As regulatory pressures intensify and the demand for measurable ROI grows, health care organizations are rethinking how they approach risk adjustment. The landscape is shifting—from retrospective reviews to real-time, proactive strategies powered by smarter technology and deeper clinical insight.
In this 38-minute episode of RISE Radio, senior leaders from Cotiviti and Edifecs share how their recent partnership is fueling a new era of innovation across the full risk adjustment lifecycle. From Medicare Advantage to Medicaid and ACA markets, they explore how scalable tech, strategic foresight, and clinical expertise are helping organizations stay ahead of compliance demands and financial pressures.
About the speakers
Branka Sustic, vice president of risk and quality solutions, Cotiviti, provides leadership and oversight into product and business development, client program management, and strategy to assist health plans in meeting their quality and risk adjustment goals, optimization of revenue, and risk mitigation. She is a leader with more than two decades of health care experience, blending a strong customer service and analytic foundation with experience leading change management throughout her career. Sustic is known for creating and establishing operational and support plans leading to increased client satisfaction and performance.
Dr. Summerpal Kahlon, chief medical officer at Edifecs, a Cotiviti business, works across products and functions to guide clinical strategies and policies. His career spans over 20 years of experience in diverse health care settings, businesses, and markets. Dr. Kahlon has deep expertise in value-based care and risk adjustment, and brings unique insight to help customers make the most comprehensive, informed, and clinically relevant decisions for their populations. He is a practicing physician with Veterans Affairs and an assistant professor of internal medicine at the University of Central Florida.
Cotiviti is a leading solutions and analytics company that is reshaping the economics of healthcare, helping its clients uncover new opportunities to unlock value. Cotiviti’s solutions are a critical foundation for health care payers in their mission to lower health care costs and improve quality through higher performing payment accuracy, quality improvement, risk adjustment, consumer engagement, and network performance.