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Join the RISE team as we chat with industry leaders and explore ever-changing policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health. Produced by RISE, the number one source for information on all things Medicare Advantage.
28 Episodes
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In this hour-long episode of RISE Radio, Editorial Director Ilene MacDonald sits down with industry experts to break down the changes in CMS’ 2027 Medicare Advantage and Part D proposed rule, why removing 12 measures and bringing back the reward factor is a true Stars redesign, and how plans can pivot from operational wins to outcome performance. We also explore the new depression screening measure and the new SEP when providers exit networks, with clear steps to protect quality and retention...
As regulatory pressures intensify and the demand for measurable ROI grows, health care organizations are rethinking how they approach risk adjustment. The landscape is shifting—from retrospective reviews to real-time, proactive strategies powered by smarter technology and deeper clinical insight. In this 38-minute episode of RISE Radio, senior leaders from Cotiviti and Edifecs share how their recent partnership is fueling a new era of innovation across the full risk adjustment lifecycle. From...
Medicare Advantage plans are about to face unprecedented scrutiny as the Centers for Medicare & Medicaid Services (CMS) implements a dramatically expanded approach to RADV audits. Starting in 2025, every Medicare Advantage plan will be subject to contract-level RADV audits—a significant departure from the historical approach of randomly selecting 60 plans annually. During this 17-minute podcast, Deborah Curry, risk adjustment programs director at Medical Mutual. breaks down the cri...
The Medicare Advantage (MA) landscape is shifting dramatically. With over half of all Medicare beneficiaries now enrolled in MA plans, the program faces unprecedented scrutiny from lawmakers, regulators, and beneficiaries themselves. During this 40-minute podcast, MA policy experts Carrie Graham and Neil Patil dissect the changing political and regulatory climate surrounding MA and offer crucial insights for health plans navigating these turbulent waters. They explore how the Trump administra...
Welcome to the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health. Special thanks to DUOS for sponsoring this episode, which features Ana Handshuh, principal of CAT5 Strategies, and Jenn Kerfoot, chief strategy and growth officer, DUOS, discussing the impact of the electi...
Join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health. Katie Devlin, DHSc, MS, CPHIMS, vice president of interoperability at Cotiviti, returns to RISE Radio and is joined by Adam Gilbert, director of interoperability operations and partnerships at Cotiviti, f...
During this 20-minute podcast, Melissa James, senior consultant at Wolters Kluwer, Health Language, provides insight into RADV audits for coders, auditors, coding managers, senior leaders, chief financial officers, and chief executive officers. She discusses the latest news; technology, such as AI, that can assist Medicare Advantage organizations with audit preparation and project management; and the best strategies to prepare for audits. About Melissa James Melissa James, CPC, CPMA, CRC, r...
Dawn Carter, director of product strategy at Centauri Health Solutions, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health. In this 23-minute podcast, recorded on April 18, Carter discusses the shift from the V24 to V28 risk model, the coding changes...
Welcome to the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health. Our guests are Ana Handshuh, principal of CAT5 Strategies, Melissa Smith, founder and senior advisor of the Newton Smith Group, and Rex Wallace, founder & principal of Rex Wallace Consulting. Dur...
Errol Pierre, senior vice president of state programs at Healthfirst, the largest nonprofit health plan in New York, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health. Pierre will be a featured speaker at RISE’s Medicaid Managed Care Leadership Summit, a ...
Calum Yacoubian, M.D., director of NLP health care strategy at IQVIA, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health. In this 21-minute podcast, Dr. Yacoubian discusses natural language processing (NLP) and why it’s vital to use in health care for risk...
Katie Devlin, DHSc, MS, CPHIMS, vice president, interoperability, Cotiviti, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact policies, regulations, and challenges faced by health care professionals responsible for quality and revenue, Medicare member acquisition and experience, and/or social determinants of health. In this 21-minute podcast, Devlin, author of the new white paper, Implementing a digital quality strategy, discusses int...
Lyle Mioduszewski, vice president of population health and payer growth for Ciox Health, is our guest for the latest episode of RISE Radio. In this 26-minute podcast, Mioduszewski discusses social determinants of health (SDoH), data collection and sharing, and best practices for capturing SDoH codes in the medical record. About Lyle Mioduszewski Lyle Mioduszewski is vice president of population health and payer growth for Ciox Health, where he works with risk-bearing entities to underst...
Lesley Weir, senior director, customer and product success at Veradigm, and Kate Wormington director, product management, analytics at Veradigm Payer Analytics, join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Medicare Member Acquisition & Experience; and Social Determinants of Health. In this 31-minute podcast, they discuss the risk adjustment and quality changes in the final rules and their ...
Breanna Krebs, the director of customer success at Apixio, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Medicare Member Acquisition & Experience; and Social Determinants of Health. In this 11-minute podcast, Krebs discusses the impact of the double sweeps occurring this July and next January related to the extension deadline for submitting risk adjustment data for use in the risk score ca...
Dr. Jasmine Zapata joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Medicare Member Acquisition & Experience; and Social Determinants of Health. “Dr. Jaz,” a keynote speaker at the upcoming RISE Women in Health Care Leadership Summit, Dec. 14-15 at the InterContinental San Diego, will discuss finding and pursuing your passion. In this 20-minute podcast, Dr. Jaz discusses how to find time to t...
Five panelists who will speak about health policy at the upcoming RISE West 2022 conference join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health. They’ll speak on the first day of RISE West 2022, September 1, at the InterContinental Los Angeles Downtown. Our guests include: · Sean Creighton, managing dire...
Ryan Avery, a world record holder, two-time best-selling author, Emmy award winning journalist, and world champion, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health. Avery will be one of the keynote speakers at RISE National 2022, March 7-9, at the Gaylord Opryland in Nashville, Tenn. At the age of 25, Avery became the y...
Liz Haynes, director of risk adjustment and stars for government programs at Blue Cross and Blue Shield of Kansas City, and Melissa Smith, executive vice president of consulting and professional services at HealthMine, join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health. They’ll be the keynote speakers at RISE’s 12th annual Star R...
Angela G. Huskey, PharmD, CPE, senior vice president and chief clinical officer at Millennium Health, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health. During this 21-minute podcast, we talk to Dr. Huskey about her work on identifying drug trends, emerging threats, substance use disorder, and the increase in drug overdos...
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