HOUSTON
Legal Matters pg.3
Oncology Research pg.5
Mental Health pg.6
Healthy Heart pg.8 Financial Forecast pg.12
Memorial Hermann President & CEO recognized as One of Modern Healthcare’s “100 Most Influential People in Healthcare”
Memorial Hermann Health System is proud to announce that president and CEO, David L. Callender, MD, has been named for the third consecutive year to Modern Healthcare’s “The Most Influential People in Healthcare.”
Distinguished honorees encompass leaders from government, business and the nonprofit sector deemed by their peers and the senior editors of Modern Healthcare to have influenced positive and sustainable transformation across the health care industry resulting in positive impacts to patient care, organizational culture, employee retention and development, and overall clinical, operational and fiscal governance.
“I am truly honored to be recognized by Modern Healthcare among this nation’s health care leaders,” said Dr. Callender. “This award reflects the incredible work of our more than 34,000 employees who embody our mission of improving health every day. It is their commitment, compassion, and drive for excellence that is making a lasting impact on the communities we serve.”
David L. Callender, MD.
optimal cost, creating exceptional experiences for patients and a fulfilling work environment for its workforce and improving health equity in the communities it serves.
Among Memorial Hermann’s
This award reflects the incredible work of our more than 34,000 employees who embody our mission of improving health every day. It is their commitment, compassion, and drive for excellence that is making a lasting impact on the communities we serve...
Since joining Memorial Hermann as President and CEO in 2019, Dr. Callender has established a strategic framework to enable Memorial Hermann and the entire health care system to create more value for patients and populations; that is, delivering the greatest outcomes at an
most notable achievements this year is the launch of a new, first-of-its kind Health Education and Leadership (HEAL) High School in partnership with Aldine Independent School District. Supported by a $31 million gift from
Bloomberg Philanthropies to the Memorial Hermann Foundation, this partnership bridges the health care and education systems and provides a meaningful educational pathway to prepare students for health care jobs with family-sustaining wages after graduation from a specially designed, career-technical education high school.
“Our list of the 100 Most Influential People in Healthcare reflects the important contributions of the men and women who have helped shape the industry in 2024,” said Mary Ellen Podmolik, editor-in-chief of Modern Healthcare. “They come from all corners of the industry and their leadership has been felt from the doctor’s office to Capitol Hill. We
Legal Matters
The OIG’s Concerns with Potentially Fraudulent Medicare Advantage Marketing”
By Jeffrey Fitzgerald, J.D.
Adrienne E. Frazior, J.D. Polsinelli, PC
The HHS Office of Inspector General (“OIG”) released a Special Fraud Alert to inform health care professionals (“providers”) and Medicare Advantage Organizations (“MAOs”) about the OIG’s view of potentially abusive marketing practices in the context of the promotion of Medicare Advantage (“MA”) plans. In particular, the OIG is concerned with two types of suspect marketing practices: (1)
payments from MAOs to providers or their staff to steer patients to specific MA plans, and (2) payments from providers to MAO brokers to steer MAO enrollees to the providers.
Under the first concern, the OIG warned against MAOs paying remuneration to providers or their staff in exchange for referring patients to the MAO’s plans. The OIG acknowledges that regulations allow providers to engage in limited forms of marketing and communications related functions on behalf of a MAO, but the providers cannot accept compensation (such as gift cards or in-kind payments) for those marketing efforts.
Under the second concern, the OIG warned against providers paying MAOs (or their brokers) in exchange for the MAO directing its enrollees to the provider. OIG is concerned that, because MA brokers have established relationships with
Medicare enrollees, the brokers may be positioned to influence those enrollees’ provider selections while benefiting economically from those financial arrangements with providers. Adding to the OIG’s concern is that the enrollees are unaware of these financial relationships.
According to the OIG, the identified marketing schemes can harm enrollees in two principal ways. First, agents, brokers, and providers may skew their guidance when providing recommendations regarding providers or MA plans
based on their improper financial self-interest. In particular, when payments inappropriately steer recommendations, Medicare enrollees may find themselves switched to or enrolled in MA plans where they are unable to access their preferred providers, are unable to meet their health care needs, and pay higher out-of-pocket costs. Second, the OIG is concerned with the anticompetitive effects of these marketing schemes. They could encourage agents, brokers, and providers to direct enrollees to
Baylor College of Medicine expands STEMM Curriculum in South Texas
The Center of Educational Outreach at Baylor College of Medicine will expand science, technology, engineering, math and medicine/ biomedical science (STEMM) curriculum programs at select Corpus Christi Independent School District (CCISD) schools beginning in 2024 and 2025. Baylor-developed science and health pathways and an after-school program will be introduced to address student interest in the growing STEMM fields.
“This initiative will empower learners with the skills and knowledge necessary to excel in the rapidly evolving STEM and health science sectors,” said Dr. Nancy Moreno, chair of the Huffington Department of Education, Innovation and Technology and director of the Center for Educational Outreach at Baylor. “We look forward to working closely with CCISD to inspire students to be the next generation of innovators and
healthcare leaders.”
Baylor has developed an after-school program that is being conducted by teachers at Gloria Hicks Elementary School, introducing students to topics like microbiology and biomedical engineering.
A new STEMM health science pathway will be launched at Cunningham Middle School at South Park, providing students with coursework that dives into advanced topics like neuroscience, scientific decision-making, bioengineering and biotechnology. Similar science pathways have been implemented at the Baylor College of Medicine Academy at James D. Ryan Middle School and the Baylor College of Medicine Biotech Academy at Biotech Academy at Rusk Middle School in Houston.
Foy H. Moody High School’s existing STEMM health science pathway focuses on college-level preparedness through the summer
DocPrep program for rising high school seniors. Students from Moody High School attend the program at Baylor College of Medicine in Houston to experience engaging sessions led by Baylor physicians, work in a simulation lab, and network with peers from other South Texas health science high schools.
“We are delighted to be expanding this unique partnership,” said Corpus Christi ISD Superintendent Dr. Roland Hernandez. “Our students now have the opportunity to expand their STEMM knowledge and learn about health science careers
beginning in elementary school, and then broadening their knowledge and experience in middle school and high school. We are grateful to Baylor College of Medicine, Mrs. Gloria Hicks, the Port of Corpus Christi, Ed Rachal Foundation and the Corpus Christi Medical Center for leading this important investment in our students’ futures.”
In addition to curriculum development, Baylor education experts will work in tandem with CCISD faculty to ensure implementation of the curriculum is effective and suited to the needs of each campus.
Oncology Research
UTSW Scientists Identify Cancer-Suppressing Genetic Mutation Findings Could Eventually Lead to Improved Immunotherapies for Melanoma, Other Cancers
By UT Southwestern
UTSouthwestern Medical Center
researchers identified a genetic mutation that slows the growth of melanoma and potentially other cancers by harnessing the power of the immune system. Their findings, published in the Journal of Experimental Medicine, could lead to new treatments that improve outcomes from existing cancer immunotherapies.
“Our findings suggest a completely new type of therapeutic target that could someday be used to suppress a wide range of cancers,” said Hexin Shi, Ph.D., Assistant Professor in the Center for the Genetics of Host Defense and of Immunology at UT Southwestern.
Dr. Shi co-led the study with Bruce Beutler, M.D., Director of
the Center for the Genetics of Host Defense and Professor of Immunology and Internal Medicine. Dr. Beutler was awarded the 2011 Nobel Prize in Physiology or Medicine for his discovery of an important family of receptors that allow mammals to quickly sense infection and trigger an inflammatory response. He is also a member of the Cellular Networks in Cancer Research Program at the Harold C. Simmons Comprehensive Cancer Center at UTSW.
Researchers have identified many genes, known as oncogenes, that initiate and drive cancer when mutated. Although scientists have long speculated that mutations protecting against cancer also exist in the human genome, Dr. Shi explained, finding them by studying human subjects has been difficult because people carrying
these genetic variants don’t show any obvious differences compared to others.
To search for genes that confer tumor resistance, Drs. Shi and Beutler and UTSW colleagues created mouse models with various genetic mutations and then searched for mice that didn’t develop tumors or had limited cancer growth. Next, they used a method recently developed in the Beutler Lab called automated meiotic mapping (AMM), which traces unusual features of interest in mutant mice to the causative mutations.
The researchers quickly homed in on a gene called H2-Aa. Mice carrying two mutated copies of this gene, causing them to completely lack the H2-Aa protein, often showed no tumor growth after exposure to melanoma cells. Those carrying one mutant copy had significantly reduced growth compared with mice carrying
see Oncology ...page 13
Hexin Shi, Ph.D., left, is Assistant Professor in the Center for the Genetics of Host Defense and of Immunology at UT Southwestern. Bruce Beutler, M.D., is Director of the Center for the Genetics of Host Defense, Professor of Immunology and Internal Medicine, and a member of the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern. He holds the Raymond and Ellen Willie Distinguished Chair in Cancer Research, in Honor of Laverne and Raymond Willie, Sr. and is a Regental Professor. (UT Southwestern)
Mental Health
Ease Seasonal Affective Disorder with Exercise Routine
By Baylor College of Medicine
As the days start getting shorter and darker, people might feel impacted by seasonal affective disorder (SAD). The downturn in mood that happens with the change in light is likely associated with decreased levels of neurotransmitters, such as serotonin and dopamine, in the body. If you are affected by SAD, it is important to continue your exercise routine as exercise boosts mood. A Baylor College of Medicine expert explains how to alternate your workout routine during the darker months.
“With seasonal affective disorder, it is desirable to continue to exercise or maybe even increase your exercise,” said Dr. James McDeavitt, professor of physical medicine and rehabilitation and executive vice president and dean of clinical affairs at Baylor. “Relatively sustained aerobic exercise effects mood positively, but you don’t just have to
run or do aerobics – you can do things like yoga, tai chi or meditation, which help with symptoms of depression.”
Exercising outdoors
If you enjoy running or doing other workouts outdoors, you can still do so safely before sunrise or after sunset as long as you make yourself visible. McDeavitt recommends wearing reflective clothing as well as a blinking light that can clip on your clothes or shoes. He also suggests leaving your earbuds at home and listening to the environment and your surroundings.
“There is a balance. Find somewhere isolated enough to be protected from traffic while also making sure enough people are around you to feel safe. You can also carry personal protection with you,” he said.
Try to find a predictable running surface, such as a track or well-paved road, to avoid injury while running in low-light conditions.
Exercising indoors
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Incorporate resistance training into your exercise routine at home by using dumbbells or resistance bands. You can duplicate most resistance exercises solely with elastic resistance bands. Other bodyweight workouts that can be done at ease at home include pushups, planks and squats. If you have the resources, you can purchase an aerobic device for the home, such as a stationary bike or treadmill.
“There is value to seasonally maintaining your routine. Even if you
regularly run outdoors in the spring and have to move indoors for the winter, don’t blow off your workout,” McDeavitt said.
He also recommends including a mindfulness component in your workout, such as engaging in a stretching program a few times a week or doing yoga or tai chi.
“There are things you can do indoors that not only give you physical
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Healthy Heart Join the Heart of Houston Campaign
By Russ Labrasca American Heart Association
Did you know that heart disease and stroke are still the No. 1 and No. 5 killers in our community? The good news is that we’re working to change these statistics through the Heart of the Houston campaign.
My wife Judy and I are delighted to be serving as the Chairpersons for the American Heart Association’s 2025 Heart of Houston Gala. Our devotion to the mission of AHA has been steadfast over the years, and we are honored to enhance our commitment as the organization moves into its second century.
Our pledge to the AHA is also personal, as both of my parents struggled with heart disease. My father died of a heart attack at 63 but 24 years later, my mom’s life was extended by six years thanks to the advancement in medical research. Many of you reading this article may have experienced a similar situation in your life.
I am also inspired when I hear stories from our 2025 medical honoree, Dr. Michael Sweeney. On his way to becoming a distinguished cardiothoracic surgeon, Dr. Sweeney studied under transplant pioneers Dr. Cooley and Dr. DeBakey. And he was the first surgeon in Florida to perform a heart/ lung transplant. We are thrilled that he brought his talents home to Texas.
It is also exciting when my friend and AHA wine committee co-chair, Dr. Damien LaPar speaks of performing surgery to repair the heart of an unborn child. These stories impact the lives of patients and family members alike.
For more than 100 years, the American Heart Association has made bold moves to save lives and pioneer scientific discoveries. We haven’t done it alone. We reach our goals by working with organizations and individuals who share our vision for better health. The Heart of Houston campaign unites supporters with a shared purpose to raise the critical funds we need to ensure our work continues right here in
Houston. There’s no letting up in the next 100 years as we remain devoted to a future of health and hope for everyone, everywhere.
Judy and I invite you to join us in this endeavor. The Houston Heart Ball will take place on Saturday, February
15, 2025, at the Hilton Americas. The evening includes a reception, auction, dinner, and live entertainment. Tickets, tables, and sponsorship opportunities are still available. Details can be found at www.heart.org/HoustonHeartBall. We hope to see you there!
Russ and Judy Labrasca
Houston Methodist, Rice University Launch Groundbreaking Digital Health Institute to Transform the Future Of Health Care
Houston Methodist and Rice University have joined forces to establish the Houston Methodist-Rice Digital Health Institute aimed at transforming health care for millions through advanced technology and collaborative expertise.
This multi-year joint initiative unites Houston Methodist’s academic medicine and research infrastructure with Rice University’s world-renowned leadership in engineering, digital health and artificial intelligence (AI) to develop transformative solutions that will enhance patient and population health, operational efficiency and access to equitable care.
This collaboration will translate innovative ideas into scalable solutions, with a focus on research
and development in digital health and training the next generation of digital health leaders, ensuring a sustainable and forward-looking contribution to the field.
The initiative is led by Houston Methodist’s Khurram Nasir, M.D., Houston Methodist’s William A Zoghbi, M.D. Centennial Chair in Cardiovascular Medicine and division chief of cardiovascular prevention and wellness, and Rice’s Ashutosh Sabharwal, Ernest Dell Butcher Professor of Engineering and professor of electrical and computer engineering.
“This partnership between our institutions marks a bold new chapter in driving meaningful innovation at the intersection of health care and technology through solutions that
Elevate Your Practice
Move-in ready suites designed for patient wellbeing and specialty care.
are both visionary and practical,” said Marc L. Boom, M.D., president and CEO of Houston Methodist. “Our longstanding relationship with Rice University has produced impactful collaborations, but this initiative allows us to combine our mutual strengths in clinical medicine and computer science to lead medicine through digital innovation.”
This initiative builds on ongoing collaborations between Houston Methodist and Rice University, including the Center for
Neural Systems Restoration launched earlier this year, and the Center for Human Performance established in 2022.
“This partnership embodies Rice’s bold vision to lead at the forefront of innovation in health and responsible AI,” said Rice President Reginald DesRoches. “By combining our strengths with
Dr. Marc Boom (left), president and CEO of Houston Methodist, and Rice President Reginald DesRoches.
Baylor St. Luke’s Medical Center Honored with ANCC Magnet Recognition for Nursing Excellence
F
or the sixth time, Baylor St. Luke’s Medical Center earned the prestigious Magnet Designation from the American Nurses Credentialing Center (ANCC). Its Magnet Recognition Program® is the highest national honor for professional nursing practice.
“Six consecutive Magnet recognitions is an incredible source of pride for everyone at Baylor St. Luke’s, especially our talented nurses,” said Dr. Brad Lembcke, president of Baylor St. Luke’s. “Our repeated achievement of this credential underscores the foundation of excellence and values that drive us to strive harder each day to meet the health care needs of the people we serve.”
Research demonstrates that Magnet recognition provides specific benefits to health care organizations
and their communities, such as:
• Higher patient satisfaction with nurse communication, availability of help and receipt of discharge information.
• Lower risk of 30-day mortality and lower failure to rescue rates.
• Higher job satisfaction among nurses.
• Lower nurse reports of intentions to leave their positions.
Magnet recognition is the gold standard for nursing excellence and is a factor when the public judges a health care organization. U.S. News & World Report’s “America’s Best Hospitals,” which regularly includes Baylor St. Luke’s, relies on Magnet recognition in its ranking criteria.
The Magnet Model provides a framework for nursing practice,
research, and measurement of outcomes. ANCC evaluates applicants across many components and dimensions to gauge an organization’s nursing excellence.
The model measures elements deemed essential to delivering superior patient care such as the quality of nursing leadership and coordination, collaboration across specialties, and processes for measuring and improving the
quality and delivery of care.
Health care organizations must reapply for Magnet recognition every four years and provide documented evidence to demonstrate sustained and improved Magnet concepts, performance and quality.
Patient Returns to Houston Methodist 20 Years After Lifesaving Surgery
Morethan two decades ago,
Mitra Kamali, 4 1/2 months pregnant with twins at age 45, was having lunch with her husband in Houston when out of nowhere she suffered a major seizure.
She worked as a drilling engineer at the time and was healthy and fit. But the seizure prompted an MRI, which showed a malignant brain tumor. Everyone thought she was going to die along with her unborn children.
She was directed to Houston Methodist neurosurgeon David Baskin, MD, who removed the tumor in a 12 ½-hour surgery. Mitra survived, and so did her twin boys. Ever since, her life has been guided by an enduring sense of gratitude. And her follow-up MRIs throughout the years are clear of brain cancer.
Now a successful artist living with her family in Arizona, Mitra returned to Houston Methodist Hospital recently to present Baskin with a special painting entitled ‘Human Connection.’
adults. While more studies with broader population samples are needed, the study supports the theory that being grateful can be good for us – mentally and physically.
Throughout his long career at Houston Methodist, Baskin
“We are all born to make the world a little better,” she said. “If we didn’t have Dr. Baskin, we never would have had the chance.” Her painting, when illuminated with a black light, highlights the human heart. It now hangs in the Kenneth R. Peak Brain and Pituitary Tumor Treatment & Research Center at Houston Methodist Hospital.
While many scientific studies verify a link between gratitude and greater emotional health and overall feelings of well-being, a first-of-its-kind study published in July shows a potential physical link as well. The study, “Gratitude and Mortality Among Older Female Nurses” in JAMA Psychiatry, provided the first scientific evidence that gratitude can be linked to increased longevity among older
has received countless messages from grateful patients, and he sees gratitude’s healing power daily. Just recently he heard from a woman who considers her eyesight a daily gift after Baskin removed a complex optic tumor 23 years ago; another patient, now 32, had his life interrupted by a brain tumor while in college a decade ago, but last summer was inspired to enroll in medical school.
“These letters mean a lot to me,” Baskin says. “They illustrate how a grateful heart adds meaning and perspective to people’s lives. And I do believe gratitude can help us heal in our minds and in our bodies.”
Dear Doctors and Staff, Let us take the guesswork out of fracture referrals.
No more waiting for appointments! We at the Orthopedic Care Center wish to offer your patients and staff easy scheduling of patients.
Our office has extended office hours on Fridays to accommodate patients with fractures. On behalf of the Orthopedic Care Center
Dr. David Baskin and patient Mitra Kamali, November 2024.
Lubor Jarolimek M.D.
Financial Forecast How to Become More Financially Literate
By Grace S. Yung, CFP Midtown Financial Group, LLC
Becoming financially literate and overcoming fears about money are essential steps toward building a stable and secure financial future. For many, money is a source of stress and anxiety, often rooted in a lack of understanding or negative past experiences. However, by educating yourself and adopting healthier habits, you can make informed decisions and take control of your financial life. Here are some steps to help you achieve financial literacy and conquer your fears.
Financial literacy refers to the
interest, credit scores, and investment strategies is also important. Many websites and educational platforms break down these concepts into digestible information. Creating a monthly budget to allocate your income effectively is a practical way to begin managing your finances. A simple approach like the 50/30/20 rule—50% for necessities, 30% for discretionary spending, and 20% for savings or debt repayment—can provide structure and clarity. Setting clear financial goals, whether it’s saving for a house, paying off debt, or building an emergency fund, will give you direction and motivation. Fear of money often stems from uncertainty, lack of control, or past mistakes. Overcoming these fears requires a mindset shift and actionable steps. Reflect on your relationship with money to identify the root cause
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ability to understand and effectively use various financial skills, including budgeting, saving, investing, and managing debt. It’s not about becoming a financial expert overnight but about gaining the confidence and knowledge to make informed decisions. Start by learning the basics of personal finance through online resources, articles, and tutorials. Understanding your current financial situation is a critical first step. Take an honest look at your income, expenses, debts, and savings. Tools like budgeting apps or spreadsheets can help you track your financial activity and provide a clear picture of where you stand.
Familiarizing yourself with essential topics such as compound
of your anxiety. Are you afraid of not having enough? Do you fear making mistakes? Understanding these feelings is the first step toward addressing them. Sharing your concerns with trusted friends, family, or certified financial professionals can also provide valuable perspective and reassurance. Starting small can help reduce financial anxiety. Begin with manageable steps, such as setting aside a small amount for savings or paying off the smallest debt first. Building an emergency fund is another key step. Knowing you have a financial safety net of three to six months’ worth of
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Mental Health
Continued from page 6
benefits, but emotional benefits as well,” he said.
It takes about three months of consistently doing an activity to develop a habit. When you stop the activity, you likely extinguish the habit
Oncology
Continued from page 5
strictly the “wild type” form of the gene. H2-Aa is responsible for producing part of an immune protein called MHC class II, which helps the immune system distinguish self-proteins from non-self-proteins, readying it to attack potential invaders.
Using genetic engineering, the researchers narrowed H2-Aa’s cancer-supporting function to its presence on the surface of a subclass of immune cells called dendritic cells. Eliminating H2-Aa in only these cells was enough to mimic having
faster than you built it. It is crucial to maintain an exercise habit by blocking out some time for it daily.
“You experience low serotonin and dopamine levels in SAD, depression or other conditions, but there is a
the absence of H2-Aa throughout the body. When the researchers compared tumors that developed in wild-type mice and those in mice lacking H2-Aa, the tumors in mutant mice were infiltrated with more dendritic cells as well as more tumor-fighting CD8 T cells, and far fewer regulatory T cells that suppress anticancer immune activity.
Seeking a pharmaceutical that could produce the same effects as mutant H2-Aa, the researchers developed a monoclonal antibody – a
Financial Forecast
Continued from page 12
living expenses can significantly reduce stress. Educating yourself about risks, such as investment options, can help you make informed choices without undue worry.
Making better financial decisions often involves recognizing patterns and implementing healthier habits. Avoid impulse spending by giving yourself time before making non-essential purchases. A 24-hour rule can help you distinguish between needs and wants. Emotional spending—whether due to stress, boredom, or celebration—can also lead to trouble. Finding alternative ways to cope, such as exercise or hobbies, can help curb this behavior. Automating good habits, like setting up automatic transfers to your savings account or scheduling bill payments, can help you stay consistent and avoid penalties.
Learning from past mistakes is crucial for improvement. Instead of dwelling on financial errors, view them as opportunities to grow. Analyze what went wrong and take steps to prevent similar mistakes in the future. Seeking professional advice is also a powerful way
to gain clarity and direction. Working with CERTIFIED FINANCIAL PLANNER™ professionals can provide personalized guidance and help you create a comprehensive plan to address your financial goals.
Finally, changing how you think about money can have a profound impact on your financial behavior. View money as a tool that enables you to achieve your goals rather than a source of stress. Celebrate small victories, like sticking to your budget for a month or reaching a savings milestone. These positive reinforcements will keep you motivated.
By taking the time to become financially literate, addressing your fears, and making intentional decisions, you can create a healthier relationship with money. Remember, financial success is a journey, not a destination, and every small step brings you closer to your goals.
benefit to boosting neurotransmitter levels through exercise,” McDeavitt said.
If you experience symptoms of depression, seasonal or not, speak to your primary care provider and seek
help. Dialing 988 across the United States will connect you to the Suicide & Crisis Hotline, providing confidential support for those in distress.
protein that blocks the effects of other proteins – against H2-Aa. Although the antibody had considerable anticancer effect when delivered to mice with melanoma tumors, its effect was greatly enhanced when the researchers also treated the same mice with a checkpoint inhibitor drug, a type of immunotherapy. On the other hand, without monoclonal antibodies against H2-Aa, checkpoint inhibitors had no effect on cancer growth.
Dr. Beutler suggested monoclonal antibodies targeting the human form of
this and other closely related proteins could have a similar effect, serving as a viable cancer treatment on its own or as a boost to immunotherapy treatments. This idea might eventually be tested in clinical trials, he said.
“One-half to two-thirds of melanoma patients don’t respond to checkpoint inhibitors,” Dr. Beutler said. “These findings might be very useful if we could help everyone respond to them.”
Top 100
Continued from page 1
look forward to these honorees continuing to wield their influence to protect and improve patient care.”
Legal Matters
Continued from page 3
larger MAOs or certain providers who can afford to make marketing scheme payments. Additionally, a MAO may use payments made to providers or their staff to selectively target individuals for enrollment who are expected to increase profits for the MAO, while discouraging individuals to enroll who are expected to decrease profits to the MAO.
The most useful part of the Special Fraud Alert is its non-exhaustive list of suspect marketing arrangement characteristics. The OIG considers the following payments arrangements
between MAOs and providers to present potential compliance risk:
1. Remuneration (such as bonuses or gift cards) is in exchange for referring or recommending patients to a particular MA plan or to a particular provider.
2. Payments disguised as being for legitimate services but are actually to induce the steering of Medicare beneficiaries to a particular MA plan or a particular provider.
3. Compensation for patient information that may be used to market to potential enrollees.
4. Payment amounts that are
Future Of Health Care
Continued from page 9
Houston Methodist, we are creating a transformative platform to address critical challenges in health care with solutions that are ethical, accessible and impactful. This initiative exemplifies our commitment to driving interdisciplinary collaboration and advancing global health for the benefit of humanity.”
The Digital Health Institute will allow both institutions to share data, resources and governance in order to focus on areas such as:
• Early detection through AI algorithms for early diagnosis of cancer, infections, cardiovascular diseases and other conditions
• Predictive analytics using real-time monitoring to predict and prevent events such as strokes and heart failure
• Development of novel sensors, wearables and ingestibles to develop new remote monitoring
and care pathways
• Personalized medicine leveraging machine learning models for creating individualized health profiles based on all available data, including social, environmental and genetic profiles
• Computational biology to develop new precision therapeutics such as new antibiotics, antibodies and cancer treatments
• Development of novel imaging technologies that can see deeper and provide new diagnostic capabilities
• Development of new assistive technologies to reduce inequities across a spectrum of needs
• Telemedicine expansion delivering high quality, AI-supported medical consultations to patients in remote and underserved areas
• Patient self-management with
determined by demographics or the health status of individuals enrolled in a MA plan or assigned to a provider.
5. Payments that vary based on the number of individuals referred for enrollment in a MA plan or the number of enrollees directed to a provider.
Providers should stay on the lookout for these marketing practices and be mindful of the OIG’s scrutiny when it comes to payments between providers, MAOs, and other involved parties.
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AI-driven applications providing personalized health advice and lifestyle recommendations for proactive care management
The Houston Methodist-Rice Digital Health Institute aims to serve as a global model for collaboration, showcasing the transformative potential of combining medicine and engineering to shape the future of health care
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