audials apps

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 election on Medicare Advantage and the potential changes ahead under President-elect Donald Trump’s nominees: Robert F. Kennedy Jr. as HHS secretary and Dr. Mehmet Oz as CMS administrator.During this 55-minute podcast, they discuss the overall outlook for Medicare Advantage, as well as regulations that address marketing practices, prior authorization, Star ratings, health equity, and social determinants of health. About Ana HandshuhAna Handshuh, principal at CAT5 Strategies, is a government programs executive with expertise in

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, for this 23-minute episode. They discuss the latest regulatory requirements, what to expect for 2025, challenges, and best practices to implement a robust digital data strategy.About Katie DevlinKatie Devlin, DHSc, MS, CPHIMS, vice president, interoperability, Cotiviti, Inc. is responsible for creating an enterprise-wide health data exchange strategy to address clients’ unique business needs while reducing provider abrasion, maintaining regulatory compliance, and optimizing value. She oversees all initiatives related to di

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, risk adjustment SME, senior consultant, Wolters Kluwer, Health Language, supports the company's Health Language solutions with content maintenance. She has more than 20 years of health care experience in coding, risk adjustment, billing, physician and coder education, accounts receivable management, regulatory and compliance, and consulting. She received her associate degree from Pueblo Community College.About Wolters Kluwer Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinician

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, and its risk adjustment applications. About Dawn Carter Dawn Carter, BSBA, CPC, CRC, CPMA, CDEO, CPCO, CSPO,  is a director of product strategy at Centauri Health Solutions. Her career in health care spans 25 years, which most recently includes extensive experience in developing revenue integrity and quality software solutions, with a focus on encounter management and risk adjustment solutions for Medicare Advantage, Medicaid, and Commercial health plans. She also provides strategic advisory solutions and consulting serv

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. During this 70-minute podcast, they discuss the major changes in the 2025 Medicare Advantage Final Rule that the Centers for Medicare & Medicaid Services released on April 4. The conversation delves into the Medicare Advantage marketing changes, including supplemental benefits and compensation to MA brokers and agents; dual eligible special needs plans (D-SNPs); network adequacy standards; Star rating measures; and strategies for compliance. For more on these changes, check out RISE’s upcoming spring conferences: Special Needs Plan

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 virtual event, that will take place April 2-3. The virtual summit will explore how Medicaid managed care organizations can provide quality care to high-risk populations, connect with hard-to-reach patients, and ensure their financial viability.During this 22-minute podcast, Pierre offers his thoughts on the end of the continuous enrollment provision, how to educate members about the recertification process, and his concerns about the impact on health of members who can’t be reached and drop off Medicaid.

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 adjustment, quality,  social determinants of health, and health equity. About Calum Yacoubian, director of NLP health care strategy, IQVIADr. Calum Yacoubian is director of health care product & strategy at linguamatics, IQVIA. He is a medical doctor who trained and practiced in the UK before moving into medical technology. He has worked with NLP in clinical data for seven years and is passionate about the potential for data to drive improved patient outcomes. Dr. Yacoubian’s work has focused on the use of automati

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 interoperability, federal requirements,  challenges, and how it supports improved risk adjustment and quality programs. About Katie DevlinKatie Devlin, DHSc, MS, CPHIMS, vice president, interoperability, Cotiviti, Inc.,  is responsible for creating  an enterprise-wide health data exchange strategy to address clients’ unique business needs while reducing provider abrasion, maintaining regulatory compliance, and optimizing value. She oversees all initiatives related to digital health data acquisition, ingestion, storage, and no

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 understand the utility of social determinants of health data factors, with the goal of improved and equitable outcomes for all individuals. With 20 years of experience throughout the health care continuum, Lyle has clinical expertise in emergency and trauma nursing of adults and pediatric populations, as well as cardiac catheterization and electrophysiology nursing. Lyle has been a leader in the health information technology and medical device industries with previous companies, including McKesson Corporation, PointClickCare (Collectiv

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 recommendations and strategies for organizations going forward. About Lesley WeirLesley Weir, senior director of customer and product success at Veradigm, has over 30 years’ experience in the Medicare Managed Care industry, with specific expertise in operations, risk adjustment, and quality improvement. She has a demonstrated track record of assisting health plans in meeting operational and revenue goals, as well as developing innovative strategies to improve member’s health and experience. Prior to her role at Veradigm, she

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 calculation run that the Centers for Medicare & Medicaid Services (CMS) implemented due to the COVID-19 pandemic; what the end of the extension deadline means; potential challenges to the return of regular submission deadlines in a post-pandemic landscape; and best practices to stay ahead of these compressed deadlines and ensure the accuracy of your risk adjustment data submissions to CMS.Deadlines for the 2023 sweeps of risk adjustment data are as follows:Tuesday, January 31: Interim run of first sweep for dates of service January

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 take care of yourself to lead at a high level in all other areas of your life. She demonstrates this practice daily in her own life. She is an award-winning author, speaker, and double board-certified physician who specializes in the fields of pediatrics and public health. As a medical doctor, she does public health research, works in the hospital caring for newborn babies, trains new doctors, and serves as a state public health official. Outside of her medical roles, she is extremely passionate about mentorship and girl empowe

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 director of Avalere·       Michael Adelberg, providers and plans lead,  Faegre Drinker Consulting·       Dave Meyer, a member of the RISE Risk Adjustment Policy Committee·       Mikal Sutton, managing director, Medicaid policy, Blue Cross Blue Shield Association·       Krutika Amin, associate director for program on the ACA for the Kaiser Family FoundationDuring this 36-minute podcast, our panelists address a wide range of topics, including Medicare drug pricing negotiations, the uncertainty of Affordable Care Act expansion, Medi

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 youngest world champion of public speaking in history. Remarkably, he had never given a professional speech prior to event. He competed against 30,000 people from 116 countries to win the Toastmasters World Championships, launching his career as a public speaker. He then used the same principles and strategies he learned winning the contest to other aspects in his life. His mission is to show leaders how to go from A to The in their industry.  During this 18-minute podcast, Avery shares his thoughts on how COVID changed leadership, asp

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 Ratings Master Class, Dec. 14-15, at the Manchester Grand Hyatt, San Diego. During this 27-minute podcast, Haynes and Smith offer their thoughts on inflated 2022 Medicare Star ratings, upcoming measurement changes that will likely lead to lower ratings for 2023, and the “holistic approach” plans need to take to prepare for the changes.

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 overdose deaths since the COVID-19 pandemic. Dr. Huskey will be discussing these findings in greater detail during a special presentation about preventing overdoses at RISE’s Part D Master Class, which will take place August 9-10 in Nashville.

During this 15-minute podcast, Dr. Abdullah Albeyatti, a family physician in the UK and an advocate for digitalization in health care, talks about practicing medicine during the pandemic, audio-only visits, the challenges and opportunities of telemedicine, and how to get the most from the technology.Dr. Albeyatti is the CEO and cofounder of Medicalchain, a company that uses blockchain technology to store health records securely, and MyClinic, a telemedicine platform that allows patients to connect with their doctors remotely for free. The platform is now used by health care practitioners in 78 countries.

Our latest episode of our new podcast series, RISE Radio, explores the positive aspects of working from home as well as the challenges of managing a remote workforce.During this 18-minute podcast, Colleen Gianatasio, director, ambulatory CDQI at Devoted Health in Waltham, Mass., and Dean Ratzlaff, director, actuary/revenue management for Sentara Health Plans in Virginia Beach, Va., share tips on how to get the most out of your remote workforce while maintaining a work-life balance and staying connected to your team. Both will be presenting at RISE’s upcoming Risk Adjustment Forum, a hybrid event taking place June 30 & July 1, with pre-conference virtual workshops on June 25. Sessions will be live in Orlando and also live-streamed.

During this 30-minute podcast, Kristy Smith, HEDIS program manager, and Joshua Edwards, Stars program manager, explain how they’ve been continuing to build a culture of quality and service excellence at Martin’s Point that has helped them achieve and maintain a 5-Star rating. Martin’s Point is a not-for-profit organization with primary care health centers in Maine and New Hampshire as well as health insurance plans for Medicare beneficiaries, military retirees, and families. It has achieved a 5-Star plan rating seven times in the past 12 years. Smith and Edwards talk about the impact of COVID-19 on their team and organization, their challenges, and the importance of looking at everything through the lens of quality. They also preview their upcoming at session at RISE’s Qualipalooza 2021, a hybrid event taking place live in-person in Orlando and via live stream on June 28-29. Sessions will be live in Orlando and live-streamed.

During this 36-minute podcast, we talk to Heather O’Toole, M.D., chief medical officer at Innovation Care Partners, a clinically integrated network and an accountable care organization in Arizona.Dr. O'Toole, this year’s recipient of RISE’s Martin L. Block Award,  discusses the quality initiatives that have inspired her, including opioid safety in the ambulatory setting and training physicians on advance directives, as well as how the projects changed during COVID.

Our guest is Ana Handshuh,  principal of CAT5 Strategies and the chair of the RISE Association's Quality and Revenue Community.  Handshuh, who served as the chair of this year's RISE National, shares her key takeaways from the virtual event, and thoughts on COVID, behavioral health, and why broadband access should be a social determinant of health.

In this podcast, we talk to RISE Managing Director Ellen Wofford about the evolution of RISE during COVID, converting live events to virtual ones, and upcoming plans to host hybrid events that offer both a live-stream option and in-person learning. We also discuss RISE Association communities and opportunities to network via user groups.

In this podcast, we explore some of the regulatory issues that commercial ACA plans needs to watch in 2021. Our guests are Gabriel McGlamery of Florida Blue's marketplace business and Josh Weisbrod of Network Health in Wisconsin, both members of the RISE Risk Adjustment Policy Committee.

RISE Editorial Director Ilene MacDonald talks to members of the RISE Risk Adjustment Policy Committee about the Biden administration's health care priorities, mechanisms the administration can use to achieve these priorities given a split Senate, and regulatory issues that Medicare Advantage plans need to watch in 2021.