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RISE National 2023

RISE National 2023 recap: Regulatory changes, technology, and innovation impacting the future of healthcare delivery

Evolving regulations take center stage at RISE National 2023

Touted as RISE’s biggest Medicare Advantage event of the year, RISE National 2023 took place March 6-7 in Colorado Springs, drawing a record-breaking number of attendees representing healthcare professionals at all levels in the Medicare Advantage and Commercial ACA markets.

The industry conference was well-timed given a flurry of recent regulatory activity at the Federal level impacting health plans, including release of the Medicare Advantage Risk Adjustment Data Validation (RADV) Final Rule on January 30, and changes proposed in the Center for Medicaid & Medicare Services (CMS) 2024 Advance Notice released on February 1. Provisions within the final and proposed rules are expected to significantly impact Medicare Advantage plans – from the removal of over 2,000 ICD-10 codes as part of the RADV rule, to proposals in the Advance Notice aimed at Medicaid redetermination, expiration of COVID-19 flexibility related to the Star Ratings program, risk adjustment model changes, and more.

In addition to grappling with an evolving regulatory landscape, plans are also facing increased scrutiny by the U.S. Department of Health & Human Services (HHS) Office of the Inspector General (OIG), as described by Christi A. Grimm, the sixth inspector general of the HHS during her keynote address to RISE attendees on March 6. Citing the rapid growth of Medicare Advantage as a cause, Grimm emphasized the need for Medicare Advantage plans to prioritize efforts to combat fraud, waste, and abuse in the program by plans, providers, and vendors.

It wasn’t all shop talk, all the time. On day two of RISE, Inovalon’s President and General Manager for Payer, Craig Savage, had the distinct privilege of introducing the conference’s inspirational keynote speakers, Brent and Kyle Pease. As they shared their story, the Pease brothers reminded attendees of the importance of determination and not giving up, and the impact of having a trusted, reliable partner to be with you through the good and tough times.

Inovalon session spotlight: Improving healthcare outcomes, engagement, and efficiency with an integrated approach

Regulatory changes and intensifying Federal oversight weren’t the only hot topics on the minds of RISE National 2023 attendees. Much of the conference’s educational program and networking discussions among attendees focused on advancing opportunities for industry collaboration and technological innovation by harnessing the power of data and technology.

On day two of the conference, Inovalon hosted a dynamic speaking session with health plan leaders from Blue Cross Blue Shield of Michigan and Healthfirst to discuss improving healthcare outcomes, engagement, and efficiency with an integrated approach to quality measurement and risk adjustment. Panelists explored the new and recurring challenges facing health plans related to payment integrity within quality and risk adjustment programs, member and provider engagement, and overall health plan goal achievement tied to value-based contracts, member retention, and other priority initiatives.

The discussion shifted to examine how health plans are taking full advantage of emerging technologies – like integrated analytics, natural language processing, and digital point-of-care tools – to support managing multiple programs, teams, and the member experience. By integrating quality measurement and risk adjustment analytics, for example, health plans can access one detailed member view to better inform care planning and coordination efforts. This becomes a win-win for all stakeholders involved, resulting in:

    • Enhanced member and provider satisfaction and engagement
    • Accelerated quality and risk adjustment gap closure
    • The elimination of duplicative member and provider outreach
    • Improved operational efficiency of health plan programs

Amid these benefits, removing the silos that traditionally exist within a health plan’s quality measurement and risk adjustment programs to achieve program integration is complex. The impetus to integrate must come from the executive suite and must be supported by the right technologies. A unified analytics platform providing access to a complete, holistic dataset – including underlying clinical member data – is instrumental to enabling this integration and assuring its effectiveness.

Health plan leaders discuss industry challenges and innovations

Prior to the speaking session, Inovalon representatives convened with a group of healthcare executives to discuss current industry challenges and practical innovations to advance healthcare delivery capabilities for optimal efficiency. Over the course of two hours, participants discussed a broad range of topics; from advancing the convergence of data into one comprehensive source informing quality outcomes, risk adjustment, health equity, and care; to empowering providers and clinicians with real-time insights that enable better care delivery and achievement of value-based and other performance goals.

The ability to effectively address social determinants of health (SDOH) was a key focus, particularly in light of Medicaid redetermination, which is set to commence on April 1, 2023, and will enable state Medicaid plans to resume Medicaid disenrollments that were halted during the COVID-19 public health emergency.

“We feel if we resolve SDOH issues, the rest will follow. Some members worrying about where their next meal will come from will not worry about breast cancer screening.” – Health plan representative during the Inovalon-sponsored Think Tank at RISE National 2023

Emphasizing the need for industry and community collaboration, health plans shared that partnerships with community groups and religious institutions during the pandemic enabled them to better address SDOH factors impeding member access to care and healthcare outcomes. Identifying these pathways is essential as CMS and NCQA continue to advance initiatives that will hold health plans accountable to address healthcare disparities and advance health equity.

The quest to deliver better care, more effectively and efficiently

Throughout the three day event, RISE National 2023 attendees were able to explore the latest technological innovations and solutions empowering healthcare organizations to deliver better care, more efficiently, and in alignment with performance goals. Inovalon’s team was there in full force to talk with health plans about the power of Inovalon Converged, a SaaS suite of products and add-ons that deliver member-centric insights and actions to help health plans measure, manage, and improve healthcare outcomes, economics, and quality of care.

On March 6 and 7, Inovalon announced the launch of Converged Outreach and a new release of Converged Provider Enablement, respectively. These cloud-based SaaS solutions enable health plans and other healthcare organizations to coordinate and align disparate initiatives and programs:

    • Converged Outreach empowers healthcare organizations to coordinate the analytically-derived patient intervention programs of multiple concurrent initiatives to achieve optimal engagement, impact, and efficiency
    • Converged Provider Enablement enables health plans, “payviders”, and other value-based healthcare organizations to coordinate complex and disparate combinations of both industry standard quality and risk goals, as well as highly customized initiatives, across large provider systems at the point of care

The products are fully interoperable with Inovalon’s cloud-based Converged solution suite, helping simplify implementation, shorten the time to program impact, and avoid the need and cost of additional disparate data integrations, data security auditing processes, vendor management, and operational reporting.

If you didn’t have a chance to stop by the Inovalon booth at RISE, contact us today to schedule time with a representative and explore how Inovalon can help you harness the power of data-driven healthcare.

See you next year at RISE National 2024!

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About the author

Matthew Caminiti, Director, Sales Engineering