The Collective Voice of Health IT, A WEDI Podcast

Michael welcomes Karim Karti, CEO of RapidAI, a healthcare technology company specializing in AI-powered clinical decision support for stroke and other vascular conditions. The two discuss the benefits of leveraging AI in healthcare, highlighting Rapid AI's significant impact in the world, particularly in stroke care, where the company's AI algorithms and machine learning software allowed for rapid analysis of scans and routing of treatment decisions to physicians, ultimately saving millions of brain cells and improving patient outcomes.

Michael welcomes Sandra Johnson, SVP Client Services with CliniComp, a a healthcare technology company specializing in electronic health record (EHR) solutions and clinical information systems designed for hospitals, health systems, and government healthcare organizations. Sandra discussed the current issues plaguing providers and health systems regarding electronic health records, and how platforms like CliniComp can offer ease of use, advanced analytics and interoperability while not compromising on patient data. Sandra also addresses how the industry is embracing artificial intelligence; the current benefits and what she can see down the line.

Michael welcomed Mike O'Neill, CEO of Medicasoft, a healthcare technology company that specializes in modern, cloud-based health IT solutions designed to improve data interoperability, electronic health records (EHRs), and analytics. The two discussed topics such as legacy system transformation, cloud-based solutions, interoperability, and regulatory challenges in healthcare IT. They explored the importance of internal data organization, the potential of AI and analytics, and the evolving role of cloud computing in managing patient data securely

Michael welcomes Daniel Blumenthal, Vice President of Strategy with MDClone, a healthcare technology company specializing in data analytics and synthetic data generation to empower healthcare organizations, researchers, and life sciences companies. A former manager for Northwestern University's basketball team, Daniel finds similarities in the team-first mentality between the basketball team and the work he's doing at MDClone. He addresses the use of synthetic data to enable data access, research, and insight, without compromising patent confidentiality. Daniel emphasized the importance of making data more accessible and understandable to various healthcare teams, including physicians, nurses, and administrative staff, in order to facilitate discussions and problem-solving.

Michael welcomes Kevin Ritter, EVP, CareInMotion for Altera Digital Health, a healthcare technology company focused on modernizing and optimizing clinical, operational, and financial systems within healthcare organizations. The two address Altera's mission to enable clinicians, integrate more data at the point of care and optimize financial performance in health systems. They also discuss the importance of data, interoperability, and artificial intelligence in improving provider functionality and the overall patient experience

Michael welcomes Nick Orser, General Manager, Healthcare with Verato, a leading healthcare technology company specializing in identity data management and patient matching solutions. The two discuss the current state of identity management, how the industry is handling the mass influx of data, how patient matching and interoperability work together and how AI and other emerging technology will help us understand "who is who".

Michael chats with John Showalter, Chief Strategy Officer of Linus Health, a digital health company focusing on brain health. The two talk about the current state of early detection and management of cognitive disorders, barriers in traditional assessments and interoperability and how AI and innovation is enhancing assessments and improving patient outcomes.

Michael welcomes Dr. Hamad Husainy, Chief Medical Officer with PointClickCare, an EHR software vendor that specializes in providing technological solutions for the senior care industry. The two discuss how interoperability continues to improve care coordination, how regulations and technology has helped improve data interoperability, and how AI will usher in even more data exchange improvements.

From WEDI's recently concluded Winter Forum on Health Accessibility, Janice Karin (Massachusetts Health Data Consortium and WEDI Health Equity Workgroup Co-Chair) chats with Prerana Laddha, Director of Population Health with Epic. Prerana offers her insight on EHR's role in advancing health equity, data challenges EHRs face, interoperability and the emergence of artificial intelligence and how it can assist EHRs in supporting health equity.

Michael welcomes Sandy Rolfe, Chair of the WEDI Genomics Workgroup and Clinical Lead for the InterQual Molecular Diagnostics and Durable Medical Equipment at Optum. The two discuss the ever evolving state of Genomics research, data privacy and security, and how data interoperability and standards can aid in care and patient satisfaction. WEDI members are invited to attend a special Genomics workgroup event, Exploring Genomic Data Exchange: A Deep Dive into FHIR Integration and Interoperability, Feb 27 on Zoom, exclusive for WEDI members. Visit www.wedi.org to sign up.

Michael welcomes Neal Neuberger, President of Health Tech Strategies and lead for the National Rural Health Association's Rural Health IT Coalition. Neal addresses the current state of health care in rural US communities, the successes and challenges over the years through technology and regulations, and the "deprioritization" of telehealth. Neal and NRHA will have their NRHA Rural Health Policy Institute in Washington DC in February. Click here for more information

From a recent WEDI conference, Anna Hyde from the Arthritis Foundation and Michael Phillips with AARP discussed the role technology is playing and will play in improving patient's health care experience. Moderating this conversation is Denny Brennan, Executive Director of the Massachusetts Health Data Consortium, member of the WEDI board and co-chair of its Education Committee.

From a recent WEDI Virtual Spotlight, a presentation by Andrea Caballero, VP of Policy with Catalyst for Payment Reform.

Michael welcomes Kent Dicks, founder, CEO, and award-winning entrepreneur of Life365, a digital health platform that connects patients with their doctors at home. The two discussed how artificial intelligence creates an environment that allows patients to receive affordable and efficient care earlier in the care cycle, thus preventing costly readmissions and improve overall healthcare accessibility.

Michael chats with LA Care John Baackes, who is retiring at the end of the year after 48 years in healthcare. The two discuss John's legacy at LA Care, the industry's evolution, how he thinks the new administration will affect Health Equity initiatives, and his closing words of wisdom to current and future healthcare professionals.

Michael welcomes back Steven Berkow from InterSystems to discuss and review HCPLAN's 2024 Value-Based Care report and WEDI's special Value-Based Care virtual spotlight. How is the industry doing and how can CLEAN data and technology like AI help the industry evolve quicker.

Michael welcomes Dr. Don Rucker, Chief Strategy Officer of 1upHealth and the former National Coordinator for Health IT, to talk about CMS Star Ratings; what they are, why are they in the news lately and how will the new administration address them.

Part 2 of a 2 part episode looking at how payers and providers are transforming healthcare through value-based care partnerships. The moderator is Denny Brennan, WEDI Board Member, Co-Chair of its Education Committee, and Executive Director of the Massachusetts Health Data Consortium. The panel: Anna Taylor, AVP, Population Health & Valiue Based Care, Multi Care Connected Care Ben Pollock, PhD, Senior Associate Consultant II, Division of Health Care Delivery Research, Mayo Clinic Semira Singh, Director Population Health, Providence Brian Wallace, Vice President, Data Analytics and Reporting, Centene Corporation

From WEDI's Value-Based Care Spotlight in November, Part 1 of a 2 part episode looking at how payers and providers are transforming healthcare through value-based care partnerships. The moderator was Denny Brennan, WEDI Board Member, Co-Chair of its Education Committee, and Executive Director of the Massachusetts Health Data Consortium. The panel: Anna Taylor, AVP, Population Health & Valiue Based Care, Multi Care Connected Care Ben Pollock, PhD, Senior Associate Consultant II, Division of Health Care Delivery Research, Mayo Clinic Semira Singh, Director Population Health, Providence Brian Wallace, Vice President, Data Analytics and Reporting, Centene Corporation

Michael welcomes Scott Mattila with Intraprise Health to discuss why it seems with all the regulatory and technological advancement health care is experiencing, why does it feel we're moving backwards in terms of cyber hygiene. Scott offers his pillars for success and offers his insight on emerging technology and how it can possible reduce cyber incidents.

WEDI Chair Elect Merri-Lee Stine of Aetna CVS Health speaks with Jonathan Blum, Principal Deputy Administrator and Chief Operating Officer with CMS. The two discuss CMS' plans for the rest of the year, success stories during this administration and success stories surrounding the No Surprises Act and the Interoperability and Prior Authorization Rule.

From WEDI's 2024 National Conference, the keynote address by Emblem Health's CEO Karen Ignagni. Karen talks about the challenges of policy, the need for a broader conversation with interoperability, taking a leap toward admin simplification, prioritizing health equity and more.

Michael welcomes Michelle Barry (Availity) and Martin Cody (Madaket Health), WEDI's Provider Information Subworkgorup Co-Chairs. The three discuss the mission of the subworkgroup, which includes identifying business issues impacting the transmission and receipt of provider directory data. An extensive and complicated issue, Martin and Michelle reflect on an outstanding provider directory data panel at last week's WEDI national conference and offer a preview of the topics that will addressed at their special virtual spotlight on November 7 as they and WEDI's No Surprises Act Taskgroup discuss the critical issues with provider directory data and the impact of the act on healthcare stakeholders including patients. The November 7 event is free and open to all healthcare professionals. Register at wedi.org and select Events.

Michael discusses the Sequoia Project's Payer to Payer FHIR API Implementation Workgroup with its co-chairs, Nancy Beavin from Medica, Bob Oakley from Evernorth and the Project Lead, David Pyke with Sequoia. The workgroup was created to identify practical, implementation-level implications from a business and governance perspective. The guests discussed the workgroup makeup, their mission, what they've heard so far and why a payer, small, medium or large, should join their community of practice. To learn more about the workgroup, visit https://sequoiaproject.org/interoperability-matters/payer-to-payer-api-workgroup/

Michael welcomes Huthaifa Khan, Director, Solutions Architecture with Virtual Health. Huthaifa, a veteran health care professional, discusses the emergence and rapid adoption of the FHIR standard in healthcare data exchange, along with implementation stories, and its potential future in the industry.

Join Dr. John Harris as he takes you on a deeply personal journey through the highs and lows of transitioning from traditional paper billing to modern electronic systems. With several decades of experience in healthcare, Dr. Harris shares invaluable insights into the benefits of digital billing—streamlined processes, faster payments, and improved patient care. But this story isn't just about the smooth road; it's also about the bumps along the way and an ending you might not have seen coming. In this episode, Dr. Harris delves into the challenges faced during the transition, culminating in the unfortunate and harrowing experience of being part of the Change Healthcare ransomware attack, revealing the toll it has taken on his practice, and the lessons learned in cybersecurity and data protection. Hosted by WEDI Privacy and Security Co-Chair Lesley Berkeyheiser, this episode offers a compelling look at the intersection of medicine, evolution, technology, and resilience.

Michael welcomes Teri Thomas, CEO of Volpara and CBO of Lunit to discuss the evolution of AI in healthcare. Teri explains how Volpara and Lunit are using AI to help better understand cancer risk, empower patients in personal care decisions, and guide recommendations about additional imaging, genetic testing, and other interventions. Teri offers her thoughts on the current AI landscape, benefits and challenges in implementation, the federal government's role and any privacy & security considerations.

Michael chats with Outcomes Rocket CEO Saul Marquez on the proper steps healthcare solutions companies should take to properly market their services to an industry eager to drive change. What are Saul's 3 pillars of marketing, what strategies provide the highest ROI and what should companies avoid in order to create significant connections with their potential clients?

Michael welcomes Panda Health President and CEO Ryan Bengtson to the podcast to discuss industry complexities in the embracing of digital health tools and the importance of having all the information in order to make the best decision for your health system.

This is a companion episode to Episode 156, a conversation with CMS' National Standards Group Director Michael Cimmino on Administrative Simplification. Michael welcomes Paul Anderson (Health Insurance Specialist) and Jamie Lookabill (Technical Advisor, Enforcement Division) with the Centers for Medicare & Medicaid Services to offer an introductory look at the administrative simplification enforcement process. Paul and Jamie offer information on the different types of HIPAA enforcement, how CMS communicates with the industry about enforcement, and the overall enforcement process, from filing a complaint, the use of ASETT (Administrative Simplification Enforcement and Testing Tool), corrective action plans and civil monetary penalties. To learn more about administrative simplification, please visit go.cms.gov/adminsimp

This episode is sponsored by InterSystems, the leading provider of AI-enabled data management solutions for industries with complex challenges, including healthcare, financial services, and supply chain and logistics. Michael welcomes Steven Berkow, Senior Advisor, Value-Based Care with InterSystems. The two discuss Steve's involvement at WEDI's Summer Forum in Chicago, where he served as a moderator for the payer panel on the CMS Interoperability and Prior Authorization Rule. The two discussed the challenges and potential solutions for improving interoperability within healthcare data, and the importance of standardizing APIs for healthcare providers. Be sure to read InterSystems' latest white paper The APIs Are the Easy Part: Maximizing Your ROI While Meeting CMS Interoperability and Prior Authorization Requirements Health plans should be able to harness the investment in IT infrastructure mandated by the latest CMS rule on interoperability and prior authorization to create the data liquidity needed drive top strategic goals, such as reducing provider abrasion, improving member experience, increasing productivity, and supporting value-based care. The scope of CMS-0057-F, however, is wide ranging. This white paper: Summarizes new requirements for the four types of information sharing addressed, namely payer-to-payer, payer-to-provider, payer-to-member, and prior authorization submission and determination. Analyzes processes and workflows impacted by the regulation and resulting opportunities for performance improvement. Provides key “Questions to Consider” that should inform plan investment decisions. Designed to be shared with IT, clinical, and operational leaders, the paper will help your leadership team achieve larger strategic returns on mandated plan investment while meeting regulatory requirements.

Michael chats with Nametag CEO Aaron Painter on how emerging technology, patient-centric data policies and even remote working is affecting the cybersecurity infrastructure in healthcare. The two discuss the "old school" nature of social engineering attacks and steps that the industry can take to combat threat actors. Aaron's article in Forbes magazine can be found here- https://www.forbes.com/councils/forbesbusinesscouncil/2024/05/17/combating-threat-actors-in-the-us-healthcare-sector/

From our recently concluded Summer Forum, Part 2 of a discussion with 2 providers working on implementing the CMS Interoperability and PA Rule. Semira Singh, Director Population Health Informatics, Providence Anna Taylor, AVP, Population Health & Value Based Care, MultiCare Connected Care The moderator, from the AMA, former WEDI Board Chair Nancy Spector

From our recently concluded Summer Forum, Part 1 of a discussion with 2 providers working on implementing the CMS Interoperability and PA Rule. Semira Singh, Director Population Health Informatics, Providence Anna Taylor, AVP, Population Health & Value Based Care, MultiCare Connected Care The moderator, from the AMA, former WEDI Board Chair Nancy Spector

Michael welcomes back Shweta Maniar, Global Director, Life Sciences Solutions and Strategy for Google Cloud. The two discuss the continued emergence of artificial intelligence in health care, the need for standards or a framework in health care regarding AI, and how people new to AI can brush off misconceptions and dive in feet first and learn how they can access and leverage this growing technology.

Michael welcomes 3 of the 4 co-chairs of WEDI's Prior Authorization Subworkgroup: Heather McComas, Director, Administrative Simplification Initiatives, American Medical Association David Delano, Senior Director of Services, Massachusetts Health Data Consortium Raj Godavarthi, Associate VP of Technology and Interoperability, MCG Health The 3 discuss the changes in the workgroup and the industry since the January 2024 release of the CMS Interoperability and Prior Authorization rule, the exciting role of artificial intelligence in PA, and how their unique stakeholder roles offer a full, detailed dialogue during their monthly meetings. Tons of Prior Authorization-related education coming to you courtesy of WEDI. Visit wedi.org and click CALENDAR for more information

Michael welcomes Donna Campbell (HCSC) and Amanda Abbott (BCBS of Kansas), WEDI's Eligibility and Benefits Workgroup Co-Chairs. The co-chairs discuss the workgroup's missions and the latest discussion topics that workgroup is undertaking, including improving efficiencies in the E&B process through standards and emerging technology. If you are interested in joining the workgroup, contact Ariana Poole at [email protected]. You must be a WEDI member to join. To become a WEDI member, contact Bill Allder at [email protected]

The threat from cyberattacks is growing exponentially and health care organizations are particularly vulnerable. Michael chats with WEDI's Privacy and Security Workgroup Co-Chairs, Lesley Berkeyheiser of DirectTrust and Thanh-Thien Nguyen of Kaiser Permanente on suggested actions that health care organizations big and small can adopt, customize, and implement as they seek to establish good cyber hygiene. The top 10 list will be available soon on wedi.org

From WEDI's Spring 2024 conference, Sequoia's David Pyke moderates a conversation with its Payer to Payer FHIR API Implementation Workgroup Co-Chairs, Robert Oakley with Evernorth and Nancy Beavin with Medica. Learn more about the workgroup here- https://sequoiaproject.org/interoperability-matters/payer-to-payer-api-workgroup/

Guest host Michael Pattwell, WEDI Board Members, Co-Chair of its Payment Models Workgroup, and Principal Business Advisor with Edifecs, chats all things value based care with Lynn Carroll, Chief Operating Officer of HSBlox. The two offer a fascinating look at the progression from fee for service to value based care, recent models launched by CMS, and the importance of data interoperability and standards in improving value based care delivery and contract administration.

Michael chats with RJ Kedziora, Co-Founder of software company Estenda about the evolution of digital health and digital therapeutics. The two discuss the advances in emerging tech, privacy and security challenges, the role of regulations and the hopes that digital health can break down those data silos that still plague us. Estenda is holding a webinar; Driving Quality in Digital Health: The Role of Generative AI in Testing, on June 14th from 12pm- 1pm eastern. Find out more below. https://www.eventbrite.com/e/driving-quality-in-digital-health-the-role-of-generative-ai-in-testing-tickets-902441475747

The Centers for Medicare & Medicaid Services National Standards Group, within the Office of Burden Reduction and Health Informatics, focuses on reducing administrative burden and advancing interoperability and national standards. CMS engages beneficiaries and the health care community to understand their experiences, inform solutions, and infuse a customer-focused mindset throughout the agency. Michael welcomes CMS NSG Director Michael Cimmino to the podcast to discuss the who, what, where, when and why of administrative simplification and burden and how a standard becomes a standard. This is part 2 of a 2 part podcast conversation with CMS NSG on Administrative Simplification. Coming soon, an episode on enforcement. Learn more about CMS' work on admin simp at go.cms.gov/adminsimp

In April 2024, WEDI held a member position advisory (MPA) event on the critical topic of maintaining business continuity within healthcare organizations in the wake of cyber-attacks. The event, entitled, From Crisis to Continuity: Maintaining Health Care Data Exchange Following a Cyber Attack, offered best practices, suggestions, and key steps that stakeholders from HHS and the private sector can consider when exchanging data, processing information, and maintaining lines of communication. From WEDI’s recently concluded Spring conference, a debrief of the MPA event presented by WEDI’s privacy & security workgroup co-chairs, Lesley Berkeyheiser with DirectTrust and Thanh Thien Nguyen from Kaiser Permanente.

Michael chats with returning guest Denis O'Shea, Founder and Chairman of Mobile Mentor, about their 2024 Endpoint Ecosystem Study, which explored the intricate dynamics of hybrid work in high-risk and highly regulated industries. Conducted across the United States, Great Britain, and Australia, the study involved 2,400 knowledge workers in healthcare, finance, government, and education to understand employee attitudes and their actions related to company security and their experience, and their productivity as remote workers. Review the study at https://endpointecosystem.com/

A continuation from last week's episode on health equity data efforts from the federal perspective. Our moderator is Nancy Spector, Coding and HIT Advocacy Director at the AMA and former WEDI Board Chair. Our panel: Kristie Clarke, CDR, US Public Health Service, Senior Advisor on Data for Health Equity, Office of Public Health Data, Surveillance, and Technology, US Center for Disease Control and Prevention Kelly Cronin, Director, Center for Innovation & Partnership, Deputy Administrator, Administration for Community Living, HHS Jawanna Henry, Interoperability Systems Branch Chief, Office of Policy, Office of the National Coordinator for Health IT Meagan Khau, Director of Data Analytics& Research Group, CMS Office of Minority Health

From WEDI's February 2024 Health Equity Forum, we welcome federal representatives to discuss how they are using data, tech and standards to address health disparities and the importance of community relationships. Our moderator is Nancy Spector, Coding and HIT Advocacy Director at the AMA and former WEDI Board Chair. Our panel: Kristie Clarke, CDR, US Public Health Service, Senior Advisor on Data for Health Equity, Office of Public Health Data, Surveillance, and Technology, US Center for Disease Control and Prevention Kelly Cronin, Director, Center for Innovation & Partnership, Deputy Administrator, Administration for Community Living, HHS Jawanna Henry, Interoperability Systems Branch Chief, Office of Policy, Office of the National Coordinator for Health IT Meagan Khau, Director of Data Analytics& Research Group, CMS Office of Minority Health

Michael chats with Chris Darland, President and CEO of Peerbridge Health about how artificial intelligence is helping diagnose heart failure quicker and more efficiently than traditional methods, which could assist all patients, but especially those in rural communities.

In January of this year, to coincide with the release of CMS' Interoperability and Prior Authorization Final Rule, WEDI launched an ambitious 7-part education series examining the rule for the healthcare industry. Michael sits down with 3 of the moderators of the series, Ferris Taylor, Executive Director of the Healthcare Executive Group, Denny Brennan, Executive Director of the Massachusetts Health Data Consortium, and Robert Tennant, Vice President of Federal Affairs for WEDI to get their thoughts on the program and what it means for the industry moving forward. The entire Road to Interoperability and Prior Authorization series can be found on WEDI's Youtube Page, https://www.youtube.com/@wedionline

From WEDI’s Feb 2024 Health Equity Forum, Part 2 (Part 1 was episode 144) of a session moderated by Dr. Marc Rabner, Chief Medical Officer with CRISP Shared Services discussing the work CBOs perform to support Health Equity. The panelists: Leigh Ann Eagle, Director of Health & Wellness Program, MAC, Chief Operating Officer of the Living Well Center of Excellence Stephanie Archer-Smith, Executive Director, Meals on Wheels of Central Maryland June Simmons, President and CEO, Partners in Care Foundation Monique Powell-Davis, MD. Executive Vice President of Medical Services, Mary’s Center

Michael welcomes Taylor Webster, Head of Coding Quality with Fathom Health (https://www.fathomhealth.com/) to discuss how autonomous medical coding is aiding the industry, addressing workforce shortages, burden and revenue cycle management.