Agenda
Explore the full schedule of sessions, workshops, and networking opportunities at RISE West 2025 & start planning to join us in San Diego in 2026!
Monday - August 25, 2025
8:00 AM
8:00 AM – 4:00 PM
Information Desk Open
9:00 AM
9:00 AM – 5:00 PM
Full Day Workshop
Details TBD
Registration for this workshop includes lunch and a refreshment break.
9:00 AM
9:00 AM – 3:00 PM
Workshop A: HCC Coding 201 – Leading and Implementing HCC Coding and Documentation Programs
Additional Registration Required (additional fee). Two refreshment breaks and lunch is included with workshop registration.
Join RISE for an in-depth managerial level workshop laying out best practices for an end-to-end method of aligning chart documentation, HCC code capture and audit-readiness at both the provider and health plan levels. There is finally an industry standard through the RISE Institute that shows the “how to” of setting up your department’s workflows, aligning with your provider networks, preparing for RADV audits, and more.
Click here for full session description.
Speaker
Deb Curry
Risk Adjustment Programs Director at Medical Mutual
Speaker
Donna Malone
Director, Risk Capture at Mass General Brigham
9:00 AM – 3:00 PM
Workshop B: Operational Excellence in Medicare Advantage Plan Management: From Silos to Strategy
Additional Registration Required (additional fee). Two refreshment breaks and lunch is included with workshop registration.
Now expanded to a 6-hour deep-dive workshop.
The margin for error in Medicare Advantage has never been smaller—and navigating today’s environment requires more than isolated excellence in departments like quality, risk adjustment, or operations. It requires strategic, cross-functional alignment grounded in shared understanding of how a health plan actually generates revenue, manages risk, and drives sustainable performance.
Speaker
Jenn Kerfoot
Chief Strategy and Growth Officer at DUOS
Speaker
Kevin Pierce
FSA, MAAA Senior Consulting Actuary at Milliman
Speaker
Shannon Decker
CEO at VBC One
9:30 AM
9:30 AM – 12:30 PM
Workshop C: Lead from the Middle: Strengthening Supervision with Yale’s Proven Framework
Additional Registration Required (additional fee). Two refreshment breaks and lunch is included with workshop registration.
This interactive workshop introduces the Yale Model of Supervision — a nationally recognized framework designed to strengthen supervisory practice, enhance team performance, and improve service delivery across health and human service settings. Participants will explore practical tools and strategies to lead effectively from the middle, support staff development, and navigate change with confidence and clarity.
Speaker
Scott Migdole
Assistant Clinical Professor at Yale University School of Medicine
12:30 PM
12:30 PM – 2:00 PM
Women’s Leadership Luncheon & Panel Discussion
Lunch will be provided for registered attendees.
(*Additional Registration Required – Free to attend.)
Panel - Steady in the Storm: Resilient Leadership Amid Health Care Shifts
Join RISE for an interactive panel discussion and networking opportunity with women leaders.
Speaker
Rachel Klein
Executive Director Medicare at Kaiser Permanente
Speaker
Rafat Fields
Founder & CEO at Powered To Rise ®
Speaker
Sarah Lechner
SVP, Chief of External Affairs at Hackensack Meridian Health
Speaker
Shannon Wilson
Vice President of Population Health and Health Equity at Priority Health
2:00 PM
2:00 PM – 3:00 PM
Food Packing Event in Partnership with U.S. Hunger*
(*Additional Registration Required – Free to attend.)
3:00 PM
3:00 PM – 3:15 PM
Networking Break for All Conference Attendees
3:15 PM
3:15 PM – 3:30 PM
Opening Remarks
Speaker
Jenn Kerfoot
Chief Strategy and Growth Officer at DUOS
Speaker
Rafi Cices
Head of BOI, Coding & Billing at Cityblock
3:30 PM
3:30 PM – 4:20 PM
Opening Keynote - The Power of the Pivot: Navigating Change with Purpose and Clarity
Healthcare is constantly evolving. Scientific breakthroughs, regulatory shifts, technological advancements and shifting business priorities create a climate of both excitement and uncertainty. In this unpredictable environment, the ability to navigate change isn't just a skill, it's a necessity. For those who do it well, change is a path to opportunity.
Dr. Archelle Georgiou – a nationally recognized physician, healthcare journalist, and consumer advocate – brings a unique lens to the art and science of navigating through uncertainty. From leading healthcare innovation in corporate boardrooms to co-founding a national COVID-19 data initiative, and transitioning across roles in media, medicine, and technology, Dr. Georgiou has pivoted with intention and impact.
In this opening keynote, Dr. Georgiou draws on her multifaceted career—spanning clinical practice, executive leadership, strategic consulting, and national media—to offer a practical framework for embracing change, defining purpose, and making values-driven decisions. Whether you’re leading organizational transformation or charting a new personal path, you’ll leave this session empowered to lead through change with clarity and conviction.
Keynote Speaker
Archelle Georgiou
C-Suite Leader and Patient Advocate
4:25 PM
4:25 PM – 5:15 PM
Patient Voices: Insights on Care, Coverage and What Matters Most
Presented in Partnership with the Camden Coalition
This unique panel brings together patients and caregivers to share their personal journeys, what’s working, what’s not, and where there’s opportunity for improvement.
This candid conversation offers valuable insights for health plans, providers, and innovators committed to improving the member experience. Walk away with firsthand perspectives and actionable takeaways to better serve the Medicare population.
Panelists discuss:
- Their experiences navigating health plans and provider networks
- Access to care, communication challenges, and care coordination
- What trust and quality mean from a patient’s perspective
- Suggestions for how payers and providers can better support community health
Speaker
Alan Coker
Advocacy Unlimited and Amplify of CT at Lived experience expert and Board member
Keynote Speaker
Archelle Georgiou
C-Suite Leader and Patient Advocate
Speaker
Dionne Stalling
Rare and Black at Lived experience expert and Founder/Executive Director
Speaker
Laura Carroll
Lived experience expert, Rural storyteller, Social drivers of health champion
5:15 PM
5:15 PM – 5:20 PM
Closing Remarks
Speaker
Jenn Kerfoot
Chief Strategy and Growth Officer at DUOS
Speaker
Rafi Cices
Head of BOI, Coding & Billing at Cityblock
5:20 PM
5:20 PM – 6:30 PM
Exhibit Hall Opening & Networking Cocktail Reception
Tuesday - August 26, 2025
8:00 AM
8:00 AM – 5:30 PM
Exhibit Hall Open
8:00 AM
8:00 AM – 7:00 PM
Headshot Cafe Open
Sponsored by: ComplexCare Solutions
ComplexCare Solutions is offering complimentary professional headshots to all attendees. Swing by anytime between 8:00 AM and 6:15 PM to capture the perfect photo you can use for LinkedIn, your company website, or professional profiles. Don’t miss this chance to elevate your personal brand!
8:00 AM
8:00 AM – 4:00 PM
Information Desk Open
8:00 AM
8:00 AM – 9:00 AM
Networking Breakfast
9:00 AM
9:00 AM – 9:10 AM
Opening Remarks
Speaker
Jenn Kerfoot
Chief Strategy and Growth Officer at DUOS
Speaker
Rafi Cices
Head of BOI, Coding & Billing at Cityblock
9:10 AM
9:10 AM – 10:00 AM
Navigating the Transforming Medicare Advantage Political Landscape
- Explore key changes finalized in the Contract Year 2026 Medicare Advantage and Part D final rule and the Calendar Year 2026 Rate Announcement and discuss the impact on plans / providers
- Discuss potential legislation reforms that may occur within the next 2-3 years, how Congress is viewing the MA program overall, potential Congressional priorities, including legislation related to artificial intelligence, prior authorization, MA marketing, risk adjustment etc.
- Gain insights into how health plans and providers can navigate these changes while ensuring compliance
Speaker
Carrie Graham
Research Professor and Director, Medicare Policy Initiative at Georgetown University
Speaker
Neil Patil
Health Policy Director, The Medicare Policy Initiative at Georgetown University
10:00 AM
10:00 AM – 10:45 AM
Keynote: Understanding OIG’s Current Oversight of Managed Care Priorities
Join RISE for a special presentation with OIG leaders to understand current oversight priorities in risk adjustment, quality performance, and managed care operations.
Keynote Speaker
Ann Maxwell
Deputy Inspector General for Evaluation and Inspections at HHS Office of Inspector General
Keynote Speaker
Carolyn Kapustij
Senior Advisor for Managed Care at HHS Office of Inspector General
10:45 AM
10:45 AM – 11:15 AM
Networking Break
11:15 AM
11:15 AM – 12:00 PM
Medicare Advantage Under the Microscope: Policy, Priorities, and Planning Ahead
Join policy experts from Georgetown’s Medicare Policy Initiative for an engaging deep dive into the shifting political terrain for MA plans and risk-bearing provider groups. Building on the morning’s session, bring your questions about new and emerging federal policies—and walk away with strategic insights to help plans and providers thrive in this evolving environment.
Speaker
Carrie Graham
Research Professor and Director, Medicare Policy Initiative at Georgetown University
Speaker
Neil Patil
Health Policy Director, The Medicare Policy Initiative at Georgetown University
11:15 AM – 12:00 PM
Panel: From Disruption to Direction - Operational Leadership in the New MA Era
As the Medicare Advantage (MA) landscape undergoes profound shifts, operational leaders are no longer just reacting—they’re redefining how to grow and scale with purpose.
- Hear how forward-thinking MA leaders are pivoting from short-term adjustments to long-term strategy, turning industry disruption into opportunity
- Uncover actionable strategies to help your organization lead through change and uncertainty
- Explore how top MA organizations are aligning product design, marketing, brokers, and member communications under unified, holistic strategies
Speaker
Cathy McClain Gordon
Managing Partner & CEO at 4E Health Care Ventures, LLC
Speaker
Jacop Jung
VP Risk Adjustment at Intermountain Health, PCSS
Speaker
Jennifer Del Villar
VP, Operations at Elite Health Plan
Speaker
Kwame Appiah-Yeboah
Director, Risk Adjustment and Revenue Management at SENTARA HEALTH PLAN
12:00 PM
12:00 PM – 12:15 PM
Tools & Technology Spotlight: Inovalon
Leading service providers will showcase their offerings in a quick-pitch setting. Evaluate the latest and greatest tech tools to bring back to your organization.
Speaker
Kate Marta
VP, Clinical Quality, Training, Oversight and Innovation at Inovalon
12:00 PM – 12:15 PM
Tools & Technology Spotlight: Milliman IntelliScript
Leading service providers will showcase their offerings in a quick-pitch setting. Evaluate the latest and greatest tech tools to bring back to your organization.
Speaker
Josh Brezovar
Senior Actuarial Analyst at Milliman IntelliScript
12:15 PM
12:15 PM – 1:15 PM
Networking Lunch
1:15 PM
1:15 PM – 2:00 PM
Panel: Navigating Quality Metrics in a Shifting Landscape
- Gain insights into recent CMS updates and their implications for plan performance, reimbursement, and member outcomes
- Explore evolving quality measurement trends and how to future-proof your organization’s approach to performance management
- Discuss best practices in integrating cross-functional teams to drive sustained quality performance
Speaker
Harlan Edlin
President at Novillus, A Reveleer Company
Speaker
Katharine Iskrant
President at Healthy People, Inc.
Speaker
Melissa Cornejo-Burke
Director, Quality Improvement at Fidelis Care
Speaker
Melissa Newton Smith
Founder, Senior Advisor at Newton Smith Group
1:15 PM – 2:00 PM
Risk Adjustment Before the Claim: The Case for Concurrent Review in a Shifting Regulatory Era
Speaker
Chad Wege
VP & Head of Product, Risk Adjustment at Datavant
Speaker
Chris Towner
Manager, Risk Adjustment Analytics at Providence Health
Speaker
Kelley Scott
Manager, Risk Adjustment Clinical Programs at Providence Health
2:05 PM
2:05 PM – 2:50 PM
Actioning on Diagnosis Gaps Directly within the EHR Clinical Workflow
- Discover how a cloud-based EHR platform enhances the deployment of clinical data at scale across our provider network
- Understand how identifying diagnosis gaps within the EHR boosts performance, risk adjustment, and overall patient care
- Gain insights into how alignment with industry standards has paved the way for innovative solutions and strong partnerships
- Benefit from our "Lessons Learned" as we share valuable insights from our journey
Speaker
Gregory LeGrow
Executive Director, Payer Market Strategy at athenahealth
Speaker
John Farley
CMO at Complete Health
2:05 PM – 2:50 PM
Speaking the Language of Leadership
- Explore proven strategies for effectively communicating with senior leadership, ensuring your insights, proposals, and performance metrics align with organizational goals
- Understand what executives care about most and how to tailor your message to support core business objectives
- Learn communication techniques for delivering difficult messages with clarity, transparency, and professionalism
- Gain tools for influencing organizational change, including driving decision-making, building buy-in, and framing data and messaging for executive audiences
Speaker
Rick Whitted
CEO at U.S. Hunger
Speaker
Sarah Aranguibel-Dávila
Chief of Staff at U.S. Hunger
2:50 PM
2:50 PM – 3:20 PM
Networking Break
3:20 PM
3:20 PM – 4:05 PM
Panel: Staffing for Scale – Examining Workforce Models to Power Sustainable Growth in Medicare Advantage
- Get insights into current staffing models within MA organizations
- Learn how Medicare Advantage organizations are restructuring care teams to serve more members effectively without compromising personalized care
- Examine emerging staffing models that optimize clinical and non-clinical resources across in-person and virtual settings
Speaker
Shannon Decker
CEO at VBC One
Speaker
Tina Dueringer
CEO, Principal Advisor at Dueringer Advisors, Inc.
3:20 PM – 4:05 PM
Who Wins in Medicare Advantage?
In the competitive landscape of Medicare Advantage, it’s easy to see payers, providers, and enablers as working in opposition. But what if collaboration, not competition, is the key to success? This session will challenge conventional thinking, exploring how our panelists are reshaping partnerships to create value for all. Walk away with practical strategies for aligning incentives, overcoming challenges, and driving success in Medicare Advantage.
Speaker
Aaron DeBoer
MBA, Executive Vice President at Honest Health
Speaker
Anthony Thompson
Senior Vice President, Healthcare Network Strategy at CDPHP
Speaker
Reza Alavi
Founder / Partner at Quintuple Aim / ClinX Academy
Speaker
Stephanie Lobosco-Navarro
Senior Vice President, Strategic Initiatives at Community Care Physicians
4:10 PM
4:10 PM – 4:55 PM
Keynote Fireside Chat: Behind the Curtain – a Special Sit Down with the Honorable Christi A. Grimm
Christi A. Grimm, former Inspector General of the U.S. Department of Health and Human Services (HHS), is a nationally recognized authority in health care oversight, program integrity, and organizational leadership. Over the course of her 25-year career, she has advanced accountability, innovation, and performance across the nation's largest health and human service programs. As the sixth Inspector General of HHS, she provided independent oversight of up to $2 trillion in annual expenditures across Medicare, Medicaid (including managed care), public health, biomedical research, and social services.
Join RISE for a thought-provoking discussion with Ms. Grimm as she reflects on her tenure and shares insights into the future of independent oversight, enforcement strategy, and the growing role of technology in the healthcare sector.
Speaker
Ari Yampolsky
Founding Partner at Whistleblower Partners
Keynote Speaker
Christi A. Grimm
4:55 PM
4:55 PM – 5:00 PM
Closing Remarks
Speaker
Jenn Kerfoot
Chief Strategy and Growth Officer at DUOS
Speaker
Rafi Cices
Head of BOI, Coding & Billing at Cityblock
5:00 PM
5:00 PM – 6:00 PM
Interactive Roundtables
Roundtable 1: Agentic AI – Unlocking the Next Era of Risk Adjustment
Roundtable 2: Overcoming Risk Adjustment Barriers to Drive Member Outcomes and Plan Performance
Roundtable 3: You Bring the Challenge, We’ll Bring the Fix - A Risk Adjustment Roundtable You’ll Actually Want to Attend
Roundtable 4: Unlocking Quality Performance: Addressing Unmet Needs in Health Plan Care Management
Roundtable 5: Risk Mitigation Strategies: Pareto OIG Toolkit Technology & RADV Readiness (Best practices / Operational)
Roundtable 6: From Paper to Platform: How Physician Groups Are Digitally Transforming Dementia Detection for Greater AccuracyEducational Takeaways
Roundtable 7: Getting Ahead of RADV: A Proactive Strategy for Retrieval and Compliance
Roundtable 8: MA RADV in Focus: What Health Plans Need to Know & Do Now
Roundtable 9: HCC Coder...the tool your team can't live without!
Roundtable 10: Behavioral Intelligence Unleashed: Transforming Member Journeys into Quality & Risk Adjustment Outcomes
Roundtable 11: Agentic AI - Future in Healthcare
Roundtable 12: Transforming Healthcare: Strategic Approaches to Cut Costs in High-Impact Disease States
Roundtable 13: Boost Star ratings: the role of digital heart health solutions
Roundtable 14: Audit Ready or Audit Risky? Your 2025 Survival Plan for RADV & OIG
Roundtable 15: Audit-Ready Always: How to Build a Future-Proof RADV Strategy
Roundtable 16: Streamlining Chart Retrieval: The Power of Automation & Partnership
Roundtable 17: The Truth About RADV Audits: Myths Debunked
6:00 PM
6:00 PM – 7:00 PM
Networking Cocktail Reception
Join us for drinks, hors d’oeuvres, and face-to-face networking with peers in the Exhibit Hall.
Wednesday - August 27, 2025
8:00 AM
8:00 AM – 11:15 AM
Exhibit Hall Open
8:00 AM
8:00 AM – 11:00 AM
Information Desk Open
8:00 AM
8:00 AM – 9:00 AM
Networking Breakfast
9:00 AM
9:00 AM – 9:10 AM
Opening Remarks
Speaker
Jenn Kerfoot
Chief Strategy and Growth Officer at DUOS
Speaker
Rafi Cices
Head of BOI, Coding & Billing at Cityblock
9:10 AM
9:10 AM – 10:00 AM
Investor Perspectives: Where Capital is Flowing and Why
As the U.S. population continues to age and the Medicare Advantage market experiences sustained growth, investors are closely monitoring emerging models in care delivery, technology integration, and value-based service strategies.
In this timely and insightful discussion, a panel of leading healthcare investors examine the current landscape of healthcare and the key factors driving investment decisions.
From market trends and policy shifts to opportunities in scalable innovation, get insights into where capital is being deployed—and the rationale behind those choices.
Speaker
Abby Miller Levy
Managing Partner at Prime Time Partners
Speaker
Jenn Kerfoot
Chief Strategy and Growth Officer at DUOS
Speaker
Max Zamkow
Managing Partner at Third Act Ventures
Speaker
Rachel Kern
SVP at First Trust Capital Partners
10:00 AM
10:00 AM – 10:50 AM
Panel: The Future of Aging in Place
As Medicare Advantage enrollment continues to rise, especially among older, more clinically complex, and socially diverse populations, aging in place has emerged as a critical component of long-term strategy for health plans, providers, and community partners alike.
This panel brings together forward-thinking leaders who are taking a holistic approach to aging in place, not just through clinical interventions, but through scalable, person-centered models that address housing, transportation, nutrition, technology access, and social connection.
Together, we’ll explore:
- How health plans are evolving their aging strategies to support long-term member well-being while managing costs and utilization
- What innovative, interdisciplinary care models look like in practice and how they align with CMS guidance and quality frameworks
- What holistic strategies plans should be looking at during times of uncertainty
Speaker
Kali Peterson
Director of Policy and Programs at The SCAN Foundation
Speaker
Rachel Klein
Executive Director Medicare at Kaiser Permanente
Speaker
Rick Whitted
CEO at U.S. Hunger
10:50 AM
10:50 AM – 11:15 AM
Networking Break
11:15 AM
11:15 AM – 12:00 PM
Deep Dive: Current State of RA Litigation and Risk Areas for MA Plans, Physician Groups, Vendors and Downstream Entities
- Gain perspective on where fraud litigation in the MA space may be headed, with a focus on RA practices and potential expansion into Star Ratings-related enforcement
- Get up to speed on the latest FCA cases, DOJ priorities, and OIG audit trends—highlighting fact patterns that courts and regulators are treating as credible violations, and those that are not gaining traction at the pleading stage
- Hear about new developments in various FCA litigations, OIG audits, and other regulatory activities, with focus on what sorts of activities and fact patterns that the DOJ, as well as courts at the pleading stage, are finding to be plausible violations of the False Claims Act as opposed to fact patterns that are not meeting muster
- Participate in a Q&A with panelists to discuss real-world compliance challenges and solutions
Speaker
Ari Yampolsky
Founding Partner at Whistleblower Partners
Speaker
Jason Silberberg
Partner at Frier Levitt
11:15 AM – 12:00 PM
Fireside Chat: Unpacking AI Opportunities in Health Care – Risks, Rules & Real Talk
Join RISE for a special sit-down with Bennett B. Borden, data scientist, attorney and globally recognized authority on AI's legal, technological, and policy implications.
Come prepared for your burning questions and walk away with a better handle on:
- Classical AI (e.g., classification, recommendation systems) versus generative AI (e.g., LLMs), including their business applications and limitations such as hallucinations
- Real steps to building and operationalizing an AI governance program
- Practical advice on starting small, selecting low-risk/high-impact projects, building internal AI literacy, and handling resistance through collaboration rather than control
- The ethics of AI, including, how we keep AI in check, using things like Constitutional AI and control frameworks to make sure systems are safe, fair, and aligned with organizational values
- What regulators are saying, where the big risks are (think bias, transparency), and what health care organizations should watch for next
Speaker
Bennett Borden
Founding Partner and CEO at Clarion AI Partners
Speaker
Tina Dueringer
CEO, Principal Advisor at Dueringer Advisors, Inc.
12:05 PM
12:05 PM – 12:50 PM
Engaging the Unreachable: Transforming Medicaid Member Outreach with AI
- Understand the Landscape of Medicaid Expansion and Member Dynamics in Arkansas
- Explore the Role of AI in Enhancing Medicaid Member Engagement
- Identify Quality-Related Applications for AI Two-Way Texting
- Discover Strategies to Overcome Barriers in Underserved Populations
- Envision Future Applications of AI in Healthcare Outreach
Speaker
Judy Chappell
Arkansas Blue Cross and Blue Shield
Speaker
Kaitlin Bates
Manager, ARHOME Quality at Arkansas Blue Cross and Blue Shield
12:05 PM – 12:50 PM
So you’ve been selected for an audit… now what?
An Interactive Discussion on RADV Audit Readiness
Hear from plans that have undergone RADV audits and walkaway with tips for RADV audit readiness, with:
- Proactive preparation to RADV audit preparedness including pros and cons in working with vendors to chase chart
- Common trends and diagnosis that come up
- Insights from real-world RADV audit case studies to inform your readiness approach
Speaker
Amanda Watkins
Director, Coding / CDI Operations at Cityblock
Speaker
Gail Blacklock
Chief Compliance Officer at Elite Health Plan
Speaker
Rafi Cices
Head of BOI, Coding & Billing at Cityblock
12:50 PM
12:50 PM – 1:00 PM
Closing Remarks
12:50 PM – 1:00 PM
Closing Remarks
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