Podcasts about risk adjustment

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers welcomes Farzad Mostashari, founder & CEO of Aledade and the former National Coordinator for Health IT, to the pod to break down insights in the latest MedPAC report, quality measurement reform, and areas of opportunity for value-based care.Health Affairs is hosting an Insider exclusive event on May 29 focusing on the FDA's first 100 days under the second Trump administration featuring moderator Rachel Sachs alongside panelists Richard Hughes IV and Arti Rai.Related Links:Crossing the Chasm: How to Expand Adoption of Value-Based Care (The New England Journal of Medicine)2025 MedPAC Report Subscribe to UnitedHealthcare's Community & State newsletter.

The fiscal year (FY) 2026 Inpatient Prospective Payment System (IPPS) proposed rule introduces significant reforms to hospital reimbursement, risk adjustment, and performance measurement.Key changes include the Centers for Medicare & Medicaid Services (CMS) transition to HCC Version 28, the use of the Community Deprivation Index (CDI) for socioeconomic risk adjustment and expanded inclusion of Medicare Advantage data in quality metrics.Launching in 2026, the proposed rule mandates episode-based payments with enhanced pricing accuracy. Hospitals must adapt by updating financial models, realigning quality strategies, and fostering cross-departmental collaboration. These changes emphasize equity, accountability, and transparency, all of which is designed to help in the positioning hospitals to lead in a value-driven healthcare environment.Strategic readiness is critical to thrive under IPPS 2026. Reporting this story, during the next live edition of Monitor Mondays, will be the broadcast's special guest Penny Jefferson.The long-running broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Folana Houston, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C.• News Update: Dr. Drew Update will have an update to his recent reporting on transgender treatment practices.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Senior Deputy Editor Rob Lott interviews J. Michael McWilliams of Harvard Medical School and Brigham and Women's Hospital on his recent paper that explores opportunities for the use of patient health survey data for risk adjustment to limit distortionary coding incentives in Medicare. Order the January 2025 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.

Every Gen X'er listening to this is gonna be singing that Clash song in your head for the rest of the day. So, let's turn our attention to Medicare Advantage policy. And on the show today, I grill the one and only Betsy Seals to find out which policies she thinks are going to stay and which are going to go. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. Obviously, this is very much in the context of a new administration and also just other things that are going on. But today we talk about the following four “stay or go” policy areas. Here's the first policy area we talk about: changes and activities within the Stars program. How will the Medicare Advantage Stars program change or not? Not only with this new administration, but also there are lawsuits and how they will impact the goings-on moving forward. Second policy, will it stay or will it go, that we talk about is risk adjustment and all of the activity in government oversight and focus on recoupment of improper payments as kind of the overarching bucket and what will be the incoming administration's method around risk adjustment. This is certainly on many people's minds. The third “will it stay or will it go” policy that we discuss is the use of AI (artificial intelligence) by Medicare Advantage plans. What does the appropriate oversight of the use in AI look like? Lots of talk about those prior auth AI algorithms and the high levels of denied care. A big topic of everybody's collective mind is looking at how to ensure that oversight is appropriate and that we're using AI for good and that it's not having any adverse impact. So that's the third will it stay or will it go. Fourth, and lastly, the whole agent broker realm—additional CMS and government oversight over misleading or inaccurate information coming from the marketing or the agent broker marketing world. How will that look in 2025 and moving forward? This last one, I'm kind of all over the nuance there after reading posts and comments by Samantha George, and I would recommend following her on LinkedIn would be my suggestion. I am reflecting back on the Ann Kempski episode (EP444), where we talk about the whole, really consider the downstream impact when making any policy changes, because there can be unintended consequences. Now, in a show about carriers—in this case, Medicare Advantage carriers—I'd be pretty tone deaf not to mention the nation's ire at carriers at this exact moment in time, some of it extremely well earned and some of it reflective of an extremely dysfunctional healthcare system. I'd also be tone deaf not to mention the MedPAC (Medicare Payment Advisory Commission) report, which states that Medicare Advantage plans receive payments from CMS that are 122% of spending for similar beneficiaries in traditional Medicare. This translates to an estimated $83 billion in higher spending in 2024. And I would lastly be remiss not to mention how Medicare Advantage plans are most carriers' most profitable service lines, with average earnings of around $1800 per enrollee. All of what I said is not some kind of grand revelation, of course, to most listeners of this show. And it's also not the topic of the conversation today, although some of this did get asked and answered in the earlier shows (EP387, EP375, EP291) with Betsy Seals. One thing I will remind everyone about is that there are regional carriers that are not the big five who may or may not be doing big five types of things. And also, it is actually really difficult to run a Medicare Advantage plan successfully. They call it risk for a reason. One thing I really appreciated about the conversation with Betsy Seals that follows is her advice to contemplate value to the patient and make sure that anybody working on the carrier side, you have enough of a bead on what's actually happening to be able to identify when things are going off the rails, which does not seem to be the case in some instances. This also, by the way, having a bead on what's actually happening on the ground, helps to ensure compliance and that's piece of advice two. Last piece of advice is to learn how to be proactive and not reactive. And this is eminently more possible vis-à-vis data that's available and learning how to use it well. Betsy Seals, my guest today, has had a very busy last couple of years since she was on Relentless Health Value the last time. Betsy is CEO and co-founder of Rebellis Group, a managed care consulting firm focused specifically in Medicare Advantage. Rebellis was actually acquired in February of 2024 and joined as a family of a couple of other consulting firms that now Betsy heads up. So, in short, she's really busy. Also mentioned in this episode are Samantha George; Ann Kempski; Rebellis Group; and Vivian Ho, PhD.   You can learn more at rebellisgroup.com and alerionadvisors.com and by following Betsy on LinkedIn.   Betsy Seals is the CEO of Alerion Advisors, a family of companies dedicated to delivering unparalleled consulting services across the healthcare spectrum. As a parent organization, Alerion Advisors unites three specialized firms—Rebellis Group, Advent Advisory, and Toney Healthcare—to provide health plans and their partners with comprehensive, innovative, and results-driven solutions. With over 25 years of experience in the managed care industry, Betsy is a nationally recognized leader known for her regulatory expertise and strategic insights. Betsy brings to the table a solid mix of leadership and business acumen, as well as regulatory and strategic knowledge within the managed care landscape. Betsy's expertise is focused in the areas of mergers and acquisitions, compliance, sales and marketing, strategy, supplemental benefit landscape, innovative benefit design that address social determinants of health (SDoH), and health plan operations.   05:09 Will the Star Ratings program stay in this new administration? 08:08 How will the lawsuits against CMS policies play out with this new administration? 10:24 Why is it hard for Medicare Advantage plans to survive, let alone thrive? 16:22 How does AI directly impact beneficiary lives? 21:38 What's going on now with the override payments? 27:08 How is non-collaboration going to impact Medicare beneficiaries moving forward? 31:45 Why is it important to become more technologically savvy in compliance?   You can learn more at rebellisgroup.com and alerionadvisors.com and by following Betsy on LinkedIn.   @betsyseals discusses #medicareadvantage policies on our #healthcarepodcast. #healthcare #podcast #changemanagement #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Wendell Potter (Encore! EP384), Dr Scott Conard, Stacey Richter (INBW42), Chris Crawford, Dr Rushika Fernandopulle, Bill Sarraille, Stacey Richter (INBW41), Andreas Mang (Encore! EP419), Dr Komal Bajaj, Cynthia Fisher    

In this episode, Stacey Richter speaks with Rob Andrews, CEO of the Health Transformation Alliance (HTA) and former Congressman, about the strategic steps jumbo employers can take to achieve improved health outcomes while reducing cost. They delve into the importance of using data to discern effective practices, negotiate contracts, and hold intermediaries accountable. To Read The Show Notes With All 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. The discussion highlights maternal health as a critical area of focus, with successful interventions shown to reduce NICU admissions and overall healthcare costs. Andrews emphasizes the role of self-insured employers in driving systemic changes that align financial incentives with health outcomes. This encore is very relevant after the shows with Cora Opsahl (EP452), Claire Brockbank (EP453), and Marilyn Bartlett (EP450). Getting better health for the 160 million Americans covered by commercial insurance is all about rates, rights, and power. 07:34 How did Rob get to his current role? 09:08 The problem of maternal health and mortality rate, and how self-insured employers wind up directly and indirectly paying for this. 10:27 Why economic consequences move the needle, and why sometimes they don't. 12:26 Why the best way to address costs isn't to re-shift costs but to address them directly. 13:22 Why compensation that isn't dependent on outcomes is a problem. 16:23 “Strategy's not what people say; it's what they do.” 18:21 How do you operationalize saving money with better outcomes? 26:26 How do employers turn conflict into collaboration? 28:20 What is the win-win-win structure among employers, payers, and providers in Rob's eyes? 30:53 To whom should the task of risk adjustment fall? 34:43 “Better contracts do improve outcomes.”  

Send us a textBen and Daphna are joined by Dr. Karna Murthy from Lurie Children's Hospital to discuss CHNC's innovative approach to risk adjustment for neonatal outcomes. Dr. Murthy shares insights into developing new tools for comparing NICU performance across hospitals, allowing centers to benchmark outcomes in rare conditions like diaphragmatic hernia and severe BPD. He also offers a look into the future of the CHNC Symposium, including expanded workshops and collaborative sessions. Tune in to learn how these efforts aim to drive continuous improvement in neonatal care.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

This episode of the award-winning podcast examines the importance of risk adjustment. Dr. Tomas Villanueva leads the discussion on the impact of this crucial aspect of documentation that can affect hospital outcomes.   Moderator: Tomas Villanueva, DO, MBA, FACPE, SFHM Senior Principal, Clinical Operations and Quality Vizient   Guest: Erica Braun, MS, RN, CCDS Senior Consulting Director, Clinical Documentation Improvement Vizient   Show Notes: [01:29] Defining risk adjustment – maintaining an apples to apples comparison [02:41] Capturing comorbid conditions to the highest level of specificity [04:08] Capturing the low-hanging fruit [05:47] Case mix index issues [07:44] Severity of illness and risk of mortality [08:52] Addressing query fatigue   Resources: To contact Modern Practice: modernpracticepodcast@vizientinc.com Erica Braun's email: erica.braun@vizientinc.com   Subscribe Today! Apple Podcasts Amazon Podcasts Android Spotify RSS Feed

Jason is a full-time crypto native angel investor and the Co-Founder of Tangent, an evergreen prop investment firm that supports founders in both early-stage and liquid crypto markets. He is also the Host at the  @theblockcrunchpodcast  and was previously a General Partner at Spartan Capital, one of Asia's first institutional crypto funds. He co-led investments in over 80 companies and helped scale the Spartan fund from $9M in to $500M in Assets under management. In this conversation, we dive into: - Discovering Crypto - Biggest Loss Ever - How to get Rich in Crypto without Luck: key principles - Dunning-Kruger Effect in Crypto - Unpopular Crypto Beliefs And much more! __________________________________ PARTNERS

Coding is an often overlooked but critical aspect of health care. Dr. Victor Legner, a geriatrician with a wealth of knowledge in clinical documentation and coding integrity, unravels the intricate web of ICD-10 codes, hierarchical condition categories and risk adjustment factor scores, spotlighting how accurate coding is key to ensuring providers are adequately funded.  Dr. Legner underscores the need to regularly update patients' records to ensure all providers have up-to-date information about their patients' conditions. The episode also discusses areas where coding mistakes are common, such as chronic conditions like depression and diabetes. Tune in for insight into how precise coding can help health care professionals improve patient care and adapt to new care models that focus on value. 

Dawn Carter,  director of product strategy at Centauri Health Solutions, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health.In this 23-minute podcast, recorded on April 18, Carter discusses the shift from the V24 to V28 risk model, the coding changes, and its risk adjustment applications. About Dawn Carter Dawn Carter, BSBA, CPC, CRC, CPMA, CDEO, CPCO, CSPO,  is a director of product strategy at Centauri Health Solutions. Her career in health care spans 25 years, which most recently includes extensive experience in developing revenue integrity and quality software solutions, with a focus on encounter management and risk adjustment solutions for Medicare Advantage, Medicaid, and Commercial health plans. She also provides strategic advisory solutions and consulting services for revenue cycle operations. Prior to that, her experience spans all domains of health care including health plan claims and provider systems administration, and healthcare applications development. Her experience also includes multiple teaching engagements in medical administration, billing, and coding. Carter holds a bachelor's degree in business administration. She is a passionate and prolific industry speaker, author, blogger and subject matter expert in claims, EDI management, and risk adjustment.  About Centauri Health Solutions Centauri Health Solutions is a leading provider of technology-enabled analytics and services helping health plans and health systems to manage their variable revenue linked to population health (risk), quality, and eligibility factors. These efforts result directly in better-informed health care delivery, richer benefits, and reduced out-of-pocket healthcare costs for the members and patients they serve.    

Are you navigating the complex world of healthcare compliance, particularly when it comes to Medicare and Advanced Beneficiary Notices (ABNs)? We've got you covered in the latest episode of Compliance Conversations, featuring industry expert Keisha Wilson, founder of KW Advanced Consulting. Keisha brings over two decades of healthcare experience to the table, offering invaluable insights into the intricacies of ABNs. This episode delves deep into what ABNs mean for healthcare professionals and patients alike, recent changes to ABN forms, compliance risks, and the importance of proper education and implementation within healthcare settings. Why Tune In? - Uncover the essentials of ABNs: Learn what ABNs are and why they're critical in healthcare from a seasoned expert. - Stay updated: Get the scoop on the latest ABN form changes effective from June 2023 and how they impact practices. - Avoid common pitfalls: Keisha discusses frequent compliance risks and how to navigate them effectively. - Engage in comprehensive learning: From policy implementation to case studies, this episode is packed with actionable advice and best practices. Keisha's journey from aspiring social worker to healthcare compliance consultant adds a unique perspective to understanding patient communication and the nuances of Medicare coverage. Her passion for compliance and patient care shines throughout the conversation, making it a must-listen for anyone in the healthcare sector. You can also read a recent blog post from KW Consulting on ABNs. Keisha Wilson, CCS, CPC, CPCO, CPMA, CRC, CPB, Approved Instructor, is the Founder/CEO of KW Advanced Consulting LLC, Minority Women Own Business Enterprise (M/WBE) Certified, with 20+ years in healthcare specializing in various areas of compliance. Multi-specialty, Telehealth/Telemedicine, Risk Adjustment, provider and coder training. She currently sits on a Board of Directors for an outpatient mental health clinic. Keisha is a licensed PMCC who teaches coders looking to become Certified Risk Adjustment (CRC) and hosts various compliance documentation and coding webinars. She is a published author, having written for AAPC editors on Primary Care Coding Alert, Healthcare Business Monthly, and KW Advanced Consulting coding articles. Keisha can speak at various events this year, including the AAPC Regional Conference on Philidelphia and Cohen's Coding Summit on Telehealth in the U.S. vs Internationally.

Jay Ackerman is the CEO of Reveleer, a  data and analytics company that works with payers and providers to support them in quality improvement and risk adjustment in a value-based care environment. Using AI, natural language processing, and integration of diverse databases, Reveleer is reducing administrative burdens and supporting providers to make more informed decisions for patient care.   Jay explains, "In the AI world, a lot is being done to drive productivity and efficiency for payers and providers to anticipate how someone's health is shifting and changing. But for us, in the world of AI, what we're focused on and how we're trying to use AI, when we talk about quality improvement and risk adjustments, we ingest massive clinical data on each of these members, on each of these patients, we could capture thousands of pages." "We use AI to quickly digest, organize, and mine that data to understand what has happened over time for that member and what we think could be happening as they go forward. What we're aiming to do, and what we're doing, is mining that data and presenting a very concise set of recommendations to the provider. So when that patient walks into their office, they know what gaps in care they should be paying attention to. Gaps in care that might be tied to quality scores. Gaps in care that might be tied to validating overall risk score. " #Reveleer #ValueBasedCare #QualityImprovement #RiskAdjustment Reveleer.com Download the transcript here

Jay Ackerman is the CEO of Reveleer, a  data and analytics company that works with payers and providers to support them in quality improvement and risk adjustment in a value-based care environment. Using AI, natural language processing, and integration of diverse databases, Reveleer is reducing administrative burdens and supporting providers to make more informed decisions for patient care.   Jay explains, "In the AI world, a lot is being done to drive productivity and efficiency for payers and providers to anticipate how someone's health is shifting and changing. But for us, in the world of AI, what we're focused on and how we're trying to use AI, when we talk about quality improvement and risk adjustments, we ingest massive clinical data on each of these members, on each of these patients, we could capture thousands of pages." "We use AI to quickly digest, organize, and mine that data to understand what has happened over time for that member and what we think could be happening as they go forward. What we're aiming to do, and what we're doing, is mining that data and presenting a very concise set of recommendations to the provider. So when that patient walks into their office, they know what gaps in care they should be paying attention to. Gaps in care that might be tied to quality scores. Gaps in care that might be tied to validating overall risk score. " #Reveleer #ValueBasedCare #QualityImprovement #RiskAdjustment Reveleer.com Listen to the podcast here

This month Dr. Ankur Patel, Chief Medical Officer at Tabula Rasa HealthCare, is joined by Dr. Mike Brett, Senior Vice President, Chief Medical Officer, Capstone Risk Adjustment Services to discuss how PACE programs can utilize Risk Adjustment Services to evaluate their participants' risk scores now to better prepare for 2024.  Also,  how specificity in your documentation can improve participant care. Our experts share insights into strategies for clinical documentation and best practices for a comprehensive Risk Adjustment program.Episode Guests:• Dr. Ankur Patel, Chief Medical Officer at Tabula Rasa HealthCare (moderator)• Dr. George 'Mike' Brett - SVP of Consulting, Capstone Performance Systems#PACE #Tabularasa #healthcarePrescription Health is brought to you by Tabula Rasa HealthCare, a leader in providing patient specific, data driven technology and solutions with a mission to enable simplified and individualized care that improves the health of those served. For more information, please tabularasahealthcare.com. Learn More: https://www.tabularasahealthcare.com/https://careventionhc.com/https://www.linkedin.com/company/carevention-healthcarehttps://www.linkedin.com/company/tabula-rasa-healthcare

It's often said that to be a good CDI or coding professional you have to roll up your sleeves and get clinical. If you code just what is explicitly documented you will miss opportunities; if you don't understand A&P and pathophysiology, you will make mistakes. But what about those who take the opposite path? Katie McLaughlin became a registered nurse at age 23, then went back to school to earn her doctorates before becoming a nurse practitioner in 2007. Today—at least until very recently, when her organization opted to discontinue accepting Medicare Advantage patients and shuttered its risk adjustment program—she became Population Health Clinical Advisor: Clinical Documentation Integrity, Risk Adjustment, and Epic Informatics, for Scripps Health. A clinical path, to coding and CDI. Today she is looking for the next opportunity. But given her clinical foundation, coding expertise, EHR savvy, and above all, passion and vision, she will be landing very well, and very shortly. Katie joined me for this week's episode of Off the Record, where we discuss: • Her path into nursing, clinical medicine, and ultimately risk adjustment • Prospective chart reviews—a 2 a.m. vision, and implementation • Leveraging Medicare annual wellness visits • Scaling risk capture by customizing EPIC • Building dedicated Internal Wellness Clinics focused on screening and risk capture • Unexpected free time and plans for her next career move

This episode of the award-winning podcast examines the importance of risk adjustment. Dr. Tomas Villanueva leads the discussion on the impact of this crucial aspect of documentation that can affect hospital outcomes.   Moderator: Tomas Villanueva, DO, MBA, FACPE, SFHM Senior Principal Clinical Operations and Quality Vizient   Guest: Erica Braun, MS, RN, CCDS Senior Consulting Director Clinical Documentation Improvement Vizient   Show Notes: [01:29] Defining risk adjustment – maintaining an apples to apples comparison [02:41] Capturing comorbid conditions to the highest level of specificity [04:08] Capturing the low-hanging fruit [05:47] Case mix index issues [07:44] Severity of illness and risk of mortality [08:52] Addressing query fatigue   Resources: To contact Modern Practice: modernpracticepodcast@vizientinc.com Erica Braun's email: erica.braun@vizientinc.com   Subscribe Today! Apple Podcasts Amazon Podcasts Android Google Podcasts Spotify RSS Feed

Welcome to the Paint The Medical Picture Podcast, created and hosted by Sonal Patel, CPMA, CPC, CMC, ICD-10-CM. Thanks to all of you for making this a Top 15 Podcast for 2 Years: https://blog.feedspot.com/medical_billing_and_coding_podcasts/ I'd love your continued support of this content-rich, value-add podcast to help you succeed in the business of medicine: https://podcasters.spotify.com/pod/show/sonal-patel5/support Sonal's 9th Season starts up and Episode 15 features a Newsworthy update on the OIG Work Plan for July 2023. Trusty Tip features Sonal's compliance recommendations for risk-adjustment coding in FY 2024. Spark inspires us all to reflect on success based on the inspirational words of Deepak Chopra. Thanks to Advanced Coding Services, LLC: Website: https://advancedcodingservices.com/ Paint The Medical Picture Podcast now on: Anchor: https://anchor.fm/sonal-patel5 Spotify: https://open.spotify.com/show/6hcJAHHrqNLo9UmKtqRP3X Apple Podcasts: https://podcasts.apple.com/us/podcast/paint-the-medical-picture-podcast/id1530442177 Google Podcasts: https://podcasts.google.com/feed/aHR0cHM6Ly9hbmNob3IuZm0vcy8zMGYyMmZiYy9wb2RjYXN0L3Jzcw== Amazon Music: https://music.amazon.com/podcasts/bc6146d7-3d30-4b73-ae7f-d77d6046fe6a/paint-the-medical-picture-podcast Breaker: https://www.breaker.audio/paint-the-medical-picture-podcast Pocket Casts: https://pca.st/tcwfkshx Radio Public: https://radiopublic.com/paint-the-medical-picture-podcast-WRZvAw Find Paint The Medical Picture Podcast on YouTube: https://www.youtube.com/channel/UCzNUxmYdIU_U8I5hP91Kk7A Find Sonal on LinkedIn: https://www.linkedin.com/in/sonapate/ And checkout the website: https://paintthemedicalpicturepodcast.com/ If you'd like to be a sponsor of the Paint The Medical Picture Podcast series, please contact Sonal directly for pricing: PaintTheMedicalPicturePodcast@gmail.com --- Send in a voice message: https://podcasters.spotify.com/pod/show/sonal-patel5/message Support this podcast: https://podcasters.spotify.com/pod/show/sonal-patel5/support

A new rule, effective in 2023, expands CMS' audit scope regarding Medicare Advantage plans. Experts discuss how this change will increase the frequency of audits as well as potential plan and provider liability. Get billing and coding help from TMA at www.texmed.org/billingandcoding. Contact Sabrina Skeldon at physicianpracticeguidance.net. Find billing and coding CME programs at www.texmed.org/education FREE for TMA members

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For more information, contact us at 859-721-1414 or myhealth@prevmedheartrisk.com. Also, check out the following resources: ·Newsletter Sign Up·Purchase an Appointmen Today!·PrevMed's Locals·PrevMed's Rumble·PrevMed's website·PrevMed's YouTube channel·PrevMed's Facebook page·PrevMed's Instagram·PrevMed's LinkedIn·PrevMed's Twitter ·PrevMed's Pinterest

For more information, contact us at 859-721-1414 or myhealth@prevmedheartrisk.com. Also, check out the following resources: ·Newsletter Sign Up·Purchase an Appointmen Today!·PrevMed's Locals·PrevMed's Rumble·PrevMed's website·PrevMed's YouTube channel·PrevMed's Facebook page·PrevMed's Instagram·PrevMed's LinkedIn·PrevMed's Twitter ·PrevMed's Pinterest

We are on an enlightening journey to transform American healthcare in the race to value. Medicare Advantage increasingly stands out as a superior vehicle for value transformation due to its ability to catalyze care delivery innovation through full-risk capitation. By promoting coordinated care and integration among healthcare providers, MA plans foster a patient-centric approach that improves overall care quality and health equity. Additionally, these plans prioritize preventive care and wellness initiatives and enable early identification and management of chronic disease, ultimately reducing healthcare costs. By incentivizing providers to prioritize outcomes over volume, Medicare Advantage is our path forward to a uniquely American healthcare system that we can be proud of. Joining us this week on the podcast is Don Crane, former CEO of America's Physicians Groups. In this episode, he shares his valuable insights and expertise on Medicare Advantage and how it will shape our future in healthcare transformation. Join us as we explore the challenges and opportunities that lie ahead for Medicare Advantage and discuss the potential impact on the healthcare landscape! Episode Bookmarks: 01:30 Introduction to Don Crane (Former President and CEO of APG) and the potential for Medicare Advantage to transform American healthcare. 03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:00 Don Crane joins the Race to Value again as returning guest. (Check out his prior episode on Primary Care Transformation!) 05:00 The explosive growth of MA and the evidence showing that MA plans deliver better economic and clinical outcomes. 06:30 How a capitation in Medicare Advantage enables population health outcomes through effective SDOH interventions. 08:00 The criticisms of Medicare Advantage from notable thought leaders Richard Gilfillan and Don Berwick. 09:30 Protection of the Medicare Trust Fund is the common point of agreement between MA proponents and opponents. 10:00 Don addresses the criticisms of risk adjustment gaming and the program's overall spend. 10:45 Is it necessarily a bad thing if MA costs more than Traditional Medicare if it provides better care outcomes and supplemental benefits? 11:30 “Spending more on Medicare Advantage makes all the sense in the world to me if it provides better outcomes and value for seniors.” 12:00 The perspective from seniors enrolled in Medicare Advantage on the appropriateness of spending for supplemental benefits. 12:30 “The astronomical growth of Medicare Advantage should be celebrated.” 13:00 The V28 HCC changes to the Risk Adjustment model for payment year 2024 will decrease the number of codes by more than 2,000 from the HCC model. 14:00 The adverse impacts of risk adjustment coding changes will increase administrative complexity and hurt seniors by reducing MA funding to the tune of $10B. 15:45 The need to evaluate both Traditional Medicare and MA to determine the best path forward. 16:30 Risk adjustment is grounded on the premise of fairness to both the payer and provider and should prevent both over- and under-payment. 17:30 “Risk adjustment is such an important ingredient in capitated payment models and provides a business case for addressing inequities in underserved communities.” 18:30 Concerns about the elimination of risk adjustment and how that will adversely affect sicker patent populations through “cherry picking” during MA enrollment. 19:30 Don compares the bad actors in MA who perform upcoding to the overpayments and overutilization that occurs in Traditional Medicare. 20:00 Is the potential for upcoding exaggerated by detractors of Medicare Advantage? 20:30 Eliminated risk adjustment in Medicare Advantage is an example of throwing out the baby with the bathwater. 21:00 How Star Ratings work in Medicare Advantage to unlock bonuses and rebates when improving care quality.

After a short break that was not really a break because we were on the road at ACDIS 2023 we're back with another episode of Off the Record.  Today I'm joined by fellow conference-goer, presenter, and colleague Jason Jobes, senior vice president of solutions at Norwood.  On this show we dive into the recently concluded ACDIS 2023 national conference in Chicago, which was my 15th (yes, I've been to every single one from 2008-present, not including the virtual event of 2020, and I think I'm the only person on the planet who can say this) and Jason's first. We had a blast, learned a lot, and came back recharged and optimistic for the future of the CDI profession. I also had the honor of remembering my colleague Melissa Varnavas with a Day 1 keynote.  We then switch gears to outpatient CDI and the ongoing transition to value-based reimbursement with a focus on Jason's session from the ACDIS Outpatient Symposium, entitled The Importance of Risk Adjustment in Value Based Settings.   We cover the following topics:  Payer relationships, and how CDI and coding leaders and their respective organizations should approach payers with whom they have had (and likely still have) an adversarial relationship, but now find themselves in a shared savings agreement that rewards cooperation.  The importance of patient scheduling, including leveraging your case managers, social workers, and population health team to get patients in to be seen. Both to manage their health in less expensive settings but also to capture risk. Annual Wellness Visits can play a large role here.  What if you don't have an OP CDI program? How to figure out where your opportunities lie and where to start. Hint: It's about understanding and seeing your patients, knowing what risk program they are in and what clinical conditions they have, and seeing them at least annually. And monitoring process and outcome metrics to ensure that patient complexity is fully captured.  The Medicare Advantage 2024 Advance Notice final rule and the anticipated impact of the transition from V24 to V28 of CMS-HCCs over three years (2024-2026).  The current landscape of intense regulatory scrutiny, and the corresponding shift from revenue maximization/capture to compliance and revenue protection. We discuss Jason's recent series on LinkedIn analyzing the seemingly endless stream of OIG audits of Medicare Advantage payers on presumed overcoding, including ongoing patterns of (likely) error.  And of course, we discuss Jason's top 90s rock/pop hit. He's a little younger than me so I let him get into the music of his youth, rather than mine—the 80s. Against my better judgement. 

Lesley Weir, senior director, customer and product success at Veradigm, and Kate Wormington director, product management, analytics at Veradigm Payer Analytics, join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Medicare Member Acquisition & Experience; and Social Determinants of Health.In this 31-minute podcast, they discuss the risk adjustment and quality changes in the final rules and their recommendations and strategies for organizations going forward. About Lesley WeirLesley Weir, senior director of customer and product success at Veradigm, has over 30 years' experience in the Medicare Managed Care industry, with specific expertise in operations, risk adjustment, and quality improvement. She has a demonstrated track record of assisting health plans in meeting operational and revenue goals, as well as developing innovative strategies to improve member's health and experience. Prior to her role at Veradigm, she held various leadership positions at multiple provider-owned Medicare Managed Care Health Plans and a large national plan.  She also spent six years working in the vendor space supporting Medicare Advantage plans across the country with their risk adjustment and quality programs.About Kate WormingtonKate Wormington, director, product management, joined Veradigm in January of 2023 leading theQuality Analytics solutions. For the past 20 years, Kate has focused on HEDIS® and quality reporting for both payers and providers.  Kate spent close to 10 years managing complex operations of a quality analytics program supporting HEDIS, CMS Star, IHA AMP, QARR, QRS, and Medicaid State measurement sets for innovative health care organizations.  She has deep experience leading a multi-state Client Success Support and Implementation team, supporting 27 clients across three products.  Additionally, Kate has led an NCQA Data Aggregator Validation (DAV) project team through Cohort 2, and was in the middle of Cohort 4, providing targeted HEDIS standard supplemental data using C-CDA files. She began as a software engineer specializing in software quality, with a Masters degree in IT.   She embraced the business side, utilizing product, project and client management skills. Wormington lives in Denver, Colo., originally from the UK, starting her career in health care working for the National Health Service.  About Veradigm Veradigm Payer Analytics (formerly Pulse8) is health care analytics and technology solution delivering complete visibility into the efficacy of your Risk Adjustment, Quality, and Pharmacy Benefit Management programs. Veradigm empowers health plans and providers to eliminate waste and achieve the greatest financial impact in the Medicare Advantage, Medicaid, and ACA Commercial markets as well as with Value-Based Payment models for Medicare. Advanced analytic methodologies and flexible business intelligence tools offer real-time visibility into member behavior and provider performance while also improving efficiency for payers and at-risk providers through high-speed clinical data exchange. Veradigm's patented Dynamic Intervention Planning offers a suite of uniquely pragmatic solutions that identify the most cost-effective and appropriate interventions for closing gaps in documentation, coding, and quality. For more company information or to schedule a demo, please email payersolutions@veradigm.com

CDPHP, Johns Hopkins Medicine, Priority Health, ATRIO Health Plans and Vatica Health share successful strategies and best practices for provider-centric risk adjustment programs, which enable health plans to enjoy higher compliance, enhanced quality of care, improved risk score accuracy, higher Star and quality ratings and better financial performance. Learn how your plan can empower physicians to close care gaps, avoid common pitfalls and maintain compliant record documentation proactively.   Panelists: Gregg Kimmer, President & CEO, ATRIO Health Plans; Michelle Ilitch, MPH, Vice President, Vice President of Network Solutions and Value-Based Programming, Priority Health,; Colleen Gianatasio MHS, CPC, CPC-P, CPMA, CRC, CPCO, CDEO, CPPM, CCDS-0, CCS, and AAPC Approved Instructor, Director Clinical Documentation Integrity and Coding Compliance, Capital District Physician's Health Plan (CDPHP);  Frank Shipp, FACHE, MBA, Executive Director, Johns Hopkins Clinical Alliance, Johns Hopkins Medicine; Hassan Rifaat, MD, CEO, Vatica https://www.sharedpurposeconnect.com/events/boosting-plan-performance-improving-provider-centric-risk-adjustment-staying-compliant/   For more information on our Payer & Provider Roundtable Summit: https://brightspotssummit.eventbrite.com   This episode is sponsored by Vatica Health Vatica Health is the #1 rated risk adjustment and quality of care solution for health plans and health systems. By pairing expert clinical teams with cutting-edge technology, Vatica increases patient engagement and improves coding accuracy and completeness. It helps identify and facilitate closure of care gaps and enhances communication and collaboration between providers and health plans. The company's unique provider-centric solution helps payers, providers and patients achieve better outcomes, together.   Vatica is trusted by many leading health plans and thousands of providers nationwide. Healthcare research firm KLAS named Vatica “Best in KLAS” for risk adjustment in 2023. KLAS also named Vatica to its Emerging Solutions Top 20 list for innovative companies that have the greatest potential to impact and disrupt the healthcare market. For more information, visit VaticaHealth.com.

In this episode, we discuss the Centers for Medicare and Medicaid Services' proposed changes to the Medicare Advantage risk adjustment payment model, which will take effect in 2024 if finalized. We're joined by special guest Alex Oliphant, Director of Berkeley Research Group's Health Analytics practice, who has extensive experience in the workings of the Medicare Advantage payment model. Phil Legendy, Of Counsel in Ballard's New York office and a member of our Health Care Group, hosts the discussion.

Are there significant risks of potential fraud and abuse with Medicare Advantage (MA) by plans, vendors, and providers, with an emphasis on ICD-10-CM's impact on Centers for Medicare & Medicaid Services Hierarchical Condition Category (CMS-HCC) risk adjustment?Evidently, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) believes there are. Recently, Christi A. Grimm, Inspector General, issued a statement in which she addressed the concerns of the federal watchdog agency.In response to her speech, we invited Dr. James Kennedy, a 20-year veteran in clinical documentation integrity (CDI) consulting and a popular panelist, to share succinct advice on how a compliance plan can best prepare for OIG audits that are sure to come.   Programming note: Invite your compliance teams to hear what promises to be the best four minutes applicable to this challenge, during the next live edition of Talk Ten Tuesdays.The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will report on coding colorectal cancer.SDoH Report: Tiffany Ferguson, a subject-matter expert on the social determinants of health (SDoH), will report on the news that's happening at the intersection of coding and the SDoH.News Desk: Timothy Powell, CPA, will anchor the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.

Jacob and Nikhil sit down with Dr. Jeffrey Kang, CEO of WellBe Senior Medical, and former President of ChenMed, SVP Health and Wellness Solutions at Walgreens, CMO at Cigna, CMO at CMS and CEO of Urban Medical Group. They discuss risk adjustment, retailers in healthcare and how healthcare has/hasn't changed since his work doing risk-based care for complex patients and at CMS in the 80s and 90s.

Optimizing Risk Adjustment is one of our most downloaded episodes. In case you missed it, we are running it once more. Tune in for a conversation with two of Medical Advantage's very own risk adjustment experts, Angela Hale and Kyle Enger, to learn more about what risk adjustment in healthcare is, how it works, and strategies for optimizing risk adjustment. Topics include risk scores, the importance of capturing a population's score accurately, the meaning behind acronyms like HCC, RAF, RADV, and more – not to mention the way Medical Advantage's consultants are working hand-in-hand with organizations today to optimize their risk adjustment techniques. Have questions? Email us at info@medicaladvantage.com for more information. Thank you for listening to the Medical Advantage Podcast, where each we take time each episode to discuss the ideas and technologies changing healthcare, and the best practices your organization can take to stay productive and profitable. Subscribe wherever you get your podcasts to ensure you never miss an episode.

This episode features MGMA independent consultant Rhonda Buckholtz. Rhonda talks about her consulting experience as well as her thoughts on risk adjustment audits and the costly nature of nuances in coding. Resources: MGMA Consulting: https://www.mgma.com/consulting/overview Rhonda Buckholtz LinkedIn: https://www.linkedin.com/in/rhonda-buckholtz-28305a7/ Sponsors: Humana: The latest Value-Based Care Report from Humana outlines many interesting findings and highlights how some physician practices found creative paths to success. Check it out now at Humana.com/VBC. Humana is working closely with physician practices on their value-based journeys. MGMA Events: This episode is brought to you by the Medical Practice Excellence: Financial and Operations Conference 2023, which will be held in Orlando, FL, March 19-21. During our premiere spring event, attendees will gain key insights from both disciplines and learn about topics that shape the future success of medical practice organizations. Go to mgma.com/mpe23 to learn more and to register today. If you would like additional tools and resources related to medical practice leadership email us at podcasts@mgma.com. Thank you again for taking the time to listen to MGMA's podcast network. If you have opportunities you'd like to share with the MGMA audience, go to www.mgma.com/marketing-with-mgma/advertise to find out how you can connect with the MGMA audience.

Tune in for today's industry updates.

David Meyer joins Lance to discuss the importance of having internal audit policies for Risk Adjustment and how multiple departments stakeholders and leaders need to be involved in these conversations.

Pooja Babbrah, Pharmacy & PBM lead with Point-of-Care Partners (POCP), NCPDP Board of Trustees Chair, and host of The Dish on Health IT kicked off the episode. This last episode of 2022 featuring POCP Regulatory Resource lead, Kim Boyd and Payer & Provider Practice Lead and Da Vinci Program Manager, Jocelyn Keegancame together to break down all the big things that have happened in 2022 and what we expect for 2023. Pooja explained that while this episode's discussion will primarily be policy related, the panelists will also talk about some of the real progress being made in the standards world and the interconnectedness between federal and state health IT policy and legislation and between standards and policy, and what it means to the industry. Pooja asked Jocelyn and Kim to briefly introduce themselves and to tell the audience what topics they are most excited about discussing. Jocelyn introduced herself as the POCP payer practice lead, devoted to positive change and building/getting stuff done. She went on to say that her focus at POCP is on interoperability, prior authorizations, and the convergence of tech, standards, and product strategy. She explained that she has spent her career moving people and organizations towards APIs, unleashing data for their highest, best-purpose uses. She expressed that she couldn't be more excited about where we've been this year and the precipice of where we are headed next year.Kim expressed that it's always a pleasure convening with Pooja and Jocelyn to discuss the exciting world of health IT.  She went on to share her background which has spanned medical and pharmacy operations and implementations, with years of policy, industry, and standards development work on ePA, cost transparency, ePrescribing, and taking what she learned in these areas to work with policymakers on smart policies to advance interoperability and patient care.  Kim stated that it has been an exciting year leading POCP's Regulatory Resource Center and that so much is happening in the state and federal regulatory spaces that ties to the innovations and acceleration the industry has been experiencing in health care.   Pooja thanked them both for their introductions and then dug into the discussion by asking each of them to share the biggest Health IT highlights of 2022. Kim explained that four things really stand out in 2022:the requirements of the transparency in coverage and no surprises act going into effect and the various provisions requiring data and cost transparency and giving patients and their care teams access to information that will help them make informed decisions.  Many in the industry have been clamoring for transparency of this type for some time.The incredible work happening to advance interoperability via the SDOs and Accelerators, like HL7 Da Vinci, CodeX, FAST, and NCPDP's Pharmacy Technology and Innovations group. how Federal agencies are collaborating on aligning requirements for interoperability, like the use of standards and FHIR-based standards specifically. This collaboration and proceeding regulatory action will help align the technical and interoperability stars.  the all-hands-on-deck focus on patient health equity is a big area of concentration for not only innovators in the market but the White House, HHS, standards organizations like NCPDP and HL7, and community and public health organizations.  There is just so much happening to try and close gaps in equitable care and the data/digital transformation that needs to happen to help facilitate change.     Jocelyn followed Kim to share her perspective on the biggest highlights of 2022 first joking that Kim got to go first and steal some of the things she was going to say.She laughingly shared that she agrees with all of Kim's points and then said that she wanted to focus more on the tone and the tenor of the work happening in the industry. Jocelyn shared that from her perspective it feels as though the industry has moved from thinking about interoperability projects as something that will happen "someday" to action and reality.  She clarified that this may not be the case for everyone, but many organizations and projects are moving forward to not only do the IT work but the business transformation. The examples she gave included the real progress made on TEFCA, real-world deployments of FHIR guides, live usage of APIs, prior authorization (PA) on pharmacy getting an infusion with last year's Medicare Part DJocelyn added that she wanted to focus on and add to Kim's comment about coordination at the federal level. She explained that policymakers at the federal level have been working for well over a decade and using their levers to make change extraordinarily well.  Jocelyn went on to say that as she sees it there are three camps of folks; people and organizations who are working ahead of policy by paying attention to published roadmaps and reading between the lines of public statements, folks trying to get their organizations prepared to respond to the next wave of policy, and others playing the waiting game to see if it's real and if they'll have to follow or if another path will emerge. Finally, she added, that the last highlight from 2022 is all the waiting! The industry keeps waiting for certain regulations to drop. She explained that she doesn't think she remembers another year where there has been this much policy anticipation at year-end. Pooja thanked Jocelyn and Kim for sharing their perspectives. She shared two important topics that have been more under the radar but are growing in importance and focus. The first is consent, specifically eConsent. Stewards of change published the report “Modernizing Consent to Advance Health and Equity” to bring more attention to the need to solve this issue – not only in the context of healthcare but also social services as those are such an important tie-in to health outcomes.  Add to that, the ONC half-day discovery workshop on eConsent.  Pooja explained to those who may not have attended – that it was an amazing session that brought together so many different people across the continuum of care in addition to the people working in the social services arena.The other area is pharmacy and the growing role of pharmacists in the care team and the work that is being done to ensure that they have access to more data and information to support care teams and support patients.  Pooja explained that there has been a lot of movement by retail chains to add primary care services to their offering and community pharmacies are supporting more clinical services.  This has led to more focus and a flurry of discussion around interoperability in the pharmacy space. Pooja gave the example of the Health Information Technology Advisory Committee (HITAC) recently proposing adding a pharmacy-focused subcommittee which is a huge indicator. Pooja shifted the discussion to policy highlights, specifically, requirements that went into effect and whether the industry met the deadlines or is still working on it. She explained that she is thinking specifically of: No Surprises ActTransparency in Coverage RuleInformation BlockingKim jumped in by saying that with the No Surprises Act there is still some pushback and uncertainty about how providers are going to comply with having to pull together all the data to provide Advanced EOBs (AEOBs) and good faith estimates (GFEs) when there are multiple providers involved in delivering the expected care; however, the Da Vinci Project is working on advancing implementation guidance to support patient cost transparency. Kim encouraged folks and organizations listening to this episode to get involved in these efforts. Kim added that she expects to see more price transparency-related policies, especially given the latest request for information on AEOBs. Kim went on to say that compliance with the ONC 21st Century Cures Final Rule on information blocking has been a mixed bag. She added that she wished ONC had called this "information sharing" instead of information blocking. Kim went on to say that most of the non-compliance has been on the provider side because it is challenging when a provider falls under the rule as an actor but maybe the health system they work in does not, especially when the health system may hold the data being requested. She added that most of the EHRs have spoken with are up-to-speed on the full EHI sharing requirement. Jocelyn added her perspective on information sharing specifically around EHI. Technically all of this information needs to be put out there, while the industry waits for USCDI to fully encapsulate patient information, there is probably a lot of non-codified data in the system that isn't actionable or really useable. The EHR certification requirements will likely do more to move the industry forward.  Jocelyn confessed that she fell down the RFI response rabbit hole and spent an hour looking at the feedback to the RFIs.  She thinks there is a disconnect between the goal of the rule and how to operationally do the work. An example she provided was around PA and that it isn't automating the submission of the PA alone but how to automate the 10 steps that need to happen before a PA is submitted. Pooja shifted the conversation to ask Kim to talk a little about the state activity around price transparency and why it's so important for stakeholders to pay attention not only to federal policy but what's happening in the states.Kim agreed that so many organizations forget that state policy is a big part of the equation too.  She shared that on the data and cost transparency side, states doubling down to move the needle on data fluidity. The POCP Regulatory Resource center has its finger on this pulse.  From the required patient-specific cost, benefit, coverage, and eligibility data sharing to confirmation of compliance enforcement of the No Surprises Act and Hospital Transparency, just to name a few.Pooja concurred and added that many people forget the states can add enforcement teeth above and beyond federal enforcement. She then remarked that this has been a year of anticipation and asked Kim to share where the burden reduction and prior authorization rule that was shelved back in 2020 is currently. Kim responded by explaining that there has been so much anticipation and even angst for some when the original rule came out in 2020 but then was pulled back.So many in the industry have been endeavoring to fulfill the promise the Da Vinci CRD, DTR, PAS IGs provide on solving for medical PA. Probably the most promising sign from CMS is the rule sitting at OMB since mid-October, waiting for review and then ultimately release. Given OMB has a max of 90 days to take action on the review, health plans, vendors, providers, and their partners should be closely monitoring for OMBs response and action.   Jocelyn joined in to say that the rule that came out in 2020 was definitely more than just burden reduction and it would have codified the use of patient-access APIs. She added that the 2020 rule didn't just require FHIR but named a particular implementation guide or "recipe" for the industry to use. Jocelyn anticipates that the version of the rule that has reemerged and is sitting with OMB likely includes Medicare Advantage plans which weren't included in the 2020 version. She's really interested to see what the NPRM will include. Jocelyn added that there is legislation pending that includes prior authorization and many are hoping the proposed rule drops before the legislation passes. Pooja thanked Jocelyn for bringing up the pending legislation and then moved on to ask about the recent CMS requests for information out there. She asked about what kinds of questions is the government asking and what do these questions tell us about where their heads are at? Jocelyn started by saying that the industry is seeing an unprecedented amount of coordination and policy-making activity. It has been a challenge to marshall the resources to respond to these RFIs and participate in the conversations and discussions these RFIs generate. Clearly, the industry is leading and the RFIs are an indication that CMS and ONC want industry input into their policymaking. Jocelyn went on to say that after reviewing the comments to these RFIs, the common themes were that the industry needs time and an incremental approach is needed but no one is saying what is being explored can't be accomplished. Kim added that she was struck by how aligned the agencies releasing these RFIs seemed to be on solving for interoperability, digitization, using/reusing or referencing FHIR resources for use and across different areas of health care, from the public health infrastructure, TEFCA, Certification of HIT, PAs and more, even the RFI from CMS related to the National Directory wants to hear from health care on the applicability of the use of FHIR standards. In transition, Pooja remarked that POCP and everyone on the podcast work in the standards development space through the support of some of the Accelerators like FAST, CodeX, CARIN Alliance, and of course, Da Vinci. She asked for the discussion to now cover the biggest accomplishments so far and what's expected in 2023. Kim responded by saying that while not officially announced, the CodeX PA in Oncology Use case – focused on solving for automating PA for cancer patients using the Da Vinci IGs is progressing to the Execution Phase. Members represented in this use case are payers, EHRs, physician groups, and health systems and they have collaboratively moved the needle on this use case and will execute the proof of concept for prostate cancer in 2023. Kim added that she is proud that NCPDP for their October Pilot launch announcement of the National Facilitator Model to strengthen pandemic and epidemic preparedness using industry standards and technology to enable pharmacies, prescribers, and government agencies to access real-time information on prescription, testing, immunization, and related data – across state lines - to support patient health interventions during public health crises. The model can also be used to effectively support public health surveillance.Jocelyn chimed in to express her awe at the pace of work on IGs and new use cases. She added that another big milestone is that FHIR at Scale Taskforce (FAST) transitioned out of ONC into the HL7 Accelerator program. FAST progressed work on Security, Identity, and Exchange and they are pulling the TEFCA team in to align their work. She added that Da Vinci has made a lot of progress on Risk Adjustment, allowing payers and providers to share information to inform a change in a patient's risk status. Jocelyn went on to say that there are also some exciting real-world implementations happening with a specific shout out to the team comprised of MultiCare, Providence, Regence, leadership from Optum, and Da Vinci champions launching the first in the nation FHIR-based pre-authorization embedded into the clinical workflow. Pooja seconded the kudos for the NPCPD vaccine pilot and she also mentioned the CodeX REMS use case which is marching toward a pilot and is once again bringing NCPDP and HL7 together. Pooja went on to recognize Helios as an Accelerator that is starting to gain traction and the industry should pay attention to their work. Pooja commented that while price and cost transparency for the patient will always be a passion of mine, the growing role of pharmacists in the care team is another area she is really excited about. Additional services are being performed by pharmacists, the prescribing authority is being extended to pharmacists, and the need for standards and technology to enable clinical data to flow from pharmacists to care team members in other environments like doctors' offices and hospitals. Pooja continued by saying that the pandemic and really the Federal PREP act accelerated this movement.  Now pharmacists can administer pretty much any vaccine on CDC's list, and there are around 25 states that allow pharmacists to prescribe HIV medications. Pooja explained that this expanding role and some of the regulatory requirements make pharmacy interoperability and connection with the rest of the care team critical. For example, for pharmacists to prescribe Paxlovid, they must order or access labs for the patients.  Unless pharmacists are in a health system they will likely not have access to a patient's lab report.  If the industry wants pharmacists to continue to support providers and patients with more clinical services – there has to be a focus on interoperability. Kim agreed that it is an exciting time for the pharmacy community.  The need for clinical and administrative data access, use, storage, and exchange to improve and coordinate patient care knows no boundaries – the whole of the care team, including the pharmacist, must be able to operate in an environment where this takes place.  Kim added that the NCPDP Strategic Planning Committee Value-Based Care Subcommittee acknowledged that the industry is well positioned to support pharmacists as a part of a value-based arrangement and we have the standards to support all types of clinical care and exchange so pharmacists can provide services like dispensing, screening for Social Determinants of Health or taking and reporting labs or blood pressure, etc.   2023 will be filled with opportunities within the NCPDP standards development process, the industry, and policy, to further the role of the pharmacist, closing gaps in care and the innovations needed for the future of pharmacists as part of the care team.Pooja asked to do a round-robin weigh-in on TEFCA, HIPAA 2.0, and Health Equity. What's new, what's real, and what should our listeners be on the lookout for in 2023? Jocelyn responded by saying that each of these topics has so many sub-topics and what will be interesting is to see how these all intersect with one another. She added that there is a movement to the platform where companies are partnering to solve some of the challenges related to these areas and make data fluid but secure. Kim responded by saying that there is still confusion and conflict between HIPAA and the ONC Information blocking rules.  Technology has evolved and new interpretations and requirements are needed that provide patient data security without limiting data sharing.  The industry will see some movement from OCR in 2023.TEFCA is real and moving forward in establishing the infrastructure model and rules that will govern how different networks and their stakeholders (including providers, payers, and public health) securely share clinically relevant information with each other. Nine organizations have provided letters of intent to the Sequoia Project, the recognized coordinating entity on behalf of ONC, to apply to become QHINs including EHR vendors such as Epic and Nextgen, national networks such as the eHealth Exchange and the CommonWell Health Alliance, and tech vendors such as Health Gorilla. More organizations are expected to apply. It will be interesting to see how successful TEFCA will be in incorporating FHIR into the framework over the next few years There is a united effort that includes government entities, health systems, pharmaceutical companies, private payer groups, and community organizations working together to overcome disparities and improve equity. This requires improved access to shared clinical and social needs data. Just last week CMS released its “Path Forward to improving data to advance health equity solutions” which aims to increase the collection of standardized sociodemographic and social determinants of health (SDOH) data across the healthcare industry as an important first step towards improving population In closing, Pooja asked everyone to share what they are most hopeful to see in 2023. She kicked it off by saying that for her it's the continued focus on pharmacists. Kim responded by saying many great things are happening in health care and that she is excited as a patient. There is more focus on helping patients grow as consumers of their own health care, providing data and insights into what options are available to obtain quality, timely and cost-effective care. She also expressed excitement about working with industry and policymakers to advance medical ePA in 2023 via the HL7 Da Vinci standards and leading the CodeX work on a pilot to advance PA for cancer patients. She concluded by echoing what Pooja said about her excitement about leading and partnering with others at NCPDP to promote and advance the role of the pharmacist as a part of the care team. Jocelyn joined in to say that she is hopeful for the momentum that has built up and she is super excited to see stakeholders build their toolboxes and embark on real-world implementations. Pooja closed out the episode by thanking her POCP cohosts, Jocelyn and Kim, and wishing our audience the happiest of holidays and the best for 2023. She reminded listeners that they can find The Dish on Health IT on Apple Podcast, Spotify, or whatever platform they use to pick up their podcasts, including HealthcareNOW Radio and the Podcast Channel. And that videos of the podcast episodes can be found o on the POCP YouTube channel. Adding, Health IT is a dish best served Hot! 

In this podcast today, I will discuss the company CSI Companies! Listen to the podcast for details! --- Support this podcast: https://anchor.fm/thressa-sweat/support

Is your health system considering taking on more downside risk? In this episode, join Dr. Sandeep Wadhwa, global chief medical officer at 3M Health Information Systems, as he dives into key Medicare, Medicaid and commercial insurer payment trends that will influence risk adjustment, quality and population health.

Dawn Carter, Director of Product Strategy of Centauri Health Solutions joined Sean to discuss Risk Adjustment Audits and the ins and outs of these often times annoying administrative requirements if you participate with an MA Plan... This was such an interesting discussion and we believe you will think so too! Links to articles from the show: Article 1: Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,' Part 1: The Risk-Score Game - https://www.healthaffairs.org/do/10.1377/forefront.20210927.6239/full/ Article 2: Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,' Part 2: Building On The ACO Model - https://www.healthaffairs.org/do/10.1377/forefront.20210928.795755/full/ Article 3: Halvorsen/Crane rebuttals: https://www.healthaffairs.org/do/10.1377/forefront.20220106.907235and https://www.healthaffairs.org/do/10.1377/forefront.20220203.915914/ Article 4: Gilfillan and Berwick rebuttal to Halvorsen and Crane: The Emperor Still Has No Clothes: A Response To Halvorson And Crane - https://www.healthaffairs.org/do/10.1377/forefront.20220602.413644 Article 5: Kang/Duncan/Hunh response: Making The Right Diagnosis: A Response To Berwick And Gilfillan - https://www.healthaffairs.org/do/10.1377/forefront.20220706.909897/ About Dawn Carter: Her career in healthcare spans 28 years, which most recently includes extensive experience in developing revenue integrity and quality software solutions, with a focus on encounter management, risk adjustment, and social determinants of health solutions for Medicare Advantage, Medicaid and Commercial health plans, as well as providing risk adjustment strategic advisory services for these markets. Prior to that, her experience spans all domains of health care including health plan and provider systems administration, finance, compliance and healthcare applications development inclusive of EDI and X12 and HL7 development. Her experience also includes multiple teaching engagements in medical administration, billing and coding. Dawn holds a Bachelor's degree in Business Administration, and she holds the American Association of Professional Coders CPC (Certified Professional Coder), CRC (Certified Risk Adjustment Coder), and CPMA (Certified Professional Medical Auditor) credentials. She is also a Certified Scrum Product Owner (CSPO). Dawn is a passionate and prolific industry speaker, author, blogger and subject matter expert in claims, EDI management, and risk adjustment.

#HealthCast segment on one of the most overlooked components of Star Rating and Risk Adjustment strategy which is Vendor Management. Your partnerships are critical to the long-term success for managed care and clinical outcomes.

This episode is first in a two-part series about Clinical Documentation and Coding. In part one, we talk about the importance of Risk Adjustment with Amber Malone-Wright, Director of Clinical Documentation Integrity at CHESS Health Solutions. What is risk adjustment and why is it so important? So risk adjustment is really a way to describe funding for resources and care to manage patients chronic or serious illnesses. It really helps to identify the risk that the patient is going to incur when medical costs that are above or below average for the year. It's really a financial forecasting that the health plans use to predict the future medical needs for the patients. So for example, a health plan receives payment from the government to help pay for the services that that patient is going to seek, whether that's an outpatient visit for chronic condition or an inpatient visit for a serious or acute illness, such as sepsis or a serious infection. And the funding to the health plan that they receive from the government pays those services at the hospital and office visit or primary care level. Risk adjustment matters because it's a way for the providers to report how sick their patients are and to ensure that there are resources available to those patients are there at their fingertips. So when a provider is able to manage their patients chronic conditions and prevent the hospitalizations the health plan actually ends up in a surplus and is able to share those funds with the provider, who is controlling the costs, and those patient chronic conditions. Health plans generally are going to use the funding to offer patients better premiums and other resources as well, such as Meals on Wheels or transportation and ways to lower prescription costs and many other different programs.And how does risk adjustment work?So in risk adjustment, value is assigned to each diagnosis code that falls into this payment model that's used by the government for the health plans. The ICD-10 codes are grouped in what we call HCC's or hierarchical condition categories. And these HCC categories are related to both clinical and financial resources available for those patients. Each diagnosis code that's mapped to one of these categories provides a risk adjustment factor score to identify the acuity or the sickness of that patient. Those risk scores are then calculated and converted into our financial resource for the health plan to cover those services for those patients.How are providers impacted by risk adjustment?So many providers are not directly impacted by risk adjustment because it's a way for the health plan to receive funding. A majority of providers are still part of what we call the fee-for-service reimbursement model, where they're reimbursed for a service they provide to the patient using a procedure code or an office visit code, for example. Most hospitals are reimbursed based on what we know is the MSDRG system when a patient is admitted to the hospital. It's a similar reimbursement methodology to risk adjustment in that the hospitals are paid a lump sum based on the diagnosis to cover the cost of care provided for those chronic or acute conditions that are being treated in the inpatient setting. Value-based care is really shifting the providers to be more responsible with managing the patients more effectively and coding more accurately. This means that providers need to be aware of what specialists are they are referring to how, often the patients are seeing their specialists, if they're going to the ED for unnecessary illnesses, such as urinary tract infections, and how many times they've been admitted to the hospital. All of those are you know primary care gatekeeper responsibilities. This also means that providers need to document and code all of the chronic conditions to the highest level of specificity and this is to...

Josh Weisbrod from Network Health and Keslie Crichton and Sean Libby from BeneLynk join Eric to discuss opportunities and challenges in identifying and converting members to full dual status, including specific examples and an outlined roadmap into this additional revenue stream. After listening to this episode, you will understand: Why identifying members as “full or partial” matters How much revenue you may be leaving on the table What components need to be in place to convert members Our Guests Josh Weisbrod, Vice President, Risk Adjustment, Network Health Josh has over 20 years of healthcare, health insurance, healthcare analytics and human service experience working with local and national companies and state and federal agencies, specializing in health plan operations and data analytics. Sean Libby, President and Co-founder, Benelynk Sean has worked at the intersection of managed care and government benefit programs for the past 19 years. Before BeneLynk, Sean served as the President of Freedom Disability and Alpha Disability, one of the nation's largest Social Security Disability and Veterans Advocacy companies. Before that, Sean served as Vice President, Sales for SSC Disability, providing government program benefit services for Managed Care Organizations. Keslie Crichton, Chief Revenue Officer, BeneLynk Keslie has over 25 years of comprehensive managed care and healthcare technology experience. Before BeneLynk She spent 13 years as Vice President of Sales at Change Healthcare and its predecessor companies Altegra Health and Social Service Coordinators, helping plans improve risk-adjusted revenue and quality performance scores through dual enrollment and retention, as well as health education campaigns. Acronym Glossary MSP - Medicare Savings Programs ABD- Age Blind and Disabled MAPP - Medicaid Purchase Plan SSI - Supplemental Security Income QMB - Qualified Medicare Beneficiary SLMB - Specified Low-Income Medicare Beneficiary QI-1 - Qualifying Individual SNAP - Supplemental Nutrition Assistance Program LIS - Low-Income Subsidy SSA - Social Security Administration CMS - Center for Medicare and Medicaid Services MAO - Medicaid Add On MA - Medicare Advantage HCC - Hierarchical Condition Category FPL - Federal Poverty Level MAGI - Modified Adjusted Gross Income PMPM - Per Member Per Month HRA - Health Risk Assessment D-SNPs - Dual Eligible Special Needs Plans We are pleased to provide you with this copy of the white Hi Sherry,   Are you leaving revenue on the table? Find out by listening to our new episode, Why You Shouldn't Settle for Partial Duals, now live on Apple, Google, Spotify, Amazon Music or your favorite podcast app, and YouTube.   Josh Weisbrod, Vice President, Risk Adjustment, Network Health, Keslie Crichton, Chief Revenue Officer, BeneLynk and Sean Libby, President and Co-founder, BeneLynk, join me for an insightful discussion on the opportunities and challenges in identifying and converting members from partial dual to full dual status. Hear specific success stories and walk away with an outlined roadmap for capitalizing on this additional revenue stream.    In addition, we are pleased to provide this whitepaper, Are You Getting Partial Dual Premiums for Partial Dual & Full Dual Risk?, from our partner BeneLynk. I hope you find it valuable.  BeneLynk sponsors this Episode of Bright Spots in Healthcare. BeneLynk is arguably the most innovative Dual Advocacy organization in the country. Benelynk's mission is to improve people's lives and positively impact social determinants of health barriers by granting their healthcare partners the necessary information while providing healthcare consumers with the advocacy they deserve. They use innovative technology that enables their people to have a dynamic conversation that flows organically to meet social determinants of health challenges and, as such, can build stronger human connections. This carefully planned combination generates exceptional results. Visit their website at www.benelynk.com

Medicare Advantage Audits, Establishing Medical Necessity to Ensure Payments, and the Two-Midnight Rule are three outstanding RACmonitor webcast topics discussed by Dr. John Zelem and Chuck Buck in this current episode of Front and Center.

Risk adjustment is much more than a regulatory requirement for Medicare Advantage plans –  it can improve the quality of care by providing an accurate picture of each member's health status and ensuring each member receives the right interventions and treatment.    Providers play an important role in risk adjustment, too. An engaged partnership between health plans and providers is vital to ensure beneficiaries receive valuable benefits.    Our panel of experts from Blue Cross Blue Shield of Illinois, CommuniCare Health Centers, Priority Health, SelectHealth and Vatica Health will share successful strategies and best practices for payers and providers to work in partnership to close gaps in care, achieve better clinical and financial performance, and support value-based care. Hear both payer and provider perspectives on building a successful relationship.   Confirmed Panelists: Jeslie Jacob, Divisional Vice President, Provider Analytics, Reporting & Connectivity, Blue Cross and Blue Shield of Illinois. Rebecca Welling, Associate Vice President, Risk Adjustment & Coding, SelectHealth Lisa Wigfield, RN, BSN, CCM, CRC, CDEO, Clinical Advisor, Risk Management, Priority Health Janie Reddy, DNP, FNP-BC, Director of Family Medicine, CommuniCare Health Centers Hassan Rifaat, MD, CEO, Vatica Health Bios: https://www.sharedpurposeconnect.com/events/elevating-risk-adjustment-by-activating-physician-participation/   This episode is sponsored by Vatica Health Founded in 2011, Vatica Health is the leading provider-centric risk adjustment and quality of care solution for health plans and health systems. By pairing expert clinical teams with cutting-edge, HITRUST-certified technology at the point of care, Vatica increases patient engagement and wellness, improves coding accuracy and completeness, facilitates the identification and closure of gaps in care, and enhances communication and collaboration between providers and health plans. The company's unique solution helps providers, health plans, and patients achieve better outcomes together. Vatica Health is trusted by many of the leading health plans and thousands of providers nationwide. Vatica Health is a portfolio company of Great Hill Partners. For more information, visit www.vaticahealth.com/.  

Featuring: David Shulkin, MD, Former U.S. Secretary of Veterans Affairs Kacey L. Serrano, MPA, CPC, CRC, Director, Medicare Stars and Risk Adjustment, Arkansas Blue Cross and Blue Shield Sean Libby, President, BeneLynk Today, 22% of Medicare Advantage members are veterans of the United States Armed Forces and 5% of Medicare Advantage members use the Department of Veterans Affairs (VA) for some of their healthcare needs. However, many health plans don't have a full understanding of the care their veteran population needs. Panelists share how Medicare Advantage plans can address social determinants of health (SDOH) for its veteran members by identifying their veteran populations and coordinating care with the VA. Topics for Discussion include: Identifying your Medicare Advantage veterans, discovering the value of documenting VA care and understanding military service as a Social Determinant of Health.   This episode is sponsored by BeneLynk, a national provider of social determinants of health (SDoH) solutions for Medicare Advantage and Managed Medicaid health plans. We serve plans and their members by creating a human-to-human connection and providing the assistance a member needs to get the benefits they deserve. By employing one dynamic conversation that flows organically to meet social determinants of health challenges, we build stronger human connections that are supported by innovative technology. We help Medicaid members to retain their benefits through a comprehensive outreach campaign providing information and assistance. All of our services are customized to the specific geography where we provide services and provide the members with the specific information they need to keep their benefits in place. Our mission is to improve lives and positively impact social determinants of health barriers by providing our healthcare partners with the information they need, and people with the advocacy they deserve.   Panelist bios available at: https://www.sharedpurposeconnect.com/events/medicare-quality-and-risk-knowing-your-veteran-population/

In this episode of the CodeCast Podcast, Terry gives regulatory guidance for Fee-For-Service Time Compensation (previously known as Locum Tenens) billing and coding. She also covers the rules surrounding how to document these services. Plus, CMS updated their COVID-19 FAQ sheet again, and this time it includes HCC's and Telehealth inclusion for Risk Adjustment. You […] The post Locums Tenens Physicians appeared first on Terry Fletcher Consulting, Inc..

(Part II) Of Lance's #healthcast series interview with RaeAnn Grossman Cotiviti's EVP of Risk Adjustment....

Today's guests are Cassi Birnbaum, MS, RHIA, CPHQ, FAHIMA, senior enterprise director for HIM, CDI, and coding at CDI PeaceHealth based in Vancouver, Washington and Cheryl Manchenton, RN, CCDS, CPHM, is a senior inpatient consultant/project manager/quality services lead overseeing CDI at 3M Health Information Systems based in Salt Lake City, Utah. Today's show is hosted by ACDIS Editorial Director Melissa Varnavas and is a part of our “Membership with Melissa” series. Our intro and outro music for the ACDIS Podcast is “medianoche” by Dee Yan-Kay and our ad music is “Take Me Higher” by Jahzzar, both obtained from the Free Music Archive. Today's show is sponsored by 3M Health Information Systems. 3M Health Information Systems is committed to eliminating revenue cycle waste, creating time to care, and leading the shift from volume to value-based care through innovative software and services across the continuum of care. Get started today and improve your CDI team's impact on financial and quality metrics. Learn more at www.3m.com/cdi.  Featured solution: Today's featured ACDIS solution is Imagine: 2022 ACDIS Conference. Imagine the possibilities and join your CDI peers in Orlando May 2–5, 2022, at the Gaylord Palms Resort & Convention Center! As we reconnect after the COVID-19 pandemic, we all need a little magic in our lives, and we all need to Imagine what might be in store for us professionally. Learn more or register by clicking here. (http://ow.ly/rG5Y30s7Pzt)  ACDIS update: Register for the 2022 ACDIS National Conference and be entered to win $5,000 for your CDI department! Read more on the ACDIS website. (http://ow.ly/Cb7X30sg7gs) 

In this episode I am joined by my colleague and friend Barbara Shaw, CPC, CPCO, CDEO, CRC, CEDC . W will discuss Risk adjustment and Social Determinants of health as it relates to Mental Health Services What is Risk Adjustment? Important reminders about SDOH Risk Adjustment Documentation Mental Health and SDOH Join the Risk Adjustment Masterclass created by Risk Adjustment leaders and educators. Ask us about our special programs for Hospital Employee education This episode qualifies for 1 CEU for our Patreon Squad Members. Jump over to www.patreon.com/lifeasacoder --- Send in a voice message: https://anchor.fm/lifeasacoder/message Support this podcast: https://anchor.fm/lifeasacoder/support

(Part I) RaeAnn Grossman EVP of Risk Adjustment of Cotiviti joins the show to discuss her career in managed care and shares wisdom on leadership and the healthcare industry...

The latest essential webcasts by RACmonitor are “Payer Contracts: Keys to Increasing Your Leverage,” led by Tiffany Ferguson and Marie Stinebuck, and the perennially popular on-demand webcast, “Implantable Device Credit Reporting and Outlier Payments: Audits Reviving up in 2022.” Both are given high marks in this current episode of Front and Center.Great topics. Great analysis. More great educational opportunities now await you. So now get everyone on your team Front and Center.Use code FRONTANDCENTER  for 15% off your RACmonitor webcast purchases.

Why measure health outcomes? What information comes from outcome data? What action does the information motivate? How do disparities figure in? Why risk adjust? Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post. Subscribe to Health Hats, the Podcast, on your favorite podcast player Please support my blog and podcast. CONTRIBUTE HERE Episode Notes Prefer to read, experience impaired hearing or deafness? Find FULL TRANSCRIPT at the end of the other show notes or download the printable transcript here Contents with Time-Stamped Headings to listen where you want to listen or read where you want to read (heading. time on podcast xx:xx. page # on the transcript) Proem.. 1 Knowing enough to be dangerous 02:21. 1 Why measure health outcomes?  04:28. 2 Information from measurement 05:20. 2 Action from information (plus money) 06:07. 2 How do disparities fit in? Look past your nose. 08:12. 2 Risk adjustment 10:29. 3 Reflection 11:44  3 Please comments and ask questions at the comment section at the bottom of the show notes on LinkedIn  via email DM on Instagram or Twitter to @healthhats Credits Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger Joey van Leeuwen Quartet playing Black Narcissus by Joe Henderson Web and Social Media Coach Kayla Nelson @lifeoflesion Photo by Elise Wilcox on Unsplash The views and opinions presented in this podcast and publication are solely the responsibility of the author, Danny van Leeuwen, and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute®  (PCORI®), its Board of Governors or Methodology Committee. Sponsored by Abridge Inspired by and grateful to Matthew Pickering, Cary Sanders, Rebekah Angove, Lina Walker, Adam Thompson, Ben Zola, Amanda Brush, Ellen Schultz, Laura Marcial, Juhan Sonin, Jennifer Bright, William Lawrence Links Risk Adjustment - Factors Affecting Adjustment CMS Physician Cost Measurement and Patient Relationship Codes Technical Expert Panel National Academy of Medicine DIgital Health Learning Collaborative, National Quality Forum's Cost and Efficiency Standing Committee  GoInvo Determinants of Health Related podcasts https://health-hats.com/pod145/ https://health-hats.com/pod140/ https://health-hats.com/pod133/ About the Show Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very little. Most people wear hats one at a time, but I wear them all at once.  I'm the Rosetta Stone of Healthcare. We will listen and learn about what it takes to adjust to life's realities in the awesome circus of healthcare.  Let's make some sense of all this. To subscribe go to https://health-hats.com/ Creative Commons Licensing The material found on this website created by me is Open Source and licensed under Creative Commons Attribution. Anyone may use the material (written, audio, or video) freely at no charge.  Please cite the source as: ‘From Danny van Leeuwen, Health Hats. (including the link to my website). I welcome edits and improvements.  Please let me know. danny@health-hats.com. The material on this site created by others is theirs and use follows their guidelines. The Show Proem Can grasping risk adjustment contribute to a profound understanding of health inequities and motivate action to improve? Whaaattt are you talking about, you ask? As I write this episode, I'm preparing to join an NQF (National Quality Forum) Risk Adjustment Special Populations focus group. Understanding health disparities through measurement and experience and then acting on that information to improve equity ranks high on my list of advocacy priorities. I'm holding my nose,

The U.S. healthcare system is shifting to an incentive structure where healthcare providers are rewarded for better care, not more care. This transition from fee-for-service to value-based care is changing how patients are cared for and how providers are measured and compensated for performance. With an ever-growing number of patients covered under value-based care programs, providers must develop risk adjustment expertise to position themselves for financial success in risk-sharing arrangements.In this episode, I speak with Gaby Alcala-Levy, a Healthcare consultant all about value-based care and risk adjustment.Be sure you are subscribed to this podcast to receive your episodes automatically:Apple PodcastSpotifyGoogle PodcastJoin The Healthy Project Facebook pageSupport the show (https://www.buymeacoffee.com/coreydionlewis)