Schedule

Risk Adjustment Integrity: Best Practice Approaches for Balancing the Business Needs with Regulatory and Compliance Standards

Risk Adjustment Strategies

• Develop a multi-year strategy for improvement 
• Create and implement a comprehensive strategy for evaluating the integrity and compliance aspects of your risk adjustment programs 
• Manage internal and vendor coding reviews 
• Improve coding accuracy and auditing with provider engagement  
• Evaluate your review process for clinical documentation, audit samples, coding and more 

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

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

The Rx for Exceptional Customer Experience (CX)

Member Journey and Experience

• Discuss customer expectations from a brand when interacting with them 
• Learn consumers needs and friction points across their journey with a brand 
• Hear how COVID-19 has modified consumers’ expectations 
• Gain strategies to help you impact future Medicare Advantage consumers (GenZ, Millennial, etc.) 

Anne Stowell, Vice President Product Consumer Experience
Signify Health

Unifying NLP-enabled Risk Adjustment Processes for Improved Revenue Integrity and Gap Closure

Payer/Provider Collaboration

• Integrate the traditionally siloed processes of suspecting, retrieval, coding, and submissions to increase revenue confidence and oversight 
• Create a unified, NLP-enabled retrieval and coding platform to increase efficiency and improve gap closure 
• Enhance payer-provider collaboration through prospective gap closure and electronic data exchange 
• Unlock actionable insights from charts with NLP to support population health and value-based programs 

Katy Davis, MBA, CPC, CPMA, Director, Risk Adjustment Coding Quality and Compliance 
Medical Mutual of Ohio 

Shahyan Currimbhoy, Chief Product Officer  
Talix  

HEDIS, Stars and Risk Adjustment: A Town Hall Event with Senior Quest Clinical Leadership and TBD Health Plan Leadership

Quality, HEDIS® and Stars

• What we've learned so far about the past 2 years of the COVID pandemic and how it has affected your member’s choices on health care:  the data but most importantly; how use that data to leverage better health outcomes 
• Building and rebuilding "trust" with your members: each community is different and each communities has specific needs   
• Medical services with empathy: how to give your members safe options on access to their health care  
• Only constant in health care is change: clinical view of what to expect from the pandemic and how health care will look for the rest of 2022, 2023, and beyond  

Dr. Shannon Decker, M.Ed., MBA, PhD., Vice President, Clinical Performance
Brown & Toland

Jay Wohlgemuth MD, CMO & Physician Executive
Quest Diagnostics

Steve Goldberg, MD, MBA, VP, Chief Health Officer, Medical Affairs & Diagnostic Services
Quest Diagnostics

Realizing The Return: Ensuring Service Providers Deliver Value

Technology/Data Analytics

• Discussion of the components of a strong vendor management program, including financial accountability 
• Helping clients understand the value proposition of your platform and the strategies employed to increase value 
• How to create a process to measure return, including translating platform usage statistics to value 

Wayne Gibson, Senior Managing Director, Health Solutions
FTI Consulting

Turning Compliance into Opportunity: How Payers Can Create Growth from the 21st Century Cures Act

Strategy & Innovation

• Easily ingesting and normalizing new data about your members while complying with mandated standards.
• Applying the new data sources to drive risk adjustment, new member enrollmentand/or gaps in care strategies 
• Reducing the burden and cost of managing your patient access API ecosystem 

Jay Sultan, Vice President, Healthcare Strategy 
LexisNexis Risk Solutions

Rethinking People, Processes and Technology in Medicare Advantage for Core Administrative Services, Risk Adjustment, and Star Ratings

Risk Adjustment Strategies

• Compete in the land of the giants by attaining market leading core administration services and pricing 
• Create a model of service that allows you, the health plan and risk bearing provider group, to focus on care delivery and member experience 
• Utilize the latest in Artificial Intelligence to enhance Risk Adjustment outcomes 

Lisa Slattery, Chief Strategy and Compliance Officer 
Allymar Health Solution 

Revolutionizing Supplemental Benefits

Member Journey and Experience

• Simplify member experience by streamlining benefit access 
• Flexibility to combine multiple benefits for your members all on one card: OTC products, healthy foods, fresh produce and meal delivery, dental, vision and hearing, transportation, incentives, and more 
• Members can shop in-store, online, over the phone, or via mail order. Over 65,000 retail locations in the OTC and healthy foods network 

Dave Etling, Senior Vice President & General Manager 
InComm

Driving Risk Adjustment Accuracy with 360° Engagement

Payer/Provider Collaboration

• Use artificial intelligence to optimize engagement and reduce administrative burden 
• Partner with providers to integrate technology within their workflow 
• Leverage SDoH insights to optimize risk adjustment performance 

Aria Sameni, Vice President of Growth and Strategy 
Optum

James Hereford, Chief Executive Officer 
M Health Fairview

Risk Adjustment: Achieve Program Success by Measuring what Matters

Technology/Data Analytics

• Learn which measurements are the most effective for determining whether you’re on track to hit your goals  
• Discuss how to translate KPIs into impact for your risk adjustment program 
• Identify actions you can take to improve program performance 

Eric Hedrick, Vice President, Analytics 
Advantmed 

Donna Page, Senior Director, Risk Adjustment Operations 
Cigna 

Session to be announced

Quality, HEDIS® and Stars

Raising the Stakes on CAHPS to Boost Member Satisfaction — Real Stories from National & Regional Plans

Strategy & Innovation

• The need to understand and address human components in outreach to maximize the experience and drive action
• How leading health plans are deploying engagement programs that produce measurable results and ROI 
• How national and regional health plans think differently about their member satisfaction strategy

Steve Wigginton, CEO
Icario

Reimagining Risk Adjustment: Member Data Collection for the Digital Age

Risk Adjustment Strategies

• Ensure the right input for government reimbursements, support healthier members, and improve workflow for employees while reducing costs and provider abrasion 
• Learn how to employ data and technology to augment your risk adjustment by leveraging digital accessibility, pre-identified optimal member sets, and social determinants of health 
• Understand how the old ways and modern methods still must work together to deliver a comprehensive fulfillment yield, improve departmental efficiency, and scale to meet the plan’s needs 
• Utilize full-spectrum encounter and coding data to maximize member engagement and quality of care 

Session by Ciox 

RISE of the Payvider—AI-based Strategies for Successful Alliances

Payer/Provider Collaboration

• Hear how leading payvider organizations have tackled funding, financial incentives, and resource allocation to improve risk adjustment performance in both clinical risk capture and coding workflows 
• Discover the shared AI applications that drive payment accuracy and minimize compliance exposure via precise patient care and risk gap targeting 
• Learn about the different provider engagement, deployment approaches, and process takeaways from organizations three to five years into their payvider transformation 

Rebecca Welling, AVP, Risk Adjustment and Coding
SelectHealth

Jessica Columbus, AVP STARs & Risk Adjustment
Apex Health Solutions

National Committee for Quality Assurance (NCQA) 2022 Update

Quality, HEDIS® and Stars

Join this key update focused on the move to digital measures, new measures for 2022 and expectations for health plans, why HEDIS measures are still important during and post COVID, and a discussion involving SDoH, health equity, and the new Health Equity Accreditation program. Mr. Micciche will also discuss behavioral health challenges and related measures. 

Moderator:
Ana Handshuh, Principal
CAT5 Strategies

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

Make Each Moment Count – Strategies for achieving member-centric delivery of integrated quality and risk score accuracy excellence

Technology/Data Analytics

• Assess how care delivery is being provided today across the US healthcare landscape and the challenges towards achieving value-based care outcomes 
• Outline the merits and pitfalls of best practices in integrating quality improvement and risk score accuracy documentation and member engagement activity 
• Gain insight into different approaches to integrating programs that reflect the true disease burden of populations 
• Understand the value and challenges of an integrated program and the important role that compliance with changing and complex regulatory guidelines plays 

Moderator:
Kristopher Volrath, Vice President, Field Products and Solutions
Inovalon

Speakers:

Dr. Paige Kilian, Chief Medical Officer
Inovalon

James Clement, Vice President, Product & Services
Inovalon

Christopher McDade, Executive Director, Medicare-Medicaid Plans
AmeriHealth Caritas Family of Companies

Engaging the Member and Their Informal Caregivers to Support Risk Adjustment Data Collection and Risk Score Accuracy

Member Journey and Experience

• Understand the role informal caregivers fulfil within the dynamics of member care plans that encompass medical and medication objectives
• Discover how the informal caregiver can assist in obtaining timely and updated member diagnoses that will contribute to accurately computed risk scores and quality measures
• Learn how the active engagement of informal caregivers into members' daily lives drives the overall physical and behavioral health and wellbeing of the member 
• Gain insight into the symbiotic relationship between caregivers and providers and how this relationship promotes a "best practice" of care plan initiatives

Richard Lieberman, Chief Executive Officer
Cortex Analytics, Inc. / Mile High Healthcare Consulting, LLC

Strategies for the Implementation & Success of a Value-based Care Program 

Risk Adjustment Strategies

• Discuss critical technological components of a successful Value-Based Care Program 
• Assess how structured and unstructured patient data is being accessed and applied within the healthcare continuum 
• Gain insight on how to best integrate an AI platform into your organizations Value-Based Care Program to improve patient outcomes and decrease physician burnout 
• Hear how one company is utilizing an AI platform to improve and better coordinate the way they are delivering and measuring healthcare 

Chad Wege, Director, Product Management
Apixio

Two Birds, One Stone: Risk Adjustment Accuracy and Payment Integrity

Compliance and Regulatory Updates

• Optimize your program for the latest CMS, OIG, and DOJ investigation trends  
• How to have high accuracy above and below the compliance line 
• Win the payment integrity battle while reducing audit risk 
• Finance performance and compliance are friends 

Ana Handshuh, Principal
CAT5 Strategies

George Witwer, CEO
Cavo Health

Elevating Risk Adjustment by Activating Physician Participation

Payer/Provider Collaboration

• Learn how to create better collaboration and alignment between health plans and providers to significantly improve financial and clinical performance 
• Understand 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  

 Josh Stern, Chief Revenue Officer 
Vatica Health

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

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

Optimizing Risk Adjustment - Internal Operations, Vendor Strategy and Maintaining Control

Risk Adjustment Strategies

• Discuss chart retrieval, which records to chase and who should retrieve 
• Learn best practices for chart review – NLP, vendor alone or combined SaaS, and services 
• Maintain control throughout reporting, transparency, and provider education 

Session by GeBBS 

The Risk Adjustment “Platform”: Advanced Technologies to Improve Patient Outcomes & Plan Performance

Technology/Data Analytics

• Streamlining workflows with an end-to-end platform to reduce provider abrasion, ensure accurate risk scores and improve patient care. 
• How greater data transparency helped one health plan unlock $1M in potential lost revenue 
• Using tech for better data insights to prioritize the most impactful interventions 
• Utilizing advanced analytics for higher campaign volume and more targeted prospective strategies 
• How reimbursements ultimately impact patient outcomes 

Vinitha Ramnathan, Senior Vice President, Product
Episource

Amber Harris, CPC, CRC, Director of Risk Adjustment
MediGold

Culturally Competent Health Care: The Power of Storytelling in Risk and Quality

Risk Adjustment Strategies

• Discuss the heightened importance of complete and accurate risk adjustment and quality data, inclusive of EDPS, as a foundation for SDoH and care gap closure 
• Learn tools and strategies for accessing and using complete and accurate data when implementing SDoH programs and risk and quality care gap closure activities, inclusive of plan benefit design 
• Hear how one heath plan uses innovative new tools to understand the story the data tells as a foundation for delivering culturally competent healthcare 

Dawn Carter, Director, Product Strategy
Centauri Health Solutions

Eden Encarnacion, MHA, Director of Quality and Star Programs
Clever Care Health Plan

Improve Health Outcomes and Address SDoH with Fresh Grocery Delivery

Social Determinants of Health

• Discover innovative ways to improve member health with Food as Medicine 
• Improve members' diets and health outcomes, decrease care costs, and address social determinants of health (SDoH) by providing access to healthy foods 
• Engaging members in an interactive wellness program designed by health care practitioners with a focus on using Food as Medicine, with special attention to food security 

Moderator:
Dr. Shannon Decker, M.Ed., MBA, PhD., Vice President, Clinical Performance
Brown & Toland

Ashley Tyrner, Founder and CEO
FarmboxRx

Jennifer Spear, Associate Director of Population Health
Humana

The Value of Provider Quality in Digital Front Door Tools

Digital Health Care Delivery

• Examine how innovative health plans are leveraging new solutions to remain competitive, especially in exchange and individual markets 
• Unpack elements of provider quality like safety, efficiency, efficacy, and price as well as reveal new data insights on how virtual provider networks stack up in terms of quality 
• Discuss value-based strategies that health plans have used to ensure that virtual primary care is high-quality and clinically effective while still lowering costs 

Dr. Ian Tong, Chief Medical Officer
Included Health

Beth-Ann Roberts, President, Commercial Business
Point32Health

Real Life RA Compliance Failures:  How to Avoid Turning a “Glitch” Into a “Gotcha”?

Compliance and Regulatory Updates

• Understand the current state of the law in the RA context of how courts draw the line between what the U.S. Supreme Court has characterized as “garden-variety breaches of contract or regulatory violations,” which are not actionable under the FCA, and compliance failures that constitute actual fraud 
• Learn how RA compliance problems, if not addressed quickly and appropriately, can escalate into much bigger litigation headaches for an organization 
• Hear about real-life best practices for responding to internal whistleblower complaints, and how the active use of internal hotlines can add value and profitability to an organization 

Edward A. Baker, Of Counsel
Constantine Cannon LLP

Max Voldman, Attorney
Constantine Cannon LLP

Innovating with AI to Proactively Close the Gaps in Outpatient Care

Future of Healthcare

• Harness AI to identify patient risk and intervention opportunities 
• Proactively evaluate patient data to identify evidence of chronic/risk-adjusted conditions  
• Build a personalized patient approach to wellness and chronic disease management 

Mike S. Jones, Vice President & General Manager, Clinical Quality and Revenue Integrity 
Nuance Communications  

An Analytics-Driven Approach to Aligning Payer and Provider Incentives

Risk Adjustment Strategies

• Evaluate the maturity of payer-provider relationships to drive incentive program selection 
• Help providers, MSOs, and healthcare systems achieve success through analytic insights 
• Evolve payer-provider incentive programs to identify more mutually beneficial opportunities 

Jonas Foit, Senior Vice President, RQNC Analytics & Reporting
Cotiviti, Inc.

Avoid a Visit From the OIG: Practical Steps to Mitigate Risk

Social Determinants of Health

• Learn how to mitigate the risk of a plan having a poor audit result by performing targeted QA reviews on commonly miscoded conditions, single-occurrence conditions, and conditions not captured on claims. 
• Embed efficiency in your risk adjustment operations by focusing review efforts on what will most often impact the health plan’s risk score, audit risk, or members with known risk gaps. 
• Understand how to identify diagnoses that are inaccurate or not supported within the medical record to mitigate RADV risk and financial exposure

Lynne Padilla, Vice President of Risk Adjustment Solutions
Change Healthcare

Jimmy Liu, Vice President of Risk Analytics
Change Healthcare

What Would Failure Look Like for the ACA’s Risk Adjustment Program?

Compliance and Regulatory Updates

• Impact of reconciliation (or the absence of reconciliation) on the ACA landscape, enrollment, and risks 
• Recap beyond compliance for the commercial market– risk adjustment challenges for 2022 

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

The Authenticity Advantage: Your New Secret Weapon for Success

Special Presentation: Women in Heath Care Leadership

You've probably heard "Bring your authentic self to work" a hundred times in the last year [insert eye roll]. But here's the reality: being "yourself" at work probably feels like a fluffy unicorn that isn't really possible. 

During this talk, Erin will help you see that authenticity is a much more nuanced and complex concept. And, when embraced in this way, it turns authenticity from a passive, la-ti-da concept to your active, dy-no-mite advantage that will ensure you get the success you deserve, without compromising everything else.  

Grounded in her proprietary framework, The Six Principles of Strategic Authenticity (H.U.M.A.N.S.), she’ll provide some initial “plays” that will help you put your authenticity in motion as soon as you leave the session. Delivered of course with full-on authenticity, this talk will inspire you to break the crusty workplace "rules" to breakthrough to big success! 

Erin Hatzikostas, Founder
b Authentic
Former Corporate Health Care Financial Institution CEO turned Professional Pot-Stirrer
Author of You Do You(ish) and TEDx Speaker

Rehumanize Care Through Communication and Relationship Skills

Furture of Healthcare

The COVID-19 pandemic thrust health care into a virtual mode of delivery. Technology solutions, such as electronic health records and telehealth utilization, are often criticized in connection to dehumanization of care delivery and to provider burnout.  

Intersections between technology, human communication, and relationships pose both opportunities and threats to the quality of health care experiences. 

This session will emphasize opportunities to leverage digital health care tools, while maintaining a strong human connection through skills to strengthen communication and relationships. 

Participants will engage in brief interactive activities to demonstrate simple communication skill-building techniques.   

You will:  

1. Recognize opportunities to leverage digital health care tools to improve patient and clinician experiences. 
2. Explore communication skills to strengthen connections during in-person or virtual health care encounters. 

Laura Cooley, PhD, Senior Director of Education and Outreach 
Academy of Communication in Healthcare 
Editor-in-Chief 
The Journal of Patient Experience