Welcome to RISE

Resource Initiative and Society for Education

Welcome to the home of the Resource Initiative and Society for Education (RISE). RISE is the first national association totally dedicated to healthcare professionals meeting the challenges of accountable healthcare. We strive to serve our members on four fronts: Networking, Education, Jobs and Industry Intelligence. Please explore our website and the resources it provides. Those wanting to join the association are invited to complete and submit an application. Take a look at the benefits and services of membership. 

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Latest Posts

CMS Found to Underpay for Duals with Chronic Conditions

A new analysis by Avalere finds that the Centers for Medicare and Medicaid Services (CMS) underpay Medicare Advantage (MA) plans for the costs of treating individuals with multiple chronic conditions. CMS uses a risk adjustment model to determine its payments to plans based on the expected healthcare costs of each plan’s enrollees. This process is known as risk adjustment. Avalere finds that CMS’s risk adjustment model under-predicts costs for individuals with multiple chronic conditions by $2.6 billion on an annual basis. CMS last updated the model in 2014 and has indicated that it will make changes to the model intended to improve its accuracy for certain Medicare-Medicaid “dual eligibles” in 2017....
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News Flash! CMS Delays MA Sweeps Deadline by Three Weeks

We have a report that CMS extended the sweeps deadline by 3 weeks today. An executive at one of our RISE affiliated health plans met with CMS on Monday and explained the impact of the new 410 edit which caused a surge in rejects for 2014 RAPS data. CMS graciously decided to rescind the edit and allow everyone an extra 3 weeks. ...
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Upcoming Conference


RISE Nashville

Entering its 10th year, the RISE Nashville Summit has become the most comprehensive learning event for Medicare Advantage plan, Commercial plan, and provider group senior leaders dedicated to Quality Improvement, Risk Adjustment, Analytics and Care Management initiatives.


Upcoming Webinar

Ensuring Revenue Success with a 1-2 Punch: Close operational gaps to improve your bottom line

Health plans operating in both the government and commercial arenas are facing steep competition in their attempts to achieve revenue success. In one corner, they’re battling the ICD-10 shift and its impact on HCC scores. In the other corner, they’re faced with trying to figure out how to prioritize and address encounter exceptions based on revenue impact. Either way, health plans can quickly find themselves financially “down for the count” if they fail to successfully take on both challengers.


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