Reid Kiser

🚨 Top 10 #PatientSafety Concerns for 2024. 📌 Have significant changes been made over the last decade? An important question is to reflect on what has been done, what we are doing, and what remains to be done.

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A new study from Humana leaders in Health Affairs provides more compelling evidence that hybrid payments provide primary care practices with the predictability they need to build out more effective care teams. Read here: https://lnkd.in/eCXbu3Tu

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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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The Office of the National Coordinator for Health Information Technology (ONC) has proposed new rules aimed at enhancing data interoperability within the healthcare industry. These regulations will significantly impact health plans by imposing new data standards, encryption requirements, and API certifications. Key Provisions: - Data Standards: Health plans must adopt the newer USCDI version 4 for data exchange, replacing version 3. - SMART on FHIR: Plans must upgrade to SMART v2.2 to enable third-party app access to EHR data. - Data Encryption: Stricter encryption standards are mandated to safeguard patient data. - API Certifications: Voluntary certifications for payer-to-payer, prior authorization, and provider directory APIs are introduced to streamline processes. Learn more: https://hubs.ly/Q02K6qlc0

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Health plan strategist and executive coach Dominick Bizzarro believes that an agile approach to strategic planning can help turn regulations like the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) from something done TO you to something done FOR you. #Interoperability #digitalhealthinnovation

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Health Data News Roundup: Rising Inpatient Hospital Days for Medicare Advantage Enrollees; ACO Models Can Support Patient Engagement; and Health Data Access #MAPlans #HealthData #Payers #HealthPayers https://bit.ly/3WrkTpU

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Customizing your change management approach is crucial for success. On our Knowledge Center, OCM expert Lily Farris highlights ways to tailor your strategy to engage stakeholders and ensure a smooth transition. Read the article here: https://gag.gl/fh1rdl You'll learn about our methodology 📋 and the critical ingredients for a successful change management strategy 🔀. #Change #ChangeManagement #OCM

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📢 Webinar Invitation for Health Plan Leaders From Data Overload to Actionable Intelligence: Lowering Barriers to CDI Implementation 🗓️ November 4, 2024, 11 AM PST   In a healthcare landscape driven by data, Health Plans face complex barriers to Clinical Data Integration (CDI) that can hinder quality improvement, resource management, and patient outcomes. Join Thameem Ansari(CTO) and Nikita Ravindran (Product Manager) as they address these challenges and provide strategies for Health Plan executives:   🌐 Data Overload: With patient information dispersed across EHRs, lab results, claims, and surveys, executives often grapple with identifying actionable data insights. This webinar will outline how to streamline data to unlock critical intelligence and drive efficiency.   🔍 Inconsistent Data: Non-standardized data complicates analysis and decision-making, impacting everything from reporting accuracy to reimbursement processes. Learn approaches to data standardization that enhance data reliability and provide a consistent foundation for strategic planning.   📊 Fragmented Sources: Integrating patient data from multiple sources remains a significant obstacle for implementing effective CDI. Our speakers will discuss integration techniques that support cohesive patient records, enabling coordinated care and a clear view of health trends.   During the session, you’ll gain actionable insights on:   ✅ Leveraging automation to reduce manual tasks, freeing teams to focus on high-value analysis. ✅ Applying data mining techniques to reveal trends in health outcomes, disparities, and utilization—guiding targeted interventions and proactive planning. ✅ Embedding CDI initiatives seamlessly into your operational goals for lasting impact.   💡 Join us to explore how to overcome these CDI barriers and turn raw data into valuable intelligence that strengthens healthcare delivery and elevates member experience. This is a must-attend for executives looking to maximize the impact of their data.   👉 Secure your spot and transform your approach to Clinical Data Integration today! https://lnkd.in/ex7M-CWZ #healthchain #clinicaldata #healthplans #payers #ehr #patientoutcomes #healthcarewebinars

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Healthcare interoperability has come a long way, but gaps remain in data access and standardization. This article from Health Data Management explores these hurdles and why patient-centered models are essential. With Hart’s secure and compliant data solutions, healthcare providers gain the reliability and speed they need to elevate patient outcomes. https://hubs.ly/Q02W_fXb0 #HealthcareIT #DataSecurity #Interoperability

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There's a lot to this article to consider. It freely admits the difficulty associated with success in VBC programs unless huge investments are made in data analytics and infrastructure. These types of investments are hard to support for smaller organizations such as IPA's, rural hospitals, etc. Unless an organization is prepared to take full risk on Medicare lives, the challenges associated with VBC operations (both Medicare and Commercial) in our current environment are difficult to manage. This is doubly important when you are faced with asking doctors to change work flows and processes with the promise of potential dollars 16-18 months downstream. Adoption of these programs will not truly hit a tipping point until we find a way to pay our providers in real time for the outstanding work that they are doing everyday. (I.e. it shouldn't take three additional codes to justify that blood pressure was measured during a visit. I can't go to a dentist without having my BP measured.) Patient Physician Network #Libertatem P.S.> Thinking that handing off 50+% of the Medicare lives to major payors operating MA programs will fix this is flawed also, in that they will undoubtably seek reductions from the very providers that they are asking for behavior change from.

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DirectTrust summarizes a recent #InteropHero interview with eHealth Exchange's Jay Nakashima. Read more at the link below as Jay shares more about his career-long focus on health data interoperability and what it means for eHealth Exchange to be designated a QHIN under TEFCA. https://buff.ly/4bgJfc5 #TEFCA #interoperability #BeMyQHIN

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Small acute care organizations face unique challenges—such as financial constraints and limited internal resources—that impact or even delay their EHR purchase decisions. Still, progress is being made: between 2021 and 2023, KLAS validated go-forward EHR decisions made by 184 such hospitals (almost 14% of the market). This report examines how a sample of those organizations are faring with their new EHR, including what their decisions suggest about future buying energy in this space, how much value they have realized, and how their training experience has been. To read the report by Tyson Blauer and Paul Warburton, click here: https://lnkd.in/gEGSf2PQ #AcuteCareEHR #HealthcareIT

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📣 CMMI Update on Value-Based Care Initiative ICYMI: This week, CMMI released an update on its value-based care initiative, which focuses on value-based payment and service delivery models to reduce costs, improve care quality, and ensure equitable outcomes through high-quality, affordable, person-centered care. Models like ACO REACH, Transforming Maternal Health (TMaH), and Making Care Primary (MCP) mandate sociodemographic data collection, health equity plans, and HRSNs screening and referrals. They feature innovative payment policies and support for underserved populations. 📊 Significant strides have been made in 2023. CMMI highlighted progress in safety-net provider participation, data collection, and payment innovations aimed at reducing disparities. These new models ensure diverse provider participation and offer much-needed support for Medicaid beneficiaries, including Federally Qualified Health Centers (FQHCs) and community-based behavioral health providers. We are excited to hear the progress they are making in their efforts to enhance whole-person care, address HRSNs, and advance health equity. 📖 Read the blog https://lnkd.in/eXrpC5Je #HealthEquity #ValueBasedCare #CMMI #CMS #HealthcareInnovation

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Another signal that CMS understands the importance of standardizing the types of data and access to it for a learning health system. Two major points: 1. emphasize and increase the collection and sharing of actual clinical and patient- reported OUTCOMES data in this strategy. Claims data doesn’t tell the whole story and continues to keep us in the process measure rocking chair. 2. Make sure data sharing is with all interested stakeholders rather than just contractors or plans. Patient organizations and small research organizations are asking better questions and have insights that can both validate the real world applicability of such data and all challenge us to do more. Don’t miss the opportunity to truly transform actual care and results for the health of people! International Consortium for Health Outcomes Measurement (ICHOM) can be a resource to guide what, when and how to measure outcomes that matter to patients and clinicians. #measurewhatmatters #rebalance #datatransparency

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Federal and State DTx Adoption: Facing the Same Challenges, Driving Toward the Same Goals Last month, DTA’s Development Manager, Stephanie Bossong, attended the 11th Annual Colorado Health Innovation Summit, hosted by Prime Health in partnership with the Colorado Office of eHealth Innovation. The event underscored how challenges in adopting digital health innovations—like education, awareness, and increasing adoption—are not confined to federal initiatives. State-level efforts face the same hurdles, but also share the same potential: using digital health to enhance care, expand access, and advance health equity. The Summit brought together providers, entrepreneurs, start-ups, and investors to tackle healthcare’s most pressing issues, with themes that resonate nationally:  🔷 Keynote: Is Innovation Grief Healthcare’s Greatest Challenge?  Theo Edmunds shared how creativity and innovation are critical to progress, urging us to overcome “innovation grief”—the resistance to change that stifles advancement. 🔷  Colorado’s Living Lab  A panel discussion showcased Colorado as a “living lab” for mental health and well-being innovations, emphasizing collaborative, community-driven solutions. 🔷  Public-Private Partnerships for Social Needs  Panelists from the Medicaid Innovation Collaborative, Colorado Medicaid Office, and the Blueprint to End Hunger highlighted innovative approaches to addressing food insecurity and housing through statewide partnerships. The parallels between state and federal efforts to drive digital health adoption are striking. Whether at the state or national level, collaboration and innovation are essential to overcoming barriers and achieving meaningful progress. These shared goals move us closer to a future where digital health transforms care, improves access, and ensures equity for all. Thank you, Prime Health, for fostering these crucial conversations and advancing the mission of innovation in healthcare!

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#ICYMI: Nearly 10% of full-benefit #Medicaid beneficiaries disenroll and re-enroll in services within 12 months, disrupting care continuity and impacting health outcomes. A recent MACPAC - Medicaid and CHIP Payment and Access Commission study found that implementing 12-month continuous eligibility significantly reduces this churn and ensures more stable access to care. But this starts with a comprehensive Medicaid eligibility #assessment that evaluates the member’s clinical and social needs. With more than 700,000 assessments conducted annually, our experience shows a member-centric approach that combines human expertise and technology that maximizes impact and improves access to support and services. Check out this 3-minute article with best practices for running a member-centric Medicaid program for your state: https://hubs.li/Q02VKJfY0 Don’t forget to check out the MACPAC research at: https://hubs.li/Q02VKt0f0

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Are you seeking a practical approach to managing AI-related risks in your daily practice? Don’t miss this live presentation hosted by the Florida Medical Association, where Susan Boisvert will highlight AI implementation examples, as well as concerns and real-world solutions. After completing the course, attendees will be able to: ✔ Discuss ethical considerations associated with using generative AI. ✔ Apply at least two frameworks for evaluating healthcare AI. ✔ Understand your role in the responsible use of AI in the healthcare setting. This free course is approved for a maximum of one (1.0) American Medical Association PRA Category 1 Credit™. To learn more and register, visit: https://lnkd.in/gY_bbbvU #Healthcare #PatientSafety #RiskManagement #AIinHealthcare #HealthcareAI #generativeAI #AIRisk

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