Todd Quartiere

Accurately predicting rising healthcare risk is critical to any provider, payor or health system. Knowing the rising risk AND cost helps you better manage patients and members healthcare. Only Optmycare does this with a 90+% accuracy rate! #predictiveanalytics #populationhealth #prescriptiveanalytics #healthcarerisk

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Interesting perspective on #TechnologicalDebt in health care by Dave Lamar focused on the provider market, but we seem the same issues within state depts and payers. While good data governance practices are key, there must be a better way to solve this common - if not universal - challenge in health care, if only by offloading some of the administrative responsibilities that require the individual management and administration of no-value-add administrative functions. #healthdata

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My colleagues, James R. Bush, Adarsh Gosu and I were honored to lead an Executive Roundtable at the #BeckersAnnualMeeting last month. Leaders discussed the capabilities of Generative AI in health care, emphasizing the trust, governance, data modernization, and workforce training. Some highlights included: ☑ Establishing effective governance is crucial for successful AI implementation. ☑ The importance of change management can’t be overlooked. ☑ Building consumer trust and engagement is essential in AI adoption. ☑ Workforce upskilling is necessary for AI fluency and successful implementation. ☑ Designing AI solutions with scalability in mind is a must. A special thanks to Becker's Healthcare for the opportunity! Read a recap of our conversations on Beckers Hospital Review. https://lnkd.in/gEVWxwzq Want to learn more about Deloitte guidance for the potential of #AI in healthcare? We have a report with critical insights about implementation and governance. https://lnkd.in/gXE_HVG2 Bill Fera, Tina Wheeler, Adarsh Gosu, Dan Kinsella, Anne Phelps #AIinHealthCare #GenAI #FutureofHealth #Deloitte #hospitals #HealthIT *Information posted here is a personal opinion and is not a substitute for medical advice. Shared publications contain general information only and Deloitte is not, by means of this publication, rendering accounting, business, financial, investment, legal, tax, or other professional advice or services.

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An interesting article that highlights the importance of aligning strategies with value-based care #VBC goals to enhance patient outcomes and operational efficiency. One critical aspect is #datadrivencare management. Utilizing analytics platforms to aggregate and analyze data from sources like electronic health records #EHRs allows for population health analysis, risk stratification, and tracking quality metrics, all of which contribute to improving care quality. Additionally, placing proactive #preventivecare at the center of your strategy is essential. Implementing wellness visits, chronic disease management, and timely immunizations can boost overall health while reducing long-term costs. Another vital factor is enhancing #carecoordination. Developing care transition protocols, streamlining provider communication, and creating multidisciplinary care teams help ensure a seamless patient journey and better outcomes. Furthermore, increasing #patientengagement and education plays a crucial role. Addressing #socialdeterminants of health is also key. Screening for social challenges, building a community resource database, and ensuring proper referrals and follow-ups are necessary steps to support overall patient well-being. Finally, building #partnerships and aligning incentives with payers, community organizations, and technology vendors is essential. Collaborative efforts to align goals, share data, and explore innovative solutions lead to better patient care and organizational performance. By integrating these strategies into your healthcare business approach, you can effectively align with VBC goals and enhance #patientcare. #healthcarestrategy #resourceoptimization #performanceincentives #stafftraining #healthcareinnovation #hbr #leadership #strategy #lifelonglearner #digitaltransformation #innovations

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In case you missed it last week, we discussed "TEFCA Operations (aka TEFCA for Payers)". Key Topics Covered - Payer Use Cases: Exploration of data exchange use cases and the regulatory landscape (CMS-9115, CMS-0057, HTI-2). - TEFCA Operations Overview: How payers can access data for care coordination, HEDIS reporting, and quality measures. - Comparative Analysis: TEFCA Operations vs. alternatives like Individual Access Services (IAS) and secondary use patterns. - Data Reciprocity: The importance of avoiding asymmetric relationships in health information networks. - Regulatory Integration: Potential integration of TEFCA with CMS-0057 requirements. -Adoption Timeline: Overview of upcoming deadlines and the current state of TEFCA adoption. We had great discussion after the overview presentation, tackling: - Challenges in managing multi-line business organizations and data usage rules - The February 2026 deadline for certain healthcare operations exchange purposes - Industry participation in real-world testing initiatives (e.g., NCQA's Bulk FHIR Quality Coalition) - Integration of TEFCA and CMS-0057 requirements, particularly for provider access API and payer-to-payer API - TEFCA's potential as a foundation for payer-to-payer exchange - The significance of the 10x10 initiative in shaping healthcare interoperability - Proposal for an "11x11" initiative to include health plans working with pharmacies/pharmacists in TEFCA operations Check it out here! https://lnkd.in/gP4ys37W

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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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"We have a lot of data, but how do we make that data AI-ready?" This has been on my mind a lot lately. In healthcare, we’re swimming in data, but how do we actually prep it for AI—and, even more importantly, keep it secure? There's a lot of talk about keeping large language models localized instead of on cloud servers because of the risk of data breaches. In the US, we often sign up to share our data—whether it’s with platforms like Facebook, LinkedIn, or in systems like Epic Cosmos—but once it’s in their hands, we don’t really know what happens to it long-term. We don’t have anything like GDPR, which gives people in Europe more control over how their data is used over time. As we push forward with AI and tech in healthcare, data privacy has to stay a priority, especially when we don’t have the same comprehensive regulations in place to protect that data in the long run. #AIinHealthcare #DataPrivacy #GDPR #Informatics #AI

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I’ve been given advice that the fastest way to monetize HER Heard without charging the end user (woman) is trackers and selling data. Instead, I’d like to build something more trustworthy. I don’t want to be in a headline like this. If you are not paying, then you are the product (you/your data are being sold). There are newer ways to deindentify data or even to aggregate things women search for that can be of interest to various stakeholders. In theory that could be okay to sell, but in a post-Roe world with laws encouraging bounty hunting, I am vetting the choices ahead. I am all for moving fast, without breaking things.

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“Although significant progress has been made over the last several years to introduce more standardization and connectivity between public health and health care IT systems, more work is needed. This commentary describes the benefits and potential of robust, modern interoperability between health care and public health systems, defines key policies and technology activities that will drive toward a future state of a highly connected public health and health care data ecosystem, and summarizes potential challenges that must be overcome.”

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Eye Opening! As noted by Matthew Holt below, Doximity promotes itself as “The Professional Medical Network for Physicians” with a mission to “help clinicians be more productive so they can provide better care for their patients.” Sounds simple enough, a community built for doctors—a space where they can connect, share insights, and access tools to support their work. Their main source of revenue, subscriptions. Of course, you'd think the subscribers would be the doctors using this valuable platform and its tools, like video calls, hiring services, and various apps, platforms. But look a little deeper at their financials? Yuck. Doximity’s revenue doesn’t come from clinicians at all. The“subscriptions” (main source of revenue) are actually sold to pharmaceutical and other industry players that want access to docs and the powerful (and profitable) prescription pads they wield. These “Marketing Solutions” subscriptions allow advertisers to push tailored content directly into doctors' "news" feeds, with pricing set according to the type and number of doctors targeted. In effect, the platform sells access to doctors to those looking to drive up utilization of their products. Doximity’s real revenue engine (which is pretty amazing, see post below) lies in its advertisers. Life sciences companies and the highest bidders pay for the privilege of influencing what doctors see in their feeds—not just ads, but entire modules and news updates. What seems like a physician’s trusted source of industry news and updates is, in reality, a curated stream designed to serve business interests. This brings us to the key question: when doctors use Doximity as their “news feed” and source of the latest research, are we comfortable knowing their information stream is largely influenced by advertising dollars? When we scroll through platforms like Instagram or Facebook, we’re well aware of how advertising shapes our experience. Mention a skincare product in a text, and suddenly, your feed is filled with face cream ads. We know this, we accept it, and we view each ad with a healthy dose of skepticism. But are we okay with doctors facing the same experience? Are we comfortable with Doximity’s advertisers shaping the content doctors see, especially when they rely on this platform for up-to-date clinical research and product information? Let's hope our docs approach these tools with the same skepticism I do when I'm promised younger looking skin:). Jessica DaMassaPreston AlexanderDutch RojasPatient Rights Advocate Marilyn BartlettDave Chase, Health Rosetta-discovering archaeologistAnn LewandowskiJeffrey HoganDavid Contorno Stacey RichterLee Lewis Shawn GremmingerAndré WENCKER Renzo Luzzatti

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Navigating Real-World Evidence for Health Technology Assessment: Key Insights from Industry Experts 📊🔍 *The recent webinar featuring insights from April Betts (UCB), Stephen J. Duffield (NICE), and Rachel Cummings (Decisive Consulting) provided an in-depth look into the evolving role of real-world evidence (RWE) in health technology assessments (HTAs). Here are the key takeaways: ✔ Evolution and Importance of RWE: RWE is becoming a staple in healthcare, impacting regulatory decisions and market access. It addresses gaps inherent in randomized controlled trials (RCTs) by providing data on larger populations and real-world practices. 🌐🧬 ✔ Challenges and Opportunities: The integration of RWE faces challenges such as data quality, relevance, and regulatory acceptance. However, it presents opportunities to enhance evidence for HTAs, especially in demonstrating long-term effectiveness and safety. 🚧📈 ✔ Strategic Applications: RWE is critical in areas like cost-effectiveness analyses and can influence the decision-making processes of bodies like NICE. Effective RWE strategies involve early planning and continuous adaptation to evolving healthcare landscapes. 📝💡 ✔ Collaborative Efforts: Successful RWE utilization requires collaboration across various stakeholders, including academia, industry, and regulatory bodies. This collaboration helps ensure that RWE meets diverse regulatory requirements and adds value to HTA submissions. 🤝🌍 ✔ Future Directions: The use of RWE is expected to grow, with increasing sophistication in data analytics and broader regulatory acceptance. Stakeholders must remain agile and proactive in leveraging RWE to inform healthcare decisions and policies. 🔮📊 *These discussions highlight the critical role of RWE in shaping the future of healthcare decision-making, underscoring the need for strategic alignment and robust methodologies in its application. #HealthcareInnovation #RealWorldEvidence #HTA #Pharmaceuticals #HealthTech

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This is an interesting article because EHR companies, like Epic and Oracle's Cerner, have made siloing data a major part of their business model. Overall, I like EPIC’s ability to review records from other EPIC shops. It also has a nod to interoperability with its “Care Everywhere“ feature. However, this is often a disorganized and outdated collection of information. Using it requires a ninja level of both tech expertise and medical knowledge possessed mainly by younger physicians and chief residents. I am a fan (and advisor) of companies like Zus Health focused on user-friendly, comprehensive, and up-to-date interoperable health care data tools.

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In win for #healthinsurers and #members, CMS will recalculate 2024 Medicare Advantage star ratings. After recent wins in court, Federal judges told Medicare to recalculate star ratings for SCAN’s plans and one Elevance plan. The new CMS guidance would recalculate quality ratings industrywide, likely increasing bonus payments for many insurers. As health insurers assessed poor financial performance and lower star ratings, member benefits were in the crosshairs. While this won't save all those extra benefits members have come to enjoy, they will hopefully save some of the most critical. Want to learn more about the latest trends in #MedicareAdvantage? Forrester clients can check out our published and upcoming research, including a data deep dive on individuals aging into and enrolled in #Medicare and Medicare Advantage (link in comments). #starratings #qualityratings #CMS #healthcare #memberexperience

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Leigh McCormack shares her insights on AI model drift in this Data Nerds in the OR episode! Her perspective aligns with how we at Caresyntax focus on maintaining data integrity across the surgical journey. It’s a great reminder that AI models need constant monitoring to remain safe and effective, especially as their role expands in clinical settings.   Learn more here: https://lnkd.in/gDSKJXfk   #AIinHealthcare #DataScience #Caresyntax

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📘 Chapter Highlight: "Harnessing Data to Drive Healthcare Innovation" 🚨 Are you leveraging data effectively to drive healthcare innovation? 🤝 In Chapter 6 of "Mastering Healthcare Excellence," I share the secrets to transforming healthcare through data-driven decision-making. This chapter is a treasure trove of techniques and strategies for using data to improve patient outcomes and operational efficiency. 📖 Learn how to: • Integrate cutting-edge data analytics into your healthcare strategies. • Utilize data to predict trends and improve healthcare delivery. • Transform raw data into actionable insights that can lead to better decision-making and streamlined operations. 🎁 Don’t let your data go to waste! Pick up your copy of "Mastering Healthcare Excellence" on Amazon today and start leveraging data to its fullest potential in your healthcare organization. Transform your healthcare operations with the power of data. Your path to data-driven excellence starts here! 🌟 #HealthcareExcellence #OperationalMastery #InnovationInHealthcare #Leadership #ContinuousImprovement #HealthcareManagement

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Predictions for the Healthcare Analytics Space in 2025 Increased Integration Across Data Ecosystems As value-based care models continue to expand, seamless data integration across clinical, claims, and social determinants of health (SDOH) sources will become critical. Organizations will prioritize interoperability through networks like QHINs, Carequality, and CommonWell to create a unified patient view. Interoperability Will Become Non-Negotiable Regulatory and operational pressures will force healthcare organizations to embrace true interoperability, with frameworks like TEFCA, QHINs, and platforms like Carequality/CommonWell gaining momentum. Seamless data exchange will shift from a competitive edge to a baseline requirement. Shift from Retrospective to Predictive Analytics Organizations will move away from merely reporting past events and toward anticipating future risks, costs, and care needs. Predictive models will guide both operational efficiencies and patient care interventions. Demand for Transparent ROI Healthcare organizations will increasingly demand clear ROI from analytics investments, driven by financial pressures and accountability in value-based contracts. Solutions must demonstrate tangible outcomes like cost savings, care improvements, and enhanced risk stratification. Rise of Decentralized and Multi-Tenant Data Repositories As data ownership and governance become central, healthcare providers will adopt multi-tenant architectures to securely store and access aggregated data while maintaining control over proprietary information. AI and Machine Learning in Care Pathways(*) The use of AI to identify care gaps, optimize workflows, and automate routine tasks will grow exponentially. Providers will seek analytics solutions incorporating explainable AI to maintain trust and compliance. (*) Steep adoption curve Focus on SDOH for Equitable Healthcare Delivery Payers and providers will deepen their focus on SDOH to address health inequities. Analytics platforms will need to integrate SDOH data into actionable strategies for population health management. Emergence of Modular and Workflow-Specific Tools Comprehensive dashboards will give way to modular, workflow-specific tools that empower users to interact directly with data. These tools will emphasize usability and decision-making at the point of need. Partnerships Over Proprietary Solutions Collaboration between analytics providers and adjacent industries (e.g., tech, pharma, and public health) will drive innovation and adoption. Open ecosystems will gain traction over closed, proprietary platforms.

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🌟 Informed Decisions, Better Outcomes 🌟 In today's complex healthcare landscape, access to the correct data isn't just a nice-to-have—it's essential. Data insights can illuminate inefficiencies, drive innovation, and improve patient care and operational outcomes. At Salient Health, we're passionate about turning data into actionable intelligence. It's about more than just numbers—uncovering the stories they tell and empowering organizations to make informed, impactful decisions. From addressing price transparency to enhancing value-based care, data insights can break down barriers, foster trust, and ensure resources are aligned where they matter most: improving health outcomes. The future of healthcare lies in collaboration, clarity, and a commitment to continuous improvement. Let's build that future together. 💡 #HealthData #Innovation #ContinuousImprovement #Salient Health

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