2025 Schedule
We are thrilled to announce that RISE National 2025 is being extended by an extra day to accommodate even more essential content, regulatory updates, networking opportunities, and after-hours fun! You’ll have even more time to deep dive into sessions and workshops, connect with industry leaders, exchange ideas with Medicare Advantage peers, and explore innovative solutions in the exhibit hall. Don’t miss out on this expanded opportunity to maximize both your learning and networking experiences to make meaningful change in health care!
11:00 AM 12:00 PM
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
12:00 PM 6:00 PM
11:00 AM 5:00 PM
10:00 AM 4:00 PM
9:00 AM 3:00 PM
Please note: This workshop requires additional registration.
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
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:
Instructors:
Colleen Gianatasio, Director, Clinical Documentation Integrity and Coding Compliance
CDPHP
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.
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
6:00 AM 7:00 AM
10:00 AM 6:00 PM
9:00 AM 5:00 PM
8:00 AM 4:00 PM
7:00 AM 3:00 PM
10:00 AM 1:00 PM
9:00 AM 12:00 PM
8:00 AM 11:00 AM
7:00 AM 10:00 AM
Please note: This workshop requires additional registration.
Jason E. Christ, Member of the Firm
Epstein Becker Green
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
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
Quality
Total Cost of Care
Analytics & Reporting
Contract Evaluation
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
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.
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.
2:00 PM 2:10 PM
1:00 PM 1:10 PM
12:00 PM 12:10 PM
11:00 AM 11:10 AM
Ellen Wofford, Founder & CEO
RISE
Conference Chairs:
Liz Haynes MSN, RN, CCM, DVP, Risk Adjustment & Stars Government Programs
Blue Cross and Blue Shield of Kansas City
2:10 PM 3:00 PM
1:10 PM 2:00 PM
12:10 PM 1:00 PM
11:10 AM 12:00 PM
3:00 PM 3:30 PM
2:00 PM 2:30 PM
1:00 PM 1:30 PM
12:00 PM 12:30 PM
3:30 PM 4:15 PM
2:30 PM 3:15 PM
1:30 PM 2:15 PM
12:30 PM 1:15 PM
Anna Carley, RHIT, Senior Director - CRM, Payer Solutions
GeBBS Healthcare Solutions
Dr. Shannon Decker, Principal
VBC One
3:30 PM 4:15 PM
2:30 PM 3:15 PM
1:30 PM 2:15 PM
12:30 PM 1:15 PM
Chris Lance, Chief Product Officer
Edifecs
Brian Murtha, Director of Risk Adjustment Digital Strategy
Centene
Jennifer Holman, Director of Risk Adjustment Programs
Centene
3:30 PM 4:15 PM
2:30 PM 3:15 PM
1:30 PM 2:15 PM
12:30 PM 1:15 PM
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.
Expected Outcomes:
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, SVP Community Affairs, Corporate Affairs
Highmark Health
Dr. Eugene Scioscia, Chief Patient Experience Officer, Obstetrics and Gynecology
Allegheny Health Network
3:30 PM 4:15 PM
2:30 PM 3:15 PM
1:30 PM 2:15 PM
12:30 PM 1:15 PM
Arati Swadi, MBA, Vice President of Product
Optum
3:30 PM 4:15 PM
2:30 PM 3:15 PM
1:30 PM 2:15 PM
12:30 PM 1:15 PM
Paul Burke, Chief Product Officer
Reveleer
4:25 PM 5:25 PM
3:25 PM 4:25 PM
2:25 PM 3:25 PM
1:25 PM 2:25 PM
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
5:30 PM 7:30 PM
4:30 PM 6:30 PM
3:30 PM 5:30 PM
2:30 PM 4:30 PM
5:30 PM 7:30 PM
4:30 PM 6:30 PM
3:30 PM 5:30 PM
2:30 PM 4:30 PM
Let's kick off the mega Medicare Advantage event of the year in style! 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!
9:00 AM 7:00 PM
8:00 AM 6:00 PM
7:00 AM 5:00 PM
6:00 AM 4:00 PM
9:00 AM 7:00 PM
8:00 AM 6:00 PM
7:00 AM 5:00 PM
6:00 AM 4:00 PM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
6:00 AM 7:00 AM
10:00 AM 10:10 AM
9:00 AM 9:10 AM
8:00 AM 8:10 AM
7:00 AM 7:10 AM
Ellen Wofford, Founder & CEO
RISE
Conference Chairs:
Liz Haynes MSN, RN, CCM, DVP, Risk Adjustment & Stars Government Programs
Blue Cross and Blue Shield of Kansas City
10:10 AM 11:00 AM
9:10 AM 10:00 AM
8:10 AM 9:00 AM
7:10 AM 8:00 AM
Ann Maxwell Deputy
Inspector General for Evaluation and Inspections Office of Evaluation and Inspections
Department of Health and Human Services
Office of Inspector General (OIG)
Ann Maxwell, the Deputy Inspector General for Evaluation and Inspections in the Department of Health and Human Services (HHS) Office of Inspector General (OIG), will share her vision for cultivating trust in Medicare Advantage. The Deputy Inspector General will demonstrate the OIG’s commitment to ensuring that the Medicare Advantage program delivers cost-effective, high-quality care for the millions of enrollees who rely on it by focusing on the future of the Medicare Advantage program and what steps plans can take now to ensure managed care lives up to its potential. The Deputy Inspector General will emphasize how plans and others can build trust and elevate integrity through compliance, including how plans can use OIG’s oversight and program integrity tools to focus on key gaps where managed care has tremendous opportunities to earn trust and reduce risk.
11:00 AM 11:45 AM
10:00 AM 10:45 AM
9:00 AM 9:45 AM
8:00 AM 8:45 AM
11:45 AM 12:15 PM
10:45 AM 11:15 AM
9:45 AM 10:15 AM
8:45 AM 9:15 AM
12:15 PM 1:00 PM
11:15 AM 12:00 PM
10:15 AM 11:00 AM
9:15 AM 10:00 AM
Presented by Apixio
12:15 PM 1:00 PM
11:15 AM 12:00 PM
10:15 AM 11:00 AM
9:15 AM 10:00 AM
12:15 PM 1:00 PM
11:15 AM 12:00 PM
10:15 AM 11:00 AM
9:15 AM 10:00 AM
John Criswell, Founder, CEO, Chairman
Porter
12:15 PM 1:00 PM
11:15 AM 12:00 PM
10:15 AM 11:00 AM
9:15 AM 10:00 AM
Dr.Mansoor Khan, CEO
Persivia
Dr. Fauzia Khan, CMO
Persivia
12:15 PM 1:00 PM
11:15 AM 12:00 PM
10:15 AM 11:00 AM
9:15 AM 10:00 AM
Andrew Lockhart, CEO
Fathom
12:15 PM 1:00 PM
11:15 AM 12:00 PM
10:15 AM 11:00 AM
9:15 AM 10:00 AM
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
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:
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
2:00 PM 2:45 PM
1:00 PM 1:45 PM
12:00 PM 12:45 PM
11:00 AM 11:45 AM
Jimmy Liu, VP, Analytics and MRR Solutions
Advantmed
2:00 PM 2:45 PM
1:00 PM 1:45 PM
12:00 PM 12:45 PM
11:00 AM 11:45 AM
2:00 PM 2:45 PM
1:00 PM 1:45 PM
12:00 PM 12:45 PM
11:00 AM 11:45 AM
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
2:00 PM 2:45 PM
1:00 PM 1:45 PM
12:00 PM 12:45 PM
11:00 AM 11:45 AM
Dr. Edward Likovich, CEO
Nymbl
Lori Rund, VP Government Programs
Blue KC
Dr. Robert Mirsky, Former CMO
Aetna Medicare
Charlotte Yeh, Former CMO
AARP
2:00 PM 2:45 PM
1:00 PM 1:45 PM
12:00 PM 12:45 PM
11:00 AM 11:45 AM
Presented by Duos
2:00 PM 2:45 PM
1:00 PM 1:45 PM
12:00 PM 12:45 PM
11:00 AM 11:45 AM
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.
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
2:45 PM 3:15 PM
1:45 PM 2:15 PM
12:45 PM 1:15 PM
11:45 AM 12:15 PM
3:15 PM 4:00 PM
2:15 PM 3:00 PM
1:15 PM 2:00 PM
12:15 PM 1:00 PM
Debbie Conboy, SVP, Risk Adjustment
Signify Health
Heidi Schwarzwald, MD, MPH, CMO, Home & Community Services
Signify 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
Presented by Healow Insights
3:15 PM 4:00 PM
2:15 PM 3:00 PM
1:15 PM 2:00 PM
12:15 PM 1:00 PM
Presented by 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
Building an Enterprise Risk Management model can be difficult; building one that effectively integrates AI is even more so. Designing an ERM risk taxonomy that identifies and defines the larger AI risk profile enables strong governance to have line of sight into potential risks. Risk leaders that optimize ERM design principles create clear classification models for tracking AI risks, resulting in high leadership/board engagement and strong mission alignment. In a world of increasing vulnerability to cyber and operational risk emerging from AI, effective ERM practices can eliminate excessive complexity and nuance, and instead, provides purposeful direction and improved comprehension to assist building out an organization's AI risk profile. This session will examine effective strategies on how to optimize building AI into an ERM model to enhance risk identification, monitoring, and mitigation efforts.
Amir St. Clair, Vice President, Enterprise Risk Management
Advocate 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
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:
Colleen Gianatasio, Director, Clinical Documentation Integrity and Coding Compliance
CDPHP
4:10 PM 4:55 PM
3:10 PM 3:55 PM
2:10 PM 2:55 PM
1:10 PM 1:55 PM
Let's take a deep dive into coding practices to ensure accuracy of data to avoid CMS fines. We will discuss:
Deb Curry, MBA, RHIA, CCS-P, CRC, Risk Adjustment Programs Director
Medical Mutual
5:05 PM 6:05 PM
4:05 PM 5:05 PM
3:05 PM 4:05 PM
2:05 PM 3:05 PM
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!
Participate in 4 roundtables between Thursday and Friday’s roundtable sessions and be entered into a drawing; 100 participants will receive complimentary Maui Jim sunglasses!
6:05 PM 7:00 PM
5:05 PM 6:00 PM
4:05 PM 5:00 PM
3:05 PM 4:00 PM
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!
8:30 AM 12:30 PM
7:30 AM 11:30 AM
6:30 AM 10:30 AM
5:30 AM 9:30 AM
8:30 AM 11:50 AM
7:30 AM 10:50 AM
6:30 AM 9:50 AM
5:30 AM 8:50 AM
8:30 AM 10:00 AM
7:30 AM 9:00 AM
6:30 AM 8:00 AM
5:30 AM 7:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
6:00 AM 7:00 AM
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!
Participate in 4 roundtables between Thursday and Friday’s roundtable sessions and be entered into a drawing; 100 participants will receive complimentary Maui Jim sunglasses!
10:00 AM 10:05 AM
9:00 AM 9:05 AM
8:00 AM 8:05 AM
7:00 AM 7:05 AM
Conference Chairs:
Liz Haynes MSN, RN, CCM, DVP, Risk Adjustment & Stars Government Programs
Blue Cross and Blue Shield of Kansas City
10:05 AM 10:20 AM
9:05 AM 9:20 AM
8:05 AM 8:20 AM
7:05 AM 7:20 AM
In the spirit of the RISE mission to encourage continuous improvement in the health care system, The Dr. Martin L. Block Award for Innovation & Excellence is presented to an esteemed nominee each year at RISE National. This prestigious accolade acknowledges an individual’s effort to enhance the lives of America’s seniors through clinical leadership, policy vision and by superior example. Nominate a colleague here.
10:20 AM 11:20 AM
9:20 AM 10:20 AM
8:20 AM 9:20 AM
7:20 AM 8:20 AM
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
11:20 AM 11:50 AM
10:20 AM 10:50 AM
9:20 AM 9:50 AM
8:20 AM 8:50 AM
11:50 AM 12:35 PM
10:50 AM 11:35 AM
9:50 AM 10:35 AM
8:50 AM 9:35 AM
This session walks through the foundation of value-based care and the importance of accurate documentation, including:
Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP
Director Risk Capture – Population Health
Mass General Brigham
11:50 AM 12:35 PM
10:50 AM 11:35 AM
9:50 AM 10:35 AM
8:50 AM 9:35 AM
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
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
Moderator:
Laura Cooley, PhD, Editor-in-Chief
Journal of Patient Experience
Rachel Biblow, Associate Editor of Strategy, Innovation, and Outcomes
Journal of Patient Experience
Namita Seth Mohta M.D., Executive Editor
NEJM Catalyst Innovations in Care Delivery
11:50 AM 12:35 PM
10:50 AM 11:35 AM
9:50 AM 10:35 AM
8:50 AM 9:35 AM
Kailey Collier, Director of Quality Performance
Kern Health Systems
Tina Dueringer, RN, BSN, CCM, PCC, CEO, Principal Advisor
Dueringer Advisors, Inc
12:40 PM 1:25 PM
11:40 AM 12:25 PM
10:40 AM 11:25 AM
9:40 AM 10:25 AM
1:25 PM 1:30 PM
12:25 PM 12:30 PM
11:25 AM 11:30 AM
10:25 AM 10:30 AM
This year, we’re wrapping up before lunch to give you ample time to travel home and start your weekend. Parting is such sweet sorrow!
Conference Chairs:
Liz Haynes MSN, RN, CCM, DVP, Risk Adjustment & Stars Government Programs
Blue Cross and Blue Shield of Kansas City