Care Decoded

3d ago

Welcome back to Care Decoded! In this episode, host Dr. Sunil Nihalani, CEO of Inferscience, sits down with interoperability expert Brendan Keeler, better known as the “health API guy.” Together, they tackle one of health tech’s biggest promises: interoperability. You’ll hear a down-to-earth exploration of what interoperability really looks like in practice, from the daunting challenges of connecting healthcare systems and sharing patient data, to the recent regulatory pushes trying to bridge the gaps. Dr. Sunil Nihalani and Brendan Keeler dive into the evolution of healthcare data exchange, discuss the real progress and persisting pain points, and unpack both the tailwinds and headwinds shaping the future of seamless data sharing. With candid stories from the front lines and practical insights, this episode cuts through the industry buzz, spotlighting where we’re at and where we need to go to make interoperability meaningful for providers, patients, and everyone in between. If you care about the future of healthcare, data access, and smarter care, you won’t want to miss this conversation! Timestamps: 00:00 "Healthcare, Consolidation, and Frustration" 03:57 "Progress and Continuous Improvement" 07:15 EHR Data Sharing Challenges 11:23 AI Modernizing EHRs and Visit Prep 15:59 "TEFCA Driving Patient Data Access" 18:03 "Boost for Tech-Enabled Care" 21:03 "Trust Strain Threatens Care Networks" 25:01 Illegal Loopholes Exploiting Patient Data 27:46 Identity Proofing vs Scribble Debate 31:42 "EPIC's Dominance in Vertical SaaS" 34:57 EHR Integration and Antitrust Rulings 39:04 EHRs, APIs, and Information Blocking 41:11 "Ubiquity Over Structured Data" 46:16 "Optimism Through AI and Interoperability" 47:40 "Driving Interoperability Through Advocacy" 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/ “Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Nov 18

Welcome back to Care Decoded, the podcast where we make sense of the fast-evolving world of documentation, coding, and clinical AI to power better patient care. In today’s episode, host Michael Lesnik welcomes healthcare innovation and policy leader Dr. Shannon Decker for a deep dive into the major changes facing risk adjustment as we approach 2026. You’ll hear Michael Lesnik and Dr. Shannon Decker tackle the ripple effects of a recent court ruling that vacated CMS’s RADV final rule and what that means for audit compliance, health plans, and provider groups. As the landscape shifts, they’ll explore how AI is revolutionizing regulatory oversight, the urgent need for data accuracy, and why quality and total cost of care matter more than ever in the value-based care era. This episode is packed with practical insights for health plan leaders and providers alike, including firsthand stories, strategies to shore up documentation workflows, and tips for staying competitive as technology and compliance expectations accelerate. If you want to be ready for the future of risk-based contracting and avoid common blind spots, you won’t want to miss it. Timestamps: 00:00 "CMS Compliance Pause Insights" 06:26 AI in Medical Data Challenges 07:12 "Good Data is Essential" 10:16 "Risk Adjustment Impacts Provider Groups" 14:15 AI Advancements and Hiring Delay 17:27 Improving Claims & Patient Care 22:15 Optimize Documentation and Systems Effectively 24:49 Risk Improvement Strategies 31:18 Renegotiating Contracts and Data Strategy 32:16 Streamlining Medical Record Management 35:24 Unfair CAHPS Survey Impact 41:05 Advancing Physician Support Effectively 44:30 Investing for Growth and Healthcare Challenges 46:13 "Thoughtful System Implementation Strategy" 49:12 "Risk Adjustment: Accuracy Matters" 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/ “Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Nov 3

Welcome back to Care Decoded, the podcast where we simplify the complex world of healthcare documentation, coding, and clinical AI so we can power better care, today and for the future. In this episode, Dr. Sunil Nihalani is joined by Dr. Stella Onuoha-Obilor, a nationally recognized leader in clinical quality and population health. Her track record speaks volumes: she’s driven high-star ratings, optimized value-based programs, and built systems that put patient outcomes at the heart of performance. Together, they dive into how data leadership and human insight are converging to reshape quality and population health in the value-based era. With new CMS measures and a growing focus on health equity, it’s no longer enough to just check boxes; organizations must push beyond compliance and harness data for real clinical transformation. From bridging teams and building trust to leveraging AI and advanced analytics, Dr. Stella Onuoha-Obilor shares actionable strategies for moving from metrics to meaningful impact. If you’re curious about the future of healthcare, how technology can actually make care more compassionate, and what it takes to sustain high performance in a fast-evolving landscape, this episode has insights you won’t want to miss. Let’s decode care together. Timestamps: 00:00 Redefining Quality in Value-Based Care 03:48 "Whole Patient Care Focus" 08:11 Personalized Care Through Data Leadership 12:10 "Data Governance for Transparency" 16:23 "Data Drives Healthcare Decisions" 19:47 "Data Trust and Stewardship Challenges" 24:05 Proactive Healthcare Through Real-Time Data 26:34 People-Driven Leadership for Success 28:07 "Transformational Leadership for Progress" 32:29 Transforming Care: Data, KPIs, Trust 35:34 "Optimizing Care, Restoring Joy" 39:40 Future-Proofing Organizational Success 42:44 "Proactive Healthcare Transformation" 45:15 "Future of Value-Based Care" 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/ “Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Oct 8

Welcome back to Care Decoded ! In this episode, we dive into the second part of our RADV miniseries, shifting focus from what RADV is, to the crucial role of frontline providers in ensuring accurate, defensible documentation as part of everyday care. Host Mark McKeown is joined once again by Colleen Gianatasio, an expert in risk adjustment and value-based care with over 20 years of experience. Together, they explore why provider documentation is the foundation for RADV compliance, the biggest barriers clinicians face in meeting documentation requirements, and how the right technology, like AI-driven coding support, can help bridge the gap between compliance demands and real-world clinical practice. You’ll hear practical strategies for reducing provider burnout, cultivating a culture of accuracy, and fostering effective collaboration between plans and providers, ultimately leading to better patient outcomes and a stronger, more resilient healthcare system. Let’s keep decoding care together! Disclaimer: The opinions expressed by any participants in this podcast recording are solely their own and do not represent any organization they worked for in the past or present. Timestamps: 00:00 "RAD V: Provider Role & Technology" 04:08 Coding vs. Clinical Guidelines Conflict 07:08 Advancing Patient Care Through Coding 11:47 Optimizing Patient-Provider Time 14:39 Celebrate Success, Share Best Practices 17:00 Concluding RAD V Miniseries 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/ “Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Sep 29

Welcome to a brand new episode of Care Decoded! In this episode, host Mark McKeown is joined by renowned risk adjustment and coding expert Colleen Gianatasio to kick off a special two-part series diving into CMS’s heightened focus on RADV (Risk Adjustment Data Validation) audits. As Medicare Advantage plans face unprecedented scrutiny with CMS now pledging to audit all eligible contracts every year, the stakes have never been higher for compliance, documentation, and risk management. Together, Mark and Colleen unravel the far-reaching impact of these changes across the healthcare industry, from the increased resource demands on health plans to building a culture of compliance and leveraging people, process, and technology for audit readiness. Drawing on her expertise, Colleen shares actionable strategies for integrating risk adjustment compliance into the fabric of organizations, explains the most common pitfalls in documentation and coding, and explores how AI and prospective tools can improve audit outcomes. Whether you’re part of a health plan, provider group, or just interested in the world of healthcare compliance, this episode is packed with practical advice and insights on navigating the evolving landscape of RADV audits and value-based care. Tune in as we decode the latest industry challenges and get ready for the next episode, where we’ll dive deeper into the provider’s role in RADV success. Disclaimer: The opinions expressed by any participants in this podcast recording are solely their own and do not represent any organization they worked for in the past or present. Timestamps: 00:00 Medicare Advantage Under Scrutiny 06:18 Proactive RADV SWAT Strategy 07:18 Continuous Provider Communication Strategy 12:17 Top Coding Issues in Risk Adjustment 15:29 Optimizing Risk Adjustment with Data Analytics 19:34 Risk Adjustment Reporting Overhaul 23:09 Prospective Risk Beats Retro Adjustment 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/ “Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Sep 8

Welcome to another episode of Care Decoded, the podcast where we break down the most pressing issues in modern healthcare. In today’s episode, host Michael Lesnik, VP of Provider Sales at Inferscience, sits down with Dr. Sunil Nihalani, CEO of Inferscience and a practicing physician, to unravel the complexities of “care gaps”, those critical yet often overlooked opportunities to improve patient care and outcomes. Drawing on over fifteen years of experience in healthcare IT and value-based care, Michael and Dr. Nihalani dive deep into why care gaps persist, the challenges providers face in closing them, and why it’s about more than just checking a box on a metric sheet. From the realities of data accuracy and insurance hurdles to the vital importance of patient communication and trust, this episode explores the human side of healthcare quality. You'll also hear firsthand strategies for closing care gaps effectively, how technology, including AI, is changing the landscape, and why these efforts matter for both health equity and patient relationships. Whether you’re a healthcare provider, a member of a clinical team, or simply passionate about better patient care, this conversation offers practical insights and fresh ideas to help you and your organization “decode” the intricacies of care gap closure. Let’s get started! Timestamps: 00:00 "Optimizing Patient Care Opportunities" 05:17 Patient Data and Trust Issues 08:07 Patient Education on Health Screenings 13:32 "Small Practice, High Ratings Success" 14:18 AI's Role in Healthcare Gaps 18:57 AI-Powered Care Gap Detection 23:11 "Closing Care Gaps: A Holistic Approach" 23:50 "Decoding Care Together" 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/ “Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Aug 1

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/ “Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Jul 8

Welcome back to Care Decoded , the show where we break down the complexities of risk adjustment, documentation, and the evolving role of AI in healthcare. In today’s episode, host Lucy Medina sits down with Dr. Sunil Nihalani, CEO of Inferscience and practicing physician, to tackle a topic that hits close to home for every clinician: documentation burnout. Together, they pull back the curtain on how clunky EHR systems, endless documentation demands, and poorly designed workflows are taking a toll not just on clinicians’ efficiency but also on their emotional well-being, patient relationships, and even financial outcomes. From the frustrations of lost patient moments to the hidden costs of delayed or inadequate documentation, Lucy and Dr. Nihalani explore the very real burdens today’s healthcare professionals face. But it's not all doom and gloom; they’ll also shed light on how AI-powered tools and smarter EHR integrations are starting to transform the landscape, offering hope for a future where technology truly works in service of both providers and patients. If you’re a clinician who’s ever felt buried under paperwork or a health system leader looking for real solutions, this conversation is for you. Let’s decode the path from burden to benefit together. Timestamps: 00:00 Disruptive Documentation in Healthcare 04:16 Physician Documentation Overload 07:05 EHR Challenges Impacting Patient Care 10:52 "Ambient Scribe: AI in Practice" 16:10 Dual Life: Doctor and Entrepreneur 17:51 Improved Data Flow in Healthcare 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/ “Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”