Agenda

Please note that our team is working to re-confirm sessions and speakers for our June virtual conference and aspects of the program may be subject to change. Check back for updates! 

March 15, 2020

7:00 AM - 8:00 AM
Workshop A & B Registration Opens
7:00 AM - 8:00 AM
Networking Breakfast

8:00 AM - 4:00 PM

Workshop A - Risk Adjustment Practitioner

  • The essentials of and differences between Medicare Advantage, Commercial and Medicaid risk adjustment  
  • Understanding how risk scores are calculated  
  • Making sense of varying payment models  
  • An intro into using data and predictive analytics to optimize your risk adjustment practices  
  • Tools for achieving data accuracy  
  • Where do we stand with the transition from RAPS to EDS? The latest in a long journey  
  • Provider engagement strategies that will impact your risk adjustment initiatives  
  • Risk adjustment vendor selection and management  
  • Determining whether you need RA vendors  
  • How do you effectively vet potential vendors and ultimately select them?  
  • Strategies for on-going, thorough vendor management  
  • The future of risk adjustment – what you need to know to stay ahead of possible changes  
  • Initial steps for preparing for a RADV audit  
  • Which staff is essential to overseeing your RADV audit prep?  
  • Staying ahead – key items to monitor well in advance of an actual audit  

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

8:00 AM - 4:00 PM

Workshop B - Advanced HCC Auditor

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 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 bring a laptop or a tablet, as well, for note-taking.   

Dialogue, interact and work in small facilitated groups with peers and colleagues   

  • Understanding the financial overlay – HCC codes mapping to risk adjustment scores   
  • A single coding and documentation process for  
  • Quality improvement  
  • Risk adjustment   
  • Skill development on choosing diagnoses from portions of the encounter – permitted and not permitted   
  • Clinical documentation barriers for risk adjustment purposes (data validation audit risks) 

Instructor:

Donna Malone, CPC, CRC, CRC-I, AAPC Approved Instructor, Director of Enterprise Risk Adjustment: Coding and Provider Education (CDI)
Tufts Health Plan 

Colleen Gianatasio, Director of Ambulatory CDQI
Mount Sinai Health Partners

11:00 AM - 1:00 PM
Workshop C, D & E Registration Opens

1:00 PM - 4:00 PM

Workshop C - What Health Plans Should Be Seeing at the Crossroads of Better Data and Advanced Analytics

Realizing the future of EMR connectivity, provider engagement, and social determinants of health

  • Value-based Care: Synergizing Advanced Analytics, Technologies, and Interoperability for More Successful Risk Adjustment and Quality Outcomes
  • Reducing Plan and Provider Burden for Better Engagement and Outcomes in a Rapidly Shifting Healthcare Landscape
  • Integrating Risk, Quality, and Pharmacy Opportunities at the Point of Care to Improve Clinical and Financial Outcomes

Moderator:
Scott Filiault, Chief Revenue Officer
Pulse8

Instructors:

Scott Fries, Chief Administrative Officer 
Pulse8

Jennifer Hunt, Administrative Director, Actuarial Services
Paramount Healthcare

Dr. Neeta Shah, MD, FACP, FFSMB, SVP, Quality & Risk Adjustment
HealthCare Partners, IPA

Scott Stratton, Chief Data Scientist & VP, Product Analytics
Pulse8

Courtney Yeakel, Chief Product Officer
Pulse8

Eddie Ortiz, MD, Chief Executive Officer
International Medical Card, Inc.

 

1:00 PM - 4:00 PM

Workshop D - Taking your Medicare Advantage Program to the Next Level

Arriving at the Intersection of Stars and Risk Adjustment  

This hands-on workshop is exclusively for upper-level management and those in strategic planning roles within Stars, Risk Adjustment and Compliance. Very Limited space due to interactive nature of the workshop.  

This workshop will guide you through the lessons learned and best practices for combining and streamlining processes related to Stars and Risk Adjustment. You will walk away with a game plan and actionable steps to apply in your organization.  

  • Promote a five-star culture  
  • Take a deep dive into your risk adjustment strategies 
  • Discuss key measures directly affecting your stars rating 
  • Learn strategies to help you successfully prepare and navigate for audits  

Instructors:
Ana Handshuh, Principal
CAT5 Strategies

Dave Meyer, Vice President, Stars
Cigna

 

1:00 PM - 3:00 PM

Workshop E - Attention Spans and the Human Brain More intimate

Join last year's top keynote as he addresses the brain science behind delivering powerful and engaging presentations. Limited space available.  

It is axiomatic that brains don’t pay attention to boring things. Yet speakers regularly lose their audiences after just a few minutes at the podium. Can brain science help? How can presenters create clear and compelling presentations?

In this talk, we discuss how the brain pays attention to information. We start with a few facts about brain processing and end with practical advice on how to make presentations sharp, stimulating and sticky. 

Dr. John Medina
Brain Scientist
Author of New York Times bestseller Brain Rules: 12 Principles for Surviving at Work, Home and School

1:00 PM -5:00 PM
Main Registration Opens
4:30 PM - 6:30 PM
Welcome Reception in Exhibit Hall

March 16, 2020

7:00 AM - 8:45 AM
Registration and Networking Breakfast
7:00 AM - 6:35 PM
Exhibit Hall Opens

8:45 AM - 9:00 AM

Opening Remarks

Ellen Wofford, Managing Director
RISE

Conference Chairs:

Ana Handshuh, Principal
CAT5 Strategies

Nathan Goldstein, Chief Strategy Officer
Signify Health

 

9:00 AM - 10:00 AM

Keynote Address

John Quiñones
ABC News Veteran, Creator & Host, What Would You Do?

A lifetime of “never taking no for an answer” took Quiñones from migrant farm work and poverty to more than 30 years at ABC News and the anchor desk at 20/20 and Primetime. Along the way, he broke through barriers, won the highest accolades, and became a role model for many. As host and creator of What Would You Do?, the highly-rated, hidden camera ethical dilemma newsmagazine, Quiñones has literally become “the face of doing the right thing” to millions of fans.  

It was that hardship and hunger, Quiñones says, that gave him the determination to turn disadvantages into assets and achieve his ambitions With drive and perseverance, Quiñones relentlessly pursued his vision to become a television journalist, while building a lifelong reputation for hard work and integrity. The lessons he learned about overcoming challenges, believing in oneself and defying the negative messages that society often sent inspire all of us to reach for our highest potential. 

10:00 AM - 10:30 AM
Networking Break

10:30 AM - 11:20 AM

OIG’s Identification of Vulnerabilities that Exist in Medicare Advantage

Presenters will provide an overview of OIG’s work to combat fraud, waste, and abuse in Medicare Advantage.  They will also discuss the findings and recommendations of work conducted by OIG’s Office of Evaluation and Inspections on the financial impact of chart reviews on risk scores in Medicare Advantage. 

Megan H. Tinker, Senior Advisor for Legal Affairs
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)

11:20 AM - 12:10 PM

CMS Policy Update

Kelly Drury, Director, Division of Risk Adjustment Operations
Centers for Medicare & Medicaid Services (CMS)

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

12:10 PM - 1:10PM
Networking Lunch

1:10 PM - 1:55 PM

Concurrent Sessions

Risk Adjustment Strategies

Beyond Chart Audits and In-home Assessments: How to use micro-strategies to adapt to changing models and falling risk scores

 

  • Staple Risk Adjustment programs of Chart Review and Prospective Assessments will yield RAF up to 7% lower, but new techniques will allow plans to capture codes that would otherwise fall through the cracks  
  • Best practices will be to employ a well-timed comprehensive list of retrospective and prospective campaigns, as well as the established and emerging technologies that will support programs (i.e. analytics programs, EDS-specialized submissions, NLP etc.) 
  • Plans and provider groups can work together to improve the accuracy of risk scores through commitments to share risk and actively collaborate 
  • Risk Adjustment departments need to implement a range of microstrategies for capturing codes, including provider query, second level review coding audits, and year-round analytics  

Jason McDaniel, Vice President, Risk Adjustment and Quality
Healthcare Partners Nevada

Harshith Ramesh, Co-CEO
Episource

Provider/Payer Collaboration

Improve Provider Engagement: Present Risk Gaps in the Provider Workflow

A More Effective Way to Achieve Significant Risk Adjustment Results 

  • Accurate diagnosis codes are critical for calculating appropriate capitation rates and health plans must rely on providers for those codes 
  • Learn how to engage providers within their existing workflow to make coding validation an integral part of their day-to-day process 
  • Discuss the benefits of proactive medical record review at the point of billing, close to the medical encounter, and how it can be a more efficient, effective approach than costly retrospective reviews 
  • See how improved diagnosis coding accuracy can build stronger plan-provider collaboration while also delivering faster, more accurate risk adjusted payments   

Jimmy Liu, Vice President, Risk Analytics
Change Healthcare


Laura Sheriff, RN, MSN, CPC, CRC, National Director, Risk Adjustment
Molina Healthcare, Inc Molina Healthcare

Technology and Analytics

Connecting Health Care: The Future of Clinical Interoperability

  • Gain a multi-stakeholder perspective on how payers and providers are finding value in new approaches to interoperability and data sharing  
  • Explore how healthcare electronic exchange standards are transforming the interoperability landscape to solve today’s common challenges around provider connectivity and patient engagement, care gap closure, and the ability to leverage advanced, intelligent clinical decision support  
  • Hear from industry experts as they discuss the impacts the regulatory environment has on improving data speed and transparency in capturing the holistic patient view at the point of care. 

Moderator:

Eric Sullivan, Senior Vice President of Innovation and Data Strategies
Inovalon  

Panel:

Paul Wilder, Executive Director
CommonWell Health Alliance

Chad Brooker, Associate Principal, Policy
Avalere Health

Anna Wetherbee, Principal, Business Planning and Effectiveness – Clinical Quality
Blue Shield CA

Social Determinants of Health

Launching an Outcomes-Driven Social Determinants of Health Initiative 

  • Actionable steps for establishing a social determinants of health program that drive improvements in health plan performance, including quality measures, member experience, and cost
  • The importance of unique member segmentation efforts that are often missed in traditional case/clinical management initiatives 
  • How SDOH initiatives can improve conversion rates for in-home health assessments 
  • How the provision of social services can garner trust and goodwill within a community, ultimately improving scheduling rates
  • Methods to track, measure, and report downstream outcomes that result from upstream SDOH resolution

Clayton Walberg, VP Strategy
Signify Health

Julia Weatherly, Program Analyst
Independence Blue Cross

Compliance, Quality and Stars

RADV Redux: What We Learned from the Latest CMS and OIG RADV Audits

  • Learn how plans have responded to changes in the CMS sample selection and overall audit approach 
  • Discuss if plans or providers should modify their readiness plans based on these changes and the latest audits 
  • Evaluate expectations for the future based upon early feedback

Biggs Cannon, Senior Managing Director, Health Solutions
FTI Consulting

Wayne Gibson, Senior Managing Director, Health Solutions
FTI Consulting

Annie Miyazaki-Grant, SVP, Chief Compliance & Privacy Officer
Visiting Nurse Service of New York (VNSNY)

Ankur Goel, Partner
McDermott Will & Emery

2:00 PM - 2:45 PM

Concurrent Sessions

Risk Adjustment Strategies

The CHA of the Future: A Focus on In-Home Care, Value Creation and Artificial Intelligence

• The rapidly changing healthcare landscape demands that providers that can get into the home should do more than basic risk adjustment
• There should be a focus on value creation – for all stakeholders – across risk adjustment, quality, education and cost domains
• Data, predictive models and artificial intelligence (AI) all help enable value creation
• Matrix and Berkeley will share cutting-edge information on this exciting, new journey to the Comprehensive Health Assessment (CHA) of the future

Dr. Jon Kolstad, Associate Professor of Economic Analysis and Policy
Haas School of Business, Department of Economics
University of California, Berkeley


Dr. Daniel Castillo, Chief Medical Officer & Group President, Product, Quality & Innovation
Matrix Medical Network

Provider/Payer Collaboration

How to Improve Risk and Quality Through Payer and Provider Collaboration

Learn how a comprehensive approach to payer provider collaboration can positively impact quality outcomes. Experts will discuss how the following strategies work together to benefit members: 

  • Prospective engagement programs designed to drive quality outcomes  
  • Actionable data within provider technology platforms 
  • Reimbursement aligned to value 
  • Operating model, support staff and expertise

Jeff Dumcum, Senior Vice President, Clinical Performance and Compliance
Optum

Panel:
Peter Janelle, Risk Adjustment Associate Director
UCare

Jessica Cunningham, RN, BSN, PHN, Director Population Health Strategy
M Health Fairview

Boyd Barsness CRC, Senior Healthcare Advocate
Optum  

Technology and Analytics

Using Predictive Analytics and Identification of Gaps in Care to Help Determine the Best Path for Your Members

  • Identify and quantify members with the highest gaps and therefore highest-value within your population 
  • Ensure that providers gain trust and therefore rely on the use of care gap reports   
  • Focus your internal resources on closing the most impactful HEDIS gaps 
  • Access analytics to demonstrate effective and actional provider and member engagement initiatives 

Kathleen Dalziel, MHA, CPHQ, HEDIS and Accreditation Manager
Health Plan of San Joaquin

Michelle Miller, Chief Technology Officer
Centauri Health Solutions

Social Determinants of Health

Introducing a SDoH Initiative within Your Organization

  • Discuss approaches for identifying members needing assistance with addressing SDoH  
  • Address actuarial methodologies to estimate the size of the financial opportunities associated with addressing SDoH needs in the Medicaid population 
  • Discover the predictive value of incorporating SDoH elements into risk adjustment processes 
  • Learn the framework for closing the communication loop between the various entities involved in addressing SDoH needs – the health plan, the CBO, the healthcare provider and the member 

Moderator: 

Sara Ratner, SVP of Government Programs & Strategic Initiatives                                                          Revel

Panel:

Rajesh Munjuluri, ASA, MAAA, Medicare Actuary
Capital District Physicians' Health Plan

Compliance, Quality, and Stars

Partnering for Star Rating Success  

  • Explore the benefits of vendor/client partnerships to support Star rating improvements  
  • Develop a robust plan to delineate roles and responsibilities, along with communication and reporting processes 
  • Review practical examples of programs utilized to drive improvement, establish metrics and increase positive outcomes  

Shelley Collins, Director of Clinical Quality Improvement
BCBS Nebraska

Erica Krieger, Vice President – Quality
Advantasure

2:45 PM - 3:10 PM
Networking Break

3:10 PM - 3:55 PM

Concurrent Sessions

Risk Adjustment Strategies

Moving Risk Adjustment Upstream for Better Care Plans and Revenue Capture

  • Hear clinical and operational experts weigh in on how to find the ideal combination of technology and human expertise for a risk adjustment initiative 
  • Learn how interacting with integrated risk workflows before, during, and after the encounter impacts patient outcomes, day-to-day operation, and year-over-year goals 
  • Discover how NLP and analytics combine to empower staff, not replace them, to improve an organization’s capacity to provide a more specific, higher quality of care while meeting resource initiatives to fund that care 

Moderator:

Robin Lloyd, Chief Commercial Officer
Health Fidelity

Panel:

Helen Yde Brown, Risk Adjustment Revenue Manager
Security Health Plan

Rebecca Welling, RHIT, CCS-P, Senior Director Coding Compliance
Providence Health Plan

Darcie Robran-Marquez, MD, MBA, CPE, CRC, Executive Medical Director Population Health 
Presbyterian Healthcare Services

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

Provider/Payer Collaboration

NLP at the Intersection of Risk and Quality

  • How providers and payers, respectively, are utilizing NLP enabled workflow applications to optimize RA outcomes 
  • How are these technology advances improving speed, accuracy, quality and access to actionable analytics across the provider/payer continuum 
  • How can providers/payers leverage technology to create more transparent, collaborative relationships that improve patient/member outcomes 

Jeff Preuss, CEO
Complete Health

Kristina (Kris) Trafton, Director, Risk Adjustment
Geisinger Health Plan

Marilee Klock, Director, Coding Operations
Geisinger Health Plan

Dean Stephens, CEO
Talix

Technology and Analytics

The Magic of Integrating Data to Solve Everyday Problems

  • Understand the power of integrated data and identify key metrics that help solve business problems 
  • See how actionable insights can be driven by a core set of integrated metrics 
  • Know the right steps to fully realize the value locked within data silos 

David Costello, Ph.D, Chief Analytics Officer
Cotiviti

Lynn M. Kryfke, RN, MSN, Executive Director, Health Plan Clinical Services
Children's Community Health Plan

Jacob LeRoy, Project Manager
Children's Community Health Plan

Social Determinants of Health

The Social Determinants of Health (SDoH): Has Risk Adjustment Met its Match?

  • Evaluate the monetary impact that SDoH related readmissions (attributing to National Health Expenditures at $3.5 trillion and rising) has in your risk adjustment program  
  • Discuss how SDoH has prompted the largest number of mergers and acquisitions to date and what that means to your business  
  • Learn how the SDoH movement is getting providers to prioritize fiscal and human capital and implement innovative strategies 
  • Find solutions to challenges related to uncompensated care, coding, costs and compliance surrounding SDoH to assure the financial sustainability of your organization 

Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP, Subject Matter Expert
EFS Supervision Strategies

Kent Holdcroft, MA, Executive VP of Enterprise Accounts and Strategic Partnerships
AdhereHealth

Daniel Weaver, VP Stars, Quality & Risk Adjustment
Gateway Health

Compliance, Quality, and Stars

Hot 2020 Legal and Compliance Issues for Risk Adjustment Organizations

  • Explore recent settlements, cases and government investigations pertaining to risk adjustment 
  • Focus on actionable items for operations, management, compliance and legal personnel that align with government enforcement trends 
  • Discuss recent litigation with CMS including updates on the Part C overpayment rule and join an interactive discussion of regulatory challenges and frustrations faced by plans, providers and risk adjustment vendors  
  • Identify key risk areas, learn best practices and have a roadmap for risk mitigation for 2020 

Jason Christ, Member of the Firm
Epstein Becker & Green

Teresa Mason, Senior Legal Counsel, RN
Epstein Becker Green

Dave Meyer, Vice President, Stars
Cigna

4:00 PM - 4:45 PM

Concurrent Sessions

Risk Adjustment Strategies

Unlocking the Power of Insights at the Point of Care

  • Collaborate to tailor risk adjustment solutions to address member-specific health goals  
  • Leveraganalytics to better support members at the point of care 
  • Use technology to offer timely, relevant insights that improve healthcare outcomes 

Jay Baker, Senior Vice President – Data Management and Analytics
Advantmed

T.K. Desai, M.D., Chief Administrative Officer
Advantmed

Dominic Henriques, Vice President of Performance Improvement
Prominence Health Plan

Provider/Payer Collaboration

Population Health Platforms to Enable Value-Based Care: Practical Approaches for Health Plan and Provider Collaboration

  • Fund and build platforms to enable deeper levels of trust, collaboration, effective contract performance evaluation and execution of actionable care management strategies 
  • Overcome the most critical barriers to effective collaboration, with a heavy emphasis on strategic alignment, agreement on key performance metrics and balancing care recommendations across business, quality, cost and access considerations  
  • Identify and pursue the right priorities to balance near-term ROI requirements with long-term strategic initiatives 
  • Define a logical and manageable progression from initial platform implementation to long-term scalable capabilities 

Michael J. Patti, Partner
Baker Tilly

David Gregory, Partner
Baker Tilly

David Dafilou, VP/Chief Administrative Officer
Capital Health 

 

Technology and Analytics

The Future of Healthcare Technology: More Data-Driven Insights, Less Physician Burnout

  • How existing technologies and new value-based care program requirements have contributed to physicians’ growing administrative burden
  • What processes and systems need to change to support more efficient data capture, analysis, and decision-making at the point of care
  • How emerging technologies can surface insights into patient health needs, conditions, and care routing while reducing physician burnout

John Schneider, Chief Technology Officer
Apixio

Fred Brodsky, MD, VP, Population Health Informatics 
Advocate Aurora Health

 

Social Determinants of Health

Motivating Providers to Embrace Social Determinants in Primary Care

  • Creating a vision and purpose that includes social determinants of health 
  • Using social determinants to enhance predictive analytics 
  • Measuring the impact of addressing social determinants 
  • Improving patient satisfaction and brand recognition 

Dr. Mayank Shah, MD, MBA, FAAFP, Chief Medical Officer
Alegis Care

Dave Meyer, Vice President, Stars
Cigna

Compliance, Quality, and Stars

Commercial RADV Reconsidered: What’s Wrong and What CMS Plans to Do About It

  • Errors and actuarial risk – discuss how they are related and whether they are related at all 
  • Learn how the IVA sample skews the data 
  • Things get dumb when smart systems collide: hear what happened when we mixed HCC Groups, HCC hierarchies, Neyman distribution, and Failure Rate Grouping  
  • How much can we fix by changing the data we collect? Procedure Codes v. Diagnosis Codes 
  • Diabetes is the biggest health care problem in America – why should it be different for RADV? 

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

Dr. Hassan Rifaat, M.D. – Chief Executive Officer
Vatica Health

4:45PM - 5:45PM

Roundtables Part One

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

Pull up a chair and settle in for 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.  A bell will ring three times within this special 60-minute session, alerting you to transition to the next roundtable of your choice.  

 

5:45PM - 6:45PM
Networking Cocktail Reception

March 17, 2020

7:30 AM - 9:00 AM
Networking Breakfast
7:30 AM - 3:35 PM
Exhibit Hall Opens

8:00 AM - 9:00 AM

Roundtables Part Two

Select from 20 Different Presentations Spotlighting Healthcare’s Most Influential Technology and Solution Gurus presenting Tools to Elevate your Plan’s Initiatives.  

Pull up a chair and settle in for 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.  A bell will ring three times within this special 60-minute session, alerting you to transition to the next roundtable of your choice. 

9:00 AM - 9:05 AM

Day Two Welcome Remarks and Day One Takeaways

Conference Chairs:
Ana Handshuh, Principal
CAT5 Strategies

Nathan Goldstein, Chief Strategy Officer
Signify Health

9:05 AM - 10:00 AM

Keynote Address

Jeff Henderson
Inspiring Celebrity Chef, Star of Flip My Food with Chef Jeff & Author of “If You Can See It, You Can Be It”

Jeff Henderson inspires with his emotional journey of redemption from the streets to the stove, sharing real-life strategies to help you achieve your dreams, no matter your stage of life.

10:00 AM -10:20 AM
Networking Break

10:20 AM - 11:10 AM

Keynote Address

Allison Massari
Executive Coach, Celebrated Artist, Burn Survivor
Transforming Lives: The Art of Person-Centered Care  

With her perceptive view inside the “patient experience”, Allison Massari’s riveting and insightful keynote illuminates the immense value that healthcare teams have upon a patient who is suffering. This dynamic and poignant program offers real solutions to the struggle of how to keep the patient first despite limited time and other practical constraints 

11:15 AM - 12:00 PM

Concurrent Sessions

Risk Adjustment Strategies

Modernizing Provider Communication Strategy to Improve Risk, Quality & Clinical Outcomes

  • Build a successful provider communication strategy that “meets providers where they are” through flexible connectivity and delivery (e.g., Direct Messaging, FHIR, API, batch)
  • Evaluate the strategic and operational considerations that complement the strategies needed to streamline payer-provider communications and reduce provider abrasion
  • Deliver insights to providers within existing workflows at point of care to solve the asymmetry of patient information between payers and providers, and ultimately, improve outcomes
    • Close risk documentation gaps to improve risk score accuracy
    • Close quality gaps to improve Stars/HEDIS® measures
    • Gain access to critical clinical health information to provide higher quality care

Leah Hannum, Director of Risk Adjustment & Provider Strategy Leader
Blue Cross of Idaho

Brandon Solomon, Vice President of Client Advisory & Business Development
Pareto Intelligence

Provider/Payer Collaboration

Breaking Down Barriers Between Providers and Health Plans

• Leveraging technology to reduce provider abrasion
• Finding innovative approaches to collaboration
• Enabling providers to capture appropriate and comprehensive patient acuity

Debbie Conboy, Director of Risk Adjustment and Quality Strategy
Arcadia

Alan Whittington, Director of Risk Adjustment Programs and Portfolio Management
Highmark, Inc.

Technology and Analytics

New HHS Regulations and Making Data Interoperability a Reality

  • HHS's Office of the National Coordinator for Health IT (ONC) and CMS are both in the final stages of drafting new regulations aimed at ushering an era of much wider and easier access to electronic health data.
    • Application programming interfaces (APIs) will be used more broadly for access to and exchange of health data.
    • Building and managing a patchwork of digital connections and massive new data streams could be overwhelming without a robust understanding of the landscape and possibilities within it.
  • Discuss the new regulatory environment
  • Review how it may affect payor-provider data interactions
  • Explore strategies to prepare for the new reality

 

Aneesh Chopra
Former United States Chief Technology Officer (’09-’12)

Ram Balagopal, President of Clinical Data Acquisition and Insights
Ciox Health

Kirk Andersen, Vice President and Chief Technology Officer  
Cambia Health Solutions

 

Talent Retention and Leadership Management

How to Build a World Class Coding Team

  • Targeting the best candidates…and where to find them
  • How to measure success through quality and production benchmarks
  • Spreading your team’s value throughout the enterprise

Moderator:
Christine D’Amico, Executive Vice President
Cognisight          

Panel:
Kristen Viviano, CPC, CRC, Manager, Risk Adjustment Coding Operations 
Capital Districts Physicians’ Health Plan

Colleen Gianatasio, Director of Ambulatory CDQI
Mount Sinai Health Partners

Risk Adjustment Strategies

Empowering Members to Connect to Better Care

  • Learn how to improve member engagement and increase program awareness and access with multi-channel delivery platform
  • Innovate with real-time solutions to engage members & streamlined reporting to members, providers and health plans
  • Explore digital member engagement tactics to empower members to close gaps in care 
  • Learn about implementing HRAs, specialty services, and how lab services can help to improve your HEDIS® and Star ratings

 

Sy Zahedi, VP, Extended Care
Quest HealthConnect

Nicholas Bellos, Medical Director
Quest Diagnostics

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

Daniel Weaver, VP Stars, Quality, & Risk Adjustment
Gateway Health

12:00 PM - 1:00 PM
Networking Lunch

1:05 PM - 1:50 PM

Concurrent Sessions

Risk Adjustment Strategies

Risk Adjustment and Quality Impact Through Coding Best Practices

  • Discuss how coding is helping pave the way for an industry based on quality 
  • Hear about our embedded coding educator program and how it came together through successes and lessons learned  
  • Discover how this is helping our patients/members 

Marilee Klock, Director, Coding Operations 
Geisinger Health Plan

Kristina (Kris) Trafton, Director, Risk Adjustment
Geisinger Health Plan

Risk Adjustment Strategies

An Extra Special Regulatory Risk Adjustment Update

  • Accuracy or Precision: debate why you can’t have both and which one CMS plans to choose
  • Acute conditions – hear why CMS might add them to the model and whether that is a good idea
  • Discuss what can risk adjustment do about drugs and alcohol and how it might go horribly wrong
  • The Count Model and the Non-Linear Model for multiple HCCs – how they can help your validation strategy and make prediction and analytics impossible

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

Provider/Payer Collaboration

The Provider Panel: Actionable Solutions for More Effective Engagement

  • Hear from the provider side of the equation on how to develop and maintain a more efficient and effective workflow  
  • Learn what works and what does not work when engaging providers and the benefits of utilizing technology  
  • Address gaps and coding challenges, as well as breaking down the barriers around data interoperability  

 
Kenneth Persaud, M.D., Chief Executive Officer
Visualize Health


Ralph Tang, President, MD/VA IPA
WellCare Health Plans / Collaborative Health Systems

Workgroups

The Benefits of Collaboration between Health Plan and Provider Group on Risk Adjustment

  • The case for collaboration between health plan and provider group
  • Risk adjustment priorities- activities, timelines and dependencies
    • Health Plan perspective
    • Provider Group perspective
    • Key points where these priorities differ
  • Current state of risk adjustment
    • Health plan workflow and challenges
    • Provider group workflow and challenges
    • Key points where collaboration makes sense
  • Desired state of collaboration-bridging the gap
    • How collaboration can drive improved outcomes
  • Areas of potential collaboration  

Vera Grodzen, Associate Vice President Network Operations 
NAMM California 

Rick Liu, Vice President Risk Adjustment                                                                                          SCAN Health Plan 
 

Eduardo Silva, CFO                                                                                                                      Family Choice of NY

 

 

 

 

Workgroups

Peer Workgroup: How to Measure Success for your Risk Adjustment Program?

  • Join your peers to discuss key guiding benchmarks and metrics to use to measure your programs performance 
  • Identify which data points should plans review and track regularly to keep a pulse on their programs 
  • Find solution to effectively engage and collaborate with business areas such as finance, clinical quality and others, to remove silos  
  • Hear lessons learned and practical tools for combining efforts related to stars, HEDIS and risk adjustment

Jenni Monfils, CPC, CRC, Risk Adjustment Compliance Coding Manager
UCare

Donna Malone, CPC, CRC, CRC-I, AAPC Approved Instructor, Director of Enterprise Risk Adjustment: Coding and Provider Education (CDI)
Tufts Health Plan  

1:50 PM - 2:10 PM
Networking Break

2:15 PM - 3:00 PM

Concurrent Sessions

Risk Adjustment Strategies

Build a Coding Education Program Centered Around Physician Engagement

  • Learn about the changes in health care reimbursement and how risk adjustment coding is changing the role of diagnosis coding for coders and providers alike 
  • Obtain details around how to implement a program to better their organization’s chronic condition recapture rates and risk adjustment factor scores, helping to create a clearer picture of the patient’s medical complexity along with helping to meet thgoals/incentives set by the various payers in the region 
  • Gain an insider’s view into what has worked (and not worked) for an organization, like Virginia Mason, in engaging providers, creating urgency and an education strategy 

Sarah Ramsey Director, Documentation and Coding Director
Virginia Mason Medical Center

Christine Palermo, MD, Medical Director, Patient Financial Services
Virginia Mason Medical Center

Benefit Innovation and Care Management

Coordinate 3 Programs for Improved Outcomes: Quality, Risk Adjustment and Utilization Reduction

  • Discuss how technology and innovative data analytics can improve the lives of your members
  • Hear lessons learned and practical tips on program coordination from a national leader in risk-based, polychronic care 


Michael Le, MD, Chief Medical Officer
Landmark Health

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

Provider/Payer Collaboration

Hitting the Target: Leveraging Data to Optimize Processes, and Find Success in Value-Based Health Care

  • Explain how to use point of care tools and clinical data to supply providers with accurate information and education regarding documentation  
  • Describe how an organization collaborates with executive leadership, consultants, payers and vendors to achieve greater results  
  • Identify strategies to raise provider awareness and acceptance of initiatives aimed at improving performance in value-based contracts, through improved expert relationships 

Jennifer Houlihan, Vice President of Value-Based Care and Population
Wake Forest Baptist Health

Jessica Vaughn, Manager, Clinical Documentation Excellence
Wake Forest Baptist Health

Talent Retention and Leadership Management

Member Engagement Initiatives, What is Working and What Is Not

  • 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

    Merrill Friedman, Senior Director Disability Policy Engagement
    Anthem

    John Tschida, Interim Executive Director
    Association of University Centers on Disabilities (AUCD)

Workgroups

Peer Workgroup: Vendor Management Best Practices

  • Develop a plan for managing the RFP and potential vendor vetting process 
  • Understand and negotiate contracts – what is required and what is recommended?  
  • Identify who should be involved in the vendor selection and management process  

Jenni Monfils, CPC, CRC, Risk Adjustment Compliance Coding Manager
UCare

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

3:05 PM - 3:50 PM

Executive Advisory Board Member Roundtable: Preparing for Success in 2021

As the health care space continues to evolve, join the RISE Executive Advisory Board members as they discuss the conference’s key takeaways, share strategies to get you and your team ready for 2021 regulatory changes and demystify emerging tech tends.   

Moderator:
Kevin Mowll, Executive Director
RISE Institute

 

Speakers:

Patrick Coulson, Chief Growth Officer
Advantasure

Scott Filiault, Chief Revenue Officer
Pulse8

Kenneth Persaud, M.D., Chief Executive Officer
Visualize Health

Dr. Allysceaeioun D. Britt, Associate Vice President of Faculty Affairs and Development and Assistant Professor in the School of Graduate Studies and Research
Meharry Medical College

3:50 PM - 4:00 PM

Closing Remarks