Rise

Track A: Risk Adjustment Strategies

Session Presented by Veradigm

Track B: Quality and Member Experience

Panel: Unpacking the Star Ratings Changes in the 2024 Advance Notice – What Should Plans Do Next?

Panelists discuss strategies in addressing changes from the newly released 2024 MA and Part D Advance Notice and look ahead for what’s on the horizon for 2025 and 2026 Star Ratings changes. Walk away with guidance on the necessary enhancements to your Stars program to ensure success.  

Moderator:
Jenn Kerfoot
Chief Experience Officer
FarmboxRx

Panelists:
Savannah Gonsalves, RN, MHA 
Director of Quality
Hometown Health

Track C: Compliance and Regulatory Updates

Panel: The Current State of RA Litigation and Risk Areas for MA Plans, Physician Groups, Vendors and Downstream Entities

• Hear about new developments in various FCA litigations, OIG audits, and other regulatory activities, with focus on what sorts of activities and fact patterns that the DOJ, as well as courts at the pleading stage, are finding to be plausible violations of the False Claims Act as opposed to fact patterns that are not meeting muster 
• Hear some predictions about what’s next in the FCA arena when it comes to MA and whether MA plans can be both whistleblowers and victims if providers submitted false claims to MAOs 
• Gain insights into how the new RADV rule may affect these cases, and similar cases, moving forward 
• Walk away with a sense of which behaviors the DOJ and various District Courts are finding to be violations of the FCA, and some advice on how to stay clear of those land mines  
• Stay informed of some predictions of where the future of fraud litigations related to the MA industry seem to be heading 

Mary Inman
Partner in Whistleblower Practice Group
Constantine Cannon

Stephen Bittinger
Health Care Audit & Integrity Partner
K&L Gates

Gregory Demske
Partner
Goodwin Proctor

Track A: Risk Adjustment Strategies

Session presented by BioMedix

Track B: Quality and Member Experience

Panel: Experiences in Closing Quality Gaps for Hard-to-Reach Populations

• Hear various approaches from MA plans in engaging hard-to-reach populations, with takeaways of what’s worked and what hasn’t 
• Discuss where to focus your member engagement efforts  
• Examine when patients should be put into risk assessment programs  
• Discuss the pros and cons of the change in CAHPS measure weights 

Moderator:

Savannah Gonsalves, RN, MHA 
Director of Quality
Hometown Health

Panelists:

Kaitlyn Bertrand, PA-C
ACD Physician Assistant
SCMG Internal Medicine APC Lead
Scripps Health

Track C: Compliance and Regulatory Updates

Panel: Identifying Risk Adjustment Operation Pitfalls and Building Compliance Focused Guardrails for “Medicare Program Integrity”

Financial incentives tied to HCCs are muddying the waters, damaging the integrity of value-based care. Learn about the best practices from a panel including a physician, risk adjustment certified coder and auditor, and coding educator, auditor, and documentation integrity specialist. 

Khush Singh, MD, MHA, CRC, CPMA, CPCO, CDIP
Director, Risk Adjustment & Value-based Care
Program operations & Compliance
Granite GRC Consulting

Colleen Gianatasio, MHS, CPC, CPCO, CPC-P, CPMA, CPC-I, CRC, CCS, CCDS-O
Director Clinical Documentation Integrity and Coding Compliance
Capital District Physician’s Health Plan (CDPHP)

Track A: Risk Adjustment Strategies

The Trifecta of Risk Adjustment Coding: How to Operationalize Retrospective, Concurrent, and Prospective Coding Programs to Enhance Patient-Centered Care

• Discuss coding challenges provider groups are facing in the transition to value-based care. 
• Identify the differences between the three types of risk adjustment coding and evaluate appropriate use cases. 
• Prepare a plan to operationalize your coding programs by building and testing workflows and conducting implementation. 
• Measure the results of your coding programs with key performance indicators (KPIs). 

Speaker from Episource to be announced 

Co-presenter to be announced  

Track B: Quality and Member Experience

Keys to Incorporating Health Equity Performance into Your Plan’s Quality Measures

• Discuss the impacts and implications of the potential new Health Equity Index (HEI) proposed for MA plans that serve populations of members with certain defined social risk factors (SRFs) 
• Hone in on ways that MA plans can take coordinated, proactive actions to develop high-impact interventions to close SDoH gaps  
• Examine other health equity provisions proposed by CMS, such as digital health education resources, and look at the best ways to start incorporating disparity reducing initiatives now   

Speaker to be announced  

Track C: Compliance and Regulatory Updates

AI in Healthcare – Compliance and Ethical Considerations for Managed Care Plans and Providers

• Get a big picture perspective of trends related to AI, ML and generative AI in the health care space   
• Understand the risks and benefits of the use of these technologies as it relates to managed care  
• Discuss the unique risks and considerations with using AI in managed care  por 

Gregg Kimmer
President and CEO
Atrio Health Plans

Track A: Risk Adjustment Strategies

Secret Recipe for Success: Enhancing Risk Adjustment Operations with AI

• Unlock the quality ingredients needed to maximize coder productivity while reducing burnout 
• Learn why leveraging AI for first-pass chart reviews ensures accuracy and efficiency right from the start 
• Discover how Blue Cross Blue Shield of Massachusetts utilized an AI-driven platform to transform risk adjustment operations and performance 
• Uncover strategies to utilize AI technology as a valuable tool to enhance existing workflows and empower your team for greater efficiency and effectiveness 

Mia Bell
Sr. Manager, Medicare & Commercial Risk Adjustment
Blue Cross Blue Shield of Massachusetts

Breanna Krebs
Vice President, Operations
Apixio

Track B: Quality and Member Experience

Panel: Operationalizing Shared Goals – Case Examples of Interdepartmental Collaboration to Achieve RA Success and a Boost in Star Ratings

• Examine examples from MA plans around operationalizing interdepartmental collaboration to achieve shared goals 
• Look at opportunities during the annual visit to streamline competing priorities and create the best member experience  
• Share internal reporting and governance structures that help to integrate Quality and Risk Adjustment departments

Moderator:
John Criswell
Founder, CEO, Chairman
Porter

Panelists:
Susan Waterman, RHIT, CCS, CPC, CRC
Director of Risk Adjustment
Scott and White Health Plan

John M. Barkley
Vice President, Enterprise Risk Adjustment & Data Integrity
EmblemHealth/ConnectiCare

Payal Kumar
Director, Risk Adjustment
Superior HealthPlan
(pending confirmation)

Track C: Compliance and Regulatory Updates

Panel: Advice for RADV Audit Preparedness

• Examine the current landscape of RADV audits, with tips on risk mitigation as well as advice for audit preparedness  
• Get tips for surviving a contract-level RADV audit based on lessons learned  

Moderator:
Beth Zuehlke
Chief Customer Officer
Moxe Health

Panelists:
Deb Curry, MBA, RHIA, CCS-P, CRC
Director, Risk Adjustment & Recoveries
Actuarial Services
Paramount

Additional Speakers to be announced

Track A: Risk Adjustment Strategies

Panel: RA Strategies Are Not a One-Size-Fits-All – Real Life Experiences from Seasoned RA Leaders

Experienced leaders know that the “secret sauce” for success in meeting, and exceeding, risk adjustment and quality goals is the deployment of your strategy. And, there is not one strategy that fits all.  

In this panel discussion, seasoned RA and Quality leaders share what’s worked, and what hasn’t, with advice on navigating the nuances of one strategy vs. the other.  

Moderator:
Speaker from Pareto Intelligence

Panelists:
Wynda Clayton, MS, RHIT
Senior Director, Risk Adjustment
Providence Health Plan

Mandvi Tandon
Director of Medicaid Quality & Risk Adjustment
HealthCare Partners

Katie McLaughlin, DNP
Sr. Clinical Advisor, Risk Assessment
Lead Risk Adjustment Nurse Practitioner
SCMG  | SHPS

Track B: Quality and Member Experience

A Blueprint for Knocking Down Barriers, Getting Members to Needed Care and Delighting Them at the Same Time

• Hear from a panel of health plan leaders overseeing Medicare Advantage and dual-eligible beneficiaries and gain insights into their strategies and blueprints that got members to schedule and follow through with appointments  
• Discuss how they are identifying and addressing barriers and the results they achieved, including more care gaps closed, delighting members with the experience and directly impacting those members with the highest disadvantage 
• Walk aways with lessons on when and how to effectively engage members who are overdue for preventive care, how to identify and address member barriers to getting care and how to delight members in the process 

Moderator:
Chad Baugh
Chief Revenue Officer
ReferWell

Panelists:
Gerri Cash
Vice President Medicare & FEP Quality Improvement Performance
BCBS Arizona

Track C: Payer / Provider Alignment

Panel: Beyond Burnout – Post-Pandemic Learnings in Avoiding Abrasion and Meeting Providers Where They Are

• Benchmark best practices in engaging providers in a post-pandemic environment  
• Identify how plans and providers can work together to address gaps and manage data in today’s challenging environment  
• Discuss tactical ways to approach shared goals and joint next steps to improve care quality and patient experience, including removing administrative burden off of plans  

Moderator:
Colleen Gianatasio, MHS, CPC, CPCO, CPC-P, CPMA, CPC-I, CRC, CCS, CCDS-O
Director Clinical Documentation Integrity and Coding Compliance 
Capital District Physician’s Health Plan (CDPHP) 

Panelists:
Mark Dabney, PMP
Director, Risk Adjustment
Community Health Plan of Washington

Melissa Cornejo
Director of Quality
Wellcare

Track A: Risk Adjustment Strategies

Tech-Enabled Care for Medicaid and Dual-Eligibles: Empowering FQHCs with Next-Generation Partnerships, Technology, and Care Model Support

• Learn what FQHCs need today for success in value-based care models 
• Hear how contracting and partnership strategies are evolving for community-based Medicaid and Medicare Advantage delivery for under-resourced populations 
• Enhance your understanding of how data and technology can play a part in accelerating quality and risk adjustment success in FQHC settings 

Track B: Quality and Member Experience

Case Study: Focus on Pharmacy Measures – An Opportunity to Positively Impact Your MA Plan’s Star Ratings

Speaker to be announced 

Track C: Payer / Provider Alignment

Panel: Early Lessons from Working within the ACO REACH Model

• Discuss how plans and providers are working within this new model, with insights into HCC coding, data capture and perspectives on targeting the right population 
• Examine the pros and cons of working within the new ACO REACH Model, with perspectives from both sides of the fence   
• Gain operational insights from ACO REACH organizations  

Moderator:
To be announced

Laura Sheriff, RN, MSN, CPC, CRC
Vice President, Risk Adjustment
Southwestern Health Resources

Dr. Shannon I. Decker, MBA, MBA, MEd., MEd, PhD
Principal
VBC One

Carmela Costiniuk, B.Sc. OT, MHA, D. EdD (C)
Vice President, Population Health and Clinical Transformation 
Catholic Medical Partners
(pending confirmation)

Track A: Risk Adjustment Strategies

Lessons in Building a Compliant Risk Adjustment Team – A Case Study from AdventHealth

• 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
Director Risk Adjustment and Quality
AdventHealth
(pending confirmation)

Track B: Quality and Member Experience

Session to be announced

Track C: Payer / Provider Alignment

CMS HCC Model V28 & the Impact on Risk Adjustment Education Programs

• Discuss how CMS HCC Model V28 comes with some significant changes to conditions represented along with the value of these conditions and your providers, coders and support staff on these changes is crucial for continued success 
• Learn how to educate providers based upon documentation best practices   
• Get tips for updating your resources  
• Provide support to coders for appropriate queries and accurate ICD-10 code selection 

Jenni Monfils
Director of Risk Adjustment Coding and Compliance
Bright HealthCare
(pending confirmation)