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Risk Adjustment & Revenue Cycle Management Value Visit 2016

Event Date: 1/25/2016 - 1/27/2016

Event Overview

Commercial Exchange and Medicare Advantage Products
What We Learned in 2015 and Tactics for Success in 2016

With the release of 2015 CMS’s Risk Adjustment Transfer Payment report both Commercial and Medicare Advantage plans intensified their efforts in risk adjustment and risk scoring as part of an overall effort to manage revenue cycle. During this timely Value Visit we will discuss the experience of health plans both nationally and specifically among Alliance members and we will share our lessons learned and evolving best practices. 

​Who should attend?

The meeting is designed as a multi-disciplinary meeting for managers of both commercial and Medicare Advantage risk adjustment initiatives.  There is much the two products can learn from one another.  
Executives and managers with responsibility for: Actuarial, Compliance management, Exchanges, Financial management, Health Care Reform and implementation of ACA, Provider relations, Risk Adjustment, Risk Management, Underwriting.

Agenda

To download the most updated, detailed agenda, click the Documents tab  

Note: the detailed agenda referenced above was last updated on November 4, 2016

 

AGENDA AT A GLANCE

Mon, Jan 25

 

12pm

Registration and Lunch

1pm

Welcome and introductions

2pm

2015 results and trends overview: Key take aways for the risk adjustment learning curve

3pm

Break

3:15pm

Payment transfer formula – the mystery revealed

4:15pm

Case study: One plan’s commercial risk adjustment journey

6pm

Dinner

 

 

Tues, Jan 26

 

7:30am

Breakfast

8am

Taming the formula: Taking an RA-informed approach to the upcoming QHP filing

9am

Break

9:15am

Case study: Engaging all parts of an integrated system in the risk adjustment strategy

10:15am

Case study: Engaging providers through data transparency and performance insights

11:15am

Case study: Engaging providers around case management efforts

12:15pm

Lunch

1:15pm

The political landscape: How today’s environment will impact risk adjustment

1:45pm

Panel presentation: Strategies for risk score improvement

3:30pm

Case study: Ensuring data integrity on the edge server

6pm

Dinner

 

 

Wed, Jan 27

 

8:30am

Breakfast

9am

Enhancing risk adjustment transfers with benefit design, formulary and provider contracting

10am

Break

10:15am

Case study: Engaging physicians and members in collecting and maintaining risk adjustment data

11:15am

Open discussion and wrap up

 

Documents
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1/27/2016

Presentation: Case study - Engaging physicians and members in collecting and maintaining risk adjustment data
As a fairly new MA plan, SelectHealth has focused a tremendous amount of energy in the annual wellness visit ? and on getting both physicians and members more engaged in this critical component of care delivery AND accurate coding. In this case study, they share their challenges and successes thus far in their Annual Wellness Visit efforts.

1/27/2016

Presentation: Case study - Ensuring data integrity on the edge server
The importance of data accuracy submitted to CMS through the Edge Server cannot be overstated as this data is used to term risk adjustment transfer payments. Because CMS does not permit resubmission of data Alliance members have expended significant resources to ensure the integrity of their submitted data. And as is typical CMS?s guidance was often vague at best or unworkable at worst. Some plans developed their own capabilities and others used a 3rd party vendor. In this session we will discuss what technological and data issues were encountered, what solutions and processes were developed, what was our experience if vendors were used, and what lessons can be learned for 2016?

1/27/2016

Audio: Case study - Ensuring data integrity on the edge server
The importance of data accuracy submitted to CMS through the Edge Server cannot be overstated as this data is used to term risk adjustment transfer payments. Because CMS does not permit resubmission of data Alliance members have expended significant resources to ensure the integrity of their submitted data. And as is typical CMS?s guidance was often vague at best or unworkable at worst. Some plans developed their own capabilities and others used a 3rd party vendor. In this session we will discuss what technological and data issues were encountered, what solutions and processes were developed, what was our experience if vendors were used, and what lessons can be learned for 2016?

1/27/2016

Audio: Case study - Engaging physicians and members in collecting and maintaining risk adjustment data
As a fairly new MA plan, SelectHealth has focused a tremendous amount of energy in the annual wellness visit and on getting both physicians and members more engaged in this critical component of care delivery AND accurate coding. In this case study, they share their challenges and successes thus far in their Annual Wellness Visit efforts.

1/26/2016

Audio: Taming the formula - Taking an RA-informed approach to the upcoming QHP filing
Health insurers have discovered how critical a sophisticated understanding of risk adjustment can be to profitably managing business in the individual and small group markets. Many have focused their risk adjustment efforts toward bolstering risk scores in the active plan year, but haven?t fully explored how to influence the remaining elements of the equation. This session will continue the dive into the formula, highlighting connections where plans can exert influence prospectively on the formula as a whole, as issuers ready their portfolios for the 2017 QHP filing period.

1/26/2016

Audio: Case study - Engaging providers through data transparency and performance insights
At the end of the day, success in risk adjustment all comes down to complete and accurate documentation. With this in mind, HNE has leveraged their risk adjustment partner, AltegraHealth, to develop a brand new physician engagement approach when it comes to risk adjustment. With a much higher level of transparency and conversation around risk adjustment data trends at the group, practice and physician level, HNE is working to engage their provider partners in risk adjustment in new and exciting ways.

1/26/2016

Audio: Enhancing risk adjustment transfers with benefit design, formulary and provider contracting
This session will focus on non-coding approaches to boost risk scores. Specifically, we will discuss tactical approaches a health plan can implement that may enhance risk adjustment transfers. Topics will include items such as plan design considerations, prescription drug formulary, and provider contracting.

1/26/2016

Audio: Strategies for risk score improvement
In this first payment year, we saw that risk adjustment transfers can have a significant and material financial impact to health plans. This session will discuss lessons learned from that experience and describe the strategies that two health plans are using to succeed in the commercial risk adjustment markets. While the end goal of risk score improvement is the same, each plan has taken a unique approach to using data to work with its network providers and members to ensure accurate and complete capture of risk.

1/26/2016

Audio: The political landscape - How todays environment will impact risk adjustment
In a charged political environment like what we face in 2016, government sponsored healthcare can always expect difficulty. In this session, Ken Lewis offers an update on how the industry is engaging policy makers in conversations around risk adjustment, the goals of these talks, and what to expect.

1/26/2016

Presentation: Taming the formula - Taking an RA-informed approach to the upcoming QHP filing
Health insurers have discovered how critical a sophisticated understanding of risk adjustment can be to profitably managing business in the individual and small group markets. Many have focused their risk adjustment efforts toward bolstering risk scores in the active plan year, but haven?t fully explored how to influence the remaining elements of the equation. This session will continue the dive into the formula, highlighting connections where plans can exert influence prospectively on the formula as a whole, as issuers ready their portfolios for the 2017 QHP filing period.

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Attendees

Below is a list of all delegates registered to date for this event

  • Samantha Davis
  • ALLIANCE GUEST
  • Manager of Regulatory Affairs and Strategic Development at VIVA Health
  • Jessica Althouse
  • ALLIANCE MEMBER
  • Director, Risk Adjustment at Presbyterian Health Plan
  • Dennis Bolin
  • ALLIANCE MEMBER
  • Consultant at Health Plan Alliance
  • Stephen Bush
  • ALLIANCE MEMBER
  • CFO at Baylor Scott & White Health Plan
  • Deb Curry
  • ALLIANCE MEMBER
  • Director Risk Adjustment & Recoveries at Paramount Health Care
  • Jessica Dupont
  • ALLIANCE MEMBER
  • Vice President of Government Programs at Alliant Health Plans
  • Lisa Fallert
  • ALLIANCE MEMBER
  • Chief Operating Officer at University of Utah Health Plan (UHHP)
  • Jaime Gonzalez
  • ALLIANCE MEMBER
  • Chief Business Development Officer at Health Plan Alliance
  • Susan Herbert
  • ALLIANCE MEMBER
  • Director, Health Plan Integration & Development at AdventHealth (FHHS)
  • Daniel Hoffman
  • ALLIANCE MEMBER
  • Director of Medicare Services at Sentara Health Plans
  • Mary Ingram
  • ALLIANCE MEMBER
  • Chief Actuary at Western Health Advantage
  • Zach Keeling
  • ALLIANCE MEMBER
  • CEO, Medical Associates Clinic & Health Plans at Medical Associates Health Plans
  • Barb Koerperich
  • ALLIANCE MEMBER
  • Director of Health Care Services at Medical Associates Health Plans
  • Ryan Lown
  • ALLIANCE MEMBER
  • Network Strategies Executive at Adventist Health Plan
  • Mark Mixer
  • ALLIANCE MEMBER
  • Chief Executive Officer at Alliant Health Plans
  • Sara Neese
  • ALLIANCE MEMBER
  • Former COO for Health Plan Alliance at
  • Kari Pace
  • ALLIANCE MEMBER
  • Clinical Documentation Improvement Nurse-Risk Adjustment/Quality Management at Medical Associates Health Plans
  • Michelle Peake
  • ALLIANCE MEMBER
  • Manager Analytics Risk Adjustment and HEDIS at Health First Health Plans
  • Rita Ruecker
  • ALLIANCE MEMBER
  • Chief Financial Officer at Western Health Advantage
  • Irina Shikin
  • ALLIANCE MEMBER
  • Sr. Regulatory Auditor at Health Alliance Plan (HAP)
  • David Vis
  • ALLIANCE MEMBER
  • VP, Chief Financial Officer at MediGold
  • Susan Waterman
  • ALLIANCE MEMBER
  • Director, Risk Adjustment at Baylor Scott & White Health Plan
  • Joan Wilberg
  • ALLIANCE MEMBER
  • Manager, Healthcare Economics at IU Health Plans
  • Mike Gaal
  • SPEAKER
  • Consulting Actuary at Milliman
  • Kim Hiemenz
  • SPEAKER
  • Principal and Consulting Actuary at Milliman
  • Julia Lambert
  • SPEAKER
  • Principal & Senior Consulting Actuary at Wakely Consulting Group
  • Alexis Levy
  • SPEAKER
  • Managing Director at HealthScape Advisors, LLC
  • Kenneth Lewis
  • SPEAKER
  • Executive Director at Hospital Health Plan Coalition
  • Gabriel Odeh
  • SPEAKER
  • Director, HCC Revenue Management at DST Health Solutions
  • John Steele
  • SPEAKER
  • Managing Partner at HealthScape Advisors, LLC
  • Scott Weltz
  • SPEAKER
  • Principal and Consulting Actuary at Milliman
  • Becky Erbe
  • SPONSOR
  • Chief Business Development Officer at hunterAI
  • Chris Jaffe
  • SPONSOR
  • Senior Education Specialist at Bloom Insurance Agency
  • Donna Mayer
  • VIRTUAL ATTENDEE - MEMBER
  • Nurse Auditor at Presbyterian Health Plan
  • Mark Mixer
  • VIRTUAL ATTENDEE - MEMBER
  • Chief Executive Officer at Alliant Health Plans
  • Carol Potts
  • VIRTUAL ATTENDEE - MEMBER
  • Senior Vice President, Healthcare Data Analytics at Health Partners Plans / Jefferson Health Plans (HPP/JHP)
  • Kris Trafton
  • VIRTUAL ATTENDEE - MEMBER
  • Director, Risk Adjustment at Geisinger Health Plan
  • Rebecca Welling
  • VIRTUAL ATTENDEE - MEMBER
  • VP Risk adjustment at SelectHealth
Speakers