Donna M. Roach, MS, CHCIO, CDH-E, LFCHIME, LFHIMSS

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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Hopeful this will drive impact industry wide.

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The info you need for nationwide interoperability: Our #QHIN Readiness Guide. Learn more about how Qualified Health Information Networks (QHINs) support intelligence sharing from coast to coast, no matter where the patient is—and get ready to connect. https://ow.ly/vpab30sBT6f

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Behavioral healthcare has many facets. Can your #EHR handle your complex needs? Core's recent blog post shares valid food for thought. 

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Today I want to talk about "Little Build, BIG Wins". So often we focus on the complex and sexy projects and implementations and overlook the small enhancements that when deployed, have the power to impact not only our end-users and patients, but as demonstrated in the example below, our entire Commonwealth of Virginia! Improving Immunization Record Accuracy for Newborns in Virginia 💉 At Sentara Health, we're always looking for ways to enhance healthcare processes and improve outcomes for the communities we serve. Recently, we identified a challenge that because, as standard practice, newborns are assigned generic names (e.g., "Girl Mom’s Name") in their health record, it creates an issue with matching vaccination data to the state’s immunization registry—especially for Hepatitis B vaccines. Here’s how we solved it: We introduced a new system that holds Hep B vaccine records for 30 days to ensure that the baby’s legal name is added to the chart before sending it to the Virginia Department of Health (VDH). A filter was put in place to block any vaccine records with incomplete names, and failed records are automatically retried once the legal name is updated. This change, implemented on May 14, 2024, has already had a significant impact—by September 30, 2024, over 4,600 vaccinations have been sent to VDH with the correct information, helping to streamline immunization tracking and reduce manual reconciliation. What this means for the community: ✅ VDH can now build accurate, comprehensive immunization records for each child. ✅ This solution reduces errors and manual effort, leading to more efficient vaccine tracking. ✅ Healthcare providers benefit from better data integrity, improving care for our youngest patients. We're proud to be part of the solution and are excited that VDH has shared this improvement with health systems across Virginia. Together, we’re helping create a stronger, more connected healthcare ecosystem for all. Thank you to Anissa Jones, Audra Wilkins and teams for taking on this "Sentara" issue, and finding a way to help our entire state improve health every day!! Sarah Richardson Dawn Whitney Rebecca Woods, MHA, SHIMSS, PM Centers for Disease Control and Prevention Virginia Department of Health Sentara Health Plans Joseph Evans, MD, FACP Amy Rosa Tim Skeen Bluebird Leaders This Week Health #HealthTech #Immunization #PublicHealth #Innovation #HealthcareSolutions #PatientCare #Virginia

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To lead effectively amid the 2025 Medicare Advantage and Part D Final Rule changes, leverage data-driven compliance measures, employing predictive analytics to anticipate and prevent regulatory breaches. Champion ethical marketing practices, employing sentiment analysis to ensure transparency and authenticity in communications. Forge partnerships with community organizations to enhance access to behavioral health services, utilizing geospatial analysis and machine learning to optimize resource allocation. By pioneering these strategies, healthcare analytics leaders can navigate regulatory complexities while ensuring equitable care delivery. #DataDrivenCompliance #EthicalMarketingr #EquitableCare #PredictiveAnalytics. https://lnkd.in/eq3vf6qs

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The best patient-focused apps, and digital front doors, will do very little to help with patient satisfaction (and retention) if the hospital/clinic doesn't first improve its internal processes and culture. It's the carpenter, not the hammer. If only this weren't true... #healthcare #patientexperience #patientsatisfaction #customerexperience #consumerism #patientportals #digitalhealth #ehr #emr #customerretention https://lnkd.in/g5wkKE_X

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Change Management and Quality Improvement are always top of mind!

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Struggling to get your Health IT project approved? This article breaks down the IRACIS framework - a useful tool for building a compelling business case in hospital settings.

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💡 Did you know? Post-acute care operators with low hospitalization rates save health plans tens of thousands of dollars—with the average cost of a single inpatient hospitalization ranging from $15K to $20K. Under the Affordable Care Act (ACA), these savings are required to be reinvested in care improvements or gain-shared with providers. That means if you’re helping reduce hospitalizations, you could be eligible for a share of those dollars. [Read more about these ACA provisions here: https://lnkd.in/geHxR7nc - Is your ACO or Special Needs Plan sharing the savings you’ve worked hard to create? - Do you know how much potential revenue is being left on the table? 📞 Our team at PointClickCare is here to help you find out! Schedule a review with your Customer Success Manager to uncover your potential gain-sharing opportunities. And if you’re not using PointClickCare today—don’t worry, we’re still here to help. You can contact me or my team directly to explore how to maximize your value-based care potential. 💬 Let’s start the conversation. The savings you’ve created should be working for you. #PostAcuteCare #ValueBasedCare #HealthcareSavings #VBC #HospitalizationRates #GainSharing #AffordableCareAct #ACOs #SpecialNeedsPlans #CareCollaboration #PopulationHealth #HealthIT #PatientOutcomes #CareOptimization #HealthPlans #CareDelivery #MedicaidSavings #ReimbursementModels #SeniorCare

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Scott Code, MBA great article below for opening the conversation. Thank you and #leadingage for being a leader, catalyst, and advocate for AI in senior living and health care. Are you catching the buzz surrounding artificial intelligence (AI) in aging services? LeadingAge’s Scott Code, vice president of the Center for Aging Services Technologies (CAST), has authored an article on that topic, published April 17 in HealthTech: “Embracing Generative AI and Large Language Models in Senior Care.” #SeniorCareAI #AgeInnovation #SmartSeniorCare #AIHealthcare #SeniorLivingTech #DigitalHealth #SeniorWellbeingAI

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To keep up with the evolving health care landscape, organizations need to prioritize access as a fundamental part of their value proposition to patients. Inspired by successful retail strategies, health care can streamline processes to eliminate barriers to care and enhance service delivery, increasing both value and patient satisfaction. Check out this blog that outlines how this transformation necessitates a clear definition of access, effective use of consumer insights, and ongoing efforts to refine services.

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The HCAHPS Survey is evolving, and your strategy needs to keep up. NRC Health's latest article explains the new changes and our CAHPS Insider Live webcast offers actionable tips. Check them out here: https://bit.ly/4euy4yB #PatientExperience #NRCHealth #HealthcareInnovation

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This November 19th, I'll be joining symplr's Chief Nursing Informatics Officer Allison Morin to discuss how healthcare organizations can turn outcomes data into actionable improvements that drive meaningful change. Here's a quick overview of some of the key takeaways we'll be covering: • Explore the 3 crucial steps to increase your quality program’s influence on operations • Learn effective techniques for identifying quality problems and initiatives • Master the art of goal setting: Prioritize efforts for maximum impact while avoiding low-yield changes • Gain insights on sharing quality data with executive stakeholders for improved decision-making Learn more and register below: bit.ly/3Cg5Bhz #HealthcareOperations #HealthcareLeadership

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We started ChartPath a little over 10 years ago. There were already legacy systems in the sub-acute space and more than 400 EHRs across the total market. We did not set out to build a better EHR, we built a better EHR company. This philosophy drives everything we do with a focus on customer experience from sales to implementation, support, and even offboarding. Empathy is our core value. Over those 10 years, together with our clients, we’ve faced way too many changes and challenges. The biggest change that keeps coming back every year even stronger than the year before is the increased documentation requirements and CEHRT requirements that all of us must execute perfectly to simply stay in the game. We try to be smart about this. We treat each new requirement as an opportunity. Our product team and development team are the best I’ve ever had the pleasure of working with and their only focus is to “make everything ChartPathy.” We keep it light weight, we keep it elegant, and we deliver value. Our goal is for our providers to spend more time with their patients or their families, and far far less time with us. But no matter how elegantly we implement CMS’s new “requested features,” it still requires more from our users. More data, more process, more time spent in the EHR. We are not accomplishing our goals and we cannot always deliver on our promise. We are a growing chasm between our users’ work life and family life. As a CEO and product guy, that is simply devastating. Today, we get to change this forever. There are so many great companies out there hacking charting and hacking the EHR experience. This market is moving so fast and innovation is continually pushing us to greater heights.  We had the opportunity to build on this ourselves. To develop tools similar to these amazing companies and release them to our clients. We chose not to do that. Instead, today we are launching the ChartPath Automation Marketplace. Here, our clients can select from any number of innovative tools to enhance their daily experience with our EHR. These tools are vetted by our team, integrated with ChartPath, and built by teams we respect. I want you to stop using ChartPath and start using ChartPath automations. I’ve always been the CEO who wants you to use our product less, and today we are delivering on that promise. I’m grateful to our launch partners. These are some of the most impactful technologies I’ve had the pleasure of experiencing in a long time. Specifically, thank you to our friends at Beam Health, Brellium, Evolytix, Limo Health, NuIQ, Omaiven Health, Scribematic, and Text Blaze. More importantly, thank you to our team who made this happen. It is your relentless dedication to your vision of making the lives of the people we serve better that keeps us moving so strongly in the right direction. I’m so grateful for you. https://lnkd.in/ggiT_qEZ

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“It is not just about the numbers. Whether opening a facility or adding a service, we pay strict attention to ensuring we deliver quality, evidence-based care in a safe environment with expertly trained staff.” Read more from Stephanie Eken, Chief Medical Officer, and Navdeep Kang, PsyD, Chief Quality Officer, Inpatient Services, about the clinical priorities that are in place that will allow Acadia Healthcare to continue to set the standard for patient care. #QualityCare #Healthcare #Commitment.

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At the KLAS K2 Collaborative Payer/Provider Summit in Salt Lake City tomorrow, I'll be talking about how data partnerships and interoperability developments are changing the dynamics between health plans and provider organizations. If fragmented healthcare is a problem for you and you want to do something about it, let's connect. #KLASK2Summit2024, #K2Collaborative, #Interoperability, #payer, #provider, #KLAS, #klasresearch

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Suki plans to incorporate the it's assistant’s available technology to date, which includes ambient scribing, clinical note generation and suggested ICD-10 billing codes, into Zoom telehealth. The combination of telehealth and AI will be able to power AI assistive abilities that exceed what can be done in a clinic. #telehealth #AI #technology

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