March 11-13, 2018 | Omni Nashville Hotel
Advancing Risk Adjustment, Quality Improvement, Predictive Analytics and Compliance Initiatives
2017 RISE Nashville Street Party
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Contents Table of Contents
What is RISE Nashville?
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Featured Speakers
3
Pre-Conference Workshops
4
Agenda at a Glance
5
Track A: Risk Adjustment
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Track B: Quality 360
10
Track C: Care Outcomes
11
Track D: Data Analytics
12
Track E: Compliance
13
Track F: The Payer-Provider Connection
14
Track G: 2018 & Beyond
15
Registration
16
Sponsors
18
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WHAT IS RISE NASHVILLE?
The RISE Nashville Summit convenes the best and brightest thought-leaders in the industry. Focused on professional growth and positive industry outcomes, this allencompassing summit has been carefully designed to educate, develop and connect our attendees.
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Featured Speakers Meet Dr. Peter Salgo, Our Keynote Presenter
Dr. Peter J Salgo Healthcare Futurist and Medical Crisis Expert Dr. Peter Salgo - an experienced medical correspondent, professor, and practicing physician - is one of this country’s most respected healthcare futurists. Educated at Columbia University and Columbia University College of Physicians, Dr. Salgo practices Anesthesiology and Internal Medicine at Presbyterian Hospital in New York City and teaches Anesthesiology and Internal Medicine at his alma mater.
J.R. Martinez In March of 2003, Jose Rene “J.R.” Martinez was deployed to Iraq. In April, he sustained severe burns to over 34 percent of his body when his humvee hit a roadside bomb. Since his recovery, Martinez has since become a highly sought-after motivational speaker, travelling around the country speaking about his experiences to corporations, veterans’ groups, schools and other organizations.
Naomi Judd Singer, songwriter, actress, activist, and author of “River of Time: My Descent Into Depression and How I Emerged with Hope”
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Pre-Conference Workshops Sunday, March 11, 2018
WO R KS H OP A
WORKS HOP A
WORKS HOP B
Foundations of Risk Adjustment
Foundations of Risk Adjustment
HCC Coding Accuracy
WO R KS H OP B
WORKS HOP C
WORKS HOP C
Social Determinants: The Nuts & Bolts
Social Determinants of Health: The Nuts & Bolts
Stars and Quality Primer
WO R KS H OP D
WORKS HOP D
WORKS HOP E
Stars and Quality Primer
Innovative Risk Adjustment Technologies
Innovative Risk Adjustment Technologies
D AY O N E : M O N D Track A: Risk Adjustment
Track B: Quality 360˚
7:45 Registration & C
8:30 Co-Chair’s Welcom
8:40 Opening Keynote Address
9:30 Dr. Martin Block RISE L
9:40 Morning Ne
9:55 Featured Address: Survival, Perseverance an
10:45 CMS P
RAF Capture and Compliance: How Technology Enables Accurate and Complete Risk Adjustment
Lessons Learned on Reaching the Top & Stay on Top: 4 & 5 Star Panel
11:
12:15 Network
12:25 Featured Lunch Panel: W
Winning Strategies for the New Era of Risk Adjustment
Optimizing Results Across Your Risk Adjustment and Care Management Programs: Successfully Managing Your Organization’s “Portfolio”
Deep Dive – Real Examples of How to Actually Close the Gaps
Session TBA
1:3
2:2
3:05 Afternoon N
D AY, M A R C H 1 2 Track C: Care Outcomes
Track D: Data Analytics
Continental Breakfast
me and Opening Remarks
s: The Next Phase of Healthcare
Lifetime Achievement Award
etworking Break
nd the Integral Role of the Healthcare Professional
Policy Update
:30
Case Study: Optimizing Comprehensive Care Coordination and Improving Outcomes Through InHome Care Management
Data Patterns and Predictive Magic: How to Improve Suspecting and Chart Valuations
king Luncheon
Women in Healthcare Leadership
30
Bringing Innovative Diabetes Care to Patients in Need: Combining Quality Strategies and Risk Adjustment
Demystifying Machine Learning - A Tool to Simplify Complex Member Data and Launch Effective Risk Adjustment Campaigns
20
Engaging Your Members in a New Era of Communication
Addressing Payer Challenges with Clinical Lab Results
Networking Break
Medicaid Risk Adjustment Optimization
The Most Difficult Star: Using TeleHealth Solutions to Raise Your Diabetic Retinopathy Star Rating
3:2
4:10 “Choose Your Own Adv
5:15 Cockta
D AY T W O : T U E S Track A: Risk Adjustment
Track E: Compliance
8:00 Network
9:00 Co-Chairs’ Day Two Wel
9:10 Featured Panel: Providers Unplugged - Optimizing Medicare
10:25 Morning N
10:40 Spotlight Address: Overcomin Building a Compliant Risk Adjustment Program with Artificial Intelligence
RADV Drill Down
11:
12:20 Network
Don’t Fear the Audit: Using NLP Enabled Technology to Increase Coding Accuracy, Validate Claims Submissions, and Ensure Risk Adjustment Compliance
A Balanced Coding Approach and Its Impact on Plan and Provider Initiated Programs
1:3
2:15 Afternoon N The Next Generation of Innovation for Risk Adjustment and Quality Improvement Programs
Compliance/Audit-Readiness: Retrieve and Code Like Everyone Is Watching
2:3
3:15 Conferen
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Moving the Needle: Finding and Connecting with High-Risk, Dually Eligible and SNPs Members
Risk Adjustment Analytics
venture” Roundtables Part 1
ail Reception
S D AY, M A R C H 1 3 Track F: Payer-Provider Connection
Track G: 2018 and Beyond
king Breakfast
lcome and Recap of Day One
e Advantage Performance with Delivery System/Payer Alignment
Networking Break
ng the Challenges of Mental Health
:35
Strategies Every Plan Should Use to Improve Network Performance
Building a Medicare Advantage Solutions Company A Health Plan Case Study
king Luncheon
30
Understanding and Using Social Determinants of Health to Improve Outcomes – The Power of PayerProvider Collaboration
Using Health Value Management to Improve Member Health Status: An Interactive Discussion
Networking Break
30
Medicaid Member Engagement Approach & Quality Improvement
nce Concludes
Data Visualization: Unlocking Where You’ve Been, Where You Are, Where You Need to Go and How to Get There
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Track A: Risk Adjustment Medicare Advantage, Commercial, and Medicaid Essentials
FEAT URED S PEAKER
Dave Meyer, Vice President, Risk Adjustment, Scan Health Plan
FEAT URED S ES S IONS
RAF Capture and Compliance: How Technology Enables Accurate and Complete Risk Adjustment Rebecca Welling, RHIT, CCS-P, Director Coding Compliance, Providence Health Plan Anand Shroff, Founder and Chief Development Officer, Health Fidelity
Winning Strategies for the New Era of Risk Adjustment Eric Livingood, Director, Medicare Advantage, Blue Cross Blue Shield of Tennessee Lisa DiSalvo, Senior Vice President of Strategic Development, CenseoHealth
Don’t Fear the Audit: Using NLP Enabled Technology to Increase Coding Accuracy, Validate Claims Submissions, and Ensure Risk Adjustment Compliance Wendy Payne, Director, Risk Adjustment Programs, Medical Mutual Marilyn Garry, RN, BSHA/HM, CPC, CRC, BLS, ACLS, Senior Director, Risk Adjustment & Quality, Talix
The Next Generation of Innovation for Risk Adjustment and Quality Improvement Programs Dave Meyer, Vice President, Risk Adjustment, Scan Health Plan Doug Loop, Senior Vice President, Strategy & Finance, Advantmed
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Track B: Quality 360˚ Star Ratings, HEDIS, and CAHPS Deep Dive
F EAT URED S PEAKER
Ana Handshuh, Vice President, Managed Care Services Ultimate Health Plans
FEAT URED S ES S IONS
Lessons Learned on Reaching the Top and Stay on Top: 4 & 5 Star Panel Jane R. Elliott, RHIA, MHSA, CPHQ, Executive Director of Quality Management, Health Alliance Renée Golderman MS, RN, NE-BC, Vice President, Health Care Quality, Capital Districts Physicians’ Health Plan Karen Manning, Director, Strategic Quality Programs, Martin’s Point Health Care
Deep Dive – Addressing the Most Difficult to Move Measures The Most Difficult Star: Using TeleHealth Solutions to Raise Your Diabetic Retinopathy Star Rating Dr. Richard Bernstein, Consulting Medical Director, Oscar Health Sy Zahedi, President and Chief Executive Officer, MedXM
Achieving Quality Improvement with Advanced Population Health Analytics & Intelligence Strategies Danielle Reno, Director, Data Strategy & Integration, Sutter Health
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Track C: Care Outcomes Delivery Coordination, Member Engagement and High-Risk Populations
FEAT URED S PEAKER
William G. Wood, MD, PhD, Managing Medical Director, Anthem
FEAT URED S ES S IONS
Case Study: Optimizing Comprehensive Care Coordination and Improving Outcomes Through In-Home Care Management William G. Wood, MD, PhD, Managing Medical Director - Medical Management, Behavioral Health, Government Business Division, Anthem Kevin Kearns, MD, Chief Medical Officer, Advance Health
Bringing Innovative Diabetes Care to Patients in Need: Combining Quality Strategies and Risk Adjustment Elizabeth Bainter, RN, BSN, Vice President, Clinical Quality Improvement, Pacificsource Health Plans Aerste Howells, Senior Vice President, Sales, Matrix Medical Network
Engaging Your Members in a New Era of Communication Amy Swanson, Vice President of Marketing, Advocacy and Member Experience, UnitedHealthcare Erin McEvoy, Director of Communications, Health Partners Plans
Moving the Needle: Finding and Connecting with High-Risk, Dually Eligible and SNPs Members Deltreice Gates, State Public Programs/ Community Relations Manager, Blue Cross Blue Shield Minnesota Karin VanZant, Executive Director of Life Services, Caresource
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Track D: Data Analytics Meaningful Data, Effective Analytics and Predictive Modeling
F EAT URED S PEAKER
David Costello, PhD, Chief Analytics Officer Verscend
FEAT URED S ES S IONS
Data Patterns and Predictive Magic: How to Improve Suspecting and Chart Valuations David Costello, PhD, Chief Analytics Officer, Verscend Jessica Althouse, Director, Risk Adjustment, Presbyterian Health Plan/Presbyterian Insurance Company
Demystifying Machine Learning - A Tool to Simplify Complex Member Data and Launch Effective Risk Adjustment Campaigns David Costello, PhD, Chief Analytics Officer, Verscend Erik Simonsen, Chief Operating Officer, Episource Donna Malone, CPC, CRC, Senior Manager Enterprise Risk Adjustment Coding, Quality Assurance & Provider Education, Tufts Health Plan
Addressing Payer Challenges with Clinical Lab Results Jason Bhan, Co-Founder & Chief Medical Officer, Prognos Ana Handshuh, Vice President, Managed Care Services, Ultimate Health Plans
Risk Adjustment Analytics
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Track E: Compliance Best Practices and Audit-Prep
FEAT URED S PEAKER
Ryan C. Dodson, CRC, Director of Risk Adjustment Northern California Physician Network
FEAT URED S ES S IONS
RADV Drill Down Tom Nasadoski, MBA, Manager, Risk Adjustment, Capital District Physicians Health Plan
A Balanced Coding Approach and Its Impact on Plan and Provider Initiated Programs Tim Burke, National Vice President, Comprehensive Health Assessment Programs (CHAPs), DaVita Medical Group Biggs Cannon, Senior Managing Director, FTI Consulting
Compliance/Audit-Readiness: Retrieve and Code Like Everyone Is Watching Ryan C. Dodson, CRC, Director of Risk Adjustment, Northern California Physician Network Matt Streiff, ASA, MAAA, Director of Actuarial Services, WPS Health Solutions Dawn Carter, Director of Product Strategy, Centauri Health Solutions Monica M. Watson, RHIA, CPC, CCS, CCS-P, CPMA, CIC, CRC, CDEO, AAPC Fellow AHIMA ICD-10-CM/PCS Trainer & Ambassador, Director of Coding Services, Centauri Health Solutions
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Track F: The Payer-Provider Connection Collaborative Strategies
F EAT URED S PEAKER
Dr. Amy Helwig, Chief Quality Officer, UPMC
FEAT URED S ES S IONS
Strategies Every Plan Should Use to Improve Network Performance: A Holistic Approach to Provider Engagement Across Risk Adjustment and Quality Stephanie Will, Senior Vice President, Risk Adjustment, Optum
Understanding and Using Social Determinants of Health to Improve Outcomes – The Power of Payer-Provider Collaboration Merrill Friedman, Vice President, Advocacy Government Business Division, Anthem William G. Wood, MD, PhD, Managing Medical Director - Medical Management, Behavioral Health, Government Business Division, Anthem Dr. Amy Helwig, Chief Quality Officer, UPMC Karin VanZant, Executive Director of Life Services, Caresource
Provider Engagement: A Look at the Big Picture Colleen Gianatasio, Risk Adjustment Quality & Education Program Manager, Capital Districts Physicians’ Health Plan Shannon Decker, MEd, MEd, MBA, MBA, PhD, Executive Director, Risk Adjustment, NAMM California, Optum, UnitedHealth Group
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Track G: 2018 & Beyond State of the Industry, Emerging Trends & Preparedness Tools
FEAT URED S PEAKER
Deirdra Yocum, Senior Vice President, Quality and Population Outcomes Caresource
FEAT URED S ES S IONS
Building a Medicare Advantage Solutions Company - A Health Plan Case Study Dr. John Fong, Senior Vice President, Medical Management & Chief Clinical Officer - Emerging Markets - Shared Services, Blue Cross Blue Shield Michigan Eric Cormier, Chief Operating Officer, Tessellate
Using Health Value Management to Improve Member Health Status: An Interactive Discussion Adele Allison, Director, Provider and Payment Innovation Strategies, DST Health Solutions Deirdra Yocum, Senior Vice President, Quality and Population Outcomes, Caresource
Data Visualization: Unlocking Where You’ve Been, Where You Are, Where You Need to Go, and How to Get There Kris Volrath, Associate Vice President, Products, Inovalon Ron Purisima, Director, Quality Improvement, Gateway Health Plan
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Interested in Registering? Talk to Whitney Whitney Betts (704) 341-2445 wbetts@healthcare-conferences.com
Downtown Nashville
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Sponsors A Special Thank You to Our Platinum Sponsors