View Agenda | RISE West 2024

Rise

/media/5211/rise-logo.png

RISE West 2024
September 11-13, 2024
Colorado Springs, CO

Agenda

With over 30 timely topics and 80+ handpicked speakers, RISE West 2024 covers the tried-and-true risk adjustment and quality content, plus expanded themes covering member engagement, policy, regulatory updates, and payer/provider alignment.

The main conference kicks off at 4:10pm on Wednesday, September 11. Pre-conference sessions begin at 9:00am on Wednesday, September 11 and require pre-registration. Please note the time that each of these sessions begins so you can plan your travel accordingly.

Wednesday - September 11, 2024

10:00 AM 11:00 AM

9:00 AM 10:00 AM

8:00 AM 9:00 AM

7:00 AM 8:00 AM

Registration Desk

Preconference Workshop Registration Desk Hours: 9:00AM - 4:00PM

*Additional Registration Required

Main Conference Registration Desk Hours: 1:00PM - 5:30PM

10:00 AM 11:00 AM

9:00 AM 10:00 AM

8:00 AM 9:00 AM

7:00 AM 8:00 AM

Networking Breakfast for Morning Workshops Attendees

*Additional Registration Required

11:00 AM 5:00 PM

10:00 AM 4:00 PM

9:00 AM 3:00 PM

8:00 AM 2:00 PM

Workshop A: Implementing an Outpatient Clinical Documentation Improvement (CDI) Program

*Additional Registration is Required. Breakfast and Lunch is Included with Workshop A.

Join RISE for an interactive workshop where participants will learn the building blocks of implementing a strong outpatient clinical documentation improvement program at their organization.   

Outpatient CDI brings the information needed for better patient outcomes closer to the point of care. This improves both patient experience and provider engagement.  This workshop is designed for administrators, coding/cdi professionals, and any healthcare leader who wants to take their value-based healthcare efforts to the next level.    

Join RISE for an introduction on why CDI is such a hot topic in the outpatient setting.    

Participants will learn from our expert facilitators as well as their peers from across all sectors of our industry.  Participants can expect to dialogue, interact, and work in small, facilitated groups with peers and colleagues.  

Get insights into:   

  • Why CDI vs. traditional retrospective chart review  
  • Basics of CDI for risk adjustment   
  • How to create compliant querying policies and procedures  
  • The role of technology in outpatient CDI  
  • Hiring for your outpatient CDI program  
  • Measuring success  
  • Improving provider engagement  

Colleen Gianatasio CPC, CPCO, CPC-P, CDEO, CPMA, CPPM, CRC 
Director, Clinical Documentation Integrity and Coding Compliance 
Capital District Physician’s Health Plan 

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

11:30 AM 1:00 PM

10:30 AM 12:00 PM

9:30 AM 11:00 AM

8:30 AM 10:00 AM

Women4Women Brunch N’ Learn – Panel: Closing the Gap in Health Care Leadership

*Additional Registration is Required. Brunch is Included.

Hear stories from women leaders that have risen the ranks in health care, with take aways on how they got to where they are, gain practical tips on navigating the “corporate ladder” and discuss how women can help others both in their organizations as well as women’s initiatives in their community.  

  • 10:30AM – 10:55AM Pre-session networking and breakfast   
  • Note: Breakfast will be served but is reserved for attendees of this session only 
  • 10:55AM Welcome remarks   
  • 11:00AM – 11:45AM Session    
  • 11:45AM Audience Q&A / Takeaways  

 

 

1:00 PM 2:00 PM

12:00 PM 1:00 PM

11:00 AM 12:00 PM

10:00 AM 11:00 AM

Networking Lunch for All Workshop Attendees

*Additional Registration Required

1:00 PM 5:00 PM

12:00 PM 4:00 PM

11:00 AM 3:00 PM

10:00 AM 2:00 PM

Headshot Café

Snag a complimentary professional headshot while attending a pre-conference workshop. Whether updating your LinkedIn profile, company website, or personal branding materials, a high-quality headshot can make a significant impact.  

 

Interested in sponsoring the Headshot Café? Contact sponsorshipwfra@wilmingtonplc.com 

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 B: AI is Here to Stay

*Additional Registration is Required. Lunch is Included with Workshop B.

Designed for professionals from health plans and health care providers with beginner to intermediate knowledge of AI, this workshop is focused on practical applications, emerging risks, and opportunities of AI in the managed care sector.  

  • Examine current trends, legislation, risks and opportunities in the field of AI    
  • Discuss the governance and ethical principles of AI   
  • Explore essential AI technologies reshaping health care and dive into the applications / uses for health plans and risk-bearing provider groups  
  • Weigh the pros and cons of outsourcing vs. insourcing an AI solution  
  • Look at real-life case studies how AI is benefitting managed care organizations 

Laura Sheriff, RN, MSN, CPC, CRC 
Contracting Risk Adjustment Specialist 

Additional Speakers to be announced  

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 C: Operational Excellence in Medicare Advantage Plan Management 

*Additional Registration is Required. Lunch is Included with Workshop C.

New to this year’s conference, join RISE for a groundbreaking interactive workshop and team-based game offering an unparalleled opportunity to dive deep into the complexities and strategies of managing a Medicare Advantage health plan. 

This session is designed for both industry veterans and newcomers alike. Whether you are an experienced professional looking to refine your strategies or a newcomer eager to learn the ropes, this workshop will provide valuable insights and practical skills. 

Collaborate with peers in the MA space for a highly interactive and engaging workshop setting curated by expert leaders who have steered their own plan teams to success during turbulent times. Learn from multi-disciplinary expertise in Star Ratings, Risk Adjustment, Benefit Design, Compliance, and Plan Operations and walk away with takeaways on connectivity amongst departments, keys to budget management, and practical strategies to enhance plan performance all while staying compliant during times of change. 

Walk away with a greater understanding of how to mitigate the challenges and seize the opportunities that plans face today and in 2025. (and, did we mention there’s prizes?!) 

Attendees will: 

  • Participate in an educational team-based game where you will take control of a simulated health plan. Make strategic decisions, manage budgets, and navigate real-life scenarios to lead your plan to victory  
  • Gain a better understanding of cross-functional departmental goals and strategies that are essential for success, and get a better grip on the levers to pull to maximize the impact of your initiatives 
  • Learn how to integrate efforts across finance, quality improvement, member engagement, and risk adjustment to achieve optimal results 
  • Better advocate within your own plans for resources that can have maximum impact on plan performance 
  • Understand the intricacies of balancing budget constraints with the need for high-quality care and above all, compliance 

Jenn Kerfoot 
Chief Strategy and Growth Officer  
DUOS  
 
Rex Wallace 
Principal  
Rex Wallace Consulting, LLC 

 
Nate Lucena 
CSO 
Rex Wallace Consulting, LLC 

 
Ryan Dodson 
Risk Adjustment Consultant 
Choice Medical Group  

 

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: Embracing Authentic Leadership – A Workshop for Rising Stars* (*limited to 35 attendees)

*Additional Registration Required (Limited to 35 Attendees). Lunch is Included with Workshop D.

Leadership is an art that can be learned and practiced by anyone who aspires to make a difference in their organization, their community or the world. But what does it mean to lead authentically? 

Learn that, and more, in this special workshop.  

Designed for rising stars who are ready to sit the driver’s seat of the future and make meaningful steps towards the next steps in their career,  

A mix of theory, lived experience shared by authentic leaders and interactivity with workshops leaders and attendees, this session is sure to leave an impact on your leadership development.  

Attendees: 

  • Define Authentic Leadership and get the roadmap to identifying your own personal and professional values  
  • Discuss how your own ethical values intertwine with your leadership values; and what that means for your day-to-day leadership style  
  • Uncover  
  • Gain real-life lessons learned from authentic leaders  

 

DeAnna Minus-Vincent 
President & CEO 
The D-velopment Group, Inc. 
former Executive Vice President and Chief Social Justice and Accountability Officer at RWJ Barnabas Health 

Marci Lesko 
CEO 
UnitedWay of the Lehigh Valley   

5:00 PM 5:10 PM

4:00 PM 4:10 PM

3:00 PM 3:10 PM

2:00 PM 2:10 PM

Session Transition

5:10 PM 5:15 PM

4:10 PM 4:15 PM

3:10 PM 3:15 PM

2:10 PM 2:15 PM

Opening Remarks

5:15 PM 6:15 PM

4:15 PM 5:15 PM

3:15 PM 4:15 PM

2:15 PM 3:15 PM

Opening Keynote Presentation: Unlocking the Hero Within

Join us as Heather “Lucky” Penney recounts her experience on the morning of 9/11, when she and her flight lead were sent in a suicide mission against Flight 93. Her reflections on the extraordinary heroism of the passengers show us how we, too, can choose to cultivate our own inner hero. 

Heather “Lucky” Penney 
Heroic 9/11 F-16 Fighter Pilot 

Learn More 

6:15 PM 7:15 PM

5:15 PM 6:15 PM

4:15 PM 5:15 PM

3:15 PM 4:15 PM

Networking Cocktail Reception

Join us for drinks, hors d’oeuvres, and face-to-face networking with peers.

Thursday - September 12, 2024

8:30 AM 9:45 AM

7:30 AM 8:45 AM

6:30 AM 7:45 AM

5:30 AM 6:45 AM

Registration Desk Opens and Networking Breakfast

8:30 AM 7:25 PM

7:30 AM 6:25 PM

6:30 AM 5:25 PM

5:30 AM 4:25 PM

Exhibit Hall Open

8:30 AM 9:30 AM

7:30 AM 8:30 AM

6:30 AM 7:30 AM

5:30 AM 6:30 AM

Food Packing Volunteer Event in Partnership with U.S. Hunger (free to attend but separate registration required)

*free to attend but separate registration required

9:45 AM 10:00 AM

8:45 AM 9:00 AM

7:45 AM 8:00 AM

6:45 AM 7:00 AM

Welcome Remarks

Co-Chair: Ana Handshuh, Cat5 Strategies   

10:00 AM 10:50 AM

9:00 AM 9:50 AM

8:00 AM 8:50 AM

7:00 AM 7:50 AM

Keynote Session: Assess Areas of Risk for Medicare Advantage Plans, Providers and Downstream Entities

Hear insights directly from the OIG and DOJ on areas of risk to be mindful of and what to anticipate coming down the pike.  

Carolyn Kapustij 
Senior Advisor for Manged Care 
HHS Office of Inspector General  

Speaker from U.S. Department of Justice (invited) 

10:50 AM 11:40 AM

9:50 AM 10:40 AM

8:50 AM 9:40 AM

7:50 AM 8:40 AM

Leadership Panel – The Only Constant is Change: Steering the Ship During Waves in Risk Adjustment and Quality Operations

  • Get the bigger picture on MA Operational Excellence in a post-Final Rule era 
  • Hear how MA leaders are balancing financial considerations with best-in-class patient care    
  • Discuss wholistic strategies to increase plan revenue, both on the RA and Quality side, and walk away with tactical insights for your plan’s operations 

Moderator: 
to be announced 
 
Panelists:  
Greg Dadlez, MHA 
VP, Value-Based Performance 
Ochsner Health Network 

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

Rebecca Welling 
Vice President Risk Adjustment  
Intermountain Health 

11:40 AM 12:05 PM

10:40 AM 11:05 AM

9:40 AM 10:05 AM

8:40 AM 9:05 AM

Networking Break

12:05 PM 12:55 PM

11:05 AM 11:55 AM

10:05 AM 10:55 AM

9:05 AM 9:55 AM

Leadership Panel – Scaling SDoH Programs for the Aging Population

  • Hear innovative approaches in addressing SDoH needs in the aging population across all lines of business (Commercial, MA, Medicaid, SNPs, etc.) 
  • Discuss funding streams and opportunities for sustainability for SDoH initiatives 
  • Hear how plans are tapping into supplemental benefits to address the needs of their populations   

 

Vivian Nava-Schellinger, JD, MS 
Director of Diversity, Equity, Inclusion, and Community Impact  
The SCAN Foundation 

Additional speakers to be announced 

12:55 PM 1:35 PM

11:55 AM 12:35 PM

10:55 AM 11:35 AM

9:55 AM 10:35 AM

Special Presentation – Building Resilience Against All Odds

With a lifetime of experience as a congenital quad amputee, seasoned Paralympic swimmer, and accessibility designer, Jonathan brings a worldly perspective unmatched. Fueled by his desire to trailblaze for future generations and those whose voices aren’t heard, he has set out to be the change. Jonathan thrives to find unique and out-of-the-box solutions to overcome any form of obstacle that stands in the way.  

In this special presentation, Jonathan shares his unique outlook on resiliency, determination, and discusses ways for health care to be more inclusive for all.  

Jonathan Heider Laedtke 
Paralympic Swimmer, Inclusivity Expert, Speaker 
Split Star Productions 

Learn More 

1:35 PM 2:35 PM

12:35 PM 1:35 PM

11:35 AM 12:35 PM

10:35 AM 11:35 AM

Networking Lunch

Concurrent Sessions 2:35 PM - 3:20 PM 1:35 PM - 2:20 PM 12:35 PM - 1:20 PM 11:35 AM - 12:20 PM
Track Chairs:

2:35 PM 3:20 PM

1:35 PM 2:20 PM

12:35 PM 1:20 PM

11:35 AM 12:20 PM

Track A: Health Plan Operations (RA & Quality)

Panel: Unpacking the V28 Model

  • Benchmark best practices in navigating the new CMS risk adjustment model for MA plans  
  • Hear how plans have been navigating the impact on RAF scores and other levers to pull to balance out revenue  
  • Gain tips on updating coding practices to maximize value for your plan and your members  

 

Moderator: 
Speaker from Veradigm 
 

Panelists: 
Dr. Shannon Decker, PhD., MBA, MBA, M.Ed., M.Ed.  
Principal 
VBC One  

Katie O’Hearn, MS, RHIA, CCS-P, CRC 
Manager, Program Management – Risk Adjustment  
Star and Risk Adjustment Center of Excellence 
BlueCross Blue Shield MN  

Carrie Horn MSHA, BBA, RN, CCDS, CCDS-O, CRC, CPC 
System Director Outpatient Clinical Documentation Integrity 
Baylor Scott & White Health 

2:35 PM 3:20 PM

1:35 PM 2:20 PM

12:35 PM 1:20 PM

11:35 AM 12:20 PM

Track B: Digital Transformation

Unlocking Health Data’s Potential Across the Enterprise

  • Learn how data and insights can be effectively leveraged to foster collaboration between payers and providers 
  • Discover best practices for integrating provider and patient engagement strategies into risk adjustment efforts 
  • Uncover strategies to support your business's ability to make data-driven decisions 

 

Presented by Apixio 

2:35 PM 3:20 PM

1:35 PM 2:20 PM

12:35 PM 1:20 PM

11:35 AM 12:20 PM

Track C: Plan / Provider Partnerships

To be announced

3:20 PM 3:25 PM

2:20 PM 2:25 PM

1:20 PM 1:25 PM

12:20 PM 12:25 PM

Session Transition

Concurrent Sessions 3:25 PM - 4:10 PM 2:25 PM - 3:10 PM 1:25 PM - 2:10 PM 12:25 PM - 1:10 PM
Track Chairs:

3:25 PM 4:10 PM

2:25 PM 3:10 PM

1:25 PM 2:10 PM

12:25 PM 1:10 PM

Track A: Health Plan Operations (RA & Quality)

Session Presented by Fathom

3:25 PM 4:10 PM

2:25 PM 3:10 PM

1:25 PM 2:10 PM

12:25 PM 1:10 PM

Track B: Digital Transformation

Session Presented by Persivia

3:25 PM 4:10 PM

2:25 PM 3:10 PM

1:25 PM 2:10 PM

12:25 PM 1:10 PM

Track C: Plan / Provider Partnerships

Panel: Focus on Plan / Provider Alignment- Examples in Reducing Provider Abrasion

  • Hear examples of how plans are effectively engaging providers to avoid abrasion  
  • Learn about data-driven ways that plans are using to meet providers where they are 
  • Get tactical ways to get provider buy in, with examples of plans that have had success in this area  

Moderator: to be announced 
 
Panelists:  
Kenneth Persaud, MD 
CEO 
White-Wilson Medical Center, P.A.  

Sunita E. Varghees, MD  
VP, Physician Documentation  
Baylor Scott & White Health 

Kwame Appiah-Yeboah 
Director, Risk Adjustment & Revenue Management 
Sentara Health Plans  

Jeremy Cale Browning, MBA, CPC, CRC 
Director – CDE Performance Management 
Ochsner Health Network (OHN) 

 

 

4:10 PM 4:35 PM

3:10 PM 3:35 PM

2:10 PM 2:35 PM

1:10 PM 1:35 PM

Networking Break

Concurrent Sessions 4:35 PM - 5:20 PM 3:35 PM - 4:20 PM 2:35 PM - 3:20 PM 1:35 PM - 2:20 PM
Track Chairs:

4:35 PM 5:20 PM

3:35 PM 4:20 PM

2:35 PM 3:20 PM

1:35 PM 2:20 PM

Track A: Health Plan Operations (RA & Quality)

Audit Readiness – Keep Calm and Code On

  • Get an overview of the audit types – OIG, CMS, RADV, etc. and gain a better understanding of the nuances of each  
  • Explore the differences in preparation for small, medium, and larger organizations to identify alternative approaches  
  • Examine the changes to RADV extrapolation to confirm understanding and educate your team  
  • Distinguish critical stakeholders needed when preparing for an audit  

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

4:35 PM 5:20 PM

3:35 PM 4:20 PM

2:35 PM 3:20 PM

1:35 PM 2:20 PM

Track B: Digital Transformation

Panel: The Move to Digital Quality Measurement  

  • Unpack new developments in ECDS measures and discuss the future of HEDIS® quality measurement    
  • Get best practices in operationalizing the integration of ECDS measure data into existing processes    
  • Benchmark best practices for fully digital reporting  

 

Katharine Iskrant  
President 
Healthy People, Inc.  

Speakers from Clover Health to be announced  

4:35 PM 5:20 PM

3:35 PM 4:20 PM

2:35 PM 3:20 PM

1:35 PM 2:20 PM

Track C: Plan / Provider Partnerships

Case Study – Learnings from a Nurse-Led AWV Program that Nearly Doubled Its Rates

  • Hear about one group’s innovative program increase AWV Completion rates and decrease provider burden  
  • Learn about how cross-functional collaboration contributed to success 
  • Walk away with tips on how your organization can increase AWV rates  

 

Nicole Wright MSN, RN, CBN 
Director of Clinical Competency & Practice Coordination  
Inspira 

Renee Cline RN, MSN, CNML 
Manager of Practice Coordination  
Inspira 

5:20 PM 5:25 PM

4:20 PM 4:25 PM

3:20 PM 3:25 PM

2:20 PM 2:25 PM

Session Transition

5:25 PM 6:25 PM

4:25 PM 5:25 PM

3:25 PM 4:25 PM

2:25 PM 3:25 PM

Interactive Roundtables & A Chance to Take Home Maui Jim Sunglasses

Join us for interactive roundtables featuring the latest technologies and solutions for boosting your organization’s endeavors. These speed-networking type presentations are 20 minutes long, allowing you to make your way to three roundtables per session. 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!

6:25 PM 7:25 PM

5:25 PM 6:25 PM

4:25 PM 5:25 PM

3:25 PM 4:25 PM

Networking Cocktail Reception

Join us for drinks, hors d’oeuvres, and face-to-face networking with peers.

Friday - September 13, 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

Registration Desk Opens and Networking Breakfast

9:00 AM 2:45 PM

8:00 AM 1:45 PM

7:00 AM 12:45 PM

6:00 AM 11:45 AM

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

Interactive Roundtables & A Chance to Take Home Maui Jim Sunglasses

Join us for interactive roundtables featuring the latest technologies and solutions for boosting your organization’s endeavors. These speed-networking type presentations are 20 minutes long, allowing you to make your way to three roundtables per session. 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 10:10 AM

9:00 AM 9:10 AM

8:00 AM 8:10 AM

7:00 AM 7:10 AM

Welcome Remarks and Day One Takeaways

Co-Chair: Ana Handshuh, Cat5 Strategies

10:10 AM 11:00 AM

9:10 AM 10:00 AM

8:10 AM 9:00 AM

7:10 AM 8:00 AM

Patient Focus Panel

 

Back by popular demand, hear direct feedback from a panel of Medicare & MA customers around their experience, access to care and ways to improve health plan services.      

Kathleen Ellmore 
Cofounder & Managing Partner 
Engagys  

11:00 AM 11:50 AM

10:00 AM 10:50 AM

9:00 AM 9:50 AM

8:00 AM 8:50 AM

Keynote: A Conversation on End-of-Life Care

Hear from Hadley Vlahos, a hospice nurse and storyteller on life lessons and profound wisdom gleaned from her hospice patients as well as suggestions on how managed care leaders can positively impact end-of-life care.  

Reflect how end-of-life care not only imparts lessons on mortality but also enlightens us on how to truly live. 

Hadley Vlahos, RN   
Registered Nurse Specialized in Hospice and Palliative care 
NYT Best-Selling Author 
“The In Between – Unforgettable Encounters During Life’s Final Moments” 
Founder 
Hadley House  

Learn More 

11:50 AM 12:10 PM

10:50 AM 11:10 AM

9:50 AM 10:10 AM

8:50 AM 9:10 AM

Networking Break

Book Giveaway and Signing

“The In Between – Unforgettable Encounters During Life’s Final Moments” by Hadley Vlahos, RN   

Concurrent Sessions 12:10 PM - 12:55 PM 11:10 AM - 11:55 AM 10:10 AM - 10:55 AM 9:10 AM - 9:55 AM
Track Chairs:

12:10 PM 12:55 PM

11:10 AM 11:55 AM

10:10 AM 10:55 AM

9:10 AM 9:55 AM

Track A: Health Plan Operations (RA & Quality)

Panel: Operationalizing the 2025 Changes to Medicare Part D

  • Understand what plans need to know about the 2025 Medicare Part D redesign including the financial, operational and strategic implications      
  • Discuss ways that plans can adjust their operations to account for the Part D changes  
  • Understand the interactions among the changes and how they could offset each other 

Moderator 
Speaker from Datavant 
 
Panelists:  
Omar Daoud  
Senior Director of Pharmacy 
Community Health Plan of Washington 

Melissa Smith 
Founder 
Newton Smith Group 

Additional speakers to be announced  

12:10 PM 12:55 PM

11:10 AM 11:55 AM

10:10 AM 10:55 AM

9:10 AM 9:55 AM

Track B: Keys to Compliance

Flip the Script: Using Data and Measures to Identify Potential Fraud

  • Get tips on pivoting the use of existing data measures to address potential fraud, waste, and abuse within your book of business and provide practical examples of how data usage has increased the rapid identification of fraud, waste, and abuse indicators 
  • Apply standard measures in innovative ways to address fraud, waste and abuse identification    
  • Hear lessons learned in implementation and gaining leadership buy-in 

 

Jennifer Dietz 
Director, Health Care Fraud Division 
Defense Health Agency (OIG) 

12:10 PM 12:55 PM

11:10 AM 11:55 AM

10:10 AM 10:55 AM

9:10 AM 9:55 AM

Track C: Provider Spotlights

Panel: Spotlight on Providers Addressing Social Drivers of Health

  • Discuss the challenges that providers face in addressing SDoH and how to overcome them, including coordinating care with social service organizations  
  • Examine reimbursement for meeting SDoH needs 
  • Look at ways to improve payer / provider partnerships in meeting the needs of underserved communities

Moderator: 
Laura Sheriff, RN, MSN, CPC, CRC 
Contracting Risk Adjustment Specialist 

Panelists:  
Helen L. Veet DNP, RN 
Director of Quality Management- PA Medicaid 
AmeriHealth Caritas Pennsylvania  
Keystone First 

Mital Brahmbhatt, MHA, LMSW 
Director, Health Management 
Memorial Hermann 

Additional speaker to be announced  

12:55 PM 1:00 PM

11:55 AM 12:00 PM

10:55 AM 11:00 AM

9:55 AM 10:00 AM

Session Transition

Concurrent Sessions 1:00 PM - 1:45 PM 12:00 PM - 12:45 PM 11:00 AM - 11:45 AM 10:00 AM - 10:45 AM
Track Chairs:

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

10:00 AM 10:45 AM

Track A: Health Plan Operations (RA & Quality)

Setting Your Ethical Stars and Risk Adjustment Trajectory 

  • Identify the clinical and fiscal ROI for Ethical Stars and Risk Adjustment strategies 
  • Define the pillars of an Ethical Stars and Risk Adjustment Strategy  
  • Define the quality impact of adopting and ethical strategic plan for Health Equity Index, HEDIS, HOS and CAHPS success 

 

Dr. Ellen Fink-Samnick DBH, MSW, LCSW, ACSW, CCM, CCTP, CRP, FCM 
Wholistic Health Equity Strategist, Content Developer, Educator  
EFS Supervision Strategies, LLC 

Melissa Smith 
Founder 
Newton Smith Group 

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

10:00 AM 10:45 AM

Track B: Keys to Compliance

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 
  • Understand the risks and compliance implications of specific retrospective chart review methods, such as chart “refreshing” and “coding parties,” enabling providers and MAOs to make informed decisions and avoid potential pitfalls 
  • Equip yourself with knowledge on the challenges and risks of documenting quality metrics under the Stars program in the post-pandemic era, ensuring your organization remains compliant and efficient in a changing environment 
  • Stay informed of some predictions of where the future of fraud litigations related to the MA industry seem to be heading as it relates to Risk Adjustment and Star Ratings  

 

Panelists: 
Mary Inman 
Partner 
Whistleblower Partners LLP  

Additional Speakers to be announced  

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

10:00 AM 10:45 AM

Track C: Provider Spotlights

Session to be announced

  

1:45 PM 2:45 PM

12:45 PM 1:45 PM

11:45 AM 12:45 PM

10:45 AM 11:45 AM

Networking Lunch

Concurrent Sessions 2:45 PM - 3:30 PM 1:45 PM - 2:30 PM 12:45 PM - 1:30 PM 11:45 AM - 12:30 PM
Track Chairs:

2:45 PM 3:30 PM

1:45 PM 2:30 PM

12:45 PM 1:30 PM

11:45 AM 12:30 PM

Track A: Health Plan Operations (RA & Quality)

Panel: Building Your Bench – Tips on Hiring, Staffing and Retention

  • Discuss the current landscape in hiring for Risk Adjustment and Quality roles  
  • Benchmark best practices for hiring, the right mix and makeup of staffing and retaining top performers  
  • Have an open dialogue of what’s working for plans and risk-bearing provider groups and what’s not  

Moderator: to be announced 

Panelists:  
Colleen Gianatasio CPC, CPCO, CPC-P, CDEO, CPMA, CPPM, CRC 
Director, Clinical Documentation Integrity and Coding Compliance 
Capital District Physician’s Health Plan 

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

Jeanine Bumford CPC CRC 
Director of Risk Adjustment Operations 
Christus Health  

 

2:45 PM 3:30 PM

1:45 PM 2:30 PM

12:45 PM 1:30 PM

11:45 AM 12:30 PM

Track B: Keys to Compliance

Case Study: Master the HHS RADV Audit - Strategies for Success

  • Get a better handle on what HHS RADV audits are - break down the audit's purpose, Health Plan requirements, and how results affect risk scores and payments 
  • Gain case study insights on HHS RADV audits from a seasoned Risk Adjustment Coding Manager with a proven track record of decreasing error rates year-over-year 
  • Be audit-ready with tactical knowledge to ensure a smooth, organized, and compliant audit process including learnings from vendor selection, chart retrievals, the appeals process and more

Amy Jack 
Risk Adjustment Coding Manager  
SelectHealth 

2:45 PM 3:30 PM

1:45 PM 2:30 PM

12:45 PM 1:30 PM

11:45 AM 12:30 PM

Track C: Provider Spotlights

Bridging the Divide – Keys for Providers to Meet Clinical and Reporting Goals

  • Discuss the disconnect with health care providers and payers, with focus on tactical ways to tie in clinical work with the pressure to meet reporting measures (e.g. quality measures)  
  • Integrate population health improvement strategies in alignment with the work of providers to reduce abrasion 
  •  Discuss ways to achieve better scores while creating meaningful change  

Rebecca Yanniello   
Vice President, Population Health  
Regal Medical Group 

3:30 PM 3:40 PM

2:30 PM 2:40 PM

1:30 PM 1:40 PM

12:30 PM 12:40 PM

Session Transition

3:40 PM 4:20 PM

2:40 PM 3:20 PM

1:40 PM 2:20 PM

12:40 PM 1:20 PM

Closing Session: Moving to Impactful Change

Hear from a panel of distinguished and seasoned leaders in public health and managed care on keys to moving the needle in patient care.   

  • Hear case examples of panelists’ own experiences in taking a step back and reassessing their programs with a keen focus on patient care  
  • Discuss matching care to science and not just checkboxes   
  • Examine ways to look at effective care that’s under utilized  
  • Discuss what bridging silos looks like in practice  

Moderator:  
Dr. Shannon Decker, PhD., MBA, MBA, M.Ed., M.Ed.  
Principal 
VBC One  

Panelists:  
DeAnna Minus-Vincent 
President & CEO 
The D-velopment Group, Inc. 
former Executive Vice President and Chief Social Justice and Accountability Officer at RWJ Barnabas Health 

Rebecca Yanniello   
Vice President, Population Health  
Regal Medical Group   

Helen L. Veet DNP, RN 
Director of Quality Management- PA Medicaid 
AmeriHealth Caritas Pennsylvania  
Keystone First 

4:20 PM 4:25 PM

3:20 PM 3:25 PM

2:20 PM 2:25 PM

1:20 PM 1:25 PM

Closing Remarks

Co-Chair: Ana Handshuh, Cat5 Strategies   

;