Agenda

RaeAnn Grossman, Chief Growth Officer  
DataLink Software

Lou Steinberg, Senior Vice President, Payer Market Sales
Apixio

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”

• 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

• 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)

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
IMPAACT Health

• 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 

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

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

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

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

• 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

• 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

• 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
Apixio

Josh Weisbrod, Vice President of Risk Adjustment
Network Health

• 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
Pulse8

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

• 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
Episource

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

Josh Weisbrod, Vice President of Risk Adjustment
Network Health

• 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 

Moderator:

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

Panelists:

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

• 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

• 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

• 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  

•  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
IMPAACT Health

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

• Dynamic Healthcare Systems
• Signify Health
• AdhereHealth
• Advantmed
• ATTAC Consulting Group
• Bloom Insurance Agency
• Cavo Health
• Change Healthcare
• Cognizant
• Connect America
• Cozeva
• Edifecs
• GeBBS Healthcare Solutions
• Health Data Decisions
• Healthcrowd
• HealthTrio
• Matrix Medical Network
• Medical Advantage Group
• Omega Healthcare Management
• Pareto Intelligence
• Qmetrics
• Vatica Health

RaeAnn Grossman, Chief Growth Officer  
DataLink Software

Lou Steinberg, Senior Vice President, Payer Market Sales
Apixio

• 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

• 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

  
  Moderator:

  Kathleen Ellmore, Managing Director
  Engagys

  
  Member Panelists to be Announced

• 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

• 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
EmblemHealth

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

• 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

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 

Chair: 

To be announced

• 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
ProMedica

• 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

• 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.

• 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

   

   

   

   

   

  Moderator:
  Rodney Reider,
  Managing Partner and CEO Strategic Advisor
  KA-Ventures
  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
  Cigna

Co-Chair: To be announced