Update on RISE RAPS / EDS Industry Collaboration with Inovalon

Closing Off Contracting Shortly!

The industry collaboration that RISE has pioneered with several healthplans is making significant progress with business partner, Inovalon, under Jason Rose's leadership.  There are several MAOs now confirmed for participation in the joint study project, some in final contracting stages, putting the aggregated MA membership at roughly 500,000 and climbing.  

Given the CMS announcement that they plan to publish the final MAO-004 filtration guidance in December, we have taken a few more weeks to recruit as many healthplans into the project as possible.  The project support provided by Inovalon has enabled us to continue discussions with plans that expressed interest and bring them onto the project.  We will be wrapping up recruitment by approximiately October 31 so we can begin crunching the numbers for the plans that committed to signing up, allowing us to complete the first round of the study by the end of December.  Representations of participating MAOs may want to join our Steering Committee. 

Our Steering Committee now includes:  

  • Dave Meyer, SCAN Health Plan (RISE Board Member)
  • Kathy Graf, Emblem Health
  • Brian Bodnar, Horizon BC in New Jersey
  • Larry Bishoff (RISE Board Member)
  • Jason Rose, Inovalon (RISE Sponsor Advisory Board Member) 
  • Tom Kornfield, Avalere

Our Collaboration Steering Committee is also announcing the addition of Tom Kornfield, former CMS executive.  As explained in the announcement by Avalere, recently acquired by Inovalon, "Tom served as a senior advisor in the Center for Medicare and Medicaid Innovation (CMMI) where he assisted in developing alternative payment models in Medicare Advantage.  Prior to joining CMMI, he was the director of the Division of Payment Systems in the Medicare Plan Payment Group (MPPG) at CMS where he led the 2014 and 2015 Medicare Advantage and Prescription Drug Plan payment rate announcements, and served as the technical lead on risk adjustment. "  http://avalere.com/news/former-cms-officialtom-kornfield-joins-avalere  We are very pleased to welcome Tom to our group and we look forward to incorporating his insights and perspective into the guidance and thought process behind our joint study. 

Categories: risk adjustment, RAPS, EDS
Tags: RISE, industry collaboration

Log on to Your Rise Account

Forgot your password?
Create an Account


Latest Posts

CMS Gives EDPS Transition Some Breathing Room

CMS published the final call letter for 2018 yesterday, April 3, which included a welcome accouncement regarding the transition from RAPS to EDPS-based RAF scores. Citing numerous public comments on the subject, CMS throttled back the speed with which they plan to switch over to an encounter-based methodology. Instead of the blended rates originally contemplated, they announced that the more modest blend of 85% RAPS to 15% EDPS would be used in 2018, allowing more time to improve the reliability of the encounter data methods. While the RISE data collaboration study was not cited, we believe that the educational value of our study, along with our communication and advocacy of a more moderate approach by CMS, contributed to the confidence with which plans and other interested parties spoke up during the open comment period. Once again, we owe thanks to the folks at Avalere and Inovalon, as well as at AHIP, for the collegial and professional collaboration. Also, we want to thank the health plans that actively participated in our study for making this work possible. ...
Read More

Take Aways from RISE Nashville Summit

The 11th Annual RISE Nashville Summit continued the event’s tradition of yearly growth. The return to downtown Nashville was widely applauded by attendees, who were glad to be back near Broadway’s nighttime funk and fun. While festive, this year's event occurred in the wake of the new administration in Washington, D.C., and the healthcare themes surrounding the "repeal and replace" of the Affordable Care Act (ACA) cast a long shadow. In contrast to the upbeat, confident notes struck by last year’s keynote speaker Senator Tom Daschle, this year’s sobering keynote address by Howard Fineman, NBC/MSNBC political analyst, The Huffington Post Media Group global editorial director, and bestselling author, was an assessment of the pluses and minuses of our new president. Mr. Fineman's remarks indicated that the political alliances in power will seek to undo what Senator Daschle viewed as "irreversible” a year ago....
Read More

Upcoming Conference


Qualipalooza: The 2nd Annual RISE Quality Leadership Summit 

This unique event incorporates three conferences presented side-by-side: the Star Ratings Strategic Planning Forum, the HEDIS Forum, and the CAHPS, HOS & Member Survey Forum. Register for one conference for an in-depth examination of a single area, or design your own event by opting for the all-access pass and choosing the sessions from each conference which correspond exactly to your interests.


Upcoming Webinar

The Impact of Quality Incentive Models in Medicaid Markets


Thirty-one of our fifty states now have Medicaid managed care, and several markets are expected to implement managed care in the next few years. More than $160B in Medicaid spending occurs through the Managed Care Organizations. As more and more states seek to do more with less, increasing accountability for health quality outcomes is placed on health plans. Join this webinar to learn the typical quality payment approaches states use, issues often faced by health plans under each model and what states are expected to do with payment models tied to quality performance in light of near term Medicaid reform efforts.


Connect With Us

Copyright © 2014 Resource Initiative & Society for Education. All rights reserved.