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Join the RISE team as we chat with industry leaders and explore ever-changing policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health. Produced by RISE, the number one source for information on all things Medicare Advantage.
RISE Radio
Episode 27: Innovation roadmap: Cotiviti on a proactive approach to risk adjustment
As regulatory pressures intensify and the demand for measurable ROI grows, health care organizations are rethinking how they approach risk adjustment. The landscape is shifting—from retrospective reviews to real-time, proactive strategies powered by smarter technology and deeper clinical insight.
In this 38-minute episode of RISE Radio, senior leaders from Cotiviti and Edifecs share how their recent partnership is fueling a new era of innovation across the full risk adjustment lifecycle. From Medicare Advantage to Medicaid and ACA markets, they explore how scalable tech, strategic foresight, and clinical expertise are helping organizations stay ahead of compliance demands and financial pressures.
About the speakers
Branka Sustic, vice president of risk and quality solutions, Cotiviti, provides leadership and oversight into product and business development, client program management, and strategy to assist health plans in meeting their quality and risk adjustment goals, optimization of revenue, and risk mitigation. She is a leader with more than two decades of health care experience, blending a strong customer service and analytic foundation with experience leading change management throughout her career. Sustic is known for creating and establishing operational and support plans leading to increased client satisfaction and performance.
Dr. Summerpal Kahlon, chief medical officer at Edifecs, a Cotiviti business, works across products and functions to guide clinical strategies and policies. His career spans over 20 years of experience in diverse health care settings, businesses, and markets. Dr. Kahlon has deep expertise in value-based care and risk adjustment, and brings unique insight to help customers make the most comprehensive, informed, and clinically relevant decisions for their populations. He is a practicing physician with Veterans Affairs and an assistant professor of internal medicine at the University of Central Florida.
About Cotiviti
Cotiviti is a leading solutions and analytics company that is reshaping the economics of health care, helping its clients uncover new opportunities to unlock value. Cotiviti’s solutions are a critical foundation for health care payers in their mission to lower health care costs and improve quality through higher performing payment accuracy, quality improvement, risk adjustment, consumer engagement, and network performance
Hello and welcome to the latest episode of RISE Radio. I’m your host, Ilene MacDonald, the editorial director at RISE. Today we will be talking about innovation in risk adjustment. Joining me today are senior leaders from Cotiviti: Branka Sustic, vice president of risk and quality solutions, and Dr. Summerpal Kahlon, chief medical officer, Edifecs, a Cotiviti business. Welcome to you both. To start , perhaps you both could give us
Ilene MacDonald, host:a brief introduction of your roles and then talk a little bit about this partnership and what inspired it. Branca, could you start?
Branka Sustic :Absolutely, and thank you, Ilene, for having us today. Branka Sustic, and I have been with Cotivity now for almost 24 years in different roles throughout the time, but currently lead our risk adjustment and quality solution client success teams and implementation teams. And it's really nice to be here with you today.
Ilene MacDonald, host:Thank you. And Dr. Kahlon, can you give a brief description and then maybe talk about this partnership between Cotivity and Edifecs.
Dr. Summerpal Kahlon:Sure. Thanks, Ilene. And I appreciate everyone taking the time to join us today. I joined Cotivity through Edifecs where I served as chief medical officer, and I have responsibility over the risk adjustment product portfolio. For me, I've been doing risk adjustment from a number of different angles over the years. So as a physician myself, I've been the guy sitting there trying to do the documentation and do the coding myself. But also having led ACOs, having worked in health plans, having been on the technology and vendor side, I've really had a chance to kind of see risk adjustment from a variety of different angles and try to figure out how do we continue to advance the state of the art and do it effectively, knowing that this is an area where it's really important to be accurate. It's important to do things the right way. So, you know, as you mentioned, we've come together and Branka and I hang out quite a bit these days. We've been working together pretty closely ever since we joined together back in March. Really, when I look at it, I really see a great hand-in-glove fit for our capabilities together. As Edifecs , we've got a lot of technology and expertise through data that we bring to the table. And with Cotiviti, they also have some great technology assets that are complementary and a deep bench and knowledge of the industry and skill sets around not just risk, but also quality and consumer engagement and a variety of other things that drive into effective performance. So for me, it's actually been a lot of fun working with my Cotivity colleagues as we've gotten together. And I Branka and I, like I say, we we talk quite a bit, we hang out quite a bit, and we've really looked at some great opportunities to bring our skill sets and our capabilities together in a way where we can really offer what, you know, in my own personal opinion, is the most comprehensive offering out there in the industry: a true end-to-end portfolio where you can help an organization, whether it's a health plan, an ACO or provider group, really be effective around risk and quality. Branka I hope you feel the same way that you've enjoyed kind of hanging out together these last seven months.
Branka Sustic :Well, I I absolutely have and I do. And I I think some are mentioned in here, but the capabilities across both enterprises and what we now have as a combined organization really are second to none, right? When we are talking about risk and quality and and really being more proactive with where our clients and our customers need us to be, it it really is is transformational in many different ways. And coupled with Summer's experience on the risk adjustment in the in the industry as well as being a physician, I mean, we bring a wealth of experience on the services side and subject matter expertise, also just operationally upgrading, making processes more efficient. I mean, this is what we do. We do it incredibly well keeping up with our with our customers while meeting their needs. So I think it's an incredible partnership that we are all very, very excited about.
Ilene MacDonald, host:Terrific. So let's get into risk adjustment. Can you both talk about some of the biggest developments you've seen in the industry in 2025 and the impact they've had on the health care organizations?
Branka Sustic :Yeah, I can kick this off, Ilene. I think from our side, I mean, one of the things that's been really big is obviously the regulatory changes. We are there is continued scrutiny on most recently with some of the RADV audit expansion that now seems to be in a little bit of a limbo, but still a big focus on RADV audit expansion, which obviously make the plans help plan clients of ours pay very much close attention. I mean, I think this is always an area of focus, but it brings even focus on that coding intensity and the oversight that needs to happen. The No Upcode Act, uh, another item that's or is very much active out there, but the bipartispartisan bill that was that really aims to curb that upcoding and reduce the Medicare Advantage overpayments. We are seeing a lot of different things on the ACA enrollment changes, right? The expiration of the enhanced subsidies and the premium tax credits that are set to expire at the end of 2025, and then Medicaid enrollment changes and some of the work requirements that starting in 2027 that that are going to happen. So there's a lot of different things that are playing a role, and these regulatory changes absolutely have an impact on what we do, how we do it, and how we can help our clients be better prepared to meet um and adhere to all of these different regulations.
Dr. Summerpal Kahlon:Yeah, and I would add, you know, I totally agree with Branka . There's a lot happening in the regulatory space right now, and some of it is unpredictable. It really is kind of hard to know when and where some of these things are going to land. But even beyond the regulatory side, there's a lot of pressure out there on health plans to remain profitable and continue to offer a strong benefit. There's a lot of pressure on providers to manage cost and continue to sustain their operations. There's a lot of business pressures out there, somewhat related, but also very much independent of some of the regulatory elements Branka just touched on. So if I look, for example, there's been a lot of talk lately about Medicaid coverage. Will some people end up falling off the rolls given some of the new regulations, the potential increase in cost of ACA plans that again may affect affordability there. And then we've seen some significant challenges in the Medicare Advantage space where some plans have had difficulty maintaining profitability with the increase in their medical loss. So, you know, you see a lot of shifts out there, especially in the government plan space where plans are sort of shifting their markets, shifting their lines of business, trying to offer a strong benefit, but do so in a way where it continues to be cost effective. You see a lot of pressure out there. And I'll say some of that is probably magnified by the post-COVID hangover. It doesn't really feel like it's been that long. It's been just about five years since COVID happened. We saw a significant dip in utilization in the couple of years after that. And we're seeing that rise again now, where people are again engaging in the health care system. So all those pressures are kind of coming together and creating a lot of pressure around cost and again being able to offer a good, high-quality health care experience and a cost-effective health plan in that model. But, you know, that said, that's where technology, automation, AI, a lot of the things that we can bring to the table to both create efficiencies, but also create an improved experience, a cost-effective experience, so that in the end, people can still get out there and get the health care they need without blowing the budgets. I think there's some great opportunity out there. And we've really been doing some fun things ourselves that we can talk about a little bit later, applying AI and data, looking for ways to continue to get more efficient and effective. And, you know, one of the big things we've been working on as well is what we tend to call the left shift, you know, moving more prospective, engaging providers and members earlier in the process, earlier in the cycle, not only to capture codes and close gaps, but also, you know, if I look at it through the lens of a physician, learn more about our patients and our members earlier in the year so we can engage them in the right care programs, the right management, really give them a better health care experience. And, you know, Branka , I know you've been working on this as well. You know, would love to get your perspective because I really see the opportunity to kind of continue to move more forward in the cycle, really engage people much earlier where they are to improve outcomes.
Branka Sustic :Oh, I absolutely and I think that was one of the other big reasons why Cotiviti and Edifecs are now a single entity, right? Because some of the capabilities across the enterprise. But there is, as Summer just mentioned, the the goal here is really to improve the health of the population, right? And the risk adjustment is one small component of that,, one very critical component. But, so in order to really get there and to transition into that space, this whole impact is around a lot of it around technology enablement, right? So investing in those CDI programs, real-time analytics, integrated platforms that can help physicians that can help help plans and ultimately their their members. It does require a lot of work on the help plan side or provider side as well, right? Provider own plans when it comes to those different aspects, whether it's audit readiness or operational or as I mentioned, that technology enablement really helping with to ease potentially those cost pressures while increasing the interoperability and really leveraging that digital data for to meet these different um different initiatives. So a lot going on, but I think we are very well positioned to be able to meet the demands of the members and the health plans, health plan clients as well as the provider clients of ours.
Ilene MacDonald, host:Can you go a little bit deeper into sort of the tech trends that health care leaders should be following for the upcoming year?
Dr. Summerpal Kahlon:Well, you know, Ilene, as you've probably heard, AI is the big thing these days. And, you know, AI is kind of whatever you want it to be, to be totally honest with you. And so I know that makes it hard for people to kind of filter out well, what is this and how does it benefit me? You know, so when I look at what we've done at Edifecs over the years, you know, we really were one of the early adopters, early leaders around AI and leveraging that, particularly in risk adjustment as well as other places. And I will say, I know the the cool thing is to say my new AI is somehow different, better, cooler, flashier, but there is a significant value in having history, having experience, having mature AI that's been vetted and tested and built over time. And there's more of an understanding of just how it all works, you know. And so I see that myself with colleagues at other organizations who are trying to create their own AI now. It's a lot harder than they thought. It always takes a lot longer than they thought it would take. Now, that said, you know, I think there's a number of areas where AI can be applied, particularly in the risk adjustment space, to really add additional value. So one I'll say is around productivity. I know that's always a concern with folks who run coding operations, and even more so if you're working to engage providers and that left shift prospective kind of model we talked about. Not only using AI in terms of, you know, identifying the gaps, identifying the opportunities, but also in those workflows to create more efficiency in the workflow to make it easier for people to find the right information and move forward both quickly and effectively. And I think the key is effectively, not just sort of skip through the process, but do it effectively. I think that's where we see a lot of opportunity with AI. The other is predictive modeling. And again, that left shift that I mentioned earlier, starting to get more insight using AI and leveraging data to say what can we predict? What do we see coming? How do we run an operation effectively? I think those are areas where we see some significant trends and opportunities. Again, kind of tying back to that idea that it's not only about doing this well, it's about doing it in a cost-effective way given a lot of the pressures that we see out there. And, you know, I tend to be heavily focused on risk, but I know as part of Cotivitt, Cotivitt has a very broad sort of portfolio of capabilities. And in particular, Branka works quite a bit on quality and some of the elements that relate to that. I know and NCQA is doing a lot of cool stuff these days. So, Branka , I know you've been working on some other technologies. Anything else you want to add in there?
Branka Sustic :Yeah, so Summerr, I think you you touched on it, right? The AI is the big thing right now, everywhere. And I will just add on a little bit on the risk adjustment side. I think the way that we approach risk adjustment coding, it's really we always like to say it's an art, not a science, right? While technology absolutely enables the coders to do their work, the human coder touch is always an approach that we take, right? The technology enables them and it helps be more efficient. However, the human always does review those final results before making that determination. So I think it's just an important component in a world where there's a lot being done on the technology side, right? But that that that human touch in our world is never we never plan for it to go away. So but transitioning over on the on the quality side, I mean, one of the big things that we are hearing, we are seeing from our customers integration of risk and quality, right? I mean, there is a lot of pressure out there for to do less or to have less pressure on the providers to provide the charts, right? Provider offices. They're they're so busy doing what they're doing to improve the health care that um how can we make it easier for them so that they can provide us data one in one swoop, let's call it, where we can serve multiple purposes. This is much easier said than done, but that integration, I will say, across risk adjustment and quality is creating inefficiencies and it is providing creating that provider abrasion. So based on the work that we have done, and I there is about 20 to 35% potential efficiency gains by reusing potentially medical records. We are currently doing some different pilots with our customers to really evaluate how we can do this more effectively, ultimately reducing that provider abrasion while helping our clients become more efficient. Therefore, ultimately, I think saving some money as well in the process, right? But so there's a there's a lot going on from that integration perspective, but it doesn't really help that most of our most of the plans also operate in silos. So risk adjustment and quality programs tend to be two different departments within the plan that don't necessarily talk to each other. Some are, and I think we are seeing also a lot of our clients kind of trying to tie those pieces together. But at the end of the day, that operational efficiency is something that everybody should be looking at in order to improve how they do work and lower those administrative costs.
Ilene MacDonald, host:What would you say are some of the biggest barriers to risk adjustment innovation? And if you have any suggestions on how organizations could overcome them, I think our listeners would appreciate that.
Branka Sustic :So, I mean, from my perspective, I will just say a couple of things. Maybe embedding that compliance and ROI metrics into every innovation initiative. I mean, there's there's always that I will say pulling forces right around what do you budget for? Where do you invest your dollars? It's not easy and a lot of organizations are struggling, like what should be their top priorities? Um, so I think I would say in in my from my perspective, really leverage some of those integrated platforms, look at what you can do and what you already have in place across different areas of the organization that can risk and quality effort and reduce those manual inefficiencies. I would also say, and we are seeing this across the board and we are doing it ourselves, building those governance framework frameworks that support scalable AI adoption without necessarily falling into those hype cycles, right? So really know what you're doing, know what your what your success metrics are and then I think build fast, fail fast, right? If it doesn't work, let's scratch it and move on and invest your dollars and time elsewhere in areas that can help you, you as an organization, as well as the members that you serve, because ultimately that's what it all boils down to.
Dr. Summerpal Kahlon:Yeah, you know, Branka , you talk about hype. And I guess I've been around long enough that I get cynical about all the hype. I always hear about the next thing, the newest thing. But like you mentioned, it's all about really being practical and saying, what's going to work? How is it gonna work? How can I measure that it's gonna work and drive that ROI, drive that success, drive that business value? I know for me, one of the things that's kind of always been a challenge ever since the advent of health tech and the adoption of EMRs several years ago, for all the progress we've made, we've still got a lot of data fragmentation. And when we talk about that left shift becoming more prospective and also leveraging concurrent risk adjustment, there's still a lot of challenges in acquiring data, not only acquiring it, but acquiring it in a timely manner so that you can make an impact. And also integrating into workflows. And so, you know, what I'll say is one of the things I'm excited about as a combined cotivity is that we bring a lot of different touch points in the workflow. So starting with kind of spawning the prospective HCC gap, you know, let's see if there's potentially something there by taking a look at some of these documents that we might have access to all the way through, you know, getting that to the point of care with the provider, addressing that post-visit, making sure documentation looks good, and then reviewing it before it gets sent out and processed as a claim to make sure we've had every opportunity to kind of touch things and vet and make sure we've done the best we can in terms of our documentation, done it appropriately. You know, I'll say there's no one size fits all. There's a need to really adapt out there. And in some cases, there's great opportunity for scale, particularly in the concurrent space. It may be low touch but easy scale. Whereas there may be other cases around direct EMR integration where it's high touch, high impact, but it's difficult to scale, especially when you talk about all the different hundreds of EMRs that are out there and the various landscape of providers that use them. So, really, I think for any organization to be successful, you've got to have a multi-pronged approach. There's no one size fits all. But again, that's one of the things that excites me about being part of Cotiviti is we can touch all those areas. We have great mechanisms around interoperability, chart reuse, data storage, being able to touch various points in the timeline around when a gap is identified and then ultimately closed. It really is kind of a nice opportunity to give organizations an opportunity to figure out what works best for me. How do I leverage that full spectrum in a way that works best for my situation, my environment, my access to data, my providers that I work with, et cetera. In the end, a lot of it comes down to trust, you know, and this is a difficult sort of space in the sense that you're really looking at trying to help folks get accurate documentation, not only for financial reasons, but also really for clinical reasons. So that you're out there doing the best you can to really know what type of care, what amount of care, how complex are these patients, so that we can make sure we take good care of them and again do it in a cost-effective way. So I think that's one of the things that I get excited about being part of Cotiviti is that we really can offer that sort of comprehensive approach, not that it's a one size fits all, but that it's the kind of thing where you can adapt and change over time as well to organize yourself, run an operation, run it effectively, do it in a way where you feel like you can learn and grow as you go.
Ilene MacDonald, host:You know, we we talked a lot about the barrier to innovation and all the hype with AI and where it was going and no one decides if it's all. But organizations are in different stages, right, of innovation. So do you have any advice for depending on where an organization is in this innovation curve, what they should be thinking about in the upcoming year?
Branka Sustic :So I can I can kick this off. I think in in my mind, it's really setting the clear business objectives. Again, different organizations, you have different budgets that you can work with. So you know what you can what you can invest in. But defining what the problem, the technology solves and how you want to measure the success, right? I think I mentioned it a little bit earlier as well, but start small scale fast, do pilot if necessary, but look at where you can get the most benefits with quick ROI that can build confidence, it can build momentum so that you can move forward. And then I think another one is really to champion the enablement. I talk through this with my team, believe me, every day. And I challenge myself in the same way, right? Work smarter, not harder. There is just so many different technologies and tools out there today and offerings from anybody out there, like other vendors like Cotiviti or Cotiviti as our organization, right? Like where you h work with us or to see what those solutions are and how they can help you move forward. But, yeah, again, set clear business objectives, define what the problem and technology you want to use or product offerings you want to use to help you achieve those business goals, and then ultimately have those ROI and KPI trackings. Are you achieving what you want to achieve with these particular services and solutions that can help you achieve your own business goals? So some very tangible things that I think can help overcome those challenges.
Dr. Summerpal Kahlon:Yeah, and I would kind of build on what you mentioned, Branka , in the sense of scalability is critical. You don't have to do everything all at once. So, like you mentioned, sometimes there are programs where you want to go ahead and scale right up front because you've done the analysis, you know it's gonna work, you have a high degree of confidence. In other cases, you need to try things a little bit, or you may find that it's really just a focused effort. So, for example, if I give kind of the health plan lens to this, if I'm a health plan, maybe I need to do a retrospective coding review at scale. That's something I just need to do and do effectively and figure out how to make it work. But if I want to pursue that left shift that we were talking about, you know, perhaps I do want to try to reach a large number of providers. And I know it's going to be light touch, but I'd rather get light touch at scale, see how that works, see if I can touch some high-value documentation opportunities while then working on perhaps some high-value large provider groups, maybe a big health system in a metro area that has a large number of my members as a health plan to say, hey, maybe I want to come in and integrate into your EMR, help your providers, give them information at the point of care. So there can be a multi-pronged approach. And I'll say also from a health plan perspective, they're getting more data than they really have ever had before. And they're still trying to figure out how best to mobilize it, how best to get value out of it. You know, so I see this all the time where health plans have now, you know, a thousand-page chart where once upon a time they were lucky to have any charts, you know, and now they're they're drowning in high volume charts. How do I get value out of that? How do I unlock the information in there so that it can drive good, efficient business value? And I'll say on the provider side too, providers are drowning in data, you know, especially now as we've got more mature around EMRs. You know, there's organizations that have acquired other, you know, hospitals and clinics, they've switched out their EMRs. They might have eight different data repositories sitting around and still internally trying to figure out how to integrate it all and present it all in one organized way to help drive patient care. So, you know, there's a lot of challenges in scale. The bigger we get, the more complex we get. And the more there's a need to really be able to sort of take that thoughtful, multi-pronged approach. I'll say it becomes important to set your success targets. So when you look at those kind of opportunities, especially in sort of a pilot mode or a sort of small-scale early adopter kind of mode, it's important to start with the end in mind. Know what metrics you want to hit, really have a clear sense of what success looks like, so that you know if you've achieved that success, you can scale rapidly. So, I'll just kind of have a little fun for a minute here. But Branka and I were together in a meeting earlier this week, and she brought cookies to the meeting. So that's become now a metric of success for me. Any meeting where Branka brings cookies is going to be a successful meeting. And I know Branka, you've got some real KPIs that you're looking at that you track very closely.
Branka Sustic :Yeah, yeah. Other than the cookies for sure. No, we are, I mean, from the retrieval coding perspective, this the coding quality rates. I mean, those are some of the things that we take very seriously, right? The quality of the work that we are doing on behalf of our clients really is something that we take incredibly seriously. Like do what we say, say what we are going to do, and then do what we said we were going to do. Sounds simple, but it's one of those things that we take incredible pride in in terms of just delivering to our clients that then builds on that trust that Summer talked about, right? Trust is hard to come by, but those the transparency in the relationship and the work that we do really does help overcome many different challenges when it comes to the real real or real work that we all do day in, day out.
Ilene MacDonald, host:Very good. And what are your for the company for maybe your clients, what are your strategic priorities for 2026?
Dr. Summerpal Kahlon:Yeah, I'll say for our customers, really our strategic priorities are to give them those options that allow them to continue to evolve. So, you know, again, I'll I'll use the health plan example. Any health plan that operates in the government space at this time has a mature retrospective coding operation. It's sort of a table stakes operation. So then the issue becomes again, knowing these cost pressures, knowing the importance of being compliant, being accurate, how can we continue to serve those customers in a way where they get the most value for their money, the highest ROI for their money, high quality of work. And so, we see a lot out there so-called body shops, you know, where it's just all about kind of the race to the bottom on price. We really look at the idea of let's put something out there that's cost effective and the effective part is the most important thing. So then if I kind of walk to the left, like we talked about earlier, I look at an opportunity around concurrent risk adjustment to really begin to explore that prospective concurrent space before the claim, so to speak, at scale. And again, that's where health plans really want to see ROI is at scale. great to get into one provider group, one health system, but if I can kind of go live across a large network relatively instantly and be able to affect documentation in a positive way, give insights that help people understand information they may have been missing so they can do the right thing the way they document, I can do that at scale and begin to get into that left shift, but also learn, collect data, learn what providers want or don't want to engage with, use that as an opportunity then to do those higher touch engagements, the direct-to-provider, you know, sort of pre-visit, intra-visit kind of engagement at the point of care, really begin to kind of move all the way to the left and build a holistic operation. But I think at every step, it's important to be effective. It's important to be cost effective, it's important to deliver high quality, compliance, accuracy all those things need to be done in a way where an organization feels confident in their operation. So, you know, I think as any organization looks at their readiness, looks at those opportunities, they really need to sort of use an effective data-driven approach to say, where do I want to put my resources? How do I want to positively impact my operation? And how do I do that in a way that drives positive ROI and positive outcomes? So, you know, Branka, I'll I'll kind of turn things over to you because I know you work with a lot of health plans, some very large-scale health plans that do retrospective coding at scale. And, you know, they're very mature, very experienced. They know what to look for, they know what success looks like, and they also know they still need to continuously improve no matter how successful they are. So I don't know if you want to share any insights there. You've seen a lot of evolution there over the years.
Branka Sustic :Oh, absolutely. W e have, and we see, yes, as you mentioned, just that focus on the on the coding quality and scale, right? So whether we are talking about Medicare Advantage or Medicaid or commercial lines of business, right? But really across the board. And I would say one of the things that we are doing uh that is a strategic priority for us continues to be the focus on the interoperability. I think Summer mentioned it earlier, but having the access to the digital connections and digital data. I mean, this is an area where we've invested significantly as an organization and have some very real bests of class capabilities in Edifec's suites of products, but retrieving the data through the digital means. And then yes, the coding, coding quality and enhancing on the way that we do m by enable technology enabling our coders continues to be a focus for and an area of big investments. And also coupled with the digital quality engine. I know quality and risk, we talked a little bit about that integration and how that whole ties together. But the big picture fits with all of the capabilities that we have and that focus on digital, both again, risk and quality continues to be something that is top of top of roadmap for for us as we embark on this journey. And then I will be remiss to say for me, specifically operationally focused, a big priority is continue to listen to our customers. I mean, we do a lot of based on the market needs, of course, and market trends, but at the end of the day, delivering to our customers and what again, do what we said we were going, say what we're going to do, and then do what we said we were going to do continues to be an incredibly important thing for us because at the end of the day, that's where it all boils down making those commitments, standing true to them, and delivering for all of our clients on a day-to-day basis, which allows us the ability to look strategically and develop new tools and solutions and offerings. So I would say that's continues to be a strategic priority for me and and our and my teams, and I know for Summer and his teams as well.
Ilene MacDonald, host:Fantastic. I thank you both for your time today. I just want to give you some final thoughts, anything that we didn't discuss that you think is important for listeners to consider in the end of 2025 and for the year ahead.
Dr. Summerpal Kahlon:Yeah, you know, Ilene, I think for me there's a couple of things. You know, one is this left shift that I've talked about repeatedly. I'll say for me, when again I look at it through a clinical lens, why wait till the end of the year to find out how complex your patients are, how complex your members are? Why not learn that earlier in the year so that you can then make a positive impact? So again, it's it's not only about just capturing a code, it's what does that code mean? That code ideally tells you how sick is somebody, is that illness evolving? You know, are they developing complications during the course of the year? And again, the value of that is to say not only do I know how sick that person is, but I can engage that person. So a diabetic with complications, let me enroll them in a care management program. Someone who, you know, is newly shown to have heart disease, let's make sure that person is getting engaged and meeting all their quality measures around managing blood pressure and cholesterol and all those sorts of things. I think really that's where there's opportunity, not only from a business perspective and running an effective operation, but really again looking at how do you positively impact care and you know, in the macro sense, how do you continue to meet a lot of those cost pressures out there in the industry? How do you find out earlier in the process that somebody needs more care than you thought they did or needs more engagement than you thought they did and be able to address it early? So for me, that's a big strategic priority, along with having more meetings with cookies. So, you know, we'll work on that next year more.
Branka Sustic :Yes, we will and I will just say from from my perspective, continue for for plans is really to again look at what those priorities should be for the m and then find if either do it in-house or find a partner that can help you achieve your goals. and fail fast and move fast. Decide what makes most sense and for you as an organization. And once you find that trusted partner, move forward and make changes that you need to be because change is hard, but it we are at a place where we all need to do it. it having that organizational discipline to stick by it is critical. So a lot of change forthcoming, but we are right here along for the ride with with all of the rest of the industry.
Ilene MacDonald, host:Right. Standing still isn't an option, I guess. Thank you both.
Dr. Summerpal Kahlon:Thank you. We appreciate the time.