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]

Breanna Krebs, the director of customer success at Apixio, joins 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 11-minute podcast, Krebs discusses the impact of the double sweeps occurring this July and next January related to the extension deadline for submitting risk adjustment data for use in the risk score calculation run that the Centers for Medicare & Medicaid Services (CMS) implemented due to the COVID-19 pandemic; what the end of the extension deadline means; potential challenges to the return of regular submission deadlines in a post-pandemic landscape; and best practices to stay ahead of these compressed deadlines and ensure the accuracy of your risk adjustment data submissions to CMS.

Deadlines for the 2023 sweeps of risk adjustment data are as follows:

• Tuesday, January 31: Interim run of first sweep for dates of service January 1-December 31, 2021
• Monday, July 31: Final run or second sweep for dates of service January 1-December 31, 2021

About Breanna Krebs
Breanna Krebs oversees the relationships and supports the services delivered to Apixio’s clients. With over 20 years in health care, she has a strong understanding of the core components that drive customer success and uses this ability to work with external vendors and cross-functionally to ensure business deliverables and client needs are aligned. Prior to joining Apixio in 2015, Krebs was a vice president of development at Quirk Healthcare Solutions, where she created, trained, and mentored technical teams in India, Ukraine, Mexico, and the United States to provide development services and support for clients and internal software solutions for Quirk Healthcare. At Muir Medical Group IPA, she provided technical leadership to identify areas for system improvements and ensure projects met customer expectations and budget parameters. She holds a Bachelor of Arts degree in Sociology from the University of Oregon.

About Apixio
Apixio is advancing value-based care delivery with data-driven intelligence and analytics. Its AI-powered Apicare platform gives value-based care organizations across the health care spectrum the power to mine clinical information at scale, creating meaningful insights that will change the way health care is measured, care is delivered, and value is realized.

Dr. Jasmine Zapata joins 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.

“Dr. Jaz,” a keynote speaker at the upcoming RISE Women in Health Care Leadership Summit, Dec. 14-15 at the InterContinental San Diego, will discuss finding and pursuing your passion.

In this 20-minute podcast, Dr. Jaz discusses how to find time to take care of yourself to lead at a high level in all other areas of your life. She demonstrates this practice daily in her own life. She is an award-winning author, speaker, and double board-certified physician who specializes in the fields of pediatrics and public health. As a medical doctor, she does public health research, works in the hospital caring for newborn babies, trains new doctors, and serves as a state public health official. 

Outside of her medical roles, she is extremely passionate about mentorship and girl empowerment and describes her mission in life as one to heal, uplift, and inspire. Dr. Jaz is the founder of the Beyond Beautiful Girls Empowerment Movement, which helps girls increase their confidence, self-esteem, and leadership skills. Beyond Beautiful means you are more than what people see on the outside—your true beauty is within! The Beyond Beautiful books, live events, music, and courses have now reached schools, churches, health systems, and nonprofits both nationally and internationally. 

Attendees of The RISE Women in Health Care Leadership Summit who attend her fireside chat will receive a copy of her book, Beyond Beautiful.

To learn more about the Beyond Beautiful Girls Empowerment Movement, visit www.BeyondBeautifulTour.org and https://madison365.com/beyond-beautiful-celebration-an-afternoon-of-pure-joy/.

Click here to connect with Dr. Jaz. 

Five panelists who will speak about health policy at the upcoming RISE West 2022 conference join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.

They’ll speak on the first day of RISE West 2022, September 1, at the InterContinental Los Angeles Downtown.

Our guests include:

·       Sean Creighton, managing director of Avalere

·       Michael Adelberg, providers and plans lead,  Faegre Drinker Consulting

·       Dave Meyer, a member of the RISE Risk Adjustment Policy Committee

·       Mikal Sutton, managing director, Medicaid policy, Blue Cross Blue Shield Association

·       Krutika Amin, associate director for program on the ACA for the Kaiser Family Foundation

During this 36-minute podcast, our panelists address a wide range of topics, including Medicare drug pricing negotiations, the uncertainty of Affordable Care Act expansion, Medicare Advantage (MA) equity elements and supplementary benefits that address social determinants of health, RADV, Medicaid redeterminations, Medicaid expansion, the end of the COVID-19 public health emergency, and the future of telehealth flexibilities.