Rise

Track 1: Risk Adjustment Strategies

Start Looking Forward: How Analytics-Fuelled Prospective Strategies Transform Member Outcomes

• Examine the industry shift from retrospective to prospective risk adjustment 
• Discuss technologies that can fuel your prospective strategy, such as point-of-care tools and advanced analytics  
• Understand the differences between technologies that are customized for Medicare Advantage plans, Medicaid plans, PACE plans, and ACOs 
• Discover how these strategies can lead to a more accurate understanding of your member population, more timely interventions, and improved patient outcomes 

Eric Segal, Sr. Director of Platform Strategy and Solutions
Episource

Roy Oaks, Senior Director, Data Analytics
Driscoll Health Plan

Lisa Marshall, Manager, Alternative Payment Strategies
Driscoll Health Plan

Track 2: Integrating Silos

Mission Optimal is Business Optimal: Case Studies in Connecting Member, Stakeholder and Business Outcomes

• Taking charge: lessons from the VA on connecting the true north of healthcare to key business decisions  
• Mutual of Omaha’s strategic investments to engage seniors, empower their care journey, and drive healthcare cost sustainability  
• Low cost, high value and scalable tactics to help seniors navigate the digital + in person care ecosystem 

Moderator: 
Craig Hittle, SVP Health Plans
Kaia Health

Dr. David Shulkin, Ninth Secretary, US Department of Veteran Affairs-Shulkin
Solutions, LLC

Dr. Manoj Pawar, Chief Medical Officer
Mutual of Omaha

Nigel Ohrenstein, President
Kaia Health

Track Chair:
Reva Sheehan, Sr. Director of Customer Insights
mPulse Mobile

Track 3: Quality and Member Experience

Point of Care Strategies and Innovative Technology That Drive Better Clinical Outcomes and Patient Experience

• Discuss how aligning data (your physician EHR data and incentives) drive outcomes and build trust 
• Hear how healthcare table stakes are shifting from in-home and by-phone workarounds to investing in the point of care 
• Bridge data and member engagements across payers, medical groups, and other stakeholders to close the loop with providers 

Moderator:

David Meyer, Chief Customer Officer, Applied Research Works 
COZEVA

Khanh Nguyen, PharmD, Chief Executive Officer, Applied Research Works 
COZEVA 

Rina Shah, MD - Regional Medical Director, Board Member
Hill Physicians Medical Group

Maya Gumatay-Marmo, MPH, Director, Data Analysis, Quality Improvement
Health Net

Track 4: Payer/Provider Collaboration

The Keys to Successful Health Plan and Provider Collaboration for Improved Outcomes and Increased Revenue Performance

• Explore how interoperability speeds data lags for faster, more accurate reimbursements
• Discover how shared data platforms enable accurate, longitudinal records across risk and quality
• Discuss how the digital data imperative will help close gaps in care – and how to get there
• Chart a course for the ongoing convergence between health plans and providers

Moderator:
Elissa Toder, VP, Quality Improvement Strategy & Solutions
Reveleer

Sundar Ramalingam, Senior Manager of Government Programs
AvMed Health Plans

Deniese Crittenden, RN, MSN, MHA, BSW, CRC, Vice President, Risk Adjustment Strategy and Solutions
Reveleer

Margaret Paroski, MD, MMM, President & CEO and Chief Medical Officer 
Catholic Medical Partners  

Track 5: Technology/Data Analytics

Data to Action: Improve Quality Scores and Reduce RADV Risk in One Shot!

• Reducing RADV Risk sounds easy…but takes persistence!
• SDoH: Non-clinical factors that impact an individual’s health
• Addressing NCQA Gap Closures

Schawn Pedersen, CPC, Director, Coding and Quality Compliance
Matrix Medical Network

Track 6: Compliance and Regulatory Updates

2023 Update from the Office of the Inspector General (OIG) 

Presenters will provide an overview of OIG’s recent reports and current priorities in the managed care space. Topics will include OIG risk adjustment data validation audits as well as Medicare Advantage Organizations’ denials of payments and services. The panel will also outline future work regarding health disparities.
 
Moderator:
Ana Handhsuh, Principal 
Cat 5 Strategies

Megan H. Tinker, Chief of Staff 
Office of Inspector General  
U.S. Department of Health and Human Services (HHS) 
  
Blaine Collins, Regional Inspector General, Office of Evaluation and Inspections  
Office of Inspector General  
U.S. Department of Health and Human Services (HHS) 

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

Track 1: 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

Troy Garland, MBA, BA, RN, Vice President Clinical and Quality Operations
Equality Health

P.J. Morris, MHA, Manager, Risk Adjustment Operations & Analytics
Fallon Health

Track 2: Integrating Silos

Case study: Improving outcomes, Engagement, and Efficiency with One Data-Driven Member View

• Learn how combining the efforts of quality and risk teams through a single analytics-based program can transform health plan operations, performance, and costs
• Discover the power of seamless information sharing with your provider network and greater internal collaboration to drive better outcomes and happier members
• Gain real-world insight as health plan leaders share their organizations’ strategic vision for undertaking an integrated approach to quality measurement and risk adjustment

Moderator:

Michael Hasbany, EVP, Customer Success and Commercialization
Inovalon

Matthew Caminiti, Sr. Principal Solutions Engineer
Inovalon

Gabriel L. Medley, Vice President, Risk Adjustment & Analytics
Blue Cross Blue Shield of Michigan

Track 3: Quality and Member Experience

Improve Patient Experience by Getting More Out of The BioPsychSocial 

• Discuss mental health and the convergence with the risk model, opportunities for code capture, correlation with physical health, and options for service offerings 
• Learn the psychology behind best-in-class patient and physician engagement 
• Develop a better connection with your patients learning active questioning techniques, while improving patient engagement for better risk, CAPHS and quality performance 
• Learn how you can still be efficient AND most effective with patient engagement. An engaged patient means better compliance for quality, risk and satisfaction overall 

Dr. Shannon Decker, Principal  
VBC One  

Track 4: Payer/Provider Collaboration

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

• Learn about four key components for reducing total cost of care while improving member outcomes 
• Understand the importance of partnering with providers to assess their current digital footprint to help them reach their interoperability goals  
• Hear how M Health Fairview developed a best-in-class workflow to streamline care delivery and meet the needs of their payer partners 

Aria Sameni, Vice President of Growth and Strategy  
Optum  

James Hereford, Chief Executive Officer  
M Health Fairview

Track 5: Technology/Data Analytics

What’s Your Data Missing? Utilizing Interoperability to Transform the Delivery of Care

• Discuss the challenges and opportunities with the data available at your fingertips.
• Learn how one of the largest healthcare companies has transformed how they deliver care by utilizing interoperability to capture data from multiple disparate sources.
• Hear how capturing missing data is key to improving outcomes by creating a holistic, longitudinal view of the member.

Moderator
Ashish Kachru, CEO
DataLink Software

James D. Murray, MS, VP, Clinical Informatics and Interoperability
CVS Health/Aetna

Josh Hetler, Chief Operating Officer
DataLink Software

Track 6: Future of Health Care

Delivering Better Health Outcomes Through a Data-Driven, Holistic and Personalized Member Experience

• Using technology to identify the members who need care, the type of care they need, and which modality of care is better for them
• Delivering a member-centered holistic approach to care coordination and delivery 
• Converging risk adjustment and stars quality efforts to improve the member experience, drive quality outcomes and ensure accurate reimbursement

Debbie Conboy, SVP, Risk Adjustment and Quality
Signify 

Lynne Newson, Vice President, Medicare Strategy
Blue Cross Blue Shield of Massachusetts

Track 1: Risk Adjustment Strategies

Driving Organizational Alignment Utilizing AI for a Prospective Risk Adjustment Strategy

• Discuss the challenges and opportunities with pivoting from retrospective to prospective risk as well as digital approaches to artificial intelligence (AI)
• 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 

Matt Plack, VP for Innovation and New Solution Strategy
Apixio 

Track 2: Integrating Silos

Using Member Data Within Your Health Plan to Close Gaps, Reduce Cost and Optimize Utilization

• New NCQA/CMS requirements impact on business operations
• Centralized data set from fewer vendors for a more expansive view of your member population
• Enhancing clinical data with patient reported and third-party validated sources
• Outlining which SDoH codes are available and best practices to capture them with coding
• How sharing data from one department can be utilized across an organization like RA and member engagement 

Moderator:

Lyle Mioduszewski, Vice President of Population Health
Ciox Health

Michelle Zilisch, Director, Product Management
Ciox Health/Datavant

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

Track 3: Quality and Member Experience

Reducing Hospitalization and Readmission Risk Through In-Home Support and Comprehensive Transitional Care for High-Risk Members

• Hear about how Providence Health Plan’s (PHP) care management intervention reduced hospital readmissions to support star ratings and reduce the cost of care 
• Learn how to build and deploy an effective program for high-risk members 
• Understand how quality home-based care supports support care transition for members returning home after hospitalization 

Francesca Rinaldo, MD, PhD, SVP, Clinical Product & Innovation 
Sharecare 

Jessica Wack-Alexander, MBA, Program Manager, Health Care Services
Providence Health Plan

Track 4: Payer/Provider Collaboration

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  

Michael (Mike) Nemeth, MSM-RMI, AVP, Revenue Program Management                          
Blue Cross Blue Shield of North Carolina

Samantha Rodgers, CPC, CRC, Provider Coding & Education Implementation Manager
Premera

Nicole Clarke Luck, Chief Development and Commercial Officer, Principal
Apex Health 

Jennifer Holman, LPN, CRC, Director Risk Adjustment
Centene Corporation 

Track 5: Technology/Data Analytics

Data Analytics – The Pros, and Potential Pitfalls, to Leveraging Your Information

• How harnessing the information you maintain can unlock huge value to your beneficiaries and your organization 
• Proving the ROI of programs can be tricky, but can also provide a pathway for expanded growth and organizational evolution 
• Clinical standards and coding still matter and should utilize data analytics to be even better than they already are 

Biggs Cannon, Senior Managing Director, Health Solutions Practice
FTI consulting

Nikki Hungate MS, MHA, Director, Medicare & Gov't Programs Product Strategy
MVP Health Care

Track 6: Future of Health Care

Next Generation AI for Risk Adjustment

• Understand the creation of the Intelligent Coding Solution
• Learn how next gen AI improves patient quality of care
• Be inspired through a modern best-in-class modern app

Lynne Padilla, Vice President, Risk Adjustment Solutions 
Change Healthcare 

Leo Janze, Head of Data Engineering, NLP 
Change Healthcare

Laura Sheriff, RN, MSN, Vice President Operations, Risk Adjustment
Southwestern Health Resources (SWHR) 

Track 1: Risk Adjustment Strategies

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, CRC, CPMA, CDEO, CPCO, CSPO, Director, Product Strategy, AAPC Fellow
Centauri Health Solutions

Melissa McVaugh MSN-LM, RN, CPC, Director Clinical Programs
Mountain Health CO-OP

Track 2: Integrating Silos

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  

Kevin M. Healy, CEO  
Allymar Health Solutions  

Gregg Kimmer, CEO 
ATRIO 

Track 3: Quality and Member Experience

5 Steps to 5 Stars: High Performing Plans Differentiate Themselves on 5 Key Parameters

• Discover how leading from the top, designing benefits, partnering with providers and suppliers, making key touchpoints count, and leveraging cutting edge listening and analytics have enabled plans to achieve a 5 Star rating. 
• Learn how a health plan and their integrated provider network worked to differentiate their performance and achieve a 5 Star rating for multiple years. 
• Explore the use of predictive analytics to focus your improvement efforts on those members who will impact specific CAHPS ratings. 
• Learn how provider partnerships post visit CG CAHPS surveys, and provider network training can impact your plan’s Star rating. 
• Learn how a holistic approach to member experience can improve multiple key measures, such as CAHPS and Net Promoter Score 

Moderator:

David L. Larsen RN MHA, Senior Advisor Payor Solutions 
Press Ganey 

Adam Higman, DHA, FACHE, Partner, Strategic Consulting
Press Ganey

Kim Barrus, MSN,RN, PMP, Director Clinical and Outcomes Management
SelectHealth 

Track 4: Payer/Provider Collaboration

Challenges and best practices for Provider-Centric Risk Adjustment

• 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 

Hassan Rifaat, MD, Chief Executive Officer 
Vatica Health  

Steve Romary, Director, Risk Adjustment Programs and Strategy
Highmark

Paul Linder, MD
Paul G. Linder and Associates PC

Track 5: SDoH & Health Equity

Raising the Bar: Advancing Equity Through Member Experience & Care Access

• Why Health Equity is coming to the forefront of NCQA & CMS potential quality ratings
• Innovative ways to close care gaps through SDoH data
• How to improve member experience using language that is understandable, approachable, & inclusive

Troy Jelinek, Chief Commercial Officer 
Icario 

Jennie Roberts, Senior VP, Quality and Clinical Modernization UnitedHealthcare 

Track 6: Future of Health Care

Leveraging Technology to Move to Value-Based Medicine: How Not to Let Chronic Diseases Cost You an Arm and a Leg (or a Foot)

• Hear from industry experts how they use clinical decision support tools to transform the management of chronic diseases through earlier diagnosis, with the potential to reduce costs and deliver improved health outcomes and patient satisfaction.
• RETHINK - how early detection and management of chronic diseases using best-in-class clinical innovation can deliver value-based care
• GROW - how early diagnosis of chronic disease has the potential to optimize clinical management, a practical example
• TRANSFORM – how to deliver earlier diagnosis of heart disease with QuantaFlo™ HD, and simplify insulin management with Insulin Insights™

Moderator:
Dr. Shannon Decker, Principal
VBC One

Scott Howell, D.O., MPH&TM, CPE, Chief Innovations Officer
Semler Scientific Inc.

Robert London, MD, Senior Consultant 
Semler Scientific Inc. 

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

 

Interactive Roundtables

Select from Different Presentations Spotlighting Health Care’s Most Influential Technology and Solution Gurus Presenting Tools to Elevate Your Plan’s Initiatives.  

Pull up a chair and settle in for this unique opportunity to select three interactive, speed-networking type presentations featuring the latest technologies and solutions for boosting your plan’s risk, quality and data management endeavours. A bell will ring three times within this special 60-minute session, alerting you to transition to the next roundtable of your choice. 

Roundtable A

Utilizing NLP/AI to improve Clinical documentation for Retrospective and Concurrent

• Improve RAF score accuracy through Point of care documentation
• Compare claims and suspecting to what is found in chart or encounter
• Higher recapture rates

Roundtable B

CMS RADV Final Rule is Here: What You Need To Know

• Discuss ways providers and payers can work together to minimize the impact of takebacks and improve the health of members
• Learn how more accurate and complete HCC Coding reviews help optimize reimbursement and improve outcomes for high-risk populations
• Best practice ideas on how health plans can prepare for RADV and OIG audits

Roundtable C

Blocking and Tackling: Provider Engagement is the Key to Success in Risk Adjustment and Quality Improvement

• 100% human driven reviews
• Compliance
• Provider support via our field staff

Roundtable D

Three Things to do Now in Today's Rapidly Changing Risk Adjustment Environment

• Focus on the disease, not the HCC code
• Pay providers for time understanding and treating a patient's clinical history, not for coding it
• It's not about the data, it's about the workflow

Roundtable E

N1 Health’s AI Platform Predicts the Highest-Risk Individuals to Drive Prospective Risk Adjustment Activities

• Proactively identify new and unengaged members with unknown clinical risk and high social risk
• Improve initial reach rates by providing additional contact information, engagement preferences, and the most effective outreach channel
• Increase engagement within Annual Wellness Visits and In-Home Assessments to capture appropriate documentation

Roundtable F

Pareto Hub: MA Revenue Integrity Platform Solution

• Ingest, validate, score and enrich MA Revenue Management data assets in a ready to analyze environment
• RAF build-up and cohort analysis, HCC provider performance, HCC prevalence, member level drilldown
• Continuous data integrity monitoring and financial accrual projections

Roundtable G

Actionable Insights at the Point of Care

• Streamline clinical data exchange
• Present insights within the clinical workflow
• Improve quality, accuracy, and efficiency

Roundtable H

Navigating Member Centricity with Coordinated Convergence

• Align enterprise data strategy with Performance Analytics
• Unify, prioritized outreach to influence member behavior
• Synchronize Quality programs with digital strategies

Roundtable I

Connecting Payers and Providers to Meet Today`s Challenges of Providing Value Based Care

• See firsthand how seamlessly provided actionable insights at the point of care help deliver better patient care
• Learn how you can solve all your clinical data acquisition requirements
• Results – improved provider satisfaction, boost quality ratings, reduce overall costs

Roundtable J

Leveraging Mobile Technology to Improve Quality Measures, Reduce Risk, and Enhance the Member Experience

• Learn how smartphone-powered testing provides an opportunity to reach the 80% of at-risk members who aren't taking their annual albumin-to-creatinine ratio (ACR) test
• Discover how to raise testing adherence and improve the detection of CKD – a critical component to addressing the proposed KED Star measure and reducing the cost of care for your members
• Hear how immediate, clinical-grade results from home can achieve adherence rates up to 50%

Roundtable K

Not Just Another Digital Solution: How an 80-year-old Academic Health System stands out in the Digital Health Space

• Why RPM means Remote Patient Management in a true care delivery model
• Moving from episodic to continuous treatment while improving the care journey and member experience
• Success for the member means success for the health plan – better quality scores and HEDIS measures, lower utilization/costs, and a world-class NPS

Roundtable L

More Effective Member Engagement and Activation through Intelligent, Secure Digital Automation

• Industry look into member experience automation innovations
• Weaving new channels into current live, online and digital ones
• Diabetes Closing Gaps in Care "Art of the possible" demonstration

Roundtable M

How MyCare Medical Uses Vim's Point-of-Care Technology to Improve Performance on Risk Adjustment and Quality While Making Doctors Happier

• Hear from MyCare's Chief Value Based Care Officer about how this leading value-based care group evaluated point-of-care technology options
• Learn how MyCare delivers gaps directly into workflow across diverse EHRs to improve performance and experience on HEDIS and risk score accuracy
• Explore how MyCare enabled seamless read-write data operations and reduced physician burnout while enhancing engagement with value-based activities

Roundtable N

HCC Risk Adjustment Strategies for Quality and Effective care

• Optimize your program workflow; focus on opportunities to drive outcomes
• Leverage technology to improve data capture
• Ensuring accurate and appropriate measurement of patient RAF scores

Roundtable O

Achieve Higher Star Ratings Through Interoperability

• The Surescripts Network Alliance convenes nearly every EHR vendor, PBM, pharmacy and clinician in the U.S. fueling significant growth in health intelligence shared across the Surescripts network.
• Learn from Surescripts how in-work flow technology improves the efficiency and exchange of intelligent clinical insights and information.
• Surescripts Clinical Direct Messaging is a simple, secure, standards-based way for health plans and PBMs to efficiently deliver critical payer insights electronically.

Roundtable P

Emerging Trends and best practices with Supplemental Benefits Flex Cards

Roundtable Q

How Meaningful Engagement Improves Member’s Lives

• Let's talk about what really matters when addressing gaps in care – getting members to take action that leads to real outcomes
• What motivates members to act? We asked and they shared. Come learn the 3 keys to vastly improving member engagement and experience.
• Hear an incredible story from 2022 about how our at-home diagnostic testing literally saved a life!

Roundtable R

Connecting the Dots: AI-Informed Solutions for Clinically Impactful and Financially Sustainable Outcomes

• Follow a guided tour of a no-cost health equity solution designed to pinpoint health disparities in communities
• Discover the biggest problems and opportunities to enable healthcare providers to expand reach and improve member experience
• Illustrate how predictive models incorporate non-clinical factors

Roundtable S

Getting More from the Last Mile of Interoperability: Higher Quality Clinical Data with Less Provider Abrasion through Automation across a Widening Provider Network

• Gain access to clinical data needed to achieve premium accuracy goals with an ever growing network of providers, and connectivity with over 240 EHRs, PM, and LI systems.
• Explore clinical data exchange technology and services that leverage standardized and proprietary approaches to facilitate a seamless data exchange, providing enriched, high value data to payers.
• Hear how a Mid-Atlantic Payer leverages the last mile of interoperability with their provider network.

Roundtable U

Supporting Providers in the Moment of Care with Payer Insights

• Learn how athenahealth partners with payers and how the athenahealth platform enables efficient care and diagnosis gap data in the moment of care
• See a demonstration of the athenaClinicals encounter workflow, including surfaced gaps and actions recorded
• Discuss how payer-provider collaboration works today and explore how athenahealth can bring you closer to the care your members receive

Roundtable V

How to Advance Health Equity and Improve Quality

• Understanding latest industry and regulatory trends' impact on health plans
• Using health equity data to address disparities and increase value of care
• Improving diversity and impact by coordinating with community services

Roundtable W

No More Missing Diagnoses: Using AI for Comprehensive Diagnosis Code Capture

• Fathom’s AI coding engine reviews the entire patient chart and reports diagnosis codes to a higher level of specificity than human coders could
• Unlike human coders, Fathom ingests the whole chart – capturing all the buried, obscure, "long-tail" diagnosis codes that humans often miss – in minutes
• Higher accuracy of Fathom coding ensures all diagnoses are appropriately documented, improving RAF scores and limiting risk from data validation audits

Roundtable X

Data Driven Strategies to improve Health Equity and Member Engagement

• Explain how NCQA is addressing health inequities in quality measures
• Identify problems and solutions associated with the collection of race, ethnicity and languages data
• Discuss how health plans can alleviate known data quality issues to enhance risk analytics and member engagement

Roundtable Y

Speak to the Value Proposition of Tabula Rasa HealthCare’s MedWise and Risk Adjustment Solutions for Medicare Advantage

• Tabula Rasa Risk Adjustment Services improves compliance, accuracy, and completeness with proven return on investment via its coding, auditing, provider education and data analytics monitoring services.
• TRHC’s MedWise® Science provides simultaneous, multi-drug analyses that assess the risk of a patient’s medication regimen to improve outcomes and reduce the cost of care.
• Capstone Risk Adjustment Services improves compliance, accuracy, and completeness with proven return on investment via its coding, auditing, provider education and data analytics monitoring services.

Roundtable Z

How can I be ready for Stars today and tomorrow? Tools to focus on improving both experience and quality.

• Discuss how to prioritize limited resources to maximize improvement programs
• Learn how to discover trends in member experience long before survey results are available
• Discover an achievable pathway to Stars improvement by viewing the full picture in a single place

Interactive Roundtables Part II

Select from Different Presentations Spotlighting Health Care’s Most Influential Technology and Solution Gurus Presenting Tools to Elevate Your Plan’s Initiatives.  

Pull up a chair and settle in for this unique opportunity to select three interactive, speed-networking type presentations featuring the latest technologies and solutions for boosting your plan’s risk, quality and data management endeavours. A bell will ring three times within this special 60-minute session, alerting you to transition to the next roundtable of your choice. 

Roundtable A

Optimize Your Point-of-Care and In-Home Assessments with Real Time Reporting

• See how to aggregate data from a variety of diagnostic devices to optimize patient outcomes for whole person health, and optimized risk adjustment
• Learn how to access longitudinal data for chronic condition surveillance and care planning
• Discover how to securely collect and access SDoH data collected at the point-of-care for HEDIS and STARS

Roundtable B

Optimize CM/UM Integration with Embedded AI and Automated Rules Engines

• Understand why an integrated CM/UM solution should utilize data integration and automation to best drive efficiency and reduce cost
• Learn how Vital Data Technology enables health plans to seamlessly embed robust predictive data models into CM/UM workflows
• Discover how payers can uncover actionable insights that automate existing CM/UM workflows increase collaboration and improve whole-member care

Roundtable C

Strategies for Reducing Clinical Documentation Burden and Provider Burnout

• Understand the problem of provider burnout as precipitated by increasing clinical documentation burden.
• Comprehend the confluence of root causes contributing to clinical documentation burden to include poor workflow design, EHR functionality flaws and increasing regulatory requirements for coding and risk adjustment.
• Take away strategies for reducing documentation burden and improving provider satisfaction, including tools such as immersive workflow redesign, and EHR Optimization.

Roundtable D

Explore how Nymbl approaches Balance Training Hands On

• Come wake up your brain with Nymbl's app!
• Away from the usual pitch, Nymbl wants to have you try our cognitive games and start your day with your balance improved
• We will have tablets with our app to demo, and the Nymbl team will be there, excited to answer any questions

Roundtable E

Provider Engagement: Meet Your TRC Goals and Receive Clinical Charts Without Provider Abrasion

• Explore the provider's perspective on clinical data exchange
• Discover how to meet the TRC STARS measure for provider notifications
• Achieve clinical data retrieval goals without provider abrasion

Roundtable F

Tackling Cancer Costs: How to Curb Rising Oncology Spend and Improve Member Outcomes through Navigation.

• Discuss why oncology spend is spiraling out of control and why existing methods to curb costs and improve outcomes have failed.
• Discover how oncology management programs improve outcomes, reduce barriers to care and lower spend through targeted, patient-facing, cost-effective interventions.
• Discuss the key elements of a successful oncology program, including the need for robust technology analytics, specialty-specific expertise, and deep provider integration

Roundtable H

Supplemental Benefits 3.0: Moving Beyond the Card Swipe

• You’re investing millions in supplemental benefits. How are you calculating benefit ROI or impact on total cost of care?
• Flex cards can be a powerful tool but it takes more than receiving a card to affect health outcomes - and your bottom line
• Supporting individuals is not a one-size fits all endeavor and the most effective benefit programs evolve to be increasingly personalized as individual needs are identified

Roundtable I

How Intelligent Engagement Can Delight Members and Increase Satisfaction

• Improve your member’s voice experience and enable self-service with Artificial Intelligence (AI), Natural Language Understanding (NLU) and Dialog engines
• Empower service teams with machine learning capabilities that provide relevant, real-time information, guidance, and recommendations
• Proactively engage members with personalized wellness programs or next best actions on the channel they prefer

Roundtable J

Peripheral Neuropathy Detection Reveals Risk of Falls, Diabetic Foot Ulcers, and Chronic Pain in Seniors

• Understand the powerful correlation between Peripheral Neuropathy (PN), its prevalence in the over-65 population, and these costly complications
• Explore how technology aids in the early detection and staging of PN, empowering payers/providers to mitigate the risk of complications
• Discuss how you can document and substantiate a peripheral neuropathy diagnosis with accurate, objective, and replicable data

Roundtable K

Small MA Plans: Are You Competitive with Larger Plans? If not, Join Us to Learn how Sharing Resources will create a Competitive Advantage

• Shared technology lowers capital costs by improving efficiencies, enhancing data security and compliance, effectively implementing operational upgrades and automation, and minimizing the need for physical space
• Shared human capital lowers operating costs by enabling organizations to quickly scale up or down
• Shared expertise maximizes effectiveness by having access to clinical and compliance experts, which reduces risk, and lowers turnover and indirect costs

Roundtable L

New Member Engagement and Digital Strategies That Transform Delivery of Care, Quality Improvement, Member Satisfaction and Risk Score Coding Accuracy

• Learn about Remote Patient Monitoring and population health strategies to engage members to improve clinical quality outcomes
• Reduce ED/Hospitalizations by proactively targeting members at-risk
• Increase health literacy and self-management using innovative technology

Roundtable M

Worried about RADV? EXL is Well Prepared to Help MAO’s Maintain Compliance and Reduce Risk to the New CMS RADV Final Rule

• Identify compliance risks by deploying powerful NLP/AI technology on the current data set
• Stratify and analyze these compliance risks using advanced compliance analytics to understand the financial impact
• Craft strategies to mitigate these compliance risks with help from subject matter experts

Roundtable N

Meet Seasonal Demand by Leveraging Digital Services

• For the AEP, OEP, and ANOC Surge, the Secret Is You May Already Have the Solution
• Can You Repurpose and Leverage Tools Already in Place?
• Outcomes: Improved Member Education, Empowered Agents, Reduced Costs, Enhanced Member Experiences

Roundtable O

Improve RAF Scores Using 3 Key Steps

• Transform unstructured clinical documentation into structured data
• Leverage NLP to extract and map to relevant clinical terminologies
• Present clear and concise codes in an interoperable format for review

Roundtable P

How Transportation Improves Member Experience and Reduces Risk for our most Vulnerable Patients

• The snowballing effects of missed appointments due to unreliable transportation, and why real-time visibility is critical to addressing issues before or as they happen
• Best practices on building and maintaining a robust national transportation network to drive low grievance rates and excellent member experience
• Meeting the needs of diverse patient populations: behavioral health, chronic care, rural communities, and beyond

Roundtable Q

Minimizing the Total Cost of Care: Why Cardiometabolic Care is Essential for your Strategy?

• Learn about the connection between cardiometabolic health and ROI
• Understand why stronger cardiometabolic management can help close key gaps in HEDIS measures and improve Rx adherence
• Gain insight into why the combination of human providers, technology, and prescribing capabilities are essential for the member experience and scalable outcomes

Roundtable R

The New Era of American Healthcare: The Shoppable Healthcare Consumer

• Explore the 30+ regulatory changes recently passed to create a shoppable healthcare consumer and what they mean to health plans
• Learn how a unified patient experience centralized on publicly available data to consumers can drive financial improvement to your bottom line with examples of case studies
• Learn how to achieve a personalized communications strategy via advanced identity and consent frameworks and the resulting outcomes that can be achieved with this approach

Roundtable S

Impact of the Medicare Advantage RADV Audit Final Rule

• Learn how changes reflected in the MA RADV final rule might impact your organization
• Utilize RADV audit industry best practices
• Explore the SIU’s role in risk adjustment

Roundtable U

How to Attract & Retain Your Members Through Technology Offerings | A Supplemental Benefits Discussion

• Find out how plans utilizing LifeStation grew membership by 87% YoY
• Explore how our suite of solutions help to promote active aging
• Learn how you can leverage our caregiver services when planning your marketing strategy

Roundtable V

Keep Your Cancer and Autoimmune Costs on Course: Navigate a Better Approach to High-quality, High-value Care by Learning How to

• Leverage technology to redirect care in compliance with formulary
• Extend your team with cost- and time-saving oncology and autoimmune services delegation
• Improve member experience with personalized, evidence-based support

Track 2: Integrating Silos

Understand The Unique Needs of Your Members: Looking Beyond Standardized Data and Meeting Your Members Where They Are

• Engaging hard to reach members through a population health approach  
• How to build trust and strong relationships within communities with culturally and linguistically appropriate services 
• Aligning internal teams to support cross collaboration between departments to mitigate abrasion and duplicative efforts 
• How one health plan is taking "to the streets" to meet members where they are  

Jenn Kerfoot, Chief Experience Officer  
FarmboxRx

Julianne Eckert RN BSN, CCM, CMCN, ACMP, Senior Director, Clinical Quality Programs 
Clover Health

Track 3: Population Health and Health Equity

How SDoH Solutions Can Impact Risk and Quality Performance and Allow ‘Aging at Home’ 

• Learn the latest innovations and strategies to support members’ health related social needs and the opportunities to improve member health  
• Discuss the importance of transportation options that connect seniors whose limited mobility hinders their ability to access necessary healthcare and social services and potentially impacting their ability to age in place   
• Hear how organizations can lessen the impact of HRSNs and decrease utilization of expensive—and often avoidable—medical services 

Moderator
Brett Hickman, Strategic Advisor
Modivcare 

Christopher N. Aguwa, Executive Vice President Head of Growth and Business Development
Cityblock Health 

Dr. Mohamed Diab, Chief Executive Officer, Accountable Care Organization
CVS Health 

Dr. Garth Graham, MD, Director and Global Head of Healthcare and Public Health
Google/YouTube at Alphabet, Inc.
Modivcare Board member 

Seth Ravine, Senior Vice President
Modivcare   

Track 4: Social Determinants of Health

Building an Integrated Social Care Strategy

• Aligning SDoH barrier identification and intervention
• How flexible advocacy can produce a better member experience and optimize results
• Dual eligible advocacy and social care strategy

Lisa A. Barrett, Vice President, Member Navigation Solutions My Community Connections
UnitedHealthcare

Sean Libby, President
BeneLynk

Track 5: Future of Health Care

The New Era of Health Benefits: Achieving Equitable Health Outcomes for All with Consumer-Centric Payment Experiences  

• Raise retention by setting a new standard for personalized, convenient, and accessible support  
• Amplify positive interactions with members by expanding consumer choice and focusing on maximizing the value of their benefits 
• Create real change in your member’s lives and leave none of them behind 

Joe Gabler, Chief Revenue Officer
Solutran

Scott Weiner, Director, Government Programs 
Sentara  

Track 1: Risk Adjustment Strategies

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

Ellen Fink-Samnick, Chair  
RISE SDoH Community

Track 2: Integrating Silos

Elevate your Risk Adjustment Program: How to Leverage Data and Analytics with your Providers

• Understand Provider performance and learn revolutionary ways to impact member engagement
• Identify root causes of poor performance and discuss innovative key metric opportunities in your population
• Gain visibility into the critical data needed to drive the best results

Moderator:
Erin Montgomery
Advantmed

Eric Hedrick, Vice President, Analytics 
Advantmed 

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

Track 3: Technology / Data Analytics

Clinical Data Plus Proactive Notifications Equals Improved Quality Measure Performance

• Streamline your clinical quality measure data acquisition process
• Improve quality measures that have short windows to close gaps
• Reduce cost around your quality program
• Repurpose clinical data for other use cases such as UM or risk adjustment

Lynda Rowe, Senior Advisor, Value-based Markets
InterSystems

Autumn Kerr, AVP, Clinical Quality
Healthfirst

Kate Beck, AVP, Health Information Exchange
Healthfirst

Track 4: Payer/Provider Collaboration

Building Successful Payer and Provider Collaboration

• Understand the critical ingredients for a successful partnership
• Identify best practices for structuring data sharing arrangements
• Identify best practices for structuring payment models
• Identify best practices for provider enablement

Anna Basevich, VP of Enterprise Partnerships
Arcadia

Laura Sheriff, RN, MSN, Vice President Operations, Risk Adjustment
Southwestern Health Resources (SWHR)