Jerry Barsz

Medicaid in many ways is paving the way for value-based payments. Many states are taking innovative approaches and requiring MCO/provider participation in risk arrangements. As one of the largest VBP platforms operating in Medicaid, we get the privilege of aggerating these APMs to better enable provider success. Please come by our booth to see how we can help your provider network and health plan teams better operationalize and support VBP performance and growth.

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As I've continued to reflect on the recent Nashville Health Care Council Data and AI event, I found myself considering the intersection of data interoperability and the need to leverage healthcare data in a compliant way for AI to truly live up to its promise. At Integral, where we focus on automating regulated data compliance to enable collaboration and AI innovation, questions often arise about HCOs' data challenges, interoperability vs. collaboration, data quality impacts, and balancing innovation with risk. To gain some guiding thoughts on these topics, I phoned a friend Leigh McCormack, the co-founder and CEO of Platypus, and the former Data Science Lead for BlueCross BlueShield of Tennessee. Here's what she had to say: "Over the past decade, our progress in improving data quality for healthcare AI has been minimal, and we have significantly overlooked the importance of data collaboration. It's important to distinguish that collaboration goes beyond just interoperability. While interoperability focuses on the technical aspects of data sharing, primarily for operational needs, collaboration emphasizes the people and purpose behind utilizing that collective knowledge. As we work to overcome challenges in AI, data quality and interoperability remain crucial, but they can only take us so far. To truly advance, we must also adopt collaborative strategies and mindsets, allowing our foundational knowledge to evolve and enhancing our ability to use these technical tools for the benefit of the entire healthcare ecosystem." What are your thoughts on the evolving landscape of healthcare data, collaboration, and AI? #RegulatedData #DataInteroperability #DataQuality #DataCollaboration

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There's still time to sign up for Plug In to Technology! I was able to work with Christopher Copsey on his Connections article (just published today! link below) around creating affinity scores, so I know this presentation, and the others will be fantastic. This is your opportunity to learn how to harness the power of technology in the nonprofit sector, including AI and its impact on fundraising and prospect identification. Plus, uncover the secrets of successful CRM conversions, change management and consolidation, concluding with the essential skill of building metrics for your CRM. As prospect development delves further into how technology can help our organizations succeed, Plug In to Technology will surely help you become a more rounded member of your team! https://lnkd.in/grASQdgM

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In this video series, listen in as Optum Advisory experts @Jeremiah Reuter and @Aaron Jurgaitis share their perspectives on how to adapt to constant changes in health care and leverage data to help care coordination. Watch part 1 here: https://optum.co/wqeyrq Watch part 2 here: https://optum.co/00xw8i #provider #healthcare #OptumAdvisory #Optum #healthcareperspectives #carecoordination #healthcaredata #healthcareconsulting

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Just posted Capital Strategies Insight #023. Let's take a look at counting the costs of equipment re-use, especially when you change locations. Check it out at https://lnkd.in/epsfT_NR #medicalequipment, #capitalequipment, #medicalassets

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Listen Here: https://lnkd.in/g7WGs7VJ In this episode, Dr. Erik Summers, Chief Medical Officer at Atrium Health Wake Forest Baptist Medical Center, shares his journey from hospitalist to CMO and discusses the importance of relationships in healthcare leadership. He highlights successful initiatives in patient flow and the ongoing challenges in staffing and system integration, providing valuable advice for aspiring physician executives. For more information about Becker's Healthcare, please contact Jessica Cole or Scott Becker. #podcast #healthcare #leadership

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Really interesting article. ASC operations are proving crucial for the successful adoption of value-based payment systems and evolving healthcare as we know it. Strong operational foundations inherently lead to economic success and greater flexibility in adopting new care models, which in turn improves patient outcomes. #ASCs #Healthcare #PatientCare

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"How do I improve my medical expense trend month over month for a Medicare population......." Listen to Taryn Shipley, MBA, CSSBB and Arcadia's CEO, Michael Meucci discuss how leveraging data can reduce strain on finances, staffing, consumer preferences, care coordination and much more in healthcare. Consider this: Why aren't we offering daily on-site pulmonary diagnostics to our patients? If you don't have a compelling answer, reach out to me. Let's explore how we can collaborate to deliver a 🌟 🌟 🌟 🌟 🌟 all-in-one healthcare experience for your patients.

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Approached from the right perspective, new regulatory requirements can be harnessed to put in place infrastructure and business processes that will strengthen the enterprise for years to come. #health #qualityofcare #dataanalytics #healthequity #populationhealthmanagement #valuebasedhealthcare #valuebasedcare #vbc #integratedhealthcare #integratedhealthcaresystems #healthtech #Persivia #PersiviaAI https://lnkd.in/gpauVqzR

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Are you attending the 340B Grantees Conference? Swing by Booth #3 to see me and the FQHC 340B Compliance team. Connect with us to explore innovative solutions and strategies to optimize compliance in your FQHC. Let's empower your organization together! #340BConference #FQHC #ComplianceExperts

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#ICYMI MedImpact Healthcare Systems, Inc.'s VP of trade relations, Arpit Patel, recently spoke to Specialty Pharmacy Continuum about how we’re expanding access to #Humira #biosimilars, without disrupting current patients. Read the interview: https://okt.to/SykVeK #wearemedimpact #atruepartner #Humira #healthcare #pbm

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Meaningful connections between healthcare providers and beneficiaries are the cornerstone of exceptional care. Effective communication builds trust and understanding, ensuring patients feel connected and valued. Education empowers patients to make informed decisions about their health, leading to better outcomes. And when providers prioritize these connections, it boosts patient retention by fostering loyalty and satisfaction. Let's continue to nurture these relationships for healthier communities! I welcome discussions about PatientPoint and how our service is being used by our #VeteransAdministration customers and making a difference in #VHA facilities across the country. Let's talk. #DHA #VA

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AccendoWave - A Pain #Data Company More recently, the federal government has begun using the QIS program and QRS parameters to advance health equity. Federal rules now require all marketplace insurers to adopt a strategy for reducing health disparities and to stratify certain clinical data by race and ethnicity. While state-based marketplaces (SBMs) have authority to supplement these federal minimum QIS and QRS standards with state-specific quality rules, most have hewed closely to the federal default approach. California and Washington are notable exceptions. Each has implemented a customized QIS program and robust data collection standards to identify and reduce racial and ethnic health disparities. Time to Focus on - #Pain not being Believed. A Root Cause Health Equity Problem. A Top 4 Global Health Equity Solution and Top 15 Global Remote Monitoring Company, AccendoWave, benchmarks objective brain wave pain data (specialty, gender, age) and has nine #pain databases: Emergency Department, Maternal Health, Oncology, MSK, Medical Surgical, ICU, #Women, Adults, #Seniors to eliminate bias, improve outcomes and reduce health care costs. If desired, AccendoWave can also create customized pain databases for partners that can be accessed on the Datavant platform.

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#Biosimilars have the potential to help #health payers rein in specialty costs–but what other opportunities are there to reduce spend? MedImpact Healthcare Systems, Inc.'s Vice President of #Clinical Services has a solution in this MedTalks Minute. #wearemedimpact #atruepartner #innovation #healthcare #drugtrends

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Prior authorizations are a critical component of delivering efficient and effective care and benefits to patients and employees. Optimizing pharmacy benefits is dependent on understanding how to navigate them. To learn more strategies to streamline prior authorization procedures, listen below. #pharmacy #benefits #RxBenefits

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Take a listen to this podcast and explore how payers and providers can collaborate to achieve payment accuracy and forge stronger relationships. In this episode of Compliance Conversations, CJ Wolf welcomes David Cardelle RPh to discuss the payer perspective on payment integrity. From the complexities of DRG claims to the use of AI, this conversation sheds light on how automation and collaboration can transform the healthcare landscape.  What you’ll gain:  A deep dive into DRG audits and common pitfalls.  The role of technology in reducing abrasion between payers and providers.  Real-world solutions to improve payment accuracy and efficiency. Hate to listen but love to read? https://lnkd.in/e7hEiktz

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Negotiating for the Future: How Medical Groups Can Prepare for 2025 and Beyond Healthcare is changing at lightning speed, and if you’re in payer contracting, you know the negotiations aren’t getting easier. As we look ahead to 2025, medical groups need to be proactive, not reactive. Let’s talk about what’s coming and how to prepare for it—because the future of payer contracts is already knocking at the door. 1. AI-Driven Contracting Artificial Intelligence is no longer a futuristic concept. In fact, payers are already starting to use AI to evaluate provider performance in real-time. Pro Tip: Start building your data arsenal now. If you don’t have solid, measurable outcomes to show, AI might not be your friend during negotiations. 2. Health Equity Isn’t Just a Buzzword Health equity and social determinants of health are going to be built into future payer contracts. Why? Payers are being pushed to show they’re addressing disparities in care, and they’ll pass that responsibility to providers. Pro Tip: Start thinking about partnerships with community organizations to improve outcomes for underserved populations. Health equity initiatives could be a key bargaining chip. 3. Telehealth: A Moving Target Telehealth took center stage during the pandemic, but now it’s in a gray area. Some payers are still figuring out their long-term stance on telehealth reimbursement. By 2025, we’ll likely see more uniform policies around telehealth, but it’s up to us to prove its value now. Pro Tip: Make sure you’re tracking patient satisfaction and cost savings from telehealth services. Data-driven proof of telehealth’s value will strengthen your negotiating position. 4. Quality Metrics Are Here to Stay Gone are the days when quality measures were just “nice-to-have” add-ons in contracts. Payers are now demanding clear quality metrics tied directly to reimbursement. Pro Tip: Medical groups need to ensure they have programs in place to consistently hit quality benchmarks—whether it's patient outcomes, readmission rates, or preventive care. This will be key in future negotiations. 5. More Risk, More Reward? Payers want providers to take on more financial risk. Shared savings models, capitation, and other alternative payment models will become more common, and groups that can show they can manage that risk will stand out. Pro Tip: If your group isn’t ready for risk-sharing, start building the infrastructure now. Population health management tools and strong financial forecasting will be critical. The bottom line? 2025 isn’t that far off, and the future of payer contracting is all about value and innovation. Medical groups that can prove their worth, manage risk, and embrace new models of care will be at the forefront. What’s the biggest challenge you see on the horizon for payer contracts? Share your thoughts in the comments! #HealthcareInnovation #PayerContracts #ManagedCare #HealthEquity #AIinHealthcare #ValueBasedCare

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