Agenda

Wednesday, Feb 21, 2024
7:30

Networking Continental Breakfast

8:20

Chairperson’s Opening Remarks:

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

David Meyer, Senior Vice President, Risk Management and Quality Beacon Healthcare Systems

8:30

Opening Keynote Address: OIG Workplan and Findings: Preparing for OIG Audits, Preventative Measures, and Tangible Solutions for Health Plans

  • Practical and usable audit take-aways
  • Where else is OIG focusing their efforts?
  • How do you implement what OIG is doing to improve your compliance plans
  • High risk miscoded diagnosis codes: Common red flags

Christopher G. Bresette, CPADirector, Medicare Part C AuditsOffice of Inspector General

9:15

A Real-Time Discussion from Various Perspectives: Moving RADV and OIG Audits from Risk to Value: Does Your Risk Adjustment Program Truly Reflect a Member-Centric Approach?

  • Implementing internal RADV audit strategies
  • Preparing for the inevitable audit
  • RADV final rule
  • Revamping your RADV protocol
  • How do you choose a partner?
  • Actuarial method: Upside-downside and the methodology on the flow of data
  • Problematic delegation for targeted conditions
  • Analytics to clean up data
  • End to tend practice in coding and practices
  • Effectively and systematically extrapolate data
  • How are you utilizing home assessments and telehealth for continuity of care?

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

Colleen Gianatasio, MHS, CPC, CPC-P, CPMA, CRC, CPCO, CDEO, CPPM, CCDS-0,CCS, and AAPC Approved Instructor, Director, Clinical Documentation Integrity, and Coding Compliance CDPHP

10:00

Outpatient CDI Benefits, Strategies, and Vendor Evaluation and Contracting

  • Outpatient CDI compliant queries
  • Recapture opportunities
  • Alternative options for suspect diagnosis
  • Is your technology and process compliant?
  • Making sure the technology is supporting the query process
  • Double checking your vendors are compliant
  • What questions to ask initially? What to not fall for?
  • What language to make sure is in your contracts

Colleen Gianatasio, MHS, CPC, CPC-P, CPMA,CRC, CPCO, CDEO,CPPM, CCDS-0, CCS, and AAPC Approved Instructor,Director, Clinical Documentation Integrity and Coding Compliance,CDPHP

Adele L. Towers, MD MPH FACP CRC, Professor of Medicine, Division of Geriatric Medicine,University of Pittsburgh School of MedicineDirector, Risk AdjustmentUPMC Enterprises

10:30

Networking Refreshment Break

11:00

Restructuring Your Member Engagement Initiatives for Enhanced Risk Adjustment

  • Targeting in-home assessments based on open gaps versus other criteria
  • A payer’s role in coordinating outreach among multiple care delivery partners
  • Using social determinants of health data to adjust member engagement strategies
  • Incorporating risk adjustment into enterprise Next Best Action program
  • Provider incentives for direct member engagement & preventative visits
  • Using risk adjustment gap details to influence outreach strategy

Moderator:

Keslie Crichton, Chief Sales Officer,Benelynk

Panelists:

Jacqueline Edison, MPP, Director of Program Management, Risk Adjustment, Star, Quality and Risk Adjustment Center of Excellence,BlueCross BlueShield of Minnesota

Andrew Loewer, Director, Quality & Risk Adjustment Analytics,BlueCross BlueShield of Minnesota

11:30

How Are Plans Using SDoH, Supplemental Benefits, and Duals to Enhanced their Risk Adjustment Initiatives

  • What are you doing to impact SDoH and how does that impact risk?
  • Using supplemental benefits for whole person care? Impact and execution
  • Are the initiatives leading to better outcomes: What do the numbers say? Did you spend money and save cost?
  • Initiatives/programs where cost savings can be directly linked to the SDoH initiative
  • Social and dual care: Meeting the needs of your member where they are
  • Who will lead this collaboration?
  • How will SDoH, Duals, and supplemental benefits look after V28?
  • High cost utilization and management
  • Maintaining cost of care
  • Regulatory requirements

Jennifer Hayes, DNP, CPC, CRC, CDEO, AAPC Fellow,Lead Director, Quality Management,Aetna

Charles Baker,Vice President, Compliance Solutions,Attac Consulting

12:15

Networking Lunch

1:15

Artificial Intelligence (AI) and Nature Language Process (NLP) Innovations: Supportive Tools for Capturing Data and Reducing Provider Burnout

  • Using NLP for proper risk adjustment, quality gaps, medical management, and auditing
  • Clinical language and evidence interpretation challenges
  • Tangible and intangible results
  • Using real AI in to find incorrect diagnosis
  • New technology to support complicated and important workflows in risk adjustment
  • Identifying and reviewing AI/NLP after the fact to make sure it is documented compliantly
  • Leveraging NLP in a compliant manner and capable of withstanding audits
  • Interplay of NLP and human coders/auditors

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

Adele L. Towers, MD MPH FACP CRC, Professor of Medicine, Division of Geriatric Medicine,University of Pittsburgh School of MedicineDirector, Risk AdjustmentUPMC Enterprises

2:00

The Search for Suspect Conditions

  • Analytical approach for finding potential open gaps
  • Risk Mitigation strategies while looking for suspect conditions
  • Accessing Medical Records
  • “Last minute” strategies to meet regulatory deadlines
  • Role of AI or NLP in identifying suspect conditions
  • Identifying the sensitivity level that is “just right” for clinical indicators

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

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

2:45

Payor/Provider Interoperability & Data Sharing Strategies: Tactical Steps to Improve Interoperability Challenges

  • Examining the rules and regulations around interoperability: What does it look like and what type of changes are you making?
  • Improving data integration to support risk adjustment initiatives
  • Systematically taking data from health plans to providers
  • EMR access and integration
  • Enhancing chart collection, retrospective chart reviews, and chart chase returns
  • How can you reduce provider abrasion?
  • How are you ensuring quicker and better data flows?
  • Approaches for collecting proper data
  • What are the latest interoperability rules?
  • How are EMRs handling interoperability challenges- best practices to meet the latest guidelines
  • What are the rules around structured vs non-structured data - challenges on the non- structured end


Dean Ratzlaff, Director – Actuary/Revenue Management,Sentara Health Plans

Megan Zakrewsky, VP Product, Clinical Data Exchange,Veradigm

3:30

Networking Refreshment Break

4:00

A Complete Ensemble Approach to Surviving Regulatory Audits

  • Current regulatory pressures challenging MAOs RA programs
  • Financial impacts of avoidable coding errors
  • How to strategically prepare your RA team to handle any regulatory audit
  • What tools and technology are available to help you respond and survive an audit

Melissa James, CPC, CPMA, CRC,Content Management Consultant – Risk Adjustment SME,Wolters Kluwer, Health Language

Kimberly Rykaczewski, RN, BSN, CPC, CRC, Senior Clinical Content Specialist – Nursing ,Wolters Kluwer, Health Language

4:30

A Unicorn Spotting Step-By-Step Strategies to Close the Risk Adjustment and Quality Gap: A Collaboration that Pays to Get it Right

  • Top three items that RA and Quality/STARS teams need to understand about the other to foster collaboration
  • How can leaders meld the knowledge and initiate?
  • Data sharing and communication tactics that work
  • Creating interdisciplinary resources for each department
  • A behind the scenes look at the operational efficiencies required for risk and quality success
  • The benefits of combining RA and STARS/HEDIS programs – provider, member and operations impacts
  • The building block of a unified team – cross-functional teams that bring expertise from both areas to find efficiencies
  • The need for a common language – building on the common elements of the two programs rather than focusing on the differences
  • Presenting the right information at each level, from analysts, educators, coders to senior leadership

Scott Weiner,Director, Government Programs,Sentara Healthcare

Susan L. Waterman, Director of Risk Adjustment,Baylor Scott & White Health

Dean Ratzlaff, Director – Actuary/Revenue Management,Sentara Health Plans

5:15- 6:16

Networking Cocktail Reception

Sponsored by

Thursday, Feb 22, 2024
7:45

Networking Continental Breakfast

8:20

Chairperson’s Opening Remarks:

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

David Meyer, Senior Vice President, Risk Management and Quality Beacon Healthcare Systems

8:30

How are Health Plans Adjusting to a New Era of Provider Engagement and Education

  • How well do you know your providers and their office staff?
  • How are your providers contacted and how often?
  • How to get provider buy in?
  • Educating your providers for accurate and complete documentation will support all
  • business lines
  • Streamlining office workflow for better documentation results
  • Roll out an analytic program that will give your provider real time data at the point of care
  • Creating a meaningful incentive program
  • Maximize time and resources for the greatest impact on your network
  • V28 considerations

Moderator:

Ryan C. Dodson, CRC,Chief Operating Office/Co-Founder New Vision Healthcare Solutions

Panelists:

Susan L. Waterman,Director of Risk Adjustment,Baylor Scott & White Health

Dr. Julio Perez, AHCCA,Director, Medicare Risk Adjustment Ultimate Health Plans, Inc.

9:15

Case Study: Strategies to Better Engage Subspecialists and Other Workgroups

  • Benefits of utilizing specialist in Risk Adjustment
  • Identification of which specialties to start with
  • Recruiting more than just the doctors to the team
  • Ensuring your strategy is addressing the utilization conundrum

Sunita E. Varghees, MD, PhD, CHCQM, VP System Clinical Documentation Improvement,Baylor Scott & White Health

Carrie Horn, MSHA, BBA, RN, CCDS, CCDS-O, CHFP, CRCR, CPC, CRC,Director Outpatient CDI,Baylor Scott & White Health

9:45

V28 Changes and Its Impact on Scoring, Provider Engagement, & Your Financial Model

  • How will v28 impact your program and provider engagement efforts?
  • How are plans handling the financial and logistical impact of this model change
  • How are you adapting your EMR processes to handle?
  • What no longer carries risk value?
  • Taking a deep dive into clinical documentation examples
  • How are plans weaving V24 and V28 together?
  • How do you get providers to engage when they are not responding to your requests?
  • V28 effects on prospective, retrospective, and operational workflow
  • Educating your provider network to prevent risk and enhance quality
  • Keeping your coding accuracy separate from the risk score value
  • How do we adapt from a provider engagement standpoint to keep requests for coding accuracy despite there being no financial motivation for that deeper granularity under V28?

Moderator:

Dr. Julio Perez, AHCCA,Director, Medicare Risk Adjustment Ultimate Health Plans, Inc.

Panelists:

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

Kacey Holman Manager for Risk Adjustment Consulting Pareto Intelligence

10:30

Networking Refreshment Break

11:00

Navigating the Future: Innovative Strategies for Building Transformative Risk Adjustment Programs

  • Discover rapid strategies for initiating effective risk adjustment programs that reduce provider abrasion, enhance patient satisfaction, and deliver measurable ROI
  • Navigate the evolving risk adjustment landscape by discussing crucial shifts, breaking silos between risk and quality, and leveraging patient interactions to address wider healthcare gaps
  • Learn to seamlessly integrate risk adjustment into Annual Wellness Visits, maximizing face- to-face patient interactions to capture risks, identify barriers, and promote Social Determinants of Health programs
  • Explore tactics for innovation within risk adjustment, coupled with effective change management. Secure organizational buy-in and establish clear success parameters for a smooth transition
  • Define and measure success in dynamic risk adjustment environments. Uncover key performance indicators for continual improvement, ensuring adaptability in the ever- changing healthcare landscape

Jessica Columbus,Vice President, Value Based Care, Operations Apex Health Solutions

Amy Page Vice President, GrowthGreater Good Health

11:30

Restructuring Your Submission Reconciliation Process from Beginning to End

  • Finding the loopholes in your submission process
  • Where can the data fall out?
  • Clearinghouse initiatives
  • Should supplemental claims be used to submit additional diagnoses?
  • Streamlining data after the clearinghouse
  • Systematically mapping your submission from end to end
  • Access and reconciliation improvements
  • Monitoring submissions
  • Michelle Mitchell, MHA, CRC, Director of Risk Adjustment, CorporateModa Health

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

12:00

Driving Efficiency and Quality Outcomes through Value Based Care: The Real Impact of Risk Adjustment on VBC

  • Improving quality care while sustaining cost
  • Documentation required for risk adjustment process
  • What are the best metrics that can be used to manage VBC in a compliant manner?
  • Predictable cash flows, reducing billing staff, preventative care, and accountability of care
  • Incentives that work, and those that don’t
  • Coding to the highest level of specificity
  • Who is driving cost of contracts and how do you manage it?
  • Strategies to optimize and manage VBC properly
  • Providing actionable data to your VBC groups to maximize performance

Jennifer Hayes, DNP, CPC, CRC, CDEO, AAPC Fellow, Lead Director, Quality Management,Aetna

Alan Bratton, Senior Vice President Operations and Principal Consultant,Attac Consulting

12:45

End of the Conference