Welcome to the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health.

Special thanks to DUOS for sponsoring this episode, which features Ana Handshuh, principal of CAT5 Strategies, and Jenn Kerfoot, chief strategy and growth officer, DUOS, discussing the impact of the election on Medicare Advantage and the potential changes ahead under President-elect Donald Trump’s nominees: Robert F. Kennedy Jr. as HHS secretary and Dr. Mehmet Oz as CMS administrator.

During this 55-minute podcast, they discuss the overall outlook for Medicare Advantage, as well as regulations that address marketing practices, prior authorization, Star ratings, health equity, and social determinants of health.

About Ana Handshuh
Ana Handshuh, principal at CAT5 Strategies, is a government programs executive with expertise in creating and implementing corporate programs for the health care industry. Her background includes quality, core measures, care management, benefit design and bid submission, accreditation, regulatory compliance, revenue management, communications, community-based care management programs and technology integration. She is a sought-after speaker on the national health care circuit in the areas of quality, Star ratings, care management, member and provider engagement, and revenue management.

About Jenn Kerfoot
Jenn Kerfoot, chief strategy & Growth officer, DUOS, is a visionary health care leader with deep expertise in Medicare Advantage and value-based care. Kerfoot leverages her extensive background in health care policy, regulation, and business development to drive strategic growth and innovation at DUOS, developing tailored solutions that meet the evolving needs of Medicare Advantage plans. A seasoned podcast host, Kerfoot regularly explores critical issues like the looming threat of Medicare insolvency, the challenges of financing care for an aging population, the impact of rising health care costs, and disparities in care access. With previous leadership roles at FarmboxRx, Excelera Health, and NationsBenefits, Kerfoot has a proven track record of navigating complex health care regulations and aligning strategies with market demands. Beyond her executive role, she is a recognized thought leader and advocate for progressive health care practices, advising venture capital and private equity firms on investments in transformative health care solutions. Kerfoot’s pragmatic optimism and relentless problem-solving approach are key to her success in fostering collaboration and pushing the boundaries of what’s possible in health care.

About DUOS
DUOS is a health care technology company building solutions to improve plan performance and enhance the continuum of care. Our AI-powered digital experiences match social determinants of health (SDoH) and care navigation needs with more than 100,000 Medicare benefits, community resources and government programs to improve health outcomes and beneficiary satisfaction and close gaps in care. 

Join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health.

Katie Devlin, DHSc, MS, CPHIMS, vice president of interoperability at Cotiviti, returns to RISE Radio and is joined by Adam Gilbert, director of interoperability operations and partnerships at Cotiviti, for this 23-minute episode. They discuss the latest regulatory requirements, what to expect for 2025, challenges, and best practices to implement a robust digital data strategy.

About Katie Devlin
Katie Devlin, DHSc, MS, CPHIMS, vice president, interoperability, Cotiviti, Inc. is responsible for creating an enterprise-wide health data exchange strategy to address clients’ unique business needs while reducing provider abrasion, maintaining regulatory compliance, and optimizing value. She oversees all initiatives related to digital health data acquisition, ingestion, storage, and normalization, including the expansion of Cotiviti’s electronic health data networks and strategic partnerships. Drawing on her extensive informatics and health information exchange experience, she is an advocate for ensuring health information is delivered in a way that enhances the member, provider, and payer experience.

About Adam Gilbert
Adam Gilbert, director, interoperability operations and partnerships, works collaboratively with payers, providers, and vendors to increase the use of clinical data exchange. With over 20 years of experience in health care operations and consulting, He is committed to enhancing the health care landscape through effective interoperability strategies and operational excellence. Prior to joining Cotiviti, he held senior management roles at Change Healthcare and McKesson. 

About Cotiviti
Cotiviti enables health care organizations to deliver better care at lower cost through advanced technology and data analytics, helping to ensure the quality and sustainability of how health care is delivered in the United States. Cotiviti’s solutions are a critical foundation for health care payers in their mission to lower health care costs and improve quality through higher performing payment accuracy, quality improvement, risk adjustment, consumer engagement, and network performance management programs. The company also supports the retail industry with data management and recovery audit services that improve business outcomes. 

During this 20-minute podcast, Melissa James, senior consultant at Wolters Kluwer, Health Language, provides insight into RADV audits for coders, auditors, coding managers, senior leaders, chief financial officers, and chief executive officers. She discusses the latest news; technology, such as AI, that can assist Medicare Advantage organizations with audit preparation and project management; and the best strategies to prepare for audits.

About Melissa James
Melissa James, CPC, CPMA, CRC, risk adjustment SME, senior consultant, Wolters Kluwer, Health Language, supports the company's Health Language solutions with content maintenance. She has more than 20 years of health care experience in coding, risk adjustment, billing, physician and coder education, accounts receivable management, regulatory and compliance, and consulting. She received her associate degree from Pueblo Community College.

About Wolters Kluwer
Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers, and the next generation of healthcare providers. With a focus on clinical effectiveness, research and learning, clinical surveillance and compliance, as well as data solutions, our proven solutions drive effective decision-making and consistent outcomes across the continuum of care.

Dawn Carter,  director of product strategy at Centauri Health Solutions, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health.

In this 23-minute podcast, recorded on April 18, Carter discusses the shift from the V24 to V28 risk model, the coding changes, and its risk adjustment applications. 

About Dawn Carter 

Dawn Carter, BSBA, CPC, CRC, CPMA, CDEO, CPCO, CSPO,  is a director of product strategy at Centauri Health Solutions. Her career in health care spans 25 years, which most recently includes extensive experience in developing revenue integrity and quality software solutions, with a focus on encounter management and risk adjustment solutions for Medicare Advantage, Medicaid, and Commercial health plans. 

She also provides strategic advisory solutions and consulting services for revenue cycle operations. Prior to that, her experience spans all domains of health care including health plan claims and provider systems administration, and healthcare applications development. Her experience also includes multiple teaching engagements in medical administration, billing, and coding. Carter holds a bachelor’s degree in business administration. She is a passionate and prolific industry speaker, author, blogger and subject matter expert in claims, EDI management, and risk adjustment. 

 About Centauri Health Solutions 

Centauri Health Solutions is a leading provider of technology-enabled analytics and services helping health plans and health systems to manage their variable revenue linked to population health (risk), quality, and eligibility factors. These efforts result directly in better-informed health care delivery, richer benefits, and reduced out-of-pocket healthcare costs for the members and patients they serve. 

Welcome to the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health.

Our guests are Ana Handshuh, principal of CAT5 Strategies, Melissa Smith, founder and senior advisor of the Newton Smith Group, and Rex Wallace, founder & principal of Rex Wallace Consulting. 

During this 70-minute podcast, they discuss the major changes in the 2025 Medicare Advantage Final Rule that the Centers for Medicare & Medicaid Services released on April 4. The conversation delves into the Medicare Advantage marketing changes, including supplemental benefits and compensation to MA brokers and agents; dual eligible special needs plans (D-SNPs); network adequacy standards; Star rating measures; and strategies for compliance. 

For more on these changes, check out RISE’s upcoming spring conferences:

Special Needs Plan Leadership Summit, May 1-3 in New York City

Risk Adjustment Forum, May 20-22 in New Orleans

Qualipalooza 2024, June 2-4 in Atlanta 

Errol Pierre, senior vice president of state programs at Healthfirst, the largest nonprofit health plan in New York, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health.

Pierre will be a featured speaker at RISE’s Medicaid Managed Care Leadership Summit, a virtual event, that will take place April 2-3. The virtual summit will explore how Medicaid managed care organizations can provide quality care to high-risk populations, connect with hard-to-reach patients, and ensure their financial viability.

During this 22-minute podcast, Pierre offers his thoughts on the end of the continuous enrollment provision, how to educate members about the recertification process, and his concerns about the impact on health of members who can’t be reached and drop off Medicaid. 

Calum Yacoubian, M.D., director of NLP health care strategy at IQVIA, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health.

In this 21-minute podcast, Dr. Yacoubian discusses natural language processing (NLP) and why it’s vital to use in health care for risk adjustment, quality,  social determinants of health, and health equity. 

About Calum Yacoubian, director of NLP health care strategy, IQVIA

Dr. Calum Yacoubian is director of health care product & strategy at linguamatics, IQVIA. He is a medical doctor who trained and practiced in the UK before moving into medical technology. He has worked with NLP in clinical data for seven years and is passionate about the potential for data to drive improved patient outcomes. 

Dr. Yacoubian’s work has focused on the use of automatic deep phenotyping from the EHR to support a variety of use cases, from population health to rare disease diagnosis. He works closely with users in leading academic medical centers–and other areas such as diagnostic labs, to ensure IQVIA’s NLP toolkit remains at the cutting edge of augmented intelligence.

About IQVIA

IQVIA is a leading global provider of advanced analytics, technology solutions, and clinical research services to the life sciences industry. IQVIA NLP unlocks and transforms data, at scale, from bench to bedside. Its leading natural language processing platform is used by 19 of the top 20 pharma, as well as health care organizations and government, to uncover previously hard to reach information or replace manual extraction. 

Katie Devlin, DHSc, MS, CPHIMS, vice president, interoperability, Cotiviti, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health.

In this 21-minute podcast, Devlin, author of the new white paper, Implementing a digital quality strategy,  discusses interoperability, federal requirements,  challenges, and how it supports improved risk adjustment and quality programs.

About Katie Devlin
Katie Devlin, DHSc, MS, CPHIMS, vice president, interoperability, Cotiviti, Inc.,  is responsible for creating  an enterprise-wide health data exchange strategy to address clients’ unique business needs while reducing provider abrasion, maintaining regulatory compliance, and optimizing value. She oversees all initiatives related to digital health data acquisition, ingestion, storage, and normalization, including the expansion of Cotiviti’s electronic health data networks and strategic partnerships. Drawing on her extensive informatics and health information exchange experience, she is an advocate for ensuring health information is delivered in a way that enhances the member, provider, and payer experience. 

About Cotiviti
Cotiviti enables health care organizations to deliver better care at lower cost through advanced technology and data analytics, helping to ensure the quality and sustainability of how health care is delivered in the United States. Cotiviti’s solutions are a critical foundation for health care payers in their mission to lower health care costs and improve quality through higher performing payment accuracy, quality improvement, risk adjustment, consumer engagement, and network performance management programs. The company also supports the retail industry with data management and recovery audit services that improve business outcomes. 

Lyle Mioduszewski, vice president of population health and payer growth for Ciox Health, is our guest for the latest episode of RISE Radio.

In this 26-minute podcast, Mioduszewski discusses social determinants of health (SDoH), data collection and sharing, and best practices for capturing SDoH codes in the medical record.

About Lyle Mioduszewski 

Lyle Mioduszewski is vice president of population health and payer growth for Ciox Health, where he works with risk-bearing entities to understand the utility of social determinants of health data factors, with the goal of improved and equitable outcomes for all individuals. With 20 years of experience throughout the health care continuum, Lyle has clinical expertise in emergency and trauma nursing of adults and pediatric populations, as well as cardiac catheterization and electrophysiology nursing. Lyle has been a leader in the health information technology and medical device industries with previous companies, including McKesson Corporation, PointClickCare (Collective Medical), and Zoll Medical. He is passionate about advancing value-based care modalities, augmenting processes relative to varying health literacies, care collaboration, interoperability, and influencing an end to the opioid epidemic using innovative technologies.  

About Ciox Health

Ciox Health, a Datavant company, provides leading clinical data technology that empowers greater health by unlocking the potential of data in medical records. The company leverages a ubiquitous network of clinical data connections to connect health care decision-makers simply and securely with the data and hidden insights in patient medical records. Ciox helps customers connect, control, and comply in solving last mile challenges in clinical interoperability. Supporting a range of connectivity needs including risk adjustment, research to revenue cycle, Ciox’s solutions include clinical data acquisition, release of information, and coding. 

Lesley Weir, senior director, customer and product success at Veradigm, and Kate Wormington director, product management, analytics at Veradigm Payer Analytics, join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Medicare Member Acquisition & Experience; and Social Determinants of Health.

In this 31-minute podcast, they discuss the risk adjustment and quality changes in the final rules and their recommendations and strategies for organizations going forward.

About Lesley Weir

Lesley Weir, senior director of customer and product success at Veradigm, has over 30 years’ experience in the Medicare Managed Care industry, with specific expertise in operations, risk adjustment, and quality improvement. She has a demonstrated track record of assisting health plans in meeting operational and revenue goals, as well as developing innovative strategies to improve member’s health and experience. Prior to her role at Veradigm, she held various leadership positions at multiple provider-owned Medicare Managed Care Health Plans and a large national plan.  She also spent six years working in the vendor space supporting Medicare Advantage plans across the country with their risk adjustment and quality programs.

About Kate Wormington

Kate Wormington, director, product management, joined Veradigm in January of 2023 leading theQuality Analytics solutions. For the past 20 years, Kate has focused on HEDIS® and quality reporting for both payers and providers.  Kate spent close to 10 years managing complex operations of a quality analytics program supporting HEDIS, CMS Star, IHA AMP, QARR, QRS, and Medicaid State measurement sets for innovative health care organizations.  She has deep experience leading a multi-state Client Success Support and Implementation team, supporting 27 clients across three products.  Additionally, Kate has led an NCQA Data Aggregator Validation (DAV) project team through Cohort 2, and was in the middle of Cohort 4, providing targeted HEDIS standard supplemental data using C-CDA files. She began as a software engineer specializing in software quality, with a Masters degree in IT.   She embraced the business side, utilizing product, project and client management skills. Wormington lives in Denver, Colo., originally from the UK, starting her career in health care working for the National Health Service. 

About Veradigm

Veradigm Payer Analytics (formerly Pulse8) is health care analytics and technology solution delivering complete visibility into the efficacy of your Risk Adjustment, Quality, and Pharmacy Benefit Management programs. Veradigm empowers health plans and providers to eliminate waste and achieve the greatest financial impact in the Medicare Advantage, Medicaid, and ACA Commercial markets as well as with Value-Based Payment models for Medicare. Advanced analytic methodologies and flexible business intelligence tools offer real-time visibility into member behavior and provider performance while also improving efficiency for payers and at-risk providers through high-speed clinical data exchange. Veradigm's patented Dynamic Intervention Planning offers a suite of uniquely pragmatic solutions that identify 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 email [email protected]