2023 Schedule
RISE National 2023 featured an agenda designed for the functional thinker to leave equipped and re-energized to push your organization forward in the evolving Medicare Advantage landscape. Take a look at what our attendees experienced in Colorado Springs, and make plans to join us for RISE National 2024.
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
11:00 AM 6:00 PM
10:00 AM 5:00 PM
9:00 AM 4:00 PM
8:00 AM 3:00 PM
11:00 AM 5:00 PM
10:00 AM 4:00 PM
9:00 AM 3:00 PM
8:00 AM 2:00 PM
Instructors:
Laura Sheriff, RN, MSN, Vice President Operations, Risk Adjustment
Southwestern Health Resources (SWHR)
Susan Waterman, RHIT, CCS, CPC, CRC, AHIMA ICD-10-CM/PCS, Trainer, Director, Risk Adjustment
Baylor Scott & White
Scott Weiner, Director, Government Programs
Sentara
11:00 AM 5:00 PM
10:00 AM 4:00 PM
9:00 AM 3:00 PM
8:00 AM 2:00 PM
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
Instructor:
Colleen Gianatasio, Clinical Documentation Integrity and Coding Compliance
Capital District Physician’s Health Plan (CDPHP)
Donna Malone, CPC, CRC, CRC-I, AHCCA, RAP
AAPC National Advisory Board
Director Ambulatory CDQI
Clinical Documentation Quality Improvement
Mount Sinai
3:00 PM 6:00 PM
2:00 PM 5:00 PM
1:00 PM 4:00 PM
12:00 PM 3:00 PM
Moderator:
Laura Sheriff, RN, MSN, Vice President Operations, Risk Adjustment
Southwestern Health Resources (SWHR)
Jason Eric Christ, JD, Attorney
Epstein Becker Green
David Meyer, CCO, Applied Research Works/Cozeva
Advisor, EBG
Wilson Gabbard, Vice President, Quality and Condition Management, Enterprise Population Health
Advocate Health
2:00 PM 6:00 PM
1:00 PM 5:00 PM
12:00 PM 4:00 PM
11:00 AM 3:00 PM
Moderator:
Jill Strassler, VP, Product Management, Payer Analytics
Veradigm
This workshop will be divided in three topics:
Setting the Shared Destination: Aligned Program Objectives
David DeHommel, Managing Director of Risk Adjustment
BCBS of Michigan
Scott Stratton, MPH, Chief Data Scientist & VP Industry Development
Veradigm
Choosing the Routes: Engaging Providers Where They Are
Bruce Waugaman, Risk Adjustment Leader
EmblemHealth
Meghan West, Sr. Manager Product Management, Clinical Data Exchange
Veradigm
Getting the Most Out of Your Destination: Submissions and More
Lisa Pouncey, Director Product Management, Data Transformation and Submissions
Veradigm
Deborah Coakley, Ed.D., MBA, Director, Risk Adjustment Programs – Operations
Baylor Scott & White Health Plan
2:00 PM 6:00 PM
1:00 PM 5:00 PM
12:00 PM 4:00 PM
11:00 AM 3:00 PM
A member-centered approach to Quality, Risk Adjustment, SDOH, and benefits.
As CMS continues its pursuit of the Triple Aim through interoperability and innovation, this workshop will help attendees improve complete and accurate risk adjustment practices through the pursuit of high-quality clinical care. The workshop is designed for risk adjustment, quality, SDOH, finance, and analytics professionals. Join us for an interactive panel and breakout sessions from the leading risk adjustment and quality experts.
John Criswell, Founder, CEO, Chairman
Porter
Melissa Smith, EVP, Consulting & Professional Services
Healthmine
Ana Handhsuh, Principal
Cat 5 Strategies
Dr. Shannon Decker, Principal
VBC One
Liz Haynes, DVP, Risk Adjustment & Stars- Government Programs
Blue Cross and Blue Shield of Kansas City
Daphne Klausner, Plan President
Honest Medical Group
Alyson Spencer, Sr. Director, Clinical Quality
Blue Shield California
Ally Thomas, Ph.D., AVP, Quality Improvement
UPMC Health Plan
6:00 PM 8:00 PM
5:00 PM 7:00 PM
4:00 PM 6:00 PM
3:00 PM 5:00 PM
Let's kick off the mega Medicare Advantage event of the year! All attendees are invited to join us in the exhibit hall for drinks, hors d'oeuvres, and face-to-face networking. We will have a color-coded system in place to allow attendees to self-select and display their comfort level for interacting with peers.
9:30 AM 11:00 AM
8:30 AM 10:00 AM
7:30 AM 9:00 AM
6:30 AM 8:00 AM
9:30 AM 8:00 PM
8:30 AM 7:00 PM
7:30 AM 6:00 PM
6:30 AM 5:00 PM
9:30 AM 9:30 PM
8:30 AM 8:30 PM
7:30 AM 7:30 PM
6:30 AM 6:30 PM
11:00 AM 11:15 AM
10:00 AM 10:15 AM
9:00 AM 9:15 AM
8:00 AM 8:15 AM
Ellen Wofford, Managing Director
RISE
Conference Chairs
Nikki Hungate MS, MHA, Director, Medicare & Gov't Programs Product Strategy
MVP Health Care
11:15 AM 12:00 PM
10:15 AM 11:00 AM
9:15 AM 10:00 AM
8:15 AM 9:00 AM
Christi A. Grimm
Inspector General
Office of Inspector General
Department of Health and Human Services
Christi A. Grimm, the Inspector General for the Department of Health and Human Services, will share her office’s vision for its oversight of and coordination with Medicare Advantage plans. As Medicare Advantage hits 50% of Medicare enrolment this year, the Inspector General will mark this milestone by highlighting the importance of addressing core program integrity issues to help ensure the future success of the program. She will provide an overview of OIG’s approach to understanding risks and opportunities associated with managed care and how that informs OIG’s oversight and enforcement associated with Medicare Advantage. Additionally, the Inspector General will explain the importance of coordination between OIG and plans on key issues like combatting health care fraud, waste, and abuse.
12:00 PM 12:45 PM
11:00 AM 11:45 AM
10:00 AM 10:45 AM
9:00 AM 9:45 AM
The annual regulatory review is back this year to discuss pressing topics such as the Advance Notice, RADV, policy and technology rule updates and their implications for Medicare Advantage as well as Part D. This session will also discuss the Medicaid redetermination and its downstream impact on the ACA marketplaces.
The panel will address expectations around health equity and gaps in care, star rating changes to address disparities, and supplemental benefits utilization, cost and outcomes.
Moderator
Sean Creighton, RISE Policy
Expert Contributor
Greg Gierer, MMP, Vice President of Policy and Research
Better Medicare Alliance
Mikal L. Sutton, Managing Director, Medicaid
Blue Cross Blue Shield Association
12:45 PM 1:15 PM
11:45 AM 12:15 PM
10:45 AM 11:15 AM
9:45 AM 10:15 AM
Track Chairs
Track 1 - Tom Rhodes, Director – Payer Sales, Risk Adjustment - Wolters Kluwer, Health Language
Track 2 - Reva Sheehan, Sr. Director of Customer Insights - mPulse Mobile
Track 3 - Evelyn Chojnacki, MPH, Director, Health Plan Strategy - Sword Health
Track 4 - Siva Tunga, Chief Product Officer - Invent Health
Track 5 - Keith Bruns , Senior Director Business Development - InComm Payments
Track 6 - Gene Huang, Executive Chairman - Referwell
1:15 PM 2:00 PM
12:15 PM 1:00 PM
11:15 AM 12:00 PM
10:15 AM 11:00 AM
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
1:15 PM 2:00 PM
12:15 PM 1:00 PM
11:15 AM 12:00 PM
10:15 AM 11:00 AM
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
1:15 PM 2:00 PM
12:15 PM 1:00 PM
11:15 AM 12:00 PM
10:15 AM 11:00 AM
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
1:15 PM 2:00 PM
12:15 PM 1:00 PM
11:15 AM 12:00 PM
10:15 AM 11:00 AM
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
1:15 PM 2:00 PM
12:15 PM 1:00 PM
11:15 AM 12:00 PM
10:15 AM 11:00 AM
Schawn Pedersen, CPC, Director, Coding and Quality Compliance
Matrix Medical Network
1:15 PM 2:00 PM
12:15 PM 1:00 PM
11:15 AM 12:00 PM
10:15 AM 11:00 AM
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)
2:00 PM 2:55 PM
1:00 PM 1:55 PM
12:00 PM 12:55 PM
11:00 AM 11:55 AM
Track Chairs
Track 1 - Tom Rhodes, Director – Payer Sales, Risk Adjustment - Wolters Kluwer, Health Language
Track 2 - Reva Sheehan, Sr. Director of Customer Insights - mPulse Mobile
Track 3 - Evelyn Chojnacki, MPH, Director, Health Plan Strategy - Sword Health
Track 4 - Siva Tunga, Chief Product Officer - Invent Health
Track 5 - Keith Bruns , Senior Director Business Development - InComm Payments
Track 6 - Gene Huang, Executive Chairman - Referwell
3:00 PM 3:45 PM
2:00 PM 2:45 PM
1:00 PM 1:45 PM
12:00 PM 12:45 PM
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
3:00 PM 3:45 PM
2:00 PM 2:45 PM
1:00 PM 1:45 PM
12:00 PM 12:45 PM
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
3:00 PM 3:45 PM
2:00 PM 2:45 PM
1:00 PM 1:45 PM
12:00 PM 12:45 PM
Dr. Shannon Decker, Principal
VBC One
3:00 PM 3:45 PM
2:00 PM 2:45 PM
1:00 PM 1:45 PM
12:00 PM 12:45 PM
Aria Sameni, Vice President of Growth and Strategy
Optum
James Hereford, Chief Executive Officer
M Health Fairview
3:00 PM 3:45 PM
2:00 PM 2:45 PM
1:00 PM 1:45 PM
12:00 PM 12:45 PM
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
3:00 PM 3:45 PM
2:00 PM 2:45 PM
1:00 PM 1:45 PM
12:00 PM 12:45 PM
Debbie Conboy, SVP, Risk Adjustment and Quality
Signify
Lynne Newson, Vice President, Medicare Strategy
Blue Cross Blue Shield of Massachusetts
3:45 PM 4:15 PM
2:45 PM 3:15 PM
1:45 PM 2:15 PM
12:45 PM 1:15 PM
Track Chairs
Track 1 - Tom Rhodes, Director – Payer Sales, Risk Adjustment - Wolters Kluwer, Health Language
Track 2 - Reva Sheehan, Sr. Director of Customer Insights - mPulse Mobile
Track 3 - Evelyn Chojnacki, MPH, Director, Health Plan Strategy - Sword Health
Track 4 - Siva Tunga, Chief Product Officer - Invent Health
Track 5 - Keith Bruns , Senior Director Business Development - InComm Payments
Track 6 - Gene Huang, Executive Chairman - Referwell
4:15 PM 5:00 PM
3:15 PM 4:00 PM
2:15 PM 3:00 PM
1:15 PM 2:00 PM
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
4:15 PM 5:00 PM
3:15 PM 4:00 PM
2:15 PM 3:00 PM
1:15 PM 2:00 PM
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
4:15 PM 5:00 PM
3:15 PM 4:00 PM
2:15 PM 3:00 PM
1:15 PM 2:00 PM
Francesca Rinaldo, MD, PhD, SVP, Clinical Product & Innovation
Sharecare
Jessica Wack-Alexander, MBA, Program Manager, Health Care Services
Providence Health Plan
4:15 PM 5:00 PM
3:15 PM 4:00 PM
2:15 PM 3:00 PM
1:15 PM 2:00 PM
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
4:15 PM 5:00 PM
3:15 PM 4:00 PM
2:15 PM 3:00 PM
1:15 PM 2:00 PM
Biggs Cannon, Senior Managing Director, Health Solutions Practice
FTI consulting
Nikki Hungate MS, MHA, Director, Medicare & Gov't Programs Product Strategy
MVP Health Care
4:15 PM 5:00 PM
3:15 PM 4:00 PM
2:15 PM 3:00 PM
1:15 PM 2:00 PM
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 Chairs
Track 1 - Tom Rhodes, Director – Payer Sales, Risk Adjustment - Wolters Kluwer, Health Language
Track 2 - Reva Sheehan, Sr. Director of Customer Insights - mPulse Mobile
Track 3 - Evelyn Chojnacki, MPH, Director, Health Plan Strategy - Sword Health
Track 4 - Siva Tunga, Chief Product Officer - Invent Health
Track 5 - Keith Bruns , Senior Director Business Development - InComm Payments
Track 6 - Gene Huang, Executive Chairman - Referwell
5:05 PM 5:50 PM
4:05 PM 4:50 PM
3:05 PM 3:50 PM
2:05 PM 2:50 PM
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
5:05 PM 5:50 PM
4:05 PM 4:50 PM
3:05 PM 3:50 PM
2:05 PM 2:50 PM
Moderator
Patrick Coulson, Senior Vice President, Sales and Marketing
Allymar Health Solutions
Kevin M. Healy, CEO
Allymar Health Solutions
Gregg Kimmer, CEO
ATRIO
5:05 PM 5:50 PM
4:05 PM 4:50 PM
3:05 PM 3:50 PM
2:05 PM 2:50 PM
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
5:05 PM 5:50 PM
4:05 PM 4:50 PM
3:05 PM 3:50 PM
2:05 PM 2:50 PM
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
5:05 PM 5:50 PM
4:05 PM 4:50 PM
3:05 PM 3:50 PM
2:05 PM 2:50 PM
Troy Jelinek, Chief Commercial Officer
Icario
Jennie Roberts, Senior VP, Quality and Clinical Modernization UnitedHealthcare
5:05 PM 5:50 PM
4:05 PM 4:50 PM
3:05 PM 3:50 PM
2:05 PM 2:50 PM
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
5:55 PM 6:45 PM
4:55 PM 5:45 PM
3:55 PM 4:45 PM
2:55 PM 3:45 PM
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:
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
6:45 PM 6:50 PM
5:45 PM 5:50 PM
4:45 PM 4:50 PM
3:45 PM 3:50 PM
Conference Chairs:
Nikki Hungate MS, MHA, Director, Medicare & Gov't Programs Product Strategy
MVP Health Care
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.
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
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.
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• Improve RAF score accuracy through Point of care documentation
• Compare claims and suspecting to what is found in chart or encounter
• Higher recapture rates
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 100% human driven reviews
• Compliance
• Provider support via our field staff
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• Streamline clinical data exchange
• Present insights within the clinical workflow
• Improve quality, accuracy, and efficiency
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• Align enterprise data strategy with Performance Analytics
• Unify, prioritized outreach to influence member behavior
• Synchronize Quality programs with digital strategies
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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%
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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.
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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!
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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.
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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.
6:50 PM 7:50 PM
5:50 PM 6:50 PM
4:50 PM 5:50 PM
3:50 PM 4:50 PM
• 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
7:50 PM 9:00 PM
6:50 PM 8:00 PM
5:50 PM 7:00 PM
4:50 PM 6:00 PM
Grab a cocktail and small bite and get back to that face-to-face networking we’ve all been missing. During this extended networking reception, enjoy comfortable networking with our color-coded system in place allowing attendees to self-select and display their comfort level for interacting with peers.
9:30 AM 11:00 AM
8:30 AM 10:00 AM
7:30 AM 9:00 AM
6:30 AM 8:00 AM
9:30 AM 4:15 PM
8:30 AM 3:15 PM
7:30 AM 2:15 PM
6:30 AM 1:15 PM
9:30 AM 5:30 PM
8:30 AM 4:30 PM
7:30 AM 3:30 PM
6:30 AM 2:30 PM
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
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.
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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.
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
10:00 AM 11:00 AM
9:00 AM 10:00 AM
8:00 AM 9:00 AM
7:00 AM 8:00 AM
• 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
11:00 AM 11:05 AM
10:00 AM 10:05 AM
9:00 AM 9:05 AM
8:00 AM 8:05 AM
Conference Chairs:
Nikki Hungate MS, MHA, Director, Medicare & Gov't Programs Product Strategy
MVP Health Care
11:05 AM 11:20 AM
10:05 AM 10:20 AM
9:05 AM 9:20 AM
8:05 AM 8:20 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 today at risehealth.org/MLblock.
11:20 AM 12:20 PM
10:20 AM 11:20 AM
9:20 AM 10:20 AM
8:20 AM 9:20 AM
Brent and Kyle Pease, Ironman Champion Triathletes
This amazing journey started when Kyle watched his brother finish the Louisville triathlon. He counts it as 'one of the most transformative moments in [his] life.' Kyle asked his brother 'Can people in wheelchairs do IRONMAN?' Brent never hesitated with his response; the answer was a resounding 'YES!'. Even though finishing an IRONMAN was something that had never crossed his mind, from that day forward Kyle wanted in.
Allow America's most highly recognized team of brother/brother triathletes take you on their journey from their first race, through the multiple 'NOs', to the final 'YES' from KONA, getting to the start line, the ups and downs to the finish line, and beyond. Hear about growing up Peasey, and how it meant living a life of doing all within your power to succeed, and to also ensure that no single person is ever left on the side-lines.
Through the Pease brothers' unbreakable bond, they show how individual and team focus, determination, and spirit are the keys to achieving and accomplishing feats others might say are impossible. They show you the profound ways a family proved that by illuminating and including individuals with disabilities they were able to find and reveal who they truly are
You will:
Introduced by
Craig Savage, President & General Manager, Payer
Inovalon
12:20 PM 12:40 PM
11:20 AM 11:40 AM
10:20 AM 10:40 AM
9:20 AM 9:40 AM
12:40 PM 1:40 PM
11:40 AM 12:40 PM
10:40 AM 11:40 AM
9:40 AM 10:40 AM
Wendy Sue Swanson, M.D.
Director of Digital Health, Professor, Sean N. Parker Center for Allergy and Asthma Research, Stanford University Author, Mama Doc Medicine
As technology infuses the health space, we must examine the opportunities of novel innovation on improving wellbeing, health care, and the experience of both prevention and treatment of disease.
From chatbots, AI software, social media, and digital health to cancer screening, mental health, and the toll of the “diseases of despair,” Dr. Swanson will explore the challenge at the confluence of rapid, technologic innovation and health. Some things are changing, and some things must not. As our lives are inevitably altered by things like ChatGPT, we can guide what health care becomes.
You’ll explore:
Dr. Swanson will explore what matters most with today’s challenges for humans (prevention of disease, COVID, violence, isolation, cancer, heart disease, mental health, costs in health care…) as smartphones and technology transforms the way we live our lives. And she’ll discuss where technology cannot encroach on care. She’ll provide a way forward to improve your approach and provide examples to peak curiosity and solution-making.
Track Chairs
Track 1 - Matthew Markham, Director, Business Development - Wolters Kluwer, Health Language
Track 2 - Reva Sheehan, Sr. Director of Customer Insights - mPulse Mobile
Track 3 - Evelyn Chojnacki, MPH, Director, Health Plan Strategy - Sword Health
Track 4 - Will Stabler, Executive Vice President, Payer Solutions - GeBBS Healthcare Solutions
Track 5 - David Etling , Senior Vice President & General Manager - InComm Healthcare
1:45 PM 2:30 PM
12:45 PM 1:30 PM
11:45 AM 12:30 PM
10:45 AM 11:30 AM
Jenn Kerfoot, Chief Experience Officer
FarmboxRx
Julianne Eckert RN BSN, CCM, CMCN, ACMP, Senior Director, Clinical Quality Programs
Clover Health
1:45 PM 2:30 PM
12:45 PM 1:30 PM
11:45 AM 12:30 PM
10:45 AM 11:30 AM
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
1:45 PM 2:30 PM
12:45 PM 1:30 PM
11:45 AM 12:30 PM
10:45 AM 11:30 AM
Lisa A. Barrett, Vice President, Member Navigation Solutions My Community Connections
UnitedHealthcare
Sean Libby, President
BeneLynk
1:45 PM 2:30 PM
12:45 PM 1:30 PM
11:45 AM 12:30 PM
10:45 AM 11:30 AM
Joe Gabler, Chief Revenue Officer
Solutran
Scott Weiner, Director, Government Programs
Sentara
2:30 PM 3:30 PM
1:30 PM 2:30 PM
12:30 PM 1:30 PM
11:30 AM 12:30 PM
Track Chairs
Track 1 - Matthew Markham, Director, Business Development - Wolters Kluwer, Health Language
Track 2 - Reva Sheehan, Sr. Director of Customer Insights - mPulse Mobile
Track 3 - Evelyn Chojnacki, MPH, Director, Health Plan Strategy - Sword Health
Track 4 - Will Stabler, Executive Vice President, Payer Solutions - GeBBS Healthcare Solutions
3:30 PM 4:15 PM
2:30 PM 3:15 PM
1:30 PM 2:15 PM
12:30 PM 1:15 PM
Elaine Taverna, Senior Vice President, Risk Adjustment and Quality
Advantasure
Ellen Fink-Samnick, Chair
RISE SDoH Community
3:30 PM 4:15 PM
2:30 PM 3:15 PM
1:30 PM 2:15 PM
12:30 PM 1:15 PM
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
3:30 PM 4:15 PM
2:30 PM 3:15 PM
1:30 PM 2:15 PM
12:30 PM 1:15 PM
Lynda Rowe, Senior Advisor, Value-based Markets
InterSystems
Autumn Kerr, AVP, Clinical Quality
Healthfirst
Kate Beck, AVP, Health Information Exchange
Healthfirst
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 Basevich, VP of Enterprise Partnerships
Arcadia
Laura Sheriff, RN, MSN, Vice President Operations, Risk Adjustment
Southwestern Health Resources (SWHR)
4:15 PM 4:55 PM
3:15 PM 3:55 PM
2:15 PM 2:55 PM
1:15 PM 1:55 PM
As the health care space continues to evolve, join this rapid-fire conversation with health care executives as they discuss upcoming compliance and regulatory changes, trends in technology and data affecting risk adjustment and quality, social determinants of heath, diversity, equity and inclusion, and practical advice to get you ready for the rest of 2023.
Moderator
Vandna Pandita, Vice President, HEDIS Strategy & Analytics
AmeriHealth Caritas
Melanie A. Prince, MSN, BSN, NE-BC, CCM, FCM, FAAN, President/CEO
MAPyourWAY, LLC
Carmela Costiniuk, B.Sc. OT, MHA, D. EdD (C), Vice President, Population Health and Clinical Transformation
Catholic Medical Partners
Margaret Paroski, MD, MMM, President & CEO and Chief Medical Officer
Catholic Medical Partners
4:55 PM 5:00 PM
3:55 PM 4:00 PM
2:55 PM 3:00 PM
1:55 PM 2:00 PM
Nikki Hungate MS, MHA, Director, Medicare & Gov't Programs Product Strategy
MVP Health Care