RISE Nashville 2014 Recap

The annual RISE conference in Nashville was attended by more than 600 people, about 50% more than last year, and garnered a lot of praise as a valuable and productive event. Healthcare Education Associates is still combing over the evaluations and the feedback to tease out all the comments and suggestions, but it is clear it was a big hit.

What is driving this big upswing in attendance?  Why the surge over last year? The previous year also witnessed a big year-over-year boost, as well. Of course, HEA puts on a top notch program and it runs very nicely, so I do not want to minimize that. But there is more driving it than that. 

I believe the extra factor is the intensified threats and risks that are impressed on the Medicare Advantage market, added to the larger currents of the national health reform movement. We have multiple currents simultaneously moving and converging on the way healthcare is being financed and delivered, placing demands on us all for accountability to achieve what has eluded our healthcare industry for decades. Fair or not, it is what it is, and people came to the RISE Nashville summit to:

  • Learn about the changes in CMS risk adjustment
  • Understand how the Health Insurance Exchanges are unfolding and what the implications are
  • Pick up the tips and insights from best practice presentations
  • Get nuggets on how the plans are navigating the sunset of the Stars demo
  • Numerous other objectives

It is clear that 2015 is going to be a tough revenue year for the Med Advantage world. Not only are we seeing the planned phase-down of payment rates, ratcheting down versus Original FFS Medicare, but a lot of simultaneous factors are combining to whammy the industry at the same time. There is the sun setting of the Medicare Stars demo that will whack even the 4 and 5 star plans in 2015. The insurer fee steps up and further shrinks net revenues. But CMS is proposing to curb the use of the in-home assessment approach to risk score accuracy, which has previously been a useful tool helping to overcome the ever-eroding effect of the intensity adjustment in the annual payment model. 

It is also clear that, as CMS shifts from RAPS methodology to encounter data for risk adjustment. This is promising to have a corrosive impact on payment rates. Some health plans approached RISE for some help in forming a collaboration with RISE Sponsors to demonstrate this effect to CMS. We are keen on garnering RISE member support in this effort. 

Additionally, I noticed something beyond these formal conference objectives.  It was the networking and informal connectivity taking place, a parallel agenda that people had for extracting value from their experience at the conference.  People tell me that they value the content of the conference itself, but they are also hungry for opportunities to connect with peers at other health plans or provider groups to share and compare notes and experience. This is one of the key RISE mission goals: to support and promote networking for our members. The “nuggets” taken home after the conference include these valuable contacts, shaping up the way the virtual community becomes a vital part of the fabric of a learning community. 

I got a lot of great reactions to the announcements I made regarding the RISE programs, which is very exciting and reaffirming:

  • New Website / Relaunch
    • Transition from RA Society website to new www.RISEHealth.org
    • New look and feel, cleaner and more contemporary, easier to navigate
    • Compatibility with mobile apps
    • Member application functionality added
      • Standard membership (employed by healthplans or providers) is complementary
      • RFP Initiative to support vendor shopping
        • Created web functionality to accept RISE members submitting RFP to RISE
        • RISE circulates RFP to sponsors for bidding on business
        • RISE members because they can get more qualified bidders
        • Job Board
          • Anyone can post jobs on RISE Health
          • Only RISE members can see posting and reply
          • Webinar pipeline – sponsors speak, RISE produces event, markets event and registers people
            • 2014 calendar of events set with 30 events
            • First 40 RISE members registering get complementary passes

These are exciting yet difficult times. Driving accountable care and participating in healthcare reform is sometimes a messy and stressful business. It is also a great time to pull together as a community of professionals doing this work, and RISE is prepared to support you all as you strive to RISE to the occasion. 

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Quality measurement and risk adjustment regulations are increasing and the financial impact upon health plans is progressively driving accountability and influencing profitability through payments, penalties, and bonuses. To improve performance and optimize risk and quality payments, Health Plans need to streamline processes, employ best practices for data capture, and focus on strategic interventions that use a member-centric approach.  

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