We help physicians, scientists, entrepreneurs and managements change the world

ALDA & Associates International, Inc. Newsletter

 2020 SPRING EDITION

Features & Articles in this issue

Breaking News

A reminder about our Newsletter. Since we specialize in Healthcare, the feature article will always deal with healthcare. Its content will benefit all constituents-providers, insurers and patients so even though you may not work in healthcare you will benefit in knowing what is emerging which may affect your patient experience. The second article may also feature healthcare but may also focus on an aspect of business that will be of interest to our readers. Additionally, earlier editions of the Newsletter will be archived on the website. Readers can find them by scrolling down to the bottom of the newsletter.

In this edition, as the entire country is consumed by the Corona Virus Pandemic, the status quo cannot remain.  We offer up certain predictions as to how we believe COVID-19 will transform how health care will be delivered in a post COVID-19 universe. We don't claim to have a crystal ball but rather just several predictions gained by our experience in healthcare and observing what is happening on a daily basis.

The second article has been contributed by one of our clients, Dr. Russell M. Jaffe. Dr. Russell Jaffe received his BS, MD and Ph.D from the Boston University School of Medicine in 1972. He completed residency training in clinical chemistry at the National Institutes of Health (1973 – 1976), remaining on the permanent senior staff until 1979. He is board certified in Clinical Pathology and in Chemical Pathology. Dr. Jaffe has advocated a system that treats people not diagnoses, cause not consequence, and promotes long term sustainable solutions as an alternative to a system dominated by prescriptive, symptom suppressive solutions. Dr. Jaffe’s cumulative experiences enabled him to take his efforts one step further and build PERQUE Integrative Health, a company that offers the world scientifically proven, integrative health solutions that speed the transition from sick care to healthful caring. This is consistent with the direction healthcare is heading as well as with the Triple Aims of Quality Outcomes, Reasonable Cost and Patient Satisfaction. We are pleased to include his insight directed to individual patients in a world with COVID-19 running amok.

ALDA continues to add client engagements in the industry and is now working with several drug development companies to assist in refining their strategy, capital raising, getting their drug candidates through clinical trials  and thus adding to their product pipeline and navigating the Food and Drug Administration. We also have been retained to assist in a post-acquisition dispute involving the development of a recovery strategy against a public acquirer that has defaulted on their acquisition obligations.

Book News

   Essentials of Corporate and Capital Formation
   by David H. Fater
   ISBN (13): 978-0-470-49656-5
   ISBN (10): 0-470-49656-8
   Cost: $39.95
   Paperback: 224 pages


 

 Brief Description: A simple and effective guide to the mechanics of finance and corporate structure.

About ALDA:

ALDA & Associates International, Inc. is a business and financial consulting firm committed to assisting companies with:

We help physicians, scientists, entrepreneurs and managements change the world. Our experienced professionals are dedicated to helping clients unlock inherent value and create new value. The real-world experience of the ALDA team is leveraged for each client's unique circumstances, challenges, and people.

Among ALDA's hallmark services:

Our experienced professionals can show you all the right steps. For additional information on how we can help, please contact us by email at dfater@alda-associates.com or rcohen@alda-associates.com.

Back to Top

The Transformation of the Health Care System
by David H. Fater

Across the nation, non-essential businesses have closed or transitioned to remote work while hospitals and surgical centers have canceled elective procedures to avoid further spreading the coronavirus and devote resources to treating COVID-19 patients.
 
The federal government is delivering billions to healthcare organizations to support those efforts, and the $2 trillion stimulus package has special provisions for small businesses. Congress is considering a second stimulus package that would include a big focus on funding healthcare organizations. The pandemic is transforming healthcare on every level and the agile organizations that keep quality care and patient experience top of mind will thrive.

Over the past 20 years, we have seen three crises cause fundamental industry transformation. The terrorist attacks of 9/11 brought about a complete change in domestic security and the homeland security industry; the 2008 financial crisis brought about fundamental changes to the banking and financial industry; and the current COVID-19 pandemic will drive transformational change in healthcare,  Not all of the changes implemented from the first two were necessarily good or beneficial but, nevertheless, they occurred and most remain in effect today impacting many of the things we do on a daily basis. It is inconceivable to not think that many changes being implemented to deal with COVID-19 in the short-term will remain with us in the long-term and represent major transformation in the way healthcare is practiced and delivered.

What follows are 6 significant ways healthcare will change dramatically as a result of this pandemic- and some of those are not even on our conscious mind..

1. Efficient resource allocation will be achieved by more centralized command and governance of healthcare. The pandemic has highlighted several major issues with the way the current  U.S. healthcare system is functioning impacting resource allocation, information sharing, and lack of collaboration. States and health care systems were incredibly bidding against one another for the same resources and supplies. .Thankfully, with prodding from the government, competing organizations,  health systems cities and states are now collaborating to ensure  providers have what they need to care for patients. In the hardest hit areas, including New York, the state government has usurped a lot of control of healthcare to force more sharing of resources among providers. 

It would not be inconceivable that states and governments will create an organization similar to the Homeland Security Department that has the authority to acquire the necessary information and power to make sure they understand what the problem is such as identifying where more supplies are needed, and making a decision to efficiently allocate resources,  In the future this will be an issue of national security. If governments don't have that power (which they do not now have, the next time this happens we won't be able to react any better.

One could envision a new type of governing body that will manage the data aggregation and reporting in healthcare. CMS has already directed hospitals to send daily updates on COVID-19 testing as well as bed capacity and supply needs so the federal government can respond accordingly. This, interestingly enough, leads us into the next item.

 

2. Healthcare organizations will engage in greater information sharing. Sadly, we have been preaching interoperability and data sharing for years with little to no progress because of the 500+ software vendors peddling Electronic Medical Records. (Unlike the retail industry in the 1970's that formed a committee and developed standards that gave us UPC codes and the ability of manufacturers and retailers to communicate, healthcare now has no standards and systems that are incapable of talking to one another).  Long before the coronavirus emerged, the  guidelines around interoperability were being examined with the 21st Century CURES Act. In early March, the agency announced new guidance that prohibits blocking the spread of information blocking and gives patients access to their personal health records. As the coronavirus hit, the federal government continued to relax regulations around information sharing to ensure the best outcomes possible during the pandemic.

As a result of the experience of the pandemic there finally is no question now that there will be greater sharing of medical records between hospitals and providers as I have been recommending for years.
Patients need to be able to take their information from one place to the next via a personal health record, much like they can take their debit cards from one bank to the next and withdraw funds without extra cost. In healthcare, going from one system to another should be seamless for the patient. In fact, there was a company that had developed such a vehicle with special image compression software such that the patient had a "credit card" with a USB connection such that all interactions with providers together with images could be possessed by the patient so he has up to date medical records for the provider to access during the encounter.

3. Patients will take a more active role in their care. Almost all physicians have turned to telemedicine during the pandemic to stay connected with their patients. CMS finally adopted reimbursement levels for telemedicine permitting more widespread use. With the expanded access to telemedicine, and as the patient comfort level increases, it will be easier for patients to shop for their care. Coupled with the ability to take their health records with them, patients won't need to be locked into one provider or health care system.This will be a major change and shift power to the patient. In doing so, the patient will become better educated and start to take a greater role in their care decisions. This is another philosophy I have expounded for years and see the preceding comment for a vehicle

4. Patients will want to stay away from hospitals and want more procedures performed in outpatient settings such as Ambulatory Surgery Centers, Urgent Care Centers and Imaging Centers.  The push to free standing facilities out of the hospital has been initiated by the Affordable Care Act and the push to reduce healthcare costs. Now with the risk of hospital acquired infections increased as a result of COVID-19, more and more services will be performed outside of hospitals.  

5. Direct Primary Care may see even more rapid growth..  The Winter Edition of this Newsletter featured an article on the concept of Direct Primary Care (DPC).  Please scroll down to refer to that article rather than repeat it here but the important features are:
A. DPC physicians foster an enduring doctor-patient relationship
B. DPC is growing and DOs are joining in
C. Efforts are underway to enhance DPC
D. DPC offers upfront pricing
E. DPC embraces the ‘quadruple aim of medicine’.

6. Insurance Companies may suddenly find themselves less relevant or important.  As I have indicated in past newsletters, employers may accelerate their direct contracting with providers. This may not be directly attributable to COVID-19 but employers may contract directly with providers eliminating the insurance company in the equation.  A perfect example of this is General Motors which directly contracted with the Henry Ford Health System (kind of ironic-Ford and GM) to provide all medical care for their 34,000 employees in a risk-sharing contract.  We have local examples in Florida with JM Family Enterprises and Walt Disney World. This is still a work in process.


The Corona Virus has had a worldwide impact and there will be permanent ramifications in the United States.  Right now, the most important issue is to rid the virus and return to a better state of normallcy.

*******************************************************

To explore ways in which we can provide assistance in assisting with your  strategy or decipher the changing reimbursement rules being promulgated by CMS in this evolving health care environment, please contact David H. Fater at dfater@alda-associates.com or Richard M. Cohen at rcohen@alda-associates.com

Back to Top

PIH Protocol Recommendations (including COVID-19 Virus) by Russell M. Jaffe, MD, PhD, CCN

 
Enhancing your immune system competence reduces risks associated with Coronavirus (COVID19), or any viral, bacterial, prion or other pathogen. There is much nature offers to reduce risks and avoid infections.

Acute depletion of antioxidants especially ascorbate is increasingly recognized as a hallmark of COVID-19 infection; in afflicted cases the ascorbate and mineral deficits are profoundly lethal. Reduce risks. Boost immune defense and repair abilities and stay resilient.

Exposure is widespread; illness is not. For each symptomatic individual, there are likely 5-10 people whose immune defense and repair system recognize the virus and neutralize it effectively. Frequent hand washing, social distancing and skin nourishment are recommended. We suggest organic sesame oil or your favorite skin ‘butter’ such as Waleda’s biodynamic ‘skin food’ to support healthy skin integrity.

Much recent attention has focused on co-morbidities and known risk factors that include>97% of all severely affected people.

Those at risk are diabetics with hemoglobin >5% (people who keep their blood sugar in healthy ranges are not at risk), people with prior lung pathology from air pollution and/or smoking tobacco or vaping, and people taking certain medicines for heart disease. While there are more unhealthy people on the older population, birth age is not important; functional age is. While there are more at risk people in older populations, the above risks include those at these specific high priority risks who are younger.

Intensive bioavailable antioxidant, mineral, and essential cofactor supplementation have generated multiple anecdotal or early observational scientific reports strongly suggest their value, particularly when natures nutrients are used and not synthetic work-a-likes that too often do not work. Health is about what people eat, drink, think and do. The recommendations below are known to boost your immune defense and repair system and reduce infection intensity if exposed.
 
Eat a diet that is easier to digest, assimilate and eliminate without immune burden. This means eating organic or biodynamic ripe fruits, vegetables. (mostly grasses while avoiding grains), nuts, seeds, sprouts, sea vegetables, herbs, edible flowers and spices. Metabolic and nutritional balance is reflected in a urine pH between 6.5-7.5 after six or more hours of rest. Resources at the end of this article provide additional information.
 
Digestion improves when people start each meal with something warm, wet and savory. Enhance healthier methylation by making dietary staples from garlic, ginger, onions, brassica sprouts and eggs (the sulfur rich foods sometimes referred to as GGOBE). Avoid processed foods, at least because they have too much processed fat, salt, and sugar.
 
Methylation is important for proper translation of genetic code, cell detoxification, and for proper cell product synthesis. A healthy methionine to homocysteine ratio is suggested.
 
For those concerned about co-infections and lung surfaces that are more hospitable to viral ‘docking’. The comments here are the best defense enhancement we know to successfully adapt to this global health challenge. Fever can be a helpful change in temperature that improves immune defense and repair abilities. Current best guidance is to avoid NSAIDS, particularly ibuprofen.
 
There are benefits from each and synergy of benefits from all of the following:
1. Stay well hydrated – Drink plenty of water and herbal beverages –1 gallon per day. I keep a glass and a carafe of water on my desk. When the glass is full, I drink it; when it is empty, I fill it and repeat.
2. Keep your 1st morning Urine pH between 6.5 and7.5. Excess acid in cells prevents healthy cell activity. While known as metabolic acidosis in clinical pathology it is really magnesium cell deficit in physiology. See item 2 in the essential supplements section below.
3. Get enough quality, restorative sleep by following a sleep preparation plan. I suggest 30 minutes before bed taking a salt and soda bath (½ cup Epsom Salt & ½ cup baking soda) and practicing abdominal breathing and a relaxation response or active meditation such as you would find at activemeditation.org. Stretch regularly. For me this includes stretching in bed before sleep, before getting out of bed on waking and in the shower. Stretching helps renew body infrastructure and helps reverse gravity’s tendency to contract while improving sleep quality. For some, enhanced uptake Tryptophan, natures source of serotonin and melatonin more safely, is recommended.
4. Eat what you can digest, assimilate, and eliminate without immune burden. Hidden immune burdens hinder your immune system’s defense and repair function. Start each meal with something warm, wet and savory. Eat easier to digest, nutritionally dense whole foods in a wide variety of ways. Choose foods without toxic residues. 

The LRA (lymphocyte response assay) by ELISA/ACT ® tests your personal immune response to up to 500+ common foods, colors, preservatives, environmental compounds and medications. When you identify and substitute for dietary immune burdens, you make your immune system better able to fully function. To find a healthcare practitioner who offers the LRA by ELISA/ACT tests, available with safer home phlebotomy, email ClientServices@ELISAACT.com or to order testing directly, visit https://www.betterlabtestsnow.com/.
 
 5. Consider improving the air quality in your home or office with a room ionizer similar to those sold on molekule.com or bionaire.com. In the 21st century, a healthy diet and lifestyle are no longer sufficient to optimize your immune and neurohormone functioning. Being proactive about the air in your home, school or office is timely. 
6. There are four self-assessment personal kits that are good places to start on a journey to healthier life. Predictive biomarkers that cover epigenetics are available and are more helpful when interpreted to best outcome goal values. 
7. Anxiety and fear reduce and repress immune defense and repair ability. Knowledge and experience improve immune defense and repair ability, neurohormonal balance and quality of life. 

My team developed the PERQUE® brand of professional, scientifically researched and validated quality formulations to meet these needs through the most advanced, highest quality, full disclosure, all active formulations of nature’s nutrients.
 
The seven suggestions below provide meaningful amounts of safer essential nutrients.
  1. Take enough L-ascorbate (based on your C cleanse/calibration results). L- ascorbate is an excellent antioxidant and a potent natural anti-viral, but only when it is 100% L- ascorbate, fully reduced and buffered as you find in PERQUE Potent C Guard™ powder or tabsule.
  2. PERQUE MG Plus Guard™ and PERQUE Choline Citrate™ taken together are a proven system for improving the amount of magnesium your body can absorb and use. Take 2 capsules + 1 teaspoon twice or more daily to keep first AM urine pH 6.5 – 7.5.
  3. PERQUE Life Guard™ mini tabsules, 2-4/day (enough to keep your well hydrated urine sunshine yellow). This super-multi-vitamin/mineral provides a solid foundation of nutrients necessary for resilient health.
  4. PERQUE Zinc & Throat Guard Lozenges™, 1-3 lozenges/day or as needed. These fully soluble, synergistic nutrients help fight infection and provide maximum immune support. Learn about assessing your zinc status.
  5. PERQUE Repair Guard™ / PERQUE Pain Guard Forte™, 4-12 tabsules/day. This potent flavonoid/flavanol polyphenolic combination of quercetin dihydrate and OPC works synergistically with L-ascorbate to activate cells responsible for defense and repair.
  6. PERQUE K2/D3 Plus Guard™, 1 capsule/day and/or PERQUE D3 Cell Guard™, 5- 10 drops/day or sufficient to keep your D3 levels with the best outcome goal range of 50-80 ng/ml. Maintaining an adequate level of D3 supports a healthy immune system with enhanced viral protection especially from respiratory and intestinal infection.
  7. PERQUE Liva Guard Forte™, 1-2 softgels per day provides much needed liver detox support with milk thistle and additional antioxidant nutrients. Additionally, it is a good source of vitamin D. Daily Vitamin D intake should be enough to maintain healthy blood vitamin D (25-OH-D) levels of 50-80 ng/ml.
What about ascorbate?
 
The devastating consequences of COVID-19 infection can all be explained as multiple expressions of acute vitamin C depletion. Acute scurvy can present in this way. From red cell destruction to iron oxidation; from tiny blood vessel damage to lung and heart dysfunctions. Multiple reports suggest benefit in people at risk when adequate ascorbate is taken in. Nature’s fully buffered, fully reduced l-ascorbate is needed and recommended.

What about hydroxychloroquine?

Hydroxychloroquine works by increasing cell zinc and magnesium that, in turn, reduce viral replication. Several of the suggestions above include zinc ionophores, nature’s way to facilitate zinc and other helpful minerals be taken up by cells in need.
Experienced clinicians have long reported multiple adverse effects from this medication. It is immune suppressive and can be helpful when the immune system is attacking the body for unclear reasons.
LRA tests allow personalized assessments of immune tolerance and intolerance. This includes helpful recommendations to restore healthy internal balance in both the digestive microbiome and the metabolic metabolome.

What about Cytokine Storm?

People at risk from repair deficit (inflammation) and/or self-attacking chronic illness (autoimmune conditions) are particularly in need of this tolerance and resilience enhancing guidance. More Omega 3 (EPA and DHA) and less Omega 6 (Arachidonate and Alpha-Linoleate) reduces risk. Processed foods are Omega 6 rich and often contain anti-nutrients that further deplete essential nutrients and increase risk.
When your immune system is burdened, further foreign invasion can cause over stimulation of pro-inflammatory, Omega 6 fat-derived amplification molecules known as cytokines. A well supported immune system never causes such self-attack. This protocol avoids the risk of cytokine storm syndrome.

What about glyphosate?
 
Glyphosate is one of many persisting organic pollutants that deplete magnesium, zinc, and antioxidants such as ascorbate. This qualifies as an anti-nutrient. This, among other
reasons, is why we recommend non-GMO, non-glyphosate foods.
 
What about co-infection?
 
When people become hospitable to viruses they are also often susceptible to other infections. Increasing evidence confirms that enough healthy prebiotic fiber, probiotic digestive organisms, and symbiotic recycled glutamine crowd out pathogens and promote host resistance to infections.
Antibiotics are available. We suggest prebiotics, probiotics, and symbiotics before antibiotics. When antibiotics are given, it typically takes months to restore healthy digestion and metabolism.

Strengthen host defense and repair to live well and avoid viremias

Restore immune tolerance and balance neurohormones starting with four self- assessments and eight predictive epigenetic biomarker tests interpreted to best outcome goal values with life style physiology before pharmacology guidance.
This brings us full circle for now. Strengthening host defenses and reducing risks are a choice. If not now, when is the time to invest in your health and well-being?
 

****************************************************************
More information is available from DrRussellJaffe.com, Dr Russell Jaffe on YouTube, BetterLabTestsNow.com, ELISAACT .com, PERQUE.com, and HealthStudiesCollegium.org

You may also be interested in free downloads… A Users Guide to Vitamin C and Your Viral Risk Reduction Plan. You are also encouraged to download The Joy of Living the Alkaline Way.

Back to Top

Representative Engagements

  • Advisor to three drug development companies for raising capital, designing and implementing clinical trials and interfacing with the FDA.
  • Initiated and developed a de novo Accountable Care Organization to participate in the Medicare Shared Savings Program which grew to over 250 physicians over three years which successfully generated savings.
  • Financial advisor to large physician practice in connection with a potential acquisition transaction where engagement includes determination of strategic and fair value and assisting in negotiations for closing the acquisition and in post acquisition integration.
  • Review and in-depth analysis of new Medicare Reimbursement rules for subsidiary of Fortune 50 insurance company and assistance in developing a business model enabling the capture of a new revenue stream for both physician practices and affiliated providers.
  • Acquisition due diligence and integration assistance for a public healthcare staffing company involved in numerous acquisitions. Retained by parent company to manage acquired company for 22 weeks through ALDA developed integration plan.
  • Turnaround assistance for a near bankrupt client company, including tax and financial restructuring, and ultimate sale at a significant cash price.
  • Leadership of development of client company's strategic plan for the next decade and assistance in repositioning the company.
  • Determination of strategic value of a client company, packaging for sale and assisting in negotiations.
  • Providing the entire management team for several life science and healthcare companies from early stage through obtaining additional patent protection, guiding clinical development plans, navigating the pathway through the FDA, establishing the manufacturing processes, initiating commercial sales and eventually transforming the Company into a publicly traded Company.
  • Determination of strategic implications of a line of business with weak performance; development of strategies to maximize profitability contribution.
  • Turnaround assistance for a troubled venture-backed company, including raising additional debt and equity capital.
  • Acquisition and financing assistance for a public, international railroad in connection with a $300 million cross-border acquisition and refinancing.

Our experienced professionals are dedicated to helping clients unlock inherent value and create new value.

The ALDA Team includes, among others:

David H. Fater - Chief Executive Officer

Strategy, capital markets, restructuring, and mergers and acquisitions experience with public healthcare companies focused on physician management, rural healthcare, nursing homes, HMO's, diagnostic imaging and medical devices. Deeply involved in the implementation of the Affordable Care Act with Accountable Care Organizations, Independent Practice Associations and Management Services Organizations. 

Richard M. Cohen - Senior Operations and Business Development Executive

Healthcare operations and worldwide sourcing experience. Skilled in healthcare (physician management, clinical trials, medical and patient process flow, diagnostic imaging and life science) operations as well as in issues dealing with importing, exporting and manufacturing operations in South America, Far East and Europe. 

Thomas J. Bohannon - Senior Financial Executive

Accomplished, creative CPA, outstanding analytical and technical abilities. Has experience for over 40 years in public accounting and private industry including nursing homes, medical device companies,  hospitals, not-for-profits, retail, manufacturing, import/export and natural resources.

A. Ronald Turner - Senior Healthcare Executive

Senior healthcare industry executive with strong entrepreneurial focus including CEO and COO positions with start-up hospital companies and a publicly-traded hospital company. Extensive and successful operations experience for more than 50 hospitals and 9 nursing homes, and senior reimbursement experience for a major publicly-traded hospital company and a national accounting firm. Experienced in mergers and acquisitions, led operational turnarounds and debt restructurings that created significant value.

Mark W. Caton – Senior Healthcare Executive

Senior hospital executive with over 30 years experience in operating not-for-profit and investor-owned rural/community hospitals as CEO or COO, and Regional COO with several national hospital companies.  Skilled in strategic planning and business development, operations management, revenue cycle management, medical staff development, and quality/resource management.

Daniel N. Weiss, M.D., F.A.C.C. - Chief Medical Officer

Medical devices and healthcare practice experience, engaged in a private medical electrophysiology practice where he performs numerous invasive cardiac procedures and has served as a consultant for several Fortune 500 Medical Device Companies including Philips, Boston Scientific/Guidant, St. Jude and Medtronic, as well as for several medical device and drug start-up companies. 

David Bott - Senior Information Technology Executive

Systems and network support solutions experience, proviedes analyis of strategic business needs and assessment of business models and their integration with technology.  

Santiago Guzman - International Executive

Experienced in new project development for companies in a variety of industries from start-up to Fortune 500. Client relations management, fluent in English and Spanish. Skilled facilitator for introductions with influential leaders in South America including those in the health care industry. 

With offices in:

  • Delray Beach/Boca Raton, FL
  • Atlanta
  • New York
  • Quito, Ecuador

For additional information, please contact:
David H. Fater, Chief Executive Officer
ALDA & Associates International, Inc.
15977 Brier Creek Drive, Suite 100
Delray Beach, FL 33446
(877) 845-4657
dfater@alda-associates.com

Would you like to receive a copy of the Alda & Associates Newsletter in your e-mail? Simply fill out the brief form below.

Subscribe to our mailing list

* indicates required
Email Format

© 2003-2024 ALDA & Associates International, Inc. All Rights Reserved.
Dayton Ohio website design by Design Chemistry