RISE West 2019 is shaping up to be bigger than ever. Our annual event returns to San Diego on September 9-11 to bring together senior leaders from Medicare Advantage health plans, commercial marketplace sponsors, Part D health plans, providers groups, pharmacy benefit managers, and accountable care organizations to discuss strategies to improve payer-provider collaboration and the member experience and address social determinants of health. We talked to Kevin Mowll, executive director of the RISE Association, and Marina Adamsky, executive director of production for RISE, to learn what’s new and what attendees can expect at this year’s premier event.

Advanced workshops on risk adjustment, HCC coding, and member engagement

This year RISE West will kick it up a notch by offering three high-level half-day workshops plus one all-day workshop on September 9 that focus on management and strategy on member engagement techniques and strategies, HCC coding management training, and risk adjustment management techniques in Medicare risk adjustment for non-actuaries, and management techniques in commercial risk adjustment for non-actuaries. In addition, RISE will host an invitation-only executive think tank that focuses on practical innovation in healthcare.

These “201” workshops will drill down on what leaders need to know to do their jobs and put these programs together. “Instead of focusing on the individual contributor, these workshops concentrate on what they need to do to execute these programs as a leader or a manager,” said Mowll.

The sessions will offer practical advice, so attendees will take back action items that they can implement at their organizations, Adamsky said. “We want to make sure that the innovation ideas are not pie in the sky. They need to be tangible and scalable,” she said.

Sessions that focus on providers and collaboration with health plans

Mowll anticipates that because of this year’s location, the conference will attract large physician groups from California that take on capitated risk contracts. Health plans will have an opportunity to network with these providers to learn how they can work together and improve quality, revenue, star ratings, and how they can differentiate themselves from their competitors.

Planned sessions will feature:

Amy Nguyen Howell, M.D., chief medical officer, America’s Physician Groups (APG), who will discuss from the provider’s perspective how providers and payers can better collaborate in a fragmented health care system to improve risk adjustment programs and the patient experience.

A discussion on how health plans tackle provider training activities and avoid provider fatigue and push back. Speakers will include Shannon I. Decker, Ph.D., executive director of risk, NAMM California, part of OptumCare, UnitedHealth Group; Donna Malone, CPC, CRC, director of enterprise risk adjustment, HCC coding and quality assurance, Tufts Health Plan; Stacy Garrett-Ray, M.D., vice president, medical director, population health services organization, president, quality care network, University of Maryland Medical System, and Cristina Lopez-Pollard, director of government programs, Hill Physicians Medical Group.

A panel of experts will also provide tips on payer-provider collaboration techniques that impact quality and risk adjustment on day two of the main conference. Panelists include Molly T. Turco, managing director of legislative policy and regulation, Blue Cross Blue Shield Association; John M. Kirk, founding CEO of Pioneer Medical Group and the former vice-chair of APG’s Public Policy Committee; and Dave Meyer, vice president of stars, Cigna.

A focus on member engagement

In addition to the advanced workshop, the main conference will feature sessions that address member engagement, including:

Matt Wallaert, chief behavioral officer, Clover Health, will provide examples of programs that have proven to change behavior and motivate members to be active participants in the health care system.

Kathleen Ellmore, managing director of Engagys, will moderate a panel discussion on insights into the Medicare and Medicare Advantage product. Attendees will hear directly from Medicare and Medicare Advantage members about their experience, access to care, and suggestions on how health plans can improve their product offerings.

Strategies to address social determinants of health

It’s estimated that medical care only addresses 10 to 20 percent of a population’s health outcomes. The rest are due to social determinants of health or the conditions in the places where people live, learn, work, and play. RISE West will take a deep dive into programs that have successfully addressed these conditions and improved patient outcomes.  

Kathleen Stillo will discuss how the Medicaid insurance arm of UnitedHealthcare successfully implemented a program that addressed housing and wrap-around care for formerly homeless members. Stillo, who serves as the president and chief operations officer, clinical redesign community & state for UnitedHealthcare, will also discuss “hot spotting” for health care super users and how organizations can help put patients on the right track of care.

Attendees will also walk away with strategies to calculate the ROI of interventions that address social determinants of health. Shannon Decker will join Su Bajaj, vice president of product and payor solutions, Episource, in a session that connects revenue-generation operations with social determinant projects, funding options, and how to align financial goals with medical management.

David DiGiuseppe, vice president of health care economics, Community Health Plan of Washington, will present a case study on how to use data-driven decision-making to drive resource allocation for social determinants of health. He’ll describe the lessons learned from Community Health Plan’s work developing a predictive model to identify members for care management programs.

Allysceaeioun Britt, Ph.D., director of strategic initiatives and quality assurance for the Tennessee Department of Health, will offer a case study on how to create cross-sectional partnerships to address social determinants of health issues. She will provide examples of government and non-profit partnerships across several states and learn how to implement them within your organization.

RISE West 2019 will take place September 9-11 at the beautiful Loews Coronado Bay Resort in San Diego. Click here to see the entire online agenda, the list of speakers, and how to register for the program.