a general mistrust of healthcare establishments and advertising. This group is responsible for making or influencing medical decisions not only for themselves, but potentially also their parents and their children, making them an extremely valuable target group for this clarifying messaging. 

For millennials, who were raised with the internet, convenience and technology are top of mind; however, they also lack trust in services that have not embraced technology thoroughly. Millennials seek out healthcare providers who offer virtual appointments, online booking, and pricing transparency, and they are open-minded when it comes to alternative care options – making them a more adaptable patient population. Urgent cares should lean in here in order to reach the millennial population. 

Generation Z has a powerful impact on the healthcare industry as consumers. This group is most likely to be open-minded when seeking care, so urgent care has an opportunity to gain their trust – and, hopefully, lifelong patients and advocates. Wait times are top of mind for Gen Z, and UC should capitalize on this attitude by touting their comparably fast service. 

As consumer preferences change, healthcare must evolve. In the case of older consumers, familiarity breeds loyalty. Baby Boomers and the Silent Generation value longtime PCP loyalty as they have more complicated medical histories and typically need more extensive care. Gen Z and Millennials, on the other hand, look for convenience, speed, and ease of access – all of which are characteristics of urgent care. UC operators must be flexible, tapping into each of these audiences strategically through different forms of communication. 

A time and place for tech 

With virtual appointments, online booking, waiting room/treatment times, mistrust in technology, and accessibility all playing into the healthcare consumers decision-making, urgent care must also take aspects of care into consideration as they utilize technology to improve a practice and its operations. Patient engagement solutions can help urgent care clinics address these concerns from top to bottom. They allow patients to make appointments through clinic websites; provide virtual waiting rooms; offer wait time transparency; and more. As for treatment room time, if providers are spending significant time on charts, a clinic’s EMR is likely not as efficient as it should be. Technology being implemented should reduce manual efforts through automation and speed up processes so that providers aren’t spending time on menial tasks instead of with patients.

Along with technology in practice clinically, it’s also the best tool to reach each generation of patients. From paid digital ads, blog or website content, email campaigns and podcasts, to social media, new outlets, or television and radio – there are numerous pathways through which urgent care can most effectively reach each group by knowing their comfort with consumer-facing media and technology that is available. For example, Boomers typically get their news from television and radio outlets, but those traditional news sources are not lucrative options for Millennials or Gen Z. These two groups more commonly source their information from digital media such as paid ads, podcasts, or social media which point to the accessibility to information they like to have at their fingertips. 

Communication with patients should be a top area of focus as urgent cares look to develop their marketing strategies, tailored to each generation they are trying to reach, with an eye toward relieving unnecessary demand on emergency departments. With its on-demand nature, urgent care can give patients the care they need in the timeframe that other care sites are typically unable to deliver. Investing in the right technology to engage with patients supports this effort and is essential to deliver care and even exceed their expectations. A tailored approach to marketing these services will boost urgent care by helping clinics best serve their communities, setting them up for long-term business success.

Photo: elenabs, Getty Images