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Authors

Nancy M. Enos, FACMPE, CPC-I, CPMA, CEMC,
CPC, is an independent consultant and coding
instructor. She owns and operates Enos Medical
Coding in Warwick, Rhode Island.

The goal of transitional care management (TCM)  codes is to achieve increased involvement of primary care physicians (PCPs) in order to improve patient care and reduce mistakes in care coordination that can lead to readmission.

How to code and bill for transitional care management

: to have 100% of Traditional Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care relationships, a type of 

 are enrolled in Medicaid, that’s nearly half of the entire U.S. population.

It’s an admirable goal, but the reality is value-based care is difficult to execute for both health plans and providers. Significant roadblocks, including- financial obstacles, lack of organizational readiness, and poor data integration, exist that unintentionally deter health care professionals from delivering value-based care as consistently as they may want to. For example, take medical records, which are complex and contain vast amounts of structured and unstructured data. In the context of value-based care, precise coding of this complicated data, which has historically been time consuming to analyze, is essential for delivering quality patient care, to achieve accurate rating scores like HEDIS, and secure fair reimbursements. The shift from CMS-HCC Model V24 to V28 will require even greater specificity in documentation and code assignment to ensure the accurate level of Medicare Advantage patients’ illness severity is captured.

These types of challenges have long felt insurmountable. But now, AI-powered technology offers a new, incredibly efficient way to overcome these obstacles, and simplifies the complexities of value-based care by turning vast amounts of data into actionable insights and, most importantly, enabling better patient care.

How AI-powered solutions can deliver on the promise of value-based care

AI is revolutionizing health care, particularly in the realm of value-based care. It addresses long-standing issues like fragmented data and inefficient workflows, driving improvements that include:

 AI can significantly streamline operations by automating time-consuming tasks, such as clinical documentation, data entry, and coding, as well as routine tasks like appointment scheduling, claims processing, and regulatory compliance checks.

 Human error, particularly in tasks like documentation and data analysis, can lead to misdiagnoses, incorrect treatment plans, or billing issues. AI can quickly sift through vast amounts of patient data to identify patterns, predict potential risks, and flag inconsistencies in clinical records or diagnoses, reducing errors and saving time.

AI can transform raw patient data into actionable insights that guide clinical decision-making. By pulling data from various sources, AI can identify key trends, early signs of deterioration, or opportunities for intervention.

As health systems continue to embrace value-based care, the volume of data they need to process is exploding. AI is purpose-built to manage large amounts of data quickly and efficiently, helping organizations scale up without sacrificing quality or efficiency.

 Thanks to machine learning, AI systems are constantly evolving. As they process more data and receive feedback from clinical outcomes, they become smarter and more accurate, refining their capabilities over time to improve overall performance.

By implementing AI-driven solutions, health care organizations can navigate the complexities of value-based care with confidence, optimizing both clinical and financial outcomes. That said, hesitancy in embracing this technology still exists.

Physicians indicate both optimism and apprehension towards AI

 conducted by The Harris Poll, 60% of physicians are concerned that 

 could lead to a loss of human touch in patient care. Additionally, 42% believe AI will just be one more thing that will complicate health care, while 40% believe AI is overhyped and won’t meet expectations.

At the same time, many physicians indicated they are open to embracing AI. The same Physician Sentiment Survey found that 83% of physicians believe that AI has the potential to ease some of the biggest challenges in health care, particularly by cutting down on administrative burdens and boosting efficiency. For many, the "silver lining" in AI advancements is the hope that it will ultimately allow them to spend more time with patients and improve care outcomes.

AI has the potential to fully achieve the goals of value-based care by enabling proactive, personalized, and predictive patient care. To turn this vision into reality, collaboration among health care providers, technologists, and policymakers will be the key to unlocking AI’s full capabilities. Health care providers, and the industry, should embrace AI-driven solutions to optimize data utilization, improve health predictions, streamline administrative tasks, and foster collaboration across care teams. By exploring the right AI partners and strategies, providers can stay ahead in this evolving landscape and drive better patient outcomes, lower costs, and improve care coordination.

AI-powered technology offers a way to overcome the obstacles to value-based care, by turning vast amounts of data into actionable insights and enabling better patient care.

Topics

The future of accountable care: How AI is redefining value-based health care

New research into the development of prostate cancer

Prostate cancer disrupts the body’s natural functions within the prostate, reworking the androgen receptor to accelerate tumor development. Research out of Weill Cornell Medicine and published in 

 has paved the way for future diagnostic tests that could guide treatment and help drug developers identify methods to stop the disease.

“It’s pretty well known in the field that the androgen receptor gets hijacked in a variety of ways and starts taking on new functions to drive prostate cancer cell growth,” Christopher Barbieri, MD, PhD, senior author of the study, said in a 

McKinsey to pay $650 million to resolve investigation into company’s work with Purdue Pharma

McKinsey & Company Inc. (McKinsey), a global management consulting firm, has agreed to 

 to resolve a criminal and civil investigation into their consulting work with the opioids manufacturer, Purdue Pharma L.P. (Purdue). McKinsey advised Purdue on steps to “turbocharge” sales of their extended-release opioid drug, OxyContin, in 2013. This is the first time a management consulting firm has been held criminally responsible for advice resulting in the commission of a crime by a client. Additionally, a former senior partner at McKinsey, who had worked on Purdue matters, was charged with obstruction of justice in Virginia.

BMI and obesity in the U.S. decreased in 2023 for the first time in over a decade

Journal of the American Medical Association (JAMA) Health Forum

, found that body mass index (BMI) and obesity among U.S. adults decreased in 2023 for the first time in more than a decade. The most notable decrease was in the Southern U.S., which also had the highest observed dispensing rate of GLP-1RA, per capita. The study’s authors do note that dispensing is not a direct indicator of uptake, and the South also experienced disproportionately high COVID-19 mortality among individuals with obesity.

Putting the brakes on prostate cancer; McKinsey to pay $650 million to resolve criminal and civil investigations; BMI and obesity decreased in the U.S. – Morning Medical Update

Regarding your legacy, there's a fine line between ensuring 

 endures for generations and leaving behind a financial burden for your loved ones. Without a solid estate plan, your wealth could be eroded by taxes, administrative fees, or even disputes among heirs. Advanced estate planning systems, driven by technology, are becoming essential tools for safeguarding your wealth in today's unpredictable 

 developments. With fluctuating tax laws and rising interest rates, relying solely on traditional methods for estate planning can leave your assets vulnerable.

Legacy or liability? Creating a plan to protect your wealth

The first step in defending your wealth from unnecessary loss is to design an estate plan prioritizing protection over liability. The general idea of estate planning only revolves around deciding who inherits what. On the contrary, it's about creating a structure that minimizes taxes, avoids probate complications, and ensures your intentions are executed smoothly. This makes relying on outdated methods to lose more than you preserve.

Modern technology enhances wealth protection more efficiently in the following ways:


1. Mobile applications for asset management

One of the most significant advancements in estate planning is the development of mobile applications that track and manage assets. These tools provide an up-to-date overview of your financial portfolio and send reminders for critical estate planning tasks. For example, apps can alert you when it's time to update your will or review beneficiaries, ensuring your estate plan remains current. These applications streamline the estate management process and make staying organized and proactive with your wealth protection efforts easier.


2. Data analytics for optimal asset allocation

Advanced algorithms can analyze your portfolio and suggest strategies that minimize tax burdens while maximizing wealth transfer. These insights can inform decisions about how assets are divided, allocated, and distributed, helping you create a more resilient plan to tax changes and inflation. You can identify your estate plan's potential weaknesses and mitigate risks with data-driven recommendations.


3. Electronic signatures for streamlined execution

In the digital age, executing legal documents should be as straightforward as possible, which is where electronic signatures present their advantages. E-signature technology makes signing estate planning documents like wills, trusts, and power of attorney forms more efficient without compromising legal compliance. Not only does this save time, but it also reduces the chances of delays or errors in executing crucial legal documents. This is especially useful when dealing with time-sensitive situations or when signatories are in different locations.


The digital revolution has also made it possible to create and store wills online securely. Digital wills on online platforms offering legal guidance allow individuals to quickly draft, modify, and access their estate documents. These platforms ensure that your will is verifiable and easily accessible whenever needed. Services offering cloud storage of these documents guarantee that your estate plan can be located and executed efficiently, providing peace of mind that your wealth distribution instructions will be followed accurately.

Accurate asset documentation is the foundation of a smooth transition

If your records are not clear, transferring wealth to heirs can become complicated, often resulting in extended probate processes or legal disputes. Probate can be time-consuming, costly, and emotionally draining for your loved ones, especially if asset ownership is unclear.

Estate planning is crucial and beneficial in many ways as it documents all your assets—from real estate, bank accounts, investments, and business interests to personal items like family heirlooms and even your monthly subscriptions. This comprehensive record ensures a smooth ownership transition, reducing the need for legal intervention and minimizing delays in asset distribution.

Moreover, estate planning allows for better management of financial liabilities, ensuring that debts, taxes, and other obligations are settled fairly and efficiently. Trustees or executors can manage these responsibilities without ambiguity, reducing the risk of legal challenges or financial mismanagement, given you have well-documented records. Preserving family relationships and avoiding costly legal battles become the cherry on this straightforward, intentional process.

Mitigating common estate planning mistakes

To create a foolproof estate plan, avoid these common mistakes that lead to unintended consequences:

Life changes, and so should your will. Whether you're changing marital status, having a new child, or acquiring a new asset, your estate plan should reflect your current situation. Regularly review and update your will to ensure that no one is left out and that your assets are distributed according to your latest intentions.

The individual you select as your executor or trustee is crucial in ensuring your estate plan is carried out. Choosing someone ill-equipped to handle these responsibilities can delay the process, bring about errors, and even attract legal disputes. Ensure your executor is trustworthy and capable of managing the administrative tasks involved.

We live in a digital world where assets aren't limited to physical possessions. Cryptocurrency, online accounts, and intellectual property rights are all part of your digital footprint. Ensure that these assets are included in your estate plan and instructions on accessing them.

I am 100% confident that the primary cause of family disputes is unequal or inadequate asset distribution. To prevent this, ensure that your estate plan clearly outlines how assets, especially sentimental items like family heirlooms, should be distributed. Transparency in your intentions can help mitigate disagreements and ensure your wealth is transferred peacefully.

Estate planning creates a solid foundation for financial security, free from unnecessary complications; it doesn't have to revolve solely around safeguarding wealth for the future. From mobile applications to data analytics and digital wills, estate planning has become way more accessible, and you can take proactive steps to protect your assets anytime, anywhere.

Leverage these technologies to keep a clear and accurate record of your assets, helping you avoid common mistakes in estate planning. This gives you peace of mind that your wealth will be passed on according to your wishes—without the stress of taxes, rising interest rates, or family disputes. Ultimately, a well-thought-out and up-to-date estate plan protects your legacy from potential challenges and ensures your hard-earned wealth is not vulnerable to outside threats or unnecessary complications.

Ensuring wealth endures for generations requires a robust estate plan to prevent financial burdens on heirs. Advanced estate planning systems, driven by technology, are essential in today's volatile financial landscape. Modern tools like mobile applications, data analytics, and electronic signatures enhance wealth protection by streamlining asset management, optimizing tax strategies, and facilitating legal document execution. Comprehensive asset documentation and avoiding common estate planning mistakes, such as failing to update wills or ignoring digital assets, are crucial. Leveraging technology ensures a smooth wealth transition and protects against potential challenges.

Relying solely on traditional methods for estate planning can leave your assets vulnerable.

Estate planning is your first line of defense against wealth loss—Here’s what you should know

Regarding your legacy, there’s a fine line between ensuring your wealth endures for generations and leaving behind a financial burden for your 

. Unless you have a solid estate plan, your 

 could be eroded by taxes, administrative fees or even disputes among heirs.

The first step in defending your wealth from unnecessary loss is to design an 

 prioritizing protection over liability. Generally, most individuals’ idea of estate planning revolves around deciding who inherits what. On the contrary, it is about creating a structure that minimizes taxes, avoids probate complications and ensures your intentions are executed smoothly. This will help you to avoid using outdated methods that may cause you to lose more than you preserve.

To create a foolproof estate plan, avoid these common mistakes that lead to unintended consequences.

Life changes, and so should your will. Whether you are changing marital status, having a new child or acquiring a new asset, your estate plan should reflect your current situation. Regularly review and update your will to ensure no one is left out and that your assets are distributed according to your latest intentions.

The individual you select as your executor or trustee is crucial in ensuring your estate plan is carried out. Choosing someone ill-equipped to handle these responsibilities can delay the process, bring about errors and even attract legal disputes. Ensure your executor is trustworthy and capable of managing the administrative tasks involved.

We live in a digital world where assets are not limited to physical possessions. Cryptocurrency, online accounts and intellectual property rights are all part of your digital footprint. Ensure these assets are included in your estate plan, and provide instructions on accessing them.

Estate planning creates a solid foundation for financial security, free from unnecessary complications; it does not have to revolve solely around safeguarding wealth for the future. From mobile applications to data analytics and digital wills, estate planning has become far more accessible, and you can take proactive steps to protect your assets anytime, anywhere.

Leverage technologies to keep a clear and accurate record of your assets, helping you avoid common mistakes in estate planning. This gives you peace of mind that your wealth will be passed on according to your wishes — without the stress of taxes, rising interest rates or family disputes. Ultimately, an estate plan that is well thought out and up to date protects your legacy from potential challenges and ensures your hard-earned wealth is not vulnerable to outside threats or unnecessary complications.

Relying solely on traditional methods for estate planning can leave your assets vulnerable.



Estate planning is the physician's first line of defense against wealth loss

GLP-1 RA antiobesity medications: an introduction

GLP-1 RA antiobesity medications: a new panacea?

GLP-1 RA antiobesity medications: Patients’ No. 1 question

GLP-1 RA antiobesity medications: Talking about cost

GLP-1 RA antiobesity medications: Lifestyle changes are needed too

GLP-1 RA antiobesity medications: Learning about side effects, and managing them

GLP-1 RA antiobesity medications: Long-term safety

GLP-1 RA antiobesity medications: Predictions for the future

The new glucagon-like peptide-1 receptor agonist (GLP-1 RA) antiobesity medications have taken medicine by storm.

, with manageable side effects and no indications yet of harmful long-term effects. 

 are clamoring for them. What do physicians think about these treatments?

, is the author or editor of 15 books, 65 book chapters and hundreds of scientific articles on overweight, obesity, nutrition, diet and exercise. He has traveled to dozens of countries speaking as an expert on those topics.

 about the effects these medicines are having, not just on BMI, but in physician and patient interactions around the country.

The introduction of new GLP-1 receptor agonist antiobesity medications has significantly impacted the medical field, offering effective BMI reduction with manageable side effects and no known long-term harm. These medications have generated high demand among patients, influencing physician-patient interactions nationwide. Dr. Robert Kushner, a renowned expert in obesity and nutrition, has extensively contributed to the literature on these topics. His upcoming book, "Patient Centered Weight Management," aims to provide healthcare professionals with a comprehensive program for weight management, following his previous work on effective weight loss strategies.

Robert Kushner, MD, an expert in overweight, obesity, nutrition, diet and exercise, discusses the effects of the new antiobesity medications.

Nancy M. Enos, FACMPE, CPC

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