Agenda | RISE National 2025

Rise

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2025 Schedule

At RISE National 2025, handpicked industry experts provided the guidance, training, and education needed to navigate this evolving landscape with confidence. RISE National 2025 was extended by an extra day to accommodate even more essential content, regulatory updates, networking opportunities, and after-hours fun! Attendees had even more time to hear directly from the top minds in Medicare Advantage about the game-changing shifts coming with the new administration's fresh priorities and regulations.


Due to a recent Executive Order signed by the President, the OIG and DOJ were unable to attend or speak virtually. Despite this, we restructured our agenda and added a Former CMS Director to ensure attendees still received the valuable insights, key takeaways, and meaningful connections they expect from RISE.

 

Tuesday - March 11

11:00 AM 5:00 PM

10:00 AM 4:00 PM

9:00 AM 3:00 PM

8:00 AM 2:00 PM

Workshop Registration

12:00 PM 6:00 PM

11:00 AM 5:00 PM

10:00 AM 4:00 PM

9:00 AM 3:00 PM

Pre-Conference Workshop A: Risk Adjustment Practitioner

Please note: This workshop requires additional registration. 

  • The essentials of and differences between Medicare Advantage, Commercial and Medicaid risk adjustment   
  • Understanding how risk scores are calculated 
  • Understanding the different payment models, and how plans are paid 
  • Provider engagement strategies that will impact your risk adjustment initiatives 
  • Member engagement and SDOH 
  • Risk adjustment vendor selection and management 
  • Strategies for ongoing, thorough vendor management 
  • Initial steps for preparing for a RADV 
  • Which staff is essential to oversee your RADV audit prep? 
  • Staying ahead – key items to monitor well in advance of an actual audit 
  • The future of risk adjustment – what you need to know to stay ahead of changes 

Instructors:   
Laura Sheriff, RN, MSN, CPC, CRC 
Healthcare Expert 

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

 

There will be the letter A on your badge if you are registered for this program. Two refreshment breaks and lunch is included.

12:00 PM 6:00 PM

11:00 AM 5:00 PM

10:00 AM 4:00 PM

9:00 AM 3:00 PM

Pre-Conference Workshop B: Advanced HCC Auditor

Please note: This workshop requires additional registration. 

With the switch from V24 to V28 and unprecedented scrutiny on the work we do in Risk Adjustment now is the time to consider attending our always popular HCC Coding for Accuracy workshop!   

If you are responsible for the coding, auditing, analytics, or financials of your program you can’t miss this discussion!  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. 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 the 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 take notes on their laptop or tablet. 

You will learn the answers to:  

  • How will the transition to V28 impact your organization?  We will provide an overview of the financial overlay – HCC codes mapping to risk adjustment scores  
  • Why is Clinical Documentation Integrity more important than ever?   Join us to discuss A single coding and documentation process for Risk adjustment  
  • How challenging is accurate coding?  You will have the opportunity to review real life examples of accurately coding from various portions of the encounter. 
  • Why are providers burning out?  Learn about the clinical documentation barriers clinicians and practices face.   

Instructors:  
Colleen Gianatasio
Value Based Care Expert

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP    
Director Risk Capture – Population Health 
 
Mass General Brigham   

There will be the letter B on your badge if you are registered for this program. Two refreshment breaks and lunch is included.

Wednesday - March 12

8:30 AM 6:30 PM

7:30 AM 5:30 PM

6:30 AM 4:30 PM

5:30 AM 3:30 PM

Conference Registration

10:00 AM 1:00 PM

9:00 AM 12:00 PM

8:00 AM 11:00 AM

7:00 AM 10:00 AM

Pre-Conference Workshop C: 2025 Government Program Legal and Compliance Deep Dive – How to Navigate the Wave of Enforcement While Still Trying to Manage a Population and Stay Sane

Please note: This workshop requires additional registration. 

  • Educate attendees on issue spotting key risk areas and takeaways based on developing cases and agency audits; 
  • Discussion of the hard questions related to auditing, monitoring, and overpayments; 
  • The promise and pitfalls of AI as it relates to enforcement risk 
  • Discuss emerging enforcement areas such as prior authorizations, network (in) adequacy and UM 
  • Discuss impacts to value-based contracting, risk adjustment operations (both at the health plan and medical group level), and incentive programs/pay for performance 
  • Weighing enforcement and oversight risks as they relate to:  
  • Physician organizations, VS. Health plans, who does what in 2025 and beyond? 
  • Insourcing versus outsourcing key revenue and EDI functions 

Jason E. Christ, Member of the Firm 
Epstein Becker Green  

David Meyer, Medicare Advantage Expert 

Tom Kornfield 
MAST Health Policy Solutions 

There will be the letter C on your badge if you are registered for this program. Registration for this workshop includes a refreshment break.

10:00 AM 1:00 PM

9:00 AM 12:00 PM

8:00 AM 11:00 AM

7:00 AM 10:00 AM

Pre-Conference Workshop D: Value Based Care Operational Excellence Workshop

Please note: This workshop requires additional registration.

Designed for both health plan operations and risk bearing provider groups--both MA and ACO. During this workshop, we will discuss these key areas:  

Risk 

  • Basics 
  • Programmatics (e.g., prospective, concurrent, retrospective reviews; internal coding team management; home assessment programs) 
  • Oversight 

Quality 

  • Basics 
  • Programmatics (E.g., member communication programs/incentives, health fairs) 
  • Oversight 

Total Cost of Care 

  • Basics 
  • Programmatics (e.g., hospital contracting--inpatient vs observation, ASC procedures, partnering with specialists, ER UC Campaigns, Hospital at Home)  
  • Oversight  

Analytics & Reporting 

  • Operational monitoring for management 
  • Interdepartmental Collaboration--who to work with, how often to communicate 
  • Community Partnerships--how to evaluate, who to select, implementation guidance 

Contract Evaluation 

  • What's in it, how to prioritize, etc. 
  • Financial implication of the components above and how to monitor throughout the year 

Dr. Shannon Decker, Principal    
VBC One   

Gaby Alcalá , Founder and CEO  
MAPA HealthCare  

 

There will be the letter D on your badge if you are registered for this program. Registration for this workshop includes a refreshment break.

10:00 AM 1:00 PM

9:00 AM 12:00 PM

8:00 AM 11:00 AM

7:00 AM 10:00 AM

Pre-Conference Workshop E: How to Operationalize a Risk Adjustment Program for Leadership 

Please note: This workshop requires additional registration.

How to Operationalize a Risk Adjustment Program for Leadership 

This session will focus on the managerial role of risk adjustment, with strategies on operationalizing your program.   

  • Operations from the director level and above  
  • Vendor management  
  • Managing the data  
  • Coder operations  
  • Submission management    

 

Laura Sheriff, RN, MSN, CPC, CRC 
Healthcare Expert 

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

 

There will be the letter E on your badge if you are registered for this program. Registration for this workshop includes a refreshment break.

1:00 PM 2:00 PM

12:00 PM 1:00 PM

11:00 AM 12:00 PM

10:00 AM 11:00 AM

Workshop Lunch

*Registration Required

Networking Lunch for Workshop Attendee's only

2:00 PM 2:15 PM

1:00 PM 1:15 PM

12:00 PM 12:15 PM

11:00 AM 11:15 AM

Main Conference Kicks Off with Opening Remarks

Ellen Wofford, Founder & CEO 
RISE 

Conference Chairs: 
Liz Haynes MSN, RN, CCM, Vice President of Quality, STARS, & Risk Adjustment 
CareFirst BlueCross BlueShield 

Kim Miller, D.C., CPC, CEDC, CRC, Government Programs Clinical Coordinator, SR. 
Blue Cross Blue Shield of Kansas City 

2:15 PM 3:15 PM

1:15 PM 2:15 PM

12:15 PM 1:15 PM

11:15 AM 12:15 PM

Navigating Medicare Advantage in Times of Change: Strategies for Success Amid Industry Shifts

  • Explore key changes and priorities under the new administration  
  • Strategies for health plans and providers to navigate evolving regulations and maintain compliance while ensuring member satisfaction 
  • Insights into potential long-term impacts on Medicare Advantage programs and actionable steps to stay ahead in a shifting policy landscape 

Moderator: 
Melissa Smith, Founder  
Newton Smith  

Ana Handshuh, Principal   
CAT5 Strategies   

Sean Creighton, Former CMS  
Managing Director 
Avalere Health 

Andrew Schwab, Founder & CEO  
Platform Government Strategies 

3:15 PM 3:45 PM

2:15 PM 2:45 PM

1:15 PM 1:45 PM

12:15 PM 12:45 PM

Networking Break

Concurrent Sessions 3:45 PM - 4:30 PM 2:45 PM - 3:30 PM 1:45 PM - 2:30 PM 12:45 PM - 1:30 PM

Track 1: Risk Adjustment Strategies - Track Chair: Matt McClasky, Executive Vice President - Fusion Advantage

Track 2: Integrating Silos - Track Chair: Steven Berkow, Senior Advisor, Value Based Care- InterSystems

Track 3: Quality and Member Experience - Track Chair: Reva Sheehan, Sr. Director of Customer Insights -mPulse 

Track 4: Provider/Payer Strategic Alignment - Track Chair: Beth Zuehlke, Chief Customer Officer - Moxe Health

Track 5: Technology/Data Analytics - Track  Chair: Amit Jindal, SVP, Healthcare & Private Equity - Ciklum

Track Chairs:

3:45 PM 4:30 PM

2:45 PM 3:30 PM

1:45 PM 2:30 PM

12:45 PM 1:30 PM

Track 1: Risk Adjustment Strategies

Revolutionizing Risk Adjustment with Autonomous Coding

  • 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 healthcare 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 

Moderator: 
Swati Patel, AVP, Product Development 
GeBBS Healthcare Solutions   

Dr. Shannon Decker, Principal    
VBC One   

3:45 PM 4:30 PM

2:45 PM 3:30 PM

1:45 PM 2:30 PM

12:45 PM 1:30 PM

Track 2: Integrating Silos

Integrating Prospective and Retrospective Risk Adjustment with Encounter Submissions for Enhanced Synergies and Compliance 

  • How prospective and retrospective risk adjustment and encounter submissions can function together effectively 
  • The financial and operational benefits of concurrent risk gap closure 
  • How to enhance synergies and ensure compliance by integrating risk adjustment processes with advanced technology solutions  

Moderator: 
Dr. Summerpal Kahlon, Chief Medical Officer 
Edifecs 

Brian Murtha, Senior Director, Digital Initiatives
Centene 

Jennifer Holman, Senior Director, Risk Adjustment Program Oversight 
Centene 

Chris Punzalan, Director, Financial Analysis  
Caloptima Health  

3:45 PM 4:30 PM

2:45 PM 3:30 PM

1:45 PM 2:30 PM

12:45 PM 1:30 PM

Track 3: Quality and Member Experience

RISE to the Challenge: Community-Driven Solutions for Health Equity in Medicare Advantage

This panel discussion will delve into the complex issues of trust, cultural humility, and Black infant mortality. Within the context of Medicare Advantage, panelists will explore how community-centered design, philanthropic investment, and patient-centric care can create meaningful change. 

  • Community-Centered Design: We'll explore how community-based organizations and residents can be empowered to shape healthcare solutions that address the unique needs and challenges facing Black families 
  • Addressing Social Determinants of Health: The panel will discuss how factors beyond healthcare access, such as housing, education, and economic stability, contribute to Black infant mortality and how Medicare Advantage plans can leverage their resources to address these issues 
  • Philanthropic Investments: The panel will examine how philanthropic dollars can be strategically deployed to support community-driven initiatives focused on reducing Black infant mortality 
  • Patient Experience: We'll highlight the importance of culturally competent care and personalized approaches to ensure minoritized families feel heard, understood, and empowered within the healthcare system 

 
Expected Outcomes: 

  • Gain a deeper understanding of the complex factors that improve awareness and access and contribute to Black infant mortality 
  • Learn how Medicare Advantage plans can partner with communities to develop and implement impactful solutions 
  • The discussion will inspire collaboration and action among stakeholders to address this critical health equity issue 
  • Cultivate trust and cultural humility within their work, leading to improved health outcomes for minoritized communities 

Moderator  

Veronica Villalobos, JD, VP DEI Strategy, Enterprise Equitable Health Institute 
Highmark Health/ Allegheny Health Network  

Dr. Margaret Larkins-Pettigrew, Senior Vice President and Enterprise Chief Diversity, Equity and Inclusion Officer, Enterprise Equitable  
Health Institute for Highmark Health / Allegheny Health Network 
Dean for Obstetrics and Gynecology  
Drexel School of Medicine 

Kenya Boswell, Senior Vice President, Community Affairs
Highmark Health 

Dr. Eugene Scioscia, Chief Patient Experience Officer, Obstetrics and Gynecology 
Allegheny Health Network 

3:45 PM 4:30 PM

2:45 PM 3:30 PM

1:45 PM 2:30 PM

12:45 PM 1:30 PM

Track 4: Provider/Payer 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 

Moderator:
Amy Frankowski, MD, Clinical Leader
 
Optum 

Dr. Marie McCormack, MD, Division Chief of Primary Care 
Renown Medical Group 

3:45 PM 4:30 PM

2:45 PM 3:30 PM

1:45 PM 2:30 PM

12:45 PM 1:30 PM

Track 5: Technology/Data Analytics

The Power of AI in Value-Based Care: Achieving Holistic Patient Insights for Better Decision-Making

  • Trusted AI: Harness technology for better productivity with 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 to aggregate and align structured and unstructured holistic views of patient conditions to enable better decision-making, more accurate risk stratification and consistently meet quality benchmarks.   
  • 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 

Reza Alavi, MD, MHS, MBA, Faculty
Johns Hopkins Medicine

Henish Bhansali, MD, FACP, Chief Medical Officer 
Medical Home Network 

4:40 PM 5:40 PM

3:40 PM 4:40 PM

2:40 PM 3:40 PM

1:40 PM 2:40 PM

Opening Keynote Address: Purpose. Performance. Impact.

Sponsored by 

Justin will take you through an exploration of the power of service, the profound difference we can make in the lives of others, and the ripple effect that extends far beyond what we can imagine – including the transformation that occurs within ourselves when we choose to live purposefully and serve selflessly. He also unravels the secrets of the overcomer’s mindset, the unyielding spirit that separates the victors from the defeated. You will learn how to transform pain into fuel, setbacks into comebacks, and doubts into unwavering belief—in order to overcome obstacles and win this fight called life.  


Justin Wren
 
Elite UFC/MMA Fighter turned Global Humanitarian and Founder of Fight for The Forgotten 

Learn More 

Introduced by 
Mike Jones, President & General Manager, Payer 
Inovalon  

5:30 PM 7:30 PM

4:30 PM 6:30 PM

3:30 PM 5:30 PM

2:30 PM 4:30 PM

Exhibit Hall Open

5:45 PM 7:30 PM

4:45 PM 6:30 PM

3:45 PM 5:30 PM

2:45 PM 4:30 PM

Welcome Cocktail Reception in the Exhibit Hall

Let's kick off the mega Medicare Advantage event of the year Fiesta style! In celebration of Fiesta San Antonio which honors the battles of the Alamo and San Jacinto, we encourage all attendees to wear bright and cheerful colors. Join us for drinks, hors d'oeuvres, lively networking, and fun!

Thursday - March 13

8:30 AM 6:00 PM

7:30 AM 5:00 PM

6:30 AM 4:00 PM

5:30 AM 3:00 PM

Conference Registration

9:00 AM 7:00 PM

8:00 AM 6:00 PM

7:00 AM 5:00 PM

6:00 AM 4:00 PM

Exhibit Hall Open

9:00 AM 10:00 AM

8:00 AM 9:00 AM

7:00 AM 8:00 AM

6:00 AM 7:00 AM

Networking Breakfast in Exhibit Hall

10:30 AM 10:40 AM

9:30 AM 9:40 AM

8:30 AM 8:40 AM

7:30 AM 7:40 AM

Opening Remarks

Conference Chairs: 

Liz Haynes MSN, RN, CCM, Vice President of Quality, STARS, & Risk Adjustment 
CareFirst BlueCross BlueShield 

Kim Miller, D.C., CPC, CEDC, CRC, Government Programs Clinical Coordinator, SR. 
Blue Cross Blue Shield of Kansas City 

10:40 AM 11:00 AM

9:40 AM 10:00 AM

8:40 AM 9:00 AM

7:40 AM 8:00 AM

RISE Trailblazer Award

In the spirit of the RISE mission to drive meaningful impact in the health care industry, the RISE Trailblazer Award honors outstanding innovation, leadership, and dedication. This prestigious accolade celebrates an individual who has made a significant difference in the lives of America’s seniors by introducing groundbreaking ideas, driving transformative change in the industry or community, and setting an inspiring example through courage, creativity, and determination. Inspired by the legacy of the late Dr. Martin L. Block, this award pays tribute to his enduring passion for transforming the health care system and his tireless efforts to inspire positive change. 

11:00 AM 11:45 AM

10:00 AM 10:45 AM

9:00 AM 9:45 AM

8:00 AM 8:45 AM

Keynote: A Tale of Two Governments

A discussion of what has emerged during the first 7 weeks of the Trump Administration, how this transition is materially different than any previous transition, and why that matters to any company that depends upon federal health programs for stable revenue. The discussion will close by noting the unfortunate side effects for the government that presents an opportunity for the industry.

Jeffrey Grant 
Former Operations Director 
Center for Consumer Information and Insurance Oversight at Centers for Medicare & Medicaid Services 

11:45 AM 12:15 PM

10:45 AM 11:15 AM

9:45 AM 10:15 AM

8:45 AM 9:15 AM

Networking Break in Exhibit Hall

Concurrent Sessions 12:15 PM - 1:00 PM 11:15 AM - 12:00 PM 10:15 AM - 11:00 AM 9:15 AM - 10:00 AM

Track 1: Risk Adjustment Strategies - Track Chair: Matt McClasky, Executive Vice President - Fusion Advantage

Track 2: Integrating Silos - Track Chair: Steven Berkow, Senior Advisor, Value Based Care- InterSystems

Track 3: Quality and Member Experience - Track Chair: Reva Sheehan, Sr. Director of Customer Insights - mPulse

Track 4: Hot Topic - Track Chair: Beth Zuehlke, Chief Customer Officer - Moxe Health 

Track 5: Technology/Data Analytics - Track  Chair: Amit Jindal, SVP, Healthcare & Private Equity - Ciklum

RISE Innovation Theater 1: Track Chair: Mark DabneyDirector, Risk Adjustment - Community Health Plan of Washington  

RISE Regulatory Compliance Theater 2 - Track Chair: Ana Handshuh, Principal  - CAT5 Strategies 

Track Chairs:

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

Track 1: Risk Adjustment Strategies

Beyond Risk Adjustment: Harnessing Data Strategy for Enhanced Healthcare Outcomes

Key Discussion Points:

  • The Power of Comprehensive Partnerships: Highlighting the limitations of vendors offering fragmented solutions and the advantages of partnering with organizations capable of scaling services, including coding, AI assistance, and layered analytics.
  • Achieving a Unified Data Approach: Discussing strategies to bridge data gaps and implement end-to-end solutions that go beyond concurrent data handling, ensuring a fuller picture of healthcare delivery. This includes dynamic data intelligence that lets health plans track data throughout the RA program, ensuring more accuracy, depth, and usability of their data.
  • Expanding Data Utilization: Exploring how data can be leveraged beyond risk adjustment to enhance quality programs, providing a more holistic view of member care.

Moderator: 
Bill Horn, Chief Commercial Office, Payer  
Datavant 

Josh Weisbrod, Risk Adjustment and Payment Integrity 
Network Health

Gabriel Medley, Vice President, Risk Adjustment 
BCBS-MI  

Amir Keren, Senior Vice President of Payer Solutions
Datavant

 

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

Track 2: Integrating Silos

Optimizing Provider and Member Engagement by Leveraging EHR and Digital Platforms

  • Ensure that members with chronic conditions are receiving the right care to stay healthy 
  • Leverage predictive analytics to identify ideal intervention channels 
  • Reduce costly interventions that cause abrasion in the member-provider relationship 
  • Engage providers within their workflow to drive patient and financial outcomes 

Hemanth Doma, AVP, Product Management 
Inovalon 

Kathryn Eshelman, MD, MPH, VP, Medical Informatics 
Inovalon 

Matt Yancisin, Chief Financial Officer 
Alterwood Health 

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

Track 3: 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 

 

Moderator:
John Criswell,
Founder, CEO, Chairman  
Porter  

BK Kajopaiye - Risk Adjustment and STARS Manager 
CareFirst BlueCross BlueShield 

Melissa McVaugh - AVP Clinical Operations 
Mountain Health CO-OP 

John Barkley – Vice President, Enterprise Risk Adjustment & Data Integrity 
Emblem Health/ConnectiCare 

Deb Curry, Risk Adjustment Programs Director 
Paramount 

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

Track 4: Hot Topic

Daily Living RADV Compliance: Modernizing Audit Preparation with an AI-Driven Risk Management Approach

  • AI-Powered Compliance Infrastructure: Demonstrating how purpose-built Risk Adjustment AI and DocumentAI technologies work together to maintain continuous coding accuracy 
    CMS can/will now apply extrapolation to any audit year without restriction, increasing financial risk for MA plans. This applies retroactively to audits starting from 2018. 
  • Understand where Variance Creeps In, Year-Round Audit Readiness: Learn practical strategies for transitioning from reactive to proactive compliance management, reducing resource burden while maintaining regulatory standards. Why now, “The impact of updated extrapolation allowances in 2025” 
  • Real-World RADV Success: AI-powered audit preparation, creating insights, measurable outcomes and compliance improvements 
  • Navigating Regulatory Evolution: Examine contemporary and evolving DoJ and OIG priorities, focusing on how technology-enabled preparation addresses emerging compliance challenges 

Moderator:
Michael Clark, President & Chief Growth Officer
 
RAAPID 

Wynda Clayton, Consultant, Risk Adjustment 

Nehal Shah, CEO DataOrb, CTO  
RAAPID 

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

Track 5: 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 

RaeAnn Grossman 
Medicare Advantage Expert 

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

RISE Innovation Theater

Research Findings: A Study of the Interactions Between Clinicians and Patients Since the Pandemic

This phenomenological study gets at the essence of our motivations.  You will walk away with a better understanding how to engage with key stakeholders, particularly those that have experienced COVID and in the wake of all these regulatory changes.   

Leave with insights and strategies to yield better engagement and better performance in light of "cuts" imposed by greater restrictions on risk, quality, and other key areas 

Dr. Shannon Decker, Principal    
VBC One   

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

RISE Regulatory Compliance Theater

Anatomy of a Whistleblower Case: Examining a Successful False Claims Act

from initial sealed whistleblower complaint alleging risk adjustment fraud to DOJ investigation, intervention and ultimate settlement  

Many of the biggest Medicare Advantage insurers face False Claims Act lawsuits accusing them of risk adjustment fraud. Most of those lawsuits were initiated by whistleblowers who were current or former employees of the plans.  

Follow along with whistleblower Teresa Ross, a former Director of Risk Adjustment at Group Health Cooperative (GHC) and her whistleblower counsel as they take you through the story of Ross’s successful whistleblower lawsuit against health insurers GHC and Independent Health for alleged risk adjustment fraud.  

Learn about the risks posed to GHC and Independent Health by their use of the same risk adjustment coding vendor.  Hear about the types of evidence uncovered in the whistleblower’s and DOJ’s joint investigation that led to successful settlements with both insurers.     

Attendees will leave this session with:   

  • An understanding of the mechanics of a False Claims Act case launched by a whistleblower including the dynamics between the whistleblower and DOJ in jointly investigating and prosecuting cases of alleged risk adjustment fraud.  
  • An appreciation for the different types of practices DOJ has found to constitute risk adjustment fraud when engaged in by health plans and their vendors.    
  • An understanding of how to create an environment in which whistleblowers feel safe to raise their concerns internally and have them remedied in a way that eliminates the need for a whistleblower to go external and raise concerns with the Government by filing a False Claims Act complaint in federal court.   

Teresa Ross 
Whistleblower 

Mary A. Inman, Partner 
Whistleblower Partners LLP 

Max Voldman, Partner 
Whistleblower Partners LLP 

1:00 PM 1:55 PM

12:00 PM 12:55 PM

11:00 AM 11:55 AM

10:00 AM 10:55 AM

Networking Lunch in Exhibit Hall

Concurrent Sessions 2:00 PM - 2:45 PM 1:00 PM - 1:45 PM 12:00 PM - 12:45 PM 11:00 AM - 11:45 AM

Track 1: Risk Adjustment Strategies - Track Chair: Matt McClasky, Executive Vice President - Fusion Advantage

Track 2: Integrating Silos - Track Chair: Steven Berkow, Senior Advisor, Value Based Care- InterSystems

Track 3: Quality and Member Experience - Track Chair: Reva Sheehan, Sr. Director of Customer Insights - mPulse

Track 4: Hot Topic - Track Chair: Beth Zuehlke, Chief Customer Officer - Moxe Health 

Track 5: Technology/Data Analytics - Track  Chair: Amit Jindal, SVP, Healthcare & Private Equity - Ciklum

RISE Innovation Theater 1: Track Chair: Mark Dabney, Director, Risk Adjustment - Community Health Plan of Washington  

RISE Regulatory Compliance Theater 2 - Track Chair: Ana Handshuh, Principal  - CAT5 Strategies 

Track Chairs:

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

Track 1: Risk Adjustment Strategies

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  

Jennifer Hawkes, Manger of Member Engagement 
Blue Cross of Idaho 

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

Track 2: Integrating Silos

Meeting the Patient Where They Are… How to Succeed at Risk

  • Expanding Access & Equity: Utilizing in-home and community-based care models to address social determinants of health and improve outcomes for underserved populations 
  • Optimizing Risk-Based Models: Strengthening ACO support and provider collaboration to drive cost-effective, high-quality care 
  • Leveraging AI for Success: Harnessing artificial intelligence to enhance care management, identify risk, and personalize patient engagement 

Shannon Thorpe, DNP, RN, CNL, SVP 
Sharecare/CareLinx  

Kevin Agatstein, Consultant  
Sharecare 

Miranda Meunier, NP, Vice President of Clinical Services 
Greater Good Health 

Michelle Nelson, Senior Vice President of Risk Adjustment 
Illumed 

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

Track 3: Quality and Member Experience

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  

Barb Nelson, Director of Clinical Services Optimization 
Medica Health Plans

Crystal Sawyer, Associate Director, Process Improvement 
Humana 

 

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

Track 4: Hot Topic

Stars and Savings: A Playbook for Medicare Advantage Success

  • Cutting Costs and Reducing MLR: Learn proven methods and untapped categories to unlock cost savings opportunities and lower your MLR 
  • Case Studies and Best Practices: Hear from industry leaders about successful adaptations to previous CMS changes, providing a roadmap for navigating the current landscape 
  • Future-Proofing Your Plan: Explore forward-thinking strategies to ensure your Medicare Advantage plan remains competitive and compliant in an evolving regulatory environment 
  •  

Moderator:
Dr. Edward Likovich, CEO 
Nymbl 

Lori Rund, Former VP Government Programs  
Blue KC 

Dr. Robert Mirsky, Former CMO 
Aetna Medicare  

Charlotte Yeh, Former CMO 
AARP 

Jessica Muratore 
Muratore Advisory Services, LLC 

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

Track 5: Technology/Data Analytics

A Documentation Journey

This session walks through the foundation of value-based care and the importance of accurate documentation, including: 

  • Impact on patient complexity 
  • Impact on quality metrics 
  • Impact on appropriate resources and programs 
  • Impact on the patient  
  • Utilization and cost trends  

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP   
Director Risk Capture – Population Health 
Mass General Brigham   

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

RISE Innovation Theater

Lessons in Building a Compliant Risk Adjustment Program

In order to take advantage of Shared Savings opportunities, AdventHealth needed to undergo a practice transformation from a Fee for Service to Model to providing value-based care.   

Part of this transformation included educating clinicians on proper Coding Documentation Integrity.     

  • Hear about one Health System’s transformational journey in building a compliant Risk Adjustment team, with learnings on internal buy in, provider education and operational processes   
  • Gain insights into overcoming barriers and coming out on the other side of success, with focus on good people, strong policies and procedures, and technology          
  • Discuss what’s worked in provider education and engagement, including incentives, relationship building and tapping into provider mentors    

Michael Zeli, Executive Director of Clinical Documentation Integrity PHSO
AdventHealth

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

RISE Regulatory Compliance Theater

Navigating Uncertainty: Driving Success Amid Medicare Advantage Challenges

  • Learn how to navigate budget constraints, reduced benefits, and evolving financial models 
  • Stay Ahead of regulatory shifts and adapt to retroactive changes, industry-wide Star Rating recalculations, and pending program updates 
  • Enhance operational resilience and discover strategies to refine processes, drive innovation, and maintain plan performance 
  • Build stronger regulatory relationships and gain insights on effectively collaborating with regulators to ensure compliance and long-term success 

Dan Weaver, Senior Vice President, Stars & Quality 
Zing Health 

2:45 PM 3:15 PM

1:45 PM 2:15 PM

12:45 PM 1:15 PM

11:45 AM 12:15 PM

Networking Break in Exhibit Hall

Concurrent Sessions 3:15 PM - 4:00 PM 2:15 PM - 3:00 PM 1:15 PM - 2:00 PM 12:15 PM - 1:00 PM

Track 3: Quality and Member Experience- Track Chair: Reva Sheehan, Sr. Director of Customer Insights - mPulse

Track 4: Provider/Payer Strategic Alignment - Track Chair: Jenny Ritchie, Area Vice President Sales, East -Veradigm

Track 5: Hot Topic - Track Chair: Branka Sustic, Vice President, Risk & Quality Operations - Cotiviti, Inc.

RISE Innovation Theater 1: Track Chair: Mark Dabney, Director, Risk Adjustment - Community Health Plan of Washington  

 

Track Chairs:

3:15 PM 4:00 PM

2:15 PM 3:00 PM

1:15 PM 2:00 PM

12:15 PM 1:00 PM

Track 3: Quality and Member Experience

From Hype to Harmony: Market Voices on AI and Automation Enhancing Member Experience

Government-sponsored health plans are navigating and balancing seasonal surges, operational efficiency goals, Stars, Quality and Risk Adjustment goals and the need to consistently drive strong member experiences and outcomes.  

Providing timely support to members with live resources is an ongoing challenge. Communication automation and Agentic AI solutions offer a scalable, secure, and empathetic way to meet these challenges, enabling members to be digitally guided to take better actions and complete self-service tasks across the plan year for member service, quality and population health, and more. 

In this session, explore how Automation and AI are transforming member engagement while ensuring HIPAA compliance and seamless escalation to proper or live resources for sensitive inquiries.  

Moderator 
Yvonne Daugherty, Global Head of Industries  
Ushur 

Dan Weaver, Senior Vice President, Stars & Quality 
Zing Health 

Jenny Smith, Market Strategy
Consultant

3:15 PM 4:00 PM

2:15 PM 3:00 PM

1:15 PM 2:00 PM

12:15 PM 1:00 PM

Track 4: Provider/Payer Strategic Alignment

Acing Value-Based Care with Point of Care Alerts and Automated Supplemental Data Feeds

  • Improving star ratings in the challenging environment by enabling proactive care gap closure and prospective risk stratification 
  • Leverage standard FHIR Implementation guides to scale bi-directional data exchange for improving delivery of patient care and member satisfaction 
  • Learn from payers and providers experiences how access to accurate and timely data has helped reduce burden, improve compliance & achieve better outcomes 

Moderator:
Rohit Shinde, Vice President  
Healow  

Aurelious Bankston, Information Technology (IT) Director 
SOUTH TEXAS RENAL CARE GROUP 

Brian Murtha, Senior Director, Digital Initiatives 
Centene Corporation 

 

 

3:15 PM 4:00 PM

2:15 PM 3:00 PM

1:15 PM 2:00 PM

12:15 PM 1:00 PM

Track 5: Hot Topic

Maximize Risk Adjustment Performance During Turbulent Times with a PCP-First Strategy

  • Learn about the current state of in-office risk adjustment solutions 
  • Hear from a provider how a large group practice selected an in-office solution 
  • Gain insights into the results from an in-office program 

Frederick Bloom, MD, President 
Guthrie Medical Group 

Hassan Rifaat, MD, CEO 
Vatica Health 

3:15 PM 4:00 PM

2:15 PM 3:00 PM

1:15 PM 2:00 PM

12:15 PM 1:00 PM

RISE Innovation Theater

Ensuring Payment Integrity in Your Risk Adjustment Program

Risk adjustment has changed.  In today’s landscape it is crucial to protect your organization from over coding and regulatory audits.  Join us for this interactive session as we discuss ensuring payment integrity from various angles including: 

  • EMRs  
  • Vendor solutions 
  • Vigorous education and audit programs  

 

Colleen Gianatasio 
Value Based Care expert 

Concurrent Sessions 4:10 PM - 4:55 PM 3:10 PM - 3:55 PM 2:10 PM - 2:55 PM 1:10 PM - 1:55 PM

Track 1: Risk Adjustment Strategies - Track Chair: Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP Director Risk Capture – Population Health  - Mass General Brigham 

Track 2: Integrating Silos - Track Chair: Laura Cooley, PhD, Editor-in-Chief - Journal of Patient Experience 

Track 3: Quality and Member Experience - Track Chair: Reva Sheehan, Sr. Director of Customer Insights - mPulse

Track 4: Provider/Payer Strategic Alignment - Track Chair: Jenny Ritchie, Area Vice President Sales, East -Veradigm

Track 5: Hot Topic - Track Chair: Branka Sustic, Vice President, Risk & Quality Operations - Cotiviti, Inc.

RISE Innovation Theater 1: Track Chair: Mark Dabney, Director, Risk Adjustment - Community Health Plan of Washington  

RISE Regulatory Compliance Theater 2 - Track Chair: Ana Handshuh, Principal  - CAT5 Strategies 

Track Chairs:

4:10 PM 4:55 PM

3:10 PM 3:55 PM

2:10 PM 2:55 PM

1:10 PM 1:55 PM

Track 1: Risk Adjustment Strategies

Data Overload: How Advanced Real-Time Analytics Protect Your Bottom Line in Our Data-Rich World

  • Identify key hurdles such as data quality issues, incomplete medical records, and regulatory changes that complicate healthcare risk adjustment 
  • Explain how real-time analytics can address challenges related to incomplete data and regulatory compliance in healthcare 
  • Learn how to employ innovative analytics to improve member health outcomes, accelerate revenue growth, and reduce costs 

Rebecca Elhassid 
Secure Exchange Solutions 

Brian Murtha,Senior Director, Digital Initiatives 
Centene Corporation 

4:10 PM 4:55 PM

3:10 PM 3:55 PM

2:10 PM 2:55 PM

1:10 PM 1:55 PM

Track 2: Integrating Silos

AI in Medicare Advantage: Innovation, Controversy & Responsible Use

  • Understand AI’s role in Medicare Advantage (MA) for predictive analytics, member insights, outreach, risk adjustment, call centers, and operations.
  • Analyze recent AI controversies and misuse in MA 
  • Explore federal AI initiatives, including CMS and DOGE (Department of Government Efficiency) efforts to combat fraud, waste, and abuse   
  • Discuss ethical AI use in MA, balancing efficiency with fairness and patient-centered care 
  • Reflect on AI’s broader healthcare impact, emphasizing transparency, oversight, and responsible implementation 

Karl Ulfers, Co-founder & CEO 
DUOS 

Jessica Assefa, President and Senior Consultant 
Ameropia Advisors, LLC 

4:10 PM 4:55 PM

3:10 PM 3:55 PM

2:10 PM 2:55 PM

1:10 PM 1:55 PM

Track 3: Quality and Member Experience

Identifying and Acting on Million-Dollar Opportunities to Deliver High-Quality Care 

  • Discover how comprehensive data drives robust quality improvement and outcomes strategies 
  • Learn practical analytics techniques to guide members to high-value care and optimize network performance  
  • Understand the impact of provider performance on member experience and overall quality scores 

Moderator: 
Luke Hansen, MD, MHS, Chief Medical Officer 
Arcadia 

Susan Kopp, Director, Provider Network Analytics 
MVP Health Care 

Marilee Klock, MBA, CPC, CRC, Senior Director, Diagnosis Accuracy Program Guidehealth 

4:10 PM 4:55 PM

3:10 PM 3:55 PM

2:10 PM 2:55 PM

1:10 PM 1:55 PM

Track 4: Provider/Payer Strategic Alignment

Reducing Cost and Improving Quality Reporting for Providers and Payers

  • Reducing Administrative Burden: Leveraging clinical and claims data to streamline data collection and reporting, cutting down on manual work and data collection costs 
  • Enhancing Data Accuracy & Actionability: Implementing real-time data validation and interoperability to ensure providers and payers use high-quality, actionable insights for better quality reporting 
  • Aligning Incentives for Cost Savings & Quality: Creating collaborative frameworks between providers and payers to balance cost reduction with improved patient outcomes through value-based reporting models 

 

Moderator:
Diana Allen, PhD, CEO  
The SSI Group 

Sharon Barnicle, Executive Director 
Springhill Medical Center 

Katrina Miller Parrish, M.D., FAAFP, Chief Medical Officer, President 
SSI/Patient.com 

Jeffrey A Blomgren, Director of Engineering 
The SSI Group 

4:10 PM 4:55 PM

3:10 PM 3:55 PM

2:10 PM 2:55 PM

1:10 PM 1:55 PM

Track 5: Future of Health Care

Rewriting Rules of Engagement for Value Based Care – Henry Ford Health and Populance

  • Understand how health systems especially those with integrated payers are addressing the quintuple aim and embracing advanced value based models 
  • Introduction to Henry Ford Health’s value-based journey and the launch of our new population health subsidiary, Populance  
  • Description of Populance approach to population health service portfolio and application to clinically integrated networks, physician practices, health systems, and health plans 
  • Intensive review of Populance approach to ambulatory care supports as a case study for learning with specific review of: 
    • Focused approaches on social drivers of health mitigation to aid clinical practice  
      • Case management deployment including integrated, embedded clinic model  
      • Use of integrated electronic health record tools in Epic to enhance performance  
      • Use of other technical applications to enhance population health outcomes  

Jodi Buchholz, MSW, Director Ambulatory Case Management 
Populance  

4:10 PM 4:55 PM

3:10 PM 3:55 PM

2:10 PM 2:55 PM

1:10 PM 1:55 PM

RISE Innovation Theater

Coding Accuracy at Its Highest Level

Let's take a deep dive into coding practices to ensure accuracy of data to avoid CMS fines. We will discuss:  

  • Coding specificity   
  • How to avoid common coding errors and/or omissions  
  • Effective documentation guidelines 

Deb Curry, MBA, RHIA, CCS-P, CRC, Risk Adjustment Programs Director 
Medical Mutual 

4:10 PM 4:55 PM

3:10 PM 3:55 PM

2:10 PM 2:55 PM

1:10 PM 1:55 PM

RISE Compliance Theater

Incorporating Health Equity Performance into Your Plan’s Marketing, Interventions, and Products

  • As changes in health equity policy and Medicare Advantage regulations evolve under a new administration, it remains critical for plans to effectively understand and act upon individual personas, social risk factors, and health disparities—despite uncertainty in the regulatory landscape. This session will explore how to apply social risk factor data to enhance member engagement, optimize marketing strategies, and develop high-impact interventions and products 
  • Participants will engage in a hands-on, interactive breakout exercise to assess member scenarios based on limited demographic and health data. Through this activity, attendees will gain insight into how assumptions about member needs influence plan strategies and where gaps may exist in decision-making 
  • The exercise will culminate in the integration of additional USH social risk factor data, including completed assessments, risk scores, and Z-code correlations. Using this enhanced data, participants will refine their original recommendations, demonstrating the power of comprehensive social risk insights in shaping more effective, equitable, and personalized outreach and interventions 
  • This session will provide practical, real-world applications of health equity frameworks, helping plans prepare for shifting CMS requirements while proactively addressing disparities in member engagement and health outcomes 

Rick Whitted, President & CEO 
U.S. HUNGER 

Ana Handshuh, Principal   
CAT5 Strategies   

5:05 PM 6:05 PM

4:05 PM 5:05 PM

3:05 PM 4:05 PM

2:05 PM 3:05 PM

Food Packing Event

5:05 PM 6:05 PM

4:05 PM 5:05 PM

3:05 PM 4:05 PM

2:05 PM 3:05 PM

Interactive Roundtables in the Exhibit Hall

Grab a seat and get ready for a unique opportunity to engage in three dynamic, speed-networking-style presentations. Each session will feature cutting-edge technologies and solutions designed to enhance your plan’s risk, quality, and data management efforts. Throughout this special 60-minute session, a bell will ring three times, signaling the transition to the next roundtable of your choice. Don’t miss out on this fast-paced, interactive experience!

View Topics  

6:05 PM 7:00 PM

5:05 PM 6:00 PM

4:05 PM 5:00 PM

3:05 PM 4:00 PM

Networking Cocktail Reception in the Exhibit Hall

All attendees are invited to join us in the exhibit hall for drinks, hors d'oeuvres, and some lively networking. Come mingle, connect, and enjoy a fun evening with fellow attendees!

Friday - March 14

9:00 AM 12:00 PM

8:00 AM 11:00 AM

7:00 AM 10:00 AM

6:00 AM 9:00 AM

Help Desk Open

8:30 AM 12:00 PM

7:30 AM 11:00 AM

6:30 AM 10:00 AM

5:30 AM 9:00 AM

Exhibit Hall Open

8:30 AM 10:00 AM

7:30 AM 9:00 AM

6:30 AM 8:00 AM

5:30 AM 7:00 AM

Networking Breakfast in Exhibit Hall

10:15 AM 10:20 AM

9:15 AM 9:20 AM

8:15 AM 8:20 AM

7:15 AM 7:20 AM

Day Two Welcome Remarks and Day One Takeaways

Conference Chairs: 
Liz Haynes MSN, RN, CCM, Vice President of Quality, STARS, & Risk Adjustment 
CareFirst BlueCross BlueShield 

Kim Miller, D.C., CPC, CEDC, CRC, Government Programs Clinical Coordinator, SR. 
Blue Cross Blue Shield of Kansas City 

10:20 AM 11:20 AM

9:20 AM 10:20 AM

8:20 AM 9:20 AM

7:20 AM 8:20 AM

How AI Will Revolutionize Elder Care: Addressing the Aging Population's Unique Challenges with Artificial Intelligence and Compassion

As the global population ages, healthcare systems are facing unprecedented challenges in providing quality care to older adults. In particular, the rapid growth of artificial intelligence, the need for data-driven and cost-controlled care, and the need for personalized medicine all make Elder Care particularly unique.  

Dr. Sikka will explore how artificial intelligence is transforming elder care, enhancing diagnosis, treatment, and personalized care through predictive analytics, remote monitoring, and smart technology integration, and can meet patients halfway. By addressing issues such as chronic disease management, mobility, and cognitive decline, AI can empower healthcare professionals to offer more efficient, accessible, and patient-centered care to the aging population. This talk will highlight the latest innovations, real-world applications, and future trends in AI-driven solutions for senior health.  

Robby Sikka, MD 
NBA Physician & Technology Innovator
Former Senior Consultant at Tonal, Oura Ring, Pacaso & Other Tech Unicorns
Former Associate Director of Data Analytics at the Mayo Clinic
 

Learn More 

 

Introduced by American Logistics  
Brandon Piersant, Chief Marketing Officer 

11:20 AM 11:50 AM

10:20 AM 10:50 AM

9:20 AM 9:50 AM

8:20 AM 8:50 AM

Networking Break in the Exhibit Hall

Concurrent Sessions 11:50 AM - 12:35 PM 10:50 AM - 11:35 AM 9:50 AM - 10:35 AM 8:50 AM - 9:35 AM

Track 1: Risk Adjustment Strategies - Track Chair: Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP Director Risk Capture – Population Health  - Mass General Brigham 

Track 3: HOT TOPIC - Track Chair: Reva Sheehan, Sr. Director of Customer Insights - mPulse

Track 4: Provider/Payer Strategic Alignment - Track Chair: Jenny Ritchie, Area Vice President Sales, East -Veradigm

Track 5: Hot Topic - Track Chair: Branka Sustic, Vice President, Risk & Quality Operations- Cotiviti, Inc. 

Track Chairs:

11:50 AM 12:35 PM

10:50 AM 11:35 AM

9:50 AM 10:35 AM

8:50 AM 9:35 AM

Track 1: Quality and Member Experience

Making a Right Turn in The Intersection of Quality and Member Experience in a Dual eligible Environment

  • Learn how to enhance member experience and quality for dual eligible members 
  • Understand how to develop person centered, and equitable member experience initiatives through quality 
  • Learn best practices in Integrating accountability models into quality programs and initiatives to improve member satisfaction and experience 
  • Gain insights into how CalAIM is improving member outcomes by implementing Health Equity initiatives that are rooted in quality 

Kailey Collier, Director of Quality Performance 
Kern Health Systems 

Tina Dueringer, RN, BSN, CCM, PCC, CEO, Principal Advisor 
Dueringer Advisors, Inc  

11:50 AM 12:35 PM

10:50 AM 11:35 AM

9:50 AM 10:35 AM

8:50 AM 9:35 AM

Track 3: Hot Topics

The Changing Landscape of The Pharmacy Under IRA, From a Health Plan Perspective

  • Describe the final rules and how this will impact the overall pharmacy    
  • How to implement the programs and anticipate the impact of the changes     
  • How to anticipate and continue identifying opportunities for growth and cost savings 

Helen Liu, Pharm.D.
Health Plan Leader/ Senior Consultant

11:50 AM 12:35 PM

10:50 AM 11:35 AM

9:50 AM 10:35 AM

8:50 AM 9:35 AM

Track 4: Provider Focus

Don't Box Me In: A Lesson in Saving a Life

  • Health maintenance must be a focus of our patient care 
  • Some causes for why patients avoid seeing providers 
  • How focusing on health maintenance can save lives and allow patients to live healthier, longer lives 

Donna Furlong, RN Clinical Services Senior Director 
Banner Medical Group 

11:50 AM 12:35 PM

10:50 AM 11:35 AM

9:50 AM 10:35 AM

8:50 AM 9:35 AM

Track 5: Future of Health Care

Advancing Patient Engagement in Medicare Advantage: Practical Strategies for Implementation

  • Define and identify opportunities for meaningful patient engagement 
  • Apply practical, effective strategies to operationalize engagement 
  • Leverage metrics to evaluate impact and enhance program outcomes 

Moderator:  
Laura Cooley, PhD, Editor-in-Chief 
Journal of Patient Experience 

Rachel Biblow, Associate Editor of Strategy, Innovation, and Outcomes 
Journal of Patient Experience 

Calvin Chou, MD, PhD, FACH
Professor of Clinical Medicine, UCSF
Faculty, Academy of Communication in Healthcare
Director, UCSF-VALOR Program
Sustaining Member, UCSF Academy of Medical Educatorsy 

Leticia Bresnahan, MBA   
Patient Representative  

Erika Bowen, PhD 
Patient Representative