Risk adjustment is much more than a regulatory requirement for Medicare Advantage plans. Not only does it have a significant financial impact, but it can also improve the quality of care by providing an accurate picture of each member’s health status and ensuring each member receives the right interventions and treatment. Providers play an important role in risk adjustment, too. An engaged partnership between health plans and providers is vital to financial success and ensuring beneficiaries receive valuable benefits.
Our panel will share successful strategies and best practices for payers and providers to work in partnership to close gaps in care, achieve better clinical and financial performance, and support value-based care. Hear both payer and provider perspectives on building a successful relationship.
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Caring for the people of San Antonio, TX, Janie specializes in family medicine. She received her doctorate and master’s in nursing from the University of Texas, San Antonio. She obtained her bachelor’s from the same institution. Janie gives her patients her undivided attention and practice with the goal of helping each of them lead healthy and fulfilling lives.
He has over 25 years of experience in leading healthcare organizations. He served as CEO of Windsor Health Group with 300,000+ members, held senior executive positions at Humana, and served as SVP at Coventry Health Care for over 1.5 million members across 11 states.
Rebecca’s responsibilities include oversight of all risk adjustment programs pertinent to Medicare, Medicaid and ACA lines of business with focus on physician coding education, coder training and clinical documentation initiatives. Rebecca directs a team of highly trained HCC coders and educators that perform retrospective, prospective and RADV audits for all government related lines of business. This work entails a thorough understanding of financial implications associated with an efficient and ethical risk adjustment program. In addition, Rebecca’s team oversee encounter data submissions, and analytical analysis of risk adjustment work. Rebecca also serves in a consultative role for Intermountain Health for risk adjustment related initiatives. Rebecca’s primary focuses is to ensure ethical, compliant and comprehensive risk adjustment programs.
In this role, Jeslie is responsible for developing and executing the organization’s strategies to enable the adoption of enhanced reporting, analytics, and data exchange capabilities to improve health outcomes, reduce costs, and enhance the quality of care for more than 16 million members across five states.
Lisa has spent the past 21 years in the Health Insurance Industry in various roles. She piloted and in turn created an in-office strategy focused on Risk Adjustment, HEDIS measures, and Stars.
Lisa is a Registered Nurse and holds a Diploma of Nursing from St Clair College and a Bachelor of Science Degree from the University of Windsor. In addition, she holds several certifications including Certified Case Manager (CCM), Certified Risk Adjustment Coder (CRC) and Instructor and Certified Documentation Expert Outpatient (CDEO).