Kathleen Bennett

Providers and health plans have been working on their Fee for Service payment processes for decades (still work to be done there), but the data flows needed to support Value Based Care arrangements are in their infancy. Organizations involved in Value Based Care (VBC) should consider using modern processes (like APIs) and standards (like HL7 FHIR) to exchange: · Rosters of members attributed to VBC populations · Financial performance on VBC contracts · VBC contract details · Patient care gaps for VBC contracts · Clinical quality performance · And the list goes on In his interview with Rick Daly from HMFA, Deepak Sadagopan talks about why his team is building the data infrastructure to support VBC and why it should matter to you. https://lnkd.in/ggKeA985

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“This tension forces you to either compromise your product's user experience to satisfy buyer requirements, or risk failing to gain institutional adoption despite having happy users.”

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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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🔔 CMS's recent push for electronic prior authorization is transforming the payer landscape. This Cognizant article outlines critical steps payers can take to get ahead of these changes. As someone on the front lines of helping healthcare organizations navigate regulatory mandates, here’s what I’m seeing: ▪️Biggest Shift: Automation and interoperability are now essential to meet compliance and streamline operations. ▪️Key Challenge: Limited resources and tight timelines make it difficult to balance compliance and operational priorities. Readiness Tip: ➡️ Conduct a gap analysis of your current prior authorization processes: ➡️ Identify manual workflows that could be automated. ➡️ Assess whether your data-sharing capabilities meet CMS interoperability standards. ➡️ Early action here can reduce administrative burdens and improve decision-making speed. Let’s discuss—how is your organization preparing for these changes? #CMSCompliance #HealthcareInnovation #Interoperability

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Can generative AI revolutionize RCM? Generative AI has made impressive strides in healthcare, from diagnosing complex cases to aiding in drug research. However, its potential for transforming revenue cycle management is often overlooked. Where generative AI might be helpful? ✔️Generating appeals for claim denials ✔️Streamlining prior authorizations & documentation ✔️Data-powered decision making ✔️Strategic financial planning through predictive analytics However, there are areas where generative AI may fall short. ❗️Limitations of Generative AI: ❗️Understanding nuanced communication ❗️Dependence on data ❗️Tackling intricate claim denials While generative AI might not be an answer to all revenue cycle challenges, it holds promise in reducing administrative burdens and improving workflows. What do you think? Kenny Dewan Monika Roots, MD, FAPA Scott Penn #RevenueCycle #RevenueCycleChallenges #GenerativeAI #RCM #RevenueCycleManagement

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Cost analysis in isolation lacks depth. Consider comparing costs - or cash shortfalls - from multiple angles: -Procedure codes -CPT codes -Payers -Aged A/R A record of CARCs and RARCs can be used to map shortfalls and denials, getting you closer to the root causes. This is what my team calls an RCM Health Check and I’m covering the concept in a webinar this Thursday. Join me here: https://lnkd.in/epuhRSn7 

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Patient Care is at the root of our exsistence. It's why I get up everyday. A "one cloud strategy" is really important to me especially how it relates to a unified approach to EHR data security. I think we can all agree that it's not "if" an attack will happen it's more "when." Operational efficiency can only be as good as your DR/BC stance. Sharing my lastest podcast with Becker's Healthcare. Take a listen.

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Adapting to Technological Advancements Big Tease – more to come to introduce Max Powers and Sophia Phoenix. In today’s world, leaders like Max Powers are faced with the challenge of adapting to the rapid evolution of technology, especially advancements in AI and automation. But fear not—this journey can be filled with humor, simple solutions, and, yes, even a few friendly robots along the way. Max Powers and the Great AI Adventure: A Leader’s Guide to Tech Adaptation Meet Max Powers, fearless leader, tech enthusiast (well, mostly), and the embodiment of every leader trying to keep up with today’s whirlwind of technological advancements. Max recently realized he could either embrace the AI revolution or risk being the person still trying to send faxes in 2024. Spoiler: nobody wants to be that person. So remember, adapting to technology doesn’t mean becoming a tech wizard overnight. Take a page from Max Powers’ playbook: embrace AI to streamline the mundane, keep the human element alive, and have some fun along the way. Because leading with humor and adaptability is the real key to staying ahead in today’s tech-driven world. Read More: https://lnkd.in/e2TdDier And leave a comment or start a conversation! 

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Good Morning HIM and Revenue Cycle leaders. I would encourage you to take a look at how AGS Professional Coding Automation can impact your health system or physician group. #healthcare #revenuecycle AGS Health

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Join us for a crucial session where we delve into the Health Equity Index. Learn how it's calculated and its significant impact on quality and Star metrics for Medicare Advantage plans. View the SOA Health Meeting agenda here: https://optumin.co/ssw6cc #Optum #SOA #HealthEquity #Medicare #Payer

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Take a look at these alternatives to built in EHR communications tools. Break out of the mold and consider solutions that drive ease and efficiency for your team!!!

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💡Interesting recent stat from Beckers! A consistent (3% to 5%) margin of revenue opportunity is lost due to the complexity of documenting and coding for complex inpatient cases. This uncaptured revenue is significant to a hospital's bottom line, with a 5% loss in a mid-size hospital potentially equaling $22 million to $38 million in lost revenue annually‼️ MDaudit can help with our Hospital and Coder audit workflows. Check out this short demo!

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Great article by Priti Choksey Shah on the importance of integrating Clinical Documentation Integrity (CDI) and Utilization Management (UM) in hospitals. #HealthcareInnovation #RevenueManagement #AIinHealthcare #HospitalEfficiency #CDI #UM

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There is still time to register for the upcoming webinar on 7/18. The most common question we receive from practices is around incident to guidelines and when it’s appropriate to be utilized. Don’t miss out on this informative webinar from two industry experts to help you understand the guidelines for your practice. Jessica Whitney, CPC, CPMA, Approved Instructor Alicia Shickle AHFI, CHC, CPC, CPCO,CPMA, CRC

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Epic Systems’ recent move to back the TEFCA medical records exchange is interesting. On the surface, it’s all about creating a seamless flow of patient data across hospitals, QHINs, and all relevant stakeholders. But let’s be real—data is the oil of the new economy, and interoperability is the pipeline that delivers this precious resource to all the right stakeholders. By aligning with TEFCA, Epic might just be positioning itself as the refinery. All in all, this is a welcoming move by Epic Systems—especially if it really is as straightforward as they make it sound. But given the lack of details, one has to wonder if there are any hidden catches. After all, when it comes to something as valuable as healthcare data, it’s wise to look out for the fine print. Let’s hope this is genuinely about improving patient care. https://lnkd.in/gDdDCcmj

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Clinical data is flowing more freely to health plans, but vital financial data is not getting to providers. U.S. provider organizations need to understand how information asymmetry will impact them and what to do about it. Here is my latest. https://lnkd.in/gZ-jnTJB #informationasymmetry #interoperability #valuebasedcare #healthtechmagazine

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A service catalog is not just a list of IT offerings. It’s a strategic tool that drives alignment with corporate goals, especially in the healthcare sector. In an industry where every decision impacts patient care, clarity is crucial. A well-structured service catalog ensures that IT initiatives support organizational objectives, enhancing efficiency and accountability. Here’s how to create one that resonates: 𝟭. 𝗨𝗻𝗱𝗲𝗿𝘀𝘁𝗮𝗻𝗱 𝗦𝘁𝗮𝗸𝗲𝗵𝗼𝗹𝗱𝗲𝗿 𝗡𝗲𝗲𝗱𝘀: Engage with clinical and administrative teams. Their insights will shape relevant IT services. 𝟮. 𝗠𝗮𝗽 𝗦𝗲𝗿𝘃𝗶𝗰𝗲𝘀 𝘁𝗼 𝗚𝗼𝗮𝗹𝘀: Clearly link each service to specific corporate objectives. This demonstrates IT’s direct impact on patient outcomes. 𝟯. 𝗣𝗿𝗶𝗼𝗿𝗶𝘁𝗶𝘇𝗲 𝗖𝗼𝗺𝗽𝗹𝗶𝗮𝗻𝗰𝗲 𝗮𝗻𝗱 𝗦𝗲𝗰𝘂𝗿𝗶𝘁𝘆: In healthcare, regulations are paramount. Ensure your catalog reflects compliance requirements and security protocols. 𝟰. 𝗣𝗿𝗼𝗺𝗼𝘁𝗲 𝗖𝗼𝗻𝘁𝗶𝗻𝘂𝗼𝘂𝘀 𝗜𝗺𝗽𝗿𝗼𝘃𝗲𝗺𝗲𝗻𝘁: Regularly review and update the catalog. This keeps it aligned with evolving healthcare demands and technological advancements. 𝟱. 𝗖𝗼𝗺𝗺𝘂𝗻𝗶𝗰𝗮𝘁𝗲 𝗘𝗳𝗳𝗲𝗰𝘁𝗶𝘃𝗲𝗹𝘆: Use clear language and visuals. A well-communicated catalog increases utilization and fosters collaboration. Establishing a service catalog is an investment in operational excellence. It positions IT as a strategic partner in delivering superior healthcare. ---------------------------- #ServiceCatalog #ITStrategy #HealthcareIT #OperationalExcellence #StakeholderEngagement #Compliance #DataSecurity #ITAlignment #HealthcareInnovation #ITServices #DigitalTransformation #HealthcareLeadership #ITGovernance

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OIG ALERT: Diagnoses reported only on enrollees’ HRAs and HRA-linked chart reviews, and not on any other 2022 service records, resulted in an estimated $7.5 billion in MA risk-adjusted payments for 2023. Before we dive in here I want to say that I have seen HRAs used appropriately and inappropriately during my time in this space. There can be great value for patients, particularly those with limited access to care and or those reluctant to visit their primary care provider. However there is tremendous risk to the system if these visits are a fragmented approach to care and or not aligned with care planning. What the OIG has identified represents the risks and shows care continuity breakdowns. Ultimately organizations and payers must know their vendor partners because there are some really good ones in this space. Earlier this week the OIG released a really interesting look into Health Risk Assessment, or HRAs. These HRAs are often performed in the home by payers or vendor partners. These should be in depth reviews of the patient and include a host of assessments that often are hard to complete in a condensed visit to a provider office. What the OIG found was that 7.5B or about 2% of all Medicare revenue was tied to conditions captured only during these visits. Is that bad? I don’t know. If these are new conditions and then ultimately incorporated into a broader care plan that improves outcomes then they are a great thing. If they are captured, never shared with the care team, and ultimately used to solely drive revenue with little focus on outcomes then it is bad. I suspect there is a mix of both. If I was at the OIG I would want to take a multi-year look at what was captured year over year only in a HRA as a next step. The report recommends CMS take the following actions. CMS subsequently agreed with recommendation number three but not numbers one and two. 1) Impose additional restrictions on the use of diagnoses reported only on in-home HRAs or chart reviews that are linked to in-home HRAs for risk-adjusted payments. 2) Conduct audits to validate diagnoses reported only on in-home HRAs and HRA-linked chart reviews. 3) Determine whether select health conditions that drove payments from in-home HRAs and HRA-linked chart reviews may be more susceptible to misuse among MA companies. I am doing some advanced analytics on information in the report for future posts but this is a nice easy read for folks. https://lnkd.in/ehNzzSWu

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