Michelle Winkler, PhD, MPH

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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AI’s Impact on CDI A recent ACDIS Survey of ACDIS members gauging impact of AI on CDI processes and the CDI profession revealed some interesting points and sentiments towards AI. The most common impacts from the implementation of CDI technology are increases in remote work and in productivity (cited by 67% each), followed by identifying “low-hanging fruit” queries (65%) and improving documentation issues with high-volume DRG groups (54%). Additional responses appear in Table 4 below. Remote work is not conducive to effectively providing sustainable measurable physician documentation educational training. One-on-One training or small group training is most effective in ultimately changing overall physician behavioral patterns of documentation. Often, the best form of training is small bit size nuggets provided in a quick conversation specific to a case on the floor. Productivity is not a valid and reliable measure of CDI performance. The mere fact that the CDIS reviewed a record does not necessarily equate to achieved improvement/integrity of the record. Identifying low hanging fruit diagnoses through queries implies CDI has room for improvement in physician documentation education through reinforcement that improves physician's muscle memory of better documentation practices. Electronic querying serves to mechanize the query process and is no substitute for physician documentation training and knowledge sharing. Physicians do not want more queries, they prefer to document right the first time versus more repetitive transactional reactive queries. AI definitely can assist and serve as an effective tool in CDI activity. However, it must be considered as a tool and not a crutch. There simply is no substitute for good old fashioned CDI boots on the ground, helping physicians achieve clinical documentation excellence through documentation training with reinforcement and guidance. AI is the panacea for improving documentation. #AI, #documentationimprovment, #notapanacea

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Join Ingrid Pan, Pharm.D, BCPPS, as she discusses a Phase 1 trial exploring upadacitinib for pediatric patients with pcJIA! Ingrid breaks down the promising results, including a low rate of serious adverse events, in this insightful journal club review. Check out the full review on bit.ly/424GY2n.

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Is your Clinical Documentation Integrity (CDI) program optimized for better quality outcomes? Have you positioned your CDI team to be a key player in helping to maximize risk adjustment variables used in rankings and ratings methodologies? If the answer to these questions is "No" or "I don't know" or you have a little spare time for a quick read, check out this piece that my colleague Susan Fantin, MSA, BSN, ACM, CCDS, CDIP and I wrote on the subject matter.

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Interested in running a productionized predictive model? If so, it's important to check for statistical bias in production risk scores. Pleased to announce a new study out in Health Services Research that assesses Hilltop's Pre-AH (avoidable hospital event) Model for race- and sex-based biases. In production for ~350,000 Medicare beneficiaries in Maryland, this model performs well and we find no evidence for meaningful race- or sex-based bias. Thanks to the The Hilltop Institute at UMBC research team Leigh Gayle Goetschius Fei Han, Ph.D. and Ruichen Sun and University of Maryland Baltimore County faculty member Ian Stockwell. #predictivemodels #bias #health https://lnkd.in/efmFRvjG

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Happy to share my new research showing that growth in #340B provider participation over the past decade was associated with a significant ($32 billion annually!) increase in overall per-enrollee Medicaid spending. The 340B program leads to distortions in provider behavior that appear to reverberate across the system. Read the full report to learn about the impact of 340B and the program’s cost to taxpayers: https://bit.ly/4c4p3dG 

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NEW PROPOSED RULE: Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2). We will be holding an overview info session on July 17 at 2:00 PM ET. Learn more about the proposed rule: https://lnkd.in/eCAgEU4v #ONCHTI2

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Heading into the holidays, don't miss a couple updates for you this morning: - An FAQ to help you identify whether a CDS software may or may not meet the definition of a device: https://lnkd.in/eUUQeF9g. These are, quite literally, frequently asked questions that we receive and answer through our inbox at [email protected]. If you have additional questions, please send them over! - An updated list of over 1,000 FDA-authorized AI/ML-enabled devices: https://lnkd.in/eAs2Z9Mi

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Recent proposed rules from 2025 CMS Inpatient Prospective Payment System (IPPS) have potential impact for new GME programs across the country. Check out the blog below on our summary of the rules and where to go on CMS's website to provide feedback on the proposed rules.

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Great commentary and details to be considered from post by Deborah Williams Too few probably understand what you've posted, the other major part of the problem. Commercial insured populations (employers & employees) pay the price for government policy failures that represent major hits on company bottom lines or lead to more individual bankruptcies today. #employeebenefits #employers #commerialinsurance #epcouncil.org

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A new #EBHC scoping review explores how health service and delivery systems in high-income countries define and operationalise #HealthEquity. 👉 https://ow.ly/ZxaY50ShGWU

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Kudos #CMS 👏🏿👏🏿 This is not with Medicare Advantage Risk Adjustment (my usual subject area of posts), but it’s about data and data sharing (my informatics self). I got this in my email AB2D and I was impressed with the intiative by #CMS. Claims Data to Part D Sponsors API (AB2D API) Prescription Drug Plan (PDP) sponsors, You may be eligible to access Medicare Part A & B data for enrollees participating in your plan. CMS developed the AB2D Application Programming Interface (API) at no cost to PDP sponsors to provide them with the Medicare Parts A & B claims data for their active plan enrollees. AB2D gives access to claims data including diagnosis (ICD-10) codes, primary care providers, and medical services received. This can help you build a holistic overview of your patients’ health histories which PDP sponsors can use to: Target MTM program enrollees Identify Medication Therapy Management (MTM) enrollees by using data for a more thorough search capability. Boost health outcomes Enhance MTM enrollee health and program results by improving medication use and adherence. Prevent fraud, waste, and abuse Identify suspicious activity from providers or suppliers through access to data. Enhance MTM consultations Leverage insights from enrollee medical histories for more effective services. https://ab2d.cms.gov/

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Excellent discussion. Monopolization (consolidation) of healthcare providers and insurance companies has driven up prices, reduced quality of care and limited access to care. Site neutral payments are definitely needed.

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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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SDOH Acquisition (TSSA) product is designed to capture self-reported outcomes, life events and contextual data from health plan members. TSSA facilitates the collection and Integration of all longitudinal clinical data supplemented by invaluable social determinative information. https://lnkd.in/ghaCntpM #healthcaredata #bigdata #data #datascience #healthcaredataengine #healthcaredataanalyst #healthcaredataprivacy

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