Charles DeShazer, M.D.

Most viewed in the last 7 days from JAMA Health Forum: This JAMA Forum discusses the current data collection mechanisms used for Medicare and proposes ways to improve nationwide data collection efforts for Medicaid. https://ja.ma/4dJuqzJ

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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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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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It was a pleasure to talk with Minalkumar Patel about the distinct needs of ACOs and where we see the biggest opportunities to optimize data to benefit patient health and provider success. I am delighted to share our conversation and look forward to much continued discussion on this important area of innovation for our industry. #valuebasedcare #aco #healthtech

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The healthcare landscape is undergoing a seismic shift, driven by vertical consolidation led by insurance giants. A recent perspective in the New England Journal of Medicine highlights this trend and its far-reaching implications for patients, physicians, and the entire healthcare system. Key points to consider: 🏢 Vertical Consolidation: Major insurers like UnitedHealth Group, Humana, and CVS are rapidly acquiring physician practices and care-delivery companies. This has resulted in over 50% of Medicare beneficiaries now enrolled in Medicare Advantage plans. 💰 Financial Scale: The government will pay approximately $500 billion to insurance companies in 2024 alone to administer Medicare Advantage programs. 🚑 Patient Impact: This consolidation poses significant risks to patient care. Insurers can deny coverage or discourage use of necessary services, steer patients toward their own services (potentially disrupting longstanding care relationships), and replace physicians with lower-cost clinicians. 📈 Cost Inflation: In Medicare Advantage, abuse of risk adjustment accounts for $54 billion in overspending per year compared to traditional Medicare. 👨‍⚕️ Physician Autonomy: Corporate ownership promises to unburden physicians from administrative tasks, but it may be a Faustian bargain. Insurers can dictate staffing, scheduling, and patient visit durations, potentially compromising care quality. America's complex health care system in an "object in motion" with sizeable inertia- without intervention, it will continue on its current path. The status quo has a predictable outcome: a healthcare system increasingly controlled by a handful of insurance conglomerates, potentially at the expense of patient care and physician autonomy. Changing course will require intentionality and energy. The article suggests several policy approaches: 1. 🔍 Strengthening antitrust scrutiny 2. 🚫 Limiting vertical integration of insurance companies 3. 📜 Revitalizing corporate practice of medicine laws 4. 📊 Enhancing medical loss ratio regulations and closing loopholes As healthcare professionals, policymakers, and concerned citizens, we must actively engage advocate for reform. The future of our healthcare system - and the quality of care available to patients when they need it most - depends on the actions we take today. What are your thoughts on this trend? How can we work to ensure a healthcare system that prioritizes patient care and physician autonomy over share holders? #HealthcarePolicy #MedicareAdvantage #VerticalIntegration #HealthcareReform

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The Association of Healthcare Value Analysis Professionals (AHVAP) celebrates Elizabeth Eisenberg, MSN, RN, CVAHP from Scripps Health for commitment to excellence in the specialty of healthcare value analysis! Liz has signified this commitment by signing the official Association of Healthcare Value Analysis Professionals (AHVAP) healthcare value analysis pledge. To learn more about the Association of Healthcare Value Analysis Professionals (AHVAP) Commitment pledge: https://lnkd.in/gqEWPBue. #AHVAP #valuebasedcare #excellenceincare #valueanalysis

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Access and affordability to healthcare services in the United States continues its slow and endless decline as the stresses on a broken and collapsing system become ever more evident. Wait times and PCP availability mean patients are often fully recovered or dead by the time their appointment time comes around. Meanwhile US healthcare is becoming less and less affordable - even with health insurance as more and more of the aggregate sum of individual and employer funds are sucked up in profits (across our mostly so-called not-for-profit system) or by often unjustified price inflation and medical billing that bears absolutely no relation to actual costs. Zero cost transparency means you are playing a game of monopoly with meaningless fake money and hoping not to land on a property where the rent will medically bankrupt you and your family for generations to come. And the advent of PayViders where a payer and provider are under the same roof have shown just how bad access to services can become and where Medicare Advantage customers can't even access their own money because profit and corruption allow it currently. US healthcare faces an existential crisis in more ways that one! https://lnkd.in/gUN68vib

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