RISE Nashville Summit brings you the most comprehensive agenda that truly epitomizes a dynamic learning event with eight tracks and over 40 sessions, topics addressing existing and emerging industry issues including risk revenue management, quality improvement, member engagement and care management, payer-provider collaboration, new technologies and advanced analytics, and policy updates. 


This program has been approved for 17.5 max continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.

This program has the prior approval of AAPC for 21 continuing education hours max (main conference plus workshops A/B approved for 21 CEUs; main conference plus workshops C/D/E approved for 16 CEUs; main conference only approved for 13 CEUs). Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. This AAPC approval is valid until 1/31/2020.

Sunday, March 17th

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

8:00 – 4:00

Workshop A: Foundation of Risk Adjustment

- 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 EDPS? The latest in a long journey
- Provider engagement strategies for impacting 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


Deb Curry, MBA, RHIA, CCS-P, CRC, Manager, Risk Adjustment

Laura Sheriff, RN, MSN, CPC, CRC, Regional Director, Risk Adjustment |FL, MI, NM, NY, OH, SC, TX
Molina Healthcare, Inc.

Scott Weiner, CMA, CFM, MBA,
President, Quadralytics
Director of Risk Programs, Virginia Premier Health Plan

8:00 – 4:00

Workshop B: HCC Coding Accuracy

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
- Billing E&M CPT codes
- 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)

Donna Malone, CPC, CRC
Senior Manager, Enterprise Risk Adjustment, HCC Coding and Quality Assurance

Tara Russo, MPH, CPC, CPMA, CRC, CPC-I
Vice President of Navigate Directorate, Vice President of Medicare Risk Adjustment and HEDIS Quality Initiatives
Island Doctors

11:00 – 1:00
Workshop C, D & E Registration Opens

1:00 – 4:00

Workshop C: Active Intelligence: Breakthrough Technologies Revolutionizing Risk, Quality, and Related Analytics for Value-Based Care

AI and Value-Based Care: Joining Forces for Better Outcomes
- Learn how to thrive amidst more sources, more data, and more demands with fewer resources and less lead time
- Set it and forget it: Learn how to set objective-based performance corridors so the machine alerts you when a provider group needs attention
- Learn and adapt: Let the machine learn and inform you when a group needs attention due to unusual behavior

Shifting Gears: How Value-Based Care is Transforming the Quality Landscape
- Make it Real – Learn how plans can support providers and align incentives to improve quality ratings
- Understand how value-based care is changing the landscape for health care providers and health payers
- Learn key strategies for risk adjustment and quality programs that are critical to successfully managing the shift

The 3 Ps – Payers, Providers, and Pharma: How Value-Based Care must be a Collaborative Effort
- Incorporating member preferences and social determinants into an integrated risk, quality, and clinical program
- Using AI to develop interventions that leverage personal preferences regarding healthcare system access
- Driving a higher level of performance for risk, quality, and cost by leveraging the pharmacy benefit, information, and network

Kari Hadley, Senior Director, Medicaid and Quality Products

Jennifer Hunt, Director, Actuarial Services         
Paramount Health Care

Scott Fries, Executive VP, Pharmacy Solutions

Scott Stratton, Chief Data Scientist & VP, Product Analytics

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

1:00 – 4:00

Workshop D: Advanced HCC Audit Preparation

- Knowing your audit risks from a provider documentation and coding perspective
- Selecting and auditing your vendor partners
- Building and keeping your coding team with efficient and effective standards

Wynda Clayton, Risk Adjustment Manager
Providence Health Plan

Colleen Gianatasio, Risk Adjustment Quality & Education Program Manager
Capital Districts Physicians’ Health Plan

1:00 – 4:00

Workshop E: Key Strategies to Succeed (and Profit!) in Medicare Advantage

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

Over the coming years, industry profits will continue to shift toward a smaller number of winning high-performing plans. These winners will have more cash flow to invest in critical differentiated capabilities and to enhance their market position. You can’t afford to stand still.  Don’t just survive, but THRIVE, amidst the current challenges of cost pressures, performance-driven reimbursement rates and increasingly demanding compliance requirements. Join the conversation as we discuss key areas in which to focus investment, time and energy in this highly engaging, interactive workshop.

- Provider Network Strategies
- Payment Innovations: New ways to tie payment to value and quality in order to improve health outcomes and reduce unnecessary spending
- Network Management: Key strategies to refine the provider network, support analysis and reporting, and improve provider engagement
- Enhanced Care Models
- Manage delivery of health services through new robust, coordinated care models and innovative benefit design
- Leverage technology solutions across your enterprise to customize the member experience, improve engagement and provide integrated care coordination
- Risk-Based Compliance Approach
- Tap into member-centric data analysis to identify the greatest areas of compliance risk
- Foresee potential future compliance problems and line up resources to prevent or mitigate negative impact
- Address highest impact risk areas in the short and long-term
- Member Experience
- Serve the “new” tech-savvy MA member by successfully harnessing their technology expertise and expectations
- Identify and respond to member needs by creating differentiated user experiences along the care continuum



Ana Handshuh, Vice President, Managed Care Services
Ultimate Health Plans

Dave Meyer, Vice President, Stars

1:00 – 5:00
Main Registration Opens
4:30 – 6:30
RISE Welcome Reception in Exhibit Hall

The luck of the Irish is on your side this St Patrick's Day at RISE Nashville. Don your brightest green, bowler hats, and shamrock out with us at the RISE Welcome Reception. 

Monday, March 18th

7:00 - 8:30
Registration and Networking Breakfast
7:00 – 6:35
Exhibit Hall Opens

8:30 – 8:45

Opening Remarks

Conference Chairs:
Nathan Goldstein, Chief Revenue Officer
Signify Health

Ana Handshuh, Vice President, Managed Care Services
Ultimate Health Plans

Introduced by:
Kevin Mowll, Executive Director
The RISE Association

8:45 – 9:45

Keynote Address- Dr. John Medina

Acknowledged as one of the most engaging and crowd-pleasing speakers in the world of neuroscience, Dr. Medina is a developmental molecular biologist, researcher, professor and the author of ten books. His New York Times bestseller, Brain Rules: 12 Principles for Surviving at Work, Home and School has been celebrated as the standard handbook on understanding the brain and optimizing its performance. Brain Rules has been translated into more than 20 languages and selected as a textbook at numerous universities. Dr. Medina’s focus is on the genes behind brain development and psychiatric conditions. He has spent most of his professional life as an analytical research consultant, working primarily in the biotechnology and pharmaceutical industries on research related to mental health. He also consults with hospitals and healthcare facilities on designing brain-healthy environments that reduce staff stress and improve patient outcomes. Recently, he expanded his interest in how the brain interacts with environments to office spaces, teaming up with award-winning architecture firm NBBJ. Dr. Medina is an Affiliate Professor of Bioengineering at the University of Washington School of Medicine. He is also the Founding Director of the Talaris Research Institute studying how infants encode and process information at the cognitive, cellular and molecular level. Dr. Medina’s extensive study of the developing brain at different stages of life resulted in his most recent book, Attack of the Teenage Brain! Understanding and Supporting the Weird and Wonderful Adolescent Learner. He is also the author of Brain Rules for Baby and Brain Rules for Aging Well.

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

9:45 – 10:05

The Dr. Martin L. Block Award for Excellence and Innovation

10:05 – 10:35
Networking Break in Exhibit Hall

10:35 – 11:35

Plenary Session: Health care Hot Topics – An Audience-Driven Discussion with the RISE Executive Advisory Board

Join a panel of leading health care experts and solution providers as they address questions submitted by attendees themselves two weeks prior to the conference. This timely and lively discussion will tackle challenges in the healthcare industry including the latest risk adjustment strategies, impact of government program reform and changes in audit protocols, innovations in technology, as well as implications from the 2019 call letter released by CMS. This is a session you do not want to miss. 

Nathan Goldstein, Chief Product Officer
Signify Health

Sean Creighton, Vice President
Avalere Health

Ana Handshuh, Vice President, Managed Care Services
Ultimate Health Plans

Dave Meyer, Vice President, STARS

Jennifer Pereur, VP of Solutions
Formerly Director of Government Programs for Hill Physicians Medical Group

11:40 – 12:25

Concurrent Sessions

Risk Adjustment Strategies

Risky Business: Accurately Generating Financial Projections from EDPS/RAPS Submissions

- Learn how to fit the pieces together in the Medicare Risk Adjustment Model in order to predict revenues around EDPS impact, final revenue, and program ROI
- Dive into the areas of the prospective model that will better prepare you for the sweeps timeline
- See how to reconcile your final EDPS based payments and how to use the data and model to forecast the retroactive payment

Meleah Bridgeford, Director, Risk Adjustment Analytics 

Dominic Henriques, Director of Quality Improvement and Risk Adjustment
Prominence Health Plan

Quality, Accountability and Transparency

How to Utilize your Risk Adjustment Reviews for Provider Education

Identifying which providers are in the need of the most assistance
Grouping documentation education by risk adjusted conditions 
Best practices in preparing providers for changes in documentation 
Introducing incentives for quality of documentation


Fia Roberts, Senior Director, Risk Adjustment Program Oversight, Provider Performance and Analytics
Health Net, Inc.

Rachel Nelson, Director, Payer Solutions
GeBBS HealthCare Solutions

Member Engagement and Care Outcomes

Panel Discussion: Strategies for members seen by network PCPs to improve risk adjustment and quality measures

- Health plan and physician’s perspectives on risk adjustment and quality measures
- Drive consistency in data capture for CMS submission without impeding face-to-face interaction
- Go in-depth on the challenges PCPs encounter with prospective programs
- Hear best practices for optimizing prospective programs and overcoming PCP challenges to increase patient and PCP satisfaction


Lisa DiSalvo
Signify Health


Kevin Kearns, MD, Chief Medical Officer
Signify Health

Dr. Mark Dambro, CMO
Signify Health

Kathleen Faulk (Kat), General Manager Government Programs

Dr. Joe Jasser, CMO
Signify Health

Data Management and Analytics

Augmented Intelligence: How to Optimize Risk and Quality Analysis

- Learn about augmented intelligence and how to implement it
- Utilize augmented intelligence to streamline and improve your risk adjustment and quality programs, care authorization, and physician referrals
- Increase productivity and accuracy of your healthcare experts to perform key activities in healthcare delivery


Nina Foreman, CPC, Director of Risk Adjustment Program
St. Joseph Heritage Healthcare

Darren Schulte, MD, Chief Executive Officer

Trends and Developments

Cybersecurity, Hackers and Health care – Protecting your and your Members’ Information

- Embracing technology and innovation while keeping vigilant to fraud, identity theft and cyber attacks
- Learn and stay ahead of current hacking techniques, malware and ransomware that jeopardize your network and data
- Develop internal security awareness program and protocol in case of a security breach



David Andrews, Chief Technology Officer
Visualize Health

John Bandler, Founder
Bandler Law Firm PLLC
Bandler Group LLC

12:25 – 1:40
Networking Lunch

1:40 – 2:25

Concurrent Sessions

Risk Adjustment Strategies

360 Risk Adjustment: Health Plan and Provider Perspectives

- Panelists from across the spectrum of risk-bearing organizations will share their experience with NLP-enabled payer-provider collaboration tools in pursuit of risk adjustment optimization within a variety of at-risk payment models
- Review the programs, processes, and workflows leveraged to enhance prospective identification, point of care documentation, pre-claim billing accuracy, and retrospective reviews for enhanced clinical, financial, and operational outcomes
- Discover how AI, machine learning, and analytics come together to transform risk adjustment performance through superior identification, prioritization, and confirmation of population risk

Steve Whitehurst, Chief Executive Officer
Health Fidelity

Wynda Clayton, MS, RHIT, Risk Adjustment Manger
Providence Health Plan

Helen Brown, Risk Adjustment Revenue Manager
Security Health Plan

Mari Finley, Executive Vice President, Silverback Care Management
North Texas Specialty Physicians BOD

Dr. Adele Towers MPH, FACP, Senior Clinical Advisor
UPMC Enterprises

Quality, Accountability and Transparency

Innovative Care Gap Strategies: The Evolution of Accessible and Convenient Advanced Screenings and Diagnostic Testing

- Major advancements in screening and testing technology means more affordable, convenient and accessible care for members
- Capturing multiple diagnoses and completing key follow up tests can now be accomplished in a single visit
- Engaging members by offering a choice of alternative venues increases member engagement

Carmen Hill-Mekoba, DNP, APRN-BC, CCM, COHN, Senior Vice President, Clinical Services
Matrix Medical Network

Dr. Martin Wesolowski,  DO, MBA, Medical Director of Strategic Programs
Martin's Point Health Care

Member Engagement and Care Outcomes

Improve Patient Health with a Holistic Approach to Quality and Risk Adjustment

- Impact members’ health positively – find out how analytics help identify the best engagement programs and close gaps
- Tailor information effectively to share with different providers -- hear about best practices to tailor information that fits seamlessly into provider workflows
- Match provider incentives to drive risk and quality performance - gain insights into aligning incentives to increase patient and provider satisfaction

Jason Eschbach, Regional Vice President, Field Operations 

John Barkley, Director, Medicare and Commercial Risk Adjustment

Data Management and Analytics

“Drowning in Data” – Practical Approaches to Data Management to Power Your Analytics

- How healthcare data has changed and what is needed to simply manage the ever-increasing amounts of data
- How to use data more effectively to support informed cost and quality initiatives and drive data-enabled collaboration
- Data management “best practices” and how to evaluate partners in managing big data

David Costello, Ph.D, Chief Analytics Officer

Sumant Rao, Senior Vice President, Data Operations

Kiran Raja, Vice President and Practice Leader

Divya Patel, Director, Data Analytics
Marsh and McLennan Agency 

Scott Mayer, Director, Data Analytics
AP Benefit Advisors, LLC 

Steve William, Sr. Vice President
Precept Group

Trends and Developments

Disrupting Risk Adjustment Economics with NLP: A Health Plan Success Story

- Learn how a health plan implemented an NLP enabled coding solution to take control of their risk adjustment program and successfully improve performance, productivity and accuracy
- Hear about the primary levers that resulted significant cost savings and ROI within months of going live
- See how these disruptive economics apply to not only health plans with in-house coding teams, but also to health plans that use 3rd party coding services 


Shahyan Currimbhoy, SVP Product Management and Engineering

Jeff Snegosky, MBA, CPHQ, Director of Program Management and Operations, Star and Risk Adjustment Center of Excellence
Blue Cross Blue Shield of Minnesota

2:30 – 3:15

Concurrent Sessions

Risk Adjustment Strategies

The Collaboration Trifecta: Improve Risk Score Accuracy through True Provider Engagement

- Improve quality of care for members through true collaboration between payers, providers and
- Learn how real-time interactions with providers take prospective programs to the next level
- The proof is in the data: high-touch provider engagement leads to improvements in risk adjustment


Jeffrey De Los ReyesDirector, Risk Adjustment, Medicare 

Paula Lempart, Regional General Manager

Quality, Accountability and Transparency

How Cultivating a Culture of Quality Can Support the Transformation to Value-Based Care

- Understand the importance and reasons for having quality improvement initiatives
- Examine a framework for developing a culture of quality
- Learn how to plan and implement a quality improvement program


Dave Meyer, Vice President, Stars

Mayank Shah, MD, Chief Medical Officer
CareAllies At Home

Member Engagement and Care Outcomes

Mining the Gaps: Using Analytics to Develop Provider Education Strategies

- Simultaneously identify risk adjustment and quality care gaps
- Analyze member patterns and provider trends
- Develop and deliver actionable provider scorecards

Gail Boettcher-Bruno, RN, Director, Client Services
Centauri Health Solutions

Carol Davis, LBSW, CPC, CRC, Executive Director of Provider Engagement and Risk Adjustment
VIVA Health

Data Management and Analytics

Achieving Payer Technology Innovation Results with Machine Learning and Artificial Intelligenc

- Harness the power of all your data to reveal insights that can transform your business
- Leverage AI and Machine Learning models to make continuous improvement to algorithms over time
- Combine disparate sources of data without complex customization to add value to existing suspecting logic

Jimmy Liu, Vice President, Risk Analytics
Change Healthcare

Rich Hall

Andrew Fannon, Director Actuarial Services

Travis Parker, Associate Actuary

3:15 – 3:45
Networking Break in Exhibit Hall

3:45 – 4:30

Concurrent Sessions

Risk Adjustment Strategies

Is There a Link Between Risk Adjustment and Care Management?

- What’s next on the horizon for quality and risk adjustment?
- Using care management strategies for risk adjustment and quality initiatives
- Next generation home assessments with clinical coordination to improve clinical outcomes
- How does an advanced in-home assessment program coordinate risk adjustment and quality to affect clinical outcomes?


T.K. Desai, MD, Chief Medical Officer

Scott Howell, DO, Chief Medical Officer
Vitality Health Plan of California

Quality, Accountability and Transparency

Detailing the Pros and Cons of Natural Language Process; Is it the Right Solution for You?

- What is NLP and how can it be used in an effective medical coding program
- What controls should be in place to ensure that your use of NLP is in compliance with coding guidelines
- How could ongoing investigations and regulatory changes impact the use of NLP going forward


Kyle Campbell, Manager, Professional Documentation and Coding
Intermountain Healthcare

Biggs Cannon, Senior Managing Director, Health Solutions
FTI Consulting

Jason Christ, Member of the Firm
Epstein Becker & Green

Wayne Gibson, Senior Managing Director, Health Solutions
FTI Consulting

Member Engagement and Care Outcomes

Evolving your Member Engagement Approach Using Socioeconomic, Behavioral, and Environmental Data

- Learn best practices for identifying and quantifying the impact of SDOH on health outcomes
- Adjusting and changing dynamics to address population statistics and enhance reach and engagement
- Explore solutions to reduce inpatient admissions, decrease cost and improve quality of care


Shannon Decker, MEd, MEd, MBA, MBA, PhD, Executive Director, Risk Adjustment  
NAMM California, UnitedHealth Group

Merrill Friedman, Senior Director Disability Policy Engagement

Data Management and Analytics

Solving Data Challenges with Lab Data & AI

  • Can you use data to predict near sick and high cost patients? 
  • The new payer breakthrough: applying AI to clinical data for actionable insights 
  • How AI driven insights lead to differentiated outcomes for payer 


Frank Jackson, EVP, Payer Markets 

4:35 – 5:35

Roundtables Part One - Select from 15 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 endeavors. A bell will ring three times within this special 60-minute session, alerting you to transition to the next roundtable of your choice

5:35 – 6:35
Networking Cocktail Reception in Exhibit Hall

Tuesday, March 19th

7:30 – 9:00
Networking Breakfast
Exhibit Hall Open

8:00 – 9:00

Roundtables Part Two - Select from 15 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 endeavors. 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 – 9:05

Day Two Welcome Remarks and Day One Takeaways

Conference Chairs:

Nathan Goldstein, Chief Product Officer
Signify Health

Ana Handshuh, Vice President, Managed Care Services
Ultimate Health Plans

9:05 – 9:55

Keynote Address- Aron Ralston

An ordinary man pushed to extraordinary limits, Aron Ralston takes you inside the story that captured international headlines in which he proves that courage, perseverance and the human spirit can help you triumph over tough challenges when the stakes are extraordinary. An experienced climber and avid outdoorsman, Aron was canyoneering alone in Utah when he became trapped between two boulders in a remote location for more than five days, ultimately freeing himself by severing his own arm with a pocketknife. His harrowing tale captivated global news outlets and remains one of the most incredible and extreme survival stories of all time.    

Aron recounts his ordeal in searing detail in his New York Times best-selling book, Between a Rock and a Hard Place, which inspired the major motion picture, 127 Hours, starring James Franco.   On stage, he brings his gripping story to life – and audiences to the edge of their seats. With great candor and humility, Aron reflects on his remarkable triumph over insurmountable odds, and shares the lessons he learned about the importance of examining one’s priorities and outlook on life. Take away a true appreciation for the power of the human spirit and the value of relationships to overcome life’s challenges, no matter how large or daunting one’s “boulder” may be.

Aron Ralston-RISE Nashville 2018.png
Aron Ralston
Fearless Adventurer & Subject of the Film, 127 Hours
9:55 – 10:10
Networking Break in Exhibit Hall

10:10 – 10:55

Plenary Session: CMS Policy Update and Q&A


Nathan Goldstein, Chief Product Officer 
Signify Health

10:55- 11:45

Keynote Address - Kelly J. Clark

Kelly J. Clark, MD, MBA, currently serves as President of the American Society of Addiction Medicine, the largest group of physicians specializing in addiction in the country with over 6,000 addiction physician specialists and allied health professionals.  In addition to direct clinical practice, Kelly has focused her career on issues of addictive disease, evidence informed and quality behavioral health care, and payment reform.  Board certified in both psychiatry and addiction medicine, Clark founded Addiction Crisis Solutions to provide both consulting and education of all stakeholder groups in the service of transforming addiction care into evidence-based, cost-effective practice.

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Kelly Clark, MD, MBA
American Society of Addiction Medicine

11:45- 12:30

Office of the Inspector General Update and Q&A

Joanna Bisgaier, PhD, Deputy Regional Inspector General 
U.S. Department of Health & Human Services 
Office of Inspector General 
Office of Evaluation and Inspections

Rosemary Rawlins, Social Science Research Analyst
U.S. Department of Health & Human Services 
Office of Inspector General 
Office of Evaluation and Inspections


Nathan Goldstein, Chief Product Officer
Signify Health

12:30 – 1:25
Networking Lunch

1:25 – 2:10

Concurrent Sessions

Risk Adjustment Strategies

Developing Strategies and Standards Around Building an Internal Coding Team

- Identify production and quality standards, challenges and successes
- Establishing robust lines of communication with internal teams that result in efficiencies and clear goals setting
- Supplementing internal efforts with vendors to ensure consistency and maintain high productivity

Kristen Viviano, CPC, CRC, Risk Adjustment Coding SupervisorCAPITAL DISTRICTS PHYSICIANS’ HEALTH PLAN

Colleen Gianatasio, Risk Adjustment Quality & Education Program Manager

Quality, Accountability and Transparency

Tools and Strategies to Positively Affect your Star Measures through the Member Experience

- Utilizing “Tests of Change” to find where your biggest successes can be
- Thinking outside the box – going against the current can lead to big gains
- Continuous improvement – just because it works well doesn’t mean it can’t work better
- Scaling departments together can lead to big gains in both – why Quality and Risk Adjustment should go hand-in-hand
- Member experiences directly impact the clinical effectiveness of care – why you should be ensuring members have a positive experience

Audit Readiness and Compliance

Recent Risk Adjustment Government Enforcement Actions and What to do Now

- Review of False Claims Act cases and settlements shaping the industry
- Identifying key risk areas for plans, vendors and providers
- Strategies to be compliant without putting yourself out of business
- Preparing for a whistleblower or government inquiry now

Jason Christ, Member of the Firm
Epstein Becker Green

Teresa Mason, Senior Legal Counsel, RN
Epstein Becker Green

Olga Ziegler, Vice President of Revenue Program Management 
Highmark Inc.

The Future of Healthcare

The Three Futures | Accelerating Data-Driven Healthcare

- How changes in clinical standards, technology, and policy are shaping the way medicine is practiced today
- Discuss key market changes that will affect plans and providers in the next five years and beyond
- Learn about potential changes to entitlement programs, the expanding role of states to oversee health programs in their states, efforts to improve affordability of drugs, and initiatives to promote value-based care


Lindy Hinman, Senior Vice President, Health Plans and Managed Care
Avalere Health

Will Kinsman, Manager, Product

George Lyford, VP, Legal and Chief Compliance Officer
Bright Health Plan

Charles Zonfa, MD, Chief Medical Officer

Trends and Developments

Success Stories and Case Studies: Innovative Approaches to Provider Education and Resource Maximization

- Tailoring outreach initiatives based on provider size, location, risk-based contracts as well as FFS
- Developing corrective plans and creating accountability for systematic problems around data and client information
- Creating the right incentive programs and partnerships with providers in order to receive useful information for your risk adjustment program


Rob Bramblett, Chief Operating Officer/Clinical Data Scientist
Visualize Health

Mark Wiacek, Chief Information Officer & ACO Executive
White Wilson Medical Associates

2:15 – 3:00

Concurrent Sessions

Risk Adjustment Strategies

Lessons Learned: Combating Opioid Epidemic in Today’s Environment

- Enlisting collaboration from providers to reduce opioid prescriptions
- Assigning resources and making treatment accessible to members
- Partnering with community stakeholders to address addition and find solutions
- Utilizing data to find optimal methods to engage members and their families for preventive care


Randall M. Taubman MD, CPE, Assistant Affiliate Professor of Medicine
Florida Atlantic University

Paul Cheek, Physician Assistant HIMSS
Visualize Health

Audit Readiness and Compliance

Be the Hero, How to Take a Step-Change Improvement in your Retrospective Chart Review Process

- Case study: Learn how BCBSMN was able to achieve a 60%+ reduction in their operating budget and increase the quality of their output at the same time
- Hear from National Solutions, a newly formed sister company to BCBSMN that is making available the validated tools and tailored roadmap you need to achieve similar results
- Walk away with the information to help take the next step in your journey toward operational excellence


Chris J. Taylor, Sr. Director Innovation & Commercialization
National Solutions a Stella Health company

Jeff Snegosky, MBA, CPHQ, Director of Program Management and Operations, Star and Risk Adjustment Center of Excellence
Blue Cross Blue Shield of Minnesota

Provider Collaboration

Day in The Life of a Physician: Starting a Dialog and Strengthening Partnerships

- Closing gaps and addressing coding challenges
- Leverage connections and driving value-based treatment across the board
- Utilizing technology to improve documentation and diagnosis accuracy


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

Greta Moseley, CMS Program Specialist / Software Developer
Visualize Health

The Future of Healthcare

High-Tech Meets High-Touch: Leveraging Emerging Technology to Deliver Better Member and Patient-Centric Results

- Separate legitimate emerging tech opportunities from the ‘hype” in today’s buzz-word heavy landscape
- Understand practical, real-life scenarios where application of emerging technology enables more relevant, higher touch member and patient interactions
- Discuss industry, business, member and patient implications as a result of widespread adoption of key emerging technologies


Gaurishankar Chandrashekhar, Director - Revenue Management
Harvard Pilgrim Health Care

Michael Patti, Principal, Healthcare Consulting and Health Plan Practice Leader
Baker Tilly

Data Management and Analytics

Technology and Data Analytics, an Agent of Change to Achieve Outcome Optimization

  • Understand the importance of a dual provider strategy using information to manage both immediate member needs and anticipate member’s future needs to initiate early interventions 
  • Hear real-world experience from a health plan currently using advanced analytics to share data with providers 
  • Learn about new provider intervention technologies on the pharmacy benefit side   


Dao Dang, Sr. Director, Product Innovation 
DST Pharmacy Solutions, INC. 

Terri Johnson, MHA, BSN, RN, Director of Quality Analytics 
Blue Cross Blue Shield Rhode Island 

Amy SallsDirector, Population Health Strategy  
DST Health Solutions

Gary Kitching, Director of Health Informatics

Melissa Sherry, MPH, CPH, Director of Population Health Innovation & Transformation
Johns Hopkins HealthCare

3:05 – 3:35
Networking Break in Exhibit Hall

3:35 – 4:20

Concurrent Sessions

Risk Adjustment Strategies

High Performing Plan: Can Members Drive the Highest Performing Plan?

- The math reveals how members can help drive the highest performing plan
- Align best practices to drive plan revenue opportunities
- Increase quality and engagement through member health actions

Jean Arrington, SVP, Chief Innovation Officer
HealthMine, Inc.

Mike Turrell, CEO
Ultimate Health Plans, Inc.

Provider Collaboration

Positively Impacting RA though Meaningful Chart Reviews and Provider Education

- Utilizing chart review as a tool to education providers – what works and what doesn’t
- Dissecting chart information to help doctors improve accuracy and completeness
- Developing a plan for chart audits and corrective actions


Sonal V. Mankodi, MD, Medical Director/Internal Medicine
North Shore Physicians Group 

Donna Malone, CPC, CRC, Senior Manager, Enterprise Risk Adjustment, HCC Coding and Quality Assurance  
Tufts Health Plan


Audit Readiness and Compliance

Lessons Learned and Expectations: Preparing for RADV Audits

- Preparing your team, setting procedures and committing to a being “audit ready” at all times
- Creating a tool kit for your coding team to work more accurately and efficiently
- Learn strategies for dealing with past inaccurate medical history or problems during an audit


Christine D’Amico, Vice President


Wynda ClaytonRisk Adjustment Manager 
Providence Health Plan 

W. Todd Gibson, MHA, Risk Adjustment Compliance and Medical Record Integrity Lead, Risk and Revenue Management

Trends and Developments

Early Warning System: Utilizing Data to Optimize Preventive Care Management

- Learn the latest predictive methods based on data and analytics
- Leverage big data to identify conditions and optimize care
- Identify the best course for intervention and population management


Puneet Budhiraja, ASA, FCA, MAAAVP / Chief Actuary 
Capital District Physicians' Health Plan

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

Trends and Development

Revolutionizing Health care with Blockchain Technology

- Utilizing blockchain technology to increase data quality and accuracy
- Exploring the benefits of blockchain including operational cost reduction and decentralized content management system
- Understanding the regulatory and transparency challenges surrounding the use of blockchain technology

4:25 – 5:10

Executive Advisory Board - Roundtable Discussion: Lessons Learned and Strategies to Succeed in 2020

The conference concludes with a compelling discussion dissecting key takeaways from this year’s conference and tools to help you navigate healthcare’s evolving landscape.

Kevin Mowll, Executive Director 

John Broderick, MD, FACEP, CPE, Chief Clinical Officer - East 
Landmark Health  

Patrick Coulson, Chief Growth Officer

Scott Filiault, Chief Revenue Officer 

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

5:10 – 5:15
Closing Remarks