Start Looking Forward: How Analytics-Fuelled Prospective Strategies Transform Member Outcomes

Risk Adjustment Strategies

• Examine the industry shift from retrospective to prospective risk adjustment 
• Discuss technologies that can fuel your prospective strategy, such as point-of-care tools and advanced analytics  
• Understand the differences between technologies that are customized for Medicare Advantage plans, Medicaid plans, PACE plans, and ACOs 
• Discover how these strategies can lead to a more accurate understanding of your member population, more timely interventions, and improved patient outcomes 

Eric Segal, Sr. Director of Platform Strategy and Solutions
Episource

Roy Oaks, Senior Director, Data Analytics
Driscoll Health Plan

Lisa Marshall, Manager, Alternative Payment Strategies
Driscoll Health Plan

Vinitha Ramnathan,Senior Vice President, Product
Episource

Mission Optimal is Business Optimal: Case Studies in Connecting Member, Stakeholder and Business Outcomes

Integrating Silos

• Taking charge: lessons from the VA on connecting the true north of healthcare to key business decisions  
• Mutual of Omaha’s strategic investments to engage seniors, empower their care journey, and drive healthcare cost sustainability  
• Low cost, high value and scalable tactics to help seniors navigate the digital + in person care ecosystem 

Moderator: 
Craig Hittle, SVP Health Plans
Kaia Health

Dr. David Shulkin, Ninth Secretary, US Department of Veteran Affairs-Shulkin
Solutions, LLC

Dr. Manoj Pawar, Chief Medical Officer
Mutual of Omaha

Nigel Ohrenstein, President
Kaia Health

Point of Care Strategies and Innovative Technology That Drive Better Clinical Outcomes and Patient Experience

Quality and Member Experience

• Discuss how aligning data (your physician EHR data and incentives) drive outcomes and build trust 
• Hear how healthcare table stakes are shifting from in-home and by-phone workarounds to investing in the point of care 
• Bridge data and member engagements across payers, medical groups, and other stakeholders to close the loop with providers 

Khanh Nguyen, PharmD, Chief Executive Officer, Applied Research Works 
COZEVA 

David Meyer, Chief Customer Officer, Applied Research Works 
COZEVA

Rina Shah, MD - Regional Medical Director, Board Member
Hill Physicians Medical Group

The Keys to Successful Health Plan and Provider Collaboration for Improved Outcomes and Increased Revenue Performance

Payer/Provider Collaboration

• Explore how interoperability speeds data lags for faster, more accurate reimbursements
• Discover how shared data platforms enable accurate, longitudinal records across risk and quality
• Discuss how the digital data imperative will help close gaps in care – and how to get there
• Chart a course for the ongoing convergence between health plans and providers

Elissa Toder, VP, Quality Improvement Strategy & Solutions
Reveleer

Deniese Crittenden, RN, MSN, MHA, BSW, CRC, Vice President, Risk Adjustment Strategy and Solutions
Reveleer

Data to Action: Optimizing Member Engagement by Understanding the Voice of the Customer

Technology/Data Analytics

• Knowing your customer via ethnographic research, user journey mapping, and a detailed understanding of member motivations  
• Confirming your learnings with data – identifying target KPIs and metrics, expected changes, and designing testing methodologies to “fail fast, iterate, and improve” 
• Building an actionable strategy based on data-backed findings – to home in on impact, priority focus areas, individualized engagement modalities, and desired improvements/outcomes 

Belinda Marcel, VP, Member Engagement
Matrix Medical Network

2023 Update from the Office of the Inspector General (OIG) 

Compliance and Regulatory Updates

Presenters will provide an overview of OIG’s recent reports and current priorities in the managed care space. Topics will include OIG risk adjustment data validation audits as well as Medicare Advantage Organizations’ denials of payments and services. The panel will also outline future work regarding health disparities.
 
Moderator:
Ana Handhsuh, Principal 
Cat 5 Strategies

Megan H. Tinker, Chief of Staff 
Office of Inspector General  
U.S. Department of Health and Human Services (HHS) 
  
Blaine Collins, Regional Inspector General, Office of Evaluation and Inspections  
Office of Inspector General  
U.S. Department of Health and Human Services (HHS) 

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

Integrating Chart Retrieval with Precise Word Matching NLP: What’s NEW and Why it’s Important

Risk Adjustment Strategies

• Discuss how new chart retrieval methods produce faster and more accurate risk adjustment coding  
• Learn how to automate risk adjustment and HEDIS workflows with symbiotic technologies  
• Retrospective and prospective coding simplified with flywheel process  

George Witwer, CEO 
Cavo Health

Troy Garland, MBA, BA, RN, Vice President Clinical and Quality Operations
Equality Health

P.J. Morris, MHA, Manager, Risk Adjustment Operations & Analytics
Fallon Health

Case study: Improving outcomes, Engagement, and Efficiency with One Data-Driven Member View

Integrating Silos

• Learn how combining the efforts of quality and risk teams through a single analytics-based program can transform health plan operations, performance, and costs
• Discover the power of seamless information sharing with your provider network and greater internal collaboration to drive better outcomes and happier members
• Gain real-world insight as health plan leaders share their organizations’ strategic vision for undertaking an integrated approach to quality measurement and risk adjustment

Michael Hasbany, EVP of Sales and Commercialization
Inovalon

Matthew Caminiti, Sr. Principal Solutions Engineer
Inovalon

Gabriel L. Medley, Vice President, Risk Adjustment & Analytics
Blue Cross Blue Shield of Michigan

Shontelle Mixon, CPA, MBA, Vice President – Enablement
Health Care Service Corporation

Improve Patient Experience by Getting More Out of The BioPsychSocial 

Quality and Member Experience

• Discuss mental health and the convergence with the risk model, opportunities for code capture, correlation with physical health, and options for service offerings 
• Learn the psychology behind best-in-class patient and physician engagement 
• Develop a better connection with your patients learning active questioning techniques, while improving patient engagement for better risk, CAPHS and quality performance 
• Learn how you can still be efficient AND most effective with patient engagement. An engaged patient means better compliance for quality, risk and satisfaction overall 

Dr. Shannon Decker, Principal  
VBC One  

Establishing Best-In-Class Collaborative Workflows Between Payers and Care Delivery

Payer/Provider Collaboration

• Learn about four key components for reducing total cost of care while improving member outcomes 
• Understand the importance of partnering with providers to assess their current digital footprint to help them reach their interoperability goals  
• Hear how M Health Fairview developed a best-in-class workflow to streamline care delivery and meet the needs of their payer partners 

Aria Sameni, Vice President of Growth and Strategy  
Optum  

James Hereford, Chief Executive Officer  
M Health Fairview

What’s Your Data Missing? Utilizing Interoperability to Capture/Recapture HCCs for Gap Closure

Technology/Data Analytics

• Leverage automated chart retrieval to capture/recapture chronic conditions 
• Lower costs through advanced interoperability technology to streamline processes for closing gaps in care and reducing leakage 
• Ensure the accuracy of real-time data for chronic conditions and quality at the point of care 

Moderator
Ashish Kachru, CEO
DataLink Software

James D. Murray, MS, VP, Clinical Informatics and Interoperability
CVS Health/Aetna

Josh Hetler, Executive Vice President, Business Intelligence
DataLink Software

Delivering Better Health Outcomes Through a Data-Driven, Holistic and Personalized Member Experience

Future of Health Care

• Using technology to identify the members who need care, the type of care they need, and which modality of care is better for them
• Delivering a member-centered holistic approach to care coordination and delivery 
• Converging risk adjustment and stars quality efforts to improve the member experience, drive quality outcomes and ensure accurate reimbursement

Debbie Conboy, SVP, Risk Adjustment and Quality
Signify 

Lynne Newson, Vice President, Medicare Strategy
Blue Cross Blue Shield of Massachusetts

Driving Organizational Alignment Utilizing AI for a Prospective Risk Adjustment Strategy

Risk Adjustment Strategies

• Discuss the challenges and opportunities with pivoting from retrospective to prospective risk as well as digital approaches to artificial intelligence (AI)
• How to drive prospective risk adjustment strategy with people, process, and technology 
• Learn how AI can automate and scale across prospective risk adjustment workflows (pre-visit, point of care, post-visit) 
• Understand the hurdles and successes in driving organizational alignment across clinicians, IT, and others 

Kelley Scott MSN FNP-c, Nurse Practitioner at Providence Medical Foundation 
Providence St. Joseph Health 

Matt Plack, VP for Innovation and New Solution Strategy
Apixio 

Using Member Data Within Your Health Plan to Close Gaps, Reduce Cost and Optimize Utilization

Integrating Silos

• New NCQA/CMS requirements impact on business operations
• Centralized data set from fewer vendors for a more expansive view of your member population
• Enhancing clinical data with patient reported and third-party validated sources
• Outlining which SDoH codes are available and best practices to capture them with coding
• How sharing data from one department can be utilized across an organization like RA and member engagement 

Michelle Zilisch, Director, Product Management
Ciox Health/Datavant

Lyle Mioduszewski, Vice President of Population Health
Ciox Health

Susan Waterman, RHIT, CCS, CPC, CRC, AHIMA ICD-10-CM/PCS, Trainer, Director, Risk Adjustment 
Baylor Scott & White

Reducing Hospitalization and Readmission Risk Through In-Home Support and Comprehensive Transitional Care for High-Risk Members

Quality and Member Experience

• Hear about how Providence Health Plan’s (PHP) care management intervention reduced hospital readmissions to support star ratings and reduce the cost of care 
• Learn how to build and deploy an effective program for high-risk members 
• Understand how quality home-based care supports support care transition for members returning home after hospitalization 

Francesca Rinaldo, MD, PhD, SVP, Clinical Product & Innovation 
Sharecare 

Jessica Wack-Alexander, MBA, Program Manager, Health Care Services
Providence Health Plan

Creating Successful Payer + Provider Alliances with AI and Interoperability

Payer/Provider Collaboration

• Gain insight into financial, quality, and contractual performance across multiple APM populations and payment models to improve stakeholder reporting, communication, and negotiations 
• Discuss utilization management decision support for prior authorization procedures and precise patient care and risk gap targeting insights at the point of care within the EMR to inform care delivery and improve health outcomes 
• Learn clinical risk capture and coding workflows that increase payment accuracy and minimize compliance exposure to improve risk adjustment performance  

Mark Filiault, VP Payer Sales  
Edifecs  

Data Analytics – The Pros, and Potential Pitfalls, to Leveraging Your Information

Technology/Data Analytics

• How harnessing the information you maintain can unlock huge value to your beneficiaries and your organization 
• Proving the ROI of programs can be tricky, but can also provide a pathway for expanded growth and organizational evolution 
• Clinical standards and coding still matter and should utilize data analytics to be even better than they already are 

FTI consulting  

Next Generation AI for Risk Adjustment

Future of Health Care

• Be inspired through a best-in-class modern app 
• Understand the creation of the intelligent coding solution 
• Learn how auto-coding plays a significant role now & in the future 

Lynne Padilla, Vice President, Risk Adjustment Solutions 
Change Healthcare 

Leo Janze, Head of Data Engineering, NLP 
Change Healthcare

Laura Sheriff, RN, MSN, Vice President Operations, Risk Adjustment
Southwestern Health Resources (SWHR) 

Would You Water Your Garden with a Leaky Hose?

Risk Adjustment Strategies

• How risk adjustment is like an iceberg, and how system configuration issues outside of risk adjustment operations can sink the risk adjustment ship regardless of how well the risk adjustment department is executing
• The importance of measuring the right things, at the right time, by the right people to prevent drowning in data - "analysis paralysis"
• How to develop a customized "leakage map" as a tool to measure and manage, in addition to CMS reporting and metrics

Dawn Carter, BSBA, CPC, Director, Product Strategy
Centauri Health Solutions

Melissa McVaugh MSN-LM, RN, CPC, Director Clinical Programs
Mountain Health CO-OP

Integrating Technology and Services Enabling You to Focus on Members and Growth

Integrating Silos

• Break down the silos between risk adjustment, quality, core administration, and health management groups 
• Unify your data into one source across your organization to be proactive and not reactive  
• Utilize real-time data and analytics to meet member needs and outperform your competition 

Moderator 
Patrick Coulson, Senior Vice President, Sales and Marketing  
Allymar Health Solutions  

Kevin M. Healy, CEO  
Allymar Health Solutions  

Gregg Kimmer, CEO 
ATRIO 

MCAHPS is the Backbone of the CMS Stars Program with 32% of a Health Plan’s Star Rating Being Based on CAHPS

Quality and Member Experience

• Discover lessons learned related to avoiding member surprises and negative benefit changes 
• Learn how avoiding member abrasion can impact your plan’s ratings 
• Explore the use of predictive analytics to focus your improvement efforts on those members who will impact specific CAHPS ratings 
• Learn how provider partnerships and post visit CG CAHPS surveys can impact your plan’s Star rating 
• Identify how best practice benchmarking can lead to important improvement strategies 

David L. Larsen RN MHA, Senior Advisor Payor Solutions 
Press Ganey 

Best Practices and Pitfalls of Provider-Centric Risk Adjustment Programs

Payer/Provider Collaboration

• Learn best practices for provider-centric risk adjustment programs, based on first-hand experience from the front lines 
• Avoid common pitfalls in designing a program  
• Hear a case study on how a payer worked closely with providers to drive mutual success 

Hassan Rifaat, MD, Chief Executive Officer 
Vatica Health  

Steve Romary, Director, Risk Adjustment Programs and Strategy
Highmark

Paul Linder, MD
Paul G. Linder and Associates PC

Raising the Bar: Advancing Equity Through Member Experience & Care Access

SDoH & Health Equity

• Why Health Equity is coming to the forefront of NCQA & CMS potential quality ratings
• Innovative ways to close care gaps through SDoH data
• How to improve member experience using language that is understandable, approachable, & inclusive

Troy Jelinek, Chief Commercial Officer 
Icario 

Jennie Roberts, Senior VP, Quality and Clinical Modernization UnitedHealthcare 

Value-Based Testing Innovations to Reduce Cardiovascular Morbidity and Mortality

Future of Health Care

• Identify new, accurate point-of-care methods for detecting early-stage cardiovascular disease 
• Discover how the early presence of PAD can be used as a marker for atherosclerosis before it becomes symptomatic 
• Learn how the presence of PAD in asymptomatic patients has been shown to be an independent outcomes indicator of increased mortality and major adverse cardiovascular events (MACE) 

Moderator:
Dr. Shannon Decker, Principal
VBC One

Robert London, MD, Medical Director 
Semler Scientific, Inc. 
 
Wayne Pan, MD, PhD, MBA, Medical Director 
Banner Health 

Making Your Risk Adjustment Compliance Driven

Risk Adjustment Strategies

In this session we will outline compliance concepts that are important in managing risk adjustment operations.  

• Start with the end mind— are you set for validation?  
• How can you be sure a new Dx is compliant?  
• When must a Dx be deleted?  
• Are you sure you have a complete view of each members current acuity status  
• Whose job is it anyway?  

Anna Carley, RHIT, Senior Director- CRM, Payer Solutions 
GeBBS Healthcare Solutions 

Will Stabler, Executive Vice President, Payer Solutions 
GeBBS Healthcare Solutions

Kathleen Faulk, SVP & General Manager, Government Programs
Regence Blue Cross Blue Shield

Understand The Unique Needs of Your Members: Looking Beyond Standardized Data and Meeting Your Members Where They Are

Integrating Silos

• Engaging hard to reach members through a population health approach  
• How to build trust and strong relationships within communities with culturally and linguistically appropriate services 
• Aligning internal teams to support cross collaboration between departments to mitigate abrasion and duplicative efforts 
• How one health plan is taking "to the streets" to meet members where they are  

Jenn Kerfoot, Chief Experience Officer  
FarmboxRx

Julianne Eckert RN BSN, CCM, CMCN, ACMP, Senior Director, Clinical Quality Programs 
Clover Health

Population Health Track Session: How SDoH Solutions Can Impact Risk and Quality Performance and Allow ‘Aging at Home’ 

Population Health and Health Equity

• Learn the latest innovations and strategies to support members’ health related social needs and the opportunities to improve member health  
• Discuss the importance of transportation options that connect seniors whose limited mobility hinders their ability to access necessary healthcare and social services and potentially impacting their ability to age in place   
• Hear how organizations can lessen the impact of HRSNs and decrease utilization of expensive—and often avoidable—medical services 

Moderator
Brett Hickman, Chief Commercial Officer
Modivcare 

Christopher N. Aguwa, Executive Vice President Head of Growth and Business Development
CityBlock Health 

Dr. Mohamed Diab, Chief Executive Officer, Accountable Care Organization
CVS Health 

Dr. Garth Graham, MD, Director and Global Head of Healthcare and Public Health
Google/YouTube at Alphabet, Inc.
Modivcare Board member 

Seth Ravine, Senior Vice President
Modivcare   

Building an Integrated Social Care Strategy

Social Determinants of Health

• Aligning SDoH barrier identification and intervention
• How flexible advocacy can produce a better member experience and optimize results
• Dual eligible advocacy and social care strategy

Lisa A. Barrett, Vice President, Member Navigation Solutions My Community Connections
UnitedHealthcare

Sean Libby, President
BeneLynk

Session to be announced

Compliance and Regulatory Updates

Meaningful Approach to Social Determinants of Health

Risk Adjustment Strategies

• Evaluate current ability to target social risk factors and barriers to care that fall into key categories
• Leverage existing data that can be used to target at risk beneficiaries with barriers to care
• Improving health outcomes while securing the data for improved

Elaine Taverna, Senior Vice President, Risk Adjustment and Quality
Advantasure

Ellen Fink-Samnick, Chair  
RISE SDoH Community

Elevate your Risk Adjustment Program: How to Leverage Data and Analytics with your Providers

Integrating Silos

• Understand Provider performance and learn revolutionary ways to impact member engagement
• Identify root causes of poor performance and discuss innovative key metric opportunities in your population
• Gain visibility into the critical data needed to drive the best results

Moderator:
Erin Montgomery
Advantmed

Eric Hedrick, Vice President, Analytics 
Advantmed 

Susan Waterman, RHIT, CCS, CPC, CRC, AHIMA ICD-10-CM/PCS, Trainer, Director, Risk Adjustment 
Baylor Scott & White

Clinical Data Plus Proactive Notifications Equals Improved Quality Measure Performance

Technology / Data Analytics

• Streamline your clinical quality measure data acquisition process
• Improve quality measures that have short windows to close gaps
• Reduce cost around your quality program
• Repurpose clinical data for other use cases such as UM or risk adjustment

Lynda Rowe, Senior Advisor, Value-based Markets
InterSystems

Autumn Kerr, AVP, Clinical Quality
Healthfirst

Kate Beck, AVP, Health Information Exchange
Healthfirst

Building Successful Payer and Provider Collaboration

Payer/Provider Collaboration

• Understand the critical ingredients for a successful partnership
• Identify best practices for structuring data sharing arrangements
• Identify best practices for structuring payment models
• Identify best practices for provider enablement

Anna Basevich, VP of Enterprise Partnerships
Arcadia

Laura Sheriff, RN, MSN, Vice President Operations, Risk Adjustment
Southwestern Health Resources (SWHR)