Arif Kamal MD, MBA

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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Advance care planning conversations save money and increase utilization of specialized end-of-life care (hospice and palliative care). On a personal note, I had been speaking with my in-laws about completing an advance directive. At Christmas one year, we had a direct conversation about the Five Wishes document that they had completed. My Father-in-law Gary was very direct and clear in how he spoke about his wishes; no machines. He fiercely did not want to become depended on others. Gary had a heart attack a year later. He was kept alive on a ventilator until my husband could fly in and say goodbye. We were all so grateful to have had that conversation. There was no second-guessing. He was clear in telling us his wishes and so we were clear in honoring them. ACP conversations are VITAL for practitioners and family members to have in order for people to have the ending they want, or hope for. (Gary died before the launch of The Death Deck or we would have also used it to help have these important conversations).

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I recently had the privilege of conversing with Joe Kiani, a trailblazer in the healthcare industry and a visionary leader. Our discussion centered around his innovative approach to making healthcare more accessible and efficient for everyone. Joe Kiani emphasized the importance of leveraging technology to provide high-quality care  -- including in the comfort of patients' homes. This not only improves patient outcomes but also reduces the burden on our healthcare system. His work is a testament to how technological advancements can bridge gaps in care delivery and bring about transformative change. One key takeaway from our conversation was Joe's commitment to patient-centered care. By focusing on continuous monitoring and early intervention, we can significantly enhance patient experiences and outcomes. His vision aligns perfectly with the growing trend of personalized medicine and the need for more flexible healthcare solutions – including when it comes to addiction. I love talking to leaders – especially in healthcare – and learning more about their style. Take a listen to how he talks about microfixing and his need to tackle big problems, while at the same time, speaking up when he sees injustice. Let's keep pushing the boundaries and working towards a more inclusive and efficient healthcare system! #HealthcareInnovation #HomeBasedCare #PatientCenteredCare #TechInHealthcare #HealthcareLeaders #Inspiration

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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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❔ How do we position regional and community sites for success and mitigate risks for sponsors? ❔ In our new Oncology report, Parexel’s Karen McIntyre and Angela Hirst weigh in on why the traditional approach to site selection in oncology has created bottlenecks at major centers, potentially limiting patient access to life-changing therapies. 🚧 That’s why Parexel is bridging the gap by partnering with regional and community sites while still ensuring the high-quality standards of academic centers. Find out how: https://lnkd.in/ePsJbZ8n #ResearchSites #Oncology #NovelInsights

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It's time to rethink how we think about #340B. At the request of the committee, I had the privilege of writing a statement for the record for yesterday's House Committee on Energy and Commerce Oversight subcommittee hearing on 340B: (https://lnkd.in/eTZXZKzp). My goal was to help explain to the committee and other stakeholders how the unprecedented growth of (and flagrant abuse of) a well-intentioned program is harming employers, purchasers, and working families. AND that the most significant victims of this abuse are employers and workers - not the pharmaceutical industry, which is the program's most vocal critic. As I note in the testimony, "At its core, the 340B drug pricing program represents a government-regulated price arbitrage program in which certain healthcare providers can purchase prescription drugs at a steep statutory discount and sell those drugs at the prevailing market rate." First, on the pharmaceutical industry: Drug makers have an obvious gripe about a program that requires them to provide very large discounts (often exceeding 50%) on a significant portion of their products. But despite the rapid growth in 340B, drug makers remain highly profitable. And there is evidence (cited in my testimony) that manufacturers are effectively "pricing in" the 340B hit to them by raising their prices on commercial payers. In fact, it would be shocking if drug makers didn't consider 340B - the second largest drug purchasing program in the country, after Medicare Part D - in their pricing calculations. But there are three other ways - all cited by significant evidence in the testimony - that employers, purchasers, and consumers are paying more for drugs AND other medical care, uniquely #Becauseof340B. 1) Supercharged consolidation: It is an unambiguous fact that hospital system consolidation has significantly increased health care prices over the past 20 years. 340B is a significant driver of that consolidation. Independent practices cannot participate in 340B. But more than 50% of hospitals can and do. And they can reap huge profits by buying physician practices, converting them to outpatient clinics and watching the arbitrage dollars role in. 2) Distorted prescribing and pricing patterns. 340B clinics are demonstrably more likely to prescribe higher cost drugs than non-340B clinics. Again, so they can maximize arbitrage on the differential. 3) Lost discounts. I'm a vocal critic of PBMs, but at least SOME rebates get passed back to employers. Not in 340B. There are no PBM rebates, only the big statutory one for hospitals. Every time a prescription is filled in the 340B channel, employers lose the discount. I don't have a single figure (because of 340B, we all pay $XXX more), but for the employer market, the number would easily be in the several billions, if not tens of billions per year. And growing. I hope #Congress is paying attention.

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Walmart joins so many others in quickly entering and leaving or scaling back in healthcare after ambitious plans to scale. This morning, Walmart said it will close all 51 of its health-care clinics, as well as shut down their telehealth virtual care services. This is right after an announcement in March that they wanted to double the size of their clinical operations by opening up over 20 more locations this year and more next year. The reasons they cited? “Like others, the challenging reimbursement environment and escalating operating costs create a lack of profitability that make the care business unsustainable for us at this time.” As a physician, it’s been fascinating to watch over the past few years as so many non-medical companies try to get their bite of the huge percentage of the GDP that is healthcare. They pour money into trying to deliver healthcare at scale, ignoring the many concerns that hospital systems and physician private practices have been citing for years: declining reimbursements, shortages of clinicians, and expensive labor costs. Healthcare is broken, and those that are in it understand why. Patients need - and deserve - quality health care. This requires safe staffing practices, skilled clinicians who can feel good about what they do, and insurance companies that pay their bills. We can’t have a system where insurance companies can get away with record profits while finding more and more reasons not to pay for care and eroding away at the heart of healthcare. You cannot scale your way out of America’s healthcare problem. You actually need to fix the incentives, regulate insurance companies, pay clinicians appropriately, prioritize clinician well being and retention, and focus on the patient. The days of paying lip service to physicians leaving medicine and physician burnout are numbered. Supply and demand forces will necessitate real solutions that move the needle. Companies will come and go in the healthcare space when they realize how hard it is on the ground in healthcare these days. The question for patients and legislators is, who will be left to pick up the pieces if there’s no support for physicians, other healthcare workers, and hospital systems?  The percentage of clinicians leaving healthcare annually because they no longer recognize the heart of why they joined the profession is astounding, with over 1/4 of clinicians looking to leave within the next few years. Relying on the altruism of clinicians and the erosion of quality healthcare to support profits for corporations is just not a sustainable business model in healthcare - not to mention terrifying for public health. #HealthcareOnLinkedIn #PhysicianBurnout #PhysicianShortage #Walmart

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Many thoughts as Medicare Advantage continues to come under scrutiny. - MA has features of a value-based program, but most of the current "value" is being delivered through diagnosis capture and complexity payments. Ironically, much like FFS, it pays more to keep people sick (or make them look sick). Don't think that's anyone's definition of value. - To be fair, most doctors (especially specialists) don't do a great job of capturing diagnosis and patient complexity beyond their immediate area of expertise. (We're especially bad at this in MSK). We should have accurate representation of a patient's health in the medical record. Complexity and co-morbidities affect treatments and outcomes. We don't yet have a good way to account for this complexity -- and it's becoming clear the MA system isn't it. - EMRs make all of this worse. It's both too easy and too hard to record, change, or resolve diagnoses. EMRs should facilitate accurate complexity capture and treatment personalization. The goal shouldn't be to increase billing, it should be to increase sophistication and precision. - As MA scrutiny grows, the business model of many alternative care models (especially in primary care) will be challenged (potentially dealing another blow to retail healthcare). - CVS' purchase of Signify health is put into full context by this article. - It boggles the mind that CMS can develop and administer a program that nets billions for inscos (at the expense of taxpayers) while reducing physician reimbursement yearly and rolling out ineffective VBC programs for providers. CMMI should have an open-door policy for anyone delivering care and working on true value-based models. Ears, eyes, and minds should be wide open. h/t Mahek Shah MD, MBA Moby Parsons, MD #medicine #healthcare #vbc #valuebasedcare #health

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Keep our rurals open but if you really want to help get the foreign equity owned GPO that sets the pricing for our hospitals BANNED from our state. Economies of scale are used by Vizient against Oklahoma rural hospitals. If you have 13 tiers, hidden tiers, and tier maxes…that’s not a contract, that a free for all nightmare of a scam we all fell for. Their awful written tiered agreements force our rurals to pay more for the exact same items that our large hospitals pay less for. Example box of gloves a large hospital system in the state will pay 6-8 bucks for a box of 250 exam gloves. That same box for a rural EMT? 24 bucks. There is no price transparency and you are forcing patients who live in rural areas to pay more because of the lack of infrastructure by the corporations serving them to effectively and economically get goods and services to these hospitals. And distributors who whine about the cost of delivering to rural hospitals all while posting BILLIONS in profit every quarter are the first on my 💩 list. Let’s keep our rurals open but let’s make them more profitable so that they can continue to add much needed services and gainfully employ more community members.

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Valuable discussion with lawmakers, government officials, and experts at POLITICO's Transforming Health Care event this week on policy solutions to expand access to innovative therapies and digital health technologies. 🏥 Digital health and medical diagnostics were in the spotlight as innovations that could meet urgent needs for a healthcare system facing staffing shortages, a burnout epidemic, growing access gaps, and rising costs as demand grows. 🏥 "The user interface should be a priority for development of digital health tools. Ease of access and ease of use are all factors in promoting adoption and addressing health disparities with these innovations." 🏥 AI in healthcare was a hot topic as panels weighed regulations to ensure patient safety and privacy while supporting health system ability to adopt the technology to alleviate administrative burden and improve outcomes 🏥 Several sessions focused discussion on reimbursement reform, the need to rework Medicare Advantage (MA) quality ratings, and how payment systems can be improved to keep up with innovations. 🏥 "I try to be more prudent" in using diagnostic imaging to treat patients, because it's not covered like other medical options. "We're well aware patients must pay out of pocket...new tech is "not cheap..." 🏥 Panelists, including U.S. Rep. Ami Bera, MD considered how government incentives could support medtech innovation and advancement of digital health to expand access and advance health equity. Good insights from Paul Blanchfield, Lantheus, Susan Coller Monarez, Advanced Research Projects Agency for Health (ARPA-H), Dartmouth Health, and Alexander Ding, MD, MBA. #POLITICOHealth #digitalhealth #diagnostics #healthtech #medtech #healthcarepolicy #healthcareregulation #healthcareinnovation

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What does calling my cable company have to do with Medicaid? I had to call a certain notorious cable/internet provider recently. The one with customer service so bad that it was skewered in a classic South Park episode. I blocked out an hour and braced for my inevitable PCOM aneurysm rupture. Shockingly, it was a breeze. The rep was friendly, and my issue vanished in minutes—a far cry from their usual 'dial-one-to-scream-into-the-void' reputation. So, what changed? Competition happened. A decade ago, our choices for cable and internet were as limited as the soda options in a health spa. Now, thanks to a buffet of streaming services—even including live local TV—the old cable giants had to step up their game or step aside. Turns out, competition is more effective than caffeine at improving service quality. Why can't Medicaid beneficiaries get the same treatment? Currently, most Medicaid coverage is through Managed Care Organizations (MCOs), where the state pays a fixed monthly rate per patient. This model should spur cost-efficiency, but it often just limits the scope of care. Low payments to doctors, restricted access to necessary services—who does that help? Could strict government regulations guarantee better service? Maybe, but FA Hayek (and a basic reading of history) prove that bureaucracy alone can't engineer excellence. And choice for Medicaid patients? Virtually non-existent. Many areas offer just one MCO. If you're dissatisfied, too bad—there's no alternative. It's like being stuck with dial-up in the era of fiber optics. Long wait times for basic procedures, no freedom to seek better coverage... It's eerily reminiscent of the old cable monopoly days. In the private sector, at least there's a semblance of choice: HMOs, PPOs, HSAs... But for Medicaid recipients? Sorry, the state chooses for you. Hope you like it. Our Medicaid system desperately needs a dose of competition. Isn't it time we offer Medicaid patients the luxury of choice that drives quality up and costs down? https://t.co/C7XE6CpIIP Joe Grogan Lisa Grabert Joanne Spetz Cheerag Upadhyaya, MD, MBA, MSc, FAANS, FACS Brian R. Gantwerker, MD, FAANS, FACS Sanjay Dhall Larry Bucshon, M.D.

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Humanizing healthcare through collaboration. In my approach, I'm deeply committed to igniting change at its core. Challenging the status quo isn't easy, but as a bold leader, I'm always eager to embrace the challenge. My aim is to collaborate with the right great minds in the industry , like Alvin Gore, MD leading the charge at UM and collaboration in care through coding CDI and providers. In addition to Cesar M. Limjoco, M.D. , to revolutionize patient care through innovative practices and insights for Sepsis and quantitative fallacies in diagnosing. I am inspired by Zeev Neuwirth, MD "Reframing Healthcare," I'm driven to unravel the legacy framework that hinders efficiency and quality, aiming to reshape healthcare for the better. Dr. #Zeev puts it so well, “our brains are wired in a legacy framework that is engrained in higher cost, lack of efficiency and quality of care for our patients”. Together, let's embark on this transformative journey, rallying all clinicians, & all healthcare leaders, to join the movement towards a more compassionate and effective healthcare system. Vasanth Kainkaryam, MD, MSHI, CPE, ADS, FAAP, FACP, DABOM thank you for your dedication, passion,and contribution to this noble cause. Together, we can truly make a difference through education and thought driven solutions.

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Indeed a turning point for women's health. I am not a political person, but this is something I can proudly support. Very proud of my friends Liz Powell, Jodi Neuhauser, and Candace McDonald for launching this Women's Health PAC who have the support of thousands of women in the healthcare industry. With more money, research, information, innovation, funding, and focus on women's health... everyone wins. Including men. This is not exclusive, this ensures inclusion of all people, especially women who have been excluded from most of the above including in healthcare. Equity ensures equality, and without a focus on women's health there will be not achievement of equity. #healthequity #healthequityforwomen #womenshealth #women #equality #womeninhealth #womenleaders #womeninleadership #womeninmedtech #PAC #womenshealthPAC

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Worth a listen. Much more interesting than the phrase “virtual nutrition solution”, first, because I thought it was an app and it’s not, they’re scaling insurance-supported dietician consulting, where dietician is not a technical but a person-first interaction; but second, because their story of growth reminds us of the many paths to scaling. We need more Vanessa M. Rissetto, MS, RD, CDN who are focused on the end goal of improved health and health services, unconditionally, and the means is a company, as necessary courting investors, and continually confirming results.

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If you build it, will they come? I’ve heard countless organizations - #MA plans, #Medicaid plans, risk-bearing providers, vendors, PBMs, and retail players - say “we need to build the capabilities to XX”. Many are looking to vendors for solutions, but few vendors are ready to invest in new capabilities without contracts.  Anyone else sensing this (problematic) new conundrum? Here’s my quick take and a few ideas to break through this barrier. Many sales meetings are often held with functional departments, and often do not include the #MedicareAdvantage #StarRatings, #RiskAdjustment, #HEDIS, IT or P&L owners. We must collaborate to get those departments’ urgent needs integrated into new vendor purchases in order for new activities to meet new and emerging needs, remembering that: 🌟 Vendors are vital to your success.  🌟 Vendors operate in a more volatile environment than plans. 🌟 Vendors have smaller budgets than plans. 🌟 Vendors need signed contracts to make significant investments.   🌟 Vague RFPs waste vendors’ time and resources. Collaboration creates win-win contracts which expand capabilities of both parties. I encourage plans to: ✅ Ask vendors about their roadmap; including timing and certainty of planned enhancements. ✅ Include the #Stars, Risk Adjustment and #PartD teams in new vendor discussions. ✅ Consider adding a vendor's roadmap capabilities to contracts. ✅ Co-create with trustworthy vendors. I encourage vendors to: ✔ Ask about the customer’s unmet needs. ✔ Offer to co-create solutions to new and emerging needs with willing customers. ✔ Offer to accelerate roadmap capabilities with willing customers.   ✔ Articulate the things you would be willing to do if a customer would be willing to contract for it. This is a #MarketMakingMoment as #CMS has thrown down the gauntlet with #NewNeedsOfStars and #NewNeedsOfMA. This is a stellar time for vendors to review current and planned capabilities with a broader lens on new and emerging MA, #Compliance, Stars, #ECDS, #Interoperability, #HealthEquity, Medicaid & #SNP Aligment, and Risk Adjustment needs. If you need help, reach out to us.  #WhatGotYouHereWontGetYouThere  ⭐ ⭐ ⭐ ⭐ ⭐

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Excellent insights in this piece from stakeholders on what is not working with Value Based Care. It’s encouraging that CMS is listening, let’s hope it will translate into meaningful reform.. #healthcare #qualityofcare #innovation Honor Aging

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📣 This month's Best Practice to Advance #HealthEquity: The #CEO presents an Equity, Diversity and Inclusion Report to the health system's Board of Trustees. [The CEO presents an annual review highlighting results of activities conducted to advance health equity and includes specific attention to efforts at reducing known #healthinequities, improving diverse #patientexperience and retaining diverse staff at all levels.] Here are key questions to evaluate your site's level of adoption for this best practice: 💡 How is your Board of Trustees kept informed about your site's health equity strategies? 💡 How frequently do key leaders come to present their progress on health equity in key service lines or program initiatives (i.e. maternal health, diabetes, heart health, cancer screenings, immunizations, etc.)?  💡 How does the CEO report to the Trustees on the progress made and challenges faced in health equity? 💡 When and how often does the CEO's report on health equity strategies get discussed by the Board?  💡 Does the report include comments from your key stakeholders--Patient Advisory Committees or your Health Equity, Diversity and Inclusion Council?    💡 How often do the Trustees hear about innovations in health equity? The Inclusion Scorecard for Population Health has this and 88 more best practices to support your health equity playbook! Impact4Health sets these up for free for health systems and FQHCs. 📢 Please let me know if you'd like to have this assessment tool for your site! Our highest compliment is that we have operationalized health equity! #healthcare4all #healthcare #impact4health

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🏥 Extending Hospital at Home: A Bipartisan Initiative 🏥 Senators Tom Carper (D-Del.) and Tim Scott (R-S.C.) have introduced the Hospital Inpatient Services Modernization Act of 2024. This pivotal legislation aims to extend the CMS Acute Hospital Care at Home waiver program for five additional years. Here's what this means: - **Continued Success**: The program has shown to reduce healthcare costs, improve patient outcomes, and alleviate hospital burdens. - **National Reach**: Currently active in 37 states, including Delaware and South Carolina, with the program set to expire on December 31, 2024. - **Home Care Benefits**: Enables Medicare beneficiaries to receive hospital-level care in the comfort of their own homes. - **Bipartisan Support**: This extension builds on prior successes and bipartisan efforts to innovate healthcare delivery. - **Healthcare Evolution**: ChristianaCare has successfully admitted over 1,000 patients, showcasing the effectiveness and patient satisfaction with home-based care. 🗨️ "Our efforts aim to revolutionize healthcare by allowing vulnerable Americans to receive high-quality care at home, reducing traditional hospital risks," said Senator Scott. Take a look a the bill here: https://lnkd.in/ge4CMpx8 #HospitalAtHome #HealthcareInnovation #BipartisanHealthcare #Medicare #HomeCare #PatientCare #HealthPolicy #ModernMedicine #SeniorCare #CMS 👩‍⚕️🏡 Let's support the future of healthcare, where home is where the healing happens!

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