Edward Marx

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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Thank you to our wonderful participants this afternoon in the HCT Consulting Group Healthcare Transformation Executive Roundtable. Brian D. Washburn, DHA, MHA, FACHE, FACMPE, CHFP, PMP Chris Saxman Elizabeth Crawford Restat Elya Prystowsky, MS, PhD Mark Korth. I was encouraged by several insights from this amazing group: 👉 #Transformation - we know it when we see it! 👉 #Valuebasedcare - we know it when we don't! 👉 #Valuebasedcare means different things to #patients and #providers but we should not lose sight that like or not, we have to play by the language and definitions being proposed by the Centers for Medicare & Medicaid Services 👉 #Transformation towards #VBC should be keeping healthcare simple, local and well-coordinated - what 99% of people are trying to do today. Organizing to stop the despicable 1% is adding 30% of costs to everyone - especially #ruralhealth 👉 #EMR Transformation has put some hospitals out of business and in some communities, when the hospital closes, the whole community shuts down 👉 #Transformation this group sees on the horizon includes demand for change only intensifying, doing more with fewer providers, addressing #documentation challenges, #AI should focus on removing the hassle of the little things 👉 MAJOR RISK AHEAD - Will #transformation defined by CMS + #BigTech lead to a loss of simplifying the provider-patient experience? Will documentation to meet #VBC demands only escalate due to the 'potential' of what technology offers? And therefore, will health disparities only expand due to the inability of #ruralhealth to keep up? Ultimately - will we eventually have to unwind many of the current technology investments to one day return to a simpler provider-to-patient connection? Thanks again to our amazing participants. DM me if you'd like to be on our roster to participate in the next one!

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Interesting perspective on #TechnologicalDebt in health care by Dave Lamar focused on the provider market, but we seem the same issues within state depts and payers. While good data governance practices are key, there must be a better way to solve this common - if not universal - challenge in health care, if only by offloading some of the administrative responsibilities that require the individual management and administration of no-value-add administrative functions. #healthdata

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As 2024 concludes, healthcare leaders have gained critical insights amidst rapid advancements and challenges. Here's a glimpse of the year's key lessons: 🔍 Data as a Strategic Ally: Harnessing real-time analytics transforms operations and patient care. 💻 Telehealth’s New Era: Virtual care isn't just an option—it's expected. 🩺 Workforce Resilience: Supporting staff well-being is pivotal for quality care. 💡 Personalized Patient-Centered Care: Building trust through tailored approaches ensures loyalty and satisfaction. 📜 Adapting to Regulations: Proactive compliance safeguards growth and quality. 🚀 Tech Integration: Innovations like AI show promise but demand careful execution. 💰 Value-Based Care's Rise: Aligning rewards with patient outcomes reshapes operations. As we step into 2025, the focus remains on resilience, innovation, and care. These takeaways set the stage for a robust and adaptable future. What 2024 lessons resonate most with your healthcare journey? Let’s connect and discuss! #HealthcareLeadership #InnovationInCare #2024Lessons #FutureOfHealthcare

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The Association of Healthcare Value Analysis Professionals (AHVAP) celebrates Elizabeth Eisenberg, MSN, RN, CVAHP from Scripps Health for commitment to excellence in the specialty of healthcare value analysis! Liz has signified this commitment by signing the official Association of Healthcare Value Analysis Professionals (AHVAP) healthcare value analysis pledge. To learn more about the Association of Healthcare Value Analysis Professionals (AHVAP) Commitment pledge: https://lnkd.in/gqEWPBue. #AHVAP #valuebasedcare #excellenceincare #valueanalysis

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Health literacy is vital for advancing Medicaid equity. Center for Health Care Strategies latest resource equips healthcare professionals with practical strategies to improve how they communicate with Medicaid members, ensuring patients understand and access the care they deserve. Strengthening these communication efforts helps break down barriers, fosters trust, and leads to more equitable health outcomes. Explore these insights to enhance patient engagement and drive better results in your community.

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Centers for Medicare & Medicaid Services 2023 ACO REACH Model results highlight substantial progress in improving healthcare access, quality, and equity for underserved populations. By fostering collaboration and reducing costs, the model delivers positive outcomes for Medicare beneficiaries. However, challenges remain, such as care coordination complexities and the financial burden on smaller providers. Discover how Ensure Data Solutions can support your ACO REACH initiatives with our powerful tools—ENSUREQUAL©, ENSUREXCHANGE©, and ENSURECM©—designed to streamline operations, optimize care, and improve financial and clinical performance. Learn more today! ⤵️

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On October 8th, U.S. News & World Report released its annual rankings of Children's Hospitals, called "Best Children's Hospitals". It is a 174-page report describing the methodology and data tables which I scanned through. Appendix C-10 has the data on Pediatric Pulmonology which I took a deep dive into. In the attached carousel, I have recreated two datasets that matter. If I were to shop around for a hospital for my care, what really matters to me is the outcome data for a particular condition I am seeking care for and not the reputation score. However what separates the top-ranked "Best Children's Hospitals" is their reputation scores, not the outcome scores for selected conditions as in asthma here. It's a different matter whether the outcome scores used in the rankings are good measures. We will discuss them in another post. What are your thoughts? Feel free to like, share, and comment. #healthcare #hospitals #physician

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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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What does the future hold for retail medicine and virtual care? Walmart is the latest to announce their health center closure. https://lnkd.in/geZpMTkS. This following Optum news, VillageMD closing in Nevada, Teladoc Health problems, etc. What comes next? This is another in a long line of examples that technology and even consumer willingness are not enough when the reimbursement environment does not support particular care models. Are we getting ready to lose all the lessons painfully learned during the pandemic? Or will new virtual care models emerge following this round of closures?

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Within the new #hti2 rule are some critical signals: 1. It is a joint effort between Office of the National Coordinator for Health Information Technology (ONC) and Centers for Disease Control and Prevention —and also heavily influenced by recent rules from Centers for Medicare & Medicaid Services 2. #mfa (multi-factor authentication) is called out as required in some use cases 3. #ai algorithms for #caremanagement will need to be more transparent. 4. It attempts to harmonize #tefca from the The Sequoia Project 4. It sets specific versions of USCDI, and #fhir. https://lnkd.in/edb7NpaZ

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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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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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Navigating healthcare government affairs is key to improving patient outcomes. Success relies on building strong relationships with policymakers, staying updated on legislation, and engaging in policy discussions. https://hubs.la/Q02PR5Mt0

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https://lnkd.in/gywCYUvv AMAs continued advocacy to help #FixPriorAuth targeting ERISA plans.  Although very welcomed, part of the practical workflow challenge is keeping track of what federal/state regulations apply to which plans based on a specific services.  Not so easy to do in today’s legacy EMRs. #Valer can help keep track of payer rules as regulatory requirement for prior auth ramp up on an individual payer and service level basis. www.valer.health 

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📊 Care transitions play a critical role in patient outcomes—and it’s time we treat them as such. 📊 The latest study in the AJMC - The American Journal of Managed Care underscores the tangible impact of care transition activities (CTAs) and Transitional Care Management (TCM) on Medicare patient outcomes. The results speak for themselves: hospitals that emphasize comprehensive CTAs and #TCM saw significantly lower readmission rates, reduced spending, and better overall patient outcomes. In a healthcare system increasingly moving toward value-based care, these findings reinforce the importance of optimizing care transitions, reducing miscommunication, and enhancing follow-up care. As we continue to build smarter, more patient-centered systems, the value of well-implemented, evidence-based interventions can’t be overstated. Check out the full study here for deeper insights into how hospitals can not only improve outcomes but also lower costs by prioritizing these critical moments in care. 🔗 https://lnkd.in/eCNnfvPf #CareTransitions #ValueBasedCare #PatientOutcomes #HealthcareInnovation #TransitionalCare #Medicare #HealthcareLeadership #ResponsibleAI #ACO #AccountableCareOrganizations #VBC

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