RISE News Nยบ2 - AUTUMN 2018
Getting Excited for 2019 yet? Get a Sneak Peek Into RISE Nashville.
Want the opportunity for your voice to be heard? Sign Up for User Groups.
SUMMARY 3
The Latest News
4
Taking Charge: RISE Nashville Sneak Peek
6
Growing with You in Mind: Note from the Director
6
Webinars To Watch
6
User Group Sign-Up
7
Highlighted Overview: RISE West 2018
8
Save The Date
2
NEWS THE LATEST Pre-Emptive and Analytics-Based Early Action Can Improve Quality of Life Early intervention is the key to slowing or stopping chronic kidney disease (CKD), improving the quality of lives for those at risk and containing health plan costs. Avoiding dialysis for just one member represents a health plan savings of $350,000 to $700,00 per year, which more than pays for the CKD program by itself. A well-reasoned, proactive kidney disease management program is a necessity, not a luxury, write representatives from Advanced Plan For Health. READ MORE
3 Strategies to Engage and Activate Hard-to-Reach Members Engaging your members in their health is easier said than done. Members move, prioritize other “to-dos” over wellbeing activities, and frequently ignore communications. Here are three proven ways from Welltok to improve engagement with hard-to-reach members while also saving valuable resources. READ MORE
RISE West 2018: OIG Official Provides Insight on the Potential of MA Encounter Data Among the findings of the OIG report: The most common errors involved duplicated services, incorrect original control numbers, inappropriate codes, and missing values from other data. READ MORE
A Look at How Partnerships, Tools Can Improve Your Risk Adjustment Program This article recaps a RISE West 2018 session about the success that Brown & Toland Physicians have had with three partnerships that provided HCC Analytics, Natural Language Processing, and the Annual Health Assessment Program. READ MORE
Medicare Advantage and MACRA: Are you Ready for the All-Payer Combination Option? A fundamental change is well underway in health care payment models, with a shift toward value over volume. Read the full white paper from DST Health to find out if you are ready. READ MORE
The Biggest Changes in CMS’ Updated Medicare Communications and Marketing Guidelines A new definition of marketing, the addition of the term communications, and guidance for the pre-enrollment checklist are just a few of the changes that CMS has introduced in its updated Medicare Communications and Marketing Guidelines. READ MORE
RISE West: 3 Topics That Generated the Most Buzz More than 350 participants gathered at the La Quinta Resort & Club in Palm Springs to attend RISE West 2018, where they networked and learned tips to address risk adjustment, quality ratings, coding, financial compliance, and audit readiness. READ MORE
Rosy Forecast: Average Health Care Marketplace Premiums for 2019 Will Stabilize Two new reports show modest increases for average premiums on the health insurance exchanges next year. Another piece of good news: Insurers are expanding in new markets. READ MORE
Fate of ACA Now in Hands of Federal Judge U.S. District Judge Reed O’Connor has yet to render a decision on a high-profile case that centers on whether the Affordable Care Act is constitutional. READ MORE
RISE Institute: Make the Most of These Flexible Learning Opportunities to Advance Your Career Looking to expand your education but your budget doesn’t always allow you to travel to conferences and summits? Consider the programs offered by the RISE Institute. READ MORE
WA N T TO K N O W MO R E?
Click to see our entire collection of insights & articles
3
Newsletter Highlight
Taking Charge: The Future of Health Care
A SNEAK PEEK AT RISE NASHVILLE Registration is now open for the 13th Annual RISE Nashville Summit, a dynamic learning event that features eight tracks and more than 40 sessions for executives and senior managers from Medicare Advantage, Commercial, and Medicaid health plans, provider groups/integrated health systems and service providers from across the United States.
to vendors about the latest developments, and hear from the research perspective about the results of our different approaches to our work,” he says.
KEYNOTE SPEAKERS
In addition to networking, attendees will hear from keynote speaker John Medina, a developmental molecular biologist, researcher, The theme of the event, which will take professor and author of 10 books. His place March 17-19, 2019 at the Gaylord New York Times bestseller, “Brain Rules: 12 Opryland Resort, is “Taking Charge of the Principles for Surviving at Work, Home and Future of Health Care.” Session topics will address existing and emerging industry issues including risk revenue management, quality improvement, member engagement and care management, payer-provider collaboration, new technologies and advanced analytics, and policy updates. “This is the place to understand the inner workings of these programs, where finances and member experience are concerned,” says Conference Chair Nathan Goldstein, chief product officer, Signify Health. “One theme is around member engagement and how we get to a closer relationship with the beneficiary.”
“...this conference is a huge opportunity for people who work in risk adjustment and quality improvement”
School,” has been celebrated as the standard handbook on understanding the brain and optimizing its performance. He has spent most of his professional life as an analytical research consultant, working primarily in the biotechnology and pharmaceutical industries on research related to mental health. Medina Goldstein says that whether a participant also consults with hospitals and health is brand new to the industry or a seasoned care facilities on designing brain-healthy veteran, he or she will get something out of environments that reduce staff stress and improve patient outcomes. His presentation at the conference. RISE Nashville will focus on the aging brain.
COUNTLESS NETWORK OPPORTUNITIES
The summit attracts more than 1,200 participants each year. No other networking event in the industry compares to it, says Goldstein. “One of my ‘Dad’ jokes that I give at the podium is that this is the biggest gathering of people who understand what you do for a living,” he says. “There are tremendous amounts of networking opportunities. I will introduce 10 people to jobs. Networking can become a cliché. But can you think of a place that gathers more than 1,000 people who understand your value to your company?”
Motivational speaker Aron Ralston, an experienced climber and avid outdoorsman, will recount his five-day ordeal when he
became trapped between two boulders in a remote location of Utah. Ultimately, he freed himself by severing his own arm with a pocketknife. His New York Times best-selling book, “Between a Rock and a Hard Place” inspired the major motion picture, “127 Hours.” Dr. Kelly J. Clark, president of the American Society of Addiction Medicine, will also give a keynote presentation. Clark has focused her career on issues of addictive disease, evidence-informed behavioral health care, and payment reform. She has provided expertise about the opioid crisis to the Food and Drug Administration, Department of Justice, the Office of Comptroller General, Pew Trusts, and the National Safety Council.
HEALTH CARE HOT TOPIC PANEL New this year is an audience-driven discussion on health care hot topics. Goldstein will moderate a panel of health care experts and solution providers who will address questions submitted by attendees two weeks prior to the conference. This discussion will tackle challenges in the industry, including risk adjustment strategies, impact of government program reform, changes in audit protocols, innovations in technology, and implications from the 2019 call letter released by the Centers for Medicare & Medicaid Services. Panelists will include Creighton; Ana Handshuh, vice president, managed care services, Ultimate Health Plans; Dave Meyer, vice president, Stars, Cigna; and Jennifer Pereur, director of government programs, Hill Physicians Medical Group.
Speaker Sean Creighton, vice president in policy practice, Avalere Health, agreed. “It’s very important for people at the health plans to get together and talk to each other, talk
4
Newsletter Highlight
(cont.)
BREAKOUT SESSIONS Creighton says that the conference is a huge opportunity for people who work in risk adjustment and quality improvement to learn what’s happening in the industry, new developments in policies, and approaches to improving health plans in all phases of operations. The conference will feature more than 40 sessions within eight tracks on risk adjustment strategies; quality, accountability, and transparency; member engagement and care outcomes; data management and analytics; trends and developments; audit readiness and compliance; provider collaboration; and the future of health care.
“...hear from health care’s most influential technology and solution gurus”
ROUNDTABLE DISCUSSIONS & EXHIBITS
breakthrough technologies revolutionizing risk, quality, and related analytics for value-based care; advanced HCC audit preparations; advanced risk adjustment tactics, issues, and advice. The workshops are taught by people in the industry, he says, and the foundation sessions are meant to give newcomers to the industry a basic knowledge of risk adjustment.
The summit will also include 15 interactive, speed-dating type presentations on both days of the conference, so participants can hear from health care’s most influential technology and solution gurus who will present tools to help elevate your plan’s initiatives. A bell will ring three times during the special 60-minute Ilene MacDonald sessions, alerting participants to transition to Editor, the next roundtable of their choice. Attendees RISE will also be able to browse through the exhibit hall, which will feature more than 55 vendors that will display the latest technologies and solutions to help boost your plan’s risk, quality, EDITOR’S NOTE: and data management endeavors. Don’t miss your chance to attend RISE Nashville. For more information or to register, PRE-CONFERENCE WORKSHOPS click here. Creighton recommends that participants who are new to the industry attend one of the preconference workshops on Sunday, March 17. The workshops offered include a foundation of risk assessment; HCC coding accuracy;
5
DON’T FORGET TO SIGN UP! Don’t forget to sign up for a user group. Quarterly online user groups offer the opportunity for your voice to be heard. Everyone learns from each other through moderated in-depth conversations covering the topics you care most about. You also won’t want to miss our quarterly “live mic” meetups with community chairpersons.
SIGN UP
UPCOMING WEBINARS Engage Providers for Complete, Accurate Diagnosis Coding Tuesday, October 9, 1:30 PM EST
Boost Star Ratings: How to Use Business Intelligence Insights to Optimize Health Plan Operations Thursday, November 1, 1:30 PM EST
Real-World NLP: Capabilities, Results, and Measures from Risk Adjustment and Quality Thursday, November 8, 1:30 PM EST
Reducing Physician Burnout: Actions for Managed Care Organizations and Staff Thursday, November 15, 1:30 PM EST
NOTE FROM THE DIRECTOR
Kevin Mowll Executive Director, The RISE Association
GROWING WITH YOU IN MIND The RISE Association is building out services to better support health plans, provider organizations, sponsors, and other clients as part of our mission to serve the industry. As we grow, we learn that it is increasingly difficult to find certain types of talent for the kind of roles needed to succeed in today’s environment, including non-traditional roles with special knowledge of Medicare Advantage, HHS marketplace, quality and accountability that are only found in our industry. Secondly, it is also difficult to find training and education that fits these kinds of jobs, so you must rely on homegrown training using borrowed slide decks and procedure manuals. For that reason, we believe The RISE Association and The RISE Institute can help, since we are bringing together professionals in these kinds of roles when we hold conferences, run workshops, and provide e-learning tools. While we have a good idea about some of the needs and we try to fill them, we need better insight into where you are struggling most and where we might provide services and support to you beyond what we currently do. Please give us your feedback to help us zero-in on your pain points in finding talent to fill these jobs and identifying resources to properly train for these roles. We would appreciate your guidance regarding what you would find most useful. We would greatly appreciate a few minutes of your time to complete this brief survey to focus on areas and ideas that resonate most with you.
Give Your Feedback 6
HIGHLIGHTED OVERVIEW
WEST
How to successfully manage and survive a CMS/HHS-RADV audit
I
t is possible to survive a Medicare Advantage Risk Adjustment Data Validation Audit, according to Deb Curry, RHIA, CCS-P, manager, risk adjustment, of Promedica, who spoke at RISE WEST 2018.
Deb Curry, RHIA, CCS-P, manager, risk adjustment, Paramount Healthcare, an affiliate of Promedica, and a self-described “coding geek,” conducted a session at RISE West 2018 on lessons learned from past audits and best practices to minimize errors. Rest assured, she told participants, you will survive a Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) Audit. CMS conducts the audits to ensure the integrity and accuracy of the providers data submission to substantiate risk adjustment. The agency’s goal is to identify any discrepancy by comparing risk adjustment diagnosis data submitted by Medicare Advantage organizations via coded conditions, such as cancer, chronic encounters and claims against the data provided condition not captured year over year; and to CMS per the RADV audit. suspect or rule-out conditions in an outpatient setting (per coding guidelines these are only Her advice based on past audits: Establish acceptable during an inpatient stay). If doctors your internal team early. Although some have ruled out a condition before the definite organizations may turn to external vendors, diagnosis, it is not valid and the coder shouldn’t Curry said she prefers to use internal staff who have captured it, she explained. can help by conducting retrospective coding. They can also gain experience by auditing a Best practices to keep in mind for a future chart the way an auditor would. Once the coder audit include implementing a quarterly internal reviews the chart, Curry serves as the secondquality audit process. That means you should level review. She also suggests remaining establish an audit team now, Curry said. If you flexible because the CMS audit dates are often are unsure who to put on the team, Curry said subject to change. to consider who you would call if you needed to recover documents after a disaster. She The most common coding errors she has seen suggests the audit team include representatives include acute (critical) condition codes in an from compliance, finance, enrollment or member office setting, such as acute stroke or heart services, risk adjustment (coders, analysts), attack (Place of Service Code 11); infrequently actuarial, and a project lead/internal auditor.
But most importantly, she said, engage the provider community. Plans must work with them to make sure they code to the highest specificity and ensure documentation is accurate. Acceptable documentation must be clear, concise, consistent, complete, legible and signed. If signed electronically, it must include their first and last names and credentials. Otherwise, it won’t be acceptable. For more information on risk adjustment, consider attending the 12th Risk Adjustment Forum and/or RISE Nashvillle.
7
MMS
UPCOMING EVENTS
February 25 - 26, 2019 | Las Vegas, NV 2nd Annual RISE Symposium on Partnering to Address
SOCIAL DETERMINANTS OF HEALTH
January 28-29, 2019 | Fort Lauderdale, FL
MMS T h e
A n n u a l
Medicare Marketing & Sales Summit
Medicare Marketing & Sales Summit
Risk Adjustment Workshops
Interactive workshops designed for health plans and providers that include collaborative exercises and lectures from expert faculty.
1 2 t h
2018 October 29-30 | Baltimore, MD
SAVE THE DATE
March 17-19, 2019 | Nashville, TN
8
