The 11th ANNUAL
In its 11th year, the Annual RISE Nashville Summit is the healthcare industry’s premier event addressing risk adjustment, Stars, quality management, financial compliance, care management, performance analytics and engagement strategies. Featuring special presentations from healthcare’s most influential leaders, this comprehensive summit offers timely general session presentations, dynamic panel discussions, and solutions-focused sessions providing you and your team with the latest tools in risk revenue optimization, quality data, compliance and audit-readiness and so much more.
Featuring an Expanded Agenda Covering 40+ Topics.
This program has the prior approval of AAPC for 13 continuing education hours (10 for main conference and 3 for pre-conference workshops). Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. This approval is valid until 1/31/2018.
Rotating Workshops Exploring Integrative Technologies to Successful Risk and Quality Programs
Mastering the Essentials, an Intro to Risk Adjustment and Star Ratings
Navigating the Nuts and Bolts of Coding
Next Level Integration of Risk Adjustment for Quality and Care Management
7 Track Themes
Risk Adjustment: Medicare Advantage, Commercial, and Medicaid
Quality Performance: Star Ratings, HEDIS and CAHPS
Care Management, Coordination and Outcomes
Actionable Data Analytics and Predictive Modeling
Financial and Operational Compliance & Audit Readiness
Provider-Focus: Engagement and Collaboration
Topics on the RISE: 2017 & Beyond
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RISE welcomes inquiries on sponsorship of the RISE 2017 Conference. Sponsors enjoy a variety of benefits and recieve unmatched access to the healthcares most influencial audience. View Sponsorship Opportunities.
Advance Health is the leading healthcare provider of in-home and facility-based HRAs and care management services to the Medicare Advantage, Medicaid, dual-eligible and commercial markets. What differentiates the company is its combination of meaningful technology and national network of full-time, locally based Nurse Practitioners. This combination yields industry leading financial and clinical results with indisputable compliance and oversight. The Advance Health electronic health record is proven to recognize, document and address 100% of prior chronic or persistent conditions, and suspect conditions or disease progression statuses. With every assessment captured electronically, Advance Health delivers results in a matter of hours along with individual, actionable member and PCP follow-up. The rapid growth of risk-adjusted populations coupled with dramatically increased CMS and OIG scrutiny requires a partner as qualified as Advance Health.
Advantmed is a health information management company that helps managed care organizations optimize revenue and improve quality outcomes. Utilizing our Elevate! Healthcare™ platform to deliver and manage integrated products and services, we capture, organize and analyze financial and clinical data so clients can better understand their member populations to improve their quality of care and optimize risk-adjusted revenue. Advantmed delivers the optimal combination of capabilities unique to each client’s objectives, including risk analytics (ELEVATE! Risk Insights™), NCQA-certified HEDIS® Measures software (ELEVATE! Quality Insights™), medical record retrieval, medical record abstraction, risk adjustment coding, compliance and data validation services, member engagement, provider education and professional services. To learn more, please visit: www.advantmed.com
Altegra Health, a Change Healthcare company, provides technology-enabled, next-generation payment solutions using advanced analytics and supporting intervention platforms to enable health plans and other risk-bearing healthcare providers to generate, analyze and submit data needed to successfully manage member care and ensure appropriate reimbursement, allowing them to elevate care quality, optimize financial performance, increase cost transparency, and enhance member experience and engagement.
Apixio is the data science company for healthcare. Apixio’s proprietary cognitive computing platform extracts and analyzes clinical data in electronic and PDF health records, generating deep insights into patient health. It feeds these insights into applications such as HCC Profiler which enables fast, comprehensive, and accurate HCC coding review.
ArroHealth is the premier provider of risk adjustment and HEDIS services offering a suite of analytics, medical record retrieval and abstraction, data aggregation, risk adjustment coding, along with telehealth and telemedicine solutions. These services are offered on a unique and proprietary technology platform designed for excellence in results, quality and transparency. ArroHealth recognizes the importance of performance excellence and accuracy—by providing the most extensive guarantees in the industry. We focus on our clients and delivering solutions that accurately impact their risk adjustment and HEDIS programs, while offering insights into the health status of their members. In addition, we provide full transparency into all that we do for clients, allowing them to adapt quickly and maximize financial and clinical results. ArroHealth serves several of the top national health plans as well as many regional and local plans and is committed to accuracy, intelligence and impact for clients.
CenseoHealth is a leading provider of prospective health risk assessments for health plans and healthcare delivery organizations. Our physicians perform comprehensive, Annual Wellness Visit-compliant evaluations with members in their home, at network physician offices and in community settings. We capture a complete health and lifestyle assessment to drive better clinical outcomes through care management referrals and return-to-care recommendations. Our insights help enhance member engagement, improve quality ratings and reduce overall healthcare costs. Our network of nearly 5,000 licensed physicians are uniquely qualified to identify and diagnose health conditions. We have completed more than 1.5 million assessments, averaging more than 1,800 per day.
Centauri Health Solutions was founded to improve lives by revealing care opportunities within the health system. We create and deliver software and services that increase collaboration and visibility to solve complex problems for our clients. With insight into the unmet needs which currently exist in the marketplace, we have designed our Centauri platform of tools to deliver the truly transparent end-to-end integrated system that clients have asked for and deserve. We deliver data-driven services, private cloud-based software solutions, and comprehensive data management designed specifically for risk adjustment and quality-based revenue programs. Centauri seeks to improve member outcomes and financial performance for health plans and at-risk providers by supporting initiatives in risk adjustment, RADV risk mitigation, HEDIS®, Star Ratings and care gap management.
Our data agnostic platform makes it easier for our clients to have visibility into how physicians provide care and members receive care. We are committed to constant innovation in partnership with our clients, which is evident in how we develop and offer our products and services. Centauri’s product suite is a comprehensive technology platform, consisting of data integration, data analytics, workflow software and reporting / business intelligence software. Services offered from the Centauri platform include end-to-end risk adjustment and quality services for Medicare, Medicaid and commercial populations, including: medical record retrieval, abstraction and coding; health risk assessments and services and tools for both risk adjustment and quality measure gap closure.
Ciox Health facilitates and manages the movement of health information with the industry’s broadest provider network. Through our expertise in release of information, record retrieval, and HIM, we improve the management and exchange of health information by modernizing workflows, facilitating access to clinical data, and improving the accuracy and flow of health information.
DST Health Solutions, LLC delivers contemporary healthcare technology and service solutions that enable its clients to thrive in a complex, rapidly evolving healthcare market. Supporting commercial, individual, and government-sponsored health plans, health insurance marketplaces, and healthcare providers, DST Health Solutions’ services include enterprise payer platforms, population health management analytics, care management, and business process outsourcing solutions, each designed to assist a company manage the processes, information, and products that directly impact quality outcomes. DST Health Solutions is a wholly-owned subsidiary of DST Systems, Inc. For more information visit www.dsthealthsolutions.com.
EMSI Health empowers health plans with end-to-end risk-adjustment services for care management, quality support and improved risk score accuracy. We offer best-in-class risk analytics, in-home assessments, medical chart retrieval, HCC coding, risk profiles, audit support, and Stars and HEDIS measurement support to health plans in all markets. StratusIQ, our web-enabled customer portal and data repository, provides clients with easy and transparent access to their project data and our self-scheduling tool allows members to efficiently and conveniently schedule Healthy House Calls® anywhere, anytime. Our integrated approach leverages experienced industry professionals, proven and secure technology, and flexibility to produce the best quality results for health plans and improved outcomes for plan members. EMSI Health: Powerful Information. Improved Outcomes. Learn more at www.emsinet.com.
Episource provides US health plans and other risk adjusting organizations with powerful data analytics, tools, and insights to drive interventions, benefiting patients and providers alike.? Solutions offered include risk adjustment and quality data analytics, medical coding, encounter data submission, and medical chart retrieval.
As a healthcare business services and technology company, Episource is constantly striving to help its clients simplify the complex challenges of the healthcare industry with specialized services, and innovative technology. Headquartered in Los Angeles, the Company has over 1,500 professionals with extensive experience in risk adjustment.
FTI Consulting Health Solutions works closely with payers, providers and other healthcare enterprises to anticipate challenges, identify areas for potential growth and operationalize changes. We provide unparalleled expertise, analytics, innovation, and the necessary global reach to achieve success.
FTI can help you optimize performance in the short term and prepare for the inevitable strategic, operational, regulatory and financial challenges of the future.
Health Fidelity offers the most comprehensive, scalable risk adjustment solution for the value-based care era. Our modern prospective and retrospective RAF approaches combine big data analytics and natural language processing (NLP) technology to extract valuable insights from medical charts for faster and more accurate processing. With a streamlined coding workflow, Health Fidelity empowers risk-bearing organizations with a 360-degree view, allowing them to project, detect, and capture all commensurate member risk, and thereby risk-adjusted payments, to maximize efficiency, compliance, and reimbursement accuracy.
HealthFair has pioneered a new standard of care, operating the largest fleet of mobile medical centers nationwide. Since 1998, the company has grown to become the leading provider of mobile clinical solutions, providing prospective risk assessments and advanced diagnostic testing to individuals at convenient locations in their community. HealthFair delivers an innovative solution to improve access and provide efficient encounters focused on improving patient care, engagement, quality measures, and assessment of risk factors and conditions.
These state of the art mobile clinics can provide a wide scope of services within a comfortable clinical setting, from Comprehensive Evaluations, AWV’s, or Child Wellness Visits, to advanced diagnostics such as mammography, ultrasound, or diabetic retinopathy, all within one visit. HealthFair’s unique delivery system and proprietary assessment technology increases patient engagement and access to care, all while delivering encounters that are unparalleled in the industry from a quality and risk assessment perspective.
During a HealthFair visit, patients can complete labs, immunizations, wellness visits, and diagnostic imaging, minimizing the need for expensive and timely follow up appointments. Information is then shared back through a proprietary care coordination process which ensures that not only the right data is captured, but it makes it to the place where it’s needed most.
Learn more at www.HealthFair.com.
Inovalon is a leading technology company that combines advanced cloud-based data analytics, and data-driven intervention platforms to achieve meaningful insight and impact in clinical and quality outcomes, utilization, and financial performance across the healthcare landscape. Inovalon’s unique achievement of value is delivered through the effective progression of Turning Data into Insight, and Insight into Action®. Large proprietary datasets, advanced integration technologies, sophisticated predictive analytics, data-driven intervention platforms, and deep subject matter expertise deliver a seamless, end-to-end capability that brings the benefits of big data and large-scale analytics to the point of care. Driven by data, Inovalon uniquely identifies gaps in care, quality, data integrity, and financial performance – while bringing to bear the unique capabilities to resolve them. Inovalon provides technology that supports hundreds of healthcare organizations in 98.4% of U.S. counties and Puerto Rico with cloud-based analytical and data-driven intervention platforms that are informed by data pertaining to more than 804,000 physicians, 306,000 clinical facilities, and more than 137 million Americans. Through these capabilities, Inovalon is able to drive high-value impact, improving quality and economics for health plans, ACOs, hospitals, physicians, consumers and pharma/life-sciences researchers.
Matrix Medical Network is the leader in supporting care in the home through our national network of Nurse Practitioners. From in home assessments to chronic care support, Matrix helps health plans engage members and their physicians to ensure members receive needed care, improving their health and overall outcomes.
Medivo is a healthcare clinical diagnostics company that leverages a vast amount of clinical lab results using AI and advanced analytics technologies in its products to drive the right decisions earlier to improve health. Medivo has made significant progress growing their data assets and is now processing over 5B clinical lab test results. As the largest source of clinical diagnostics assets, these test results are from a growing network of lab partnerships. Medivo continues to connect with more labs and has a actionable clinical insights in key areas of concern to health plans including chronic conditions such as asthma, diabetes, cardiovascular disease, and cancer. Medivo provides an advanced analytics focus on dramatically improving care management, HEDIS / Star reporting, and risk adjustment processes. Through this Medivo can enable increases in reimbursement and improvement in quality throughout the year.
Learn more about Medivo at www.medivo.com or by reaching out to Bob Maluso on Medivo’s business development team at firstname.lastname@example.org. You can also follow Medivo on Twitter (@gomedivo) and LinkedIn (www.linkedin.com/company/medivo-inc).
Since 1990, MedXM has been a national leader in the design and implementation of preventive care technology and in-home health risk assessments for the purpose of care management, quality improvement, and member engagement. MedXM offers a complete network of connections between members, their health plan, and providers. MedXM is focused on delivering Risk Adjustment and Quality Solutions by providing clients with fully customizable healthcare solutions to fulfill specific needs. MEDXM can help develop and implement your preventive care management strategy to help your plan reach better financial and quality outcomes.
Mile High Healthcare Analytics is a new kind of healthcare technology and strategic consulting firm. We provide software technology to Medicaid managed care organizations (MCOs), Medicare-Advantage health plans, Exchange issuers, ACOs, and risk-bearing provider groups. One of Mile High’s software products, QISim, facilitates scenario-planning to map out a strategy for tracking quality improvement programs. Medicaid state- or ACO-specific scenarios can be created that focus on the measures that are key to redeeming capitation withholds and preventing the imposition of liquidated damages. QISim is optimized for Medicaid managed care, supporting all states that impose financial penalties or rewards on their MCOs. In addition to Medicaid, QISim supports Marketplace, Medicare-Advantage Stars, and ACOs. QISim also includes measure-level compliance tracking with dynamic scorecards at the plan level and with drill-downs to the member and provider levels. QISim provides insight into the measures that drive improvement, not a “laundry-list” of every measure.
Mile High Healthcare Analytics’ next-generation risk adjustment solutions include revenue management targeting built with a disease-specific clinical focus, reconciliation of EDPS/RAPS or EDGE data submissions, and operational consulting for health plans across lines of business struggling with optimizing financial performance. Mile High Healthcare Analytics can also provide business process assessments, operational assessments, and feasibility studies to improve the operational performance.?
Optum is a leading health services and innovation company dedicated to helping make the health system work better for everyone. With more than 100,000 people worldwide, Optum combines technology, data and expertise to improve the delivery, quality and efficiency of health care. Optum uniquely collaborates with all participants in health care, connecting them with a shared focus on creating a healthier world. Hospitals, doctors, pharmacies, employers, health plans, government agencies and life sciences companies rely on Optum services and solutions to solve their most complex challenges and meet the growing needs of the people and communities they serve.
Pulse8 is the only Healthcare Analytics and Technology Company delivering complete visibility into the efficacy of your Risk Adjustment and Quality Management programs. We enable health plans and at-risk providers to achieve the greatest financial impact in the ACA Commercial, Medicare Advantage, and Medicaid markets. By combining advanced analytic methodologies with extensive health plan experience, Pulse8 has developed a suite of uniquely pragmatic solutions that are revolutionizing risk adjustment and quality. Pulse8’s flexible business intelligence tools offer real-time visibility into member and provider activities so our clients can apply the most cost-effective and appropriate interventions for closing gaps in documentation, coding, and quality. For more company information, please contact Scott Filiault at (732) 570-9095, visit us at www.Pulse8.com, or follow us on Twitter @Pulse8News.
Based in West Hartford, Connecticut, SCIO Health Analytics is a leading health analytics solution and services company. It serves more than 80 healthcare organizations across the continuum including over 20 provider groups and 30 health plans representing more than 90 million members, four of the top six PBMs, and clients in 30 countries for 8 of the top 15 global pharmaceutical companies. SCIO provides predictive analytic solutions and services that transform data into actionable insights, helping healthcare organizations create the understanding that drives change through care, network and reimbursement optimization as well as commercial effectiveness. www.sciohealthanalytics.com
Talix provides patient risk management solutions to help healthcare organizations address the challenges of value-based healthcare and risk-based contracts. Its SaaS applications leverage patient data analytics to turn structured and unstructured health data into actionable insights that drive improved risk adjustment, better patient outcomes and reduced costs.
As healthcare adapts to an aging demographic, new payment models, and the rising cost of care, our clients face increasingly complex clinical and financial risk. Verscend Technologies (formerly Verisk Health) drives better healthcare outcomes through data analytics. Our solutions help organizations organize and optimize their data so they can efficiently and cost-effectively succeed in the new era of healthcare.
We offer an array of solutions that create value across four major functional areas:
Verscend has extensive experience helping healthcare payer organizations use their data in meaningful ways. We currently serve than 200 health plans, including regional and national plans with commercial, Medicare, Medicare Advantage, and Medicaid lives. Over more than two decades, we have built a reputation for the knowledge and integrity our team, our ability to organize data for smarter solutions, and our history of delivering quantifiable results.
For more information, please visit www.verscend.com.
WhiteGlove Health, is a healthcare provider that is focused on both treating the individual and achieving improved overall health, well-being and cost of populations. Our comprehensive healthcare strategy is to provide the highest quality of care at the lowest cost through highly skilled board-certified nurse practitioners in collaboration with physicians, hospitals, other health care providers and payers.
Glenridge HealthCare Solutions, is a wholly owned subsidiary of WhiteGlove Health, Inc. Glenridge is a full-service network management solution to leading national and regional health plans, health systems and ACOs. Through the use of proprietary technology, we provide professional and consulting services and develop network strategies that enable sustainable growth and profitability.
For more information please visit us at: www.whiteglove.com,
www.glenridgehealth.com, or call 888.976.7660.