Category Archives: Podcast

Drug treatment for opioid addiction: Podcast interview with CleanSlate CEO Greg Marotta

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The opioid epidemic gives addiction treatment providers an opportunity to demonstrate what they can do to stem the tide. CleanSlate operates treatment centers in multiple states, employing a medication assisted approach. In this podcast interview, CEO Greg Marotta describes what he’s seeing and how the company is responding.

We discussed:

  • (0:10) How serious is the opioid epidemic?
  • (1:09) What kind of approaches are traditionally to treat addiction? What works well and where are there shortcomings?
  • (2:22) Are people coming to treatment through primary care? Or the behavioral health system?
  • (4:06) How does medical/behavioral integration work? What does it really mean?
  • (6:56) CleanSlate is well know for medication based treatments. What kind of medications are available? Who is the approach best suited for?
  • (8:09) What is the typical course of treatment?
  • (9:49) As addiction has become more visible, it’s now front and center for others in health care. Do you collaborate with other organizations and if so, how has it gone?
  • (12:52) You operate in a variety of states, with different cultures. Do you see key differences between Massachusetts, and other states like Texas, Indiana and Wisconsin?
  • (14:53) Will we still be talking about an opioid epidemic in five years? What will it take to get out of it?

By healthcare business consultant David E. Williams, president of Health Business Group.

Bringing on-demand rideshare to medical transport. Interview with Veyo’s CEO

 

Uber and Lyft have transformed (and largely destroyed) the taxi industry. Now startup companies like Veyo are applying similar approaches to the medical transportation field. I interviewed Veyo’s CEO, Josh Komenda to get his take.

1.How is non-emergency medical transportation (NEMT) defined? What’s included? How big is it?

Non-Emergency Medical Transportation (NEMT) is a transportation benefit for Medicaid or Medicare members who need to get to and from medical services, but have no means of transportation. NEMT provides eligible patients with trips that are non-emergency in nature, meaning there is no immediate threat to the health or life of the participant, and no elements of life support are required in the vehicle during the trip. This includes transportation to medical appointments, urgent care, or the hospital. NEMT exists to ensure that participants have access to routine and preventative care, increasing overall health outcomes and avoiding costly ambulance bills or emergency room visits and it’s especially important for those with chronic conditions such as diabetes, heart disease, cancer, COPD, or asthma. As of December 2016, just under 70 million Americans were eligible for Medicaid NEMT benefits.

2.How is NEMT provided today? What’s good and bad about the traditional model?

Today, a large majority of NEMT benefits are managed under the brokerage model. State Medicaid agencies and health plans contract with an NEMT broker to manage their NEMT benefits for them. The broker is responsible for ensuring their members have access to transportation and managing the transportation providers who perform the actual services. Brokers must manage provider procurement, provider credentialing, trip scheduling, eligibility, reporting, FWA monitoring, provider payments, etc.. NEMT benefits may cover a variety of transportation modes, including sedan, wheelchair van, taxis, stretcher cars, and mileage reimbursement. It also may include reimbursement for public transportation or long-distance accommodations such as air travel if a member requires long-distance or out-of-state treatment. NEMT benefits cover all regions from urban to rural, and transportation is always the least costly and most appropriate mode, which is determined on a case-by-case basis for each member.

Quality of service in the NEMT field is plagued by inadequate technology, outdated business models, inconsistent and unprofessional medical transportation providers, and virtually non-existent transparency for the customer. The issues stem from an overly complex, fragmented, and difficult to manage process that has not changed in decades. For example, limited communication between the broker and transportation provider means little to no data is collected around the actual trips. Important metrics like on-time percentage or customer satisfaction are often self-reported by the provider. And the fixed fleet model that traditional brokers employ leaves little opportunity for flexibility – any issues stemming from scheduling, traffic, or weather can throw off the entire system. Even with current NEMT benefits, over 3.6 million Americans still miss or delay medical care due to transportation issues.

3.What are the characteristics of NEMT users?

Those receiving NEMT benefits are often frail, handicapped, disabled, in rural areas and without smartphones. Patients may require NEMT for a variety of reasons, including: lack of a valid driver’s license, lack of a working vehicle, geographic isolation, or the inability to take traditional transportation for physical, mental, or developmental reasons.

4.Who pays? What is the role of government and private insurers?

Medicaid NEMT is a $5 billion industry, funded by state and taxpayer dollars, and overseen by the Center for Medicare & Medicaid Services. Over the past several years, Medicaid spending for NEMT equates to approximately 1% of total Medicaid expenditures.

5.Have the rideshare companies like Uber and Lyft had an impact? What has limited their effect?

Some traditional NEMT brokers have begun exploring partnerships with consumer TNCs such as Uber and Lyft, although due to credentialing and training requirements set by CMS, most trips completed by those TNCs are consumer trips based in a healthcare setting (aka the member or facility is paying), instead of true NEMT trips. It’s important to note that this results in a solution that is not as efficient, coordinated, or suited to healthcare as Veyo’s. Veyo’s vertically integrated model is far superior for a number of reasons. Veyo is directly connected to its own TNC supply that it controls. When a traditional broker partners with a consumer TNC, it necessarily includes an extra administrative middleman in the value chain which is less economically efficient. What’s more, Veyo directly controls and oversees all aspects of its Independent Driver-Provider (IDP) network, meaning it can directly affect credentialing, training, background checks, messaging, etc., ensuring that its network is optimized and trained specifically for its customers. In addition, it can directly monitor, track, and manage its supply to ensure it always has the right vehicles in the right places, and it can directly control matching, routing, and scheduling tactics to make sure that it solves transportation needs for all member needs in all areas.

6.What does Veyo do? How are you different or better? What barriers do you face?

Veyo is a next-gen tech solution for patient transportation. The traditional NEMT model utilizes commercial fleets that are inflexible, expensive to maintain, and managed using traditional dispatch models. These fixed fleets have a difficult time scaling when demand is high, and leave providers with a surplus of vehicles on the road when demand is low. Unlike a fixed fleet, flexible fleet models allow capacity to be rapidly scaled up and down in minutes to meet demand changes. Our dynamic supply system constantly manages and optimizes the right supply levels for different modes across geographies (both urban and rural), ensuring that every member gets picked up on time.

The Veyo Virtual FleetTM is composed of traditional transportation providers and our flexible independent driver-providers (IDPs). Our cost-effective fleet provides the safest, most reliable, on-time service possible. Veyo’s model is a complete, end-to-end NEMT solution that matches supply with demand, making it more efficient and effective, and ensuring the right vehicles are dispatched each and every time. This provides a better participant experience and more efficient use of vehicles. Launched in November 2015, Veyo is changing the face of what it means to be a non-emergency medical transportation broker by bringing this innovative ride-sharing technology to the antiquated NEMT industry.

Here is how we are different and better:

  • Veyo brings innovation for the very broad needs of health plan memberships. Consumer TNCs are built to primarily serve individuals without any special needs in urban geographies. Veyo’s virtual fleet model seamlessly includes its network of IDPs (Independent Private Drivers), and traditional, specialized NEMT fleets to meet the broad array of needs from ambulatory, wheelchair, bariatric, stretcher, and other modes as required. Our IDP drivers are trained and credentialed to federal and state CMS requirements, including First Aid, CPR, HIPAA, ADA, patient sensitivity, and hand-to-hand service. We serve members in big cities, small towns, and rural areas, and use a variety of scheduling, routing, and matching techniques that are designed to get every member to their appointments on time with efficiency and high quality service no matter where they live or what their needs are.
  • Veyo’s platform is designed for management of a transportation benefit. Government agencies and managed care organizations spend millions of dollars on a critical benefit that ensures their memberships can get to and from their appointment reliably. Veyo’s system is designed to bring next-generation tools to manage this benefit to ensure maximum effectiveness. Veyo supports call centers, booking portals, and member apps that verify eligibility, determine the most appropriate mode of transportation, and ensure the highest-quality access, reliable on time performance, and trackability and transparency, while employing sophisticated mechanisms to detect and prevent fraud, waste, and abuse. In addition, it can support customized eligibility criteria and steer members to alternative cost-saving modes such as mileage reimbursement and public transit where appropriate.
  • Veyo is built from the ground up to be a healthcare ally and use data and technology to cut costs and improve outcomes. From basic requirements, like managing eligibility files, PHI, and providing encounter data, to more advanced dashboards, reports, caseworker/intervention alerts, and app campaigns, Veyo’s platform, data, and tools are at plans’ disposal to drive initiatives aimed at understanding their membership better and piloting new programs to drive better outcomes. More than just a basic transportation service, Veyo understands that it is part of the continuum of care, and uses its ability to interact with members and collect data to help plans make the most of their investment in NEMT.

Some barriers we are currently facing include hesitation in the market about such a new solution. Because Veyo was built on technology for the healthcare market, our model is drastically different than the traditional players in the market and our results can often seem too good to be true. As we continue to record data and results from our current markets, it allows us to prove that the Veyo model does work for the NEMT market and can make huge changes for health plans and state agencies alike. For example, in our current markets, after completing 3.4 million trips, we are seeing on-time performance percentages of 98% and an overall grievance rate of just 0.09%.

7.Where do you go from here?

We are continuing to expand our model into new states, with plans to double in size in 2017. We are continually adding new benefits and features to the Veyo model, including a member-facing app that will allow members to book and manage trips on their own schedule. In addition to managing their own trips, members will be able to manage their own information, ensuring that health plans always have the most up-to-date contact information for their member population. In addition to focusing on improving the trip lifecycle, we’re also looking for ways to better increase the transparency between health plans and their members. Wellness initiatives such as flu shot reminders and annual wellness exam reminders can be built into member-facing apps, giving health plans one more connection to their members.  Our high-powered, data-oriented technology team and strategic focus allows us to reimagine many processes within the broker’s function, introduce new automation and efficiency, and provide new NEMT-specific tools and data insights for plans, agencies, and members.

By healthcare business consultant David E. Williams, president of Health Business Group.

 

Concierge Cardiology: podcast interview with Wayne Lipton

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Wayne Lipton runs Concierge Choice Physicians, which converts traditional physician offices to “hybrid”concierge practices that provide new options for patients and increase physician income. While we typically hear about concierge practices in primary care, the model is expanding to other specialties.

In this podcast interview, Wayne and I discuss the hybrid concierge model for cardiology:

  • (0:11) What is a typical cardiologist’s practice like these days and how has it changed?
  • (1:01) How have the practice changes worked out for physicians and patients?
  • (1:48) Do patients with cardiac issues use their cardiologist as primary care physicians or do they still maintain primary care relationships?
  • (3:06) Within primary care we’ve seen a shift toward concierge models. Why haven’t we seen that in the specialties?
  • (4:22) What is a hybrid model like? Does a physicians have to remember when they are acting as a concierge versus the traditional hamster wheel model?
  • (6:15) Are a lot of the cardiology concierge patients also concierge primary care patients?
  • (8:26) How does a concierge cardiology practice differ from a concierge primary care practices? How do the economics compare?
  • (11:08) What do health plans think of concierge medicine? What is the impact on new models of reimbursement?
  • (13:37) Would a practice that added on a hybrid model be more or less attractive to an ACO? Would the practices want to participate?
  • (15:50) How broad is the opportunity to add this model in cardiology? Are other specialties also ripe?
  • (18:29) How do you implement?
  • (21:35) How does your company get paid?

By healthcare business consultant David E. Williams, president of Health Business Group.

Kindly Care streamlines home care hiring. Podcast with CEO Igor Lebovic

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Kindly Care got its start by helping families hire, onboard, manage and compensate caregivers. Now it is expanding its offering with Care Exchange, which allows home care agencies to collaborate.

I interviewed CEO Igor Lebovic to find out more.

  1. (0:10) What is the problem you are addressing with Kindly Care?
  2. (0:37) How did you decide to pursue this market?
  3. (2:32) You say you meet the caregivers. How do you meet them?
  4. (3:58) How much overlap is there between what you do and what Nanny Tax companies do?
  5. (4:58) You just launched Care Exchange. What is it?
  6.  (6:10) I’m confused. Are you disintermediating agencies or are you working with them?
  7. (8:52) Care.com and Honor sound like they are doing something similar. How are you different?
  8. (10:28) How are you funded? What are your hopes and aspirations?

By healthcare business consultant David E. Williams, president of Health Business Group.

Recreational marijuana is becoming legal. How will the laws be implemented?

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I opposed the ballot question legalizing recreational marijuana in Massachusetts. Nonetheless, the measure passed and it looks like legalization is going to happen. I asked marijuana entrepreneur Rob Hunt, President of Teewinot Life Sciences, to provide the industry perspective on some of the key issues.

Here’s what he had to say:

How does recreational marijuana interact with the market for alcohol? Do you expect alcohol sales to rise or fall? Why?

The adult use cannabis market should have almost no impact on the alcohol market at all. What this market represents is simply an orderly conversion from a long-standing illicit market to a now regulated legal market. It is not as if this new adult use market is emerging from nowhere, it already exists and has existed for years. Now adult cannabis users simply have a safe way to purchase cannabis from licensed retailers who have laboratory tested state-approved products rather than from a criminal enterprise with no safety considerations or government oversight.  

What is the evidence of the impact of marijuana legalization on the black market?

Adult-use legalization will have a very large impact on the illicit market. Using Colorado and Washington as comp sets, the legalization of adult-use almost eliminated the illicit market overnight for adult cannabis users within the state. There is simply no reason for one to put themselves in a potentially dangerous situation when they can go to a local shop down the street that has a larger selection of tested products at a comparable price. Best of all, in a legal market, the money stays in the local community and generates tax revenues for the state and the Federal Government.

Some (including me) are concerned that the availability of edible marijuana products will pose a danger for children but also for adults and pets, especially when they are packaged as candies or treats. Are these concerns warranted?

The cannabis industry is very aware that edibles must be very closely monitored. The trend is to make edibles less potent for this reason and to make sure that labeling and packaging are obvious and accurate and that the exit packaging is childproof. As for making products that are packaged as candies or treats, it is no different than making an alcohol product as a blend with fruit juices or iced tea. Flavor should not be the consideration, education and making sure products are kept in safe places should be a much larger consideration for adults using any cannabis product.

According to published research, about 30 percent of marijuana users have some degree of marijuana use disorder, including dependence and addiction. What is the argument for introducing a product that causes harm in a significant percentage of users?

I think the most simple answer is that the state is not “introducing” a product at all. This product was, is and would continue to be available to anyone that wishes to consume it on the illicit market. The question that should be asked is “If this product is already available to anyone that wants it, would it not be smarter to regulate it, keep it out of the hands of children, make sure it is labeled and packaged properly, has potency information available and is grown using specific standards?” If the answer to that question is yes, which is what the voters recently decided it was, then the next question, to address the concerns of many should be, “With the revenue and taxes that are being produced from this now regulated program, would it not be prudent to reallocate some of those dollars back to education and treatment for those who need it? Furthermore, perhaps should we not allocate some of the money that was previously earmarked for incarceration to rehabilitation?” 

The medical marijuana ballot initiative was passed in Massachusetts just a few years back. Was that initiative mainly a tactical stepping stone by the marijuana industry on the way to recreational legalization, as appears to have been the case in Colorado? 

The two issues are not at all related. Those who need cannabinoid based medications to treat a host of indications had no other options to procure it outside of these compassionate state programs. This was a health question. It is very likely that cannabinoid based medicine continues to move away from the plant and further into the lab. Patients that require cannabinoid based therapies are not concerned with cannabis, they are focused on the complex chemical compounds that the plant produces called cannabinoids. There are to date one-hundred and eleven of these cannabinoids identified. Many of them have been proven to have efficacious qualities, most notably to treat spasticity and for palliative care. As science progresses, new ratios and formulations of cannabinoids will be developed to advance where these medicines will be used to treat the infirm. 

Legalizing cannabis for use by responsible adults is a social justice question. These laws were passed simply to allow adults to use a product that has been statistically shown to be less harmful than alcohol without fear of arrest or incarceration. 

There is a very clear bright line distinction between these two laws and the reasons for their respective introduction. The one thing they both have in common, as evidenced by the percentage of voters supporting each, is that they are sensible policy by comparison to cannabis prohibition.

What did the Massachusetts ballot measure get right, and what are you concerned about?  

It is too early to tell either way. The law just passed and has not made it through rulemaking yet. We will see how it is implemented before we will be able to opine on what is right and wrong with it. 

What do you project as the net economic benefit or harm to Massachusetts? What are the key factors to consider?

As James Carville once famously said “It’s the economy, stupid” This law will create many new local jobs both directly tied to cannabis and on the ancillary as well. More importantly, it will take jobs away from criminal enterprises. Previously revenue derived from the sales of cannabis flowed directly back to Mexican cartels, Canada, or local criminal organizations. Now it will all stay in the Commonwealth. Then there are the taxes. Not just the excise taxes, but the Federal and State business taxes, payroll taxes and others. Lastly, the state will not need nearly as much capital for prisons, policing or other programs reliant on cannabis prohibition. You will also see much of this windfall redirected to support social welfare programs. That is good for all citizens in the Commonwealth.

As for harms, there will be a greater need for proper cannabis education and that will cost money. New state agencies or internal departments will be created to oversee the program and that will have related costs as well. Finally, there will no doubt be capital required to treat some users as there is with alcohol and tobacco.

There is tension between US and state law in places like Massachusetts that have voted for legalization. What are the key issues and what is your expectation for how they will be addressed by the incoming Administration and Congress?

I do not think there is enough room to discuss all the related issues in a short article. Things to consider are: the 10th Amendment to the Constitution, The Supremacy clause, the Rohrabacher-Farr amendment, the power of the incoming Attorney General – Jeff Sessions, How Trump or Pence decide to direct AG Sessions, how people close to the administration who are strongly supportive of cannabis progression, such as Peter Thiel or Congressman Dana Rohrabacher, influence the administration policy. 

But the most important issue to consider when addressing any political question is – What is the will of the people? What do they want? Because ultimately, politics is about winning elections and if a politician believes that an issue is important enough to the voters in their district, then they will not likely take a stand against it if they wish to remain in office. At this point in time, there is no doubt how the voters feel about advancing cannabis policy. Almost 60% of the electorate supports adult use cannabis and that is taken from polling across both sides of the aisle in liberal and conservative states alike.

Anything else you would like to add? 

Please take a look at what is being done on the true pharmaceutical side of cannabinoid-based therapy. I am certain that it will alleviate many of your articulated concerns. When you realize that these pharmaceutical and biotechnology companies are conducting clinical trials and are undertaking all the same steps with the FDA as for any other forward thinking drug development, I am certain that it will illuminate that this issue is about helping patients and not about finding a way to back-door legalization. I am happy to point you in the right direction.   


By healthcare business consultant David E. Williams, president of Health Business Group.

Podcast interview with Dexcom CEO Kevin Sayer

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Dexcom “Warriors” surround CEO Kevin Sayer on World Diabetes Day 2016

Kevin Sayer is CEO of Dexcom, and on World Diabetes Day he had the privilege of ringing the NASDAQ bell at the start of the session. I caught up with him afterwards to ask about developments in Continuous Glucose Monitoring.

Here’s what I asked:

  • (0:10) What is World Diabetes Day and what does it accomplish?
  • (0:45) Your company is a pioneer in Continuous Glucose Monitoring (CGM). What is the impact on patients?
  • (1:48) Does CGM replace finger sticks or do you have to do both?
  • (2:23) Is CGM relevant only for those with insulin pumps? Is it useful for people who inject insulin?
  • (3:24) What is an artificial pancreas? How does CGM fit in?
  • (5:15) How do you model the financial impact of CGM for individual patients and for populations?
  • (6:49) How important are online patient communities and data registries, such as T1D Exchange? Do they play an important role in your R&D?
  • (8:11) As we look to 2017 and beyond, what are the next big things we can expect?

By healthcare business consultant David E. Williams, president of Health Business Group.

Mass Health Quality Partners: 21 years young

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Barbra Rabson, MHQP President and CEO

Health Business Group is a sponsor of the upcoming anniversary party for Massachusetts Health Quality Partners (MHQP). I asked MHQP’s President, Barbra Rabson to reflect on the first couple decades.

MHQP is about to celebrate its 21st anniversary. What are you celebrating?

We are celebrating the courage and vision it took 21 years ago to found MHQP, and the amazing two decades of progress we’ve made since our inception. Our 21st anniversary is symbolic of our coming of age and reaching a level of maturity. MHQP has become an important part of the Massachusetts healthcare landscape over the decades thanks to the commitment and hard work of our diverse stakeholders – including patients, physicians, hospitals and payers.  More than 40 sponsors and over 300 people are gathering on November 2 to celebrate MHQP’s unwavering commitment to reliable healthcare measurement and transparency and our pioneering work in the Commonwealth and the nation to systematically capture the patient voice and integrate it into care improvements.

At our anniversary celebration we will be honoring the vision of MHQP’s Founding Circle –Blue Cross Blue Shield of MA, Fallon Health Plan, MA Business Roundtable, MA Hospital Association (MHA), MA Medical Society (MMS), Harvard Pilgrim Health Care (HPHC), Tufts Health Plan and the State (Governor Charlie Baker was a founding member of MHQP when he was Secretary of Administration and Finance).

We will also be awarding MHQP’s first award in honor of the late Richard Nesson, MD, a founding visionary of MHQP when he was the Chair of the MHA Board in 1995 when MHQP was established.  We are delighted that Susan Edgman-Levitan, the executive director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital and the founding president of the Picker Institute will be the first recipient of MHQP’s H. Richard Nesson Award.

How has the environment changed in MA over the past 21 years? What role has MHQP played in that?

The healthcare environment is drastically different than it was when MHQP was founded in 1995.  When MHQP first started collecting and reporting comparative statewide performance information, we were the only game in town.  For example, MHQP’s first in the nation statewide patient experience survey of acute care hospitals and public release came a full decade before CMS developed the hospital H-CAHPs survey! Likewise, when MHQP began collecting and reporting statewide clinical and patient experiences measures for ambulatory care, MHQP’s data was the only reliable source for quality benchmarks for our provider organizations.  Before MHQP’s comparative quality reports, Massachusetts provider organizations only knew their own performance scores, they had no comparative benchmarks or best practices to drive performance improvements.  Physician leaders  (Barbara Spivak, Tom Lee and others) have told us MHQP’s performance reports were invaluable to them because our reports became the writing on the wall that they needed to make significant investments in their organization in the form of electronic health records and quality improvement infrastructure to advance their performance to the level they aspired to.

Another big change is that our reimbursement systems now provide millions of dollars of incentives for provider organizations to improve performance.  When MHQP first started the term ‘pay-for-performance’ had not yet been coined.  MHQP has always [encouraged] improvements through public reporting of reliable and trusted comparative performance information – relying on physicians’ intrinsic motivation to perform as well as they can. Now that provider compensation depends heavily on measurement we need to work harder to make sure we have accurate and fair measurements of quality care.

Finally, back in 1998 when MHQP first started reporting on patient experiences of care, patient experience was not considered a core measure of quality.  MHQP’s statewide collection and reporting of patient experience helped draw national attention to the importance of listening to patients, and in 2001 the IOM introduced the concept of patient centered care as a key element of quality care in the Crossing the Quality Chasm Report.

Kindred organizations to MHQP have arisen around the country over the last couple decades. How do you relate to them?

MHQP was one of the first regional health improvement collaboratives (RHICs) to be founded in the country. Gordon Mosser (founding CEO of ICSI in Minnesota) and I organized the first meeting of regional collaboratives in 2004.  As a founding member and past Board chair of NRHI (the Network for Regional Healthcare Improvement), it has been very gratifying to see so many new RHICs being established.  There are now more than 40 across the country.  I have been told by many of the younger RHICs that MHQP was a role model for them when they were first starting out, and I take great pride in that.

What does the future hold?

Great question, and one I have been reflecting on as we have been looking back on our first 21 years. One of the biggest challenges (and one of our greatest failures as a health care system) has been that we have not done a good job engaging our patients as a resource to help us improve outcomes. In many cases we have actively refused to seek input from patients, and when given feedback we have ignored it.  We are now trying to make a 180 degree shift on this, to better engage patients in the co-production of solutions, and it is not easy because it requires a shift in mindset.  I believe that MHQP’s two decades of experience capturing the patient voice and integrating that voice into care improvements positions us extremely well to support our practices and healthcare systems as they embark on this journey.

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By healthcare business consultant David E. Williams, president of Health Business Group.