2022 Agenda

Gap Identification to Dynamic Interventions: Climbing the Risk Adjustment Analytics Curve to Intelligently Target Members and Achieve Premium Accuracy   

Track A: Risk Adjustment Strategies

• Learn how your organization’s risk adjustment analytics capabilities compare to your health plan peers according to the latest industry benchmark data  
• Gain practical steps to implement a more dynamic, analytics-driven approach to prioritizing and prescribing interventions for your plan’s member population  
• Understand what it means to deconstruct data silos to enable aggregated insights and comprehensive gap closure efforts across risk adjustment and quality (HEDIS/Stars) programs.   

RaeAnn Grossman, EVP, Operations - Risk Adjustment, Population Health Management and Quality
Cotiviti, Inc.

Andres Aguirre, MPH
QI Director
Sharp Health Plan

Panel: 2022 CMS Star Ratings Changes – Future Impacts and Implications

Track B: Quality

• Discuss changes that impacted Measurement Year (MY) 2022 and will be coming to the program in MY2023 
• Examine CMS’ expectations for health plans to utilize digital engagement and activation in CAHPS reporting and care gap closure strategies going forward 
• Consider CMS’ targeting requirements for rewards and incentives  

Moderator:
Daniel Weaver
EVP Product Operations and Stars Strategy
NationsBenefits

Panelists:
Eden Encarnacion, MHA
Director, Quality and Stars Program
Clever Care Health Plan

Ally Thomas, Ph.D. 
AVP, Quality Improvement
UPMC Health Plan

Carmela Costiniuk, MHA
Vice President of Population Health and Clinical Transformation
Catholic Medical Partners

Panel: RISE Policy Committee Perspectives on Policy Issues

Track C: Compliance & Regulatory Updates

Back by popular demand, the RISE Policy Committee takes on the most pressing policy issues impacting health plans and risk-bearing providers in the Managed Care, ACA and Commercial Sectors.     

Conference attendees will be able to vote on topics to be featured ahead of time.  

Potential talking points include: 

• Deciphering the latest CMS guidance affecting Risk Adjustment and Quality  
• Transparency and interoperability 
• Health equity  
• RADV Audits and how the model will be evaluated going forward   
• Changes in audits in the ACA space  
• MA MLR Changes and rebates 

Moderator:
Sean Creighton
Managing Director
Avalere

Panelists:
Michael Adelberg
Practice Leader, Healthcare
Faegre Drinker Consulting

Mikal Sutton
Managing Director
Medicaid Policy 
Blue Cross Blue Shield Association

Krutika Amin
Associate Director for Program on the ACA
Kaiser Family Foundation

Session presented by Edifecs

Risk Adjustment Strategies

Hear the latest innovation for payers and providers to:

• Improve visibility and control into value-based care contracting and negotiations
• Manage performance and reporting in real-time
• Derive accurate and complete patient payments

Gary Singh, Director Product Management

Mark Filiault, VP Payer Sales

Session presented by Pareto Intelligence

Quality

Austin Bostock
Manager, Client Advisory
Pareto Intelligence

Session presented by Wolters Kluwer

Compliance & Regulatory Updates

Tom Rhodes
Director of Payer Sales-Risk Adjustment
Wolters Kluwer

Panel: The Trifecta Approach to Improving Member Health Outcomes

Track A: Risk Adjustment Strategies

• Data – discover the key sources of data needed for all three programs 
• Business operations- learn how to move from a siloed approach to programs to an integrated “next best action” approach. 
• The multi-year strategy- learn how to design your strategy for success for the long term 

Moderator: 
Elaine Taverna 
Senior Vice President, Risk Adjustment and Quality 
Advantasure  

Panelists:
Ana Handshuh
Principal
CAT5 Strategies

Gregory Pastor
Managing Director of Risk Adjustment Operations
Advantasure


Additional speakers to be announced

More Than Test Results: At-home Diagnostics Raise the Score for Quality and Member Satisfaction

Track B: Quality

• Uncover how the home is serving as a critical and convenient hub for the continuum of care, from annual health evaluations to integrated preventive screening and diagnostic tests that, when coupled with advanced analytics, can detect chronic conditions such as cancer, hypertension, diabetes, and COPD 
• Learn how at-home lab and diagnostic tools are creating new opportunities for patient-centered care 
• Hear how health plans can engage at-risk members while driving down avoidable utilization and boosting quality performance safely and effectively 

Marc Rothman, MD 
Chief Medical Officer 
Signify Health  

Dona Doran 
Program Director Risk Adjustment Operations 
Cambia Health Solutions 

Panel: The Current State of RA Litigation and Risk Areas for MA Plans, Vendors and Downstream Entities

Track C: Compliance & Regulatory Updates

• Examine the current state of risk adjustment litigation and learnings from recent audit activity   
• Assess risk areas and liability under the false claims act with insights into where the government is pursuing litigation related to chart reviews, physician incentives and home health risk assessments 
• Gain a better handle on how government entities like the DOJ, OIG and CMS are pursuing or responding to litigation and how to stay on the right side of the line  

Moderator:
Deb Curry, MBA, RHIA, CCS-P, CRC, RAP, AHCCA
Director Risk Adjustment & Recoveries
Paramount Healthcare/ProMedica Health System

Panelists:
Mary Inman
Partner
Constantine Cannon

Ed Baker
Of Counsel
Constantine Cannon

Stephen D. Bittinger
Partner
K&L Gates, LLP

Concurrent Coding – What You Need to Know

Track A: Risk Adjustment Strategies

• Learn the keys to setting up a program for concurrent coding, including benefits, costs and setting up the internal infrastructure to support it 
• Dig into the compliance aspects of concurrent coding and what to avoid 
• Discuss what’s working and what’s not working for health plans, with takeaways on what could work for your organization

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

Laura Sheriff, RN, MSN, CPC, CRC
Contracting Risk Adjustment Specialist

When Galaxies Collide – A Case Study on Achieving Integrated Quality and Risk Program Excellence

Track B: Quality

• Explore the current universe of siloed quality and risk programs and the merits of moving to an integrated approach.
• Discover the benefits of aligning quality and risk data, combined with advanced analytics, to drive a consolidated approach for providers
• Learn how one health plan is implementing an integrated analytics strategy and gain insights from their first-hand experience in fostering successful organizational change to support their integration program

Moderator:
James Clement
Vice President, Product & Services
Inovalon

Panelists:
Kristopher Volrath
Vice President, Field Products & Solutions
Inovalon

Dr. Jocelyn Hines, Medical Director
Inovalon

Leah Hannum, Director of Government Funding Operations
Blue Cross of Idaho  

The Outlook of OIG Audits of Medicare Advantage Plans & Ideas to Mitigate Risk

Track C: Compliance & Regulatory Updates

• Gain a better handle on the outlook of OIG audits and what’s to come down the pike 
• Discuss the differences in OIG versus CMS RADV standards of documentation and best practices when juggling multiple types of audits 
• Examine ways that health plans are anticipating other fact patterns in its submissions that may point to improper coding and discuss how organizations are using these results / data to inform future decision making

Osato F. Chitou, Esq., MPH
Principal Consultant
NMOC Healthcare Compliance Consulting, LLC, d/b/a Compli by Osato  

Measure What Matters in Risk Adjustment

Track A: Risk Adjustment Strategies

• Discuss key KPIs and how to measure them
• Understand changes in KPI and their impact on overall program
• Learn how to measure the impact of EMR Integration & NLP

Erin Montgomery, COO
Advantmed

Meredith Diep
LA Care

Quality & the Member Experience: How to take a first date and make it a long lasting “marriage”

Track B: Quality

• Learn how to integrate an innovative cohesive culture of quality awareness across an organization to drive member satisfaction and internal buy-in of quality programs and initiatives
• Designing intentional programs that address quality outcomes and social determinants of health
• Learn how creating partnerships with organizations aligned in health equity initiatives yield stronger programmatic outcomes, move the needle on quality improvement, and deliver first-class member experience
• Walk through how one plan looked to address SDoH and bridge historically underserved and difficult to reach populations

Moderator:
Jenn Kerfoot
Chief Customer Officer
FarmboxRx

Ashley Tyrner
Founder and CEO
FarmboxRx

Lauren Barca, MHA, BSN, RN
Executive Officer, Population Health & Quality
UnitedHealthcare Community Plan of Tennessee

Panel: The Checks and Balances of RADV Audits

Track C: Compliance & Regulatory Updates

• Discuss the checks and balances that health plans should have in place to proactively mitigate submission of unvalidated HCC’s  
• Hear about juggling audits from multiple entities 
• Consider best practices in RADV audit preparation

Moderator:
Deb Curry, MBA, RHIA, CCS-P, CRC, RAP, AHCCA
Director Risk Adjustment & Recoveries
Paramount Healthcare/ProMedica Health System

Panelists:
Tom Nasadoski, MBA
Vice President, Risk Adjustment
CDPHP

Wynda Clayton, MS, RHIT Director Risk Adjustment
Providence Health Plan

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

Panel: Leveraging Point-of-care Diagnostics for Provider Engagement and Telehealth Care Planning

Track A: Risk Adjustment Strategies

• Utilize multi-modality testing results for care management 
• Enact care management on members with chronic conditions  
• Leverage analytics platform to consolidate testing data for RADV audit support  

Moderator:
John Romans
CEO
Biomedix

Panelists:
Archita Sood
Chief Medical Officer Homebase Medical

Ryan Dodson
Risk Adjustment Coordinator
Choice Medical Group 

Mark Ishimatsu
Former Director, Enterprise Risk Adjustment Strategies/Initiatives 
L.A. Care Health Plan

Case Study - Creating the Audience of One: Working Together to Revolutionize HEDIS Care Gap Closures and Member Experience

Track B: Quality

• Examine trends in Stars Quality Improvement and the need to explore new care models to remain relevant among members, and to stay competitive among industry players  
• Learn how forward-thinking partnerships are creating new innovative strategies that deliver best in class member experience and close HEDIS care gaps  
• Hear a case study of how Clover Health and Walgreens partnered to meet members where they are to orchestrate better outcomes while hitting HEDIS, HOS, CAHPS and member experience measures   
• Consider why it is critical to have your HEDIS auditor be a strong partner on your innovation processes

Archana Mahimkar, MS, MBA, CPHQ
Senior Director, Clinical Quality Improvement and Safety
Walgreens Health

Julianne Eckert
Senior Director of Clinical Quality Programs
Clover Health

Katharine Iskrant, Founder and Practice Lead
Healthy People

Surfacing High Risk Diagnosis Codes: Leveraging OIG’s Methodology to Better Ensure Integrity in Submissions

Track C: Compliance & Regulatory Updates

• Discuss the recent literature from the Office of Inspector General focused on integrity in diagnosis code submissions, and impacts on coding in Medicare Advantage   
• Learn the power of data analysis of medical and pharmacy claims for surfacing problematic diagnoses, and of NLP for evaluating these diagnoses 
• Understand how to efficiently follow-up on high-risk diagnosis codes in preparation for a potential future audit 
• Learn what data available in standard claims is key for customizing and expanding the search for high-risk diagnosis codes 

William Schweitzer
Associate, Platform Strategy and Solutions
Episource

Erik Simonsen, Chief Operating Officer
Episource

Deb Curry, MBA, RHIA, CCS-P, CRC, RAP, AHCCA
Director Risk Adjustment & Recoveries
Paramount Healthcare/ProMedica Health System

Interactive Roundtables

Join us for interactive roundtables featuring the latest technologies and solutions for boosting your organization's endeavors. These speed-networking type presentations are 20 minutes long, allowing you to make your way to several roundtables per session. 

Data Analytics and Risk Adjustment: How are you managing your evolving needs?

Roundtable A

• Join us for a truly interactive chat where we’ll dig into your biggest challenges.
• What are the barriers you face in executing your data analytics strategy? How would you rate the strength of your risk adjustment workflows?
• We’re here to listen to you and share insights on how you can approach these challenges.

Discover How Reveleer’s Revolutionary New AI Will Transform Your Risk Adjustment Program

Roundtable B

• Join us to experience real-world proof points and examples of how Reveleer's AI can deliver on the promise of superior accuracy, efficiency, and outcomes
• Discover how our AI-enabled automation can accelerate coding workflows by 25% and improve accuracy by up to 45%
• Learn how our proprietary Broad Match NLP and Confidence Scoring deliver 98% HCC discovery accuracy

DataLink: Quality Attestation Module

Roundtable C

• Creating streamlined abstraction workflow for quality gap closure
• Providing automated gap closure through interoperability to reduce leakage
• Ensuring real-time quality gap information for providers at the point of care

Risky business: Leveraging digital framework to accelerate your risk adjustment and quality performance

Roundtable D

• Learn how to improve risk adjustment coding accuracy and data integrity needs
• Help increase coding accuracy with analytics
• Improve productivity and performance for risk coders and contracts

Live Fast, Live Easy, LiveWell: Build member loyalty and grow your bottom line with Medline’s OTC Benefit Solution Program

Roundtable E

• Learn how Medline can bring together products, process and people to deliver a fully functional OTC supplemental benefits program that positively impacts member satisfaction and loyalty
• Understand how Medline’s end-to-end benefit management, diversified product offering and personalized service make it easy for you to provide a supplemental OTC benefit option for your members.
• Collaborate and discuss with us! Let’s talk about the current state of your OTC program and what you envision.

Compliance Driven Risk Adjustment

Roundtable F

• How to amplify retrievals to receive a member’s full medical history
• Prospective/Retrospective work to enhance provider’s pre-visit planning
• Compliance (ADDS/DELETES) Validation of all HCCs

How to Drive Member Engagement with AI

Roundtable G

• Join this session to learn how an applied AI platform can help you to predict the right individuals to engage with the right interventions to drive better health outcomes and business results.
• Discover how to create a holistic profile for every one of your members using consumer data and predictive models to develop high-performing engagement programs that transform predictions into actions at scale.
• Discuss proven AI-driven engagement strategies and tactics to get the right members into your program funnels to improve care management engagement, close care gaps, ensure accurate risk adjustment capture, and more.

Leveraging Technology to Improve Member Experience and CMS Alignment in Supplemental Benefit and Incentive Programs

Roundtable H

• Complying with CMS’ direction of broadened benefits while narrowing allowable incentives
• What do members want/value?
• Impacting STARS and HEDIS scores

Move the Needle on High-Risk, Perpetually Nonadherent Members and Improve MA Star Ratings

Roundtable I

• Understand how to effectively target members that have demonstrated to be at the highest risk for negative outcomes on adherence-related measures
• Learn how to develop a holistic approach toward Patient Relationship Management (PRM) to reduce SDOH-driven barriers to care
• Explore strategies to create meaningful relationships with the most challenging populations to improve CAHPS performance

Prospective risk & quality gap closure

Roundtable J

• Learn how to increase compliance, efficiency, and transparency by helping to ensure accuracy, completeness, and truthfulness of risk adjustment data in a prospective manner
• Streamline provide workflow and minimize retrospective chart review
• Discussion on use of prospective tool for quality care gap closure

Leveraging True AI to Drive Prospective Efforts, EHR Integration, and Industry-Leading Risk Adjustment Performance

Roundtable K

• Drive prospective initiatives by harnessing AI-driven analytics + EHR integration
• Optimize coder productivity + accuracy and compliance efforts combining leading-edge technology + expert review
• Deliver healthier member outcomes via quality care gap closure + optimal risk revenue for your organization

Interact with Medicare and Medicaid members via HIPAA-secure intelligent automation

Roundtable L

• Enhancing member experiences with secure, omnichannel, two-way intelligent digital automation
• Augmenting your live member interactions with convenient digital options via member channel of choice
• Increasing engagement, collecting and sharing needed data for surveys, closing gaps in care and more

Ways to Achieve better provider Outcomes through your coding reviews

Roundtable M

• Utilize provider score cards and education reports to track quality outcomes
• Review HCC analysis to watch trends year over year
• Ways to query your providers to improve documentation insufficiencies

Coming Soon

Roundtable N - A Collaborative, Technology-based Approach to Member Engagement to Maximize RAF & Member Experience

• Modernize your member engagement with a digital-first approach for tailored, cost-effective outreach in one centralized system
• Learn how to coordinate all prospective quality and risk adjustment operations to optimize revenue capture and reduce member abrasion
• Capture important member information on race, ethnicity, and language to support the Health Equity strategic pillar

How AAPC Is Reducing Risk by Unifying Providers and Payers

Roundtable O

• Join us for a candid discussion around your biggest pain points, and how AAPC can help solve them.
• With a medical coder at the center of every claim, we will explore risks exposed in provider documentation by non-certified coders.
• Get the latest updates in hot topics in risk adjustment.

20 Minutes to More Accurate HCC Scores

Roundtable P

• HCC Coding can be made simple
• Improve speed and accuracy
• Minimize errors and boost productivity

Stop Settling: Are you Getting Partial Dual Premium for Full Dual Risk?

Roundtable Q

• Partial and Full duals have very different premiums and distinct member benefits. Learn about how model changes in 2017 affected Medicare Advantage dual enrollment strategies.
• In this session, we’ll cover several Medicaid pathways to explore that may qualify a member for full Medicaid benefits.
• We’ll discuss how leading with help while re-evaluating partial dual members to find missed opportunities and identify changed circumstances could lead to partial-to-full enrollment.

The Data is in - Focusing on Member Experience Closes More Care Gaps

Roundtable R

• Join us for an insightful conversation on key learnings we've discovered that improve the member experience
• Learn how our direct-to-consumer insights and health plan member research is reshaping the way we engage members, and delivering better results
• Together we'll explore ways to bridge the trust gaps, foster credibility, and establish value to delight your members

Three Population Health Tactics That Drive Efficient Risk and Quality Gap Closure

Roundtable T

• Understand the impact AWVs have in risk adjustment and how it can drive positive HCC and HEDIS® gap closures
• Learn how using Deviceless Remote Patient Monitoring® provides quality insights and data to address staffing challenges and ultimately leads to CMS Star gap closures
• Divulge effective new member plans for open enrollment that properly identifies risk and ensures each measure is met

Are you getting accurate data, or is it being stuck in the black hole between provider note and CMS?

Roundtable U

• Educating provider offices on proper billing of all codes
• Ensuring the data isn’t clogged in clearing house
• Validating your data versus what CVMS has accepted, and how to fill in the GAP

Faster than One, Smarter than All: Harnessing the Accuracy of AI Crowdsourcing

Roundtable V

• Enable new risk-adjustment optimization strategies
• Compliment the tools you use today
• Validate 3rd party services for accuracy and compliance

Engaging, Retaining and Improving Member Experience Through Companion Care

Roundtable W

• Understand the far-reaching impacts of member experience
• Explore proven strategies for improving member experience, engagement and retention
• Learn how paid companions in the home can build member trust and loyalty, while helping members better navigate plan benefits and address care needs

Cost, quality, experience, and revenue are positively impacted by choosing the right partner for in-home services and supplemental benefits.

Roundtable X

• Reducing readmissions, addressing isolation, and closing care gaps by leveraging high-tech and high-touch resources.
• Partnering with Clinical Quality and Care Management Teams at the Health Plan to customize programs across your entire member population.
• Collect and share valuable data from in-home SDoH assessments that result in real-time delivery of support services.

Leveraging Social Risk Analytics to Manage Risk, Improve Outcomes, & Advance Equity

Roundtable Y

• Identify community-level SDOH and person-level social risk factors for their markets and members
• Quantify the impact of social risk on utilization, cost, quality measure attainment, and member retention
• Prioritize strategies and solutions to effectively support the social needs of their member populations

Stranger Things about Provider Engagement for Risk Adjustment

Track A: Risk Adjustment Strategies

• Hear perspectives from provider engagement experts on what’s going well and what challenges are left to overcome regarding managing patients’ risk and quality gaps
• Learn technical approaches to targeting providers and members for risk adjustment and quality gaps
• Gain new ideas for engaging your providers through transparent alignment strategies and education

 
Moderator:

Jill Strassler 
VP Solutions Management 
Veradigm Payer Solutions (formerly Pulse8)

Panelists:

Lynn Kryfke
Executive Director Health Plan Clinical Services
Children’s Community Health Plan (CCHP)

Amanda Banister, CPC
Manager of Provider Engagement
Veradigm Payer Solutions (formerly Pulse8)

Savannah Gonsalves, RN, MHA, Director of Quality
Hometown Health 

Case Study: Insights into Kaiser Permanente’s Accelerated Efforts in Addressing SDoH

Track B: The Intersection of RA, Quality & Population Health 

• Gain insights into Kaiser Permanente’s investment in addressing SDoH across all lines of business, with learnings on the internal structure, interdepartmental collaboration 
• Hear about the intersection of ROI with focus on the connection to Star Ratings and HCC coding and how leadership is justifying their investment in this space 
• Learn about various tools that are being used on the journey to health equity

Anand Shah, MD, MS
Vice President of Social Health
Kaiser Permanente

Panel: Approaches in Value-Based Contracting Between Payers and Providers

Track C: Payer/Provider Alignment

• Consider the changing state of value-based care & care delivery, including developments in contracting and incentives between payers and providers  
• Examine recent changes proposed by CMS in provider incentives and hear what plans are doing to build incentives into contracting in a compliant manner  
• Discuss case examples of effective contracting between payers / providers 
• Learn keys in evaluating the success of contracts on an ongoing basis  

Moderator:
Beth Zuehlke
Chief Customer Officer
Moxe Health

Panelists:
Barry Stelmach
CFO
Catholic Medical Partners

George G Sauers
Chief Managed Care and Strategy Officer
Rockport Healthcare Services

Panel: Opportunities for Efficiency and Alignment Between Risk Adjustment & Quality Departments

Track A: Risk Adjustment Strategies

• Find interdepartmental efficiencies among risk adjustment and quality to make the most of your data, reduce provider outreach, and enhance member experience 
• Hear case examples of health plans with integrated departments, with highlights of successes 
• Discuss data management and analytical tools that help centralize and consolidate initiatives  
• Prospectively identify likely care gaps for both risk adjustment and quality improvement together

Moderator:
Dawn Carter
Director, Product Strategy
Centauri Health Solutions

Panelists:
Amy Smith
Director, Provider Enablement
Sentara Health Plans

JoJuan Rowe, RHIT
Manager of Medicare Risk Adjustment 
Arkansas Blue Cross Blue Shield

Case Study: Collaboration Beyond COVID-19 - Aligning Quality Metrics with Public Health Goals

Track B: The Intersection of RA, Quality & Population Health

• Learn about the COVID-19 vaccine journey within Los Angeles County, with insights in what it took to get over 90% of seniors 65+ to receive 2 doses & nearly 70% to get boosted  
• Gain insights into the collaboration between the public health department, local health systems, community organizations and payers   
• Discuss the connection to health plan quality metrics and overall immunization efforts  

Tracey Veal, DrPHA, MBA  
Senior Advisory Consultant  

LA County Public Health Department 

Strategy for Chart Acquisition and Management

Track C: Payer / Provider Alignment

• Examine the current state and pain points associated with chart acquisition and management and its impact on your value-based care initiatives
• Learn how Centene Corporation is using a digital approach to access, store, and share member data in a centralized location
• Gain practical steps to implementing a chart data management solution that will aid your organization's retrospective and prospective data acquisition and management

Pritesh Patel
Director of Strategy
Apixio

Brian Murtha
Director, Digital Strategy
Centene

Session to be announced

Track A: Risk Adjustment Strategies

The Z Code Quandary: Reimbursement vs. Reality

Track B: The Intersection of RA, Quality & Population Health

• Get a grasp on the SDoH Z code landscape – where we started, where we’re at and where we’re going
• Discuss progress that industry groups, such as the Gravity Project, have made and the impact on plans and providers
• Consider what providers and plans can be doing to solve for the disconnect between Z code reimbursement and use

Ellen Fink-Samnick 
Chair 

RISE SDoH Community

Case Study: The Journey to Reduce PCP Burden

Track C: Payer / Provider Alignment

• Examine the current state of PCP burden, including balancing the burnout vs. patient expansion  
• Learn about a comprehensive project at Cedars Sinai supporting primary care burnout focused on people, processes and technology 
• Hear about interim results of several pilots positively impacting primary care physicians and in turn impacting RAF and Quality measures as well as plans to scale those models  

Sonja Rosen MD, FACP, AGSF
Chief, Section of Geriatric Medicine, Dept of Medicine, Cedars-Sinai
Medical Director, Geriatrics, CSMCF
Professor of Medicine
UCLA David Geffen SOM

Suzanne N. Chipello
Director, Program Management
Cedars-Sinai