In this article we look at the sessions planned as part of the Risk Adjustment Strategies track, one of the scheduled tracks to take place at the annual RISE West conference, September 1-2, in Los Angeles. Upcoming articles will focus on the other tracks: Quality, compliance/regulatory updates, payer/provider alignment, the intersection of risk adjustment, quality, and population health.
Risk adjustment analytics
Jonas Foit, senior vice president, analytics and reporting, Cotiviti, Inc. and Andres Aguirre, MPH, QI director, Sharp Health Plan, will present the session, Gap identification to dynamic interventions: Climbing the risk adjustment analytics curve to intelligently target members and achieve premium accuracy. Participants will learn how their organizations risk adjustment analytics capabilities compare to their health plan peers according to the latest industry benchmark data. Foit and Aguiree will also offer practical steps to implement a more dynamic, analytics-driven appropriate to prioritizing and prescribing interventions for member populations. They’ll also help attendees understand what it means to deconstruct data silos to enable aggregated insights and comprehensive gap closure efforts across risk adjustment and quality (HEDIS®/Stars) programs.
Member health outcomes
A panel of industry experts will explain “the trifecta approach to improving member health outcomes.” Panelists include Ana Handshuh, principal, CAT5 Strategies, and Gregory Pastor, managing director of risk adjustment operations, Advantasure. Additional panelists will be announced shortly. Elaine Taverna, senior vice president, risk adjustment and quality, Advantasure, will moderate the session that will focus on the key sources of data needed, an integrated approach to business operations, and a multi-year strategy.
Learn the keys to setting up a program for concurrent coding, including benefits, costs, and setting up the internal infrastructure to support it with speakers Susan Waterman, RHIT, CCS, CPC, CRC, director of risk adjustment, Scott and White Health Plan, and Laura Sheriff, RN, MSN, CPC, CRC, contracting risk adjustment specialist. They’ll dig into the compliance aspects of concurrent coding and what to avoid and will also discuss what’s working and what’s not working for health plans.
Akash Patel, CEO, Advantmed, and Meredith Diep, LA Care, will lead a discussion on how to measure what matters in risk adjustment. They’ll discuss key KPIs and how to measure them, changes in KPI and their impact on the overall program, and learn how to measure the impact of EMR integration and NLP.
A panel will discuss the importance of leveraging point-of-care diagnostics for provider engagement and telehealth care planning. Panelists include Archita Sood, chief medical officer, Homebase Medical; Ryan Dodson, risk adjustment coordinator, Choice Medical Group; and Mark Ishimatsu, director, enterprise risk adjustment strategies/initiatives, L.A. Care Health Plan. Moderator John Romans, CEO, Biomedix, will navigate the discussion on the use of multi-modality testing results for care management, how to enact care management on members with chronic conditions, and how to leverage the analytics platform to consolidate testing data for RADV audit support.
Participants will learn how three health plans target providers and members for interventions. Jill Strassler, vice president solutions management, Pulse8, and Lynn Kryfke, executive director health plan clinical services, Children’s Community Health Plan, will discuss the “stranger things about risk adjustment.” They’ll share lessons learned and how to engage providers through transparent alignment strategies and education.
During this panel discussion, attendees will discover opportunities for efficiency and alignment between risk adjustment and quality departments. Panelists will include Amy Smith, director, provider enablement, Sentara Health Plans, and JoJuan Rowe, RHIT, manager of Medicare Risk adjustment, Arkansas Blue Cross Blue Shield. The discussion, moderated by Dawn Carter, director, product strategy, Centauri Health Solutions, will focus on how to find interdepartmental efficiencies among risk adjustment and quality to make the most of your data, reduce provider outreach, and enhance member experience. Attendees will hear case success stories of health plans with integrated departments, and the types of data management and analytical tools that help centralize and consolidate initiatives.
RISE West 2022 will take place September 1-2, with preconference workshops on August 31, at the InterContinental Los Angeles Downtown. Proof of a negative COVID-19 test or proof of vaccination is required to attend the live event. Click here for the complete agenda, roster of speakers, registration information, and our health and safety protocols.