Care Decoded
Care Decoded is the go-to podcast for clinicians, health plan leaders, and quality champions navigating the evolving world of risk adjustment, value-based care, and smarter documentation. Hosted by Inferscience, this show takes you inside the workflows, decisions, and technologies that turn clinical complexity into clarity. From demystifying HCCs and RAF scores to decoding CMS changes and exploring the impact of AI, we help you understand the data behind every diagnosis.
This show isn't about theory. It's about impact. Not about compliance. But confidence. Not about more clicks. But clarity at the point of care.
If you're building the future of care – one chart, one visit, one code at a time – Care Decoded is your ultimate guide.
Care Decoded
Decoding CMS HCC V28 for Real-World Impact
Welcome back to Care Decoded, the podcast where we make sense of the evolving world of healthcare documentation, coding, and clinical AI. In today’s episode, hosts Dr. Sunil Nihalani and Biodun Kajopaiye, Risk Adjustment and Stars Manager at CareFirst BlueCross BlueShield, dive into the seismic changes brought about by version 28 of the CMS HCC risk adjustment model. Whether you’re a seasoned pro or new to the world of risk adjustment, this episode will break down exactly what V28 is, how it’s shaking up provider and health plan workflows, and why specificity in documentation is more crucial than ever. From the altered landscape of risk score coefficients for common conditions like diabetes and obesity, to the growing role of pharmacy data and the challenges these shifts bring to providers, Dr. Nihalani and Biodun Kajopaiye share real-world insights, actionable advice, and strategies to help you lead with confidence through this moment of major change. If you want to understand how policy updates connect with patient care on the ground, you’re in the right place: let’s get decoding!
Timestamps:
00:00 Healthcare Advocate and Risk Adjustment Expert
06:29 "Improving Diagnosis Documentation and Risk Management"
10:25 RADV Impact on Health Providers
12:04 Risk Adjustment Incentives Explained
15:20 Health Care's Shift to Value-Based Contracts
18:28 Reducing Stress in Healthcare Providers
24:03 Towards Focused Healthcare Management
25:51 Optimizing Risk Adjustment Strategies
29:40 "Prioritize Clinical Perspective First"
Podcast's Website - https://caredecoded.com/
Dr. Sunil Nihalani - CEO and Founder at Inferscience - https://www.linkedin.com/in/sunil-nihalani-a6983a5/
Inferscience - https://www.inferscience.com/
Podcast Powered by TopHealth - https://tophealth.care/