Rajesh Godavarthi

The new CMS prior authorization rule plays a key role bringing in automation and efficiencies to the current manual processes. It is not just compliance but more than that. Thrilled to be a co-author of the article below, providing insights into what payers need to consider along their prior authorization journey. #citiustech #priorAuthorization #CMSRule

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The Behavioral Health EHR Software market is witnessing remarkable growth, fueled by factors like enhanced health records management efficiency and the ease of digital systems. The market benefits from increasing mental health awareness and the demand for integrated treatment methods, enabling streamlined care coordination and empowering therapists with valuable patient insights for improved outcomes. Delving deeper, the Behavioral Health EHR Software market's intricacies unveil a landscape influenced by digital transformation and the imminent impact of AI & Machine Learning technologies. The future promises abundant opportunities for innovation and progress in this vital sector. How do you foresee harnessing technology to further elevate Behavioral Health EHR software? Share your insights on the key trends and growth drivers shaping this dynamic market. #BehavioralHealth #EHRSoftware #DigitalTransformation

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Enhancing Accuracy with AI in Medical Coding: AI algorithms analyze clinical notes to generate precise codes, significantly reducing errors and claim rejections. This ensures proper reimbursement and regulatory compliance, streamlining the revenue cycle for healthcare providers. #Healthcare #AI #RCM #Innovation https://lnkd.in/db8UAHsR

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We’re excited to share Optum Rx is the first to develop a new capability that helps address a major provider pain point: prior authorizations. Prior authorization is an important checkpoint helping patients receive coverage for safe, effective care supported by the most up-to-date clinical guidelines. But the process can add manual, time-consuming tasks to providers’ already heavy workloads. Together with our partners, Surescripts and Cleveland Clinic, we developed Optum Rx PreCheck Prior Authorization, an innovative solution that helps automate the prior authorization process for select drugs, including GLP-1s – from 8.5 hours to under 30 seconds. Learn more about Optum’s commitment to providing a better provider and patient experience: http://spr.ly/6045S4vph

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Truly a world-class AI in healthcare conference! Great honor to present key note - Security in AI and AI in Cybersecurity. Agentic AI,ASI,AGI Quntum Computing,Gen AI and Edge Computing - cross- domain AI with self learning recursive training and context window concepts. Panel Discussion - AI Ethics, Compliance & Regulations building -Safe & Trustworthy AI. Pushing the boundary of innovation with AI. Making a dent in the universe!

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𝗣𝗿𝗼𝗱𝘂𝗰𝘁 𝗣𝗼𝘀𝘁 #𝟭𝟰: 𝗟𝗼𝗼𝗸𝗶𝗻𝗴 𝘁𝗼 𝗧𝗿𝗮𝗻𝘀𝗶𝘁𝗶𝗼𝗻 𝗶𝗻𝘁𝗼 𝗣𝗿𝗼𝗱𝘂𝗰𝘁 𝗠𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁? 𝗗𝗼𝗻’𝘁 𝗠𝗶𝘀𝘀 𝗧𝗵𝗶𝘀 𝗣𝗼𝘀𝘁! 🙂 Over the past two years, I have worked as a Product Manager in the Healthcare industry at Optum and AthenaHealth. These companies share a powerful 𝘃𝗶𝘀𝗶𝗼𝗻: to integrate doctors, clinicians, and hospital administrators more deeply into their Product Management Ecosystem.   Their 𝗺𝗶𝘀𝘀𝗶𝗼𝗻: to leverage firsthand experiences and create better Healthcare products and services. This initiative is nothing short of groundbreaking 🤯  I have had the privilege of collaborating closely with 𝗱𝗼𝗰𝘁𝗼𝗿𝘀 who transitioned into Product Management roles. Their unique perspective consistently surprised me. As doctors, they infuse 𝗶𝗻𝘁𝗮𝗻𝗴𝗶𝗯𝗹𝗲 𝗾𝘂𝗮𝗹𝗶𝘁𝗶𝗲𝘀—empathy, compassion, understanding, and collaboration—into the products they shape. 𝗜𝘁’𝘀 𝗮𝗻 𝗮𝗿𝘁 𝗳𝗼𝗿𝗺 🔥 Recently, I discovered a similar game-changing move: #ZomatoCopilot by Zomato. 𝗧𝗵𝗲𝘆 𝗲𝗹𝗲𝘃𝗮𝘁𝗲𝗱 𝗳𝗼𝘂𝗿 𝗱𝗲𝗹𝗶𝘃𝗲𝗿𝘆 𝗽𝗮𝗿𝘁𝗻𝗲𝗿𝘀 𝘁𝗼 𝗣𝗿𝗼𝗱𝘂𝗰𝘁 𝗠𝗮𝗻𝗮𝗴𝗲𝗿 𝗽𝗼𝘀𝗶𝘁𝗶𝗼𝗻𝘀.   𝗜𝗺𝗮𝗴𝗶𝗻𝗲 𝘁𝗵𝗲 𝗶𝗺𝗽𝗮𝗰𝘁! These partners bring invaluable insights directly from the field, understand customer pain points firsthand, and offer a fresh perspective to the product team. After all, who knows customers better than those on the front lines? Deepinder Goyal, Zomato’s founder, shared an exciting feature these 𝗱𝗲𝗹𝗶𝘃𝗲𝗿𝘆 𝗽𝗮𝗿𝘁𝗻𝗲𝗿𝘀 𝗶𝗻𝘀𝗶𝘀𝘁𝗲𝗱 𝘂𝗽𝗼𝗻: “Get your extra change credited into Zomato Money on all Cash on Delivery orders”. It’s an innovation driven by real-world experience. 𝗧𝗵𝗲 𝗹𝗲𝘀𝘀𝗼𝗻 𝗵𝗲𝗿𝗲? Anyone with domain expertise, customer insights, and a problem-solving mindset 𝗰𝗮𝗻 𝗯𝗲𝗰𝗼𝗺𝗲 𝗮 𝗣𝗿𝗼𝗱𝘂𝗰𝘁 𝗠𝗮𝗻𝗮𝗴𝗲𝗿. It’s about understanding people and their needs. Also, in the coming days, I am planning to 𝗼𝗳𝗳𝗲𝗿 𝟭:𝟭 𝗴𝘂𝗶𝗱𝗮𝗻𝗰𝗲 𝗮𝗻𝗱 𝘀𝘂𝗽𝗽𝗼𝗿𝘁 for transitioning to a Product Manager role. Meanwhile, if you need any assistance, please don’t hesitate to direct message me. Let’s unlock new paths together! 🙂 🤔 Which industry are you in? 𝗛𝗮𝘃𝗲 𝘆𝗼𝘂 𝗻𝗼𝘁𝗶𝗰𝗲𝗱 𝗮 𝘀𝗶𝗺𝗶𝗹𝗮𝗿 𝘁𝗿𝗲𝗻𝗱 in your field where partners, users, customers, or stakeholders are encouraged to take up Product Management roles to bring fresh perspectives? #ProductManagement #ProductManager #CareerTransition #Zomato #Healthcare #HealthTech #Doctor #DeliveryPartner #Innovation #Diversity #Guidance

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The positive impacts of GenAI will be far reaching and we are just getting started !! #Fractal #GenAI

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Nikhil Krishnan joked about chat room functionality in the context of value-based care coordination as if it were a pipedream. It was all a dream until a couple of months ago - now it’s real - along with automated value-based care administration. We’ve natively integrated and automated enrollment, authorization, claims, adjudication, repricing & provider reimbursement to remove the bottleneck hindering greater direct-to-employer adoption. Scalable same-day payvider reimbursement is here. This rough demo video shows the functionality in the context of a multi-party surgical bundle ordered and pre-approved (ie codified plan design) by a DPC doc anchoring a level-funded plan. The pre-authorized procedure order triggers automated claims fund withdrawal at predefined direct contract rates stored in the dedicated plan environment in our database. The member chats and shares records with the physician, facility, and anesthesiologist right from the comfort of their personal longitudinal health record in Mishe. The video then cycles through the views from each individual provider’s dashboard where they “redeem” their “voucher” (ie submit their claim) for instant adjudication triggering automated EFT reimbursement. The team’s been HARD at work bringing the value-based surgical bundle administration automation to life. Personally, I've been actively working towards this moment for about 2 years and passively for 10. We're officially a clinically integrated network (CIN) without the admin headaches and look forward to developing unique quality-driven care models with the best clinical advisory board one could ask for. More on this soon. We’re implementing this with surgery centers treating patients from your favorite venture-scale COE companies and look forward to accelerating DTE adoption with the release of our API later this year. The applications for automated value-based care bundles are endless: physical therapy groups, labs/diagnostics (solving for continuity problem), pharmacies, DPC, urgent care, etc. If you’re a clinician who sends or receives referrals, wants to get a better handle on care plan compliance, and/or believes that compensation for care coordination is table stakes, please DM me. If you’re a health system of any kind looking to integrate administration with care coordination to streamline operations, eliminate leakage & boost compliance, please DM me. We look forward to making bundle creation and network enrollment self-serve in the coming months, but for now you’re just a few minutes away when chatting with our 24/7 support team. This is the very tip of the iceberg of what’s to come. James Dimarco Adrienne Moore Ahilan "Siva" Sivaganesan, MD Benjamin Schwartz, MD, MBA Zach Mitchell Chris Severn Peter Pronovost MD, PhD, FCCM Austin F. Cheng, Esq. Benjamin Fenster Sam Moen Adam Hornback Nicholas M. Sean Kelley Keith Smith Duc M. Vo, MHA Ryan Kline Demetrio J. Aguila, III, MD, MA, FACS Lee Dragoonis Jon Van Der Veer, DO, MBA

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Somewhat predictably, the headlines of Epic's UGM were mostly focused on AI. In my mind, the ones to focus on got buried as footnotes. Products leveraging Epic's position as the dominant inpatient EHR and selling differentiated products as a wedge into new markets (mostly under Health Grid) should frighten other healthcare vendors more than the AI arms race (which they'll largely win as the default option): - Payer Platform: A Health Grid product for payers. This was decently well covered, but that's because it's a mature product at this point. A lot of outlets covered it as if it was net new, but it was launched in 2019. The most noteworthy piece is Judy's quote saying they’re investigating submitting claims directly through Epic so you don’t need a clearinghouse - this represents a threat to clearinghouses and could represent the expansion from Payer Platform as a beachhead to attack incumbent SaaS, claims processing systems. - Epic Aura (labs): This is a Health Grid product for labs. This was launched previously. I don't see any announcements, but this is a beachhead for Epic to sell to labs that have or built their own LIS, allowing them to eventually replace it over time (or at least have all major labs as customers). This threatens existing LISes even more than Epic's LIS product, Beaker. They also announced a planned Blood Bank module, which increases their appeal as an all-encompassing LIS in this push. - Epic Aura (medical devices): A new sub-category of Aura (and Health Grid) for expanding into medical devices. I was waiting to see if they'd launch a separate category for medical devices or reuse Aura. First devices are cardiac arrhythmia and CGM. This threatens businesses like Redox to some degree. - Per Healthcare IT today, "Judy said they’re working on better surgical device manufacture planning leveraging the Epic schedule." This sounds like further expansion of Aura/Health Grid to surgical supply manufacturers. - I was surprised to not hear any updates about Discovery, Epic's Health Grid program for pharma. I'm curious what shape that will take. - I thought the use of the state of Washington + the Garden Plot model is a smart distribution play. Garden Plot has existed since at least 2022, but using a state for distribution to get to new markets that Epic struggles to sell to (small clinics, behavioral health clinics, correctional medical facilities and tribal facilities) is again another example of their expansionary mode. Health Grid products will be more impactful than the Vendor Services rat races or AI wars. It's worth paying attention to and taking advantage of: https://lnkd.in/gimisDzZ

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"SimAI empowers healthcare providers to distill actionable insights from sprawling and disparate data sources encompassing EMR and EHR systems," - Sanjeev Pant, VP or Cloud Solutions. Discover how PMsquare's SimAI is enabling healthcare organizations to meet HTI-1 compliance and harness the full potential of their #data. Dive into the details here: https://lnkd.in/gS7DPcRg #HealthcareData #EMR #EHR

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Great, quick listen on this “Build in Healthcare” podcast by a16z outlining the consumer health opportunities that can be advanced and accelerated with the help of technologists focusing on logistics, data, operations and consumer engagement. Agree with #Vijay Pande and #Daisy Wolf that it’s time to build in healthcare and that AI needs healthcare as much as healthcare needs AI. “The business model of UnitedHealth Group married with the consumer experience of Apple”…a truly compelling and achievable vertical integration strategy.

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Exciting news! Our SVP and Chief Informatics Officer, Bala Hota, discussed the impact of technology and data analytics in healthcare on the Empowered Patient Podcast. Listen now to learn more about leveraging data to enhance patient care and drive innovation! On-Demand webinar here: https://lnkd.in/gKsu--f4 #HealthTech #DataAnalytics #Tendo

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Chhavi Sharma Just wanted to give a quick shoutout for your amazing book: 'AI for Product Managers'! 🙌 Am halfway through and loving how you nailed the sweet spot between #AI, #ML theory and real-world tips. Finding myself nodding along and taking notes on every chapter! If you're in Product and looking to level up your AI game, grab yourself a copy of Chhavi's book - you won't regret it! #ProductManagement #AI

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Are time zone gaps delaying your CAPS Cloud implementation?   Time zone differences between health plans and their cloud providers can pose major challenges, especially during critical phases like go-live or parallel testing.   These gaps can lead to delayed support response, operational disruptions and extended project timelines.   Day 45 of 100: CAPS Turnaround Series - Cloud Migration Challenges (Part 9)   Challenge: Support Availability and Time Zone Differences  1) Understand how time zone gaps create bottlenecks during critical project phases. 2) Learn from a health plan that faced delays in resolving configuration issues due to limited vendor support hours. 3) Swipe through practical strategies like negotiating 24/7 support SLAs, leveraging regional teams, and using proactive monitoring tools to minimize disruptions.   Leadership Insight: The key to overcoming time zone barriers is preparation. Effective leaders plan ahead, establish strong SLAs, and build flexibility into team schedules to ensure seamless support during critical project phases.   Have time zone differences impacted your IT projects? What strategies have worked for your team to overcome these challenges?    Share your insights - I’d love to hear your thoughts. ==========================================   ♻️ Found this valuable? Repost to share with your network. ✅ Follow me for daily insights on program management, AI, digital transformation, and tools for navigating complex projects. #CAPSImplementation #HealthcareIT #ClaimsModernization #DigitalTransformation #CAPSTurnaround #HealthPlans #SystemIntegration #CAPSTurnaround #HealthEdge #HealthRulesPayor #TriZetto #QNXT #Facets #Cognizant #ProjectManagement #ProgramManagement #DataMigration #CloudTransformation #HealthcareCompliance #CloudMigration #TimeZoneChallenges #VendorManagement #ProgramManagement #LeadershipTips

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Welcome to the latest episode of Startups For Breakfast! I'm Ravi Venkatraman, and today we're navigating the future of tech in healthcare with special guest Rajiv Sikka, the CIO of Medanta Hospitals. We're diving deep into the intersection of technology disruption and health tech, examining the transformative impact of Artificial Intelligence in diagnostics and treatment. We'll also discuss how emerging deep tech startups in India are revolutionizing healthcare, going beyond human intelligence to deliver assertive healthcare solutions. This eye-opening conversation will explore key industry trends that startups need to stay ahead in this rapidly evolving landscape. Don't miss out on this insightful episode! Subscribe to Startups For Breakfast and join us every Thursday at 6 PM IST for a fresh perspective on entrepreneurship and technology. #HealthTech #TechDisruption #Startups #Innovation #MedTech #DigitalHealth #Healthcare #FutureTech #IndustryTrends #BusinessIdeas #Entrepreneurship #HealthcareInnovation #MedantaHospitals #CIOInsights #StartupAdvice #HealthTechTrends #DigitalTransformation #EmergingTechnologies #EntrepreneurLife #TechStartups #HealthcareIndustry #MedicalInnovation #BusinessStrategy #DisruptiveTech #StartupCommunity #DigitalDisruption #FutureOfWork #EntrepreneurMindset #HealthcareTech #StartupSuccess #TechInnovation #DigitalStrategy #HealthcareIT #EntrepreneurJourney #Medanta #CIOInterview #TechTalk #YouTube #Subscribe #StartupsForBreakfast #ThursdayThoughts #AIInHealthcare #DeepTech #HealthAI #MedTechStartups #DigitalHealthRevolution #HealthcareTechTrends #AIInMedicine #FutureOfHealthTech #HealthTechInnovation #TechInHealthcare #SmartHealthcare #HealthTechStartups #HealthcareTransformation #AIHealthcare #HealthcareEntrepreneur #DeepTechIndia #EmergingHealthTech #HealthTechFuture #InnovativeHealthcare #AIAndHealthTech #MedantaCIO #TechHealthcare #HealthcareInnovationTrends

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🌟 At Ambience Healthcare, we're giving clinicians their lives back.🌟 🩺 Meet Dr. Long, a dedicated #urologist at John Muir Health, who describes Ambience as: "Career changing...life changing." This testimonial captures the heart of our mission! By lifting the heavy burden of documentation, we're helping clinicians rediscover the joy in their work. 🦴 But the story doesn't end there. Dr. Long's wife, an #orthopedic surgeon, was also overwhelmed by documentation demands. Now, she too enjoys the relief and balance that Ambience brings. 🥰 Also, can we take a moment to appreciate how cute and #heartwarming this is? Two married physicians who used to spend their evening completing documentation, now get to come home on time and leave their work at work! At Ambience Healthcare, we know that when clinicians thrive, their families and patients benefit too. We're not just reducing paperwork; we're empowering clinicians to focus on what truly matters—providing exceptional patient care. #AmbientAI #physicianburnout #healthcare #innovation #worklifebalance #inspirational #medicine #patientcare

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The Centers for Medicare & Medicaid Services (CMS) Burden Reduction Rule, designed to streamline administrative processes in healthcare, promises significant financial implications, particularly concerning electronic prior authorizations (ePAs). As the healthcare industry transitions from manual to electronic systems, the Burden Reduction Rule aims to simplify and expedite prior authorizations, offering substantial cost savings and efficiency improvements for healthcare providers, payers, and patients. #Healthcare #Interoperability #BurdenReduction #FinancialImplications #ePA https://lnkd.in/dJnJWFpc

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