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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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5/24/2016

Audio: Intro to CGAD models and the possible impact to plans
This session features CJ Rathbun of First Consulting, who provides an intro to the CGAD models, the possible impact to fraternal board structure, and the changing roles of internal staff to support board objectives.

5/24/2016

Audio: 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.

5/24/2016

Audio: Communication and training in corporate governance/ risk management
CJ RathBun of First Consulting covers communication and training in corporate governance; Coordination of employee, management and board training; and increasing communications about risk.

5/24/2016

Audio: Case study - Network Health Plan on the shifting roles of compliance leaders and CRO
Augustine Doe, VP of Enterprise Risk Management at Network Health Plan covers: how to create a more robust ERM program; the changing role of compliance leadership and the changing role of CRO.

5/24/2016

Audio: Case study - Health Alliance Medical Plan on the formation of the risk management team
Scott McAdams, the Chief Compliance and Risk Officer at Health Alliance Medical Plans, covers the formation or function of ERMT/Committee (company-level risk management team) and Metrics – reporting, forms, documentation, follow-ups, heat map.

5/24/2016

Audio: Your risk incident team and reporting of incidents – SWAT team, Triage team
CJ Rathbun of First Consulting, covers risk incident team and reporting of incidents – SWAT team, triage team; SWAT team – setting it up and running it; Compliance role in helping ensure risk mitigations, monitoring etc. are appropriately funding

5/24/2016

Audio: Facility risks and business continuity: The audits expect more than a check-the-box approach
Based on over 25 years of disaster recovery experience, and thousands of recoveries conducted for institutions of all types, these straight-forward and simple to implement steps from Mike Merz of Agility Recovery could mean the difference between surviving a disaster, and giving in to one.

5/24/2016

Audio: QHP Audits: Preparing for them, and what to expect when it comes to enforcement actions
With the expiration of the "Good Faith Compliance" standard in the Federally-run exchanges, insurers in the 37 states where CMS manages the health insurance exchange are now subject to fines and other penalties for not meeting federal requirements. Informal "compliance reviews" will become more formal, audit-like, and potentially punitive. Dawn Stocker of Geisinger and Mike Adelberg of FaegreBD Consulting share insights with Value Visit attendees regarding what to expect next.

5/24/2016

Audio: Case study series: Life after a CMS Audit - How to survive the fall out
Understanding audit protocols is one thing: But making it through an audit successfully and – more challenging – all of the subsequent to-dos following an audit, is what often precipitates unexpected consequences for health plan compliance leaders. In this series of case studies, CMS audit veterans Alissa Beattie of New West and Deborah Marine from SummaCare share their perspective and lessons learned.

5/24/2016

Audio: The secret to compliant operations (Hint: it’s not about P&Ps)
In 2010, CMS completely revamped their audit process, shifting what had always been a preoccupation with documented policy and procedures to a strong focus on outcomes … meaning a strong focus on Data. CMS auditors are completing more and more invasive sampling and extrapolation, seeking to identify problems, identify the root, and quantify the scope of the beneficiary impact. Former CMS auditor Shelley Stevenson of Change Healthcare shares her insights for health plan compliance leadership.

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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