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 the financing and delivery 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

Evaluating the Results of the Enrollment Seasons

The annual review and selection of health insurance for one’s self and family has become an American tradition. During these annual enrollment periods (AEP’s, but referred to under various names), employees, Medicare recipients, and those in the individual and family markets conduct their own variations of the due diligence necessary to assure they will be in the right plan in the coming year. While consumers are pondering their options, health insurers will spend millions in the attempt to attract, retain, and enroll new members. As we near the end of the enrollment seasons, Deft Research will be fielding major national studies geared to evaluate the degree of success these efforts have produced. The research season starts with “shopping and switching” studies published in the first months of the new year, looking at the individual and family plan (IFP) market and at the individual market for Medicare-related insurance. What to look for when diagnosing AEP results Here are some of the factors Deft Research will be tracking and evaluating in 2018. Timing of Consumer Shopping. In the past, the number of seniors ...
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HOW A 360-DEGREE VIEW OF RISK ADJUSTMENT IMPACTS VALUE-BASED CARE

Over the past several years, a shift towards value-based care has begun in the US healthcare system. Within value-based care, incentives and policy structures exist to prevent risk selection, where insurers try to avoid enrolling high-risk members who may be costly to cover. Risk adjustment seeks to project and correct for costs incurred by health plans to treat members of varying risk levels. The Centers for Medicare & Medicaid Services (CMS) first introduced risk adjustment with Medicare Advantage, which has been using CMS’s Hierarchical Condition Category (HCC) models to risk adjust since 2004. Medicare Advantage enrollment has been steadily growing and is expected to reach 22 million by 2020. With the move towards value-based care—fueled not only by the Patient Protection and Affordable Care Act (ACA), but also the Department of Health & Human Services’ (HHS)—a bold goal was made to have 90% of CMS payments linked to value-based care and 50% under APMs by 20181. Given this shift, risk-based payments have become more common. Today, risk adjustment also impacts Managed Medicaid plans, Qualified Health Plans under the ACA, Accountable Care Organizations, and provider groups that share risk with their health plan partners. With value-based model enrollment growth, risk adjustment is becoming increasingly important to a health plan’s success. At the same time, market dynamics are putting pressure on the risk adjustment environment....
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Upcoming Conference

 

RISE Risk Adjustment Academy: CMS & HHS Risk Adjustment 101 and HCC Coding Accuracy

Designed as an introduction or refresher that covers all the bases when working with Medicare Advantage or on commercial health insurance exchanges lines of business. The workshop program is a holistic orientation to the risk adjustment panorama and deep dive into HCC coding for accuracy. With a mix of health plan and provider audiences, a powerful environment for interaction and collaboration is built over two-days. You will gain insight, tips, and best practices to build upon your knowledge of risk adjustment, coding, and documentation.

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Upcoming Webinar

A Hitchhiker's Guide to HCCs, RAFs and More from a Payer Perspective

This webinar will provide a compelling and insightful overview of HCCs, Risk Adjustment Factors and Clinical Data. It seeks to present a clear understanding of what Payers must do to use these CMS mandated levers for improving patient care and getting appropriately reimbursed for the most severely ill patients. Join Prognos to get broad guidance on a pragmatic approach to implementing HCCs using all of the available clinical data resources including lab test results in a repeatable and streamlined process throughout the 12 month HCC reference period.

 

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