RISE Summit aims to help attendees master risk adjustment

conference room
The upcoming RISE Summit in Nashville will feature a variety of sessions on the topic of risk adjustment.

Attendees at the upcoming RISE Summit with questions about risk adjustment will have plenty of options to learn from the experts during the three-day event at the Omni Nashville Hotel. Sessions covering the topic range from broad, comprehensive strategy recommendations to more focused discussions on topics ranging from ICD-10 codes to the integration of laboratory analytics in risk-adjustment strategies.

Here are some highlights:

Monday, March 6

3 p.m.: Three panelists will discuss strategies for comprehensive risk-adjustment programs in a session titled “Risk-Bearing Organizations on the Value of a 360 Degree Approach to Risk Adjustment.”

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The session will use real-world examples to suggest analytical strategies, technological best practices, and risk-adjustment approaches tailored to the current value-based care environment.

Panelists include Adele Towers, M.D., senior clinical adviser at UPMC Enterprises; Donna Malone, senior manager of risk-adjustment coding, quality assurance and provider education for Tufts Health Plan; and Rebecca Welling, director of coding compliance for Providence Health Plan.

3:45 p.m.: Another panel looks at the nuts and bolts of risk adjustment from a Medicare Advantage perspective, answering questions such as “What is risk adjustment truly?” and “Is prospective risk adjustment really worth it?”

For the session, titled “Medicare Advantage: Gamification of Clinical Math—How to Drive the Maximum Impact for Premium Accuracy and Accelerate Cash Flow Timing,” speakers include Tim Burke, vice president of comprehensive health assessment programs for Healthcare Partners; RaeAnn Grossman, chief growth officer at Arrohealth; and Marc Lucas, vice president of Blue Cross Blue Shield of Michigan.

Tuesday, March 7

10:30 a.m.: Olga Ziegler, vice president of revenue program management at Highmark, and Sean Creighton, senior vice president of risk adjustment for Verscend, tackle the implications of ICD-10 on risk adjustment. The session—"The Impact of Transition to ICD-10: A Real World Experience!”—will include advice from a practicing physician, as well as industry leaders in risk adjustment, about the impact of ICD-10 on people, processes and technology.

11:20 a.m.: A session titled “Risk Adjustment in State Medicaid Programs: Evolution and Developments Over 20 Years” looks at the lessons gleaned from the early adopters of diagnosis-based risk adjustment in Medicaid.

Speakers John Kaelin, senior adviser for Centene, and Richard Lieberman, chief data scientist with Mile High Healthcare Analytics, will discuss “key policies, approaches, methods and challenges faced by states and their insurer partners in successfully meeting the goals of risk adjustment.”

2:15 p.m.: This session promises to include the point of view of a yet-to-be-announced health plan general counsel on risk adjustment initiatives. Attendees will participate in a "candid discussion" during a Q&A, as well as learn how to build cohesive strategies across risk, quality, compliance and legal departments in the session, titled "Aligning Your Legal, Compliance and Risk Adjustment Initiatives—Taking a Collaborative Approach."

3:15 p.m.: A session titled “Leveraging Lab Analytics to Improve Risk Adjustment in Exchange Markets” will look at lab results from the perspective of a health plan and discuss ways to integrate laboratory data with existing processes and information.

Speakers include David Meyer, vice president of risk adjustment, encounters, coding and audit for SCAN Health Plan, and Frank Jackson, executive vice president of payer markets for Prognos.

Editor's note: This article has been updated to reflect Frank Jackson's correct title.

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