2020 Agenda

Ana Handshuh, CHC, Principal
CAT5 Strategies

Dave Meyer, Vice President, Risk Adjustment and Quality
Cigna

During this motivational talk, Brent compares stories from the battlefield, the lessons learned, and how those lessons apply to leadership during times of crisis, such as COVID-19 hitting the healthcare industry. Brent talks about how to build a culture of leadership, servant leadership, adaptive change management, and much more. 

Brent Gleeson
Navy Seal Combat Veteran & Leadership, Culture and Engagement Expert

Former politician John McDonough will give insights into the potential scenarios in the 2020 Presidential Election and subsequent implications for health plans working across Medicare, Medicare Advantage, ACA and Medicaid.  

Discuss pressing topics and walk away with an understanding of: 

• The effect of COVID-19 on the landscape as it relates to healthcare policy (i.e. Medicaid waivers, the impact of unemployment and Medicaid Expansion, etc.) 
• The long-term view of the damage done to the healthcare infrastructure and future healthcare policy  
• The landscape for pandemic preparedness and the national vs. states’ roles in policy and readiness  

John E. McDonough, DrPH, MPA
Professor of Public Health Practice
Harvard T.H. Chan School of Public Health
Former Member
Massachusetts House of Representatives
Former Senior Advisor on National Health Reform
U.S. Senate Committee on Health

• Dealing with the revenue shortfall: what the pandemic means for 2021 risk & quality scores 
• Discuss how the absence of that documentation (because of COVID-related seclusions) could adversely impact risk adjustment (HCC) for next year and beyond – and strategies to combat this  
• Hear perspectives from health plans on how they are catching up on the 5-Star Quality Program  

Moderator:
Sean Creighton, Vice President of Federal Policy
Humana

Panelists:

Mark Dodge 
AVP of Stars, Risk and Quality 
Bright Health Plan  

Tom Lutzow 
President and CEO 
Independent Care Health Plan 

Jason McDaniel 
Vice President of Risk Adjustment and Quality 
Intermountain Healthcare

• Discuss the impact of COVID-19 on your Risk Adjustment program and one health plan’s lessons learned
• Develop strategies to recover from the pandemic and improve your Risk Adjustment scores and assess implications of intervention costs
• Dive into RADV implications and areas of improvement

Yamilet Truex, Manager for Risk Adjustment Data Analytics
Pulse8

Antonette Buenavides, CCS, Director of Risk Adjustment Programs & Audit
SCAN Health

Part I: The Whole Business Model Has Changed  

• Discuss the implications on risk adjustment / quality metrics and what the new wraparound looks like pre-post, and during the pandemic  
• Assess the regulatory landscape and the future direction that telemedicine is headed  
• Compare health plans’ experiences with various technology providers  
• Assess various approaches in provider engagement, including provider readiness and training methods that have worked  

Part II: Operationalizing & on the Ground 

• Learn how various health plans are operationlizing telehealth visits on the ground and what their plans are moving forward  
• Get perspectives on the operational aspects including: what health plans are covering, whether they are waiving copays, what codes are being billed, what is being substituted for home assessments and a discussion on whether rates will be risk adjustable 
• Touch upon auditing and reconciliation of encounters 

Panelists:

Dawn Peterson, CPC, BSPH
Director of Risk Adjustment
Martin’s Point Health Care

Michelle Duran, CPC, CRC
Practice Transformation Facilitator
Hill Physicians Medical Group

Jenni Monfils, CPC, CRC 
Risk Adjustment Compliance Coding Manager
UCare

David Weathington
Senior Vice President, Health Plan Operations
Clover Health

Cooper Watts
Senior Director of Clinical Strategy
UnitedHealthcare Medicare & Retirement

Provider Perspective Panel: Keys to Provider / Payer Collaboration in a Post-Pandemic World  

• Get down to the financials – discuss which incentives actually work and hear how providers have been financially affected as a result of the pandemic (and ultimately, what that means for the payer / provider relationship) 
• Hear the barriers, roadblocks and resources needed for a successful risk adjustment & 5-star quality program 
• Examine how COVID-19 has changed the patient experience and how that affects member engagement on health plan side  

Moderator:  

Joyce Nuesca, MD, MBA, MS, CPE 
Regional Medical Director 
Blue Shield of CA   

Panelists:  

Matthew Anderson  

Clinical Innovation Leader 

Banner Health  

Eric Harman, MD 

Physician  

Mountain Region Family Medicine  

Stephanie Conners, MBA, BSN, RN, NEA-BC 

Executive Vice President and Chief Operating Officer  

Jefferson Health 

Elissa Langley, MHA, VP, Chief Operating Officer 
Triad HealthCare Network 

Part I: The Whole Business Model Has Changed  

• Discuss the value of telemedicine visits,  the implications on risk adjustment / quality metrics and what the new wraparound looks like pre-post, and during the pandemic  
• Assess the regulatory landscape and the future direction that telemedicine is headed  
• Compare health plans’ experiences with various technology providers  
• Assess various approaches in provider engagement, including provider readiness and training methods that have worked  

Part II: Operationalizing & on the Ground 

• Learn how various health plans are operationlizing telehealth visits on the ground and what their plans are moving forward  
• Get perspectives on the operational aspects including: what health plans are covering, whether they are waiving copays, what codes are being billed, what is being substituted for home assessments and a discussion on whether rates will be risk adjustable 
• Touch upon auditing and reconciliation of encounters 

Panelists:

Dawn Peterson, CPC, BSPH 
Director of Risk Adjustment 
Martin’s Point Health Care

Michelle Duran, CPC, CRC 
Practice Transformation Facilitator 
Hill Physicians Medical Group

Jenni Monfils, CPC, CRC  
Risk Adjustment Compliance Coding Manager 
UCare

David Weathington 
Senior Vice President, Health Plan Operations 
Clover Health

Cooper Watts 
Senior Director of Clinical Strategy 
UnitedHealthcare Medicare & Retirement

Mix and Mingle with solution providers and peers to learn the latest and greatest advancements in improving your Risk Adjustment & Quality programs.

• Hear lessons learned from one plan’s partnership with their vendor in identifying and correcting data leakage prior to claims submission
• Delve into the steps taken to initially recognize lost opportunities, clarify and quantify the missed submissions, and correct the process – with takeaways on how your plan can also improve submission accuracy and acceptance rates 
• Walk away with new insights on RAPS/EDPS reconciliation, how to identify indications of data leakage affecting claims / encounter submissions and effectively reconcile submissions in time for sweeps

Amber Harris, Director Risk Adjustment
MediGold

Mike Sloan, Manager, Risk Adjustment Submissions and Analytics
MediGold

Meleah Bridgeford, Director, Risk Adjustment Analytics
Episource

• Identify documentation and coding requirements during the public health emergency (PHE) and their impact on Risk Adjustment 
• Determine a proactive audit strategy to prepare for future RADV audits 
• Discuss the types of conditions that are appropriate to capture from telehealth visits 

Monica Watson, RHIA, CPC, CCS, CCS-P, CPMA, CIC, CRC, CDEO, AHIMA ICD-10-CM/PCS
Trainer & Ambassador, Director, Coding Services
Centauri Health Solutions

Tina Tressler CPC
Manager of Coding and Chart Operations
Prominence Health Plan

Join RISE for a special presentation led by Chief Derek Bergsten, Chief Fire Officer and Chief EMS Officer in the second largest Fire Department in the state of IL, as he discusses a success story in partnering with healthcare stakeholders in his community to improve patient outcomes.  

In this talk, Chief Bergsten sheds light on how health plans and other healthcare stakeholders can: 

• Learn from and implement a similar partnership as the Rockford Fire Department did with MCOs and hospital systems to optimize emergency medical services  
• Tap into already established resources within their community to impact member health  
• Reduce costs through mobile integrated care  

Derek Bergsten
Chief
Rockford Fire Department

Ana Handshuh, CHC, Principal
CAT5 Strategies

Dave Meyer, Vice President, Risk Adjustment and Quality
Cigna

Take a breath, calm your nervous system and quiet your mind. Join Yoga veteran, Kim Larkin as she guides attendees through breathing exercises, meditation and a gentle yoga to tart the morning off the right way.  

Yoga mats are optional.  

Kim Larkin
Yoga & Meditation Instructor  

With a flood of inaccurate health headlines vying for your attention every day, it can feel overwhelming to find actionable, accurate tips you can use right here and now. Dr. Milstein’s scientist training will help you to cut through the hype and tap into the latest breakthroughs in science to help you live a healthier, happier life. 

Dr. Marc Milstein,  PhD
Scientist and Researcher on Health & Happiness

• Hear direct feedback from a panel of Medicare & MA customers around their experience, access to care and ways to improve  
• Understand how satisfied they are from a benefits perspective and discuss what is missing from the MA product 
• Discuss the pros and cons of Medicare & Medicare Advantage products  
• Hear the effects of COVID-19 on the member experience  
• Hear how the experience at the provider, access to care, etc. colors members’ view of the plan and what they can do about that 
• Discuss what plans have done to try and retain members and hear what worked and what didn’t  

Moderator:
Kathleen Ellmore, Managing Director
Engagys

Member Panelists to be Announced

Mix and Mingle with solution providers and peers to learn the latest and greatest advancements in improving your Risk Adjustment & Quality programs.

Join an intimate Q&A session with NCQA’s VP of Public Policy and External Relations, Frank Micciche, to discuss today's most pressing quality topics, including:  

• Where are you seeing the industry shift?  
• We are seeing more emphasis on CAHPS and a deemphasis on maintenance – how do you see things evolving? 
• What kind of feedback are you getting from health plans and how is that affecting some of your decisions?  
• What are the implications of utilizing telehealth on quality metrics? 

Moderator:
Daniel Weaver, Vice President, Medicare & Medicaid Quality Programs
Gateway Health Plan

Frank Micciche, Vice President of Public Policy and External Relations
NCQA

Join esteemed panelists from the RISE Policy Committee as they break down current regulatory guidelines in the Risk Adjustment and Quality space. Hear a variety of perspectives discuss the real-world implications of telehealth guidance, the pending changes of Star Ratings and advice on staying compliant in an uncertain environment. 

Sean Creighton
Vice President of Federal Policy
Humana

Larry Bishoff
President
Laurence Bishoff & Associates

Dave Meyer
Vice President, Risk Adjustment and Quality
Cigna

J. Gabriel McGlamery, J.D.
Senior Health Care Policy Consultant
Florida Blue Center for Health Policy

Howard Weiss
Associate Vice President, Policy
EmblemHealth  

• Discuss the quality changes announced by CMS, understand the downstream implications and the impact of the rest of the calendar year on Star Ratings 
• Examine provider engagement/member engagement strategies as well as budgetary shifts that can positively impact your quality performance moving forward  
• Hear a case example of how one health plan is shifting in the second half of this year / early next year including insights from their “welcome back” strategy 

Will Dukes, Director of Business Development
iCare Intelligence, Inc.

Daniel Weaver, Vice President, Medicare & Medicaid Quality Programs 
Gateway Health Plan

Anticipating a Risk Score Deficit in 2020 and beyond? Well, you’re not alone. Join your peers to benchmark best practices, share tips and strategies in how AI Analytics and other technologies can help close diagnosis and coding gaps. This will be an interactive idea exchange session with other attendees, so, please come ready to ask questions, share challenges in capturing condition shortfall this year and take home tactical ideas to improve your risk capture for 2020 dates of service and beyond. 

Session Leader:

Bryan Lee, Vice President of Payer Solutions
Apixio

Co-presenter to be announced 

• Hear progress, challenges and lessons learned from one health plan’s innovative partnership with their primary care providers  
• Learn how these win-win arrangements can be operationalized and hear what the feedback from providers has been  
• Gain insights in how real-time, concurrent code review can optimize revenue streams for both parties and reduce RADV audit risk for your health plan 

Kristen Viviano, MHA, CPC, CRC 
Manager, Risk Adjustment Coding Operations
Capital District Physicians’ Health Plan

• Learn how one health plan is leveraging novel sources of data to inform, improve and advance SDoH efforts 
• Gain insights into the operational challenges, successes and outcomes of pilot projects focused on a longitudinal patient record  
• Hear results from pilot projects and discuss how similar projects can inform the future       

Anna Wetherbee, MBA, PMP
Principal, Technology Innovation and Integration
Blue Shield of CA

Dr. Stephen Klasko is a transformative leader and advocate for a revolution in our systems of healthcare and higher education. 

As president and CEO of Philadelphia-based Thomas Jefferson University and Jefferson Health since 2013, he has steered one of the nation’s fastest growing academic health institutions based on his vision of re-imagining health care and higher education. In his five years at the helm, Jefferson has grown from a one university campus-two hospital system to, after regulatory approval of the merger with Einstein health network, a two-university campus-18 hospital system with annual revenues of $6.1 billion and over 35,000 employees. 

After this talk, attendees will talk away with: 

• Lessons learned from Dr. Klasko’s book on “Un-Healthcare: From Sick Care to Health Assurance” 
• Insights into how COVID-19 has affected the healthcare landscape, including concrete tips for payers and providers to navigate the changes and prepare for the future  
• Tactical ways to redefine roles within the healthcare system to provide best-in-class patient care

Moderator:
RaeAnn Grossman, President
Bright Health Plan

Dr. Stephen Klasko, MD, MBA
President and Chief Executive Officer
Thomas Jefferson University and Jefferson Health