RISE Radio

Revenue cycle success increasingly depends on an organization's ability to access, exchange, validate, and use data across a growing health care ecosystem. Documentation quality, coding accuracy, and compliant billing practices have supported performance for decades. Today, those foundations must connect with a broader approach to data.

Financial performance, audit readiness, and compliance increasingly depend on more than coding and billing. As interoperability requirements expand and regulatory expectations evolve, revenue cycle leaders need to understand how readily data moves across organizations, how it is governed, and how organizations work together.

In this 30-minute episode, Dawn Carter, senior director of health policy and regulatory affairs at Centauri Health Solutions, explains how health care organizations can turn regulatory and interoperability initiatives into practical operational advantages. She shares strategies for building a unified, data-driven revenue integrity model by aligning coding, CDI, audit, compliance, analytics, and payer engagement efforts.

About Dawn Carter

Dawn Carter, BSBA, MHA, CPC, CRC, CPMA, CDEO, CPCO, AAPC Fellow, is the senior director of health policy and regulatory affairs at Centauri Health Solutions, with over 30 years of experience in the health care industry. She has a proven track record of success in developing innovative products and services for the Medicare Advantage, Medicaid, and commercial health plan markets and is a sought-after industry speaker and author as well as independent consultant and educator.

She holds a Bachelor of Science in Business Administration and a Master of Science in Healthcare Administration and is currently pursuing a Doctorate in Business Administration and Healthcare Management. She is a member of the American College of Healthcare Executives (ACHE) and is a Fellow of the American Academy of Professional Coders (AAPC). Her extensive AAPC certifications and recent appointment to the AAPC National Advisory Board for the 2025 -2027 term further demonstrate her deep commitment to knowledge and expertise in the health care field.

About Centauri Health Solutions

Centauri delivers data-driven technology solutions that transform fragmented clinical and member data into actionable intelligence—maximizing accuracy, quality performance, and outcomes for health plans and health systems. Through close collaboration with our customers, Centauri improves patient and member outcomes by providing advocacy, advanced data insights, and intelligent clinical data delivery future-proofed for interoperability.

The rules of health care quality are changing fast, and the biggest shift is simple to say but harder to execute. Our latest episode focuses on this fundamental shift in health care quality performance, the future of digital quality, and the multi-pronged approach organizations need to stay ahead. 

Our guest, Shariff Baseer, vice president of product, quality, at Optum, unpacks what the CMS and NCQA digital quality roadmap really means for health plans, especially as STARS and HEDIS performance becomes more dependent on interoperable clinical data, eCQMs, dQMs, and IDSS total-population reporting.

About Shariff Baseer

Shariff Baseer is the vice president of product, quality for Optum and has almost a decade of industry experience building health care products. He specializes in quality and member engagement. Prior to his current role, he has spent time enhancing risk adjustment products focusing on advanced analytics in this area. Baseer has an MBA degree from Indiana University of Pennsylvania and engineering from VTU, India.

About Optum

Optum is a trusted information and technology-enabled health services business dedicated to helping make the health system work better for everyone. With more than 315,000 people worldwide, Optum delivers intelligent, integrated solutions that help to modernize the health system and improve overall population health. Click here to learn more about its risk and quality solutions.

In our latest episode, we break down the biggest findings from Reveleer's  "The State of Technology in Value-Based Care 2026," a report based on a survey of 200 senior payer and provider executives. 

During this 26-minute discussion, Reveleer President and CEO Jay Ackerman weighs in on the growing gap between fast AI adoption and slow accountability. He shares what payers and providers can do now to improve governance, data confidence, and audit readiness before pressure peaks. 

About Jay Ackerman
Jay Ackerman is chief executive officer and president of Reveleer, where he directs the company's vision, strategy, and growth across risk adjustment, quality improvement, and clinical intelligence. He has spent more than 30  years in health care technology leadership, including prior roles as chief revenue officer at Guidance Software and senior positions at ServiceSource and WNS. He holds an MBA from NYU's Stern School of Business and a bachelor's degree in economics from Connecticut College.

About Reveleer

Reveleer, a health care software and services company, uses machine learning and intelligent automation technology to empower health plans control over their quality improvement, risk adjustment, and member management programs. With one transformative solution, Reveleer allows plans to independently execute and manage provider outreach and data retrieval, coding, abstraction, member management, and reporting. Reveleer leverages proprietary technology, robust data sets, and subject matter expertise, so health plans can execute programs that deliver value and improved outcomes.

About the report

The 2026 State of Technology in Value-Based Care report is based on a national online survey of 200 U.S.-based senior decision-makers at value-based care organizations.

Reveleer collaborated with Mathematica, a policy data and analytics company, to analyze the findings. The report identifies a widening accountability gap across value-based care operations. Organizations are deploying more technology than ever before, but many still rely on manual workflows, lack confidence in their data, and lack the processes needed to validate AI-driven outputs. The findings reveal how far adoption has outpaced the governance and operational discipline required to support it.

 Click here to download the report. For additional insights, listen to the Reveleer-RISE webinar, AI Governance, Audit Readiness, and the Defensibility Standard in Value-Based Care.

In this episode of RISE Radio, we share an excerpt from the April 29 RISE webinar featuring Ana Handshuh, principal at CAT5 Strategies, and Melissa Smith, founder of Newton Smith Group, as they walk through the 2027 Medicare Advantage Final Rule.

This episode focuses on what Medicare Advantage plans need to know about flex card and Special Supplemental Benefits for the Chronically Ill (SSBCI) changes, including: 

• Codified flex card and debit card disclosures for benefits, conditions, and limitations
• Alternate pathways when members cannot use the card due to technical or non-technical barriers
• SSBCI determinations that require both chronic illness criteria and benefit-level health impact rationale
• Publicly posted eligibility criteria and the operational labor required ahead of January 1, 2027

To listen to the entire 75-minute webinar, including their deep dive into the Star ratings redesign, click here or visit risehealth.org to access our webinar library.

Dawn Carter, senior director of health policy and regulatory affairs at  Centauri Health Solutions, joins RISE Radio for a lively discussion on the five skills health care leaders need to succeed in value-based care, starting with how to turn analytics into decisions that actually change outcomes. 

During this hour-long episode, Carter shares practical frameworks for working with data, regulations, interoperability, strategic storytelling, and social determinants of health.

To learn more, see Carter in person at RISE National March 23-25 in Orlando where she will lead an interactive "Bingo" game roundtable discussion to uncover smarter strategies for risk adjustment. She'll also speak at the upcoming RISE webinar on interoperability that powers SDoH referral loop closure in value-based care on April 28 at 2 p.m. EDT.

About Dawn Carter

Dawn Carter, BSBA, MHA, CPC, CRC, CPMA, CDEO, CPCO, AAPC Fellow, is the senior director of health policy and regulatory affairs at  Centauri Health Solutions, with over 30 years of experience in the health care industry. She has a proven track record of success in developing innovative products and services for the Medicare Advantage, Medicaid, and commercial health plan markets and is a sought-after industry speaker and author as well as independent consultant and educator.

She holds a Bachelor of Science in Business Administration and a Master of Science in Healthcare Administration and is currently pursuing a Doctorate in Business Administration and Healthcare Management. She is a member of the American College of Healthcare Executives (ACHE) and is a Fellow of the American Academy of Professional Coders (AAPC). Her extensive AAPC certifications and recent appointment to the AAPC National Advisory Board for the 2025 -2027 term further demonstrate her deep commitment to knowledge and expertise in the health care field.

About Centauri Health Solutions

Centauri delivers data-driven technology solutions that transform fragmented clinical and member data into actionable intelligence—maximizing accuracy, quality performance, and outcomes for health plans and health systems. Through close collaboration with our customers, Centauri improves patient and member outcomes by providing advocacy, advanced data insights, and intelligent clinical data delivery future-proofed for interoperability.

In this 20-minute episode of RISE Radio, Editorial Director Ilene MacDonald sits down with Dr. Matt Lambert, the former chief medical officer at Reveleer, to unpack the rapidly evolving landscape of Medicare Advantage risk adjustment. Together, they discuss the implications of the 2027 Advance Notice, new OIG compliance guidance, and the industry’s shift toward encounter-based, prospective risk adjustment. 

Dr. Lambert explains how hybrid AI—combining generative AI with long‑standing clinical rules—can improve accuracy, reduce false positives, and streamline workflows for providers, payers, and risk adjustment teams. He also shares practical strategies for organizations beginning this transition, emphasizing partnership, user‑friendly workflows, and technology that meets clinicians at the point of care.

About Matt Lambert, M.D. 

Dr. Matt Lambert, is the former chief medical officer at Reveleer and a leader in health care innovation, blending clinical expertise with technology, policy, and payment strategies. He previously served as CMO of Curation Health (acquired by Reveleer in 2024) and led digital transformation at Clinovations and The Advisory Board. He has been CMIO for New York City Health + Hospitals, RWJ Barnabas, and Johns Hopkins, overseeing Epic and Cerner implementations. An emergency medicine physician for 20+ years, he authored two books on health care reform. He earned his MD from Marshall University and trained at West Virginia University. 

About Reveleer

Reveleer, a health care software and services company, uses machine learning and intelligent automation technology to empower health plans control over their quality improvement, risk adjustment, and member management programs. With one transformative solution, Reveleer allows plans to independently execute and manage provider outreach and data retrieval, coding, abstraction, member management, and reporting. Reveleer leverages proprietary technology, robust data sets, and subject matter expertise, so health plans can execute programs that deliver value and improved outcomes. Click here for Reveleer’s Guide to AI in Value-Based Care.

Join RISE Radio Editorial Director Ilene MacDonald for this 15-minute episode that explores how agile engagement replaces slow, campaign-centric outreach with rapid testing, hyper-personalization, and real-time learning that lower cost of care and raise member trust. 

Our guest is Kathleen Ellmore, cofounder and managing partner of Engagys, a health care consumer engagement consulting and advisory services firm, who shares proof points, practical steps, and why 2026 is the moment to act.

About Kathleen Ellmore

Kathleen Ellmore, cofounder and managing partner of Engagys, is one of the earliest pioneers in bringing the best of consumer marketing and data-driven methodologies to health care. Instead of getting you to eat when you are not hungry and buy things you don’t need, Ellmore uses the same strategies to instead change the health equation in America. 

Ellmore previously led the consumer engagement consulting practice for Welltok (formerly Silverlink) for 12 years, leveraging its data repository of over a billion consumer health interactions, the best of behavioral economics, and the latest in clinical research, to create evidenced-based communications on what works to drive consumer health care behavior yielding better outcomes and lower costs. She is often quoted in the trade and national press and is a regular speaker on the national stage, having spent the first 20 years of her career in brand marketing at leading consumer marketing organizations, including General Mills and P&G. 

She also was a vice president at Digitas, a leading direct marketing firm. Recently she was selected as consultant member of the first ever FDA’s Patient Engagement Advisory Committee.

About Engagys

Founded in 2017, Engagys is a leading health care consumer engagement consulting and advisory services firm. With decades of combined experience in health care and having deployed hundreds of engagement and marketing projects, Engagys has driven significant value in revenue generation, consumer behavior change, and more.

In this hour-long episode of RISE Radio, Editorial Director Ilene MacDonald sits down with industry experts to break down the changes in CMS’ 2027 Medicare Advantage and Part D proposed rule, why removing 12 measures and bringing back the reward factor is a true Stars redesign, and how plans can pivot from operational wins to outcome performance. We also explore the new depression screening measure and the new SEP when providers exit networks, with clear steps to protect quality and retention.

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. 

For more on these changes, join us at The RISE Star Ratings Master Class, December 16-18 in Frisco, Texas or RISE National 2026, March 23-25 in Orlando, Fla. 

As regulatory pressures intensify and the demand for measurable ROI grows, health care organizations are rethinking how they approach risk adjustment. The landscape is shifting—from retrospective reviews to real-time, proactive strategies powered by smarter technology and deeper clinical insight.

In this 38-minute episode of RISE Radio, senior leaders from Cotiviti and Edifecs share how their recent partnership is fueling a new era of innovation across the full risk adjustment lifecycle. From Medicare Advantage to Medicaid and ACA markets, they explore how scalable tech, strategic foresight, and clinical expertise are helping organizations stay ahead of compliance demands and financial pressures.

About the speakers

Branka Sustic, vice president of risk and quality solutions, Cotiviti, provides leadership and oversight into product and business development, client program management, and strategy to assist health plans in meeting their quality and risk adjustment goals, optimization of revenue, and risk mitigation. She is a leader with more than two decades of health care experience, blending a strong customer service and analytic foundation with experience leading change management throughout her career. Sustic is known for creating and establishing operational and support plans leading to increased client satisfaction and performance. 

Dr. Summerpal Kahlon, chief medical officer at Edifecs, a Cotiviti business, works across products and functions to guide clinical strategies and policies. His career spans over 20 years of experience in diverse health care settings, businesses, and markets. Dr. Kahlon has deep expertise in value-based care and risk adjustment, and brings unique insight to help customers make the most comprehensive, informed, and clinically relevant decisions for their populations. He is a practicing physician with Veterans Affairs and an assistant professor of internal medicine at the University of Central Florida. 

About Cotiviti

Cotiviti enables health care organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States. Cotiviti’s solutions increase transparency and collaboration between payers and providers while empowering them to reduce medical and administrative costs, enable better health, improve claims payment efficiency, streamline operations, drive interoperability, and advance value-based care. Its customers serve the majority of U.S. health care consumers, providing coverage and care for over 300 million members and patients.

Medicare Advantage plans are about to face unprecedented scrutiny as the Centers for Medicare & Medicaid Services (CMS) implements a dramatically expanded approach to RADV audits. Starting in 2025, every Medicare Advantage plan will be subject to contract-level RADV audits—a significant departure from the historical approach of randomly selecting 60 plans annually.
 
During this 17-minute podcast, Deborah Curry, risk adjustment programs director at Medical Mutual. breaks down the critical changes that compliance teams need to prepare for immediately. She offers practical strategies for surviving this new audit environment, emphasizing the importance of designated backup personnel, weekly progress huddles, and careful oversight of vendors retrieving medical records. 

Whether you're already facing a RADV audit or preparing for the inevitable, this episode provides essential guidance for navigating CMS' aggressive new approach. For deeper insights, join RISE in Tampa, Fla. on October 21-23 for the 26th Risk Adjustment Forum, where Curry will be sharing additional strategies for RADV readiness.

About Deborah Curry

Deborah Curry, risk adjustment programs director, Medical Mutual, joined Paramount Healthcare in May 2013 and oversees the Risk Adjustment, Coordination of Benefits, and Subrogation departments. Prior to her position with Paramount, she had 21 years’ experience working with the State of Ohio workers’ compensation program, both for the government and a contracted managed care organization. She came to Paramount with extensive knowledge in medical coding, provider billing and education, Medicare payment methodologies, quality assurance, and regulatory compliance.

Curry attended The University of Toledo for both her undergraduate and graduate degrees and currently holds a Master of Business Administration with major in Healthcare Systems Management. She is an active member of the American Health Information Management Association (AHIMA) and is a Registered Health Information Administrator (RHIA) and Certified Coding Specialist, physician based (CCS-P).Curry is also an active member of the America Academy of Professional Coders (AAPC) and is a Certified Risk Adjustment Coder (CRC). She holds certificates as a Risk Adjustment Practitioner (RAP) and Advanced HCC Auditor (AHCCA and serves as a Board Member of the University of Toledo Health Information Administration Advisory Board, Health and Human Services Alumni Affiliate at The University of Toledo, and Health Information Technology Advisory Committee at Owens Community College.

About the Risk Adjustment Forum

RISE’s Risk Adjustment Forum is designed for leaders in risk adjustment, coding, compliance, finance, and analytics across Medicare Advantage, Medicaid, Affordable Care Act, and commercial plans. 

The three-day event, which will take place Oct. 21-23 at the Grand Hyatt Tampa Bay, will tackle RADV audit ramp‑up and extrapolation, the Big Beautiful Bill Act, V28/RxHCC shifts, internal audit design, and CDI.