RaeAnn Grossman, EVP, Cotiviti, who co-chaired RISE National 2022 with Kevin Healy, CEO, Allymar Health Solutions, reflects on her experience at this year’s conference, which returned to Nashville as a live, in-person event for the first time since March 2019.

Conference co-chairs RaeAnn Grossman and Kevin Healy

Absence does indeed make the heart grow fonder. After a multi-year hiatus, RISE National returned as an in-person conference. And it’s not a stretch to say that everyone in attendance shared a greater appreciation for the privilege of gathering under one roof.

It was a pleasure to co-chair RISE 2022 with Kevin Healy, CEO, Allymar Health Solutions, and facilitate valuable discussions and challenge the health care community to do better and drive greater impact intelligently. I’d like to share my reflections on the themes that stood out during our time together in Nashville. Our goal is to empower thought leadership across the industry and enable risk adjustment excellence.

Protect the provider-patient relationship

“Getting back to the basics” was a common refrain of RISE 2022. There is nothing more fundamental in our industry than a patient and a doctor meeting in an exam room. Our health care system was placed under incredible strain over the past several years and more effort is required to protect the time physicians devote to patient care. A well-known study published in the Annals of Internal Medicine noted that primary care physicians spend just 27 percent of their time on care delivery. While we’re making great strides in interoperability and digital capture, basic improvements such as coordinating record requests for risk adjustment and HEDIS® that cross all lines of business can go a long way in reducing the administrative burden that’s burning out providers.

Use a playbook to limit OIG compliance audit exposure

RISE National attendees during the OIG presentation

Hearing directly from regulators is one of the greatest benefits of RISE National. The Office of Inspector General (OIG) update was the “viral moment” of RISE 2022 as many attendees continually referred to OIG’s remarks. Concerning as it was, the OIG presentation gives payers a playbook to limit risk adjustment compliance audit exposure. Here are a couple of best practices payers can act upon right now to avoid non-compliance and improve health outcomes:

  • Ensure follow-up care as part of your in-home or virtual health risk assessment (HRA) workflow. Diagnoses collected from HRAs that are the lone source of documentation or cannot be traced to follow-up care are a red flag to OIG and raise concerns that payers are simply inflating risk-adjusted payments.
  • Focus on commonly miscoded conditions. Historically, certain conditions have higher error rates than others. By performing targeted reviews and working with providers to validate such claims, payers can lower the risk of non-compliance.

RELATED: Live from RISE National 2022: Day one recap

OIG anonymously singled out one Medicare Advantage (MA) organization for its disproportionate use of chart reviews and HRAs to drive risk-adjusted payments. While questionable practices should be called out, payers acting in good faith by submitting deletes prior to an OIG compliance audit deserve credit for that work as regulators are calculating error rates.

Personalize the message

Keynote Nancy Messonnier, M.D. discusses COVID-19 and lessons learned 

The presentation on learnings from the COVID-19 pandemic delivered by Nancy Messonnier, M.D., was extremely insightful. In her closing remarks, Dr. Messonnier, who was the top respiratory disease official at the Centers for Disease Control and Prevention (CDC) at the start of the pandemic, lamented the challenge of fighting back against misinformation. She cautioned that the days of a single, trusted source such as the CDC or the White House informing on public health matters were over. Instead, she noted that public health officials and other organizations (e.g., payers), working to persuade individuals to make healthier choices, should focus on developing more personalized, localized messaging and identifying trusted members of the community to deliver those messages.

Personalized member engagement that resonates with the recipient is vital to moving our industry forward. Everything from at-home test kits to medication adherence campaigns to at-home HRAs must be personally and culturally relevant to make an impact.

Recognize there are challenges to SDoH data collection

Momentum to formally incorporate social determinants of health (SDoH) data into risk adjustment models is building. Recommendations as to how SDoH data collection can improve were solicited in the 2023 CMS Advance Notice. There are inherent challenges to SDoH data collection; chief among them is placing an even greater onus on providers by asking them to capture SDoH-related Z codes (Z codes ranging from Z55-Z65 are the ICD-10-CM encounter reason codes used to document SDoH data).

Expanded sources of data collection outside of the primary care setting by non-physicians deserve serious consideration, most notably in-home HRAs where information on variables such as fall risk and food insecurity are readily available.

Think big: Projects that start small can have a large impact

In breakout session after breakout session, we heard about bottom-up initiatives having an outsized impact. Agility is a catalyst for organizational transformation, and RISE National 2022 was a reminder that a small group of committed individuals can make waves.

RELATED: Live from RISE National 2022: Day two recap

There are more success stories than I can share, but I’d like to recognize my favorite example of a single idea blossoming to have a big impact. The Equity from End-to-End: Transformative Strategies to Power Impactful SDoH Programs session described a grassroots initiative with minimal upfront investment at Horizon BCBS of New Jersey. Horizon harnessed SDoH data to advance health equity goals and ease member care journeys. The program was extremely successful, and the organization made a significant investment to expand its application. Congratulations to Tracy Parris-Benjamin and the Horizon team on your success.

Thanks for reading. I look forward to seeing you all next year for RISE National 2023 at The Broadmoor Resort in Colorado Springs.

About the author

As executive vice president of operations for population health management, risk adjustment, and quality, RaeAnn Grossman is responsible for leadership and management oversight of financial performance and operations, as well as innovation, vision, strategic and business planning. In this capacity, she is reframing and accelerating the success and impact of Cotiviti’s industry-leading risk adjustment, quality and stars, network and clinical analytics, and consumer engagement solutions focused on health plan success, health equity and outcomes, and provider performance. With her extensive track record of customer focus, value creation, along with government program and industry experience, Grossman drives the Cotiviti portfolio to improve financial and clinical metrics, reduce the cost of care, and create a landscape for health equity.