Agenda

RISE Nashville 2020 Conference Agenda

The #1 Trusted Source For Risk Adjustment, Quality, Stars, And Beyond

We've carefully designed our conference program with all of our attendees in mind. 

Conference agenda features 5 pre-conference workshops, 35+ concurrent sessions, 40+ presentations, 3 keynote speakers, 5 targeted learning tracks, and more. 

March 15, 2019

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

8:00 AM - 4:00 PM

Workshop A - Risk Adjustment Practitioner

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

Instructors:

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

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

8:00 AM - 4:00 PM

Workshop B - Advanced HCC Auditor

The HCC Coding for Accuracy workshop is not just for those directly involved in HCC coding work. It is designed for other disciplines, as well, including finance and analytics professionals. Join us for an introduction to best practices, the opportunity to work through case examples, and to share experiences with your peers. This workshop will zero-in on regulatory compliance while teaching you how to optimize the accuracy of the information gathered and submitted at the practice level. What you will also learn about the way charting is often done, how to overcome “disconnect” with the clinicians and how their typical charting practices and EMRs can create significant problems, and how RADV views documentation in contrast with the way clinicians were taught and EMRs were built initially. Please note: Attendees are encouraged to bring questions to pose to our expert workshop facilitators and to table for the group. We provide your workbook which includes copies of the slide deck. You will not need your coding manuals, but most people bring a laptop or a tablet, as well, for note-taking.   

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

  • Understanding the financial overlay – HCC codes mapping to risk adjustment scores   
  • A single coding and documentation process for  
  • Quality improvement  
  • 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) 

Instructor:

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

Colleen Gianatasio, Director of Ambulatory CDQI
Mount Sinai Health Partners

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

1:00 PM - 4:00 PM

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

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

  • Advanced analytics for risk adjustment and quality in the age of improved connectivity & interoperability
  • Reducing provider burden for better engagement and outcomes in a shifting healthcare landscape
  • Balancing spending on Social Determinants of Health (SDOH) and medical/pharmacy costs

Instructors:

Scott Fries, Executive Vice President, Pharmacy Solutions
Pulse8

Jennifer Hunt, Administrative Director, Actuarial Services
Paramount Healthcare

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

Courtney Yeakel, Chief Product Officer
Pulse8

 

1:00 PM - 4:00 PM

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

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.  

 

Instructors:

Ana Handshuh, Principal 
CAT5 Strategies

Dave Meyer, Vice President, Stars
Cigna

1:00 PM - 3:00 PM

Workshop E - Attention Spans and the Human Brain More intimate

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

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

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

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

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

March 16, 2019

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

8:30 AM - 8:45 AM

Opening Remarks

Ellen Wofford, Managing Director
RISE

Introduced by:
Kevin Mowll, Executive Director
RISE Institute

8:45 AM - 9:45 AM

Keynote Address

9:45 MA - 10:05 AM

Dr. Martin Block RISE Excellence and Innovation Award

10:05 AM - 10:35 AM
Networking Break

10:35 AM - 11:35 AM

OIG’s Identification of Vulnerabilities that Exist in Medicare Advantage

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

Megan H. Tinker, Senior Advisor for Legal Affairs
Office of Counsel to the Inspector General
Office of Inspector General
U.S. Department of Health and Human Services (HHS)

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

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

11:40 AM - 12:25 PM

Concurrent Sessions

Risk Adjustment Strategies

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

 

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

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

Harshith Ramesh, Co-CEO
Episource

Provider/Payer Collaboration

Improve Provider Engagement: Present Risk Gaps in the Provider Workflow

A More Effective Way to Achieve Significant Risk Adjustment Results 

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

Jimmy Liu, Vice President, Risk Analytics
Change Healthcare


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

Technology and Analytics

Connecting Health Care: The Future of Clinical Interoperability

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

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

 

Social Determinants of Health

Privacy and Collaboration: Can We Really Do This?

  • Collaboration is an amplifier for any organization's results. What can community organizations really share with each other? What can health care organizations really share with each other? And most importantly, what can community and health care organizations share with each other? 
  • More important than "can share" is "should share." What does this look like for the member/client/patient perspective? 
  • Collaboration is all about outcomes. What is privacy's role in outcomes? 

Jamo Rubin, M.D., President
Signify Community  

 

Compliance, Quality and Stars

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

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

Biggs Cannon, Senior Managing Director, Health Solutions
FTI Consulting

Wayne Gibson, Senior Managing Director, Health Solutions
FTI Consulting

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

12:25 PM - 1:25 PM
Networking Lunch

1:30 PM - 2:15 PM

Concurrent Sessions

Risk Adjustment Strategies

A Member-Centric Approach: Bringing Health Care Directly to Individuals Where They Live

  • Giving members greater choice and convenience to access important care and preventive services leads to better engagement 
  • In-home and mobile health clinic options are an effective strategy for overcoming common barriers to access members who may not have the resources, time or motivation to travel to traditional provider locations 
  • A community-based, nationwide network of providers meet with members where it is most convenient and effective, offering more options for improved outcomes 

Presented by Matrix Medical Network 

Provider/Payer Collaboration

How to Improve Risk and Quality Through Payer and Provider Collaboration

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

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

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

Joell Keim, Staff Vice President, Medicare Revenue and Reconciliation
Anthem

Technology and Analytics

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

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

Catherine Flanagan, Director Quality
Health of San Joaquin

Michelle Miller, Chief Technology Officer
Centauri Health Solutions

Social Determinants of Health

Introducing a SDoH Initiative within Your Organization

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

Moderator:
Jeff Fritz, CEO
Revel


Panel:
Puneet Budhiraja, ASA, FCA, MAAA, VP / Chief Actuary
Capital District Physicians' Health Plan

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

Compliance, Quality, and Stars

Partnering for Star Rating Success  

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

Shelley Collins, Director of Clinical Quality Improvement
BCBS Nebraska

Erica Krieger, Vice President – Quality
Advantasure

2:20 PM - 3:05 PM

Concurrent Sessions

Risk Adjustment Strategies

Moving Risk Adjustment Upstream for Better Care Plans and Revenue Capture

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

Steve Whitehurst, CEO
Health Fidelity

Provider/Payer Collaboration

NLP at the Intersection of Risk and Quality

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

Presented by Talix 

Technology and Analytics

The Magic of Integrating Data to Solve Everyday Problems

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

David Costello, Ph.D, Chief Analytics Officer
Cotiviti

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

Social Determinants of Health

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

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

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

Compliance, Quality, and Stars

Hot 2020 Legal and Compliance Issues for Risk Adjustment Organizations

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

Jason Christ, Member of the Firm
Epstein Becker & Green

Teresa Mason, Senior Legal Counsel, RN
Epstein Becker Green

Dave Meyer, Vice President, Stars
Cigna

3:05 PM - 3:35 PM
Networking Break

3:40 PM - 4:25 PM

Concurrent Sessions

Risk Adjustment Strategies

Unlocking the Power of Insights at the Point of Care

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

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

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

Dominic Henriques, Vice President of Performance Improvement
Prominence Health Plan

Provider/Payer Collaboration

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

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

Sarah Rittman, Director
Baker Tilly

Technology and Analytics

Advancing Value-Based Care Delivery with Artificial Intelligence (AI)

  • Learn latest advancements in AI and their impact in delivering care  
  • Discuss cutting-edge AI techniques and how they are benefitting health care organizations 
  • Discover how AI can streamline workflows for quality and power prospective insights  

John Schneider, Chief Technology Officer
Apixio

Social Determinants of Health

Motivating Providers to Embrace Social Determinants in Primary Care

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

Dave Meyer, Vice President, Stars
Cigna

Compliance, Quality, and Stars

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

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

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

4:30 PM - 5:30 PM

Roundtables Part One

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

Pull up a chair and settle in for this unique opportunity to select three interactive, speed-dating type presentations featuring the latest technologies and solutions for boosting your plan’s risk, quality and data management endeavours.  A bell will ring three times within this special 60-minute session, alerting you to transition to the next roundtable of your choice.  

 

5:30 PM - 6:30 PM
Networking Cocktail Reception

March 17, 2019

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

8:00 AM - 9:00 AM

Roundtables Part Two

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

Pull up a chair and settle in for this unique opportunity to select three interactive, speed-dating type presentations featuring the latest technologies and solutions for boosting your plan’s risk, quality and data management endeavours.  A bell will ring three times within this special 60-minute session, alerting you to transition to the next roundtable of your choice. 

9:00 AM - 9:05 AM

Day Two Welcome Remarks and Day One Takeaways

9:05 AM - 10:00 AM

Keynote Address

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

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

10:00 AM -10:20 AM
Networking Break

10:20 AM - 11:10 AM

Keynote Address

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

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

11:15 AM - 12:00 PM

Concurrent Sessions

Risk Adjustment Strategies

An Extra Special Regular Regulatory Risk Adjustment Update

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

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

Benefit Innovation and Care Management

Practice-Based Care Management as A Strategic Building Block to Value-Based Care: The Mandate for Change (Part 1)

  • Learn core competencies for primary care in the successful delivery of value-based care  
  • Discuss ambulatory care management program design & delivery 
  • Use of behavioral economics and patient activation to drive patient engagement 
  • Leverage free or low-cost community resources to remove/mitigate SDOH barriers 
  • Change culture and scalability, and introduction of non-licensed clinical staff to the care coordination team 

Debra McGill, Senior Director of Population Health
Maine Medical Partners, a division of MaineHealth

Technology and Analytics

Surviving a Breach & Thriving Post-Breach

  • Understand the anatomy of a breach, key players to involve and how to deploy technical aspects  
  • React swiftly and thoughtfully – build a timeline and key needs for notes and communications as well as an incident process  
  • Deal with things that go wrong proactively – understand the legalities and mis-steps that occur during a breach and how to avoid them  

Daniel Sergile, Deputy Chief Information Security Officer
Ciox Health

Talent Retention and Leadership Management

How to Build a World Class Coding Team

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

Moderator:
Christine D’Amico, Executive Vice President
Cognisight          

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

Colleen Gianatasio, Director of Ambulatory CDQI
Mount Sinai Health Partners

Risk Adjustment Strategies

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

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

Vera Grodzen, Associate VP Network Operations
NAMM California

Rick Liu, VP Risk Adjustment
SCAN Health Plan

Eduardo Silva, CFO
Family Choice of NY

 

12:00 PM - 1:00 PM
Networking Lunch

1:05 PM - 1:50 PM

Concurrent Sessions

Risk Adjustment Strategies

Risk Adjustment and Quality Impact Through Coding Best Practices

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

Marilee Klock, Director, Coding Operations 
Geisinger 

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

Benefit Innovation and Care Management

Practice-Based Care Management as A Strategic Building Block to Value-Based Care: Program Effectiveness (Part 2)

  • Measure the contributions and effectiveness of the program 
  • Learn performance management & process improvement tools 
  • Discuss lessons learned and practical takeaways

Debra McGill, Senior Director of Population Health
Maine Medical Partners, a division of MaineHealth

Provider/Payer Collaboration

The Provider Panel: Actionable Solutions for More Effective Engagement

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

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

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

Workgroups

Peer Workgroup: Member Engagement Initiatives, What is Working and What Is Not

  • Share best practices on effective communication and innovative avenues for reaching members, including barriers such as language, literacy, and implicit bias  
  • Address successful community outreach programs including homelessness, mental health and substance use disorders, disability and loneliness 
  • Utilize existing resources and possible technologies for geographically remote populations 

Merrill Friedman, Senior Director Disability Policy Engagement
Anthem

Workgroups

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

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

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

Susan Wyatt, CPC, CPC-I, CPMA, CHCCS
Independent Consultant

1:50 PM - 2:10 PM
Networking Break

2:15 PM - 3:00 PM

Concurrent Sessions

Risk Adjustment Strategies

Build a Coding Education Program Centered Around Physician Engagement

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

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

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

Benefit Innovation and Care Management

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

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


Michael Le, MD, Chief Medical Officer
Landmark Health

Megan Lent, MSI, Director, Risk Adjustment & Clinical Documentation
Landmark Health

Kyle Mendez, MBA, Director of Quality Operations
Landmark Health

Provider/Payer Collaboration

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

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

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

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

Talent Retention and Leadership Management

Developing a Strong and Diversified Hiring Pipeline

  • Learn how to mirror your membership diversity to those sitting at the table at your organization  
  • Discuss how to implement standards around diversity and inclusion to hire and retain talent  
  • Compare effective techniques for removing unconscious bias during the hiring process  

Merrill Friedman, Senior Director Disability Policy Engagement
Anthem

Workgroups

Peer Workgroup: Vendor Management Best Practices

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

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

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

3:05 PM - 3:50 PM

Executive Advisory Board Member Roundtable: Preparing for Success in 2021

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

Moderator:
Kevin Mowll, Executive Director
RISE Institute

 

Speakers:

Patrick Coulson, Chief Growth Officer
Advantasure

Scott Filiault, Chief Revenue Officer
Pulse8

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

3:50 PM - 4:00 PM

Closing Remarks