Podcasts about cmmi

The U.S. healthcare system is approaching a major inflection point. Nearly $1 trillion in Medicaid cuts are set to take effect in January 2027, driven by new work requirements, more frequent eligibility checks, and tighter limits on state financing. While the policy changes are months away, their consequences are already clear: millions of Americans are at risk of losing coverage, and provider organizations — many operating on margins near zero — will absorb the downstream impact through rising uncompensated care. In this episode, hosts Rae Woods and Abby Burns are joined by former Optum Executive Director of Product and Strategy Sunay Shah to help healthcare leaders move from “scramble” to strategy. Drawing on lessons from past Medicaid shifts, including redeterminations and state level work requirement experiments, they explain why administrative disenrollment —not ineligibility — is the biggest threat facing patients and providers alike. Together, they break down what health systems can do now to keep eligible patients covered: redesigning workflows earlier in the patient journey, using technology more thoughtfully, partnering with community organizations, state agencies, and operational support partners, and rebuilding trust with patients during moments of vulnerability. We're here to help: Episode | 288: Health policy update: VBC, site-neutral payments, and 340B Playlist | Radio Advisory health policy playlist Ready-to-Use Resource | Your guide to CMMI's 25+ innovation models Expert Insight | How policy changes will impact your bottom line White Paper | Navigating the next era of Medicaid On-Demand Webinar | Adapting to the changes in Medicaid policies Want to learn more about how Optum can help? Connect with our team today Register today for the 2026 Advisory Board Summit in Washington, D.C. 2026 State of Healthcare Procurement: Cost, Quality, Resilience A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.

Government contracting certifications like CMMC, ISO, and CMMI are no longer optional — they're the difference between standing out and getting buried in a pile of minimum-qualified vendors. In this episode, a seasoned IT govcon professional breaks down the exact moves small businesses need to make to get their foot in the door and grow once they're in. You'll learn: Why niche certifications win contracts — With CMMC Level 2 deadlines approaching, the shortage of certified companies is your window to stand apart from competitors still meeting bare minimums How security clearance sponsorship actually works — There is no application you can submit; you have to create value first, and this episode shows you exactly how to position yourself to get sponsored Subcontracting as a low-risk entry strategy — Learn why starting as a sub gives you past performance, prime relationships, and critical compliance knowledge without carrying all the risk Fractional support and contract funding — Discover how to build a back office with SME-level talent on a startup budget, and why getting funded before you win is non-negotiable OASIS Plus and contract vehicle timing — Why you need to start the onboarding process now, and how to use the Mentor-Protege Program to unlock reimbursable expenses and government-backed growth EPISODE CHAPTERS: 0:00 - Welcome to the Federal Help Center Podcast 0:31 - How to add value and address government pain points 1:29 - Niche certifications that set your company apart 2:27 - Subcontracting strategy for low-risk market entry 3:19 - How security clearance sponsorship really works  5:15 - Building your govcon growth strategy from the ground up 5:44 - Fractional support and getting your business funded 7:36 - OASIS Plus onboarding and contract vehicle timing 8:33 - Networking, mentors, and the Mentor-Protege Program If you want to learn more about the community and to join the webinars go to: https://federalhelpcenter.com/ Website: https://govcongiants.org/ Connect with Encore Funding: http://govcongiants.org/funding

Send us Fan MailCheck us out at:  https://www.cisspcybertraining.com/Get access to 360 FREE CISSP Questions:  https://www.cisspcybertraining.com/offers/dzHKVcDB/checkoutGet access to my FREE CISSP Self-Study Essentials Videos:  https://www.cisspcybertraining.com/offers/KzBKKouvAn AI model that can uncover thousands of zero-days and potentially chain multiple vulnerabilities into an automated exploit is not just a scary headline, it's a stress test for every risk program on the planet. I open with what the Mythos news implies for real-world defense: attacker behavior may shift from human pace to machine speed, and many SIEM and EDR detections are still tuned for human patterns. That's why we talk candidly about what security teams may need to do next, including tightening externally facing systems and moving faster toward a zero trust architecture. Then we pivot into CISSP Domain 1 risk management concepts, translating exam language into decisions you'll actually make in a business. We define the core terminology like assets, threats, vulnerabilities, exposure, safeguards, attacks and breaches, then walk through control categories (technical, administrative, physical) and control types (preventive, detective, corrective, deterrent, recovery and compensating). If you've ever wondered why risk conversations go sideways, we also dig into the difference between risk appetite, risk capacity, and risk tolerance, and why you can't set these without business leaders in the room. We also tackle quantitative risk analysis versus qualitative risk analysis, including CISSP formulas such as AV, EF, SLE, ARO and ALE, plus a critical reality check on “fake precision” and how to apply a cost-benefit analysis that holds up. Finally, we cover security control assessments, monitoring and measurement, building a risk register safely, and how maturity models and risk frameworks like CMMI, ISO 31000, NIST approaches, ISO 27005, COBIT, SABSA and PCI DSS fit into a defensible cybersecurity risk management program. Subscribe, share this with a CISSP study partner, and leave a review so more security pros can find the show.Gain exclusive access to 360 FREE CISSP Practice Questions at FreeCISSPQuestions.com and have them delivered directly to your inbox!  Don't miss this valuable opportunity to strengthen your CISSP exam preparation and boost your chances of certification success. Join now and start your journey toward CISSP mastery today!

After a turbulent 2025, the early months of 2026 are proving that the policy landscape isn't quieting down. Federal agencies are rolling out new payment models, lawmakers are revisiting long debated rules, and courts continue to shape what policies move forward and which stall. From value based payment to drug pricing and site of care policy, leaders are navigating a fast shifting environment with real implications for finances, operations, and long term strategy. In this episode, host Abby Burns invites three Advisory Board experts to break down the major policy forces that leaders need to watch now: [1:35] Clare Wirth explains the newest wave of value based payment models out of CMMI, and what they signal about this administration's posture toward value-based care. [10:20] Nick Hula explores how site neutral payments, the return of inpatient only list changes, and state level certificate of need laws could accelerate site of care shifts. [20:51] Chloe Bakst unpacks the chaos surrounding 340B — from the halted rebate pilot to impacts of HR1 and emerging state reporting requirements — and the decisions leaders must make today to prepare for what's coming next. We're here to help: Webinar | How to be successful under TEAM Cheat sheet | 340B Drug Pricing Program Ready-to-Use Resource | Policy Scenario Impact Calculator Expert Insight | How policy changes will impact your bottom line Expert Insight | Inside CMS' final rule changes for 2026 Stay Informed | Healthcare Policy Updates Timeline Radio Advisory's Health Policy playlist Webinar | Join Optum Advisory experts at this upcoming webinar to learn how optimizing patient access unlocks the value of digital innovations and drives long-term sustainability A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.

On this episode of Higher Exchanges, Jesse Redmond and Morgan Paxhia are joined by Bill Morachnick, CEO of Charlotte's Web, to explore whether the CBD category is entering a true restart or simply experiencing another policy-driven moment.The conversation covers the evolution of CBD since the 2018–2019 boom, the emerging Medicare/CMMI reimbursement channel, and how regulatory momentum could reshape access, adoption, and total addressable market — particularly among senior consumers.Bill shares how Charlotte's Web is positioning for a more medical and regulated future, including advantages in compliance, formulation, distribution, and brand trust, as well as the company's botanical drug development strategy and long-term optionality.We also discuss minor cannabinoids, capital markets implications, the role of BAT's investment, lessons from the last CBD cycle, and what a durable path forward for the category could look like.Higher is exchanges is presented by Flowhub. 

 In Episode 123 of DC EKG, Joe Grogan sits down with Jackson Hammond (Senior Policy Analyst, Paragon Health Institute) to unpack what the latest CMS National Health Expenditure (NHE) data says about where U.S. health care is headed. They break down the June 2025 NHE release, compare it to Jackson's earlier “Paragon Prognosis” analysis, and explain what changed, what didn't, and what it means for affordability, Medicare, Medicaid, and long-run fiscal pressure. They also connect the spending outlook to Jackson's paper, “How to Reform the CMS Innovation Center with a Choice and Competition Approach,” and debate whether CMMI is bending the cost curve or just adding bureaucracy without accountability. Jackson argues we should aim for health care so affordable you barely need insurance. Chapters / Timestamps  00:00 – Intro + welcome  00:55 – Jackson's background: how he got into health policy  03:39 – Focus areas: Medicare, hospitals, drug pricing, PBMs, 340B  05:14 – What the NHE report is showing  06:14 – $5.2T → $5.6T → $8.6T: why the trajectory matters  08:00 – Why health spending isn't really “optional”  10:11 – Where the money is going: payer mix + per-enrollee costs  12:23 – Medicaid costs, provider taxes, and state financing tactics  15:58 – Medicare spending pressure and fiscal risk  21:06 – Misconception: “coverage = care”  26:18 – Why provider payments keep rising (post-COVID demand + consolidation)  33:01 – Rural care, consolidation, and the REH / hub-and-spoke model  40:08 – Drug pricing: retrospective vs prospective MFN  49:20 – 2026 outlook + closing thanks In This Conversation  • NHE 2025: what the June 2025 data confirms about spending growth and the federal share.  • Rising prices, flat health: why prices climb while outcomes lag.  • Medicare and Medicaid: why they remain major budget drivers.  • Coverage vs access: why an insurance card doesn't guarantee care or better health.  • Hospitals and consolidation: what's driving higher payments and fewer choices.  • Rural vs urban: why patients bypass local hospitals and what a better model could look like.  • Drug pricing: what MFN approaches might mean for costs and innovation.  • 2026: what Jackson expects next and what reform could realistically look like. Key Takeaways  • NHE data points to continued, unsustainable spending growth.  • Medicare and Medicaid drive long-term budget pressure.  • Consolidation and payment incentives shape prices as much as utilization.  • CMMI reform hinges on accountability, choice, and competition.  • Smarter drug pricing policy should lower costs without undermining innovation. About Our Guest  Jackson Hammond is a Senior Policy Analyst at the Paragon Health Institute focused on health spending, CMS policy, and reforms centered on choice, competition, and patient-centered care. He authors Paragon's “Paragon Prognosis” analyses and wrote “How to Reform the CMS Innovation Center with a Choice and Competition Approach.”

 In Episode 123 of DC EKG, Joe Grogan sits down with Jackson Hammond (Senior Policy Analyst, Paragon Health Institute) to unpack what the latest CMS National Health Expenditure (NHE) data says about where U.S. health care is headed. They break down the June 2025 NHE release, compare it to Jackson's earlier “Paragon Prognosis” analysis, and explain what changed, what didn't, and what it means for affordability, Medicare, Medicaid, and long-run fiscal pressure. They also connect the spending outlook to Jackson's paper, “How to Reform the CMS Innovation Center with a Choice and Competition Approach,” and debate whether CMMI is bending the cost curve or just adding bureaucracy without accountability. Jackson argues we should aim for health care so affordable you barely need insurance. Chapters / Timestamps  00:00 – Intro + welcome  00:55 – Jackson's background: how he got into health policy  03:39 – Focus areas: Medicare, hospitals, drug pricing, PBMs, 340B  05:14 – What the NHE report is showing  06:14 – $5.2T → $5.6T → $8.6T: why the trajectory matters  08:00 – Why health spending isn't really “optional”  10:11 – Where the money is going: payer mix + per-enrollee costs  12:23 – Medicaid costs, provider taxes, and state financing tactics  15:58 – Medicare spending pressure and fiscal risk  21:06 – Misconception: “coverage = care”  26:18 – Why provider payments keep rising (post-COVID demand + consolidation)  33:01 – Rural care, consolidation, and the REH / hub-and-spoke model  40:08 – Drug pricing: retrospective vs prospective MFN  49:20 – 2026 outlook + closing thanks In This Conversation  • NHE 2025: what the June 2025 data confirms about spending growth and the federal share.  • Rising prices, flat health: why prices climb while outcomes lag.  • Medicare and Medicaid: why they remain major budget drivers.  • Coverage vs access: why an insurance card doesn't guarantee care or better health.  • Hospitals and consolidation: what's driving higher payments and fewer choices.  • Rural vs urban: why patients bypass local hospitals and what a better model could look like.  • Drug pricing: what MFN approaches might mean for costs and innovation.  • 2026: what Jackson expects next and what reform could realistically look like. Key Takeaways  • NHE data points to continued, unsustainable spending growth.  • Medicare and Medicaid drive long-term budget pressure.  • Consolidation and payment incentives shape prices as much as utilization.  • CMMI reform hinges on accountability, choice, and competition.  • Smarter drug pricing policy should lower costs without undermining innovation. About Our Guest  Jackson Hammond is a Senior Policy Analyst at the Paragon Health Institute focused on health spending, CMS policy, and reforms centered on choice, competition, and patient-centered care. He authors Paragon's “Paragon Prognosis” analyses and wrote “How to Reform the CMS Innovation Center with a Choice and Competition Approach.”

This week in the Breakroom, Simeon Niles and Amy Kelbick join Maddie News to dive into recent administration announcements and CMMI models related to drug pricing and accessibility.

Catherine Olexa-Meadors, head of growth and partnerships at Town Hall Ventures, joins Josh Israel, MD, and Sean Cavanaugh to discuss the recently announced ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model from the Center for Medicare and Medicaid Innovation (CMMI), also known as the CMS Innovation Center. They explain the new payment system, which includes outcome-aligned payments tied to demonstrating improved patient outcomes, and how advances in technology, specifically in digital patient engagement, could help this model succeed. They also explore challenges, including the delay in the announcement of payment rates and the concern that patients not in an accountable care organization (ACO) may not have someone monitoring the total cost of care.   Watch the full episode on YouTube   Listen to Episode 193: Breaking down CMMI's new strategy with Abe Sutton, director of CMMI, and Farzad Mostashari, MD

Physicians and other senior-serving professionals trying to operate within the complicated Medicare ecosystem must be constantly learning, as the landscape, rules, tools, and vendors are in constant flux. We interview eldercare and Medicare industry experts, do deep dives into their companies, services, and experiences, and share their stories and insights with you.

This episode announces the launch of CMS's ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) model - a groundbreaking payment innovation that enables technology-enabled care organizations to treat Medicare fee-for-service patients with chronic conditions through outcome-aligned payments rather than traditional fee-for-service. Abe Sutton (Director of CMMI) and Jacob Shiff (Chief AI & Technology Officer at CMMI) explain how the model addresses a fundamental gap in healthcare: while commercial and Medicare Advantage patients have access to digital therapeutics and technology-enabled chronic disease management, original Medicare beneficiaries have been left behind. ACCESS changes this by paying providers monthly fees for managing conditions like diabetes, hypertension, obesity, behavioral health issues, and musculoskeletal pain - but only when patients achieve measurable clinical improvements. The model is designed to be deflationary rather than inflationary, encourages innovation by simplifying go-to-market for digital health startups, integrates with existing risk-bearing models like ACOs, and represents a broader CMMI strategy to shift from activity-based to outcome-based payments while leveraging new AI capabilities to democratize high-quality care. (0:00) Intro(0:57) The ACCESS Model: Advancing Chronic Care(4:35) Outcome-Aligned Payments and Technology(7:40) Encouraging Innovation and Investment(09:23) Practical Implementation and Examples(24:28) Evaluating Success and Future Goals(26:18) Connecting the Dots: Broader CMMI Initiatives(28:40) Generous and Its Impact on Drug Pricing(30:11) Challenges and Benefits of Prior Authorization(35:19) The Role of Technology in Healthcare(37:59) AI and Technology-Enabled Care(40:26) Reflections on Value-Based Care Models(43:51) Encouraging Competition in the Healthcare Market(48:24) Quickfire Out-Of-Pocket: https://www.outofpocket.health/

From being at the center of some of the most significant shifts in U.S. healthcare policy over the past two decades, Liz Fowler can offer valuable perspective in uncertain times. In her most recent government role, Liz served as director of the Center for Medicare and Medicaid Innovation (CMMI), an organization she helped create a decade earlier. As Chief Health Counsel at the Senate Finance Committee, Liz played a major role in the drafting and passage of the Affordable Care Act (ACA) in 2010, which established CMMI. She then served as special assistant to President Obama on health care and economic policy at the National Economic Council to implement the ACA. She also played a key role drafting the 2003 Medicare Prescription Drug, Improvement and Modernization Act (MMA).Liz says she's a public servant at heart, but credits her time in the private sector at Johnson & Johnson and WellPoint (now Elevance) for making her a more effective government leader. Today, Liz provides guidance, insight, and strategy for a broad array of health care stakeholders, including payers, health systems and providers, trade associations, technology companies and more as co-founder and managing partner of Health Transformation Strategies.Liz talked to Keith Figlioli for this episode of Healthcare is Hard to share insight and perspective as healthcare organizations navigate changing regulations, including those in the “Big Beautiful Bill.” Topics they discussed include:The ROI of CMMI. Liz explained the difficulties tracking the savings that CMMI generates. She believes the mechanisms for measuring CMMI are too narrowly defined, making it hard to capture the full impact of its work. She advocates for a broader definition of success, emphasizing that innovation is a process—one where failure can provide just as much impact and opportunity for learning.Limited bandwidth for innovation. It's a challenging time for healthcare organizations that are scrambling to meet deadlines and ensure they're in compliance with various regulations, including provisions of the “Big Beautiful Bill.” Liz believes this is pulling time and attention away from innovation and slowing progress toward advancing value-based care. Despite the overall constraints Liz sees with the current regulatory environment, she's optimistic about rural health transformation funding and how that could spark some innovation.The revolution that's not coming. Throughout the conversation, Liz reiterated that “healthcare is hard.” She cautioned against expecting sweeping, revolutionary change, noting that progress in healthcare is incremental. Drawing on her 25+ years in health policy, Liz encouraged listeners to celebrate small victories and keep pushing forward, as real transformation happens step by step.To hear Liz and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Operating as a small business in government contracting is expensive and competitive. Everyone tells you to "stand out" and "differentiate," but when you're already stretched thin on resources, how do you decide where to invest?In this co-host episode, Tasha and Yas tackle the real costs and challenges of strategic differentiation. They explore how selling hardware and software products can create new revenue streams (and what compliance hurdles you'll face), examine certifications like CMMC and CMMI that can unlock contract opportunities (and whether the six-figure price tags are worth it), and discuss creative diversification strategies that don't require massive capital investments.From GSA Schedules and FedRAMP certification to strategic partnerships and niche specialization, this episode delivers an honest conversation about what it takes to compete effectively in today's GovCon market. Whether you're considering your first product line, evaluating whether a certification makes sense for your business stage, or exploring SLED and commercial opportunities, Tasha and Yas provide a practical decision framework to help you invest strategically.Key topics covered include product sales and the compliance differences between hardware and software, how to prioritize certifications like CMMC, CMMI, ISO, and FedRAMP, and alternative differentiation strategies such as geographic expansion, partnerships, IP development, and niche specialization. They also break down real cost and timeline expectations for each option, along with a clear decision-making framework that highlights green lights and red flags for smart investments. The episode even includes accessible strategies designed specifically for businesses under $5M in revenue.Whether you're new to the GovCon space or a seasoned professional looking to grow with intention, this episode provides the honest insights you need to make smarter decisions about differentiation and investment.Call(s) to Action:Interested in learning more about or leveraging Collective's services? Click here to schedule a call and learn more about how Collective can help power your business.Help spread the word about Unveiled: GovCon Stories.Do you want to be a guest or recommend a topic that you would like to learn or hear about on the podcast? Let us know through our guest feedback and registration form.Sponsors:The views and opinions expressed in this podcast are solely those of the hosts and guests, and do not reflect the views or endorsements of our sponsors.Withum – Diamond Sponsor!Withum is a forward-thinking, technology-driven advisory and accounting firm, helping clients to be in a position of strength in today's complex business environment. Go to Withum's website to learn more about how they can help your business! Hosted on Acast. See acast.com/privacy for more information.

Send us a textQuantum threats aren't waiting politely on the horizon, and neither should we. We kick off with Signal's bold move to deploy post-quantum encryption, unpacking the “belt and suspenders” approach that blends classical cryptography with quantum-resistant algorithms. No jargon traps—just clear takeaways on why this matters for privacy, resilience, and the pressure it puts on other messaging platforms to evolve. We point you to smart reads from Ars Technica and Bruce Schneier that make the technical guts approachable and actionable.From there, we switch gears into a focused CISSP Domain 8 walkthrough: how to weave security into every phase of the software development lifecycle. We talk practical integration across waterfall, agile, and DevOps; show why change management, continuous monitoring, and application-aware incident response are non-negotiable; and explain how maturity models like CMMI and BSIMM help teams move from reactive to repeatable. We also break down the developer's toolbox—secure language choices, vetted libraries with SCA, hardened runtimes, and IDE plugins that surface issues in real time—so teams can ship faster without trading away safety.Speed meets rigor in the CI/CD pipeline, where shift-left security comes alive with SAST, DAST, and SOAR-driven checks. We cover repository hygiene, secret scanning, and how to measure effectiveness with audit trails and risk analysis that map code issues to business impact. You'll get a clear view of third-party risk across COTS and open source, the shared responsibility model for SaaS, PaaS, and IaaS, and the daily practices that keep APIs from leaking data: least privilege, strict authorization, input validation, and rate limiting. We close with software-defined security—policies as code—bringing consistency, versioning, and automation to your defenses. Subscribe, share with a teammate who owns your pipeline, and leave a review to tell us the next Domain 8 topic you want us to deep-dive.Gain exclusive access to 360 FREE CISSP Practice Questions at FreeCISSPQuestions.com and have them delivered directly to your inbox! Don't miss this valuable opportunity to strengthen your CISSP exam preparation and boost your chances of certification success. Join now and start your journey toward CISSP mastery today!

In this episode, Shiv is in conversation with Naresh Choudhary, Senior Vice President, Quality & Productivity, Infosys Ltd.Naresh shares his career journey starting from humble beginnings in Mumbai, studying engineering at VJTI, working at Arvind Mills, and eventually contributing to Infosys for 25 years. The discussion covers his transition from manufacturing to IT, the influence of mentors, various roles at Infosys, and the importance of reframing roles. Naresh also emphasizes the value of great work, networking, mentorship, and maintaining a work-life balance. He talks about driving innovation and change management effectively within a large organization through transparent communication, planning, and continuous feedback. Finally, Naresh offers personal practices like journaling, exercising, and separating work from family time to stay grounded and calm.00:00 Welcome and Introduction00:23 Early Career and Education02:00 Transition to Infosys03:43 Roles and Responsibilities at Infosys07:16 Mentorship and Career Growth10:28 Defining Great Work15:32 Overcoming Self-Doubt and Imposter Syndrome19:28 The Importance of Mentors24:23 Networking and Time Management29:19 Clearing the Mind for Focus29:51 Work-Life Balance and Breaks30:59 Organizational Change and Trust33:51 Planning and Transparency in Change34:51 Process Over Tools36:04 Sponsorship and Milestone Reviews37:46 Encouraging Knowledge Sharing43:58 Innovation and Idea Management47:33 Staying Grounded Amidst Responsibilities53:00 Personal Practices for Balance56:48 Conclusion and Final ThoughtsBio:In his stint at Infosys over 2 decades, Naresh has worked in different roles in Software Delivery, Consulting, Quality Assurance, Open Source, Enterprise Platforms, Products, Tools & Technology that have provided him opportunities to work on key transformation programs.Naresh has experience in Software Development, Quality System Design, Process definition, Implementation and Consulting, Product & Platform Engineering, Software Reuse, Knowledge Management, Training, Audits and Assessments. He possesses a sound understanding of various quality models, methodologies and frameworks like CMMI, ISO, Six Sigma, MBNQA, AI, Automation,  Agile, DevSecOps & SRE.Naresh participates on several product councils and advisory boards with Infosys' global technology partners and is currently leading the effort on reimagining the tooling, engineering excellence, digital platforms, Lean and automation landscape for the enterpriseHe is a self confessed Foodie, History enthusiast, Amateur Chef, Motivational Speakerhttps://www.linkedin.com/in/nareshchoudhary/

This past summer CMS, more specifically CMMI, announced a six-year Medicare Part A demonstration that would require hospitals in six states to submit claims for prior authorization (PA) approval by non-medical, CMS-contracted, 3rd party entities using enhanced technologies, i.e., AI, for 17 medical items and services. Private/commercial Medicare or Part C Medicare Advantage plans have for years extensively used PAs though data suggests Medicare Advantage PA use has been excessive, e.g., a very high percentage of PA denials are reversed upon appeal) and widely viewed as a tool to enhance profit taking. CMMI-contracted tech/AI companies will be compensated based on a share the money saved from PAs contractors' deny though subject to meeting quality criteria. The WISeR demo has attached a fair amount of criticism, e.g., 12 Senate Democrats and 17 House Democrats each wrote letters to HHS/CMMI noting their concerns that include the demo will present patient roadblocks, cause some patients to abandon care, risk denying necessary care, inflict substantial administrative burden on clinicians, perversely incent AI contractors and they argued Americans do not want AI involved in their healthcare decisions. The July 1 Federal Register WISeR notice is at: https://www.govinfo.gov/content/pkg/FR-2025-07-01/pdf/2025-12195.pdf.The CMS/CMMI WISeR website is at: https://www.cms.gov/priorities/innovation/innovation-models/wiser.Liu and Wadhera's NEJM Perspective essay re: the WISeR demo is at: https://www.nejm.org/doi/abs/10.1056/NEJMp2510451. Don Berwick and Andrea Ducas's STAT opinion essay re: the WISeR demo is at: https://www.statnews.com/2025/07/25/medicare-advantage-prior-authorization-cms-innovation-center-wiser-project/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Parce que… c'est l'épisode 0x644! Préambule Ce n'est pas CMMI… mais CMMC!?! Shameless plug 12 au 17 octobre 2025 - Objective by the sea v8 14 et 15 octobre 2025 - ATT&CKcon 6.0 14 et 15 octobre 2025 - Forum inCyber Canada Code rabais de 30% - CA25KDUX92 4 et 5 novembre 2025 - FAIRCON 2025 8 et 9 novembre 2025 - DEATHcon 17 au 20 novembre 2025 - European Cyber Week 25 et 26 février 2026 - SéQCure 2026 Description Introduction Ce podcast de la série PME réunit Nicholas, Cyndie et Dominique pour aborder un enjeu crucial auquel font face les petites et moyennes entreprises : les certifications de sécurité. La discussion explore comment les PME doivent réagir lorsqu'un client majeur leur demande si elles possèdent une certification spécifique, une situation qui peut rapidement devenir problématique si l'entreprise n'y est pas préparée. L'évolution des certifications : d'un avantage à une obligation Les certifications de sécurité les plus courantes incluent l'ISO 27001, le SOC de type 2, et pour le secteur de la santé au Québec, la certification TGV. Historiquement, ces certifications étaient réservées aux grandes entreprises et représentaient un avantage concurrentiel permettant de se distinguer et de garantir un certain niveau de sécurité aux clients. Cependant, la réalité a considérablement changé. Aujourd'hui, ces certifications ne sont plus un simple atout commercial, mais bien une obligation pour maintenir des relations d'affaires avec les grandes compagnies. Les entreprises qui ne possèdent pas la certification requise risquent de perdre des clients existants, une situation nettement plus dommageable que de ne pas en acquérir de nouveaux. Le rôle des certifications et l'alternative des questionnaires Les certifications font appel à un tiers de confiance qui garantit que l'entreprise respecte certaines normes de sécurité. Comme l'explique Dominique, il s'agit de déléguer à un organisme externe la vérification de la sécurité, généralement des comptables, bien qu'il existe également un processus d'audit interne à l'entreprise. Le choix du cadre normatif doit être stratégique : l'ISO convient mieux au marché européen, tandis que le SOC 2 est privilégié pour les affaires aux États-Unis. L'une des principales raisons pour lesquelles les entreprises recherchent ces certifications est d'éviter de répondre à d'innombrables questionnaires de sécurité. Bien que le Cloud Security Alliance ait développé le Consensus Assessment Initiative Questionary pour standardiser ces évaluations, cette initiative demeure peu connue. En l'absence de certification, les entreprises doivent répondre à des questionnaires exhaustifs de 100 à 150 questions, une expérience que les participants qualifient de « violente ». Face à ces questionnaires, les répondants se divisent en deux catégories : ceux qui embellissent la vérité et ceux qui mentent. Cette situation découle du fait qu'avouer ne pas avoir certaines mesures en place pourrait entraîner la rupture d'un contrat, transformant ainsi un enjeu de sécurité en enjeu purement commercial. Le problème s'aggrave lorsque le même questionnaire est envoyé à toutes les entreprises, qu'elles comptent trois ou deux mille employés. De plus, les personnes qui envoient et évaluent ces questionnaires ne sont pas toujours des experts en sécurité, ce qui signifie qu'une réponse négative sera simplement enregistrée comme telle, même si l'entreprise a mis en place des mesures alternatives tout aussi efficaces. L'importance cruciale du périmètre Un aspect fondamental abordé dans le podcast concerne la définition du périmètre de certification. Contrairement à ce que l'on pourrait croire, même les grandes organisations ne certifient pas l'ensemble de leur structure. Elles fragmentent leurs environnements et ne certifient que les lignes d'affaires qui en ont réellement besoin. Pour les PME, la stratégie recommandée consiste à choisir le plus petit périmètre conforme qui répond aux exigences du client final. Il faut absolument éviter la mentalité du « tant qu'à y être » qui augmente inutilement le périmètre et les coûts associés. Les certifications touchent l'ensemble de l'organisation : les personnes, les lieux physiques, la technologie, la sécurité physique, la sécurité humaine et la conformité légale. Il ne s'agit pas simplement d'une question informatique. L'ISO 27001, par exemple, repose sur le pilotage de la sécurité par la gestion des risques business, tandis que le SOC 2 garantit que l'entreprise respectera ce qui est marqué dans les contrats clients grâce aux contrôles mis en place. Conformité versus sécurité : une distinction essentielle Un point crucial soulevé par les experts est que conformité et sécurité ne sont pas synonymes. Une entreprise peut être conforme sans être véritablement sécurisée. Par exemple, avoir réalisé un test d'intrusion sans corriger aucune vulnérabilité identifiée ne rend pas l'entreprise conforme, mais ne l'a pas rendue plus sécuritaire non plus. Cette distinction frustre souvent les professionnels de la cybersécurité, car des mesures de sécurité efficaces peuvent ne pas être reconnues du point de vue de la conformité, tandis que certaines exigences de conformité peuvent être inefficaces d'un point de vue sécuritaire. L'exemple de PCI illustre bien cette problématique, avec des exigences qui sont restées longtemps inefficaces avant d'évoluer. L'amélioration continue comme philosophie Les cadres de certification reposent sur le principe d'amélioration continue plutôt que sur la perfection immédiate. Ils n'exigent pas que l'entreprise soit parfaite le jour de la certification, mais qu'elle ait mis en place un système de contrôle permettant l'amélioration continue. Ces certifications engagent le management et la direction à maintenir cette démarche d'amélioration, ce qui constitue un principe philosophique bénéfique à long terme. Cependant, l'entreprise doit être réellement prête à s'engager dans cette démarche, car il ne s'agit pas simplement d'un argument commercial ou d'un logo attrayant à afficher. Conseils pratiques pour les PME Pour les PME qui démarrent ce processus, il est recommandé d'adopter ou de s'inspirer d'un cadre normatif pour faire les premiers essais à leur propre rythme, avant qu'un client ne les pousse à le faire dans l'urgence. Cela permet de mettre en place les revues et contrôles nécessaires sans dépenser des sommes faramineuses. Les participants encouragent les entrepreneurs à poser des questions à leur réseau professionnel, car ceux qui ont vécu l'expérience de la certification, bien que souvent « traumatisante », seront heureux de partager leurs apprentissages. L'important n'est pas d'être parfait, mais de démontrer un engagement sincère envers la sécurité, d'être proactif, de poser les bonnes questions et d'établir des échéanciers réalistes. Être en mouvement et éviter la fossilisation constituent la clé du succès dans cette démarche. Collaborateurs Nicolas-Loïc Fortin Cyndie Feltz Nicholas Milot Dominique Derrier Crédits Montage par Intrasecure inc Locaux virtuels par Riverside.fm

In this episode, Stacey Richter talks with Dr. Stan Schwartz, co-founder of ZERO.health about the tension between mission-driven healthcare and financial incentives within the healthcare system. Highlighting examples like the Comprehensive Primary Care Initiative and other advanced primary care efforts, Schwartz shares insights on how health system economics, particularly the reliance on emergency room admissions, often undermine initiatives aimed at reducing costs and improving patient outcomes.  The discussion delves into the role of employer-sponsored health plans as potential change agents in the healthcare system, given their significant influence over commercially insured patients, who are highly attractive to providers. Dr. Schwartz underscores the importance of aligned financial incentives and collective action among employers to drive meaningful change in healthcare. If you would like to get a copy of the mentinoed personal integrity and “are you in healthcare for the right reasons” policy called the Guiding Principles Policy that Doug Geinzer and Amy Mecham from High Performance Providers put together.please either check your inbox for the newsletter this week that you just got when this show went live and find the link to download or sign up for the newsletter and I will include it again next week on Thursday. === LINKS ===

Abe Sutton, director of the Center for Medicare and Medicaid Innovation (CMMI), sits down with Aledade CEO Farzad Mostashari, M.D., and Sean Cavanaugh to unpack the new strategic framework for CMMI models. Sutton explores CMMI's focus on three pillars: promoting evidence-based prevention, improving patient access to their health data and driving choice and competition in health care markets. He discusses the recently announced WISeR (Wasteful and Inappropriate Service Reduction) Model, which aims to leverage artificial intelligence (AI) in reviewing prior-authorization requests to prevent harmful or unnecessary services. He also talks about the Ambulatory Specialty Model (ASM), which would reward specialists for improving health outcomes in Medicare patients with lower back pain or heart failure and CMS efforts to improve risk adjustment through permanent programs and testing new ideas on a smaller scale through the Innovation Center. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

Send us a textIn this episode, CMMI Director Abe Sutton shares his unique journey from the private sector back to government service and reveals how he's rapidly transforming Medicare through innovative payment models. Sutton discusses the newly launched WISER (Wasteful and Inappropriate Service Reduction) model, which leverages AI technology to reduce fraud and waste in Medicare, and the upcoming ASM (Ambulatory Specialty Model) targeting heart failure and lower back pain. The conversation explores CMMI's 2025 strategy focused on evidence-based prevention, patient empowerment, and choice and competition, while addressing how emerging technologies like generative AI are creating unprecedented opportunities to streamline healthcare administration and improve patient outcomes. Sutton also reveals how he spent four years during his "off season" developing a comprehensive roadmap for healthcare innovation that he's now implementing at warp speed.Links:WISeR (Wasteful and Inappropriate Service Reduction) model: https://www.cms.gov/priorities/innova...ASM (Ambulatory Specialty Model): https://www.cms.gov/priorities/innova...CMMI's 2025 Strategy Focus: https://www.cms.gov/priorities/innova...Learn how AI can amplify your care coordination team by visiting https://link.careco.ai/HTRKQsTimestamps:00:00:00 - Introduction and Welcome00:00:37 - Why Leave Private Sector for Government Service00:09:16 - AI and Technology's Impact on Healthcare Innovation00:17:49 - WISER Model Introduction and Goals00:30:45 - Food Policy and Making America Healthy Again00:34:08 - ASM Model for Heart Failure and Lower Back Pain00:38:31 - Four Years of Preparation During "Off Season"

Send us a textIn this episode of Healthcare Trailblazers, host speaks with Dr. Boris Vabson, head of Medicare Advantage policy at CMMI (Center for Medicare & Medicaid Innovation). Dr. Vabson shares his fascinating journey from being born in the Soviet Union to becoming a Harvard health economist focused on dysfunctional healthcare systems. The conversation explores Medicare Advantage's evolution since 1965, current challenges including cost inefficiencies and prior authorization burdens, and CMMI's ambitious plans to transform the program. Dr. Vabson discusses the ongoing debate about Medicare Advantage overpayments, risk adjustment auditing using AI technology, and how CMMI plans to leverage its statutory flexibility to test innovative reforms that could be scaled nationwide. With recent leadership changes under Dr. Mehmet Oz at CMS, this timely discussion provides crucial insights into the future direction of Medicare Advantage policy affecting over 30 million Americans.Timestamps: 00:00:00 - Introduction and Dr. Vabson's Background 00:05:35 - Healthcare System Problems and Technology Solutions 00:09:42 - Medicare Advantage Overview and Current Challenges 00:18:25 - Policy Debates and Reform Efforts 00:32:44 - CMMI's Future Plans for Medicare Advantage Transformation

The new iteration of the Center for Medicare and Medicaid Innovation promises to focus on health, not healthcare. Will its plans come to fruition? David W. Johnson and Julie Murchinson graded CMMI's new strategic direction on, “CMMI Pursues an Ounce of Prevention,” the new episode of the 4sight Health Roundup podcast, moderated by David Burda

CMS Changes and the Future of Value-Based CareJennifer Houlihan and Jennifer Gasperini of Advocate Health discuss the impact of new CMS and CMMI leadership, current challenges in value-based care, and the future of ACOs, ECQMs, and Medicare Advantage. A timely conversation for anyone navigating the evolving policy landscape.Welcome to the Move to Value Podcast, powered by CHESS Health Solutions.In this episode, we're joined by Jennifer Houlihan, Vice President, and Jennifer Gasparini, Director of Policy, from Advocate Health's Population Health Team. Together, we unpack the implications of the recent administration change, explore what new leadership at CMS could mean for value-based care, and hear their perspectives on the legislative priorities they hope to see take shape.Thomas Royal Jennifer Houlihan, Jennifer Gasparini, welcome to the move to Value podcast.Jennifer GasperiniThanks for having us.Jennifer Houlihan Happy to be here.Thomas Royal So you both just attended the NAACOS conference?Can you tell us what are some of the hot topics that folks were talking about?Jennifer GasperiniI can get us started.I think it's always great to see colleagues at the NAACOs conference and was also great to see Kim Brandt, who is the deputy administrator and COO at CMS, come and share some of Doctor Oz's priorities. For CMS and I think a lot of those priorities align really well with value based care. So they they really spoke a lot about tackling fraud and abuse. And as you know, ACOs are really the early identifiers of fraud.And so really was pleased to see them talking about that and also using technology and better data really for beneficiaries and providers to advance care. And I think ACOs obviously are very focused on that goal as well.Jennifer, do you have anything else to add there?Jennifer Houlihan Yeah. There, in addition, there were some really good sessions on the new team model, the transferring Episode Accountability model as well as guide and a lot of thoughtful conversation around how to integrate these models into the ACO and a clearer path for outcomes there. So I think there was a great discussion and got to give kudos to Jennifer. She was part of a really well attended and fantastic panel on how ACOs are adapting ECQMs and MIPCQMs and some of the kind of demands and multiple issues that are impacting ACOs on how to do all payer adjustments leveraging some of these requirements. So a lot of really timely topics and I think then the kind of final was Specialty Care integration, I think continued to be a recurring topic that we need to think more deeply about that and and how those get nested within cost, so hopefully we'll see more about that in the future.Thomas Royal So there is new leadership in place at HHS, CMS and CMMI.What does NAACOS think this might signal for the future of value-based care?Jennifer HoulihanSure, I I can. I can jump in on that one first, so I think you know, looking at Abe Sutton, you know, as as Jennifer mentioned, Kim Brandt was there from CMS. But we've also seen with Abe Sutton's appointment, who's been a strong supporter of value-based care. I think the mood was mostly positive, that there has been sort of a lot of statements, whether it's in some of the confirmation hearings, or direct statements that value-based care and the need to achieve savings is is one of the priorities. I think there's gonna be some different thinking about more aggressive requirements for more savings and as as as we've seen already, some of the model review that's already taking place. The ability to kind of end models early if they're not achieving the outcomes and the savings. So I think the mood in...

In this episode, Mon-Chaio and Andy discuss the Capability Maturity Model (CMM) and its implications for software development organizations. They explore why CMM was chosen for this episode and its connection to previous topics such as the Team Software Process. The conversation delves into the maturity levels defined by CMMI, from 'incomplete' to 'optimizing,' and explores whether the lack of a 'why' behind processes affects the model's utility. The discussion detours into how modern tools like Large Language Models (LLMs) and Copilot can impact software development, highlighting both their benefits and limitations. It ends with reflections on continuous improvement and how organizations can leverage CMM and LLMs for better outcomes.ReferencesCapability Maturity Model for Software, Version 1.1Capability Maturity Model® Integration (CMMI), Version 1.1The Capability Im-Maturity Model (CIMM)

In this episode of The Daily Windup, I interview a guest who shares their career journey from being a software developer to transitioning into business development in the government contracting industry. The guest discusses their experience managing a CSO (Customer Service Operations) and how it led to an opportunity to work for a government contracting company. We delve into the process of joining an 8(a) company that was graduating from the 8(a) program and acquiring CMMI Level 3 certification, which ultimately attracted the attention of GDIIT (General Dynamics Information Technology). We also got insights into the motivations behind GDIIT's acquisition of the company they worked for, including the value of the acquired company's CMMI certification and its strong presence in the civilian market. Also we talk about our guest's own aspirations of future acquisition and passing on the business to their sons. We also highlighted the importance of mentorship and the mentors who played a pivotal role in their transition from program management to business development, learning how to craft effective pitches for different audiences, and gaining confidence in their abilities.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Senior Deputy Editor Rob Lott interviews Dr. Meena Seshamani, the incoming Maryland Secretary of Health, to discuss her time as the director of Medicare at the Centers of Medicare & Medicaid Services and what the future holds in her new role. Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone. Subscribe to UnitedHealthcare's Community & State newsletter.

This week's episode features Moser's Director of Quality, Alphia Stephens, who joins us to discuss audits and auditing. Alphia leads a dynamic team that thrives on the principles of continuous process improvement and exceptional service delivery. With deep expertise in information technology and a passion for service delivery and customer satisfaction, she has strategically integrated best practices to boost efficiency and quality. The team's dedication to excellence is reflected in their impressive CMMI rating and ISO 9001 certification. Aligned with the organization's culture of excellence, Alphia and her team are committed to delivering innovative solutions that consistently exceed client expectations. 

In our final episode of season 4, we look ahead to 2025 and beyond, with AMRPA's policy team. Our guests are Kate Beller, President of Government Relations and Policy, Troy Hillman, Director of Quality and Health Policy, and Joe Nahra, Director of Government Relations and Regulatory Policy. Read more about AMRPA's Policy Priorities on our website. This episode is hosted by Patricia Sullivan, AMRPA Director of Content & Marketing.

In today's episode we have Chitra in conversation with Lekha Bajpai where she shares –Tech veteran of 30 plus yearsStarted her career in Calcutta with Deep Tech across many sectors like manufacturing, commercial apps, engineering aps and supply chainInspired by her father to study engineeringFirst project on inter machine communication protocols, the excitement of innovation Working on an experiment to build a control system to ship coalShowcasing use cases to the businessSupply chain software solutions – building was easy, convincing users and allaying their fears was the big challenge to roll out the solution across 350 locations in IndiaDeveloped strong experience with ERP implementations leading to building of data warehouses, BI reporting and monitoring apps for execsExperience at Kantar with challenges in data preparation and processing, working with just CPU's, expensive cloud resourcesHelping apps scale, developing market research products to support the entire data life cycle from collection to dashboardsEncouraging POC's and learning with data techniques Approaching AI today – Bring Your Own AI to work, encourage usage, take risks and also take care of Data privacy, protection, governance & complianceData bias challenges for IndiaAdvice to young folks aspiring for a career in AI – discover different AI personas, understand business catalysts, use AI tech, drive adoption of AI, besides only aspiring to build/develop AIM.Tech BIT Messra, Greenbelt Six Sigma, Strategic IT Management (IIM Ahmedabad), Enterprise Architecture, Certified Process Professional, Certified Data ScientistWith over 30 years of technology leadership experience, Lekha has been a thought leader and mentor in driving digital transformation and process automation across end-to-end processes and analytics.As a CIO/CTO and a Strategic Leader, she has led technology strategy functions for multiple units in APAC and MENA, as a member of the Executive Committee of Kantar IMRB. Delivered technology products and solutions to global & local clients, transforming IT into a strategic business partner.Worked on cutting-edge Technology adoption and Innovation, including cloud, big data environments, data warehouses & data lakes, to drive business improvements. Expertise spans across IT Strategy development & execution, Product & Application management for large scale applications & products on mobility, e-commerce, business analytics, social text analytics, chatbots, and image analysis using AI/ML and deep learning algorithms. Has Architected enterprise platforms for analytics delivery across diverse domains – Supply chain management, Logistics, Warehousing and freight forwarding, Chemical consultancy, Civil contracting, Manufacturing, Market research, Media and digital research, Social media analytics, Digital marketing and EdTech & Job Tech.Achieved Process Excellence within multiple organization and setup measure to monitor business process and growth. Achieved IT security processes like ISO27001 across various organizations. Streamlined IT services delivery across APAC using ITIL processes, Agile methodology & CMMI framework emphasizing on service availability and performance measurement.Accreditations and Contributions:Awarded the “Innovation Leader” Award by World Innovation Congress, featured in CIO Magazine “Top 30 – Ones to watch”, CIO & Leader Magazine as “11 Most Powerful Women in Tech in India” and a few others. Case study published in CIO Decisions & Network Computing, Logistics Magazine, Dataquest, & CIO Magazine. Presented technology papers at the Market Research Society of India (MRSI) on new age Technologies and won awards on “Best Analytics product” & “Best E2E Process Automation”. Actively involved as a technology expert speaker on multiple tech forums and colleges, project guide, evaluator, mentor for data science & technology students.

In today's episode we have Chitra in conversation with Lekha Bajpai where she shares -Tech veteran of 30 plus yearsStarted her career in Calcutta with Deep Tech across many sectors like manufacturing, commercial apps, engineering aps and supply chainInspired by her father to study engineeringFirst project on inter machine communication protocols, the excitement of innovation Working on an experiment to build a control system to ship coalShowcasing use cases to the businessSupply chain software solutions - building was easy, convincing users and allaying their fears was the big challenge to roll out the solution across 350 locations in IndiaDeveloped strong experience with ERP implementations leading to building of data warehouses, BI reporting and monitoring apps for execsExperience at Kantar with challenges in data preparation and processing, working with just CPU's, expensive cloud resourcesHelping apps scale, developing market research products to support the entire data life cycle from collection to dashboardsEncouraging POC's and learning with data techniques Approaching AI today - Bring Your Own AI to work, encourage usage, take risks and also take care of Data privacy, protection, governance & complianceData bias challenges for IndiaAdvice to young folks aspiring for a career in AI - discover different AI personas, understand business catalysts, use AI tech, drive adoption of AI, besides only aspiring to build/develop AIM.Tech BIT Messra, Greenbelt Six Sigma, Strategic IT Management (IIM Ahmedabad), Enterprise Architecture, Certified Process Professional, Certified Data ScientistWith over 30 years of technology leadership experience, Lekha has been a thought leader and mentor in driving digital transformation and process automation across end-to-end processes and analytics.As a CIO/CTO and a Strategic Leader, she has led technology strategy functions for multiple units in APAC and MENA, as a member of the Executive Committee of Kantar IMRB. Delivered technology products and solutions to global & local clients, transforming IT into a strategic business partner.Worked on cutting-edge Technology adoption and Innovation, including cloud, big data environments, data warehouses & data lakes, to drive business improvements. Expertise spans across IT Strategy development & execution, Product & Application management for large scale applications & products on mobility, e-commerce, business analytics, social text analytics, chatbots, and image analysis using AI/ML and deep learning algorithms. Has Architected enterprise platforms for analytics delivery across diverse domains - Supply chain management, Logistics, Warehousing and freight forwarding, Chemical consultancy, Civil contracting, Manufacturing, Market research, Media and digital research, Social media analytics, Digital marketing and EdTech & Job Tech.Achieved Process Excellence within multiple organization and setup measure to monitor business process and growth. Achieved IT security processes like ISO27001 across various organizations. Streamlined IT services delivery across APAC using ITIL processes, Agile methodology & CMMI framework emphasizing on service availability and performance measurement.Accreditations and Contributions:Awarded the “Innovation Leader” Award by World Innovation Congress, featured in CIO Magazine “Top 30 - Ones to watch”, CIO & Leader Magazine as “11 Most Powerful Women in Tech in India” and a few others. Case study published in CIO Decisions & Network Computing, Logistics Magazine, Dataquest, & CIO Magazine. Presented technology papers at the Market Research Society of India (MRSI) on new age Technologies and won awards on “Best Analytics product” & “Best E2E Process Automation”. Actively involved as a technology expert speaker on multiple tech forums and colleges, project guide, evaluator, mentor for data science & technology students.

In this episode of the Quality Hub podcast, Xavier Francis interviews experts from CORE, including Lori Engle, Renee Ferry, and Kevin Metz, about the role of ISO certifications in driving business growth and marketing success. They discuss how certifications like ISO 9001 can differentiate businesses by showcasing their commitment to quality & reliability. They also talk about maintaining these certifications and how it requires ongoing effort and leadership involvement, which also supports customer trust. They emphasize that ISO standards, such as ISO 9001 and CMMI, can be crucial for securing contracts in fields like government contracting. A success story highlighted also illustrates how strategic certifications can boost revenue and strengthen market positioning. Helpful Resources: Contact us at 866.354.0300 or email us at info@thecoresolution.com A Plethora of Articles: https://www.thecoresolution.com/free-learning-resources ISO 9001 Consulting: https://www.thecoresolution.com/iso-consulting

Last week on Radio Advisory, we broke down what healthcare leaders need to know for 2025 and beyond following the recent elections. But before we move on from 2024 completely, we have to acknowledge that there's been a lot moving in the policy space this year, and frankly, there have probably been a few important policy areas on your radar that we haven't discussed. That's why this week, host Abby Burns invites Advisory Board experts Gina Lohr, Sarah Roller, and Paul Trigonoplos to dive into three major policy areas of the last year: Medicare drug negotiations, changes to physician employment and payment, and an emerging mandatory bundled payment model called TEAM. The experts unpack how these policies are affecting the industry, how the elections outcomes may impact them, and, critically, how much attention leaders should be paying them going forward. In other words, should leaders consider each policy a big deal, a little deal, or no deal? Links: Ep. 230: Elections results are in: What healthcare leaders need to know State-level healthcare ballot measures that passed (and failed) CMS' TEAM payment model is here. How should hospitals prepare? Your guide to CMS' 14 value-based payment models Medicare announces 10 new drug prices following negotiations A federal judge just blocked FTC's noncompete ban The Hospital Benchmark Generator Market Scenario Planner Get exclusive, early access to Advisory Board's annual “What CEOs need to know” briefing. 2 ways labs can embrace innovation to drive revenue and accelerate growth Market Scenario Planner A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.

In this episode of "The Quality Hub," Xavier Francis and Rick Krick discuss "What is CMMI Part 2?" They start by covering the advanced levels of the Capability Maturity Model Integration (CMMI) framework, focusing on levels four and five, which involve quantitative management and continuous process improvement. Rick explains that implementing CMMI poses challenges, such as the need for accessible, active projects, and more. Effective leadership is crucial, as it supports resource allocation, barrier removal, and other needs. Achieving CMMI certification allows, among other things, organizations to bid on government contracts and enhances process efficiency. Despite its complexity, Rick assures that CMMI is accessible to businesses of all sizes and can significantly improve organizational structure and competitiveness. Helpful Resources: https://www.thecoresolution.com/cmmi-ml2-ml3-consulting-services https://www.thecoresolution.com/what-is-the-difference-between-cmmi-dev-and-cmmi-svc https://www.thecoresolution.com/cmmi-maturity-levels-2-and-3 https://www.thecoresolution.com/cmmi-v3-update-explained Contact us at 866.354.0300 or email us at info@thecoresolution.com A Plethora of Articles: https://www.thecoresolution.com/free-learning-resources ISO 9001 Consulting: https://www.thecoresolution.com/iso-consulting  

In this episode of the Quality Hub Podcast, Xavier Francis interviews Rick Krick from Core Business Solutions about What is CMMI (Capability Maturity Model Integration), a process improvement framework. Unlike ISO 9001, which focuses on quality processes, CMMI emphasizes evidence-based project management. Rick discusses the basics of CMMI and then outlines the first three of CMMI's five maturity levels: Level 1 (Initial) Level 2 (Managed) and Level 3 (Defined). Most companies aim for levels 2 or 3, while levels 4 and 5, which require extensive data monitoring, will be covered in “What is CMMI Part 2” next week.  Helpful Resources: https://www.thecoresolution.com/cmmi-ml2-ml3-consulting-services https://www.thecoresolution.com/what-is-the-difference-between-cmmi-dev-and-cmmi-svc https://www.thecoresolution.com/cmmi-maturity-levels-2-and-3 https://www.thecoresolution.com/cmmi-v3-update-explained Contact us at 866.354.0300 or email us at info@thecoresolution.com A Plethora of Articles: https://www.thecoresolution.com/free-learning-resources ISO 9001 Consulting: https://www.thecoresolution.com/iso-consulting      

Discover the transformative changes on the horizon for orthopaedic coding and payment models with our esteemed guest, Dr. Adam Bruggeman. Covered are the new CMS-mandated procedural-based bundles, specifically the "team" bundle affecting 25% of US hospitals. Dr. Bruggeman sheds light on the financial and administrative hurdles these mandates bring and compares them to the cost-saving success of physician-led bundles.Prepare yourself for an in-depth exploration of the evolving landscape of hospital-based healthcare bundles and their profound implications for orthopaedic surgeons. The conversation reveals how these new regulations might shift financial risks between hospitals and doctors, leading to a rare alignment of interests in opposing mandatory bundles. We also dive into the CMMI's push for value-based care and its potential impact on the sustainability of Medicare, putting a spotlight on the delicate balance of cost and care quality.Join us as Dr. Bruggeman shares his expert views on the future of medical coding, particularly within the contexts of fee-for-service models and ambulatory surgery centers. From CPT and ICD-10 codes to the Resource-Based Relative Value Scale (RUC), we cover the complexities that define this space. We also discuss the slow shift towards value-based care and the promising, albeit underused, concept of condition-based bundles. This episode is packed with insights and foresight into the future of orthopaedic surgery and healthcare reimbursement models.

The Ilumed team is noted for their expertise in risk management and a deep commitment to putting patients first, which is evident throughout the company. In this episode, Melissa Conboy, Marketing Director at Ilumed, discusses how the company partners with physicians and health systems to transition patients to value-based care. She highlights CMMI's temporary but promising program, which aims to improve patient health outcomes and reduce Medicare spending. Mel shares a recent case study from a rural health clinic in West Virginia that saw increased annual wellness visits and better patient outcomes. She also explains why the illumed team is praised for their expertise in risk management and their deep commitment to patient care.  Join us and discover the growing importance of value-based care in healthcare's future! Resources:  Watch the entire interview here. Connect and follow Melissa Conboy on LinkedIn. Learn more about Ilumed on their LinkedIn and website.

My conversation today is with Will Shrank, MD. Dr. Shrank led the evaluation group at CMMI (Center for Medicare and Medicaid Innovation). He has spent time in the private sector, first at CVS Health and UPMC (University of Pittsburgh Medical Center) as chief medical officer of the health plan in Pittsburgh, and then as the chief medical officer for Humana. Now he is a venture partner at Andreessen Horowitz and doing some consulting for CMMI. To read the full article and show notes which include mentioned links, visit the episode page.  If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. We start out this conversation talking about waste in healthcare. In fact, Dr. Shrank was on a team who did a study about waste in the US healthcare system. (The article is, unfortunately, paywalled.) In that study, it says estimates suggest we have upwards of a trillion dollars of waste a year. This waste can be categorized into administrative and clinical failures. Dr. Shrank emphasizes the need for aligning incentives with higher quality care, paying for patient outcomes, and highlights the potential rising power of PCPs. The discussion covers the progress made towards value-based care, the challenges faced by the current fee-for-service model, and the future landscape of primary care and healthcare delivery. In sum, we have a waste problem in this country. Aligning incentives might be one way to curb that waste. 06:54 Can we cut healthcare waste while improving patient care? 07:33 What does “healthcare waste” consist of? 07:46 What are the six categories of “healthcare waste”? 10:23 EP363 with David Scheinker, PhD. 10:37 How much money does Dr. Shrank estimate is wasted each year in healthcare? 13:09 Where is that healthcare waste going, and why does it happen? 20:07 Uncaring by Robert Pearl, MD. 21:18 “We've built a backbone of extraordinary waste on a fee-for-service chassis.” 22:16 EP409 with Larry Bauer, MSW, MEd. 24:24 EP359 with Dan O'Neill. 26:02 Dr. Shrank's warning to providers out there. 30:03 Summer Shorts 2 with Scott Conard, MD. 31:41 Why there might be a generational shift among younger providers looking to work with different models.

In this episode Amanda Freed talks about how her body was so foreign to her she had to count hers steps as a child. That journey took her on a truth seeking path to be able to full embody her humanness and help others claim their primordial power. More About Amanda Amanda Freed LMT,RYT,CMMI has been a bodyworker, yoga, meditation, and mindfulness teacher for over 30 years. She has helped thousands of groups and individuals achieve freedom in body, mind, and spirit through nervous system reset yoga, simple meditation practices, and intuitive coaching. Amanda's current focus is helping women reclaim their Primordial Power. Contact Amanda on Fb, IG @afyoga25, youtube -Amanda Freed meditation https://youtube.com/@amandafreedmeditation6711?si=yocqBEOBxifYgDie

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs Editor-in-Chief Alan Weil welcomes Liz Fowler, Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services, to A Health Podyssey to discuss the future of health care payments, CMMI's specialty care strategy, mandatory models versus voluntary alternative payment models, CMS' newly-proposed Medicare Physician Fee Schedule for 2025, and more!Related Articles from Liz Fowler on Health Affairs:The CMS Innovation Center's Strategy To Support Person-Centered, Value-Based Specialty Care: 2024 UpdateAdvancing Health Equity Through Value-Based Care: CMS Innovation Center UpdateUpdate On The Medicare Value-Based Care Strategy: Alignment, Growth, EquityOrder the July 2024 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone. Subscribe to UnitedHealthcare's Community & State newsletter.

Medicare is betting that taking care of the caregiver will help dementia patients stay at home longer. Patients and their caregivers are often left to navigate the confusing world of dementia by themselves, but Medicare is launching a new program to change that.Guests:Malaz Boustani, MD, PhD, Founding Director, Sandra Eskenazi Center for Brain Care Innovation; Professor of Aging Research, Indiana University School of Medicine Rosanne Corcoran, Caregiver Liz Fowler, PhD, JD, Director of CMMI and Deputy Administrator, Centers for Medicare and Medicaid Services Cindi Hart, Caregiver Alex Olgin, Reporter/Producer, Tradeoffs Lauren Sullivan, Care Coordinator, Eskenazi Health Learn more and read a full transcript on our website.Want more Tradeoffs? Sign up for our free weekly newsletter featuring the latest health policy research and news.Support this type of journalism today, with a gift.Follow us on Twitter. Hosted on Acast. See acast.com/privacy for more information.

This series aims to demystify Medicaid, starting with insights from federal and state agencies, FQHCs, and managed care organizations, before exploring successful founders' strategies. It will start with a primer on the key players and innovations, evolving with new posts featuring interviews and insights. Read more about this series here. Today, we're excited to get to know Eliot Fishman, a director at CMMI who focuses on policy and programs that affect Medicaid beneficiaries. Eliot comes to us with a long history of impact in public health policy. Eliot started his career as a policy associate at Mt. Sinai Health System in NYC and then went on to Manatt, Phelps & Phelps. He transitioned into a management policy role on the provider side again at MJHS, a large health system in the New York Area before he left to join the government.  Eliot then served at NJ Department of Health and Senior Services and Centers for Medicare and Medicaid Services for several years across different groups on Medicaid, Medicare and CHIP. Eliot also served in consulting roles at Health Management Associates and at nonprofits like Families USA. In this episode, we learn about payment models within CMMI that attempt to foster innovation in care delivery for Medicaid, program and payment integrity and value-based care models as well as how the Federal government collaborates with State governments to improve care delivery.

Welcome to another episode of "The Art of Consulting Podcast" with your hosts, Andy Fry and Cat Lam. As seasoned IT consultants, CPAs, and professional development connoisseurs, we aim to bring you inspiring messages to help you discover the X factor in your professional field, leading to the success you truly deserve in your career and life. Welcome back, the one and only Edmund Metera. Edmund Metera is a senior project manager at CWB Financial Group in Canada. He firmly believes that the keys to delivering successful projects are not only founded upon expert project management and business analysis competencies but on recognizing, tailoring and applying the best-suited methodologies and techniques to suit the unique technologies, constraints and opportunities at hand. Topic Overview: Focus on what a trusted advisor needs when embarking on a consulting engagement. Insights derived from Ed Matera's book and his work at processmodellingadvisor.com. Types of Consultants: External Consultants: Advise client organizations. Internal Consultants: Advise different business areas within the same organization. Key Points Discussed: Importance of Deliverable Schedule and Effort Budget: Deliverable Schedule: Highly important. Effort Budget: Less important for the advisor; focus is on meeting the schedule rather than the budget. Project Stakeholders and Relationships: Critical for understanding stakeholder perspectives and pain points. The advisor acts as an advocate for the business within the project. Relationships vary from one engagement to another but are always crucial. Organizational Assets: Includes specialized tools, prior work, and training (e.g., SAP tools). External consultants bring their own assets and tools, which are essential. Organizational assets are important but secondary to interpersonal relationships and stakeholder understanding. Episode Highlights: Why Discuss Simple Concepts? Importance of asking the right questions early in a project or consultation. Being mindful and diligent upfront acts like insurance, preventing future issues. Preparation and Diligence: Taking initial steps to understand the project helps tailor the approach. This preparation keeps consultants out of potential pitfalls and allows them to leverage their knowledge effectively. Using a Checklist: Ed discusses a checklist available on his website, processmodellingadvisor.com. The checklist helps in tailoring your approach from one engagement to the next. Resources: The checklist can be found on the homepage of processmodellingadvisor.com. It is also published in BA Times, Modern Analyst, and IRM Connects. Conclusion: The episode delves into the balance between internal and external resources, the critical nature of stakeholder relationships, and the varying importance of schedules and budgets in consulting engagements. Ed Metera believes that philosophy is loud and clear in Ed's book: Universal Process Modeling Procedure: The Practical Guide to High-Quality Business Process Models. He has taught and mentored project managers and business analysts in best practices for professional organizations such as PMI, IIBA, and CMMI. He teaches IIBA-registered business analysis courses and serves as an advisor to the Northern Alberta Institute of Technology's Corporate and International Training department's Business Analysis Certificate Program. He is also the founder of www.ProcessModelingAdvisor.com and a regular BATimes, Modern Analyst and IRM Connects contributor.

Optum Rx serves more than 62 million people, processes 1.6 billion prescriptions and generates more than $110 billion of revenue annually. Dr. Patrick Conway, CEO of Optum Rx, is the third and final guest in a series of Healthcare is Hard episodes exploring the transformation of the pharmacy business – following conversations with Mark Cuban and Dr. Troyen Brennan.Dr. Conway brings an expansive view of the healthcare system to this discussion and his role leading one of the most influential organizations in the pharmacy space. He became CEO of Optum Rx in August 2023 and before that, served as CEO of Care Solutions at Optum for more than three years. He was president and CEO of Blue Cross and Blue Shield of North Carolina for two years and spent more than six years at the Centers for Medicare and Medicaid Services where he held several positions including Chief Medical Officer, Director of CMMI, and Deputy Administrator for Innovation and Quality. Before joining CMS, he oversaw clinical operations and quality improvement at Cincinnati Children's Hospital Medical Center, and he is still a practicing pediatrician in Boston where he occasionally works at an area medical center on weekends.Some of the topics Dr. Conway discussed with Keith Figlioli in this episode of Healthcare is Hard include:VBC – A way or THE way. As someone who has spent a significant portion of his career focused on improving cost and quality in the U.S. healthcare system, Keith starts the interview asking Dr. Conway for his perspective on value-based care. Dr. Conway says we can either figure out VBC, or raise taxes and reduce benefits, noting that the American public would not be happy about the latter. He firmly believes that VBC is THE way through. He discussed the positive impacts he's witnessed from VBC, and how he believes it's been a major contributor to slowing the growth of healthcare costs over a significant period of time. However, he's concerned about how the transition to VBC has slowed.Affordable innovation. When discussing the extremely high cost of new specialty drugs, Dr. Conway points out that innovation is useless if it's unaffordable and inaccessible to people. He shared personal stories contrasting very difficult conversations he's had with parents in the past about the failing health of their children, and a more recent experience where Optum Rx delivered a new gene therapy to a child with a rare disease who will now live a full life. With therapies like that one costing $3 million, Dr. Conway discussed his views on some of the public and private financing options that could help improve access to life-changing therapies while still rewarding the innovators.Choice and transparency. Dr. Conway explains some of the solutions Optum Rx has brought to market to serve its customers, and areas where the company is exploring new solutions to keep customer satisfaction high. While customers are happy with Optum Rx, he makes it clear that continuously developing new solutions to stay ahead of a fast-evolving market is essential. During this discussion, customer choice – for both patients and the employers who fund their benefits – is a recurring theme and a major focus.To hear Dr. Conway and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Today we sit with Roberto Ibarra, co-founder and CTO of Expediente Azul. Roberto shares how he transitioned from a software development company to building a product-focused business, driven by the need to solve a specific problem in the financial sector. Expediente Azul streamlines the loan onboarding process by automating the collection and verification of documents and data. As the platform evolves, it focuses on extracting data directly from reliable sources and creating documentation from that data. The ultimate vision is to create a digital marketplace for lenders to share opportunities and data, fostering trust and speeding up loan processes globally. As Expediente Azul gained traction and more customers, the team realized that the real value lay not in the documents themselves, but in the data they contained. Financial institutions didn't want the documents; they wanted the data for analysis. This realization led to a shift in focus from gathering documents to extracting and utilizing the data within them. The platform began integrating with third-party tools that connected to tax authorities' databases, allowing for the extraction of accurate and up-to-date income data directly from the source. This eliminated the need for customers to provide physical or scanned copies of their tax records. Instead, the platform automatically retrieved the necessary data, ensuring its accuracy and reducing the risk of fraud If your company is looking to scale its AI initiatives, head over to Tesoro AI (www.tesoroai.com). We are experts in AI strategy, staff augmentation, and AI product development. Founder Bio: Roberto Carlos Ibarra Rabadán entered the world of computing over 25 years ago assembling and selling personal computers. He went on to start a software development services company called Innox, being the 9th company in Mexico with a CMMI 4 quality rating (military/medical grade) with over 70 employees which was sold in 2013. Later, Roberto developed various apps with millions of downloads, two of them nominated the best in the world during the Mobile World Congress in Barcelona. During his sabbatical year, Roberto created the podcast Vidaentrepeneur.com where he interviewed over 290 Latin American inspiring entrepreneurs. Today he is the founder of the Fintech company Expediente Azul or Blue File in English, a software platform that simplifies the document-gathering process for large loans and other KYC processes currently operating in Mexico, Brazil, Ecuador, Colombia, Perú, the Caribbean, and South East Asia. Roberto was educated by the Tec de Monterrey, IPADE Business School, Harvard, and Oxford and was nominated by CNN as one of Mexico's 30 promises as well as a Young Global Leader by the World Economic Forum. Time Stamps: 03:07 Introduction and background of Roberto Ibarra 05:37 Transition from software development to a product Company 08:14 Finding a Problem worth solving 13:55 Scaling loan brokerage business with automation 18:07 Product evolution from document gathering to data sharing 26:27 Countries Expediente Azul operating today 27:46 Bringing in the right talent to build the initial version 30:38 Investing in sales over tech 33:32 The importance of thinking beyond the happy path 37:04 Building a lean and efficient tech team 42:02 Building a multilingual platform 44:23 Funding journey and resourcefulness 49:21 How to get in contact with the Expediente Azul team Resources Company website: https://bluefile.expedienteazul.com/ LinkedIn: https://www.linkedin.com/company/xpazul/ Facebook: https://www.facebook.com/xpAzul] Twitter: https://twitter.com/AzulExpediente Email: ribarra@expedienteazul.com  

In this episode of the Global Medical Device Podcast, host Etienne Nichols sits down with Kim Kaplan from ISACA at the MD&M West trade show in Anaheim, California, to discuss the pivotal Voluntary Improvement Program (VIP). This conversation sheds light on how the program, stemming from FDA's Case for Quality initiative, utilizes the Capability Maturity Model Integration (CMMI) to push medical device companies beyond compliance, towards excellence. Kaplan elucidates the history of VIP, its benefits, and how it aligns with the FDA's vision for a more innovative and quality-focused MedTech industry.Key Timestamps:[00:00:30] Introduction of Kim Kaplan and the Voluntary Improvement Program[00:05:00] Explanation of CMMI and its adoption in the medical device industry[00:15:45] Distinctions between CMMI and other quality methodologies[00:25:30] In-depth discussion on the specifics and benefits of the Voluntary Improvement Program[00:40:00] How companies can implement change based on VIP insights[00:50:00] FDA's perspective and regulatory opportunities tied to VIP participationNotable Quotes:“Organizations that are compliant aren't necessarily avoiding the types and numbers of issues faced by non-compliant ones.” - Kim Kaplan“CMMI focuses on the 'what' to do rather than the 'how,' allowing for a framework that compliments existing processes.” - Kim Kaplan“The Voluntary Improvement Program isn't just about compliance; it's about embracing continuous improvement as a culture.” - Kim KaplanKey Takeaways:Understanding VIP: The program aims to elevate quality and operational efficiency through a collaboration involving FDA, MDIC, industry stakeholders, and ISACA.CMMI's Role: CMMI's flexible, globally adopted framework helps MedTech companies identify and implement best practices in product development and project management.Benefits of Participation: Beyond improving quality, VIP participation can streamline regulatory processes, fostering quicker innovation and market access.Practical Tips for Listeners:Engage with CMMI: Consider how CMMI's framework could complement your company's existing quality and project management processes.Explore VIP: Assess your organization's readiness and potential benefits from enrolling in the Voluntary Improvement Program.Continuous Improvement: Embrace continuous improvement, not just for compliance, but as a cornerstone of your company culture.Future Questions:How will the integration of AI and digital health technologies impact the criteria for CMMI and VIP?In what ways might the Voluntary Improvement Program evolve to further incentivize innovation in MedTech?How will FDA's regulatory framework adapt to the rapid advancements in medical device technologies?References and Resources:Etienne Nichols on LinkedInKim Kaplan on LinkedInFDA's Final Guidance on the Voluntary Improvement ProgramISACA's overview of FDAs Voluntary Improvement Program (VIP)Regulatory opportunities of the...

In this episode of the Global Medical Device Podcast, host Etienne Nichols sits down with Kim Kaplan from ISACA at the MD&M West trade show in Anaheim, California, to discuss the pivotal Voluntary Improvement Program (VIP). This conversation sheds light on how the program, stemming from FDA's Case for Quality initiative, utilizes the Capability Maturity Model Integration (CMMI) to push medical device companies beyond compliance, towards excellence. Kaplan elucidates the history of VIP, its benefits, and how it aligns with the FDA's vision for a more innovative and quality-focused MedTech industry.Key Timestamps:[00:00:30] Introduction of Kim Kaplan and the Voluntary Improvement Program[00:05:00] Explanation of CMMI and its adoption in the medical device industry[00:15:45] Distinctions between CMMI and other quality methodologies[00:25:30] In-depth discussion on the specifics and benefits of the Voluntary Improvement Program[00:40:00] How companies can implement change based on VIP insights[00:50:00] FDA's perspective and regulatory opportunities tied to VIP participationNotable Quotes:“Organizations that are compliant aren't necessarily avoiding the types and numbers of issues faced by non-compliant ones.” - Kim Kaplan“CMMI focuses on the 'what' to do rather than the 'how,' allowing for a framework that compliments existing processes.” - Kim Kaplan“The Voluntary Improvement Program isn't just about compliance; it's about embracing continuous improvement as a culture.” - Kim KaplanKey Takeaways:Understanding VIP: The program aims to elevate quality and operational efficiency through a collaboration involving FDA, MDIC, industry stakeholders, and ISACA.CMMI's Role: CMMI's flexible, globally adopted framework helps MedTech companies identify and implement best practices in product development and project management.Benefits of Participation: Beyond improving quality, VIP participation can streamline regulatory processes, fostering quicker innovation and market access.Practical Tips for Listeners:Engage with CMMI: Consider how CMMI's framework could complement your company's existing quality and project management processes.Explore VIP: Assess your organization's readiness and potential benefits from enrolling in the Voluntary Improvement Program.Continuous Improvement: Embrace continuous improvement, not just for compliance, but as a cornerstone of your company culture.Future Questions:How will the integration of AI and digital health technologies impact the criteria for CMMI and VIP?In what ways might the Voluntary Improvement Program evolve to further incentivize innovation in MedTech?How will FDA's regulatory framework adapt to the rapid advancements in medical device technologies?References and Resources:Etienne Nichols on LinkedInKim Kaplan on LinkedInFDA's Final Guidance on the Voluntary Improvement ProgramISACA's overview of CMMI and the tailored MDDAP for the medical device industryQuestions for the Audience:Poll: Which area of MedTech do you believe will benefit most from VIP and CMMI in the next five years? Email us your thoughts at

The transformation of healthcare is a seemingly insurmountable challenge, yet overcoming any obstacle in the journey begins with the belief that it is possible to win!  It's not about the magnitude of the task; it is about the collective will to prioritize the wellbeing of every person we serve in our population.  Perhaps when approached with the audacity to imagine a healthier and more equitable future for all, we'll actually get there.  And that is just what the Physicians of Southwest Washington (PSW) is realizing as they navigate a successful transition from volume to value. Our guest on the Race to Value this week is Melanie Matthews, the dynamic, creative, and innovative CEO of PSW. She leads a population health company that has been around for three decades. Melanie is not only leading their ACO and managing their progression in the adoption of full-risk Medicare Advantage delegation; she has become a nationally recognized voice for value-based health policy.  In listening to this interview, you will hear from a leader that has a real personal capacity for leadership and a clear focus on excellence. If you want to hear from someone that is at the absolute forefront of risk-based contracting and innovation, who understands the issues at a granular level, this episode with Melanie is a must-listen! Episode Bookmarks: 01:30 Introduction to Melanie Matthews and the Physicians of Southwest Washington (PSW) 04:30 PSW has evolved over the last three decades from an IPA to a diverse business that includes a national leading ACO and risk-bearing entity for MA. 06:00 "PSW is a story of independent physicians who, in a time of market consolidation, want to remain independent and focus on the patient relationship." 06:45 Achieving success in delegated risk and taking accountability for both quality and total cost of care. 07:00 The impact of MACRA on the long-term value-based care strategy of PSW. 08:30 Building an infrastructure and developing capabilities to move a value-based agenda. 09:00 Developing a business model for agility in responding to new rules ("a kayak in a sea of cruise ships") and engaging all types of physicians in the landscape. 09:30 "The value-based movement is important as the fee-for-service chassis is not realistic, has poor quality and outcomes, and rising costs." 10:00 Taking risk with physician partners and providing them with MSO services, leveraging a technical infrastructure and population health platform. 10:45 The glacial pace of scaling payment model transformation at CMS and CMMI's bold goal for 2030. 12:00 The increasing shift to home-based care delivery and the use of generative AI in reshaping care delivery. 13:00 How the flawed economic design of the fee-for-service system creates industry inertia. 14:00 Diverting to the known (i.e. fee-for-service care delivery) in times of stress is an unsustainable path forward. 15:00 Convincing the Board room on the tenets of VBC when it hasn't historically delivered on its promises. 16:00 Trends in consumer cost-shifting and the challenges of private insurers cross-subsidizing provider losses from public payers. 16:30 Unsustainable economics in employer-based healthcare and the looming insolvency of Medicare. 17:00 What does the CMMI 2030 Goal mean for future of the value movement? 18:30 An overview of the extensive services offered by PSW that empowers success in VBC. 19:30 The explosive growth of strategic transactions of physician groups and how mass consolidation is impacting the landscape. 21:00 Aligned incentives and access to a population health platform as keys to VBC success. 22:00 PE investment impacts on competition in an independent physician ecosystem. 23:00 Generational differences in the approach to the business of practicing medicine. 23:30 "Organizations that are convened with independent physicians are able to show better costs of care." (vs. employed or vertically integrated systems)

Chip and Dr. Liz Fowler, Deputy Administrator of CMS and Director of the agency's Center forMedicare and Medicaid Innovation (CMMI), discuss CMMI's mission to improve healthoutcomes, overcome the obstacles to health equity, and reduce care costs. They look back onwhat CMMS has accomplished in its first 10 years, what we have learned from thisexperimentation, and the future of care and payment innovation.Topics they examine include: CMMI's successes over the last decade and what programs have resonated most. Controversial CBO report that says CMMI's programs have increased federal spending –not lowered it. Performance of CMMI bundled payments and rationale behind a new mandatory bundledpayment program. Goals of the newly announced state-based AHEAD model and how it will interact withother ACO and value-based care programs. Dealing with the challenges created by massive growth in Medicare Advantage. How CMMI is addressing the broad issue of health equity.MORE:Dr. Fowler has the unique role of leading an agency she helped create. From 2008-2010, she wasChief Health Counsel to Senate Finance Committee Chair, Senator Max Baucus (D-MT), whereshe played a critical role in developing the Senate version of the Affordable Care Act. Theframework for the CMMI was embedded in the law – so now, after several roles in the private

My conversation today is with Will Shrank, MD. Dr. Shrank led the evaluation group at CMMI (Center for Medicare and Medicaid Innovation). He has spent time in the private sector, first at CVS Health and UPMC (University of Pittsburgh Medical Center) as chief medical officer of the health plan in Pittsburgh, and then as the chief medical officer for Humana. Now he is a venture partner at Andreessen Horowitz and doing some consulting for CMMI. We start out this conversation talking about waste in healthcare. In fact, Dr. Shrank was on a team who did a study about waste in the US healthcare system. (The article is, unfortunately, firewalled.) In that study, it says estimates suggest we have upwards of a trillion dollars of waste a year. There's two main groupings of said waste, turns out. The first is in administrative failures. There's three subcategories here: fraud, waste, and abuse; administrative complexity; and pricing failures. Then there's the clinical failures side of the waste house. There's three subcategories here as well, and they are failures in care coordination, failure in care delivery, and then low-value care. Dr. Shrank digs in a bit on each of these in the interview that follows, but I have to say, I go in fast for the now what. Great that we know where the waste is coming from, because gotta know the problems to solve for them. But really, what's the best way to solve for this waste? You know me by now, so I, of course, point out immediately that someone's waste is someone else's profit. So, that's a wrinkle. And it's a really rough wrinkle, because now you have groups lobbying to basically protect the waste. As just one example, what are pricing failures, after all, if not someone else's margin? Major spoiler alert here, but Dr. Shrank says one sort of broad-stroke solution is aligning incentives with higher-quality care, paying for the longitudinal patient journey, and paying for outcomes. If you do this, then at least the clinical failures side of the equation could improve. The implication here is that if the incentive is to be accountable for value—which is, you know, numerator quality denominator cost—then the supply chain has an incentive to reduce its own waste because effectively, at that point, it's coming out of their pocket as opposed to somebody else's. Will this resetting of the financial model happen overnight? That was a rhetorical question that we all know the answer to. Commercial payers are slow to change, and all but the best employers have been (historically, at least) busy making extremely lateral moves and going nowhere fast. Few seem super inclined to reward and pay for what they care about rather than just negotiating a price. I sort of say this to Dr. Shrank, and he says, yeah, true enough. I'm paraphrasing with a lot of creative license right now, but he says, let's reset our expectations with reality. We've actually come a pretty long way, baby, in not a particularly long time if you consider the whole value-based thing really only started not that long ago, relatively speaking. So, there will be problems to overcome and bumps in the road. We should expect that, and we haven't had the time to work them all out yet. I think a couple of other interesting insights for me, one was a little sidebar we go off on about the power that PCPs might find themselves wielding if they can gang up and harness it. And this is kind of starting. We'll see if it goes anywhere. I recently heard a story about a bunch of employed PCPs who went to their health system bosses and asked to stand up an APCP (advanced primary care practice) able to coordinate care, etc, do all the things that at this juncture we know are the right things to do for patients. Now they got shot down—bam!—with the backhands from above. I hope those engaged and activated PCPs quit and start up their own thing. Maybe they will. PCPs getting together here could be a way to solve for waste if they can gang up and harness it. And that's actionable if you happen to be a PCP or are looking to continue to employ them moving forward. The potential rising power of PCPs might cause some health systems to rethink some of the choices they are making (ie, the choice to employ PCPs as RVU [relative value unit] referral machines). PCPs, better than anyone, can see the harm inflicted by the business model that forces a drive-by PCP level of care. Moral injury is at an all-time high, and in addition, I just saw that study recently that showed to do all the administrative work of a PCP these days, it would take longer than 24 hours in a day. If you're a self-insured employer, I'd also kind of take note of this because it also could be actionable for you. Someone who would know told me recently that if enough employers demanded some value-based accountability, some advanced primary care going on, even a dominant consolidated health system would listen. So there seems to be some alignment here between employers and PCPs if these groups can come together and collaborate. In sum, we have a waste problem in this country. Aligning incentives might be one way to curb that waste. Can I just share with you some of the reviews that we got on iTunes recently? They make my heart so warm. I just want to acknowledge these individuals who took the time to write reviews. Here's the first one. It's from Jspeaks1987. He wrote, “[RHV is] my weekly go-to for smart takes on VBC [value-based care]. I have recommended this podcast to literally hundreds of people (including onstage at our recent customer success summit). Anyone who cares about the sustainability of our healthcare system owes it to themselves to give [Relentless Health Value] a permanent spot on their playlist. Always smart, often provocative, scrupulously fair [I like that … scrupulously fair], it's well worth the listen.” Thank you so much, Jspeaks1987. Here's another one. And this is from happygilmore80. I know who you are, happygilmore. “RHV is an amazing podcast and sorely needed in the healthcare community. I tell everyone about it. … I'm a recent listener and have learned so much from [episode] 399 and 400 [which are the manifestos]. Episode 410 was packed with knowledge, 407 was great, etc. Let's start a hundred RHV communities across the US where we implement small experiments so change is grassroots and ubiquitous. Then the status quo will concede.” And yeah, for sure with that. If anyone is interested in creating a meetup or something in your local area, reach out. I'll try to hook you up with others in the Relentless Tribe. Here's a third one, and this is by Miriam. Thank you so much for this, Miriam. Miriam says, “I scoured the podcast world to find a healthcare industry podcast that offers intelligent, relevant, clear information and dialogue. I found it. Stacey and RHV cover the US healthcare industry across all sectors while managing to go deep within those sectors. Most importantly, [RHV] highlights how all of those sectors interact, supposedly with the patient at the center, while performing as businesses that are really driven by capitalism.” Miriam says she never misses an episode. To the three of you, thank you so much. It's actually reviews like this that keep me and the team going over here.   You can learn more by connecting with Dr. Shrank on LinkedIn.     William H. Shrank, MD, MSHS, is serving as venture partner, bio and health, at Andreessen Horowitz. Previously, Dr. Shrank served as chief medical officer for Humana, where his responsibilities included implementing Humana's integrated care delivery strategy, with an emphasis on advancing the company's clinical capabilities and core objective of improving the health outcomes of its members. Dr. Shrank previously held the position of chief medical and corporate affairs officer, during which time he oversaw government affairs. From 2016 to 2019, Dr. Shrank served as chief medical officer, insurance services division, at the University of Pittsburgh Medical Center. Previously, Dr. Shrank served as senior vice president, chief scientific officer, and chief medical officer of provider innovation at CVS Health. Prior to joining CVS Health, he served as director of the Research and Rapid-Cycle Evaluation Group for the Center for Medicare and Medicaid Innovation. Dr. Shrank began his career as a practicing physician with Brigham and Women's Hospital in Boston and as an assistant professor at Harvard Medical School. He has published more than 270 papers on improving the quality of prescribing and the use of chronic medications. Dr. Shrank received his MD from Cornell University Medical College. He completed his residency in internal medicine at Georgetown University and his fellowship in health policy research at the University of California, Los Angeles. He also earned a master of science in health services from the University of California, Los Angeles, and a bachelor's degree from Brown University.   05:56 Can we cut healthcare waste while improving patient care? 06:35 What does “healthcare waste” consist of? 06:48 What are the six categories of “healthcare waste”? 09:25 EP363 with David Scheinker, PhD. 09:39 How much money does Dr. Shrank estimate is wasted each year in healthcare? 12:11 Where is that healthcare waste going, and why does it happen? 19:09 Uncaring by Robert Pearl, MD. 20:20 “We've built a backbone of extraordinary waste on a fee-for-service chassis.” 21:18 EP409 with Larry Bauer, MSW, MEd. 23:26 EP359 with Dan O'Neill. 25:04 Dr. Shrank's warning to providers out there. 29:04 Summer Shorts 2 with Scott Conard, MD. 30:43 Why there might be a generational shift among younger providers looking to work with different models.   You can learn more by connecting with Dr. Shrank on LinkedIn.   @WillShrank discusses #healthcarewaste, #vbc, and #PCPs on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Carly Eckert (Encore! EP361), Dr Robert Pearl, Larry Bauer (Summer Shorts 8), Secretary Dr David Shulkin and Erin Mistry, Keith Passwater and JR Clark (Summer Shorts 7), Lauren Vela (Summer Shorts 6), Dr Jacob Asher (Summer Shorts 5), Eric Gallagher (Summer Shorts 4), Dan Serrano, Larry Bauer  

The Congressional Budget Office released a report showing that the Center for Medicare and Medicaid Innovation, created under Obamacare to test new ways to pay for health care, will increase federal spending rather than reducing it. In 2010, CBO projected CMMI would reduce spending by $2.8 billion over 10 years, but current estimates show it increasing $1.3 billion from 2021 to 2030. Host Ben Leonard talks with Robert King about why.