Waley Abolarin, MD,MSHI

A Testament to Loyalty and Commitment!! Let's take a moment to honor Kurt Simmons for his remarkable 28-year journey with AmeriHealth Caritas. Kurt's story is more than just a career trajectory; it's a testament to the power of loyalty and commitment to an employer's vision. Starting from the ground level and rising to a leadership position, Kurt exemplifies unwavering dedication and persistence. His journey serves as a beacon of inspiration for anyone feeling stuck in their careers or starting out anew. Kurt's commitment to his employer's vision is a shining example of how staying loyal and persistent can lead to sustainable development and personal growth. While his roles and responsibilities have evolved over the years, Kurt's loyalty to AmeriHealth Caritas has remained steadfast. His unwavering dedication not only speaks volumes about his character but also highlights the value of long-term commitment in today's fast-paced world. His journey teaches us that success is not just about climbing the corporate ladder but about staying true to our values and commitments. His example reminds us that with dedication and perseverance, we can overcome obstacles and achieve our professional goals. So, here's to Kurt and the invaluable lesson he teaches us about the power of loyalty and commitment. May his journey inspire us all to stay dedicated to our paths and strive for excellence in everything we do. #CareerJourney #Loyalty #Commitment #ProfessionalGrowth #Inspiration

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🔍 Prior Authorization Process in Cardiology 🩺 Specializing in cardiology, doctors perform various procedures that require prior authorization to ensure optimal patient care and compliance with insurance policies. 💡 Understanding the Prior Authorization Process: - Cardiologists often request prior authorizations for procedures like cardiac catheterizations, stent placements, or pacemaker insertions. - Insurance companies may require detailed documentation, including patient history, test results, and justification for the procedure. 📊 Case Study: Dr. Smith, a cardiologist, requested prior authorization for a coronary angiogram for a patient with chest pain. By providing thorough documentation, the authorization was approved promptly, allowing for timely treatment. 🔑 Key Points: - Prior authorizations in cardiology aim to streamline the process and prevent delays in crucial cardiac interventions. - Collaboration between cardiologists, insurance companies, and prior authorization specialists is essential for a smooth workflow. 🔗 #Cardiology #PriorAuthorization #Healthcare Ending Message: If you are looking for Prior Authorization Outsourcing Services, please connect with me via email at dan@staffinglyhealthcare.com or by scheduling a Meeting at https://lnkd.in/e4nbe7jV

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ACOs have limited time left to shift to electronic quality reporting. While some are prepared, many are not. Gain insights from a valuable webinar by MRO offering guidance on this critical transition. #accountablecare #mssp #ecqm Watch the webinar here: https://lnkd.in/eACyXHUB

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🔍 Understanding Prior Authorization: Cardiology Procedures 👨‍⚕️ Cardiology plays a vital role in healthcare, with various procedures necessitating the prior authorization process. 🛡️ Why Prior Authorization? Cardiology procedures like heart catheterization require thorough validation to ensure patient safety and cost-effectiveness. 📊 Case Study: A patient scheduled for a cardiac catheterization faced delays due to incomplete prior authorization documentation, emphasizing the importance of a streamlined process. 🔍 Key Points: - Prior authorization ensures appropriate utilization of resources in cardiology. - Complex procedures like ablation and stent placements require careful review. 🤔 Have you encountered challenges with cardiology prior authorizations? #Cardiology #PriorAuthorization #Healthcare If you are looking for Prior Authorization Outsourcing Services, please connect with me via email at dan@staffinglyhealthcare.com or by scheduling a Meeting at https://lnkd.in/e4nbe7jV

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🔍 Understanding Prior Authorization for Cardiology Procedures 🫀 Navigating the prior authorization process is crucial for ensuring timely approvals for various medical procedures. Let's delve into the specifics of prior authorization, focusing on cardiology procedures. 🫀 Cardiology Procedures: 1. **Case Study:** Dr. Smith, a cardiologist, recommended a cardiac catheterization for a patient with chest pain. Prior authorization was required. 2. **Key Points:** Understanding the documentation needed, including the patient's medical history, test results, and the provider's rationale for the procedure. ⏳ The Prior Authorization Timeline: 1. **Efficiency is Key:** Delays in prior authorization can impact patient care. Streamlining the process is essential for timely approvals. 2. **Collaboration:** Effective communication between providers and payers is crucial for expediting approvals. 🔍 Exploring Prior Authorization in Dermatology Procedures 🩺 Today, let's focus on the prior authorization process for dermatology procedures, shedding light on the nuances specific to this specialty. 🩺 Dermatology Procedures: 1. **Case Study:** Dr. Lee recommended a skin biopsy for a patient with concerning moles. Prior authorization was necessary due to insurance requirements. 2. **Patient Advocacy:** Advocating for patients' needs in the prior authorization process is vital to ensure they receive appropriate care. ⏳ Overcoming Prior Authorization Challenges: 1. **Documentation Precision:** Accurate and detailed documentation is essential for justifying the medical necessity of dermatology procedures. 2. **Education and Training:** Continuous education on prior authorization guidelines helps streamline the process and minimize rejections. #PriorAuthorization #MedicalProcedures #HealthcareManagement If you are looking for Prior Authorization Outsourcing Services, please connect with me via email at dan@staffinglyhealthcare.com or by scheduling a Meeting at https://lnkd.in/e4nbe7jV

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🌟 Upcoming Live Webinar: Enhancing Dialysis Facility Preparedness 🌟 🗓️ Date: June 25 ⏰ Time: 2 PM ET Join me, Kristi Wells, RN from Greenfield Health System, for an essential webinar explicitly designed for nurse leaders in the dialysis industry. Here's why you should attend: 🔍 Insightful Learnings: Gain firsthand insights into state surveyors' crucial findings and perspectives. Understand what they look for during evaluations and how this impacts facility operations. 📈 Improve Facility Readiness: Learn about the latest trends and focus areas identified by surveyors. This knowledge will help enhance your facility's preparedness and compliance, ensuring you meet and exceed regulatory standards. 💡 Actionable Strategies: I'll share key strategies and best practices to prepare your facility for upcoming surveys, helping you avoid common pitfalls and enhance patient care. 🎓 Earn CE Credits: Earn 1.00 Continuing Education credit by attending this webinar and completing the required post-test and evaluation. This webinar is not just a learning opportunity—it's a chance to improve your facility's operations and patient outcomes directly. Stay ahead of the curve by understanding the latest surveyor expectations and industry standards! Register Here: https://lnkd.in/eBpmNXbw ✨ Don't miss out on this chance to elevate your professional practice and facility standards! ✨ #DialysisCare #NurseLeaders #HealthcareWebinar #DialysisPreparedness #StateSurveyors #ContinuingEducation #NursingEducation #DialysisNursing #HealthSystem #PatientCareExcellence

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#RepLloydDoggett from Texas nails it in his opening remarks on CMMI models, MA plans AND Medicare Physician Fee Schedule. Thankyou Rep. Doggett! House Ways and Means Subcommittee on Health Hearing: “Improving Value-Based Care for Patients and Providers” Wednesday, June 26, 2024 Ranking Member Doggett: “While I support paying for value over volume, efforts to achieve that have so far experienced very mixed results. Over the last decade, CMMI has launched more than 50 models, with only six delivering savings and two demonstrating improved quality. One of the primary challenges in achieving genuine value-based care is that we have struggled to define and measure value. Some of us sat in this same room and heard the grand promise of a Medicare Advantage (MA) program that would give us the greatest value by expanding beneficiary choices, reducing health inequities, and saving taxpayer dollars. MA plans aren’t just getting paid more to deliver the same care you would receive under traditional Medicare. They are often covering less care. MA plans continue to interfere with the doctor- patient relationship through burdensome prior authorization (PA) requirements, step therapy, and other management tools. For the care that is delivered, many physicians face inadequate payment. While some alternative payment models (APMs) appear to show greater promise and achieve the outcomes we aim for, they must be carefully designed to avoid repeating the failures in MA. These models also should not serve as the back door to greater privatization of Medicare. As part of today’s discussion, we do need greater attention on improving the Medicare physician fee schedule (MPFS). Providers rightfully want to see payments keep pace with inflationary costs. We also continue to underpay primary care providers, who offer some of the most important and high value preventative care. And of course, MA plans, which now cover more than half of beneficiaries, may reimburse less than the MPFS. To achieve greater value, payment reform must include MA reform.”

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🚀 Unlocking the Power of Health Records: PHR vs. EHR vs. EMR 🚀 Hey! 👋 Have you ever wondered about the differences between PHR, EHR, and EMR? 🤔 Let’s break it down in a way that's easy to understand! 🗂️ PHR (Personal Health Record) 🗂️ ✨ Who owns it? YOU do! 🙌 ✨ What is it? A digital treasure trove of your health info, from medical history to medications, managed by you. 💊📝 ✨ Why use it? Empower yourself by keeping track of your own health and sharing it with your doctors when needed. 📲👩‍⚕️👨‍⚕️ 🏥 EHR (Electronic Health Record) 🏥 💡 Who owns it? Healthcare providers, but you can access it too. 🔍 💡 What is it? A comprehensive, digital record of your health, spanning multiple providers and facilities. 🏨🔗 💡 Why use it? Ensures coordinated care across various healthcare providers, improving treatment outcomes. 🌟🤝 🩺 EMR (Electronic Medical Record) 🩺 🔧 Who owns it? Your doctor’s office or healthcare facility. 🏢 🔧 What is it? Digital version of your paper charts, specific to one provider. 📋💻 🔧 Why use it? Helps your doctor track your health and provide personalized care. 🩺📈 🌐 In Summary 🌐 PHR: Your health info, your control. 👐 EHR: Holistic view of your health, accessible by multiple providers. 🌐 EMR: Specific to one provider, focused on individual care. 📍 🚀 Have questions or insights? Drop them in the comments below! ⬇️ Let’s discuss! #HealthIT #MedicalRecords #HealthData #PatientEngagement #Interoperability #DigitalTransformation #HealthInformation #AIinHealthcare #HealthManagement

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Market Access Insider The Value of Interoperability From the vantage point of a federal agency like Medicaid or the Centers for Medicare & Medicaid Services (CMS), interoperability stands as a cornerstone in advancing the nation's healthcare agenda. It represents a fundamental principle that underpins the delivery of efficient, high-quality care to beneficiaries across the United States. Interoperability within healthcare systems is vital for Medicaid and CMS to fulfill their mission of providing accessible and effective healthcare services to millions of Americans. By ensuring that different healthcare providers and systems can seamlessly exchange information, interoperability promotes care coordination, enhances patient safety, and improves health outcomes. In the realm of Medicaid and CMS, interoperability initiatives are integral to modernizing and optimizing the administration of healthcare programs. These initiatives aim to break down silos that inhibit the flow of information, enabling Medicaid agencies, healthcare providers, and other stakeholders to access relevant data efficiently. Through interoperability, federal agencies like Medicaid and CMS can facilitate the exchange of critical health information, such as patient records, care plans, and medication histories, in real-time. This seamless exchange of data empowers healthcare professionals to make informed decisions, deliver more personalized care, and prevent adverse events. Moreover, interoperability supports Medicaid and CMS in their efforts to promote value-based care and payment models. By enabling the aggregation and analysis of data from various sources, interoperability facilitates the measurement of healthcare quality, outcomes, and costs. This data-driven approach allows Medicaid and CMS to incentivize providers based on performance, promote care coordination, and drive continuous improvement in healthcare delivery. From a regulatory standpoint, Medicaid and CMS play a crucial role in shaping interoperability standards and policies that govern the healthcare ecosystem. Through initiatives such as the Interoperability and Patient Access final rule, Medicaid and CMS establish guidelines and requirements to ensure that healthcare organizations prioritize interoperability and data sharing. In conclusion, interoperability is not just a technical aspiration but a strategic imperative for federal agencies like Medicaid and CMS. By championing interoperability initiatives, these agencies can foster a healthcare system that is more connected, efficient, and patient-centered, ultimately improving the health and well-being of millions of Americans. #HIE #Interoperability #HealthcareData #Medicaid #CareCoordination

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Oracle’s clinical and operational technologies are helping health systems like Ascension to manage, innovate and simplify processes. Read why “Ascension is betting on Oracle” here. https://lnkd.in/gtDTCyy9

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Here’s your recap of last week’s health IT news 🗞️ 👇 🖊️ AI Ambient Scribes • CHRISTUS Health + Abridge: The 15,000 provider Texas health system adopted the ambient scribe enterprise-wide.    • Tampa General Hospital + Nuance Communications DAX Copilot: Over 500 providers at the health system will begin utilizing the AI ambient scribe.    • Texas Oncology + DeepScribe: The statewide oncology practice adopted the AI ambient medical scribe. (ed. note: scribes continue to be hot!) ☎️ AI Contact Center • Clearstep: The AI conversational chat vendor launched a new feature allowing patients to self-schedule specialist visits. 📊 Data & Analytics • InterSystems + CLEAR: The cloud-based patient data service is integrating the identity technology to expedite access to patient records.    • WakeMed + Bamboo Health: The health system is adopting the data interoperability and encounter notification service. 🥼 Clinical Decision Support • University Hospitals + Aidoc: The Cleveland-based health system is implementing the AI clinical decision support platform across 13 of its hospitals and additional outpatient locations. 🧑‍💻 Virtual and At-Home Care • University of South Carolina School of Medicine + Rimidi: The hospital group and an affiliated multispecialty clinic are adopting the remote patient monitoring platform to reduce complications from postpartum hypertension.    • Mount Sinai Health System + HealthSnap: The medical center announced a new remote patient monitoring and chronic care management program in partnership with the virtual care management platform.    • Wheel: The telehealth company released a new AI-driven virtual care platform designed to enhance the patient experience and offer resources to help partners scale their virtual care services. 💬 Patient Engagement • CipherHealth: The patient engagement solution focused on patient rounding released a new AI summary tool.    • DexCare: The care orchestration platform completed a $75M series C funding round 🩼 Durable Medical Equipment • Better Health: The medical device and peer support network completed a $14M funding round. 🧠 Food for Thought: • Silicon Valley Bank released an interesting report on the state of investment in AI in healthcare, including stats on AI usage at healthcare organizations and the impact of leveraging AI on startup valuation. https://lnkd.in/em7AfivT    • The journal Critical Care Medicine published an editorial on an “in clinico” evaluation of a machine learning-based early warning system to predict in-hospital deterioration. We found it to be an interesting look at the actual impact of a model’s deployment on care processes and patient outcomes in a critical care setting. https://lnkd.in/eQhZbVKu

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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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❗Trained Outpatient Coders to Code Inpatient Charts 🏃‍♂️🏋️ During our Coder Development Program Announcement, Janetta B. explained the how her team was able to cross-train hospital Outpatient Coders. 👩‍💼👨‍💼 One of the greatest challenges that continues to face us... getting enough strong hospital Inpatient Medical Coders. 📑 The opportunity might be within your own team of hospital Outpatient Coders. We have experience cross-training Outpatient Coders to be productive coding Inpatient charts in months. 🗓️ HIM Directors, are there other chart types your facility needs help with, but you don’t have the trainers, education, or time to get them cross-trained? 🤔 Check out our announcement to learn more information about our program! 💻 🚀 Introducing the Coder Development Program! At Renown Talent, we not only train, but upskill the next generation of Medical Coders, ensuring their success in this ever-evolving landscape. ✍📚 Be Renown, Bertram 🔔 Like | Comment | Share 🔔 #MedicalCoding #RevenueCycle #OnTheJobTraining

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Yesterday I met with some software developers who created a tool to guide clinicians using advanced data science tools. However, they didn't include an action arm to tee up the orders that would execute on the guidance due to regulatory concerns. Even though adding the orders was technically quite feasible, adding this feature would classify the tool as a "medical device" by the FDA and that was something they didn't want to trigger. I found it also ironic that thalidomide birth defects influenced the FDA to become the agency it is now. This type of closed-loop decision support system like this could prevent similar complications in the future. Anyone else think the FDA approach is misguided, or at least need to be adjusted? #FDA #Healthcare #Regulations #DataScience #MedicalDevice

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In this LeaderReadyCast episode, I interview Heather M. Costa, MPS, CBCP, CCRP Director of Technology Resilience at the Mayo Clinic, discussing resilience in the context of healthcare technology. Resilience has regained importance due to the pandemic and increasing complex risks. Costa emphasizes resilience as incremental improvement, tackling adversity with hope and confidence, and adapting to changes effectively. The Mayo Clinic, a large, complex healthcare system, requires robust #technology #resilience to ensure patient care is not disrupted. Costa’s approach involves fostering relationships, prioritizing impact mitigation, and maintaining a shared purpose focused on patient care. Her leadership principles include accepting imperfections, emphasizing gratitude, and ensuring continuous improvement. Three key take-aways: - Incremental Improvement: Focus on being better tomorrow than today through small, consistent improvements, acknowledging that perfection is unattainable. - Impact Mitigation: Prioritize minimizing impacts to patients, anticipating disruptions, and being ready to respond and recover effectively. - Building Relationships: Emphasize strong interpersonal connections, active listening, and shared purpose to foster collaboration and support across the organization. #leadership #crisisleadership #podcast https://lnkd.in/eASsdCkc

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Global IT outage takes down health system EHRs, forces hospitals to cancel or delay services https://lnkd.in/gcMVfSZH #anesthesia #global #IT #outage #healthsystems #health #systems #hospitals #cancel #delay #services #crowdstrike #crowdsourcethetruth #CrowdStrikeIssue

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