Kirby Farrell

Radiologists are achieving payments 500% above the Qualified Payment Amount (QPA) in surprise billing disputes, thanks to the No Surprises Act. This figure is staggering and highlights an important reality: many providers might not realize the tremendous potential of this opportunity. When the No Surprises Act (NSA) was enacted in 2022, the rates at which providers were reimbursed took a major hit, often cut in half. Payors exploited the QPA to justify lower payments, essentially giving themselves the green light to underpay claims. If a provider disagreed with the payment, they had to navigate the cumbersome claims process to recover what they deserved. But here’s the good news: By participating in the IDR process, radiologists are claiming up to 5 times their initial payments. This result is a powerful incentive for payers to engage in a meaningful negotiation and ensure fair compensation. Providers should leverage the NSA to their advantage - and capture every dollar they’re owed.

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Epic Systems’ recent move to back the TEFCA medical records exchange is interesting. On the surface, it’s all about creating a seamless flow of patient data across hospitals, QHINs, and all relevant stakeholders. But let’s be real—data is the oil of the new economy, and interoperability is the pipeline that delivers this precious resource to all the right stakeholders. By aligning with TEFCA, Epic might just be positioning itself as the refinery. All in all, this is a welcoming move by Epic Systems—especially if it really is as straightforward as they make it sound. But given the lack of details, one has to wonder if there are any hidden catches. After all, when it comes to something as valuable as healthcare data, it’s wise to look out for the fine print. Let’s hope this is genuinely about improving patient care. https://lnkd.in/gDdDCcmj

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What Could the Election Mean for Data Interoperability? – MedCity News - MedCity News As the election approaches, the implications for healthcare data interoperability are profound yet often overlooked. Arcadia CEO Michael Meucci emphasizes that the administration's stance on data sharing can significantly influence care continuity, outcomes, and costs. While both presidential candidates agree on the need to combat data blocking, their approaches differ. Meucci warns that rolling back recent data sharing regulations could hinder progress and innovation. Regardless of the outcome, he remains optimistic about continued advancements in healthcare technology. Understanding these dynamics is crucial for healthcare IT professionals. #HealthcareIT #DataInteroperability #HealthTech #Innovation #Elections2024 #DataSharing #PatientCare ai.mediformatica.com #data #healthcare #datasharing #administration #this #interoperability #better #datainteroperability #election #healthcaredata #abortion #arcadia #digitalhealth #healthit #healthtech #healthcaretechnology @MediFormatica (https://buff.ly/48r7zHK)

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I get Dr. Yang's concern about large, wealthier health systems adopting AI sooner than smaller, poorer organizations, but this is actually a good thing...unless your time horizon is myopically short. Big organizations, with much larger budgets and sophisticated IT teams, can afford to take risks, make mistakes, and test out exciting (but still unproven) emerging tech while smaller organizations certainly can't (for the most part). So let the behemoths take all the risk, do the heavy lifting first, and then smaller organizations get to adopt truly proven solutions at lower risks/prices...once these have run the Kaiser, Mayo, Intermountain, etc., gauntlet. It's all part of the plan... #healthcare #startups #startup #ai #generativeai #digitalhealth #emergingtech Kaiser Permanente Cleveland Clinic Mayo Clinic Risant Health Intermountain Health https://lnkd.in/gckgQB_q

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As we settle into our regular fall routines, I’ve been thinking a lot about the state of healthcare so far this year and what I hope we can continue working towards as an industry in the final months of 2024. First, Surescripts latest data report backs-up the anecdotes we’ve all heard about how healthcare is hurting. But it also highlights how the industry can collaborate to eliminate barriers and enable meaningful health intelligence sharing between clinicians. The result? More accessible care for patients in communities across the country. Check out all of the insights we’ve gathered from our annual clinician survey and more trends in our full report -- link in the comments.   Next, healthcare technology innovation and interoperability: this is a big one. Last year, Surescripts supported 24 billion exchanges of patient clinical and benefit information, connected 2.14 million care providers and organizations that reached more than 99% of the U.S. population. This means clinicians spent less time searching for patient information – sending faxes or making phone calls to get what they need to make safe, quality and less costly care decisions with their patients. But we have so much more to do: pharmacists and other clinicians still say it is somewhat or very difficult to share patient information securely and confidently with other care providers (46% of pharmacists and 31% of other clinicians). And clinicians hope to see better access to clinical information: 85% of pharmacists and 57% of other clinicians said that they would place a high priority on connecting both pharmacists and prescribers with centralized information about their patients. We know that secure health intelligence sharing is essential for true care collaboration that improves patient care. We will be working alongside the The Sequoia Project's new Pharmacy Workgroup under the Interoperability Matters program. The goal is to advance interoperability and allow clinicians, including pharmacists, to have access to key clinical insights that help them provide care for their patients. Check it out at the link below. Lastly, I’m reassured and hopeful. Despite the differences in the services they provide, the clinicians, health plans and advocacy organizations who came together for the Evolving Care Team Summit in D.C. earlier this summer proved that, not only can we have meaningful conversations about ways to work better together, but we really do share the same goal of improving patient care. I hope this meeting will continue to inspire us to find ways to collaborate across the industry on issues like reimbursement and access to needed health intelligence for clinicians working as a team. It's this kind of collaboration that can help patients get the care they need and deserve and ultimately, it’s also how we can help healthcare heal itself.

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It's wild to think in 2024 we're FIRST seeing the DOJ accuse telemedicine conglomerates of criminal drug distribution. How long have we known about these practices in brick and mortar care...? Answer: decades! Take it from someone who prescribed stimulants and other psychotropics to kids over the years - painstakingly measuring and documenting the need and impact - these appalling abuses by Done and Cerebral mean we need more calls for thoughtful pause when it comes to working with startups. Particularly about funding's role - my favorite topic! 🤑 How did we end up with venture capital and PE financing in healthcare that risk the safety of kids in the name of exorbitant returns? Not that all VC or PE dollars are bad, of course, but they're certainly key drivers who shouldn't be in that seat. Did we underestimate these funders as 'barbarians at the gate', much like the pharma reps of the 90's and early 2000's heyday? Have we not learned from Purdue Pharma's aggressive and deadly Oxoycontin marketing? Purdue pleaded guilty to criminal charges and paid $600 million in fines in 2007. Or TAP Pharmaceutical Products's Lupron kickback scheme for the prostate cancer drug? TAP also pleaded guilty to criminal charges and paid $875 million in fines in 2001. Or Pfizer marketing Neurontin, an anti-seizure drug, for off-label uses, such as treating pain and bipolar disorder, even though the drug was not approved for these purposes, and paying physicians kickbacks. In 2004, Pfizer pleaded guilty to criminal charges and paid $430 million in fines. Cerebral and Done's playbooks were practically the same thing, just with a modern mid-pandemic, low-regulatory scrutiny, digital-platform twist. Will appropriate regulation ever outpace American venture greed? Is it even possible to ensure patient safety AHEAD of tragedies driven by the intersection of innovation and venture funding? If you're keeping score, healthcare regulatory reactivity: 1 million. Healthcare ounces of smartly preventive policy: 3. Blech. 😖 When will we finally own that prevention in-house? #healthcare #overdoseprevention #suicideprevention

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#ICYMI Don Woodlock, Head of Global Healthcare Solutions at InterSystems, joins eHealth Exchange President Jay Nakashima for a HIMSS Media podcast to discuss advancing FHIR exchange in healthcare. 📻 Tune in to hear how it's being used for Public Health and Provider-Payer exchange: https://buff.ly/3Rh467o Talking points: - Providers are apprehensive about FHIR exchange. - Healthcare is sitting on a "gold mine" of data and needs to grow provider exchange with payers, public health agencies and others. - Government agencies are getting real-time drug experience data using the model. - What the FHIR standard still needs to deploy at scale. - TEFCA helps to facilitate national FHIR use cases. - Regulatory specificity and funding are needed to facilitate greater FHIR exchange. #PublicHealth #Interoperability #HIMSScast #FHIR

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A new survey from Black Book Research highlights multiple healthcare IT implementations that have failed to meet expectations, with industry technology professionals pointing to issues like poor user experience, lack of interoperability, and high costs.https://https://lnkd.in/e2h3fqyt #healthcareIT #artificialintelligence #machinelearning #healthcareAI #AI #healthIT #BlackBookResearch

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Let's keep hospice focused first and foremost on the PATIENT. After all, we only get one chance to do it right... "There are six primary trends that are influencing consolidation and professional practices: regulatory complexity. technology and integration, private equity ownership. demographics, economies of scale and consumer expectations,” Henderson said. “So many of these things that we see that are influencing health care consolidation need to be pointing toward the patient." #patientsfirst #hospicecare #youonlygetoneshot https://lnkd.in/gbbgV-YF

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If you're worried about building trust in AI maybe quit (obsessively) talking about it so much in your marketing/messaging/positioning. Seriously, the only people who truly care about your tech stack are VCs....customers/users sure don't. Tell me how your solution helps me and quit wasting my time telling me how you built it and what's under the hood. #ai #generativeai #healthcareai #medicalai #software #applications #saas #cloud #marketing #messaging #positioning #strategy #gotomarket https://lnkd.in/gWuf8Yc9

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The 'payvider' becoming a healthcare delivery niche player. It appears all outpatient...infusion, pharma, home health, urgent care, etc. Seeing more signs of consumers being directed by payers. No real, big box hospital purchases. Are beds being isolated and commoditized? #hospitals #healthcare #business #payers

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Exciting times at 4C Digital Health! Wilmington, Delaware - 4C Digital Health (4C), the preeminent organization delivering independent financial oversight and control solutions for self-funded employee health plans, recently announced the strategic expansion of its services into the Commonwealth of Kentucky. In late 2023, 4C successfully competed for an initial award issued by Kentucky’s Department of Employee Insurance, and Kentucky has since extended the initial contract to allow 4C to continue its important work on behalf of the Commonwealth, its employees, and its taxpayers. The Kentucky Employee Health Plan (KEHP) serves more than 288,000 members, which amounts to 1 in 16 Kentuckians. In addition, KEHP spends over $1.8 billion dollars in total healthcare benefits on behalf of its members per year and covers over 8.2 million claims per year. KEHP objectives include “improving employee health and well-being” and “providing state-of-the-art benefits while maintaining reasonable premiums.” Recognizing its important fiduciary responsibilities to its employees and its state health plan, the Commonwealth of Kentucky enacted Senate Bill 42 (2023) introduced by Senator Stephen Meredith for the purpose of ensuring that critical health plan dollars are being spent properly on behalf of state employees. The legislation requires that 4C analyze 100% of medical claims submitted for payment to KEHP; identify erroneous overpayments; and identify inappropriate or erroneous fees imposed by KEHP’s third-party administrator. Ron Templeton CEO of 4C Digital Health stated: “4C Digital Health is grateful to the Commonwealth of Kentucky for recognizing the fiduciary responsibility that state and local governments have to their employee health plans and for the opportunity to provide our services in support of this mission. We appreciate Kentucky’s goal of using 4C’s expertise and innovative solutions to improve healthcare outcomes and reduce healthcare costs for the Commonwealth, its employees, and its taxpayers.” About 4C Digital Health: 4C Digital Health (https://lnkd.in/eB-fJg4X) is a healthcare data analytics company that was founded for the purpose of developing a disruptive technology targeted at bringing transparency and honesty to the healthcare marketplace.

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The Centers for Medicare & Medicaid Services recently announced the first states to participate in their new #PopulationHealth-focused payment model. The States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model is a voluntary, state total cost of care (TCOC) model designed to address population health in specific regions, reduce health disparities and lower #healthcare costs. States participating in this model will be responsible for the quality, coordination and cost of healthcare while receiving funding and additional tools to address current payment and equity challenges in their state. 💡 My thoughts: It's exciting to see how we continue evolving our thinking around value and innovation, looking across payers, states and state agencies to push some of these practices forward. Not only that, but the timeline of these models has also been extended from 3 years to 10 years – allowing us a longer period to gather more comprehensive learnings and understand if these interventions are having a true impact. Efforts like these help us more accurately assess if the current work we’re doing is making a difference. I look forward to following the development of this model and seeing how it plays out with the first cohort (Maryland and Vermont) in 2026! 

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Tornado chart.. Tornado chart.. Tornado chart.. Check out this dynamic, interactive dashboard that enables healthcare providers to analyze patient`s costs from provider perspective. Utilizing the add-in featured tornado chart, we can effortlessly compare incurred costs Vs charges. The tornado chart allows for real time parallel comparison between costs and charges among different patient age groups or different diseases. Applying business intelligence in healthcare.. #healthcare #healthcaredata #datanalytics

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Traditional EHR systems often fall short in supporting the essential functions of Enhanced Care Management (ECM) under #CalAIM. ECM requires seamless coordination across physical, behavioral, and social determinants of health, proactive member engagement, and real-time data exchange—capabilities that extend beyond the scope of many EHRs. Our Incedo #CareManagement platform is fully aligned with ECM and fills the gap of traditional EHR systems. Incedo offers an integrated whole-person approach to care management and facilitates collaboration across providers and managed care plans to improve outcomes for California’s most vulnerable populations. If you’re looking for a complete #ECM solution, let’s talk about how Incedo can help. https://hubs.ly/Q02RnVwW0 #HealthcareInnovation

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Elevance Health’s Carelon plans to acquire CareBridge, a Nashville-based provider of value-based home and community care for patients with chronic needs. This acquisition aims to enhance Carelon’s capabilities in managing healthcare spending, as noted by Elevance’s CEO during an investor call on October 17. CareBridge serves over 115,000 patients across 17 states and Washington, D.C., employing more than 500 staff. Elevance recently reported a third-quarter net income of $1 billion, while Carelon’s operating revenue increased 15% year-over-year to $13.8 billion, with a 5.8% operating margin. https://lnkd.in/erCDYsTT

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Great Post Bob ... I have said a few times... "The role of Supply Chain in healthcare is evolving significantly, shifting from a transactional role to a strategic function with a direct impact on financial performance. Supply Chain now has a presence at the C-level, underscoring its importance in driving margins and supporting sustainable financial models. By adopting a holistic approach to expense management and overseeing all non-labor spending, Supply Chain leaders can create substantial value.And its not all created equal. Exmaple: reducing costs by just 5% can yield the same profit impact as increasing revenue by 100%, highlighting the efficiency of cost management over revenue initiatives in improving profitability. This transformation aligns closely with strategic imperatives around delivering higher value with fewer resources, supporting revenue generation, and enhancing competitive advantage. Moving towards clinically integrated, population health-focused, and value-based contracting models is critical for the future."

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I was excited to see Jason Barry’s recent coverage in Digital Health Wire about new research published in JAMA Network Open that shows increased telehealth usage in primary care can be associated with reductions in certain types of low-value services. This aligns with Ovatient’s belief that virtual-first care isn't just about convenience; it's about delivering targeted, patient-centered care without the burden of unnecessary interventions or increasing costs to patients or the healthcare system. Virtual-first care represents a fundamental shift in how healthcare is delivered - one that emphasizes accessibility, efficiency, and a deeper focus on appropriate care. However, it's essential to recognize that the relationship between telehealth and low-value care isn't straightforward. Not all low-value services are inherently more likely to be ordered when performed in-person or, for that matter, when delivered virtually. For example, imaging for conditions like uncomplicated back pain or headaches did not significantly change with telehealth usage. This is encouraging for those who perhaps had posited that telehealth would drive such use of imaging higher. I would also caution that not all healthcare organizations - especially in the digital health and virtual care space - approach clinical decision making in the same way. For virtual-first organizations like ours, we are excited to further demonstrate and explore how telehealth influences clinical decision-making and patient outcomes for good. At Ovatient, we commit to doing our part to help push this important work forward. https://lnkd.in/gbBnvdTw #VirtualFirst

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Mandatory bundles in surgery are a bi-partisan objective, and (in)ability to optimize cost/quality will dramatically impact hospital P&L. Regular insights from granular data , and AI-based decision support are the only way to systemically reduce unwanted variability and be both profitable and high quality.

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