Tressa Springmann

Glad to share our upcoming Gainwell Technologies webinar on how our team is leveraging automation and advanced analytics to tackle #SDoH head-on. By harnessing technology, we're gaining deeper insights into state needs, streamlining interventions, and ultimately improving health outcomes. #HealthcareInnovation #DataDrivenHealthcare

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At the KLAS K2 Collaborative Payer/Provider Summit in Salt Lake City tomorrow, I'll be talking about how data partnerships and interoperability developments are changing the dynamics between health plans and provider organizations. If fragmented healthcare is a problem for you and you want to do something about it, let's connect. #KLASK2Summit2024, #K2Collaborative, #Interoperability, #payer, #provider, #KLAS, #klasresearch

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Huge shoutout to the Frederick Health team on their outcomes captured in this amazing case study! 🎉🙌 This one checks some important boxes: ✅ Meaningful outcomes around 30, 60, and 90 day readmissions 🏥 ✅ Stellar patient satisfaction ratings 😁 ✅ Significant cost savings to the system 💰 I highly encourage checking this one out, congratulations to all those involved in these achievements! #rpm #remotepatientmonitoring #telehealth #digitalhealth #frederickhealth

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To lead effectively amid the 2025 Medicare Advantage and Part D Final Rule changes, leverage data-driven compliance measures, employing predictive analytics to anticipate and prevent regulatory breaches. Champion ethical marketing practices, employing sentiment analysis to ensure transparency and authenticity in communications. Forge partnerships with community organizations to enhance access to behavioral health services, utilizing geospatial analysis and machine learning to optimize resource allocation. By pioneering these strategies, healthcare analytics leaders can navigate regulatory complexities while ensuring equitable care delivery. #DataDrivenCompliance #EthicalMarketingr #EquitableCare #PredictiveAnalytics. https://lnkd.in/eq3vf6qs

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Guidehouse helped a regional health system modernize its EHR, ERP, and IT infrastructure, better manage cost pressures and improve interoperability, productivity, and patient-engagement through an effective IT Modernization framework. Learn more with the link below. Guidehouse Technology Solutions, Guidehouse Health | #ITModernization #TechnologyModernization #Healthcare #SystemsModernization #DigitalTransformation #ERP #EHR

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THRILLED to see Healthcare IT News talking about RPM reimbursement this week! ICYMI: The AMA is set to discuss proposed changes to the RPM and RTM CPT codes in their upcoming CPT Editorial Panel meeting May 9-11th. The public agenda summarizes 3 main proposals: 1. To add a device supply code representing 2-15 days of data; 2. To revise the time requirements for CPT code 99457 to 11-20 minutes instead of a fixed 20-minute threshold; and 3. To reduce the time requirement for CPT code 99458 from 20 minutes to 10 minutes. I am really happy to see the first proposal -- we know that 16 days of data is often not clinically valid or necessary. Since this is an additional code rather than a revision to 99454, my hope is that this will increase access for patients. I am slightly concerned, though, that reducing the time requirement for 99457 will also reduce the reimbursement amount, which could result in less reimbursement for providers, not more as indicated in the attached article. Same thing for 99458. With the lower time threshold of 10 minutes, I would not be surprised if payors reduce reimbursement for 99458 by 50%. There is currently an MUE indicating 99458 should only be billed 2-3 times in a particular month, and if that remains the guideline, that could limit the total amount of monitoring time that is actually covered. Last time around, proposed changes to the RPM codes were pulled from the meeting agenda without warning to most stakeholders. I am hoping that does not happen again and that these proposals actually make it to the live discussion so we can hear how interested parties are thinking about the proposals. Note: There are additional changes proposed which are available to Interested Parties but that cannot be discussed publicly. If this is applicable to you and you haven't yet, I strongly recommend registering to attend the May meeting! You can do so virtually. Registration link here: https://lnkd.in/edXMicMP #remotemonitoring #RPM #reimbursement #digitalhealth Carrie Nixon William Paschall Rebecca E. Gwilt Aizaz Chaudhary Reema Taneja https://lnkd.in/ek-PpJRa

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This Thursday the Energy and Commerce Committee will hold a hearing on the Centers of Medicare and Medicaid Improvement (CMMI). Members of the Committee are expected to raise concerns and praise for the agencies' efforts to test and achieve savings in value-based payment models over the years. Since its inception in 2010, CMMI has tested many new payment models including bundled payments, multiple accountable care organization offerings, and the making care primary model. The agency continues to face challenges, such as finding ways to engage rural providers and solo or small physician specialty practices. Reps. Michelle Steel and Susie Lee and Sens. Markwayne Mullin, Kyrsten Sinema and Thom Tillis introduced the EASE Act (HR 7149 / S.4078) to encourage CMMI to create a new payment model for rural and underserved communities to reduce long wait times that many seniors and residents face in these communities when seeking care from a specialist. The bill was developed based on years of data collected and reviewed by OCHIN to help community health centers and rural hospitals improve care integration and create a new value-based payment model. While Congress looks for ways to improve outcomes and reduce costs; and medical schools continue to look for ways to grow the physician workforce, one pathway that would fill the needs of communities (especially rural areas) and prevent avoidable hospital admissions is the EASE Act which looks to utilize telehealth or e-consults to help our most vulnerable populations receive timely care

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It was a pleasure to talk with Minalkumar Patel about the distinct needs of ACOs and where we see the biggest opportunities to optimize data to benefit patient health and provider success. I am delighted to share our conversation and look forward to much continued discussion on this important area of innovation for our industry. #valuebasedcare #aco #healthtech

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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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🏥 CMS Releases Proposed 2025 Medicare Physician Fee Schedule The Centers for Medicare & Medicaid Services (CMS) has released their proposed Physician Fee Schedule (PFS) for CY 2025, with several important telehealth-related proposals. Here are the key highlights: - Audio-Only Expansion: CMS proposes to allow audio-only for any telehealth service, not just mental health. - New Telehealth Codes: Several new codes are proposed for addition to the telehealth-eligible services list. - Frequency Limitations: Proposal to remove frequency limitations on certain telehealth services through 2025. - Direct Supervision: Continued allowance for use of live video to meet direct supervision requirements. - FQHC and RHC Flexibility: Proposal to continue allowing FQHCs and RHCs to provide non-behavioral health telehealth visits through 2025. - Opioid Treatment Programs: Permanent allowance for audio-only periodic assessments when video isn't available. These proposals aim to mitigate potential disruptions if current telehealth waivers expire on December 31, 2024. The public comment period is open until September 9, 2024. Source: Center for Connected Health Policy (CCHP) Fact Sheet, July 2024 #Healthcare #Telehealth #Medicare #CMS

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🚀 Excited to be tagged in Dylan Reid(Moskowitz) announcement about the FY24 LEAP in Health IT! This initiative marks a significant leap towards integrating #AI and #BehavioralHealth in our healthcare systems, aligning perfectly with the urgent need for innovative health IT solutions. The focus on enhancing health care data quality for AI applications and accelerating health IT in behavioral health settings is not just timely but critical. These efforts by the ONC to push for scalable, interoperable health IT solutions could dramatically improve care coordination and patient outcomes. 💡 I'm particularly intrigued by the emphasis on developing lightweight IT solutions for behavioral health—a sector that has long awaited such forward-thinking integration. It's an area ripe for impactful innovations that could reshape patient care dynamics. Hats off to the teams at HHS and ONC for driving this change. Looking forward to the transformative projects that will emerge from this initiative. 🔗 For more details on the funding opportunity and how to apply, check out the full announcement here: HHS LEAP in Health IT Announcement https://www.hhs.gov/news #HealthcareInnovation #DigitalHealth #HHS

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This is an interesting article because EHR companies, like Epic and Oracle's Cerner, have made siloing data a major part of their business model. Overall, I like EPIC’s ability to review records from other EPIC shops. It also has a nod to interoperability with its “Care Everywhere“ feature. However, this is often a disorganized and outdated collection of information. Using it requires a ninja level of both tech expertise and medical knowledge possessed mainly by younger physicians and chief residents. I am a fan (and advisor) of companies like Zus Health focused on user-friendly, comprehensive, and up-to-date interoperable health care data tools.

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This is fascinating. Clearly clinicians won’t be able to review the tsunami of data that could flow in. This is why nurses and doctors must have AI and data analytics literacy as new clinical decision support tools are developed to analyze this data.

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2 hospital systems have widely been reported to take these positions: HHC and NYPHS. With the large impact to employer healthcare costs and the push toward transparency, not sure why these stories have not gotten more traction and attention. Plans have also said yes to this. Hopefully this changes moving forward. "HHC purportedly engaged in antitrust violations through their “all-or-nothing” contracts with insurers. A 2021 presentation to the Connecticut legislature’s Insurance and Real Estate Committee defined “all-or-nothing” contracts as contracts that require insurers to include the entirety of a network’s facilities in its coverage plan, regardless of price. Another alleged anticompetitive strategy HHC enacted was the use of “anti-steering” and “anti-tiering” provisions in their contracts with insurers.  According to the Department of Justice, steering is “a method used by insurers to offer consumers options to reduce some of their health care expenses.” Anti-steering provisions prohibit health insurers from including anything that may steer patients to more cost-effective hospitals and facilities. According to the National Academy for State Health Policy, a nonprofit dedicated to analyzing national health policy, tiered networks are when insurers “place providers into tiers based on price and quality and then offer patients financial incentives, typically through lower cost-sharing, to choose providers from a higher-value tier.” Under anti-tiering provisions, insurers are barred from offering tiered networks to patients, which encourage patients to pursue more affordable care.  The lawsuit goes on to say that HHC’s conduct has “forced patients and employers in Connecticut to pay higher prices for routine services that are often available at other hospitals only minutes away for substantially less.”

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Scott Code, MBA great article below for opening the conversation. Thank you and #leadingage for being a leader, catalyst, and advocate for AI in senior living and health care. Are you catching the buzz surrounding artificial intelligence (AI) in aging services? LeadingAge’s Scott Code, vice president of the Center for Aging Services Technologies (CAST), has authored an article on that topic, published April 17 in HealthTech: “Embracing Generative AI and Large Language Models in Senior Care.” #SeniorCareAI #AgeInnovation #SmartSeniorCare #AIHealthcare #SeniorLivingTech #DigitalHealth #SeniorWellbeingAI

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