Doug Duskin

Great defense of “private equity medicine” from former CMS administrator Leslie Norwalk. Though few clinicians fully understand it, PEM has become a popular bogeyman for a wide range of complaints about US health care. A few key takeaways: ·      All health care organizations require working capital. They should be judged on their behavior, rather than their source of capital. ·      Pushing health care organizations to more expensive sources of capital (e.g,, high interest loans) doesn’t serve anyone’s interests (except the banks). ·      The financial successes of private equity-backed companies accrue to everyone with a 401K or a mutual fund, not just a small number of wall street elites. ·      Reducing competition in health care (based on investment class) only accelerates market consolidation by integrated health systems, and the higher prices that come with it.

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Really interesting article. ASC operations are proving crucial for the successful adoption of value-based payment systems and evolving healthcare as we know it. Strong operational foundations inherently lead to economic success and greater flexibility in adopting new care models, which in turn improves patient outcomes. #ASCs #Healthcare #PatientCare

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This industry report includes my thoughts on the growing PE traction in a buoyant, recession-proof sector, which is healthcare! https://lnkd.in/gFgm4eEv

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Check out this quick and insightful review of the latest updates from CMS, brought to you by the #Michigan Health & #Hospital Association (MHA)! 🚑📊 The proposed #Medicare 2025 Outpatient Prospective Payment System rule includes a net 2.3% increase, new service additions, the adoption of three measures related to health equity and more: https://lnkd.in/gS8rTHEr #HealthcareUpdates #CMS #Medicare2025 #MHA #OPPS

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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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Please join my colleagues James Rountree and Marc Johnson as they provide their perspectives and recommendations for recovering from a cyber breach. With so many organizations in the healthcare space impacted by breaches, understanding how to protect your organization and steps to take when the inevitable happens is crucial. #ScottsdaleInstitute

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When implementing change, don't get bogged down by the 30% who resist. Instead, leverage your early adopters - the 20% who embrace change - to influence the undecided 50%. Their enthusiasm can be contagious! What strategies have you used to engage your change champions? Our recent blog post offers some ideas. https://bit.ly/3zdKcUW #ChangeChampions #LeadershipStrategy #HealthcareInnovation

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Employee engagement is key to improving patient experience. When healthcare staff feel valued and engaged, they deliver better care. Can you spot levels of engagement? We can show you how to spot the levels of engagement and how to coach individuals to improve engagement. https://lnkd.in/g68wfJ8g #PatientExperience #EmployeeEngagement #HealthcareCulture

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Program Audit season is over. Join our webinar to hear all about what CMS is focusing on. If you haven’t done a mock audit now is a great time to do one and incorporate our lessons learned.

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Several recently published articles discussing human services portfolio management really resonate. I liked the three Open Minds options for evaluating the viability of each program - keep, fix, close. Rigorous portfolio management is a key to high performing providers and networks demonstrating value. One important topic missing from each of the articles is how to manage the response to and the emotion of program closure. Simple advice for an executive preparing to announce a closure is to brace yourself. Perhaps brace is not a strong enough term - better and more adequate a phrase is 'know your reasons, ensure they relate to your mission and go forward with resolve'. In most cases, the world does not respond positively when providers close programs, and the teams managing the closure underestimate this element of the process. Communities often believe human service providers and hospitals should maintain and expand all services, seldom sympathetic to viability concerns, and even less, portfolio management. It is one thing to manage responses from concerned recipients and a workforce feeling jilted, but teams should also be prepped to address and respond to incensed community members, skeptical state/federal regulators as well as the media's spin on the decision. Realistically, mission-driven agencies focused on strengthening long-term sustainability will be required to close programs at some point, and often the reasons given for closure (regardless how logical) will be challenged by key stakeholders. Preparing yourself and your team, for this element in the closure process and having a solid tailored communication plan in place will ensure it doesn't catch you by surprise and leave you reeling when it happens.

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CFO's are facing mounting and growing pressure in meeting cash flow targets. In a survey of over 75 CFO’s in the hospital realm, the focus is on rebuilding cash reserves post-pandemic by cutting costs and increasing revenue through service line management. These efforts are often mired in difficulties – from payment vulnerabilities to high denial rates, to underpayments, to resource gaps – and more. So the question really is – what can be done to help position our healthcare systems, something vital to the survival of our country – in a better way, and bypass some of these challenges? In the marketplace, we’ve managed to put together a comprehensive solution package under Healthcare Evolution Group, with help for nearly every issue presented in this article. - PERC’s – with no upfront cost, we create brand new revenue at margins hospital systems can not create themselves. Our services also help with another cost issue – retention and turnover – doctors are fulfilled and happy with the work they get to do, versus the work they have to do. - CareLync – whereas normal current process is cumbersome and leads to only 5% engagement with minimal economic uplift ($100-200/patient/year on 5% engagement) our SaaS software streamlines the intake, sends the right info to CMS, is done as a PPPM, and creates 35-80% engagement with a $3000/patient/year lift. - We partner with a group that helps hospitals recover medical underpayments plus creates an expectation with the carriers to improve the denial rates. - Also, we have bill collection solutions that are far more efficient than the norm, some with an empathetic, compassionate touch. The trend, according to the article is that “81% of survey respondents expecting to integrate AI within three years” - We work with a group that saves hospitals 20-35% on their major medical and ancillary insurance premiums while increasing benefits – meaning better recruiting and retention, as well as major bottom line savings with no disruption upfront. - We help aid in combatting the increasing costs of Rx and behavioral health. - We work with companies that help find cash flow or hidden overpayments or costs that can be reduced after a complimentary audit and examination. Why does this matter? See the comments to understand how all this savings REALLY factors in:

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There’s a substantial difference between being a software vendor and a true solution partner. Software vendors sell you a tool, provide a help desk, and offer basic support—but their focus is on transactions, not on helping you achieve your broader goals. They’re in the business of selling software. Solution partners, however, focus on empowering you to achieve your long-term objectives. Yes, we provide software and tools—but our support goes far beyond that. Software doesn’t assist you in divesting or acquiring facilities. Software doesn’t pivot with agility when a cyber event occurs. Software doesn’t onboard and train your new team members. Software doesn’t understand your goals or help you leverage data to advance them. Software vendors struggle to support health systems through the inevitable ups and downs. But solution partners make the hard things easier. Great people make things easier. Partners make it easier. Health systems that partner with companies like Ludi, Inc. - Provider Compensation Management and our team of dedicated physician compensation experts, gain confidence in knowing that no matter what challenges arise, they have a committed partner ensuring their physician enterprise is supported, and physicians are paid fairly and accurately. https://lnkd.in/g_5ukEaQ

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Accelerating MMIS Implementation with Newgen Software: GHIT Digital POV The Medicaid Management Information System (MMIS) is a vital platform that automates and manages the Medicaid program lifecycle. It ensures smooth administration of Medicaid services, from claims processing and beneficiary eligibility to provider management and compliance reporting. MMIS integrates business workflows with advanced technology to improve operational efficiency, maintain compliance with Centers for Medicare & Medicaid Services (CMS) regulations, and deliver better outcomes for Medicaid beneficiaries. Challenges in MMIS Implementation - While the vision for MMIS is clear, execution faces hurdles: - Complex Business Rules: Customization for state-specific Medicaid programs. - Regulatory Overload: Adapting to evolving CMS requirements and audits. - Legacy System Integration: Ensuring interoperability with outdated platforms. - Scalability: Managing the increasing volume of claims and beneficiaries. GHIT Digital, in partnership with Newgen Software, addresses these challenges with the NewgenOne Platform. This AI-powered, Low-Code, and Modular platform is perfectly aligned with the modern MMIS architecture and provides the tools necessary for efficient implementation and long-term success. Call to Action For Medicaid agencies, Managed Care Organizations (MCOs), and other stakeholders, GHIT Digital and Newgen Software offer the expertise and technology to revolutionize MMIS implementation. Connect with Monika Vashishtha, President of GHIT Digital, to schedule a personalized demo of the NewgenOne Platform and see how it can transform your MMIS deployment. MonMass, Inc. (the legal name of GHIT Digital) will work on your strategic IT Projects or Consulting requirements (NAICS codes 541511 / 541512 / 541330 / 541618). Feel free to call at 646.734.6482 or write to me at [email protected] for no obligation discovery conversation. You are welcome to share your RFPs/RPQs for us to review and respond on time. Click the Pic below to read the rest of the POV.. https://lnkd.in/eniSWN-e

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Purchased services are vital to healthcare, but they can also become financial drains if not managed properly. A mature purchased services strategy includes insight into all expenses, reduction in unnecessary variation, and prioritized patient care, outcomes, and experience. By focusing on these areas, health systems can lower costs, improve clinical care, and enhance patient experiences. Learn more in Advantus Health Partners article about how to create a mature purchased services strategy: https://lnkd.in/g4UwCjCW #HealthcareSupplyChain #ValueBasedCare #SupplyChainManagement

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Check out the latest on cybersecurity and how to recovery from a breach! #IAImpact

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Exciting times at 4C Digital Health! Wilmington, Delaware - 4C Digital Health (4C), the preeminent organization delivering independent financial oversight and control solutions for self-funded employee health plans, recently announced the strategic expansion of its services into the Commonwealth of Kentucky. In late 2023, 4C successfully competed for an initial award issued by Kentucky’s Department of Employee Insurance, and Kentucky has since extended the initial contract to allow 4C to continue its important work on behalf of the Commonwealth, its employees, and its taxpayers. The Kentucky Employee Health Plan (KEHP) serves more than 288,000 members, which amounts to 1 in 16 Kentuckians. In addition, KEHP spends over $1.8 billion dollars in total healthcare benefits on behalf of its members per year and covers over 8.2 million claims per year. KEHP objectives include “improving employee health and well-being” and “providing state-of-the-art benefits while maintaining reasonable premiums.” Recognizing its important fiduciary responsibilities to its employees and its state health plan, the Commonwealth of Kentucky enacted Senate Bill 42 (2023) introduced by Senator Stephen Meredith for the purpose of ensuring that critical health plan dollars are being spent properly on behalf of state employees. The legislation requires that 4C analyze 100% of medical claims submitted for payment to KEHP; identify erroneous overpayments; and identify inappropriate or erroneous fees imposed by KEHP’s third-party administrator. Ron Templeton CEO of 4C Digital Health stated: “4C Digital Health is grateful to the Commonwealth of Kentucky for recognizing the fiduciary responsibility that state and local governments have to their employee health plans and for the opportunity to provide our services in support of this mission. We appreciate Kentucky’s goal of using 4C’s expertise and innovative solutions to improve healthcare outcomes and reduce healthcare costs for the Commonwealth, its employees, and its taxpayers.” About 4C Digital Health: 4C Digital Health (https://lnkd.in/eB-fJg4X) is a healthcare data analytics company that was founded for the purpose of developing a disruptive technology targeted at bringing transparency and honesty to the healthcare marketplace.

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