Kevin Mowll

Kevin Mowll

Executive Director of RISE

Chair of the Executive Committee of the Board

Chair of the RISE Association Advisory Board 

Kevin is responsible for building up the RISE association, creating a better value for our members, enhancing member education and content, as well as expanding and enhancing our conference offerings.

Prior to joining RISE, Kevin was Vice President for Senior Products with the Tufts Health Plan in Boston, responsible for sales, marketing, product development, business performance and strategic planning for the senior products business unit. Kevin has a diverse background and an expertise in Medicare health plans. His expertise focuses on:

  • Consumer-driven product design and value segmentation
  • Growth-oriented product development and implementation
  • Market-based sales team development and execution
  • Strategic and business planning
  • Financial performance management and business plan execution
  • Optimization of sales channel distribution models

Kevin was previously Vice President for Senior Products with the Tufts Health Plan in Boston. He was responsible for sales, marketing, product development, business performance and strategic planning for the strategic business unit. Kevin has a diverse background and an expertise in Medicare health plans.

Earlier, Kevin was the Vice President, Medicare Products, for Capital District Physicians’ Health Plan in Albany, New York, when the Medicare Advantage membership grew from 12,000 to 30,000, including both individual and group retiree business.

Originally, from Southern California, Kevin worked for PacifiCare Health Systems and CIGNA Healthplans. At PacifiCare (which was acquired in 2005 by United Healthcare) Kevin led the development and launch of multiple products and conducted service area expansions for health plans, led a multi-functional franchise team for start-up Medicare health plans, and ran provider network management.

A speaker at national conferences on Medicare Advantage business themes, Kevin has also chaired several events. He founded a professional social networking group on LinkedIn called Medicare Advantage Healthplan Colleagues, focused on educating and sharing best practices by developing a virtual community with shared interests and concerns. The group attracted over 11,000 members from across the country.

Kevin is married and has three adult children, and now lives in Santa Cruz, California.

Tags: Kevin Mowll, RISE, Board

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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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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.


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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