Sharon Moise, MD

Direct Primary Care: Great Idea, or Great Execution? In this month’s Self-Insurers’ Publishing Corp (SIPC)’s Self-Insurer magazine, Direct Primary Care is spotlighted as a cost-containment tool for medical stop loss. The conclusion? DPC is a win if it's built for real-world results. At Healthcare2U, we’ve tailored our hybrid DPC model to tackle the biggest concerns head-on: ✅ Cost Containment: Our DPC memberships are a capitated cost containment solution that carves claims out of the plan with a fixed monthly price. ✅ Access: Private Physician Network with easy access to primary care, urgent care and virtual care. No searching for in-network providers. No guesswork. ✅ Countrywide: One model. All 50 states. Access in-person care easily and access virtual care anytime, anywhere. ✅ Continuity of Care: Proprietary Electronic Medical Records follow members wherever they go. ✅ Utilization: Our bilingual Patient Advocacy Line navigates members to care, ensuring benefits are understood and utilized. DPC is more than just a healthcare buzzword- it’s a solution. To learn more about how our DPC membership can benefit you, reach out to us at https://lnkd.in/giV3xTnM. Self-Insurance Institute of America #DirectPrimaryCare #CostContainment #Innovation #HealthcareRevolution

12

Institute Director Mark McClellan and Policy Analyst Sara Debab have co-authored a new Viewpoint article in JAMA Health Forum to outline steps that reduce clinician burnout by modernizing Medicare’s risk adjustment mechanism. Risk adjustment is a consequential Medicare payment policy, influencing billions of dollars in adjusted payments to account for the health status of beneficiaries. However, risk adjustment continues to rely on fee-for-service claims, which exacerbates burden on clinicians in accountable care programs. The Centers for Medicare & Medicaid Services (CMS) have implemented reforms to alleviate this burden, but the authors recommended that CMS could advance their reforms further by shifting risk adjustment to rely on key electronic health data that are already part of quality measurement reform. Read the article here: https://duke.is/w/tdna

20

Surgical optimisation only works if patients actually engage with it. Every orthopaedic surgeon knows that patient preparation matters. Better pre-operative function supports better recovery, fewer complications, and smoother post-operative care. The challenge isn’t the evidence. It’s engagement. Most patients are prescribed prehab. Few are actively supported through it. Between booking and admission, motivation drops, pain fluctuates, and uncertainty creeps in. Beyond the Clinic's Project Mobilise set out to close that gap. In the hip and knee replacement surgical cohort (public and private pathways), the results were notable: 📥 88.2% onboarding (30 of 34 referred patients commenced) 🔁 90.0% program retention 🎯 57% achieved their pre-operative health goals, with 43% actively progressing 📉 4 out of 5 improved pain by six weeks post-operatively 💬 86% rated their health coaches as very helpful 💪 100% reported feeling more confident prior to surgery That confidence matters. Patients who feel prepared are less anxious, more adherent, and less likely to generate avoidable practice workload. The difference wasn’t more information. It was a structured hybrid model — digital convenience, clinician guidance, and active physiotherapist support. If you’re exploring structured surgical optimisation pathways, the full Project Mobilise Outcomes Report details the cohort data and workflow model. https://lnkd.in/gUUPds_F #SurgicalOptimisation #PatientEngagement #DigitalHealth

19

2 Comments

What if your cardiology practice could deliver better outcomes and thrive financially? McKinsey & Company’s latest analysis shows that cardiology is poised to lead the next wave of value-based care through specialty risk—where practices are rewarded for keeping patients healthier. The opportunity is clear, but the barrier is real: - Risk models require predictive analytics and early-warning systems - Success demands care coordination that spans beyond the clinic - Payers expect contracting and reporting sophistication many groups don’t have today Chamber bridges that gap. We equip cardiology practices and health systems with the platform, pathways, and operational know-how to step into value-based care with confidence—turning high-risk cardiac populations into measurable and sustainable outcomes. If you’ve been waiting for a practical way to enter value-based cardiology, the window is open. Read McKinsey’s article here: https://lnkd.in/eXcb8VGR

15

I have given many many keynote speeches where I have said “the insurance companies are the smartest people in the room of healthcare”. Nearly every time I get pushback. The reason I keept on saying was “because they have all the data no one has”. That second part continues to be true. Their problem is they have lost their arbitratrage between cost and premiums. The problem is out of control in part because the baby-boomer that have changed every industry sequentially since 1946, is now nearly all in high use care because of age. That generation is the most educated by far of any “older generation” before. We are used to reading and demanding attention. Generational flaw you can call it, and insurance companies are using actuarial tables that are NOT adjusted for it. They don’t even talk about it. You don’t beleive me? Go back to national health expenditures and see what happened starting 2012? Why ? 2012 is around when the first baby boomers hit 65. They are this year hitting 65 at a rate of 13,000 a month. Now you see the problem? Modern Healthcare reports that health insurers are in a “pretty defensive posture… probably for the first time in a decade.” Chris Deacon

4

Mike Adams and I believe that every employer needs to start by addressing the top five chronic conditions: musculoskeletal issues, heart disease, diabetes, cancer, and mental health. These account for the majority of claims costs, absenteeism, and lost productivity. Too many benefit plans are broad and shallow—covering “a little of everything” but failing to focus on the conditions that matter most. The result is diluted impact and wasted investment. At 7-Eleven, we’ve seen how MyPHA changes this. By aligning resources with these priority conditions, we’ve been able to deliver tangible improvements for employees while controlling costs for the employer. For example, targeted support for musculoskeletal conditions has reduced injury-related absenteeism, while expanded mental health resources have improved engagement and retention. Focusing on the “big five” is not about narrowing scope—it’s about maximizing impact. And it’s a strategy every HR and C-suite leader should consider when designing benefits.

18

Another very large payment to resolve an FCA claim for alleged upcoding, this time by Aetna. Check out our own Jason Jobes post below.

1

1 Comment

🔥 DOCS MD HEALTHCARE ANALYSIS “Healthcare Leadership Is Still Reactive—And That’s the Risk” Most healthcare leaders are experienced. Qualified. Clinically aware. Operationally involved. Yet many organizations are still led in reaction mode. Not because leaders lack capability— but because systems are designed to inform late, not early. 🌍 A Global Leadership Pattern Across the United States, UK, Europe, UAE, Australia, and Canada, healthcare leadership often looks like this: Problems surface after revenue drops Meetings happen after denials spike Corrective action follows audits, not signals Strategy responds to damage, not trajectory Leadership becomes firefighting, not foresight. 🏥 What Reactive Leadership Looks Like Operationally Organizations stuck in reaction mode show common traits: Weekly reviews of last month’s losses Escalations based on volume, not risk Dashboards that explain outcomes, not causes Decisions driven by urgency, not intelligence Everything feels busy. Very little feels predictive. 💰 The Revenue Impact of Late Decisions When leadership reacts instead of anticipates: Denials are addressed after payment cycles close Underpayments are discovered after write-offs Payer behavior patterns go unnoticed Cash flow volatility becomes normalized Revenue is managed historically, not strategically. 🧑‍⚕️ The Cultural Cost Inside Organizations Reactive environments create: Teams conditioned to wait for issues Low ownership of early signals Fatigue from constant escalation Frustration among high performers Over time, organizations lose not just money—but momentum. 🌐 Different Markets. Same Leadership Challenge. United States: Complexity delays clarity UK & Europe: Centralized reporting slows response UAE & Australia: Growth outpaces governance maturity The structures differ. The reaction pattern remains. 💡 The Hard Truth Modern healthcare cannot be led in hindsight. Effective leadership today requires: Early-warning operational intelligence Predictive revenue indicators Payer-behavior foresight Decision systems built for speed and context Without these, even strong leaders are forced to react. 🔍 The Question Leaders Must Ask Are you leading your organization with foresight… or responding to problems your systems should have warned you about? 💬 Let’s Open the Conversation 👉 What information do leaders receive too late in your organisation? 👉 Where does reaction replace anticipation? Share your perspective. This series exists to redefine leadership for modern healthcare operations. — Sriram Kannan DOCS MD Group of Companies #DOCSMDHealthcareAnalysis #HealthcareLeadership #OperationalIntelligence #RevenueCycleManagement #HealthcareOperations

1

Healthcare contract negotiations can feel opaque, but they have very real impacts on patients. In this episode of The Vitals, Dr. Alan Adler walks through how hospital–insurer negotiations unfold and why they matter, from reimbursement rates to continuity of care. A thoughtful conversation for anyone who wants to better understand the inner workings of these negotiations. https://lnkd.in/eX777Fy7

3

Our data aligns with McKinsey & Company’s analysis of specialist healthcare. Nonsurgical specialty groups have seen the biggest growth in revenue over the last five years. And 76% of providers in this group are still paid based on salary alone, more than primary care or surgical providers. Spending on specialty care is growing in part because referrals to specialists are increasing. Medicine has become more complex and primary care doctors have become more overburdened. https://mck.co/46dCzKT

16

2 Comments

RMLC Member Andrew Zengilowski CoachCare provided opening remarks to U.S. House Committee on Ways & Means Health Subcommittee at the hearing: Health at Your Fingertips: Harnessing the Power of Digital Health Data "RPM is a flagship example of “Harnessing the Power of #DigitalHealth Data.” "By transmitting physiologic #data from a patient’s home to a care team in near real time, RPM gives clinicians the actionable insights they need to intervene early, adjust treatment plans promptly, and prevent avoidable hospitalizations. RPM supports both #chronic and acute conditions across short- and long-term episodes of #care, and is also used in inpatient settings to assist with #caring for #patients in the hospital." Full testimony: https://lnkd.in/gC_wUy2Q Tune into the hearing: https://lnkd.in/eKjwBetn #RMLC CoachCare Cadence HealthSnap Biofourmis BioIntelliSense, Inc CopilotIQ Impilo

123

6 Comments

Post-Traumatic Stress Disorder (PTSD) has undergone significant evolution in both understanding and diagnosis over the past century. In our new MEC Connect Expert Insights podcast, “PTSD Diagnosis Dilemma,” our Chief Medical Officer, Dr. Fernando Branco, provides a comprehensive overview of PTSD, its progression in medical understanding, and why it is becoming overdiagnosed in modern practice. Dr. Branco challenges listeners to recognize the critical distinction between Acute Traumatic Stress Disorder – a standard, time-limited response to abnormal events – and true PTSD, which persists beyond six months and manifests through specific symptoms that are often misunderstood. He also shares his perspective on how our understanding of PTSD has shifted, the prognosis criteria and promising treatment approaches, especially for first responders. Listen now to hear an essential conversation about how trauma affects the human mind and gain valuable insights about the vital importance of maintaining diagnostic integrity while still honoring the very real suffering of those affected by PTSD. Listen Now! https://lnkd.in/eKJBjG6b #mentalhealth #PTSD #makingadifference #mecasualty

18

Behavioral health patients continue to face long emergency department (ED) stays and access challenges—particularly those with government insurance. In this episode, Sg2 expert Jennifer Goff joins host Jayme Zage, PhD to explore how ED utilization trends are evolving and to highlight innovative crisis care models gaining traction across the country. From mobile response teams to empath units, learn how hospitals and community partners are collaborating to deliver more effective, efficient crisis services. Jen also shares practical guidance for organizations working to strengthen their behavioral health strategies. https://lnkd.in/etaz7CBx

8

Proud moment for MD Revolution, now part of CoachCare! Today, CEO Andrew Zengilowski delivered the opening remarks before the U.S. House Committee on Ways & Means Health Subcommittee as part of a landmark hearing: “Health at Your Fingertips: Harnessing the Power of Digital Health Data.” As a founding member of the Remote Monitoring Leadership Council, Andrew highlighted the critical role of Remote Patient Monitoring (RPM) in transforming care delivery: “By transmitting physiologic data from a patient’s home to a care team in near real time, RPM gives clinicians the actionable insights they need to intervene early, adjust treatment plans promptly, and prevent avoidable hospitalizations.” We’re excited to help lead this movement as part of the CoachCare family. 📄 Read the full testimony: https://lnkd.in/gC_wUy2Q 🎥 Watch the hearing: https://lnkd.in/eKjwBetn #RPM #DigitalHealth #RemoteCare #CareManagement #HealthTech #ChronicCare #Policy #CoachCare #HealthEquity #ValueBasedCare

23