Daniel L. Blake

When I look at the CMS roadmap for 2026 and 2027, it’s clear: healthcare industry has reached a point of no return. While much of the current discussion focuses on the "how" of FHIR API implementation, the real strategic challenge lies in the "why." Why are clinical decisions still being stalled by data silos in an era of instant connectivity? The mandate for a 72-hour turnaround on urgent Prior Authorizations is more than a regulatory hurdle. It is a real call to eliminate the friction that costs time, money, and, ultimately, patient outcomes. In our experience , meeting these deadlines shouldn't be treated as a painful compliance exercise. It is a unique opportunity to finally re-engineer the fragmented workflows that have slowed the industry down for decades. 2026 is here! The time to align technical infrastructure with clinical reality is now. How is your leadership team preparing for the shift from "storage" to "action"? #HealthTech #CMS #Interoperability #DigitalHealth #CEOInsights #ClinicalWorkflow #HealthIT #ITIRRA #AIDA

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We’re officially pilot-ready.! After a year of focused building, Burse by The Numeracy Group is ready for 1–2 pilot partners. Burse is built for teams operating under risk adjustment; health plans, ACOs, and health systems who are done relying on manual chart audits and slow, retrospective reporting cycles. What’s different: -Full clinical picture in, signal out: notes, imaging, labs, meds, vitals, claims + admin data—analyzed longitudinally across 24 months to surface undercoding, overcoding, and documentation gaps. -Workflow that actually closes: opportunities route to the right team (providers in the EHR, scheduling, medical records) and we track resolution to closure. -Audit defensibility built in: documentation is evaluated and diagnoses are flagged when support is thin (missing MEAT, unclear linkage, weak evidence). -Nightly cadence: say goodbye to quarterly reports—hello to updates that reflect today’s reality. This isn’t an MVP. It’s pilot-ready with audit integrity, workflow, and EHR integration at the core—with testing built into our build process. If you lead risk adjustment, documentation integrity, or value-based performance and want to pilot a next-generation approach, comment or DM me. www.numeracygroup.com #RiskAdjustment #HCC #ValueBasedCare #ACO #MedicareAdvantage #ClinicalDocumentation #HealthcareAnalytics #HealthTech

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Understanding HCC and RAF: The Medicare Advantage Financial Engine For Medicare Advantage professionals, mastering the HCC-RAF relationship is essential for financial optimization and patient care. What Are HCCs? Hierarchical Condition Categories (HCC) are risk-adjustment codes that estimate future healthcare costs. The 'hierarchical' structure means severe conditions override less severe ones in the same category. For example, complicated diabetes (HCC 37) supersedes uncomplicated diabetes, preventing double-counting. The RAF Connection: Risk Adjustment Factor (RAF) scores are part of the model used by CMS to estimate the associated cost of Medicare Advantage beneficiaries. Here's where it gets interesting: each HCC carries a specific weight or coefficient that contributes to the overall RAF score. Each HCC associated with a patient is assigned a relative factor that is averaged with any other HCC code factors and a demographic score. The RAF calculation combines three elements: Demographic factors (age, gender, disability) HCC condition coefficients (disease burden) Interaction factors (condition-demographic relationships) 2024-2025 Model Transition: Organizations are navigating the shift from V24 (33%) to V28 (67%) models for 2024 dates of services, with full V28 implementation for 2025 dates of services. Critical change: V28 assigns equal weight to complicated and uncomplicated conditions, fundamentally altering RAF calculations. Financial Impact: The RAF score determines the amount paid by CMS to the health plan per beneficiary during the corresponding payment year. Higher RAF scores mean higher reimbursements, reflecting sicker patient populations requiring more resources. However, a low RAF score could also be an indicator of inaccurate coding due to lack of information on the patient record or a gap in care. Bottom Line: Understanding this relationship is essential for MSOs and health plans. Accurate HCC capture directly impacts financial sustainability, while proper RAF optimization ensures appropriate resource allocation for patient care. The ongoing model changes require sophisticated systems and processes to maintain compliance and maximize appropriate reimbursement. As we navigate these evolving requirements, the intersection of clinical documentation, coding accuracy, and financial performance has never been more critical to healthcare delivery success. What HCC/RAF challenges is your organization facing? #MedicareAdvantage #RiskAdjustment #HealthTech

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CMS has launched 50+ payment models in the last decade. Most never scaled beyond pilot. ACCESS is a 10-year national model healthcare leaders can't ignore. Here's the 4-step breakdown ↓ 𝟭/ 𝗣𝗿𝗼𝗯𝗹𝗲𝗺: People with Original Medicare have limited access to technology-supported care for managing chronic conditions. Previous models tied reimbursement to specific activities, time thresholds, and documentation requirements, not to whether the patient's condition actually improved. The result: fragmented workflows, siloed data, and care teams optimizing for compliance rather than outcomes. 𝟮/ 𝗦𝗼𝗹𝘂𝘁𝗶𝗼𝗻: ACCESS emphasizes outcomes over activities. Instead of rewarding utilization management or paying for minutes of service, it ties payment to actual clinical improvement: blood pressure reduction, HbA1c levels, PHQ-9 depression scores. 𝟯/ 𝗢𝘂𝘁𝗰𝗼𝗺𝗲𝘀: These metrics improve when you have visibility into what's happening between visits and the infrastructure to act on it. Patients get more options to meet their health goals. Providers gain new partners to co-manage care. Medicare gets a path to pay for technology-supported services. 𝟰/ 𝗦𝘁𝗿𝗮𝘁𝗲𝗴𝘆: Consistent workflows. Proactive outreach. Real-time data capture. That's what gives teams the capacity to deliver better care and what ACCESS is designed to reward. When no one falls through the cracks, outcomes improve. ACCESS aligns payment with that reality.

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As CTO, I've architected 50+ custom EHR systems for behavioral health practices. And here's the uncomfortable truth: Most practices that want a new EHR don't actually need one. They need better workflows on their current system. From a technical perspective: Modern EHRs (even the ones people complain about) are actually pretty capable. The problem? How they're configured and how workflows are designed around them. Real data from our audits: → 73% of "EHR issues" are actually workflow configuration problems → Average practice has 12-18 unnecessary steps in intake-to-billing → Most can cut 10-15 hrs/week of admin work without touching the EHR But sometimes, you DO need to switch. The question is: How do you know? TODAY at 1pm EST, I'm joining CEO Ganesh Varahade and COO Jiten Muradnar to break this down from a technical lens. Register here: https://lnkd.in/dx3G_PDm What I'll cover: Technical signs you've outgrown your EHR Configuration issues vs. platform limitations The 7-question framework (from an engineering perspective) 20 minutes. No marketing spin. Just technical reality. If you're evaluating EHR options for 2026, this will save you from expensive mistakes. See you at 1pm, Thinkitive Inc. #HealthcareTechnology #EHR #SoftwareEngineering #BehavioralHealth #HealthIT

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Systems Design Interview Question: Q. You've been given a gratuitous $5K ER bill because insurance won't pay -- how do you resolve? A. 1. Attempt to access patient portal online to get records 2. Find patient portal, create account 3. Discover patient portal access requires invitation 4. Look for patient portal invitation department online, can't find 5. Call hospital switchboard to find out which department issues invitation 6. Get transferred to hospital IT, wait on hold for 10 minutes 7. IT can't do it, but they give you number for who can 8. Call them; phone menu is bunk, take a guess 9. Get the right person -- find out you have to go in in-person, takes 45 minutes after 10. Ask person if ER visit data will be accessible -- find out "they just do registration" -- gotta call medical records 11. Call medical records, find out "yes" Pretty simple design that I felt sick and old people can easily follow. Incredibly this design did not net me an offer and now I'm hella resentful!

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𝗖𝗠𝗦’ 𝗔𝗖𝗖𝗘𝗦𝗦 𝗠𝗼𝗱𝗲𝗹: 𝗔 𝗖𝗼𝗺𝗽𝗹𝗶𝗰𝗮𝘁𝗲𝗱 𝗜𝗱𝗲𝗮 𝗧𝗵𝗮𝘁 𝗠𝗶𝗴𝗵𝘁 𝗙𝗶𝗻𝗮𝗹𝗹𝘆 𝗠𝗼𝘃𝗲 𝘁𝗵𝗲 𝗡𝗲𝗲𝗱𝗹𝗲 CMS just rolled out the new ACCESS Model, a 10‑year experiment that does something Medicare rarely does: it pays providers based on whether patients actually get better.    Not whether they checked the box.  Not whether they documented the right codes.  𝘐𝘵’𝘴 𝘢𝘣𝘰𝘶𝘵 𝘢𝘤𝘵𝘶𝘢𝘭, 𝘮𝘦𝘢𝘴𝘶𝘳𝘢𝘣𝘭𝘦 𝘪𝘮𝘱𝘳𝘰𝘷𝘦𝘮𝘦𝘯𝘵.   Is it complicated? Absolutely. But that’s healthcare. And this might be the right kind of complexity.   The playbook for improving chronic disease is clear. Personalized support. Digital tools. Care coordinators. Continuous monitoring.   The question has always been: Can we get the outcomes without infinite cost? ACCESS is a chance to find out.   https://lnkd.in/efgXgDtd  

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You know it is worth multi-millions 💵 to ensure you have accurate RAF scores on your at-risk MA patients heading into 2026, and also that building up the claims content for your Alternative Submission Method (ASM) supplemental file generation is labor-intensive and requires analytical rigor. Imagine a platform that ingests and wrangles all of that data for you, confirms your gaps against raw payer feedback files, gives you work queues if the RCM team needs to confirm any EHR research, outputs your ASMs in the various payer preferred formats, and queues up rebillable ICD-10 misses for payers that struggle with ASMs. How much easier would that make your life, and how dramatic would that lift your risk-based MA reimbursement ⁉️ ➡️ ValueCycle Health

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🧬 We talk about “health data” as if it’s one thing, but it’s really hundreds of incompatible languages trying (and failing) to talk to each other. Every layer speaks a different dialect: • EHRs: HL7 v2, CDA, FHIR • Claims: X12 837, UB-04, CMS-1500 • Labs: LOINC, SNOMED CT • Devices: DICOM, IEEE 11073 • Genomics: VCF, FASTQ, BAM Each was built for a single purpose, not interoperability. The result? 🚑 A patient’s data is scattered across 40+ systems, each with its own schema, timestamps, and access controls. But things are shifting. Newer models are moving beyond formats to: • Graph-based data structures • Semantic layers • Federated architectures These approaches preserve context, not just content, across systems. FHIR paved the road. But the next frontier is semantic interoperability. That’s not just data exchange; it’s data understanding. 🧠 The future of healthcare intelligence isn’t in collecting more data, it’s in connecting meaning. #HealthTech #DataInteroperability #FHIR #HealthcareAI #KnowledgeGraphs #SemanticWeb

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