Rise

Track A: Risk Adjustment Strategies

Redefining Member Engagement for Risk Adjustment – it’s not all about the IHAs and the MRRs anymore!

• Learn about the impact of the risk adjustment V28 model changes set with the Final Notice and the pending ‘No Upcode Act’ bill
• Hear about other member and provider engagement strategies to address the scrutiny surrounding the use of in-home assessments and medical record reviews for risk adjustment
• Set your Risk Adjustment program up for future success as well as align with your health plan’s goals for Stars and HEDIS

Moderator:
Jill Strassler 
VP, Solutions Management
Veradigm

Panelists:
Aaron Winkel
Senior Solutions Manager
Veradigm

Jonathon Graham
Director, Opargo Business Operations
Veradigm

Kwame Appiah-Yeboah, PhD, CRC
Director, Risk Adjustment and Revenue Management
Sentara Health Plan

Eric Pfleger
Senior Vice President, Population Health
Southeast Primary Care Partners

Allison Kirsch
Vice President Operations
Southeast Primary Care Partners

Track B: Quality and Member Experience

Panel: Unpacking the Star Ratings Changes in the 2024 Advance Notice – What Should Plans Do Next?

Panelists discuss strategies in addressing changes from the newly released 2024 MA and Part D Advance Notice and look ahead for what’s on the horizon for 2025 and 2026 Star Ratings changes. Walk away with guidance on the necessary enhancements to your Stars program to ensure success.  

Moderator:
Phil Collins
Senior Director of Quality
FarmboxRx

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

Katharine Iskrant
President
Healthy People, Inc.

Vandna Bhrany, MPH
Vice President, HEDIS Strategy & Analytics
AmeriHealth Caritas

Track C: Compliance and Regulatory Updates

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

• Hear about new developments in various FCA litigations, OIG audits, and other regulatory activities, with focus on what sorts of activities and fact patterns that the DOJ, as well as courts at the pleading stage, are finding to be plausible violations of the False Claims Act as opposed to fact patterns that are not meeting muster 
• Hear some predictions about what’s next in the FCA arena when it comes to MA and whether MA plans can be both whistleblowers and victims if providers submitted false claims to MAOs 
• Gain insights into how the new RADV rule may affect these cases, and similar cases, moving forward 
• Walk away with a sense of which behaviors the DOJ and various District Courts are finding to be violations of the FCA, and some advice on how to stay clear of those land mines  
• Stay informed of some predictions of where the future of fraud litigations related to the MA industry seem to be heading 

Mary Inman
Partner in Whistleblower Practice Group
Constantine Cannon

Stephen Bittinger
Health Care Audit & Integrity Partner
K&L Gates

Gregory Demske
Partner
Goodwin Procter

Track A: Risk Adjustment Strategies

Leveraging point-of-care diagnostics for provider engagement and telehealth care planning

• Combining data on chronic conditions, behavioral health and SDoH
• Real-world applications and case studies for risk and quality in a changing landscape
• Leveraging a centralized analytics platform for RADV audit support 

Moderator:
John Romans
CEO
Biomedix

Panelists:
Dr. Shannon I. Decker, MBA, MBA, MEd., MEd, PhD
Principal
VBC One

Ryan Dodson
Chief Operating Officer/Co-Founder
New Vision Healthcare Solutions

Dr. Archita Sood
Chief Medical Officer
Homebase Medical

Track B: Quality and Member Experience

Panel: Experiences in Closing Quality Gaps for Hard-to-Reach Populations

• Hear various approaches from MA plans and providers in engaging hard-to-reach populations, with takeaways of what’s worked and what hasn’t 
• Discuss where to focus your member engagement efforts  
• Examine when patients should be put into risk assessment programs  
• Discuss the pros and cons of the change in CAHPS measure weights 

Moderator:

Savannah Gonsalves, RN, MHA 
Director of Quality
Hometown Health

Panelists:

Kaitlyn Bertrand, PA-C
ACD Physician Assistant
SCMG Internal Medicine APC Lead
Scripps Health

Helen L. Veet DNP, RN
Director of Quality Management
AmeriHealth Caritas Pennsylvania and Keystone First

Jessica Vaughn, DNP, RN, CCDS, CCDS-O, CRC
Director of Operations, Condition Management and Documentation
Enterprise Population Health
Advocate Aurora Health

Track C: Compliance and Regulatory Updates

AI in Healthcare – Compliance and Ethical Considerations for Managed Care Plans and Providers  

• Get a big picture perspective of trends related to AI, ML and generative AI in the health care space  
• Understand the risks and benefits of the use of these technologies as it relates to managed care 
• Discuss the unique risks and considerations with using AI in managed care 

Ezekiel Brooks 
Chief Technology Officer 
U.S. Hunger 

Ana Handshuh
Principal
CAT5 Strategies

Track A: Risk Adjustment Strategies

Innovations in Chronic Care Management: The Analytics Behind Better Health Outcomes

• Discover proactive strategies to identify clinical disease indicators and alert providers at the point of care, allowing providers to deliver tailored healthcare to their patients.
• Learn how one innovative organization improved chronic care outcomes by focusing on year-over-year case management.
• Hear how insurance companies, provider organizations, and their partners are creating alignment across programs and care settings that are enabling providers to make data-driven decisions

Jon Wasson, Sr. Director of Product
Episource

Syed Rizvi, Director of Risk Adjustment & Vendor Operations
Southwestern Health Resources

Laura Sheriff, RN, MSN, CPC, CRC
Vice President, Risk Adjustment
Southwestern Health Resources

Track B: Quality and Member Experience

Home is a hub to drive better health: Engaging with members to influence quality and experience

• Creating convenient, positive experiences for members when and where they want it
• In home health evaluations increase face to face time with members
• Technology advancements to influence quality and close more care gaps in the home

Moderator:
Debbie Conboy
SVP, Risk Adjustment and Quality
Signify Health

Panelists:
Becky Simmons
Stars Program Manager
Security Health Plan

Meghan Sinclair
VP, Product Management
Signify Health

Track C: Compliance and Regulatory Updates

Bullet Proofing Your Plan from an OIG Audit

• Get a look into the OIG cases over the last few years, examining the impact on the industry
• Discuss what codes the OIG is targeting for compliance purposes 
• Get takeaways on how remain compliance and protect your plan  

Brett J. Goff
Director of Risk Adjustment 
Peach State Health Plan

Dean Ratzlaff
Director – Actuary/Revenue Management
Sentara Health Plans

Track A: Risk Adjustment Strategies

Secret Recipe for Success: Enhancing Risk Adjustment Operations with AI

• Unlock the quality ingredients needed to maximize coder productivity while reducing burnout 
• Learn why leveraging AI for first-pass chart reviews ensures accuracy and efficiency right from the start 
• Discover how Blue Cross Blue Shield of Massachusetts utilized an AI-driven platform to transform risk adjustment operations and performance 
• Uncover strategies to utilize AI technology as a valuable tool to enhance existing workflows and empower your team for greater efficiency and effectiveness 

Mia Bell
Sr. Manager, Medicare & Commercial Risk Adjustment
Blue Cross Blue Shield of Massachusetts

Breanna Krebs
Vice President, Operations
Apixio

Track B: Quality and Member Experience

Panel: Operationalizing Shared Goals – Case Examples of Interdepartmental Collaboration to Achieve RA Success and a Boost in Star Ratings

• Examine examples from MA plans around operationalizing interdepartmental collaboration to achieve shared goals 
• Look at opportunities during the annual visit to streamline competing priorities and create the best member experience  
• Share internal reporting and governance structures that help to integrate Quality and Risk Adjustment departments

Moderator:
John Criswell
Founder, CEO, Chairman
Porter

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

John M. Barkley
Vice President, Enterprise Risk Adjustment & Data Integrity
EmblemHealth/ConnectiCare

Subbu Ramalingam
Vice President Quality, Stars and Risk Adjustment
CareFirst BlueCross BlueShield

Track C: Compliance and Regulatory Updates

Panel: Advice for RADV Audit Preparedness

• Examine the current landscape of RADV audits, with tips on risk mitigation as well as advice for audit preparedness  
• Get tips for surviving a contract-level RADV audit based on lessons learned  

Moderator:
Beth Zuehlke
Chief Customer Officer
Moxe Health

Panelists:
Deb Curry, MBA, RHIA, CCS-P, CRC
Director, Risk Adjustment & Recoveries
Actuarial Services
Paramount

Jenni Monfils, CPC, CDEO, CRC 
AVP, Risk Adjustment Coding and Compliance
Bright HealthCare

Roundtable A

Strategies to Engage Practitioners to Improve Documentation, Coding, and Quality Outcomes for your Health Plan

• Use technology to empower clinicians through better coding support
• Reduce provider abrasion and burnout by streamlining administrative workflows and reducing documentation time
• Leverage a population-health approach to improving STARS ratings

Roundtable B

Improve Clinical Outcomes and Reduce Costs Through Early Diagnosis Treatment of Cardiovascular Disease

• Rapid office-based screening
• Early diagnosis while patient still asymptomatic
• Actionable insights at the point of care

Roundtable C

New Risk Adjustment Model Keeping You Up At Night? Ease Your Concerns With

• Analysis of the current model versus the new one
• Overview of how the new model will impact your plan
• Strategies to prepare for the impact now

Roundtable D

The ABCs of Preventing the Costly Mistakes of Risk Adjustment

• A is for Audit: Implementing compliance program improvements related to proactive auditing that are aligned with OIG’s expectations
• B is for Basics: The key to the success of compliance program improvement is in the basics of coding and auditing
• C is for Complete and Accurate Data: Management of encounter data in alignment with industry best practices also affects the success of your compliance program

Roundtable E

Leveraging In-Home Assessments for Best Medical Record, SDoH Gathering, and RADV Proofing

• In-Home Assessments are usually a better/more complete source of clinical data than from standard provider/PCP medical records
• The In-Home Assessment captures data that goes beyond the provider’s office
• Using the In-Home assessment in a RADV

Roundtable F

Longitudinal Member Data at Point of Care Improves Provider Engagement

• Building actionable, longitudinal patient views that engage providers
• Driving member insights to the point of care to close gaps
• Transforming Risk and Quality operations with prospective workflows

Roundtable G

Improve Patient Outcomes and Provider Engagement and Eliminate the Complexity of Managing Multiple Value-Based Initiatives

• Align reporting between health plans and providers
• Impact population health
• Accelerate the shift from volume to value

Roundtable H

Enhance Documentation Outcomes with EHR-Integrated CDI Reviews

• Enhance the precision of diagnoses communicated to healthcare providers
• Propel improved documentation outcomes, optimizing code capture
• Seamlessly integrate analytic reviews to bridge clinical reviewers and providers

Roundtable I

Cards Against CMS Stars

• Have you played Cards Against Humanity? Join us and play the CMS Stars Version.
• A fun interaction with industry colleagues discussing some of CMS’s interesting decisions
• Learn about Member Experience and how you can move the needle with data

Roundtable J

What can HCC Coder do for you? An Inside look at HCC Coder

• Improve your Risk Adjustment coding speed, accuracy, and productivity
• Get a look at HCC Coder from an actual user perspective
• Schedule a 2 week free trial for your team

Roundtable K

Reducing Friction in Payer/Provider Relationships: How to Successfully Leverage Tools for Mutual Success

• All stakeholders are inundated with data from unreliable sources with no clear value drivers.
• Leverage Arcadia’s single source of truth architecture and workflow tools to present actionable insights.
• Optimize provider information sharing to meet them where they are and provide only the information they need to be successful.

Roundtable L

Health Equity Impacts on Government Programs

• Implementing the health equity framework and the road to NCQA® Health Equity Accreditation Plus
• Best data management practices to address Social Determinants of Health
• Learning the health system framework to accelerate the knowledge discovery process

Roundtable M

More than Just the Financials: “Does Your Risk Adjustment Program Truly Reflect a Member-Centric Approach for Optimal Outcomes?”

• Explore the importance of complete and accurate data submissions in enhancing member care, an end-to-end approach to effectively identify and address data leakage
• Delve into expert strategies for ensuring risk adjustment compliance and effective oversight; quantify and mitigate high-risk diagnosis codes
• Three keys to success for objectively assessing the impact of prospective and retrospective risk adjustment programs on improving risk score accuracy

Roundtable N

5-Star Medicare Rating and Strong Provider Relations Starts with Data

• How SDOH data can improve member experience
• How SDOH data can improve provider relations and how healthcare is used
• How visibility into member insurances saves money and improves benefits coordination

Roundtable O

Leverage Community Based Groups to Support Members Locally, Address Social Isolation, Close SDoH Gaps, and Move the Needle on Cost and Quality with a Peer-Reviewed, Actuarially Sound Solution.

• Community based interventions improve outcomes, lower cost and have a significant impact on Social Isolation and Loneliness
• Leveraging Community based interventions delivers a 50% improvement in member loyalty and retention
• Investing in a Community based intervention such as Wider Circle as a significant and measurable ROI for payers

Roundtable P

Generate Real Engagement in Risk Adjustment with the Treating PCP

• Embed clinical resources to create trusted connections
• Reduce PCP abrasion by only presenting high confidence conditions and minimizing time spent for coding to 3-4 minutes per patient per year
• Incent PCPs appropriately for their work and time

Roundtable Q

Increase Stars & RA Revenue with Modernized Member Engagement

• Identify tools with quick implementation that delivers meaningful engagement and fast gap closure
• Learn how the right type of outreach can bring in-year risk adjustment revenue
• Discover strategies to identify and close the Q4 care gaps that will influence Star Ratings

Roundtable R

Prospective Risk Adjustment: Using AI to Predict Risk and Engage Members

• Leverage AI to surface social risk
• Engage historically unengaged members in preventive care
• Improve AWV scheduling through member-first engagement

Roundtable S

Leveraging SDOH Data and Insights to Optimize Star Ratings

• Strategies to gain a complete view of social risk exposure for your full market and member population
• How to proactively identify Stars-eligible members facing elevated social risk
• Strategies to deploy gap closure resources

Roundtable T

Understanding the Health Plan Member Experience

• Uncover opportunities for insurance plans to elevate member experiences
• Understand the popularity of technology use with a balanced combination of human and digital interactions
• Remove barriers to care - learn what's missing from the health plan consumer experience

Roundtable U

Revolutionizing Healthcare Data Solutions: Tackling Challenges & Unleashing Possibilities for 2023 and Beyond

• Identify the top 3 healthcare data challenges faced by providers and payors in 2023.
• Explore Cozeva's innovative strategies and tactics to remedy these data problems, revolutionizing data management in the industry.
• Discover high-level features that differentiate Cozeva's platform, providing seamless integration and comprehensive solutions for healthcare organizations.

Roundtable V

Reduce Health Inequity by Making Benefits Smarter

• Raise the standard for personalized engagement
• Help members change behaviors, close care gaps, and access the resources they need
• Leverage data to identify and provide needed resources

Roundtable W

Blocking and Tackling – Provider Engagement is the Key to Success in Risk Adjustment and Quality Improvement

• 100% human driven reviews
• Compliance
• Provider support via our field staff and tailored education

Track A: Risk Adjustment Strategies

Panel: RA Strategies Are Not a One-Size-Fits-All – Real Life Experiences from Seasoned RA Leaders

Experienced leaders know that the “secret sauce” for success in meeting, and exceeding, risk adjustment and quality goals is the deployment of your strategy. And, there is not one strategy that fits all.  

In this panel discussion, seasoned RA and Quality leaders share what’s worked, and what hasn’t, with advice on navigating the nuances of one strategy vs. the other.  

Moderator:
Eric Shapiro
Principal
Pareto Intelligence

Panelists:

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

Mandvi Tandon
Director of Risk Adjustment
HealthCare Partners

Katie McLaughlin, DNP
Sr. Clinical Advisor, Risk Assessment
Lead Risk Adjustment Nurse Practitioner
Scripps Health

Track B: Quality and Member Experience

Case Study: A Blueprint for Knocking Down Barriers, Getting Members to Needed Care and Delighting Them In The Process

• Hear a case study from BCBS Arizona outlining exactly how they got their members to schedule and follow through 
   with appointments   
• Discuss how they are identifying and addressing barriers and the results they achieved, including more care gaps closed, delighting members with the experience and directly getting members to the care they need. 
• Walk aways with lessons on when and how to effectively engage members who are due or overdue for preventive care, how to identify and address member barriers to getting care and how to delight members in the process 

Q&A Faciliator / Session Moderator:
Chad Baugh
Chief Revenue Officer
ReferWell

Panelists:
Gerri Cash
Vice President Medicare & FEP Quality Improvement Performance
BCBS Arizona

Track C: Payer / Provider Alignment

Panel: Beyond Burnout – Post-Pandemic Learnings in Avoiding Abrasion and Meeting Providers Where They Are

• Benchmark best practices in engaging providers in a post-pandemic environment  
• Identify how plans and providers can work together to address gaps and manage data in today’s challenging environment  
• Discuss tactical ways to approach shared goals and joint next steps to improve care quality and patient experience, including removing administrative burden off of plans  

Moderator:
Colleen Gianatasio, MHS, CPC, CPCO, CPC-P, CPMA, CPC-I, CRC, CCS, CCDS-O
Director Clinical Documentation Integrity and Coding Compliance 
Capital District Physician’s Health Plan (CDPHP) 
(pending confirmation)

Panelists:
Mark Dabney, PMP
Director, Risk Adjustment
Community Health Plan of Washington

Melissa Cornejo
Director of Quality
Wellcare

Heather Bullock
Director, Risk Adjustment Process and Operations 
Horizon Blue Cross Blue Shield of New Jersey

Jennifer Cobb 
Lead Director, Risk Adjustment 
Aetna

Track A: Risk Adjustment Strategies

Tech-Enabled Care for Medicaid and Dual-Eligibles: Empowering FQHCs with Next-Generation Partnerships, Technology, and Care Model Support

• Learn what FQHCs need today for success in value-based care models 
• Hear how contracting and partnership strategies are evolving for community-based Medicaid and Medicare Advantage delivery for under-resourced populations 
• Enhance your understanding of how data and technology can play a part in accelerating quality and risk adjustment success in FQHC settings 

Moderator:
Grant Gaillard
Head of Business Development 
Vim

Panelists:
Sujata Bajaj
Chief Technology Officer
Yuvo Health

Essence Williams MHA, BSN, CRC, CPC
Head of Risk Adjustment
Yuvo Health

Dr. Scott Kim
Chief Medical Officer
Long Island Select Healthcare, LISH

Dr. Ari Benjamin
Chief Medical Officer
Joseph P. Addabbo Family Health Center (New York)

Track B: Quality and Member Experience

Prospective Assessments and Social Determinants: Are You Maximizing Your Member Opportunities?

• During this session we’ll discuss how to extrapolate the most important info from your health assessments
• Learn how develop an action plan using this info so you can best engage and care for your member population
• Discover other ways you can engage and learn from your members to improve their overall health and well-being

Doug Wackowski 
VP, Prospective Service Solutions 
Advantmed 

Rhonda Farrar  
Sr. Manager, Data Analytics 
Advantmed 

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

Track C: Payer / Provider Alignment

Panel: Early Lessons from Working within the ACO REACH Model

• Discuss how plans and providers are working within this new model, with insights into HCC coding, data capture and perspectives on targeting the right population 
• Examine the pros and cons of working within the new ACO REACH Model, with perspectives from both sides of the fence   
• Gain operational insights from ACO REACH organizations  

Moderator:
Jennifer Cobb 
Director, Risk Adjustment for Georgia, the Gulf States and Arkansas
Aetna

Laura Sheriff, RN, MSN, CPC, CRC
Vice President, Risk Adjustment
Southwestern Health Resources

Dr. Shannon I. Decker, MBA, MBA, MEd., MEd, PhD
Principal
VBC One

Margaret Paroski, MD, MMM, President & CEO and Chief Medical Officer  
Catholic Medical Partners  

Track A: Risk Adjustment Strategies

Lessons in Building a Compliant Risk Adjustment Team – A Case Study from AdventHealth

• Hear about one Health System’s transformational journey in building a compliant Risk Adjustment team, with learnings on internal buy in, provider education and operational processes 
• Gain insights into overcoming barriers and coming out on the other side of success, with focus on good people, strong policies and procedures, and technology         
• Discuss what’s worked in provider education and engagement, including incentives, relationship building and tapping into provider mentors  

Michael Zeli
Director Risk Adjustment and Quality
AdventHealth

Track B: Quality and Member Experience

Keys to Incorporating Health Equity Performance into Your Plan’s Quality Measures

• Discuss the impacts and implications of the potential new Health Equity Index (HEI) proposed for MA plans that serve populations of members with certain defined social risk factors (SRFs) 
• Hone in on ways that MA plans can take coordinated, proactive actions to develop high-impact interventions to close SDoH gaps 
• Examine other health equity provisions proposed by CMS, such as digital health education resources, and look at the best ways to start incorporating disparity reducing initiatives now 

Ana Handshuh
Principal
CAT5 Strategies

Rick Whitted
CEO
U.S. Hunger

Track C: Payer / Provider Alignment

CMS HCC Model V28 & the Impact on Risk Adjustment Education Programs

• Discuss how CMS HCC Model V28 comes with some significant changes to conditions represented along with the value of these conditions and your providers, coders and support staff on these changes is crucial for continued success 
• Learn how to educate providers based upon documentation best practices   
• Get tips for updating your resources  
• Provide support to coders for appropriate queries and accurate ICD-10 code selection 

Jenni Monfils
Director of Risk Adjustment Coding and Compliance
Bright HealthCare

Gabriel Ruiz
Manager, Risk Adjustment Coding Success
Bright Healthcare