News Roundup

Reflecting on RISE National 2020

RISE National was a test in more than one way. In a narrow sense, it was a test of RISE’s versatility to organize an event that would still present value to attendees. In a broader sense, it was a test of our industry’s ability to communicate effectively despite the isolated and uncertain nature of work right now. After witnessing the presentations that were put together in a short window of time, under unusual circumstances, it seems safe to say the participation of speakers and exhibitors was an overwhelming success. There may be things everyone misses from RISE Nashville, but the drive was still there, and the ideas were still there.

Tech Talk


One predominant theme was innovation through technology. In their illuminating presentation, Southwestern Health Resources touched on the various ways they are leveraging technology to inform providers, prevent burnout, and improve care. Their work includes using NLP to augment and increase coding efficiency as well as employing telehealth to continually provide member care during COVID.

As expected, telehealth was a hot topic overall at the conference, with Quest Diagnostics reporting that more than nine out of ten respondents said they would use telehealth again. Telehealth was also compared to Uber or Lyft for travel, DoorDash for food, or Amazon for shopping in terms of ease of use for members. In the same presentation, Brown and Toland reported a 70% drop in patient visits as soon as shelter in place began—alongside a huge uptick in telehealth.

A notable statistic pulled from the presentation of Episource’s very own Su Bajaj was cited in the closing statements of the conference. Su’s observation states that without a visit by June, the chance of a member not completing a visit by the end of the year will be approximately 57%. In light of the fact that patients are only now starting to come back to the office, this number stresses the importance of scheduling with members sooner rather than later.

Even with the gradual return of office and in-home assessments, health plans don’t expect visits to return to pre-COVID ratios soon and they believe telehealth is here to stay. While telehealth has proven itself as a worthwhile tool for Risk Adjustment and care, participants were quick to point out we are still in the early days of its broad use, and we should continue to expect innovations that will shape the future of healthcare.

Talking with, Not at


A standout session presented by Sarah Ramsey and Dr. Christine Palermo of Virginia Mason Medical Center spoke to the value of technology in a slightly different way. They promoted partnerships with IT departments to effectively quantify engagement with providers. Additionally, their talk also emphasized elements of their strategy that are altogether human. Ramsey and Palermo stressed the importance of having provider advocates who help legitimize requests from Risk Adjustment departments and maintain a cohesive message over time.

Reiterated in session after session was the belief that providers as well as the rest of the healthcare workforce are all absolutely necessary participants in Risk Adjustment. Fostering lasting connections with providers and their support staff was a key point in a majority of talks. Sean Creighton of Humana stated that integration of telehealth may seem to distance providers from patients, but, when done properly, it calls for a holistic view of care that places the PCP at the center. Brian Savage of UCareMN spoke to the importance of provider buy-in and how cleaning up clinical suspecting data can improve provider participation by minimizing analytics errors that could lead to objections and, ultimately, distrust.

Real Talk


A truly unique session to call out would be Gabriel McGlamery’s talk on updates to the ACA Risk Adjustment model. If limited to one word of summary, piquant would suffice. McGlamery was able to make the hyper-detailed policy reviews he conducts at Florida Blue sound like a one-on-one debate with CMS. Possibly because the distance to government can seem unnavigable, his work to respond to CMS’ requests for commentary brought forward a noticeable degree of praise from the attendees. Without pandering, it was clearly a crowd-pleaser.

All of the presentations and presenters noted above are testament to the industry’s drive to exchange information and better their performance. Engagement could have very easily been forfeited in transferring to a virtual conference, but the chats were constantly active. There was a mixture of agreement, objection, and frequent personal greetings that made the necessity to connect unquestionable. It wasn’t as exciting or as engrossing to remotely take part in a virtual conference, but it was, without question, a test. Presenters and participants took part, and now everyone understands a little bit more.

The experimental nature of the conference aside, attendees and presenters both demonstrated reassuring resilience. The world may not go back to normal, programs will need to adapt, and policies can be expected to lag behind trends, but Risk Adjustment continues to see innovation. Value-based care calls for initiatives that are predictive and flexible. Telehealth has gone from a nice-to-have resource with limited applicability to a key tool across all of healthcare, even within our little world of Risk Adjustment. We support the push for adaptability and are excited to take part in the innovations in technology and coordination yet to come.



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Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider