Paul Joiner

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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Epic Systems’ recent move to back the TEFCA medical records exchange is interesting. On the surface, it’s all about creating a seamless flow of patient data across hospitals, QHINs, and all relevant stakeholders. But let’s be real—data is the oil of the new economy, and interoperability is the pipeline that delivers this precious resource to all the right stakeholders. By aligning with TEFCA, Epic might just be positioning itself as the refinery. All in all, this is a welcoming move by Epic Systems—especially if it really is as straightforward as they make it sound. But given the lack of details, one has to wonder if there are any hidden catches. After all, when it comes to something as valuable as healthcare data, it’s wise to look out for the fine print. Let’s hope this is genuinely about improving patient care. https://lnkd.in/gDdDCcmj

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In CTN's episode,"Optimizing Healthcare IT for Enhanced Patient Care and Efficiency," Jeremy Meller, CIO of Children's Healthcare of Atlanta, shares an innovative approach to enhancing patient care through strategic data analytics and operational expertise. Jeremy’s organization implemented a top-down strategy, starting with leadership, to optimize their structure across the care continuum and reduce silos. By bringing in an expert with strong operational knowledge and data analytics skills, they built a strategic data asset focused on access analytics. This collaboration allowed them to visualize and understand operational dynamics, enabling more efficient operations from a unified playbook. For those passionate about transforming healthcare with technology and data, this episode offers valuable strategies and insights. Watch the latest episode of #CTN for more! https://zurl.co/rnUo #HealthcareIT #DataAnalytics #PatientCare #CTN #DigitalTransformation #OperationalExcellence #HealthcareInnovation

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Find out how real-time data sharing is empowering providers to deliver more personalized care experiences.​ Avaneer Coverage Direct​: - Provides immediate hard savings from improved administrative efficiencies and reduced denial rework​ - Reduces write-offs​ - Eliminates retroactive prior authorizations​ - Improves regulatory posture (No Surprises Act)​ - Improves patient financial experience and patient retention​ - Lowers clearinghouse costs​ Transform your revenue cycle workflow. Sign up for a demo here​ https://hubs.li/Q02PpRTb0 #HealthcareTransformation #DataDrivenCare ​

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NEWS ALERT- CMS has finally released the 2023 MSSP results. The results provide tremendous insight on the ACO landscape, risk adjustment, and value based care. Here are some numbers: Thanks for reading. Help us get the word out by smashing the like button, sharing the post, or commenting. Key stats -453 ACOs with data released -69% of ACOs achieved shared savings -$3.08 billion dollars in shared savings payments to organizations -The top 10 organizations with the most savings racked up $631M, or 20% of all savings. -Average risk score for the top 10 organizations with the largest savings in pure dollars (not adjusted for ACO size) was 1.137 -Average risk score for the top 10 organizations with the largest savings per beneficiary was 1.379 -75% of organizations with a risk score above 1.00 had shared savings. Only 65% of organizations with a risk score below 1.00 had shared savings. -78% of the largest 100 ACOs by size had savings while only 64% of the 100 smallest ACOs had savings. CMS noted "ACOs led by primary care clinicians had significantly higher net per capita savings than ACOs with a smaller proportion of primary care clinicians. These results continue to underscore how important primary care is to the success of the Shared Savings Program." This makes sense because primary care is such a critical driver in overall patient care success and in accurately reflecting risk scores. There is a LOT more to dig into. My main takeaways are: 1) Primary care participation is a driver of success 2) Risk scores are a critical component of success and organizations in risk should have outpatient CDI programs and strong compliance programs 3) Larger organizations may have more resources and infrastructure to build scale for success Let's talk more about this. What do you see in the data? What is your experience with your ACO? https://lnkd.in/erjc-peV

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🔥Really big news out of Centers for Medicare & Medicaid Services right now with their plan for payments from the government to MA plans expected to increase on average by 4.33%, or over $21 billion, from 2025 to 2026, as proposed. 📰 The news is much needed as Medicare Advantage has faced two years of flat reimbursement growth from CMS that has Humana down 43% in the last year along with CVS Health down 44% that leaned into MA last year. 💵 Humana is up big (4.5%) in after hours trading along with UnitedHealth Group up 2.5% as they UNH is the largest Medicare Advantage provider with over 7.8 million lives (3 million pdp) while Humana is second with 6.2 million lives (2.3 million pdp/8.5 million total). CVS Health is up 2% in after hours trading as well which is a nice shift for them. ⬇️ Medicare Advantage was one of the hottest lines of business in healthcare but over the past 6 quarters seniors have experienced high utilization post COVID, reimbursement was starting to slow as there was a 5.0% increase in 2023, 3.32% in 2024, and 3.7% for 2025. This 4.33% increase is a big unexpected tailwind for Medicare Advantage providers. UnitedHealth Group, Humana, CVS Health, Elevance Health, Kaiser Permanente and Centene Corporation are the largest providers of Medicare Advantage in the US so this will be good news headed into the weekend! Nice little shot in the arm for HCSC which is expected to close on the 600,000 member Medicare Advantage business from The Cigna Group in Q1! Interested to hear comments this week J.P. Morgan Healthcare Conference in San Francisco #healthcare https://lnkd.in/g2qZTaxM

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As 2024 concludes, healthcare leaders have gained critical insights amidst rapid advancements and challenges. Here's a glimpse of the year's key lessons: 🔍 Data as a Strategic Ally: Harnessing real-time analytics transforms operations and patient care. 💻 Telehealth’s New Era: Virtual care isn't just an option—it's expected. 🩺 Workforce Resilience: Supporting staff well-being is pivotal for quality care. 💡 Personalized Patient-Centered Care: Building trust through tailored approaches ensures loyalty and satisfaction. 📜 Adapting to Regulations: Proactive compliance safeguards growth and quality. 🚀 Tech Integration: Innovations like AI show promise but demand careful execution. 💰 Value-Based Care's Rise: Aligning rewards with patient outcomes reshapes operations. As we step into 2025, the focus remains on resilience, innovation, and care. These takeaways set the stage for a robust and adaptable future. What 2024 lessons resonate most with your healthcare journey? Let’s connect and discuss! #HealthcareLeadership #InnovationInCare #2024Lessons #FutureOfHealthcare

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Simplify financial management with PointClickCare's Marketplace! 🌟 Oaks Senior Living, Presbyterian Communities of South Carolina, and Cambridge Healthcare Services, LLC transformed their workflows by integrating TransactCare with PointClickCare’s EHR. The results? ✅ Seamless data flow ✅ Reduced manual entry ✅ Improved payment tracking Learn more about the power of integrated solutions: https://bit.ly/3ZqowiA #HealthTech #SeniorCare #Efficiency

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In its latest report, Gartner® notes that "healthcare provider CIOs can craft value narratives to accelerate initiatives and enhance strategic influence.” We feel this comprehensive report provides valuable strategies for crafting compelling value stories that align IT with enterprise goals and showcase your role in advancing key initiatives like implementing a new EHR. Don’t miss out on this opportunity to gain actionable insights that can elevate your IT strategy and influence within your organization. 📥 Get the report: https://bit.ly/3Bv70QZ

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Tornado chart.. Tornado chart.. Tornado chart.. Check out this dynamic, interactive dashboard that enables healthcare providers to analyze patient`s costs from provider perspective. Utilizing the add-in featured tornado chart, we can effortlessly compare incurred costs Vs charges. The tornado chart allows for real time parallel comparison between costs and charges among different patient age groups or different diseases. Applying business intelligence in healthcare.. #healthcare #healthcaredata #datanalytics

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The CMS Innovation Center (CMMI) announced the Transforming Episode Accountability Model, a proposed mandatory episode-based bundled payment model, is slated to begin in January 2026. It is among a list of alternative payment models supporting CMS's goal to have all Medicare beneficiaries in an accountable care relationship by 2030. The five-year model structure marks significant changes from previous versions and reflects how the approach to bundled payments is evolving.

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PSA from Anne Snowdon: if you're looking to connect analytics to outcomes, our AMAM model is how you do it. Here's a quick primer from her on how the model helps you measure the full value of your tech in improving patient outcomes. Get started on your digital transformation journey: https://bit.ly/3LCwQEN

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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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From modernizing codesets and #USCDI v4, to ePrior Auth and bulk #FHIR data, the #HTI-2 rule builds on #ONC’s prior efforts to improve processes across #payer, #provider, #publichealth, and more. While the use cases are wide ranging, the entire industry benefits from improved #quality and access to #healthdata. Great news for Tenasol, as we process #clinicaldata of all shapes and sizes, so we are excited to see ONC’s continued efforts to raise the bar for #healthIT and #interoperability.

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In our work with health systems and revenue cycle teams, we noticed a gap. Providers don't have an objective tool to measure what "good" looks like when it comes to the patient financial experience. So, we're offering benchmarking free of charge to healthcare providers. Using Cedar's PFX Benchmarks, providers can compare their performance against industry peers and see where they can make meaningful improvements—independent of product utilization and without vendor bias. All in service of redefining "good" through a patient's perspective. Learn more: https://lnkd.in/dgA6bM7J

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If you're worried about building trust in AI maybe quit (obsessively) talking about it so much in your marketing/messaging/positioning. Seriously, the only people who truly care about your tech stack are VCs....customers/users sure don't. Tell me how your solution helps me and quit wasting my time telling me how you built it and what's under the hood. #ai #generativeai #healthcareai #medicalai #software #applications #saas #cloud #marketing #messaging #positioning #strategy #gotomarket https://lnkd.in/gWuf8Yc9

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