Data Analytics Healthcare providers

8/18/2019 Data Analytics Healthcare providers

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HEALTHCARE EDUCATION ASSOCIATES AND THE RESOURCE INITIATIVE & SOCIETY FOR ED UCATION RISE PROUDLY PRESENT

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 A T W W W . H E A L T H C A R E C O N F E R E N C E S .

SPONSORS

P L A T I N U M

G O L D

Transforming Vision into Excellence in Risk Adjustment, Stars Performance,

Predictive Modeling and Clinical Outcomes

S E N A TO R TO M D A S C H LE D -S D

F O R M E R S E N A T 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

A N N E F I L I P

P R E S I D E N

E N R O L L A M E R

KEYNOTE ADDRESS FEATURED PRESENTE

N A S H V I L L E , T NG A Y L O R D O P R Y L A N D R E S O R TM A R C H 2 0 - 2 2 , 2 0 1 6

®



VENUE DETAILS

Gaylord Opryland Resort

2800 Opryland Drive

Nashville, Tennessee 37214615-889-1000

We have a limited number of hotel rooms reserved for the conference. Theegotiated room rate of $259.00 per night will expire on March 1, 2016,lthough we expect the block to sell out prior to this date. To ensure youeceive a room at the negoated rate, book well before the expiraon date. Uponell out of the block, room rate and availability will be at the hotel’s discretion.

TEAM DISCOUNTS

Three people will receive 10% off

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

n order to secure a group discount, all delegates must place their registraons athe same time. Group discounts cannot be issued retroactively. For morenformation, please contact Whitney Betts at 704-341-2445 or

[email protected]

REFUNDS AND CANCELLATIONS

or information regarding refunds, complaints and/or p rogram cancellation

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

TOP REASONS TO ATTEND

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

Next Phase of Healthcare Reform”, former Senate Majority Leadeand Founder & Chairman of The Daschle Group, A Public Policy Advisoof Baker Donelson

• Gain timely updates during the featured address by Anne Filipic,President of Enroll America on the latest trends within the healthexchange marketplace

• Enjoy a comprehensive learning environment unlike any other inthe industry, featuring eight different track themes over two daysfilled with strategy-driven discussions and case studies led by thebest and brightest

• Create your ultimate conference experience with the choice of o

35 different sessions covering Medicare Advantage and CommerciRisk Adjustment, Stars and Quality, Data Analycs, Compliance and somany more

• Select from four pre-conference workshops carefully designed tokick-start your conference experience by addressing the nuts and bof Risk Adjustment, Star Rangs, Data Management and ICD- 10/Cod ing

• Benefit from numerous networking opportunities, providing ampletime to make new connections and reconnect with existing contain a lively, dynamic s etting

• Participate in an interactive 90-minute roundtable session featuringnewest innovaons for opmizing your risk revenue, quality improvemeand data management initiatives

• Get a rare look into the member experience during a live focusgroup complete with a panel of real Medicare Advantage membesharing candid feedback on health plan customer service performan

communication strategies, and overall satisfaction

WHO WILL ATTEND?

eaders and Senior Management from Medicare Advantage Health Plans,

ommercial Plans, Provider Groups, ACOs, Pharmacy Benefit Managers,

rescription Drug Plans, and Medicaid Plans with

esponsibilities in the following areas:

Risk Adjustment and HCCManagementStar Ratings and QualityImprovement

HEDIS/CAHPS/HOSMedicare and GovernmentProgramsData Management/PerformanceAnalyticsRevenue Management/Financial Performance

• Provider Education• Member Engagement• Part D• Plan Strategy and Product

Development

• Operations and PerformanceImprovement

• ROI and Value Assessment

• Accountable Care• Care Coordination

• Compliance/Regulatory Affairs

CPE CREDITS

Financial Research Associates is registered with the Naonal Association ofState Boards of Accountancy (NASBA) as a sponsor of connuing professioneducaon on the Naonal Registry of CPE Sponsors. State boards of accountanchave final authority on the acceptance of individual courses for CPE creditComplaints regarding registered sponsors may be submied to the NaonaRegistry of CPE Sponsors through its website: www.learningmarket.org.

The recommended CPE credit for this course is 16 credits for the workshop andconference, and 12 credits for the conference only in the following eld(s) of stu

Specialized Knowledge and Applicaons. For more informaon, visit our websitwww.healthcare-conferences.com/theneprint.aspx

XTRAORDINARY SPONSORSHIP AND EXHIBITOPPORTUNITIES!

nhance your markeng eorts through sponsoring or exhibing your product athis exceponal event. We can design custom sponsorship packages tailored to your

markeng needs, such as a cocktail recepon or a custom-designed networking event.n addion, the 2016 RISE Nashville Exhibit hall providesnprecedented networking opportunies. Enjoy the benets of an expandedxhibit hall designed to accommodate an anticipated sellout crowd!

o learn more about sponsorship opportunies, please contact Kevin Weigel at

04-341-2448 or [email protected]

“Great information and speakers were knowledgeable”

Londi Jaramillo, AFFINITY HEALTH PLAN

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

The Compliance Certification Board (CCB) has approved this event for up 13.1 CCB CEUs. Continuing Education Units are awarded based on individu

aendance records. Granng of prior approval in no way constutes endorseby CCB of this program content or of the program sponsor.

This program has been approved for 13 continuing education unit(s) fouse in fulfilling the continuing education requirements of the AmericaHealth Information Management Association (AHIMA). Granting priorapproval from AHIMA does not constitute endorsement of the programcontent or its program spon sor.



®

THE 10th ANNUAL RISE SUMMIT

SUNDAY, MARCH 20, 2016

9:30 – 12:30

RISE ADVISORY BOARDMEETING

11:00 - 1:00

PRE-CONFERENCE WORKSHOPREGISTRATION

1:00 – 4:00

PRE-CONFERENCEWORKSHOPS

3:00

EXHIBIT HALL OPENS

5:30 – 6:30 OPENING NIGHT COCKTAIL RECEPTION sponsored by

3:00 - 5:00 MAIN CONFERENCE REGISTRATION

EVERAGING POWERFUL DATA ANALYTICSO IGNITE FINANCIAL PERFORMANCE

The power of data + analycs:- Ulizing a combo of sources: claims

data, lab results, care managementdata, assessment data (HRA and IHA)and lifestyle/consumer data

- Determining condence levels byreviewing member and providerbehavior paerns

- Integrang with EMRs ulized by yourmost important medical groups andengaging network providers to obtainreal-me clinical data

- Rening algorithms using data mining,clinical inferencing and various types ofpredicve models

Innovave gap closure techniques:- Dierenang your approach upon

whether the condions are “persisng”or “suspecng”

- Eliminang low-yield intervenons(“wasteful tails”) with dynamic interventionmodels

- Minimizing provider abrasion- Implemenng an ecient gap closure

strategy that deploys the right

intervenon with the right providers forthe right paent at the right me

- Linking your risk adjustment and qualitygap closure eorts for HEDIS®, StarRangs or ACA QRS

Financial projecons for Commercial RA,Medicare Advantage and Medicaid:

- Calculang “condence-adjusted” riskscores, RAF points and RAF dollars

- Discounng your expected risk score bythe likelihood that the opportunity willclose within the current plan year

- Reducing false posives withoutincreasing your false negaves

- Tracking and modeling competors

iro Arai, Sta Actuary

LUE CROSS BLUE SHIELD OF NORTHAROLINA

Mark Hillix, Director, Risk Adjustment and Star

angs

LUE CROSS BLUE SHIELD OF KANSAS CITY

ohn Criswell, Chief Execuve Ocer, PULSE8

co Straon, Chief Data Scienst, Viceresident, Product Analycs, PULSE8

ourtney Yeakel,Director, Customer Engagement

ULSE8

A RISK ADJUSTMENT PRIMER:FOUNDATIONS OF MEDICAREADVANTAGE AND COMMERCIALRISK

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

Expanded Use• Medicaid• Exchanges

Strategy & Programs• Data and analytics to optimize risk-

adjustment• An overview of programs and acvies

to optimize risk adjusted revenue• Provider opportunies 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 andreporting

• Value-based care integration

Ryan McKeown, Vice President, Market

Strategy and Business Integraon

OPTUM

David Meyer, Vice President, Risk Adjustment,

Encounters, Coding and Audit

SCAN HEALTH PLAN

Stephanie Will, Senior Vice President

Risk and Quality

OPTUM

THE NUTS AND BOLTS OF STAR

RATINGS: AN INTERACTIVEWORKSHOP

Part One: What is the Medicare StarsProgram?

• Historical view: Stars program in MedicareAdvantage

- Roots of comparave quality andtransparency- HEDIS models – reference dates- CAHPS – content & calendar- HOS – how it factors in- Bonus payment model overview- Naonal performance levels- Financial implicaons of Star levels

achieved (bonus payments and rebates)• Changes to the model: Implementaon of

ACA and cut-o levels• Predicng future Star levels and bonus

revenues: market analysis, cut-pointprojecons and ACA phase-in changes

Part Two: How Does a Medicare StarsShop Work?• Organizaonal structure and overview of

typical health plan Star Rangs program• Governance structure• Department & operang structure - - Data administraon and analycs• Interdepartmental relaonships -

- Quality management- Care management- Provider relaons- Markeng- Customer service

• Program Mechanics -- Managing melines- Managing the measures- Display measures- Score card illustraon

• Geng proxy measures for real-meassessments

• Analysis and predicve analycs• Managing under CMS program changes

Ana Handshuh, Vice President, Managed

Care Services

ULTIMATE HEALTH PLANS

Nichole Crandall, Manager of Medicare

Strategic Programs

MARTIN’S POINT HEALTH CARE

CODING INTENSIVE: MASTERINACCURATE DOCUMENTATION,PHYSICIAN EDUCATION, ANDCOMPLEX DIAGNOSES

• Understanding the methodology of

diagnosis documentaon and codingrisk adjustment

• Applying ICD-10-CM and CMS RADVParcipant Guidelines

• Understanding the nancial impact oacute diagnosis capture in non-acutesengs, non-specic diagnoses codiand non-recaptured chronic condio

• Best pracces for querying providersmore robust documentaon

• Tips for provider educaon: “know yaudience”

• Applying risk adjustment methodoloreal cases

Donna Malone, CPC, CRC, Risk Adjustm

Coding & Quality Assurance Manager

TUFTS HEALTH PLAN

Dawn Strong, Revenue Cycle and Co

Resource Manager

NORTH SHORE PHYSICIANS GROUP

WORKSHOP A –DATA & ANALYTICS FOCUS

WORKSHOP B –RISK ADJUSTMENT PRIMER

WORKSHOP C –STAR RATINGS ESSENTIALS

WORKSHOP D –CODING INTENSIVE

“This workshop was exactly what I

was looking for. An excellent overview

of risk adjustment”

Chris Frederickson, Risk Adjustment,NETWORK HEALTH

“I would recommend this worksh

anyone looking for the basic

fun dam entals of HCC s & HHS, a

coding & documentaon best prac

Brandy Frieson , Piedmont CliniPIEDMONT MEDICAL CARE COR



ACHIEVING A PERFECT MARRIAGEBETWEEN RISK AND STAR RATINGS:MAXIMIZING THIS CRITICALRELATIONSHIP

• Achieving opmal performance of

risk and quality through value-basedarrangements

• Creang a customized approach tomeet goals while increasing physicianengagement

• Year-round iniaves to improveeciencies and results

• Improving operaonal performance tocreate a more posive impact onquality and risk

Jamie Benedict, Director, Support Services

MEDIGOLD

Shawn Larsen, RN, Vice President Clinical

Quality Soluons

ADVANTMED

STRATEGIES FOR SUCCESSFULLYCONTRACTING WITH MEDICAREADVANTAGE PLANS

• Understanding the nuances of at-riskcontracts

• Examining quality-based contracts• Migang Part D risks• Negoang more eecvely by beer

understanding how plans developtheir bids

Dhyan D. Lal, Vice President, Network

Strategy and Contracng - Payer Strategy

Group | Pacic Northwest Region

CATHOLIC HEALTH INITIATIVES

Stephanie W. Schreiber, Shareholder

BUCHANAN INGERSOLL & ROONEY PC

Robert Ramsey, III, Shareholder

BUCHANAN INGERSOLL & ROONEY PC

ACHIEVING RESULTS-DRIVEN DATHE NEW CRITICAL OPERATIONSCOMPONENT OF THE HEALTHCAINDUSTRY

With the ACA, the commercial mark

is now highly regulated and heavilydependent on data for delivering quoutcomes and remaining nanciallysound. In light of this transformaoits impact on data management, thisession will examine:• Why data management has such

crucial role in healthcare today• Migang risk and data governan• Handling pre-validaon errors pr

federal submissions• Managing external data submissi

- Vendor les - Commercial HIX - EDGE server subm - Medicare RAPS/EDS

Jessica Smith, Senior Director of Risk

Adjustment Soluons

GORMAN HEALTH GROUP

Sco Miller, Principal Data Architect

BLUE CROSS BLUE SHIELD OF MINNES

TRACK A:MEDICARE ADVANTAGE

RISK ADJUSTMENT

TRACK B:STAR RATINGS & QUALITY

PERFORMANCE

TRACK C:PROVIDER FOCUS/

ACOS

TRACK D:DATA ANALYTICS AND

PREDICTIVE MODELIN

11:15 - 12:00

12:00 – 1:10 NETWORKING LUNCHEON FOR ALL ATTENDEES AND SPEAKERS sponsored by

MONDAY, MARCH 21, 2016

:30 – 8:45 REGISTRATION sponsored by

:30 – 8:45 BREAKFAST sponsored by

:30 EXHIBIT HALL OPENS

:45 – 9:00 CO-CHAIRS’ WELCOME AND OPENING REMARKS

o-Chairs:

athan Goldstein, Chief Strategy Ocer , CENSEO HEALTH

evin Healy, Senior Vice President, Clinical Payer Soluons, OPTUM

ntroduced by: Kevin Mowll, Executive Director

RISE (Resource Initiative & Society for Education)

9:00 – 10:00 OPENING KEYNOTE ADDRESS: THE NEXT PHAFOR HEALTHCARE REFORM

Senator Tom Daschle

FORMER SENATE MAJORITY LEADER and Author of Geng it Done

How Obama and Congress Finally Broke the Stalemate to Make W

Health Care Reform; Founder and Chairman, THE DASCHLE GRO A PUBLIC POLICY ADVISORY OF BAKER DONELSON

Introduced by:

Nathan Goldstein, Chief Strategy Ocer, CENSEO HEALTH

10:00 – 10:15 DR. MARTIN BLOCK RISE LIFETIM EACHIEVEMENT AWARD

10:15 – 10:30 MORNING NETWORKING BREAK

sponsored by

10:30 – 11:10 CMS POLICY UPDATE

Je Grant, MPA, Senior Advisor, Payment and Policy and Financial Manageme

Group; Center for Consumer Information and Insurance Oversight

CENTERS FOR MEDICARE & MEDICAID SERVICES

ASE STUDIES: HOW MEDICAREDVANTAGE PLANS EMPLOYEDOINT-OF-CARE TESTING TO CLOSEARE GAPS AND RAISE STAR RATINGSND HEDIS PERFORMANCE

ase Study #1Operaonalizing a quality-of-careprogram targeng the cardiovasculardisease process at an earlier stageMoving the needle on vascular diseaseof the lower extremies -- the mostunderdiagnosed disease state among

the HCC categories

ase Study #2A health plan’s experience usingpoint-of-care tesng to:- Close gaps of care through risk

adjustment- Increase Star Rangs performance

while achieving HEDIS measures

sa Cabrera, RN, BSN, Senior Manager,

Managed Care IniavesEMLER SCIENTIFIC, INC.

co Howell, DO, MPH & TM, CPEenior Execuve

ERITAGE PROVIDER NETWORK

12:15 – 1:10 SPECIAL CMS ADDRESS: EDGE SERVER OPERATIONS IN ACA INSURANCE MARKETS

Presented by:

Linda Osinski, Senior Advisor, Division of Reinsurance Operaons

CENTERS FOR MEDICARE & MEDICAID SERVICES

Located in: Ryman Ballroom A

®



COALESCING QUALITY, RISK

ADJU STME NT, AND COSTS OF CARE TO

PROMOTE POPULATION HEALTH

• Combining total costs of care withrevenue metrics

• Calculang quality composites in theabsence of xed-cut points

• Concise reporng: reporng on mulplelines of business together

• “Stars on Steroids:” harnessing themerit-based incenve paymentsystem

• Incorporang the member’sexperience

• Exploring the member experience of

quality iniaves• Connecng your CAHPS data with your

health outcome data• Using member experience informaon

to close more gaps in care• Analyzing call monitoring data to

improve member experience

Richard Lieberman, Chief Data Scienst

MILE HIGH HEALTHCARE ANALYTICS

Nichole Crandall, Manager of Medicare

Strategic Programs

MARTIN’S POINT HEALTH CARE

MANAGING THE IMPACT OF PATIENTSELF-PAY ON EMR PROCESSING

• Evaluang the pros and cons of remoteEMR access

• How paent self-pay rules impact EMRprocessing

• A “behind the scenes” view of theEMR chart request fulllment process

• Methods for ensuring providers, plansand paents are protected

Jeannie Hennum, Senior Vice President

CIOX HEALTH

Tressa Lyon, RHIT, Health Informaon

Manager

NORMAN REGIONAL HEALTH SYSTEM

CASE STUDY: UPMC HEALTHPLAN’S RISK ADJUSTMENTTRANSFORMATION

• Explain The challenges UPMC HePlan was facing in risk adjustmenMedicare Advantage and Comme

ACA populaons• Discuss How UPMC Health Plan eval

available soluons and technologaddress the challenges

• Review Raonale for selecng asoluon for risk adjustment departmwith intuive workow, NLP technoland robust analycs that transfooperaons

• Results demonstrate: - Substanal increase in RAF cap - Visibility into potenal complia

issues/audit risks - 4x gain in coder producvity• Highlight Key takeaways and less

learned that can enable your organizto succeed in similar circumstanc

Mary Beth Jenkins, Senior Vice Presi

& Chief Operang Ocer

UPMC HEALTH PLAN

Adele L. Towers, Senior Clinical Advi

UPMC ENTERPRISES

2:00 -2:45

2:45 – 3:00 AFTERNOON NETWORKING BREAK sponsored by

MANAGING RISK LIKE A MEDICAL

ROUP TO IMPROVE FINANCIA LAND CLINICAL PERFORMANCE

ill Physicians Medical Group haspmized the risk management of their

Medicare Advantage members over severalears. In this session, medical directorsr. Mark R. Dambro, CenseoHealth and

r. Carvel Te, Hills Physicians Medicalroup (HPMG) will explore:Why it’s imperave that you understandthe ways in which the pracce ofprimary care is changingHow successful health plans and medicalgroups are oering comprehensivehealth assessments for members intheir homes, at network physicianoces, health fairs and in communitysengsDesigning your risk adjustment programto address the socio-economic driversof chronic condionsConnecng “super-ulizers” into primarycare for consistent care managementand documentaon accuracy

Supplemenng your physician networkto improve documentaon accuracyand drive members back to care

Mark R. Dambro, MD, Chief Medical Ocer

ENSEO HEALTH

arvel Te, MD, Medical Director

ILL PHYSICIANS MEDICAL GROUPHPMG

RESULTS-DRIVEN APPROACHES TOMOVIN G THE NEEDLE ONCHALLENGING STAR RATINGSMEASURES

Focus on Part C:• Strategies for improving your

collaboraon eorts with physiciansand hospitals

• Methods for making closing gapsconvenient for members

• Ensuring the correct members aretargeted

Focus on Part D:• Learn how to navigate the various

factors that aect paent behavior• Understand the obvious (and not so

obvious) Star Rang implicaons ofsuccess or failure with Part D measures

• Get a preview of new measures on thehorizon

• See proven intervenons and strategiesfrom organizaons around the country –what’s worked and what hasn’t worked?

• Explore reporng and predicon tools,as well as resources and programsthat work

Moderator:

Brad Towle, Vice President of Business

Development

CARECENTRIX

Co-Presenters:

Lisa Campbell, Senior Manager, CMS Stars

UPMC HEALTH PLAN

Ana Handshuh, Vice President, Managed

Care Services

ULTIMATE HEALTH PLANS

CASE STU DY: HOW AN ACO IS

MITIGATING RISK ADJUSTMENT

CHALLENGES WITH TARGETED

STRATEGIES

Many organizaons connue to strugglewith protability around their risk-basedcontracts. For instance, in the case ofMSSP ACOs, only about 26 percent of theACOs received shared savings paymentsfrom CMS in 2014. This session willexamine:• How to leverage data analycs at the

point-of-care to – - Intelligently mine structured and

unstructured data in paent records,provider organizaons and ACOs toopmize risk scoring

- Achieve more accurate reimbursementsand improved care planning

• Using Village Family Pracce as a case

example, Dr. Clive Fields will discuss: - The risk adjustment challenges

facing the pracce- The advanced analycs, coding tools

and addional strategies theyimplemented to address these

challenges - The results from these iniaves

Murray Brozinsky, Chief Strategy Ocer

TALIX

Francis Cheung, Chief Informaon Ocer

CRYSTAL RUN HEALTHCARE

HOW ON-DEMAND PO INT-OF-C

ACTIONABLE ANALYTICS IS

TRANSFORMING PROVIDER VINow more than ever, big data proceconnecvity and aconable insightscrical to achieving goals that drivein the healthcare landscape. Paneliswill discuss:

• How real-me paent-specicanalycs available on demand at point-of-care within providers’ exworkow address -- Gaps in quality- Risk score accuracy

- Ulizaon and medical historyinsights

Jason Rose, Chief Strategi c Developm

Ocer

INOVALON

David Klebonis, Chief Operang Oce

PALM BEACH ACO

Kate Eshelman, MD, Senior Medical

Director INOVALON

1:10 - 1:55

APS TO EDS TRANSITION:ANALYSIS AND IMPLICATIONS FO R

HE INDUSTRY

Why EDS is radically dierent fromRAPS- Understanding the dierence in the

two systemsAnalyc framework for understandingthe impact of the RAPS to EDS transionLessons learned from analysis of RAPSversus EDS risk-adjustable dataAvoiding the pialls and maintainingrevenue under the transionCase studies from the eld

ean Creighton, Vice President of Risk

djustment Soluons

ERISK HEALTH

uzanna-Grace Sayre, Director, Risk

djustment Analycs

ERISK HEALTH

Moon Leung, PhD, Senior Vice President,

Healthcare Informacs

CAN HEALTH PLAN

avid Meyer, Vice President, Risk Adjustment,

ncounters, Coding and Audit

CAN HEALTH PLAN

TRACK A:MEDICARE ADVANTAGE

RISK ADJUSTMENT

TRACK B:STAR RATINGS & QUALITY

PERFORMANCE

TRACK C:PROVIDER FOCUS/

ACOS

TRACK D:DATA ANALYTICS AND

PREDICTIVE MODELIN



5:00 – 6:00 COCKTAIL RECEPTION sponsored by

A S E S T U D I E S : H OW W E L L C A R EMP ROV ED THEIR RISK ADJUSTMENTY LEVERAGING COGNITIVEOMPUTING

What is cognive compung forhealthcare?How does cognive compung enablean accurate paent care prole for riskadjustment?How did the technology improveWellCare’s coding process and providedeeper coding insights?

What is the future of cognivecompung in healthcare?- Clinical documentaon- HEDIS & Star Rangs- Care opmizaon

eidre Nealon, CPA, CPC-A, Senior Director,

sk Adjustment Programs

WELLCARE HEALTH PLANS, INC.

arren Schulte, Chief Execuve Ocer

PIXIO

TAKING A SYNERGISTIC APPROACH

TO MAXIMIZE STAR RATINGS/

QUALITY AND COMPLIANCE

OUTCOMES

• Idenfying strategies quality andcompliance departments can employto improve their respecve outcomes

• Improving levels of compliance byworking through Stars/quality iniaves

• Achieving beer Stars performance byvaluing the impact of complianceeorts

• Protecng clinical and nancialoutcomes with a cohesive compliance/ Stars approach

Moderator:

Deniese M. Sche-Crienden, RN, MSN,

MHA,BSW, Senior Consultant, RA

DYNAMIC HEALTHCARE SYSTEMS

Co-Presenters:

Osato Chitou, Esq., MPH, Director of

Medicare Compliance

AMIDA CARE

Cassandra Blair, RN, CHC, Director STARS

& Oversight, Government Programs

MEMORIAL HERMANN

PROVIDER PERSPECTIVE: MAKING

THE PAYER-PROVIDER CONNECTION

– IMPROVING OUTCOMES WI TH

BETTER COMMUNICATION AND

COLLABORATION

• Types of value-based contracngagreements we have in place and howwe have structured these partnerships

• Which data we share with each otherand why

• The quality metrics we track• How we have developed plan

collaboraon strategies that are win-winfor both pares

• How we have clinically integrated withother provider types and hospitals to

ensure success

Michael Ruiz de Somocurcio, Vice President

– Payer and Provider Collaboraon

REGIONAL CANCER CARE ASSOCIATES LLC

THE ADVANTAGE OF L AB DATA IN

NEW PAYER PARADIGM: DRIVING

QUALITY OUTCOMESThis session will explore:• How detailed views into the pae

journey have become increasinglyimportant for payers’ reporng anmanagement acvies

• Why lab data, a superior, highly acoclinical data source, is:

- Inuenal: a crical, high valuesource of clinical intelligence, labdata accounts for 3% of healthcaspend but inuences 70% of medecisions

- Dicult to aggregate: at scale, ladata is dicult to access

- Challenging to use: there aresignicant dierences betweentradional transaconal level daand clinical data -- lab data is noexcepon

• Real-world examples of how lab dis being used to provide addionainsights in the payer space

Frank Jackson, Executive Vice Presi

Payer Markets

MEDIVO

Troy Trygstad, PharmD, MBA, PhDVice President for Pharmacy Progra

COMMUNITY CARE OF NORTH CARO

3:00 - 3:45

3:45 – 5:00 “CHOOSE YOUR OWN ADVENTURE” ROUN DTABLES: SELECT F ROM 25 DIFFERENT PRESENTATIONS SPOTLIGHTING HEALTHCARE’S MO

INFLUENTIAL TECHNOLOGY AND S OLUTION GURUS PRESENTING TOOLS TO ELEVATE YOUR PLAN’S INITIATIVES

ull up a chair and sele in for this unique opportunity to select three interacve, speed-dang type presentaons featuring the latest technologies and soluons for boosng your psk, quality and data management endeavors. A bell will ring three mes within this special 75 minute session, alerng you to transion to the next roundtable of your choice.

OUNDTABLE A:MSI HEALTH

OUNDTABLE F:ARENET HEALTHCARE SERVICES

ROUNDTABLE K:PRIME THERAPEUTICS

ROUNDTABLE P:MEDICAL DATA EXCHANGE

ROUNDTABLE U:ATTAC CONSULTING

OUNDTABLE C:NTEGRA SERVICECONNECT

OUNDTABLE H:YNAPTIC AP

ROUNDTABLE M:CENTAURI HEALTH SOLUTIONS

ROUNDTABLE R:HEALTH DATA VISION, INC.

ROUNDTABLE W:RELAY HEALTH

OUNDTABLE B:

OME ACCESS HEALTH

OUNDTABLE G:PISOURCE

ROUNDTABLE L:POINTRIGHT

ROUNDTABLE Q:ACCENTURE

ROUNDTABLE V:NAVIGANT

OUNDTABLE D:REDILYTICS WELLTOK

OUNDTABLE E:EACON HEALTHCARE

OUNDTABLE I:OZEVA

ROUNDTABLE J:TRIZETTO

ROUNDTABLE N:PHARMMD

ROUNDTABLE O:NAGNOI

ROUNDTABLE S:IONHEALTHCARE

ROUNDTABLE X:BLUE HEALTH INTELLIGENCE

ROUNDTABLE T:

CLEAR VISION INFORMATION SYSTEMS

ROUNDTABLE Y:DST HEALTH SOLUTIONS

ROUNDTABLE Z:EDIFECS

®



TUESDAY, MARCH 22, 2016

:30 – 8:30 BREAKFAST sponsored by

:00 EXHIBIT HALL OPENS

:30 – 8:45 CO-CHAIRS’ RECAP OF DAY ONE

o-Chairs:

athan Goldstein, Chief Strategy Ocer

ENSEO HEALTH

evin Healy, Senior Vice President, Clinical Payer Soluons

PTUM

:45 – 9:45 FEATURED SESSION – THE HEALTH EXCHANGES:ENROLLMENT AND IMPACT-TO-DATE

Anne FilipicPresident

ENROLL AMERICA

nne Filipic serves as President of Enroll America, a non-prot organizaonedicated to maximizing the number of Americans who enroll in and retain healthoverage made available through the Aordable Care Act. Most recently, Ms. Filipicas the Deputy Director of the White House Office of Public Engagement.epresenting Enroll America and its coalion, Ms. Filipic has become a leadingoice on the consumer experience and best pracces around ACA enrollment andngagement. In this session, Ms. Filipic will discuss the latest trends in marketplacend Medicaid enrollment and best practices in consumer outreach andnrollment work.

:45 – 10:00 MORNING NETWORKING BREAK sponsored by

0:00 – 11:15 SPECIAL FOCUS GROUP: MEDICARE ADVANTAGEMEMBER JOURNEY SNAPSHOT

ear directly from Medicare Advantage members about how they engage withheir health plan in this one-of-kind session! Conducted as an in-person focusroup, explore members’ mindsets concerning their relaonships with their health

an, and see health insurance through their eyes.

usan Semack, Vice President, Healthcare Division, MORPACE

11:15 – 12:15 FEATURED PANEL: ATTRACTING, ENGAGING,RETAINING AND EDUCATING YOUR MEMBERS –EMBRACING A NEW ERA OF COMMUNICATION

In this interacve, mely session, our panelists of health plan consumer en-gagement and social media experts will explore novel strategies for engagingdicult-to-reach members and niche populaons using less tradional, moreinnovave modes of communicaon. This discussion will examine why you mexpand your thinking from healthcare administrator to healthcare marketer aadvocate if you wish to exceed paent/member expectaons and achieve suc• Determining how tech savvy your members really are• The latest trends and stascs in social media and new technology usage

• Less tradional approaches to contacng and retaining at-risk segments• Making the extra eort: if you really want to engage all of your members, whyou must tailor your communicaon iniaves to their individual demogr

- Understanding, acknowledging and valuing socio-economic, cultural aregional dierences

Moderator:

Nathan Goldstein, Chief Strategy Ocer

CENSEO HEALTH

Panelists:

Sharon LaSure-Roy, Senior Consultant, Social Media and Digital Communicao

FLORIDA BLUE

Neal Soan, Director of Member Engagement , PREMERA BLUE CROSS

Amy N. Swanson, Vice President of Markeng, Advocacy and Member Experie

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 LUNCHEON FOR ALL ATTENDEES AND SPEAKER

sponsored by

XCELLENCE IN COMMERCIAL RISKADJUSTMENT: INNOVATIVE STEPS

O ENSURE TRANSFER PAYMENTUCCESS

Altering your telephonic HRA screeningsto highlight chronic and behavioralcondionsUsing your web-based engagementplaorm to reward members forwellness exams and follow theircare pathwayEmbracing telemedicine for wellnessand behavioral health needs

Running a solid claims validaon andprovider CDI program

Using the rst quarter to ck and eyour numbers

aeAnn Grossman, Chief Growth Ocer

RROHEALTH

rt Diaz, Director, Risk Adjustment Programs

ORIZON BLUE CROSS BLUE SHIELD OFEW JERSEY

HOW TO ENSURE YOUR RISKADJUSTMENT REVENUE IS COMPLIANT

Recent OIG & CMS scruny has us allthinking about compliant risk adjustmentprograms. This session will examineprocesses and technologies that healthplans or their assessment and caremanagement vendors should have in

place to assure compliant revenue• Validate AND delete condions to

ensure appropriate revenue and

maximum compliance• Provider tracking technologies

• ICD-10 incorporaon for increasedspecicity

• Clerical vs. clinical quality assurance• Audit best pracces

Kevin Kearns, MDADVANCE HEALTH

Colleen Gianatasio, CPC, CRC, Risk Coding

and Educaon Specialist

CAPITAL DISTRICT PHYSICIANS’ HEALTHPLAN

HIGH-RISK POPULATIONMANAGEMEN T: THE NEW FRONTIEROF CARE DELIVERY

Even with system-level changes underway asa result of the shi towards value-basedpurchasing, opportunity sll exists (andwill connue to exist) to improve the costsand outcomes associated with high-riskpopulaons. We will discuss:• The current environment and key challenges

in healthcare and how they impact themanagement of high-risk populaons

• The importance of value-based care

and how care is evolving fromtradional delivery methods

• Why new models are not mutuallyexclusive of one another and howdierent systems can integrate well ifplanned properly

• Results from a comprehensive eld-basedlongitudinal care program that improvespaent care, closes care & quality gaps, andimproves risk-adjusted revenue accuracy

Chris Lundeen, Chief Innovaon Ocer

MERCY CARE PLAN AND MERCYMARICOPA INTEGRATED CARE

Andrew Walsh, Chief Markeng Ocer

POPHEALTHCARE

IMPROVING ENGAGEMENT, QUAAND RISK PERFORMANCE UTILIZMOBILE CLINICS

• How improving access and convencan elevate member engagement

• Using health fairs to engage memand close quality gaps

• How diagnosc tesng can improclinical documentaon and reducaudit risks

• How to get the most out of a prospeassessment

- Missed opportunies to improv

quality - Closing more HCC gaps through

beer clinical data• Using mobile clinics as a supplem

to primary care

Aprihl Shapiro MBA, ME, PMP, Direc

Risk Adjustment Management Prog

MOLINA HEALTHCARE OF UTAH, IN

James Metcalf DO, MBA, Medical Dir

OPTUMCARE UTAH

Karl Brown, Medical Director, Risk Adjus

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 D1:25 - 2:10

2:10 - 2:25 AFTERNOON NETWORKING BREAK sponsored by



DVANCES IN THE COMMERCIALISK MODEL: THE NEW WORLDYMPHONY

Outreach & engagement: a holiscapproachHealth Exchanges: Using HCCs todene those who need care the mostThe state of the commercial risk model

Member retenon: keeping whatyou worked hard to achieveParadigm shi on giving your membersopons to healthcare

ana L. Mangly, BS, RN, Senior Director

ealthcare Quality, Clinical Strategy

ETNA COMMERCIAL RISK MANAGEMENTRGANIZATION

y Zahedi, President , MEDXM

BUILDING A RADV SURVIVAL TOOLKIT

• RADV simulaon: how to structure itand what you can learn

• Working eecvely with internal controls:internal audit and compliance

• Geng your contract language withprovider groups right

• Surviving the audit:

- Eecve data validaon techniques- Organizing and choosing the ‘best’

medical record- The latest on extrapolaon

- Appeals/key factors aecng payment

David Meyer, Vice President, Risk Adjustment,

Encounters, Coding and Audit

SCAN HEALTH PLAN

Tom Nasadoski, MBA, Manager Risk

Adjustment and Encounter Operaons

CAPITAL DISTRICT PHYSICIANS’ HEALTHPLAN

EARLY INSIGHTS INTO MEDICAIDEXPANSION: WHAT WE’VE LEARNEDTO-DATE

• Lessons learned from early expansioniniaves

• The inial impact on providers: thegood and bad

• Managing Medicaid risk

• Revealing commonalies across statesModerator:

Kim Browning, CHRS, PMP, CHC, Execuve

Vice President

COGNISIGHT

Co-Presenters:

Eric C. Hunter, Chief Operang Ocer

BMC HEALTHNET PLAN / WELL SENSEHEALTH PLAN

Dhyan D. Lal, Vice President, Network

Strategy and Contracng - Payer Strategy

Group | Pacic Northwest Region

CATHOLIC HEALTH INITIATIVES

PRACTICING MTM AND ENCOURAMEDICATION ADHERENCE TO ACHCLINICAL & QUALITY OUTCOMEPOPULATION HEALTH INITIATIV

When clinical pharmacists addressmedicaon adherence and performMTM, clinical and quality outcomeare positively affected. Dr. Joseph

Manganelli will discuss his experiewith elevang quality outcomes witadherence and MTM initiatives in aPioneer ACO:• The economic burden of adhere

and strategies to increase medicadherence

• The key areas where the clinicalpharmacist can support the goathe interdisciplinary team

• The contribution of the clinicalpharmacist on clinical and qualitmeasures

• Evaluation of collaborative drugtherapy management on populahealth iniaves

Joseph Manganelli, PharmD, MPA,

Senior Director - Network Care ManagemPharmacy Program

CMO - MONTEFIORE CARE MANAGEM

2:25 - 3:10

EVERAGING THE LATEST STATISTICALECHNIQUES TO MAXIMIZE RISKCORE PERFORMANCE AND INTEGRITY

Extending beyond tradional methodsby integrang machine learningAchieving the most complete andecient suspect list(s)Ensuring transparency and clinicalrelevance

va Borden, FSA, Chief Risk Ocer

GNA

mes E. Dalen, Chief Health Economist

LTEGRA HEALTH

KEYS TO IMPLEMENTING A VIABLEFWA OVERSIGHT PROGRAM

This crical session will:• Explore strategies compliance

departments can employ to idenfy,report and migate FWA

• Examples of the nancial andoperaonal impact of recent incidentsof FWA

• Cauonary tales: how to avoid thesereal-life missteps

Alanna Lavelle, Program Manager for

Health Care Fraud

MITRE CORPORATION

ENGAGING YOUR DUAL ELIGIBLEPOPULATION: MEMBER SEGMENTATIONAND OUTREACH STRATEGIES THATDRIVE RESULTS

Learn how to improve your memberengagement and outcomes by:• Engaging more members through

cross-channel outreach and tesngenabled by campaign management

• Deepening member engagementthrough use of psychographicsegmentaon and applicaon of life

cycle-based campaigns to driverelevant, member-specic messaging

• Improving member adherencethrough engagement of care providers

• Closing care gaps and impacngmember sasfacon 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 Operaons

HEALTH CHOICE ARIZONAHEALTH CHOICE GENERATIONS

David Goodspeed, Director Member

Engagement

MATRIX MEDICAL NETWORK

NOVEL APPROACHES TO MEMBEENGAGEMENT: GETTING THEIRATTENTION AND KEEPING IT

This session will explore how HCSC iexpanding the conversaon beyondengagement to encompass the full meexperience. In detail, we will:• Share the approach HSCS has use

to understand, dene and measuthe member experience

• Idenfy the key elements being pplace to drive improvements

• Explore a case study that demonstrhow member engagement has beaddressed more holiscally

• Explain how best-in-class technolhave been leveraged to supportHCSC’s engagement strategies

Lynde O’Brien, Senior Director, DCommunications

HEALTH CARE SERVICE CORPORATIO(BLUE CROSS AND BLUE SHIELD OFILLINOIS, MONTANA, NEW MEXICOOKLAHOMA AND TEXAS)

Juliane Pearson, Senior Manag er,

Customer Experience

HEALTH CARE SERVICE CORPORATIO(BLUE CROSS AND BLUE SHIELD OFILLINOIS, MONTANA, NEW MEXICOOKLAHOMA AND TEXAS)

3:15 - 4:00

4:00 CONFERENC E CONCLUDES

“It was very interesng and informave. Helped me to gain a wider knowedge base of both CMS & HHS Risk Adjustment”

Brandon Wol, Actuarial Risk Adjustment, ASSURANT HEALTH

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



SPONSORS

PLATINUM

Altegra Health is a naonal vendor of technology-enabled, end-to-end payment soluons providing health plans and other risk-bearing organizaons witthe data they need to expertly manage member care and ensure appropriate reimbursement. The power of Altegra Health’s advanced analyticand supporting interventions enables healthcare organizations to elevate care quality, optimize financial performance, and enhance the memb

xperience. For more information, visit AltegraHealth.com

Advance Health is the leading healthcare provider of prospective member engagement services to health plans. What differentiates the company is icombination of meaningful technology and national network of full-time, locally based Nurse Practitioners. This combination yields industry leadingfinancial and clinical results with indisputable compliance and oversight. Advance Health offers in-home and facility-based HRAs and chronic c

manageme nt services to the Medicare Advantage, Medicaid, dual-eligible and commercial markets. This year, Advance Health NPs will complete over 300,000 full hssessments, across forty-eight states, for many of the largest health plans. With every assessment captured electronically, Advance Health delivers results in a matours. 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 informaon management company that helps risk-bearing enes opmize revenue and improve quality outcomes. We accomplish

fundamental objecve by using our proprietary Elevate! Healthcare™ health informaon management plaorm to deliver and manage integrated products services, which help clients capture, organize, and analyze nancial and clinical data to beer understand their member populaons and ulmately ulize th

ata to improve quality of care and optimize risk-adjusted revenue. Through the platform, Advantmed partners with managed care organizations to deliver the optombination of capabilies unique to each organizaon’s objecves, including risk analycs (ELEVATE! Risk Insights™), NCQA-cered HEDIS® Measures soware (ELEVATE

Quality Insights™), medical record retrieval, medical record abstraction, risk adjustment coding, compliance and data validation services, member engagement, producation, and professional services.

ArroHealth, formerly MedSave USA, is the premier provider of risk adjustment and HEDIS services oering a suite of analycs, medical record retrieval ancoding, customizable in-home and in-oce programs and member engagement strategies. These services are oered on a unique and proprietary technoplaorm designed for excellence in results, quality and transparency. ArroHealth recognizes the importance of performance and accuracy and provides th

most extensive guarantees in the industry. We focus on medical record collection rates, timing, ROI, provider satisfaction, accuracy and quality. In addition, we proull transparency into all that we do for clients; allowing them to adapt quickly and maximize nancial and clinical results. This includes unltered access to back-end syste

enabling clients to see ― in real-me ― the smallest details of their projects’ status. ArroHealth serves most of the top naonal health plans as well as many regional and lplans and is commied to accuracy, intelligence and impact for clients.

CenseoHealth is a leading provider of prospective health risk assessments for health plans and healthcare delivery organizations. Our physiciansperform comprehensive, Annual Wellness Visit-compliant evaluations with members in their home, at network physician offices and in communitysettings. We capture a complete health and lifestyle assessment to drive better clinical outcomes through care management referrals and return-to

ecommendations. Our insights help enhance member engagement, improve quality ratings and reduce overall healthcare costs. Our network of nearly 5,000 licensphysicians are uniquely qualified to identify and diagnose health conditions. We have completed more than 1.5 million assessments, averaging more than 1,800 per

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

navigate the complex home care system.

Apixio was founded in 2009 with the vision of uncovering and making accessible clinical knowledge from digized medical records for opmal healthcare demaking. In 2012, Apixio applied its cognive compung plaorm to tackle risk adjustment, the fundamental basis for value-based health. The result was theProler, a proven soluon which enables insights into document and coding gaps for a more accurate risk score. Now with its world-class team of data scien

ngineers, product experts, and healthcare gurus, Apixio has set its sights on other applicaons powered by its patented plaorm to enable healthcare systems to learn froracce-based evidence to individually tailor care.

Centauri Health Solutions improves member outcomes and financial performance for health plans and at-risk providers by supporting initiatives inAdjustment, 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 oechnology and service resources. We idenfy risk adjustment gaps, care and quality gaps, and support the closure of those gaps to benet our clients and their membe

We know from experience that data alone is not enough – the combination of data, experience, and execution is required to improve outcomes in today’s environmentauri’s core leadership team is comprised of seasoned healthcare executives from managed care organizations, pharmacy benefit managers and HCIT companieshey understand from personal experience the challenges facing today’s health system – and have set out to resolve them in a better way for their clients and their

members / patients.

entauri partners with respected Medicare Advantage, Managed Medicaid and Health Insurance Exchange plans, as well as at-risk provider groups to answer criticausiness 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 audind compliance risk, and whether they are optimally utilizing their scarcest resources.

isk 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 accurWe oer best-in-class risk analycs, in-home assessments, medical chart retrieval, coding, risk proles, audit support, and Stars and HEDIS measurementsupport to health plans in all markets. StratusIQ, our web-enabled customer portal and data repository, provides clients with easy and transparent acc

o their project data and our self-scheduling tool allows members to efficiently and conveniently schedule Healthy House Calls® anywhere, anytime. Our integratedpproach leverages experienced industry professionals, proven and secure technology, and flexibility to produce the best quality results for health plans and improvutcomes for plan members. EMSI Health: Powerful Information. Improved Outcomes. Learn more at www.emsinet.com .

Gorman Health Group, LLC (GHG) is a leading consulng and soware soluons rm specializing in government health programs, including Medicare managecare, Medicaid and Health Insurance Exchange opportunies. For nearly 20 years, our unparalleled teams of subject-maer experts, former health plan execuvand seasoned healthcare regulators have provided strategic, operaonal, nancial, and clinical services to the industry, across a full spectrum of business needs.

urther, our soware soluons have connued to place ecient and compliant operaons within our client’s reach. Find out more at www.gormanhealthgroup.com.

Health Fidelity’s risk adjustment soluon is the most comprehensive, scalable soluon in the market for perfecng the risk adjustment cycle. Our cung-edtechnology combines big data analycs and natural language processing (NLP) to automacally extract valuable insights from medical charts to enhance prospeand retrospecve RAF processes. Equipped with this proprietary technology and a team of industry experts, Health Fidelity can help organizaons opmize their

oding operaons to increase eciency, achieve beer compliance, and maximize value through improved idencaon of HCCs.

HealthFair has pioneered a new standard of care, operang the largest eet of mobile medical centers naonwide. Since 1998, the company has grownbecome the leading provider of mobile clinical soluons, providing prospecve risk assessments and advanced diagnosc tesng to individuals at convelocaons in their community. HealthFair delivers an innovave soluon to improve access and provide ecient encounters focused on improving paen

are, engagement, quality measures, and assessment of risk factors and condions. These state of the art mobile clinics can provide a wide scope of services within a comfortableinical seng, from Comprehensive Evaluaons, AWV’s, or Child Wellness Visits, to advanced diagnoscs such as mammography, ultrasound, or diabec renopathy screenl within one visit. HealthFair’s unique delivery system and proprietary assessment technology increases paent engagement and access to care, all while delivering encoun

hat are unparalleled in the industry from a quality and risk assessment perspecve. During a HealthFair visit, paents can complete labs, immunizaons, wellness visits,nd diagnosc imaging, minimizing the need for expensive and mely follow up appointments. Informaon is then shared back through a proprietary care coordinaon prohich ensures that not only the right data is captured, but it makes it to the place where it’s 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 serve110 health plans across the nation, providing medical chart retrieval services. We are located in over 3,000 hospitals, 13,000 physician clinics, and 1,5pharmacies providing release of information services, giving us the ability to electronically retrieve charts onsite quickly using our workflow system

nd staff of over 6,000 employees. In addition, we have relationships with over 65,000 provider offices, p rocessing over 30 million records annually. Using ourombined 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 analycs, and data-driven intervenon plaorms to achieve meaningful insight and imin clinical and quality outcomes, ulizaon, and nancial performance across the healthcare landscape. Inovalon’s unique achievement of value is delivered through the eeprogression of Turning Data into Insight, and Insight into Acon®. Large proprietary datasets, advanced integraon technologies, sophiscated predicve analycs, data-drivintervenon plaorms, and deep subject maer experse deliver a seamless, end-to-end capability that brings the benets of big data and large-scale analycs to the point

care. Driven by data, Inovalon uniquely idenes gaps in care, quality, data integrity, and nancial performance – while bringing to bear the unique capabilies to resolve them. Inovalorovides technology that supports hundreds of healthcare organizaons in 98.2% of U.S. counes and Puerto Rico with cloud-based analycal and data-driven intervenon plaorms thatformed by data pertaining to more than 777,000 physicians, 266,000 clinical facilies, and more than 127 million Americans. Through these capabilies, and those of its subsidiary HYPERNK “hp://avalere.com/” Avalere Health, which oers data-driven advisory services and business intelligence to more than 200 pharmaceucal and life sciences enterprises, Inovalon is

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 supporng care in the home through our naonal network of Nurse Praconers. From in home assessments to chronic casupport, 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 analycs 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 tover 150M paents through its naonwide network of partner labs. Medivo analyzes large data sets and shares its ndings with the medical community at large, as as with its payer, lab and life science partners, to ensure that appropriate available treatments are provided to paents sooner.

Medivo’s Lab Data Advantage™ applies clinical analycs to lab data to provide payers with material health plan value by supporng Care Management Programs, HEDIS/STAR and Ridjustment iniaves by idenfying gaps in quality and care, disease status changes and improvement in outcomes.abs in the U.S. are highly fragmented, and depending on the lab, paent records are oen incomplete and contain unstructured data, rendering the data unusable for certain use ca

Medivo provides a “one to many” connecon from payers to labs that intakes, renes, standardizes, and enriches the data to ensure aconable data output. Founded in 2010, Medivvestors include Safeguard Sciencs, Inc. (NYSE:SFE) and Merck Global Health Innovaon Fund (GHIF). Learn more about us at medivo.com, reach out to Bob Maluso with queson

nd follow us @gomedivo or on LinkedIn.

Episource is a leading services provider for chart reviews and quality measure abstracon for Medicare Advantage, Commercial/HIX, Medicaid health plans, and ACOs acthe United States. Using an integrated global delivery methodology, with onshore and oshore Medical Professionals, Clinicians, and Cered Coders, Episource is able tprovide extensive and quality Medical Record Review Services with signicant cost savings to increase ROI on organizaons’ Risk Adjustment and Government aliatedPrograms.

We began by providing medical coding soluons to both provider and payer organizaons. Over the last ve years we have expanded our core service oerings to include:ADV/IVA Audit Support, Home Health Assessments, HEDIS Abstracon, ACO GPRO reporng, and medical record retrieval.ur vision is to provide health informaon exchange soluons that allow healthcare organizaons to safely and eciently manage member-centric data, quality of care iniaves,

member intervenon and risk adjustment programs in Medicare, Medicaid, Commercial and Health Insurance Exchanges.



“Paent Care and Understanding is our focus”

Mobile Medical Examinaon Services, Inc. “MEDXM” was founded in 1990. Our mission is to provide the most qualied Medical Doctors and other Mid-Level Medrofessionals, equipped with the latest medical devices and diagnosc equipment to our clients. We have built a vast network of medical professionals throughout the USA. From ttart, 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 client’s home. We pride ourselves in makinierence and serving a purpose with your member’s wellbeing.

MEDXM would like to be a part of your ecient, proacve and sound management strategy and help your plan realize beer nancial performance.

Mile High Healthcare Analycs provides praccal populaon-oriented analycs to health plans, Exchange issuers, ACOs, and risk-bearing provider groups. Our stratconsulng focus is on risk adjustment operaons, performance measurement and improvement, Stars, the Quality Rang System, and alternave payment designs.

rovide business process assessments, operaonal assessments, and feasibility studies-- striving to improve the operaonal performance of our clients.Mile High Healthcare Analycs is also data-focused. We analyze large and complex datasets of paent-level data from claims, pharmacy, clinical laboratory results, mem

nrollment, and supplemental data. Our healthcare analycs pay as much aenon to the underlying completeness of the data as to the analyc models. With good data we derivnd validate predicve models in clinical, operaonal and nancial areas for healthcare organizaons bearing nancial or insurance risk. Mile High ensures the validity of the resultsnalycs and the applicability of those results to our clients’ objecves.

HCC in-home health assessmentsAnnual wellness visits (AWV)

• Star iniaves-labs and DEXA• Post hospital reduced re-admissions

Optum is a leading health services and innovaon company dedicated to helping make the health system work beer for everyone. With more than 94,000 peopleworldwide, Optum combines technology, data and experse to improve the delivery, quality and eciency of health care. Optum uniquely collaborates withparcipants in health care, connecng them with a shared focus on creang a healthier world. Hospitals, doctors, pharmacies, employers, health plans, governmen

gencies and life sciences companies rely on Optum services and soluons to solve their most complex challenges and meet the growing needs of the people and communies they serve

Peak focuses on delivering Risk Adjustment and Quality Soluons to provide our clients with full service and customized opons that give you the ability tochoose services which best meet your needs. Peak provides top quality sta, a state-of-the-art technology workow, chart reviews, in-home assessments and chart

retrieval specic to your needs. With Peak as your partner, you will receive quality, mely results from a caring team of professionals that will guide you through thechallenges of this ever changing industry.

PopHealthCare oers groundbreaking programs in high-risk populaon management that drive rapid, large, and demonstrable improvements in member quaof life and sasfacon, while helping its partnering health organizaons realize appropriately enhanced revenues, enhanced quality scores, and reduced mecosts. With decades of experience, PopHealthCare is led by a team of long-standing leaders in health care analycs, eld-based high-risk populaon care de

uality improvement, and both prospecve and retrospecve risk adjustment services. PopHealthCare has designed its high impact services to meet the needs of local, regind naonal health plans and provider organizaons and currently partners with over 35 health plans across the U.S. and in Puerto Rico.

Pulse8 is the only Healthcare Analycs and Technology Company delivering complete visibility into the ecacy of your Risk Adjustment and Quality Management programs. enable health plans and at-risk providers to achieve the greatest nancial impact in the ACA Commercial, Medicare Advantage, and Medicaid markets. By combining advancanalyc methodologies with extensive health plan experience, Pulse8 has developed a suite of uniquely pragmac soluons that are revoluonizing risk adjustment and qual

ulse8’s exible business intelligence tools oer real-me visibility into member and provider acvies so our clients can apply the most cost-eecve and appropriate intervenons for closingdocumentaon, coding, and quality. For more company informaon, please contact Sco Filiault at (732) 570-9095, visit us at www.Pulse8.com, or follow us on Twier @Pulse8News.

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

We oer health plans, employers, and healthcare providers an array of soluons across four major funconal areas:Payment Accuracy: Fraud, waste, and abuse soluons that ensure accurate payment and cost containmentRevenue Accuracy: Soluons that simplify commercial and Medicare risk adjustment iniaves and ensure appropriate funding for members and their condionsPopulaon Health: Decision analycs and reporng soluons that help organizaons beer understand and manage the populaons they serveQuality Improvement: End-to-end support for unied quality measurement, reporng, and improvement

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

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

The QuantaFlo System for Peripheral Arterial Disease (PAD) allows providers to quickly nd and document paents with Vascular Disease (HCC 108). TheWellChec Risk Assessment Service provides a turnkey soluon for administering clinical tests that impact HHC classicaons, CPT coding, HEDIS and Quality Measures. Visit

emlerscienc.com

Talix, a premier provider of healthcare risk adjustment soluons, delivers intelligent data analycs that enable healthcare organizaons to turn structured and

unstructured health data into aconable insights that drive improved risk adjustment and beer paent outcomes.

Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for healthplans, 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

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

ompanies in the nation.



PointRight is the industry-standard analytics leader that enables heaproviders and payers to measure risk, quality of care, rehospitalizacompliance and reimbursement accuracy. Using some of the larg

and best databases in the industry, PointRight’s naonally recognized clinicalsta, researchers, and technologists expertly translate data from mulple sources in

aconable informaon and insight. Founded in 1995, PointRight is the leader in analypost-acute care, with over 40 million Minimum Data Set (MDS) paent assessments fSNFs naonwide. The PointRight Pulse™ analycs suite helps prevent high-cost eventas pressure ulcers and falls, while also delivering these benets:

Visit www.pointright.com or call 781.457.5900.

Headquartered in Ann Arbor, Michigan, ATTAC Consulng Group

(ACG) specializes in compliance soluons, auding, business operaonsand process controls, for insurers and healthcare organizaons. ACG

cuses on the space between what’s supposed to happen on paper and what’s actuallyappening on the ground. Our rm assists our clients idenfy and resolve the dierence.

CG’s team of professionals is comprised of industry experts with extensive real-world,ands-on experience working in, and with, the organizaons operang governmentealth programs including: Medicare Advantage, PDP, Medicaid and Duals, Qualied Healthans (QHPs), ACOs and provider groups. Our team focuses on instuonalizing

ompliance throughout health plan operaons to enhance eciency and return onvestment.

CG’s audit speciales include:

MS Performance Audits, Data Validaon Auding, Third-Party Correcve Acon Outcomealidaon, CMS Financial Audit Preparaon, First Tier, Downstream and Related Entyonitoring and Auding, QHP Compliance Auding, Development of Internal Monitoring,

uding and Process Controls

Beacon Healthcare Systems Inc. is your trusted partnerplan operations, compliance and analytics. With more th

75 years combined in health plan technology and operaoBeacon provides innovative, enterprise class solutions that ensure greateaccountability, accuracy and eciency for our clients operang in Medicare,Medicaid, Commercial, Health Insurance Exchanges, ACOs and other risk-beaenes. Each of our customizable soluons are a role-based, SaaS (Soware a Service) system that are scalable to t your health plan’s needs. Beacon’s cofocus is to opmize and make proacve your plan’s Operaons, Risk ManageCompliance and Analycs funcons through the use of customized monitorinmanagement technologies and professional services using our Virtual CompliManager (VCM), Virtual Operaons Manager (VOM),Virtual Appeals Manage(VAM), and Virtual Incident Manager (VIM). Our team of technology designesubject maers experts together have built these plaorm of soluons enablour clients to monitor operaonal and compliance events and ensure mely aappropriate responses to ever-changing requirements all while avoiding costlsancons, nes and penales.Contact us today to set up a demo and let us show you how our technologsolut ions can help beer manage your Medicare Part C and D compliance ris

Visit us at beaconhcs.com for more informaon.

Cozeva enables value-based purchasing and supports triple aimobjecves through aconable dashboards and data visualizaon. mul-payer system takes in data feeds for aributed paents and

them into registry-driven, real-me aconable dashboards that support care coordinaPayers use Cozeva’s customizable, role-specific views to support quality performance, utilizcost, payments and risk assessment across the network. Payers rely on SureMetrics’ cto spot outliers, idenfy trends, compare performance and track campaign ecacy.

Cognisight is a leading health care solutions vendor,special izing in risk adjustment services for MedicareAdvantage plans, Health Insurance Exchange issuers,PACE/Duals programs, Medicaid Managed Care plans,

ccountable Care Organizaons, and Independent Pracce Associaons. Wenderstand all sides of the risk adjustment equaon and provide our serviceso plans throughout the United States. Our mission is simple: capture the mostccurate and complete diagnosc informaon to help ensure our clients have theest informaon to care for their members. As HCC risk adjustment experts, wenable our clients to improve the quality of health care they deliver while assuringccurate revenue.ull suite of risk adjustment services:

877) 271-1657 | Cognisight.com | [email protected]

AnalycsRetrospecve/ConcurrentChart ReviewsHealth Risk Assessments

• Risk Adjustment Data Validaon(RADV/IVA)

• Risk Vericaon• Provider & Coder Training

Alegis Care provides comprehensive health assessments forboth Medicare and Medicaid plans naonally. Alegis Care alsoprovides Chronic Care Management and value based purchasing

ervices. Alegis Care has over 20 years of experience. Our physicians provide chronicare management resulng in successfully reducing MLR, admissions, readmissionsnd increasing STAR and HEDIS rangs. Our program is made up of face-to-face interaconsith members in their homes or wherever they reside. We provide services to Medicaredvantage/Medicaid and 55% of the members we service daily are dual eligible. Forddional informaon, please contact Michael Doherty, Senior Vice President of Sales,t 954.648.4773 or [email protected] .

DST Health Soluons, LLC delivers contemporary healthcare technology andservice soluons that enable its clients to thrive in a complex, rapidly evolvinghealthcare market. Supporng commercial, individual, and government-sponsored

ealth plans, health insurance marketplaces, and healthcare providers, DST Healtholuons’ services include enterprise payer plaorms, populaon health managementnalycs, care management, and business process outsourcing soluons, each designedo assist a company manage the processes, informaon, and products that directly impactuality outcomes. DST Health Soluons is a wholly-owned subsidiary of DST Systems, Inc.or more informaon visit www.dsthealthsoluons.com.

Dynamic Healthcare Systems, Inc. is a strategic business partner toHealth Plans parcipang in government-sponsored Healthcareprograms and is a cered third-party submier with CMS. Dynamcomprehensive and fully integrated soluons address the followin

business areas of a Health Plan’s operaons: risk adjustment (including RAPS, EDPS anAnalycs), enrollment and eligibility processing, MSP/COB, correspondence/fulllmenmember premium billing, revenue reconciliaon, and PDE management and audit.

Edifecs develops innovave, cost-cung informaon technologysoluons to transform the global healthcare marketplace. Since 1

Edifecs technology has helped healthcare providers, insurers, phabenet management companies and other trading partners trim waste, reduce costs increase revenues. More than 350 healthcare customers today use Edifecs soluons tosimplify and unify nancial and clinical transacons. In addion, Edifecs develops suppchain management soluons to support worldwide customers in non-healthcare indusegments. Edifecs is based in Bellevue, WA, with operaons internaonally. Learn moabout us at www.edifecs.com.

• Mortality predicon for hospice/ palliave care placement• Reduced readmissions• Acute-to-SNF matching

• Medicare risk adjustment forSNF-based members

• Medicaid rebalancing• Long-term services and support an

Allscripts (NASDAQ: MDRX) delivers the insights that healthcareproviders require to generate world-class outcomes. The company’sElectronic Health Record, pracce management and other clinical,

evenue cycle, connecvity and informaon soluons create a Connected Communityf Health™ for physicians, hospitals and post-acute organizaons.

o learn more about Allscripts, please visit www.allscripts.com.

Accenture: Insight Driven Health

Insight driven health is the foundaon of more eecve, ecient,

and aordable healthcare. That’s why the world’s leading healthlans and healthcare providers choose Accenture for a wide range of insight drivenealth services that help them use knowledge in new ways—from the back oce tohe doctor’s oce. Our Risk Score Accuracy pracce puts insight at the center withur proprietary performance management plaorm. With global scale operaons for

member and provider engagement, medical chart review, and CMS/HHS submissions,ccenture brings integraon, coordinaon, and transparency to risk adjustment operaons.o learn more contact Rob Deal at [email protected] Availity integrates and manages clinical, administrave, and nancia

data to fuel real-me coordinaon between providers, health plans,paents in a growing value-based care environment. Facilitang over 7 million transadaily, Availity’s ability to provide accurate, mely, and relevant informaon is vital nancial success of its customers.

GOLD

SILVER



For 27 years, the Carenet team has been passionate about thecompany’s role in tackling the rising cost of healthcare by helpingmore than 25 million people navigate our complex healthcare

ystem and measurably impacng both the quality and cost of care. By combining

deep clinical history and consumer engagement experse with aconable data,arenet helps more than 100 healthcare organizaons maximize performance

while educang, empowering and movang consumers worldwide to take ancve role in their healthcare and make beer healthcare decisions. Award-winningoluons include Healthcare Navigaon, 24/7 Care Coordinaon, Point of Needngagement and Co-Sourcing to posively impact areas such as Star Rangs,EDIS, Medicaon Adherence, HRAs, ER and Re-admission avoidance, CAHPS, HOSnd more.

Health Data Vision, Inc., provides a SaaS-based healthcare analycsplaorm for medical records analysis and targeted soluons for HEDIS®Hybrid, Medicare and Exchange Risk Adjustment and comprehensive,year-round clinical data analysis eorts as well as RADV Audits. Theplaorm provides exible scalable workows and automaon for

medical records-intensive project needs of health plans in the United States. HDVI’satent-pending, process-centric approach provides state-of-the art automaon, qualitynd audit features, and real-me analycs; all crical for successful medical record

eview iniaves.

ionHealthcare is a naonally renowned partner for health plan

ACO’s, physician pracces, hospitals, and individual coders.ionHealthcare® is a naonal leader in the risk adjustment induoering risk adjustment educaon for coders and physicians as well as medical coreview for risk adjustment to include CMS HCC, Medicaid CDPS, and HHS HCC moin addion to predicve analycs support. Services for auding include internaexternal coding audit and RADV/IVA services. Our CEO is the author of the ociaCRC© (Cered Risk Adjustment Coder) curriculum and credenal that is naonaoffered through the AAPC. Our coders are all on-shore and h ighly trained risk adjustment, and have assisted with concurrent, retrospecve, and prospecprojects as well as auding work to include RADV experience.ionHealthcare® also provides aordable online courses (many carry CEU value) anin-person training for coders and providers on many subjects to include HIPAA, EtICD-10-CM, Fraud, Waste & Abuse, and more. Contact us at www.ionHealthcare.for more informaon or to inquire about customized soluons.ionHealthcare® also oers consultaons for physician pracce eciency, manageleadership mentoring, change management, paent safety, JCAHO, and OSHA su

LifePlans, a leader in health assessments, member engagemeand care management has been helping the naon’s leadinhealthcare and insurance organizaons improve health outcom

lower medical spend, reduce risk and increase quality since 1986. With anacclaimed research team, evidence-based results and a deep experse workiwith senior and vulnerable populaons, ulizing our naonal clinical networkmul-channel digital plaorm our oerings include HRAs, fall prevenon, cartransions, health coaching, quality compliance programs, underwring and management soluons. LifePlans is an NCQA cered subsidiary of Munich Rwww.lifeplansinc.com

Clear Vision Information Systems, Inc. is a risk adjustmentand HEDIS/Stars solutions company that balances care quality

nd revenue optimization for health plans and provider groups.

lear Vision provides an integrated mix of risk adjustment analytics andontinuity-of-care strategies tailored to the individual needs of each client. Theasy-to-implement, high-impact software and services Clear Vision delivers

esults in improved risk scores and measureable return on investment. Ourroduct offerings and services include:

Our decades of experience at the forefront of Medicare policy translate into aeep understanding of the business processes, risk adjustment strategies and bestracces that improve care and opmize revenue.

lear Vision is headquartered in Westlake Village, California and serves clientsaonwide. Please contact us at www.cvinfosys.com or toll-free at 888-778-9899.

Synapc AP specializes in the development and deployment ofsecure cloud-based enterprise applicaons on the Salesforce.com plaorm for organizaons worldwide. Headquartered

n Annapolis, MD, Synaptic has been developing care, physician and patientmanagement soluons on the Salesforce.com plaorm since 2008. Their agship

roduct, SynapseTM, is a revoluonary soluon for organizaons looking for aimple, smart and intuive tool to help lower costs, improve health outcomes andruly engage their paents and care teams.

Integra ServiceConnect®works with vulnerable, high cost membthat may not be reached with regular phone calls and mailin

thereby becoming a complementary extension of clients’clinical sta and programs. Integra uses a community health worker modelto identify and address the social, environmental and behavioral barriers tachieving better health. Specially trained non-clinical Community Coordinare hired from within the members’ neighborhoods to empower, educateassist members in navigating the health care system.

Integra can successfully nd and engage up to 70% of the unreachable membOnce engaged, Integra is able to close most impactable HEDIS care gaps, aver4 – 5 gaps closed per member. Integra consistently delivers a positive retuon investment for clients through increased revenue and lowered inpatienemergency room expense.

ATA

EALTH

SION, INC.

ON EXECUTION RESULTS

Risk Adjustment Analycs HEDIS and Stars Tracking Inpaent Data Pursuit Paent and Provider Outreach,

Coding and Data Collecon

• CMS-Rejected Diagnosis Trackingand Correcon

For over 40 years, GA Foods has been supporng healthy andindependent aging for the elderly populaon with our nutriousHome-Delivered Meals. Our Registered Dieans and Execuve

hef plan every meal to meet federal and state guidelines, while also being suitable forndividuals managing chronic condions such as diabetes or cardiac disease. GA Foods

ses proprietary tablet technology for route opmizaon and tracking, enabling us torovide in-person, in-home delivery of our frozen meals across the United States, whilemultaneously capturing useful member informaon for the plan’s care managers.

MARSI, an established document and coding audit company since 19has an excellent reputation and track record. MARSI has been innova

developing processes at least five years ahead of our competitors, such as: pre-billing auditcomprehensive review compliance and physician documentation improvement . . . that actuallyMARSI is a known expert among healthcare attorneys. We have never lost a case.MARSI is known for educaon which we have broadened into on-line HCC training anexperienal training for all the areas of coding.MARSI is a proven leader with a wide range of successful programs for documentation and c

Home Access Health seeks to empower members to take the rst step imanaging their health using our pioneering at-home laboratory tesng seOur unique kit design makes sample collecon easy, which increases procompliance. As a result, your plan receives the data needed to improve qmeasures and manage risk. Members win too; they get a picture of the

health and a connecon to a primary care physician. Our tests include A1c, microalbucholesterol and colorectal cancer. To learn more please visit www.homeaccess.co

Blue Health Intelligence (BHI) is the naon’s premiere healthintel ligence resource, delivering data-driven insights resulng inhealthier lives and more aordable access to safe, eecve care.With over 140 million lives, BHI’s healthcare claims data reects

lizaon in every ZIP code. With Xchange Advisor, our customers achieve greaterontrol, unequaled insights, and highest nancial impact with analycs for Commercial and

Medicare Advantage risk adjustment. Blue Health Intelligence is an LLC and an Independentcensee of the Blue Cross and Blue Shield Associaon. www.bluehealthintelligence.com



Established in 1975, Morpace is a MarkengNews Gold Top 25 full service research andconsulng rm with oces in Detroit, Los Angeles,

ondon and Shanghai. Morpace’s healthcare pracce encompasses customerxperience research, branding and communicaons, and product developmentor health plans, providers and health technology rms. Morpace is one of thergest NCQA-cered HEDIS CAHPSTM vendors in the United States, and is aenters for Medicare and Medicaid (CMS)-approved MA&PDP CAHPS vendor.

ur experts analyze consumer data and insights to develop strategies drivingmproved Star Rangs and other business outcomes. Morpace was named the014 CASRO Research Organizaon of the Year. Visit www.morpace.com.

For Health Plans or Self-Insured Employers that want to measurablyimprove member and employee health, PharmMD is the proven

choice for pharmacy quality soluons. Founded by healthcare andharmacy innovators, PharmMD’s outcomes-driven reporng, priority on personalouch, and scalable clinical network are backed by performance-based pricing thatuarantees fast results for Part D Star Rangs improvement, the most eecve

Medicaon Therapy Management, and improved overall health outcomes. For morenformaon visit www.PharmMD.com

Milliman IntelliScript® specializes in risk management soluons forthe health insurance industry. We combine industry-leading dataand experse with superior customer service to bring our clients

market leading soluons. Our prescripon history tools provide intelligent insights intoour members, thereby enabling faster, more accurate and consistent risk-managementecisions. Learn more about how IntelliScript soluons can opmize revenue, improveisease and case management and enhance group underwring by vising us at

www.rxhistories.com.

Pareto Intelligence™ is an analycs company focused on helpingproviders and health plans deliver improved nancial and medical cost

outcomes. Our HCC Sennel ulizes sophiscated stascal models toidenfy, priorize, and capture undocumented risk. Member Economics®

traes and segments members to understand protability and eecvely designroducts, network, and go-to-market strategies. Performance Management evaluates

ntervenon eecveness, monitors risk score trends, and provides a greaternderstanding of nancial performance.www.paretointelligence.com

TMG Health is the leading naonal provider of expert solufor Medicare Advantage, Medicare Part D and Managed Med

plans. With more than 15 years of experience in providing technology-enablservices to the government market exclusively, our knowledge of health planprocesses, regulatory requirements, and the daily challenges plans face withthe government market is second to none. Our experse, coupled with a strocommitment to our clients’ success, posions us as a trusted partner who casolve the challenges of today and prepare for those of tomorrow.

TMG Health is headquartered in King of Prussia, Pa. and is a subsidiary of HeCare Service Corporaon (HCSC), the largest customer-owned health insurerthe United States and fourth largest overall, operang through its Blue CrossBlue Shield® Plans in Illinois, Montana, New Mexico, Oklahoma and Texas. HCheadquarters is located in Chicago, IL.

Your clinical analytics partner

Nagnoi, LLC is a leading systems integrator and consulng rmspecialized in Business Analycs for Healthcare with products and

ervices for Payors, Providers, and Public Health organizaons. STARSTrack, our agshiproduct, is one of the most advanced analycs soluons providing health plans thestant visibility needed to achieve their goals in quality as dened by the Star Rangrogram of the Center of Medicare and Medicaid Services (CMS). In 2011, Nagnoi waswarded Worldwide Business Intelligence Company of the Year and in 2013 and 2014,he Health Partner of the Year Award, both by Microso Corporaon. In 2012, Nagnoi

was included in the Forrester Research Business Intelligence Service Provider Shortlist.or more informaon, visit www.starstrack.com.

Navigant Consulng, Inc. (NYSE: NCI) is an independent specialized,global professional services rm that combines deep industry knowledge

with technical experse to enable companies to defend, protect and create value.With a focus on industries and clients facing transformaonal change and signicantegulatory and legal issues, the rm serves clients primarily in the healthcare, energynd nancial services sectors which represent highly complex market and regulatorynvironments. Professional service oerings include strategic, nancial, operaonal,echnology, risk management, compliance, invesgave soluons, dispute resoluonservices and business process management services.

RelayHealth Pharmacy Soluons (RHPS) connects health plansmore than 50,000 retail pharmacies enabling them to ulize a

pharmacy’s accessibility to drive member engagement, medicaon adherencan overall improvement in quality measures.To learn more, visit relayhealth.com/intervenonmessagingrx, call 800.868.1email [email protected].

Predilycs is a healthcare informaon technology company thhelps drive decisions that improve populaon health, quality ocare, and business performance. Using patented machine learanalyc tools, we idenfy opportunies at an individual consum

level, priorize them based on recepvity to engagement, and idenfy acons to the greatest value.

TriZeo, a Cognizant company and business unit within Cognizhealthcare pracce, provides world-class informaon technolsoluons to make beer healthcare happen. TriZeo’s world-c

technology products, in combinaon with Cognizant’s consulng, IT and businprocess services at scale dramacally simplies the deployment and adoponof technology and improves operaons—helping to reengineer the business ohealthcare today, while reimagining it for tomorrow.

3M Health Informaon Systems works with payers, providers angovernment agencies to ancipate and navigate a changing healthcalandscape. 3M provides healthcare data aggregaon, analysis, and

strategic services that help clients move from volume to value-based health carresulng in millions of dollars in savings, improved provider performance, and hquality care. 3M’s innovave soware is designed to raise the bar for computer-assiste

coding, clinical documentaon improvement, performance monitoring, qualityoutcomes reporng, and terminology management.

Since 1985, Medical Data Exchange (MDX) has been serving theHealthcare Industry by creang systems that process healthcare scaland clinical data. MDX provides a suite of products consisng of MAXII (hospital claims system), AXIS Physician Pracce Management,VChart (EHR), AXIS IPA Management (IPA/MSO/TPA management

ystem), HCC Manager (risk adjustment), P4P, and integrated Case Management systemso support hospitals, health plans and physician organizaons. Our systemac applicaonsssist healthcare organizaons to move toward integrated healthcare data management inrder to opmize quality of care and cost-eecve models of care management. For moreformaon call MDX Business Development at (562) 256-3800.

Evolent Health partners with leading health systems to drive vaue-based care transformaon. By providing clinical, analycal anancial capabilies, Evolent helps physicians and health syste

achieve superior quality and cost results. Evolent’s approach breaks down barrialigns incenves and powers a new model of care delivery resulng in meaningalignment between providers, payers, physicians and paents.

Enjoin delivers a comprehensive soluon for advancing clinidocumentaon integrity. With thirty years of direct physicialeadership, our team ensures evidenced-based care is accurate

reected through precise documentaon and coding for value-based, pay for

performance reimbursement. Whether inpaent or ambulatory, the precision ohealthcare data denes risk adjusted value-based outcomes through reliabldocumentaon and coding.Led by expert physicians with coding and documentaon credenals, our clientachieve a demonstrable improvement in CMI, coding accuracy, quality metrics,adjustment and physician alignment—with an average return on investment ov700%.



Hello. We’re EyeMed – America’s fastest growing vision benetscompany. We have 15+ years of experience providing vision benet

opons for Medicare partners – supporng over 4 million Medicaremembers.

y examining the needs, wants and concerns of the Medicare eligible populaon,we have developed eecve vision benet soluons – from Medicare-focused

lan opons with the network members want, to senior-centric, award-winningustomer service.

takes vision to challenge the status quo. Visit our booth to learn more!

NeuroMetrix is an innovave medical device company foon the most costly and prevalent chronic complicaon o

diabetes – diabec neuropathy. NeuroMetrix markets the NC-stat® DPNChdevice, which is a rapid, accurate, and quantave point-of-care test for dianeuropathy. Due to the limitaons of tradional clinical detecon methodsas monolament tesng, many organizaons under diagnose diabec neuropand unknowingly carry the risk of this costly and debilitang complicaon. technology helps Medicare Advantage organizaons improve the accuracy odiabec neuropathy detecon, accurately risk assess their diabetes paentsopmize neuropathy and general diabetes treatment.

MediCheck™ is a proacve health risk assessment program

oered by ExamOne that gets to the source of aconable datOur program can help maximize your resources, close gaps inimprove quality outcomes and aain bonus payments. With an industry-leadhealth outreach team, MediCheck helps improve discovery, idencaon anddocumentaon of member medical condions through mobile laboratory anbiometrics collecons, as well as comprehensive in-home health assessmentulmately helping you stay on target with quality reporng deadlines.Learn more at MediCheck.ExamOne.com.

Health Soluons Plus (HSP) oers the most comprehensive coreadministraon payer soluon in the industry. The HSP Payer Suiteend-to-end payer plaorm that integrates Medicare, Medicaid, Du

Eligible and Exchange data and business processes. This end-to-end system oetechnological innovaon and experience leading to unmatched revenue improvebusiness eciency, exibility, and self-managed regulatory compliance. Plus, data is securely held in one locaon, eliminang the costly issues and down

associated with mulvendor interfacing.

Visionary RCM specializes in Risk Adjustment Coding SoluoOur 1700+ experienced coders and Nurse Praconers guara95%+ accuracy and faster turnaround me.

• Retrospecve / Prospecve Risk Adjustment Coding• Commercial Risk Adjustment Coding• RADV Audit / IVA• HEDIS Abstracon• Comprehensive Condion Audit• Clinical Documentaon Improvement & Data Validaon

MedHOK is an innovave soware company enabling healthplans, managed care organizaons, pharmacy benet manag

and specialty pharmacies to simplify member care and coordinmaintain compliance, and maximize revenue. Our SaaS-based soware plaopulls together all pharmacy and medical data into one plaorm, creang a 36view of the member, allowing payers to idenfy and target health risks, intelligentlytrigger workflow interventions, and improve quality of care throughout thconnuum of care. Out-of-the-box compliant and proacvely updated for MedicMedicaid, and Affordable Care Act regulations, MedHOK is a compliancpowerhouse.

Recognized by Inc. magazine as the naon’s 25th fastest growing private comand the 6th fastest growing private healthcare company, MedHOK is NCQA cerHEDIS®, Pay for Performance, and Disease Management. MedHOK is the soplatform of choice for more than 50 of the nation’s largest healthcare paymanaging close to 40 million lives. Visit www.MedHOK.com or call (888) 9MEDH

Athenahealth is a leading provider of cloud-based servicesproviders and health plans including population healtmanag ement , care coordinaon, and clinical data exchang

services. By connecng care across the enre connuum, athenahealth helits network of 75,000+ providers and health plan partners drive unprecedentnancial and quality outcomes through interoperability and provider-payercollaboraon.

OS2 Healthcare Soluons is a veteran owned medical coding rmand academy specializing in risk adjustment coding, RADV audits,physician clinical documentaon improvement, and coder educaon.OS2 has created a state of the art business process to improve

our healthcare organization’s bottom line by enabling your facility and staffo foc us on continuity of care, quality outcomes, and reimbursement.or more informaon, contact Melissa Freeman at [email protected] or

isit our site, www.os2healthcaresoluons.com.

Health Care Excel offers customized services in the areasof combating healthcare fraud/waste/abuse, commercial riskadjustment, quality improvement, program integrity, and ulizaon

anagement. By aligning clinical experse with proprietary technology, Health Carexcel delivers innovave soluons and measureable results to clients naonwide.or over 41 years, Health Care Excel has been a strategic partner to health plans,roviders, and state and federal governments.

ealth Care Excel is URAC Accredited for Health Ulizaon Management and is alsourrently in process for Independent Review Organizaon (IRO) accreditaon fromRAC. The company is a premier member of the Naonal Health Care Anfraudssociaon (NHCAA) and also a member of the Naonal Associaon of Dental Plans

NADP). Addionally, Health Care Excel has been designed by the Centers for Medicaidnd Medicare Services (CMS) as a QIO-like enty.

ComplexCare Solutions, Inc. (CCS): ComplexCare Soluons isa naonal Care Management and Risk Assessment company whichprovides services to Medicare Advantage and Medicaid Health Plansin support of high risk, frail and complex care members. It operates

ith clinicians and mul-specialty teams in the member’s home to coordinate andanage the delivery of care, improve member outcomes and reduce the associated

ost of care.

Indegene Healthcare, is a leading integrated provider of end-to-endRisk Adjustment, HEDIS/STARS rang improvement, and providerengagement soluons. With over 1200+ healthcare experts across

he globe, Indegene brings its rich clinical experse, proprietary analycs models,ducaon outreach, and training capabilies that enable payers and providerso thrive by driving beer business and health outcomes. Leveraging its strongtellectual property and innovaon capabilies, Indegene deploys a porolio

f next-generaon plaorms in quality improvement, risk adjustment, and providerngagement to drive integrated outcomes and business success for its clients.

Novu enables the health care ecosystem to deliver, incent andtrack protocols and healthy outcomes through tailored consumerexperiences. The company creates an empowering connecon

etween consumers and the health system, driving eciencies for health care’sost impacul areas. The company’s consumer-centered plaorm facilitates this

onnecon through proven consumer markeng strategies, including personalizaon,amicaon, rewards and social community. Novu works with health care’sost innovave leaders and delivers an empowering, inuenal and connected

xperience via desktop, mobile and tablet. The company is headquartered in

Minneapolis, MN. More informaon is available at www.novu.com.

U n i f y i n g t h e B u s

i n e s s

o f H e

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Judge Healthcare is a leader in providing customized clinicalworkforce soluons to healthcare organizaons throughoutthe country. With engagements in almost 50 states, we

urrently have clinicians working as far away as Hawaii, Puerto Rico and St. Thomasnd as remote as Indian Reservaons in New Mexico. Judge Healthcare delivers theighest quality healthcare professionals for execuve search, physician recruitment,ontract/temp, contract-to-hire, per diem/travel/locum tenens, in-home/facilityssessments, and on-going case management opportunies across the healthcarepectrum. Visit judge.com or contact 1-800-650-0035

SPH Analycs (SPHA) is a leader in acon analycs for provider,payer, member, and health networks. SPHA soluons enable

clients to enhance the paent care experience, improveopulaon health, reduce the overall cost of care, and elevate provider performance.PHA soluons incorporate an engaging social-media style user experience opmized for

mobility to measure data, create easy-to-understand analycs, and empower acon.or more informaon, call 1-866-460-5681 or visit www.SPHAnalycs.com.

Eliza Corporaon (‘Eliza’) helps our customers engage individualsand close gaps in care by combining behavior-driven healthcareanalycs with mulchannel communicaons that make memberinterventions more efficient and effective. After 15 years’

xperience and billions of healthcare consumer interacons and insights, Elizathe recognized leader in Health Engagement Management. We collaborate

with healthcare organizaons to deliver results that measurably improve quality,ost and care outcomes. For more informaon, visit elizacorp.com or contact.800.701.7864. Join Eliza on LinkedIn, and Twier.

Capitol Coding Management is a superior custom coding soluonfor your Health Informaon Management needs. We bring insight,innovaon, and strategies for success with our expert codingsoluons and unbeatable rates. We work closely with our clientsto create custom work models that generate maximum value. We

nderstand how vital ecient coding is for your company’s revenue cycle. Therefore,we are commied to ensuring you receive the highest reimbursement with

nrivaled quality of service.

apitol Coding Management’s products and service specialties include Riskdjustment, HEDIS, STAR Rangs, RADV Audits, and record retrieval. To learn

more visit www.capitolcoding.com or call (855) 771-7226

Welch Allyn is a leading medical diagnosc device company,and is a division of Hill-Rom (NYSE: HRC).

t RISE we are featuring the RenaVue™ Network—a proven turnkey diabecenopathy screening program made simple and aordable enough for individ-al primary-care pracces and scalable for naonwide health-plan screeningrograms.etinaVue can double DRE patient compliance rates in just 12 months toositively impact HEDIS scores and Medicare Star rangs on the DRE metric, andelp preserve vision in paents with diabetes.top by Booth 89 to see the new RenaVue 100 Imager in acon—the world’s

most advanced handheld fundus camera!

BeamMed is a developer and manufacturer of bone density

assessment and monitoring soluons who has pioneered the earlyassessment of bone density, with the rst - and sll the only -devices that enable ultrasound-based, mul-site measurement for

he early assessment and monitoring of osteoporosis.eamMed’s Sunlight product line overcame the cost and radiaon exposure-relatedhallenges of Dual X-ray Absorpon technology (DXA).he MiniOmni oers high accuracy, small size, ease of use, reliability, excellentordability, and radiaon-free operaon that can easily and safely be used in anyoctor’s oce, clinic, HMO or retail venue such as pharmacies and checkup centers.

Simbiote is a healthcare technology company oeringunique automated point of care technology, seamlessintegrated within the EHR providing real me, dynami

updang nocaon of risk adjustment and quality gaps. Our soluon provideautomac assignments of care to clinicians based upon user login and role.The CareSentry soluon ensures that providers are meeng quality improvememeasures (Medicare risk adjustment HEDIS, CMS Star, MSSP, PQRS, PCMH) byproviding gaps in care (and risk adjustment gap) nocaon within providers exEHR workow via mappings directly into EHR data points. Providers know instaif they are missing measures and care. Simbiote’s disease registry, care manageand populaon health management soluon improves quality at the point of cawww.simbiote.com

SDLC Partners, L.P., headquartered in Pisburgh, PA, opened itdoors in 2004 as an alternave to large consulng organizaonsrm’s high performing employees take a praccal and collabora

approach to deliver process improvement, analycs, and technology soluons tregional and naonal customers by eecvely working with business and I.T. toas the “execuon partner of choice”.

Vee Technologies is a pioneer in outsourced healthcare,insurance, nancial, and engineering services. The compandelivered secure HIPAA compliant, ISO-cered, quality woto its customers since 2001. One of Vee Technologies’ biggstrengths is its very own Sona University which custom-tra

students to directly meet the ever-changing demands of today’s global marketp

Vee Technologies commits to deliver excellent soluons, guided by innovaand security, to achieve and render extraordinary outcomes.

Looking for Healthcare Providers?PPR Risk Adjustment Staffing is the leading recruitmentorganizaon working with risk adjustment organizaons an

health plans who need healthcare professionals to perform prospecve hearisk assessments.

We hire your Health Providers so you don’t have too.PPR Risk Adjustment Stang will recruit, hire and manage your healthcareproviders allowing for quicker starts and the ability to ex your sta up or dbased on your project needs. Most importantly, we eliminate your recruincosts and the hassles of managing healthcare professionals.

We can Manage it All!No more hiring costs, employee issues, payroll or benets management.

Contact Je Lo at 800-508-5038 or [email protected]

DDDS is an innovave healthcare services company with yeaof experience in collaborang with health plans and providerdeliver high-quality provider and member-centric soluons tmarket that improve risk scores, quality, and compliance - w

ensuring accuracy of nancial reimbursement. DDDS oers technology-enaservices and soluons including: a dierenated prospecve program, medrecord retrieval and review, data analytics and reporting, RAPS/EDPS dasubmissions, enrollment reconciliaon and nancial reconciliaon.

Convey Health Soluons is a leading healthcare-focused Business POutsourcing and technology organizaon. They have spent near

decade building a compliant and ecient operaonal organizaproven healthcare IT infrastructure, and a comprehensive Medicare Services PlaThey also have deep experse in navigang the increasing regulatory challengeof Medicare compliance (under the direcon of their seasoned Chief ComplianOcer). They are relied upon as a trusted and proven outsourcing and technopartner that consistently delivers high quality Medicare member experiences –inial markeng inquiry through enrollment, billing, reconciliaon, member and prservice, grievance and appeals, wellness and chronic condion management.



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

HEALTHCARE EDUCATION

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THE 10TH ANNUAL RISE NASHVILLE SUMMIT

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N A S H V I L L E , T NG A Y L O R D O P R Y L A N D R E S O R TM A R C H 2 0 - 2 2 , 2 0 1 6

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Conf. & Workshop B - A Risk Adjustment Primer - Govt/Community Service rate*

Conf. & Workshop A- Leveraging Powerful Data Analycs - Health Plan/Provider rate*

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Conf. & Workshop C - Nuts and Bolts of Star Rangs - Govt/Community Service rate*

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Conf. & Workshop B - A Risk Adjustment Primer - Health Plan/Provider rate*

Conf. & Workshop B - A Risk Adjustment Primer - Service Provider/Consultant rate

Conference only - Health Plan/Provider rate*

Conference only - Service Provider/Consultant rate

early bird - ends 1/20/2016

$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

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