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» » Hear Directly from CMS and NCQA

T h e 3 rd A n n u a l R I S E Q u a l i t y L e a d e r s h i p S u m m i t



J u n e 2 5 -26 , 2018 | Ari zona Bi l t m ore Hotel | Ph oen ix Wit h Tra cks D esi gn ed to Boost Performan ce on M edic are Star Rat i n g s , H E D I S ® , CA H PS & HOS , a n d P harma cy-Related M easures S PE AK IN G FACU LTY INC LU DE S: Ashby Wolfe, MD, MPP, MPH, Chief Medical Officer, Region IX



Paul Cotton, Director of Federal Affairs NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA) Sunil Budhrani, MD, MPH, MBA, Chief Medical Officer/Chief Medical Informatics Officer



To Regi s ter: Call 8 66.676.7 689 o r v i s i t u s a t r i s e h ea l th .o r g

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TOP REASONS TO ATTEND This innovative multi-track program allows you to design your own conference by choosing the sessions that most suit your interests. Get the latest insights from regulatory agencies, top-rated plans, and leading innovators for the tools you will need to boost your organization’s quality ratings in 2019 and beyond.



• Hear directly from CMS about the most recent measure

• Get insight from a top NCQA official about how NCQA is

changes and what the future holds for MA Stars • Learn how to leverage lean process improvement methods to maximize the effectiveness of your Star Ratings program • Find out how, with all your competitors trying to hit the same targets, you can ensure maximum ratings impact for your QI efforts • Understand how to increase scores by getting people “out of the denominator” • Network with leading quality innovators from 4 & 5 Star plans

working to reduce your reporting burden and other new developments • Learn the latest facts about HEDIS® Electronic Clinical Data System reporting • Find out strategies for success with the new HEDIS® Transitions of Care measures • Understand how to focus quality interventions using Social Determinants of Health data • Learn how to align provider incentives and measures to maximize compatibility with MACRA

WHO SHOULD ATTEND? Health plan leaders, healthcare providers and consultants with responsibilities in the following areas:


Quality Improvement

Network Management

Star Ratings

Physician Outreach & Education


Member Outreach & Engagement


Customer Service


Care Management



• Learn how one plan achieved a 5 Star rating on all its

• Learn how you can maximize the value of your data to hone

medication adherence measures • Hear from health plans who are making progress in the opioid epidemic • Learn how to boost medication adherence by training providers in motivational interviewing • Find out how to overcome members’ hidden barriers to adherence • Understand how to increase quality scores by implementing a medication advisor program

in on the trouble areas having the most significant impact on your quality performance • Get cost-saving tips to help prioritize when and how you use monetary incentives and how you can incorporate parallel survey initiatives • Find out how to use member feedback to develop more effective policies, processes and customer service initiatives • Get tips and tools to help diagnose the underlying causes of member dissatisfaction in your CAHPS scores • Learn how one innovative plan boosted its CAHPS scores

Risk Adjustment & HCC Management

Pharmacy Administrator

Data Management

Health Management

Performance Management

Clinical Audit


Product Development


DAY ONE: MONDAY, JUNE 25, 2018 8 : 0 0 – 8 :4 5

R e gi s tration & Net work ing Bre ak f a s t

8 : 4 5 – 8 : 5 0

Chairp e r s o n’s O p e ning R e mark s

8 : 5 0 – 9 : 3 0

CM S Ad dre s s Dr. Wolfe will provide an update on CMS policy as it pertains to the Medicare STARS program, including a review of recent quality measures. She will also provide an update on CMS policy related to Medicare Advantage and the work CMS is involved in related to overall quality improvement and health system transformation. Ashby Wolfe, MD, MPP, MPH, Chief Medical Officer, Region IX CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) (via teleconference link)

9 : 3 0 – 1 0 :1 5

N CQ A Ad dre s s The latest news on what the immediate future holds for quality improvement, including: • An update on proposed changes in Washington D.C. • How NCQA is working to reduce your reporting burden • NCQA strategies for adjusting to the new CMS “Meaningful Measures” initiative by retiring some measures and aligning with others Paul Cotton, Director of Federal Affairs NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA)

1 0 :1 5 – 1 0 : 3 0 Morning Net work ing Bre ak


DAY ONE: MONDAY, JUNE 25, 2018 1 0 : 3 0 – 11 :1 5 Into Ac tio n: H ear H ow A n Innov ati ve H ealth Plan I s M ak ing Pro gre s s in the O pioid Cri s i s The National Institute on Drug Abuse points out that more than 115 Americans die every day after overdosing on opioids and that the total “economic burden” of prescription opioid misuse in the U.S. is estimated at $78.5 billion a year, leading the government to declare a nationwide public health emergency. Here are some actionable strategies you can use at your health plan to make a difference. • Alignment of Opioid Program to address NCQA Population Health Management (PHM) Standards for Patient Safety or Outcomes Across Settings • Interventions for program include member placement into a pharmacy lock program, member education on the risks of using multiple pharmacies, and prescriber outreach • Utilizing population health modeling tools to define our member identification logic to identify short and longterm opioid use • Segmentation of population to address new Opioid HEDIS measures (UOP and UOD) • Goals of the program: decrease the use of Opioid medications in targeted populations, decrease in UOD & UOP HEDIS eligibility, a decrease in the number of prescribers and pharmacies, as well as a decrease in unnecessary utilization of the Emergency Room, Inpatient Hospitalizations, and readmissions Amy Lung, Vice President of Quality Improvement MERIDIAN HEALTH PLAN 11 :1 5 – 1 2 :1 5

S o cial D e te rminant s of H ealth: S p e cial Two - Par t Feature I . A H ealth Plan Pre s id e nt E xp lain s Why Hi s O rganiz atio n I s Ad dre s s ing S o cial D e te rminant s , an d What H e S e e s A s the R O I • The importance of addressing social needs factors in achieving quality improvement and other key company goals • Identifying the initiatives to target • Evaluating current and future returns • How to make the case to achieve leadership buy-in for social determinants initiatives at your company Thomas Lutzow, President-CEO INDEPENDENT CARE HEALTH PLAN


DAY ONE: MONDAY, JUNE 25, 2018 I I . A Uniqu e L o o k at O ne H ealth Plan’s Innov ati ve Proje c t to Ad dre s s Nu tritio n f ro m the Pe r s p e c ti ve of the Plan a s We ll a s O ne of it s M e mb e r s Geisinger’s “Fresh Food Farmacy” Program uses food as medicine. Food-insecure members with Type II Diabetes receive a “prescription” for high quality fresh fruits, vegetables, whole grains and lean meats. These are provided free of charge to patients and families that cannot afford the food needed to control their condition. This presentation will include: • How-to: working with a local food bank and community partners to build a prescription-based food pantry • The results in numbers: evidence you can use to achieve buy-in for social determinants initiatives at your health plan • The personal viewpoint: A member who is a Farmacy client explains the effect the project has had on his life and health Michelle Passaretti, Director of Health

Tom Shicowich

Management Clinical Operations




Net work ing Lunche on

DAY ONE: MONDAY, JUNE 25, 2018 Medicare Star Ratings Strategic Planning Forum

HEDIS ® Forum

Pharmacy-Related Measures Forum

1:15 -2 : 0 0 How Physicians Are Using New and Innovative Engagement Strategies to Close Care Gaps

1:15 -2 : 0 0 INTER AC TIVE SESSION: Focusing Qualit y Inter ventions Using Social Determinant s of Health Data

1:15 -2 : 0 0 Special Feature: How this Plan Went from a 1 - to a 5 -Star Rating on all Medication Adherence Measures in 2 Years

Primary care physicians are at the front lines of efforts to close gaps in care and improve performance on overall quality measures. In this session, learn about new and innovative approaches to support their efforts that improve convenience and encourage members to close gaps in care. See how these new techniques raise overall member engagement and impact health outcomes.

Best practices and future approaches to using social determinants data as a supplement to your HEDIS ® analysis and program management efforts. This session will feature real-time surveys and crowd-sourced suggestions and best practices to guide the discussion. Key topics will include:

• MTM using a multi-prong approach • Breaking down the Silos between Part C and Part D improvement Initiatives • How building a solid base can help prevent the bottom from falling out • Data/ metrics: what front-line staff need to know

• Sourcing data and evaluating its accuracy and relevancy • Strategies for integrating this data into your program analysis • Examples of use cases: Which lines of business and measures would likely have the most related data • What might the added data yield to your intervention approaches and analytical pathways, and ultimately rates • Live demo: A review of a Social Determinants database, and applying it to an analytic model

Kevin Park, MD, Chief Medical Officer CARE WISCONSIN

Key topics include: • How physicians are increasingly involved in the overall role of quality performance • How using alternative sites can reach more members and address hard-to-close gaps • Identifying specific segments of your population to target with the intervention approach most likely to succeed • How a streamlined and integrated member experience raises improves overall program performance James Metcalf, DO, MBA, Medical Director OPTUMCARE UTAH Ray Ekbatani, Chief Growth Officer, Mobile Clinics MATRIX MEDICAL NETWORK

Michael Blumental, President HEALTH DATA DECISIONS Janine Sala, Associate Director Clinical Quality – HEDIS® Operations UNITEDHEALTHCARE


DAY ONE: MONDAY, JUNE 25, 2018 Medicare Star Ratings Strategic Planning Forum

Pharmacy-Related Measures Forum

2 : 0 0 -2 :4 5 Using Data to Drive a Prospec tive Approach for Your Stars Program

2 : 0 0 -2 :4 5 Strategies for Success with the New HEDIS ® Transitions of Care Measure

2 : 0 0 -2 :4 5 Lessons Learned from Ef fec tive MTM Programs

• Why a prospective approach is critical to 5-Star success and how to leverage data for year-round interventions • Understanding the “how and what” of data when monitoring overall contract performance • Key data approaches that work and those to avoid • What data and reports are essential and how to use them for a targeted approach • Identifying high impact providers and members across CDC, Med-Adherence Measures, SPC, and SUPD

• Ensuring communication between inpatient and outpatient providers • How to be sure that follow-up occurs within 30 days • Leveraging telehealth and other technologies • Pitfalls to avoid in satisfying the medication reconciliation post-discharge requirement

• Structuring your program to optimize adherence • Establishing eligibility criteria that maximize effectiveness • Effectively engaging members • Leveraging telehealth and other technologies

Kari Hadley, Senior Director, Medicaid and Quality Products PULSE8 Mike Wilson, Medicare Advantage Analytics Consultant Senior BLUE CROSS BLUE SHIELD OF K ANSAS CIT Y


HEDIS ® Forum

Claire O’Rear, Stars Director Alabama, Mississippi, North Florida CIGNA-HEALTHSPRING

Twila Johnson, Pharm. D., former Director of Pharmacy Services SECURIT Y HEALTH PL AN

DAY ONE: MONDAY, JUNE 25, 2018 Medicare Star Ratings Strategic Planning Forum

HEDIS ® Forum

Pharmacy-Related Measures Forum

2 :4 5 - 3:15 Empowering Internal Stakeholders to Improve Star Ratings Measures

2 :4 5 - 3:15 Paradigm Shif t: Member Communications as a Strategic Tool

2 :4 5 - 3:15 Overcoming Members’ Hidden Barriers to Medication Adherence

• Identifying those internal stakeholders who influence Star Ratings measures most directly • Why empowering those departments to own measures accelerates improvement • The importance of determining secondary influencers, and facilitating cross-functional discussions • What to avoid when setting up this system

• Learn how digital communications, when done right, can: • Contain cost • Optimize outcomes • Create a positive perception in the minds of your members • Witness how secular changes are driving Medicaid member communications

Josh Edwards, MBA, MSC, Medicare Stars Programs Manager MARTIN’S POINT HEALTH CARE

Lauren Jensen, Senior Customer Success Manager HEALTHCROWD

• Learn the steps one health plan took to increase their Star Rating in a D-SNP Population • Understand how and why this plan decided to streamline processes and decrease the number of vendor support • How much of an impact does a Q4 surge support have on a Health Plan’s Star Rating performance?

3:1 5 – 3: 3 0

Cyndi Alexander, Chief Health Services Officer PHARMMD

Af terno on Net work ing B re ak


DAY ONE: MONDAY, JUNE 25, 2018 Medicare Star Ratings Strategic Planning Forum

HEDIS ® Forum

3: 30 – 4:15 Boos ting the Ef fec tiveness of HEDIS & Stars Campaigns , and Delivering the Repor t s to Prove It

3: 30 – 4:15 SPOTLIGHT: Unders tanding HEDIS ® Elec tronic Clinical Data Sys tem (ECDS) Repor ting

• Learn how to determine the best intervention for your members • Best ways to segment your member population and build campaigns that can be measured • What are the best KPIs to measure campaign effectiveness?

Beginning in 2016, NCQA introduced a new domain of HEDIS ® measures, referred to as measures collected using Electronic Clinical Data Systems (ECDS). The focus of this new domain is measures requiring structured electronic clinical data available to clinicians at the point of care and shared with plans to support quality improvement and quality reporting. The HEDIS ® 2018 specifications include 5 measures in the ECDS domain with 2 additional measures in the public comment for HEDIS ® 2019. NCQA is reviewing existing administrative, hybrid and medical record HEDIS ® technical specifications to determine which could be re-engineered to utilize the wealth of data available in ECDS. In this session, learn about:

Sujata Bajaj, Vice President Product EPISOURCE

• Review of current and proposed ECDS measures • Changes to ECDS General Guidelines affecting the types and categories of data allowed for ECDS reporting • Differences in reporting elements compared to other HEDIS ® domains • Practical insights from health plans who participated in the NCQA HEDIS ® Learning Collaborative Health Plan speaker: TBA Lisa Kabasakalian, Business Solutions Manager, Risk and Quality Solutions DST HEALTH SOLUTIONS


Pharmacy-Related Measures Forum 3: 30 – 4:15 Building Strategies for Star- Level Adherence and CMR Completion Rates • Turning “never-numerator” denominator segments into completions • Cost saving benefits of numerator production • PBM alignment for higher numerator completions • Facilitating adherence through pharmacy program design • Telemonitoring and other mechanical assists Thomas Lutzow, President-CEO INDEPENDENT CARE HEALTH PL AN

DAY ONE: MONDAY, JUNE 25, 2018 Medicare Star Ratings Strategic Planning Forum 4:15 – 4:4 5 Improve Your Star Scores by Increasing Measure Per formance Accuracy • Ensuring that members truly belong in each measure • Identifying opportunities and improving coding precision • Ways to improve performance accuracy Donna Sutton, MBA, Director Medicare Star Quality SCAN HEALTH PL AN

HEDIS ® Forum 4:15 – 4:4 5 Using Intelligent Member Engagement Strategies to Drive Incremental HEDIS ® Per formance and Star Ratings This presentation will reveal how an objectivebased framework centered on consumer engagement is a powerful strategy to drive improvement in HEDIS ®, HOS and other member-centered Star rating measures, in addition to overall plan performance, in today’s value-based performance environment. Participants will take away practical ideas on: • Using member segmentation strategies to drive incremental HEDIS ® performance • Identifying the right members to engage using propensity modeling, machine learning techniques, and third-party consumer data • Leveraging rewards & incentives as a key approach to improving member activation rates

Pharmacy-Related Measures Forum 4:15 – 4:4 5 Strategies for Success on the Statin Use in Persons with Diabetes (SUPD) Measure • Examining the details of the measure • Evaluating how the treatment regimen might be simplified • Medication adherence management tools that are effective in statin therapy • Adequately documenting discussions with patients regarding the need for statins Twila Johnson, Pharm. D., former Director of Pharmacy Services SECURIT Y HEALTH PL AN

Kristin Gasteazoro, Vice President of Payer Sales NOVUHEALTH


DAY ONE: MONDAY, JUNE 25, 2018 Medicare Star Ratings Strategic Planning Forum 4:4 5 – 5: 30 With Ratings Cut Point s Var ying and Competitors All Tr ying to Hit the Same Target s , How Do You Ensure Maximum Ratings Impac t for Your QI Ef for t s? • Determining the gap to the next stars level for each measure • Calculating the impact value of moving to next stars level • Estimating the likelihood of success • Developing your value set of measures for meaningful engagement Patrick Donnelly, General Manager, Quality Improvement INOVALON

HEDIS ® Forum 4:4 5 – 5: 30 Aligning Provider Incentives and Measures to Maximize Compatibilit y with MACR A • Examining MACRA regulations and how they impact providers • Comparing the specifics of your current incentives with MACRA quality elements • Aligning your incentives with MACRA for maximum effectiveness and minimum abrasion Terry Whitlock, Senior Bio-Statistical Research Scientist BLUE CROSS BLUE SHIELD OF TENNESSEE

Pharmacy-Related Measures Forum 4:4 5 – 5: 30 Boos ting Member Engagement and Medication Adherence by Training Your Providers in Motivational Inter viewing MI is an approach that attempts to move an individual away from a state of uncertainty and towards finding motivation to make positive decisions and accomplishing established goals. This session will look at: • Examining the foundational principles of MI • Understanding how employing MI can help providers empower patient engagement and self-management • How your health plan can develop practical and experiential practitioner training initiatives in MI Jeffrey Ring Ph.D, Clinical Professor of Family Medicine, Keck School of Medicine UNIVERSIT Y OF SOUTHERN CALIFORNIA

5:30 – 6:30

Co ck tail R e ception - Contac t Kev in Weigel f or more inf ormation on our sp ons or ship opp or tunitie s at k w eigel @ he althcare - conf erence s .com or 70 4 . 3 41 . 24 4 8


DAY TWO: TUESDAY, JUNE 26, 2018 8 : 0 0 – 9 : 0 0

Net work ing Bre ak f a s t

9 : 0 0 – 9 : 4 5

S P OT L I G H T: L eve r aging the N ew Po s s ibilitie s f o r Inco rp o r ating Te l e m e dicine to Imp rove Q ualit y Following passage of significant recent legislation regarding telemedicine, many public and private payers are envisioning a future where they will be able to offer greatly expanded telehealth services. Many organizations are already making strides with innovative technologies that improve care quality while reducing costs. In this special session, the former Co-Chair of the American Telemedicine Association’s Guidelines Committee for Practice of Primary Care and Urgent Care Telemedicine tells us where things stand right now on reimbursement for telemedicine, and examines some of the most inventive technologies that your plan can adopt which are already being used to boost care quality. Sunil Budhrani, MD, MPH, MBA, Chief Medical Officer/Chief Medical Informatics Officer INNOVATION HEALTH


DAY T WO: TUESDAY, JUNE 26, 2018 Star Ratings wwStrategic Planning Forum

CAHPS, HOS & Member Survey Forum

9 :4 5 - 10 :4 5 Chairperson’s Recap of Day One

9 :4 5 - 10 :4 5 Chairperson’s Recap of Day One

9 :4 5 - 10 :4 5 Chairperson’s Recap of Day One

10 : 0 0 - 10 :4 5 Leveraging Lean Process Improvement Methods to Maximize the Ef fec tiveness of Your Star Ratings Program

10 : 0 0 - 10 :4 5 FE ATURED C A SE S TUDY: Utilizing Population Health Analy tics to Achieve Better Outcomes for People with Diabetes

10 : 0 0 - 10 :4 5 Innovative C AHPS Programs for Health Plans

• How to identify process improvement opportunities • Implementing Star Quality program improvements • Case review

• Data-driven strategy to segment the diabetic population and design tailored interventions • Identifying the emerging risk population using predictive modeling • Example of how to utilize analytics to help address health disparities

Donna Sutton, MBA, Director Medicare Star Quality SCAN HEALTH PL AN Robert Gofourth, MBA, Vice President, Operations Strategy & Performance BLUE CROSS BLUE SHIELD NORTH CAROLINA

1 0 :4 5 - 11: 0 0 Morning Bre ak


HEDIS ® Forum

Amy Lung, Vice President of Quality Improvement MERIDIAN HEALTH PL AN

• Access when there is none: programs from a plan with access challenges • Kicking and Screaming…getting providers to help with CAHPS • HEDIS ® and satisfaction? Using HEDIS ® to improve CAHPS • NPS (for providers too) NPS and CAHPS intersection Kimberly S. Johnson, MHA CHC CPHQ, Director Quality Improvement UNITEDHEALTHCARE NEVADA

DAY T WO: TUESDAY, JUNE 26, 2018 Star Ratings wwStrategic Planning Forum 11: 0 0 - 11:4 5 E xamining the CMS Proposed Rule on Employing Non- Medical Supplemental Benef it s to Improve Health • A look at what may and may not be allowed • Determining what supplemental benefits would be most impactful on your quality ratings • How these methods are working in other markets Roderick Kersch, Vice President of healthcare Solutions Sales & Marketing INCOMM

HEDIS ® Forum 11: 0 0 - 11:4 5 Developing a Qualit y- Data Dashboard for Optimal QI Decision- Making Ensuring the data displayed is: • High level • Meaningful • Displays historical trends Examining various dashboard uses: • ROI • Measure specification impact • Measure/chase status and KPI • Predictive analysis • Tracking Amanda Middleton, Manager Quality Analytics BLUE CROSS BLUE SHIELD OF TENNESSEE Janine Sala, Associate Director Clinical Quality – HEDIS Operations UNITEDHEALTHCARE

11:4 5 - 12 :4 5

CAHPS, HOS & Member Survey Forum 11: 0 0 - 11:4 5 Original Strategies for Minimizing Member Abrasion • How to identify the impact of member abrasion and when you have crossed the threshold of too much abrasion • Using predictive modeling to target members to close the right gaps at the right time. • Using a multifaceted communication approach as outreach strategies to members, based on their preferences • Engaging providers to close gaps to avoid member abrasion David Larsen, RN, MHA, Director, Quality Improvement SELECTHEALTH

Net work ing Lunche on


DAY T WO: TUESDAY, JUNE 26, 2018 Star Ratings wwStrategic Planning Forum 12 :4 5 - 1: 30 E xploring Machine Learning — A Tool for Simplif ying Complex Member Data and Boos ting QI • Understanding what machine learning is and why it is critical to your business future • Examining what role machine learning can play in QI programs now and in the near future through case studies • How deep learning can simplify complex patterns in member data to enable more effective QI efforts • How an organization can get started in machine learning so that it can be successfully leveraged in the future Ed Broughton, Manager, Operational Strategic Planning BLUE CROSS BLUE SHIELD NORTH CAROLINA

HEDIS ® Forum

CAHPS, HOS & Member Survey Forum

12 :4 5 - 1: 30 Moving the Needle on the Mos t Challenging Measures

12 :4 5 - 1: 30 Unders tanding the Voice of the Medicare Cus tomer

• Determining which measures to target for maximum ratings impact • Proven strategies for improving specific measures • Methods that work to improve multiple measures

Lay the framework: Audit existing research and identify other internal sources that may benefit from the insights

Ana Handshuh, Vice President, Corporate Programs ULTIMATE HEALTH PL ANS

Identify opportunities: Synthesize information to provide a more complete view of the Medicare member Develop the plan: Conduct primary research to fill gaps beyond standardized surveys Forecast the future: Leverage existing tracking programs to provide an early look at annual performance Julie Landers, Senior Manager, Strategic Market Research BLUE CROSS AND BLUE SHIELD OF ILLINIOS, MONTANA , NEW MEXICO, OKL AHOMA & TEX AS Aaron Burgess, Manager, Strategic Market Research BLUE CROSS AND BLUE SHIELD OF ILLINIOS, MONTANA , NEW MEXICO, OKL AHOMA & TEX AS


DAY T WO: TUESDAY, JUNE 26, 2018 1 : 3 0 - 2 :1 5

S p e cial Inte r ac ti ve Co nf e re nce Wr ap - Up In this unique, open Q&A session with our panel of quality improvement experts, get answers to the questions you’ve been formulating these past two days but didn’t have a chance to ask. Be part of the discussion, and leave with insights that will further enrich your conference experience.

Kevin Park, MD, Chief Medical Officer

Thomas Lutzow, President-CEO



Twila Johnson, Pharm. D., former Director of

Ed Broughton, Manager, Operational Strategic

Pharmacy Services




Kimberly S. Johnson, MHA CHC CPHQ, Director

Janine Sala, Associate Director Clinical Quality –

Quality Improvement

HEDIS Operations



Josh Edwards, MBA, MSc, Medicare Stars Programs Manager MARTIN’S POINT HEALTH CARE

2 :1 5 pm

Conf erence Conclude s




• Three people will receive 10% of f • Four people will receive 15% of f • Five people or more will receive 20% of f In order to secure a group discount, all delegates must place their registrations at the same time. Group discounts cannot be issued retroactively. For more information, please contact Whitney Betts at (704) 341-2445 or

Arizona Biltmore


2400 E Missouri Ave Phoenix, AZ 85016

For information regarding refund, complaint and/or program cancellation policies, please visit our website:

We have a block of rooms reserved at a special rate of

$179/night. This rate expires on June 2, 2018; although, we expect the block to sell out prior to this date. To receive a room at the negotiated rate book well before the expiration


date. Mention the “RISE Quality Leadership Summit” when placing your room reservation by phone to receive the negotiated rate. We urge you to book your room early as we

Health Plans & Providers Service Providers & Consultants

Early Bird Rate


ends 5/18/18


$ 1795

$ 1995

$ 1995

$ 2195

expect the block will sell out. Upon sell out of the block room rate and availability will be at the hotel’s discretion. Please call (602) 955-6600 to book your room or click on the link: About the hotel: Since 1929, the Arizona Biltmore, a Waldorf Astoria Resort, has been a destination of inspiration and unforgettable



memories. An “Editor’s Pick” in Conde Nast Traveler’s Gold List 2018, the resort features thirty-nine acres of gardens, eight swimming pools, championship golf, Spa Biltmore and an array of restaurants amidst iconic architecture and majestic mountain views.


CPE CREDITS Financial Research Associates is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National

RISE (Resource Initiative & Society for Education) Vision: To build a community and an educational system that promotes successful careers for professionals who aim to advance the quality, cost and availability of health care. RISE provides: • A forum to build professional identity and a network of colleagues

Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: Program Level: Overview Anticipated CPE Credits: 14 Recommended Field(s) Of Study: Specialized Knowledge

• A platform to capture and share knowledge and insights

Prerequisites: None

• A venue to develop and share benchmarks and document

Advance Preparation: None

best practices

Instructional Delivery Method: Group Live

• Career track development support

Learning Objectives: Upon completing the course,

• A channel for building alliances, partnerships and

participants will:

affiliations that fulfill the vision RISE (Resource Initiative & Society for Education) Mission: RISE is the first national association totally dedicated to enabling healthcare professionals working in organizations and aspiring to meet the challenges of the emerging landscape of accountable care and health care reform. We strive to serve our members on four fronts: Education, Industry Intelligence, Networking and Career Development. To learn more about RISE and to join, visit us online:

• Understand how to use the latest strategies telemedecine strategies to boost quality scores • Learn how to improve ratings by implementing a medication advisor program • Understand the latest insights on regulatory changes from CMS and NCQA For more information, visit our website:


SPONSORSHIP AND EXHIBIT OPPORTUNITIES Enhance your marketing efforts through sponsoring a special event or exhibiting your product at this event. We can design custom sponsorship packages tailored to your marketing needs, such as a cocktail reception or a custom-designed networking event. To learn more about sponsorship opportunities, please contact Kevin Weigel at 704.341.2448 or

SPONSORS PL AT I N U M Health Data Decisions provides strategic and analytic consulting related to quality, efficiency and population health. We help health plans, atrisk provider groups and analytics vendors to maximize the use of their data for predictive and retrospective measurement and modeling. Our team brings decades of experience with measurements including HEDIS, Stars, QRS, AHRQ and P4P in management, analytics, and programming. We can manage your team, your vendors and your data to improve your HEDIS 2017 project. Talk to us about improving the value of your data and your overall measure rates. Matrix Medical Network brings care directly to individuals in their homes through its clinical network of 4,000 providers spanning all 50 states. Matrix providers deliver innovative revenue, quality and care management services in support of the country’s leading health plans and atrisk provider organizations. Leveraging advanced analytics and leading-edge technologies, Matrix achieves unprecedented engagement of plan members and patients to improve quality of care and outcomes, while generating positive impact for healthcare payors. Matrix solutions include risk adjustment, quality gap closure, community and needs assessments, care management and post-acute support. Matrix supports populations of all ages from infants to seniors across all plan types including Medicare, Medicaid, Commercial and Exchange. Pulse8 is the only Healthcare Analytics and Technology Company delivering complete visibility into the efficacy of your Risk Adjustment and Quality Management programs. We enable health plans and providers to achieve the greatest financial impact in the Medicare Advantage, Medicaid, and ACA Commercial markets as well as with Value-Based Payment models for Medicare. Pulse8 has developed a suite of uniquely pragmatic solutions that are revolutionizing Risk Adjustment and Quality Management. Our advanced analytic methodologies and flexible business intelligence tools offer real-time visibility into member behavior and provider performance. Pulse8’s products are powered by our patent-pending Dynamic Intervention Planning to deliver the most cost-effective and appropriate interventions for closing gaps in documentation, coding, and quality. For more company information or to schedule a demo, please contact Scott Filiault at (732) 570-9095 or You can also visit us at, and follow us on Twitter @Pulse8News.


GOLD DST Health Solutions, LLC delivers contemporary healthcare technology and service solutions that enable its clients to thrive in a complex, rapidly evolving healthcare market. Supporting commercial, individual, and government-sponsored health plans, health insurance marketplaces, and healthcare providers, DST Health Solutions’ services include enterprise payer platforms, population health management analytics, care management, and business process outsourcing solutions, each designed to assist a company manage the processes, information, and products that directly impact quality outcomes. DST Health Solutions is a wholly-owned subsidiary of DST Systems, Inc. For more information visit Episource provides a complete and integrated set of services and products to simplify the way Medicare, Commercial and Medicaid health plans manage their Risk Adjustment and Quality programs. We work with health plans and healthcare organizations to absorb the most challenging aspects of program implementation, operations, and management. We simplify by modernizing workflows to better assess the full cycle of Risk Adjustment and Quality programs to improve clinical outcomes and financial performance. Our services include: Retrospective Chart Reviews, HCC Gaps and RAF Campaign Workflow (epiAnalyst), Encounter Data Error Resolution and Financial Analytics (epiEncounter), HEDIS & STARS Analytics & Reporting, Gaps in Care Reporting, and HEDIS Retrieval & Abstraction. We also offer clinical services such as HRAs (Health Risk Assessments) and NP programs. For more company information, please contact Claudia Gallardo at (424) 295-0491, visit us at, or follow us on Twitter @ EpisourceLLC HealthCrowd is the industry’s first end-to-end communications solution for payers. Our vision? To transform healthcare communications from tactical activity to strategic lever. The company’s product suite comprises its flagship Unified Communications Platform, Clairvoyance(TM) for advanced campaign analytics, and HealthNeuron(TM) to comply with federal and industry regulations around digital member outreach. HealthCrowd helps health plans unify, automate and optimize multimodal communications to deliver member-centric engagement, at scale, in a risk-managed way. The impact is profound: A positive difference in members’ perception of health plan communications and significant, quantifiable savings to the health plan.


NovuHealth is the health care industry’s leading consumer engagement company. Combining performance analytics, behavior science and comprehensive technology solutions, our rewards and engagement programs enable health plans to increase high-value member activities— improving member health and driving plan performance.

PharmMD is a leading healthcare technology company providing data-driven medication adherence platform solutions that deliver valuebased care outcomes. PharmMD partners with health plans, providers and other risk-bearing entities seeking to improve patient and employee healthcare through better medication adherence. Founded by healthcare and pharmaceutical innovators, PharmMD’s outcomesdriven solutions bolster initiatives in quality improvement and related regulatory compliance through better medication adherence. For more information, please visit Advantmed is an integrated risk adjustment optimization and quality improvement company dedicated to helping health plans and riskbearing entities. Our ELEVATE! Healthcare™ platform delivers fully transparent insights for all of our solutions, which include: •

Medical Record Retrieval (Risk Adjustment/HEDIS®)

Risk Adjustment Coding (MA/ACA/Medicaid

Clinical Abstraction (HEDIS)

Risk Adjustment Suspecting & Targeting (MA/ACA)

CMS & HHS RADV Support/Data Validation

NCQA-Certified HEDIS Software (Measuring & Reporting)

Health Risk Assessments (In-Home/In-Office)

To learn more about Advantmed, visit us online at Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of the National Committee for Quality Assurance (NCQA).


S I LV E R Eliza, an HMS Company gets modern healthcare consumers to act by engaging them in personalized conversations at enterprise scale. Your top priorities have never been clearer: improved quality, better cost management, incremental revenue generation, and a better consumer experience. The Eliza Health Engagement Management solution integrates a scalable multi-channel technology platform, proprietary data sources, industry leading analytics, and experience-driven program design to help clients achieve outcomes that make a difference. InComm Healthcare & Affinity, formerly Medagate, has been a wholly owned subsidiary of InComm since 2012. By combining our pointof-sale and customized-spend payment capabilities with InComm’s wide-reaching distribution and redemption network, InComm Healthcare & Affinity builds innovative and intelligent methods of driving member engagement and brand awareness. Learn more at Inovalon is a leading technology company providing cloud-based platforms empowering a data-driven transformation from volume-based to value-based models throughout the healthcare industry. Through the Inovalon ONE™ Platform, Inovalon brings to the marketplace a national-scale capability to interconnect with the healthcare ecosystem on massive scale, aggregate and analyze data in petabyte volumes to arrive at sophisticated insights in real-time, drive impact wherever it is analytically identified best to intervene, and intuitively visualize data and information to inform business strategy and execution. Leveraging its platform, unparalleled proprietary data sets, and industry-leading subject matter expertise, Inovalon enables the assessment and improvement of clinical and quality outcomes and financial performance across the healthcare ecosystem. From health plans and provider organizations, to pharmaceutical, medical device, and diagnostics companies, Inovalon’s unique achievement of value is delivered through the effective progression of “Turning Data into Insight, and Insight into Action®.” Providing technology that supports nearly 500 healthcare organizations, Inovalon’s platforms are informed by data pertaining to more than 903,000 physicians, 385,000 clinical facilities, and more than 231 million Americans.




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Qualipalooza: The 3rd Annual RISE Quality Leadership Summit  

Qualipalooza is the year's must-attend mega event for leading-edge quality improvement strategies delivered in an innovative format.

Qualipalooza: The 3rd Annual RISE Quality Leadership Summit  

Qualipalooza is the year's must-attend mega event for leading-edge quality improvement strategies delivered in an innovative format.