Mark Blackham - Nashville Metropolitan Area | Professional Profile | LinkedIn (original) (raw)

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Morgan Cheatham There is a misconception emerging that AI agents will lead to immediate reductions in healthcare labor costs. While AI agents can automate end-to-end workflows such as booking appointments, answering basic patient questions, and performing form completion for prior authorizations, automating a single task is not equivalent to automating an entire job. Nurses are a prime example. Certain nursing tasks, such as care coordination and patient documentation, are highly automatable by AI agents; however, there is a tremendous amount of work nurses perform on the ground that cannot be fully automated with current technologies such as direct patient care, physical examinations, medication administration, wound care, patient support, and clinical assessments. These nuances make full role elimination less likely with current technologies. When articulating the ROI of an AI agent, we need to be both precise and accurate. Automating a task is more often not automating an entire profession. For roles that encompass many functions, such as nursing, AI agents can be invaluable tools for unburdening staff, increasing efficiency, and boosting throughput—benefits that are particularly valuable given current healthcare staffing and resource shortages. The most promising job candidates for full role elimination through AI remain positions with monolithic task structures, of which there are relatively few in healthcare today—scribes, medical coders, and data entry specialists for example. It is therefore unsurprising then that the most progress has been made in these categories.
Chad Holmes 👿👨‍🏫 The Dark Side of Brilliance👨‍🏫👿 How Hackers are Exploiting Real Estate Transactions and Small Businesses One of my perverse cybersecurity joys is appreciating the evil genius of hackers. Many of their attacks are so effective. So patient. So financially rewarding. It’s hard to not see the brilliance in their simplicity. In the last month I’ve stumbled upon a new favorite that goes something like this: ***The Scheme*** 🎯 Breach: Hackers infiltrate a network processing large financial transfers (think mortgages or business deals). 🕶 Lurk in the Shadows: They spend months studying the system, communication styles, and payment methods. Basically, they become silent observers. ❗ Strike Time: They identify high-value, time-sensitive transfers - every minute counts for them. 👩‍🏫 Fake Customer Service: These cyber-cons then impersonate real customer service, mimicking communication styles down to a tee. They "verify" details like service, name, and payment dates. 💸 Wire Fraud: The unsuspecting victim, trusting the "verification," sends the money (often around $100k) straight to the fraudster's account. 🤦‍♀️ Confusion Reigns: The real vendor starts asking for the actual transfer, and guess what? The fake vendor does the same! This double request creates chaos, leading to even more misplaced funds. 💔 Fallout: Home sales fall through, businesses are crippled, and hackers walk away with millions - all thanks to a simple hack, patience, and some basic social engineering. Here's the Shocker: This happens THOUSANDS of times a month, and most go unresolved! **How to Fight Back? ** ✅ Never Trust, Always Verify: Don't respond to calls or emails claiming to "verify" transfers. Reach out directly to your authorized contact using previously established methods. 📂 Old School is Cool: Paper checks are a pain, but way harder to hack than wire transfers. Consider them for extra security (yes, it might take longer). 🏦 Think Local: Whenever possible, work with local sales reps or lenders. Building a face-to-face relationship can be a powerful defense. By staying vigilant and implementing these simple steps, you can protect yourself from falling victim to these elaborate scams. Let's outsmart the cybercriminals together! #cybersecurity #realestatescam #informationsecurity #staysafe Check out this article for a deeper dive into this specific scam. https://lnkd.in/gRmTPWKM
Ellen Brown Day 1 of my inaugural "2023 MSSP results week" - let's start with the 100Mwinner(andbigwinnersingeneral).Yousee,I′minheavengeekingoutonthedata,soIfiguredwhynotgivemyself5wholedaystoboreyoualltotearswithobservations.Asforthe100M winner (and big winners in general). You see, I'm in heaven geeking out on the data, so I figured why not give myself 5 whole days to bore you all to tears with observations. As for the 100Mwinner(andbigwinnersingeneral).Yousee,I′minheavengeekingoutonthedata,soIfiguredwhynotgivemyself5wholedaystoboreyoualltotearswithobservations.Asforthe100M, yep, you read that right. One single Medicare Shared Savings Program participant saved CMS 138Mandtookhome138M and took home 138Mandtookhome100M of it. Health Connect Partners (Providence) but get this... this is their second year running at around 100Minsharedsavings.Quickstats.1˜25kbeneficiaries.>8100M in shared savings. Quick stats. ~125k beneficiaries. >8% savings rate. You bet I'm going to be digging into this one more because with this type of year to year success and a risk score that is actually reasonable along with 125k lives (talk about actuarial credibility) this isn't an anomoly, there is some best in class to share. Next up in the big winners. How about a 19.44% savings rate?! Congrats to Citrus Aco who took home a cool 100Minsharedsavings.Quickstats.1˜25kbeneficiaries.>810M for their ~7k lives. In case you are wondering that's 122perbeneficiarypermonthinsharedsavings.Sohowdidtheyhitthatnumber?Welltheirriskscoreis1.419forAgedNon−Dualscomparedto1.077forthe122 per beneficiary per month in shared savings. So how did they hit that number? Well their risk score is 1.419 for Aged Non-Duals compared to 1.077 for the 122perbeneficiarypermonthinsharedsavings.Sohowdidtheyhitthatnumber?Welltheirriskscoreis1.419forAgedNon−Dualscomparedto1.077forthe100M winner above. So when I tell clients risk score matters just as much as utilization for ACO (REACH or MSSP) you can see why... wonder how year 2 and year 3 of HCC v28 will play out for Citrus as it seems accurate risk coding is a key to their success. Side note, they are low revenue, wonder if they have any plans for ACO Flex? And to round out this quick top winners edition: 🤑 The 6 participants that took home >$50M in shared savings - Baylor Scott & White Health ($79M, 118k lives), Palm Beach ACO, a perennial success ($73M, 78k lives), Mercy HealthACO ($70M, 115k lives), MercyHealth Select ($60M, 87k lives), Caravan Health Pathways ($57M, 247k lives - FYI only 2.65% savings they are just BIG, so total savings not very impressive) and Privia Health Quality Network, LLC, only one of their eight MSSP ACOs ($70M, 61k lives) Don't worry, I'm going to cover the biggest winners NOT based on totals but based on savings rates later in the week. And dedicate a day to the "aggregators" like Privia and Aledade. And of course dedicate a day to biggest losers although there aren't many this year - which is a story unto it's own. So what do you want to see tomorrow? We at BP2 Health may have fun investing in effecting REAL change with The Reverse Mullet Healthcare Podcast but we also know ACOs like the back of our hand.
Scott Dickinson, CISSP Breaking into cybersecurity.... I saw a post today where it said there was a person charging people a fee to watch their webinar on how to break into cybersecurity. I thought that was sad and not helpful to the community. I saw several other people bashing that person as well. Here's my "TED" talk for free. If you want to break into cybersecurity you have to acquire the skills, even if it means doing it on your own time or taking on additional unpaid duties at work. I have seen plenty of people come through interviews and when I ask them to tell me what they have done around using offensive or defensive cybersecurity tools, they often give me the response of "I haven't been given those duties yet at work..." OK, but have you sought them out on your own time???? Last I checked Kali Linux was free, Virtual Box was free, etc. Have you built your own home lab? Have you asked at work for extra duties (without demanding you get paid for those duties first?). Sometimes the wheels of HR turn slowly and they want to pay you for what you have done not for what you are promising them you will do. Would you take on these new duties at work if it meant no additional pay? What if took HR 2-3 years to redefine job duties and adjust the pay? What if they never rewrote your job duties? Would it be worth it to you? If you say no, then it will probably be hard for you to break in to cybersecurity. If you have the mentality of "The company is using me to do these jobs without paying me!" then it will be harder for you to break in. How about having this mentality instead? I am using the company to improve my skills which will be worth more in the future, whether that is here or at another company. When you take on new skills, the reward is often improvement in yourself and your future abilities, not your bank account. The reward is often delayed. I coached sports for 15 years. The starters were always the ones who listened to the coaching staff, went the hardest at practice, and, most importantly, put in effort outside the practice. So look for opportunities to improve your cyber skills. Another tip. Don't do a skill once and then put that you are an expert in that skill on your resume. Really take the time to learn that skill.
Niko J. Caparisos CSFS CHVP - Principal Prosperity Benefits, LLC is so thrilled to welcome Georgia Waller to the team! There is an equation for fixing healthcare, and whenever anyone is honest with themselves after giving healthcare an iota of critical thinking, they come to terms with the realization that SO MUCH is broken that it takes a new delivery model, entirely! Health Rosetta and Free Market Medical Association organizations help to enable learning to uncover exactly what that corrected model is built upon. In large part, it focuses on fundamentally sound, advanced primary care, an absence of pressure to generate referrals to costlier care settings, increases RVU's, and the like, in a proactive model that promotes quality above all else to ensure the patient is the central focus, above all else! This became backwards in bureaucracy over the past few decades. I wager nobody, if given a fresh choice between a proactively built plan and a status quo one would choose the latter--it literally makes no sense when a comparison is drawn! That is ALL of our challenge; properly framing the problems and introducing ACTUAL solutions. We identify risk drivers in populations and promote optimal medical therapy within groups to truly bend the cost curve down. We reduce unit costs of existing expenses. We work to incorporate direct contracts into plans to eliminate layers, cost, and inefficiencies. We've been diving into content, presentations, conversations, and that which will promote an effective approach that is devoid of simply "quoting the market"! We have spent ZERO time looking at spreadsheets and drawing elementary comparisons up; what does that solve for? We won't build upon the notion that bigger is better (because quality comes irrespective of size), because when prospective clients see what can be offered that they've likely never heard of or seen before, we know our impact is in growing only when we move the needle forward and change lives! The future is bright, Georgia Waller! #innovationatwork #healthrosetta #fmma #COHP #savannahga #UGA #bulldogs #CFOinsights https://lnkd.in/e_jUxRKj
Mario Amaro, MD We're underestimating how physicians will build and access software in the future and we're 100% underestimating how this will impact independent practice. By now I'm sure you've seen the Claude 3.5 Sonnet demos and all of the use cases or application non technical folks are building with 1-3 line prompts. Even Jensen Huang, CEO of Nvidia made a controversial comment on the future of coding, “It is our job to create computing technology such that nobody has to program. And that the programming language is human, everybody in the world is now a programmer. This is the miracle of artificial intelligence,” This is absolutely true, and if there's one area where this will have the biggest impact on society, it will be healthcare. The reason for that is that physicians and clinicians have NOT been included in the design of healthcare technology over the last 20ish years, leaving them to practice in systems designed by non-clinical people. Claude 3.5 offers a glimpse into the future of independent practice. Physicians will be able to design, build, and launch AI applications as needed without requiring developer support. In the future, I envision independent practices hiring their own AI Agent developers who can not only build these applications, but also integrate them into their practice operations infrastructure to create the ultimate practice management system. What application would you build if this were possible today? ----- Hi, I'm Dr. Mario Amaro, Founder and CEO Ease, and I talk about all things starting, running, and growing a private practice with AI. Follow me, if you are planning to start one or are currently figuring out creative ways to grow one. #PrivatePractice #SelfEmployment #HealthcareOnLinkedin #HeyEase #IndependentTogether #Fintech #Infrastructure #AIinHealthcare #CareDelivery
Bobby Guelich Last week, Elion covered the AI prior auth space for providers. This week we're looking at it from the payer side. For payers, prior authorization (PA) is a necessary burden: important for utilization management (UM) and financial planning, but a nightmare to manage. After PA requests are sent in, payers have to process the request from various channels into a case, match it with clinical criteria, validate required information, review and make the PA determination, then respond and iterate through any appeals. As payers update their procedures with new clinical evidence guidelines and new diagnostics and treatments, managing policies and creating decision trees for PA decisions requires enormous effort. Payer-facing AI prior authorization platforms have a huge opportunity to streamline these workflows by: 📒 Improving rules-engine generation and updates from unstructured policy documents and PDFs 📤 Automatically processing PA requests across all channels ✅ Matching the case to the right clinical criteria, validating data completeness, and determining if policies have been met through machine learning models and generative AI 📬 Generating decision documents and automating appeals correspondence with providers Several vendors are already making strides in AI-enabled PA for payers. Banjo Health offers tooling both for the PA request and clinical decision policy creation workflows for health plans, TPAs, and pharmacy benefit managers. basys.ai uses LLMs to offer rapid ingestion of policy documents for fast integration and up-to-date policies. Cohere Health is one of the more mature vendors in the space, and offers a variety of products for UM. Co:Helm is a generative AI platform for payers, with initial use cases around enabling UM nurses to make complex PA decisions more quickly. Finally, GenHealth.ai has built their own large medical foundation model and is using it to enable both rapid policy ingestion and PA review. We see PA as the first place where payers will incorporate advanced clinical AI. Although PA denials should never be fully automated, vendors that can drive efficiency here stand to become a core part of payers’ clinical decision-making process. --- We received a number of interesting responses last week regarding the AI prior auth space. We're continuing to dive deep here, so please reach out if you're currently investigating it and would like to discuss.

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