2019 Agenda

September 9, 2019

7:00 AM - 8:00 AM
Workshop Registration and Networking Breakfast

8:00 AM

Concurrent Workshops

8:00 AM - 4:00 PM
Conference Registration Open

9:00 AM - 12:00 PM

Workshop A: Member Engagement Techniques & Strategies

Detailed and methodical documentation of member health conditions is not only critical for plan revenue, but it’s integral for member health and quality of care. Now, more than ever, health plans need to create a cohesive member engagement journey and it’s proving to be the next big hurdle.  


In this hands-on workshop, participants cover the A to Z of member engagement, and walk away with the tools to:  

  • Gain best practices in onboarding and retaining new members 
  • Explore and evaluate tools, technology and data analytics applications pertinent to member engagement activities  
  • Stratify populations, align internally and weave your member engagement plan together with providers to avoid member abrasion 
  • Create effective and actional member engagement plans that tie into Risk Adjustment Programs   

Judy Kang, Associate Vice President of Product Management & Strategy

8:00 AM - 4:00 PM

Workshop B: HCC Coding 201 – Leading and Implementing HCC Coding and Documentation Programs

Join RISE Institute for an in-depth managerial level workshop laying out best practices for an end-to-end method of aligning chart documentation, HCC code capture and audit-readiness at both the provider and health plan levels. There is finally an industry standard through the RISE Institute that shows the “how to” of setting up your department’s workflows, aligning with your provider networks, preparing for RADV audits, and more.  

Attendees will walk away with the tools and tactical know-how to:  

  • Achieve plan -level program process, collaboration and continuous Improvement 
  • Create a framework for provider office-based program and learn how to roll this out  
  • Review clinical documentation evaluation in current systems 
  • Get a handle on program development and implementation: creating compliant & quality coding 


Donna Malone, CPC, CRC, Senior Manager of Enterprise Risk Adjustment, HCC Coding and Quality Assurance
Tufts Health Plan

Colleen Gianatasio, Risk Adjustment Quality & Education Program Manager
Capital District Physicians’ Health Plan

10:30 AM - 11:00 AM
Morning Break for Workshop A, B Participants
12:00 PM - 1:00 PM
Networking Lunch for Workshop A, B Participants Workshop Registration for C, D & Executive Think Tank Badge Pickup

1:00 PM

Concurrent Workshops

1:00 PM - 4:00 PM

Workshop C: Risk Adjustment 201 – Management Techniques in Commercial Risk Adjustment for Non-Actuaries

J. Gabriel McGlamery J.D., Senior HCR Policy Consultant
Florida Blue Center for Health Policy

1:00 PM - 4:00 PM

Workshop D: Risk Adjustment Professional Advanced Workshop

As an update to RISE’s 101 workshop, this advanced version guides attendees in the managerial role of risk adjustment – from running the department to the day-to-day duties – with a primary focus on risk adjustment for the Medicare Advantage line of business.  


Upon completion, participants will: 

  • Gain the tools to navigate reporting and review, achieve data accuracy and manage the transition from RAPS to EDPS  
  • Discuss managing within the organization, including what should be reported to senior management and when  
  • How to manage vendors effectively – including make or buy decisions and collaboration techniques  
  • Leverage your coding & documentation team’s capabilities and your analytics tools 
  • Keep a finger on the pulse of the expected revenue volume and timing of cash flow realization 
  • Learn how to be prepared for future changes within the risk adjustment landscape 

Laura Sherriff, RN, MSN, CPC, CRC, Regional Director, Risk Adjustment
Molina Healthcare, Inc.

Susan Waterman RHIT CCS CPC CRC, Director of Risk Adjustment
Scott and White Health Plan

1:00 PM - 4:00 PM

Executive Think Tank - Focus on Practical Innovation in Healthcare

*Invitation Only – for more information, contact Conference Director – Marina Adamsky madamsky@fraconferences.com  

Hand-picked executives from payers (Medicare, MA and Medicaid/Medical leaders focused on Quality, RA, Population Health and Medical Teams), providers, health systems and other innovators convene to brainstorm practical and compliant innovation ideas that will impact the future of healthcare.  

As a result, participants will walk away with strategies to diligently repair the healthcare system by building the infrastructure, internal buy in and project management road map to support it. 


Rodney Reider
Managing Partner and CEO Strategic Advisor                                                                                        KA-Ventures
Former President and CEO                                                                                                                -Saint Alphonsus Health System 


  • Creagh Milford, DO, MPH, Chief Medical Officer, Healthcare Highways, Inc. 
  • Judy Kang, Associate Vice President of Product Management & Strategy, Healthfirst  
  • Kimberly Swanson, Vice President of Quality & Clinical Integration, Network Health  
  • Renee Golderman, Senior Vice President of Health Care Quality, Capital District Physicians’ Health Plan 
  • Dave Meyer, Vice President of STARS, Cigna  
  • Amy Nguyen Howell, MD, MBA, FAAFP, Chief Medical Officer, America’s Physician Groups (APG) 
  • David DiGiuseppe, Vice President of Healthcare Economics, Community Health Plan of Washington 
  • Kathleen Stillo, MBA, President & Chief Operating Officer, Clinical Redesign, Community & State, UnitedHealthcare 
  • Dirk Wales, Chief Medical Officer, Cigna-HealthSpring 
  • Stacy Garrett-Ray, MD, MPH, MBA, VP, Medical Director, Population Health, President, Quality Care Network and Transform Health MD, University of Maryland Medical System  
  • Josh Weisbrod, Vice President of Risk Adjustment, Network Health  
  • Tom Burroughs, Dean and Professor, SLU College for Public Health and Social Justice 
  • Mallory Sheth, Director of Strategy and Transformation, Sharp Health Plan  
  • Carey Ketelsen, Senior Vice President of Risk Adjustment and Coding Operations, Ciox Health 
  • RaeAnn Grossman, Chief Growth Officer, DataLink Software 
  • Michael Hasbany, Executive Vice President of Sales, Inovalon 
  • Su Bajaj, Vice President of Product and Payor Solutions, Episource 
  • Terry Ward, Senior Vice President of Solutions, Apixio 
  • Greg Pastor, Managing Director of Risk Adjustment Operations, Advantasure   
  • Brooke Ivey, Executive Vice President of Business Development,Bloom Insurance Agency   
  • Lynne Padilla, CPC, Senior Vice President, Risk Adjustment Coding Operations, Clinical Review, Change Healthcare 
2:00 PM - 3:00 PM
Afternoon Break for B, C, D Workshop Participants
4:00 PM - 6:00 PM
Opening Networking Cocktail Reception on Bay Terrace

September 10, 2019

7:30 AM - 8:30 AM
VIP Breakfast with Keynote Richard Picciotto (*invitation only)
7:45 AM - 8:45 AM
Main Conference Registration and Networking Breakfast
7:45 AM - 6:30 PM
Exhibit Hall Open

8:45 AM - 9:00 AM

Opening Remarks

RaeAnn Grossman, Chief Growth Officer  
DataLink Software

Lou Steinberg, Senior Vice President, Payer Market Sales

9:00 AM - 10:00 AM

Lessons in Leadership – the FDNY Way

Join us for a special keynote presentation as Chief Richard Picciotto delivers a gripping, firsthand account of the day that altered history, underscoring the significance of courage, preparation and effective leadership when confronted with enormous adversity. Richard will impart his lessons learned via valuable insights for business leaders to effectively lead teams through significant challenges and crises. 

Richard Picciotto, FDNY Chief and Highest-Ranking Firefighter to Survive the World Trade Center Collapse, Author of “Last Man Down”

10:00 AM - 10:45 AM

Featured Plenary Talk: Out of Industry Perspective – Tools for Practical Innovation in Healthcare and Beyond

  • Get a fresh perspective on Healthcare innovation from the lens of an innovation expert, walking away with a tool kit with 15 ways to reframe a problem 
  • Learn innovation insights from other industries, using lessons from various case examples that you can apply within your own organization 
  • Dig deep into the science and strategies of innovation in order to develop breakthrough solutions to common problems in Healthcare 

Stephen Shapiro
Author of 5 books, Ex-Accenture Leader and Innovation Expert

10:45 AM - 11:00 AM
Networking Break in Exhibit Hall

11:00 AM - 11:45 AM

Payer/Provider Collaboration – How We Can Get it Right in a Fragmented Healthcare System, from a Provider’s Perspective

  • Hear the barriers, roadblocks and resources needed for a successful risk adjustment program –from a provider’s point of view 
  • Learn how the provider industry is looking at the patient experience and where it intersects and aligns with payers’ goals  
  • Analyze the changing landscape of how payers and providers are functioning together – and in turn, how payers can tap into behavioral change to motivate providers  
  • Examine a cultural of health and what that means in an organization, whether you’re a payer, provider or employer 

Amy Nguyen Howell, MD, MBA, FAAFP, Chief Medical Officer
America’s Physician Groups (APG)

11:45 AM - 12:45 PM
Networking Luncheon

12:45 AM

Concurrent Sessions

12:45 - 1:00 PM

Chair Introductions

Track A - Risk Adjustment and Quality

Adele L. Towers, MD MPH FACP, Director of Risk Adjustment
UPMC Enterprises

Track B - Collaborative Models

John M. Kirk, Founding CEO of Pioneer Medical Group and former Vice-Chair
APG Public Policy Committee

Track C - Trending Topics in SDoH

Allysceaeioun Britt PhD MPH, Founder

1:00 PM -1:45 PM

Track A: Panel: Innovative Approaches to Improving Quality Metrics

  • Dissect the changing landscape of quality measures and what’s coming down the pike  
  • Discuss approaches to aligning quality metrics, specifically HEDIS, with Risk Adjustment Programs  
  • Hear how health plans are approaching ECDS, Behavioral Health Measures and Customer Satisfaction Surveys 

Colleen Gianatasio, Risk Adjustment Quality & Education Program Manager
Capital District Physicians’ Health Plan

Renee Golderman, Senior Vice President of Health Care Quality
Capital District Physicians’ Health Plan

Janine Sala, Associate Director, Quality, Strategy and Performance Operations

Adele L. Towers, MD MPH FACP, Director of Risk Adjustment
UPMC Enterprises



1:00 PM - 1:45 PM

Track B: Point-of-Care Solution: The Right Provider, the Complete Picture, and the Right Integrated ROI

  • Ensure the right provider is engaged, understand how to determine if your attribution model is correct 
  • Determine whether you have connectivity, interoperability, and the most robust data aggregation  
  • Develop the right workflow, from pre-visit alerts and post-visit quality assurance excellence

RaeAnn Grossman, Chief Growth Officer  
DataLink Software

Tim Burke, Vice President of Operations
Healthcare Partners

1:00 PM -1:45 PM

Track C: Case Study: Addressing the Social Factors of Health is Good Medicine

  • Hear a case example of SDoH in practice, from the Medicaid insurance arm of UnitedHealthcare, focused on developing and deploying innovative direct care models for underserved populations 
  • Discuss the process, scalability and outcomes of projects around housing and wrap around care for formerly homeless members, primary care in the home for frail home-bound members, and work done within the primary care space   
  • Address  “hot spotting” for super utilizers and determine how to put patients on the right track of care 

Kathleen Stillo, MBA, President and Chief Operations Officer, Clinical Redesign Community & State,
United Healthcare

1:45 PM

Concurrent Sessions

1:45 PM - 2:30 PM

Track A: Moving Risk Capture Upstream with Prospective Intelligence

  • Explore why many payers are adopting prospective RA programs to improve physician documentation and coding 
  • Learn how artificial intelligence can be used for patient suspecting and care gap closure 
  • Hear about the downstream operational and revenue benefits for plans and providers implementing prospective programs 

Terry Ward, Senior Vice President of Solutions

Josh Weisbrod, Vice President of Risk Adjustment
Network Health

1:45 PM - 2:30 PM

Track B: The Problem with the Problem List: What the Provider’s EMR Doesn’t Know Can Hurt You

  • Gain a better understanding of the implications of an incomplete problem list in a provider’s EMR provider’s problem list in his/her EMR is an incomplete picture of the burden of illness 
  • Look at the pitfalls of using the problem list or historical diagnoses within the EMR as a target list for HCC capture and learn how to avoid this  
  • Discuss how to introduce other sources of information to the provider in ways that will limit provider burden 

Eric Hedrick, Director of Provider Solutions

Karen Wilding, Senior Director of Quality & Value Based Care
University of Maryland Medical System & UM Quality Care Network

1:45 PM - 2:30 PM

Track C: Strategies on Calculating ROI on SDoH Interventions

  • Examine how SDoH initiatives have impacted the bottom line and how to communicate this internally to gain traction for pilots  
  • Connect revenue-generation operations with SDoH projects 
  • Explore funding and how to align financial goals with medical management 

Shannon I. Decker, PhD, MBA, MBA, MEd, MEd, Executive Director of Risk
NAMM California, Part of OptumCare, UnitedHealth Group

Su Bajaj,Vice President of Product and Payor Solutions

2:30 PM - 3:00 PM
Networking Break in Exhibit Hall

3:00 PM

Concurrent Sessions

3:00 PM - 3:45 PM

Track A: Case Example of When It Works -- The Integration of Risk Adjustment and Quality

Kimberly Swanson, Vice President of Quality & Clinical Integration
Network Health

Josh Weisbrod, Vice President of Risk Adjustment
Network Health

3:00 PM - 3:45 PM

Track B: Panel: Perspectives on Provider Engagement Programs – Strategies on Training, Avoiding Provider Fatigue and Achieving a True Partnership

  • Discuss the dos and don'ts of provider incentives in a Value-Based world  
  • Hear how other health plans are tackling provider training activities and challenges and strategies they use to avoid provider fatigue and push back   
  • Focus on integration – discuss how to partner with vendors better to incorporate the workflow at the provider level 


Donna Malone, CPC, CRC, Senior Manager of Enterprise Risk Adjustment, HCC Coding and Quality Assurance
Tufts Health Plan


Shannon I. Decker, PhD, MBA, MBA, MEd, MEd, Executive Director of Risk
NAMM California, Part of OptumCare, UnitedHealth Group

Stacy Garrett-Ray, MD, MPH, MBA, Vice President, Medical Director, Population Health Services Organization, President, Quality Care Network
University of Maryland Medical System

Cristina Lopez-Pollard, Director of Government Programs
Hill Physicians Medical Group

3:00 PM - 3:45 PM

Track C: Case Study: Using SDoH Data in Data-Driven Decision Making

  • Hear lessons learned from work Community Health Plan of Washington has done developing a predictive model to identify members for care management programs
  • Discuss the value of adding SDoH data to predictive modeling and how it affects the performance of the model
  • Assess the correlation between a member’s HRA response-generated SDoH data and their utilization data

David DiGiuseppe, Vice President of Healthcare Economics
Community Health Plan of Washington

3:45 PM

Concurrent Sessions

3:45 PM - 4:30 PM

Track A: Need More Data? Leveraging Multiple Data Streams to Mitigate Risk and Regulatory Audit

  • Hear how you can mitigate regulatory audit exposure by having full access to complete claims and clinical data
  • Get the key to generating accurate member and HCC target lists to ensure that the disease burden of your membership can be accurately documented and that members are getting the care they need
  • Leverage machine learning capabilities to mine clinical data elements to provide HCC validation

Kate Marta
Senior Director of Quality
Inovalon Inc.

William Kinsman
Senior Manager of Product Innovations
Inovalon Inc.

Anna Wetherbee
Principal of Business Planning and Effectiveness
Blue Shield of California

3:45 PM - 4:30 PM

Track B: It’s All Related: Revolutionizing Your Quality Strategy Through Enhanced Provider Engagement

  • Understand how provider engagement programs not only improve risk score accuracy, but also drive quality ratings 
  • Learn how provider education translates to increased member satisfaction 
  • See how high-touch provider engagement combined with process and technology impacts quality 


Greg Pastor, Managing Director of Risk Adjustment Operations                                                    Advantasure    

Cheryl Babo, Director of Risk Adjustment, Stars and Provider Engagement                                        Regence Health Insurance  

3:45 PM - 4:30 PM

Track C: Create Cross-Sectional Partnerships to Address SDoH Issues Upstream

  •  Assess the federal and state government, non-profit/community-based and payor partnerships are occurring, learn about untapped opportunities and overcome internal roadblocks by communicating ROI 
  • Hear case examples of government & non-profit partnerships across several states and learn how to implement them within your organization  
  • Understand the nuances that state governments and non-profits endure and how to align their workflow with yours to achieve optimal care coordination 

Allysceaeioun Britt PhD MPH, Founder

4:30 PM - 5:30 PM

“Choose Your Own Adventure” Roundtables

Choose from different presentations spotlighting healthcare’s most influential technology and solution gurus presenting tools to elevate your plan’s initiatives.  

A             Dynamic Healthcare Systems

B              Signify Health

C              Cavo Health

D             GeBBS Healthcare Solutions

E              Cognizant

F              Change Healthcare

G             Cozeva

H             Edifecs

I               Health Data Decisions

J               Matrix Medical Network

K              Qmetrics

L              Omega Healthcare Management

M            Medical Advantage Group

N             Advantmed

O             AdhereHealth

P              HealthTrio

Q             Pareto Intelligence

R              Vatica Health

S              Connect America

T              ATTAC Consulting Group

5:30 PM - 6:30 PM
Networking Cocktail Reception in Exhibit Hall

September 11, 2019

7:45 AM - 8:45 AM
Networking Breakfast
7:45 AM - 1:00 PM
Exhibit Hall Opens

8:45 AM - 9:00 AM

Opening Remarks

RaeAnn Grossman, Chief Growth Officer  
DataLink Software

Lou Steinberg, Senior Vice President, Payer Market Sales

9:00 AM - 9:45 AM

Tapping into Behavioral Science to Enrich the Member Journey

  • Dive deep into the application of behavioral science as it relates to engaging members  
  • Tap into case examples of programs that have proven to change behavior and motivated members to be an active participant in the healthcare system  
  • Use behavioral decision making to identify gaps in member knowledge and evaluate interventions 

Matt Wallaert, Chief Behavioral Officer
Clover Health

9:45 AM - 10:45 AM

Focus Panel – Direct Insights into the Medicare & MA Product from Members Themselves

  • Hear direct feedback from a panel of Medicare & MA customers around their experience, access to care and ways to improve

  • Understand how satisfied they are from a benefits perspective and discuss what is missing from the MA product

  • Discuss the pros and cons of Medicare & MA products


    Kathleen Ellmore, Managing Director

    Member Panelists to be Announced

10:45 AM - 11:15 AM
Networking Break in Exhibit Hall

11:15 AM - 12:00 PM

The Future for Payers, Providers and Policy – Examine Scenarios that Could Play Out in the 2020 Election and the Effect on MA

  • Compare Medicare for All and public plan proposals from both parties
  • Examine a world of Medicare for All and the potential impact on Medicare and Medicare Advantage Plans
  • Explore what’s happening at the ACA on a national level

Molly T. Turco, Managing Director of Legislative Policy & Regulation
BlueCross Blue Shield Association

12:00 PM - 1:00 PM
Networking Lunch in Exhibit Hall

1:00 PM

Concurrent Sessions

1:00 PM - 1:45 PM

Track A: Leveraging NLP-enabled 2nd level reviews for increased coding accuracy


  • Explore secondary HCC coding reviews as a cost-effective way to enhance your risk adjustment accuracy
  • Learn tips for using technology as the foundation of a more efficient and successful 2LR program
  • Discuss how to partner across organizations for optimal value

Jeff De Los Reyes, Associate Vice Presidennt of Government and State Sponsored Programs

Carey Ketelsen, Senior Vice President of Risk Adjustment and Coding Operations
Ciox Health

1:00 PM - 1:45 PM

Track B: There’s a Hole in the Bucket: Update on Interoperability, Commercial RADV, and Universal Coverage

  • Grasp the must-know factors affecting the current regulatory landscape and explore whether Interoperability will reshape the face of Healthcare as we know it 
  • Explore the other RADV – same acronym, different problems, and possible solutions 
  • Gain simple solutions to complicated problems in the ACA – hear how universal coverage is closer than you think, and what it will take to get us there 

J. Gabriel McGlamery J.D., Senior HCR Policy Consultant
Florida Blue Center for Health Policy

1:00 PM - 1:45 PM

Track C: Will Physicians Ever Welcome a Health Plan into the Exam Room?

  • Hear a case study from Cigna on a dramatically different approach in partnering with thousands of providers around the country to help them transition to value-based care and improve their clinical and financial performance
  • Learn how to achieve widespread, rapid provider adoption via technology tools that reduce provider abrasion and makes it easier for providers to perform against their value-based contracts
  • Leverage technology to make actionable insights available to providers within their existing clinical workflows


Becky Trotter, Manager of Population Health Solutions

Debbie Conboy, Director of Risk Adjustment

1:45 PM

Concurrent Sessions

Track A: Risk Adjustment & Quality

Chair:                                                                                                                                            Adele L. Towers, MD MPH FACP, Director of Risk Adjustment
UPMC Enterprises

Track B: The Intersection of Policy & Risk Adjustment 

Chair:                                                                                                                                                William DeMarco, President, Pendulum HealthCare
Development Corporation

Track C: Trending Topics in Data & Tech 


To be announced

1:45 PM - 2:30 PM

Track A: Survival Skills for RADV Audit Preparedness

  • Review the A to Z of RADV audits: how to be prepared before, during and after an audit may occur  
  • Learn tools of the trade from an experienced audit survivor  
  • Hear about the different levels of audits you may face and how to guard against them 

Deborah Curry, MBA, RHIA, CCS-P CRC, Manager of Risk Adjustment

1:45 PM - 2:30 PM

Track B: Risk Adjustment Methodology as it Relates to Silver Loading and Marketplace Subsidy

  • Discover the effects and impacts of Silverloading on premiums and how insurers should optimize their plan designs  
  • Discuss how Silverloading is intertwined with Risk Adjustment Programs  
  • Tap into insights on attrition management – specifically how non-payment / partial year enrollment factors will be affected 

David Anderson, MSPPM
Research Associate
Duke-Robert J. Margolis, MD, Center for Health Policy

1:45 PM - 2:30 PM

Track C: Mediating the RAPS Reconciliation Process

  • Discover a proactive, easier and efficient way to innovate and immediate RAPS reconciliation  
  • Sync internally and externally (with vendors) to get data analytics in line  
  • Tap into the right analytics tools and analytical processes to measure gaps as well as opportunities   
  • Recon beyond RAPS Return files: Let’s look into MAO-004 files and others 

Robin Wilson, Senior Business Analyst, Risk Adjustment
WellMed Medical Management, Inc.

2:30 PM - 3:15 PM

Expert Perspectives Weigh in - Keys to the 3P’s: Addressing Policy Changes, Provider Engagement and ‘Practical Innovation’

  • Tie in the themes heard across 3 days of RISE West programming and get practical ideas on how you can implement lessons learned within your organization

  • Hear diverse perspectives weigh in on proposed policy changes and the impact it could mean for your organization

  • Gain tips on payer/provider collaboration techniques and scalable, compliant innovation solutions that impact quality & RA






    Rodney Reider,
    Managing Partner and CEO Strategic Advisor
    Former President and CEO
    Saint Alphonsus Health System

    Panelists:                                                                                                                                 Molly T. Turco, Managing Director of Legislative Policy & Regulation
    BlueCross Blue Shield Association

    John M. Kirk, Founding CEO of Pioneer Medical Group; former Vice-Chair
    APG Public Policy Committee

    Dave Meyer, Vice President of STARS


3:15 PM - 3:30 PM
Closing Remarks

Co-Chair: To be announced