RISE National 2020

Jun 26, 2020 ‐ Jun 30, 2020

Presentations: 2

As the #1 trusted source for risk adjustment,quality, Stars, and beyond, RISE National is back for its fourteenth consecutive year as the must attend mega-conference for professionals of all levels in the Medicare Advantage and ACA market. This year we will be virtual, streaming 100% live content plus real time speakers tuning in from home offices across the nation. Join other health plans and physician groups and network with key stakeholders in the health care industry. Learn best practices from peers and partners to re-energize and push your organization forward, including what’s to come in government health care reform. We heard you – and RISE National 2020 is designed based on your feedback and suggestions to ensure it tackles your most pressing challenges. The agenda is full of takeaways, peer-to-peer

exchange, solutions, and networking, including tracks customized to meet your preferred learning style. Real-life examples and actionable ideas will take center stage at RISE National with ample opportunities for networking. We’ve put together a program to help you navigate the ever-evolving Medicare Advantage and ACA market, keep up with regulatory trends, and hear about the latest technologies shaping the future of health care.

Standard: $1000.00


Workshop A: Risk Adjustment Practitioner

Jun 26, 2020 9:00am ‐ Jun 26, 2020 4:00pm

Learning Objectives:

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

  • Susan Waterman, RHIT, CCS, CPC, CRC, Director of Risk Adjustment, Scott and White Health Plan
  • Laura Sheriff, RN, MSN, CPC, CRC, Risk Adjustment Specialist

Workshop B: Advanced HCC Auditor

Jun 26, 2020 9:00am ‐ Jun 26, 2020 4:00pm

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. 

Learning Objectives:

  • Dialogue, interact and work in small facilitated groups with peers and colleagues 
  • Understanding the financial overlay – HCC codes mapping to risk adjustment scores 
  • A single coding and documentation process for Risk adjustment 
  • Skill development on choosing diagnoses from portions of the encounter – permitted and not permitted
  • Clinical documentation barriers for risk adjustment purposes (data validation audit risks)

  • Colleen Gianatasio, Devoted Health
  • Donna Malone, CPC, CRC, CRC-I, AHCCA, RAP, AAPC Approved InstructorDirector of Ambulatory Clinical Documentation Quality Improvement, Mount Sinai Health System

Workshop C: What Health Plans Should Be Seeing at the Crossroads of Better Data and Advanced Analytics

Jun 26, 2020 1:00pm ‐ Jun 26, 2020 4:00pm

Learning Objectives:

  • Value-based Care: Synergizing Advanced Analytics, Technologies, and Interoperability for More Successful Risk Adjustment and Quality Outcomes 
  • Reducing Plan and Provider Burden for Better Engagement and Outcomes in a Rapidly Shifting Healthcare Landscape 
  • Integrating Risk, Quality, and Pharmacy Opportunities at the Point of Care to Improve Clinical and Financial Outcomes

  • Scott Stratton, Chief Data Scientist & Vice President, Product Analytics, Pulse8
  • Jennifer Hunt, Adminstrative Director, Actuarial Servcies, Paramount Healthcare
  • Scott Fries, Chief Administrative Officer & Executive Vice President, Pharmacy Solutions, Pulse8
  • Eddie Ortiz, MD, Chief Executive Officer, International Medical Card, Inc.
  • Diane Escandell, RN, CPC, Senior Director of Provider Engagement, Pulse8
  • Karl Brown, MD,MPH, MBA, CRC, Chief Quality and Risk Adjustment Officer, HealthCare Partners, IPA

Workshop D: Taking Your Medicare Advantage Program to the Next Level

Jun 26, 2020 1:00pm ‐ Jun 26, 2020 4:00pm

This hands-on workshop is exclusively for upper-level management and those in strategic planning roles within Stars, Risk Adjustment and Compliance. Very Limited space due to interactive nature of the workshop. 

This workshop will guide you through the lessons learned and best practices for combining and streamlining processes related to Stars and Risk Adjustment. You will walk away with a game plan and actionable steps to apply in your organization.

Learning Objectives:
  • Promote a five-star culture
  • Take a deep dive into your risk adjustment strategies
  • Discuss key measures directly affecting your starts rating
  • Learn strategies to help you successfully prepare and navigate for audits

Workshop E: Attention Spans and the Human Brain

Jun 26, 2020 1:00pm ‐ Jun 26, 2020 3:00pm

It is axiomatic that brains don’t pay attention to boring things. Yet speakers regularly lose their audiences after just a few minutes at the podium. Can brain science help? How can presenters create clear and compelling presentations?

In this talk, we discuss how the brain pays attention to information. We start with a few facts about brain processing and end with practical advice on how to make presentations sharp, stimulating and sticky.

  • Dr. John Medina, Brain Scientist Author of New York Times bestseller Brain Rules: 12 Principles for Surviving at Work, Home and School

Opening Remarks iconOpening Remarks

Preview Available

Opening Remarks

Jun 29, 2020 9:00am ‐ Jun 29, 2020 9:10am


Updating Your Risk Adjustment Playbook 2020

Jun 29, 2020 10:10am ‐ Jun 29, 2020 10:55am

Whether you’ve been in Risk Adjustment for 20-years or 20-minutes you’ve been impacted by Covid-19. From deadline shifts to new HCC codes, it’s a new world for payers. With all this change, you need to update your playbook while keeping the tried and true methods intact.

Learning Objectives:
  • We will review current policy changes
  • Discuss anticipated impacts of Telehealth on value based care Risk Adjustment reimbursement, and how to succeed as care patterns may change
  • Explore the benefits of adding a digital first retrieval strategy to your traditional methods

Improving 2020: Risk Adjustment Micro Strategies

Jun 29, 2020 10:10am ‐ Jun 29, 2020 10:55am

During 2020 3rd Quarter Risk Adjustment, health plans still have an opportunity to improve clinical documentation errors, meet with patients in-person or virtually, and develop chart review campaigns to identify issues in charting that can be corrected before the end of the year. 

Learning Objectives:
  • Reviewing actual Q1 and Q2 risk adjustment strategies for efficacy
  • Attribution of financial value to individual campaigns
  • How and when to pivot programs to correct issues in performance
  • Su Bajaj, Senior Vice President of Product Development, Episource
  • Jason McDaniel, Vice President, Risk Adjustment & Quality, Intermountain Healthcare, Nevada

Connecting Health Care: The Future of Clinical Interoperability 

Jun 29, 2020 10:10am ‐ Jun 29, 2020 10:55am

Learning Objectives:
  • Gain a multi-stakeholder perspective on how payers and providers are finding value in new approaches to interoperability and data sharing.
  • Explore how healthcare electronic exchange standards are transforming the interoperability landscape to solve today’s common challenges around provider connectivity and patient engagement, care gap closure, and the ability to leverage advanced, intelligent clinical decision support.
  • Hear from industry experts as they discuss the impacts the regulatory environment has on improving data speed and transparency in capturing the holistic patient view at the point of care.
  • Eric Sullivan, Senior Vice President of Innovation and Data Strategies, Inovalon
  • Paul Wilder, Executive Director, CommonWell Health Alliance
  • Yogi H. Suarez, MD, MBA, FACOG, ice Provost for Population Health and Well-being, Associate Dean for Clinical and Community Affairs, Florida International University
  • Chad Brooker, Associate Principal, Policy, Avalere Health

CMS Policy Update iconCMS Policy Update

Preview Available

CMS Policy Update

Jun 29, 2020 11:05am ‐ Jun 29, 2020 12:00pm

Join CMS as they delve into the latest policy updates and expectations for the upcoming year.

  • Kelly Drury, Director, Division of Risk Adjustment Operations, Centers for Medicare & Medicaid Services (CMS)
  • Erin Sutton, Deputy Director, Payment Policy and Financial Management Group, Centers for Medicare & Medicaid Services (CMS)
  • Allison Yadsko, RADV Policy Team Lead, Centers for Medicare & Medicaid Services (CMS)