RISE Radio

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. 

Ryan Avery, a world record holder, two-time best-selling author, Emmy award winning journalist, and world champion, joins 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.

Avery will be one of the keynote speakers at RISE National 2022, March 7-9, at the Gaylord Opryland in Nashville, Tenn. 

At the age of 25, Avery became the youngest world champion of public speaking in history. Remarkably, he had never given a professional speech prior to event. He competed against 30,000 people from 116 countries to win the Toastmasters World Championships, launching his career as a public speaker. He then used the same principles and strategies he learned winning the contest to other aspects in his life. His mission is to show leaders how to go from A to The in their industry.  

During this 18-minute podcast, Avery shares his thoughts on how COVID changed leadership, aspects that differentiate a leader from the leader, the five “Ds” of achievement, and the leaders who inspire him to become the best he can be. 

Avery will join a roster of more than 150 speakers at RISE National 2022, the #1 trusted source for all things Medicare Advantage, March 7-9, 2022, at the Gaylord Opryland in Nashville, Tenn. Proof of COVID-19 vaccination is required to attend the event. Click here for the full agenda, registration information, and our health and safety protocols. 

Liz Haynes, director of risk adjustment and stars for government programs at Blue Cross and Blue Shield of Kansas City, and Melissa Smith, executive vice president of consulting and professional services at HealthMine, 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 be the keynote speakers at RISE’s 12th annual Star Ratings Master Class, Dec. 14-15, at the Manchester Grand Hyatt, San Diego. 

During this 27-minute podcast, Haynes and Smith offer their thoughts on inflated 2022 Medicare Star ratings, upcoming measurement changes that will likely lead to lower ratings for 2023, and the “holistic approach” plans need to take to prepare for the changes. 

Angela G. Huskey, PharmD, CPE, senior vice president and chief clinical officer at Millennium Health, joins 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.

During this 21-minute podcast, we talk to Dr. Huskey about her work on identifying drug trends, emerging threats,  substance use disorder, and the increase in drug overdose deaths since the COVID-19 pandemic. 

Dr. Huskey will be discussing these findings in greater detail during a special presentation about preventing overdoses at RISE’s Part D Master Class, which will take place August 9-10 in Nashville. 

During this 15-minute podcast, Dr. Abdullah Albeyatti, a family physician in the UK and an advocate for digitalization in health care, talks about practicing medicine during the pandemic, audio-only visits, the challenges and opportunities of telemedicine, and how to get the most from the technology.

Dr. Albeyatti is the CEO and cofounder of Medicalchain, a company that uses blockchain technology to store health records securely, and MyClinic, a telemedicine platform that allows patients to connect with their doctors remotely for free. The platform is now used by health care practitioners in 78 countries. 

Our latest episode of our new podcast series, RISE Radio, explores the positive aspects of working from home as well as the challenges of managing a remote workforce.

During this 18-minute podcast, Colleen Gianatasio, director, ambulatory CDQI at Devoted Health in Waltham, Mass., and Dean Ratzlaff, director, actuary/revenue management for Sentara Health Plans in Virginia Beach, Va., share tips on how to get the most out of your remote workforce while maintaining a work-life balance and staying connected to your team. 

Both will be presenting at RISE’s upcoming Risk Adjustment Forum, a hybrid event taking place June 30 & July 1, with pre-conference virtual workshops on June 25. Sessions will be live in Orlando and also live-streamed. 

During this 30-minute podcast, Kristy Smith, HEDIS program manager, and Joshua Edwards, Stars program manager, explain how they’ve been continuing to build a culture of quality and service excellence at Martin’s Point that has helped them achieve and maintain a 5-Star rating. 

Martin’s Point is a not-for-profit organization with primary care health centers in Maine and New Hampshire as well as health insurance plans for Medicare beneficiaries, military retirees, and families. It has achieved a 5-Star plan rating seven times in the past 12 years. 

Smith and Edwards talk about the impact of COVID-19 on their team and organization, their challenges, and the importance of looking at everything through the lens of quality. They also preview their upcoming at session at RISE’s Qualipalooza 2021, a hybrid event taking place live in-person in Orlando and via live stream on June 28-29. Sessions will be live in Orlando and live-streamed.