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Risk Adjustment Value Visit 2017

Event Date: 2/15/2017 - 2/17/2017

Event Overview

2017 Risk Adjustment Value Visit in Orlando, FL

Access the Risk Adjustment Toolkit

Visit the documents tab to access the event podcasts, presentations and shared resources from the Risk Adjustment Value Visit (department org charts, job descriptions and best practices).

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The defining operational and strategic issue for any health plan serving government sponsored beneficiaries is risk adjustment. Join us February 15-17 for a deep dive into documentation, operational, and strategic issues related to risk adjustment.

 

Who should attend?

  • Chief Financial Officers
  • Risk adjustment leaders
  • Clinical analysts and population health stakeholders
  • Government program leaders with responsibility for Medicare Advantage, Medicaid, or the marketplace
  • Certified coders and/or those who manage certified coders


Event highlights

  • EDPS and RAPs reconciliation: How member plans are mitigating risks, managing the process in house, or identifying vendor partners to help them succeed
  • Case Study from Community Health Options (Maine): Translating risk adjustment intel meaningfully into product design
  • Case Study from Health First (Florida): How this plan is capitalizing on its investment in the risk adjustment to extend the program's value

 

Coding Work Group: Live broadcast (in-person and online)

Wednesday, February 15  |  8:30 AM ET  |  90 minutes

A collection of case studies from Alliance member plans, with a focus on appropriate documentation. To join the online broadcast, register for the Value Visit as a virtual attendee and you will receive the dial-in information. (NOTE: CEU earning opportunity*)

 

CEU Earning Opportunities*

This event has been approved for 3.5 CEUs by AAPC and AHIMA.  Individuals who attend the live broadcast of the coding workshop are eligible to earn 1.5 AAPC CEUs and 1.5 AHIMA CEUs for that session and individuals who attend the whole Value Visit in Orlando are eligible to earn 3.5 CEUs from both organizations.

This program has been approved for 3.5 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor. 

 

Thank you to our Sponsors

SILVER SPONSORS

 

     

BRONZE SPONSORS

 

 

     

OTHER SPONSORS

                   


 
 
Functions

Wednesday, February 15, 2017

6:30 - 8:30 pm Networking dinner for event delegates at The Rusty Spoon

 

Thursday, February 16, 2017

6:30 - 8:30 pm Networking dinner for event delegates at 310 Lakeside

 
Agenda

AGENDA AT A GLANCE*   (Full agenda can be found in the Documents tab)

*note: this is a working agenda and will be updated as sessions changed a/or speakers are confirmed

**We have been approved for AAPC and AHIMA CEUs 

WED, FEB 15

Documentation, department structure and data management

8:30am

Coding workshop: Case study examples and best practices review (CEU opp)

10:15am

Best practices for a smooth and effective IVA process (CEU opp)

11:15am

RADV: risk mitigation, audit preparation and lessons learned (CEU opp)

12:15pm

Lunch and Learn: Roundtable discussions

1:15pm

Understanding and managing the risks of overpayment

3:15pm

Flash case studies: EDPS and RAPs reconciliation – homegrown solutions

4:15pm

Case study recap: Alliance member plans take RAPID-M for a test drive

THURS, FEB 16

The political environment and strategies for survival

8:30am

Understanding the political environment and the anticipated impact on risk adjustment

10:30am

The fringe impact: How to surf the public exchange risk adjustment wave

1:00pm

Case study: The lifecycle of beginning a new vendor relationship

2:50pm

Case study: Translating risk adjustment intel meaningfully to product design

4:00pm

Case study line up: Working with providers for effective risk adjustment communication and intervention

FRI, FEB 17

Expanding the value prop of risk adjustment

8:00am

Breakfast break outs: Roundtable discussions

8:45am

Department structures and policy and procedure show and tell

9:30am

Case study: An Alliance member health plan capitalizes on their risk adjustment department’s value proposition

 


Venue

Grand Bohemian Hotel in Orlando, FL

Grand Bohemian Hotel
325 S Orange Avenue
Orlando, FL 32801
407.313.9000

Our room rate is $209 plus taxes/fees. Internet access in the guest rooms is complimentary. This rate may be available three days prior and three days after our meeting dates, depending on the hotel's availability. You should call the reservations department at 866-663-0024 and ask for the Health Plan Alliance (HPA) room rate or click here to book your room online. You must call the hotel by January 23, 2017 in order to receive our group room rate. Should you call after this deadline, you will not be guaranteed to receive our group room rate or the hotel may be sold out. Please note that the group block could sell out before this date.

DRESS
Business casual attire is appropriate for the meeting.  Remember that the hotel meeting room temperatures vary, so we recommend that you layer clothing to be comfortable in case the room becomes either hot or cold.

GROUND TRANSPORTATION
The hotel is about 13 miles from Orlando International Airport (MCO) and is approximately a 25 minute drive. Taxi service is available for an estimated $45 one way.  Valet parking is $26 overnight and $16 if not staying overnight. 

ORLANDO WEATHER
Click here for the latest weather forecast.


Documents
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3/31/2017

2017 HHS RADV IVA Auditor Report: 2015 Audit
In q1 2017, the Health Plan Alliance invited member plans to share their experience with IVA vendors, and results were reported out in March 2017.

3/6/2017

Audio: Working with providers for effective risk adjustment communication and intervention
Discussion on integrating RA and quality information, the use of clinical data to improve risk score suspecting and the evolution of risk score coding for a high-cost subpopulation in response to HHS model changes.

3/6/2017

Audio: Coding Work Group February 2017 in Orlando
Case studies shared by Health Alliance Medical Plans with the Coding Work Group for discussion of coding best practices.

3/6/2017

Audio: The unintended consequences of dual encounter submissions
EDPS risk scores are sometimes higher than the corresponding RAPS score. While higher revenue can seemingly look like a good thing, these larger risk-adjusted payments could be increasing health plans RADV exposure. This session explores the key components of adequate mitigation.

3/6/2017

Audio: EDPS and RAPS reconciliation - homegrown solutions
This session explores the homegrown solutions some member plans have employed and invites conversation regarding the pros and cons of vendor vs in-house approaches to this critical function.

3/6/2017

Audio: Best Practices for a smooth and effective IVA process
This session takes a deep dive into the IVA process and explores lessons learned when it comes to working with your IVA vendors.

3/6/2017

Audio Case: Understanding and managing the risks of overpayment
In this session we explore how large risk adjusted payments could be increasing health plans RADV exposure.

3/6/2017

Audio: Alliance member plans take RAPID-M for a test drive
Alliance member plans take RAPID-M for a test drive

3/3/2017

Audio: Department structures and policy and procedure show and tell
Two Alliance member plans review their risk adjustment and/or coding department organization charts, job descriptions, policies and procedures, and audit tools, and request other members share theirs as well.

3/3/2017

Audio: Medicare risk adjustment department's value proposition
This session brings Health First back to share updates on how their vision for risk adjustment has evolved, where they are making additional investments and the organization's vision for the road ahead.

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Attendees

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

  • Rick Alexsonshk
  • ALLIANCE MEMBER
  • Director ACA Risk Adjustment at SummaCare
  • Terri Bowers
  • ALLIANCE MEMBER
  • HCC Risk Adjustment Analyst at Providence Health Plan
  • Rudy Dominguez
  • ALLIANCE MEMBER
  • Population Health Managment Process Specialist at Community Health Plan of Washington
  • April Dos Santos
  • ALLIANCE MEMBER
  • Plan Development Specialist at Alliant Health Plans
  • Jessica Dupont
  • ALLIANCE MEMBER
  • Vice President of Government Programs at Alliant Health Plans
  • Chris Frederickson
  • ALLIANCE MEMBER
  • Manager, Risk Adjustment Data Analytics at Network Health
  • Sara Hansen
  • ALLIANCE MEMBER
  • Senior Director, Population Health & Clinical Operations at Avera Health Plans
  • Amber Harris
  • ALLIANCE MEMBER
  • Director Risk Adjustment at MediGold
  • Susan Herbert
  • ALLIANCE MEMBER
  • Director, Health Plan Integration & Development at AdventHealth (FHHS)
  • Jennifer Hunt
  • ALLIANCE MEMBER
  • AVP Actuarial Services at Paramount Health Care
  • Karen Jensen
  • ALLIANCE MEMBER
  • Manager, Risk Adjustment and SIU at Quartz Health Solutions
  • Luce Lohier
  • ALLIANCE MEMBER
  • Director, Government Programs Reimbursement at AvMed
  • Rachel Musacchio
  • ALLIANCE MEMBER
  • Director of Value Capture at Health First Health Plans
  • Daniel O'Connell
  • ALLIANCE MEMBER
  • Vice President of Health Services at Cox HealthPlans
  • Michelle Peake
  • ALLIANCE MEMBER
  • Manager Analytics Risk Adjustment and HEDIS at Health First Health Plans
  • Kylie Rasmussen
  • ALLIANCE MEMBER
  • Risk Adjustment Coding Auditor at SelectHealth
  • Dean Ratzlaff
  • ALLIANCE MEMBER
  • Director, Actuary/Revenue Management at Sentara Health Plans
  • David Seal
  • ALLIANCE MEMBER
  • Executive Director Provider Outreach and Engagement at AdventHealth (FHHS)
  • Julia Lambert
  • SPEAKER
  • Principal & Senior Consulting Actuary at Wakely Consulting Group
  • Alexis Levy
  • SPEAKER
  • Managing Director at HealthScape Advisors, LLC
  • Alison Pool
  • SPEAKER
  • Sr. Consulting Actuary at Wakely Consulting Group
  • Karan Rustagi
  • SPEAKER
  • Senior Consulting Actuary at Wakely Consulting Group
  • David Smith
  • SPEAKER
  • Founder at Third Horizons Strategies
  • Abdo Abdo
  • SPONSOR
  • Vice President, Business Development at Talix
  • Becky Erbe
  • SPONSOR
  • Chief Business Development Officer at hunterAI
  • Michael Nemeth
  • SPONSOR
  • Director of Revenue Management Strategy at DST Health Solutions
  • Lisa Alexander
  • VIRTUAL ATTENDEE - MEMBER
  • Point of Service Coding Analyst at Health Alliance Medical Plans
  • Dania Alvarez
  • VIRTUAL ATTENDEE - MEMBER
  • BI Systems Analyst III at AvMed
  • Julie Bartels
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Analyst at Quartz Health Solutions
  • Robin Bibler
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Coding Analyst at Providence Health Plan
  • Dalene Brandenburg
  • VIRTUAL ATTENDEE - MEMBER
  • Data Analytics Coordinator at Health Alliance Medical Plans
  • Sarah Burke
  • VIRTUAL ATTENDEE - MEMBER
  • Lead Quality Auditor at Health First Health Plans
  • Yang Cao
  • VIRTUAL ATTENDEE - MEMBER
  • Actuary at Fidelis Care New York
  • Charniece Carter
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Operations Supervisor at Health First Health Plans
  • Zhuo Chen
  • VIRTUAL ATTENDEE - MEMBER
  • Actuary at Fidelis Care New York
  • Colleen Degenhardt
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Compliance Analyst at Quartz Health Solutions
  • Doris Ewing
  • VIRTUAL ATTENDEE - MEMBER
  • Coding Analyst at Health Alliance Medical Plans
  • Craig Humphrey
  • VIRTUAL ATTENDEE - MEMBER
  • President & COO at FirstCarolinaCare Insurance Company
  • Amy Jack
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Coding Manager at SelectHealth
  • Morgan Johnson
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Coding Auditor at SelectHealth
  • Erin Kavanagh
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Analyst at Samaritan Health Plans
  • Kaesie Kettinger
  • VIRTUAL ATTENDEE - MEMBER
  • Senior Risk Adjustment Auditor at Paramount Health Care
  • Anji Lefler
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Coding Auditor at SelectHealth
  • Rhonda Long
  • VIRTUAL ATTENDEE - MEMBER
  • Value Based Coding Educator at Health Alliance Medical Plans
  • Stephne Morgan
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Program Manager at Health New England
  • Jaylene Olson
  • VIRTUAL ATTENDEE - MEMBER
  • Point of Service Coding Analyst at Health Alliance Medical Plans
  • Kari Pace
  • VIRTUAL ATTENDEE - MEMBER
  • Clinical Documentation Improvement Nurse-Risk Adjustment/Quality Management at Medical Associates Health Plans
  • Jessica Phillips
  • VIRTUAL ATTENDEE - MEMBER
  • Quality Improvement Specialist at Health New England
  • Jennifer Rohs
  • VIRTUAL ATTENDEE - MEMBER
  • Manager, Documentation and Coding Education at Henry Ford Health System
  • Kristy Russell
  • VIRTUAL ATTENDEE - MEMBER
  • HCC Coding Analyst Supervisor at SelectHealth
  • Krista Schonrock
  • VIRTUAL ATTENDEE - MEMBER
  • AVP, Senior Medical Director at SelectHealth
  • Stefanie Shelton
  • VIRTUAL ATTENDEE - MEMBER
  • Sr. Claims and Reimbursement Specialist at Community Health Plan of Washington
  • Ashley Stipanovich
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Coding Auditor I at SelectHealth
  • Tana Turner
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Coding Auditor ll at SelectHealth
  • Erin Walsh
  • VIRTUAL ATTENDEE - MEMBER
  • Compliance Manager at IU Health Plans
  • Kimberly Watkins
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Coding Auditor Supervisor at Intermountain Healthcare
  • Joan Wilberg
  • VIRTUAL ATTENDEE - MEMBER
  • Manager, Healthcare Economics at IU Health Plans
  • Colin Yi
  • VIRTUAL ATTENDEE - MEMBER
  • Actuary Analyst at Fidelis Care New York
  • Xiaoling Zhang
  • VIRTUAL ATTENDEE - MEMBER
  • Actuary at Fidelis Care New York
Speakers