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Agenda

Module #1
Tuesday, May 4, 2021: 10 a.m. ET – 12:00 p.m. ET
GHG Hands-on Interactive Workshop
Medicare Advantage Risk Adjustment & Revenue Management Innovations
Module #2
Tuesday, May 4, 2021: 1:00 p.m. ET – 5:00 p.m. ET
The Big Picture: Impact of Changing CMS Regulations, the New Administration and the Pandemic on Risk Adjustment & Revenue Management
1:00

Welcome & Introduction: How to Maximize Your Virtual Conference Experience

Roz Applebaum,Vice President, Conferences,Strategic Solutions Network

1:05

Advocacy, Legislation and Regulation for Risk Adjustment Flexibility

The COVID-19 pandemic continues to cause disruption and pose challenges for health care systems and their consumers. This session will provide a high level legislative and regulatory update that will encompass 2020 finalized changes impacting our industry in 2021 and beyond. While certain flexibilities have been granted to plans to deal with the unique challenges created by the pandemic, there continue to be outstanding issues that have not yet been addressed that will impact the future of the MA risk adjustment program. Join Aldiana Krizanovic as she provides an overview of key legislative and regulatory changes impacting the risk adjustment program as well as advocacy insight into how the health plan industry is working to address outstanding issues disrupting the stability of the MA risk adjustment program.

Aldiana Krizanovic,Senior Health Policy Consultant, Federal Government Relations, Florida Blue

1:30

Panel Discussion: Capitalizing on CMS’ Extension of the Risk Adjustment Submissions Deadline

Moderator:

Dawn Carter, Director Product Strategy, Centauri Health Solutions

Panelists:

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

Antonette Buenavides,Dir. Risk Adjustment Programs & Audit,,SCAN Health Plan

Matt Peterson,Executive Vice President, Client Success & Growth,Ciox Health

2:05

RADV Audit Survival “Kit”

What you need to know about RADV and WHY CMS audits

  • Financial Implications
  • Extrapolation Methodology
How YOU can be audit ready
  • RADV Playbook
  • Lessons Learned
  • Accurate Coding
  • Reducing Risk Mitigation Strategies

Deb Curry, MBA, RHIA, CCS-P, CRC,Manager, Risk Adjustment,Paramount Health Care

Expanding the Efficiency of Your Plan’s Foundation: Breaking Down Silos
2:25

Break

2:35

Integrating Risk Adjustment with Stars and Quality Strategies

  • Breaking the history of siloed programs
  • Integration of Data Assets – functional reporting to obtain Stars, Quality and HCC’s
  • Integrating common KPI’s and Leading Indicators to marry Stars, Quality and HCC opportunities
  • A case study of Diabetic Opportunities

Shawn Larsen, RN,Director of Stars Strategy & Risk Adjustment, Medicare, Allina Health Aetna

2:55

Leveraging Quality Improvement to Boost Risk Adjustment Performance Scores

Quality Improvement departments have been collaborating with Risk Adjustment departments to boost Quality scores for years, however the relationship between these departments should be bi-directional. Quality Improvement organizations have the ability to significantly impact Risk Adjustment scores. This session will explore ways that various Quality initiatives can bolster Risk scores by impacting provider engagement, simplifying member engagement, and streamlining processes to maximize program efficacy.

Dan Weaver,Vice President, Stars, Quality & Risk Adjustment, Gateway Health

Advanced Technology and Analytics Tools and Strategies
3:15

Interoperability: Bolstering Data Sharing with Providers that Supports Risk Adjustment & Quality

Network Health Risk Adjustment (RA) and Information Systems (IS) staff will discuss the need for provider-payer data exchanges to support revenue and quality initiatives.  Network has evaluated multiple data exchange platforms over the years with limited provider buy-in.  With the CMS payer to member interoperability deadline looming in July, Network has been considering ways to leverage FHIR data protocols to not only share data with our members, but also more efficiently exchange data with our providers.  Network’s IS experts will detail their vision for a comprehensive FHIR data storage infrastructure that will allow for the open exchange of claims, medical record and supplemental quality data.

Josh Weisbrod,Vice President, Risk Adjustment, Network Health

Diane Gabrielsen,Vice President, IS Delivery, Network Health

Bruce Kissinger,Solution Architect Director, Network Health

3:30

Panel Discussion: Digital Transformation, Technology Impact on Risk and Quality Programs

4:00

Augmenting Coding with AI and NLP to Exponentially Increase Efficiency & Minimize Outsourcing

4:20

Looking Ahead, Moving Forward - Innovative Health Plan Responses to the Challenges of COVID-19

The session will provide an understanding of the challenges posed by the COVDI-19 pandemic the stages set for future member engagement. We will cover: 1) The disproportionate effects of COVID-19; 2) Impact of Deferred Care from 2020; 3) The emergence and acceptance of digital health technologies. Additionally, we will be taking “A Look ahead to understand what plans should consider to successfully navigate post COVID-19 with a look at expansion and quality of delivery opportunities.” The session will conclude with a forward thinking perspective looking at some innovative solutions plans recently undertaken along with options to advance quality support to members and providers.

Craig Vretas,Vice President, Healthcare Solutions, Ameridial

Module #3
Wednesday, May 5, 2021: 10:00 a.m. ET – 12:00 p.m. ET
Telehealth and Risk Adjustment
10:00

Revamping Risk Adjustment with Telehealth

While the COVID-19 pandemic required nimble pivoting to provide member care, it also re-shaped health care delivery with the utilization of telehealth.  Telehealth has become a vital instrument in risk validation to preserve revenue targets.  This session will focus on key strategies to effectively utilize telehealth in supporting risk adjustment activities.

  • Discuss vendor utilization for capture rates
  • Review strategies for successful telehealth programs
  • Examine the impact of COVID-19 on telehealth

Jen Hayes,Manager of Quality, HEDIS & Coding,Highmark

Chart Review, Coding and Documentation to Boost Revenue
10:20

Case Study: Value-based Contracting to Optimize Revenue Streams Through Real-time, Concurrent Code Review -- A Win-Win Partnership Between a Payer and their PCPs

Value based contracting is becoming increasingly prevalent in the health care industry.  This session will focus on risk adjustment based contracting between payer and PCP in a network model.  Hear progress, challenges and lessons learned from CDPHP’s innovative partnership with their primary care providers and learn how these win-win arrangements can be operationalized.  Gain insights in how real-time, concurrent code review can optimize revenue streams for both parties and reduce RADV audit risk.

Tom Nasadoski, MBA,Director, Risk Adjustment and Recovery, Capital District Physicians’ Health Plan

10:40

Capturing Social Determinants of Health Using “Z” codes

Hospitals and health systems are desperately working to address the social needs of their patients as well as the social determinants of health within the communities that they serve.  This includes conditions such as food, housing, transportation, education, violence and more.  One way to do this is by using ICD-10_CM “Z” codes to capture the robust data related to patients’ social needs and those in the community.  Join us for this session to see what efforts are needed to improve the health of your patients and the community.  Find out ways to employ a standardized approach for screening, documenting and coding the social needs.  Most of all, come prepared to share what your company is doing to capture SDoH.

Wynda Clayton, MS, RHIT,Risk Adjustment Manager,Providence Health Plan

11:00

Break

11:10

RA Coding BEFORE the Patient Visit

HCC coding has traditionally been performed on a retrospective basis. This session will highlight how HCC coding can be performed prospectively, before the patient is seen and the benefits of doing this method.

Wendy Schmerse, CPC,Risk Adjustment Program Manager,AmericasHealth Plan

Provider Engagement, Education and Incentives
11:30

Provider Engagement Strategies to Achieve Accurate Coding & Documentation

This session will focus on at time of care technologies to assist with HCC capture activities. We will also cover the importance and difference between Payor and Physician incentives from both a Shared Savings/ VBR and Individual Program perspective. Last but not least review return on investment when investing in clinical staff to assist with provider engagement through clinical review and ongoing education and reporting.

Kelly Cupec,Manager, Strategic Risk Adjustment Programs,Highmark

11:50

Close of Conference