John Celona

What needs to change first and foremost is healthcare finance. These insurance bizdiots consume more than half your healthcare dollar, up front. Then we need to make the big hospital systems run efficiently. Finally, we need to stop hemorrhaging 84% of healthcare expenditures on avoidable, behavior-based chronic disease. These three financial problems can be solved with education and automation. 1. Automate the health insurance industry. Provide the EMR, pay 150% of Medicare for procedures documented. 2. Provide an ERP style hospital administration system to find cash leaks and inefficiencies. 3. As the insurance company, offer double digit discounts for improved lab results. Problem solved Overview of the solution (that's in production, by the way): https://lnkd.in/eUt_HTQX

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In healthcare, making smarter decisions means understanding more than clinical data. By combining predictive analytics with behavioral and attitudinal insights, providers can design experiences that improve outcomes and meet patients where they are. From risk forecasting to personalized communication, data is the key to human-centered care. Read more: https://lnkd.in/eherbHUR #HealthcareInnovation #PredictiveAnalytics #PatientCenteredCare

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“Ninety-three percent of health plan executives believe AI will contribute value by automating prior authorizations, according to an analysis of Deloitte survey results released Jan. 15.” #ai #prior #authorizations #survey

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Insightful post on the evolution and future of AI in value-based care workflows by our Chief Product Officer, Paul Burke. As a leader of value-based care programs, you'll want to give this a read before making any decisions around adopting AI for risk adjustment.

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I just published a new article on Prospective vs. Retrospective Risk Adjustment, and how AI is changing the way both are executed. AI is bringing intelligence earlier into the care journey—surfacing suspect conditions before visits, guiding documentation at the point of care, and reducing manual chart review after the fact. At the same time, AI strengthens retrospective review by improving accuracy, scalability, and audit readiness. The real focus isn’t prospective or retrospective. It’s using AI to optimize each of them independently and together in service to faster, earlier, more defensible outcomes. 👉 Read the full article: https://lnkd.in/eBPt3-NC Learn more at Reveleer #AIinHealthcare #RiskAdjustment #ValueBasedCare #HealthcareTechnology

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BOOM!!! BIG news at symplr -- and a big win for the health systems we serve.  We’ve officially acquired Smart Square®, AMN Healthcare’s Best in KLAS nurse and staff scheduling software. By adding Smart Square’s predictive, AI-driven scheduling to the symplr Operations Platform, we’re doubling down on a top priority for our customers: simplifying workforce complexity. Together with our Best in KLAS timekeeping and broader workforce suite, this helps health systems: ·      Align staffing to patient demand ·      Reduce manual overhead ·      Give time back to care teams I’m super proud of the teams that made this happen — and grateful to the healthcare operations community for pushing this work forward every day. You inspire us! If you’re reporting on the future of workforce optimization, scheduling tech, or AI in healthcare, we’d love to connect. Appreciate the continued focus on this space from outlets like Fortune, Fast Company, CNBC, CHIME, HIMSS, Becker's Healthcare, HIStalk and others helping to shape the conversation. More on the announcement below.

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The future of digital experiences for marketers appears to be divided...what would this internet experience look like as a marketer in today's landscape contemplates optimizing for AI (LLMs) rather than optimization for the human experiences we were taught to uphold as best practice? Great read below ⬇️ #AI #llm #h2hmarketing #digitalmarketing

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I’ve been in this space for 25 years, and this fight cycles back like clockwork. The new “Hospital Watch” coalition is the latest round. Yes, hospital consolidation has real pricing impact. In many markets a handful of systems control most inpatient beds and outpatient sites, and commercial prices often land 150–200% of Medicare. But focusing only on hospitals misses the bigger structural issue. Payers have consolidated just as aggressively. Vertical integration across insurance, PBMs, care delivery, and data has created enormous pricing power on that side of the market too. What employers and policymakers are actually wrestling with is the combination of three forces: • regional provider consolidation • vertically integrated insurers • site-of-service payment differences that reward higher-cost settings Together they drive the commercial price gap that ultimately shows up in employer premiums and patient out-of-pocket costs. Real reform probably will not come from pointing fingers at one side of the table. It will come from fixing incentives across the entire system. Curious how others see it. Are hospital systems really the primary driver of commercial cost growth today, or is the problem more evenly distributed across hospitals, insurers, and intermediaries? #healthcarepolicy #hospitalconsolidation #healthcarecosts #healthcareeconomics #valuebasedcare

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𝗔𝗲𝘁𝗻𝗮 𝗟𝗮𝘂𝗻𝗰𝗵𝗲𝘀 𝗔𝗜 𝗔𝘀𝘀𝗶𝘀𝘁𝗮𝗻𝘁 𝘁𝗼 𝗛𝗲𝗹𝗽 𝗠𝗲𝗺𝗯𝗲𝗿𝘀 𝗡𝗮𝘃𝗶𝗴𝗮𝘁𝗲 𝗕𝗲𝗻𝗲𝗳𝗶𝘁𝘀 Aetna introduced a new conversational AI tool that helps members understand their coverage and out-of-pocket costs without using medical jargon. Embedded in the Aetna app and website, the assistant can walk users through benefit questions, estimate costs for surgeries or procedures, and surface related information such as required follow-up care. The tool connects with Aetna’s Care Paths programs, which guide members with conditions like diabetes, joint issues, and maternity needs through more personalized care and benefits navigation. After a successful beta launch, Aetna plans to expand the AI assistant throughout the first half of 2026 and add voice and screen reader support.

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The shift from vendor to growth engine 🚀 Direct contracting flips the script: self-funded employers and health systems need more than clean data they need partners who drive revenue growth through: 👉 Custom network design. Enriched provider data identifies high-value specialists, benchmarks pricing against Medicare baselines, and flags gaps in oncology, cardiology, or ortho coverage turning data into network leverage that wins employer deals. 📍 Growth opportunity mapping. Longitudinal claims + clinical data reveals underpenetrated markets: “Which employers have 20%+ GLP-1 spend but no specialty pharmacy contracts?” Data partners surface these multimillion-dollar opportunities before competitors see them. 📊 Contract performance optimization. Real-time dashboards track episode costs, readmission rates, and adherence proving ROI that unlocks renewals, expansions, and referrals to peer employers. Real B2B growth math 📈 When LakeB2B enriches a provider network for direct contracting: ⏱️ 20–30% faster contract negotiations (transparent pricing data eliminates back-and-forth) 📍 15% higher network utilization (right providers in the right geographies) 🤝 Employer LTV doubles (proven outcomes lead to multi-year expansions) The growth partner playbook 🎯 Data companies win when they: Own the full stack from data validation → analytics → actionable recommendations Measure mutual growth where employer savings = your expansion revenue Healthcare data isn’t table stakes anymore. It’s the growth accelerator that positions: Providers for employer wins 💼 Pharma for volume guarantees 💊 Payers for smarter risk transfer 📉 Data partners: Are you still billing by the record… or sharing in the growth you create? #HealthcareData #DirectContracting #ValueBasedCare #B2BGrowth #ProviderNetworks #LakeB2B #Ampliz

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AI is the New Language of Leadership. For years, marketers treated AI like a luxury... a nice-to-have tool for teams with extra time or budget. That era is over. Today, AI and predictive performance systems aren’t optional. They’re the operating system for how modern CMOs think, plan, and execute. The brands that will win aren’t the ones spending more; they’re the ones predicting better. Because growth today isn’t about who has the biggest team. It’s about who has the smartest system. Over the past 25 years, across both the agency world and the CMO seat, I’ve built and refined a tool that captures everything I’ve learned about how to grow brands. It analyzes emotional resonance, message sequencing, spend efficiency, and creative impact, and turns that data into clear, predictive insights for decision-making. It’s not a theory. It’s what happens when intuition meets intelligence. The future CMO won’t just use AI to automate tasks; they’ll use it to amplify judgment because the new competitive advantage isn’t effort. It’s awareness. DM me if you would like to see the tool I've created.

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Some thoughts on CMS's primary care VBC strategy: While the healthcare industry braces for potential cuts to Medicaid and Medicare Advantage due to regulation like the Big Beautiful Bill (BBB), there's a silver lining that many primary care providers (PCPs) are missing, incentives to transition to value-based care (VBC). I wanted to understand more about these programs to learn how vendors like NeuroFlow or Ilant Health might take advantage of them. I hope this is helpful to others as well. After more than a decade of pilots and iterations, CMS has finally created two programs (both for traditional Medicare) that could be impactful for smaller practices: 1. Making Care Primary (MCP) (https://lnkd.in/e_sEBKDA) and 2. ACO Primary Care FLEX (https://lnkd.in/ejWfCjs4). Here's why PCPs & vendors should pay attention—and how to get started. *The Programs That Actually Work for Small Practices* Making Care Primary (MCP) - CMS's new 10-year flagship model --> Direct payments of $25-40 per patient per month to practices, paid at the beginning of each month --> For a 1,000-patient Medicare panel: $300K-480K annually --> No ACO required—perfect for independent practices --> Gradual ramp into risk-based contracts ACO Primary Care FLEX - Add-on for existing Medicare ACOs --> $15-25 PBPM for qualifying low-revenue practices --> $180K-300K annually for 1,000 Medicare patients, paid quarterly --> Focuses on practice transformation within ACO structure ‍ *CMS explicitly encourages spending on:* 🧠 Behavioral Health Integration - The biggest cost multiplier across all conditions --> Collaborative care models --> On-site mental health clinicians --> Substance use disorder screening 🏠 Health-Related Social Needs --> Community health workers --> Transportation coordination --> Housing and food security partnerships 📱 Remote Patient Monitoring --> Cardiac, respiratory, and metabolic monitoring --> Chronic disease management --> Post-discharge follow-up 👥 Enhanced Staffing --> Care coordinators --> Population health nurses --> Data analysts ‍ *The Technology Enablement Opportunity* For healthcare IT companies, this represents a massive market opportunity. The dollars don’t go far if programs rely on staffing alone. PCPs will need: --> Patient engagement and registry solutions like DocResponse --> Analytics platforms for population health like HealthEC, LLC --> Remote monitoring technologies such as Caption Care & Neurotrack --> Care navigation & other wrap-around services like Ilant Health, Sylvan Health --> Behavioral health integration tools like NeuroFlow ‍ Read more here: https://lnkd.in/eE3mjv6X

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GenAi has had multiple impact vectors across verticals - one of the most fascinating ones are across lifesciences and healthcare. Some of our largest customers including payers, and HST organizations are progressing to implement use cases such as : Clinical decision support, Drug discovery and development, Managing electronic health records, Genomics etc. Cloudera customers continue to see increasing demand from their practioners to leverage our gen ai and inferencing capabilities to drive autonomous actions, knowledge graph based semantic querying, vector RAG, and predictive analytics in order to make better decisions across historical and real-time patient health data https://shorturl.at/e6ZQB AbbVie IQVIA Anthem, Inc. Eli Lilly and Company Mayo Clinic

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💰⚠️HUGE WEEK AHEAD⚠️🚀 If you care about healthcare AI, pay attention to the broader market too. The biggest players in AI will be reporting earnings this week: Amazon, Meta, Alphabet Inc., Microsoft, Apple, Reddit, Inc., Why is this important? Earnings directly impact investor confidence; investor confidence impacts capital flow, including to startups that are innovating in healthcare.

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Large enterprise CMOs are facing a critical challenge: Drive AI transformation while doing right by the teams that built your organization. The C-suite wants AI transformation yesterday. Their teams—many with decades of institutional knowledge—are skeptical, exhausted, or both. Here's what I keep hearing: "I know we need to move fast. But I can't just blow up my team in the process." These leaders aren't stuck because they don't understand AI. They're stuck because they understand people. They need a plan for that first and foremost when the org gets to a certain size. They know that legacy expertise is still valuable and long-tenured employees deserve honesty about what's coming, not false promises. Transformation that breaks trust isn't really transformation—it's just chaos with better tech. This is the real leadership challenge of AI transformation - navigating the human complexity of change in organizations where relationships, tenure, and culture run deep.

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AI is changing stores, marketing and advertising. Trust becomes #1 asset. This quote from the article sums it up: “Investments are shifting from flashy ads to building a strong, recognizable presence in the digital spaces where decisions are made. The focus is on being familiar and trusted, wherever shoppers and algorithms look,” Ruthlessly spending money on eyeballs and clicks does not make sense anymore. Building trust and credibility is key. This means initial new sales ramp up might slow down, but the tail becomes longer and wider. Good lessons for retail that also translate to b2b marketing in my opinion.

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Such an exciting year ahead. Healthcare AI is finally crossing from digitization to cognition shifting value from administrative drag to clinical and scientific productivity, with revenue cycle intelligence as the first scalable proof of ROI. Today, administrative functions consume roughly one-quarter of total U.S. healthcare spending making AI-driven cognitive automation one of the few levers capable of reallocating dollars back to care, not just cutting costs. With average hospital operating margins near 2%, even a 30–50 basis-point improvement from AI-driven clinical intelligence can translate into a 15–25% relative margin uplift without adding beds, clinicians, or capital spend. #MBA #Healthcare #AI

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Huge news from CMS for anyone building in tech-enabled care delivery & focused on chronic conditions. Yesterday, CMMI released a new outcomes-based payment model that some industry insiders are calling the biggest tailwind for digital health since COVID. It has major implications for companies managing chronic conditions, remote monitoring, virtual care, and value-based models. I spent time digging into the details with Jared Augenstein and Randi Seigel, who have been in the weeds on the ACCESS model since it dropped. Their insights helped me unpack: • How outcomes will actually be measured • Which digital health companies are best positioned • Who won’t qualify (and why) • What still isn’t clear about payment rates and targets • How this could impact PCPs, beneficiaries, and infrastructure vendors • Where the fraud and compliance risks live If you're working in digital health, chronic care, RPM, MSK, metabolic health, or infrastructure…this one is worth a read. Full breakdown here: https://lnkd.in/erSbFkd3

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