What Practice Leaders Need to Know About Today’s Compliance Risks with Michelle Wright

On this episode of the MGMA Insights Podcast, Host and Sr. Editor Daniel Williams, sits down with Michelle Wright, strategic advisor and board director with more than 30 years of experience across payers and providers.

Michelle shares lessons from her career spanning actuarial science, health plan leadership, provider operations, and board service — offering a candid look at why smart strategies often fail in execution. The conversation explores accountability, governance, and change management in healthcare organizations, emerging compliance and enforcement trends, and Michelle’s deeply personal advocacy work focused on access to care for individuals with profound autism.

Episode Takeaways

• Execution — not strategy — is where organizations struggle most. Even well-designed strategies falter without clear ownership, follow‑through, and ongoing performance monitoring.
• Accountability must be explicit. Projects involving AI, revenue cycle, quality, or operations often touch multiple departments, but success depends on clearly defining who owns outcomes from start to finish.
• Governance is the connective tissue. Effective governance helps organizations document decisions, clarify expectations, and sustain progress beyond individual leaders or initiatives.
• Change management is consistently underestimated. Leaders often acknowledge its importance but fail to invest the time and structure required to truly change behaviors—especially during periods of stress.
• Operators and providers aren’t misaligned — they’re under pressure. Close working relationships can create communication blind spots that surface during change initiatives, making listening and translation critical leadership skills.
• Compliance risk is evolving, not disappearing. Enforcement trends are shifting as regulators increasingly use data analytics and AI to identify patterns, even when underlying rules haven’t changed.
• AI tools introduce new compliance considerations. Documentation, coding, and workflow automation can unintentionally create risk if organizations don’t monitor how these tools affect claims and clinical records.
• Access to care for individuals with profound autism remains a systemic gap. Despite significant research funding for autism overall, those with the most severe needs remain underserved in clinical care, research, and policy.

Resources

• Connect with Michelle on LinkedIn
• Epstein Becker Green
• National Council for Severe Autism
• (Upcoming!) Practice Compliance in 2026: Regulatory Updates, Enforcement Trends, and Leadership Priorities — Join Michelle and attorneys from Epstein Becker Green on April 22 for the first session in MGMA’s member-exclusive, semi‑annual compliance webinar series, covering key HIPAA updates, enforcement trends, AI and Health IT risks, and practical compliance priorities for medical practices.

This episode is sponsored by ModMed.
Every denied claim costs time and money to rework — for care you’ve already delivered. While payers sharpen their own AI tools, ModMed RCM Services pairs seasoned billing specialists with AI designed to help flag claims at risk before they go out the door, so your team can fix issues upfront instead of appealing after the fact. Learn more here.