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.”

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.”

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.”