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Organizational risk management and compliance value visit

Event Date: 5/10/2016 - 5/12/2016

Event Overview

Organizational risk management and compliance 

Join your Alliance peers for a 2 1/2 day deep-dive into enterprise risk management and compliance.  This value visit will examine both the risk management process itself, as well as specific high-risk areas such as cybersecurity, CMS audits, data governance, and fraud, waste and abuse.

Who should attend?

Executives with responsibility for risk management, compliance, internal audit, and legal.

Functions

Tuesday, May 10, 2016

6:00 - 8:00 pm Networking dinner for event delegates.  Restaurant location to be announced.

 

Wednesday, May 11, 2016

6:30 - 9:00 pm Networking dinner for event delegates.  Restaurant location to be announced.

 
Agenda

For a printable, detailed agenda, visit the Documents tab noted above

AGENDA AT A GLANCE  

Tues, May 10

 

8am

Registration and Breakfast

8:30am

Welcome and introductions

9:30am

Enterprise risk management: Preparing your health plan to stay ahead

10:30am

Break

10:45am

Intro to CGAD models and the possible impact to plans

11:15am

Case study: Medical Associates on the formation of the governance committee of the board

12:15pm

Lunch

1:15pm

Communication and training in corporate governance – risk management

1:45pm

Case study: Network Health Plan on the shifting roles of compliance leaders and CRO

2:45pm

Fitness Break

3:15pm

Case study: Health Alliance Medical Plan on the formation of the risk management team

4:15pm

Your risk incident team and reporting of incidents – SWAT team, Triage team

4:45pm

Small Group Discussion: Mapping your risk management procedures from occurrence to final report out

5:15pm

Day adjourns

6:30pm

Dinner - Cooper’s Hawk Winery & Restaurant

Wed, May 11

 

8am

Breakfast

8:30am

Facility risks and business continuity: the audits expect more than a check-the-box approach

9:45am

Break

10am

QHP audits: Preparing for them, and what to expect when it comes to enforcement actions

11:15am

Case study series -- Life after a CMS Audit: How to survive the fall out

12:30pm

Lunch

1:30pm

The secret to compliant operations (Hint: It’s not about P&Ps)

2:30pm

Fitness Break

3pm

The CMS Journey to EDS: Mitigating the risks inherent to revenue cycle management

4:15pm

Case Study: SummaCare on RADV risk mitigation

5:15pm

Day adjourns

6:30pm

Dinner – P. F. Changs

Thurs, May 12

 

8:00am

Breakfast

8:30am

Case study: The Health First strategy to mitigate data security risks

9:45am

Break

10am

Managing a breach response without losing members

11am

Case study: Paramount shares their risk mitigation strategy development process

12pm

Working Lunch: Roundtable discussion
Documents
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6/2/2016

Presentation: Case study: Medical Associates on the formation of the governance committee of the board
This session features Karen Hoffman, Director of Operations with Medical Associates Health Care, who shares how they formed a governance committee from start to finish, with lessons learned regarding reports, interviews, and self-evaluations by board members.

5/31/2016

Template: Risk issues log
Risk Issues Log template shared by Scott McAdams, Chief Compliance Officer at Health Alliance Medical Plans, during the May 2016 Organizational Risk Management and Compliance value visit

5/31/2016

Template: ERM risk incident reporting form
Risk incident reporting form; a template shared by Scott McAdams, Chief Compliance Officer at Health Alliance Medical Plans, during the May 2016 Organizational Risk Management and Compliance value visit

5/31/2016

Template: ERM heat map
Enterprise Risk Management heat map; a template shared by Scott McAdams, Chief Compliance Officer at Health Alliance Medical Plans, during the May 2016 Organizational Risk Management and Compliance value visit

5/25/2016

Recording: Case study: The Health First strategy to mitigate data security risks
Large breaches and large sanctions have dominated healthcare security news for some time now with one key message for all of us: It’s time to move from "being compliant" to "being secure". Jutta Williams, Chief Compliance Officer of Health First Health Plans, focuses on what Health First did to operationally improve security, from assessing risk - reading and interpreting the HIPAA Risk Assessment – to gaining board support to invest more in security. She shares how they built an action plan that is achievable, are measuring results and sustaining changes.

5/25/2016

Audio: The CMS Journey to EDS: Mitigating the risks inherent to revenue cycle management
Particularly with the recent announcement from CMS that MA payment source is shifting to 25% Encounter Data, data governance best practices are more critical than ever to your overall risk mitigation strategies as it relates to your revenue cycle. In this session, Jim Corbett of Dynamic Healthcare Systems discusses EDS versus RAPS and the ways in which this much more complicated data set, driving plan revenue, requires aggressive risk mitigation from a multi-disciplined team. We focus on the compliance component of this challenge, rather than risk adjustment operations and tactics, and will address issues related to reconciliation, data governance, vendor oversight, quality assurance, and provider education strategies.

5/25/2016

Audio: Case study - SummaCare on RADV risk mitigation
Rick Alexsonshk of SummaCare provides a Medicare Risk Adjustment Overview and addresses the need For Risk Mitigation, as well as what A Plan Can Do To Protect Themselves. He also covers the RADV process and shares what SummaCare has done to mitigate this risk.

5/25/2016

Audio: Managing a breach response without losing members
Anyone responsible for risk management, compliance, internal audits, and legal should pay special attention to the increasing cybersecurity threat that’s darkening the healthcare industry landscape. Breaches can’t be stopped, but there are ways to prepare for the worst and minimize the fallout. This presentation from Erich Lambert with AllClear ID provides four valuable tips to help an organization respond to a breach in a way that not only reassures members and stakeholders, but that also sets the stage for recovery.

5/25/2016

Audio: Case study: Paramount shares their risk mitigation strategy development process
Jonathan Burns of Paramount Health Care partners with RSM to share how Paramount built their risk mitigation strategy from the ground up. The session covers the current state assessment process, the future state assessment, risk identification process, and the development of risk response and risk mitigation plans of action.

5/24/2016

Audio: Enterprise risk management: Preparing your health plan to stay ahead
Enterprise Risk Management is a new way for boards and senior management to attempt to manage the specific risks associated with a particular business enterprise. This session features Patricia Wagner of Epstein Becker Green, who explores ways in which the board and senior management can establish Enterprise Risk Management priorities.

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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
  • Nicole Beadle
  • ALLIANCE MEMBER
  • Manager, Medicare Compliance at Paramount Health Care
  • Alissa Beattie
  • ALLIANCE MEMBER
  • Vice President, Operations & Compliance at New West Health Services
  • Jaime Gonzalez
  • ALLIANCE MEMBER
  • Chief Business Development Officer at Health Plan Alliance
  • Karen Hoffmann
  • ALLIANCE MEMBER
  • Director of Operations at Medical Associates Health Plans
  • Tracy Jones
  • ALLIANCE MEMBER
  • Chief Compliance Officer at SummaCare
  • Sabrina LeBeau
  • ALLIANCE MEMBER
  • Director of Human Resources and Compliance Officer at Alliant Health Plans
  • Alan Lederman
  • ALLIANCE MEMBER
  • Chief Operating Officer at Community Health Plan of Washington
  • Rachel Reimann
  • ALLIANCE MEMBER
  • AVP Regulatory Compliance at SelectHealth
  • Jason Rio
  • ALLIANCE MEMBER
  • Sr. Director of Revenue Assurance and Risk Management at Health New England
  • Ben Steiner
  • ALLIANCE MEMBER
  • Director of Internal Audit at Community Health Plan of Washington
  • Dawn Stocker
  • ALLIANCE MEMBER
  • Program Manager, Health Care Reform Compliance at Geisinger Health Plan
  • Mike Adelberg
  • SPEAKER
  • Executive Director at National Association of Dental Plans
  • Jim Corbett
  • SPEAKER
  • Founder and Chief Strategy Officer at Reveleer
  • Mike Merz
  • SPEAKER
  • Strategic Sales Manager at Agility Recovery Solutions
  • Patricia Wagner
  • SPEAKER
  • Member of the Firm & Chief Privacy Officer at Epstein Becker Green (EBG)
  • Tina Bailey
  • SPONSOR
  • Senior Director, Compliance Solutions at Gorman Health Group
  • Becky Erbe
  • SPONSOR
  • Chief Business Development Officer at hunterAI
  • Thomas Joyer
  • SPONSOR
  • Chief Commercial Officer at Altruista Health, Inc
  • Brad Piper
  • SPONSOR
  • Principal and Consulting Actuary at Milliman
  • Deb Curry
  • VIRTUAL ATTENDEE - MEMBER
  • Director Risk Adjustment & Recoveries at Paramount Health Care
  • JoAnna Destino
  • VIRTUAL ATTENDEE - MEMBER
  • Government Relations Manager at Fidelis Care New York
  • Erin Heckethorn
  • VIRTUAL ATTENDEE - MEMBER
  • Director of Operations and Program Management at FirstCarolinaCare Insurance Company
  • Mark Mixer
  • VIRTUAL ATTENDEE - MEMBER
  • Chief Executive Officer at Alliant Health Plans
  • Jack Randolph
  • VIRTUAL ATTENDEE - MEMBER
  • Chief Executive Officer at MediGold
Speakers