MONDAY - August 30, 2021
9:00AM - 3:00PM MT / 11:00AM - 5:00PM ET
Pre-Conference Virtual Workshops - Available to All Attendees
The virtual workshops on Monday, August 30 are streaming live, and are available to all RISE West attendees, whether you plan to join the main conference virtually or live in Colorado Springs.
9:00AM - 3:00PM MT / 11:00AM - 5:00PM ET
Virtual Workshop A: 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
Colleen Gianatasio
Devoted Health
Donna Malone, CPC, CRC, CRC-I, AHCCA, RAP
AAPC Approved Instructor
Director of Ambulatory Clinical Documentation Quality Improvement
Mount Sinai Health System
10:00AM - 1:00PM MT / 12:00PM - 3:00PM ET
Virtual Workshop B: 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
Deb Curry, MBA, RHIA, CCS-P, CRC
Manager, Risk Adjustment
ProMedica
Susan Waterman RHIT CCS CPC CRC, Director of Risk Adjustment
Scott and White Health Plan
TUESDAY - August 31, 2021
1:00PM - 4:00PM MT
Pre-Conference In-Person Workshops
The in-person workshops on Tuesday, August 31 are taking place at The Broadmoor in Colorado Springs, and are available to in-person attendees only.
In-Person Workshop C
Doubling Down on Member Engagement
Medicare Advantage Plans are faced with resounding challenges as a result of the COVID-19 pandemic, with member engagement being at the top of the list. Current CMS guidance allows for using prior HEDIS® and CAHPs survey scores, which may be positive or detrimental to a plan’s success dependent on their position. Moreover, most providers have seen substantially less patients so, the big question is, how do you double down on member engagement and catch up?
Attendees will walk away with the tools and tactical know-how to:
- Keep up with the changing quality guidelines for health plans, including the change of CAHPs survey scores to four way
- Implement CAHPS improvement strategies and customer service operations to optimize member experience
- Assess the member experience with telehealth and understand the implications moving forward
- Plan for a second wave of COVID-19 and strategies to close gaps in the meantime
Sara Hansen, MS, Director of Quality & Clinical Risk Services
Avera Health Plans
Ally Thomas, Ph.D., AVP, Quality Improvement
UPMC Health Plan
In-Person Workshop D
Success in Risk-Based Arrangements: The Next Frontier of Provider Engagement & Education
Now more than ever, it is important for health plans and health care providers to work hand-in-hand to better, more efficient patient care. In this interactive workshop, adult education and provider engagement experts provide guidance and new ideas for health plans looking to better engage their provider partners. Walk away with a mix of tips from the 10,000-foot view as well as operational examples that you can implement into your provider engagement programs.
Dr. Christie McMullen
Adult Learning Expert & Author
Learning Can Stick
Dr. Shannon Decker, M.Ed., MBA, PhD.
Vice President, Clinical Performance
Brown & Toland Physicians
4:00PM - 5:30PM MT
Opening Happy Hour at The Broadmoor for All In-Person Attendees
In-person attendees will enjoy a socially distanced reception, compliant with CDC guidelines, providing networking opportunities among other in-person attendees, speakers, and solutions providers.
WEDNESDAY - September 1, 2021
7:45AM - 8:45AM MT / 9:45AM - 10:45AM ET
Morning Networking & Registration
In-person attendees will enjoy a socially distanced reception, compliant with CDC, state, & venue guidelines, providing networking opportunities among other in-person attendees, speakers, and solutions providers. For virtual attendees, turn on your camera and join us in the virtual networking lobby for face-to-face networking with other attendees that are joining us from the comfort of their home. No matter how you join, you’ll have access to those hallway conversations we’ve all been missing.
8:45AM - 9:00AM MT / 10:45AM - 11:00AM ET
Welcome Remarks
Conference Chair
Ana Handshuh, Principal
CAT5 Strategies
9:00AM - 9:45AM MT / 11:00AM - 11:45AM ET
Keynote: Lead with Your Best Foot Forward – Lessons Learned from the World’s Best Athletes to Achieve Sustained High Performance
Join RISE for a special presentation with Dr. Jim Loehr, world-renowned performance psychologist and author of 17 books, sharing insights into 30+ years of proprietary research and training of elite performers, including Olympic gold medalists, military Special Forces, Hostage Rescue teams, surgeons, and Fortune 500 CEOs to achieve sustained high performance.
In this keynote talk, Dr. Loehr focuses on the single most important factor in successful achievement, personal fulfilment, and life satisfaction, with takeaways on how you too can learn these characteristics.
Jim Loehr, Ed.D.
Co-Founder
Johnson & Johnson Human Performance Institute
10:00AM - 10:50AM MT / 12:00PM - 12:50PM ET
Leadership Panel: The Current and Future State in Risk Adjustment and Star Ratings
- Dissect the impact of deferred care due to COVID-19 and hear ways to mitigate the impact on Risk Adjustment and Quality Programs
- Discuss the revenue impact of COVID-19 and hear how health plans are dealing with the effects
- Examine new changes in Star Ratings & supplemental benefits and understand how these may affect your programs
Moderator:
James Lewis
Former VP of Risk and Quality
BCBS of Arizona Advantage
Principal Owner
Paragon 7ven Studios & Consulting Group
Panelists:
Rick Liu
VP, Risk Adjustment
SCAN Health Plan
Renée Golderman
Senior Vice President, Chief Quality Officer
CDPHP®
Elaine Taverna, Senior Vice President Risk Adjustment and Quality
Advantasure
11:05AM - 11:50AM MT / 1:05PM - 1:50PM ET
Panel – The Biden Administration’s Impact on Managed Care: What We’ve Seen So Far and Where We are Headed
Experts dissect the Administration's impact on Medicare Advantage, Medicaid and the ACA Marketplace and discuss what's to come, including insights into:
• Fiscal Policy
• Budget and Reconciliation Packages
• Medicaid Expansion
• What's next on the legislative agenda and what's possible on the regulatory side
Moderator:
Sean Creighton, Vice President, Risk Adjustment Policy
Humana
Panelists:
Marc Goldwein, Senior Vice President and Senior Policy Director
Committee for a Responsible Federal Budget
Mikal Sutton, Managing Director, Medicaid Policy
Blue Cross Blue Shield Association
David Meyer, Member
RISE Policy Committee
Michael S. Adelberg, Principal
Faegre Drinker Consulting
12:05PM - 12:50PM MT / 2:05PM - 2:50PM ET
Tools & Tech Showcase
Leading service providers showcase their offerings in a quick-pitch setting:
- 12:05PM – 12:20PM MT– Vatica Health
- 12:20PM – 12:25PM MT
- 12:25PM – 12:50PM MT
12:50PM - 1:55PM MT / 2:50PM - 3:55PM ET
Lunch & Networking Break - Roundtables for In-Person Attendees Only
Join us for interactive roundtables featuring the latest technologies and solutions for boosting your organization's risk and quality endeavours. These speed-networking type presentations are 20 minutes long, allowing you to make your way to several roundtables per session.
2:00PM - 2:45PM MT / 4:00PM - 4:45PM ET
Concurrent Sessions
Track A: Risk Adjustment & Quality
Panel: What’s in the Stars for Star Ratings?
- Discuss new measures and new weights in Star Ratings, with focus on member experience and care transitions
- Hear various approaches on care plans and different models being implemented by health plans
- Explore different ways to implement communication requirements
Moderator:
Melissa Smith
EVP of Consulting & Professional Services
HealthMine
Panelists:
David Larsen
Director of Quality Improvement
SelectHealth
Laura Breisch
VP of Value Capture
Oscar Health
Track B: Provider Engagement
Panel: Payer Experiences in Provider Engagement – What Works and What Doesn’t
- Explore recent developments in provider engagement, with takeaways what’s worked and what hasn’t for health plans
- Hear different models and internal structures in provider outreach
- Get insights into various approaches to incentive design
Moderator:
Colleen Gianatasio
Director of Ambulatory Clinical Documentation Quality Improvement
Mount Sinai Health System
Panelists:
Susan Waterman RHIT CCS CPC CRC, Director of Risk Adjustment
Scott and White Health Plan
Jill Alessi, RN, BSN, MHA Vice President of Healthcare Operations
Blue Cross of Idaho
Jeslie Jacob
Divisional Vice President, Provider Performance, Provider Analytics, Reporting and Connectivity
Blue Cross Blue Shield of Illinois
Jessica Columbus, LVN, CCS-P, CRC, CPHQ
AVP, STARs & Risk Adjustment
Memorial Hermann Health Plan
Michael Schopke, Chief Growth Officer
DataLink Software
Track C: Trends in Care Delivery
Panel: Continuing the Efforts of Telehealth – Current Successes and Future State
- Hear industry perspectives on the continuing telehealth efforts, tying those into the needs of Quality and Risk Adjustment
- Hear an update on where Telehealth stands and insights into future state
- Hear from other health plans on how they are maintaining member engagement through telehealth / telephonic outreach, tips for working with physicians to deliver telehealth
- Discuss innovative approaches to telehealth efforts
Moderator:
Mark Bigelow
Vice President
EXL
Panelists:
Mark Ishimatsu
Director of Enterprise Risk Adjustment
L.A. Care
Andy Ellner, MD
Founder
Firefly Health
Laura Sheriff, RN, MSN, CPC, CRC
Risk Adjustment Specialist
Track B: Provider Engagement
Leading with Digital: How technology is shifting outreach in multi-modal record retrieval
- Learn why digital fulfillment is now the preferred methodology of providers and how payers can support their need
- Hear what changes in technology are driving the reshuffling of priority including EHR Integrations, interoperability mandates & smarter chase lists
- Learn the benefits to payer and provider including reduced manhours, quicker access, greater quality & improved security
Andy Kumar
Vice President of Product
Ciox Health
Amir Keren
Ciox Chief Technology Officer
Ciox Health
Deb Curry, MBA, RHIA, CCS-P, CRC
Manager, Risk Adjustment
ProMedica
Track C: Trends in Care Delivery
Navigating the Wild West of Digital Clinical Data
- Gain a blueprint for success in leveraging clinical data; including how to identify and connect to data sources such as HIEs and cloud-based EHRs and build a business case to support quality and risk
- Learn about advances in technology that can be used to normalize, synthesize and enrich these complex data, which are notoriously inconsistent and fragmented
- Identify the best source of data for your initiatives and learn how to anticipate and mitigate clinical data and quality issues
Daniel Z. Sands, MD, MPH, FACMI
Chief Medical Officer
Diameter Health
Darren Schulte, MD
President of Advanced Technology
Centene Corporation
3:00PM - 3:45PM MT / 5:00PM - 5:45PM ET
Concurrent Sessions
Track A: Risk Adjustment and Quality
Oil & Vinegar, Thunder & Lightning, RA & QM Data, and other Indelible Pairs
• Explore real-world pain points from multiple innovative health plans in tying together electronic data feeds for Risk and Quality
• Hear best practices for successful bi-directional data flow between a payer and its provider network
• Discover opportunities to improve utilization and results via a common workflow with providers
Moderators:
Jay Scholes, Regional Sales Manager
Pulse8
John Cover, Vice President of Sales
Pulse8
Panelists:
April Vogelsang, RN, MS, SVP, Chief Clinical Integration Officer
Health Alliance Medical Plans
Lynn M. Kryfke, RN, MSN, Executive Director, Health Plan Clinical Services
Children's Community Health Plan
Steve Sanders, Vice President, Platform Strategy & Business Development
Veradigm
Track B: Provider Engagement
Provider Perspective Panel: Keys to Provider / Payer Collaboration in a Post-Pandemic World
- Get down to the financials – discuss which incentives actually work and hear how providers have been financially affected as a result of the pandemic (and ultimately, what that means for the payer / provider relationship)
- Hear the barriers, roadblocks and resources needed for a successful risk adjustment & 5-star quality program
- Examine how COVID-19 has changed the patient experience and how that affects member engagement on health plan side
Moderator:
Leah Hannum
Director, Government Funding Operations
Blue Cross of Idaho
Panelists:
Jennifer Ross
Director of Risk Adjustment Compliance Programs
Aegis Medical Group
Tiffany E. Wandy, Executive Director, Clinically Integrated Network
LifeBridge Health
Stephanie Zeiber, MPA, PA-C
APP Programs Manager for Value Based Care
Sentara Family Medicine Physicians
Track C: Trends in Care Delivery
Leveraging a Patient Phenotype to Support Care Guidance
- Discuss the latest interoperability standards and artificial intelligence and hear about new tools that your organization can tap into and create a patient phenotype
- Learn how a patient phenotype can power insights for risk, quality, utilization management, and beyond
- Hear case examples from leading institutions on how they are building patient phenotypes for value-based care
Bryan Lee
Vice President of Solutions
Apixio
Kelley Scott, MSN FNP-c
Nurse Practitioner
Providence St Joes
Track B: Provider Engaement
Panel: Payer Experiences in Provider Engagement – What Works and What Doesn’t
- Explore recent developments in provider engagement, with takeaways what’s worked and what hasn’t for health plans
- Hear different models and internal structures in provider outreach
- Get insights into various approaches to incentive design
Moderator:
Colleen Gianatasio
Director of Ambulatory Clinical Documentation Quality Improvement
Mount Sinai Health System
Panelists:
Susan Waterman RHIT CCS CPC CRC, Director of Risk Adjustment
Scott and White Health Plan
Jill Alessi, RN, BSN, MHA Vice President of Healthcare Operations
Blue Cross of Idaho
Jeslie Jacob
Divisional Vice President, Provider Performance, Provider Analytics, Reporting and Connectivity
Blue Cross Blue Shield of Illinois
Jessica Columbus, LVN, CCS-P, CRC, CPHQ
AVP, STARs & Risk Adjustment
Memorial Hermann Health Plan
Michael Shopke, Chief Growth Officer
DataLink Software
Track C: Trends in Care Delivery
Panel: Continuing the Efforts of Telehealth – Current Successes and Future State Panel: Continuing the Efforts of Telehealth – Current Successes and Future State
- Hear industry perspectives on the continuing telehealth efforts, tying those into the needs of Quality and Risk Adjustment
- Hear an update on where Telehealth stands and insights into future state
- Hear from other health plans on how they are maintaining member engagement through telehealth / telephonic outreach, tips for working with physicians to deliver telehealth
- Discuss innovative approaches to telehealth efforts
Moderator:
Mark Bigelow
Vice President
EXL
Panelists:
Mark Ishimatsu
Director of Enterprise Risk Adjustment
L.A. Care
Andy Ellner, MD
Founder
Firefly Health
Laura Sheriff, RN, MSN, CPC, CRC
Risk Adjustment Specialist
4:00PM - 4:45PM MT / 6:00PM - 6:45PM ET
Concurrent Sessions
Track A: Risk Adjustment & Quality
The New World of Data Interoperability: Linking Administrative and Clinical Data
- Learn how to use the various data models, such as Health Level 7® (HL7) Fast Health Interoperability Resources® (FHIR) and the Common Payer Consumer Data Set (CPCDS) to transition administrative and clinical data into and out of FHIR resources
- Recognize how clinical data in FHIR format can be used to link claims, pharmacy and other administrative data to clinical data from EMRs and patient-reported outcome measures (e.g., functional status, symptoms and symptom burden, etc.)
- Gain an appreciation for how NCQA and CMS are integrating FHIR into quality measurement in the coming years
Richard Lieberman, Chief Data Scientist
Cortex Analytics/Mile High Healthcare Consulting
Michael Klotz, Managing Consultant
MK Advisory Services LLC
Track B: Provider Engagement
Leading with Digital: How technology is shifting outreach in multi-modal record retrieval
- Learn why digital fulfillment is now the preferredmethodology of providers and how payers can support their need
- Hear what changes in technology are driving the reshuffling of priority including EHR Integrations, interoperability mandates & smarter chase lists
- Learn the benefits to payer andprovider including reduced manhours, quicker access, greater quality & improved security
Andy Kumar
Vice President of Product
Ciox Health
Amir Keren
Ciox Chief Technology Officer
Ciox Health
Deb Curry, MBA, RHIA, CCS-P, CRC
Manager, Risk Adjustment
ProMedica
Track C: Trends in Care Delivery
Navigating the Wild West of Digital Clinical Data
- Gain a blueprint for success in leveraging clinical data; including how to identify and connect to data sources such as HIEs and cloud-based EHRs and build a business case to support quality and risk
- Learn about advances in technology that can be used to normalize, synthesize and enrich these complex data, which are notoriously inconsistent and fragmented
- Identify the best source of data for your initiatives and learn how to anticipate and mitigate clinical data and quality issues
Daniel Z. Sands, MD, MPH, FACMI
Chief Medical Officer
Diameter Health
Darren Schulte, MD
President of Advanced Technology
Centene Corporation
Track B: Provider Engagement
Provider Perspective Panel: Keys to Provider / Payer Collaboration in a Post-Pandemic World
- Get down to the financials – discuss which incentives actually work and hear how providers have been financially affected as a result of the pandemic (and ultimately, what that means for the payer / provider relationship)
- Hear the barriers, roadblocks and resources needed for a successful risk adjustment & 5-star quality program
- Examine how COVID-19 has changed the patient experience and how that affects member engagement on health plan side
Moderator:
Leah Hannum
Director, Government Funding Operations
Blue Cross of Idaho
Panelists:
Jennifer Ross
Director of Risk Adjustment Compliance Programs
Aegis Medical Group
Tiffany E. Wandy, Executive Director, Clinically Integrated Network
LifeBridge Health
Stephanie Zeiber, MPA, PA-C
APP Programs Manager for Value Based Care
Sentara Family Medicine Physicians
Track C: Trends in Care Delivery
Leveraging a Patient Phenotype to Support Care Guidance
- Discuss the latest interoperability standards and artificial intelligence and hear about new tools that your organization can tap into and create a patient phenotype
- Learn how a patient phenotype can power insights for risk, quality, utilization management, and beyond
- Hear case examples from leading institutions on how they are building patient phenotypes for value-based care
Bryan Lee
Vice President of Solutions
Apixio
Kelley Scott, MSN FNP-c
Nurse Practitioner
Providence St Joes
5:00PM - 5:50PM MT / 7:00PM - 7:50PM ET
Panel – Cross-Sector Perspectives on The Impact of SDoH & Actionable Solutions in Health Care
Leaders from health plans, health care providers and CBO’s share their experiences in addressing SDoH, focusing on real-world solutions.
Moderator:
Ana Handshuh, Principal
CAT5 Strategies
Andy McMahon
Vice President, Health and Human Services Policy
UnitedHealthcare Community & State
Karin VanZant
Vice President, National SDOH Strategy
CareSource
Vivian Nava-Schellinger, J.D.
Director, Partnerships & Network Activation
NCOA
Baligh Yehia, MD, MPP, FACP
Senior Vice President
Ascension
President
Ascension Medical Group
Amir Sweha, MD
Chief Medical Officer
Hill Physicians Medical Group
5:50PM - 6:00PM MT / 7:50PM - 8:00PM ET
Closing Remarks
Conference Chair
Ana Handshuh, Principal
CAT5 Strategies
6:00PM - 7:00PM MT / 8:00PM - 9:00PM ET
Networking Reception
In-person attendees will enjoy a socially distanced reception, compliant with CDC, state, & venue guidelines, providing networking opportunities among other in-person attendees, speakers, and solutions providers. For virtual attendees, turn on your camera and join us in the virtual networking lobby for face-to-face networking with other attendees that are joining us from the comfort of their home. No matter how you join, you’ll have access to those hallway conversations we’ve all been missing.
THURSDAY - September 2, 2021
7:00AM - 7:45AM MT
In-Person Morning Yoga (Optional – Pre-Registration Required)
Take a breath, calm your nervous system, and quiet your mind. Join us in person as we explore a full range of standing and seated postures, complimented by relaxation and meditative techniques. Release tension, reduce stress, and start your morning off the right way.
7:45AM - 8:45AM MT / 9:45AM - 10:45AM ET
Morning Networking & Registration - Roundtables for In-Person Attendees Only
In-person attendees will enjoy a socially distanced reception, compliant with CDC, state, & venue guidelines, providing networking opportunities among other in-person attendees, speakers, and solutions providers. For virtual attendees, turn on your camera and join us in the virtual networking lobby for face-to-face networking with other attendees that are joining us from the comfort of their home. No matter how you join, you’ll have access to those hallway conversations we’ve all been missing.
In-person attendees are invited to join us for interactive roundtables featuring the latest technologies and solutions for boosting your organization's risk and quality endeavours. These speed-networking type presentations are 20 minutes long, allowing you to make your way to several roundtables per session.
- Gain insights into one health plan’s journey to delivering continuous member experience, through a health equity lens
- Hear about their evolving member experience plan and the small steps they have taken to change their approach along the way
- Learn how you too can focus on continuous member experience improvement, aligning with quality measures to provide an end-to-end member experience journey
Tejaswita Karve, Ph.D.
Former Director, Quality Improvement
Johns Hopkins Health System
8:45AM - 9:00AM MT / 10:45AM - 11:00AM ET
Welcome Remarks
Conference Chair
Ana Handshuh, Principal
CAT5 Strategies
9:00AM - 9:50AM MT / 11:00AM - 11:50AM ET
KEYNOTE: How to Change Anyone’s Mind
In this special presentation, hear from Dr. Berger, a world-renowned expert on change, word of mouth, influence, consumer behavior, and how products, ideas, and behaviors catch on.
He has published over 50 articles in top‐tier academic journals, teaches Wharton’s highest rated online course, and popular outlets like The New York Times and Harvard Business Review often cover his work.
In this talk, Dr. Berger gives insights into how to change anyone’s mind, with specific examples to payer, provider and member relationships.
Jonah Berger
International Bestselling Author of Contagious, Invisible Influence, and The Catalyst
Professor
Wharton School at the University of Pennsylvania
10:05AM - 11:00AM MT / 12:05PM - 1:00PM ET
Focus Panel – Direct Insights into the Medicare & MA Product from Members Themselves
Back by popular demand, hear direct feedback from a panel of Medicare & MA customers around their experience, access to care and ways to improve health plan services.
Moderator:
Kathleen Ellmore, Managing Director
Engagys
11:15AM - 12:00PM MT / 1:15PM -2:00PM ET
Concurrent Sessions
Track A: Risk Adjustment & Quality
Prospectively Identify & Manage Risk Using Robust Member Data
- Understand the value of using comprehensive data for risk adjustment, and in turn, enable your organization to improve outcomes, close gaps in care and improve provider follow-up with state-of-the-art member selection
- Leverage comprehensive member data using prospective risk adjustment to gain meaningful insights and target those populations with the most critical needs, and to address those needs in collaboration with providers
- Optimize member identification beyond risk adjustment gaps (quality, utilization, SDoH)
Archie Block
SVP, Analytics and Insights
Signify Health
Janette Gacaferi
Assistant Director Risk Adjustment
Cambia Health Solutions
Track B: Member Engagement & Experience
Panel: Approaches in Member Acquisition, Outreach & Engagement
- Learn about multifunctional approaches that Health plans are taking to engage members (Medicare Marketing & Sales, Stars, Medicaid Conversion, etc.)
- Discuss ways to align benefits for member satisfaction
- Explore strategic shifts of resources to impact member experience and satisfaction
Moderator:
Steve Wigginton
CEO
Icario
Panelists:
Archie Dey
Director of Consumer Experience and Insights
SCAN Health
Laura Sheriff, RN, MSN, CPC, CRC
Risk Adjustment Specialist
Scott Weiner
Director, Government Programs
Virginia Premier
Track C: Compliance & Audit Readiness
Legal Insights Panel: Trends in Audit and Compliance Issues
- Understand the current state of the law in the MA risk adjustment context of how federal courts draw the line between what the U.S. Supreme Court has characterized as “garden-variety breaches of contract or regulatory violations,” which are not actionable under the False Claims Act, and compliance failures that constitute actual fraud
- Hear points of view on the increasing importance of risk adjustment data validation (“RADV”) audits in today’s Medicare Advantage enforcement landscape
- Gain insights into the interconnectedness of the government audit process and government litigation process in Medicare Advantage
- Learn about government enforcement trends in managed care, including the extent to which the Covid-19 pandemic has impacted on-going FCA litigation
- Analyze recent state and federal cases involving compliance problems, such as the failure of managed care plans to activate compliance software, report unsupported diagnoses, supervise consultants or vendors, audit providers, or “look both ways” when conducting chart reviews
Moderator:
Naomi Irvin
Director, Divisional Compliance, Sales, Marketing & Communications
BCBS NC
Panelists:
Stephen Bittinger
Health Care Audit & Integrity Partner
K&L Gates, LLP
Edward Baker
Of Counsel
Constantine Cannon
Jonathan A. Porter
Assistant United States Attorney
United States Attorney’s Office
Southern District of Georgia
William Sarraille
Partner
Sidley Austin LLP
Track B: Risk Adjustment & Quality
Unlocking Your Risk Adjustment Program Potential
- Unlock the right data to understand your risk adjustment program performance
- Build a better program roadmap and prioritize high-impact opportunities
- Execute the strategic interventions, at the right time, for the right members
Eric Segal
Director, Platform Strategy and Solutions
Episource
Meleah Bridgeford
Director, Risk Adjustment Analytics
Episource
Rick Alexsonshk, PAHM
Director Risk Adjustment
SummaCare
Track C: Compliance & Audit Readiness
Keys to Avoiding Legal Action in Medicare Fraud & Costly RADV Audit Mistakes – A Look into Recent Examples
- Hear legal experts discuss case examples of successful whistleblower-initiated False Claims Act cases alleging risk adjustment fraud
- Hear what went wrong, what not to do and red flags directly from whistleblower attorneys who represented the whistleblowers and one of the U.S. Attorneys who prosecuted one of the cases
- Get insights into faults they’re finding, what they’re looking for in these cases, and what the penalties are, and in turn how health plans and providers can avoid legal action
Mary A. Inman
Partner
Constantine Cannon
Max Voldman
Attorney
Constantine Cannon
Randy Harwell
United States Attorney's Office
12:15PM - 1:00PM MT / 2:15PM - 3:00PM ET
Concurrent Sessions
Track A: Risk Adjustment & Quality
Pinpointing the Most Effective Way to Close Gaps for Prospective/Point-of-Care Programs
- Optimize your gap closure strategy through PCP engagement with focus on a building an end-to-end workflow to include gap acknowledgement, quality review, and a feedback loop
- Find value beyond your suspect list by identifying new suspects via EMR / Medical Records
- Hear tactical ways that other health plans have closed gaps with PCPs, including examples in making their suspects actionable, removing false positives and going beyond traditional analytics
Akash Patel, Chief Executive Officer
Advantmed
Dominic Henriques, Vice President of Performance Improvement
Prominence Health Plan
Track B: Member Engagement & Experience
Unlocking Your Risk Adjustment Program Potential
- Unlock the right data to understand your risk adjustment program performance
- Build a better program roadmap and prioritize high-impact opportunities
- Execute the strategic interventions, at the right time, for the right members
Eric Segal
Director, Platform Strategy and Solutions
Episource
Meleah Bridgeford
Director, Risk Adjustment Analytics
Episource
Rick Alexsonshk, PAHM
Director Risk Adjustment
SummaCare
Track C: Compliance & Audit Readiness
Keys to Avoiding Legal Action in Medicare Fraud & Costly RADV Audit Mistakes – A Look into Recent Examples
- Hear legal experts discuss case examples of successful whistleblower-initiated False Claims Act cases alleging risk adjustment fraud
- Hear what went wrong, what not to do and red flags directly from whistleblower attorneys who represented the whistleblowers and one of the U.S. Attorneys who prosecuted one of the cases
- Get insights into faults they’re finding, what they’re looking for in these cases, and what the penalties are, and in turn how health plans and providers can avoid legal action
Mary A. Inman
Partner
Constantine Cannon
Max Voldman
Attorney
Constantine Cannon
Randy Harwell
United States Attorney's Office
Track B: Member Engagement & Experience
Case Study: Integrating Health Equity into Member Engagement to Achieve a True End-to-end Experience
- Gain insights into one health plan’s journey to delivering continuous member experience, through a health equity lens
- Hear about their evolving member experience plan and the small steps they have taken to change their approach along the way
- Learn how you too can focus on continuous member experience improvement, aligning with quality measures to provide an end-to-end member experience journey
Tejaswita Karve, Ph.D.
Former Director, Quality Improvement
Johns Hopkins Health System
Track C: Compliance & Audit Readiness
One Health Plan’s Journey with a RADV Audit
With the increasing importance of risk adjustment data validation (“RADV”) audits in today’s Medicare Advantage enforcement landscape, it’s imperative to be prepared. Hear one Health Plan’s journey through an audit and gain insights on what you need to know to stay prepared.
Deb Curry, MBA, RHIA, CCS-P, CRC (pending confirmation)
Manager, Risk Adjustment
ProMedica
2:00PM - 2:45PM MT / 4:00PM - 4:45PM ET
Concurrent Sessions
Track A: Risk Adjustment & Quality
A New Point of View – Use of UMLS for Data Standardization Across the Biomedical & Health Care Industry
- Hear about a greater vision for unified way of enabling data harmonization across the healthcare and biomedical research industry
- Gain insights into a semantic framework based on a hub-and-spoke model
- Walk away with ideas to leverage what the NCI is working on broadly with concrete ways to apply it within your enterprise
Denise Warzel
Science Program Analyst
National Cancer Institute
International Convenor
WG2 Metadata Standards Working Group
Track B: Member Engagement & Experience
Accelerating Member SDOH Strategies, Program Development and ROI
- Explore how payers can start leveraging robust, accurate data sets to glean meaningful insights and turn them into proactive strategies to put social determinants of health (SDOH) data to work in order to enhance member health outcomes and organizational performance
- Learn how to identify socioeconomic risk factors, alongside clinical and claims information, to build and sustain successful programs
- Track and adapt intervention programs based on specific care and cost-saving metrics to prove ROI and efficiencies
Moderator:
Jim Bohnsack
Senior Vice President & Chief Strategy Officer
TransUnion Healthcare
Panelists:
Brian McLane
Senior Director for Market Intelligence, Market Analytics and Digital Products
Priority Health
Ashley Perry
Chief Solutions Officer
Socially Determined
Track C: Compliance & Audit Readiness
One Health Plan’s Journey with a RADV Audit
With the increasing importance of risk adjustment data validation (“RADV”) audits in today’s Medicare Advantage enforcement landscape, it’s imperative to be prepared. Hear one Health Plan’s journey through an audit and gain insights on what you need to know to stay prepared.
Deb Curry, MBA, RHIA, CCS-P, CRC
Manager, Risk Adjustment
ProMedica
Track B: Member Engagement & Experience
Panel: Approaches in Member Acquisition, Outreach & Engagement
- Learn about approaches that Health plans are taking to engage members - hear what has worked and what hasn't
- Discuss ways to align benefits for member satisfaction
- Explore strategic shifts of resources to impact member experience and satisfaction
Moderator:
Steve Wigginton
CEO
Icario
Panelists:
Archie Dey
Director of Consumer Experience and Insights
SCAN Health
Laura Sheriff, RN, MSN, CPC, CRC
Risk Adjustment Specialist
Scott Weiner
Director, Government Programs
Virginia Premier
Track C: Compliance & Audit Readiness
Legal Insights Panel: Trends in Audit and Compliance Issues
- Understand the current state of the law in the MA risk adjustment context of how federal courts draw the line between what the U.S. Supreme Court has characterized as “garden-variety breaches of contract or regulatory violations,” which are not actionable under the False Claims Act, and compliance failures that constitute actual fraud
- Hear points of view on the increasing importance of risk adjustment data validation (“RADV”) audits in today’s Medicare Advantage enforcement landscape
- Gain insights into the interconnectedness of the government audit process and government litigation process in Medicare Advantage
- Learn about government enforcement trends in managed care, including the extent to which the Covid-19 pandemic has impacted on-going FCA litigation
- Analyze recent state and federal cases involving compliance problems, such as the failure of managed care plans to activate compliance software, report unsupported diagnoses, supervise consultants or vendors, audit providers, or “look both ways” when conducting chart reviews
Moderator:
Naomi Irvin
Director, Divisional Compliance, Sales, Marketing & Communications
BCBS NC
Panelists:
Stephen Bittinger
Health Care Audit & Integrity Partner
K&L Gates, LLP
Edward Baker
Of Counsel
Constantine Cannon
Jonathan A. Porter
Assistant United States Attorney
United States Attorney's Office
Southern District of Georgia
William Sarraille
Partner
Sidley Austin LLP
3:00PM- 3:45PM MT / 5:00PM - 5:45PM ET
Keynote: Show Me the Money: Examining the Business of Health Care
Dr. Andrey Ostrovsky is an investor, senior operating leader, and health policy expert with over a decade of experience applying human-centered design, agile development, lean management, quality improvement, and entrepreneurial principles to eliminate disparities and sustainably achieve the Quadruple Aim.
In this keynote session, Dr. Ostrovsky, sheds light into the current and future state of investment in the managed care + digital health sector.
Get answers to pressing questions, including:
- Where are we going to see more investment?
- Where is growth going to come from?
- How is Medicare Advantage doing in comparison to health care as a sector?
- What do investors look for in their portfolio?
Andrey Ostrovsky, MD, FAAP
Former Chief Medical Officer
US Medicaid Program
Managing Partner
Social Innovation Ventures
3:45PM - 4:00PM MT / 5:45PM - 6:00PM ET
Closing Remarks
Conference Chair
Ana Handshuh, Principal
CAT5 Strategies