AI Transforming Medicare Advantage Member Engagement with Dr. Saria Saccocio Essence Healthcare

Dr. Saria Saccocio, Chief Medical Officer at Essence Healthcare, is using AI to enhance care and services for patients who are enrolled in Medicare Advantage programs. One application is to analyze data related to health equity, care authorization, and to address biases. Their AI agent is being used to interact with patients, offering them the option to access a human. Integration with wearables, such as the Oura Ring, focuses on identifying clinically useful information to prevent physicians from being overwhelmed by data. Saria explains, "Medicare Advantage plans are absolutely that. It's an advantage because of the additional benefits that exist and the opportunity to connect with our members is rather unique. In fact, what I'll share with you and the audience is that AI has been a focus for us and a priority as we continue to expand the focus on quality and engagement with our members so that they have their best quality life possible to them. AI is a major piece of this work to make that happen. I can give you a couple of examples. In fact, when it comes to health equity, CMS has recently required Medicare plans to ensure that we are analyzing our data through a health equity lens. This year, in fact, we're focused on authorizations, authorizations of care. We want to make sure that it is critical to our members and AI. I see an opportunity to recognize any blind spots or implicit bias."   "I think that every human being has a capability for technology. And what's critical is that we meet them where they are, that we understand what they want, what they need out of technology. I think that works as well as providers. As you see all of these AI developers starting up companies and solving problems, the conversation that we're having every day at Lumeris and at Essence Healthcare is what does the patient want? What does that member need for quality of care? And then engage and include the providers in that conversation. What makes their job easier? Because one of the challenges with new technology is that we can also reach a point of technology exhaustion. So I'll give an example of our relationship with Oura ring, the wearable device that tracks for sleep, for health, for heart rate, and a number of different measures."    #EssenceHealthcare #MedicareAdvantage #HealthAI #OuraRing #DigitalHealth essencehealthcare.com Download the transcript here    

Kerry Mello-Parker, Director of Rare Diseases and REMS programs at Shields Health Solutions, addresses the complexities and challenges faced by patients with rare diseases including diagnostic delays and limited access to medication. Using an integrated specialty pharmacy model, Shields works with pharmacists to have direct access to the EHR, enabling better patient monitoring, shorter time to initiate medication, tracking outcomes, and providing patients with a direct line of communication to their care team. Pharmacists treating rare diseases are also supported with specialized information on medication administration, side effects and complex billing.  Kerry explains, "Shields Health Solutions is a specialty pharmacy accelerator. We partner with over 80 health systems across the United States. We support them in establishing and growing a specialty pharmacy. We help them to access critical medications. Some of them are not available at traditional pharmacies, and we support them in managing clinical quality care programs for their patients." "I'd like to step back a little and talk about what a rare disease is and how we define it. Currently, it is defined as a condition that affects fewer than 200,000 people. However, over 7,000 rare diseases exist. So when we do the math, we come to see that they are not so rare. And some estimates show that up to 10% of the US population may actually have a rare disease. And what I've seen is that there are really three main complexities of treating rare diseases and challenges that patients may face. One of them is that there is a lack of available treatment options when compared with more common diseases. So, for example, only about 10% of rare diseases have an FDA-approved treatment option, but that is changing. We have the Orphan Drug Act, which has actually changed the landscape. It has incentivized and facilitated the development of medications to treat rare diseases." #ShieldsHealthSolutions #IntegratedCareModel #SpecialtyPharmacy #RareDiseases #MedicationAdherence shieldshealthsolutions.com Download the transcript here

Ram Sahasranam, President and Co-Founder of Fold Health, has created a platform that integrates with the EHR to create an AI-driven interface that streamlines workflows, improves communication across the care team, and helps better manage patient care. Traditional EHR systems, while effective for documentation, were not built for proactive care and data sharing. With a focus on the patient and providers, Fold Health is integrating data sources and automating redundant administrative tasks helping to reduce clinician burnout and improve patient communication for scheduling and reminders. Ram explains, "The way to look at it is that empowering providers and patients need to go hand in hand. That is the fundamental reason why we called ourselves Fold Health, which is that healthcare needs to fold around the providers and the team supporting the providers and the patients and the families of the patients who are involved in the care. We have seen healthcare go from $1.6 trillion in spending to $5.3 trillion in spending this year. But in those 15 years, we haven't yet seen it fold around the two most important people, the provider or the patient, in terms of better outcomes or improving the burnout rates that clinicians and their teams face today." "So the fundamental challenge that we noticed was that multiple people were living in different systems and hence different silos from a data standpoint. So the clinician did not know what was happening with their care teams. The patient was living in a different system. If the patient goes to a specialist, the data comes in a compressed format to the physician in an easily digestible manner, which was a challenge. So what Fold does as a result of getting control of all these different nodes is that data can be used to summarize and provide things for the different teams in a quick, easily digestible manner."  #Foldhealth #CareCoordination #CareDelivery #ConnectedCare #HealthTech #AI #HealthAI Fold.Health Download the transcript here

Ralph Keiser, CEO of ArcheHealth, highlights the severe financial pressures that hospitals are confronting as a result of rising costs and declining reimbursements. Reductions in reimbursements are threatening hospitals that serve underinsured populations. Costs are increasing due to tariffs on medical device components and the general price inflation on medical supplies and drugs.  ArcheHealth is focused on helping hospitals improve operational efficiency to lower the expense of delivering care. Ralph explains, "The tariff index is going to come mostly around medical devices and device components. So plastics, metals, packaging, things that the device manufacturers use to deliver their products to hospitals and health systems, those will likely get passed through. It won't be huge incremental costs, so there will be additional costs due to tariffs. It depends on a couple of things. Do you have a strong contract that sort of embargoes your current price? Then maybe in the next contract term you'll see that pass through or the contract so the supplier to pass through, you'll see them. We're monitoring month by month the current or last month's spend was on these items, and do we see a chart impact by manufacturer by line." "One thing that I want to make sure we talk about, too, isn't just shared impact. So the cost to a hospital for devices and drugs averaged 8.9% more in 2024. So just by nature of the market raising its prices for goods that hospitals use to cover patient care, those moved up without tariffs 8.9% last year. We think we're tracking increases that are happening despite the tariff overlay or on top of the tariffs. We still think that the pressure on hospitals is due to the price of therapeutics, and is going to continue to go up, tariff or not. And so I want to mention that because this is the ongoing impact of the cost of MedTech and drugs that gets passed through to the consumer." #ArcheHealth #AIinHealthcare #HealthTech #HealthcareOperations archehealth.ai Download the transcript here

Dr. Marc Salzberg, President, CEO, and Chief Medical Officer at Airway Therapeutics, is developing a drug AT-100 to prevent bronchopulmonary dysplasia (BPD) in preterm infants, a severe condition with no existing treatment. These infants are at high risk for BPD because of a low level of a protective protein that reduces inflammation and clears infections from their underdeveloped lungs. The drug's mechanism of action suggests it has potential for treating other inflammatory conditions such as asthma, COPD, and severe pneumonia. Marc explains, "We're focusing on developing drugs or interventions for severe respiratory conditions for prevention or treatment of severe respiratory conditions. And our first project is focusing on the respiratory condition that preterm neonates have, which is called bronchopulmonary dysplasia, and cannot be treated or prevented yet. It's a very severe condition. And that really triggered my interest in getting engaged because it's going to be a paradigm shift if we manage to bring this drug to market." "The protein that we're developing is an endogenous protein that we all have. In the past years or decade, it has been discovered that this protein has a very essential function in fighting inflammation and infection on a daily basis. Now, there are certain conditions or instances where the protein is low-functioning. For instance, in preterm-born babies, but also in adults with severe respiratory inflammation, with pneumonias, with asthma, or COPD. In all those cases where protein is low, those are the instances where you actually need it most. So, replacing it in those instances is a kind of logical rationale for the concept for the treatment that we're developing." #AirwayTherapeutics #BPD #InflammatoryDiseases #Zelpultidealfa #PrematureBabies #PretermBabies airwaytherapeutics.com Download the transcript here  

 Wade Demmer, R&D Vice President at Medtronic, has developed a leadless pacemaker that is implanted on the heart through a minimally invasive procedure utilizing a catheter, potentially creating fewer complications and greater access for patients who could benefit from a pacemaker. This new design is a significantly smaller, safer, and longer-lasting device than traditional pacemakers and does not create a visible lump under the skin. Advancements in battery and computer technology have made the Micra next-generation pacemaker smarter, allowing cardiologists to treat a wider range of heart conditions. Wase explains, "So yes, pacemakers have been around for about seventy years. They've been helping people save lives, live fuller lives, and improve quality of life for that whole time. But you know, if you think about the history of a pacemaker, a pacemaker is a computer inside a little box that's implanted in the body. And like any computer, a computer from 70 years ago and a computer from today are very different. You know, 70 years ago, a pacemaker would've been about the size of a hockey puck, but even a little bit thicker. And nowadays, pacemakers are not much bigger than a couple of silver dollars stacked together. So we've made really big advances."   "When you had those hockey puck-sized pacemakers or even modern-sized pacemakers, there's no place in the heart for it. And so they end up in the chest, and then there's a wire called the lead that goes down through the veins into the heart, and that's where the electricity gets delivered down to make the heartbeat. And that's also where the heart's electricity comes back up, so the pacemaker can know what's wrong. As we have pacemakers smaller and smaller, though, we suddenly reach a point where a radical downsizing is a possibility. And again, leveraging the computer technology of the world, getting a pacemaker inside the heart instead of in the chest."   #Medtronic #CardiacCare #Pacemaker #LeadlessPacemaker #Micra #Cardiologists #HeartHealth #Innovation medtronic.com Download the transcript here   

Dr. Vishwa Srivastava, APAC CEO of SSI, SS Innovations International, is a leader in telesurgery, using robotic surgery to extend surgical services in underserved areas. The SSI Mantra surgical robot is used for laparoscopic surgery and offers an affordable alternative to prevailing robotic solutions without compromising quality. Telesurgery has potential in remote operations and is also revolutionizing surgical training by providing real-time expert proctoring. Vishwa explains, "My father was one of the early global pioneers in robotic cardiac surgery, and he had actually helped Intuitive Surgical back in their early days get their FDA approval. And what he recognized very quickly was that through these minimally invasive robotic cardiac surgical procedures, 20% of his patients went home the next day, 50% in two days or less, and the average length of stay was 3.2 days. So, he became convinced after they twisted his arm to launch robotic cardiac surgical programs. And Dr. Fred Moll at the time was the chairman and founder of Intuitive Surgical, and he wanted to start on the heart because it was the most complex procedure to do a beating heart, totally endoscopic, bypass surgery. And he felt that if you could do that, then everything else would be simple."   "The way that we look at remote robotic surgery, or what we call telesurgery, currently, we are the only company in India that has received formal regulatory approval from the CDSCO for both teleproctoring and telesurgery. The way that we look at teleproctoring and telesurgery, it's not like one rockstar surgeon sitting in one location operating omnipresent in a hundred different locations." "With teleproctoring and telesurgery, the way that we look at it is in addition to operating and extending expertise in the remote areas of the country, we look at teleproctoring and telesurgery the same way that doctors are trained in residency where you always have an attending in the room, the junior surgeon will be operating, and the goal of the proctor or the attending surgeon is to guide the junior surgeon to maturity."  #SSInnovations #RoboticSurgery #Telesurgery #CardiacProcedures #HeartSurgery #Teleproctoring #RemoteSurgery  SSInnovations.com Download the transcript here

Vikram Ahuja, Co-Founder and CEO, and Joe Promoppatam, Co-Founder and CTO of OsseoLabs, are utilizing 3D printing and AI to advance reconstructive surgery by enabling the creation of personalized, precision-fit implants and surgical instruments. Traditional surgery has relied on standardized implants made of titanium and involves lengthy operations. The OsseoLabs approach reduces surgical planning and operating time, improving patient outcomes by achieving a better fit and enhanced bone integration through the use of advanced implant materials. AI is used to automate and accelerate the design process for these custom devices, enabling a scalable and cost-effective approach to create complex, regulated medical devices. Vikram explains, "We want to use our engineering know-how, especially in 3D printing, to improve the quality of the outcome of the surgeries and also help the students to be able to offer a better solution at a speed, and also the outcome that is a little bit more precise. And that's what we have been working on for quite a long time. We want to use the knowledge of 3D printing, biomechanics, and also AI to help, especially in complex surgical cases. So both the patients and the surgeons are better off with the outcome. And the main gap that we are seeing here is not only in the Asian countries where we operate, but also in the US. And the use of 3D presented implants, even though it has been around for quite some time in the US, we still see a lot of gaps that can be improved in what materials are being used, and how the implants are designed. We help the surgeons and also the hospitals throughout this process." Joe elaborates, "Yes, for such a device, they all look the same way, but the patients look different. So we see this gap between the available instrumentation and the actual treatment that the surgeons want to conduct. And we want to break that barrier by being able to decide which instrument is required individually, and I mean that in the day, we could not do that. The price can be competitive because all the manufacturing technology is used to support production. But we have to depend on how they matured in the past few years. We are able to adopt the technology, which allows us to decide and print the instrument for specific care and specific surgery. I think the speed and cost become much more practical, and all we need to look into is the 3D printer. But eventually, when you come into something like customization, you talk about the speed. In terms of speed, it's not just the speed of how we make things, but it's about the speed of how we decide things. That's where we see the gap that we can fill using AI to split up the bedside process."   #OsseoLabs #ReconstructiveSurgery #3DPrinting #PersonalizedImplants #MedAI OsseoLabs.com Download the transcript here

Trân Lê, Co-Founder and CEO of Grove AI,  was founded to automate the manual and inefficient workflows in clinical trial recruitment, patient engagement, and support. The company's AI agent, Grace, is trained on specific trial protocols and approved scripts to respond to patient questions about pre-screening, logistics, and scheduling appointments. This platform aims to increase speed and quality of participant recruitment, improve representation, and expand accessibility to clinical trials by offering support in over 19 languages and providing access to information on demand. Trân explains, "The birth of Grove really came from my co-founder, Sohit, and his experience working in the hospital. We were working at Stanford, and there we were, computer scientists building a lot of internal tools for clinical trials, clinical research, as well as for the greater healthcare patient services. And that, combined with my experience trying to enroll in a clinical trial, really set us off to think deeply about how we can automate a lot of the manual workflows that exist today for patients and for providers, as well as for pharma in taking new drugs to market. Specifically, within that, we identified patient engagement and support, and prescreening to be an important part of ensuring that patients know where they're going and what to do when they're participating in these trials. And so we decided to really step out into the industry and change this process and make it an easier and more accessible experience for patients."   "I would say that having worked inside a hospital and seeing all of this lead generation or getting people educated about the trial is an important aspect, and it's being done by a lot of the recruitment vendors as well as in-house teams out there. In addition to that, a bottleneck that previously has always been there now is possible to automate with agentic AI is actually doing the work of taking all the interest from different potential patients and helping them prescreen and understand the requirements of the trials, getting them to the right site, booking their transportation, reminding them about the appointments, and scheduling that appointment."   "I would say that Grace, as we call her, is a digital staff or an AI agent - both are comparable terms to describe Grace. The difference is that Grace is trained on the trial, the requirements, and the IRB-approved script of that trial. So she really has the knowledge to be able to respond spontaneously in real time to any questions that the participant may have about the trial." #GroveAI #ClinicalTrials #PatientRecruitment #Pharma #HealthTech #DigitalHealth #AI #AgenticAI grovetrials.com Download the transcript here

Jeff Glazier, CEO of General Oncology, is taking a unique approach to treating cancer by using older chemotherapy drugs with broad action but in novel combinations designed to avoid the incidental toxicity.  Their primary drug in trials is GO-4 which is focused on shutting down DNA repair in cancer cells to overcome drug resistance.  While testing in patients with stage 4 pancreatic cancer, this approach was designed to combat tumor heterogeneity by targeting fundamental processes like proliferation that are common to all cancer cells within a tumor. Jeff explains, "We're actually taking a different approach than a lot of companies are. And I would say there are really two approaches because we have two different things on, we have a clinical trial right now where we're using old chemotherapy drugs in a new way, and when you combine them together, you really get just a different result. We're trying to shut down DNA repair and kill cancer cells. But the other really interesting thing, and I think it’s underlying general vision, is chemotherapy drugs long ago had very broad action, and with broad action comes unwanted incidental toxicity. And over the years, it's been huge in the industry, or moving towards specific drugs that target specific things and have less incidental toxicity. The unfortunate side effect is that cancer cells can evolve around a drug if there's too much specificity. So we're taking a pretty novel approach with our business of going after drugs that have broad action, but we found a way, we believe, to do it in a way that doesn't have incidental toxicity." "I certainly feel that you want to have more than one attack. If you only do one, the cancer cells can evolve around it. The drug resistance approach I was referring to was what we call GO-4 in our clinical trial, and we're altering part of the cancer cells’ fundamental biology that is involved in DNA repair and shutting it down. But we're doing it in more than one way."   #GeneralOncology #PancreaticCancer #CancerAwareness #MetastaticCancer #GO4Therapy #CancerResearch #InnovativeTherapies #DrugDevelopment generaloncology.com Download the transcript here