Event Schedule
Networking Continental Breakfast
Chairperson’s Opening Remarks:
Michael Bagel,
Associate Vice President of Public Policy
Alliance of Community Health Plans (ACHP)
Rebecca Welling,
Vice President Risk Adjustment,
Intermountain Health
Opening Keynote Address:
Update on OIG Audits and Ways to Improve Compliance
Chris Bresette will provide an overview of the various types of audits that the OIG is performing and will also discuss the 7 elements of a successful compliance plan.
Christopher G. Bresette
Director of Medicare Part C Audits
United States Department of Health and Human Services (HHS), Office of Inspector General, Office of Audit Services
V28 Impact and Pending Strategies to Implement
- Administration changes/fall out
- What are the big obstacles plans have been facing from the V28 transition?
- Mitigation strategies for V28
- Taking a closer look at things that were removed
- Searching new model for codes that can replace the old ones
- What do you show your leadership team vs providers?
- How is provider education coming along?
- What’s next after V28?
Moderator:
Dr. Julio Perez, AHCCA,
Director, Medicare Risk Adjustment
Ultimate Health Plans, Inc.
Panelists:
Ava Johnson,
Associate Director, Ambulatory CDQI
Mount Sinai Hospital, NYC
Kevin Rodriguez, CDIS,
Supervisor Risk Adjustment & Quality
Wellvana Premier Care
Case Studies:
Risk Adjustment Best Practices – How to Build a High-Functioning Department
- What are the key elements of a high-functioning risk adjustment department?
- Internal and external staffing
- Successful procedures for cross-departmental communication and data-sharing
- What constitutes a high-functioning risk adjust department
- Lessons learned and goals left to reach
Rebecca Welling,
Vice President Risk Adjustment,
Intermountain Health
Susan L. Waterman,
Director of Risk Adjustment,
Baylor Scott & White Health
Lisa Wigfield
RN CCM CRC CRC-I CDEO
Blue Cross Blue Shield of Michigan
The Networking Refreshment Break is generously sponsored by Wolter Kluwer
MA Risk Adjustment Policy Updates: Upcoming Legislation, Regulatory Activity, and Post Election Impact on MA Programs
- Where are we now and what can we expect in the near future with legislation, regulation, and policy?
- What are the latest updates from Congress?
- CY 26 MA Technical Proposed Rule: Overview of proposed changes and feedback submitted to CMS
Aldiana Krizanovic, MPH, CPH,
Senior Health Policy Consultant, Federal Government Relations,
Florida Blue
Michael Bagel,
Associate Vice President of Public Policy
Alliance of Community Health Plans (ACHP)
Driving a Robust Prospective Risk Adjustment Program
- Key elements of a robust prospective program
- Boost STAR/Quality and Impact Cost of Care
- Key best practices of exceptional prospective strategies
- Financial considerations for funding prospective program
- ROI considerations and organizational alignment
Subbu Ramalingam,
Senior Consultant
ATTAC Consulting Group
Additional Speakers TBA
Networking Lunch
Panel:
Improving Bi-Directional Data & Interoperability Between Pay/Provider: Overcoming Immediate Challenges
- Key areas to consider from EMR side and EMR integration
- Meeting push expectations for health plans and providers
- What are providers looking for? What else do we need from vendors?
- What kind of EMR advances are available? What kind of tools are they building for bi- directional data between payer and provider?
- Retrospective and prospectus side
- Accessing quicker and better data flows
- Improve medical record review
- Working with EMR vendors for better access and integration
- Latest regulatory updates
Moderator:
Syed M. Rizvi, MHA,
Director, Risk Adjustment Operations,
Southwestern Health Resources
Panelists:
Dean Ratzlaff,
Director – Actuary/Revenue Management,
Sentara Health Plans
Kaitlyn Greve,
Product/Program Development Consultant,
Advocate Health
How to Select & Implement AI & NLP Solutions: Pros & Cons
- What AI is available to help support risk adjustment programs
- How does NLP help unstructured data, risk stratification, efficiency, and accuracy?
- Closing gaps and improving care with AI and NLP: How does it work and what are the results?
- Predicting patient risk, identifying trends, and disease patterns
- RDetecting errors and inconsistencies
- Identifying and prioritizing members
- Care workflow innovations
Adele L. Towers, MD MPH FACP CRC,
Professor of Medicine, Division of Geriatric Medicine,
University of Pittsburgh School of Medicine
Director, Risk Adjustment,
UPMC Enterprises
Jessica Vaughn, DNP, RN, NEA-BC, CCDS, CCDS-O, CRC,
Director of Operations, Condition
Management and Documentation,
Enterprise Population Health,
Advocate Health
Additional Speaker TBA
Risk Adjustment and Revenue Integrity…Then What?
Amanda Brown,
Vice President - Revenue Integrity,
CoventBridge Group
Ray Evans,
Vice President – Healthcare Sales,
CoventBridge Group
Networking Refreshment Break
A Step-by-Step Guide to Improving Risk Adjustment and Star Rating Collaboration: Combining Quality and Coding into One Workflow
- Improving data integration between the two departments
- How to identify and respond to the gap closures together
- Imperative data sharing protocol
- Effectively responding to SDoH needs
- Improving operational inefficiencies
- Maximizing interdisciplinary resources
Keslie Crichton
Chief Sales Officer
Benelynk
Rebecca Welling
Vice President Risk Adjustment
Intermountain Health
How to Use Data & Analytics to Dictate Risk Adjustment Strategy?
- Targeting analytics
- Operational analytics
- Submission analytics
- Compliance analytics
Brett J. Goff,
Director of Risk Adjustment,
Peach State Health Plan/Centene
Dean Ratzlaff,
Director – Actuary/Revenue Management,
Sentara Health Plans
Networking Cocktail Reception
Networking Continental Breakfast
Chairperson’s Opening Remarks:
Michael Bagel,
Associate Vice President of Public Policy,
Alliance of Community Health Plans (ACHP)
Rebecca Welling,
Vice President Risk Adjustment,
Intermountain Health
Panel:
Engaging & Educating Providers With “One More Thing”
- Practical strategies for provider engagement
- Streamlining multiple communications/workflows
- Getting provider buy-in: What benefits them?
- Ensuring providers have all the resources they need
Moderator:
John M. Barkley,
Vice President, Risk Adjustment & Data Integrity,
EmmblemHealth/ConnectiCare/AdvantageCare Physicians
Panelists:
Kevin Rodriguez, CDIS,
Supervisor Risk Adjustment & Quality
Wellvana Premier Care
Ava Johnson,
Associate Director, Ambulatory CDQI,
Mount Sinai Hospital, NYC
Dao Vang, RHIA, CCS-P, CRC,
Senior Program Manager - Provider Enablement for Risk Adjustment,
Blue Cross Blue Shield of Minnesota
Emily Crooks, APRN, FNP-C,
Family Nurse Practitioner, Director, Population Health,
Affinity Health Group
Panel:
In-Home Care Visits: Caring for Critically Ill Patients Who Have Higher Utilization Costs
- How do you use home health risk assessment for a comprehensive diagnosis on a patient?
- What is HHRA appropriate for?
- A move toward a prospective basis in-home assessment
- What does in-home care look like for caring for critically ill patients who would have higher utilization costs?
- What does the future of home delivery look like?
- How does care remain seamless with PCP info back?
- How it affect risk adjustment performance?
Moderator:
Crystal Hartmann
Risk Adjustment Program Manager,
Blue Cross of Idaho
Panelists:
Jennifer Hawkes CPC, CRC,
Risk Adjustment, Manager, Member Engagement,
Blue Cross of Idaho
Emily Crooks, APRN, FNP-C,
Family Nurse Practitioner, Director, Population Health,
Affinity Health Group
Case Study:
Employing a Robust Clinical Documentation Improvement Program
- How does CDI work with risk adjustment?
- How does CDI differ from retrospective chart review
- Tracking CDI progress
- How are health plans and providers adapting to outpatient CDI?
- Educating providers and leaders
- Compliance obstacles
- The role of technology in CDI
Sarah J. Hartley, MHA, RHIA, CDEO, CRC,
System Director, Ambulatory Risk Adjustment and Clinical Documentation Integrity,
Endeavor Health Physician Partners/NorthShore
Dawn Marie Cusimano, CRC,
System Manager, Ambulatory Risk Adjustment and Clinical Documentation Integrity,
Endeavor Health Physician Partners/NorthShore
Networking Refreshment Break
Panel:
Choosing the Right Vendors & Ensuring Your Vendor is Delivering Quality: Partnering 2.0
- So many options where do you begin?
- Managing vendor workflows
- Demanding more from your vendors
- Ensuring quality and performance expectations
Moderator:
John M. Barkley,
Vice President, Risk Adjustment & Data Integrity,
EmmblemHealth/ConnectiCare/AdvantageCare Physicians
Panelists:
Brett J. Goff,
Director of Risk Adjustment,
Peach State Health Plan/Centene
Scott Weiner,
Director, Government Programs,
Sentara Health Plans
Brittney Peyton CPC, CRC,
Risk Adjustment Program Manager
Blue Cross of Idaho
Master the HHS-RADV: Strategies for Success
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Is your Health Plan prepared for its annual HHS Risk Adjustment Data Validation (RADV) audit?
These audits can be complex, but with the right knowledge, you can navigate them efficiently.
Join this session and gain insights from a seasoned Risk Adjustment Coding Manager with a
proven track record of decreasing error rates year-over-year.
- HHS RADV 101: We'll break down the audit's purpose, Health Plan requirements, and how results affect risk scores and payments.
- Be Audit-Ready: Discover strategies to ensure a smooth, organized, and compliant audit process.
- Health Status Validation Mastery: Learn best practices for executing this crucial audit component to achieve the most accurate and complete results.
In this session, you'll learn:
Amy Jack, RHIA, CRC, CCA,
Director of Risk Adjustment,
Select Health
Utilizing SDoH Initiatives to Enhance Risk Adjustment
- Health equity index - what does it mean for your risk adjustment and Stars?
- What’s on the SDoH horizon and how will it impact risk adjustment
- Staffing and operational nuances
- SDoH ROI: Are the SDoH initiatives improving better outcomes?
Jennifer Hawkes CPC, CRC,
Risk Adjustment, Manager, Member Engagement,
Blue Cross of Idaho
Ryan C. Dodson, CRC,
Risk Adjustment Consultant,
Choice Medical Group
End of the Conference