Mike Angelakos, DrPH, MBA

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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Behavioral healthcare has many facets. Can your #EHR handle your complex needs? Core's recent blog post shares valid food for thought. 

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How can health systems maintain clinical, compliance and revenue integrity in their utilization review process? Join our webinar to get best practices. https://optumin.co/uqunll #Optum #Provider #UtilizationReview #URbestpractices

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⚠️ Top High-Risk Compliance Zones in Healthcare ⚠️ Do you know where your compliance risks are highest? Our comprehensive guide identifies the top high-risk zones in healthcare and provides strategies to mitigate them. 🧐 Assess your preparedness and gain actionable insights to enhance your compliance efforts. 📖 Read more: Top High-Risk Compliance Zones in Healthcare. https://lnkd.in/eRwkU3Qn

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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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