Check out an exclusive sneak peek of our first 16 confirmed sessions on the agenda for RISE National 2023, taking place March 6-8 at the Broadmoor resort in Colorado Springs. RISE National 2023 offers focused sessions across nine themes to encourage a deeper dive into the content most relevant to you, your job function, and your organization.

 

NEW Track:
Integrating Silos

Risk Adjustment Integration: Impactful Strategies to Drive Maximum Value

• Building out value-based care models and the foundation needed for an integrated approach
• Amalgamating risk, quality, care, and consumer elements to drive maximum impact and value
• Improving care and member experiences by designing next best action for consumers and providers
• Embracing and monitoring your risk adjustment program for improved network management
• Achieving mutual success through collaboration with key stakeholders

RaeAnn Grossman, EVP, Operations – Risk Adjustment, Population Health Management and Quality
Cotiviti  

 

Case Study: How Integrating Quality and Risk Analytics Improves Member Satisfaction, Outcomes, and Provider Engagement

• Learn how coordinating quality and risk programs enables a health plan to reduce duplicative outreach to members and improve satisfaction and retention rates
• Discover the power of delivering analytically identified opportunities to providers that enable both patient care and documentation needs to be addressed in the same encounter
• Identify ways to demonstrate to providers the value and impact of health plan quality and risk program efforts on patient health outcomes to foster greater provider engagement

Session presented by Inovalon  

Integrating Technology and Services Enabling You to Focus on Members and Growth

• Break down the silos between risk adjustment, quality, core administration, and health management groups
• Unify your data into one source across your organization to be proactive and not reactive
• Utilize real-time data and analytics to meet member needs and outperform your competition

Moderator:
Patrick Coulson, Senior Vice President, Sales and Marketing
Allymar Health Solutions

Panelists:
Kevin M. Healy, CEO
Allymar Health Solutions

Gregg Kimmer, CEO
ATRIO

Pre-Conference Workshops

Add on these interactive, deep-dive sessions to your registration

Register Now 

 

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

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 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.

• 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 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)

Workshop C: 2023 Developments in Risk Adjustment Enforcement, Compliance, and Agency Actions and What Your Organization Should Be Doing Now

• Educate attendees on issue spotting key risk areas based on developing cases and agency audits
• Interactive discussion of the hard questions related to auditing, monitoring and overpayments
• Update on active and settled cases, lessons learned and most critical takeaways.
• Discuss impacts to value-based contracting, risk adjustment operations (both at the health plan and medical group level), and incentive programs/pay for performance

Jason Eric Christ, JD, Attorney  
Epstein Becker Green  

David Meyer, CCO, Applied Research Works/Cozeva
Advisor, EBG

Risk Adjustment Strategies

Integrating Chart Retrieval with Precise Word Matching NLP: What’s NEW and Why it’s Important

• Discuss how new chart retrieval methods produce faster and more accurate risk adjustment coding
• Learn how to automate risk adjustment and HEDIS workflows with symbiotic technologies
• Retrospective and prospective coding simplified with flywheel process

George Witwer, CEO
Cavo Health

 

Driving Organizational Alignment Utilizing AI for a Prospective Risk Adjustment Strategy

• How to drive prospective risk adjustment strategy with people, process, and technology
• Learn how AI can automate and scale across prospective risk adjustment workflows (pre-visit, point of care, post-visit)
• Understand the hurdles and successes in driving organizational alignment across clinicians, IT, and others

Kelley Scott MSN FNP-c, Nurse Practitioner at Providence Medical Foundation
Providence St. Joseph Health

Rachel Goldstein, Staff Product Manager
Apixio
 

Would You Water Your Garden with a Leaky Hose?

• How risk adjustment is like an iceberg, and how system configuration issues outside of risk adjustment operations can sink the risk adjustment ship regardless of how well the risk adjustment department is executing
• The importance of measuring the right things, at the right time, by the right people to prevent drowning in data - "analysis paralysis"
• How to develop a customized "leakage map" as a tool to measure and manage, in addition to CMS reporting and metrics

Dawn Carter, BSBA, CPC, Director, Product Strategy
Centauri Health Solutions
 

Making Your Risk Adjustment Compliance Driven

In this session we will outline compliance concepts that are important in managing risk adjustment operations.

• Start with the end mind— are you set for validation?
• How can you be sure a new Dx is compliant?
• When must a Dx be deleted?
• Are you sure you have a complete view of each members current acuity status
• Whose job is it anyway?

Anna Carley, RHIT, Senior Director - CRM, Payer Solutions
GeBBS Healthcare Solutions
 

Meaningful Approach to Social Determinants of Health

• Evaluate current ability to target social risk factors and barriers to care that fall into key categories
• Leverage existing data that can be used to target at risk beneficiaries with barriers to care
• Improving health outcomes while securing the data for improved

Elaine Taverna, Senior Vice President, Risk Adjustment and Quality
Advantasure
 

Payer/Provider Collaboration

Establishing Best-In-Class Collaborative Workflows Between Payers and Care Delivery

• Hear how M Health Fairview developed a best-in-class workflow to streamline care delivery and meet the needs of their payer partners
• Learn how to identify connectivity challenges that exist between payers and providers, and how these barriers can result in a diminished member experience
• Understand the importance of partnering with providers to assess their current digital footprint to help them reach their interoperability goals

Aria Sameni, Vice President of Growth and Strategy
Optum

James Hereford, Chief Executive Officer
M Health Fairview

 

Creating Successful Payer + Provider Alliances with AI and Interoperability

• Gain insight into financial, quality, and contractual performance across multiple APM populations and payment models to improve stakeholder reporting, communication, and negotiations
• Discuss utilization management decision support for prior authorization procedures and precise patient care and risk gap targeting insights at the point of care within the EMR to inform care delivery and improve health outcomes
• Learn clinical risk capture and coding workflows that increase payment accuracy and minimize compliance exposure to improve risk adjustment performance

Mark Filiault, VP Payer Sales
Edifecs

Best Practices and Pitfalls of Provider-centric Risk Adjustment Programs

• Learn best practices for provider-centric risk adjustment programs, based on first-hand experience from the front lines
• Avoid common pitfalls in designing a program
• Hear a case study on how a payer worked closely with providers to drive mutual success

Session presented by Vatica Health

Future of Health Care

Value-Based Testing Innovations to Reduce Cardiovascular Morbidity and Mortality

• Identify new, accurate point-of-care methods for detecting early-stage cardiovascular disease
• Discover how the early presence of PAD can be used as a marker for atherosclerosis before it becomes symptomatic
• Learn how the presence of PAD in asymptomatic patients has been shown to be an independent outcomes indicator of increased mortality and major adverse cardiovascular events (MACE)

Robert London, MD, Medical Director
Semler Scientific, Inc.

Wayne Pan, MD, PhD, MBA, Medical Director
Banner Health

 

Keynote Address

Becoming Superhuman: The Science of Productivity and Performance

Facilitated by UC Berkeley faculty, Dr. Yousef and Professor Miller, this discussion will help equip you with the knowledge you need to both think more strategically and get more work done when time and resources are limited. We will cover:

• Leading research on the three biggest mistakes of productivity and performance and the scientific reasons WHY people commonly make those mistakes
  • The ideal physical environment for focus and productivity
  • The multitasking myth and why those with certain digital hygiene practices are more prone to end-of-day exhaustion
• Learn a research-backed way of working that helps individuals get more done, in less time, with less energy expended
• Slow vs fast dopamine and why to-do lists don’t work
• How to prioritize the most important tasks, even in the face of urgent demands
• Discover your biological chronotype and how to optimally schedule your day for peak productivity and effectiveness

Dr. Sahar Yousef, Cognitive Neuroscientist
Faculty Member
UC Berkeley's Haas School of Business

Professor Lucas Miller, Faculty Member
UC Berkeley's Haas School of Business

 

Learn More About the Keynote