2021 Agenda

Opening Remarks
Ellen Wofford, Managing Director
RISE

Conference Chair:
Ana Handshuh, Principal
CAT5 Strategies

Join CMS representatives as they discuss the Proposed Model Specification Changes in the 2022 Payment Notice, 2021 RA model changes, and RADV Final Rule. They will also address operations update on 2019 and 2020 RADV and EDGE LDS.  

The conversation will continue with risk adjustment updates for the Medicare Advantage and Part D programs, reviewing the policies in the 2022 Rate Announcement, including updates to the risk adjustment models, overview of model design, and data used for risk score calculation.  

Erin Sutton, Deputy Director, Payment Policy and Financial Management Group
Centers for Medicare & Medicaid Services (CMS)

Allison Yadsko, RADV Policy Team Lead
Centers for Medicare & Medicaid Services (CMS)

Catherine Anderson, Acting Director, Division of Risk Adjustment Operations
Centers for Medicare & Medicaid Services (CMS)

Rebecca Paul, Deputy Director, Medicare Plan Payment Group
Centers for Medicare & Medicaid Services (CMS)

Dr. Emanuel shares practical, concrete steps that payers and providers, as well as businesses and government, can take in order to adapt to the major shifts happening within health care, and to transform the American health care system to provide consistently higher-quality and lower-cost care. 

Ezekiel J. Emanuel, M.D.
Vice Provost of Global Initiatives & Levy University Professor
Perelman School of Medicine and The Wharton School,
University of Pennsylvania
Special Advisor to the Director General
The World Health Organization

Join experts as they discuss today’s political climate and its trickle effect in health care. They will delve into topics such as the new administration’s priorities, impact of 2020 data as we move forward, and challenges to the revenue and bottom line in upcoming years. They will also discuss key issues regarding budget reconciliation, CMS recently released rules, risk adjustment changes affecting MA and commercial plans, and what plans should keep an eye on for 2021 and beyond.

Moderator:
David Meyer, Senior Vice President, Quality Outcomes and Informatics
NationsBenefits

Speakers:
Sean Creighton, Vice President of Federal Policy
Humana

Larry Bishoff, President
Laurence Bishoff & Associates

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

Howard Weiss, Associate Vice President, Policy
EmblemHealth

Josh Weisbrod, Vice President Risk Adjustment
Network Health

• Discuss the changing landscape of CMS Risk Adjustment impacting 2021 and on 
• Explore the role of vendors within the current mix of industry approaches 
• Learn which best practices are emerging, and which old approaches are going away 
• Coding, NLP, Telehealth and In-homes…sure, but what’s next…? 

Rachel Nelson, CPC, Director, Payer Solutions
GeBBS Healthcare Solutions

Timothy Burke, Chief Compliance Officer
Radiology Partners
Former National VP Medicare Risk Adjustment and Coding 

• Deep dive into the evolving value-based care and contracting landscape  
• Common challenges experienced by payers and providers in value-based care arrangements 
• Best practices leveraging technology and data analytics platforms to effectively implement successful value-based contracts 
• Key considerations for determining the right value-based care technology strategy for your organization 

Moderator
Kris Volrath, Vice President, Field Products and Solutions
Inovalon

Speakers:
Hemanth Doma, Senior Director, Product Management (INDICES®) 
Inovalon

Fred Bentley, Managing Director, Health Plans and Providers
Avalere | an Inovalon company

Jeslie Jacob, Divisional Vice President, Provider Performance | Provider Analytics, Reporting and Connectivity
Blue Cross Blue Shield of Illinois

Mike Grodus, Director of Healthcare Transformation
Medical Advantage Group 

• Understand the benefits of incorporating your Risk Adjustment and Quality initiatives into a Health Management workflow 
• Learn about the increasing challenges of health care delivery requirements and how you can leverage your data into relevant and actionable intelligence 
• Hear about practical examples and insights for success in harmonizing data and integrating workflows 

Dr. Chris Johnson, Managing Director, Product Management 
Advantasure 

Keith Brophy, Director, Business Lab Product Team 
Emergent Holdings

Duane J. DiFranco, MD, Vice President of Medicare Stars and Clinical Performance
Blue Cross Blue Shield of Michigan 

• Capturing and utilizing available information to improve whole-person care 
• Collaborating with stakeholders and community-based organizations to close gaps 
• Enhancing care without overburdening providers or encroaching on patients’ privacy or trust 

Joe Nicholson, DO, Chief Medical Officer 
CareAllies 

Neema Stephens, MD, National Medical Director for Health Equity
Cigna

Understanding member needs and building a holistic strategy that leverages SDoH to gather member insight can help drive better results. Join our session to:  

• Learn about a strategy that leverages SDoHto identify and support at-risk populations, aiming to address social barriers that can positively impact Stars, HEDIS, and other performance measures. 
• Discuss how payers are building on initial success to manage and increase retention, boost NPS scores, and improve other key metrics. 
• Consider the evolving application of SDoHfrom supporting and influencing social infrastructure, to applying behavioral science insights to help inform communications that facilitate better engagement. 

Jim Bridges, Senior Vice President, Government Services
Change Healthcare

Alexander Billioux, Vice President, Social Determinants of Health
United Healthcare

Select from Different Presentations Spotlighting Health Care’s Most Influential Technology and Solution Gurus Presenting Tools to Elevate Your Plan’s Initiatives.  

Join this unique opportunity to select three interactive, speed-dating type presentations featuring the latest technologies and solutions for boosting your plan’s risk, quality, and data management endeavours.  An announcement will be made three times within this special 60-minute session, alerting you to transition to the next virtual roundtable of your choice.  

• A summary of EDPS reports and their content and how they identify foundational gaps in data submission strategies, which is especially important as we have arrived at the intersection of risk adjustment and quality  
• How to proactively focus EDPS and RAPS data submission strategies around these reports as the compass for a roadmap that lays a foundation for operational and financial success rather than treating reporting as an afterthought 
• How to avoid having to submit corrective action plans (CAPs) or get caught in “analysis paralysis”, and how to submit thoughtful action plans if required to do so 
• How a health plan has successfully leveraged their people, processes and technology for the development of a successful reporting strategy that informs their overall organizational risk adjustment strategy and serves as the compass for their best practices roadmap 

Dawn Carter, Director, Product Strategy
Centauri Health Solutions

Tracy Tran, Director of Risk Adjustment and Encounter Data
Clever Care

Hiep Pham, CFO
Clever Care

• Use of internal and CMS data files in analytics, outreach and forecasting (thoughts on Payor vs Provider perspectives) 
• Integrating internal analyses with third party vendors and platforms 
• Discussion of industry best practices and integration of appropriate controls to minimize compliance risk 

Wayne Gibson, Senior Managing Director, Health Solutions 
FTI Consulting 

Deb Curry, MBA, RHIA, CCS-P, CRC, Manager, Risk Adjustment
ProMedica

• Minimizing challenges and exploiting opportunities to develop KPIs and implement processes for your prospective solution 
• Determining what a new diagnosis looks like and how to proceed with this diagnosis in alignment with your KPI 
• Develop 360 KPIs to measure the success of your prospective program 

Terry Ward, SVP, Payer Solutions
Apixio

Bryan Lee, VP, Solutions
Apixio

Jacop Jung MBA, CCS, Regional Director of Managed Care Finance 
Providence Health & Services 

Jennifer Holman, LPN, CRC, Manager Risk Adjustment  
Wellcare, Centene 

In this session, you will gain a deep understanding of how to achieve true member centricity and strategies you can apply including:  

• Learn techniques to break down barriers with a more personalized member experience 
• Define care model to identify the unique social and clinical care needs of each member and address those needs 
• Discuss the fundamental framework to empower your members to increase healthy, happy days at home 

Theresa West, Vice President, Community Solutions
Signify Health

Jackie Rivera, PMP, Population Health Strategy Lead
Humana

Julia Weatherly, Sr. GM Stars Program Analyst
Independence Blue Cross

Cara Magrane, Director of Initiatives and Partnerships
Kronkosky Charitable Foundation

Join this fireside chat to discuss NCQA’s recommendations to the new administration including efforts towards health equity and addressing social determinants of health, as well as moving to a digital quality measure system to improve data and lessen burden. They will also address questions regarding the launch of the Data Aggregator Validation program, its benefits, and what to expect in the upcoming months.  

Moderator:
Ana Handshuh, Principal
CAT5 Strategies

Speaker:
Frank Micciche, Vice President, Public Policy and External Relations
National Committee for Quality Assurance (NCQA)

Lowered utilization by patients in 2020 did largely reduce the capture of diagnosis codes for Medicare Advantage risk adjustment. However, there were plans that were resilient because of a strong RAF platform built in partnership with a vendor. This presentation will review: 

• The unique and common traits of the patient and provider populations that contributed to trends 
• Risk adjustment strategies utilized throughout 2020 and prior years which can be tied to impacts in claims count 
• Compliant program development during the PHE that will be employed moving forward 

Su Bajaj, SVP of Product Development 
Episource  

Allison Kawamoto, CPA
Blue Shield of California

Reach the Next Level of Prospective Gap Closure for Enhancing Patient Care and Improving Risk Score Accuracy  

• Learn how payers and providers are collaborating to improve prospective risk adjustment processes  
• See how payer-provider data interoperability is enabling a new frontier in risk adjustment analytics and prospective risk capture 
• Understand the opportunities and challenges in implementing a closed-loop risk capture between payers and providers 

Shahyan Currimbhoy, Senior Vice President of Products
Talix

Richard Bitting, Vice President, Actuarial Informatics
Jefferson Health/Delaware Valley Accountable Care Organization

Karena M. Weikel, Chief Actuary
Geisinger Health Plan

• See how advanced data science combined with risk adjustment is leading to early disease detection and prediction
• Learn from case studies of pilot programs that use artificial intelligence to identify high risk populations to pair members with clinical interventions to improve member outcomes  
• Hear recommendations for how you can advance your data science strategy

Sanji Fernando, SVP, AI & Analytics Platforms
UnitedHealth Group Research & Development  

Eric Haseman, General Manager
Optum

• Learn how potential rule changes by CMS may impact in-home health risk assessment programs 
• Gain knowledge on the effectiveness of IHAs in influencing patient behavior prior to and after the COVID-19 pandemic 
• Uncover opportunities to improve IHA implementation and operational process 

David Costello, Ph.D., SVP, Risk Adjustment & Innovation 
Cotiviti 

Stacy Coggeshall, Vice President of Risk Adjustment
Fallon Health

• Deliver value to your members through Comprehensive Health Assessments (CHAs)  
• Effectively educate, empower, and build genuine relationships with members through flexible physical and virtual encounters 
• Discuss the clinical value of CHA visits and the time that a clinician spends with a member, as well as appropriate follow-up care and member satisfaction 
• Learn best practices for optimizing engagement and leveraging CHAs to address member care gaps and ensure continuity of care 

Ryan Heyborne, MD, MBA, FACEP,Chief Medical Officer, Clinical Care
Matrix Medical Network

Brent Dorris, Vendor Operations Management Consultant, Sr., Medicare Revenue Department
Anthem

Presenters will provide an overview of OIG’s recent work and current priorities, including the impact of COVID-19 and telehealth as we move towards 2021-2022.  They will also discuss recent evaluations of health risk assessments and identifiers for ordering providers in Medicare Advantage encounter data.

Megan H. Tinker, Assistant Inspector General
Office of Counsel to the Inspector General
Office of Inspector General
U.S. Department of Health and Human Services (HHS)

Jacqualine Reid, Social Science Research Analyst
Office of Inspector General
U.S. Department of Health and Human Services (HHS)

San Le, Social Science Research Analyst for Evaluation and Inspections
Office of Inspector General
U.S. Department of Health and Human Services (HHS)

Robert E. Kirkner, Social Science Research Analyst for Evaluation and Inspections
Office of Inspector General
U.S. Department of Health and Human Services (HHS)

Turn on your camera and join us in the networking lobby for that face-to-face networking experience we’ve all been missing. Mimicking hallway chats, this is your opportunity to connect with other attendees, speakers, and solutions providers in risk adjustment, quality, social determinants of health, and more. Networking has never been easier – join a small group of up to 8 people, hop around to different tables with just a click, and enjoy saying hello to familiar faces and taking part in relevant industry discussions. We’ll see you in the lobby! 

Turn on your camera and join us in the networking lobby for that face-to-face networking experience we’ve all been missing. Mimicking hallway chats, this is your opportunity to connect with other attendees, speakers, and solutions providers in risk adjustment, quality, social determinants of health, and more. Networking has never been easier – join a small group of up to 8 people, hop around to different tables with just a click, and enjoy saying hello to familiar faces and taking part in relevant industry discussions. We’ll see you in the lobby! 

Ana Handshuh, Principal
CAT5 Strategies

Dr. Borio shares her experience and knowledge regarding the COVID-19 pandemic, vaccine distribution timeline, and impact in the health care arena. She will address the challenges faced by many on resource allocation and strategies on how to prepare for future disruptions. 

Luciana Borio, M.D.
Former Acting Chief Scientist and Director of Medical Biodefense Preparedness at the National Security Council
US Food & Drug Administration
Vice President
In-Q-Tel

• Discover the assessment process Memorial Hermann employed, including a pilot on 2018 & 2019 DOS, to understand their holistic value and identify a deployment path to realize it
• Hear how risk-bearing provider organizations like Memorial Hermann are leveraging NLP to close care and risk gaps as patient volumes rebound, including for commercial ACO populations
• Learn about Memorial Hermann’s prospective and retrospective combination approach to accurately identify and close diagnosis and coding gaps in conjunction with their Medicare Advantage health plan

Adam Gronsky, Chief Innovation Officer
Health Fidelity

Nicole Clarke Luck, Senior Vice President - Strategic Initiatives & Finance
Memorial Hermann Physician Organization 

• Review how AI is making a difference in health outcomes for seniors, women, and other populations  
• Discuss how more advanced technologies are impacting early detection, treatment, diagnosis, and everyday decision making  
• Learn new cost saving strategies possible with AI  

Fahad Ahmed
Independent Consultant

• Lessons learned from a year of telehealth and telemedicine, and living the new normal
• Discuss telehealth in the areas of risk adjustment, coding, digital quality measures and member experience 
• Utilizing technology to enhance care delivery and patient engagement 

Deb Curry, MBA, RHIA, CCS-P, CRC, Manager, Risk Adjustment
ProMedica

Dawn Peterson, Director, Risk Adjustment 
Martin’s Point 

• Collecting actionable data that drives results 
• Using data as a tool that team members can use 
• Identifying potential data issues – if it looks wrong, it just might be 

Kyle Mendez, MBA, Senior Director, Revenue Management
Landmark Health

A pioneer in the use of the digital space to provide humanistic doctor-patient information, Dr. Swanson speaks to how the new tech landscape offers outstanding, innovative opportunities for efficient, yet humanistic, exchange of information in the hospital environment. Drawing on her experiences as Chief of Digital Innovation for Seattle's Children's Hospital, as well as her broader observations, Dr. Swanson shows how technology can create efficient communication solutions while enhancing patient care and caretaker experience. 

Wendy Sue Swanson, M.D.
Pediatrician & Author, Mama Doc Medicine

Select from Different Presentations Spotlighting Health Care’s Most Influential Technology and Solution Gurus Presenting Tools to Elevate Your Plan’s Initiatives.  

Join this unique opportunity to select three interactive, speed-dating type presentations featuring the latest technologies and solutions for boosting your plan’s risk, quality, and data management endeavours.  An announcement will be made three times within this special 60-minute session, alerting you to transition to the next virtual roundtable of your choice. 

• Identifying and prioritizing member/HCCs 
• Learn chart acquisition prioritization 
• Discuss in-flight suspect analytics to improve outcomes 
• Review post-campaign performance evaluation 

Andy Kumar, Vice President, Product Management – Clinical Data Acquisition & Insights 
Ciox Health  

Lisa Andrews, Manger of Risk Adjustment and HEDIS
Martin’s Point 

• Share best practices on effective communication and innovative avenues for reaching members, including barriers such as language, literacy, and implicit bias  
• Address successful community outreach programs including homelessness, mental health and substance use disorders, disability, and loneliness 
• Utilize existing resources and possible technologies for geographically remote populations 

Moderator:
Dr. Shannon Decker, Vice President of Clinical Performance,
Brown and Toland

Panel:
Tejaswita Karve, Ph.D. 
Director, Quality Improvement
Johns Hopkins HealthCare 

Samantha Olds Frey, Executive Director
Illinois Association of Medicaid Health Plans  

• Discuss solutions to the lack of patient data from 2020 and its impact on revenue in the upcoming years 
• Explore strategies around costs related to the lack of adherence due to COVID-19  
• Prepare for upcoming audits utilizing the data collected in 2020  
• Examine the consequences of data gaps when it comes to interoperability  

Josh Hetler, Executive Vice President, Business Intelligence
DataLink Software

Marcia Guida, MS-CH, MBA, MS-HP, CPC, Senior Director, Provider Technology Ecosystems
Aetna CVS Health

Discuss recent ACA transformation issues - both quantifying the impact of the conventional reforms, like removing the 400% FPL cap, and breaking down some of the novel reforms such as enhancing subsidy value through AV recalibration, age adjustment of APTC, or how silver loading dynamics interact with legislative budget reconciliation and risk adjustment.   

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

• Learn how to create better collaboration and alignment between health plans and providers to significantly improve financial and clinical performance
• Discuss why it is critical to engage PCPs in risk adjustment and quality of care initiatives to achieve success in VBC arrangements
• Discover why you do not need to sacrifice yield to reduce compliance risk by implementing a PCP-centric risk adjustment program      

Moderator:
Josh Stern, Chief Revenue Officer
Vatica Health

Panel:
Hassan Rifaat, MD, Chief Executive Officer
Vatica Health

Paul Gandolfo, Vice President and Finance Officer – Value Based Payment and Risk Adjustment Programs
Excellus

Israel Cordero, M.D., Family Medicine, Primary Care
Middlesex Health

• Discuss resource allocation, vendor management, and innovative approaches impacting member experience measures
• Discuss the member journey, focusing on customer service and training for a true cultural shift
• Deep dive into benefit satisfaction, utilization, and what to do when benefits cause member abrasion

Daniel Weaver, Vice President, Stars, Quality, & Risk Adjustment
Gateway Health

Rex Wallace, Principal
Rex Wallace Consulting 

• Delivering on the NLP promise
• Discuss critical innovations in the NLP space for risk adjustment
• The why and how of NLP for risk adjustment
• Beyond NLP: outcomes that improve patient/provider interactions and lessen abrasion  

Rita Young, Senior Vice President Clinical Innovations
Reveleer

Ryan Peterson, Senior Vice President Strategy & Growth
Reveleer

Dr. Shannon Decker, Vice President of Clinical Performance,
Brown and Toland

• Discover patterns and trends emerging from recent cases and investigations
• Deep dive into recent cases and settlements involving risk adjustment and lessons learned to apply for your own program
• Learn steps to create remediation and corrective action plans for your organization

Moderator:
John Suarez, Product Development
iCare Intelligence

Panel:
Ana Handshuh, Principal
CAT5 Strategies

Teresa A. Mason, Member of the Firm
Epstein Becker Green

Morrison will address the future of the health care marketplace, trends, and implications. He will present insights and implications of health care policy based on the results of the presidential election, the continued impact of COVID-19, and mega-trends, including artificial intelligence, data analytics, and the intersection of social determinants of health and digitalization.   

David Meyer, SVP, Quality Outcomes and Informatics
NationsBenefits

Ana Handshuh, Principal
CAT5 Strategies