By Dr. Jay Anders, Chief Medical Officer, Medicomp Systems
LinkedIn: Jay Anders MD
LinkedIn: Medicomp Systems, Inc.
Host of Tell Me Where IT Hurts – #TellMeWhereITHurts
On this episode I welcome Lynn Carroll, Chief Operating Officer at HSBlox. We discuss the complexities and evolving dynamics of Medicare Advantage plans, proposed changes under the new White House Administration, a dual role artificial intelligence to clean up claims and streamline workflows, and how the value-based care model continues to rise in importance.
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Meet the Guest
Lynn Carroll, Chief Operating Officer, HSBlox
LinkedIn: Lynn Carroll
LinkedIn: HSBlox, Inc.
Lynn Carroll is COO and head of strategy at HSBlox, an Atlanta-based technology company empowering healthcare organizations with the tools and support to deliver value-based care (VBC), successfully and sustainably. He is a high-energy business professional who launched a successful healthcare payments platform business in the infancy of HIPAA compliance and helped lead its growth through the ACA and beyond. An expert in value-based contracts, bundled payments, P4P and global reimbursement, alternative payment models, episodes of care and contract administration, Carroll possesses an in-depth knowledge of the healthcare insurance and integrated payments ecosystems. Among his successful launches: enterprise solutions for premium invoicing and collection, digital payments, patient financial engagement, prospective bundled payments, and value-based contract administration.
Carroll explains that the Trump Administration proposed a 5.1% increase in base benchmark rates for Medicare Advantage in 2026, despite reducing oversight staffing. He says this creates a “catch-22” between cost containment and improving population health.
The conversation also addresses how artificial intelligence (AI) can help identify fraud or upcoding in Medicare Advantage claims. An expanding area for this technology goes beyond adding clinical codes to billing to removing inappropriate codes.
Carroll is also a proponent of ambient listening technologies powered by AI. This technology can reduce administrative burdens on physicians by creating clinical encounter notes automatically and accurately—contributing to physician satisfaction and better care outcomes. After all, what do we want doctors to spend time doing? Diagnosing and assisting patients with their health conditions, he adds, not spending a lot of time figuring out how to document what’s going on. He believes that capturing the patient interaction with a significant degree of accuracy is an appropriate use of AI.
Carroll also predicts a growing role for value-based initiatives to optimize patient satisfaction and physician reimbursement under Medicare Advantage. These programs can improve coordination across primary care, specialists, hospitals, and post-acute care, with AI supporting appropriate referrals and fostering interoperability.
Among the topics covered…
- Direct-to-employer value networks on the rise
- Upheaval over risk adjuster changes over past year
- Tracking HHS Secretary Robert F. Kennedy, Jr.’s proposal to curb chronic disease
- Medicare Advantage audits catching fraud
- Value-based initiatives aligning primary care with specialty, hospital, and post-acute care
- Interoperability fostering care teams by sharing the most up-to-date information
- “If you could change one thing…”
- And more…
Original source of content from Medicomp System’s blog and published here with permission.
About the Show
Join host Dr. Jay Anders as he sits down with experts from across healthcare and technology to discuss ways to improve EHR usability for end users. Dr. Anders and his guests explore opportunities to enhance clinical systems to make them work better for clinicians, reduce burnout, maximize revenue potential, and drive better patient care outcomes.
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