With over 35 timely topics related to the impact of the pandemic and 2020 election, 50+ industry experts discussing the current and future state of the American health care system, a blockbuster lineup of keynote speakers, plus compliance and regulatory updates from NCQA, OIG, and CMS, RISE National 2021 was a can't miss opportunity for health care professionals of all levels in the Medicare Advantage and ACA market. Preview what you can expect from the top-notch content RISE National is known for.
Instructors:
Laura Sheriff, RN, MSN, CPC, CRC, National Director, Risk Adjustment
Molina Healthcare, Inc.
Susan Waterman, RHIT, CCS, CPC, CRC, AHIMA ICD-10-CM/PCS, Trainer, Director, Risk Adjustment
Scott & White Health Plan
The HCC Coding for Accuracy workshop is not just for those directly involved in HCC coding work. It is designed for other disciplines, as well, including finance and analytics professionals. Join us for an introduction to best practices, the opportunity to work through case examples, and to share experiences with your peers. This workshop will zero-in on regulatory compliance while teaching you how to optimize the accuracy of the information gathered and submitted at the practice level. What you will also learn about the way charting is often done, how to overcome “disconnect” with the clinicians and how their typical charting practices and EMRs can create significant problems, and how RADV views documentation in contrast with the way clinicians were taught and EMRs were built initially.
Please note: Attendees are encouraged to bring questions to pose to our expert workshop facilitators and to the table for the group. We provide your workbook which includes copies of the slide deck. You will not need your coding manuals, but most people take notes on their laptop or tablet.
Dialogue, interact and work in small facilitated groups with peers and colleagues
Instructor:
Colleen Gianatasio, Director of Ambulatory CDQI
Mount Sinai Health Partners
Donna Malone, CPC, CRC, CRC-I, AAPC Approved Instructor, Director of Enterprise Risk Adjustment: Coding and Provider Education (CDI)
Tufts Health Plan
This interactive and informative workshop will explore the following topics through real life case studies and practical takeaways:
Kyle Mendez, MBA, Senior Director, Revenue Management
Landmark Health
Michael Le, MD, Chief Medical Officer
Landmark Health
Join us for a comprehensive review of 2020 and the changes to Risk Adjustment and Quality that impact your plan. Hear from experts and peers on how each of them navigated the uncharted waters of COVID-19 and how they were able to adapt to the new guidelines and restrictions without sacrificing care. Finally, discover the key to keep up success and improve growth in 2021 and beyond.
Moderator:
Jay Scholes, Regional Director of Sales
Pulse8
Panel:
John Barkley, VP, Risk Adjustment Revenue
EmblemHealth
Diane Escandell, Senior Director of Provider Engagement
Pulse8
Elizabeth Haynes, Director, Risk Adjustment and Stars Govt Programs
Blue Cross Blue Shield of Kansas City
Chris Simmons, Vice President of Clinical Analytics
Pulse8
Courtney Yeakel, Co-President & Chief Product Officer
Pulse8
Matt Bowden, Manager of Risk Adjustment
Hometown Health Plan, Inc.
Keynote Interview with:
Tara Lipinski
Olympic Gold Medalist
Figure Skating Analyst for NBC Sports Group
Conference Chair:
Ana Handshuh, Principal
CAT5 Strategies
Internationally Acclaimed Figure Skater and Olympic Gold Medalist, Tara Lipinski, discusses her career and how she has overcome the many obstacles that have stood in her path. Through anecdotes and inspirational life lessons about overcoming adversity to her storied career in figure skating, people of all ages can expect to leave feeling inspired and entertained.
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!
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
Rachel Nelson, CPC, Director, Payer Solutions
GeBBS Healthcare Solutions
Timothy Burke, Chief Compliance Officer
Radiology Partners
Former National VP Medicare Risk Adjustment and Coding
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
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
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:
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.
Dawn Carter, Director, Product Strategy
Centauri Health Solutions
Tracy Tran, Director of Risk Adjustment and Encounter Data
Clever Care
Hiep Pham, CFO
Clever Care
Wayne Gibson, Senior Managing Director, Health Solutions
FTI Consulting
Deb Curry, MBA, RHIA, CCS-P, CRC, Manager, Risk Adjustment
ProMedica
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:
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:
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
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
Sanji Fernando, SVP, AI & Analytics Platforms
UnitedHealth Group Research & Development
Eric Haseman, General Manager
Optum
David Costello, Ph.D., SVP, Risk Adjustment & Innovation
Cotiviti
Stacy Coggeshall, Vice President of Risk Adjustment
Fallon Health
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
Adam Gronsky, Chief Innovation Officer
Health Fidelity
Nicole Clarke Luck, Senior Vice President - Strategic Initiatives & Finance
Memorial Hermann Physician Organization
Fahad Ahmed
Independent Consultant
Deb Curry, MBA, RHIA, CCS-P, CRC, Manager, Risk Adjustment
ProMedica
Dawn Peterson, Director, Risk Adjustment
Martin’s Point
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.
Andy Kumar, Vice President, Product Management – Clinical Data Acquisition & Insights
Ciox Health
Lisa Andrews, Manger of Risk Adjustment and HEDIS
Martin’s Point
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
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
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
Daniel Weaver, Vice President, Stars, Quality, & Risk Adjustment
Gateway Health
Rex Wallace, Principal
Rex Wallace Consulting
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
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