Claire Howell

Only 39 days until the event of the year, #HDAA2024! Registration is still open. Those hoping to get rooms in our hotel blocks should act fast. This is projected to be one of the biggest, if not the biggest, HDAA conferences ever. #HealthcareAnalytics #HDAA #DataForGood #LeadingTheWay

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📢 Exciting News! 📢 The July/August 2024 issue of the North Carolina Medical Journal has just been published, and it highlights the opportunities and challenges of adapting to Artificial Intelligence in healthcare. I’m pleased to have joined my Acentra Health colleagues Melissa Leigh and Daniel Hallenbeck, along with thought leaders from across the state and nation, in contributing to this important discussion. Check out our article “Applying AI to Care Management and Claims Processing” to explore how AI is reshaping the landscape of healthcare administration. Access the full issue here: https://lnkd.in/g5A5SyB6 View our article here: https://lnkd.in/guiVsXkh #Healthcare #AI #Innovation #ArtificialIntelligence

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It’s Sinking In: It Ain’t Over I was honored to participate today in the 340B Report-sponsored discussion about the status of the program at an incredibly informative Association for Value-Based Cancer Care meeting. My biggest takeaway?: the #340B community has begun to grapple with the distinct likelihood that the fight over a rebate model didn’t end with Johnson & Johnson’s letter stating that it would, for now, “forego implementation”. It was a great panel discussion with Ted Slafsky, Barbara Straub Williams, and Jennifer Lockwood, MBA, ACHE—all incredibly knowledgeable and strong advocates for covered entities. It was interesting to look out on the sea of faces during the presentation. I thought I could see the light dawning on the audience as the panel spoke. “Oh, ok, I get it. This rebate fight isn’t over.” And if you read the PhRMA and Biotechnology Innovation Organization letters to the Health Resources and Services Administration (HRSAgov), HHS, which were reported on by 340B Report earlier today, the tone and content are, I think unmistakable. Gird yourself for battle, people. Those letters are precursors of the points both organizations will be making in their amicus briefs in the court cases to come. I got flamed for saying the JnJ letter wasn’t the end of this issue—I’m happy to bet a steak dinner that I was right. Any takers? #lifesciences #drugpricing #diversion #duplicatediscounts #protect340B #reform340B ed silverman

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If you're looking for an informative session to wrap up your week, consider registering for this Technology Community of Practice session that will talk about driving better outcomes, overcoming data obstacles, and applying trauma-informed principles to your data practices. See you there!

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#PublicHealth experts have stressed the urgency of driving awareness about the deadly impacts of rising temperatures across the globe. Proud to see how CVS Health is answering that call. 👇 In a first-of-its-kind initiative, CVS Health announced an environmental health impact program to help people most vulnerable to extreme weather events — like #HeatWaves — that can worsen existing chronic conditions. Initially available to our Aetna members with a goal to expand, this initiative will use advanced environmental data analytics and enable our care managers to contact vulnerable patients with tailored recommendations. Heat-related illnesses are preventable with outreach and intervention. Our initiative aims to provide up to a seven days' warning in advance of an extreme weather event, giving our members critical time to prepare. Read more about our initiative: https://cvs.co/3WWQFgl #TeamCVS

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The data science team here at N1 Health recently showed me some interesting results with a significant revenue impact. They were able to use AI-powered insights to target individuals with direct mailers and increase AEP Medicare enrollment rates. The small test campaign, which was conducted in a southeastern state at the end of 2023, found that personalization resulted in a 6x increase and hundreds of additional enrollees compared to the control. The incremental premium revenue is between $1-$2 million per year.   Traditionally, outreach was generic. Today, consumers expect a tailored message. A healthy 64-year-old might learn about a preventive care program, while an 85-year-old gets info on one of their specific needs. As we approach AEP this year, don't miss a chance to drive a consumer-oriented approach that will improve your enrollment rates. To learn more, send me a message to chat!

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While there's certainly unmet need in the space of long-term in-home care and the financial and other burdens to many families and Medicare beneficiaries are substantial, I have questions about Vice President Harris's proposed expansion to Medicare. These questions pertain to the costs of adding this benefit (as well as others she has suggested, including vision, hearing and dental) and the likelihood of Congressional approval. If elected president and she pursues these initiatives, she will encounter resistance from Congress (even in the unlikely event the Democrats have majorities in the House and Senate). https://lnkd.in/evQCTzAA

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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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An Outpatient Clinical Documentation Improvement (CDI) program offers substantial advantages to healthcare organizations by elevating patient care and operational efficiency. By integrating risk stratification with chronic conditions, enhancing quality measures, addressing social determinants of health, and establishing a collaborative team empowered by technology, such strategic initiatives result in improved patient outcomes and streamlined operations.

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“We envision a future where every child receives personalized, high-quality care. To make this vision a reality, we must overcome the challenges of #carecoordination,” said Dr. Amanda Furr, VP of #PopulationHealth at Pediatrics Associates Inc. “We understand the value of #dataanalytics, risk adjustment, quality gap closure and empowering #pediatric clinicians to improve outcomes. As our organization continues to grow, it’s imperative for us to scale our #PHM capabilities. The #Innovaccer platform enhances our understanding of patient populations and helps us make accurate diagnoses, establish and automate TCM protocols, and bridge care gaps. This holistic approach helps us to deliver a seamless, comprehensive #healthcare experience for our patients and families.” “We have an established relationship with the #PediatricsAssociates team, and we are excited to be working with them again as we are setting a new standard for #healthcare, where #technology and compassion converge to enrich the lives of children and their families,” said Abhinav Shashank, cofounder and CEO at Innovaccer. “Pediatric Associates has an impressive track record in managing over 1.5 million lives across Medicaid and commercial contracts. Innovaccer’s AI-powered, scalable PHM platform will help them effectively manage patient populations to meet their goal of managing over 1 million covered lives in the next two years. We look forward to supporting Pediatric Associates in its mission to launch a new era of pediatric care that is both proactive and profoundly impactful.” https://lnkd.in/gvUD-sm4

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Exciting news: IMO is now IMO Health!  The work we do is so critically focused in healthcare data. First, we let clinicians speak clinician. Now, we're helping clinicians, health centers, research centers and more find the best ways to leverage that valid, accurate, specific clinical documentation into the future. I'm thrilled to share that my employer, IMO, is evolving to IMO Health. This rebranding underscores our focus on healthcare innovation and reaffirms our commitment to simplifying and transforming clinical data wherever it’s used. New name. New logo. Same unwavering commitment to data quality in healthcare. #HealthcareInnovation #DataQuality https://bit.ly/4bZo4vq

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On the cusp of Walmart Health closing its clinics and virtual care units, CVS Health reports stocks dropping. This comes after missed revenue estimates, revising down its 2024 guidance, and now expects to raise insurance plan prices in the coming year as it adjusts for Medicare reimbursement cuts. Higher utilization of healthcare services, which means more insurance dollars spent, weighed on the company in addition to Medicare reimbursement rate cuts that will continue to pressure the company for the remainder of the year. Insurers also have been seeing medical costs spike as an increasing number of Medicare Advantage patients return to hospitals to undergo procedures they had delayed during the pandemic. CVS said it expects 2024 earnings per share and cash flow from operations to reduce, with adjusted EPS expected around $7, down from $8.30 previously, and revised cash flow of at least $10.5 billion, compared to the previous $12 billion estimate. Overall, between the Walmart or CVS stories, these are trends we see across the country and puts a spotlight on the approach of large corporations entering healthcare. - Is the investment in mission, prevention, primary care? - Is the complexity of healthcare understood to understand trends? - Are tools for primary and continuity care leveraged over acute care? - Are groups in it for the long haul? Even with new mergers in primary care there is much to be seen how implementation and incorporation will come together. #healthcare #corporateinvestment #healthisprimary

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We’re excited to see this coverage on HIMSS with Gregory LeGrow, MBA, Executive Director of Payer Product Market Strategy at athenahealth that highlights how the team of collaborators is addressing pain points for physicians and showcases how collaboration across the ecosystem (including with payers) can modernize the prior authorization process. #athenahealth #healthcareTech #HealthTech #healthcareIT

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This article discusses opportunities for data and analytics to help health systems bridge the gaps in health equity. "Advancements in research and technology have helped us better understand the underlying causes of health disparities and emphasize the necessity of health equity initiatives. Now, it’s time that we leverage technology and data to empower health systems to transform the way we practice and deliver care. Promising innovations include artificial intelligence to personalize treatment plans, blockchain to secure patient data and enhance transparency, and continued expansion of telemedicine to increase access. Artificial intelligence and data analytics are also invaluable tools for measuring the effectiveness of our programs. By evaluating health equity initiatives, we can refine and expand our efforts to ensure maximum impact." https://ow.ly/wjz550TyYko

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Yes, CVS/caremark is aiming to save the patient money. Yes, big corporate PBM is projecting an image to care about the patient. However, reimbursing pharmacies below the cost of the medication is robbing the pharmacy. If the pharmacy is unable to fill the script and the patient is forced to go elsewhere, highly likely to a place that has minimal knowledge the patient, this is not caring about the patient. This different pharmacy is highly likely a place where the patient doesn’t know the staff, and where the patient is often uncomfortable sharing important details. This is not caring about the patient. This could potentially endanger the patient. Also, and this is key, the claims data on claims subjected to programs like the Cost Saver and MedsYourWay programs, automatically re-routes the claim, often without the patient’s knowledge and/or full comprehension of what is happening behind the scenes. Then, there is the scenario where the patient no longer has reasonable access to a pharmacy because the excessive below cost reimbursements forces the pharmacy to close its doors. This is not caring about the patient.

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Are you in the #Nashville area? Join me for dinner to discuss the Future of Healthcare on May 2nd! This event is free to attend but seating is limited. We expect it to fill up quickly so don’t miss out! Register using the link below! Becoming a digital-first organization is imperative to success in the Future of Healthcare. But digital transformation is not solely about technology adoption. Learn how other healthcare organizations navigate the volatility and uncertainties of the healthcare climate while remaining adaptable, creative, and resilient. #FutureofHealthcare #DigitalTransformation #CustomerObsession #forrester #healthcare

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Wrap up National Health Center week with a replay of this webinar! Learn how Syntax partnered with Brevard Health Alliance, Inc. to win in VBC. And make sure to join next week's webinar about one of my favorite subjects in value-based care: attribution. How exactly are lives attributed to providers? And how do you people a software system flexible enough to handle various permutations of attribution? A great subject, tune in next week to learn more!

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Great article by Priti Choksey Shah on the importance of integrating Clinical Documentation Integrity (CDI) and Utilization Management (UM) in hospitals. #HealthcareInnovation #RevenueManagement #AIinHealthcare #HospitalEfficiency #CDI #UM

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