HEALTHCARE EDUCATION ASSOCIATES AND THE RESOURCE INITIATIVE & SOCIETY FOR EDUCATION (RISE) PROUDLY PRESENT THE

Transforming Vision into Excellence in Risk Adjustment, Stars Performance,

Predictive Modeling and Clinical Outcomes
MARCH 20-22, 2016

G AY L O R D O P R Y L A N D R E S O R T

KEYNOTE ADDRESS

P L AT I N U M

FEATURED PRESENTER
ANNE FILIPIC
PRESIDENT
ENROLL AMERICA

GOLD

SPONSORS

S E N AT O R T O M D A S C H L E ( D - S D )
F O R M E R S E N AT E M A J O R I T Y L E A D E R
Author of Getting it Done: How Obama and Congress Finally Broke the Stalemate to
Make Way for Health Care Reform; Founder and Chairman,
T H E D A S C H L E G R O U P, A P U B L I C P O L I C Y A D V I S O R Y O F B A K E R D O N E L S O N

NASHVILLE, TN

T O R E G I S T E R : C A L L 8 6 6 - 6 7 6 - 7 6 8 9 O R V I S I T U S AT W W W. H E A LT H C A R E - C O N F E R E N C E S . C O M

VENUE DETAILS
Gaylord Opryland Resort
2800 Opryland Drive
Nashville, Tennessee 37214
615-889-1000
We have a limited number of hotel rooms reserved for the conference. The
negotiated room rate of $259.00 per night will expire on March 1, 2016,
although we expect the block to sell out prior to this date. To ensure you
receive a room at the negotiated rate, book well before the expiration date. Upon
sell out of the block, room rate and availability will be at the hotels discretion.

TOP REASONS TO ATTEND

TEAM DISCOUNTS

Three people will receive 10% off

Four people will receive 15% off
Five people or more will receive 20% off

Hear a special keynote address by Senator Tom Daschle (D-SD) on The

Next Phase of Healthcare Reform, former Senate Majority Leader
and Founder & Chairman of The Daschle Group, A Public Policy Advisory
of Baker Donelson
Gain timely updates during the featured address by Anne Filipic,
President of Enroll America on the latest trends within the health
exchange marketplace
Enjoy a comprehensive learning environment unlike any other in
the industry, featuring eight different track themes over two days
filled with strategy-driven discussions and case studies led by the
best and brightest
Create your ultimate conference experience with the choice of over
35 different sessions covering Medicare Advantage and Commercial
Risk Adjustment, Stars and Quality, Data Analytics, Compliance and so
many more
Select from four pre-conference workshops carefully designed to
kick-start your conference experience by addressing the nuts and bolts
of Risk Adjustment, Star Ratings, Data Management and ICD-10/Coding
Benefit from numerous networking opportunities, providing ample
time to make new connections and reconnect with existing contacts
in a lively, dynamic setting
Participate in an interactive 90-minute roundtable session featuring the
newest innovations for optimizing your risk revenue, quality improvement
and data management initiatives
Get a rare look into the member experience during a live focus
group complete with a panel of real Medicare Advantage members
sharing candid feedback on health plan customer service performance,
communication strategies, and overall satisfaction

In order to secure a group discount, all delegates must place their registrations at
the same time. Group discounts cannot be issued retroactively. For more
information, please contact Whitney Betts at 704-341-2445 or
wbetts@healthcare-conferences.com

CPE CREDITS

REFUNDS AND CANCELLATIONS

Financial Research Associates is registered with the National Association of

State Boards of Accountancy (NASBA) as a sponsor of continuing professional
education on the National Registry of CPE Sponsors. State boards of accountancy
have final authority on the acceptance of individual courses for CPE credit.
Complaints regarding registered sponsors may be submitted to the National
Registry of CPE Sponsors through its website: www.learningmarket.org.

For information regarding refunds, complaints and/or program cancellation

policies, please visit our website:
www.healthcare-conferences.com/thefineprint.aspx

WHO WILL ATTEND?

Leaders and Senior Management from Medicare Advantage Health Plans,
Commercial Plans, Provider Groups, ACOs, Pharmacy Benefit Managers,
Prescription Drug Plans, and Medicaid Plans with
responsibilities in the following areas:

Risk Adjustment and HCC

Management
Star Ratings and Quality
Improvement
HEDIS/CAHPS/HOS
Medicare and Government
Programs
Data Management/Performance
Analytics
Revenue Management/
Financial Performance

Provider Education
Member Engagement
Part D
Plan Strategy and Product
Development
Operations and Performance
Improvement
ROI and Value Assessment
Accountable Care
Care Coordination
Compliance/Regulatory Affairs

Great information and speakers were knowledgeable

Londi Jaramillo, AFFINITY HEALTH PLAN

The recommended CPE credit for this course is 16 credits for the workshop and
conference, and 12 credits for the conference only in the following field(s) of study:
Specialized Knowledge and Applications. For more information, visit our website:
www.healthcare-conferences.com/thefineprint.aspx

This program has the prior approval of AAPC for 13 continuing education hours
(10 for main conference and 3 for pre-conference workshops). Granting of
prior approval in no way constitutes endorsement by AAPC of the program
content or the program sponsor.

The Compliance Certification Board (CCB) has approved this event for up to
13.1 CCB CEUs. Continuing Education Units are awarded based on individual
attendance records. Granting of prior approval in no way constitutes endorsement
by CCB of this program content or of the program sponsor.

EXTRAORDINARY SPONSORSHIP AND EXHIBIT

OPPORTUNITIES!
Enhance your marketing efforts through sponsoring or exhibiting your product at
this exceptional event. We can design custom sponsorship packages tailored to your
marketing needs, such as a cocktail reception or a custom-designed networking event.
In addition, the 2016 RISE Nashville Exhibit hall provides
unprecedented networking opportunities. Enjoy the benefits of an expanded
exhibit hall designed to accommodate an anticipated sellout crowd!
To learn more about sponsorship opportunities, please contact Kevin Weigel at
704-341-2448 or kweigel@healthcare-conferences.com

This program has been approved for 13 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.

THE 10th ANNUAL RISE SUMMIT

SUNDAY, MARCH 20, 2016
9:30 12:30
RISE ADVISORY BOARD
MEETING

11:00 - 1:00
PRE-CONFERENCE WORKSHOP
REGISTRATION

1:00 4:00
PRE-CONFERENCE
WORKSHOPS

3:00
EXHIBIT HALL OPENS

WORKSHOP A
DATA & ANALYTICS FOCUS

WORKSHOP B
RISK ADJUSTMENT PRIMER

WORKSHOP C
STAR RATINGS ESSENTIALS

WORKSHOP D
CODING INTENSIVE

LEVERAGING POWERFUL DATA ANALYTICS

TO IGNITE FINANCIAL PERFORMANCE
The power of data + analytics:
- Utilizing a combo of sources: claims
data, lab results, care management
data, assessment data (HRA and IHA)
and lifestyle/consumer data
- Determining confidence levels by
reviewing member and provider
behavior patterns
- Integrating with EMRs utilized by your
most important medical groups and
engaging network providers to obtain
real-time clinical data
- Refining algorithms using data mining,
clinical inferencing and various types of
predictive models
Innovative gap closure techniques:
- Differentiating your approach upon
whether the conditions are persisting
or suspecting
- Eliminating low-yield interventions
(wasteful tails) with dynamic intervention
models
- Minimizing provider abrasion
- Implementing an efficient gap closure
strategy that deploys the right
intervention with the right providers for
the right patient at the right time
- Linking your risk adjustment and quality
gap closure efforts for HEDIS, Star
Ratings or ACA QRS
Financial projections for Commercial RA,
Medicare Advantage and Medicaid:
- Calculating confidence-adjusted risk
scores, RAF points and RAF dollars
- Discounting your expected risk score by
the likelihood that the opportunity will
close within the current plan year
- Reducing false positives without
increasing your false negatives
- Tracking and modeling competitors

A RISK ADJUSTMENT PRIMER:

FOUNDATIONS OF MEDICARE
ADVANTAGE AND COMMERCIAL
RISK
Risk Adjustment 101
What is risk adjustment?
History and structure of Medicare
Advantage Payment
Basics of risk adjustment for
Medicare Advantage
- Payment model
- Calculating a risk score - examples
- Key timelines
- Data accuracy and transfer

Hiro Arai, Staff Actuary

BLUE CROSS BLUE SHIELD OF NORTH
CAROLINA
Mark Hillix, Director, Risk Adjustment and Star
Ratings
BLUE CROSS BLUE SHIELD OF KANSAS CITY
John Criswell, Chief Executive Officer, PULSE8
Scott Stratton, Chief Data Scientist, Vice
President, Product Analytics, PULSE8
Courtney Yeakel, Director, Customer Engagement
PULSE8

Expanded Use
Medicaid
Exchanges
Strategy & Programs
Data and analytics to optimize riskadjustment
An overview of programs and activities
to optimize risk adjusted revenue
Provider opportunities and challenges
In-office provider support to
close quality gaps and optimize risk
adjustment
Scaling your program: Build vs. buy
Integration of risk adjustment with
other health plan and provider
goals and objectives
Risk Adjustment Tomorrow
Future data landscape
Collaborative program strategy
using on-demand analytics and
reporting
Value-based care integration
Ryan McKeown, Vice President, Market
Strategy and Business Integration
OPTUM
David Meyer, Vice President, Risk Adjustment,
Encounters, Coding and Audit
SCAN HEALTH PLAN
Stephanie Will, Senior Vice President
Risk and Quality
OPTUM
This workshop was exactly what I
was looking for. An excellent overview
of risk adjustment

THE NUTS AND BOLTS OF STAR

RATINGS: AN INTERACTIVE
WORKSHOP
Part One: What is the Medicare Stars
Program?
Historical view: Stars program in Medicare
Advantage
- Roots of comparative quality and
transparency
- HEDIS models reference dates
- CAHPS content & calendar
- HOS how it factors in
- Bonus payment model overview
- National performance levels
- Financial implications of Star levels
achieved (bonus payments and rebates)
Changes to the model: Implementation of
ACA and cut-off levels
Predicting future Star levels and bonus
revenues: market analysis, cut-point
projections and ACA phase-in changes
Part Two: How Does a Medicare Stars
Shop Work?
Organizational structure and overview of
typical health plan Star Ratings program
Governance structure
Department & operating structure - Data administration and analytics
Interdepartmental relationships - Quality management
- Care management
- Provider relations
- Marketing
- Customer service
Program Mechanics - Managing timelines
- Managing the measures
- Display measures
- Score card illustration
Getting proxy measures for real-time
assessments
Analysis and predictive analytics
Managing under CMS program changes
Ana Handshuh, Vice President, Managed
Care Services
ULTIMATE HEALTH PLANS
Nichole Crandall, Manager of Medicare
Strategic Programs
MARTINS POINT HEALTH CARE

Chris Frederickson, Risk Adjustment,

NETWORK HEALTH

3:00 - 5:00
5:30 6:30

MAIN CONFERENCE REGISTRATION

OPENING NIGHT COCKTAIL RECEPTION

sponsored by

CODING INTENSIVE: MASTERING

ACCURATE DOCUMENTATION,
PHYSICIAN EDUCATION, AND
COMPLEX DIAGNOSES
Understanding the methodology of
diagnosis documentation and coding for
risk adjustment
Applying ICD-10-CM and CMS RADV
Participant Guidelines
Understanding the financial impact of
acute diagnosis capture in non-acute
settings, non-specific diagnoses coding
and non-recaptured chronic conditions
Best practices for querying providers for
more robust documentation
Tips for provider education: know your
audience
Applying risk adjustment methodology to
real cases
Donna Malone, CPC, CRC, Risk Adjustment
Coding & Quality Assurance Manager
TUFTS HEALTH PLAN
Dawn Strong, Revenue Cycle and Coding
Resource Manager
NORTH SHORE PHYSICIANS GROUP

I would recommend this workshop to

anyone looking for the basic
fundamentals of HCCs & HHS, and
coding & documentation best practices
Brandy Frieson, Piedmont Clinic,
PIEDMONT MEDICAL CARE CORP.

MONDAY, MARCH 21, 2016

7:30 8:45

REGISTRATION sponsored by

9:00 10:00
OPENING KEYNOTE ADDRESS: THE NEXT PHASE
FOR HEALTHCARE REFORM

Senator Tom Daschle

FORMER SENATE MAJORITY LEADER and Author of Getting it Done:

How Obama and Congress Finally Broke the Stalemate to Make Way for
Health Care Reform; Founder and Chairman, THE DASCHLE GROUP,
A PUBLIC POLICY ADVISORY OF BAKER DONELSON

Introduced by:
Nathan Goldstein, Chief Strategy Officer, CENSEO HEALTH

10:00 10:15
DR. MARTIN BLOCK RISE LIFETIME
ACHIEVEMENT AWARD
10:15 10:30

MORNING NETWORKING BREAK

sponsored by

7:30 8:45

BREAKFAST sponsored by

7:30

EXHIBIT HALL OPENS

8:45 9:00

CO-CHAIRS WELCOME AND OPENING REMARKS

10:30 11:10

Co-Chairs:

CMS POLICY UPDATE

Jeff Grant, MPA, Senior Advisor, Payment and Policy and Financial Management
Group; Center for Consumer Information and Insurance Oversight
CENTERS FOR MEDICARE & MEDICAID SERVICES

Nathan Goldstein, Chief Strategy Officer, CENSEO HEALTH

Kevin Healy, Senior Vice President, Clinical Payer Solutions, OPTUM
Introduced by:

Kevin Mowll, Executive Director

RISE (Resource Initiative & Society for Education)

TRACK A:
MEDICARE ADVANTAGE
RISK ADJUSTMENT

TRACK B:
STAR RATINGS & QUALITY
PERFORMANCE

TRACK C:
PROVIDER FOCUS/
ACOS

TRACK D:
DATA ANALYTICS AND
PREDICTIVE MODELING

11:15 - 12:00
ACHIEVING A PERFECT MARRIAGE
BETWEEN RISK AND STAR RATINGS:
MAXIMIZING THIS CRITICAL
RELATIONSHIP

CASE STUDIES: HOW MEDICARE

ADVANTAGE PLANS EMPLOYED
POINT-OF-CARE TESTING TO CLOSE
CARE GAPS AND RAISE STAR RATINGS
AND HEDIS PERFORMANCE

Achieving optimal performance of

risk and quality through value-based
arrangements
Creating a customized approach to
meet goals while increasing physician
engagement
Year-round initiatives to improve
efficiencies and results
Improving operational performance to
create a more positive impact on
quality and risk

Case Study #1
Operationalizing a quality-of-care
program targeting the cardiovascular
disease process at an earlier stage
Moving the needle on vascular disease
of the lower extremities -- the most
underdiagnosed disease state among
the HCC categories
Case Study #2
A health plans experience using
point-of-care testing to:
- Close gaps of care through risk
adjustment
- Increase Star Ratings performance
while achieving HEDIS measures

Jamie Benedict, Director, Support Services

MEDIGOLD
Shawn Larsen, RN, Vice President Clinical
Quality Solutions
ADVANTMED

Lisa Cabrera, RN, BSN, Senior Manager,

Managed Care Initiatives
SEMLER SCIENTIFIC, INC.

STRATEGIES FOR SUCCESSFULLY

CONTRACTING WITH MEDICARE
ADVANTAGE PLANS
Understanding the nuances of at-risk
contracts
Examining quality-based contracts
Mitigating Part D risks
Negotiating more effectively by better
understanding how plans develop
their bids
Dhyan D. Lal, Vice President, Network
Strategy and Contracting - Payer Strategy
Group | Pacific Northwest Region
CATHOLIC HEALTH INITIATIVES
Stephanie W. Schreiber, Shareholder
BUCHANAN INGERSOLL & ROONEY PC
Robert Ramsey, III, Shareholder
BUCHANAN INGERSOLL & ROONEY PC

With the ACA, the commercial market

is now highly regulated and heavily
dependent on data for delivering quality
outcomes and remaining financially
sound. In light of this transformation and
its impact on data management, this
session will examine:
Why data management has such a
crucial role in healthcare today
Mitigating risk and data governance
Handling pre-validation errors prior to
federal submissions
Managing external data submissions
- Vendor files
- Commercial HIX - EDGE server submission
- Medicare RAPS/EDS
Jessica Smith, Senior Director of Risk
Adjustment Solutions
GORMAN HEALTH GROUP
Scott Miller, Principal Data Architect
BLUE CROSS BLUE SHIELD OF MINNESOTA

Scott Howell, DO, MPH & TM, CPE

Senior Executive
HERITAGE PROVIDER NETWORK

12:15 1:10

S P E C I A L C M S A D D R E S S: E D G E S E R V E R O P E R AT I O N S I N A C A I N S U R A N C E M A R K E T S
Presented by:
Linda Osinski, Senior Advisor, Division of Reinsurance Operations
CENTERS FOR MEDICARE & MEDICAID SERVICES
Located in: Ryman Ballroom A

12:00 1:10

ACHIEVING RESULTS-DRIVEN DATA:

THE NEW CRITICAL OPERATIONS
COMPONENT OF THE HEALTHCARE
INDUSTRY

NETWORKING LUNCHEON FOR ALL ATTENDEES AND SPEAKERS sponsored by

TRACK A:
MEDICARE ADVANTAGE
RISK ADJUSTMENT

TRACK B:
STAR RATINGS & QUALITY
PERFORMANCE

TRACK C:
PROVIDER FOCUS/
ACOS

TRACK D:
DATA ANALYTICS AND
PREDICTIVE MODELING

1:10 - 1:55
MANAGING RISK LIKE A MEDICAL
GROUP TO IMPROVE FINANCIAL
AND CLINICAL PERFORMANCE
Hill Physicians Medical Group has
optimized the risk management of their
Medicare Advantage members over several
years. In this session, medical directors
Dr. Mark R. Dambro, CenseoHealth and
Dr. Carvel Tefft, Hills Physicians Medical
Group (HPMG) will explore:
Why its imperative that you understand
the ways in which the practice of
primary care is changing
How successful health plans and medical
groups are offering comprehensive
health assessments for members in
their homes, at network physician
offices, health fairs and in community
settings
Designing your risk adjustment program
to address the socio-economic drivers
of chronic conditions
Connecting super-utilizers into primary
care for consistent care management
and documentation accuracy
Supplementing your physician network
to improve documentation accuracy
and drive members back to care
Mark R. Dambro, MD, Chief Medical Officer
CENSEO HEALTH
Carvel Tefft, MD, Medical Director
HILL PHYSICIANS MEDICAL GROUP
(HPMG)

RESULTS-DRIVEN APPROACHES TO
MOVING THE NEEDLE ON
CHALLENGING STAR RATINGS
MEASURES
Focus on Part C:
Strategies for improving your
collaboration efforts with physicians
and hospitals
Methods for making closing gaps
convenient for members
Ensuring the correct members are
targeted
Focus on Part D:
Learn how to navigate the various
factors that affect patient behavior
Understand the obvious (and not so
obvious) Star Rating implications of
success or failure with Part D measures
Get a preview of new measures on the
horizon
See proven interventions and strategies
from organizations around the country
whats worked and what hasnt worked?
Explore reporting and prediction tools,
as well as resources and programs
that work
Moderator:
Brad Towle, Vice President of Business
Development
CARECENTRIX
Co-Presenters:
Lisa Campbell, Senior Manager, CMS Stars
UPMC HEALTH PLAN

CASE STUDY: HOW AN ACO IS

MITIGATING RISK ADJUSTMENT
CHALLENGES WITH TARGETED
STRATEGIES
Many organizations continue to struggle
with profitability around their risk-based
contracts. For instance, in the case of
MSSP ACOs, only about 26 percent of the
ACOs received shared savings payments
from CMS in 2014. This session will
examine:
How to leverage data analytics at the
point-of-care to
- Intelligently mine structured and
unstructured data in patient records,
provider organizations and ACOs to
optimize risk scoring
- Achieve more accurate reimbursements
and improved care planning
Using Village Family Practice as a case
example, Dr. Clive Fields will discuss:
- The risk adjustment challenges
facing the practice
- The advanced analytics, coding tools
and additional strategies they
implemented to address these
challenges
- The results from these initiatives

HOW ON-DEMAND POINT-OF-CARE

ACTIONABLE ANALYTICS IS
TRANSFORMING PROVIDER VISITS
Now more than ever, big data processing,
connectivity and actionable insights are
critical to achieving goals that drive value
in the healthcare landscape. Panelists
will discuss:
How real-time patient-specific
analytics available on demand at the
point-of-care within providers existing
workflow address - Gaps in quality
- Risk score accuracy
- Utilization and medical history
insights
Jason Rose, Chief Strategic Development
Officer
INOVALON
David Klebonis, Chief Operating Officer
PALM BEACH ACO
Kate Eshelman, MD, Senior Medical
Director
INOVALON

Murray Brozinsky, Chief Strategy Officer

TALIX
Francis Cheung, Chief Information Officer
CRYSTAL RUN HEALTHCARE

Ana Handshuh, Vice President, Managed

Care Services
ULTIMATE HEALTH PLANS
2:00 -2:45
RAPS TO EDS TRANSITION:
ANALYSIS AND IMPLICATIONS FOR
THE INDUSTRY

COALESCING QUALITY, RISK

ADJUSTMENT, AND COSTS OF CARE TO
PROMOTE POPULATION HEALTH

Why EDS is radically different from

RAPS
- Understanding the difference in the
two systems
Analytic framework for understanding
the impact of the RAPS to EDS transition
Lessons learned from analysis of RAPS
versus EDS risk-adjustable data
Avoiding the pitfalls and maintaining
revenue under the transition
Case studies from the field

Combining total costs of care with

revenue metrics
Calculating quality composites in the
absence of fixed-cut points
Concise reporting: reporting on multiple
lines of business together
Stars on Steroids: harnessing the
merit-based incentive payment
system
Incorporating the members
experience
Exploring the member experience of
quality initiatives
Connecting your CAHPS data with your
health outcome data
Using member experience information
to close more gaps in care
Analyzing call monitoring data to
improve member experience

Sean Creighton, Vice President of Risk

Adjustment Solutions
VERISK HEALTH
Suzanna-Grace Sayre, Director, Risk
Adjustment Analytics
VERISK HEALTH
Moon Leung, PhD, Senior Vice President,
Healthcare Informatics
SCAN HEALTH PLAN
David Meyer, Vice President, Risk Adjustment,
Encounters, Coding and Audit
SCAN HEALTH PLAN

MANAGING THE IMPACT OF PATIENT

SELF-PAY ON EMR PROCESSING
Evaluating the pros and cons of remote
EMR access
How patient self-pay rules impact EMR
processing
A behind the scenes view of the
EMR chart request fulfillment process
Methods for ensuring providers, plans
and patients are protected
Jeannie Hennum, Senior Vice President
CIOX HEALTH
Tressa Lyon, RHIT, Health Information
Manager
NORMAN REGIONAL HEALTH SYSTEM

Richard Lieberman, Chief Data Scientist

MILE HIGH HEALTHCARE ANALYTICS
Nichole Crandall, Manager of Medicare
Strategic Programs
MARTINS POINT HEALTH CARE

2:45 3:00

AFTERNOON NETWORKING BREAK sponsored by

CASE STUDY: UPMC HEALTH

PLANS RISK ADJUSTMENT
TRANSFORMATION
Explain The challenges UPMC Health
Plan was facing in risk adjustment for
Medicare Advantage and Commercial/
ACA populations
Discuss How UPMC Health Plan evaluated
available solutions and technologies to
address the challenges
Review Rationale for selecting a
solution for risk adjustment departments
with intuitive workflow, NLP technology
and robust analytics that transform
operations
Results demonstrate:
- Substantial increase in RAF capture
- Visibility into potential compliance
issues/audit risks
- 4x gain in coder productivity
Highlight Key takeaways and lessons
learned that can enable your organization
to succeed in similar circumstances
Mary Beth Jenkins, Senior Vice President
& Chief Operating Officer
UPMC HEALTH PLAN
Adele L. Towers, Senior Clinical Advisor
UPMC ENTERPRISES

3:00 - 3:45
CASE STUDIES: HOW WELLCARE
IMPROVED THEIR RISK ADJUSTMENT
BY LEVERAGING COGNITIVE
COMPUTING
What is cognitive computing for
healthcare?
How does cognitive computing enable
an accurate patient care profile for risk
adjustment?
How did the technology improve
WellCares coding process and provide
deeper coding insights?
What is the future of cognitive
computing in healthcare?
- Clinical documentation
- HEDIS & Star Ratings
- Care optimization
Deidre Nealon, CPA, CPC-A, Senior Director,
Risk Adjustment Programs
WELLCARE HEALTH PLANS, INC.
Darren Schulte, Chief Executive Officer
APIXIO

3:45 5:00

TAKING A SYNERGISTIC APPROACH

TO MAXIMIZE STAR RATINGS/
QUALITY AND COMPLIANCE
OUTCOMES
Identifying strategies quality and
compliance departments can employ
to improve their respective outcomes
Improving levels of compliance by
working through Stars/quality initiatives
Achieving better Stars performance by
valuing the impact of compliance
efforts
Protecting clinical and financial
outcomes with a cohesive compliance/
Stars approach

Osato Chitou, Esq., MPH, Director of

Medicare Compliance
AMIDA CARE

THE ADVANTAGE OF LAB DATA IN THE

NEW PAYER PARADIGM: DRIVING
QUALITY OUTCOMES
This session will explore:
How detailed views into the patient
journey have become increasingly
important for payers reporting and
management activities
Why lab data, a superior, highly actionable
clinical data source, is:
- Influential: a critical, high value
source of clinical intelligence, lab
data accounts for 3% of healthcare
spend but influences 70% of medical
decisions
- Difficult to aggregate: at scale, lab
data is difficult to access
- Challenging to use: there are
significant differences between
traditional transactional level data
and clinical data -- lab data is no
exception
Real-world examples of how lab data
is being used to provide additional
insights in the payer space

Cassandra Blair, RN, CHC, Director STARS

& Oversight, Government Programs
MEMORIAL HERMANN

Frank Jackson, Executive Vice President,

Payer Markets
MEDIVO

Moderator:
Deniese M. Scheff-Crittenden, RN, MSN,
MHA,BSW, Senior Consultant, RA
DYNAMIC HEALTHCARE SYSTEMS
Co-Presenters:

PROVIDER PERSPECTIVE: MAKING

THE PAYER-PROVIDER CONNECTION
IMPROVING OUTCOMES WITH
BETTER COMMUNICATION AND
COLLABORATION
Types of value-based contracting
agreements we have in place and how
we have structured these partnerships
Which data we share with each other
and why
The quality metrics we track
How we have developed plan
collaboration strategies that are win-win
for both parties
How we have clinically integrated with
other provider types and hospitals to
ensure success
Michael Ruiz de Somocurcio, Vice President
Payer and Provider Collaboration
REGIONAL CANCER CARE ASSOCIATES LLC

Troy Trygstad, PharmD, MBA, PhD,

Vice President for Pharmacy Programs
COMMUNITY CARE OF NORTH CAROLINA

CHOOSE YOUR OWN ADVENTURE ROUNDTABLES: SELECT FROM 25 DIFFERENT PRESENTATIONS SPOTLIGHTING HEALTHCARES MOST
INFLUENTIAL TECHNOLOGY AND SOLUTION GURUS PRESENTING TOOLS TO ELEVATE YOUR PLANS INITIATIVES

Pull up a chair and settle in for this unique opportunity to select three interactive, speed-dating type presentations featuring the latest technologies and solutions for boosting your plans
risk, quality and data management endeavors. A bell will ring three times within this special 75 minute session, alerting you to transition to the next roundtable of your choice.
ROUNDTABLE A:
EMSI HEALTH

ROUNDTABLE J:
TRIZETTO

ROUNDTABLE S:
IONHEALTHCARE

ROUNDTABLE B:
HOME ACCESS HEALTH

ROUNDTABLE K:
PRIME THERAPEUTICS

ROUNDTABLE T:
CLEAR VISION INFORMATION SYSTEMS

ROUNDTABLE C:
INTEGRA SERVICECONNECT

ROUNDTABLE L:
POINTRIGHT

ROUNDTABLE U:
ATTAC CONSULTING

ROUNDTABLE D:
PREDILYTICS WELLTOK

ROUNDTABLE M:
CENTAURI HEALTH SOLUTIONS

ROUNDTABLE V:
NAVIGANT

ROUNDTABLE E:
BEACON HEALTHCARE

ROUNDTABLE N:
PHARMMD

ROUNDTABLE W:
RELAY HEALTH

ROUNDTABLE F:
CARENET HEALTHCARE SERVICES

ROUNDTABLE O:
NAGNOI

ROUNDTABLE X:
BLUE HEALTH INTELLIGENCE

ROUNDTABLE G:
EPISOURCE

ROUNDTABLE P:
MEDICAL DATA EXCHANGE

ROUNDTABLE Y:
DST HEALTH SOLUTIONS

ROUNDTABLE H:
SYNAPTIC AP

ROUNDTABLE Q:
ACCENTURE

ROUNDTABLE Z:
EDIFECS

ROUNDTABLE I:
COZEVA

ROUNDTABLE R:
HEALTH DATA VISION, INC.
5:00 6:00

COCKTAIL RECEPTION sponsored by

TUESDAY, MARCH 22, 2016

7:30 8:30

BREAKFAST sponsored by

11:15 12:15

8:00

EXHIBIT HALL OPENS

8:30 8:45

CO-CHAIRS RECAP OF DAY ONE

In this interactive, timely session, our panelists of health plan consumer engagement and social media experts will explore novel strategies for engaging
difficult-to-reach members and niche populations using less traditional, more
innovative modes of communication. This discussion will examine why you must
expand your thinking from healthcare administrator to healthcare marketer and
advocate if you wish to exceed patient/member expectations and achieve success.
Determining how tech savvy your members really are
The latest trends and statistics in social media and new technology usage rates
Less traditional approaches to contacting and retaining at-risk segments
Making the extra effort: if you really want to engage all of your members, why
you must tailor your communication initiatives to their individual demographic
- Understanding, acknowledging and valuing socio-economic, cultural and
regional differences

Co-Chairs:
Nathan Goldstein, Chief Strategy Officer
CENSEO HEALTH
Kevin Healy, Senior Vice President, Clinical Payer Solutions
OPTUM

8:45 9:45

FEATURED PANEL: ATTRACTING, ENGAGING,

RETAINING AND EDUCATING YOUR MEMBERS
EMBRACING A NEW ERA OF COMMUNICATION

FEATURED SESSION THE HEALTH EXCHANGES:

ENROLLMENT AND IMPACT-TO-DATE

Anne Filipic
President
ENROLL AMERICA

Moderator:

Anne Filipic serves as President of Enroll America, a non-profit organization

dedicated to maximizing the number of Americans who enroll in and retain health
coverage made available through the Affordable Care Act. Most recently, Ms. Filipic
was the Deputy Director of the White House Office of Public Engagement.
Representing Enroll America and its coalition, Ms. Filipic has become a leading
voice on the consumer experience and best practices around ACA enrollment and
engagement. In this session, Ms. Filipic will discuss the latest trends in marketplace
and Medicaid enrollment and best practices in consumer outreach and
enrollment work.

9:45 10:00

MORNING NETWORKING BREAK sponsored by

10:00 11:15

SPECIAL FOCUS GROUP: MEDICARE ADVANTAGE

MEMBER JOURNEY SNAPSHOT

Nathan Goldstein, Chief Strategy Officer

CENSEO HEALTH
Panelists:
Sharon LaSure-Roy, Senior Consultant, Social Media and Digital Communications
FLORIDA BLUE
Neal Sofian, Director of Member Engagement, PREMERA BLUE CROSS
Amy N. Swanson, Vice President of Marketing, Advocacy and Member Experience
UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO
Jamey Shiels, Vice President, Digital Experience
AURORA HEALTH CARE, INC.
David Murray, Manager, Social Media, BLUE CROSS BLUE SHIELD OF MICHIGAN

12:15 1:25

Hear directly from Medicare Advantage members about how they engage with
their health plan in this one-of-kind session! Conducted as an in-person focus
group, explore members mindsets concerning their relationships with their health
plan, and see health insurance through their eyes.

LUNCHEON FOR ALL ATTENDEES AND SPEAKERS

sponsored by

Susan Semack, Vice President, Healthcare Division, MORPACE

TRACK A:
COMMERCIAL RISK ADJUSTMENT
& HEALTH EXCHANGES

TRACK B:
COMPLIANCE & AUDIT
READINESS

TRACK C:
HIGH-RISK POPULATIONS,
MEDICAID & DUAL ELIGIBLES

TRACK D:
CARE MANAGEMENT &
PART D

1:25 - 2:10
EXCELLENCE IN COMMERCIAL RISK
ADJUSTMENT: INNOVATIVE STEPS
TO ENSURE TRANSFER PAYMENT
SUCCESS

HOW TO ENSURE YOUR RISK

ADJUSTMENT REVENUE IS COMPLIANT

Altering your telephonic HRA screenings

to highlight chronic and behavioral
conditions
Using your web-based engagement
platform to reward members for
wellness exams and follow their
care pathway
Embracing telemedicine for wellness
and behavioral health needs
Running a solid claims validation and
provider CDI program
Using the first quarter to tick and tie
your numbers

Recent OIG & CMS scrutiny has us all

thinking about compliant risk adjustment
programs. This session will examine
processes and technologies that health
plans or their assessment and care
management vendors should have in
place to assure compliant revenue
Validate AND delete conditions to
ensure appropriate revenue and
maximum compliance
Provider tracking technologies
ICD-10 incorporation for increased
specificity
Clerical vs. clinical quality assurance
Audit best practices

RaeAnn Grossman, Chief Growth Officer

ARROHEALTH

Kevin Kearns, MD
ADVANCE HEALTH

Art Diaz, Director, Risk Adjustment Programs

HORIZON BLUE CROSS BLUE SHIELD OF
NEW JERSEY

Colleen Gianatasio, CPC, CRC, Risk Coding

and Education Specialist
CAPITAL DISTRICT PHYSICIANS HEALTH
PLAN

HIGH-RISK POPULATION
MANAGEMENT: THE NEW FRONTIER
OF CARE DELIVERY
Even with system-level changes underway as
a result of the shift towards value-based
purchasing, opportunity still exists (and
will continue to exist) to improve the costs
and outcomes associated with high-risk
populations. We will discuss:
The current environment and key challenges
in healthcare and how they impact the
management of high-risk populations
The importance of value-based care
and how care is evolving from
traditional delivery methods
Why new models are not mutually
exclusive of one another and how
different systems can integrate well if
planned properly
Results from a comprehensive field-based
longitudinal care program that improves
patient care, closes care & quality gaps, and
improves risk-adjusted revenue accuracy
Christi Lundeen, Chief Innovation Officer
MERCY CARE PLAN AND MERCY
MARICOPA INTEGRATED CARE
Andrew Walsh, Chief Marketing Officer
POPHEALTHCARE

2:10 - 2:25

AFTERNOON NETWORKING BREAK sponsored by

IMPROVING ENGAGEMENT, QUALITY,

AND RISK PERFORMANCE UTILIZING
MOBILE CLINICS
How improving access and convenience
can elevate member engagement rates
Using health fairs to engage members
and close quality gaps
How diagnostic testing can improve
clinical documentation and reduce
audit risks
How to get the most out of a prospective
assessment
- Missed opportunities to improve
quality
- Closing more HCC gaps through
better clinical data
Using mobile clinics as a supplement
to primary care
Aprihl Shapiro MBA, ME, PMP, Director of
Risk Adjustment Management Programs
MOLINA HEALTHCARE OF UTAH, INC.
James Metcalf DO, MBA, Medical Director
OPTUMCARE UTAH
Karl Brown, Medical Director, Risk Adjustment
MOLINA HEALTHCARE

TRACK A:
COMMERCIAL RISK ADJUSTMENT
& HEALTH EXCHANGES

TRACK B:
COMPLIANCE & AUDIT
READINESS

TRACK C:
HIGH-RISK POPULATIONS,
MEDICAID & DUAL ELIGIBLES

TRACK D:
CARE MANAGEMENT &
PART D

2:25 - 3:10
ADVANCES IN THE COMMERCIAL
RISK MODEL: THE NEW WORLD
SYMPHONY
Outreach & engagement: a holistic
approach
Health Exchanges: Using HCCs to
define those who need care the most
The state of the commercial risk model
Member retention: keeping what
you worked hard to achieve
Paradigm shift on giving your members
options to healthcare
Dana L. Mattingly, BS, RN, Senior Director
Healthcare Quality, Clinical Strategy
AETNA COMMERCIAL RISK MANAGEMENT
ORGANIZATION
Sy Zahedi, President, MEDXM

BUILDING A RADV SURVIVAL TOOLKIT

RADV simulation: how to structure it
and what you can learn
Working effectively with internal controls:
internal audit and compliance
Getting your contract language with
provider groups right
Surviving the audit:
- Effective data validation techniques
- Organizing and choosing the best
medical record
- The latest on extrapolation
- Appeals/key factors affecting payment
David Meyer, Vice President, Risk Adjustment,
Encounters, Coding and Audit
SCAN HEALTH PLAN
Tom Nasadoski, MBA, Manager Risk
Adjustment and Encounter Operations
CAPITAL DISTRICT PHYSICIANS HEALTH
PLAN

EARLY INSIGHTS INTO MEDICAID

EXPANSION: WHAT WEVE LEARNED
TO-DATE
Lessons learned from early expansion
initiatives
The initial impact on providers: the
good and bad
Managing Medicaid risk
Revealing commonalities across states
Moderator:
Kim Browning, CHRS, PMP, CHC, Executive
Vice President
COGNISIGHT
Co-Presenters:
Eric C. Hunter, Chief Operating Officer
BMC HEALTHNET PLAN / WELL SENSE
HEALTH PLAN
Dhyan D. Lal, Vice President, Network
Strategy and Contracting - Payer Strategy
Group | Pacific Northwest Region
CATHOLIC HEALTH INITIATIVES

PRACTICING MTM AND ENCOURAGING

MEDICATION ADHERENCE TO ACHIEVE
CLINICAL & QUALITY OUTCOMES IN
POPULATION HEALTH INITIATIVES
When clinical pharmacists address
medication adherence and perform
MTM, clinical and quality outcomes
are positively affected. Dr. Joseph
Manganelli will discuss his experience
with elevating quality outcomes with
adherence and MTM initiatives in a
Pioneer ACO:
The economic burden of adherence
and strategies to increase medication
adherence
The key areas where the clinical
pharmacist can support the goals of
the interdisciplinary team
The contribution of the clinical
pharmacist on clinical and quality
measures
Evaluation of collaborative drug
therapy management on population
health initiatives
Joseph Manganelli, PharmD, MPA,
Senior Director - Network Care Management,
Pharmacy Program
CMO - MONTEFIORE CARE MANAGEMENT

It was very interesting and informative. Helped me to gain a wider knowedge base of both CMS & HHS Risk Adjustment
Brandon Wolff, Actuarial Risk Adjustment, ASSURANT HEALTH
3:15 - 4:00
LEVERAGING THE LATEST STATISTICAL
TECHNIQUES TO MAXIMIZE RISK
SCORE PERFORMANCE AND INTEGRITY
Extending beyond traditional methods
by integrating machine learning
Achieving the most complete and
efficient suspect list(s)
Ensuring transparency and clinical
relevance
Eva Borden, FSA, Chief Risk Officer
CIGNA
James E. Dalen, Chief Health Economist
ALTEGRA HEALTH

KEYS TO IMPLEMENTING A VIABLE

FWA OVERSIGHT PROGRAM
This critical session will:
Explore strategies compliance
departments can employ to identify,
report and mitigate FWA
Examples of the financial and
operational impact of recent incidents
of FWA
Cautionary tales: how to avoid these
real-life missteps
Alanna Lavelle, Program Manager for
Health Care Fraud
MITRE CORPORATION

ENGAGING YOUR DUAL ELIGIBLE

POPULATION: MEMBER SEGMENTATION
AND OUTREACH STRATEGIES THAT
DRIVE RESULTS
Learn how to improve your member
engagement and outcomes by:
Engaging more members through
cross-channel outreach and testing
enabled by campaign management
Deepening member engagement
through use of psychographic
segmentation and application of life
cycle-based campaigns to drive
relevant, member-specific messaging
Improving member adherence
through engagement of care providers
Closing care gaps and impacting
member satisfaction through post-visit
engagement
Mary R. Mailloux MD, MMM, FACEP,
Medical Director Medicare Special Needs
Plans (SNP)
COVENTRY HEALTH CARE OF FLORIDA,
AN AETNA COMPANY
Katrina Cope, Vice President Operations
HEALTH CHOICE ARIZONA
HEALTH CHOICE GENERATIONS
David Goodspeed, Director Member
Engagement
MATRIX MEDICAL NETWORK

4:00

CONFERENCE CONCLUDES

NOVEL APPROACHES TO MEMBER

ENGAGEMENT: GETTING THEIR
ATTENTION AND KEEPING IT
This session will explore how HCSC is
expanding the conversation beyond
engagement to encompass the full member
experience. In detail, we will:
Share the approach HSCS has used
to understand, define and measure
the member experience
Identify the key elements being put in
place to drive improvements
Explore a case study that demonstrates
how member engagement has been
addressed more holistically
Explain how best-in-class technologies
have been leveraged to support
HCSCs engagement strategies
Lynde OBrien, Senior Director, Digital
Communications
HEALTH CARE SERVICE CORPORATION
(BLUE CROSS AND BLUE SHIELD OF
ILLINOIS, MONTANA, NEW MEXICO,
OKLAHOMA AND TEXAS)
Juliane Pearson, Senior Manager,
Customer Experience
HEALTH CARE SERVICE CORPORATION
(BLUE CROSS AND BLUE SHIELD OF
ILLINOIS, MONTANA, NEW MEXICO,
OKLAHOMA AND TEXAS)

SPONSORS
PLATINUM
Advance Health is the leading healthcare provider of prospective member engagement services to health plans. What differentiates the company is its
combination of meaningful technology and national network of full-time, locally based Nurse Practitioners. This combination yields industry leading
financial and clinical results with indisputable compliance and oversight. Advance Health offers in-home and facility-based HRAs and chronic care
management services to the Medicare Advantage, Medicaid, dual-eligible and commercial markets. This year, Advance Health NPs will complete over 300,000 full health
assessments, across forty-eight states, for many of the largest health plans. With every assessment captured electronically, Advance Health delivers results in a matter of
hours. The rapid growth of risk-adjusted populations coupled with dramatically increased CMS and OIG scrutiny requires a partner as qualified as Advance Health.

Advantmed is a health information management company that helps risk-bearing entities optimize revenue and improve quality outcomes. We accomplish this
fundamental objective by using our proprietary Elevate! Healthcare health information management platform to deliver and manage integrated products and
services, which help clients capture, organize, and analyze financial and clinical data to better understand their member populations and ultimately utilize this
data to improve quality of care and optimize risk-adjusted revenue. Through the platform, Advantmed partners with managed care organizations to deliver the optimal
combination of capabilities unique to each organizations objectives, including risk analytics (ELEVATE! Risk Insights), NCQA-certified HEDIS Measures software (ELEVATE!
Quality Insights), medical record retrieval, medical record abstraction, risk adjustment coding, compliance and data validation services, member engagement, provider
education, and professional services.

Altegra Health is a national vendor of technology-enabled, end-to-end payment solutions providing health plans and other risk-bearing organizations with
the data they need to expertly manage member care and ensure appropriate reimbursement. The power of Altegra Healths advanced analytics
and supporting interventions enables healthcare organizations to elevate care quality, optimize financial performance, and enhance the member
experience. For more information, visit AltegraHealth.com

Apixio was founded in 2009 with the vision of uncovering and making accessible clinical knowledge from digitized medical records for optimal healthcare decision
making. In 2012, Apixio applied its cognitive computing platform to tackle risk adjustment, the fundamental basis for value-based health. The result was the HCC
Profiler, a proven solution which enables insights into document and coding gaps for a more accurate risk score. Now with its world-class team of data scientists,
engineers, product experts, and healthcare gurus, Apixio has set its sights on other applications powered by its patented platform to enable healthcare systems to learn from
practice-based evidence to individually tailor care.

ArroHealth, formerly MedSave USA, is the premier provider of risk adjustment and HEDIS services offering a suite of analytics, medical record retrieval and
coding, customizable in-home and in-office programs and member engagement strategies. These services are offered on a unique and proprietary technology
platform designed for excellence in results, quality and transparency. ArroHealth recognizes the importance of performance and accuracy and provides the
most extensive guarantees in the industry. We focus on medical record collection rates, timing, ROI, provider satisfaction, accuracy and quality. In addition, we provide
full transparency into all that we do for clients; allowing them to adapt quickly and maximize financial and clinical results. This includes unfiltered access to back-end systems,
enabling clients to see in real-time the smallest details of their projects status. ArroHealth serves most of the top national health plans as well as many regional and local
plans and is committed to accuracy, intelligence and impact for clients.

CareCentrix serves leading health plans across the U.S. with solutions that leverage the home and community based settings. We help payers and
providers close the gap in care while lowering costs and improving patient outcomes. Covering more than 23 million lives, we manage over 8,000
credentialed home health provider locations increasing access to quality home care by connecting providers with patients and helping them
navigate the complex home care system.

CenseoHealth is a leading provider of prospective health risk assessments for health plans and healthcare delivery organizations. Our physicians
perform comprehensive, Annual Wellness Visit-compliant evaluations with members in their home, at network physician offices and in community
settings. We capture a complete health and lifestyle assessment to drive better clinical outcomes through care management referrals and return-to-care
recommendations. Our insights help enhance member engagement, improve quality ratings and reduce overall healthcare costs. Our network of nearly 5,000 licensed
physicians are uniquely qualified to identify and diagnose health conditions. We have completed more than 1.5 million assessments, averaging more than 1,800 per day.

Centauri Health Solutions improves member outcomes and financial performance for health plans and at-risk providers by supporting initiatives in Risk
Adjustment, RADV Risk Mitigation, HEDIS, Star Ratings, and Care Gap Management.
Our consultative approach delivers compliant end-to-end solutions that leverage clinically-rich data analytics, workflow software tools, and other
technology and service resources. We identify risk adjustment gaps, care and quality gaps, and support the closure of those gaps to benefit our clients and their members.
We know from experience that data alone is not enough the combination of data, experience, and execution is required to improve outcomes in todays environment.
Centauris core leadership team is comprised of seasoned healthcare executives from managed care organizations, pharmacy benefit managers and HCIT companies.
They understand from personal experience the challenges facing todays health system and have set out to resolve them in a better way for their clients and their
members / patients.
Centauri partners with respected Medicare Advantage, Managed Medicaid and Health Insurance Exchange plans, as well as at-risk provider groups to answer critical
business questions such as whether they are impacting the members who are the most at-risk, how much financial exposure they may face due to RADV audit
and compliance risk, and whether they are optimally utilizing their scarcest resources.
Risk Adjustment | RADV Risk Mitigation | HEDIS | Star Ratings | Care Gap Management

EMSI Health empowers health plans with end-to-end risk-adjustment services for care management, quality support and improved risk score accuracy.
We offer best-in-class risk analytics, in-home assessments, medical chart retrieval, coding, risk profiles, audit support, and Stars and HEDIS measurement
support to health plans in all markets. StratusIQ, our web-enabled customer portal and data repository, provides clients with easy and transparent access
to their project data and our self-scheduling tool allows members to efficiently and conveniently schedule Healthy House Calls anywhere, anytime. Our integrated
approach leverages experienced industry professionals, proven and secure technology, and flexibility to produce the best quality results for health plans and improved
outcomes for plan members. EMSI Health: Powerful Information. Improved Outcomes. Learn more at www.emsinet.com.

Episource is a leading services provider for chart reviews and quality measure abstraction for Medicare Advantage, Commercial/HIX, Medicaid health plans, and ACOs across
the United States. Using an integrated global delivery methodology, with onshore and offshore Medical Professionals, Clinicians, and Certified Coders, Episource is able to
provide extensive and quality Medical Record Review Services with significant cost savings to increase ROI on organizations Risk Adjustment and Government affiliated
Programs.
We began by providing medical coding solutions to both provider and payer organizations. Over the last five years we have expanded our core service offerings to include:
RADV/IVA Audit Support, Home Health Assessments, HEDIS Abstraction, ACO GPRO reporting, and medical record retrieval.
Our vision is to provide health information exchange solutions that allow healthcare organizations to safely and efficiently manage member-centric data, quality of care initiatives,
member intervention and risk adjustment programs in Medicare, Medicaid, Commercial and Health Insurance Exchanges.

Gorman Health Group, LLC (GHG) is a leading consulting and software solutions firm specializing in government health programs, including Medicare managed
care, Medicaid and Health Insurance Exchange opportunities. For nearly 20 years, our unparalleled teams of subject-matter experts, former health plan executives
and seasoned healthcare regulators have provided strategic, operational, financial, and clinical services to the industry, across a full spectrum of business needs.
Further, our software solutions have continued to place efficient and compliant operations within our clients reach. Find out more at www.gormanhealthgroup.com.

Health Fidelitys risk adjustment solution is the most comprehensive, scalable solution in the market for perfecting the risk adjustment cycle. Our cutting-edge
technology combines big data analytics and natural language processing (NLP) to automatically extract valuable insights from medical charts to enhance prospective
and retrospective RAF processes. Equipped with this proprietary technology and a team of industry experts, Health Fidelity can help organizations optimize their
coding operations to increase efficiency, achieve better compliance, and maximize value through improved identification of HCCs.

HealthFair has pioneered a new standard of care, operating the largest fleet of mobile medical centers nationwide. Since 1998, the company has grown to
become the leading provider of mobile clinical solutions, providing prospective risk assessments and advanced diagnostic testing to individuals at convenient
locations in their community. HealthFair delivers an innovative solution to improve access and provide efficient encounters focused on improving patient
care, engagement, quality measures, and assessment of risk factors and conditions. These state of the art mobile clinics can provide a wide scope of services within a comfortable
clinical setting, from Comprehensive Evaluations, AWVs, or Child Wellness Visits, to advanced diagnostics such as mammography, ultrasound, or diabetic retinopathy screening,
all within one visit. HealthFairs unique delivery system and proprietary assessment technology increases patient engagement and access to care, all while delivering encounters
that are unparalleled in the industry from a quality and risk assessment perspective. During a HealthFair visit, patients can complete labs, immunizations, wellness visits,
and diagnostic imaging, minimizing the need for expensive and timely follow up appointments. Information is then shared back through a proprietary care coordination process
which ensures that not only the right data is captured, but it makes it to the place where its needed most. Learn more at www.HealthFair.com.

CIOX Health provides the perfect combination of security and medical record request fulfillment efficiencies to providers and health plans. We serve over
110 health plans across the nation, providing medical chart retrieval services. We are located in over 3,000 hospitals, 13,000 physician clinics, and 1,500
pharmacies providing release of information services, giving us the ability to electronically retrieve charts onsite quickly using our workflow system
and staff of over 6,000 employees. In addition, we have relationships with over 65,000 provider offices, processing over 30 million records annually. Using our
combined strengths, we bring one unique and complete solution for all your medical record needs.

Inovalon is a leading technology company that combines advanced cloud-based data analytics, and data-driven intervention platforms to achieve meaningful insight and impact
in clinical and quality outcomes, utilization, and financial performance across the healthcare landscape. Inovalons unique achievement of value is delivered through the effective
progression of Turning Data into Insight, and Insight into Action. Large proprietary datasets, advanced integration technologies, sophisticated predictive analytics, data-driven
intervention platforms, and deep subject matter expertise deliver a seamless, end-to-end capability that brings the benefits of big data and large-scale analytics to the point
of care. Driven by data, Inovalon uniquely identifies gaps in care, quality, data integrity, and financial performance while bringing to bear the unique capabilities to resolve them. Inovalon
provides technology that supports hundreds of healthcare organizations in 98.2% of U.S. counties and Puerto Rico with cloud-based analytical and data-driven intervention platforms that are
informed by data pertaining to more than 777,000 physicians, 266,000 clinical facilities, and more than 127 million Americans. Through these capabilities, and those of its subsidiary HYPERLINK http://avalere.com/ Avalere Health, which offers data-driven advisory services and business intelligence to more than 200 pharmaceutical and life sciences enterprises, Inovalon is able
to drive high-value impact, improving quality and economics for health plans, ACOs, hospitals, physicians, consumers and pharma/life-sciences researchers

Matrix Medical Network is the leader in supporting care in the home through our national network of Nurse Practitioners. From in home assessments to chronic care
support, Matrix helps health plans engage members and their physicians to ensure members receive needed care, improving their health and overall outcomes.

Medivo is a healthcare data analytics company that unlocks the power of lab data to improve health. Medivo is the largest source of lab data in the U.S., with access to
over 150M patients through its nationwide network of partner labs. Medivo analyzes large data sets and shares its findings with the medical community at large, as well
as with its payer, lab and life science partners, to ensure that appropriate available treatments are provided to patients sooner.
Medivos Lab Data Advantage applies clinical analytics to lab data to provide payers with material health plan value by supporting Care Management Programs, HEDIS/STAR and Risk
Adjustment initiatives by identifying gaps in quality and care, disease status changes and improvement in outcomes.
Labs in the U.S. are highly fragmented, and depending on the lab, patient records are often incomplete and contain unstructured data, rendering the data unusable for certain use cases.
Medivo provides a one to many connection from payers to labs that intakes, refines, standardizes, and enriches the data to ensure actionable data output. Founded in 2010, Medivos
investors include Safeguard Scientifics, Inc. (NYSE:SFE) and Merck Global Health Innovation Fund (GHIF). Learn more about us at medivo.com, reach out to Bob Maluso with questions,
and follow us @gomedivo or on LinkedIn.

Patient Care and Understanding is our focus

Mobile Medical Examination Services, Inc. MEDXM was founded in 1990. Our mission is to provide the most qualified Medical Doctors and other Mid-Level Medical
Professionals, equipped with the latest medical devices and diagnostic equipment to our clients. We have built a vast network of medical professionals throughout the USA. From the
start, our growth has been fueled by an insistence of quality and service. We provide a vast array of medical services in the privacy of the clients home. We pride ourselves in making a
difference and serving a purpose with your members wellbeing.
MEDXM would like to be a part of your efficient, proactive and sound management strategy and help your plan realize better financial performance.

HCC in-home health assessments

Annual wellness visits (AWV)

Star initiatives-labs and DEXA

Post hospital reduced re-admissions

Mile High Healthcare Analytics provides practical population-oriented analytics to health plans, Exchange issuers, ACOs, and risk-bearing provider groups. Our strategic
consulting focus is on risk adjustment operations, performance measurement and improvement, Stars, the Quality Rating System, and alternative payment designs. We
provide business process assessments, operational assessments, and feasibility studies-- striving to improve the operational performance of our clients.
Mile High Healthcare Analytics is also data-focused. We analyze large and complex datasets of patient-level data from claims, pharmacy, clinical laboratory results, member
enrollment, and supplemental data. Our healthcare analytics pay as much attention to the underlying completeness of the data as to the analytic models. With good data we derive
and validate predictive models in clinical, operational and financial areas for healthcare organizations bearing financial or insurance risk. Mile High ensures the validity of the results from
analytics and the applicability of those results to our clients objectives.

Optum is a leading health services and innovation company dedicated to helping make the health system work better for everyone. With more than 94,000 people
worldwide, Optum combines technology, data and expertise to improve the delivery, quality and efficiency of health care. Optum uniquely collaborates with all
participants in health care, connecting them with a shared focus on creating a healthier world. Hospitals, doctors, pharmacies, employers, health plans, government
agencies and life sciences companies rely on Optum services and solutions to solve their most complex challenges and meet the growing needs of the people and communities they serve.

Peak focuses on delivering Risk Adjustment and Quality Solutions to provide our clients with full service and customized options that give you the ability to
choose services which best meet your needs. Peak provides top quality staff, a state-of-the-art technology workflow, chart reviews, in-home assessments and chart
retrieval specific to your needs. With Peak as your partner, you will receive quality, timely results from a caring team of professionals that will guide you through the
challenges of this ever changing industry.

PopHealthCare offers groundbreaking programs in high-risk population management that drive rapid, large, and demonstrable improvements in member quality
of life and satisfaction, while helping its partnering health organizations realize appropriately enhanced revenues, enhanced quality scores, and reduced medical
costs. With decades of experience, PopHealthCare is led by a team of long-standing leaders in health care analytics, field-based high-risk population care delivery,
quality improvement, and both prospective and retrospective risk adjustment services. PopHealthCare has designed its high impact services to meet the needs of local, regional
and national health plans and provider organizations and currently partners with over 35 health plans across the U.S. and in Puerto Rico.

Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health
plans, employers, and government programs including Medicare and Medicaid. The company processes claims and delivers medicine to members,
offering clinical services for people with complex medical conditions. Headquartered in St. Paul, Minn., Prime serves more than 26 million people. It
is collectively owned by 13 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. Prime has been recognized as one of the fastest-growing private
companies in the nation.
Pulse8 is the only Healthcare Analytics and Technology Company delivering complete visibility into the efficacy of your Risk Adjustment and Quality Management programs. We
enable health plans and at-risk providers to achieve the greatest financial impact in the ACA Commercial, Medicare Advantage, and Medicaid markets. By combining advanced
analytic methodologies with extensive health plan experience, Pulse8 has developed a suite of uniquely pragmatic solutions that are revolutionizing risk adjustment and quality.
Pulse8s flexible business intelligence tools offer real-time visibility into member and provider activities so our clients can apply the most cost-effective and appropriate interventions for closing gaps
in documentation, coding, and quality. For more company information, please contact Scott Filiault at (732) 570-9095, visit us at www.Pulse8.com, or follow us on Twitter @Pulse8News.

QuantaFlo(TM) PAD System and WellChec(TM) Risk Assessment Service.

The QuantaFlo System for Peripheral Arterial Disease (PAD) allows providers to quickly find and document patients with Vascular Disease (HCC 108). The
WellChec Risk Assessment Service provides a turnkey solution for administering clinical tests that impact HHC classifications, CPT coding, HEDIS and Quality Measures. Visit
semlerscientific.com

Talix, a premier provider of healthcare risk adjustment solutions, delivers intelligent data analytics that enable healthcare organizations to turn structured and
unstructured health data into actionable insights that drive improved risk adjustment and better patient outcomes.

Verisk Health empowers a sustainable, value-based healthcare delivery and payment system with the data services, analytics, and advanced technologies that inform
smarter business decisions and reduce risk.

We offer health plans, employers, and healthcare providers an array of solutions across four major functional areas:
Payment Accuracy: Fraud, waste, and abuse solutions that ensure accurate payment and cost containment
Revenue Accuracy: Solutions that simplify commercial and Medicare risk adjustment initiatives and ensure appropriate funding for members and their conditions
Population Health: Decision analytics and reporting solutions that help organizations better understand and manage the populations they serve
Quality Improvement: End-to-end support for unified quality measurement, reporting, and improvement

Verisk Health is a Verisk Analytics (Nasdaq: VRSK) business. For more information, please visit veriskhealth.com.

GOLD
Alegis Care provides comprehensive health assessments for
both Medicare and Medicaid plans nationally. Alegis Care also
provides Chronic Care Management and value based purchasing
services. Alegis Care has over 20 years of experience. Our physicians provide chronic
care management resulting in successfully reducing MLR, admissions, readmissions
and increasing STAR and HEDIS ratings. Our program is made up of face-to-face interactions
with members in their homes or wherever they reside. We provide services to Medicare
Advantage/Medicaid and 55% of the members we service daily are dual eligible. For
additional information, please contact Michael Doherty, Senior Vice President of Sales,
at 954.648.4773 or mdoherty@alegiscare.com.

Dynamic Healthcare Systems, Inc. is a strategic business partner to

Health Plans participating in government-sponsored Healthcare
programs and is a certified third-party submitter with CMS. Dynamics
comprehensive and fully integrated solutions address the following
business areas of a Health Plans operations: risk adjustment (including RAPS, EDPS and HCC
Analytics), enrollment and eligibility processing, MSP/COB, correspondence/fulfillment,
member premium billing, revenue reconciliation, and PDE management and audit.

Edifecs develops innovative, cost-cutting information technology

solutions to transform the global healthcare marketplace. Since 1996,
Edifecs technology has helped healthcare providers, insurers, pharmacy
benefit management companies and other trading partners trim waste, reduce costs and
increase revenues. More than 350 healthcare customers today use Edifecs solutions to
simplify and unify financial and clinical transactions. In addition, Edifecs develops supply
chain management solutions to support worldwide customers in non-healthcare industry
segments. Edifecs is based in Bellevue, WA, with operations internationally. Learn more
about us at www.edifecs.com.

Cognisight is a leading health care solutions vendor,

specializing in risk adjustment services for Medicare
Advantage plans, Health Insurance Exchange issuers,
PACE/Duals programs, Medicaid Managed Care plans,
Accountable Care Organizations, and Independent Practice Associations. We
understand all sides of the risk adjustment equation and provide our services
to plans throughout the United States. Our mission is simple: capture the most
accurate and complete diagnostic information to help ensure our clients have the
best information to care for their members. As HCC risk adjustment experts, we
enable our clients to improve the quality of health care they deliver while assuring
accurate revenue.
Full suite of risk adjustment services:
Analytics
Risk Adjustment Data Validation
Retrospective/Concurrent
(RADV/IVA)
Chart Reviews
Risk Verification
Health Risk Assessments
Provider & Coder Training

PointRight is the industry-standard analytics leader that enables healthcare

providers and payers to measure risk, quality of care, rehospitalization,
compliance and reimbursement accuracy. Using some of the largest
and best databases in the industry, PointRights nationally recognized clinical
staff, researchers, and technologists expertly translate data from multiple sources into
actionable information and insight. Founded in 1995, PointRight is the leader in analytics for
post-acute care, with over 40 million Minimum Data Set (MDS) patient assessments from
SNFs nationwide. The PointRight Pulse analytics suite helps prevent high-cost events, such
as pressure ulcers and falls, while also delivering these benefits:

(877) 271-1657 | Cognisight.com | info@Cognisight.com

DST Health Solutions, LLC delivers contemporary healthcare technology and
service solutions that enable its clients to thrive in a complex, rapidly evolving
healthcare market. Supporting commercial, individual, and government-sponsored
health plans, health insurance marketplaces, and healthcare providers, DST Health
Solutions services include enterprise payer platforms, population health management
analytics, care management, and business process outsourcing solutions, each designed
to assist a company manage the processes, information, and products that directly impact
quality outcomes. DST Health Solutions is a wholly-owned subsidiary of DST Systems, Inc.
For more information visit www.dsthealthsolutions.com.

Mortality prediction for hospice/

palliative care placement
Reduced readmissions
Acute-to-SNF matching

Medicare risk adjustment for

SNF-based members
Medicaid rebalancing
Long-term services and support analytics

Visit www.pointright.com or call 781.457.5900.

SILVER
Accenture: Insight Driven Health
Insight driven health is the foundation of more effective, efficient,
and affordable healthcare. Thats why the worlds leading health
plans and healthcare providers choose Accenture for a wide range of insight driven
health services that help them use knowledge in new waysfrom the back office to
the doctors office. Our Risk Score Accuracy practice puts insight at the center with
our proprietary performance management platform. With global scale operations for
member and provider engagement, medical chart review, and CMS/HHS submissions,
Accenture brings integration, coordination, and transparency to risk adjustment operations.
To learn more contact Rob Deal at rob.deal@accenture.com
Allscripts (NASDAQ: MDRX) delivers the insights that healthcare
providers require to generate world-class outcomes. The companys
Electronic Health Record, practice management and other clinical,
revenue cycle, connectivity and information solutions create a Connected Community
of Health for physicians, hospitals and post-acute organizations.
To learn more about Allscripts, please visit www.allscripts.com.
Headquartered in Ann Arbor, Michigan, ATTAC Consulting Group
(ACG) specializes in compliance solutions, auditing, business operations
and process controls, for insurers and healthcare organizations. ACG
focuses on the space between whats supposed to happen on paper and whats actually
happening on the ground. Our firm assists our clients identify and resolve the difference.
ACGs team of professionals is comprised of industry experts with extensive real-world,
hands-on experience working in, and with, the organizations operating government
health programs including: Medicare Advantage, PDP, Medicaid and Duals, Qualified Health
Plans (QHPs), ACOs and provider groups. Our team focuses on institutionalizing
compliance throughout health plan operations to enhance efficiency and return on
investment.
ACGs audit specialties include:
CMS Performance Audits, Data Validation Auditing, Third-Party Corrective Action Outcome
Validation, CMS Financial Audit Preparation, First Tier, Downstream and Related Entity
Monitoring and Auditing, QHP Compliance Auditing, Development of Internal Monitoring,
Auditing and Process Controls

Cozeva enables value-based purchasing and supports triple aim

objectives through actionable dashboards and data visualization. Our
multi-payer system takes in data feeds for attributed patients and turns
them into registry-driven, real-time actionable dashboards that support care coordination.
Payers use Cozevas customizable, role-specific views to support quality performance, utilization,
cost, payments and risk assessment across the network. Payers rely on SureMetrics charts
to spot outliers, identify trends, compare performance and track campaign efficacy.

Availity integrates and manages clinical, administrative, and financial

data to fuel real-time coordination between providers, health plans, and
patients in a growing value-based care environment. Facilitating over 7 million transactions
daily, Availitys ability to provide accurate, timely, and relevant information is vital to the
financial success of its customers.
Beacon Healthcare Systems Inc. is your trusted partner for
plan operations, compliance and analytics. With more than
75 years combined in health plan technology and operations,
Beacon provides innovative, enterprise class solutions that ensure greater
accountability, accuracy and efficiency for our clients operating in Medicare,
Medicaid, Commercial, Health Insurance Exchanges, ACOs and other risk-bearing
entities. Each of our customizable solutions are a role-based, SaaS (Software as
a Service) system that are scalable to fit your health plans needs. Beacons core
focus is to optimize and make proactive your plans Operations, Risk Management,
Compliance and Analytics functions through the use of customized monitoring and
management technologies and professional services using our Virtual Compliance
Manager (VCM), Virtual Operations Manager (VOM),Virtual Appeals Manager
(VAM), and Virtual Incident Manager (VIM). Our team of technology designers and
subject matters experts together have built these platform of solutions enabling
our clients to monitor operational and compliance events and ensure timely and
appropriate responses to ever-changing requirements all while avoiding costly
sanctions, fines and penalties.
Contact us today to set up a demo and let us show you how our technology
solutions can help better manage your Medicare Part C and D compliance risks.
Visit us at beaconhcs.com for more information.

Blue Health Intelligence (BHI) is the nations premiere health

intelligence resource, delivering data-driven insights resulting in
healthier lives and more affordable access to safe, effective care.
With over 140 million lives, BHIs healthcare claims data reflects
utilization in every ZIP code. With Xchange Advisor, our customers achieve greater
control, unequaled insights, and highest financial impact with analytics for Commercial and
Medicare Advantage risk adjustment. Blue Health Intelligence is an LLC and an Independent
Licensee of the Blue Cross and Blue Shield Association. www.bluehealthintelligence.com
An Independent Licensee of the
Blue Cross and Blue Shield Association

For 27 years, the Carenet team has been passionate about the
companys role in tackling the rising cost of healthcare by helping
more than 25 million people navigate our complex healthcare
system and measurably impacting both the quality and cost of care. By combining
a deep clinical history and consumer engagement expertise with actionable data,
Carenet helps more than 100 healthcare organizations maximize performance
while educating, empowering and motivating consumers worldwide to take an
active role in their healthcare and make better healthcare decisions. Award-winning
solutions include Healthcare Navigation, 24/7 Care Coordination, Point of Need
Engagement and Co-Sourcing to positively impact areas such as Star Ratings,
HEDIS, Medication Adherence, HRAs, ER and Re-admission avoidance, CAHPS, HOS
and more.
Clear Vision Information Systems, Inc. is a risk adjustment
and HEDIS/Stars solutions company that balances care quality
and revenue optimization for health plans and provider groups.
Clear Vision provides an integrated mix of risk adjustment analytics and
continuity-of-care strategies tailored to the individual needs of each client. The
easy-to-implement, high-impact software and services Clear Vision delivers
results in improved risk scores and measureable return on investment. Our
product offerings and services include:
Risk Adjustment Analytics
CMS-Rejected Diagnosis Tracking
HEDIS and Stars Tracking
and Correction
Inpatient Data Pursuit
Patient and Provider Outreach,
Coding and Data Collection
Our decades of experience at the forefront of Medicare policy translate into a
deep understanding of the business processes, risk adjustment strategies and best
practices that improve care and optimize revenue.
Clear Vision is headquartered in Westlake Village, California and serves clients
nationwide. Please contact us at www.cvinfosys.com or toll-free at 888-778-9899.

Synaptic AP specializes in the development and deployment of

secure cloud-based enterprise applications on the Salesforce.
com platform for organizations worldwide. Headquartered
in Annapolis, MD, Synaptic has been developing care, physician and patient
management solutions on the Salesforce.com platform since 2008. Their flagship
product, SynapseTM, is a revolutionary solution for organizations looking for a
simple, smart and intuitive tool to help lower costs, improve health outcomes and
truly engage their patients and care teams.

For over 40 years, GA Foods has been supporting healthy and

independent aging for the elderly population with our nutritious
Home-Delivered Meals. Our Registered Dietitians and Executive
Chef plan every meal to meet federal and state guidelines, while also being suitable for
individuals managing chronic conditions such as diabetes or cardiac disease. GA Foods
uses proprietary tablet technology for route optimization and tracking, enabling us to
provide in-person, in-home delivery of our frozen meals across the United States, while
simultaneously capturing useful member information for the plans care managers.

Health Data Vision, Inc., provides a SaaS-based healthcare analytics

platform for medical records analysis and targeted solutions for HEDIS
Hybrid, Medicare and Exchange Risk Adjustment and comprehensive,
year-round clinical data analysis efforts as well as RADV Audits. The
platform provides flexible scalable workflows and automation for
medical records-intensive project needs of health plans in the United States. HDVIs
patent-pending, process-centric approach provides state-of-the art automation, quality
and audit features, and real-time analytics; all critical for successful medical record
review initiatives.

HEALTH
DATA
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EXECUTION

RESULTS

Home Access Health seeks to empower members to take the first step in
managing their health using our pioneering at-home laboratory testing service.
Our unique kit design makes sample collection easy, which increases program
compliance. As a result, your plan receives the data needed to improve quality
measures and manage risk. Members win too; they get a picture of their
health and a connection to a primary care physician. Our tests include A1c, microalbumin,
cholesterol and colorectal cancer. To learn more please visit www.homeaccess.com

Integra ServiceConnect works with vulnerable, high cost members

that may not be reached with regular phone calls and mailings,
thereby becoming a complementary extension of clients
clinical staff and programs. Integra uses a community health worker model
to identify and address the social, environmental and behavioral barriers to
achieving better health. Specially trained non-clinical Community Coordinators
are hired from within the members neighborhoods to empower, educate and
assist members in navigating the health care system.
Integra can successfully find and engage up to 70% of the unreachable members.
Once engaged, Integra is able to close most impactable HEDIS care gaps, averaging
4 5 gaps closed per member. Integra consistently delivers a positive return
on investment for clients through increased revenue and lowered inpatient and
emergency room expense.

ionHealthcare is a nationally renowned partner for health plans,

ACOs, physician practices, hospitals, and individual coders.
ionHealthcare is a national leader in the risk adjustment industry
offering risk adjustment education for coders and physicians as well as medical coding
review for risk adjustment to include CMS HCC, Medicaid CDPS, and HHS HCC models
in addition to predictive analytics support. Services for auditing include internal and
external coding audit and RADV/IVA services. Our CEO is the author of the official
CRC (Certified Risk Adjustment Coder) curriculum and credential that is nationally
offered through the AAPC. Our coders are all on-shore and highly trained in
risk adjustment, and have assisted with concurrent, retrospective, and prospective
projects as well as auditing work to include RADV experience.
ionHealthcare also provides affordable online courses (many carry CEU value) and
in-person training for coders and providers on many subjects to include HIPAA, Ethics,
ICD-10-CM, Fraud, Waste & Abuse, and more. Contact us at www.ionHealthcare.com
for more information or to inquire about customized solutions.
ionHealthcare also offers consultations for physician practice efficiency, management,
leadership mentoring, change management, patient safety, JCAHO, and OSHA support.

LifePlans, a leader in health assessments, member engagement,

and care management has been helping the nations leading
healthcare and insurance organizations improve health outcomes,
lower medical spend, reduce risk and increase quality since 1986. With an
acclaimed research team, evidence-based results and a deep expertise working
with senior and vulnerable populations, utilizing our national clinical network and
multi-channel digital platform our offerings include HRAs, fall prevention, care
transitions, health coaching, quality compliance programs, underwriting and risk
management solutions. LifePlans is an NCQA certified subsidiary of Munich Re.
www.lifeplansinc.com

MARSI, an established document and coding audit company since 1991

has an excellent reputation and track record. MARSI has been innovative in
developing processes at least five years ahead of our competitors, such as: pre-billing auditing,
comprehensive review compliance and physician documentation improvement . . . that actually work.
MARSI is a known expert among healthcare attorneys. We have never lost a case.
MARSI is known for education which we have broadened into on-line HCC training and
experiential training for all the areas of coding.
MARSI is a proven leader with a wide range of successful programs for documentation and coding.

Since 1985, Medical Data Exchange (MDX) has been serving the
Healthcare Industry by creating systems that process healthcare fiscal
and clinical data. MDX provides a suite of products consisting of MAX
II (hospital claims system), AXIS Physician Practice Management,
VChart (EHR), AXIS IPA Management (IPA/MSO/TPA management
system), HCC Manager (risk adjustment), P4P, and integrated Case Management systems
to support hospitals, health plans and physician organizations. Our systematic applications
assist healthcare organizations to move toward integrated healthcare data management in
order to optimize quality of care and cost-effective models of care management. For more
information call MDX Business Development at (562) 256-3800.
Milliman IntelliScript specializes in risk management solutions for
the health insurance industry. We combine industry-leading data
and expertise with superior customer service to bring our clients
market leading solutions. Our prescription history tools provide intelligent insights into
your members, thereby enabling faster, more accurate and consistent risk-management
decisions. Learn more about how IntelliScript solutions can optimize revenue, improve
disease and case management and enhance group underwriting by visiting us at
www.rxhistories.com.

Established in 1975, Morpace is a Marketing

News Gold Top 25 full service research and
consulting firm with offices in Detroit, Los Angeles,
London and Shanghai. Morpaces healthcare practice encompasses customer
experience research, branding and communications, and product development
for health plans, providers and health technology firms. Morpace is one of the
largest NCQA-certified HEDIS CAHPSTM vendors in the United States, and is a
Centers for Medicare and Medicaid (CMS)-approved MA&PDP CAHPS vendor.
Our experts analyze consumer data and insights to develop strategies driving
improved Star Ratings and other business outcomes. Morpace was named the
2014 CASRO Research Organization of the Year. Visit www.morpace.com.

Nagnoi, LLC is a leading systems integrator and consulting firm

specialized in Business Analytics for Healthcare with products and
services for Payors, Providers, and Public Health organizations. STARSTrack, our flagship
product, is one of the most advanced analytics solutions providing health plans the
instant visibility needed to achieve their goals in quality as defined by the Star Rating
Program of the Center of Medicare and Medicaid Services (CMS). In 2011, Nagnoi was
awarded Worldwide Business Intelligence Company of the Year and in 2013 and 2014,
the Health Partner of the Year Award, both by Microsoft Corporation. In 2012, Nagnoi
was included in the Forrester Research Business Intelligence Service Provider Shortlist.
For more information, visit www.starstrack.com.

Navigant Consulting, Inc. (NYSE: NCI) is an independent specialized,

global professional services firm that combines deep industry knowledge
with technical expertise to enable companies to defend, protect and create value.
With a focus on industries and clients facing transformational change and significant
regulatory and legal issues, the firm serves clients primarily in the healthcare, energy
and financial services sectors which represent highly complex market and regulatory
environments. Professional service offerings include strategic, financial, operational,
technology, risk management, compliance, investigative solutions, dispute resolutions
services and business process management services.

Pareto Intelligence is an analytics company focused on helping

providers and health plans deliver improved financial and medical cost
outcomes. Our HCC Sentinel utilizes sophisticated statistical models to
identify, prioritize, and capture undocumented risk. Member Economics
stratifies and segments members to understand profitability and effectively design
products, network, and go-to-market strategies. Performance Management evaluates
intervention effectiveness, monitors risk score trends, and provides a greater
understanding of financial performance. www.paretointelligence.com

For Health Plans or Self-Insured Employers that want to measurably

improve member and employee health, PharmMD is the proven
choice for pharmacy quality solutions. Founded by healthcare and
pharmacy innovators, PharmMDs outcomes-driven reporting, priority on personal
touch, and scalable clinical network are backed by performance-based pricing that
guarantees fast results for Part D Star Ratings improvement, the most effective
Medication Therapy Management, and improved overall health outcomes. For more
information visit www.PharmMD.com
Your clinical analytics partner

Predilytics is a healthcare information technology company that

helps drive decisions that improve population health, quality of
care, and business performance. Using patented machine learning
analytic tools, we identify opportunities at an individual consumer
level, prioritize them based on receptivity to engagement, and identify actions to realize
the greatest value.
RelayHealth Pharmacy Solutions (RHPS) connects health plans with
more than 50,000 retail pharmacies enabling them to utilize a
pharmacys accessibility to drive member engagement, medication adherence and
an overall improvement in quality measures.
To learn more, visit relayhealth.com/interventionmessagingrx, call 800.868.1309 or
email pharmacy.connections@relayhealth.com.

TMG Health is the leading national provider of expert solutions

for Medicare Advantage, Medicare Part D and Managed Medicaid
plans. With more than 15 years of experience in providing technology-enabled
services to the government market exclusively, our knowledge of health plan
processes, regulatory requirements, and the daily challenges plans face within
the government market is second to none. Our expertise, coupled with a strong
commitment to our clients success, positions us as a trusted partner who can help
solve the challenges of today and prepare for those of tomorrow.
TMG Health is headquartered in King of Prussia, Pa. and is a subsidiary of Health
Care Service Corporation (HCSC), the largest customer-owned health insurer in
the United States and fourth largest overall, operating through its Blue Cross and
Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas. HCSCs
headquarters is located in Chicago, IL.
TriZetto, a Cognizant company and business unit within Cognizants
healthcare practice, provides world-class information technology
solutions to make better healthcare happen. TriZettos world-class
technology products, in combination with Cognizants consulting, IT and business
process services at scale dramatically simplifies the deployment and adoption
of technology and improves operationshelping to reengineer the business of
healthcare today, while reimagining it for tomorrow.

3M Health Information Systems works with payers, providers and

government agencies to anticipate and navigate a changing healthcare
landscape. 3M provides healthcare data aggregation, analysis, and
strategic services that help clients move from volume to value-based health care,
resulting in millions of dollars in savings, improved provider performance, and higher
quality care. 3Ms innovative software is designed to raise the bar for computer-assisted
coding, clinical documentation improvement, performance monitoring, quality
outcomes reporting, and terminology management.

Evolent Health partners with leading health systems to drive value-based care transformation. By providing clinical, analytical and
financial capabilities, Evolent helps physicians and health systems
achieve superior quality and cost results. Evolents approach breaks down barriers,
aligns incentives and powers a new model of care delivery resulting in meaningful
alignment between providers, payers, physicians and patients.

Enjoin delivers a comprehensive solution for advancing clinical

documentation integrity. With thirty years of direct physician
leadership, our team ensures evidenced-based care is accurately
reflected through precise documentation and coding for value-based, pay for
performance reimbursement. Whether inpatient or ambulatory, the precision of
healthcare data defines risk adjusted value-based outcomes through reliable
documentation and coding.
Led by expert physicians with coding and documentation credentials, our clients
achieve a demonstrable improvement in CMI, coding accuracy, quality metrics, risk
adjustment and physician alignmentwith an average return on investment over
700%.

Health Care Excel offers customized services in the areas

of combating healthcare fraud/waste/abuse, commercial risk
adjustment, quality improvement, program integrity, and utilization
management. By aligning clinical expertise with proprietary technology, Health Care
Excel delivers innovative solutions and measureable results to clients nationwide.
For over 41 years, Health Care Excel has been a strategic partner to health plans,
providers, and state and federal governments.
Health Care Excel is URAC Accredited for Health Utilization Management and is also
currently in process for Independent Review Organization (IRO) accreditation from
URAC. The company is a premier member of the National Health Care Antifraud
Association (NHCAA) and also a member of the National Association of Dental Plans
(NADP). Additionally, Health Care Excel has been designed by the Centers for Medicaid
and Medicare Services (CMS) as a QIO-like entity.

MediCheck is a proactive health risk assessment program

offered by ExamOne that gets to the source of actionable data.
Our program can help maximize your resources, close gaps in care,
improve quality outcomes and attain bonus payments. With an industry-leading
health outreach team, MediCheck helps improve discovery, identification and
documentation of member medical conditions through mobile laboratory and
biometrics collections, as well as comprehensive in-home health assessments,
ultimately helping you stay on target with quality reporting deadlines.
Learn more at MediCheck.ExamOne.com.
Health Solutions Plus (HSP) offers the most comprehensive core
administration payer solution in the industry. The HSP Payer Suite is an
end-to-end payer platform that integrates Medicare, Medicaid, Dual
Eligible and Exchange data and business processes. This end-to-end system offers
technological innovation and experience leading to unmatched revenue improvement,
business efficiency, flexibility, and self-managed regulatory compliance. Plus, your
data is securely held in one location, eliminating the costly issues and downtime
associated with multivendor interfacing.
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ComplexCare Solutions, Inc. (CCS): ComplexCare Solutions is

a national Care Management and Risk Assessment company which
provides services to Medicare Advantage and Medicaid Health Plans
in support of high risk, frail and complex care members. It operates
with clinicians and multi-specialty teams in the members home to coordinate and
manage the delivery of care, improve member outcomes and reduce the associated
cost of care.

NeuroMetrix is an innovative medical device company focused

on the most costly and prevalent chronic complication of
diabetes diabetic neuropathy. NeuroMetrix markets the NC-stat DPNCheck
device, which is a rapid, accurate, and quantitative point-of-care test for diabetic
neuropathy. Due to the limitations of traditional clinical detection methods such
as monofilament testing, many organizations under diagnose diabetic neuropathy
and unknowingly carry the risk of this costly and debilitating complication. Our
technology helps Medicare Advantage organizations improve the accuracy of
diabetic neuropathy detection, accurately risk assess their diabetes patients and
optimize neuropathy and general diabetes treatment.

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Indegene Healthcare, is a leading integrated provider of end-to-end

Risk Adjustment, HEDIS/STARS rating improvement, and provider
engagement solutions. With over 1200+ healthcare experts across
the globe, Indegene brings its rich clinical expertise, proprietary analytics models,
education outreach, and training capabilities that enable payers and providers
to thrive by driving better business and health outcomes. Leveraging its strong
intellectual property and innovation capabilities, Indegene deploys a portfolio
of next-generation platforms in quality improvement, risk adjustment, and provider
engagement to drive integrated outcomes and business success for its clients.

Novu enables the health care ecosystem to deliver, incent and

track protocols and healthy outcomes through tailored consumer
experiences. The company creates an empowering connection
between consumers and the health system, driving efficiencies for health cares
most impactful areas. The companys consumer-centered platform facilitates this
connection through proven consumer marketing strategies, including personalization,
gamification, rewards and social community. Novu works with health cares
most innovative leaders and delivers an empowering, influential and connected
experience via desktop, mobile and tablet. The company is headquartered in
Minneapolis, MN. More information is available at www.novu.com.
Daily Health Rewarded

OS2 Healthcare Solutions is a veteran owned medical coding firm

and academy specializing in risk adjustment coding, RADV audits,
physician clinical documentation improvement, and coder education.
OS2 has created a state of the art business process to improve
your healthcare organizations bottom line by enabling your facility and staff
to focus on continuity of care, quality outcomes, and reimbursement.
For more information, contact Melissa Freeman at Melissa.freeman@os2hcs.com or
visit our site, www.os2healthcaresolutions.com.

Hello. Were EyeMed Americas fastest growing vision benefits

company. We have 15+ years of experience providing vision benefit
options for Medicare partners supporting over 4 million Medicare
members.
By examining the needs, wants and concerns of the Medicare eligible population,
we have developed effective vision benefit solutions from Medicare-focused
plan options with the network members want, to senior-centric, award-winning
customer service.
It takes vision to challenge the status quo. Visit our booth to learn more!

Visionary RCM specializes in Risk Adjustment Coding Solutions.

Our 1700+ experienced coders and Nurse Practitioners guarantee
95%+ accuracy and faster turnaround time.
Retrospective / Prospective Risk Adjustment Coding
Commercial Risk Adjustment Coding
RADV Audit / IVA
HEDIS Abstraction
Comprehensive Condition Audit
Clinical Documentation Improvement & Data Validation

MedHOK is an innovative software company enabling health

plans, managed care organizations, pharmacy benefit managers,
and specialty pharmacies to simplify member care and coordination,
maintain compliance, and maximize revenue. Our SaaS-based software platform
pulls together all pharmacy and medical data into one platform, creating a 360
view of the member, allowing payers to identify and target health risks, intelligently
trigger workflow interventions, and improve quality of care throughout the
continuum of care. Out-of-the-box compliant and proactively updated for Medicare,
Medicaid, and Affordable Care Act regulations, MedHOK is a compliance
powerhouse.
Recognized by Inc. magazine as the nations 25th fastest growing private company
and the 6th fastest growing private healthcare company, MedHOK is NCQA certified in
HEDIS, Pay for Performance, and Disease Management. MedHOK is the software
platform of choice for more than 50 of the nations largest healthcare payers,
managing close to 40 million lives. Visit www.MedHOK.com or call (888) 9MEDHOK.

Athenahealth is a leading provider of cloud-based services for

providers and health plans including population health
management, care coordination, and clinical data exchange
services. By connecting care across the entire continuum, athenahealth helps
its network of 75,000+ providers and health plan partners drive unprecedented
financial and quality outcomes through interoperability and provider-payer
collaboration.

Judge Healthcare is a leader in providing customized clinical

workforce solutions to healthcare organizations throughout
the country. With engagements in almost 50 states, we
currently have clinicians working as far away as Hawaii, Puerto Rico and St. Thomas
and as remote as Indian Reservations in New Mexico. Judge Healthcare delivers the
highest quality healthcare professionals for executive search, physician recruitment,
contract/temp, contract-to-hire, per diem/travel/locum tenens, in-home/facility
assessments, and on-going case management opportunities across the healthcare
spectrum. Visit judge.com or contact 1-800-650-0035

DDDS is an innovative healthcare services company with years

of experience in collaborating with health plans and providers to
deliver high-quality provider and member-centric solutions to the
market that improve risk scores, quality, and compliance - while
ensuring accuracy of financial reimbursement. DDDS offers technology-enabled
services and solutions including: a differentiated prospective program, medical
record retrieval and review, data analytics and reporting, RAPS/EDPS data
submissions, enrollment reconciliation and financial reconciliation.

SPH Analytics (SPHA) is a leader in action analytics for provider,

payer, member, and health networks. SPHA solutions enable
clients to enhance the patient care experience, improve
population health, reduce the overall cost of care, and elevate provider performance.
SPHA solutions incorporate an engaging social-media style user experience optimized for
mobility to measure data, create easy-to-understand analytics, and empower action.
For more information, call 1-866-460-5681 or visit www.SPHAnalytics.com.

Convey Health Solutions is a leading healthcare-focused Business Process

Outsourcing and technology organization. They have spent nearly a
decade building a compliant and efficient operational organization,
proven healthcare IT infrastructure, and a comprehensive Medicare Services Platform.
They also have deep expertise in navigating the increasing regulatory challenges
of Medicare compliance (under the direction of their seasoned Chief Compliance
Officer). They are relied upon as a trusted and proven outsourcing and technology
partner that consistently delivers high quality Medicare member experiences from
initial marketing inquiry through enrollment, billing, reconciliation, member and provider
service, grievance and appeals, wellness and chronic condition management.

Eliza Corporation (Eliza) helps our customers engage individuals

and close gaps in care by combining behavior-driven healthcare
analytics with multichannel communications that make member
interventions more efficient and effective. After 15 years
experience and billions of healthcare consumer interactions and insights, Eliza
is the recognized leader in Health Engagement Management. We collaborate
with healthcare organizations to deliver results that measurably improve quality,
cost and care outcomes. For more information, visit elizacorp.com or contact
1.800.701.7864. Join Eliza on LinkedIn, and Twitter.

Capitol Coding Management is a superior custom coding solution

for your Health Information Management needs. We bring insight,
innovation, and strategies for success with our expert coding
solutions and unbeatable rates. We work closely with our clients
to create custom work models that generate maximum value. We
understand how vital efficient coding is for your companys revenue cycle. Therefore,
we are committed to ensuring you receive the highest reimbursement with
unrivaled quality of service.
Capitol Coding Managements products and service specialties include Risk
Adjustment, HEDIS, STAR Ratings, RADV Audits, and record retrieval. To learn
more visit www.capitolcoding.com or call (855) 771-7226

Welch Allyn is a leading medical diagnostic device company,

and is a division of Hill-Rom (NYSE: HRC).
At RISE we are featuring the RetinaVue Networka proven turnkey diabetic
retinopathy screening program made simple and affordable enough for individual primary-care practices and scalable for nationwide health-plan screening
programs.
RetinaVue can double DRE patient compliance rates in just 12 months to
positively impact HEDIS scores and Medicare Star ratings on the DRE metric, and
help preserve vision in patients with diabetes.
Stop by Booth 89 to see the new RetinaVue 100 Imager in actionthe worlds
most advanced handheld fundus camera!

BeamMed is a developer and manufacturer of bone density

assessment and monitoring solutions who has pioneered the early
assessment of bone density, with the first - and still the only devices that enable ultrasound-based, multi-site measurement for
the early assessment and monitoring of osteoporosis.
BeamMeds Sunlight product line overcame the cost and radiation exposure-related
challenges of Dual X-ray Absorption technology (DXA).
The MiniOmni offers high accuracy, small size, ease of use, reliability, excellent
affordability, and radiation-free operation that can easily and safely be used in any
doctors office, clinic, HMO or retail venue such as pharmacies and checkup centers.

Vee Technologies is a pioneer in outsourced healthcare,

insurance, financial, and engineering services. The company has
delivered secure HIPAA compliant, ISO-certified, quality work
to its customers since 2001. One of Vee Technologies biggest
strengths is its very own Sona University which custom-trains
students to directly meet the ever-changing demands of todays global marketplace.
Vee Technologies commits to deliver excellent solutions, guided by innovation
and security, to achieve and render extraordinary outcomes.

Looking for Healthcare Providers?

PPR Risk Adjustment Staffing is the leading recruitment
organization working with risk adjustment organizations and
health plans who need healthcare professionals to perform prospective health
risk assessments.
We hire your Health Providers so you dont have too.
PPR Risk Adjustment Staffing will recruit, hire and manage your healthcare
providers allowing for quicker starts and the ability to flex your staff up or down
based on your project needs. Most importantly, we eliminate your recruiting
costs and the hassles of managing healthcare professionals.
We can Manage it All!
No more hiring costs, employee issues, payroll or benefits management.
Contact Jeff Lott at 800-508-5038 or info@pprriskadjust.com

SDLC Partners, L.P., headquartered in Pittsburgh, PA, opened its

doors in 2004 as an alternative to large consulting organizations. The
firms high performing employees take a practical and collaborative
approach to deliver process improvement, analytics, and technology solutions to
regional and national customers by effectively working with business and I.T. to serve
as the execution partner of choice.

Simbiote is a healthcare technology company offering

unique automated point of care technology, seamlessly
integrated within the EHR providing real time, dynamically
updating notification of risk adjustment and quality gaps. Our solution provides
automatic assignments of care to clinicians based upon user login and role.
The CareSentry solution ensures that providers are meeting quality improvement
measures (Medicare risk adjustment HEDIS, CMS Star, MSSP, PQRS, PCMH) by
providing gaps in care (and risk adjustment gap) notification within providers existing
EHR workflow via mappings directly into EHR data points. Providers know instantly
if they are missing measures and care. Simbiotes disease registry, care management
and population health management solution improves quality at the point of care.
www.simbiote.com

THE 10TH ANNUAL RISE NASHVILLE SUMMIT

Four Ways to Register

Fax

Phone

Web

704-341-2641

866-676-7689

www.healthcareconferences.com

HEALTHCARE EDUCATION
ASSOCIATES
200 WASHINGTON ST. SUITE 201
SANTA CRUZ, CA 95060

Mail

HEA, LLC
18705 NE Cedar Drive
Battle Ground, WA 98604

ATTENTION MAILROOM:
If undeliverable, please forward to the
Director of Medicare or Risk Adjustment

Please Mention
This Priority Code
When Registering

Conf. & Workshop A- Leveraging Powerful Data Analytics - Govt/Community Service rate*
Conf. & Workshop B - A Risk Adjustment Primer - Govt/Community Service rate*
Conf. & Workshop C - Nuts and Bolts of Star Ratings - Govt/Community Service rate*
Conf. & Workshop D - A Coding Intensive - Govt/Community service rate*
Conf. & Workshop A- Leveraging Powerful Data Analytics - Health Plan/Provider rate*
Conf. & Workshop B - A Risk Adjustment Primer - Health Plan/Provider rate*
Conf. & Workshop C - Nuts and Bolts of Star Ratings - Health Plan/Provider rate*
Conf. & Workshop D - A Coding Intensive - Health Plan/Provider rate*
Conf. & Workshop A- Leveraging Powerful Data Analytics - Service Provider/Consultant rate
Conf. & Workshop B - A Risk Adjustment Primer - Service Provider/Consultant rate
Conf. & Workshop C - Nuts and Bolts of Star Ratings - Service Provider/Consultant rate
Conf. & Workshop D - A Coding Intensive - Service Provider/Consultant rate
Conference only - Govt/Community Service rate*
Conference only - Health Plan/Provider rate*
Conference only - Service Provider/Consultant rate

$1,495
$1,495
$1,495
$1,495
$2,195
$2,195
$2,195
$2,195
$2,995
$2,995
$2,995
$2,995
$1,095
$1,895
$2,695

$1,295
$1,295
$1,295
$1,295
$1,995
$1,995
$1,995
$1,995
$2,795
$2,795
$2,795
$2,795
$895
$1,695
$2,495

early bird - ends 1/20/2016

Name
Company
Address
City
Phone

Title

State
Email

Payment Method:
Payments must be received no later than March 13, 2016

Please bill my:

MC

VISA

AMEX

DISCOVER

Card Holders Name:

Exp. Date:
Signature:
Check enclosed:

Please bill me later:

Make checks payable to Wilmington
FRA, and write H2088 on your
check.
Conference Code: H2088

Zip

INCORRECT MAILING INFORMATION: If you are receiving multiple mailings, have updated information or would like
to be removed from our database, please fax our database team at 704-341-2641 or call 704-341-2387. Please keep in
mind that amendments can take up to 8 weeks.

HEALTHCARE EDUCATION ASSOCIATES AND THE RESOURCE INITIATIVE & SOCIETY FOR EDUCATION (RISE) PROUDLY PRESENT THE

Transforming Vision into Excellence in Risk Adjustment, Stars Performance,

Predictive Modeling and Clinical Outcomes
MARCH 20-22, 2016

G AY L O R D O P R Y L A N D R E S O R T

NASHVILLE, TN

T O R E G I S T E R : C A L L 8 6 6 - 6 7 6 - 7 6 8 9 O R V I S I T U S AT W W W. H E A LT H C A R E - C O N F E R E N C E S . C O M