AGENDA

RISE Nashville Summit brings you the most comprehensive agenda that truly epitomizes a dynamic learning event with eight tracks and over 40 sessions, topics addressing existing and emerging industry issues including risk revenue management, quality improvement, member engagement and care management, payer-provider collaboration, new technologies and advanced analytics, and policy updates. 

Sunday, March 17th

7:00 - 8:00
Workshop A & B Registration Opens
7:00 - 8:00
Networking Continental Breakfast

8:00 – 4:00

Workshop A: Foundation of Risk Adjustment

- 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 EDPS? The latest in a long journey
- Provider engagement strategies for impacting 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:
Nathan Cook, CCS-P, Supervisor, Risk Adjustment
Brown & Toland Physicians

Scott Weiner, CMA, CFM, MBA,
President, Quadralytics
Director of Risk Programs, Virginia Premier Health Plan

8:00 – 4:00

Workshop B: HCC Coding Accuracy

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 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 bring a laptop or a tablet, as well, for note-taking.

- 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
- Quality improvement
- Billing E&M CPT codes
- Risk adjustment vSkill 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:
Donna Malone, CPC, CRC, Senior Manager, Enterprise Risk Adjustment, HCC Coding and
Quality Assurance
TUFTS HEALTH PLAN

11:00 – 1:00
Workshop C, D & E Registration Opens

1:00 – 4:00

Workshop C: Active Intelligence: Breakthrough Technologies Revolutionizing Risk, Quality, and Related Analytics for Value-Based Care

AI and Value-Based Care: Joining Forces for Better Outcomes
- Learn how to thrive amidst more sources, more data, and more demands with fewer resources and less lead time
- Set it and forget it: Learn how to set objective-based performance corridors so the machine alerts you when a provider group needs attention
- Learn and adapt: Let the machine learn and inform you when a group needs attention due to unusual behavior

Shifting Gears: How Value-Based Care is Transforming the Quality Landscape
- Make it Real – Learn how plans can support providers and align incentives to improve quality ratings
- Understand how value-based care is changing the landscape for health care providers and health payers
- Learn key strategies for risk adjustment and quality programs that are critical to successfully managing the shift

The 3 Ps – Payers, Providers, and Pharma: How Value-Based Care must be a Collaborative Effort
- Incorporating member preferences and social determinants into an integrated risk, quality, and clinical program
- Using AI to develop interventions that leverage personal preferences regarding healthcare system access
- Driving a higher level of performance for risk, quality, and cost by leveraging the pharmacy benefit, information, and network

Instructors:
Kari Hadley, Senior Director, Medicaid and Quality Products
Pulse8

Scott Fries, Executive VP, Pharmacy Solutions
Pulse8

Scott Stratton, Chief Data Scientist & VP, Product Analytics
Pulse8

1:00 – 4:00

Workshop D: Advanced HCC Audit Preparation

- Knowing your audit risks from a provider documentation and coding perspective
- Selecting and auditing your vendor partners
- Building and keeping your coding team with efficient and effective standards

Instructors:
Wynda Clayton, Risk Adjustment Manager
Providence Health Plan

Colleen Gianatasio, Risk Adjustment Quality & Education Program Manager
Capital Districts Physicians’ Health Plan

1:00 – 4:00

Workshop E: Advanced Risk Adjustment Tools and Techniques

Instructors:
Ana Handshuh, Vice President, Managed Care Services
Ultimate Health Plans

Dave Meyer, Vice President, Risk Adjustment
Scan Health Plan

1:00 – 5:00
Main Registration Opens
4:30 – 6:30
RISE Welcome Reception in Exhibit Hall

The luck of the Irish is on your side this St Patrick's Day at RISE Nashville. Don your brightest green, bowler hats, and shamrock out with us at the RISE Welcome Reception. 

Monday, March 18th

7:00 - 8:30
Registration Desk Opens and Networking Breakfast
7:00 – 6:35
Exhibit Hall Opens

8:30 – 8:45

Opening Remarks

Conference Chair:
Nathan Goldstein, Chief Revenue Officer
Signify Health

Introduced by:
Kevin Mowll, Executive Director
The RISE Association

8:45 – 9:45

Keynote Address

9:45 – 10:05

The Dr. Martin L. Block Award for Excellence and Innovation

10:05 – 10:35
Networking Break in Exhibit Hall

10:35 – 11:35

Plenary Session: Healthcare Hot Topics – An Audience-Driven Discussion

Join a panel of leading healthcare experts and solution providers as they address questions submitted by attendees themselves two weeks prior to the conference. This timely and lively discussion will tackle challenges in the healthcare industry including the latest risk adjustment strategies, impact of government program reform and changes in audit protocols, innovations in technology, as well as implications from the 2019 call letter released by CMS. This is a session you do not want to miss. 

Moderator:
Nathan Goldstein, Chief Product Officer
Signify Health

Speakers:
Sean Creighton, Vice President
Avalere Health

Ana Handshuh, Vice President, Managed Care Services
Ultimate Health Plans

Dave Meyer, Vice President, Risk Adjustment
Scan Health Plan

Jennifer Pereur, Director of Government Programs
Hill Physicians Medical Group

11:40 – 12:25

Concurrent Sessions

Risk Adjustment Strategies

Risky Business: Accurately Generating Financial Projections from EDPS/RAPS Submissions

- Learn how to fit the pieces together in the Medicare Risk Adjustment Model in order to predict revenues around EDPS impact, final revenue, and program ROI
- Dive into the areas of the prospective model that will better prepare you for the sweeps timeline
- See how to reconcile your final EDPS based payments and how to use the data and model to forecast the retroactive payment

Speaker:
Tim Spaeth, Senior Vice President, Payer Solutions
EpiSource

Quality, Accountability and Transparency

How to Utilize your Risk Adjustment Reviews for Provider Education

  • Identifying which providers are in the need of the most assistance
  • Grouping documentation education by risk adjusted conditions
  • Best practices in preparing providers for changes in documentation
  • Introducing incentives for quality of documentation

 

Speaker:
Rachel Nelson, Director, Payer Solutions
GeBBS HealthCare Solutions

Member Engagement and Care Outcomes

Leveraging Complex Care Management to Improve Quality of Life for Members and Financial Outcomes for Health Plans

- Incorporating data from prospective programs to drive improved outcomes through in-home care management - Replace fragmented care with integrated care approach
- Solving for Social Determinants of Health: using data for targeted interventions
- Social services support through integrated community-based services / leveraging facility resources
- Reduce avoidable utilization of inpatient, ER, sub-acute and specialist care and address readmissions through a transitions of care program

Speaker:
Kevin Kearns, MD, Chief Medical Officer
Signify Health

Data Management and Analytics

Augmented Intelligence: How to Optimize Risk and Quality Analysis

- Learn about augmented intelligence and how to implement it
- Utilize augmented intelligence to streamline and improve your risk adjustment and quality programs, care authorization, and physician referrals
- Increase productivity and accuracy of your healthcare experts to perform key activities in healthcare delivery

Speaker:
Darren Schulte, MD, Chief Executive Officer
APIXIO

Trends and Developments

Cybersecurity, Hackers and Healthcare – Protecting your and your Members’ Information

- Embracing technology and innovation while keeping vigilant to fraud, identity theft and cyber attacks
- Learn and stay ahead of current hacking techniques, malware and ransomware that jeopardize your network and data
- Develop internal security awareness program and protocol in case a security breach

12:25 – 1:40
Networking Lunch

1:40 – 2:25

Concurrent Sessions

Risk Adjustment Strategies

360 Risk Adjustment: Health Plan and Provider Perspectives

- Panelists from across the spectrum of risk-bearing organizations will share their experience with NLP-enabled payer-provider collaboration tools in pursuit of risk adjustment optimization within a variety of at-risk payment models
- Review the programs, processes, and workflows leveraged to enhance prospective identification, point of care documentation, pre-claim billing accuracy, and retrospective reviews for enhanced clinical, financial, and operational outcomes
- Discover how AI, machine learning, and analytics come together to transform risk adjustment performance through superior identification, prioritization, and confirmation of population risk

Moderator:
Anand Shroff, Founder and Chief Development Officer
Health Fidelity

Speakers:
Wynda Clayton, MS, RHIT, Risk Adjustment Manger
Providence Health Plan

Dr. Adele Towers MPH, FACP, Senior Clinical Advisor
UPMC Enterprises

Quality, Accountability and Transparency

Innovative Care Gap Strategies: The Evolution of Accessible and Convenient Advanced Screenings and Diagnostic Testing

- Major advancements in screening and testing technology means more affordable, convenient and accessible care for members
- Capturing multiple diagnoses and completing key follow up tests can now be accomplished in a single visit
- Engaging members by offering a choice of alternative venues increases member engagement

Speaker:
Carmen Hill-Mekoba, DNP, APRN-BC, CCM, COHN, Senior Vice President, Clinical Services
Matrix Medical Network

Member Engagement and Care Outcomes

Improve Patient Health with a Holistic Approach to Quality and Risk Adjustment

- Impact members’ health positively – find out how analytics help identify the best engagement programs and close gaps
- Tailor information effectively to share with different providers -- hear about best practices to tailor information that fits seamlessly into provider workflows
- Match provider incentives to drive risk and quality performance - gain insights into aligning incentives to increase patient and provider satisfaction

Speaker:
Jon Bird, SVP of Risk Adjustment and Quality Analytics
Optum

Data Management and Analytics

“Drowning in Data” – Practical Approaches to Data Management to Power Your Analytics

 - How healthcare data has changed and what is needed to simply manage the ever-increasing amounts of data
- How to use data more effectively to support informed cost and quality initiatives and drive data-enabled collaboration
- Data management “best practices” and how to evaluate partners in managing big data

Speakers:
David Costello, Ph.D, Chief Analytics Officer
Verscend

Sumant Rao, Senior Vice President, Data Operations
Verscend

Trends and Developments

Lessons Learned: Combating Opioid Epidemic in Today’s Environment

- Enlisting collaboration from providers to reduce opioid prescriptions
- Assigning resources and making treatment accessible to members
- Partnering with community stakeholders to address addition and find solutions
- Utilizing data to find optimal methods to engage members and their families for preventive care

2:30 – 3:15

Concurrent Sessions

Risk Adjustment Strategies

The Collaboration Trifecta: Improve Risk Score Accuracy through True Provider Engagement

- Improve quality of care for members through true collaboration between payers, providers and
partners
- Learn how real-time interactions with providers take prospective programs to the next level
- The proof is in the data: high-touch provider engagement leads to improvements in risk adjustment
accuracy

Speakers:
Jeffrey De Los Reyes
Emblem

Paula Lempart, Regional General Manager
Visiant-Tessellate

Quality, Accountability and Transparency

The Future of Technology-Enabled Coding

Speakers:
Craig Hauben, EVP Coding Solutions
Ciox Health

Donna Forsyth, Director Risk Adjustment Operations
Excellus BlueCross BlueShield

Member Engagement and Care Outcomes

Mine the Gaps: Using Analytics to Develop Provider Education Strategies

- Simultaneously identify risk adjustment and quality care gaps
- Analyze member patterns and provider trends
- Develop and deliver actionable provider scorecards

Speakers:
Gail Boettcher-Bruno, RN, Director, Client Services
Centauri Health Solutions

Carol Davis, LBSW, CPC, CRC, Executive Director of Provider Engagement and Risk Adjustment
VIVA Health

Data Management and Analytics

Achieving Payer Technology Innovation Results with Machine Learning and Artificial Intelligenc

- Harness the power of all your data to reveal insights that can transform your business
- Leverage AI and Machine Learning models to make continuous improvement to algorithms over time
- Combine disparate sources of data without complex customization to add value to existing suspecting logic

Speaker:
Jimmy Liu, Vice President, Risk Analytics
Change Healthcare

Trends and Developments

Early Warning System: Utilizing Data to Optimize Preventive Care Management

- Learn the latest predictive methods based on data and analytics
- Leverage big data to identify conditions and optimize care
- Identify the best course for intervention and population management

3:15 – 3:45
Networking Break in Exhibit Hall

3:45 – 4:30

Concurrent Sessions

Risk Adjustment Strategies

Is There a Link Between Risk Adjustment and Care Management?

- What’s next on the horizon for quality and risk adjustment?
- Using care management strategies for risk adjustment and quality initiatives
- Next generation home assessments with clinical coordination to improve clinical outcomes
- How does an advanced in-home assessment program coordinate risk adjustment and quality to affect clinical outcomes?

Speaker:
Scott Howell, M.D., Chief Medical Officer
Advantmed

Quality, Accountability and Transparency

Detailing the Pros and Cons of Natural Language Process; Is it the Right Solution for You?

- What is NLP and how can it be used in an effective medical coding program
- What controls should be in place to ensure that your use of NLP is in compliance with coding guidelines
- How could ongoing investigations and regulatory changes impact the use of NLP going forward

Member Engagement and Care Outcomes

Evolving your Member Engagement Approach Using Socioeconomic, Behavioral, and Environmental Data

- Learn best practices for identifying and quantifying the impact of SDOH on health outcomes
- Adjusting and changing dynamics to address population statistics and enhance reach and engagement
- Explore solutions to reduce inpatient admissions, decrease cost and improve quality of care

Data Management and Analytics

Solving Data Challenges with Lab Data & AI

4:35 – 5:35

Roundtables Part One - Select from 15 Different Presentations Spotlighting Healthcare’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-dating type presentations featuring the latest technologies and solutions for boosting your plan’s risk, quality and data management endeavors. A bell will ring three times within this special 60-minute session, alerting you to transition to the next roundtable of your choice

5:35 – 6:35
Networking Cocktail Reception in Exhibit Hall

Tuesday, March 19th

7:30 – 9:00
Registration Desk Opens and Networking Breakfast
7:30
Exhibit Hall Opens

8:00 – 9:00

Roundtables Part Two - Select from 15 Different Presentations Spotlighting Healthcare’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-dating type presentations featuring the latest technologies and solutions for boosting your plan’s risk, quality and data management endeavors. A bell will ring three times within this special 60-minute session, alerting you to transition to the next roundtable of your choice.

9:00 – 9:10

Day Two Welcome Remarks and Day One Takeaways

9:10 – 9:55

Keynote Address

9:55 – 10:25
Networking Break in Exhibit Hall

10:25 – 11:25

Plenary Session: CMS Policy Update and Q&A

11:25 – 12:10

Keynote Address

12:10 – 1:25
Networking Lunch

1:25 – 2:10

Concurrent Sessions

Risk Adjustment Strategies

Developing Strategies and Standards Around Building an Internal Coding Team

- Identify production and quality standards, challenges and successes
- Establishing robust lines of communication with internal teams that result in efficiencies and clear goals setting
- Supplementing internal efforts with vendors to ensure consistency and maintain high productivity

Speakers:
Kristen Viviano, CPC, CRC, Risk Adjustment Coding SupervisorCAPITAL DISTRICTS PHYSICIANS’ HEALTH PLAN

Colleen Gianatasio, Risk Adjustment Quality & Education Program Manager
CAPITAL DISTRICTS PHYSICIANS’ HEALTH PLAN

Audit Readiness and Compliance

Recent Risk Adjustment Government Enforcement Actions and What to do Now

- Review of False Claims Act cases and settlements shaping the industry
- Identifying key risk areas for plans, vendors and providers
- Strategies to be compliant without putting yourself out of business
- Preparing for a whistleblower or government inquiry now

Speakers:
Jason Christ, Member of the Firm
Epstein Becker Green

Teresa Mason, Associate
Epstein Becker Green

Provider Collaboration

Tools and Strategies to Positively Affect your Star Measures through the Member Experience

- Utilizing “Tests of Change” to find where your biggest successes can be
- Thinking outside the box – going against the current can lead to big gains
- Continuous improvement – just because it works well doesn’t mean it can’t work better
- Scaling departments together can lead to big gains in both – why Quality and Risk Adjustment should go hand-in-hand
- Member experiences directly impact the clinical effectiveness of care – why you should be ensuring members have a positive experience

Speaker:
Kyle Mendez, MBA, Director of Operations and Quality
Golden State Medicare Health Plan

Trends and Developments

Success Stories and Case Studies: Innovative Approaches to Provider Education and Resource Maximization

- Tailoring outreach initiatives based on provider size, location, risk-based contracts as well as FFS
- Developing corrective plans and creating accountability for systematic problems around data and client information
- Creating the right incentive programs and partnerships with providers in order to receive useful information for your risk adjustment program

The Future of Healthcare

The Three Futures | Accelerating Data-Driven Healthcare

- How changes in clinical standards, technology, and policy are shaping the way medicine is practiced today
- Discuss key market changes that will affect plans and providers in the next five years and beyond
- Learn about potential changes to entitlement programs, the expanding role of states to oversee health programs in their states, efforts to improve affordability of drugs, and initiatives to promote value-based care

2:15 – 3:00

Concurrent Sessions

Risk Adjustment Strategies

Automate Claims Validation for Increased Coding Accuracy and Completeness

- Applying best practices to manage and close audit gaps
- How to use NLP to flag members and documentation gaps that are at audit risk
- Increase chart review efficiency by unifying coding and auditing workflows

Speaker:
Shahyan Currimbhoy, SVP Product Management and Engineering
Talix

Audit Readiness and Compliance

Assessing the Impact of the CMS Advance Notice

- Deep dive into the possible changes and implications of the newly released notice
- Developing a plan to adjust and adapt to shifts in risk adjustment models and star methodologies
- Utilizing the letter to map out improvements in operations and strategies

Provider Collaboration

Day in The Life of a Physician: Starting a Dialog and Strengthening Partnerships

- Closing gaps and addressing coding challenges
- Leverage connections and driving value-based treatment across the board
- Utilizing technology to improve documentation and diagnosis accuracy

The Future of Healthcare

High-Tech Meets High-Touch: Leveraging Emerging Technology to Deliver Better Member and Patient-Centric Results

- Separate legitimate emerging tech opportunities from the ‘hype” in today’s buzz-word heavy landscape
- Understand practical, real-life scenarios where application of emerging technology enables more relevant, higher touch member and patient interactions
- Discuss industry, business, member and patient implications as a result of widespread adoption of key emerging technologies

Speaker:
Michael Patti, Principal
Baker Tilly

3:05 – 3:35
Networking Break in Exhibit Hall

3:35 – 4:20

Concurrent Sessions

Risk Adjustment Strategies

Risk Adjustment and Quality Coming Together: Achieving Efficiencies or Just Another Trend?

- Debating the pros and cons of overlapping quality and risk adjustment initiatives from plans around the country
- Strategies for going beyond codes and creating comprehensive view of the patient
- How to achieve one requirement representing HEDIS, quality and risk and star – one message to providers encompassing all mandates

Audit Readiness and Compliance

Lessons Learned and Expectations: Preparing for Contract Level RADV Audits

- Preparing your team, setting procedures and committing to a being “audit ready” at all times
- Creating a tool kit for your coding team to work more accurately and efficiently
- Learn strategies for dealing with past inaccurate medical history or problems during an audit

Provider Collaboration

Positively Impacting RA though Meaningful Chart Reviews and Provider Education

- Utilizing chart review as a tool to education providers – what works and what doesn’t
- Dissecting chart information to help doctors improve accuracy and completeness
- Developing a plan for chart audits and corrective actions

Trends and Development

Revolutionizing Healthcare with Blockchain Technology

- Utilizing blockchain technology to increase data quality and accuracy
- Exploring the benefits of blockchain including operational cost reduction and decentralized content management system
- Understanding the regulatory and transparency challenges surrounding the use of blockchain technology

4:20 – 5:05

Plenary Session - Roundtable Discussion: Lessons Learned and Strategies to Succeed in 2020

The conference concludes with a compelling discussion dissecting key takeaways from this year’s conference and tools to help you navigate healthcare’s evolving landscape.

5:05 – 5:10
Closing Remarks