Aired: September 26, 2023
Veradigm discusses how Medicare Advantage (MA) risk adjustment is experiencing a big shift. On March 31, CMS finalized the 2024 Medicare Advantage (MA) capitation rates and payment policies and made significant changes to the new HCC model (Version 28) that will be phased in over the next three years.
Aired: September 14, 2023
Signify Health discusses best practices to drive appropriate utilization enables Health Plans to share risk, avoid high-cost services, and increase preventive care. By aggregating providers under an MA risk-based contract, Health Plans can enable even the smallest providers to succeed by capturing high need member populations across difficult to reach provider groups.
By integrating In-home health evaluations into a care continuum where stakeholders are incentivized around aligned quality and performance goals, health plans can deliver coordinated end-to-end care management that drives quality outcomes, improves engagement, with a better member experience.
Aired: August 31, 2023
Navina discusses their strategies for accurately assessing patient complexity, managing regulatory changes such as HCC V28, streamlining workflows across both clinical and coding teams, and boosting patient and provider engagement.
Aired: July 27, 2023
Centauri Health Solutions discusses that now CMS has released the 2022 HHS-RADV Protocols, it is time to dive into the major changes and how these changes will impact the provider, the health plans, and the coders. The major change that is going to have the most impact is the removal of the Lifelong Permanent Conditions list.
Aired: July 20, 2023
Episource discusses how interoperability and data-sharing across healthcare entities are coming, whether or not your organization is ready for it. But many healthcare organizations are finding the migration to full interoperability to be challenging and expensive. If you’ve run into obstacles on the road to interoperability, you might benefit from a different approach. A staged process ensures minimal disruption to existing workflows and builds confidence in being able to share data more widely.
Aired: July 13, 2023
Wolters Kluwer discusses the best practices, strategies, and tips to ensure your organization survives the next inevitable RADV audit.
Aired: July 06, 2023
Episource discusses improving retrospective strategies for risk adjustment has always been a top priority for many healthcare organizations, however, measuring member health will become more difficult over time as more beneficiaries enter the market. It's crucial, now more than ever, that health plans and provider groups are prepared to use all the tools at their disposal, including a strong prospective strategy.
Aired: June 13, 2023
Vatica Health discusses as the regulatory pressure mounts, health plans face challenges that impact the operations, compliance, and results of their risk adjustment and quality programs. While it is now becoming evident that primary care physicians should be at the center of risk adjustment initiatives, PCPs are inundated with too many programs and too few resources.
Aired: June 01, 2023
Advantmed discusses how to discover ways to collaborate with other internal departments to understand what initiatives are already in place regarding regulatory and quality improvement activities. Review existing quality initiative requirements by product line, learn how to partner with existing efforts to reduce duplication, and discuss the data required to meet multiple quality reporting needs with upcoming digital measure format and data collection considerations.
Aired: May 23, 2023
The CMS rule changes have a similar effect on Risk Adjustment as stormy weather has on the world’s oceans. But calming the ROUGH “C”s is possible thanks to modern approaches coupled with technology like Digital Retrieval, AI, and NLP, to make for smoother sailing ahead.
Topics at a Glance:
Aired: May 16, 2023
To assess current satisfaction trends, challenges, and unmet needs related to the U.S. healthcare system, LetsGetChecked conducted a nationally representative survey that analyzed primary data trends. The comprehensive research report reveals key themes around the impact that social determinants of health (SDoH) have on healthcare access, including geographic factors. Among many pain points, rural and suburban respondents reported they were 31% more likely to forgo care due to commute than those in urban areas.
Join LetsGetChecked Chief Medical Officer, Dr. Robert Mordkin, and SVP of Payor Solutions, Addison Giannini, to learn more about how at-home solutions can address geographic barriers in your population and close gaps in care.
Aired: April 27, 2023
This webinar was continuing the interactive discussion we started at RISE National 2023 about data hygiene and the importance of performing a holistic assessment of data and revenue leakage as part of an overall data governance strategy for risk adjustment using a “leaky hose” metaphor, with the claims universe being the “faucet” end of the hose and risk adjustment operations being the “nozzle” end of the hose. Our discussion included many of the typical reasons for the holes in the hose that cause risk adjustment data and revenue leakage, and an overview of how to address them. We also discussed the need for both concurrent and retrospective data governance strategies to manage leaks, and how to empower providers related to non-clinical improvement activities designed to prevent and address leaks.
Aired: April 11, 2023
When it comes to AI and your member experience, we’ve been doing it for years. Nuance customers are already using intelligent engagement technology that can personalize interactions, enable self-service, resolve complex phone inquiries, and optimize for quick resolution.
Aired: March 30, 2023
Social and Behavioral Determinants of Health (SBDoH) are seen as an underlying driver of 30-80% of variation in health outcomes, but current health care system complexities and the disconnect between payers and providers do not currently support a reimbursement model. A peer-to-peer approach tackles SBDoH in a holistic, scalable fashion that impacts outcomes and equity. Community-based, facilitated member-to-member interventions improve health equity by 115% and reduce isolation by 60%. Grouping peers with like conditions and health challenges enables payers to access hard-to-reach communities through a measurable and scalable program.
Aired: March 28, 2023
Join health care expert, Calum Yacoubian, MD, as he discusses the opportunity and value available to health care organizations who embrace technologies such as Natural Language Processing (NLP) in their practice. NLP has been widely adopted across many industries for several years, but the use and uptake in health care payers has been slower. However, with the increasing volume and complexity of data generated in the health care industry, and the sharing of data facilitated by the 21st Century Cures Act, NLP has now become a must-have technology.
Aired: March 23, 2023
Hear from Jimmy Liu, Vice President, Product Strategy, Optum and Jason Reed, Senior Director of Medicaid Risk Adjustment, United Healthcare on ways to learn how to prospectively message providers in their workflow, determine the best way to incorporate prospective gap closure that supplements retrospective chart review, and incorporate audit risk mitigation while also prospectively improving risk scores plus more.
Aired: March 21, 2023
Hear from Rebecca Darnall, Director of Product, Episource and Aaron Walters, Process Improvement Consultant, Cambia Health Solutions on the impact of current industry and CMS regulatory changes and discover how to go beyond the "gold standard" of 95% accuracy by auditing your own vendor.
Aired: February 16, 2023
Hear from industry expert Michael Dean, Director of Risk Revenue Program Management, Will Stabler, Executive VP of Payer Solutions and Anna Carley, RHIT, Senior Director of Client Relations on how to optimize your risk adjustment workflow utilizing technology to increase productivity, performance outcomes, and be able to identify actionable next steps.
Aired: February 09, 2023
Did you know 5 billion prescriptions are filled every year? While the spend on medication is even more staggering, the impact is far greater than the transactional costs. Non-optimized prescription drug therapy leads to various adverse drug reactions including emergency room visits and even morbidity and mortality. In this webinar, Dr. David F. Kisor and Dr. Avni Santani discussed how precision medicine can improve outcomes for patients on medication and lower costs to payers.
Aired: February 02, 2023
In this webinar, Apixio’s Pritesh Patel and Angele Pieters discussed how payers and providers can improve their enterprise health data management practices by leveraging retrieval, storage, and capabilities to drive success for risk adjustment and value-based care programs.
Aired: January 26, 2023
Join us for the presentation of this research, case study, and expert insights, where Sam Keith and Brandon Brooks, share their research findings and insights on how to leverage member data to improve marketing campaigns, member engagement and retention efforts.
Aired: January 24, 2023
Explore the state of member engagement, the challenges of disjointed technologies and the importance of data within your contact center. Then hear ways you can optimize your member’s journey with easy‑to‑use, personalized, and proactive experiences across all channels that allow you to retain the members you have—and attract new ones.
Aired: January 19, 2023
Watch presenter, Holly Wolinakowski, Content Strategist for Advantasure’s member acquisition & engagement platform, to explore how generational differences within the Medicare Advantage population influences marketing strategy, member acquisition and retention.
Aired: January 12, 2023
Learn how health plans and health systems are optimizing their value-based programs, leveraging embedded data & analytics in their operations, to achieve sustained value-based care performance results for risk-bearing Medicare populations.
Aired: December 15, 2022
Take a look into the data you should be incorporating into your Health Plan’s Risk Adjustment and other departments to ensure the most success in the coming year with Ciox Health, a Datavant Company.
Aired: December 06, 2022
If you’re considering developing a program for your organization, or have struggled to make your existing program successful, this is a webinar you won’t want to miss! This discussion included how to review technology options, practice management and workflows, and financial implications.
Aired: December 01, 2022
Experts from Centauri Health Solutions discussed the role of technology solutions in improving multi-stakeholder collaboration across the clinical, non-clinical, and community resources to close care gaps, improve health outcomes, better address SDoH to advance overall population health equity during this 60-minute webinar.
Aired: November 29, 2022
During this 60-minute webinar, experts from 3M discussed the impact of patient risk scores and HCCs as an increasing number of healthcare networks and physician practices are moving towards value-based/risk-based contracts with their payers and Medicare Advantage programs that are being adopted at a higher rate than originally anticipated.
Aired: November 10, 2022
Join us for a fun conversation between our two, industry specialist leading ladies: Amy Campbell, RN, MSM, CCDS-O, Clinical Documentation Improvement Director, and Melissa James, CPC, CPMA, CRC, RA SME, Senior Consultant, Coding Specialist, offering both provider and payer perspectives on existing risk adjustment workflows and coding practices.
Aired: October 25, 2022
Explore how to maximize interoperability and use it to inform strategy and enable the most effective risk-adjustment programs with experts from Change Healthcare. You will be able to come away with an understanding of flexible transaction models, tools for obtaining the highest quality data, strategies for using electronic connectivity to drive prospective programs, best practices for risk adjustment success, and principles for selecting partners who can successfully navigate improvements at scale.
Aired: October 11, 2022
Since 2021, the Office of Inspector General has employed a new audit methodology to surface non-compliant diagnosis codes, by scrutinizing particular fact patterns in coding data that correlate with improper documentation. It refers to these fact patterns as “Selected High-Risk Diagnosis Codes”. During this webinar, William Schweitzer and Deborah Curry discussed the recent literature from the Office of Inspector General focusing on integrity in diagnosis code submissions, impacts on coding in Medicare Advantage and more.
Aired: September 27, 2022
Dr. Nazeer Khan, Chief Medical Offer for Advantmed, discussed rigorous clinical pre-visit preparation and provider feedback workflows that led to health assessment program success during this webinar.
Aired: September 13, 2022
During this 60-minute webinar, Sam Keith, Manager of Digital Engagement for Advantasure, discussed a cutting-edge strategy and evolving tactics for marketing & outreach to the Medicare Advantage population.
Aired: September 08, 2022
Logan Ferrie, SVP of Value-Based Care Strategy at Easy Health, moderated a group of panelists that discussed strategies for improving communication between payers and providers in this 60-minute webinar.
Aired: July 19, 2022
During this webinar, Ciox explored the hidden data value contained within the raw EHR data available, while looking at examples of XML CCDs, the difference between CCD and CCDA, and how capturing more digital data enhances the value of the charts requested for singular use cases such as Risk Adjustment.
Aired: July 12, 2022
Examine the limitations of traditional workflows and strategies for developing a more streamlined, advanced approach to risk-adjustment that delivers better results. Through automated electronic data retrieval, NLP-powered code review and point-of-care diagnosis capture, payers can determine the true acuity of their member population and carry out the level of proactive outreach and crisis prevention that value-based care management demands, with this panel from GeBBS Healthcare Solutions.
Aired: June 28, 2022
Watch this 30-minute webinar, as Episource's Andrew Perlstein and Sarah Paine discuss risk adjustment challenges and population complexities in the ACA market, the importance of implementing NLP-powered strategies to increase accuracy and surface complex diagnoses and how to improve performance across the risk adjustment continuum.
Aired: June 21, 2022
Explore broad industry trends while highlighting what healthcare consumers expect throughout their journeys, learn how healthcare decisions are made based on an overall experience and explore strategies for addressing these challenges in healthcare, specifically in the payer-member relationship.
Aired: June 14, 2022
This webinar shared how EXL's program yielded tangible results over the last 4 years, including improvement in documentation accuracy of providers, comprehensive & early recapture of risk, and improvement in HCC RAF scores and improved patient care.
Aired: June 07, 2022
Improve your Risk Adjustment scores, close care & documentation gaps, and learn how to translate KPIs into impact for your risk adjustment program during this 60-minute webinar with Advantmed.
Aired: May 31, 2022
Industry-leading speakers will offer invaluable insights into the available solutions and proven workflows being implemented to reduce the effort required to achieve optimal risk adjustment scores at the point-of-care, during this 60-minute webinar hosted by Navina.
Aired: May 26, 2022
In this interactive webinar session, learn how NYC-based Healthfirst has used the clinical data they are getting from their provider network, to monitor quality measure performance and use that data as a source of numerator and denominator.
Aired: May 17, 2022
Now that the Social Determinants of Health (SDOH) landscape is better understood after viewing Part 1 in this series. During this final part of the series, we will dive deeper into how SDoH data can translate into actionable results.
Aired: April 28, 2022
Catch up on this webinar with Ciox, as Gaurav Kumar and Paulo Pinho, MD, demonstrated how automated technologies for semantic normalization and data integration can be used to uncover patient risk factors that more accurately reflect the health of populations and individuals. They also shared how direct access to digital clinical data can enable new operational approaches and improve coding efficiency.
Aired: April 21, 2022
Understanding Social Determinants of Health (SDOH) and the impact on members can be a complicated analytics process. This webinar will define the common words associated with SDOH and how they are used in everyday life in the first part of this series.
Aired: March 31, 2022
Join Amber Harris, Vinitha Ramnathan and Mike Sloan, from Episource, as they discuss advanced analytics via platform solutions to provide deeper transparency into data from encounters through submissions, unlocking lost revenue and improving patient outcomes in the process.
Aired: February 22, 2022
Hear tactical ways that other health plans have closed gaps with PCP’s, including examples in making their suspects actionable, removing false positives, and going beyond traditional analytics during this 60-minute webinar.
Aired: February 10, 2022
During this engaging and thought-provoking webinar led by two of Centauri’s trailblazers in the SDoH space, you will come away with actionable knowledge related to SDoH that will better inform the decisions made related to SDoH products and services that optimally suit a given population’s health, as well as risk adjustment and quality programs and care gap closure.
Aired: January 27, 2022
Learn how to automate manual retrieval workflows and enable eRetrieval during this webinar, led by Talix's Director of Product Management, Zhe Leonard. You’ll gain visibility of how the status for all the charts being chased using different retrieval methods and vendors are included in one single platform, along with strategic retrieval insights.
Aired: January 20, 2022
Get a multi-stakeholder perspective from some of the industry’s leading SDOH experts representing payers and policy experts as they explore new and innovative data-driven approaches to advancing the use of SDOH data to improve quality outcomes and reduce disparities during this 60-minute webinar.
Aired: December 16, 2021
Recently, the AHA Coding Clinics© provided guidance on the need for provider documentation as to how a diagnosis impacts the care a patient/member receives during an encounter. This webinar focused on the impact to health plans and coding professionals and how CMS has historically interpreted this process during audits.
Aired: December 08, 2021
During this 60-minute webinar, Steve Stein will explain how Medicare Advantage plans and other managed care organizations can collaborate with their SNF partners, through post-acute data transparency, to advance care coordination, strengthen PAC networks, and mitigate risk.
Aired: November 18, 2021
Led by Apixio's VP of Product, Alan Sun, this RISE-hosted webinar will focus on strategies to address data quality challenges that impact your organization's value-based care program.
Aired: October 28, 2021
Medicare Advantage organizations face the challenges of annual AEP preparation cycles, particularly when it comes to the creation of ANOC, EOC, SB, and other Medicare compliance & marketing communications. These complex documents not only introduce the risk of errata and associated penalties, but the operational complexity they introduce can prevent an MAO from scaling their plan offerings and growing their business. Watch this webinar to learn how to overcome the top 5 challenges that MAOs face each year by transforming member materials management processes.
Aired: October 20, 2021
Removing the human factor from the fulfillment process is the key to Modern Retrieval. Starting projects by assessing your entire member base and identifying qualifying encounters available electronically can remove almost all provider abrasion, expedite access to charts, and increase the quality of data received. Providers aren’t usually the problem – the old approach is. Join Ciox Health’s Andy Kumar and Amir Keren to learn how your health plan can modernize retrieval by starting with digital and ending with better results.
Aired: September 28, 2021
For years, retrospective chart reviews have been a staple of risk adjustment and quality efforts. Nearly all risk-bearing entities spend a great deal of time and budget to retrieve charts from providers for coding. Often, these efforts require a physical presence in a provider’s office spending hours copying pages and pages of medical charts. These activities, while necessary, frustrate providers and can disrupt a clinician’s office. Join us as we present an approach to prospective chart reviews that can cut costs, improve risk score accuracy and reduce provider abrasion!
Aired: September 23, 2021
The old guard of risk adjustment analytics is relegated to batch-based suspecting, leading to data lag, static insights, less effective interventions and reduced overall member health. Forward-thinking health plans know the future of risk adjustment accuracy and improved outcomes is Artificial Intelligence (AI) and FHIR-based. Driving not only real-time (or just-in-time) suspecting analytics delivered at the point of care, but enhanced provider engagement due to reduced manual operations. The summer of risk adjustment love is here!
Aired: September 15, 2021
Provider accuracy has often been a challenge as it relates to the submission of diagnoses. However, there are strategies, best practices, and effective technologies to consider that can help improve and remove these accuracy barriers that payers face today. Additionally, having the most up-to-date CMS guidance related to Quality Assurance requirements is key to being on top of what you need in order to succeed.
Aired: September 09, 2021
In this webinar, you’ll learn how advanced analytic tools, including artificial intelligence, can help support a cohesive risk adjustment strategy that mitigates information silos to ensure timely access to essential clinical and business data. Discover how you can develop detailed insight into future risk scores and their impact on projected payments, as well as tactical approaches that help identify gaps in care, support optimal chase lists, and drive improvement initiatives. You’ll also learn how customizable, standardized reporting and a simple, integrated dashboard approach can create the foundation for consistent and accurate risk adjustment across the enterprise.
Aired: August 26, 2021
Join Ciox Health for a compelling look into the power of Member & Suspect Analytics. During this one-hour webinar, we will delve into how Ciox applies advanced analytics by synchronizing market statistic proprietary algorithms and historical provider performance to produce pre-chase insights (high yield/high opportunity chases) and post-chase performance outcomes that can generate 10-12% improvement in retrospective outcome than the traditional model.
Aired: August 19, 2021
Successfully engaging Medicare and Medicaid members is critical to optimizing risk adjustment, improving quality ratings, and driving better access and affordability for members. Yet precisely identifying and relevantly activating members—and ultimately driving behavior change that improves health—can be difficult, particularly when members of a population can vary significantly in age, ability, and need. In this webinar, experts will explore how rapid advances in behavioral science and artificial intelligence (AI) offer an array of new opportunities to drive member engagement. By harnessing data and AI to develop detailed knowledge about your member’s needs, motivations, attitudes, barriers, and enablers, you can break down traditional identification and activation barriers to achieve improved outcomes and lower costs.
Aired: July 29, 2021
Join us to learn implemented and tested best practices for serving polychronic patients within a value-based care model. This webinar is designed to be interactive, providing insights from the largest risk-based provider group serving complex, chronic patients at home in the country, and answering your specific questions related to home-based care, risk adjustments, closing care gaps, improving quality scores, reducing avoidable admissions, and leveraging data to aid in ensuring your clinical teams’ patient interactions are meaningful and outcomes-focused.
Aired: July 28, 2021
During this webinar, we’ll review the key things you should incorporate into planning for a successful HEDIS® MY2021 project and considerations for MY2022 and beyond. We’ll discuss updates to the MY2021 measure set and things to consider as a result of these changes. We’ll cover best practices for managing the project and key strategies to help maximize HEDIS® rates to reflect your organization’s performance. We’ll also review the importance of leveraging your resources effectively, as well as gaining organizational support for a successful project.
Aired: July 22, 2021
Most organizations who have embraced the shift to value-based care must implement models that combat rising health care costs and create a focus on preventive care. Payers need to adopt innovative reimbursement strategies that focus on value. Provider participation in value-based and risk-based payment contracting continues to rise. Now is the time to anticipate and reimagine a payment and care delivery framework to reward better care.
Aired: July 08, 2021
Every year, Medicare Advantage Organizations face the challenge of updating highly complex Medicare plan documents before the annual enrollment period (AEP) begins. 2022 proves to be an even more challenging year with COVID-19 and disbursed teams to add or change benefits, manage last-minute updates and perform quality checks on the annual materials. Join this webinar to gain insight into the recent CMS model changes and how you can conquer your implementation for the 2022 AEP.
Aired: June 30, 2021
Value-based purchasing hinges on risk adjustment – payment is adjusted based on the illness burden of patients. Complete and accurate clinical documentation is essential but requires additional work of clinicians. We will discuss how to bridge the need for low-burden workflow with requirements for documentation and quality, and how technology and data may enable or get in the way. Join Dr. Gordon Moore, as he discusses the impact of risk adjustment models and the importance of health care organizations preparing now for future success.
Aired: June 10, 2021
Value-based programs are designed to change how healthcare is delivered and paid for. As health care organizations shift to value-based programs, the capture of HCCs will become an important factor of this shift and the reimbursement for care delivered. Join the experts from 3M HIS to discuss the impact of HCCs on your organization and the potential effect on reimbursement and how a patient-driven process is the most successful approach to HCC capture.
Aired: May 26, 2021
Encounter data, and associated risk analytics, go underutilized by many Medicare Advantage (MAO) plans. The key to overcoming these challenges is an intelligent, comprehensive risk adjustment management system utilizing AI-enabled prospective and clinical analytics.
Aired: April 21, 2021
This webinar will assist a health plan in trying to understand a patient’s social, environmental, and economic situation and how the combination impacts health outcomes. Socioeconomic health attributes to provide healthcare organizations with quick access to health outcome predictions without having to build their own complex models and/or subscribing to multiple data streams.
Aired: March 23, 2021
In this webinar, our industry experts will examine the impact of federal requirements on driving connectivity and interoperability in healthcare, provide insight into how health plans are preparing for the upcoming requirements, and explore innovative strategies and best practices helping health pans thrive in the new era of interoperability.
Aired: March 10, 2021
With increased provider and plan engagement, synchronizing data and workflows between Risk Adjustment, Quality, Health Management and the provider’s EMR is essential to success. You’ll learn about new approaches and technologies for pursuing smoother integration, with practical examples and insights for success during this 60-minute webinar.
Aired: March 02, 2021
Given all the curveballs the healthcare industry has been thrown since 2020 due to the COVID-19 pandemic, now is the time to focus on reaching the next level of gap closure for enhancing patient care and improving your risk score accuracy. During this pre-conference sneak peak, Talix’s SVP of Product Management will touch on a few hot topics at a high level to give you a preview of what’s to come during our RISE National 2021 session.
Aired: February 24, 2021
Social risk analytics offer a powerful tool for controlling costs, improving outcomes, advancing equity, and achieving key business metrics for health plans and other organizations engaged in risk-based care delivery and payment models. This session will explore an end-to-end analytic approach to: assess social risk among the communities and populations you serve; deploy tailored socio-clinical interventions to effectively mitigate these risks; and quantify the impact of these efforts on key business metrics. Whether you’re doing some of this work today or just getting started incorporating social risk analytics into your business strategy and operations, you’ll learn best practices and key considerations for developing, deploying, and evaluating effective social interventions.
Aired: February 17, 2021
In this webinar, we explored the evolution of healthcare data acquisition over time and dive into the key drivers of change today. We’ll also discuss what payers and providers need to do to prepare for the future of data exchange and how making these investments can benefit high-priority organizational initiatives now and for years to come.
Aired: January 28, 2021
The new year brings us opportunities to start fresh and to think about the things that really matter for what’s ahead. The 2020 interim final run submission deadline is February 1 and in light of the current pandemic, the Centers for Medicare & Medicaid Services (CMS) are accepting January 1, 2019 to December 31, 2019 dates of service (DOS) for the 2020 final run until August 2. This adds another 6 months for data submission! During this extra time, there are several significant opportunities for health plans to embrace. Attend this webinar to learn what you can achieve by deploying this winning strategy.
Aired: January 19, 2021
Geriatric House Calls, provided by highly trained physical, occupational, and speech therapists, enhance access and treat the physical, functional, cognitive, and expressive decline associated with many chronic diseases, sedentary behavior, and lack of social interaction that is more prevalent due to COVID-19. The ideal approach is proactive investment in the downstream heath and costs associated with these older adults. This webinar will describe an innovative model of care delivery that saves 9.5% (Optum Advisory Services) in total downstream costs for older adults, improves patient satisfaction, and increases the likelihood of increasing health plan membership.
Aired: December 21, 2020
mPulse Mobile, the leader in Conversational AI solutions for the healthcare industry, drives improved health outcomes and business efficiencies by engaging individuals with tailored and meaningful dialogue. mPulse Mobile combines behavioral science, analytics and industry expertise that helps healthcare organizations activate their consumers to adopt healthy behaviors.
Aired: December 07, 2020
The value of accurate and complete managed care encounter data is at an all-time high. From compliance to revenue accuracy, to value-based program performance, encounter data is at the heart of these health plan initiatives. However, many health plans lack connected data visibility beyond the encounter lifecycle. This gap can jeopardize compliance, risk-adjusted revenue accuracy and member care. In this webinar, managed care plans will learn how to overcome operational challenges and “connect the data dots” through best-in-class EDI, encounter submission and machine learning technology.
Aired: December 03, 2020
In this webinar, see the power of harnessing workflows, integrating data and leveraging it into relevant and actionable intelligence. You’ll learn about planning for success with practical examples and insights for success.
Aired: December 02, 2020
With the uncertainty surrounding the COVID-19 pandemic, CMS has released Part I of the 2022 Medicare Advantage and Part D Advance Notice approximately three months earlier than usual, giving MA plans more time to digest this information, estimate 2022 plan costs, and prepare for the calendar year 2022. View a comprehensive review of Parts I and II for Medicare Advantage Capitation Rates and Part C and D payment policies. Providing a thorough examination of the proposed changes in the 2022 Advance Notice, our industry experts will offer in-depth, data-driven analyses of the potential impact of the proposed payment and quality-related policy updates and risk adjustment model changes on MA plans and consumers.
Aired: November 19, 2020
As we approach the halfway point of the current AEP season, a good practice is to take a step back and evaluate your progress. The best way to gauge this progress is by utilizing data to identify areas of success and opportunity. Perhaps some of the strategies implemented in the beginning of the AEP season are not delivering the results you were looking for? Data can be utilized to pinpoint areas needing improvement and lend insight on areas to refocus efforts. Don’t wait until the end of the season to reassess your team members and strategies. Visibility throughout the AEP season is key to driving meaningful growth.
Aired: November 04, 2020
Impacts of COVID-19 turned many of our standard risk adjustment and quality processes and programs upside down. CMS regulations change almost daily, provider processes and member access shifted and expanded services for telehealth and other programs are on the rise. Success requires knowledge and agility. Join this webinar for insights into mitigating risk, embracing transformation and driving performance in the pandemic and beyond.
Aired: November 03, 2020
Join this round table discussion about what we learned from 2021 Star Ratings, pitfalls to avoid over the next few years, and strategies to maintain or grow key Star Ratings measures. Star Ratings consultant Rex Wallace joins mPulse Mobile’s Government Program Strategic Market Executive, Reva Sheehan, and Solution Marketing Manager, Jim Burke, to share different perspectives on how COVID-19 impacted 2021 Star Ratings, what that means about the future, new competition in the marketplace, and actions your organization should be taking now.
Aired: October 28, 2020
During this webinar, Learn the best practices for managing HEDIS Supplemental Data with the assistance of DataLink software, Evoke360. Evoke360 is a point of care solution that effectively engages providers and patients during the visit for gap closure activities in any care setting.
Aired: October 22, 2020
With 2021 fast approaching, the election underway, recent updates from CMS, telehealth acceptance for Risk Adjustment, and significantly reduced patient encounters during 2020, we will ask a panel of experts how they see the next 12-18 months unfolding. Topics include the following: Retrieval and how Digital Adoption is growing, Audits in 2021, RAD-V, HEDIS changes to STARS Ratings and how plans should prepare, Coding CMS 2020 Extensions impact and opportunity for second-level review, Encounters COVID-19 reduced patient visits from 2020 due to COVID and the residual effect on future, and Election impact
Aired: October 06, 2020
The industry is now standing at the intersection of risk adjustment and quality as it relates to data management, and a new roadmap is needed to successfully navigate. In this webinar, Centauri will discuss how reporting can inform a proactive data submissions management strategy as a part of the overall risk adjustment strategy, including how to successfully incorporate input from HEDIS operations.
Aired: October 01, 2020
Geriatric House Calls, provided by highly trained physical, occupational, and speech therapists, enhance access and treat the physical, functional, cognitive, and expressive decline associated with many chronic diseases, sedentary behavior, and lack of social interaction that is more prevalent due to COVID-19. This webinar will describe an innovative model of care delivery that saves 9.5% in total downstream costs for older adults, improves patient satisfaction, and increases the likelihood of increasing health plan membership.
Aired: September 22, 2020
In this panel webinar, industry leaders from both sides will present the audience with specific risk strategies between payers and providers. Real-life tactical examples will be discussed, and the panelists will explicitly depict how these risk strategies can reduce provider abrasion, increase savings, and reduce cost. Relevant data will also be shared in order to have better analytics and drive better outcomes. Insights from speakers will also include the impacts of the Covid pandemic and how it has affected telehealth and risk for both payers and providers.
Aired: September 16, 2020
Following our April joint survey, RISE and Engagys have again collaborated, reaching out to health plans and others to help industry peers leverage one another's experience during this challenging time. The second installment of this brief survey queried industry professionals to determine how their communication tactics may have changed as the pandemic develops. Join us to learn how your peers are adjusting communication strategies as the pandemic progresses.
Aired: September 01, 2020
Medical respite plays an important role overall, in providing a “warm hand-off” for individuals who are homeless, and more recently, a safe and compassionate transition for hospitals experiencing surges due to COVID-19. In this webinar, attendees hear a case example of a community-based, multi-hospital system medical respite program in Pittsburgh, PA focused on providing care to people experiencing homelessness.
Aired: August 26, 2020
Whether this is your first or fifteenth medical record review project, there is much information available to assist with your new project or an existing one. In this presentation, you will find ideas for planning as well as enhancements or a rebuild of your current project or ideas for structuring a new project if you are starting from scratch. While there are many components of a submission project, we will focus on medical record review only.
Aired: August 17, 2020
In this Webinar, you will hear from four different industry leaders surrounding how the pandemic lockdown and suppression of health care services are likely to impact risk scores and payments for risk-adjusted lines of businesses. You will have a chance to interact and hear real-time feedback in these uncharted times. Discussions will happen around what challenges plans are already facing with the pandemic. How to be prepared for changes that are inevitable.
Learn more about GeBBS Risk Adjustment Solutions. Click Here.
Aired: August 12, 2020
Historically, natural language processing (NLP) platforms haven’t lived up to expectations for risk adjustment programs, when compared with manual coding. Concerns with NLP traditionally centered around invalid codes or resources needed to reject these or even manually recode charts; often more expensive than traditional manual coding. However, NLP has turned the corner thanks to significant investments in platforms that address the complexities of risk adjustment.
Aired: July 21, 2020
This discussion will give you the inside track on coronavirus testing and the payer perspective from LGC’s frontline experts. Learn more by visiting our site.
Aired: July 16, 2020
This webinar will cover an overview of Value-Based Payment models as well as address the current state of VBP model adoption across commercial, state and federal payers. We will take a deeper look at the different ways that risk adjustment is implemented in VBP contracts from the perspective of the provider, payer, and government.
Aired: July 15, 2020
In this webinar, we’ll explore the evolution of healthcare data acquisition over time and dive into the key drivers of change today. We’ll also discuss what payers and providers need to do to prepare for the future of data exchange and how making these investments can benefit high-priority organizational initiatives now and for years to come.
Aired: July 07, 2020
Covid-19 has forced MA plans and other businesses to rethink their prospect and member engagement models. MA plan staff are increasingly migrating to Work At Home (WAH) options with an emphasis on digital and self-service interactions. This session will navigate approaches and tools on tech-enabled member acquisition and sales management needed to navigate new normal. We will take multi-sided look at emerging best practices, particularly from a prospect/member and an agent point of view.
Aired: June 18, 2020
This is the second in a series of webinars where we pull together some of the most troublesome or demanding diagnoses and chart documentation issues from the user groups and the first-hand experience of our panelists. They will share with you their approach to parsing the problems, citing guidelines and references for authority.
Aired: June 11, 2020
The pandemic has impacted virtually every aspect of the American healthcare system. The rapid expansion of telehealth has created new opportunities, but also a lot of questions. During this webinar, we’ll discuss risk adjustment in consideration of the pandemic, with an emphasis on the use of telehealth as a key resource for managing risk in this new era.
Aired: June 10, 2020
If you’ve been looking for that one webinar to give you an everything-but-the-kitchen-sink regulatory overview, wait no more! Centauri Health Solutions has identified key pieces of legislation impacting hospitals and health plans, added context, and translated them into layman’s terms.
Aired: June 09, 2020
Identifying and acquiring prospect members and retaining them, poses challenges to health plans of every size. As competitors realign, benefits change, and customer demographics shift, managing the customer lifecycle takes efficiency and accuracy. MarTech offers a solution, join us during this 1-hour webinar to learn how.
Aired: June 03, 2020
Many things have become apparent over the last few weeks – what works and what doesn’t, where your team excels and where you need more resources, what technology or practices are essential and what needs an update. Join us as we discuss what your health plan and providers should be seeing with better data, advanced analytics, and virtual connectivity.
Aired: May 28, 2020
The Coronavirus (COVID-19) has introduced a new set of challenges to healthcare that may become the new normal. Previously unforeseen challenges are manifesting for health plans in the risk adjustment organization, from the ability to conduct prospective programs, to chart retrieval and chart review. These also lead to questions about optimizing coding accuracy and productivity both during and after the COVID-19 crisis. This webinar will review ways your virtual Risk Adjustment coding team can thrive while improving efficiency, quality and operational transparency.
Aired: May 21, 2020
Industry experts from Blue Shield California, Avalere, and Inovalon will explore real-world healthcare data lake use cases that support the rapidly evolving payer landscape and regulatory environment. The panel will offer perspective and best practices on how health plans should think about constructing a patient-centered repository for structured and unstructured data – including the integration of EHR-extracted clinical data that aligns with the FHIR®-based API evolution of data-driven decision making across all sectors of the industry.
Aired: May 20, 2020
Medical precautions resulting from COVID-19 limiting office visits and member contact are posing a challenge for maintaining risk adjustment and quality operations, but unprecedented times call for innovative solutions. Control costs, improve efficiency and preserve security all through the virtual opportunities available with this integration and from the comfort and safety of your own home.
Aired: May 19, 2020
This webinar brings together professionals across the OEP and AEP playing field: market research, broker channel distribution, direct marketing, and a health plan. You will receive deeper insights and first-hand reports from the second OEP cycle and how they are planning for future membership growth and retention during the upcoming AEP. There are many crosscurrents at play, and this unique and high-powered panel will flush out for you some important themes and considerations as they reflect, digest, and analyze those ideas.
Aired: May 07, 2020
Attend this in-depth webinar on selected “Gnarly Challenges” identified through our on-going HCC Coder User Group meetings featuring a panel of RISE HCC coding faculty leaders.
Aired: May 05, 2020
As we begin moving from the acute phase of this COVID-19 pandemic into the coming weeks and months, health plans must work strategically to provide members with the healthcare information that will demonstrate a path forward. Join us to learn how your peers are addressing both near and long-term communication strategies.
Aired: April 30, 2020
Do the four letters R A D V keep you up at night? Are you concerned that you don’t have the right insights into how your organization would stand up to a risk adjustment coding and documentation audit? If you would like to learn more about the best practices to ensure a successful coding program, then this webinar is for you!
Request a consultation to see how GeBBS Healthcare Solutions can help you with your RADV program.
Aired: April 23, 2020
Our April 23rd webinar, was presented by Amir Keren, CTO and Bill Horn, SVP Payor Growth of Ciox Health. During this webinar, Amir and Bill outline the best practice approach for optimizing retrieval results, combining digital and traditional data acquisition methods. Ciox’s Digital First approach, complemented with existing provider outreach, ensures the greatest result and lowest cost, while minimizing provider abrasion.
Aired: April 15, 2020
This timely webinar focuses on using technology to support patients and frontline staff during the COVID-19 pandemic. It will provide best practices for identifying common staffing and patient home-quarantine challenges facing health care organizations, teach how to apply technology to support automated check-ins and self-monitoring for patients instructed to home quarantine, and help you evaluate remote patient engagement tools during COVID-19.
Aired: April 06, 2020
This webinar outlines the major questions around temporary risk adjustment changes, recommendations on evaluating telehealth solutions, workflow integration with your current in-home health assessment program, considerations with patient outreach, and how these changes can enable better care now and in the future.
Aired: March 31, 2020
Edifecs will use real-world examples to demonstrate how forward-thinking health plans use the industry-leading Edifecs Encounter Management platform to improve encounter submission and risk-adjusted revenue accuracy, ensure compliance and reduce costs. Upgrading your encounter DNA starts here.
Aired: March 27, 2020
Learn about a new texting tool called the COVID Companion, created by CareSignal, a consumer communication technology company. The COVID companion is a free accessible texting tool for any health care provider or payer to offer to their patient population. The texting program provides CDC-based educational tips for what to do if you have symptoms, how to protect yourself and provides locally-relevant public health department resources based on the patients’ state.
Aired: March 11, 2020
When CMS proposed the commercial Risk Adjustment Data Validation (RADV) program, it looked like a straight-forward audit. Many plans were surprised and confused when the first adjustments were announced, seven years later. Plans had a hard time seeing how RADV improves risk adjustment accuracy until CMS released a white paper where they analyzed the program.
Aired: February 27, 2020
Discover real-world examples of how Change Healthcare is using AI in risk adjustment and take away best practices for how to apply AI in your organization during this webinar.
Aired: February 19, 2020
As risk adjustment programs are looking to be more effective and less wasteful, manual tasks are being automated, processes are becoming more precise, and less friction is experienced by payers and providers. So what is left? Clinical lab data with predictive models can be valuable when combined with other available data, then leveraging the analytical models to improve risk adjustment and the resulting member outcomes.
Aired: January 30, 2020
RISE Association Executive Director Kevin Mowll moderates a panel discussion with industry experts and members of the RISE Medicare Member Acquisition & Experience Advisory Board to discuss lessons learned from the AEP, including marketing trends, changes in spending, and the impact of adding supplemental benefits that address social determinants of health to your plans.
Aired: December 05, 2019
Join Signify Health to discuss tactics to resolve fragmented care and improve member outcomes. You will learn three critical elements for a successful complex care management (CCM) program. We will dive deeper into the details of these elements and uncover the challenges we are facing and ways to overcome them.
Aired: October 29, 2019
Join Prognos for this webinar and get answers to your questions about why – and how – you should integrate NLP into your risk adjustment workflow. This webinar will discuss how the innovative use of lab data and analytics to inform population health initiatives can help payers and providers meet the goals of the Triple Aim.
Aired: September 26, 2019
Learn how Natural Language Processing and Machine Learning results in the discovery of all documented conditions, capturing risk accurately, increasing coder production by 4 times, identifying suspected conditions and addressing RADV audit risks.
Aired: September 24, 2019
Join SS&C Health’s Adele Allison as she speaks with industry expert, Amy Salls about how to identify opportunities to reduce costs and improve outcomes using TCOC data when implementing a value-based payment arrangement.
Aired: September 19, 2019
Join Edifecs to learn how payer best practices help you define and use comprehensive encounter platform selection criteria to meet current and future submission requirements. This definitive guide will help ensure continuous compliance, accurate risk-adjusted revenue, and cost reductions across all managed care lines of business.
Aired: August 29, 2019
Join us for an informative discussion that will focus on how some plan clients use analytics to gain a better insight into plan performance and trends and turn data into action items.
Aired: August 15, 2019
Join Advanced Plan for Health for an educational fireside chat webinar showcasing the use of health care analytics to identify hot spots across your entire population and identify undiscovered management opportunities – current state as well as predicted.
Aired: August 13, 2019
Join Change Healthcare to learn how advanced analytics can help deliver the information you need to address the most critical quality measures for your health plan. We’ll also discuss the importance of a complementary, holistic engagement strategy to help educate members, engage providers, and drive gap closures.
Aired: July 30, 2019
Join us to learn why using traditional data sets could be hindering your ability to maximize reimbursements, understand member risk further upstream in your process, and better target members at risk for preventative communications and intervention.
Aired: July 18, 2019
Join Talix to learn how to navigate the challenging process of evaluating the effectiveness of your risk adjustment coding process, whether you have the right risk adjustment coding partner, or if it’s time to find a new one.
Aired: July 09, 2019
CQA has set a path for their vision of an electronic claims exchange to replace today’s inefficient model of retrieving charts, which can cause provider abrasion. During this session, Optum HEDIS® experts will explain steps health plans should take now to get ready for the future of HEDIS®.
Aired: June 11, 2019
Join us to learn observations from an OEP consumer study, hear a Blue Cross case study, and discover the broker perspective in addition to national advertising trends.
Aired: May 23, 2019
Join us to better understand the shift from managing health care to managing health, gain knowledge on how to secure funds for initiatives on hold, and learn cost containment strategies.
Aired: April 25, 2019
Join industry expert, Adele Allison, to identify essential steps and technologies that will lead to success under new and emerging VBP archetypes associated with alternative payment models (APMs).
Aired: April 04, 2019
The applications for artificial intelligence (AI) and machine learning (ML) in health care are extensive…yet not completely defined. However, for managed care plans, there is one application that is not only well defined but has the opportunity to substantially improve quality measures and risk-adjusted revenue integrity: combining AI and ML capabilities with encounter lifecycle management.
Aired: March 05, 2019
Gain a physician’s perspective on risk adjustment and quality initiatives in the primary care setting and how to overcome PCP challenges that health plans face in today’s risk adjustment world.
Aired: February 19, 2019
Learn about the process that is changing the Medicare industry as Brooke Ivey, EVP- Business Development, and Aaron Eaton, SVP, Strategy, share valuable insights regarding the Value-Based Enrollment (VBE) option.
Aired: February 07, 2019
Claims processing has been around for years. While the process has evolved, until now the endgame has remained the same—pay the right amount to the right provider for the right services delivered to the right members in a timely manner. Enter the new kid on the block: Encounter data processing, which is changing the endgame for claims processing. It is no longer enough to do all the “right” things; now we must also collect the right data in the right format according to the right government agency guidelines.
Aired: February 05, 2019
Mike Baillie, Vice President Clinical Integration & Interoperability at United Healthcare, a recognized pioneer in CDI, will share his perspectives on clinical data integration, including strategies for data acquisition, primary use cases and the importance of data interoperability.
Aired: January 24, 2019
Learn about successful SDOH strategies that go beyond just a service. Participate in a dialogue about creating a program designed to reduce barriers to care and improve your member’s quality of life while increasing member satisfaction, tenure, and engagement
Aired: December 04, 2018
Learn the foolproof way to receive better documentation from your PCPs by implementing Signify Office.
Aired: November 29, 2018
Get an early indication of the potential impact to your organization of these upcoming rule changes so that you can plan accordingly.
Aired: November 15, 2018
Beacon Review identifies multiple ways in which a doctor’s daily workflow is encumbered with EMR-driven and bureaucratic distractions. We explore the various pop up’s, alerts and multiple click screens they must navigate to perform seemingly simple tasks while evaluating their patients. Alert fatigue is often to blame for physician discontent with systems as well.
Aired: November 08, 2018
It is now an accepted fact that Natural Language Processing, or NLP, is an AI technology that can significantly lower costs and improve returns in key business functions such as Risk Adjustment and HEDIS. How do you separate fact from fiction? How do you evaluate the performance of the various options? We will review key NLP capabilities, real-world results, opportunities and pitfalls. Learn how to choose the right NLP technology for your organization by separating fact from fiction.
Aired: November 01, 2018
Expert speakers from PharmMD will explore best strategies to reverse negative patterns that may hold down population-level performance and prohibit cross-departmental collaboration. They will cover interdisciplinary analytic strategies for identification, intervention, and impact measurement within the Star Ratings framework.
Aired: October 09, 2018
Learn about a provider-based tool that identifies claims that do not include a member’s previously diagnosed chronic condition(s). This unique, compliant solution supports diagnosis coding accuracy through real-time status alerts to the submitter.
Aired: September 06, 2018
A fundamental objective of managed care plans is to improve the quality of member care members while reducing costs. Tough to do when you are dealing with disjointed encounter operations and rely on voluminous/independent chart pulls to improve coding accuracy and intervention planning. Chart pulls are expensive and don’t necessarily lend themselves to timely, high impact interventions!
Aired: August 02, 2018
Learn how self-service visual analytics coupled with machine learning algorithms and publicly available data from the CMS, are helping healthcare payers forecast in-market performance within three business days from the release of plans. These insights help firms identify the top attributes that lead to plan competitiveness, design better products by simulating plan attribute levels and align marketing strategy with the reality of the marketplace.
Aired: July 31, 2018
Discover how HealthSource, the largest clinical data exchange, can service multiple data and insight demands, provide ubiquitous access to health information and unlock inherent value across the health plan value chain to drive improved clinical actions and outcomes.
Aired: July 26, 2018
Discuss actionable strategies that will help you to prepare your brokers well for AEP, help them to know your product and gain their attention.
Aired: July 24, 2018
Find out how to make intelligent design the secret sauce for your programs and deliver more value to your business and your population.
Aired: July 19, 2018
In this webinar, we'll discuss the changing landscape of options available to ensure that your plan is properly prepared regardless of how the pendulum swings. Medicare Advantage (MA) buying behaviors are changing. Few MA customers are shopping and even fewer are changing plans during AEP. With these changes, many plans are finding it difficult to determine what their Inside-Sales/Telesales needs will be for this upcoming AEP.
Aired: June 28, 2018
Learn how to fit the pieces together in the Medicare Risk Adjustment Model in order to predict revenues around EDS impact, Final Revenues, and program ROI. We'll dive into the areas of the prospective model that you need to know and better prepare you for the sweeps timeline.
Aired: May 17, 2018
Accurate and timely risk adjustment is critical to the success of payer organizations, directly impacting both plan revenue and care quality. Get answers to your questions about why - and how - you should integrate NLP into your risk adjustment workflow.
Aired: April 12, 2018
In-home visits usually include 60-90 minutes of patient interaction. Within this timeframe, providers are tasked to perform a comprehensive assessment based on very limited information about the member. How can this limited time be better utilized to close all applicable gaps?
Aired: March 01, 2018
Join Health Fidelity Founder Anand Shroff as he presents data acquisition technology that can save health care organizations over 80 percent in retrieval expenses and reduce provider abrasion.