RISE will offer two full-day and three new half-day workshops on Monday, March 6 prior to the kickoff of RISE National 2023. The preconference workshops will address risk adjustment, HCC audits, payer-provider connections, and member-centered health plans.

In addition to two days of learning and networking at RISE National 2023, attendees have an opportunity to register for one of five preconference workshops that will take place on Monday, March 6 at The Broadmoor Resort in Colorado Springs. Look at what we’ve planned:

Full-day workshops

Workshop A, The Risk Adjustment Practitioner, is a RISE National favorite. Instructors will go over the essentials of and differences between Medicare Advantage, commercial, and Medicaid risk adjustment; the calculations of risk scores; different payment models; the use of data and predictive analytics; tools for data accuracy; the transition from RAPS to EDS; provider engagement strategies; risk adjustment vendor selection and ongoing management; RADV audit preparation; and potential changes to risk adjustment. The session will take place 9 a.m. to 3 p.m. and will be led by Laura Sheriff, R.N, MSN, vice president operations, risk adjustment, Southwestern Health Resources, and Susan Waterman, RHIT, CCS, CPC, CRC, AHIMA ICD-10-CM/PCS, trainer, director, risk adjustment, Baylor Scott & White.

Workshop B, Advanced HCC Auditor, will also take place from 9 a.m. to 3 p.m. This popular workshop focuses on HCC coding accuracy and is designed for those who are directly involved in HCC coding work as well as finance and analytics professionals. Instructor Colleen Gianatasio, clinical documentation integrity and coding compliance, Capital District Physician’s Health Plan, will provide best practices and case examples, regulatory compliance, how to optimize the accuracy of the information gathered and submitted at the practice level. Participants will leave with an understanding of how HCC codes map to risk adjustment scores, a single coding and documentation process for risk adjustment, skill development on choosing diagnoses from portions of the encounter (permitted and not permitted) and clinical documentation barriers for risk adjustment purposes (data validation audit risks).

Half-day workshops

Learn the latest developments in risk adjustment enforcement, compliance, and agency actions and what your organization should be doing now to prepare. During Workshop C, participants will learn about key risk areas based on developing cases and agency audits; receive an update on active and settled cases, lessons learned, and most critical takeaways; learn about the impacts to value-based contracting, risk adjust operations (both at the health plan and medical group level), and incentive programs/pay for performance; and discuss questions related to auditing, monitoring, and overpayments. The workshop will take place from 1 p.m. to 4 p.m. and will be led by Jason Eric Christ, J.D., attorney, Epstein Becker Green, and David Meyer, CCO, Applied Research Works/Cozeva and advisor, EBG.

RISE National 2023

Workshop D, A new GPS: Navigating payer provider connections on the road to better outcomes is a four-hour class that will be split into three sections and led by different instructors:

The first section will discuss the alignment of program objectives, including risk and quality analytics objectives and KPIs and guiderails to mitigate risks and audits. David DeHommel, managing director of risk adjustment, BCBS of Michigan, and Scott Stratton, chief data scientist, Veradigm Payer Analytics, will lead this section of the workshop.

Next, participants will learn how to engage providers where they are. Bruce Waugaman, risk adjustment leader, EmblemHealth, and Meghan West, senior manager, product management & solution management, Veradigm Payer Analytics, will lead the discussion. Topics will include facilitating gap closure at the point of care, driving improved clinical models that result in higher quality of care, and member-centric approaches to decrease disparities and focus on the whole cost of care.

The final section will address submissions. Lisa Pouncey, director of product management & solutions management, Veradigm Payer Analytics, will discuss the best approach to linking supplemental records to encounters, as well as best practices for unlinked, deletes, and void. She’ll also explain what your encounter errors can tell you about your HEDIS® readiness, and introduce APCD, a new direction for patient information.

The workshop will take place from 12 p.m. to 4 p.m.

Workshop E: Creating member-centered health plans: Innovations to future-proof your success will also take place from 12 p.m. to 4 p.m. This workshop is designed for attendees who are responsible for risk adjustment, quality, social determinants of health (SDoH), finance, and analytics to improve complete and accurate risk adjustment practices through the pursuit of high-quality clinical care. The session will focus on the business case for integration, analytical models, and innovative interventions, and designing and implementing compliant programs. A team of risk adjustment and quality experts will lead this workshop, including: John Criswell, founder, CEO, chairman, Porter; Melissa Smith, EVP, consulting & Professional services, Healthmine; Ana Handhsuh, principal, Cat 5 Strategies; Dr. Shannon Decker, principal, VBC One; Liz Haynes, DVP, risk adjustment & stars-government programs, Blue Cross and Blue Shield of Kansas City; Daphne Klausner, plan president, Honest Medical Group; Alyson Spencer, senior director, clinical quality, Blue Shield California; and Ally Thomas, Ph.D., AVP, quality improvement, UPMC Health Plan. 

RISE National 2023 is the #1 trusted source for all things Medicare Advantage, crossing a variety of topics and themes from risk adjustment and quality to member experience and social determinants of health. This year’s event will take place March 7-8 at The Broadmoor Resort in Colorado Springs with the preconference workshops on March 6. Separate registration and payment are required for preconference workshops. Click here for the full agenda, roster of speakers, and registration information.