About Us

The RISE Association (Resource Initiative & Society for Education) is a national association dedicated to supporting the health plan and provider organizations involved in the healthcare reform movement, particularly those involved in the government programs markets such as Medicare Parts C & D, Affordable Care Act health insurance exchanges, special needs plans for dually-eligible individuals, Medicaid plans for needy populations, Accountable Care Organizations and MACRA initiatives. 

 

RISE Vision and Mission

To build a community and an educational system that promotes successful careers for professionals who are advancing the Triple Aim of healthcare. RISE provides:

  • A forum to build professional identity and a network of colleagues
  • A platform to capture and share knowledge and insights
  • A venue to develop and share benchmarks and document best practices
  • Career track development support
  • A channel for building alliances, partnerships and affiliations that fulfill the vision

RISE is the first national association totally dedicated to supporting healthcare professionals who aspire to meet the challenges of the emerging landscape of accountable care and healthcare reform. We strive to serve our members on four fronts: Education, Industry Intelligence, Networking and Career Development.

  • Education: Through cutting-edge conferences, webcast presentations, job-specific educational curricula, and industry-driven library resources, RISE provides our members with the crucial information they need to stay ahead of the curve. We also actively apply to industry credentialing organizations to ensure that professionals optimize every opportunity our programs offer to earn CEUs.
  • Industry Intelligence: RISE brings the marketplace to members in a collaboration between technical experts, solutions vendors and expert speakers.
  • Networking: RISE members make valuable connections with other healthcare professionals from across the nation, from every section of the industry. Through meaningful networking opportunities and roundtables, RISE brings together multiple perspectives and facilitates highly interactive discussion between professionals. Members hear the best (and worst) practices directly from their peers, and gain valuable insight into market trends.
  • Career Development: RISE members will have access to support tools, career-oriented curricula and networking to enhance their job skills and career tracks.

Who Should Join

RISE was designed to bring together healthcare professionals from all industry segments whose job functions are directly impacted by the continuing evolution of accountable healthcare financing and delivery, health care reform developments, and emerging topics.

Members include professionals working for:

  • Health Plans
  • Physician Organizations, Medical Groups, IPAs
  • Accountable Care Organizations
  • Management Services Organizations & practice management
  • Hospitals & integrated delivery systems
  • Skilled Nursing, Long Term Care and Chronic Care Facilities
  • Medical homes  
  • Sole proprietors or independent consultants 
  • People who are in transition between jobs that would otherwise qualify them for standard membership

With a range of positions: C-Suite roles, Vice Presidents, Directors, Managers, Supervisors and Professional Staff for

  • Quality assurance/improvement
  • Care Coordination, Medical Management, Population Health
  • HEDIS, Stars, Quality Measurement or  Marketplace/QRS
  • HCC coding & revenue
  • Risk adjustment and financial management
  • Compliance and government relations
  • Medical informatics
  • Network development & management
  • Provider engagement
  • Data analytics
  • Operations, claims, member service, enrollment, billing & reconciliation
  • Physician education & engagement
  • Product development & innovation
  • Medicare marketing & sales
  • Member engagement
  • Health Insurance Exchanges and the new Marketplace products
  • Business development & strategic planning

Benefits of Membership

Healthcare professionals are eligible for Standard Membership with RISE, which grants access to:

  • RISE-exclusive webcasts and educational webinars throughout the year
  • RFP Support for identifying qualified vendor support services and competitive bidding
  • Updates on the development of formal educational courses and career support tool development
  • Priority notification of RISE conferences and webinars

Membership Composition

 

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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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