Judy Jiao

HHS has released its final rule on disincentives for information blocking. This includes considerations for each of hospital/CAH providers under the Promoting Interoperability Program, individual providers through MIPS, and for ACOs under the Medicare Shared Savings program. From the following press release, “This final rule is designed to ensure we always have access to our own health information and that our care teams have the benefit of this information to guide their decisions." #hhs #interoperability #informationblocking #ONC https://lnkd.in/gNQm69CC

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This Reuters article highlights a lawsuit against UHG using #AI to deny extended care to an elderly patient. This solicits for companies to establish robust #aigovernance and #datagovernance frameworks and guidelines to prevent such fallacies. #data #dataanalytics #healthcare #ai #datamanagement #ml #artificialintelligence

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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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More from IQVIA's report on the Use of Medicines in the US for 2024. Let's break down diabetes therapies! What went down 📉 💊 Share of traditional therapies decreased from 58% to 50% 💉 Share of insulin therapies decreased from 20% to 15% I think we all know what went up 📈 💊Share of SGLT2 therapies increased from 5% to 12% 💉 Share of GLP-1 therapies increased from 5% to 16% Overall, 435 million prescriptions for diabetes were dispensed in 2023 growing on average 6% annually over the last 5 years #Pharmacists #Pharmacybenefits #PBM #diabetes #GLP1 #SGLT2

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💡 In Onpoint’s new issue brief, our Director of Data Analytics Jesse Drummond, PhD, and Director of Health Analytics Amy Kinner, MS, discuss a new method for addressing the challenge of attributing #healthcare providers to practices using claims data from all-payer claims databases (APCDs). Many #APCDs are working hard to report on performance at the practice level – rather than at the provider level – and creating practice rosters is a crucial step in this process. While Onpoint has been attributing patients to their primary care providers using claims data for many years, accurately attributing providers to practices requires both experience and #innovation. Want to learn about our team’s new method for overcoming these challenges? Follow the link below! 👇 https://lnkd.in/eZajB32W

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HTI-2 is here. Laboratories will want to take note as there are requirements for use of Laboratory Orders Interfacing (HL7 version 2.5.1) and Laboratory Results Interfacing (HL7 version 2.5.1) for public health reportables (ELR). If you don't yet have HL7 2.5.1 interfaces with trading partners (paper, fax, HL7 version 2.3.1, etc) you should make plans to update interfaces soon. This impacts both senders and receivers of laboratory data. If you are a pathology laboratory, this may impact you if you perform any public health reportables like Creutzfeldt-Jakob Disease(CJD) as it is reportable in many jurisdictions. ONC has webinars. EHR vendors, providers, and those performing specimen collections will want to ensure they send complete information such as Specimen Type, Specimen collection procedures, Specimen Source site and other Ask at Order Entry (AOE) details required by the performing laboratory and/or public health for reportables.

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This is fascinating. Clearly clinicians won’t be able to review the tsunami of data that could flow in. This is why nurses and doctors must have AI and data analytics literacy as new clinical decision support tools are developed to analyze this data.

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𝐓𝐡𝐢𝐬 𝐢𝐬 𝐬𝐨 𝐢𝐦𝐩𝐨𝐫𝐭𝐚𝐧𝐭 𝐭𝐨 𝐭𝐡𝐞 𝐋𝐓𝐏𝐀𝐂 𝐜𝐨𝐦𝐦𝐮𝐧𝐢𝐭𝐲. But the ruling could also have broader implications for data privacy and particularly around the use case of analytics companies having broad access to patient health information. I can imagine that this might also have implications for LLM training data, as AI continues to march throughout the healthcare ecosystem. Real Time Medical Systems alleges that PointClickCare (PCC) is blocking its access to EHR data by using security ciphers. Real Time claims this is an anti-competitive move following PCC's expansion into post-acute analytics. A judge appears likely to block PCC's actions, emphasizing the need for data access to improve patient care as mandated by the 21st Century Cures Act. This may enhance interoperability, but there is a lot to consider. Thank you Brendan Keeler for bringing this important topic to light.

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🚨New #JAMA Viewpoint 🚨 “Misaligned Pharmacy Incentives in Value-Based Care” The authors discuss how rising #prescription drug spending has been particularly challenging in the context of value-based contracts between payers and providers. This is partly due to confidential #rebates, which create misaligned incentives between payers/PBMs and hospital administrators. Read more below: 🔗 https://lnkd.in/dwzBT4WD #marketaccess #pbm #access #pricing #payer #valuebased #valuebasedcare #patientjourney #patientaccess #pharmacy #managedcare #pharma

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If you missed this webinar discussing our most recent research with Harvard Medical School on the impact of Medicare Advantage plan design on health outcomes among various types of Medicare enrollees I am sure you will find it informative. Better still it is moderated by Susan Denzer, President of Americas Physician Groups and if you know Susan you know she always brings keen insights, perspective, and questions. Please reach out if you want to learn more about our work exploring differences between traditional Medicare and Medicare Advantage. #Medicare #MA #FFS #benefitdesign #outcomes #quality #inovalon

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70% of hospitals participate in healthcare interoperability. Healthcare #interoperability is growing across hospitals, but gaps remain, especially in data exchange with long-term care and behavioral health providers. CapMinds offered health information exchange(#hie) and health interoperability (#fhir, #hl7, #mirthconnect) to its various clients across the specilaity including #behavioralhealth #mentalhealth

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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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Anil Bhatt, global CIO of US health insurance provider Elevance Health, began his career navigating early challenges and skepticism, which included convincing the security near the Prime Minister's residence in Delhi about his work installing a pioneering point-of-sale system. From these beginnings, he is now leading technological advancements at Elevance Health, such as leveraging AI for operational efficiency and improving customer healthcare access. Bhatt emphasises the importance of data-driven decision-making, customer-focused technology solutions and fostering a culture of inclusivity and questioning within the workplace. Read the article by Vinita Bhatia to know how Bhatt is driving digital transformation in healthcare. https://lnkd.in/gU5eGq_s #healthcare #digitalisation #AI #inclusivity #technology

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Basic “explainer” on Risk Adjustment and a RAF conundrum. This article from The Commonwealth Fund does a good job of providing the basics of risk adjustment. It also calls out one of the major contributors to patient outcomes that isn’t captured in traditional risk models, the Social Determinants of Health (SDoH). They do a great job on this, so I won’t summarize it here. However, I think there is another factor that isn’t captured that I wanted to discuss and would appreciate some different perspectives. I’d love to get some thoughts on the following. Maybe I am simply being pedantic. The issue not mentioned in the article that I think current methodologies of risk adjustment miss is duration and management of disease. A patient with a new diagnosis of diabetes, for example, now has an elevated risk of numerous complications over their lifetime. However, that risk in year 1 after the initial diagnosis is much lower than the risk at year 10. Current risk models don’t take that escalating risk into consideration, keeping the risk adjustment fixed regardless of duration of underlying diagnosis. In addition, there are few scenarios that will impact me differently as the provider: 1) Management of this patient’s diabetes has been poor for the prior 9 years and now my group “inherits” this patient at year 10. 2) My team has helped this patient manage their diabetes very well for the past 9 years. 3) For the past 9 years, this patient’s prior group had managed their diabetes well but they have now switched into my group. As noted above, in scenario 1, that “new” diagnosis of diabetes severely underestimates this patient’s risk of needing expensive resources this upcoming year. I will be adversely impacted from something that is clinically obvious (duration of a disease increases risks) but which is not captured in the current data. To go one step farther, in frameworks 2 and 3, there is a gap between what the patient’s risk would have been without 9 years of great care and what it likely is now. However, there is no recognition of this work. That is to say, if the patient switched to a group that did a terrible job of managing diabetes, they’d receive the same risk adjustment in year 10 as my group would receive after all of our time, effort and resources had been dedicated to keeping this patient healthy. If the patient’s healthcare needs in year 10 are low because of our efforts, shouldn’t we receive more credit than a group that simply gets attribution? And, what about the prior group? How are (were?) their efforts recognized? Please share your thoughts in the comments.

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There is continued fallout from the SCAN Health Plan lawsuit against CMS, in which they argued that CMS did not accurately calculate their quality scores. This led to CMS revising their 2024 Medicare Advantage Star ratings, which reportedly increased scores for over 40 insurers across 60 Medicare Advantage plans. For plans that passed the 4 star threshold due to the recalculation, this means they are now eligible for maximum bonus payments in 2025. How do you believe this will impact the MA landscape over the next 12 months? Will health plans leverage the additional reimbursement to strengthen their bids for future years? Will more payers throw their hat into the ring for MA plans? Are additional lawsuits to come? #A&MHealthcare #MedicareAdvantage #CMS #Stars https://lnkd.in/esYJE3JF

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I will be very interested to see where this goes. Changing human behavior around health is difficult, particularly with the senior population. Additionally, affordability of healthcare is becoming more challenging. Healthcare organizations might follow this model after seeing the results. #ai #artificialintelligence #machinelearning #gpt4 https://lnkd.in/gyw8p-QD

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Reboot Communications Ltd. 90% of data breaches are human error. Time to invest in training programs for health professionals involved in digital transformation. Time to hold senior executives in healthcare responsible for not protecting our personal health information. Time to invest in cyber security and privacy for our public sector healthcare systems. Witty said that UnitedHealth chose to pay a $22 million Bitcoin ransom because Change Healthcare's compromised outdated systems had crippled operations – for itself and so many of its customers. #securityindustry #canada #privacy #privacylaw #cdnpoli #dataprivacy #dataprivacylaw #law #canadianlaw #cybersecurity #cybersecurityleaders #NATO #security #securityindustry #canada #privacy #privacylaw #cdnpoli #dataprivacy #dataprivacylaw #law #canadianlaw #cybersecurity #cybersecurityleaders #airesearch #ai #vipss #isaca #futureproof #lifelonglearning #educationalleadership #collaboration #communication #digitallitera#securitycy #skillsdevelopment #digitalinnovation #commonground #sensemaking #vancouverbc #bcgov #municipalities #academia #incidentresponse #cyberforensics #bugbounty#vipss 

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