The Collective Voice of Health IT, A WEDI Podcast

From WEDI's 2025 National Conference, Beth Davis from Veradigm Payerpath moderates a discussion on the role of intermediaries in CMS-0057F. The participants:

Happy New Year from WEDI!

Michael offers some quick bites from our top 3 most downloaded episodes of 2025:

#3: Rethinking Value-Based Care: Why Children Can't Be Left Behind (Taylor Beery, Imagine Pediatrics, Ep 219)

#2: Electronic Health Records- An Integral Partner in Health Care Accessibility (Prerana Laddha, Epic, Ep 189)

#1: Bridging the Data Gap- The Role of Standards & Technology in Genomic Data Exchange (Dr Sandy Rolfe, Optum, Ep 188).

Be sure to listen to these episodes in their entirety by visiting our podcast page, www.wedi.org/category/podcasts

In this episode (from our National Conference), moderated by WEDI Chair Merri-Lee Stine (Aetna) and featuring Steve Berkow (InterSystems), Anna Taylor (MultiCare), and Stephan Rubin (Optum), we dive into the real-world state of CMS 0057 implementation, bringing together perspectives from payers, vendors, providers, and the HL7 Da Vinci implementer community. Our guests unpack where progress is being made, where complexity has crept in, and why testing, trust, and simplicity are critical to success. From navigating multiple players and messy real-world data to lessons learned from incremental implementation, the conversation highlights practical solutions that can move the industry forward. We close...

This episode, from our November National Conference, explores one of healthcare’s most persistent challenges: how hospitals and health plans can move from operating at cross-purposes to truly rowing in the same direction. Our guests are Danielle Lloyd, SVP of Private Market Innovations and Quality Initiatives, AHIP and Molly Smith, Group VP for Public Policy, American Hospital Association.

Led by moderator Stephan Rubin from Optum, Danielle and Molly dig into the misconceptions that providers and payers often hold about each other and discuss how better data transparency, shared incentives, and policy alignment — including recent CMS rules such as 005...

Michael welcomes Todd Van Meter, CEO of Accuity and a 30-year healthcare RCM veteran. Todd shares insights on navigating change in revenue cycle management. From separating AI hype from real ROI to building resilient teams and redefining the patient–provider–payer relationship, Todd offers practical lessons from decades of leading large-scale healthcare operations. A must-listen for anyone shaping the future of healthcare finance.

In this episode, Michael welcomes Lightbeam Health CTO Mike Hoxter to discuss how advanced analytics and social determinants of health (SDOH) data are reshaping population health management. As organizations deepen their commitment to value-based care, Mike explains how modern risk stratification tools help identify at-risk populations earlier, reduce avoidable costs, and drive more equitable, proactive care. With real-world examples and practical insights, this conversation offers a clear look at what’s working—and what’s next—in population health innovation.

Michael welcomes Jaelynn Williams, former CEO of Air Methods and a respected healthcare and business thought leader. Jaelynn has developed the Board AI Governance Index™, a groundbreaking framework that helps boards assess and strengthen their AI readiness—balancing innovation with accountability.

They explore how this 100-point model gives leaders a structured way to oversee AI risk, capture opportunity, and ensure responsible use of technology in complex, high-stakes environments like healthcare.

From WEDI’s recently concluded National Conference in Washington DC, co-chairs Emma Andelson from the American Medical Association and Anna Hyde from the Arthritis Foundation introduce WEDI’s newest workgroup, Patient Experience.

The workgroup’s primary aim is to embed the patient perspective into healthcare business processes and workflows while elevating the patient voice across WEDI’s broader workgroups and initiatives

Michael sits down with Ben Scharfe, EVP of AI at Altera Digital Health, to explore how artificial intelligence is reshaping healthcare. From ambient listening that lightens documentation load to specialty-trained AI agents enhancing decision-making, Ben shares practical examples of what’s working today—and where challenges like clinician resistance and AI “hallucinations” remain. Hear why he believes AI, when implemented thoughtfully, can deliver what clinicians want most: more time with patients and less time with paperwork.

Michael interviews Julie Johnson, Executive Director of the Center for Research Informatics at the University of Chicago, about synthetic data in healthcare. Julie shares her unconventional career path, which included studying nursing at Georgetown and conducting video game research to improve surgical skills. They discuss the definition, creation, and potential of synthetic data in accelerating research and improving efficiencies, while addressing challenges such as trust and privacy concerns. Julie emphasizes the importance of validating findings with real-world data and explores the future of synthetic data in reshaping medical research and decision-making.

What happens when dental data becomes as accessible and actionable as medical data? Steve Roberts, CEO of Vyne, explores how interoperability can transform the patient experience, equip providers with deeper insights, and strengthen the connection between oral health and overall health.

This podcast is sponsored by MCG Health, which offers evidence-based clinical guidelines and software tools for healthcare providers and payers. These resources aim to optimize patient care and support care management. Learn more about them at https://www.mcg.com/ 

Michael welcomes Raj Godavarthi, MCG’s AVP of Technology and Interoperability to discuss industry progress on payer-provider compliance work on the CMS Final Rule (CMS-0057-F). After that, Michael addresses artificial intelligence with Dr. Jason Gillman, MCG’s Director of Clinical Informatics. Dr. Gillman is currently involved in the NCQA AI Governance workgroup, and he’s MCG’s...

Michael welcomes 

to discuss their workgroups working together to spotlight the intersection between direct to consumer (DTC) genetic tests and some different privacy and security issues associated with these types of tests. The two workgroups collaborated to develop a Fact Sheet to help consumers take action to protect their data, available here- https://www.wedi.org/2025/07/12/direct-to-consumer-genetic-dna-testing-actions-consumers-can-take-to-protect-their-health-data/ 

Current regulations and...

Children make up nearly half of all Medicaid enrollees—37 million nationwide—yet their unique needs are too often overlooked in value-based care models. In this episode, Michael sits down with Taylor Beery, Chief Innovation & Administrative Officer and Co-Founder at Imagine Pediatrics, to explore why pediatric value-based care requires its own distinct strategy. From addressing the needs of 14.5 million children with special health care needs to building trust with families and caregivers, Taylor makes the case that centering children in healthcare reform not only improves outcomes for vulnerable populations but also strengthens the foundation for broader Medicaid and commercial models.

From WEDI's 2025 Spring Conference, Civitas Networks for Health Interim CEO Jolie Ritzo welcomes three HIE leaders to discuss how they are addressing various data exchange use cases from their unique state and regional perspectives. The panelists:

Melissa Kotrys, Chief Executive Officer, Contexture (Colorado and Arizona)

Phil Beckett, Chief Executive Officer, Texas Health Services Authority

Stephanie Brown, Executive Director, CRISP DC

Jolie returns to moderate another interesting HIE panel at WEDI's National Conference, November 3-6 in Washington DC and Zoom (virtual pre-conference on October 31). Visit https://members.wedi.org/event-calendar for more...

From WEDI's recently concluded Summer Forum, the association's Prior Authorization Sub Workgorup Co-Chairs- Heather McComas (AMA), Janice Bakos (Aetna) adn Michael Lunzer (Itiliti Health)- offer their thoughts on educational resources and open items related to industry implementation of CMS-0057F. WEDI's Executive Director Robert Tennant moderates the conversation. 

From a WEDI virtual spotlight earlier this summer, hosts and WEDI Privacy & Security Work Group Co-Chairs Lesley Berkeyheiser (DirectTrust) and Thanh-Thien Nguyen (Kaiser Permanente) moderate a conversation with Healthcare Sector Coordinating Council Cybersecurity Leadership and cut through the noise on healthcare cybersecurity. The guests, Healthcare Sector Coordinating Council Executive Director of Cybersecurity Greg Garcia and HSCC Cybersecurity Working Group Chair and Vice Chair Chris Tyberg (Abbott) and Dr. Samantha Jacques (McLaren), share the most valuable resources from HSCC, HHS, and others that every organization should prioritize, with practical advice for small providers on staying vigilant and maintaining strong cyber...

This podcast episode is sponsored by Edifecs, a Cotiviti Business. For over 25 years, Edifecs has been a market leader in healthcare data interchange. Hundreds of health plans, providers, and government agencies rely on their interoperability solutions to unify, normalize, and exchange clinical and financial data. As the healthcare industry has evolved, Edifecs’ solutions have evolved with it. Their cloud-native, AI-powered solutions are designed to help healthcare organizations thrive in value-based care. Learn more about Edifecs at www.edifecs.com

Michael welcomes Matt Spielman, Senior Director of Product Management with Edifecs, to discuss the latest and greatest regarding the...

Guest host Denny Brennan (Executive Director, Massachusetts Health Data Consortium and WEDI Board Chair-Elect, welcomes Patrick Lane, President and COO of Health Gorilla. Patrick discusses his recent White House visit for the Make Health Tech Great Again event and addresses the issue of FWA: Fraud, Waste, and Abuse. Patrick sees the solution in the industry embracing LED: Legitimacy, Efficiency, and Development, and offers thoughts on tools and resources that can best be leveraged to achieve this healthcare dream. 

Learn more about the Sequoia Project's CMS0057F Implementation checklist here- https://sequoiaproject.org/interoperability-matters/payer-to-payer-api-workgroup/ 

Michael welcomes back (Episode 174, Oct 2024) the co-chairs of the Sequoia Project's Payer to Payer API Implementation Workgroup, Nancy Beavin (Medica) and Bob Oakley (Evernorth), to discuss their new work product, a downloadable tool designed to help payers assess their readiness for compliance with the payer-to-payer components of CMS-0057-F. Along with the workgroup's project manager, Jim Adamson (Point of Care Partners), Nancy and Bob offer updates on the workgroup meetings, the origin of the checklist, and their plans for the future. 

Michael welcomes Dr. Steven Buslovich, MD, Chief Medical Officer for PointClickCare and a passionate advocate for using technology to augment care for seniors. The two discuss how AI is developing intelligent care management for seniors, improving efficiencies in senior care facilities, and what healthcare stakeholders need to consider when implementing AI into the senior healthcare field. 

Michael welcomes Todd Doze, CEO of Janus Health, to discuss how AI is being introduced to address revenue cycle and operational resilience, how AI supports staff rather than replacing them, and strategies hospitals should consider when entering the AI landscape. 

Michael welcomes Dr. Jay Anders, Chief Medical Officer at Medicomp Systems to discuss AI hallucinations and their effect on patient safety and clinician trust.  

This podcast episode is sponsored by Edifecs, a Cotiviti Business. For over 25 years, Edifecs has been a market leader in healthcare data interchange. Hundreds of health plans, providers, and government agencies rely on their interoperability solutions to unify, normalize, and exchange clinical and financial data. As the healthcare industry has evolved, Edifecs’ solutions have evolved with it. Their cloud-native, AI-powered solutions are designed to help healthcare organizations thrive in value-based care. Learn more about Edifecs at www.edifecs.com

Michael welcomes Brian Hanley, Vice President, Public Sector, with Edifecs. Brian discusses the current state of health care con...

From a recent WEDI virtual spotlight, WEDI's Emerging Technology Workgroup Chair Nick Radov (Stedi) has a great conversation about how providers are leveraging artificial intelligence to improve the industry and the special place guidance plays in ensuring not only innovation, but also responsibility.

The panel:

WEDI's Privacy & Security Workgroup Co-Chair Lesley Berkeyheiser (DirectTrust) speakers with Charles Sweat Jr. MD, Healthcare and Public Health Sector Liaison, Cybersecurity and Infrastructure Security Agency (CISA) & Charlee Hess, Director Cybersecurity Division, Critical Infrastructure Protection, US Department Health and Human Services on their organizations' missions, purposes and the resources they have that can help guide best practices for the healthcare industry as it pertains to cybersecurity. 

Michael welcomes Linda Travis Macomber, Professor in Practice and National University and a true thought leader in health care technology and innovation. Recently named a HIMSS Lifetime Fellow, Professor Macomber discusses her impressive career in nursing, health care tech development, and academia, addresses the history of AI in the industry, its bright future, and how she is preparing the next generation of health care technology professionals.

From WEDI's 2025 Spring Conference, a panel featuring health care cybersecurity subject matter experts Erik Decker, VP, CISO, Intermountain Health, and Scott Ruthe, VP, Waystar. Moderated by WEDI's Privacy & Security Workgroup Co-Chair Lesley Berkeyheiser (DirectTrust), the panel discusses cyber resilience business processes, strategies, collaboration, and resources for both public and private health care entities

From WEDI's March 27th's virtual spotlight on Artificial Intelligence, former WEDI Board Chair Ed Hafner chats with an impressive group of health care professionals about the benefits, challenges, and future of artificial intelligence in health care. The panel:

From WEDI's Spring Conference, Michael crashed the Provider Information Workgroup meeting and chatted with workgroup co-chairs Martin Cody, Senior VP of Sales, Madaket Health, and Michelle Barry, Director, Expert Health Plans, Provider Data Management with Availity. They discuss the definition of provider directories, the current issues concerning accuracy, and the incorporation of artificial intelligence with provider information, and is there hope for a national directory of healthcare providers.

From WEDI's Winter Forum earlier this year, a fireside chat about Health Equity's progress and future. The guests are LaShawn McIver, MD, SVP, Chief Health Equity Officer with AHIP, and Joy Lewis, SVP, Health Equity Strategies and Executive Director,  Institute for Diversity and Health Equity, American Hospital Association. The moderator is Nancy Spector, formerly of the American Medical Association and currently WEDI's Senior Director, Federal Affairs. 

Michael welcomes Oren Nissim, CEO and Co-founder of Brook Health, which focuses on AI-powered remote health care management, particularly for individuals with chronic conditions. The two discuss the unique balance between advanced technology and the human touch necessary to enhance the patient experience and the present and future of artificial intelligence in the industry. 

Michael recently welcomed retired WEDI President and CEO Charles Stellar for the podcast's 200th episode. Charles updates his post-WEDI activities, including travel and reuniting with old friends and colleagues. He reflected on WEDI's growth and accomplishments during his nearly 10 years with the association, and stressed collaboration, leadership development, and mentorship as the secret to organizational success.  

Michael welcomes Ovatient CEO Michael Dalton. Ovatient is a virtual health company that provides a connected, meaningful, and personalized patient experience that empowers care teams with nearly real-time data.

The two discuss trends in virtual care post-pandemic, lessons learned by health systems regarding virtual care delivery, and key factor for successful virtual-first care models. They discuss the power of patient and provider trust, integration with existing health systems, and the impact of AI and other emerging technology in hybrid care.  

Michael welcomes Brent Dover, CEO of Carta Healthcare, a healthcare technology company that leverages artificial intelligence (AI) and automation to streamline clinical data management and abstraction. Brent discusses how AI can support clinicians with data-driven issues, security and ethical considerations with AI, and how AI-powered data management can influence value based care. 

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...

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:

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:

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...

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 an...

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 p...

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' l...

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.

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:

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. V...

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 apoole@wedi.org.

You must be a WEDI member to join. To become a WEDI member, contact Bill Allder at ballder@wedi.org

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 S...

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 Kais...

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:

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:

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 ser...

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:

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. 

Michael chats with Amanda Bury, Chief Commercial Officer with Infermedica about how tools like the digital self-triage are supporting the patient while also feeding physicians valuable information to create a more productive and accurate healthcare experience. 

Michael chats with Akshay Sharma, Chief AI Officer with Lyric, a leading AI healthcare technology company looking to leverage AI to improve payment accuracy and efficiency. 

Akshay discusses the power and potential of AI, how Lyric is improving the healthcare payment process for all stakeholders and the importance of responsible AI and privacy when implementing this emerging technology. 

Michael welcomes MedicareSchool.com co-founder Marvin Musick to discuss offering valuable education to Medicare-eligible patients and the affect of technology and policy on Medicare and healthcare in general.  

From WEDI's Feb 2024 Health Equity Forum, Dr. Marc Rabner, Chief Medical Officer with CRISP Shared Services moderates a panel of CBO leaders on how they leverage data in their day to day work. 

The Panel:

This week, Matthew welcome Nick Adriance, Director, Global Software Product Management at CenTrak. The two discuss the evolution of Real Time Location Systems (RTLS) and how it can aid in streamlining cost, decrease lost equipment, increase security, and enhance patient experience. 

At WEDI's recent Health Equity Forum and Workshop, Sagran Moodley, Chief Innovation and Technology Officer with Ontada spoke with Dr. Vindell Washington, former National Coordinator for Health IT and the Chief Clinical Officer and Director of the Health Equity Center of Excellence for Verily Health Platforms. 

Michael welcomes Richard Wagner, a former WEDI Privacy and Security Workgorup Co-Chair who is the CEO of Raven Health (www.ravenhealth.com) a leader in data collection and analysis for behavioral health. Coming from a healthcare family, Richard learned early on about the frustrations of healthcare software from his clinician father, and worked to increase the time a clinician spends with their patients and decrease the time they spend doing "everything else."

Michael chats with Lisa Blue, Chief Clinical Innovation Officer with Providertech on how technology and policy is quickly shaping the future for patient engagement. 

Matthew chats with Patty Hayward, General Manager of Healthcare and Life Sciences at Talkdesk. The two discuss healthcare's current problem areas, how patient empowerment can help turn the tide and how AI can address call center challenges. 

Matthew welcomes a panel of healthcare professionals to discuss the power of SDOH data in changing communities. 

The group discusses the data-centric challenges of collecting and analyzing SDOH data and the need for the healthcare industry to continue to collaborate with community based organizations. 

"The greatness of a community is most accurately measured by the compassionate actions of its members"

Michael welcomes Shweta Maniar, Global Director, Healthcare & Life Sciences with Google. Shweta shares how early experiences of volunteer service shaped her vision of how technology, along with trust and sense of community, can improve the healthcare ecosystem. Shweta also shares advice for women leaders and others in healthcare, and unveils the secret of how almond milk is made (it's probably not a secret, Michael just didn't know). 

WEDI's Director of Events and Education Michael McNutt chats with Kim Perry, Chief Growth Officer at emtelligent, about the adoption of clinical AI and its potential to transform business processes in the healthcare market. The benefits of AI are discussed as well as the challenges that come with the technology. 

Read Kim's article on how NLP can aid payers and providers when exchanging patient information through continuity-of-care documents.

https://www.ajmc.com/view/contributor-unlocking-the-value-of-unstructured-data-from-continuity-of-care-documents-using-medical-grade-nlp

Matthew chats with Artisight Inc. President Stephanie Lahr. Inspired by her experience with an EHR system during a hurricane in Texas, Stephanie discusses the urgent need to transition from paper records, embrace technology, and how AI can support hospitals by identifying and automating high friction environments, improving the quality of care, and reducing healthcare burnout. 

Host Mike Kottmer (WEDI Board Member) talks with Dr Colin Banas, Chief Medical Officer with Dr. First. The two discuss how AI (Dr. Banas calls it Augmented Intelligence) has benefitted both patients (improved medication management) and physicians (burden reduction) as well as the challenges and future opportunities that AI will bring the industry.  

Guest host and WEDI board member Mike Kottmer chats with Dr. Luigi Vacca and Aaron Holloway, the founders of tallywell, a digital health app that utilizes AI and ML to create a FICO-like "health score" for the user.