On this episode of Tell Me Where IT Hurts, Dr. Jay Anders welcomes Lynn Carroll, Chief Operating Officer at HSBlox.
Together with Dr. Anders, Carroll discusses 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.
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.
Show Notes
- 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…
Show Links
- Lynn Carroll on LinkedIn
- HSBlox
- Dr. Jay Anders on LinkedIn
- Tell Me Where IT Hurts on Healthcare NOW Radio