Joseph Spinner, CSM, CSPO

Check out this post by my colleague Rashmi Ramaswamy about how we're improving the Search experience on the Guidewire documentation site. https://lnkd.in/gWJTrUQz

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We've unveiled our vibe coding assistant as apart of our new Pega Blueprint update. 🎉 Now teams can design workflows conversationally while maintaining enterprise-level governance and reliability. 🧠 Read more about it in Mi3: https://lnkd.in/emSYTn5S

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Big news from Salesforce with the launch of their Life Sciences Partner Network—a major step forward in accelerating digital transformation across the industry. Sware is proud to be part of this movement helping life sciences organizations streamline validation, reduce risk, and bring innovations to market faster. This marks a powerful shift toward smarter, faster, and more compliant operations, driven by a collective of innovators focused on automation, AI, and the regulated cloud. Check out the announcement: https://lnkd.in/eSxD-Mwb #LifeSciences #DigitalValidation #Compliance #Salesforce #AI #Sware

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I've seen job postings asking for 9+ years as an LSA or 5+ years as an SSA. And while experience absolutely matters (I’ve been working with Pega for 15 years myself), it’s time we talk honestly about what 𝒓𝒆𝒍𝒆𝒗𝒂𝒏𝒕 experience looks like in 2025. The tech landscape—and Pega itself—has evolved dramatically. What was considered best practice years ago might now be slowing you down. If you're still approaching Pega 24 projects like you did with PRPC or Pega 7, those years of experience aren’t telling the full story. Here’s some things that have changed: - 𝐀𝐩𝐩 𝐒𝐭𝐮𝐝𝐢𝐨 has transformed low-code development with ready-made components and prescriptive design - 𝐂𝐨𝐧𝐬𝐭𝐞𝐥𝐥𝐚𝐭𝐢𝐨𝐧 delivers a modern UI framework aligned with today’s front-end standards and designed to support the 𝐂𝐞𝐧𝐭𝐞𝐫-𝐨𝐮𝐭 𝐁𝐮𝐬𝐢𝐧𝐞𝐬𝐬 𝐀𝐫𝐜𝐡𝐢𝐭𝐞𝐜𝐭𝐮𝐫𝐞—ensuring that experiences, processes, and data are orchestrated from the core outwards, not just bolted onto the edges. - 𝐁𝐥𝐮𝐞𝐩𝐫𝐢𝐧𝐭 isn’t just about gathering requirements or designing applications—it’s fundamentally changing how we deliver them. By aligning stakeholders early, visualising workflows, and accelerating build-out, Blueprint shortens delivery timelines and improves quality. - 𝐌𝐨𝐝𝐮𝐥𝐚𝐫 𝐫𝐞𝐮𝐬𝐞 drives consistency, speeds up delivery, and reduces technical debt. The shift from heavy customisation to streamlined delivery—starting with Blueprint and powered by Constellation and App Studio—isn’t just a nice-to-have - it's fundamental to delivering modern, maintainable Pega solutions. 𝐌𝐲 𝐭𝐚𝐤𝐞? I’d rather work with someone who has 3 years of hands-on experience with these modern tools than someone with 15 years who hasn’t evolved their approach. Staying relevant isn’t about collecting badges—it’s about enabling yourself with today’s technologies and delivery methods. So the real question is not “How long have you been doing Pega?” It’s “How current is your Pega knowledge—and can you deliver modern solutions that reflect today’s capabilities?” What do you think? #Pega #LowCode #PegaBuilder #StayingCurrent #BlueprintDelivered

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43 Comments

Retrospective risk adjustment isn’t dying — it’s being redefined. A lot of headlines have declared that CMS’s 2027 Advance Notice signals the end of retrospective risk adjustment. The reality is far more nuanced — and far more important for health plans preparing for the next era of Medicare Advantage. CMS isn’t eliminating chart review. It’s tightening documentation standards, closing loopholes, and pushing the industry toward more transparent, encounter‑linked evidence. That means retrospective review becomes more important, not less — just more disciplined and defensible. This is exactly where Raapid has been focused: – Linking diagnoses to encounters – Surfacing MEAT‑based clinical evidence – Delivering audit‑ready accuracy – Scaling chart review without armies of coders As the regulatory bar rises, the tools and partners that can meet it will define the next era of Medicare Advantage performance. The industry isn’t moving away from retrospective review — it’s moving toward better, tighter, and more accountable retrospective review. https://lnkd.in/gkuvnPWq RAAPID INC Sally Ann Frank Marion Desmazières Sultan Akif #MedicareAdvantage #RiskAdjustment #ValueBasedCare #HealthPlans #HealthcareAI #CMS #HealthTech

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Are you prepared for CRA compliance? I've seen firsthand how early steps like SBOM generation, vulnerability management, and long-term support can make a big difference. These practices are helping us get ready and can help your team too. Starting now puts you in a stronger position to meet requirements and build more secure products. Learn how you can get started: https://lnkd.in/euW-Ft6P #CRA #CyberResilience #ProductSecurity #QtDev #Cybersecurity

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Quality culture isn’t established by metrics alone. Accrediting bodies assess quality through various lenses: - The Joint Commission emphasizes process reliability and compliance. - CMS focuses on outcomes tied to reimbursement. - NCQA prioritizes population-level consistency. - DNV integrates continuous improvement into daily operations. Each framework is significant and influences behavior. The most effective organizations do not merely chase surveys or scores; they seek to translate measures into meaningful insights: - What is this data actually telling us? - What behaviors are we reinforcing? - Are we improving care, or just proving compliance? Quality culture exists at the intersection of policy and practice. Metrics should enhance this work, not replace it. Where have you seen quality measurement strengthen culture, and where has it missed the mark? #healthcarequality #patientsafety #qualityculture #safetyculture #healthleadership

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2025 brought major shifts across Medicare compliance - including CMS’s new TPOC/WCMSA requirements, Section 111 penalties, and important updates to $0 WCMSAs. On December 9, my colleagues, Mark Popolizio, J.D. and Sidney B. Wong, J.D., will unpack the year’s most impactful developments and share what they mean for compliance programs heading into 2026 in our Medicare Year in Review: https://vrsk.co/4amCM1I. #Insurance #WorkersComp #Claims

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