Rise

Check out an exclusive sneak peek of our first 10 confirmed sessions on the agenda for RISE National 2025, taking place March 11-14 in San Antonio. RISE National 2025 offers focused sessions across timely themes to encourage a deeper dive into the content most relevant to you, your job function, and your organization. Our full speaker line-up will be announced soon!

 

Brand-New
RISE Regulatory Compliance Theater

OIG Updates and Guidance for Managed Care

OIG will provide updates on recent oversight and enforcements efforts in managed care.  The panel will discuss recent and ongoing audits and evaluations regarding Medicare Advantage plans that continue to raise concerns about the accuracy of risk adjustment data and payments.  OIG also will discuss compliance issues for managed care and discuss recent fraud cases and trends.   

• Learn about recent OIG reports and actions identifying fraud and improper payments as well as continuing concerns regarding health risk assessments 
• Understand the OIG compliance concerns and steps that can be taken to help avoid costly problems 
• Implement education programs and internal audits to reduce inaccuracies in documentation and billing and coding    

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

Sarah Kessler, HHS, OIG Senior Counsel
U.S. Department of Health and Human Services - Office of Inspector General 

Carolyn Kapustij, Senior Advisor for Managed Care, Office of Audit Services 
U.S. Department of Health and Human Services – Office of Inspector General  

Isaac M. Bledsoe, Special Agent, Operations Officer 
U.S. Department of Health and Human Services - Office of Inspector General 

Christopher G. Bresette, Director of Medicare Part C Audits, Office of Audit Services 
U.S. Department of Health and Human Services – Office of Inspector General 

 

Track Theme:
Risk Adjustment Strategies

Autonomous Coding: Enhancing Risk Adjustment Processes and Optimizing Accuracy in Health Care

• Explore how autonomous coding systems leverage advanced algorithms, natural language processing (NLP), and machine learning to automatically assign standardized codes to medical diagnoses and procedures, reducing the need for manual intervention
• Outline the strategic approach to planning and implementing autonomous coding systems, focusing on key milestones, integration timelines, and the importance of aligning technology with existing health care workflows
• Discuss the significant improvements in coding accuracy brought about by autonomous coding, highlighting the reduction in errors, faster processing times, and the overall impact on the efficiency and quality of chart reviews

Presented by GeBBs

Unlocking Better Access to Care: How Prospective Risk Adjustment Can Make a Difference

• Learn how HCC suspecting and targeting analytics inherently identifies and prioritizes at-risk members facing access challenges
• Hear how in-home assessments and telehealth programs can support members without consistent access to care to determine the current state of their conditions and to promote continuity of care
• See how prospective risk adjustment can both fund the collection of SDoH data and establish connections with community-based organizations, while simultaneously generating additional revenue for your organization

Jimmy Liu, VP, Analytics and MRR Solutions
Advantmed

Enhancing Payer-Provider Collaboration Through Prospective Risk Adjustment

• Evaluate and close diagnosis gaps collaboratively across structured and unstructured data
• Access complete patient health profiles together to identify diagnosis gaps
• Integrate clinical insights directly into EHR workflows to improve care coordination
• Streamline workflows to ensure accurate diagnosis capture and documentation before claims submission

Presented by Apixio

Track Theme:
Payer/Provider Strategic Alignment

 

Laying the Groundwork for Value-Based Care: Payer-Provider Interoperability to Enhance Prospective Risk Management

• Share the key components and capabilities of a best-in-class risk identification, capture, and management program
• Discuss optimization of the provider and care team experience, workflow and technology optimization, data and analytics use, and performance management processes
• Share real life provider examples of the impact to performance through timely data, insight, and analytics sharing between providers and their payer partners

Alexandra Povlishock, MHA, Vice President
Optum

Track Theme:
Quality and Member Experience

Relentless Pursuit of Excellence: Transforming the Member Experience to Achieve the Triple Aim

• Implementing Proven Best Practices: Leveraging effective approaches to manage costs while advancing population health, early detection, and preventative care
• Proactive Engagement: Engaging members in their preferred modality with personalized interventions to enhance member experience and address social determinants of health
• Risk Adjustment Integration: Aligning risk adjustment with quality improvement and SDoH gap closure efforts

John Criswell, Founder, CEO, Chairman
Porter

From Data Mining to Decision-Making: Utilizing Member Data to Uncover Risks and Enhance Health Outcomes

• Learn how member data can be leveraged as a powerful predictive tool for critical health outcomes
• Discuss the current gaps between data collection and actionable insights for physical and behavioral health outcomes
• Explore emerging technologies and methodologies for enhancing data analysis

Cory Busse, VP, Strategy & Sales Enablement
Icario

Robert Garnett, Vice President, Government Analytics and Health Benefits Cost of Care
Elevance Health

Barb Nelson, Director of Clinical Services Optimization
Medica Health Plans

Track Theme:
Integrating Silos

Enhancing Payer-Provider Collaboration Through Prospective Risk Adjustment

• Evaluate and close diagnosis gaps collaboratively across structured and unstructured data
• Access complete patient health profiles together to identify diagnosis gaps
• Integrate clinical insights directly into EHR workflows to improve care coordination
• Streamline workflows to ensure accurate diagnosis capture and documentation before claims submission

Presented by Apixio

 

Track Theme:
Technology/Data Analytics

AI-Driven AgeTech: Transforming Health Care for Independent Aging

• Discover the latest AgeTech innovations that enable older adults to live independently and thrive in their golden years
• Explore cutting-edge advancements in digital health management and AI-driven care that are redefining the health care landscape
• Understand how AI technologies like GenAI and Retrieval-Augmented Generation (RAG) can enhance member engagement, reduce costs, and optimize health care operations
• Gain insights into AI-powered solutions, such as contact centers and smart chatbots, that are reshaping the aging experience and empowering older adults to live independently

Presented by DUOS

Shaping the Future of Value Based Care – Key Trends and Advancements

• Trusted AI: Harness technology for better productivity with generative AI, ML, and advanced data analytics means organizations understand how to evaluate vendors to ensure transparency and compliance 
• Unified VBC Platform: Leverage a unified platform for holistic views of patient conditions to enable better decision-making, more accurate risk stratification and meet quality benchmarks more consistently 
• Changing Care Models: VBC models are changing fast. Understand how to adapt to new value-based care reimbursement models (V24 to V28) 

Paul Burke, Chief Product Officer
Reveleer

Track Theme:
Future of Health Care

Autonomous Risk-Adjustment Coding: The Next Frontier for Completeness, Accuracy, & Speed

• Understand the latest developments in risk-adjustment coding technology, from yesterday's NLP to today's deep-learning AI
• Assess opportunities to increase completeness, specificity, and accuracy to find missing HCCs and advance coding integrity
• Measure the operational impact of deep-learning AI for RA coding, based on real case studies

Andrew Lockhart, CEO
Fathom