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Showing posts from February, 2025

Comparison of HCC Coding: Types – ACA & MA

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Hierarchical Condition Category (HCC) coding is a risk-adjustment model used to predict healthcare costs based on patient diagnoses. It is widely used for reimbursement and risk adjustment in value-based care models. Two Major Types of HCC Coding: ACA HCC (Affordable Care Act HCCs) Used for commercial insurance plans under the Affordable Care Act (ACA) risk adjustment model . Applies to individual and small-group marketplace plans. Helps adjust payments to health plans based on the health risk of enrollees. Uses a different HCC model than Medicare Advantage, focusing on broader populations. MA HCC (Medicare Advantage HCCs) Used for Medicare Advantage (MA) plans to determine capitated payments from CMS (Centers for Medicare & Medicaid Services). Focuses on elderly and disabled populations enrolled in Medicare Advantage. Uses a risk adjustment model to ensure appropriate reimbursement based on chronic conditions. More focused on chronic diseases commonly found in senior populatio...

Prioritization Techniques MoSCoW, RICE, and Kano Models and considerations for practical use

Prioritization in data-siloed organizations demands more than just a framework—it requires a cultural and structural shift. MoSCoW is ideal for fostering early alignment, RICE brings rigor through quantification, and Kano ensures the customer voice is heard. By combining these approaches with governance, tools, and trust-building practices, organizations can prioritize effectively, break down internal barriers, and move from departmental competition to strategic collaboration. Effective Prioritization in Product and Project Management Effective prioritization is essential for project management, product development, and decision-making. Various frameworks help teams determine what to focus on based on impact, effort, and stakeholder needs. This article explores three widely used prioritization methods— MoSCoW , RICE , and the Kano Model —followed by an in-depth analysis of how to apply them effectively in large, siloed organizations. 1. The MoSCoW Method Origin and Purpose Developed by...

How healthcare solutions will change leveraging AI and ML

H ealthcare solutions will change over the next 5 to 10 years, leveraging AI and ML . Here are some key applications of AI/ML in healthcare that can a professional stand out and advance your career: 1. Predictive Analytics for Patient Care Application : Use AI/ML to predict patient outcomes, disease progression, and readmission risks. Career Impact : Demonstrating expertise in predictive analytics can position you as a leader in improving patient care and reducing costs for healthcare providers. 2. Personalized Medicine Application : Develop AI-driven models to tailor treatments based on genetic, lifestyle, and clinical data. Career Impact : Specializing in personalized medicine can make you a valuable asset in advancing precision healthcare and improving patient outcomes. 3. Medical Imaging and Diagnostics Application : Implement ML algorithms to analyze medical images (e.g., X-rays, MRIs, CT scans) for early detection of diseases like cancer or cardiovascular conditions. Career Impac...

Top 15 Non-IT Professions (2015-2035 perspective)

Top 15 Non-IT Professions (2015-2035 perspective). Prioritized focusing on high-growth, high-impact professions: 1. Healthcare Specialists (Evolved Focus) Current Drivers: - Aging populations - Preventive care emphasis - Mental health integration - Personalized medicine - Virtual health delivery Key Roles: - Nurse Practitioners - Mental Health Professionals - Specialized Therapists - Genetic Counselors - Health Informatics Specialists 2. Renewable Energy & Sustainability Current Drivers: - Climate change urgency - Government regulations - Investment trends - Technology advancement Key Roles: - Energy Systems Specialists - Carbon Management Experts - Sustainability Consultants - Green Building Specialists 3. Healthcare Support & Wellness Current Drivers: - Preventive health focus - Aging population needs - Mental health awareness - Work-life balance emphasis Key Roles: - Mental Health Counselors - Wellness Coaches - Occupational Therapists - Specialized Care Coordinators 4. Fina...

Networking, Data Science, DevOps, and Full-Stack Development compared for Market Relevance and Future Outlook

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Comparison of Networking, Data Science, DevOps, and Full-Stack Development: Market Relevance and Future Outlook Networking Professional Outlook Current Status: Networking is the backbone of digital infrastructure, ensuring seamless connectivity across systems. Strong demand continues due to the shift toward cloud computing and remote work. The field is evolving rapidly, with software-defined networking (SDN) and network automation playing a bigger role. Cybersecurity remains a major concern, making networking professionals essential for securing IT environments. Key Skills (20-Year Outlook): Network Security & Zero Trust Threat detection and prevention Security architecture and policies Access control mechanisms Advanced encryption protocols Cloud Networking SD-WAN implementation Managing virtual networks Cloud interconnectivity Multi-cloud and hybrid cloud networking Automation & Programmability Network automation tools and frameworks Python a...

Beyond Google: The Best Alternative Search Engines for Academic and Scientific Research

Google may be the most popular search engine, but it isn’t always the best for academic and scientific research. Many valuable scholarly resources are buried under commercial results or hidden behind paywalls. Fortunately, there are specialized search engines designed to help researchers, students, and professionals find high-quality, peer-reviewed content. Here’s a selection of the best alternatives to Google, focusing on science, technology, medicine, and economics. 1. RefSeek ( www.refseek.com ) Best for: General academic research. RefSeek indexes over a billion documents, including research papers, encyclopedias, and books. Unlike Google, it prioritizes educational content and filters out commercial websites. 2. WorldCat ( www.worldcat.org ) Best for: Finding books and research materials in libraries worldwide. WorldCat allows users to search for books, articles, and historical archives in over 20,000 libraries. It’s ideal for tracking down rare or specialized academic ma...

Principles for Personal and Professional Growth

  Essential  Never offer a handshake while seated – Stand up as a sign of respect and confidence when greeting someone. Refrain from criticizing food when you're a guest – Appreciate the effort, even if the meal isn't to your taste. Avoid taking the last piece of something you didn’t buy – Be considerate of others and offer it first. Protect those behind you, respect those beside you, and lead with integrity – Show awareness and responsibility in every situation. Let the other party make the first offer in a negotiation – This gives you a strategic advantage. Never take credit for work you didn’t do – Acknowledge contributions and share recognition fairly. Always dress well, regardless of the occasion – Your appearance reflects self-respect and professionalism. Speak with honesty and sincerity – Say what you mean and mean what you say. Ask more than you answer – Being curious and interested in others builds stronger relationships. Reserve profane language ...

Product management. Metrics and examples

  Business Metrics focused on startups: A Comprehensive Guide to Measuring Growth and Success for a Product manager  For startups, tracking the right metrics is critical for measuring financial performance, customer acquisition, retention, and market potential. These key indicators help founders, investors, and executives make informed decisions, optimize business strategies, and drive sustainable growth. While some metrics are universal, their application varies across industries. This guide provides a detailed breakdown of essential startup metrics, with diverse examples from SaaS, healthcare, pharma, automotive, fintech, e-learning, and more. Revenue Metrics: Understanding Financial Performance 1. Monthly Recurring Revenue (MRR) The total revenue generated from paid customer subscriptions each month. Example 1 (SaaS): A cloud-based project management platform earns $50,000 monthly from subscriptions. Example 2 (Healthcare): A telemedicine platform generates $30,00...

User story structure, acceptance criteria, Definition of Done

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 A user story in Agile typically consists of these key parts:  "As a [user role], I want to [action], so that [benefit]" which includes the user persona, the desired action, and the expected value or outcome, and is often further detailed with "acceptance criteria" to clearly define what constitutes a completed story; essentially focusing on the "who," "what," and "why" of a feature from a user's perspective. User story examples: What is User Story and Acceptance Criteria (Examples) https://www.softwaretestinghelp.com/user-story-acceptance-criteria/ "Definition of Done (DoD)" is a set of standardized criteria that a user story must meet before it can be considered "done" and closed, acting as a checklist to ensure consistent quality across all user stories within a project, while "acceptance criteria" are specific requirements tailored to each individual user story, defining the conditions under which ...

Story sizing or 'T-shirt' sizing for user stories in agile software development

XS (Extra Small): A very small, simple task requiring minimal effort.  S (Small): A relatively small, straightforward task.  M (Medium): A task with moderate complexity and effort.  L (Large): A larger, more complex task requiring significant effort.  XL (Extra Large): A very large, complex task with potentially multiple dependencies.  XXL (Extra Extra Large): An extremely large, complex task requiring a significant amount of time and effort.  More info: https://community.atlassian.com/t5/App-Central-discussions/Agile-estimation-unlocked-mastering-t-shirt-sizes-in-Jira/td-p/2707998