Agenda

• Learn best practices for integrating behavioral health into your existing infrastructure 
• Develop a successful behavioral health partnership to effectively engage patients into care 
• Define key metrics for expanding behavioral health access and outcomes at scale 

• Learn the tactics that drove a 175% Medicare membership increase at Peak Advantage in only nine months 
• See how coordinated gap-closure and referral processes boosted patient outcomes and satisfaction 
• Discover engagement strategies that deepened trust among local seniors and key community partners 
• Get practical steps to unite hospital departments, from Case Management to Marketing, for seamless care and efficient operations 

• Discover how aligning risk adjustment and quality improvement multiplies impact—driving faster care gap closure, stronger Stars performance, and long-term financial success 
• Learn how AI-powered workflows can help deliver revenue integrity at scale while supporting RADV compliance and reducing audit exposure 
• See how integrated platforms equip healthcare leaders with transparency and confidence to make data-driven financial and operational decisions in value-based care 

• Discover how real-time data connectivity across clinical, claims, and social sources creates transparent audit trails that support appropriate risk score capture and withstand regulatory scrutiny 
• Learn from MA plans that have reduced RADV risk while improving risk score accuracy through comprehensive data transparency initiatives 
• Understand how to build privacy-preserving data infrastructure that enables both prospective interventions and retrospective validation, ensuring every HCC is supported by accessible, verifiable documentation

Presented by Datavant

• Accelerate retrieval timelines through cross-functional collaboration 
• Reduce provider burden and strengthening payer-provider integration 
• Drive cost reduction and efficiency with intelligent technology 
• Deliver transparency and demonstrating measurable ROI

Presented by Virtix Health 

• Explore how payers and providers are adapting to the evolving weighting of experience in the Star Ratings formula 
• Discuss practical approaches for aligning clinical outcomes and member engagement strategies 
• Learn how organizations are building systems that listen, connect, and deliver equitable, value-based care

• RADV (Risk Adjustment Data Validation) Audit Readiness: Learn how AI-powered chart reviews uncover missing or unsupported codes to reduce audit risk, support compliant revenue recapture, and strengthen regulatory adherence. 
• CDI (Clinical Documentation Improvement): Discover how AI-driven, real-time chart review guides providers to close documentation gaps, improve coding accuracy, and optimize HCC capture of patient complexity. 
• HEDIS (Healthcare Effectiveness Data and Information Set): Understand how AI automates measure abstraction from structured and unstructured data to proactively close care gaps, elevate HEDIS scores, and improve STAR ratings.

• Closing quality gaps through in-home visits, telehealth, encounter facilitation, shipped labs, and health fairs provides efficient, scalable, and member-friendly ways to improve HEDIS® and Stars performance 
• Members with open quality gaps often have risk-adjustable conditions, making these same clinical touchpoints an ideal opportunity to accurately capture risk while reducing RADV exposure and avoiding concerns about “diagnosis harvesting.” 
• Investing in preventive care and SDoH gap closure is the most cost-effective approach, helping close gaps earlier, improve outcomes, boost Star Ratings, and generate long-term revenue through compliant, proactive risk adjustment 

• See how physician-led programs ensure quality care while meeting risk adjustment standards 
• Explore how to use data and metrics to guide performance, improve compliance, and support patient outcomes 
• Understand how building strong, clinically sound programs today positions providers for long-term success regardless of policy changes 
• Learn from examples like early dementia screening programs that improve detection and patient support.

• Build comprehensive patient profile: Leveraging multiple data sets and implementing strategies from pre-visit to post-visit to help build comprehensive patient profiles at the point of care.  
• Enable shift to value-based care: Implement programs and best practices to help providers navigate through the shift to value-based care and boost provider education year-over-year, assisting your team to stay up to date on the latest strategies. 
• Mitigate risk and improve documentation: Evaluate and refine your tactics for effective documentation specificity gap closure using various care modalities, such as pre-visit, concurrent, in-office and in-home approaches to facilitate complete and accurate documentation and be prepared for CMS/HHS/OIG audits.

• Recognize the limitations of standardized population health programs and why personalization is now essential 
• Explore how data-driven segmentation, AI, and consumer-inspired strategies can be used to curate hyper-personalized “health playlists” to create more compelling education, outreach, and care management strategies 
• Evaluate success through metrics that capture clinical outcomes, engagement and satisfaction

• Reduce administrative burden within your providers' workflow 
• Streamline prior authorization efficiency 
• Improve RADV preparedness and risk score accuracy

• Build a unified platform for collecting robust & comprehensive supplemental data sets across your entire provider network, to achieve better risk, quality, and cost/utilization benchmarks for your members 
• Access actionable data for improving compliance for closing gaps across quality, coding, pharmacy, care management, and population health while complying with regulatory requirements like medical prior authorization 
• Analyze the data sets using sophisticated modeling techniques & standards based on regulatory and performance metrics 

• Explore why DOJ and OIG are intensifying scrutiny of kickback schemes in Medicare Advantage 
• Examine major settlements and court rulings that are shaping compliance expectations 
• Evaluate the role of insurance brokers and brokerage firms in alleged kickback schemes 
• Identify proactive steps plans and providers can take to avoid violations and strengthen compliance programs

• Examine how the “One Big Beautiful Bill” and new government rules could reshape Medicaid and its connection to Medicare Advantage 
• Discuss the latest developments on Medicaid work requirements and the implications for managed Medicaid plans 
• Explore how new legislation and federal initiatives around AI will influence care delivery, compliance, and oversight 
• Consider the unique needs of individuals aging into Medicare from Medicaid and how to better support some of the nation’s most vulnerable populations

• Explore how VA and MA plans can collaborate to improve the veteran care experience 
• Understand where veterans’ benefits and MA coverage intersect 
• Share strategies for accurate coding and risk capture across both systems 
• Identify opportunities to build a more seamless path forward for veteran populations

• Quantify the Cost of Inefficiency: Learn to quantify the financial drain of outdated NLP and manual coding, revealing the true cost of these inefficient processes 
• Avoid Financial Leakage and Mitigate Audit Risk: Discover how novel AI can eliminate coding waste and improve data accuracy, boosting financial performance and reducing millions in RADV Audit clawbacks 
• Your Path to Autonomous Coding with Neuro-Symbolic AI: Learn how to transition from manual to autonomous coding on a unified platform, achieving unprecedented efficiency and full auditability 

• Master best practices to meet CMS scrutiny and ensure precise diagnosis coding 
• Identify vulnerabilities early and implement proactive strategies to reduce compliance risks 
• Build stronger partnerships with providers to align on coding accuracy and streamline claims submissions
• Understand how accurate coding and effective collaboration drive compliance and organizational success