RISE National 2024 ǀ View the Schedule

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RISE National 2024
Nashville
March 17-19, 2024

Schedule

Check out what's in store for you at RISE National 2024, taking place March 17-19 in downtown Nashville. RISE National 2024 offers focused sessions across timely themes to encourage a deeper dive into the content most relevant to you, your job function, and your organization. Each year, our agenda is designed for the functional thinker to leave equipped and re-energized to push your organization forward in the evolving Medicare Advantage landscape.

Sunday - March 17, 2024

9:00 AM 10:00 AM

8:00 AM 9:00 AM

7:00 AM 8:00 AM

6:00 AM 7:00 AM

Workshop Registration Open

10:00 AM 5:00 PM

9:00 AM 4:00 PM

8:00 AM 3:00 PM

7:00 AM 2:00 PM

Main Conference Registration Open

10:00 AM 4:00 PM

9:00 AM 3:00 PM

8:00 AM 2:00 PM

7:00 AM 1:00 PM

Workshop A: Risk Adjustment Practitioner

* Additional Registration is Required

  • The essentials of and differences between Medicare Advantage, Commercial and Medicaid risk adjustment  
  • Understanding how risk scores are calculated  
  • Making sense of varying payment models  
  • An intro into using data and predictive analytics to optimize your risk adjustment practices  
  • Tools for achieving data accuracy  
  • Where do we stand with the transition from RAPS to EDS? The latest in a long journey  
  • Provider engagement strategies that will impact your risk adjustment initiatives  
  • Risk adjustment vendor selection and management  
  • Determining whether you need RA vendors  
  • How do you effectively vet potential vendors and ultimately select them?  
  • Strategies for on-going, thorough vendor management  
  • The future of risk adjustment – what you need to know to stay ahead of possible changes  
  • Initial steps for preparing for a RADV audit  
  • Which staff is essential to overseeing your RADV audit prep?  
  • Staying ahead – key items to monitor well in advance of an actual audit  

 

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

10:00 AM 4:00 PM

9:00 AM 3:00 PM

8:00 AM 2:00 PM

7:00 AM 1:00 PM

Workshop B: Advanced HCC Auditor

* Additional Registration is Required

The HCC Coding for Accuracy workshop is not just for those directly involved in HCC coding work. It is designed for other disciplines, as well, including finance and analytics professionals. Join us for an introduction to best practices, the opportunity to work through case examples, and to share experiences with your peers. This workshop will zero-in on regulatory compliance while teaching you how to optimize the accuracy of the information gathered and submitted at the practice level. What you will also learn about the way charting is often done, how to overcome “disconnect” with the clinicians and how their typical charting practices and EMRs can create significant problems, and how RADV views documentation in contrast with the way clinicians were taught and EMRs were built initially.  

Please note: Attendees are encouraged to bring questions to pose to our expert workshop facilitators and to the table for the group. We provide your workbook which includes copies of the slide deck. You will not need your coding manuals, but most people take notes on their laptop or tablet. 

Dialogue, interact and work in small, facilitated groups with peers and colleagues   

  • Understanding the financial overlay – HCC codes mapping to risk adjustment scores   
  • A single coding and documentation process for  
  • Risk adjustment   
  • Skill development on choosing diagnoses from portions of the encounter – permitted and not permitted   
  • Clinical documentation barriers for risk adjustment purposes (data validation audit risks)   

  

Instructor 
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

1:00 PM 5:00 PM

12:00 PM 4:00 PM

11:00 AM 3:00 PM

10:00 AM 2:00 PM

Workshop C: Revolutionizing Health Plans: A Member-Centric Approach for Sustainable Success

* Additional Registration is Required

Join us for an immersive workshop tailored to professionals in risk adjustment, quality assurance, social determinants of health (SDOH), finance, and analytics. In the ever-evolving landscape of healthcare, where CMS (Centers for Medicare & Medicaid Services) is dedicated to achieving your goals through innovation and interoperability, this workshop is your gateway to pioneering strategies that ensure the future success of your health plans. 

Key Highlights: 

  • Building the Business Case - Aligning New Plan Strategies with Business Growth 
  • Data Fusion - Integrating Analytics for Member-Centric Solutions 
  • Strategic Program Design - Breaking Silos, Connecting Members and Navigating CMS Compliance 
  • Consumer-Focused Implementation - Bringing Your Vision to Life, In-House or with Expert Partners 

In this workshop, you will interact with leading experts in risk adjustment, quality, and SDOH, participate in engaging panel discussions, and attend breakout sessions that equip you with the knowledge and tools needed to revolutionize your health plan. What got you here won’t keep you here. Don't miss this opportunity to future-proof your success for this most dynamic period in healthcare. 

Ally Thomas, AVP of Quality Improvement 
UPMC 

BK Kajopaiye, Program Manager Risk Adjustment, STARS, and Quality Care
First BlueCross BlueShield
 

Gerri Cash, VP, Medicare Quality & Stars 
Molina

Liz Haynes MSN, RN, CCM, DVP, Risk Adjustment & Stars Government Programs 
Blue Cross and Blue Shield of Kansas City 

John Criswell, Founder, CEO, Chairman
Porter

Ana Handshuh, Principal  
Cat5 Strategies 

Rick Whitted, CEO 
U.S. Hunger  

 

 

 

 

1:00 PM 5:00 PM

12:00 PM 4:00 PM

11:00 AM 3:00 PM

10:00 AM 2:00 PM

Workshop E: Engagement 2.0 - A Progressive Pivot from Retrospective Strategies

* Additional Registration is Required

Join this immersive workshop on shifting from retrospective approaches to proactive care methodologies. Participate in thought-provoking discussions addressing Provider and Member Engagement, Electronic Data Interchange (EDI) Claims Processing, leveraging AI for analytics, and other emerging solutions and trends.  

Discussion Highlights:  

  • EHR integration strategies including embedding gaps in care alerts at the point of care  
  • Innovative approaches for engaging members while fostering collaborative provider relationships  
  • Addressing socioeconomic disparities to improve member engagement 
  • Case studies and success stories showcasing effective provider engagement models  
  • Leveraging EDI to streamline communication, increasing diagnosis code accuracy and enhancing efficiency  
  • Reducing RADV risk and educating practices 
  • Refining targets with advanced analytics to prioritize risk adjustment and quality strategies  
  • Emerging technologies in the marketplace and how they will impact the future of healthcare

Moderator: 
Megan Zakrewsky, Vice President Solutions Management
Veradigm  

Meghan West, Director of Product Management,  
Veradigm 

Eric Pflager, Senior Vice President, Population Health,  
Southeast Primary Care Partners 

Joseph Burnett, Leader, Risk Adjustment Analytics, Health Analytics 
MVP Health Care  

Lisa Garrett, Director, Revenue Management 
Sentara Health  

Rebecca Welling, VP, Risk Adjustment 
Intermountain Health

2:00 PM 5:00 PM

1:00 PM 4:00 PM

12:00 PM 3:00 PM

11:00 AM 2:00 PM

Workshop D: 2024 Developments in Risk Adjustment Enforcement, Compliance, and Agency Actions and What Your Organization Should Be Doing Now

* Additional Registration is Required

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

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

David Meyer
EBG Advisors  

Annie Miyazaki-Grant, the Chief Compliance & Privacy Officer 
VNS Health 

5:00 PM 7:00 PM

4:00 PM 6:00 PM

3:00 PM 5:00 PM

2:00 PM 4:00 PM

Welcome Cocktail Reception - All Conference Attendees Invited

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 networking. 

Monday - March 18, 2024

8:30 AM 7:00 PM

7:30 AM 6:00 PM

6:30 AM 5:00 PM

5:30 AM 4:00 PM

Main Conference Registration

8:30 AM 10:00 AM

7:30 AM 9:00 AM

6:30 AM 8:00 AM

5:30 AM 7:00 AM

Networking Breakfast in the Exhibit Hall

8:30 AM 8:30 PM

7:30 AM 7:30 PM

6:30 AM 6:30 PM

5:30 AM 5:30 PM

Exhibit Hall Open

9:30 AM 9:40 AM

8:30 AM 8:40 AM

7:30 AM 7:40 AM

6:30 AM 6:40 AM

Opening Remarks

Ellen Wofford, Managing Director
RISE

Conference Chairs:
Nikki Hungate MS, MHA
Health Plan Product Strategy Expert

Kaleb Holt, Medicare Program Director
SelectHealth

9:40 AM 10:25 AM

8:40 AM 9:25 AM

7:40 AM 8:25 AM

6:40 AM 7:25 AM

Address from Office of Inspector General

Christi A. Grimm, Inspector General
Office of Inspector General
Department of Health and Human Services

Learn More 

10:25 AM 11:00 AM

9:25 AM 10:00 AM

8:25 AM 9:00 AM

7:25 AM 8:00 AM

Enforcement Perspective From The Department of Justice

Edward C. Crooke, Assistant Director
Civil Division, Fraud Section
United States Department of Justice

11:00 AM 11:45 AM

10:00 AM 10:45 AM

9:00 AM 9:45 AM

8:00 AM 8:45 AM

Update from the Centers for Medicare & Medicaid Services (CMS) 

Join CMS representatives as they discuss the latest HHS-Operated Risk Adjustment and Risk Adjustment Data Validation Updates that applies in the individual and small group markets. This conversation will include an overview of the risk adjustment policies in the proposed 2025 Payment Notice and the latest updates on HHS-operated Risk Adjustment Data Validation. 

Allison Wiley, Health Insurance Specialist 
Center for Consumer Information and Insurance Oversight 
Centers for Medicare & Medicaid Services (CMS) 

Daphne Letherer, Management & Program Analyst 
Center for Consumer Information and Insurance Oversight 
Centers for Medicare & Medicaid Services (CMS) 

11:45 AM 12:15 PM

10:45 AM 11:15 AM

9:45 AM 10:15 AM

8:45 AM 9:15 AM

Networking Break in Exhibit Hall

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

Track Chairs:
Track 1: Risk Adjustment Strategies - Mary Feliz, Manager, Risk Adjustment Consulting - Pareto Intelligence 
Track 2: Integrating Silos - Jerry Gauchat, Executive Vice President - Cognisight
Track 3: Quality and Member Experience - Reva Sheehan, Sr. Director, Customer Insights - mPulse
Track 4: Payer/Provider Strategic Alignment - Beth Zuehlke, Chief Customer Officer - Moxe Health
Track 5: Technology/Data Analytics - Michael Dulin, MD PhD, Chief Medical Officer - Gray Matter Analytics
Track 6: Compliance & Regulatory Updates - Jennie Ossentjuk, Market Lead-Commercial Health Plans - Noridian Healthcare Solutions
RISE Innovation Theater 1: Jessica Muratore, Chief Operating Officer - Rex Wallace Consulting, LLC
RISE Innovation Theater 2


Track Chairs:

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

Track 1: Risk Adjustment Strategies

Risk Adjustment Strategies: Bridging the Risk Adjustment Continuum for Collaborative Payer-Provider Success

  • Learn best practices on how to leverage data and insights to foster collaboration between payers and providers 
  • Gain insights into how a unified data strategy supports Risk Adjustment across your organization 
  • Discover how technology from AI to EHR interoperability can build the bridge for payer-provider success 

Moderator:
Nana Ofori, VP, Product 
Apixio 

Chris Towner, Data Analytics Manager 
Providence St. Joseph 

Brian Murtha, Director, Digital Strategy 
Centene Corporation  

Michael Nemeth, Associate Vice President
Blue Cross Blue Shield North Carolina 

 

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

Track 2: Integrating Silos

Integrating Silos: Case Study: Synergizing Quality Analytics and Risk Adjustment Programs with a Converged Approach

  • Learn how combining the efforts of quality and risk teams through a single analytics-based program can transform health plan operations, improve performance, and reduce costs 
  • Discover the power of seamless information sharing to support member and provider engagement and enhance 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:
Hemanth Doma, AVP, Product 
Inovalon 

Kate Eshelman, M.D., M.P.H., Vice President, Medical Informatics 
Inovalon 

Gabriel Medley, Vice President, Risk Adjustment 
BCBS-MI 

Miguel Venereo, MD, FACOG, CCPS, Senior Vice President and Chief Medical Officer 
Community Care Plan 

Ken Walters, Senior Vice President, and Chief Operating Officer 
Community Care Plan 

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

Track 3: Quality and Member Experience

Quality and Member Experience: Blending the Right Data to Create Lasting Behavioural Change

  • Shift your engagement focus from measures to moments that matter most to your members 
  • How to address the most critical data gaps to build a comprehensive member record (SDoH, health equity, contact information, communication preference) 
  • Actioning that data with communication and channel strategies to maximize engagement, improve risk identification, and increase gap closure 
  • Go deeper: how to move to more hyper-targeted personalized journeys with every outreach that drives self-motivation and member retention/growth 
  • Explore a points-based experience to encourage desired behaviors while controlling reward spend 

 

Moderator: 
Kent Holdcroft, Chief Growth Officer 
Healthmine 

Kimberly Swanson, Chief of Staff 
Healthmine 

Chris Gage, Director, Experience Strategy 
Healthmine 

Laurin Dixon, Lead Executive of Medicare Product 
Arkansas Blue Cross Blue Shield 

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

Track 4: Payer/Provider Strategic Alignment

Payer/Provider Strategic Alignment: Laying the Groundwork for Value-Based Care: Payer-Provider Interoperability to Enhance Prospective Risk Management 

  • Share the key components and capabilities of a best-in-class risk identification, capture, and management program 
  • Discuss optimization of the provider and care team experience, workflow and technology optimization, data and analytics use, and performance management processes 
  • Share real life provider examples of the impact to performance through timely data, insight, and analytics-sharing between providers and their payer partners 

John Kontor, MD, Senior Vice President, Prospective Risk and Provider Solutions 
Optum   

Mark W. Lodes, MD, Chief Medical Officer and VP, Population Health and Medical Education 
Froedtert and Medical College of Wisconsin 

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

Track 5: Technology / Data Analytics

Technology / Data Analytics: Move the Needle to Deliver Quality of Care, Improved Outcomes and Efficiency of Care

  • Actionable data at the point of care within providers workflow helps close gaps in care 
  • Putting interoperability standards from paper to patient care 
  • Share perspectives from payers & providers what`s effective and what is making the biggest impact 

Moderator:
Mr. Rohit Shinde, Vice President
Healow Insights 

John Robertson, M.D., Family Medicine 
Family Medical Clinic of Harrogate 

Jennifer Holman, Director of Risk Adjustment Programs  
Centene Corporation 

 

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

Track 6: Compliance and Regulatory Updates

Compliance and Regulatory Updates: Partnering with the OIG on 2024 Priorities

 

Join this dynamic OIG panel as they discuss key priorities for 2024, including best practices for telehealth, strategies for identifying fraud from an experienced investigator, and review a toolkit for processing high risk diagnosis.  

 

Carolyn Kapustij, Senior Advisor for Managed Care, Office of Audit Services 
U.S. Department of Health and Human Services – Office of Inspector General 

Brian Martens, Director of Strategic Projects and Initiatives 
U.S. Department of Health and Human Services – Office of Inspector General 

Miriam Anderson, Subject Matter Expert 
U.S. Department of Health and Human Services – Office of Inspector General 

Alexis Mills, Social Science Research Analyst, New York Regional Office  
U.S. Department of Health and Human Services – Office of Inspector General 

Christopher G. Bresette, Director of Medicare Part C Audits, Office of Audit Services 
U.S. Department of Health and Human Services – Office of Inspector General 

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

RISE Innovation Theater 1

Innovation Theater 1: Best Practices for Maintaining a Strong Risk Adjustment Program After the Final Rules

  • Discuss what is needed for your program to thrive after the sweeping changes that were made in 2023 
  • Recognize the benefits of investing in your team through education 
  • Identify best practices from an internal audit, OIG and RADV perspective 
  • Discuss best practices re hiring and keeping your team connected and calibrated 

Colleen Gianatasio, Director, Clinical Documentation Integrity and Coding Compliance  
CDPHP  

Kathleen Spaulding, Manager, Risk Adjustment Quality Assurance
CDPHP  

Amanda Spicer, Supervisor Risk Adjustment Coding Operations 
CDPHP  

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

RISE Innovation Theater 2

Innovation Theater 2: Advance Health Equity With Effective Community Engagement

  • Learn foundational definitions about what community engagement is and is not, and opportunities to strengthen the use of shared language and terminologies  
  • Share best practices with a focus on concrete and actionable steps that healthcare organizations can take to advance meaningful community engagement initiatives/partnerships  
  • Discuss approaches to making the "business case" for community engagement including pathways to measure impact and ensure sustainability 

Evelyne Kane, Sr. Program Manager, Community Engagement & Capacity Building 
Camden Coalition 

Stephanie Burdick, Community Leader & Patient Advocate 
Camden Coalition 

1:00 PM 1:55 PM

12:00 PM 12:55 PM

11:00 AM 11:55 AM

10:00 AM 10:55 AM

Networking Lunch in Exhibit Hall

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

Track Chairs:
Track 1: Risk Adjustment Strategies - Mary Feliz, Manager, Risk Adjustment Consulting - Pareto Intelligence 
Track 2: Integrating Silos - Jerry Gauchat, Executive Vice President - Cognisight
Track 3: Quality and Member Experience - Reva Sheehan, Sr. Director, Customer Insights - mPulse
Track 4: Payer/Provider Strategic Alignment - Beth Zuehlke, Chief Customer Officer - Moxe Health
Track 5: Technology/Data Analytics - Michael Dulin, MD PhD, Chief Medical Officer - Gray Matter Analytics
Track 6: Future of Health Care - Jennie Ossentjuk, Market Lead-Commercial Health Plans - Noridian Healthcare Solutions
RISE Innovation Theater 1: Jessica Muratore, Chief Operating Officer - Rex Wallace Consulting, LLC
RISE Innovation Theater 2

Track Chairs:

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

Track 1: Risk Adjustment Strategies

Risk Adjustment Strategies: The Best of Both Worlds: Uniting Retrospective and Prospective Strategies to Achieve Improved Patient Outcomes

  • Discuss the industry’s shift from retrospective to prospective risk adjustment, in efforts to forward value-based care 
  • Explore a dual approach that balances the two methodologies to create a more holistic, patient-centric strategy 
  • Identify technologies that can be leveraged to bolster your retrospective and prospective strategies 

Erik Simonsen, Chief Operating Officer 
Episource  

Jenni Monfils, CPC, CDEO, CRC, AVP, Risk Adjustment Coding and Compliance 
Molina HealthCare 

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

Track 2: Integrating Silos

Integrating Silos: Utilize Early Risk Adjustment Insights to Drive Better Outcomes

  • Leveraging a blended V24 and V28 risk adjustment model 
  • Converting RAF and HEDIS insights into actionable decisions 
  • Aggregating SDOH, behavioral health, and clinical data to achieve whole-person care 

John Romans, Co-Founder and CEO 
Biomedix 

 

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

Track 3: Quality and Member Experience

Quality and Member Experience: Exceptional Member Experience That Leads to Growth, Retention, and Better Care

  • Gain insight into members’ experience to identify what really matters to them, and prioritize opportunities to improve across their health care journey 
  • Understand the importance of provider education and health plan communication alignment for improved effectiveness of in-home health visits 
  • Learn how in-home health evaluations can impact enterprise-wide goals 

Alex Blackstock, VP, Product Management 
Signify Health  

Jodi Biller, DNP, APRN, FNP-BC, Director of Clinical Improvement for MHC ACO 
Marshall Health Network

Uday Joshi, Assistant Vice President 
Healthfirst 

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

Track 4: Payer/Provider Strategic Alignment

Payer/Provider Strategic Alignment: Lessons Learned While Building an AI Driven-Approach to Collaborative APMs

  • Applying AI solutions to ensure compliant diagnosis and coding gap closure
  • Gaining a more complete understanding of the covered population’s disease burden through comprehensive and predictive data
  • Leveraging EHR interoperable workflows to engage the clinician at the point of care to support accurate diagnosis and documentation  
  • Realizing performance improvements against operational and financial benchmarks

Moderator:
Summerpal Kahlon, Chief Medical Officer
Edifecs

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

Deepak Sadagopan, Chief Operating Officer, Population Health  
Providence 

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

Track 5: Technology/Data Analytics

Technology/Data Analytics: Is Your MA Plan Facing Higher Utilization and Lower Reimbursement?   Learn From D-SNPs To Improve Performance.

Moderator: 
Mark Van Ert, Managing Director 
FTI Consulting     

Anne Winter, Senior Managing Director 
FTI Consulting 

David Olson, Vice President 
Molina Healthcare 

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

Track 6: Future of Health Care

Future of Health Care: Addressing Health Equity and Achieving Better Health Outcomes with Integrated Clinically-Led, Whole Patient Care

  • Do we know how CMS’ Health Equity Index Addresses the challenges in achieving good quality care?  
  • Is integrated clinically led patient care truly working between the home, PCPs/Specialists, or wherever members receive care; is clinical information getting to where it needs to go to achieve “whole-person care”?   
  • How can we achieve better health outcomes and more complete gap closures when member/patient interventions are so disjointed? 

Moderators  
Dr. Mike Cantor, CMO Matrix Medical Network 
Sophia Kim, Chief Commercial Officer, Matrix Medical Network 

Panelists 
Margaret Anderson, Senior Vice President  
Health Alliance Plan  

Olga Ziegler, Vice President  
Highmark Health  

Zeev Neuwirth, M.D., Author 
“Beyond the Walls” and “Reframing Healthcare” 

Jeff Bennett, Chief Strategy and Innovation Officer 
Matrix Medical Network 

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

RISE Innovation Theater 1

Innovation Theater 1: Building ONE Regulatory Quality Program for your Integrated Healthcare System

  • Learn how quality and risk adjustment leaders collaborate to share resources, align program initiatives, and decrease provider abrasion while increasing performance across the entire health system 
  • Insightful exploration of how aligning these programs streamlines administrative processes, enhances patient care coordination, and optimizes resource allocation   
  • Focus on the complexities of navigating dual regulatory frameworks while maintaining compliance and maximizing efficiency   
  • Harness the collaborative potential between two vital components of the healthcare landscape 

Moderator:
Savannah Gonsalves, Director of Quality
 
Hometown Health 

Erika Paquette, Director of Risk Adjustment 
Hometown Health 

Mitch Harper, Director of Network Performance 
Hometown Health 

Dr. Derek Beenfeldt, Chief Medical Officer 
Hometown Health 

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

RISE Innovation Theater 2

Innovation Theater 2: Measuring What Matters: Reframing Healthcare Experience Metrics to Drive Value

  • Review evidence on what matters most to healthcare consumers, the patients and families we support 
  • Explore opportunities to modify survey structures and measurement tools to better understand what is most important to consumers 
  • Examine ways to reduce measurement burden, increase timeliness, and apply findings generated from experience data 
  • Assess healthcare experience benchmarking opportunities to drive accountability and improvement 

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

2:45 PM 3:15 PM

1:45 PM 2:15 PM

12:45 PM 1:15 PM

11:45 AM 12:15 PM

Networking Break in Exhibit Hall

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

Track Chairs:
Track 1: Risk Adjustment Strategies - Mary Feliz, Manager, Risk Adjustment Consulting - Pareto Intelligence 
Track 2: Integrating Silos - Jerry Gauchat, Executive Vice President - Cognisight
Track 3: Quality and Member Experience -Reva Sheehan, Sr. Director, Customer Insights - mPulse 
Track 4: Payer/Provider Strategic Alignment - Beth Zuehlke, Chief Customer Officer - Moxe Health
Track 5: Technology/Data Analytics - Michael Dulin, MD PhD, Chief Medical Officer - Gray Matter Analytics
Track 6: Future of Health Care- Jennie Ossentjuk, Market Lead-Commercial Health Plans - Noridian Healthcare Solutions
RISE Innovation Theater 1: Jessica Muratore, Chief Operating Officer - Rex Wallace Consulting, LLC
RISE Innovation Theater 2

Track Chairs:

3:15 PM 4:00 PM

2:15 PM 3:00 PM

1:15 PM 2:00 PM

12:15 PM 1:00 PM

Track 1: Risk Adjustment Strategies

Risk Adjustment Strategies: Data-Driven Strategies for Payer-Provider Collaboration in Risk Adjustment

  • Describe the crucial role of integrating clinical data alongside claims data to improve risk adjustment accuracy 
  • Understand how advanced data analytics can support gaps in documentation and coding 
  • Identify tools and strategies that strengthen payer-provider collaboration, including risk documentation and provider engagement 

 

Moderator: 
Andrea Purjue, Director, Enterprise Partnerships 
Arcadia 

Cale Browning, MBA, CPC, CRC, Director, CDE Performance Management 
Ochsner Health  

Jordan Anderson, MD, MBA, SVP, Clinical Programs 
Belong Health 

Mac Davis, Partner 
Centerboard 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

Track 2: Integrating Silos

Integrating Silos: Bridging Care Pathways to Deliver Hyper-Personalized End-to-End Patient Experiences

  • Learn how to create a holistic approach to engage vulnerable and underserved populations
  • Gain successful approaches during COVID that can be implemented in other public health crises
  • Utilizing data and analytics to drive adoption and community engagement 

Sara Ratner, President, Government Programs
Nomi Health 

Jon Hamdorf, Market President 
UCare 
Former Kansas Medicaid Director 

3:15 PM 4:00 PM

2:15 PM 3:00 PM

1:15 PM 2:00 PM

12:15 PM 1:00 PM

Track 3: Quality and Member Experience

Quality and Member Experience: Data-Driven Insights are the Future of Member Engagement  

  • Data-driven health care is here and with it comes new opportunities for personalized engagement approaches. 
  • Join us to learn how healthcare technology companies and health plan leaders are coming together to use Health Risk Assessments (HRAs), Consumer Assessments of Healthcare Providers and Systems (CAHPS), and Social Determinants of Health (SDOH) data for unique insights that drive targeted member interventions. 
  • These interventions can increase perceived health, decrease healthcare utilization, and increase overall member satisfaction.  

 

Moderator:
Eric Glazer, Executive Producer & Host
 
Bright Spots in Healthcare Podcast

Matthew Baird, Consumer Experience Partner 
Intermountain Healthcare 

Eugene Hsu, MD, MBA, RVP II, Senior Clinical Officer, Medicare 
Elevance 

Marc Willard, CEO 
Icario  

 

3:15 PM 4:00 PM

2:15 PM 3:00 PM

1:15 PM 2:00 PM

12:15 PM 1:00 PM

Track 4: Payer/Provider Strategic Alignment

Payer/Provider Strategic Alignment: The Power of Collaboration: How Payers and Providers Can Find Success Together

  • Interactive discussion between payers and providers on how collaboration eases friction and success in value-based care
  • Real-world strategies to incentivize providers' time and effort, not just their results
  • Insight into what providers really need to make engaging them more effective

Moderator:
Ashish Kachru, CEO
DataLink

Kacey Serrano, MPA, CPC, CRC, Director, Medicare Stars and Risk Adjustment 
Arkansas Blue Cross Blue Shield 

Britni Hoyt, MPH, MBA, Director of Quality Operations and Care Management 
Community Quality Alliance

3:15 PM 4:00 PM

2:15 PM 3:00 PM

1:15 PM 2:00 PM

12:15 PM 1:00 PM

Track 5: Technology / Data Analytics

Technology / Data Analytics: Unlocking Provider Engagement – The Vital Elements of a CDI Program

  • Discover the art of utilizing data and analytics to steer physician engagement and quantify the effectiveness of CDI initiatives.  
  • Gain insights into the successful implementation of CDI programs within provider organizations.  
  • Uncover the essential elements crucial for building a robust CDI program 

Moderator 
Tam Pham, Chief Product Officer of Chirok Health 
Chirok Health  

Victoria Smith, Director of Process Improvement and Design 
Beth Israel Lahey Health Performance Network (BILHPN)  

Dr. Sarika Aggarwal, Chief Medical Officer 
Fast Pace Health  

Kate Casaday, Head of Product 
On Belay Health ACO REACH 

3:15 PM 4:00 PM

2:15 PM 3:00 PM

1:15 PM 2:00 PM

12:15 PM 1:00 PM

Track 6: Future of Health Care

Future of Health Care: Ethical Dimensions of AI in Shaping the Future of Healthcare

  • Explore the ethical implications of AI integration in healthcare, focusing on its benefits and potential pitfalls 
  • Discover the intricate ethical landscape of AI integration in healthcare and the imperative of building a culture of compliance 
  • Delve into ensuring usability for future potentials, addressing techquity, and safeguarding against bias & misuse with a focus on the responsibility to protect vulnerable populations 
  • Look at a programmatic design that illustrates the success & oversight associated with the deployment of a new AI product 

Moderator 
Jenn Kerfoot, Chief Strategy & Growth Officer 
DUOS   

Karl Ulfers, Co-Founder and CEO 
DUOS

Jennifer Callahan, Chief Operating Officer 
ATRIO Health Plans 

3:15 PM 4:00 PM

2:15 PM 3:00 PM

1:15 PM 2:00 PM

12:15 PM 1:00 PM

RISE Innovation Theater 1

Innovation Theater 1: Point of Care Decision Support to Drive Early Diagnosis and Improved Treatment of Chronic Disease

  • Discuss payor and provider collaboration involving use of a technology platform designed to ingest large volumes of information and perform advanced analytics  
  • Learn about machine learning and artificial intelligence to identify and surface key insights to providers during patient encounters 
  • Utilize technology for early and appropriate diagnosis of chronic disease and improved chronic disease treatment and outcomes 
  • Improve performance on HEDIS quality measures  

Dr. Kumar Dharmarajan, Associate Chief Medical Officer 
Clover Health 

Jaye Johnston, Vice President of Stars Operations 
Clover Health 

Dr. Jessica Son, Chief Medical Officer 
Clover Home Care 

3:15 PM 4:00 PM

2:15 PM 3:00 PM

1:15 PM 2:00 PM

12:15 PM 1:00 PM

RISE Innovation Theater 2

Innovation Theater 2: A Provider Perspective  – What it Takes to Make VBC Work

  • Health plan partnerships 
  • Aligning provider incentives 
  • Enabling technology 

Moderator 
Kenneth Persaud MD | CEO 
White-Wilson Medical Center  

Krishan Nagda, MD, CEO & President 
Central Florida Inpatient Medicine 

Ralph Tang, MD, Principal 
Healthcare Transformation 

 

Concurrent Sessions 4:05 PM - 4:50 PM 3:05 PM - 3:50 PM 2:05 PM - 2:50 PM 1:05 PM - 1:50 PM

Track Chairs:
Track 1: Risk Adjustment Strategies - Mary Feliz, Manager, Risk Adjustment Consulting - Pareto Intelligence 
Track 2: Integrating Silos - Jerry Gauchat, Executive Vice President - Cognisight
Track 3: Quality and Member Experience - Reva Sheehan, Sr. Director, Customer Insights - mPulse
Track 4: Payer/Provider Strategic Alignment - Beth Zuehlke, Chief Customer Officer - Moxe Health
Track 5: Technology/Data Analytics - Michael Dulin, MD PhD, Chief Medical Officer - Gray Matter Analytics
Track 6: Future of Health Care - Jennie Ossentjuk, Market Lead-Commercial Health Plans - Noridian Healthcare Solutions
RISE Innovation Theater 1: Jessica Muratore, Chief Operating Officer - Rex Wallace Consulting, LLC
RISE Innovation Theater 2

Track Chairs:

4:05 PM 4:50 PM

3:05 PM 3:50 PM

2:05 PM 2:50 PM

1:05 PM 1:50 PM

Track 1: Risk Adjustment Strategies

Risk Adjustment Strategies: How Forward-Thinking Health Plans are Achieving Better Value by Leaving The Past Behind

  • Discuss how to take a wide view of gap closure by evaluating the patient holistically  
  • Learn how to eliminate provider abrasion and increase value to the health plan 
  • Discover how you can use this in other areas of the organization to improve results 

Moderator:
Kai Tsai, Executive Vice President, Strategic Business Development 
Centauri Health Solutions 

Brian Murtha, Director, Digital Strategy 
Centene Corporation  

Rebecca Elhassid, Senior Vice President, Enterprise Solutions 
Centauri Health Solutions 

 

4:05 PM 4:50 PM

3:05 PM 3:50 PM

2:05 PM 2:50 PM

1:05 PM 1:50 PM

Track 2: Integrating Silos

Integrating Silos: Improve Compliance and Financial Performance with PCP-Centric Risk Adjustment 

  • Understand the recent regulatory trends and actions impacting risk adjustment.   
  • Learn how a payer’s in-office RA program evolved, lessons learned and best practices 
  • Learn how a large provider group developed its program in conjunction with a payer, most valuable results and suggestions for payers 

Moderator:
Hassan Rifaat, MD,
Chief Executive Officer 
Vatica Health  

Richard Charles, MD, Chief Medical Officer 
General Physician PC 

Robert Tracy, Senior Vice President of Government Programs 
Independent Health 

4:05 PM 4:50 PM

3:05 PM 3:50 PM

2:05 PM 2:50 PM

1:05 PM 1:50 PM

Track 3: Quality and Member Experience

Quality and Member Experience: Session to be announced

4:05 PM 4:50 PM

3:05 PM 3:50 PM

2:05 PM 2:50 PM

1:05 PM 1:50 PM

Track 4: Payer/Provider Strategic Alignment

Payer/Provider Strategic Alignment: Leveraging AI and NLP to Close Gaps in Care: A Transformational Journey

  • Technology transformation – harnessing NLP’s speed to value  
  • Bridging data gaps to tear down walls between risk and quality 
  • Unlocking insights at the point of care to reduce provider abrasion and close gaps 
  • How AI-powered prospective workflows can create new ways of working  

Moderator:
Brant Castellow, Senior Vice President, Head of Sales and Marketing 
Reveleer 

Amy Gleason, Chief of Product 
Main Street Health 

Erica Krieger, Vice President, Quality 
Blue Cross Blue Shield of Michigan 

Dave DeHommel, Director, Risk Adjustment Accuracy & Risk Mitigation 
Blue Cross Blue Shield of Michigan 

4:05 PM 4:50 PM

3:05 PM 3:50 PM

2:05 PM 2:50 PM

1:05 PM 1:50 PM

Track 5: Technology/Data Analytics

Technology/Data Analytics: Be A Pathfinder! Pioneering Innovative Health IT Strategies for Risk Adjustment, Quality, and Population Health Success in Value-Based Care

  • Acquire a comprehensive understanding of integrating AI, machine learning, and NLP seamlessly with risk adjustment, quality measures, and precision population health 
  • Receive the inaugural installment of RISE Value Based Care (VBC) and Risk Adjustment dynamic playbook. This tool provides a pragmatic framework for digital transformation with a focus on adaptability to technological progress. 
  • Get equipped with cutting-edge tools and analytics models for effective management of compliance, audit processes, risk adjustment, quality measures, and digital Clinical Quality Measures (CQM), HEDIS® and CMS Star Ratings ensuring continuous enhancement in healthcare delivery, financial performance, and compliance, all while offering a holistic approach to improving accuracy and efficiency 

Anna Carley, RHIT, Senior Director, Client Relations 
GeBBS Healthcare Solutions 

Dr. Shannon Decker, Principal  
VBC One  

4:05 PM 4:50 PM

3:05 PM 3:50 PM

2:05 PM 2:50 PM

1:05 PM 1:50 PM

Track 6: Future of Health Care

Future of Health Care: Leveraging In-Home Support Services to Drive Strategic Initiatives with MA Populations

  • Understand how in home care services provided as a supplemental benefit can support member’s functional needs, assess clinical and social risk, and integrate closely with the health plan’s benefit ecosystem to meet evolving member needs 
  • Recognize the value of a professional caregiver presence in the home, which can drive member engagement to improve clinical outcomes and advance the health plan’s strategic initiatives around quality and risk adjustment 
  • Learn how health plans can use home care services to enhance the member experience, support member acquisition and retention, improve quality ratings, and increase both revenue growth and cost savings 

Dr. Francesca Rinaldo, SVP, clinical product & innovation 
Sharecare 

4:05 PM 4:50 PM

3:05 PM 3:50 PM

2:05 PM 2:50 PM

1:05 PM 1:50 PM

RISE Innovation Theater 1

Innovation Theater 1: Health Confidence: A Novel Approach to Patient Education to Reduce Readmissions

  • This presentation will review the importance of health literacy, the impact that lower health literacy plays in patient engagement, readmission reduction and review tools and strategies to positively impact greater health literacy in our populations 
  • Evaluate the needs assessment completed to identify the gaps in patient education from the patient’s perspective 
  • Describe the journey to developing the program and roles and functions of all the team members involved in the interactive patient education experience.  
  • Identify through actual case studies how the team manages the collaboration and includes all members of the inter-professional team including the patients and their families, to address educational gaps and increase patient health confidence in managing their chronic conditions independently post discharge; contributing to decrease in utilization, readmissions and length of stay 

Colleen Morley, Associate Chief Clinical Operations Officer 
UIHealth 

4:55 PM 5:45 PM

3:55 PM 4:45 PM

2:55 PM 3:45 PM

1:55 PM 2:45 PM

Keynote Address: Rewire Your Brain for Less Stress & More Resilience

Stress is the great equalizer, but resilience is the antidote. Dr. Aditi Nerurkar will empower you with effective, practical, and science-based approach to rewire the brain for less stress and more resilience. She outlines strategies such as a media diet, sleep as a therapeutic intervention, monotasking, and cognitive retraining as resets for better brain health, less stress and more resilience. 

Dr. Aditi Nerurkar 
Division of Global Health & Social Medicine 
Co-Director of the Harvard Clinical Clerkship 
Harvard Medical School 

Learn More 

5:45 PM 5:50 PM

4:45 PM 4:50 PM

3:45 PM 3:50 PM

2:45 PM 2:50 PM

Closing Remarks

Conference Chairs:
Nikki Hungate MS, MHA
Health Plan Product Strategy Expert

Kaleb Holt, Medicare Program Director
SelectHealth

5:50 PM 6:50 PM

4:50 PM 5:50 PM

3:50 PM 4:50 PM

2:50 PM 3:50 PM

Interactive Roundtables Part One

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 8:00 PM

5:50 PM 7:00 PM

4:50 PM 6:00 PM

3:50 PM 5:00 PM

Networking Cocktail Reception in Exhibit Hall

All attendees are invited to join us in the exhibit hall for drinks, hors d'oeuvres, and networking. 

Tuesday - March 19, 2024

8:30 AM 2:30 PM

7:30 AM 1:30 PM

6:30 AM 12:30 PM

5:30 AM 11:30 AM

Conference Registration Open

8:30 AM 2:30 PM

7:30 AM 1:30 PM

6:30 AM 12:30 PM

5:30 AM 11:30 AM

Exhibit Hall Open

8:30 AM 10:00 AM

7:30 AM 9:00 AM

6:30 AM 8:00 AM

5:30 AM 7:00 AM

Networking Breakfast in Exhibit Hall

9:00 AM 10:00 AM

8:00 AM 9:00 AM

7:00 AM 8:00 AM

6:00 AM 7:00 AM

Interactive Roundtables Part Two

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 10:05 AM

9:00 AM 9:05 AM

8:00 AM 8:05 AM

7:00 AM 7:05 AM

Welcome Remarks and Day One Takeaways

Conference Chairs: 
Nikki Hungate MS, MHA 
Health Plan Product Strategy Expert 

Kaleb Holt, Medicare Program Director 
SelectHealth  

10:05 AM 10:20 AM

9:05 AM 9:20 AM

8:05 AM 8:20 AM

7:05 AM 7:20 AM

The Dr. Martin L. Block Award Presentation

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. 

10:20 AM 11:20 AM

9:20 AM 10:20 AM

8:20 AM 9:20 AM

7:20 AM 8:20 AM

Keynote Address: Together We Are Limitless

Sponsored by 

With a powerful personal narrative, a little wit and a strong inspirational message, Jeremy will provide a different perspective to audiences and open their eyes to see the power of interdependence.

“Although I cannot see my audiences, I can help them see how to effect change and positivity in their own lives. My mission is to help people suspend judgment and focus on the good. My objective is not to dictate how to succeed in life; I speak from experience to convince individuals that independence is good, while interdependence is great”.

How will you find the power of interdependence in your life?

Jeremy Poincenot
Blind Golf Champion

Learn More 

 

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

11:20 AM 11:40 AM

10:20 AM 10:40 AM

9:20 AM 9:40 AM

8:20 AM 8:40 AM

Networking Break in Exhibit Hall

11:40 AM 12:40 PM

10:40 AM 11:40 AM

9:40 AM 10:40 AM

8:40 AM 9:40 AM

Keynote Address: Healthcare 2050: The AI Revolution

Futurist Ian Khan delivers a visionary look at how artificial intelligence is set to transform healthcare by the year 2050. This talk anticipates groundbreaking changes in diagnosis, treatment, and patient care, driven by AI innovations. Ian envisions a future where personalized medicine becomes the norm, enabled by AI's ability to analyze vast data sets for tailored treatment plans. The keynote extends to the efficiency gains in hospital management and patient monitoring, significantly reducing human error and increasing accessibility. Ian also addresses the ethical considerations and challenges in integrating AI, emphasizing the need for a balanced approach to this technological revolution in healthcare. 

Ian Khan, the Futurist 
Featured on CNN, The BBC, Fox, Bloomberg, Fast Company, Entrepreneur, Ian is the host of “The Futurist” 

Concurrent Sessions 12:45 PM - 1:30 PM 11:45 AM - 12:30 PM 10:45 AM - 11:30 AM 9:45 AM - 10:30 AM

Track Chairs:
Track 1: Risk Adjustment Strategies - Gregory LeGrow, Executive Director Payer Product Strategy - athenahealth 
Track 2: Integrating Silos - Emma Martin, Chief of Staff - Nymbl Science
Track 3: Payer/Provider Strategic Alignment
Track 4: Provider Focus - Steve Buslovich, VP - Senior Care, VBC - PointClickCare
Track 5: Future of Health Care - Austin Weaver, VP, Medicare - Hinge Health
RISE Innovation Theater: Jessica Muratore, Chief Operating Officer - Rex Wallace Consulting, LLC

Track Chairs:

12:45 PM 1:30 PM

11:45 AM 12:30 PM

10:45 AM 11:30 AM

9:45 AM 10:30 AM

Track 1: Risk Adjustment Strategies

Risk Adjustment Strategies: Prepare to Succeed: Three Key Industry Trends to Know and Stay Ahead in Risk Adjustment and Quality 

  • What are the top regulatory changes that impact your objectives?  
  • How can you engage and enable providers to close gaps at the point of care?  
  • What are best practices to improve prospective and retrospective payer programs?  

Moderator 
Jimmy Liu, VP Analytics and MRR Solutions 
Advantmed 

Dona Doran, Assistant Director Risk Adjustment  
Cambia Health Solutions   

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

Mario Albert, Revenue Operations Manager 
Independent Health 

Leah Hannum, Director of Government Funding Operations 
Blue Cross of Idaho 

12:45 PM 1:30 PM

11:45 AM 12:30 PM

10:45 AM 11:30 AM

9:45 AM 10:30 AM

Track 2: Integrating Silos

Integrating Silos: Using AI to Bring Data & Clinical Knowledge Assets to the Point of Care

  • Learn about the importance of consolidating and organizing multiple data streams to create a comprehensive, longitudinal view of patient information 
  • Explore how the collaboration between AI algorithms and clinical knowledge contributes to a deeper understanding of patient needs, and how it translates into actionable insights at the point of care 
  • Dive into specific instances where the combination of data, AI, and clinical knowledge assets have led to improved care delivery 

 

Moderator: 
Dr. Shannon Decker, Principal  
VBC One 

Ariana Vanin, Sr. Director Product Growth 
Sanitas Medical Center 

Mansoor Khan, Sc.D., CEO  
Persivia Inc. 

Margaret Paroski, M.D., CEO 
Catholic Medical Partners 

12:45 PM 1:30 PM

11:45 AM 12:30 PM

10:45 AM 11:30 AM

9:45 AM 10:30 AM

Track 3: Payer/Provider Strategic Alignment

Payer/Provider Strategic Alignment: Enhancing Payer-Provider Synergy in Risk Adjustment

  • Pre-Visit Planning: Emphasizing the importance of thorough planning before patient visits to improve care and risk adjustment accuracy 
  • Point of Care Solutions: Integrating real-time technologies to assist healthcare providers in making informed decisions 
  • Concurrent Coding Review: Highlighting the necessity of real-time coding accuracy for precise risk adjustment 

Andy Kumar, Vice President, Product and Strategy 
EXL Health 

Sheryl Markowitz, Chief Clinical Officer 
Longevity Health Plan  

12:45 PM 1:30 PM

11:45 AM 12:30 PM

10:45 AM 11:30 AM

9:45 AM 10:30 AM

Track 4: Provider Focus

Provider Focus: Ambulatory / Outpatient CDI - Ochsner Health and Clinical Documentation Excellence

  • Bridge the educational gap between primary care and specialty provider risk adjustment comprehension and awareness   
  • Understand the point of care tools and alerts Ochsner uses to engage clinicians   
  • Learn the critical data components that Ochsner monitors and provides via our CDE Dashboards to measure success   

Cale Browning, Director, CDE Performance Management 
Ochsner Health Network 

Dr. Eirinn Erny, M.D., VP / Medical Director – Clinical Documentation Excellence
Ochsner Health Network

Dr. Randy Englert, M.D., FACC, Section Head – Consultative Cardiology / CDE Cardiology MD Lead
Ochsner Health Network

12:45 PM 1:30 PM

11:45 AM 12:30 PM

10:45 AM 11:30 AM

9:45 AM 10:30 AM

Track 5: Future of Health Care

Future of Health Care: Leveraging Interoperability to Empower a HUMAN Centric Data Strategy 

  • Gain insights on benefits for providers and payers that foster data sharing  
  • Hear data strategies that enable whole-person care delivery by integrating clinical and administrative data 
  • Learn ways to leverage technologies to improve member, provider, and employee experience  
  • Discuss ways to unearth hidden data talent 

Kathleen Aller, Director of Market Strategy, Healthcare 
InterSystems 

Autumne Smith, Manager, Information Governance and Data Integration
Payor Innovations Division  
Blue Cross BlueShield of South Carolina 

12:45 PM 1:30 PM

11:45 AM 12:30 PM

10:45 AM 11:30 AM

9:45 AM 10:30 AM

RISE Innovation Theater

Innovation Theater: Developing a Collaborative Internal Innovations Program

  • Discuss the application and effect of collaboration between Clinical Engineering and Innovations in the successful development of solutions to problems presented by clinical, administrative and technical staff 
  • Gain insight into how an organization can democratize innovation across the health system 
  • Ensure innovation is not only approachable for all but can be executed  
  • Understanding how to measure the impact of innovation across an organization. 

Casey Granack, Innovations 
WakeMed Health and Hospitals 

Ben Reed, Clinical Engineering 
WakeMed Health and Hospitals 

1:30 PM 2:30 PM

12:30 PM 1:30 PM

11:30 AM 12:30 PM

10:30 AM 11:30 AM

Networking Lunch in Exhibit Hall

Concurrent Sessions 2:30 PM - 3:15 PM 1:30 PM - 2:15 PM 12:30 PM - 1:15 PM 11:30 AM - 12:15 PM

Track Chairs:
Track 1: Risk Adjustment Strategies - Gregory LeGrow, Executive Director Payer Product Strategy - athenahealth 
Track 2: Integrating Silos - Emma Martin, Chief of Staff - Nymbl Science
Track 3: Social Determinants of Health
Track 4: Provider Focus - Michael Keyes, VP Health Plan Sales - PointClickCare
Track 5: Future of Healthcare- Austin Weaver, VP, Medicare - Hinge Health
RISE Innovation Theater: Jessica Muratore, Chief Operating Officer - Rex Wallace Consulting, LLC

Track Chairs:

2:30 PM 3:15 PM

1:30 PM 2:15 PM

12:30 PM 1:15 PM

11:30 AM 12:15 PM

Track 1: Risk Adjustment Strategies

Risk Adjustment Strategies: How to Operationalize a Risk Adjustment Program for Leadership

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

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

Laura Sheriff, RN, MSN, 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  

2:30 PM 3:15 PM

1:30 PM 2:15 PM

12:30 PM 1:15 PM

11:30 AM 12:15 PM

Track 2: Integrating Silos

Integrating Silos: Collaboration is Key: The Importance of Cross-System Partnerships to Resolve SDOH

  • Delve into the intersection of business care and the human case for resolving social determinants of health through collaborations between community-based organizations and healthcare entities 
  • Understand the business case for using collaboration between community-based organizations and healthcare entities to resolve SDOH 
  • Gain actionable quantitative and qualitative data on collaborations and their impact.   
  • Apply learned knowledge to expand partnerships between community-based organizations and healthcare entities to resolve SDOH. 

 

Holly Howat, Founder and Executive Director 
Beacon Community Connections 

Cian Robinson, Fractional Business Development Officer 
Robinson Ventures and Beacon Community Connections 

2:30 PM 3:15 PM

1:30 PM 2:15 PM

12:30 PM 1:15 PM

11:30 AM 12:15 PM

Track 3: Social Determinants of Health

Social Determinants of Health: Reimagining Social Care Network Contracting Models to Address Member’s Health-Related Social Needs

  • Leveraging a network of evidence-and-community based services, health plans have an opportunity to positively impact the member experience and close quality gaps  
  • Understand how the Community Care Hub model addresses pain points experienced by health plans when previously working with community-based organizations   
  • Identify evidence-based services commonly available to older and disabled adults through networks of community-based organizations    
  • Learn about use cases of Hub services demonstrating impact on health plan members   

Marc Rosen, MPH, System Director, Community Impact and Partnerships 
CommonSpirit Health  

AJ Diamontopoulos, Integrated Heath Manager 
Denver Regional Council of Governments  

2:30 PM 3:15 PM

1:30 PM 2:15 PM

12:30 PM 1:15 PM

11:30 AM 12:15 PM

Track 4: Provider Focus

Provider Focus: Navigating Doctor-Payer Relationships in The Transition to Value-Based Care

While value-based care models aim to improve patient outcomes and control healthcare costs, some doctors may experience frustrations with the transition from traditional fee-for-service models.  

Common frustrations include: Financial Uncertainty, Data and Technology Challenges, Quality Metrics Overload, Risk of Penalties, Administrative Burden, Patient Compliance Challenges, Inadequate Risk Adjustment, and Transition Period Challenges. 

By addressing these concerns, payers can facilitate a smoother transition to value-based care models and foster a more positive relationship with healthcare providers. Collaboration, flexibility, and ongoing communication are key components of a successful transition to value-based care.  

In this session, a panel of doctors with expertise in the Value-Based Care arena will address the following objectives: 

  • Identify common frustrations of doctors when transitioning to value-based care delivery 
  • Provide perspectives from doctors while considering how their medical training and professional commitments influence these perspectives 
  • Discuss opportunities for payers to address frustrations and build relationships with doctors 

 

Moderator 
Laura Cooley, Ph.D., Editor-in-Chief 
Journal of Patient Experience 

Namita Seth Mohta, M.D., Executive Editor 
NEJM Catalyst Innovations in Care Delivery 

Prakash Jayakumar, M.D., Ph.D., Assistant Professor 
Department of Surgery and Perioperative Care 
Director, Clinical Research and Outcome Measurement 
Department of Surgery and Perioperative Care 

Jeffrey Gleason, MD, MBA, Physician Executive
Independent Consultant on Value-based Care 

2:30 PM 3:15 PM

1:30 PM 2:15 PM

12:30 PM 1:15 PM

11:30 AM 12:15 PM

Track 5: Future of Healthcare

Track 5: Future of Healthcare - Medicare Diabetes Prevention Program (MDPP)- What's the Advantage?

  • Learn about Medicare Diabetes Prevention program and outline Medicare Advantage engagement opportunities   
  • Discuss the data collected and analyzed from NACDD’s MDPP Enrollment Project  
  • Gain resources for Medicare Advantage Plans to learn more about providing the MDPP program and contracting with MDPP suppliers, including examples and sample contract language  
  • Hear opportunities for MA plans to address health-related social needs of their members   

Jennifer Barnhart, Public Health Consultant 
National Association of Chronic Disease Directors (NACDD) 

Joanna DiBenedetto, Public Health Consultant 
National Association of Chronic Disease Directors (NACDD) 

2:30 PM 3:15 PM

1:30 PM 2:15 PM

12:30 PM 1:15 PM

11:30 AM 12:15 PM

RISE Innovation Theater

Innovation Theater: Using Relationship-Centered Communication to Coach my Team to Excellence

  • Address the importance of how relationship-centered communication can be used to improve team effectiveness 
  • The Academy of Communication framed the project in Healthcare’s relationship-centered communication to build coaching relationships through team communication training 
  • Introduce the Ask, Respond, Tell or ART of Communication model for delivering three skill sets to develop appreciative coaching skills 

Stacy Cooper, Manager of Quality Improvement- Experience 
BAYLOR Scott and White Health 

3:15 PM 3:55 PM

2:15 PM 2:55 PM

1:15 PM 1:55 PM

12:15 PM 12:55 PM

Health Care Trends and Readiness Strategies to Succeed in 2024 

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 2024.   

Moderator:
Vandna Bhrany, Vice President, HEDIS Strategy & Analytics 
 
AmeriHealth Caritas   

Dr. Shannon Decker, Principal   
VBC One  

Mikal L. Sutton, Managing Director, Medicaid  
Blue Cross Blue Shield Association   

Liz Haynes MSN, RN, CCM, DVP, Risk Adjustment & Stars Government Programs 
Blue Cross and Blue Shield of Kansas City 

Mark Wiacek, Founder / Consultant 
Vihara Health 

3:55 PM 4:00 PM

2:55 PM 3:00 PM

1:55 PM 2:00 PM

12:55 PM 1:00 PM

Closing Remarks

Conference Chairs: 
Nikki Hungate MS, MHA 
Health Plan Product Strategy Expert 

Kaleb Holt, Medicare Program Director 
SelectHealth  

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