Agenda | RISE National 2025

Rise

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2025 Schedule

We are thrilled to announce that RISE National 2025 is being extended by an extra day to accommodate even more essential content, regulatory updates, networking opportunities, and after-hours fun! You’ll have even more time to deep dive into sessions and workshops, connect with industry leaders, exchange ideas with Medicare Advantage peers, and explore innovative solutions in the exhibit hall. Don’t miss out on this expanded opportunity to maximize both your learning and networking experiences to make meaningful change in health care! 

Tuesday - March 11

11:00 AM 12:00 PM

10:00 AM 11:00 AM

9:00 AM 10:00 AM

8:00 AM 9:00 AM

Workshop Registration

12:00 PM 6:00 PM

11:00 AM 5:00 PM

10:00 AM 4:00 PM

9:00 AM 3:00 PM

Pre-Conference Workshop A: Risk Adjustment Practitioner

Please note: This workshop requires additional registration. 

  • The essentials of and differences between Medicare Advantage, Commercial and Medicaid risk adjustment   
  • Understanding how risk scores are calculated 
  • Understanding the different payment models, and how plans are paid 
  • Provider engagement strategies that will impact your risk adjustment initiatives 
  • Member engagement and SDOH 
  • Risk adjustment vendor selection and management 
  • Strategies for ongoing, thorough vendor management 
  • Initial steps for preparing for a RADV 
  • Which staff is essential to oversee your RADV audit prep? 
  • Staying ahead – key items to monitor well in advance of an actual audit 
  • The future of risk adjustment – what you need to know to stay ahead of changes 

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

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

 

There will be the letter A on your badge if you are registered for this program. Two refreshment breaks and lunch is included.

12:00 PM 6:00 PM

11:00 AM 5:00 PM

10:00 AM 4:00 PM

9:00 AM 3:00 PM

Pre-Conference Workshop B: Advanced HCC Auditor

Please note: This workshop requires additional registration. 

With the switch from V24 to V28 and unprecedented scrutiny on the work we do in Risk Adjustment now is the time to consider attending our always popular HCC Coding for Accuracy workshop!   

If you are responsible for the coding, auditing, analytics, or financials of your program you can’t miss this discussion!  Join us for an introduction to best practices, the opportunity to work through case examples, and to share experiences with your peers. This workshop will zero-in on regulatory compliance while teaching you how to optimize the accuracy of the information gathered and submitted at the practice level. You will also learn about the way charting is often done, how to overcome “disconnect” with the clinicians and how their typical charting practices and EMRs can create significant problems, and how RADV views documentation in contrast with the way clinicians were taught and EMRs were built initially. 

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

You will learn the answers to:  

  • How will the transition to V28 impact your organization?  We will provide an overview of the financial overlay – HCC codes mapping to risk adjustment scores  
  • Why is Clinical Documentation Integrity more important than ever?   Join us to discuss A single coding and documentation process for Risk adjustment  
  • How challenging is accurate coding?  You will have the opportunity to review real life examples of accurately coding from various portions of the encounter. 
  • Why are providers burning out?  Learn about the clinical documentation barriers clinicians and practices face.   

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

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP    
Director Risk Capture – Population Health 
 
Mass General Brigham   

There will be the letter B on your badge if you are registered for this program. Two refreshment breaks and lunch is included.

Wednesday - March 12

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

10:00 AM 6:00 PM

9:00 AM 5:00 PM

8:00 AM 4:00 PM

7:00 AM 3:00 PM

Main Conference Registration

10:00 AM 1:00 PM

9:00 AM 12:00 PM

8:00 AM 11:00 AM

7:00 AM 10:00 AM

Pre-Conference Workshop C: 2025 Government Program Legal and Compliance Deep Dive – How to Navigate the Wave of Enforcement While Still Trying to Manage a Population and Stay Sane

Please note: This workshop requires additional registration. 

  • Educate attendees on issue spotting key risk areas and takeaways based on developing cases and agency audits; 
  • Discussion of the hard questions related to auditing, monitoring, and overpayments; 
  • The promise and pitfalls of AI as it relates to enforcement risk 
  • Discuss emerging enforcement areas such as prior authorizations, network (in) adequacy and UM 
  • Discuss impacts to value-based contracting, risk adjustment operations (both at the health plan and medical group level), and incentive programs/pay for performance 
  • Weighing enforcement and oversight risks as they relate to:  
  • Physician organizations, VS. Health plans, who does what in 2025 and beyond? 
  • Insourcing versus outsourcing key revenue and EDI functions 

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

There will be the letter C on your badge if you are registered for this program. Registration for this workshop includes a refreshment break.

10:00 AM 1:00 PM

9:00 AM 12:00 PM

8:00 AM 11:00 AM

7:00 AM 10:00 AM

Pre-Conference Workshop D: Value Based Care Operational Excellence Workshop

Please note: This workshop requires additional registration.

Designed for both health plan operations and risk bearing provider groups--both MA and ACO. During this workshop, we will discuss these key areas:  

Risk 

  • Basics 
  • Programmatics (e.g., prospective, concurrent, retrospective reviews; internal coding team management; home assessment programs) 
  • Oversight 

Quality 

  • Basics 
  • Programmatics (E.g., member communication programs/incentives, health fairs) 
  • Oversight 

Total Cost of Care 

  • Basics 
  • Programmatics (e.g., hospital contracting--inpatient vs observation, ASC procedures, partnering with specialists, ER UC Campaigns, Hospital at Home)  
  • Oversight  

Analytics & Reporting 

  • Operational monitoring for management 
  • Interdepartmental Collaboration--who to work with, how often to communicate 
  • Community Partnerships--how to evaluate, who to select, implementation guidance 

Contract Evaluation 

  • What's in it, how to prioritize, etc. 
  • Financial implication of the components above and how to monitor throughout the year 

Dr. Shannon Decker, Principal    
VBC One   

Gaby Alcalá , Founder and CEO  
MAPA HealthCare  

 

There will be the letter D on your badge if you are registered for this program. Registration for this workshop includes a refreshment break.

10:00 AM 1:00 PM

9:00 AM 12:00 PM

8:00 AM 11:00 AM

7:00 AM 10:00 AM

Pre-Conference Workshop E: How to Operationalize a Risk Adjustment Program for Leadership 

Please note: This workshop requires additional registration.

How to Operationalize a Risk Adjustment Program for Leadership 

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

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

 

Laura Sheriff, RN, MSN, CPC, CRC 
Healthcare Expert 

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

 

There will be the letter E on your badge if you are registered for this program. Registration for this workshop includes a refreshment break.

2:00 PM 2:10 PM

1:00 PM 1:10 PM

12:00 PM 12:10 PM

11:00 AM 11:10 AM

Main Conference Kicks Off with Opening Remarks

Ellen Wofford, Founder & CEO 
RISE 

Conference Chairs: 

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

2:10 PM 3:00 PM

1:10 PM 2:00 PM

12:10 PM 1:00 PM

11:10 AM 12:00 PM

General Session

3:00 PM 3:30 PM

2:00 PM 2:30 PM

1:00 PM 1:30 PM

12:00 PM 12:30 PM

Networking Break

Concurrent Sessions 3:30 PM - 4:15 PM 2:30 PM - 3:15 PM 1:30 PM - 2:15 PM 12:30 PM - 1:15 PM
Track Chairs:

3:30 PM 4:15 PM

2:30 PM 3:15 PM

1:30 PM 2:15 PM

12:30 PM 1:15 PM

Track 1: Risk Adjustment Strategies

Autonomous Coding: Enhancing Risk Adjustment Processes and Optimizing Accuracy in Health Care

  • Explore how autonomous coding systems leverage advanced algorithms, natural language processing (NLP), and machine learning to automatically assign standardized codes to medical diagnoses and procedures, reducing the need for manual intervention 
  • Outline the strategic approach to planning and implementing autonomous coding systems, focusing on key milestones, integration timelines, and the importance of aligning technology with existing healthcare workflows 
  • Discuss the significant improvements in coding accuracy brought about by autonomous coding, highlighting the reduction in errors, faster processing times, and the overall impact on the efficiency and quality of chart reviews 

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

Dr. Shannon Decker, Principal    
VBC One   

3:30 PM 4:15 PM

2:30 PM 3:15 PM

1:30 PM 2:15 PM

12:30 PM 1:15 PM

Track 2: Integrating Silos

Achieving Proactive Gap Closure with Emergent Technology  

  • Learn how new prospective risk adjustment solutions help health plans and providers improve coding and documentation 

  • Understand the financial and operational benefits of closing risk gaps concurrently with claims processing for Medicaid populations 

  • Gain business and actuarial insights into the available opportunities for market expansion 

Chris Lance, Chief Product Officer 
Edifecs 

Brian Murtha, Director of Risk Adjustment Digital Strategy 
Centene 

Jennifer Holman, Director of Risk Adjustment Programs 
Centene 

3:30 PM 4:15 PM

2:30 PM 3:15 PM

1:30 PM 2:15 PM

12:30 PM 1:15 PM

Track 3: Quality and Member Experience

RISE to the Challenge: Community-Driven Solutions for Health Equity in Medicare Advantage

This panel discussion will delve into the complex issues of trust, cultural humility, and Black infant mortality. Within the context of Medicare Advantage, panelists will explore how community-centered design, philanthropic investment, and patient-centric care can create meaningful change. 

  • Community-Centered Design: We'll explore how community-based organizations and residents can be empowered to shape healthcare solutions that address the unique needs and challenges facing Black families 
  • Addressing Social Determinants of Health: The panel will discuss how factors beyond healthcare access, such as housing, education, and economic stability, contribute to Black infant mortality and how Medicare Advantage plans can leverage their resources to address these issues 
  • Philanthropic Investments: The panel will examine how philanthropic dollars can be strategically deployed to support community-driven initiatives focused on reducing Black infant mortality 
  • Patient Experience: We'll highlight the importance of culturally competent care and personalized approaches to ensure minoritized families feel heard, understood, and empowered within the healthcare system 

 
Expected Outcomes: 

  • Gain a deeper understanding of the complex factors that improve awareness and access and contribute to Black infant mortality 
  • Learn how Medicare Advantage plans can partner with communities to develop and implement impactful solutions 
  • The discussion will inspire collaboration and action among stakeholders to address this critical health equity issue 
  • Cultivate trust and cultural humility within their work, leading to improved health outcomes for minoritized communities 

Moderator  

Veronica Villalobos, JD, VP DEI Strategy, Enterprise Equitable Health Institute 
Highmark Health/ Allegheny Health Network  

Dr. Margaret Larkins-Pettigrew, Senior Vice President and Enterprise Chief Diversity, Equity and Inclusion Officer, Enterprise Equitable  
Health Institute for Highmark Health / Allegheny Health Network 
Dean for Obstetrics and Gynecology  
Drexel School of Medicine 

Kenya Boswell, SVP Community Affairs, Corporate Affairs 
Highmark Health 

Dr. Eugene Scioscia, Chief Patient Experience Officer, Obstetrics and Gynecology 
Allegheny Health Network 

3:30 PM 4:15 PM

2:30 PM 3:15 PM

1:30 PM 2:15 PM

12:30 PM 1:15 PM

Track 4: 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 

Arati Swadi, MBA, Vice President of Product 
Optum 

3:30 PM 4:15 PM

2:30 PM 3:15 PM

1:30 PM 2:15 PM

12:30 PM 1:15 PM

Track 5: Technology/Data Analytics

Tech/ Data Analytics: Shaping the Future of Value Based Care – Key Trends and Advancements 

  • Trusted AI: Harness technology for better productivity with generative AI, ML, and advanced data analytics means organizations understand how to evaluate vendors to ensure transparency and compliance  

  • Unified VBC Platform: Leverage a unified platform for holistic views of patient conditions to enable better decision-making, more accurate risk stratification and meet quality benchmarks more consistently  

  • Changing Care Models: VBC models are changing fast. Understand how to adapt to new value-based care reimbursement models (V24 to V28)  

 

Paul Burke, Chief Product Officer 
Reveleer 

4:25 PM 5:25 PM

3:25 PM 4:25 PM

2:25 PM 3:25 PM

1:25 PM 2:25 PM

Opening Keynote Address: Purpose. Performance. Impact.

Sponsored by 

Justin will take you through an exploration of the power of service, the profound difference we can make in the lives of others, and the ripple effect that extends far beyond what we can imagine – including the transformation that occurs within ourselves when we choose to live purposefully and serve selflessly. He also unravels the secrets of the overcomer’s mindset, the unyielding spirit that separates the victors from the defeated. You will learn how to transform pain into fuel, setbacks into comebacks, and doubts into unwavering belief—in order to overcome obstacles and win this fight called life.  


Justin Wren
 
Elite UFC/MMA Fighter turned Global Humanitarian and Founder of Fight for The Forgotten 

Learn More 

5:30 PM 7:30 PM

4:30 PM 6:30 PM

3:30 PM 5:30 PM

2:30 PM 4:30 PM

Exhibit Hall Open

5:30 PM 7:30 PM

4:30 PM 6:30 PM

3:30 PM 5:30 PM

2:30 PM 4:30 PM

Welcome Cocktail Reception in the Exhibit Hall

Let's kick off the mega Medicare Advantage event of the year in style! All attendees are invited to join us in the exhibit hall for drinks, hors d'oeuvres, and some lively networking. Come mingle, connect, and enjoy a fun evening with fellow attendees!

Thursday - March 13

9:00 AM 7:00 PM

8:00 AM 6:00 PM

7:00 AM 5:00 PM

6:00 AM 4:00 PM

Registration Desk Open

9:00 AM 7:00 PM

8:00 AM 6:00 PM

7:00 AM 5:00 PM

6:00 AM 4:00 PM

Exhibit Hall Open

9:00 AM 10:00 AM

8:00 AM 9:00 AM

7:00 AM 8:00 AM

6:00 AM 7:00 AM

Networking Breakfast in Exhibit Hall

10:00 AM 10:10 AM

9:00 AM 9:10 AM

8:00 AM 8:10 AM

7:00 AM 7:10 AM

Opening Remarks

Ellen Wofford, Founder & CEO
RISE 

Conference Chairs: 

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

10:10 AM 11:00 AM

9:10 AM 10:00 AM

8:10 AM 9:00 AM

7:10 AM 8:00 AM

General Session

Ann Maxwell Deputy  
Inspector General for Evaluation and Inspections Office of Evaluation and Inspections 
Department of Health and Human Services 
Office of Inspector General (OIG) 

Ann Maxwell, the Deputy Inspector General for Evaluation and Inspections in the Department of Health and Human Services (HHS) Office of Inspector General (OIG), will share her vision for cultivating trust in Medicare Advantage. The Deputy Inspector General will demonstrate the OIG’s commitment to ensuring that the Medicare Advantage program delivers cost-effective, high-quality care for the millions of enrollees who rely on it by focusing on the future of the Medicare Advantage program and what steps plans can take now to ensure managed care lives up to its potential.  The Deputy Inspector General will emphasize how plans and others can build trust and elevate integrity through compliance, including how plans can use OIG’s oversight and program integrity tools to focus on key gaps where managed care has tremendous opportunities to earn trust and reduce risk.

11:00 AM 11:45 AM

10:00 AM 10:45 AM

9:00 AM 9:45 AM

8:00 AM 8:45 AM

General Session

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:

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

Enhancing Payer-Provider Collaboration Through Prospective Risk Adjustment

  • Evaluate and close diagnosis gaps collaboratively across structured and unstructured data 
  • Access complete patient health profiles together to identify diagnosis gaps 
  • Integrate clinical insights directly into EHR workflows to improve care coordination 

  • Streamline workflows to ensure accurate diagnosis capture and documentation before claims submission 

Presented by Apixio  

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

Track 2: Integrating Silos

To Be Announced

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

Relentless Pursuit of Excellence: Transforming the Member Experience to Achieve the Triple Aim 

  • Implementing Proven Best Practices: Leveraging effective approaches to manage costs while advancing population health, early detection, and preventative care 
  • Proactive Engagement: Engaging members in their preferred modality with personalized interventions to enhance member experience and address Social Determinants of Health 
  • Risk Adjustment Integration: Aligning risk adjustment with quality improvement and SDoH gap closure efforts 

 

John Criswell, Founder, CEO, Chairman  
Porter  

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

Track 4: Hot Topic

Healthcare Strong: Building Resilience with Digital Health Platforms

  • Staff shortages, rising costs, and changing regulations are putting pressure on the healthcare system and creating an urgent need for better data architecture 
  • Learn what a Digital Health Platform is and how it allows the creation of intellectual property to drive rapid innovation and transform care delivery 
  • Hear how organizations leverage digital health platforms to create value and improve efficiency, care, and outcomes by implementing custom care pathways and clinical and administrative workflows in days rather than in months 

Dr.Mansoor Khan, CEO  
Persivia  

Dr. Fauzia Khan, CMO  
Persivia 

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

Track 5: Future of Health Care

Autonomous Risk-Adjustment Coding: The Next Frontier for Completeness, Accuracy, & Speed

  • Understand the latest developments in risk-adjustment coding technology, from yesterday's NLP to today's deep-learning AI 
  • Assess opportunities to increase completeness, specificity, and accuracy to find missing HCCs and advance coding integrity 
  • Measure the operational impact of deep-learning AI for RA coding, based on real case studies 

Andrew Lockhart, CEO 
Fathom 

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

RISE Innovation Theater

Research Findings: A Study of the Interactions Between Clinicians and Patients Since the Pandemic

This phenomenological study gets at the essence of our motivations.  You will walk away with a better understanding how to engage with key stakeholders, particularly those that have experienced COVID and in the wake of all these regulatory changes.   

Leave with insights and strategies to yield better engagement and better performance in light of "cuts" imposed by greater restrictions on risk, quality, and other key areas 

Dr. Shannon Decker, Principal    
VBC One   

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

9:15 AM 10:00 AM

RISE Regulatory Compliance Theater

Anatomy of a Whistleblower Case: Examining a Successful False Claims Act

from initial sealed whistleblower complaint alleging risk adjustment fraud to DOJ investigation, intervention and ultimate settlement  

Many of the biggest Medicare Advantage insurers face False Claims Act lawsuits accusing them of risk adjustment fraud. Most of those lawsuits were initiated by whistleblowers who were current or former employees of the plans.  

Follow along with whistleblower Teresa Ross, a former Director of Risk Adjustment at Group Health Cooperative (GHC) and her whistleblower counsel as they take you through the story of Ross’s successful whistleblower lawsuit against health insurers GHC and Independent Health for alleged risk adjustment fraud.  

Learn about the risks posed to GHC and Independent Health by their use of the same risk adjustment coding vendor.  Hear about the types of evidence uncovered in the whistleblower’s and DOJ’s joint investigation that led to successful settlements with both insurers.     

Attendees will leave this session with:   

  • An understanding of the mechanics of a False Claims Act case launched by a whistleblower including the dynamics between the whistleblower and DOJ in jointly investigating and prosecuting cases of alleged risk adjustment fraud.  
  • An appreciation for the different types of practices DOJ has found to constitute risk adjustment fraud when engaged in by health plans and their vendors.    
  • An understanding of how to create an environment in which whistleblowers feel safe to raise their concerns internally and have them remedied in a way that eliminates the need for a whistleblower to go external and raise concerns with the Government by filing a False Claims Act complaint in federal court.   

Teresa Ross 
Whistleblower 

Mary A. Inman, Partner 
Whistleblower Partners LLP 

Max Voldman, Partner 
Whistleblower Partners LLP 

1:00 PM 1:55 PM

12:00 PM 12:55 PM

11:00 AM 11:55 AM

10:00 AM 10:55 AM

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:

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

Unlocking Better Access to Care: How Prospective Risk Adjustment Can Make a Difference

  • Learn how HCC suspecting and targeting analytics inherently identifies and prioritizes at-risk members facing access challenges 
  • Hear how in-home assessments and telehealth programs can support members without consistent access to care to determine the current state of their conditions and to promote continuity of care 
  • See how prospective risk adjustment can both fund the collection of SDOH data and establish connections with community-based organizations, while simultaneously generating additional revenue for your organization 

Jimmy Liu, VP, Analytics and MRR Solutions  
Advantmed  

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

Track 2: Integrating Silos

To Be Announced

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

From Data Mining to Decision-Making: Utilizing Member Data to Uncover Risks and Enhance Health Outcomes

  • Learn how member data can be leveraged as a powerful predictive tool for critical health outcomes 
  • Discuss the current gaps between data collection and actionable insights for physical and behavioral health outcomes 
  • Explore emerging technologies and methodologies for enhancing data analysis 

Cory Busse, VP, Strategy & Sales Enablement 
Icario  

Robert Garnett, Vice President, Government Analytics and Health Benefits Cost of Care 
Elevance Health 

Barb Nelson, Director of Clinical Services Optimization 
Medica Health Plans

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

Track 4: Hot Topic

Stars and Savings: A Playbook for Medicare Advantage Success

  • Cutting Costs and Reducing MLR: Learn proven methods and untapped categories to unlock cost savings opportunities and lower your MLR 
  • Case Studies and Best Practices: Hear from industry leaders about successful adaptations to previous CMS changes, providing a roadmap for navigating the current landscape 
  • Future-Proofing Your Plan: Explore forward-thinking strategies to ensure your Medicare Advantage plan remains competitive and compliant in an evolving regulatory environment 
  •  

Dr. Edward Likovich, CEO 
Nymbl 

Lori Rund, VP Government Programs  
Blue KC 

Dr. Robert Mirsky, Former CMO 
Aetna Medicare  

Charlotte Yeh, Former CMO 
AARP 

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

Track 5: Technology/Data Analytics

AI-Driven AgeTech: Transforming Health Care for Independent Aging

  • Discover the latest AgeTech innovations that enable older adults to live independently and thrive in their golden years 
  • Explore cutting-edge advancements in digital health management and AI-driven care that are redefining the health care landscape 
  • Understand how AI technologies like GenAI and Retrieval-Augmented Generation (RAG) can enhance member engagement, reduce costs, and optimize health care operations 
  • Gain insights into AI-powered solutions, such as contact centers and smart chatbots, that are reshaping the aging experience and empowering older adults to live independently 

Presented by Duos 

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

RISE Innovation Theater

Lessons in Building a Compliant Risk Adjustment Program

In order to take advantage of Shared Savings opportunities, AdventHealth needed to undergo a practice transformation from a Fee for Service to Model to providing value-based care.   

Part of this transformation included educating clinicians on proper Coding Documentation Integrity.     

  • Hear about one Health System’s transformational journey in building a compliant Risk Adjustment team, with learnings on internal buy in, provider education and operational processes   
  • Gain insights into overcoming barriers and coming out on the other side of success, with focus on good people, strong policies and procedures, and technology          
  • Discuss what’s worked in provider education and engagement, including incentives, relationship building and tapping into provider mentors    

Michael Zeli, Executive Director of Clinical Documentation Integrity PHSO
AdventHealth

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

RISE Regulatory Compliance Theater

To Be Announced

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:

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

Bridging Gaps in Care: In-Home Health Evaluation Visits for Preventive Care

  • Understand how an in-home health evaluation visit with your members can be a catalyst for preventive, appropriate, and equitable care 
  • See how results collected are made actionable by members, providers, and health plans helping to facilitate disease management, care coordination, and case management referrals 
  • Hear how in-home health evaluation visits lead to diagnosis, early intervention and treatment 

Debbie Conboy, SVP, Risk Adjustment 
Signify Health 

Heidi Schwarzwald, MD, MPH, CMO, Home & Community Services 
Signify Health 

3:15 PM 4:00 PM

2:15 PM 3:00 PM

1:15 PM 2:00 PM

12:15 PM 1:00 PM

Track 4: Payer/Provider Strategic Alignment

Acing Value-Based Care with Point of Care Alerts and Automated Supplemental Data Feeds

  • Improving star ratings in the challenging environment by enabling proactive care gap closure and prospective risk stratification 
  • Leverage standard FHIR Implementation guides to scale bi-directional data exchange for improving delivery of patient care and member satisfaction 
  • Learn from payers and providers experiences how access to accurate and timely data has helped reduce burden, improve compliance & achieve better outcomes 

Presented by Healow Insights  

3:15 PM 4:00 PM

2:15 PM 3:00 PM

1:15 PM 2:00 PM

12:15 PM 1:00 PM

Track 5: Hot Topic

Maximizing Compliant Yield in Times of Premium Pressure and Increased Regulatory Scrutiny

  • Understand how various regulatory changes are impacting risk adjustment programs 
  • See how incorporating primary care physicians in risk adjustment programs can drive superior financial and clinical results  
  • Learn about a new, PCP-centric home assessment model that results in more compliant RAF yield and better patient outcomes  

Presented by Vatica health 

3:15 PM 4:00 PM

2:15 PM 3:00 PM

1:15 PM 2:00 PM

12:15 PM 1:00 PM

RISE Innovation Theater

Integrating AI with ERM to Optimize Risk

Building an Enterprise Risk Management model can be difficult; building one that effectively integrates AI is even more so. Designing an ERM risk taxonomy that identifies and defines the larger AI risk profile enables strong governance to have line of sight into potential risks. Risk leaders that optimize ERM design principles create clear classification models for tracking AI risks, resulting in high leadership/board engagement and strong mission alignment. In a world of increasing vulnerability to cyber and operational risk emerging from AI, effective ERM practices can eliminate excessive complexity and nuance, and instead, provides purposeful direction and improved comprehension to assist building out an organization's AI risk profile. This session will examine effective strategies on how to optimize building AI into an ERM model to enhance risk identification, monitoring, and mitigation efforts. 

 

Amir St. Clair, Vice President, Enterprise Risk Management 
Advocate Health 

3:15 PM 4:00 PM

2:15 PM 3:00 PM

1:15 PM 2:00 PM

12:15 PM 1:00 PM

RISE Regulatory Compliance Theater

Ensuring Payment Integrity in Your Risk Adjustment Program

Risk adjustment has changed.  In today’s landscape it is crucial to protect your organization from over coding and regulatory audits.  Join us for this interactive session as we discuss ensuring payment integrity from various angles including: 

  • EMRs  
  • Vendor solutions 
  • Vigorous education and audit programs  

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

Concurrent Sessions 4:10 PM - 4:55 PM 3:10 PM - 3:55 PM 2:10 PM - 2:55 PM 1:10 PM - 1:55 PM
Track Chairs:

4:10 PM 4:55 PM

3:10 PM 3:55 PM

2:10 PM 2:55 PM

1:10 PM 1:55 PM

RISE Innovation Theater

Coding Accuracy at Its Highest Level

Let's take a deep dive into coding practices to ensure accuracy of data to avoid CMS fines. We will discuss:  

  • Coding specificity   
  • How to avoid common coding errors and/or omissions  
  • Effective documentation guidelines 

Deb Curry, MBA, RHIA, CCS-P, CRC, Risk Adjustment Programs Director 
Medical Mutual 

5:05 PM 6:05 PM

4:05 PM 5:05 PM

3:05 PM 4:05 PM

2:05 PM 3:05 PM

Interactive Roundtables in the Exhibit Hall

Grab a seat and get ready for a unique opportunity to engage in three dynamic, speed-networking-style presentations. Each session will feature cutting-edge technologies and solutions designed to enhance your plan’s risk, quality, and data management efforts. Throughout this special 60-minute session, a bell will ring three times, signaling the transition to the next roundtable of your choice. Don’t miss out on this fast-paced, interactive experience!

Participate in 4 roundtables between Thursday and Friday’s roundtable sessions and be entered into a drawing; 100 participants will receive complimentary Maui Jim sunglasses!

6:05 PM 7:00 PM

5:05 PM 6:00 PM

4:05 PM 5:00 PM

3:05 PM 4:00 PM

Networking Cocktail Reception in the Exhibit Hall

All attendees are invited to join us in the exhibit hall for drinks, hors d'oeuvres, and some lively networking. Come mingle, connect, and enjoy a fun evening with fellow attendees!

Friday - March 14

8:30 AM 12:30 PM

7:30 AM 11:30 AM

6:30 AM 10:30 AM

5:30 AM 9:30 AM

Registration Desk Open

8:30 AM 11:50 AM

7:30 AM 10:50 AM

6:30 AM 9:50 AM

5:30 AM 8:50 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

Grab a seat and get ready for a unique opportunity to engage in three dynamic, speed-networking-style presentations. Each session will feature cutting-edge technologies and solutions designed to enhance your plan’s risk, quality, and data management efforts. Throughout this special 60-minute session, a bell will ring three times, signaling the transition to the next roundtable of your choice. Don’t miss out on this fast-paced, interactive experience!

Participate in 4 roundtables between Thursday and Friday’s roundtable sessions and be entered into a drawing; 100 participants will receive complimentary Maui Jim sunglasses!

10:00 AM 10:05 AM

9:00 AM 9:05 AM

8:00 AM 8:05 AM

7:00 AM 7:05 AM

Day Two Welcome Remarks and Day One Takeaways

Conference Chairs: 

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

10:05 AM 10:20 AM

9:05 AM 9:20 AM

8:05 AM 8:20 AM

7:05 AM 7:20 AM

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 here.

10:20 AM 11:20 AM

9:20 AM 10:20 AM

8:20 AM 9:20 AM

7:20 AM 8:20 AM

How AI Will Revolutionize Elder Care: Addressing the Aging Population's Unique Challenges with Artificial Intelligence and Compassion

As the global population ages, healthcare systems are facing unprecedented challenges in providing quality care to older adults. In particular, the rapid growth of artificial intelligence, the need for data-driven and cost-controlled care, and the need for personalized medicine all make Elder Care particularly unique.  

Dr. Sikka will explore how artificial intelligence is transforming elder care, enhancing diagnosis, treatment, and personalized care through predictive analytics, remote monitoring, and smart technology integration, and can meet patients halfway. By addressing issues such as chronic disease management, mobility, and cognitive decline, AI can empower healthcare professionals to offer more efficient, accessible, and patient-centered care to the aging population. This talk will highlight the latest innovations, real-world applications, and future trends in AI-driven solutions for senior health.  

Robby Sikka, MD 
NBA Physician & Technology Innovator
Former Senior Consultant at Tonal, Oura Ring, Pacaso & Other Tech Unicorns
Former Associate Director of Data Analytics at the Mayo Clinic
 

Learn More 

11:20 AM 11:50 AM

10:20 AM 10:50 AM

9:20 AM 9:50 AM

8:20 AM 8:50 AM

Networking Break in the Exhibit Hall

Concurrent Sessions 11:50 AM - 12:35 PM 10:50 AM - 11:35 AM 9:50 AM - 10:35 AM 8:50 AM - 9:35 AM
Track Chairs:

11:50 AM 12:35 PM

10:50 AM 11:35 AM

9:50 AM 10:35 AM

8:50 AM 9:35 AM

Track 2: Integrating Silos

A Documentation Journey

This session walks through the foundation of value-based care and the importance of accurate documentation, including: 

  • Impact on patient complexity 
  • Impact on quality metrics 
  • Impact on appropriate resources and programs 
  • Impact on the patient  
  • Utilization and cost trends  

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP   
Director Risk Capture – Population Health 
Mass General Brigham   

11:50 AM 12:35 PM

10:50 AM 11:35 AM

9:50 AM 10:35 AM

8:50 AM 9:35 AM

Track 3: Hot Topics

The Changing Landscape of The Pharmacy Under IRA, From a Health Plan Perspective

  • Describe the final rules and how this will impact the overall pharmacy    
  • How to implement the programs and anticipate the impact of the changes     
  • How to anticipate and continue identifying opportunities for growth and cost savings 

Helen Liu, Pharm.D.
Health Plan Leader/ Senior Consultant

11:50 AM 12:35 PM

10:50 AM 11:35 AM

9:50 AM 10:35 AM

8:50 AM 9:35 AM

Track 4: Provider Focus

Don't Box Me In: A Lesson in Saving a Life

  • Health maintenance must be a focus of our patient care 
  • Some causes for why patients avoid seeing providers 
  • How focusing on health maintenance can save lives and allow patients to live healthier, longer lives 

Donna Furlong, RN Clinical Services Senior Director 
Banner Medical Group 

11:50 AM 12:35 PM

10:50 AM 11:35 AM

9:50 AM 10:35 AM

8:50 AM 9:35 AM

Track 5: Future of Health Care

Advancing Patient Engagement in Medicare Advantage: Defining, Operationalizing, and Measuring Impact

  • Define patient engagement and recognize its potential to improve member outcomes and experience in Medicare Advantage programs. 
  • Identify effective strategies to operationalize patient engagement across all phases of member journey, with a focus on scalability and inclusivity. 
  • Learn how to measure the impact of patient engagement on healthcare outcomes, and how to leverage  

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

Rachel Biblow, Associate Editor of Strategy, Innovation, and Outcomes 
Journal of Patient Experience 

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

11:50 AM 12:35 PM

10:50 AM 11:35 AM

9:50 AM 10:35 AM

8:50 AM 9:35 AM

Track 1: Quality and Member Experience

Making a Right Turn in The Intersection of Quality and Member Experience in a Dual eligible Environment

  • Learn how to enhance member experience and quality for dual eligible members 
  • Understand how to develop person centered, and equitable member experience initiatives through quality 
  • Learn best practices in Integrating accountability models into quality programs and initiatives to improve member satisfaction and experience 
  • Gain insights into how CalAIM is improving member outcomes by implementing Health Equity initiatives that are rooted in quality 

Kailey Collier, Director of Quality Performance 
Kern Health Systems 

Tina Dueringer, RN, BSN, CCM, PCC, CEO, Principal Advisor 
Dueringer Advisors, Inc  

12:40 PM 1:25 PM

11:40 AM 12:25 PM

10:40 AM 11:25 AM

9:40 AM 10:25 AM

Keynote Address

1:25 PM 1:30 PM

12:25 PM 12:30 PM

11:25 AM 11:30 AM

10:25 AM 10:30 AM

Closing Remarks & Goodbyes

This year, we’re wrapping up before lunch to give you ample time to travel home and start your weekend. Parting is such sweet sorrow!

Conference Chairs: 

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