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Risk Adjustment & Quality Micro Summit 2021

Event Date: 2/9/2021 - 2/10/2021

Event Overview

 

Join your Alliance colleagues to dig into real-life examples of how provider sponsored, regional and independent health plans across the US are meeting clinical integration and risk adjustment challenges during the pandemic — and to share plans for strategic initiatives poised to launch in a post-COVID world. 


Event highlights

This virtual summit is two days of focused sessions, with Alliance members leading the faculty with case studies that outline efforts on the ground. What big wins have health plan leaders achieved when it comes to risk adjustment, quality, and clinical outcomes? What lessons learned from initiatives and pilots that didn’t go as expected? And what efforts are underway now with an eye on the future? 

Topics include:

  • How internal partnerships between quality, risk adjustment, enterprise analytics, contracting and the actuarial teams are fueling the journey to clinical integration
  • Leveraging performance improvement projects to improve at-risk Quality measures: How one Alliance member did it in their Medicaid ACO
  • Technology and interoperability opportunities (think NLP, EHRs and FHIR)
  • Big changes when it comes to members with ESRD: How health plans can meet these new challenges and ensure they’re reimbursed appropriately for these members
  • How Avera challenged themselves to take on a “wildly important goal” – and the powerful impact they saw on risk adjustment and quality when they achieved it


Who should attend

  • VP/Director/Manager of Risk Adjustment
  • VP/Director/Manager of Quality
  • VP/Director/Manager of Population Health
  • VP/Director/Manager of Care Management
  • VP/Director/Manager of Medicaid / Government Programs 


Join the Risk Adjustment & Quality Learning Collaborative


This collaborative marries two of our most active peer groups for robust sharing on topics like retrospective and prospective risk adjustment strategies, HCC capture and coding best practices, and tackling HEDIS, CAHPS, HOS and star rating quality measures in the new COVID-19 environment.
  

LEARN MORE

 

Thank you to our event sponsors


Platinum


Bronze


Sponsor


Vendor

Agenda

For a printable, detailed agenda go to the Documents tab above.

AGENDA AT A GLANCE  

Tuesday, February 9

 

10:00 - 11:00am CT

 

Case study: Clinical integration challenges during the pandemic

 

11:00 – 11:30am CT

 

11:30 – 12:45pm CT

 

BREAK

 

ESRD: New challenges and solutions

 

12:45 – 2:00pm CT

 

2:00 - 3:30pm CT

 

LUNCH BREAK

 

Health Plan Flash Case Study Line up: How to run a successful socially-distanced In-home assessment program (really!)

 

Wednesday, February 10

 

 

10:00 - 11:00am CT

 

Case study: How CDPHP is using Natural Language Processing to enhance risk adjustment and quality outcomes

 

11:00 – 11:30am CT

 

11:30 – 12:45pm CT

 

BREAK

 

Case study: Improving care follow up and health outcomes through performance improvement projects

 

12:45 – 2:00pm CT

 

2:00 - 3:30pm CT

 

LUNCH BREAK

 

Avera Case Study: How achieving one Wildly Important Goal made a $1.2M impact
Documents
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2/12/2021

Recording: Health New England Case Study: Improving care follow up and health outcomes through performance improvement projects_- February 10, Session 2
Health New England shares how they improve care follow up and health outcomes through performance improvement projects at the RA & Quality Micro Summit - February 10, Session 2.

2/12/2021

Recording: ESRD: New challenges and solutions_Change Healthcare - February 9, Session 2
Change Healthcare discusses enrolling new member with ESRD, paperwork strategies to ensure revenue is right, home and facility dialysis, and retroactive payments including the completion of CMS-2728 form. Shared at the RA & Quality Micro Summit - February 9, Session 2.

2/10/2021

Recording: How CDPHP is using Natural Language Processing to enhance risk adjustment and quality outcomes
The CDPHP team details its Natural Language Processing (NLP) structure and overview. Shared at the Risk Adjustment and Quality Micro Summit 2021.

2/10/2021

Recording: Avera Case Study: How achieving one Wildly Important Goal made a $1.2M Impact, February 10, Session 3
This case study shares the journey's story and offers key takeaways and ideas on how you could take on a WIG of your own health system. Shared during the Risk Adjustment and Quality Micro Summit 2021.

2/10/2021

Recording: Paramount Case Study: How to run a successful socially-distanced in-home assessment program (really!), February 9, Session 3
Paramount Health Plan team detailed how they moved to telehealth, and the role a device lending program has played in their efforts to partner on in-home health assessments. Shared at the RA & Quality Micro Summit - February 9, Session 3.

2/10/2021

Reference Material: CROWN collection method mandated by CMS for ESRD
Sentara shares this file as a reference document as part of their workflow: Consolidated Renal Operations in a Web-enabled Network (CROWN) is a Web-based data-collection system mandated by CMS to enable dialysis facilities to meet portions of the Conditions for Coverage for End Stage Renal Disease (ESRD) Dialysis Facilities. Discussed at RA & Quality Micro Summit during ESRD: New challenges and solutions session - February 9, Session 2.

2/10/2021

Reference Material: ESRD Workflow_Sentara
Kami Andrews developed the workflow and is Sentara's ESRD contact. Sentara Health Plans shares their ESRD workflow during ESRD session at RA & Quality Micro Summit at ESRD - February 9, Session 2.

2/10/2021

Presentation: Health New England Case Study: Improving care through performance improvement projects - February 10, Session 2
Health New England shares how they improve care follow up and health outcomes through performance improvement projects at the RA & Quality Micro Summit - February 10, Session 2.

2/10/2021

Presentation: Avera Case Study: How achieving one Wildly Important Goal made a $1.2M Impact, February 10, Session 3
This case study shares the journey's story and offers key takeaways and ideas on how you could take on a WIG (wildly important goal) at your own health plan. Presented during the Risk Adjustment and Quality Micro Summit.

2/10/2021

Presentation: Using Natural Language Processing to enhance risk adjustment and quality outcomes - February 10, Session 1
CDPHP provides actionable takeaways on how to apply NLP in new and impactful ways.

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Attendees

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

  • Katie Anderson
  • ALLIANCE MEMBER
  • MGR, Risk Adjustment Analytics at Sentara Health Plans (Optima)
  • Kami Andrews
  • ALLIANCE MEMBER
  • Medical Records Review Analyst at Sentara Health Plans (Optima)
  • Kwame Appiah-Yeboah
  • ALLIANCE MEMBER
  • Director, Risk Adjustment at Sentara Health Plans (Optima)
  • Kieley Arakelian
  • ALLIANCE MEMBER
  • Director - Quality Management at Physicians Health Plan
  • Frank Badillo
  • ALLIANCE MEMBER
  • Healthcare Payment Innovation Lead at MetroPlusHealth
  • Lucille Baxter
  • ALLIANCE MEMBER
  • Quality & Health Education Manager at Santa Clara Family Health Plan
  • Zoe Benfield
  • ALLIANCE MEMBER
  • Director of UM & Risk Adjustment Solutions at Health Alliance Medical Plans
  • Terri Bowers
  • ALLIANCE MEMBER
  • HCC Risk Adjustment Analyst at Providence Health Plan
  • Sibyl Boyd
  • ALLIANCE MEMBER
  • Medical Department Coordinator/Certified Risk Adjustment Coder at Cox HealthPlans
  • Ngoc Bui-Tong
  • ALLIANCE MEMBER
  • Chief Health Equity and Strategy Officer at Santa Clara Family Health Plan
  • Sarah Burke
  • ALLIANCE MEMBER
  • Lead Quality Auditor at Health First Health Plans
  • Joe Caldwell
  • ALLIANCE MEMBER
  • Chief Finance Officer at Denver Health Medical Plan
  • Kayleigh Cavano
  • ALLIANCE MEMBER
  • Risk Adjustment Coding Auditor at MediGold
  • Alisa Cocozza
  • ALLIANCE MEMBER
  • Vice President of Product at MetroPlusHealth
  • Jennifer Cones
  • ALLIANCE MEMBER
  • Manager, Outpatient CDI at Henry Ford Health System
  • Deb Curry
  • ALLIANCE MEMBER
  • Director Risk Adjustment & Recoveries at Paramount Health Care
  • Esther D'Arezzo
  • ALLIANCE MEMBER
  • RN, Clinical Supervisor Risk Adjustment at Neighborhood Health Plan of Rhode Island
  • D De Roche
  • ALLIANCE MEMBER
  • Manager, Goverment Programs at Community Health Options
  • David DiGiuseppe
  • ALLIANCE MEMBER
  • VP of Healthcare Economics at Community Health Plan of Washington
  • Donna Dixon
  • ALLIANCE MEMBER
  • Membership Specialist at Health Plan Alliance
  • Rudy Dominguez
  • ALLIANCE MEMBER
  • Population Health Managment Process Specialist at Community Health Plan of Washington
  • Jessica Dupont
  • ALLIANCE MEMBER
  • Vice President of Government Programs at Alliant Health Plans
  • Art Edgerton
  • ALLIANCE MEMBER
  • Medical Director at FirstCarolinaCare Insurance Company
  • Michelle Eliasen
  • ALLIANCE MEMBER
  • Senior Network Pricing Analyst at Community Health Options
  • Michael Farina
  • ALLIANCE MEMBER
  • Director, Health Care Quality at Capital District Physicians' Health Plan (CDPHP)
  • Lisa Garrett
  • ALLIANCE MEMBER
  • Risk Adjustment Manager at Sentara Health Plans (Optima)
  • Kena Hahn
  • ALLIANCE MEMBER
  • Director- Medicare Stars and Outpatient Care Coordination at Health Alliance Medical Plans
  • Kaitlyn Hammond
  • ALLIANCE MEMBER
  • Director of Government Programs at Cox HealthPlans
  • Sara Hansen
  • ALLIANCE MEMBER
  • Senior Director, Population Health & Clinical Operations at Avera Health Plans
  • Deanna Homer
  • ALLIANCE MEMBER
  • Chief Operations Officer at HealthTeam Advantage
  • Amy Jack
  • ALLIANCE MEMBER
  • Risk Adjustment Coding Manager at SelectHealth
  • Karen Jensen
  • ALLIANCE MEMBER
  • Manager, Risk Adjustment and SIU at Quartz Health Solutions
  • Erin Kavanagh
  • ALLIANCE MEMBER
  • Risk Adjustment Analyst at Samaritan Health Plans
  • Ashley Kim
  • ALLIANCE MEMBER
  • assistant compliance counsel at Central Health Plan of California
  • Christopher Kirk
  • ALLIANCE MEMBER
  • Vice President, Health Care Economics at Jefferson Health Plans
  • MWANSA KORANTENG
  • ALLIANCE MEMBER
  • Commercial Product Analyst at Denver Health Medical Plan
  • Tina Korty
  • ALLIANCE MEMBER
  • Vice President, Health Plans Legal, Compliance & Regulatory at IU Health Plans
  • Ed Lee
  • ALLIANCE MEMBER
  • Product Leader, Health Plans Medicare Advantage at IU Health Plans
  • Adam Letherby
  • ALLIANCE MEMBER
  • Quality CHA Supervisor at Health First Health Plans
  • Melanie Lewis
  • ALLIANCE MEMBER
  • Risk Adjustment Coder at Henry Ford Health System
  • Luce Lohier
  • ALLIANCE MEMBER
  • Director, Government Programs Reimbursement at AvMed
  • Archana Mahimkar
  • ALLIANCE MEMBER
  • Program Director, Quality Primary Care at Care N' Care Insurance Company, Inc.
  • Kathy Mantell
  • ALLIANCE MEMBER
  • Provider Configuration Specialist at SummaCare
  • Tamara Migut
  • ALLIANCE MEMBER
  • Director of Quality Management at Health Alliance Medical Plans
  • Stephne Morgan
  • ALLIANCE MEMBER
  • Risk Adjustment Program Manager at Health New England
  • Preeti Nakrani
  • ALLIANCE MEMBER
  • Medicaid Program Manager at Health New England
  • Kari Pace
  • ALLIANCE MEMBER
  • Clinical Documentation Improvement Nurse-Risk Adjustment/Quality Management at Medical Associates Health Plans
  • Liza Paul
  • ALLIANCE MEMBER
  • Vice President of Health Services at MediGold
  • Wade Penner
  • ALLIANCE MEMBER
  • Manager Revenue-Risk at Samaritan Health Plans
  • Allison Runyan
  • ALLIANCE MEMBER
  • Supervisor of Risk Adjustment Operations at Health First Health Plans
  • Kelly Skifton
  • ALLIANCE MEMBER
  • Assistant Vice President, Compliance & Government Regulatory Operations and Privacy at Quartz Health Solutions
  • Mike Sloan
  • ALLIANCE MEMBER
  • Manager, Risk Adjustment Submissions & Analytics at MediGold
  • Caryn Smith
  • ALLIANCE MEMBER
  • Director of Risk Adjustment at HealthTeam Advantage
  • Dolores Snyder
  • ALLIANCE MEMBER
  • Director of Quality and Regulatory Stars at Sentara Health Plans (Optima)
  • Jerald Somsen
  • ALLIANCE MEMBER
  • Director of Business Intelligence at Avera Health Plans
  • Krystal Stevenson
  • ALLIANCE MEMBER
  • Manager- Risk Adjustment Programs & Operations at Health Alliance Plan (HAP)
  • Diana Vasquez
  • ALLIANCE MEMBER
  • Senior Risk Adjustment Coding Specialist at Neighborhood Health Plan of Rhode Island
  • Kat Waldman
  • ALLIANCE MEMBER
  • Administrative Coordinator at Health Plan Alliance
  • Tracey Walters
  • ALLIANCE MEMBER
  • Risk Adjustment Claims Resolution Specialist at MediGold
  • Susan Waterman
  • ALLIANCE MEMBER
  • Director, Risk Adjustment at Baylor Scott & White Health Plan
  • Nancy Weber
  • ALLIANCE MEMBER
  • Clinical Integration Program Manager at Network Health
  • Josh Weisbrod
  • ALLIANCE MEMBER
  • VP Risk Adjustment at Network Health
  • Joan Wilberg
  • ALLIANCE MEMBER
  • Manager, Healthcare Economics at IU Health Plans
  • Margie Zeglen
  • ALLIANCE MEMBER
  • Vice President Population Health at Health Alliance Medical Plans
  • Holly Zorz
  • ALLIANCE MEMBER
  • Quality Improvement Team Lead, Medicare at Paramount Health Care
  • Nancy Dobbs
  • SPONSOR
  • Director, Strategic Accounts at MTM, Inc
  • Mary Mandish
  • SPONSOR
  • Marketing & Events Specialist at Inovalon, Inc
  • Donna Reckitt
  • SPONSOR
  • Expert Client Account Manager at Veradigm
Speakers
  • Deanna James-Anderson
    Director, Quality & Regulatory, Clinical Care Services Administration, Virginia Premier Health Plan at Sentara Health Plans (Optima)
    click here for full people profile