Jim St. Clair

Will Optum / United Health Group materially benefit from the Change Healthcare Cyberattack? ... And should regulators get involved? ... So, as I mentioned in a post sometime last week, the Change Healthcare cyberattack and disruption will lead to private healthcare provider organizations going out of business... The fact is that many private healthcare practice simply don't have the cash on hand to float operations through the cash flow disruption caused by their clearing house going offline for long periods of time... So, when Change Healthcare shut down, there was some concern about what would happen to these cash-strapped provider organizations when the money got turned off... Sure, Optum Pay extended funding relief offerings for providers who were affected by the outage... But these were loans, not advances on remittances...which means, they have to be paid back. Even if there are no fees or interest on the advances, it will still impact provider cash flow going forward, as I'm sure the recovered funds will come in as a trickle rather than a windfall... So, why do I say that United Health Group will benefit from this situation? Because they've already sought emergency approval to purchase one distressed clinical practice in Oregon back in mid-March 2024... Because it was an emergency acquisition, this request bypassed the State's review of the sale... I would assume that we are likely to see more of these types of acquisitions, as many provider organizations experienced significant financial impact as a result of the disruption... So Change Healthcare (owned by UHG) goes down, causing a cashflow disruptions to provider organizations, and UHG then goes in and buys those distressed organizations, and will most likely profit from their operations in the coming years... And these acquisitions would arguably not have been on table if it weren't for the Change Healthcare disruption... My question is: what is the right course of action here? Sure, you can say that regulators shouldn't allow UHG to "profit" from a situation for which one of its subsidiaries are at fault... But then what do you do about the distressed provider organizations? Let them fail? It's a complicated issue, for sure...and it will be interesting to see how this all transpires in the coming months as regulators, providers, and payers grapple with the issue as it continues to unfold... #healthcare #healthcareconsolidation #mergers #healthcareacquisitions #cyberattack

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Did you know the Defense Health Agency Military Health System (MHS) Data Repository (MDR) utilizes SAS to manage, analyze, and report on the vast amounts of health data collected from military personnel? Here are some key ways in which SAS is used within the MHS MDR: 1. Data Integration and Management: - SAS is employed to integrate data from various sources within the military health system, including electronic health records, medical claims, and other health-related databases. This ensures that the data is consolidated and standardized for comprehensive analysis. 2. Statistical Analysis: - SAS provides powerful statistical tools to analyze health data. This includes descriptive statistics, regression analysis, survival analysis, and more. These analyses help identify trends, patterns, and associations in the health data of military personnel. 3. Predictive Modeling: - SAS is used to develop predictive models that can forecast health outcomes, resource utilization, and other important metrics. This helps in proactive healthcare management and planning. 4. Data Visualization: - SAS offers advanced data visualization capabilities, allowing the creation of detailed and interactive charts, graphs, and dashboards. These visualizations help in better understanding the data and communicating insights to stakeholders. 5. Reporting: - The system generates comprehensive reports using SAS, which are used for decision-making by military health administrators and policymakers. These reports can include everything from individual health metrics to aggregate data trends. 6. Quality Control and Validation: - SAS is used to ensure the accuracy and reliability of the data. This includes data cleaning, validation, and quality control processes to identify and correct errors or inconsistencies in the data. 7. Health Surveillance: - SAS supports health surveillance activities by monitoring and analyzing data related to disease outbreaks, health incidents, and other critical health events within the military population. This enables timely intervention and response. By leveraging the robust capabilities of SAS the MHS MDR can efficiently manage and analyze complex health data, leading to improved health outcomes and operational efficiency within the military health system. #SAS #MilitaryHealth #Analytics

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The recent FedRAMP guidance is a powerful step forward in modernizing federal cloud adoption, particularly in areas like veteran care where secure, seamless processes are critical. Integrating AI and other emerging technologies into these cloud services can transform how agencies implement and manage their business processes. For instance, AI can automate security compliance, streamline the authorization process, and ensure real-time threat detection, allowing agencies like the Department of Veterans Affairs to focus on delivering uninterrupted care. By leveraging AI (or equally applicable and right sized technologies), agencies can optimize their workflows, enhance data management, and improve collaboration, ultimately delivering better outcomes for veterans and the public. This is more than just tech adoption; it's about driving stronger, more efficient business processes across government operations. #AI #FedRAMP #BusinessProcess #DigitalTransformation #VeteranCare #EmergingTech

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Rethinking interoperability for better outcomes. When we consider end-user experience in the context of a business workflow, interoperability becomes more than an IEEE definition ("the ability of two or more systems or components to exchange information and to use the information that has been exchanged"). To improve outcomes and address the end-user experience, a broader definition is needed that includes business, data and system elements in the context of a business workflow. For tools to help you optimize your business outcomes check out VA's interoperability principles: https://lnkd.in/ey3qX5Hk and the interoperability survey to check your interoperability maturity: https://lnkd.in/eKhmEY85

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Government Contracting #govcon seems to be a labyrinth 😕to many outsiders and newer folks coming into the space. I once created an Access database🧮 at a previous employer many years ago to highlight the importance of good data management and common unique identifiers... As the company tended to have some byzantine processes and nomenclature that I was trying to flesh out and focus 🔍on measuring the things that matter. So I've seen quite a bit of diverse contracts from over $100M 💰annual jobs to ones under $100K. I believe the process is essentially the same to ensure a smooth transition from pre-award to 🥇post-award. It starts with being able to accurately code 🔣your contract into your system of record. Do your #proposal 📚and #pricing 💵documents match the contract award 📝documents? Check that before you 🖋sign! Had an experience recently where there was some ambiguity 😵with a contract modification document in what it was doing as it relates to the changes we proposed. Some contracts get complex when you get to a dozen mods or so with many CLINs, SLINs, and 🗜ARCNs... IYKYK We both had differing interpretations🗣 as we worked through the document. There was a 💪🏼challenge with all the moving parts and new CLINs added and old ones removed and it turns out that we both had the same initial confusion that it wasn't done correctly... However, when we dug ⛏deeper into the changes in Section B (contract values) and Section G (funding values) we determined that this customer was doing It's important to have a uniform 🥋methodology on how you read and review your contract documents before you sign it and book the funding and contract values in your accounting system. Set your books up right the first time, or you'll pay💸 for it over-and-over again each month. And get the right people 🤼 and departments involved! Make it a great week 👊🏼

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Automation is transforming government agencies by streamlining processes, reducing manual workloads, and enhancing efficiency. For federal agencies, like the U.S. Department of Veterans Affairs, automation has significantly boosted efficiency, enabling the approval of over 1 million PACT ACT claims. This progress serves as a remarkable illustration of how automation aids in streamlining operations to enhance service delivery for their beneficiaries. Read the full article on Nextgov/FCW.

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