This year’s three-day conference will feature fresh perspectives on leadership challenges, quality, coding and risk adjustment strategies, Star ratings, and provider engagement. Here’s a look at five of the senior leaders who will join RISE West panel discussions for the first time:
Kiran Rangarajan, Ph.D.
Kiran Rangarajan, Ph.D., chief government programs revenue officer, Blue Cross & Blue Shield of Rhode Island, is one of three speakers profiled in this article who will take part in a leadership panel to discuss the current managed care landscape and strategies for success.
Rangarajan offers a unique perspective because in addition to his risk adjustment management experience with Blue Cross & Blue Shield, he also has worked in the provider and vendor settings. One of the biggest challenges facing organizations right now is working with providers, he said. Providers are incredibly stressed since the pandemic. They are short-staffed yet still have 24 hours a day to accomplish all the administrative tasks payers and vendors ask of them and provide care to their patients.
“They want to find solutions and do right by the members and by the payers,” he said. “So how can we, instead of demanding more things from providers, how can we work with them and find solutions that work that is a win for both the payer and providers? What can we do? How can we supplement with technology, and how do we win that trust with the provider?”
Rangarajan also said that people often forget there is a social component to building these relationships. It requires patience and listening, he said. And that’s the biggest takeaway he hopes attendees will consider after the panel decision. “Trust is what drives a lot of this and it’s important for you to live up to that trust. And I hope participants take that back and come up with some pragmatic solutions for their region or for their provider groups,” he said.
Jaye Johnston
After participating as an attendee at several RISE conferences, Jaye Johnston, vice president, Stars operations, Clover Health, said she is excited and honored to join Rangarajan on the stage to provide a quality perspective for the leadership panel discussion. “We are all working toward essentially the same goals, but each in our own unique way. I’m confident attendees will come away with concrete and actionable learnings as a result of these diverse perspectives,” she said.
Johnston’s goal is to motivate and encourage attendees just as she has been inspired when she has attended previous RISE events. She plans to share successful strategies that have worked for her at Clover Health that attendees can take back and implement at their own organizations. “My goal is to inspire action. Not only will attending contribute to their personal growth and knowledge of the industry, but more importantly, I want them to walk away with new ideas they can propose and hopefully implement at their own organizations,” she said.
Although change and mitigating risks are a constant challenge for improvement, Johnston said it is critical to look holistically at the needs of your member population and have conversations throughout your organization and reduce some of the department silos to prepare for the changes with the understanding you can’t mitigate everything. “We must strive to meet the evolving needs of our members, and it would be a shame to settle for ‘good enough’ simply because change is hard.”
Rika Kari
Also joining the leadership panel is Rika Kari, vice president, medical economics and risk, Horizon Blue Cross Blue Shield of New Jersey. Kari expects panelists will discuss the latest requirements from the Centers for Medicare & Medicaid Services (CMS) that are part of the 2024 final notice, the final RADV rule. “The 2024 final notice was significant, both for quality and for risk adjustment, and that’s one of the things I like about the panel is you have both risk adjustment and quality people on there and they potentially will have different takes on it,” he said.
Kari intends to look at what’s happening now and how this may impact the industry in the long term. He expects partnerships with providers and value-based arrangements will become increasingly important in the years ahead.
“You see a pattern of CMS really going after the revenue-based programs and then couple that with some of the comments and public reporting and testimony from MedPAC, and the space is just going to continue to be challenged as we move forward. I think organizations really need to think about how they're positioning themselves both to operate today and sort of the near term, but also to be successful in the future if some of these more drastic changes come down the line.”
Kaitlyn Bertrand
Kaitlyn Bertrand, PA-C, ACD physician assistant, SCMG internal medicine APC lead, Scripps Health, will be a panelist for a discussion on closing quality gaps for hard-to-reach populations that is part of the quality and member experience track. Bertrand will share the experiences she had at Scripps, working on the risk adjustment team, and engaging their physicians and advanced practice clinicians (APCs) about the best coding and documentation practices and obtaining their buy-in.
Along with her coworker Katie McLaughlin, senior clinical advisor, risk assessment, lead risk adjustment nurse practitioner at Scripps (who will also speak at this year’s RISE West as a panelist for a session within the risk adjustment track), they relaunched the team’s Medicare wellness visit workflow to drive provider engagement. They were able to connect with each provider on a one-to-one basis to discuss their concerns and problems and use the time to clarify the best protocols and documentation styles.
“We can do all the work on our back end to make sure the charts are 100 percent ready to go. We have all the tools and tips and tricks within the EMR system so that we're able to reach patients for their population, health care gaps and, have all these fundamentals in place. But if you don't have the understanding or buy in from the clinical team, you're not going to be successful,” Bertrand said. “If they don't see the utility and the impact on patient care, then they just are going to feel like it's another box to check. So, the best thing that we’ve been able to do is to really get at the heart of the issue with our physicians and APCs to see how this really impacts the best care for our patients and providing better patient care.”
Melissa Cornejo
Melissa Cornejo, director of quality, WellCare of NJ, will participate in a panel discussion within the payer/provider alignment track on post-pandemic learnings in avoiding abrasion and meeting providers where they are. Cornejo has had significant success engaging and partnering with WellCare providers during the COVID-19 pandemic and post-pandemic. Her team has provided administrative assistance, such as member outreach and scheduling assistance to help providers who struggled and continue to struggle with getting full-time staff. Cornejo’s team is always willing to collaborate, support, and share best practices with newly hired staff, as well as to provide refresher training to already established staff at the contracted providers’ offices.
“We are true partners, an extension of their support team, and focus on simplifying the health care experience for both: members and providers. That is our role, to engage and develop relationships with them and assist in any way we can as a true partner,” she said.
She hopes that attendees will be able to take her strategies and learn to trust and work with their Managed Care Organizations’ departments, specifically care management, quality, and marketing teams, to create an all-encompassing support system. “I can’t stress enough that provider and member engagement and partnership is key. It is extremely important for both parties to be successful to ensure that high-quality care for the members is consistently provided. One can’t do it without the other, it’s really a partnership,” Cornejo said.
RISE West 2023 will take place August 28-30 at the Omni PGA Frisco in Dallas. Click here for the roster of speakers, speaker bios, the complete agenda and registration information.