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

Association Sponsors

Latest Posts

It’s not Obamacare anymore. It’s our national health-care system.

By Drew Altman and Larry Levitt July 29 Drew Altman is president and chief executive of the Henry J. Kaiser Family Foundation. Larry Levitt is senior vice president of the Kaiser Foundation. Republicans failed to repeal and replace the Affordable Care Act early Friday because of divisions within their own ranks, and because they tried not only to repeal and replace the ACA but also to cut and cap the Medicaid program, generating opposition from many red-state governors and their senators. But most of all, they failed because they built their various plans on the false claim — busted by the Congressional Budget Office — that they could maintain the same coverage levels as the ACA and lower premiums and deductibles, while at the same time slashing about a trillion dollars from Medicaid and ACA subsidies and softening the ACA’s consumer protection regulations. Had they succeeded, they would have won a big short-term victory with their base, which strongly supports repeal, but suffered the consequences in subsequent elections as the same voters lost coverage or were hit with higher premiums and deductibles. ...
Read More

Where to Now? True North Again

By Kevin Mowll, Executive Director of the RISE Association The failure of the Republicans to repeal, replace, or wreck ObamaCare is a wakeup call for everyone, not just Republicans. While the RISE Association steers away from purely political commentary, the lesson of this protracted political mess needs to be called out for the sake of putting our priorities straight around public policy regarding healthcare reform. In the attached Wall Street Journal article, which suggests that bipartisan solutions are the only remaining way forward, the author proffers hope that the blistering truth will be obvious to all the participants in the 7-year-long fracas around repeal and replace. The bloodied players may still brood in frustration that their political wills were not enough to win, but the author wonders if cooler heads will prevail. I, for one, am not so sanguine; yet I can only hope. https://www.wsj.com/articles/republicans-search-for-answers-can-they-find-any-across-the-aisle-1501259286 The lesson I take away from the many years of wrangling is that the ObamaCare political football games demonstrates that political wills are not the way forward. They lose sight of the True North issue at hand. Rather, the failures of both political parties in arriving at a bipartisan solution signals the fact that what is good for America is good healthcare policy, not political prowess over rivals. Governing from the fringe is not sustainable in a democracy. ...
Read More

Upcoming Conference


RISE West 2017 

Featuring three pre-conference workshops, and five tracks covering 20+ in-depth session topics, this event is an extraordinary value-proposition you don’t want to miss. Hear from industry thought leaders, as well as health plan and provider group experts who will share practical insights and updated lessons learned from the trenches on critical topics in risk adjustment, quality improvement, data management, coding compliance & more!


Upcoming Webinar

The Encounter Management Best Practices Playbook

What encounter best practices can managed care plans put into place to help them manage the pace of change in formats, rules and regulations? What do managed care plans have to stop doing if they want to ensure business continuity with their encounter operations in the face of change and bleeding revenue? What can you do to make sure your plan isn’t one of the ones that figured these things out too late? Join us to get answers to these questions and more on September 12th.


Connect With Us

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