Kimberly Swanson

👩‍💼 Peer Perspective: Gain valuable insights from Nebraska Health Network (NHN) on APP Quality Reporting. NHN shares its approach to navigating the new APP Quality Reporting landscape. Discover their challenges and considerations as they transition to the new reporting standards. Learn from their experiences to make informed decisions for your ACO. https://hubs.ly/Q02vCV-J0 #PopulationHealth #HealthcareAnalytics. #Healthcare

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Risk adjustment ensures providers are paid fairly in capitated payment models, allowing them to deliver appropriate care to all patients. However, if done poorly, it can worsen health inequities by misallocating resources. In my work, I've seen the importance of accurately predicting future healthcare costs to ensure providers can care for healthier and sicker patients. Risk adjustment modifies payments based on patients' characteristics and health conditions. This method uses statistical models to assign risk scores, adjusting payments accordingly to reflect the expected cost of care. One challenge we face is inconsistent data and coding practices, which can affect the accuracy of these adjustments. Traditionally, risk adjustment focuses on factors like age and chronic conditions. However, incorporating social determinants of health—such as housing stability and food security—is essential for fair compensation. These factors impact health outcomes but are often excluded due to data standardization issues. To better support providers and reduce inequities, it’s crucial to design and implement risk adjustment models carefully, incorporating comprehensive data and considering social factors. This approach ensures we can continue to deliver high-quality care to all patients, regardless of their health needs. #Healthcare #Hospitals #doctors #hospitals #CommunityHealth

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Think market consolidation is a problem in #healthcare? You’re right, but let’s start with the insurers (payers). A new data snapshot from the AAMC Research and Action Institute demonstrates the relative market concentration among health care providers and insurers. Across all U.S. states, the largest health systems (by total inpatient hospital discharges) account for about 20% of the state market on average; the largest health insurers account for 50% of the large-group state insurance market. In any given state, the three or four largest health systems combined have an average of 43.1% of the market share, while the top three large-group insurers hold an average of 82.2% of the market share. Check out Alabama on our interactive...can you imagine being a physician practice or community hospital trying to negotiate rates with a payer controlling over 95% of the private market? Insurer consolidation can lead to higher (not necessarily lower) premiums for patients –and lower rates paid to providers, which can result in detrimental effects for patients including discontinued specialized services, hospital closures, and other cuts. Regulators and courts concerned about consolidation must consider all sides of the market for health care goods and services, including the impact of both insurer and provider consolidation on payment rates, patient access, out-of-pocket costs, and quality of care. Read the full snapshot: https://ow.ly/fWG250RtFX4

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AccendoWave - A Pain #Data Company More recently, the federal government has begun using the QIS program and QRS parameters to advance health equity. Federal rules now require all marketplace insurers to adopt a strategy for reducing health disparities and to stratify certain clinical data by race and ethnicity. While state-based marketplaces (SBMs) have authority to supplement these federal minimum QIS and QRS standards with state-specific quality rules, most have hewed closely to the federal default approach. California and Washington are notable exceptions. Each has implemented a customized QIS program and robust data collection standards to identify and reduce racial and ethnic health disparities. Time to Focus on - #Pain not being Believed. A Root Cause Health Equity Problem. A Top 4 Global Health Equity Solution and Top 15 Global Remote Monitoring Company, AccendoWave, benchmarks objective brain wave pain data (specialty, gender, age) and has nine #pain databases: Emergency Department, Maternal Health, Oncology, MSK, Medical Surgical, ICU, #Women, Adults, #Seniors to eliminate bias, improve outcomes and reduce health care costs. If desired, AccendoWave can also create customized pain databases for partners that can be accessed on the Datavant platform.

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The question "What's in it for me?" is particularly relevant in the value-based care (VBC) space when engaging physicians and other providers. A recent Humana report highlights several benefits for providers: in 2022, about half of VBC providers received shared-savings payments and earned significantly more compared to non-VBC counterparts—16 cents vs. 6.5 cents per healthcare dollar, and 3.4 times the Medicare Physician Fee Schedule, with advanced-stage risk physicians earning six times more. These statistics suggest that VBC can be financially rewarding, though the distribution of these earnings between individual providers and their employing organizations remains a point of curiosity. Beyond financial incentives, VBC allows physicians to practice more personalized and holistic care, improving patient relationships and health outcomes. For instance, 85% of VBC patients saw their PCP at least once in 2022, compared to 75% of non-VBC patients. As organizations invest structurally and culturally in VBC, they can achieve notable success, reinforcing that VBC is more than a transient trend but a pathway to sustainable, improved care. For more insights, contact article author Jason Jobes at jason@norwood.com. Read the full article here: https://lnkd.in/ghTiZi_Q

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QHINs, Health Data Exchange, FHIR, AI and More with CommonWell Health Alliance - Healthcare IT Today Summary: The blog post discusses the role of QHINs, Health Data Exchange, FHIR, AI, and more within the CommonWell Health Alliance. The headings covered include: 1. Overview of CommonWell Health Alliance #CommonWellHealthAlliance 2. Importance of QHINs in Healthcare #QHINs 3. Health Data Exchange and its Benefits #HealthDataExchange 4. Utilizing FHIR for Interoperability #FHIR 5. Integration of AI in Healthcare #AIinHealthcare The post emphasizes the significance of these technologies in improving healthcare IT systems and patient outcomes. For more information, watch the accompanying video. ai.mediformatica.com #commonwell #health #about #commonwellhealthalliance #data #community #healthinformation #patientdata #affordablecare #dataexchange #ehrvendors #ellkay #digitalhealth #healthit #healthtech #healthcaretechnology @MediFormatica (https://buff.ly/3JoRoPG)

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If health systems master the art of delivering a world-class consumer experience in urgent care, they can replicate this success across their entire operation, becoming market leaders and thriving in the long term. This is the core thesis of what we do at UCP Merchant Medicine. For nine years, UCP Merchant Medicine has partnered with 68 healthcare operators, most of whom are health systems, to create internal capabilities that allow them to thrive in consumer experience excellence. This isn’t just about having a world-class urgent care platform, this is about owning the future and the capabilities to expand these experiences across the broader health system. As healthcare shifts towards a consumer-driven model, the need for health systems to adapt is more critical than ever. Patients now have unprecedented freedom to choose their care providers, with 45% researching providers and costs before choosing a health plan, and 44% before making an appointment, according to McKinsey’s consumer Health Insights Survey. These improvements are not just numbers; they're about real people getting better access to the care they need when they need it in a way that they will love. This is what we stand for at UCP Merchant Medicine. Join us as we continue to innovate and lead the way in making healthcare more responsive, efficient, and patient-centric. Together, we can transform the future of healthcare! #HealthcareInnovation #PatientCare #UrgentCare #HealthcareLeadership #UCPMerchantMedicine Intellivisit Solutions

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An astonishing 47 percent of hospitals still use outdated methods like faxing to share healthcare information, hindering access to critical care. Patient data interoperability is crucial for timely and accurate care. Don't miss eHealth Technologies’ CEO Dan Torrens interview with HIT Consultant Media, where he discusses healthcare interoperability and why embracing interoperable technology is a strategic advantage for healthcare systems looking to enhance patient outcomes: https://hubs.la/Q02tPYQz0 #HealthcareInteroperability

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ICYMI: Our CEO Rajaie Batniji spoke at Fortune Brainstorm Health this week on value-based care and AI. Thanks to Christina Farr, Sachin H. Jain, MD, MBA, and Brent Nicholson for an insightful discussion! “So much of how we talk about AI in healthcare is focused on replacing humans, and I think that’s totally wrong. Our approach to AI development is to automate the routine tasks so that we can allow our care team to spend as much as possible with patients. Second, let’s automate the identification of which patients are going to benefit from certain services so that we can spend our time targeting the appropriate groups. That’s where you have step-change in improving access to care.” Watch the recording here: https://wymrk.co/3KdruPb

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Use patient segmentation to identify highest predicted utilization and risk for Medicaid. Humana Health Informatics applies the ACG® System for recommended actions. See how in this success guide: https://lnkd.in/eg6ta2us #ssnchealth #HopkinsACG #Medicaid #patientcare #valuebasedcare

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New proposed mandatory Transforming Episode Accountabulity Model (TEAM) to improve #patientexperience #transtions of care. Select geographic regions with 3 tracks and a #healthequity focus allowing safety net hospitals to participate in a track with lower level of risk. How is your ACO defining specialist strategy?

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Another great conference in the books! I learned so much and had great conversations with leaders improving #healthcare outcomes. Our HHS team participated in the State HIT Connect Summit taking away valuable insights around AI, interoperability, and Medicaid transformation delivery that will redefine the future of state healthcare. Check out their takeaways in the recap:

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Like many health systems, Gundersen Health System faced staffing and capacity challenges that hindered the full and efficient use of operating room (OR) time. Leaders, surgeons, and staff lacked real-time visibility into key data they needed to make actionable decisions. They overcame these challenges and optimized their OR efficiency with iQueue for Operating Rooms, including: 📈 8% increase in prime time utilization ⬆️ 8% increase in block utilization ⏱️ 14% increase in prime time robot utilization 💹 76% increase in manually released minutes Discover Gundersen Health System's full story: https://bit.ly/3yf1e4h

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Designing an equity-focused value-based payment (VBP) model involves a number of decisions — decisions that should be informed by payers, providers, and the communities they serve. This CHCS brief outlines seven key considerations for states and other payers seeking to design VBP models that reduce health disparities, reflect community needs, and positively impact health outcomes and costs in Medicaid. https://bit.ly/44HI3MM

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I'm thrilled that today, we announced a significant milestone for Clover Health: the launch of Counterpart Health. Our innovative Clover Assistant (CA) platform is now available to all Medicare Advantage payors and providers under the new brand name Counterpart Assistant. Why am I so excited about this? This move is a strategic leap forward in our mission to improve healthcare for everyone. With Counterpart Assistant, we're not just expanding our reach—we're leveraging cutting-edge AI and machine learning capabilities that have already proven to make a real difference in patient care. The healthcare landscape is evolving rapidly, and the need for advanced, data-driven tools has never been greater. Medicare Advantage plans, in particular, are under pressure to improve patient outcomes while managing costs. That’s where Counterpart Assistant comes in. By bringing our technology to more providers, we're empowering clinicians with the tools they need to deliver high-quality, personalized care. What makes Counterpart Assistant special? First, we’re broadening our impact by allowing providers outside of Clover Health's Medicare Advantage plan to benefit from our technology. Our hybrid SaaS and shared-savings model aligns financial incentives with health outcomes, ensuring flexibility and scalability. CA’s AI-driven insights enhance clinical decision-making, and are associated with earlier diagnosis and better management of chronic diseases. Plus, we've built a robust support system to ensure seamless integration and ongoing assistance for all users. Clinicians using CA have seen significant improvements in Medical Cost Ratios and patient outcomes. The timing couldn't be better. The healthcare industry is ripe for transformation, and our technology is poised to lead the way. By expanding the use of Counterpart Assistant, we’re not just keeping up with the changes—we’re driving them. Join us on this exciting journey. Visit our website for more details. Thank you for your continued support as we strive to bring high-quality healthcare to everyone on Medicare. #HealthcareInnovation #AI #MedicareAdvantage #ValueBasedCare #CloverHealth

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Part 3 of the 3-part series on simplifying C-CDA integration in InterSystems HealthShare has been released onto the LEAD North, LLC Blog site. Chi Nguyen-Rettig dives into essential solutions and strategies to streamline the complexities of integration, making life easier in this intricate domain. Check it out and let us know what you think. #HealthIT #Integration #LEADNorth #InterSystems https://lnkd.in/gMxfkW3D

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