Setting the Curve While Flattening the Curve: Effective Strategies from 2020 Risk Adjustment

Mar 29, 2021 2:00pm ‐ Mar 29, 2021 2:45pm

Identification: MON15

Lowered utilization by patients in 2020 did largely reduce the capture of diagnosis codes for Medicare Advantage risk adjustment. However, there were plans that were resilient because of a strong RAF platform built in partnership with a vendor. 

This presentation will review:

  • The unique and common traits of the patient and provider populations that contributed to trends
  • Risk adjustment strategies utilized throughout 2020 and prior years which can be tied to impacts in claims count
  • Compliant program development during the PHE that will be employed moving forward

Suspecting 2.0: Coding Right the First Time

Mar 29, 2021 2:00pm ‐ Mar 29, 2021 2:45pm

Identification: MON16

Reach the Next Level of Prospective Gap Closure for Enhancing Patient Care and Improving Risk Score Accuracy

  • Learn how payers and providers are collaborating to improve prospective risk adjustment processes
  • See how payer-provider data interoperability is enabling a new frontier in risk adjustment analytics and prospective risk capture
  • Understand the opportunities and challenges in implementing a closed-loop risk capture between payers and providers

The Future of Risk Adjustment, How Advanced Data Science Can Predict Disease

Mar 29, 2021 2:00pm ‐ Mar 29, 2021 2:45pm

Identification: MON17

  • See how advanced data science combined with risk adjustment is leading to early disease detection and prediction
  • Learn from case studies of pilot programs that use artificial intelligence to identify high risk populations to pair members with clinical interventions to improve member outcomes 
  • Hear recommendations for how you can advance your data science strategy

In-Home Health Risk Assessment Programs (IHAs): Close Encounters of The Right Kind

Mar 29, 2021 2:00pm ‐ Mar 29, 2021 2:45pm

Identification: MON18

  • Learn how potential rule changes by CMS may impact in-home health risk assessment programs
  • Gain knowledge on the effectiveness of IHAs in influencing patient behavior prior to and after the COVID-19 pandemic
  • Uncover opportunities to improve IHA implementation and operational process

Meaningful Visits, Measurable Results: Bridging the Healthcare Gap

Mar 29, 2021 2:00pm ‐ Mar 29, 2021 2:45pm

Identification: MON19

  • Deliver value to your members through Comprehensive Health Assessments (CHAs)
  • Effectively educate, empower, and build genuine relationships with members through flexible physical and virtual encounters
  • Discuss the clinical value of CHA visits and the time that a clinician spends with a member, as well as appropriate follow-up care and member satisfaction
  • Learn best practices for optimizing engagement and leveraging CHAs to address member care gaps and ensure continuity of care

Office of the Inspector General (OIG) Update

Mar 29, 2021 3:00pm ‐ Mar 29, 2021 4:00pm

Identification: MON20

Presenters will provide an overview of OIG’s work and current priorities. They will also discuss telehealth and the impact of COVID-19 as we move towards 2021-2022, health risk assessments findings and recommendations, and Medicare Advantage encounter data.


Day Two Welcome Remarks, Martin Block Award Presentation and Keynote Address

Mar 30, 2021 8:45am ‐ Mar 30, 2021 9:55am

Identification: TUE001


Day Two Welcome Remarks and Day One Takeaways

Mar 30, 2021 8:45am ‐ Mar 30, 2021 8:50am

Identification: TUE01


Impact of the Pandemic in Today’s Health Care System

Mar 30, 2021 9:00am ‐ Mar 30, 2021 9:55am

Identification: TUE02

Dr. Borio shares her experience and knowledge regarding the COVID-19 pandemic, vaccine distribution timeline, and impact in the health care arena. She will address the challenges faced by many on resource allocation and strategies on how to prepare for future disruptions.


A Journey to VBC Success: Memorial Hermann Recognizes the Importance of Risk Adjustment

Mar 30, 2021 10:05am ‐ Mar 30, 2021 10:50am

Identification: TUE03


  • Discover the assessment process Memorial Hermann employed, including a pilot on 2018 & 2019 DOS, to understand their holistic value and identify a deployment path to realize it
  • Hear how risk-bearing provider organizations like Memorial Hermann are leveraging NLP to close care and risk gaps as patient volumes rebound, including for commercial ACO populations
  • Learn about Memorial Hermann’s prospective and retrospective combination approach to accurately identify and close diagnosis and coding gaps in conjunction with their Medicare Advantage health plan