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.”

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.”