Rise

Track A: Risk Adjustment Excellence

ACA Risk Adjustment Update and Projections

• Hear about the challenges and changes to ACA risk adjustment for 2025 and 2026
• Assess how states can compensate for inaccurate or inadequate risk adjustment transfers
• Analyze the issues with the ACA RADV process and how to fix them
• Generate new ideas to better understand and explain the differences between ACA and MA risk adjustment

J. Gabriel McGlamery J.D., Director of Commercial Market Strategic Integration

Florida Blue

Track B: Compliant Coding

Strategies to Identify Discrepancies in Coding

• Implement AI tools to target areas for both increased accuracy of Risk adjustment and increased staffing efficiencies 
• Enhance current workflows to help capture identified opportunities
• Understand the impact of these interventions on your population 

Carrie Horn, MSHA, BBA, RN, CCDS, CCDS-O, CPC, CRC, Director Outpatient CDI  

Baylor Scott & White Health 

Dr. Sunita Varghees, System Vice President of CDI 

Baylor Scott & White Health 

Track A: Risk Adjustment Excellence

Impact and Implications of the Transition to V28

• Assess the impact of the transition from V24 to V28 model on risk adjustment coding
• Evaluate the success of a clinically driven approach to closing gaps and improving risk adjustment code capture
• Comprehend the importance of accurate prospective and concurrent provider review of chronic diseases and disease progression

Moderator:

Jeannine Bumford, CPC, CRC, Director of Risk Adjustment,  

Christus Health 

Panelists:

Rafael J. Gonzalez MD, Director of Clinical Coding & Clinical Documentation Integrity 

Leon Medical Centers/Leon Health 

Shannon Decker, PhD., MBA, MBA, M.Ed., M.Ed., Risk Adjustment Expert, Founder & CEO 

VBC One 

Track B: Compliant Coding

OIG Audit Review and Preparation Tactics

• Explore recent findings from OIG audits to identify common fraudulent activities that are being identified to mitigate risk
• Examine the OIG toolkit, and how it can help prepare your organization to better understand OIG’s objectives
• Educate your audit response team to have an understanding of what to expect when experiencing an OIG audit

Moderator:

Dr. Ekaette Joseph-Isang, Principal Consultant 

Ritebridge 

Panelists:

Colleen Gianatasio, Director Clinical Documentation Integrity and Coding Compliance

Capital District Physician’s Health Plan (CDPHP)

Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, Chief Operating Officer,

First Class Solutions, Inc.

Track A: Risk Adjustment Excellence

Leverage Data to Generate Informed Organizational Decisions

• Assess the value of capitalizing on valuable data for decision-making to enhance your risk adjustment efforts
• Analyze which data sets should be reviewed to help guide leadership in the decision-making process
• Explore solutions available to help collect and streamline data to improve organizational approaches to risk adjustment

Danielle Kopetman, Associate Solutions Consultant

Episource

Caroline Hebron, MPH, Senior Manager, Quality & Risk Adjustment

Cedars-Sinai

Track B: Compliant Coding

Part D Risk Adjustment Spotlight

• Discuss expanded importance of Part D Risk Adjustment following significant changes from the Inflation Reduction Act (IRA)
• Review differences between the Part C and Part D Risk Adjustment Models
• Examine risks and opportunities of Part D Risk Adjustment on overall Plan financial performance

Mark Koransky FSA, MAAA, Senior Consulting Actuary  

Wakely Consulting Group 

Laura Sheriff, RN, MSN, CPC, CRC 

Risk Adjustment Industry Expert  

Track A: Risk Adjustment Excellence

Tools & Technology Spotlights

Leading service providers will showcase their offerings in a quick-pitch setting. Evaluate the latest and greatest tech tools to bring back to your organization.

Nick Volpe, Sales Director – Risk Adjustment

Wolters Kluwer, Health Language

Track B: Compliant Coding

Transition to Networking Break

Track A: Risk Adjustment Excellence

Unpacking Change: Strategies for Adapting your Risk Adjustment Program

• Hear industry perspectives driving need for change 

• Explore contrasting traditional and new approaches used to manage under risk adjustment 

• Pick the right plays for peak risk adjustment performance 

Roxanna Cross, Solutions Architect,  

Reveleer 

Deb Curry, MBA, RHIA, CCS-P, CRC, Risk Adjustment Programs Director 

Paramount Insurance Company

Track B: Compliant Coding

The Next Frontier for Completeness, Accuracy, & Speed

• Understand the latest developments in risk-adjustment coding technology, from yesterday's NLP to today's deep-learning AI
• Assess opportunities to increase completeness, specificity, and accuracy to find missing HCCs and advance coding integrity
• Measure the operational impact of deep-learning AI for RA coding, based on real case studies

Moderator: 

Andrew Lockhart, CEO,  

Fathom 

Panelists:  

Carrie Horn, MSHA, BBA, RN, CCDS, CCDS-O, CPC, CRC, Director Outpatient CDI  

Baylor Scott & White Health 

Dr. Sunita Varghees, System Vice President of CDI 

Baylor Scott & White Health 

RaeAnn Grossman, CEO  

HLTHWorks 

Track A: Risk Adjustment Excellence

Diversify Your Care Gap Closure Strategy

• Utilize data and predictive modeling to identify gaps in care than need to be addressed
• Avoid missed opportunities through coding review and utilize data to create an accurate risk score
• Identify tools and solutions available to help close gaps in care and calculate which one is the best fit for your organization

Megan Zakrewsky, Vice President, Clinical Data Exchange

Veradigm

Karen Bowers, RHIA, CCS, CPC, Director Risk Management

American Health Plans

Track B: Compliant Coding

RADV Extrapolation Changes Impacting Audits

• Examine the changes to extrapolation and how they can financially damage your organization 
• Assess CMS approach to RADV audits and how they calculate an extrapolated amount to be reimbursed 
• Create and implement documentation review to identify potential costly errors prior to being selected for a RADV audit 

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP, Director Risk Capture, Population Health Management 

Mass General Brigham 

Track A: Risk Adjustment Excellence

Build, Grow, and Retain a Successful Risk Adjustment Team

• Explore the process of identifying, hiring, and developing valuable members of your risk adjustment team 
• Implement policies and procedures to ensure collaboration between all team members to achieve organizational success 
• Identify tactics to retain valuable employees to avoid disruption and help with organizational growth 

Moderator

Alan Crop,  Vice President of Sales

Innovihealth 

Panelists

Jeannine Bumford, CPC, CRC, Director of Risk Adjustment 

Christus Health

Yenney Orosa  CPC, CPMA, CRC, CDEO, CPCO, AHCCA, Director, ACO Risk Coding, Billing & Revenue Cycle Management 

American Choice Healthcare 

Track B: Member Engagement & Retention

Putting Members First: A Member-Centric Approach for Health Care Improvement

• Hear different approaches to member engagement
• Discuss best practices to integrate analytics for member-centric solutions to reach targeted goals
• Identify new approaches to remove silos to better connect with members while navigating CMS compliance requirements

Moderator:

John Criswell, Founder, CEO, and Chairman

Porter

Panelists:

Jennifer Hawkes CPC, CRC, Manager, Member Engagement

Blue Cross of Idaho

Helen L. Veet, DNP, RN, Director of Quality Manager ACP and KF – PA Medicaid

AmeriHealth Caritas Pennsylvania
Keystone First

Mark Bigelow, VP, Risk Adjustment 

Cambia Health Solutions 

Deb Curry, MBA, RHIA, CCS-P, CRC, Risk Adjustment Programs Director 

Paramount Insurance Company   

Track A: Risk Adjustment Excellence

The Trickle-Down Effect of Data Security Breaches

• Analyze current cases of data security breaches and the impact it has had on the health care industry
• Explore best practices and protocols to avoid costly mistakes with important confidential data
• Discuss the impact of current data breaches on information sharing and interoperability

Deb Curry, MBA, RHIA, CCS-P, CRC, Risk Adjustment Programs Director 

Paramount Insurance Company   

Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, Chief Operating Officer,

First Class Solutions, Inc.

Track B: Member Engagement & Retention

Enhancing Health Outcomes with V28

• Understand the Risks of Misdiagnosed Vascular Disease: Learn about the common misdiagnoses of vascular disease and their impact on patient outcomes. 
• Implement Effective Documentation Practices: Discover actionable strategies for accurate diagnosis coding and documentation to improve patient care and financial performance
•  Optimize opportunities in V28 risk recapture

Chris Trygstad, Vice President, Product

Biomedix 

Ava Johnson, Associate Director, Ambulatory CDQI 

Mount Sinai Hospital, NYC 

Track A: Risk Adjustment Excellence

Coding and Documentation Excellence

• A comprehensive insight into coding and documentation best practices and practical coding of major conditions to reflect accurate risk adjustment
• Discuss risk eligibility of CPT codes and how to navigate provider visits to improve point of care coding
• Evaluate codes that have the ability to impact quality measures such as SDoH codes and advanced illness and frailty codes, and diagnosis codes that drive care management services

Moderator

Jeannie Hennum, Vice President of Health Plan Performance

Verisma

Panelists

Marilee Klock, MBA, CPC, CRC, Senior Director, Diagnosis Accuracy Program

GuideHealth

Kaitlin Sebourn, Senior Manager of Clinical Programs

DaVita Integrated Kidney Care

Leigh Anne Harmon, Manager of Clinical Documentation Integrity

DaVita Integrated Kidney Care

Track B: Member Engagement & Retention

Case Management to Improve Risk Adjustment

• Understand how risk adjustment can be used to drive case management
• Assess the value of case management on reduction of hospital admissions and unnecessary costs
• Analyze which specialists need to be part of your case management team to improve health care and risk adjustment outcomes

Moderator

Ryan Dodson, CRC, Risk Adjustment Consultant,

Choice Medical Group

Panelists

Kaitlyn Brack, BSHIIM, CPC, CEMC, CFPC, CPEDC, AAPC Approved-Instructor

Coding Auditor-Educator

Baptist Health Deaconess Madisonville

Tiffany Ferguson, LMSW, CMAC, ACM

Healthcare Industry Specialist

Adjunct Professor,

Northern Arizona University