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Shared my vision for reversing chronic disease, integrating eco-system between Payers & Providers and unlocking the power of Value-Based-care models such as RA, Quality etc. in U.S healthcare along with some practical tips and thoughts to my industry colleagues about how to get PROACTIVE at the 3rd Annual RA hashtag #Innovation Forum in Dallas. Strategic Solutions Network ?? It's clear after recent pent up frustration with the current state of chronic disease, Prior Auth frustrations, high cost of care and with the administration change, its a pivotal moment for all. #?? It is even more critical to look beyond the current lens of KPIs of Risk Adjustment, STAR and value based care performance. Let's keep ourself accountable to each other on improving real health outcomes. How about % of chronic disease reversed (as an example)? Let's get hashtag #PROACTIVE! ?? As an example, More than half of the U.S population has Diabetes/Pre-Diabetes, we can change that. ?? Shared how me and my team ATTAC Consulting Group (ACG) can help assess and help drive actions to move outcomes using our unique and comprehensive hashtag #PopulationHealth and hashtag #Transformative approach. ?? It was wonderful to reconnect and meet with so many great people who are working tirelessly to make changes every day. - Laura Garza-Wojciechowski - You made it all work! Incredible to meet you and look forward to more collaborations. - Susan Waterman RHIT CCS CPC CRC - Thanks for introducing me and as always the dynamic optimism in you is inspiring. - Dean Ratzlaff - I totally want to live in the "World of Dean". Can't wait to reconnect! - Rebecca Welling - You are such a humble leader and great to connect with you and your team. - Tom Shankle - Your example of how a Risk Adjustment coding nuance and education helped your family member prevent complications was amazing! - John Barkley - Great way to lead the panels and dropping some wisdom to many on bringing providers and payers together and vendor oversight. - Kevin Barbee Jennifer Eidam Kenneth McNeal, MBA - Go Team ATTAC Consulting Group (ACG). - Amazing to re-connect with all the industry leaders Jay Scholes Austin Bostock, MBA Andrew Anzalone Eric Shapiro ATTAC Consulting Group (ACG) American Association of Health Plans American Heart Association American Diabetes Association ViVega Business Services . . . #Vivega #RiskAdjustment #ManagedCare #starratings #HealthcareLeadership #ValueBasedCare #MedicareAdvantage #RevenueIntegrity #HealthcareWebinar #digitalquality #digitization #ReverseChronicDisease #STAR #Quality #KPI #Transformation #Leadership #Valuebasedcare #v24tov28

It’s a pleasure to work with business leaders and teams driving results, jumping on actions to add value, improve care and effiency in healthcare. Thank you Sunil Nihalani and Inferscience team. Jim Gibson Gibson Consultants

?? Vivega started this summer and client testimonials about the founder and partnerships are already pouring in. ?? Call us! We can help drive results in Value Based Care, Risk Adjustment and STARS . . . #Vivega #RiskAdjustment #ManagedCare #StarRatings #ValueBasedCare #MedicareAdvantage #RevenueIntegrity #RiskAdjustment #MedicareSTARS #QualityImprovement #HCCCoding #DataAnalytics #VivegaWisdom Sunil Nihalani Inferscience

CMS Proposed Rule changes and Enhancements to Medicare Advantage and Medicare Part D were released today for Contract Year 2026 across several areas below. Stay tuned and follow for insights. #interoperability #medicareadvantage #CMS #artificialintelligence ·???????Coverage of Anti-Obesity Medication ·???????Strengthening Prior Authorization and UM Guardrails ·???????Guardrails for Artificial Intelligence (AI) ·???????Ensuring Equitable Access to Behavioral Health Benefits ·???????Promoting Informed Choice through Agent and Broker Requirements ·???????Administration of Supplemental Benefits Coverage Through Debit Cards ·???????MA and Part D Medical Loss Ratio (MLR) Reporting ·???????Medicare Prescription Payment Plan ·???????Improving Experiences for Dually Eligible Enrollees ·???????Formulary Inclusion and Placement of Generics and Biosimilars ·???????Promoting Transparency for Pharmacies and Protecting Beneficiaries ·???????Medication Therapy Management (MTM) Program Criteria ·???????Community-Based Services and Enhancing Transparency of In-Home Full CMS report available here. It's interesting how, in 2025, the new administration will take this from here. https://lnkd.in/eqUEacyq

Some practical gems from the queen of risk adjustment Dawn Carter MHA, CPC, CRC, CPMA, CDEO, CPCO,AAPC Fellow & Risk Adjustment Guru Kirk Shanks. You'll be able to listen to the recording, refer to the deck, and take some insights back to your team from this article. Webinar registrants will get complementary bonus materials, such as checklists of results-producing best practices and references. #results #riskadjustment #starratings #medicareadvantage #OIG #healthequity #VBC Subbu Ramalingam Kirk Shanks Dawn Carter MHA, CPC, CRC, CPMA, CDEO, CPCO,AAPC Fellow

?? Tomorrow’s the Day! Ready to Level Up Your Healthcare Strategy? ?? Join us for our exclusive webinar, “Preventing Audit Risks and Planning Financial Targets on Risk Adjustment” ?? Gain the insights and tools you need to drive impactful results! ?? Nov 15 ? 11 AM EST Don’t miss out on actionable strategies, expert guidance, and new knowledge! ??? Let’s get ready to tackle the challenges of healthcare together. ?? . . . Dawn Carter MHA, CPC, CRC, CPMA, CDEO, CPCO,AAPC Fellow Kirk Shanks Kirsha LLC #Vivega #RiskAdjustment #ManagedCare #starratings #HealthcareLeadership #ValueBasedCare #MedicareAdvantage #RevenueIntegrity #HealthcareWebinar

Join me on 11/15 to review and discuss key insights and actions in the context of challenging times in managed care. I will be joined by two powerhouses ?? Kirk Shanks, CEO of Kirsha, known for delivering unmatched ROI and guiding providers to profitability with his exceptional actuarial and analytical expertise. ?? ?? Dawn Carter, Director of Product Strategy at Centauri Health Solutions, with 30+ years of experience. She’s a thought leader in revenue integrity, encounter management, and social determinants of health. ?? Register Now! https://lnkd.in/eMg6AriU #Vivega #RiskAdjustment #ManagedCare #starratings #HealthcareLeadership #ValueBasedCare #MedicareAdvantage #RevenueIntegrity #HealthcareWebinar

Join and learn from the experts in the industry Dawn Carter MHA, CPC, CRC, CPMA, CDEO, CPCO,AAPC Fellow, and Kirk Shanks. Moderated by Subbu Ramalingam. #riskadjustment #v28 #OIGAudits #Revenue #RAF #STAR

ICYMI: NCQA released the 2024 ratings for 1,019 commercial, Medicaid, and Medicare organizations this week, sparked reflections, validations, and suggested actions. Key Points: - Despite their evolving nature, NCQA/HEDIS standards are crucial in assessing the outcomes for approximately 227 million Americans. - While NCQA's overall ratings don't link to incentives like CMS's Stars, individual measures significantly impact organizations through Medicaid state requirements, CMS star bonuses, and Employer Group Performance Guarantees. - This data can be used to track equity performance, quality, experience, and cost reduction. Some critical macro-level updates on ratings: - Five insurers achieved five stars (three commercial and two MA) in 2024, up from 2 in 2023. - The average score for commercial plans decreased to 3.0 from 3.15 stars in 2023. - There was a slight increase in Medicaid and Medicare plans with 4- and 4.5-star ratings compared to 2023. - Patient experience scores for commercial and Medicare health plans improved, with commercial plans averaging 3.04 stars and Medicare plans reaching 3.29 stars. - However, there was a decline in health plan performance on health equity measures. Key Takeaways: - NCQA's focus on health equity in its Rating methodology aligns with industry-wide efforts to promote equity. - Prioritize digital data collection, organization, prediction, and action. - Educate stakeholders and enhance team skills in digital quality and race-ethnicity language. - Take decisive actions through innovative approaches and organizational alignment. Stay Engaged: Connect with colleagues and advisors to impact 2025 performance and ready your organization for the future. Consider engaging with ViVega's experts for further guidance for actions: www.vivega.co Explore actual data at https://lnkd.in/emnmKwmR. NCQA Health Alliance Plan Population Health Alliance American Diabetes Association The Chamber of Commerce for Greater Philadelphia

The Medicare Star Rating Plan Preview 2 season is upon us. It is critical for health plans and related teams. The pressure can be high with millions of dollars and reputation at stake. Here are five important reminders to help navigate this challenging period: - Back your team: Supporting your team is crucial during this demanding period. Ensure you have the correct narrative to motivate and guide them effectively. - Keep executing: Focus on what you can influence now to shape future star ratings positively. - Be willing to invest: If necessary, consider investing more resources to make a significant impact. It's important to prioritize where it matters most. Innovate and obsess: Continuously innovate and fulfill your members' needs—Obsess over providing the best service possible. Stay focused: As highlighted in the second point, maintain your efforts on execution. Consistency in your actions is key to achieving success. Navigating the Medicare Star Rating Plan Preview season requires dedication, strategic thinking, and a cohesive team effort. By following these reminders, you can help ensure a successful outcome for your health plan. #Medicare #Healthcare #StarRating #Teamwork #STARPP2