Michelle Flemmings, MD

Reflecting on the implementation of structured, value-based care models: The foundation of effective clinical intervention is a deep understanding of the health system and its key stakeholders. These models must center on the individuals receiving care. Evidence-guided and value-focused care optimizes available resources within health systems, specialty programs, and health services, leading to qualitative and valuable care delivery. The result? Better resource utilization, improved outcomes, and enhanced individual health. This approach is essential for organizations that design true care pathways rather than virtue signaling or creating superficial content. Having been intimately involved in Value-Based Care design and implementation, I'm eager to partner with forward-thinking organizations to continue this vital work. The result - a healthcare system that truly serves its patients and stakeholders - is a goal worth pursuing. If you're passionate about transforming healthcare delivery, let's connect and explore how we can drive meaningful change together. #ValueBasedCare #HealthcareInnovation #ClinicalPathways #HealthcareTransformation #letstalk

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Why It’s Time to Redefine the Patient Bill of Rights for #Dialysis Care The Centers for Medicare & Medicaid Services Patient Bill of Rights, while foundational, no longer reflects the realities and evolving needs of today’s dialysis communities. Patients, care partners, and providers face challenges that go beyond what current #CMS standards address. It's time for an upgrade. Dialysis is not just a medical procedure—it’s a way of life for millions. From financial transparency to access to cutting-edge technology, patients deserve more than what the CMS framework offers. That's why I’ve developed a reimagined Dialysis Patients Bill of Rights, a forward-thinking framework tailored for the modern world. 🛠️ What’s Outdated About CMS’s Current Standards? The CMS framework prioritizes basic compliance, but it neglects: 🌐 Technological advancements like telemedicine 💼 Financial equity for underserved patients 💔 Mental health and emotional support ⚡ Emergency readiness for home patients 🤝 Inclusive roles for care partners These gaps leave patients and care teams vulnerable in areas that matter most. 🎯 Why My Proposed Version is the Future of Dialysis Care Let’s embrace a more patient-centered, inclusive, and innovative vision for dialysis care. Here’s how my proposed Bill of Rights surpasses CMS’s outdated approach: ✨ Core Innovations 📊 Financial clarity & equity 🚀 Advanced treatment access 📱 Seamless virtual consultations 🧘 Holistic Care 🫂 Mental health focus ❤️‍🔥 Support for care partners 🌍 Cultural & linguistic inclusion ⚖️ Patient Empowerment 📝 Timely transplant referrals 👩‍⚕️ Shared decision-making 🔑 Personalized care plans 🏠 Home Dialysis Revolution 📦 Timely supply deliveries 🛠️ 24/7 technical support 🌐 Emergency preparation resources 🛡️ Proactive Measures ⚡ Emergency planning 🏥 Palliative care options 📡 Community advocacy This is not just about improving healthcare delivery—it’s about empowering dialysis patients to live with dignity, equity, and hope. 🌟 💬 Now, It’s Your Turn What do you think? Is it time for CMS to modernize the Patient Bill of Rights for dialysis care? How would you improve patient experiences in today’s complex healthcare landscape? Let’s spark a conversation. Share your thoughts below or message me to collaborate on shaping a future where every dialysis patient thrives. 💭 My email to CMS is attached (do not steal) #DialysisCare #HealthcareInnovation #PatientRights #Advocacy Chiquita Brooks-LaSure Jean Moody-Williams Meena Seshamani, MD, PhD John McClellan, MD Cheri Rice

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Key Strategic Insights = A Successful OP CDI Program The challenge of value-based care starts with a collaborative approach, when launching an Outpatient Clinical Documentation Integrity (OP CDI) program. Here are some key strategic insights to success: 1. Engage with Population Health Understand Pain Points: Begin by understanding the specific challenges faced. This fosters collaboration. Tailored Questions: Use customized questions to facilitate productive discussions and ensure alignment with needs. 2. Effective Software Implementation Manage Patient (Pt.) Volumes: Implement software solutions to efficiently handle pt. volumes. OP CDI Calculator: Utilize a calculator to determine Full-Time Equivalent (FTE) needs. Data Analytics and Reporting: Emphasize the importance of continuous improvement via data analytics. 3. Workflow Creation Establish Robust Workflows: Create strong workflows before integrating reviewers. 4. Collaboration & Communication Promote Strong Collaboration: Encourage robust communication between key stakeholders. Leverage Software: Use technology to reduce physician burnout & streamline communication. 5. Patient-Centered Approach Address social determinants of health (SDOH) & ensure accurate documentation of conditions and care plans. Patient Outcomes: Keep patient care at the center of all doc. & workflow processes. 6. Regulatory Compliance Adhere to Guidelines: Follow regulatory requirements such as CMS guidelines on Hierarchical Condition Categories (HCC) coding to avoid penalties and enhance credibility. 7. Measurable Outcomes Set Clear Goals: Aim for measurable outcomes like improved HCC recapture rates, enhanced RAF scores, better HEDIS measures, and addressing SDOH needs. 8. Stakeholder Engagement Involve All Stakeholders: Ensure that executives, clinicians, and other relevant parties are involved in planning and implementation process. Success Stories Recently, I helped several CDI directors validate their cases for OP CDI programs within Accountable Care Organizations (ACOs). By engaging with population health leadership, we identified key issues such as RAF gaps and HEDIS measures, and tailored processes to address them. For instance, a CDI director I guided successfully identified HCC and HEDIS recapture as their biggest pain points. With strategic solutions in place, they are now ready to implement the project for the 2025 budget yr., aiming to improve their HCC recapture rate by 20%, leveraging data analytics for outcomes and improvement needs. Benefits of Implementing These Strategies Align Risk Stratification: Properly align risk stratification with chronic conditions and healthcare needs. Quality Measures: Improve quality measures and address SDOH. Collaborative Team: Ensure success with a collaborative team supported by technology. Overall, these strategic actions will enhance patient care and operational efficiency. #Healthcare #Leadership #CDI #PatientCare #ValueBasedCare #HealthcareInnovation

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Effective, resiliant #healthcare compliance programs are possible in organizations without an embarrassment of resources. In their upcoming HCCA webinar on December 17th, #BerryDunn experts Natalie Laaman and Robyn Hoffmann will share the how. https://lnkd.in/esQkfh6r

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📣Health Resources and Services Administration (HRSAgov), HHS has increased the initial loan repayment amount available to primary care providers by 50% through the National Health Service Corps. This means M.D.s, D.O.s, nurse practitioners, certified nurse midwives, and physician assistants can have as much as $75,000 in #loandebtforgiven in exchange for a two-year service commitment. This action will help #rural and historically #underserved communities attract providers to deliver critical primary care services. #HRSA is also offering up to an additional $5,000 in #loanrepayment to National Health Service Corps Loan Repayment Program participants who are fluent in Spanish and commit to practice in a high need area serving patients with limited English proficiency. Another step to ensure that everyone has access to quality healthcare! Read the full Release here: https://lnkd.in/gtzBaNG9 #PrimaryCareProviders #Healthcare #LoanRepayment #NationalHealthServiceCorps

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#ATANexus is off to a great start. Honored to join Helen Hughes in an important conversation about mastering the execution of inpatient virtual care. When it comes to measuring the Return on Innovation, the call to action is clear: 1. Identify, and align, on the problem your program is solving. 2. Quantify data in the current state-you need to measure what your program achieves. 3. Look for partners who are ‘in it’ with you.

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The only path to meaningful change in healthcare is through transparency, accountability, and facing the corporate behemoths—head-on. LDOs, particularly DaVita Kidney Care and Fresenius Medical Care, have long touted a commitment to "patient-centered" and "value-based" care. But the reality? A relentless drive for profit that jeopardizes patient safety, erodes the quality of care, and betrays the core medical oath—“Do No Harm.” The words "value-based care," "patient empowerment," and "wraparound patient engagement" sound like music to the ears of those seeking real health solutions. But make no mistake—these are buzzwords masking a stark truth: These corporations profit from human suffering while deepening socioeconomic divides. LDOs continuously craft a narrative that glosses over the reality of the industry: that executive bonuses, inflated salaries, and venture capital investments come before patient lives. As we peel back the layers, we see glossy marketing campaigns like NxStage Medical, Inc.'s outdoor dialysis initiatives, which claim to enhance patient independence. However, it's not about aesthetics or flashy tech; it's about oversight and genuine patient care. Where’s the accountability in how life-saving treatments are implemented and communicated? It's an industry-wide problem: The consolidation of care facilities, cost-cutting at the expense of patient safety, and the systemic underserving of marginalized communities are more than missteps—they’re tactics. DaVita's CEO receives multi-million-dollar compensation packages while patients face understaffed facilities and lower-quality care. How is this equitable, patient-centered, or ethical? Patients are not profit margins; they are humans with real needs. When "#innovation" means tools and technologies inaccessible to marginalized communities, it only deepens the distrust. "Patient engagement" should not be a privilege for the wealthy; it is a right. The issue is clear: The unchecked greed of the LDOs directly contradicts the care they claim to provide. I stand ready to expose this truth and fight for the millions of patients whose lives depend on access to quality dialysis care. We need more oversight, governance, and Corporate Social Responsibility in this industry. Patients must be at the center, not investors. It's high time that the U.S. Department of Health and Human Services (HHS) takes action. Patients deserve more than slogans—they deserve genuine care grounded in ethical principles. Attached to this post is the letter sent to Secretary Becerra, detailing this pressing issue and calling for immediate action. #PatientAdvocacy #HealthcareReform #QualityCare #EthicalHealthcare #DoNoHarm #CorporateAccountability #HealthcareJustice Andy Pate #valuebasedcaresmokescreen #NxStage

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And so it begins. You will need companies like Diosa Ara who's goal is protecting you from other businesses and individuals. We can no longer depend on the goverment for this function. If you want to see things like this exist, we NEED your support. I'm sending this message at 4:42 AM I cannot possibly give any more time, energy, and money. We NEED your help. Practical tip: If you have access to HSA or FSA (opt for HSA if available) start putting money aside TODAY. You will need it. We are the only developed country where medical bankruptcy is a concept. Protect yourself.

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Which physician specialties spend the most time in the EHR? According to this study of >200K physicians that analyzed data from Epic's analytic tool "Signal," it was ID, endo, nephrology, primary care, and heme. (My guess is that the heme findings were largely driven by malignant heme.) Oncology was in the middle of the pack. Notably, over 40% of time was spent on clinic days but outside of appointment hours and unscheduled days https://lnkd.in/ebzZCnCD Here's the link to the original article: https://lnkd.in/eprzynWq

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#Nurses and #doctors are noticing firsthand that anemia is growing faster globally than we ever thought. They truly represent a new culture of first responders in this critical area of healthcare. We hope that medical colleges, #hospitals, and nursing associations will support awareness of the vital roles these healthcare professionals play in serving the public's needs. These healthcare providers, along with many companies, also represent the foundation of potential cures for anemia worldwide. Consider this: The smallest amount of air blown into a balloon will automatically increase its size and visibility. The relationship between healthcare providers and anemia needs to be seen on a much larger, broader scale—just like that balloon. This also enhances the dignity and respect they’ve always deserved. We can't afford to let this balloon deflate, as doing so would set us back significantly. Our work focuses on building bridges that bring healthcare providers closer to understanding the patient. We’ve created a meaningful insignia for doctors and nurses that fosters trust and understanding from the very first examination. This is a new concept for #anemia, and we anticipate new partnerships and ideas that will expedite awareness even further. Until then, we deeply appreciate all collective efforts—together, we will defeat public enemy number one: Anemia. UChicago Medicine Englewood Hospital Cleveland Clinic Mayo Clinic Geisinger Johns Hopkins Medicine Loma Linda University Health Hackensack Meridian Health Penn Medicine, University of Pennsylvania Health System Mount Sinai Health System NewYork-Presbyterian Hospital MedStar Washington Hospital Center American Society of Hematology American Nurses Association American Academy of Anesthesiologist Assistants UCLA Health Yale New Haven Health Jefferson Health NYC Health + Hospitals

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The #Dialysis Dependency Model created by corporate juggernauts like Fresenius Medical Care and DaVita Kidney Care traps patients in a system designed for profit over patient well-being. It sustains dialysis as the primary, if not sole, solution for chronic kidney disease while neglecting prevention, early intervention, and transplantation. This system thrives on keeping patients dependent on machines rather than empowering them to reclaim their lives through proactive care or alternatives. Organizations like Kidney Watch and The Alliance are working to expose and dismantle this model, advocating for systemic change that prioritizes patients over corporate profit. They emphasize prevention, education, and access to transplants—areas deliberately underfunded and deprioritized by the dialysis giants who have built a business empire on patient dependence. The Dialysis Dependency Model: What Patients See    •   🚫 No Prevention Focus    •   ⏳ Stalled Transplant Access    •   💰 Profits Over Outcomes    •   📉 Early CKD Ignored    •   🔒 Education Blocked    •   ⚙️ Cosmetic “Advances”    •   🔄 Cycled Through Clinics    •   🕸️ Referral Barriers How This System Was Built 1. Profit-First Policies Dialysis generates billions annually, creating a financial incentive to maintain dependency. Prevention and transplants threaten this model, so they are deprioritized. 2. Neglect of Prevention and CKD Education Patient awareness campaigns on kidney health, CKD management, and prevention are practically non-existent. By keeping the public uninformed, the pipeline of dialysis patients remains full. 3. Transplant Access Delays Companies avoid promoting transplants, blocking or stalling referrals, and keeping patients tied to machines for as long as possible. Organ donation awareness is barely addressed. 4. Superficial “Innovation” Instead of groundbreaking solutions, companies invest in surface-level upgrades like brighter screens or new chairs, distracting from their failure to improve patient outcomes. 5. Control Over Patient Pathways Patients’ care options are limited, with referrals tightly managed to ensure dependency. The system is structured to make dialysis the default option, keeping profits high. Kidney Watch and The Alliance’s Vision Our organization challenges this dependency by advocating for:    •   Holistic CKD Management: Early intervention and patient education to halt disease progression.    •   Transparent Transplant Systems: Streamlining access to transplant referrals and increasing donor awareness.    •   Preventive Care Focus: A shift toward preventing kidney failure instead of sustaining dialysis.    •   Patient-Centered Care: Reducing corporate control over care options, empowering patients to make informed decisions. Kidney Watch and The Alliance provide an alternative path—one that values health, dignity, and life over corporate greed #EndTheDependencyCycle #TransplantsOverTreadmills #HealthcareExploitationUnmasked

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Fabulous webinar and conversation yesterday about AI in Healthcare cross-country from Mid-Atlantic Permanente Medical Group | Kaiser Permanente with my colleague from SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP Dr. John Rott, thank you Chris Corriveau and the entire team who helped organize. Sharing these apropos tips from our most recent Forbes Technology Council article on "19 Ways To Manage Different Stakeholders 😍" https://lnkd.in/eWymqdkg Top 19! 1. Strive For Collaboration 2. Prioritize Investments Based On Results 3. Communicate Openly 4. Embrace A Long-Term Portfolio Strategy 5. Prioritize With A Strategic Framework 6. Assess Dependencies 7. Develop A Transparent, Systematic Framework 8. Determine Needs And Wants 9. Use Outcome-Oriented Metrics 10. Consider The Value 11. Help Stakeholders Find Common Ground 12. Establish And Follow A Principle-Driven Approach 13. Let Data Drive Your Decision-Making 14. Implement Teams To Focus On Stakeholder Engagement 15. Prioritize Streamlining Workflows And Processes 16. Understand Your Customers’ Needs 17. Hold Stakeholder Meetings Regularly 18. Put A Governance Mechanism In Place 19. Encourage Empathy

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As I'm listening to Megan Antonelli interview Amy Boutwell, MD, MPP (link below), I was first struck by the number of times Amy referenced the need for #data, especially about the contributors to frequent use of emergency resources by Centers for Medicare & Medicaid Services patients. Yay-ish! BUT...here's the problem, and why the discussion of readmission avoidance needs to go below the surface: Who takes a disproportionate number of Medicare and Medicaid patients to AND from the emergency departments that Amy says they are using to address their "needs" that may not be acute or medical? AMBULANCES, OF COURSE! 🚑🚒🚁 ◀️▶️🏥 AND....which sector of the healthcare system is actively lamenting its own slow demise? (See also recent articles from James Mazza, MA , Raphael M. Barishansky, DrPH and more) AMBULANCES, OF COURSE! 🚑🚒🚁 ◀️▶️🏥 So....the proposed solution to the cost problem associated with frequent and/or underserved and vulnerable users of emergency resources is to take money AWAY from the ambulance services THAT THEY disproportionately rely upon to get to the emergency resources THAT THEY are using due to a lack of other approaches? That ledger doesn't balance. If the goal is to keep the patients from going to the ED -- fine. Great, even! BUT DON'T ACT SURPRISED when ambulance services that are now deprived of revenue start to disintegrate. The "who loses?" question is one that we studied EXTENSIVELY at Carnegie Mellon University - Tepper School of Business (🤜🤛 Art Boni). The sheer amount of time that has been spent NOT asking this question by agencies seeking to advance #CP_MIH is tragic. Brad Bihun - as we've talked about, this continues to be the Achilles Heel of telemedicine in #MobileMedicine's, too: for every transport that is "avoided" without an alternative source of revenue OR a loss reduction on the ambulance side, the agency starves just a little bit more. Matt Zavadsky did a tremendous job, years ago, of explaining the Shared Savings model and how it benefits Mobile Medical services. The challenge is, to Amy's point, that relatively few agencies have the data they need to enact the model and show their impact. H/T Nadav Shimoni, M.D., Michael A. Greeley They COULD have these data, but many don't. Those that do, thrive! Conejo Health, for insurance. Or Delta County Ambulance District in Colorado ( Reuben Farnsworth). The data are complex but relatively straightforward -- yet too few agencies know what they need so they spend their startup grant funds not collecting what is going to help them justify the existence of their programs -- or worse, doing such a great job of avoiding admissions that their local hospital shuts them down to stop the siphoning away of cash. THIS IS TOTALLY SOLVABLE once you know the relevant metrics. Will they come up in conversation at the National Association of Mobile Integrated Healthcare Providers meeting next week? Let's try to make sure that they do! H/T Marta Kryschuk

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Healthcare has made improvements but there's still a long way to go to become truly digital-first. While we've seen advancements in telemedicine, electronic health records, and AI-driven diagnostics, the journey to fully integrate these technologies into everyday practice is far from complete. And the “door” to care – patient navigation – needs a lot of work. If we don't evolve, patient's will find others who do! https://lnkd.in/eSJKiHSR #patientcentricity #digitalfirst #digitaltransformation #patientnavigation

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Don't miss the latest strategic health care insights from the newly released Sg2 2024 Impact of Change® Forecast! This is a great look into key trends and innovative developments poised to reshape health care demand over the next decade that you can leverage to refine your strategies and stay ahead of the curve.

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It’s surprising that Large Dialysis Organizations, such as Fresenius Medical Care and NxStage Medical, Inc., as well as other clinics, don’t consistently offer patient recognition programs to drive engagement and motivate adherence to treatment. With Fresenius leading the market, one would expect them to set the standard, yet there remains a significant lack of programs that celebrate patient achievements across the board, especially in both in-center and home hemodialysis programs. Importance of Recognition Programs Recognition programs are crucial for driving engagement and improving patient-centered care. By celebrating patients' milestones—whether it's treatment adherence or perseverance—we create a more inclusive and motivating environment. These programs aren't just a "nice to have"; they directly impact patient morale, adherence, and overall outcomes. Patients who feel valued are more likely to stay motivated, follow their treatment plans, and maintain a positive outlook on their #dialysis journey. Tangible awards, certificates, or even small recognitions for effort can make a significant difference in how patients approach their care. Given these clear benefits, it's perplexing that LDOs like #Fresenius don’t already prioritize such initiatives. They have the resources and infrastructure to implement recognition programs on a large scale, yet they fail to roll out these programs consistently across clinics. Lack of Standardization Across Clinics The lack of a standardized approach to patient recognition across #LDOs highlights a broader issue—inequality in patient care. Clinics within the same network may operate independently, applying different criteria for engaging and recognizing patients. This inconsistency creates gaps in care, with some patients being celebrated while others, especially those struggling, are left feeling unsupported. Patients on #HHD face additional challenges, like isolation and greater responsibility for their care, making recognition and engagement even more vital. A standardized program that includes both in-center and HHD patients would help ensure that every patient, regardless of their treatment setting, feels valued. Why Aren’t LDOs Prioritizing This? The big question remains: Why haven’t LDOs like Fresenius made these programs a priority? Logistical hurdles and cost-efficiency concerns are likely factors, but they should not overshadow the potential impact on patient outcomes. The benefits of improving patient engagement through recognition—leading to better adherence, motivation, and morale—far outweigh the minimal costs involved in implementing such programs. The lack of patient recognition programs across LDOs is a missed opportunity to create a more supportive and motivating environment for patients. National Kidney Foundation Andy Pate Michael Kraus Joe Turk DaVita Kidney Care Dialysis Clinic, Inc. U.S. Department of Health and Human Services (HHS)

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