David Bjork

🏥 Healthcare Providers Can Get Reimbursed for AI/ML Solutions   At this week’s MI10 Presents: AI for Healthcare event (https://www.mi10.ai/), Anthony Chang, MD, MBA, MPH, MS (CIIO of CHOC) presented examples of how healthcare providers who embrace innovation can unlock not just better outcomes—but meaningful reimbursement and payment. Dr. Chang showcased compelling examples of AI use cases driving ROI across operations, clinical decision-making, and revenue cycle management. From predictive analytics to workflow automation, it's clear that AI isn’t just a tech initiative—it’s a strategic asset.   These mechanisms offer providers a way to recover the costs of innovation while accelerating better care.   📈 Reimbursement pathways such as: * New Technology Add-on Payment (NTAP) * HCPCS C-codes and Temporary APCs * Category III CPT codes (with local MAC coverage)   Reach out or drop a comment if you want to learn more!   Big thanks to: Anthony Chang, MD, MBA, MPH, MS, Arlen Meyers, MD, MBA, Madhavan Parthasarathy, Society of Physician Entrepreneurs and Medical Intelligence 10 (MI10)   #AIinHealthcare #DigitalHealth #HealthcareInnovation #HealthTech #ValueBasedCare

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The 5-Minute Medicaid Compliance Shortcut for Healthcare Execs ⚠️ Ever feel like your compliance processes are a ticking time bomb? OBBBA’s new rules are here—and they’re brutal: Annual Medicaid redeterminations Work requirements Heavier reporting And oh yeah… zero room for error. Manual processes? They’re costing you money, risking denials, and leaving you exposed to audits. ✅ THE FIX:  The 3-Part Medicaid Compliance Checklist (That Takes 5 Minutes to Use) Copy. Paste. Audit-proof. Part 1: Automate Eligibility Checks Utilize real-time verification tools that run continuously in the background. Prevent patient loss due to lapsed coverage & unnecessary denials. Part 2: Build an Audit Trail on Autopilot Is every Medicaid interaction logged automatically? Yes, please. Utilize systems that generate audit-ready logs as you proceed (eliminating manual entry nightmares). Part 3: Monitor in Real-Time (Or Get Blindsided Later) Set up dashboards that track compliance KPIs weekly. Flag issues before the regulators do. 🧠 Why This Works: Cuts risk by automating your weakest points. Saves staff hours of admin time every week. Proves to leadership that you’re not reacting—you’re leading. 🚀 WANT THE REST OF THE SYSTEM? This is just one piece of the puzzle. 💬 Book a 30-minute Strategy Session and get: A full modernization roadmap Funding options for implementation Priority upgrades that boost revenue + compliance fast 👉 Schedule Your Call

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Thank you Sarah Moors from Digital Health Insights for taking a deeper dive into the patient privacy ramifications of CMS's new "Make Health Tech Great Again" initiative. Healthcare organizations must still protect data privacy. The HIPAA rules are still in place. I love these specific take aways from your article. 😳Many consumer health apps fall outside HIPAA protections, meaning sensitive patient data could end up sold to advertisers or used in ways patients never intended.  😳This is a test of responsibility. Access to richer patient data could enable more personalized AI tools and remote monitoring, but companies that cut corners on privacy could face regulatory backlash and consumer rejection.  😳Can the administration balance innovation with protection for vulnerable populations? Read Sarah's entire article here. #patientprivacy #dataprivacy #interoperability #makehealthtechgreatagain Stephanie Kindlick Anthony Murray Hassan F. Abdallah JD, CHC, FACHDM Jillian Schmitt Moliehi Weitnauer Angela Rose, MHA, RHIA, CHPS, FAHIMA https://lnkd.in/gvhrRzat

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🚨 New CMMI model drop: ACCESS (Advancing Chronic Care with Effective, Scalable Solutions). This is one of the clearest signals yet that CMS is serious about scaling technology-supported chronic care in Original Medicare via outcome-aligned payments. A few early takeaways after an initial read: 📈 Big idea: recurring Outcome-Aligned Payments (OAPs) tied to measurable improvement/control (vs. paying for discrete activities/devices). 📊Initial clinical tracks are pragmatic and “volume ready”: early CKM (HTN/lipids/weight/A1c), CKM (diabetes/CKD/ASCVD), MSK chronic pain, and behavioral health (depression/anxiety). 📅 Timeline: model runs 10 years starting July 1, 2026; applications opening January 1, 2026. 🩺 Integration with primary care is baked in: co-management payment for coordination (with no copay!), required electronic updates to PCPs/referrals and HIE connectivity. What we’ll be watching for as CMS releases the Request for Applications / additional implementation detail: 💲 How OAP rates & risk adjustment are set (by track, severity, rurality, etc.) and how thresholds “ratchet” over time (especially after first year of enrollment during 'maintenance' period). 📊 Measure definitions & guardrails: baseline capture, allowable data sources (claims vs. device vs. EHR), PRO requirements, and how CMS handles missingness/gaming. 🙋 Patient enrollment mechanics: referrals vs. self-enrollment, multi-track participation, disclosures, and operational impact of control group assignment for evaluation. ⚖️ Intersections with ACOs & other risk models: especially the stated transition where OAP spending begins to flow into ACO benchmarks/performance calculations starting 2028. ↔️ What this means beyond FFS: how payers may align using CMS-provided implementation resources, and what “ACCESS-like” looks like in MA/Medicaid contexts (no MA to start). 🧑‍💻 How will the non-Medicare enrolled tech-enabled health care providers participate - will they seek to enroll directly as a Part B provider/supplier or contract with existing entities? If you’re a provider, digital health org, MA plan, Medicaid leader, or ACO thinking about what performance based, tech-enabled care actually requires operationally—this model is worth a close read. Manatt Health will be publishing a full summary soon. Samantha Spear, Randi Seigel, Mandy Cohen, Christina Farr, Tom Cassels, Joshua Tauber, Amy Hunsberger https://lnkd.in/eKcZ3fPt

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📊New HPC DataPoints! The Primary Care Payment Gap: Paying Less for What Matters Most High-quality, accessible primary care is foundational to an effective and efficient health care system. In Massachusetts, however, this foundation is fracturing as primary care represents a declining share of health care spending. One of the root causes of these access, affordability, and workforce challenges is a payment structure that does not reflect the value of primary care. In comparing the relative commercial prices for primary care services to common specialty services, the HPC found that the average commercial payment for a composite of specialty services is 3.3 times as high as the average payment for an evaluation & management visit representing the same amount of work time (30 minutes). This means that, on average, the specialty procedures can generate more revenue in three hours than a primary care physician receives for a whole day of patient care.  ➡️Read more and explore the data: https://lnkd.in/ekA5shJD #PrimaryCare #HealthPolicy

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What does it take to run high-performing quality reporting across 240+ practices, 1,500+ providers, and 70+ EHRs? Tufts Medicine’s Wellforce ACO faced one of the most complex data environments in healthcare: fragmented documentation, inconsistent measure logic, and growing CMS pressure to transition to eCQMs. Instead of adding more dashboards or increasing manual effort, Tufts focused on building a unified, clinically trusted quality data foundation designed to support scale, regulatory rigor, and real population health insights. That foundation enabled Tufts Medicine’s Wellforce ACO to: - Standardize and normalize data across 70+ EHR systems and 240+ practice sites - Transition from a web-interface, Medicare-only reporting model to eCQM-based, all-payer, all-patient reporting with confidence in measure accuracy - Reduce administrative burden for clinicians, IT, and quality teams - Gain accurate network-wide visibility into performance at the payer, practice, provider, and patient level - Unlock millions in shared savings without adding documentation at the point of care This was about more than just meeting CMS requirements. It was about creating an infrastructure that supports long-term success in value-based care. In our upcoming webinar, leaders from Tufts Medicine’s Wellforce ACO and ReportingMD walk through how this transformation came together and what other ACOs, CINs, and health systems can learn from their journey. Register for the webinar to learn how Tufts Medicine’s Wellforce ACO moved from data fragmentation to scalable, high-performance quality reporting: https://hubs.ly/Q042Smn40

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BREAKING NEWS CompassPoint Health Announces Release of Emergency Alert System 12 July 2025 - SACRAMENTO, CA CompassPoint Health, a leading California Healthcare Technology company, announced the release of the nation's first universal Emergency Alert System, cPAL™ (CompassPoint Alert), utilizing its groundbreaking SmartBracelet EHR™. cPAL™ allows Pediatric Patients to initiate and send the equivalent of an AMBER ALERT, in the case of an abduction or personal emergency - Alerting Parents and other family members, as well as local and state Law Enforcement Agencies, instantly. It can typically take hours, and sometimes days until a full Amber Alert is issued. "We are honored today to announce our Public Safety Solution addressing the needs of abducted children in the United States, and providing a robust and scalable technology to dramatically improve response times, and increase the likelihood of locating and recovering victims," stated Founder and CEO Gary Brant. "Working shoulder to shoulder with Local and State Law Enforcement Agencies, our cPAL™ System is an adjunct to our Medical Emergency framework already in place and working for our Patients," stated Brant. Interested parties may contact CompassPoint Health by voice or text at: (916) 964-2767 #amberalert #abduction #police #statepolice #medicalemergency #firstresponder #patients #victims #childsafety #publicsafety #pediatric #pediatricpatients #children #emt #kidnapping

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Care Coordination is becoming the cornerstone for improving patient outcomes while reducing costs. Read the full blog to learn why agencies and community partners must embrace innovative models that prioritize continuity, clear communication with patients, and real-time data sharing: https://lnkd.in/gdZN4Z6E Learn more about our modern Care Coordination solution that connects systems, automates workflows, and puts patients at the center of care: https://lnkd.in/gdCS8x9q #CareCoordination #HealthTech #DigitalHealth #HealthcareInnovation #PatientExperience

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At Cedar’s Financial Leadership Council, I spoke with Scott Kupor — formerly of Andreessen Horowitz — about what’s next for healthcare finance. Scott offered a cautiously optimistic outlook: In an era of tighter budgets and workforce strain, resilience will come from bridging markets, innovation, and policy. The key takeaway? AI’s deflationary power could help make healthcare more sustainable over time. Progress will come not from quick fixes, but from bold leaders willing to take calculated risks.

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Agentic AI is already reshaping healthcare. Modern Healthcare is reporting that many in the field are already seeing agent-based tools quietly transforming RCM, patient engagement, and clinical research. These are functional, scalable systems unlocking time, revenue, and operational lift in the background while clinicians stay focused on care. At Sohar Health, we believe this marks the beginning of a new infrastructure layer. One that lets healthcare teams automate the noise and innovate patient outcomes. 📖 Full article: https://lnkd.in/edeG86px  #AgenticAI #DigitalHealth #HealthcareInfrastructure #RCM #SoharHealth #HealthcareInnovation

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An effective #healthcare investment strategy requires a nuanced understanding of the sector that goes beyond conventional metrics. Lisa Suennen, an accomplished venture capitalist with over 35 years of experience in healthcare, highlights this perspective in a recent interview with HLTH Inc. In her interview, the amazing Lisa: * challenges the notion that high #valuations are the primary indicator of a company's success. She argues that the focus on "unicorn status" can be misleading and that the only valuation that truly matters is the one achieved at exit. Instead of prioritizing valuation, she suggests that investors and entrepreneurs should focus on the #quality and #sustainability of the business itself. * points to the misconception that the most significant healthcare #innovations originate solely from the U.S. Lisa knows that great technology and ideation can be found #globally, and investors who broaden their perspective are likely to discover valuable opportunities outside their usual geographic focus. * advises against underestimating the role of inertia and the importance of economic #alignment in #healthcare, noting that these are critical diligence items often overlooked in favor of scientific or technical advancements. * emphasizes the value of #diverse #teams, encouraging investors not to overlook CEOs who may not fit a traditional mold and to be wary of management teams that lack diversity in thought, skills, and background. At Nina Capital, we are fortunate to have Lisa as long-time advisor and supporter to our efforts to improve healthcare. Shaped by a career spanning venture capital, entrepreneurship, and executive roles, her insights inform and mirror our data-driven and principled approach to healthcare investment. Read more at: https://lnkd.in/d3AZUckY #wearenina #healthcare #venturecapital #healthtech #digitalhealth

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Episode 2 of KLAS in Session: Ambient Speech-Real Impact, Real Outcomes features Mac Boyter taking a closer look at vendor differentiation - from technology to support models - and what providers say really matters. New episode drops September 18. Stay tuned. #KLASinSession #AmbientSpeech #VendorStrategy #HealthcareIT #KLASResearch #HealthTechPodcast

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Are your users prepared for their next workflow change? Where do users turn to for help? At Fairview Health Services, informatics leaders and education leads moved beyond one-time training to asynchronous, workflow-embedded learning designed for continuous change. As Dr. Bryan Jarabek, CMIO at M Health Fairview, puts it: 🚒 “It’s not like drinking through a fire hose anymore.” This approach has strengthened clinician trust and driven steady EHR satisfaction gains over the last seven years. 🎧 Hear how in this Becker's Healthcare Podcast episode: https://ow.ly/HSCj50YuVyu #CMIO #ClinicalInformatics #HealthITLeadership #ClinicianExperience #uPerform #BeckersHealthcare

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Revolutionizing healthcare with AI! @MassGeneralBrigham is expanding Care Connect to tackle physician shortages. Accessible to all insured residents in MA & NH. #AIHealthcare #InnovativeSolutions #PrimaryCare #HealthTech #DemandNexus 🏥💡🤖 Demand Nexus https://lnkd.in/dXS5psTb

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Why Big Consulting Companies are Bad For Hospital Bottom Lines 1- Focus on selling and pushing software as the panacea to solving problems, enhancing processes, and bettering outcomes. While I support the use of AI software applications, software is only as good as the people and the processes around the use of software. 2) Creating software and then convincing the client that they have a problem that the software can solve 3) Constantly trying to "upsell" the client on other services to perpetuate their high monthly fees, maybe on services that may not necessarily be needed or prioritized C-suite: If you are considering licensing CDI software, consider the following: * Before spending millions on CDI software, relying on the salesperson promising you even more millions in revenue, you must update current CDI processes that are not intended or designed to address widespread inefficiencies in physician documentation. Present-day CDI processes focus on only one tiny piece of the record, consisting of capturing diagnoses that impact reimbursement. Little to no effort is spent on helping physicians discover and become more proficient and highly efficient at charting and communicating in the EHR. As a result, providers continue their poor documentation practices, contributing to costly ongoing self-inflicted payer denials consisting of medical necessity, DRG downgrades, and clinical validation that are challenging to overcome. My advice- be wary and suspicious of salespeople pushing their CDI consulting services and expensive software, promising you millions in additional revenue. Case in point, one prominent CDI consulting company pushing its software asserted that if you buy our software that enhances CDI efficiency, pinpointing cases to query for a CC/MCC, you will achieve four million dollars systemwide. The fact is that the hospital system may be generating more CDI queries, but its clinical validation denials have skyrocketed as a result. Remember, just because you billed for a DRG does not mean you are going to be paid for the DRG/ What matters most is net patient revenue, not gross dollars. You cannot pay hospital obligations with gross revenue. Caveat emptor #hosptialconsultingcompaniersaregenerallybadforthe bottonline, #promiseyoutheworld, #doanyhringforasale https://lnkd.in/eBmkzJbS

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The future of healthcare operations is more strategic and deliberate than you might think. A new NelsonHall analysis offers some surprising updates on the payer industry. 𝟭. 𝗣𝗿𝗮𝗴𝗺𝗮𝘁𝗶𝗰 𝗔𝗜 𝗶𝘀 𝘄𝗶𝗻𝗻𝗶𝗻𝗴: Generative AI adoption is focused on "Quick Wins" and proven ROI for tactical, high-value applications like claim classification or call summarization. 𝟮. 𝗔 𝗴𝗿𝗮𝗱𝘂𝗮𝗹 𝗶𝗻𝘁𝗲𝗴𝗿𝗮𝘁𝗶𝗼𝗻 𝗶𝘀 𝘁𝗵𝗲 𝗰𝗵𝗼𝘀𝗲𝗻 𝗿𝗼𝘂𝘁𝗲: Organizations are stabilizing core systems by layering automation and analytics on top of existing platforms. 𝟯. 𝗧𝗵𝗲 𝗯𝘂𝘀𝗶𝗻𝗲𝘀𝘀 𝗺𝗼𝗱𝗲𝗹 𝗶𝘀 𝘀𝗵𝗶𝗳𝘁𝗶𝗻𝗴: We're moving away from traditional volume-based metrics to outcome-based engagement, where success is seen in things like the quality of member experiences. Get all the insights in the latest report, where 𝗫𝗕𝗣 𝗚𝗹𝗼𝗯𝗮𝗹 𝗶𝘀 𝗻𝗼𝘁𝗲𝗱 𝗮𝘀 𝗮 𝗟𝗲𝗮𝗱𝗲𝗿 𝗶𝗻 𝗡𝗲𝗹𝘀𝗼𝗻𝗛𝗮𝗹𝗹’𝘀 𝟮𝟬𝟮𝟲 𝗡𝗘𝗔𝗧 𝘃𝗲𝗻𝗱𝗼𝗿 𝗲𝘃𝗮𝗹𝘂𝗮𝘁𝗶𝗼𝗻 𝗳𝗼𝗿 𝗛𝗲𝗮𝗹𝘁𝗵𝗰𝗮𝗿𝗲 𝗣𝗮𝘆𝗲𝗿 𝗔𝗴𝗶𝗹𝗶𝘁𝘆 𝗮𝗻𝗱 𝗜𝗻𝗻𝗼𝘃𝗮𝘁𝗶𝗼𝗻. 𝗥𝗲𝗮𝗱 𝘁𝗵𝗲 𝗿𝗲𝗽𝗼𝗿𝘁 - https://lnkd.in/dGFUqFzt #Healthcare #PayerIndustry #AIinHealthcare #DigitalTransformation #NelsonHall

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🚨 ShiftMed is now a Strategic Business Partner of the Massachusetts Health & Hospital Association (MHA). We’re thrilled to announce this collaboration, connecting MHA member hospitals and health systems with ShiftMed’s AI-driven workforce management platform, giving them access to innovative, data-backed workforce optimization tools and the nation’s largest flexible network of credentialed clinicians.

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