Agenda
Explore the full schedule of sessions, workshops, and networking opportunities at The 26th Risk Adjustment Forum.
Tuesday - October 21, 2025
8:30 AM
8:30 AM – 4:00 PM
Information Desk Open
8:30 AM
8:30 AM – 9:30 AM
Networking Breakfast
9:00 AM
9:00 AM – 5:00 PM
Workshop A
RADV Audit Simulation
This Audit simulation workshop is designed for audit professionals from managed care health plans to successfully manage the various types of audits, but with a particular focus on RADV Audits. Join us for an introduction to best practices, the opportunity to work through case examples, and to share experiences with your peers. This workshop will zero-in on regulatory compliance while teaching you how to optimize the accuracy of the information gathered and submitted at the practice level. Please note: Attendees are encouraged to bring questions to pose to our expert workshop facilitators. You will not need coding manuals, but most people bring a laptop or a tablet, for notetaking. Benefit from a closed-door, confidential exchange of ideas, where peers can freely discuss strategies, insights, and experiences to drive innovation and improvement.
- Review of Basic Rules of Audit
- Explore Chart Retrieval and Review
- Initial steps for preparing for Audits
- Which staff is essential to overseeing your audit prep?
- Staying ahead – key items to monitor well in advance of an actual audit
Registration for this workshop includes lunch and refreshment breaks.
Speaker
Donna Malone
Director Risk Capture, Population Health Management at Mass General Brigham
Speaker
Laura Sheriff
Risk Adjustment Industry Expert
Speaker
Susan Waterman
Training Director, Risk Adjustment at Baylor Scott and White Healthcare
9:00 AM
9:00 AM – 12:45 PM
Workshop B
Risk Adjustment Practitioner
- The essentials of and differences between Medicare Advantage, Commercial and Medicaid risk adjustment
- Understanding how risk scores are calculated
- Making sense of varying payment models
- An intro into using data and predictive analytics to optimize your risk adjustment practices
- Tools for achieving data accuracy
- Where do we stand with the transition from RAPS to EDS? The latest in a long journey
- Provider engagement strategies that will impact your risk adjustment initiatives
- Risk adjustment vendor selection and management
- Determining whether you need RA vendors
- How do you effectively vet potential vendors and ultimately select them?
- Strategies for on-going, thorough vendor management
- The future of risk adjustment – what you need to know to stay ahead of possible changes
- Initial steps for preparing for a RADV audit
- Which staff is essential to overseeing your RADV audit prep?
- Staying ahead – key items to monitor well in advance of an actual audit
Registration for this workshop includes a refreshment break.
Speaker
Ava Johnson
Associate Director, Ambulatory CDQI at Mount Sinai Hospital, NYC
Speaker
Colleen Gianatasio
Clinical Documentation Integrity and Coding Compliance Specialist
1:15 PM
1:15 PM – 5:00 PM
Workshop C
Mastering ACA Risk Adjustment
This interactive workshop will provide a comprehensive understanding of ACA risk adjustment, its financial implications, and best practices for accurate data submission and compliance. Attendees will gain actionable insights into risk score optimization, audit preparedness, and regulatory updates to ensure their organizations effectively navigate ACA risk adjustment requirements.
- Understand the Purpose and Mechanics of ACA Risk Adjustment
- Interpret Risk Adjustment Methodologies and Payment Transfers
- Ensure Compliance with ACA Risk Adjustment Data Requirements
- Enhance Risk Adjustment Data Integrity and Submission Accuracy
- Prepare for RADV Audits
- Develop an internal audit readiness plan to mitigate compliance risks
- Stay Ahead of Policy Changes and Future Regulatory Updates
Registration for this workshop includes a refreshment break
Speaker
Christina M. Medrano
Sr. Director ACA Risk Adjustment Operations at Florida Blue
Speaker
Melissa Soto
Sr. Director – Advanced Analytics at Florida Blue
5:00 PM
5:00 PM – 6:00 PM
Exhibit Hall Open
5:00 PM
5:00 PM – 6:00 PM
Networking Cocktail Reception
Wednesday - October 22, 2025
7:50 AM
7:50 AM – 6:15 PM
Exhibit Hall Open
8:00 AM
8:00 AM – 4:00 PM
Information Desk Open
8:00 AM
8:00 AM – 8:50 AM
Networking Breakfast
9:00 AM
9:00 AM – 9:05 AM
Welcome Remarks
Speaker
Deborah Curry
Risk Adjustment Programs Director at Medical Mutual
Speaker
Laura Sheriff
Risk Adjustment Industry Expert
9:05 AM
9:05 AM – 10:10 AM
Keynote Address
THRIVE: Turn Uncertainty to Your Competitive Advantage
Speaker
Meridith Elliott Powell
Acclaimed Motivational Speaker, Author, and Business Growth Expert
10:10 AM
10:10 AM – 11:10 AM
Regulatory Priorities: Navigating Changes and Uncertainty
- Analyze the latest OIG findings and recommendations related to risk adjustment, including common compliance risks and areas of heightened scrutiny
- Implement best practices for proactive fraud, waste, and abuse (FWA) prevention, ensuring alignment with OIG compliance expectation
- Develop proactive strategies for adapting to risk adjustment changes while optimizing plan performance and revenue integrity
11:10 AM
11:10 AM – 11:40 AM
Networking Break
11:40 AM
11:40 AM – 12:25 PM
Track B: Risk Adjustment Safeguards
Build a Foundation: Compliance Essentials for Every Role
- Define the core principles of compliance in risk adjustment and why they matter across all roles
- Recognize key fraud, waste, and abuse risks such as improper coding, unsupported diagnoses, and billing inconsistencies
- Gain practical tips for building compliance confidence, especially for professionals in new or non-traditional roles
Speaker
Gabrielena Alcalá
Founder and CEO at MAPA Healthcare
Speaker
Prince Baawuah
Founder / Chief Tutor | Former Health Insurance Specialist at The HEALS Academy | CMS
11:40 AM – 12:25 PM
Track A: Audit Readiness
Ready or Not: RADV Audit Ramp-Up
- Understand the full scope of CMS’s RADV plan—including larger data sample sizes, and a more aggressive audit timeline targeting all MA plans
- Discover strategies to minimize operational disruption through self-auditing, proactive data reconciliation, and payment integrity
- Hear real-world examples on audit preparation, workflow alignment, and cross-functional coordination that help your plan audit-resilient
Speaker
Deborah Curry
Risk Adjustment Programs Director at Medical Mutual
12:25 PM
12:25 PM – 12:40 PM
Track A: Audit Readiness
Tools & Technology Spotlight
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.
12:25 PM – 12:40 PM
Track B: Risk Adjustment Safeguards
Tools & Technology Spotlight
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.
12:40 PM
12:40 PM – 1:35 PM
Networking Lunch
1:35 PM
1:35 PM – 2:20 PM
Track B: Risk Adjustment Safeguards
Activate End-to-End Clinical Documentation Integrity CDI
- Move beyond surface-level coding to uncover documentation gaps that can impact risk scores, quality, and compliance
- Clarify how CDI influences the entire risk adjustment lifecycle—from clinical encounter to final submission
- Explore strategies to align clinical documentation with regulatory expectations, payer requirements, and evolving industry standards
1:35 PM – 2:20 PM
Track A: Audit Readiness
Facing the Fallout: Understanding and Preparing for Extrapolation Risk
- Get a practical breakdown of the extrapolation process and how it’s being applied in audits today
- Learn how leaders are preparing for the long-term implications of extrapolated findings
- Gain cross-functional insights to strengthen your audit readiness strategy and reduce financial and reputational risk
Speaker
Donna Malone
Director Risk Capture, Population Health Management at Mass General Brigham
Speaker
Rebecca A. Welling
Vice President Risk Adjustment at Intermountain Health/Select Health
2:20 PM
2:20 PM – 2:25 PM
Session Transition
2:25 PM
2:25 PM – 3:10 PM
Track A: Audit Readiness
Build a Powerful Internal Audit Team and Stretch Resources
- Explore practical strategies for launching or strengthening an internal audit function, even with limited resources
- Learn how to prioritize high-impact areas and leverage existing staff, technology, and cross-departmental collaboration to "do more with less"
- Hear real-world examples of how organizations have built scalable audit teams that support compliance, risk mitigation, and operational improvement
Speaker
Ava Johnson
Associate Director, Ambulatory CDQI at Mount Sinai Hospital, NYC
Speaker
Rose Dunn
Chief Operating Officer at First Class Solutions, Inc.
2:25 PM – 3:10 PM
Track B: Risk Adjustment Safeguards
V28 Postmortem: Financial Lessons, Coding Shifts & Who Was Most Affected
- Take a deep dive into the real-world financial and business impact of V28—why it hit harder than expected and which populations felt it most
- Explore postmortem analyses highlighting how coding patterns, documentation strategies, and risk scores shifted under V28
- Identify key patient demographics that were disproportionately impacted and what that means for future forecasting, coding education, and payment modeling
Speaker
Carlos Rodriguez
VP of Risk Adjustment and Clinical Performance at Aegis Medical Group
3:10 PM
3:10 PM – 3:35 PM
Networking Break
3:35 PM
3:35 PM – 4:20 PM
Track A: Audit Readiness
Life After an OIG Audit: Lessons, Outcomes & What’s Next
- Hear firsthand experiences from plans that have undergone OIG audits and how they navigated the aftermath
- Unpack lessons learned—from documentation pitfalls to gaps in internal controls—and how they led to tangible changes in operations
- Explore real-world outcomes, including corrective action plans, financial impacts, and shifts in compliance strategy
3:35 PM – 4:20 PM
Track B: Risk Adjustment Safeguards
Strategic AI Vendor Selection & Partnership Management
- Identify the right partners in a rapidly consolidating healthcare landscape, ensuring alignment with strategic goals
- Implement effective vendor oversight strategies to enhance performance, compliance, and long-term collaboration
- Learn how to navigate vendor selection and demos with purpose
4:20 PM
4:20 PM – 4:25 PM
Session Transition
4:25 PM
4:25 PM – 5:10 PM
Lead Through Change: Advocating for Risk Adjustment in Uncertain Times
- Explore practical strategies for leading through industry uncertainty—both upward to senior leadership and downward to support teams on the ground
- Learn how to frame the value of risk adjustment in language that resonates with executive decision-makers
- Discover techniques for maintaining team engagement and focus during periods of high change, while ensuring operational continuity
Speaker
Carlos Rodriguez
VP of Risk Adjustment and Clinical Performance at Aegis Medical Group
Speaker
Rebecca A. Welling
Vice President Risk Adjustment at Intermountain Health/Select Health
Speaker
Shannon Decker
Founder & CEO at VBC One
5:10 PM
5:10 PM – 5:15 PM
Closing Remarks
5:15 PM
5:15 PM – 6:15 PM
Networking Cocktail Reception
Thursday - October 23, 2025
8:00 AM
8:00 AM – 1:15 PM
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
Welcome Remarks and Day One Takeaways
9:10 AM
9:10 AM – 10:00 AM
Analysis of Big, Beautiful Bill: Preparation and Impact for Health Plans
- Examine the potential impact on risk adjustment workflows, from member data access to real-time encounter data exchange and inter-plan transitions
- Identify areas of increased compliance and audit risk, especially around documentation accuracy, HCC capture, and data integrity
- Learn how risk adjustment teams can proactively collaborate with compliance, IT, and operations to align with upcoming transparency and interoperability mandates
Speaker
Gregory A. Mason
Senior Counsel at Pietragallo Gordon Alfano Bosick & Raspanti, LLP
Speaker
Melissa Newton Smith
Founder, Senior Advisor at Newton Smith Group
10:00 AM
10:00 AM – 10:05 AM
Session Transition
10:05 AM
10:05 AM – 10:55 AM
Track A: Redesigning Care
ACA Risk Adjustment Realities
- Understand the foundational similarities and critical differences between ACA and Medicare RA models
- Learn why identifying and documenting conditions in younger, harder-to-reach populations creates unique compliance hurdles
- Discuss the latest regulatory uncertainty—particularly around ACA subsidies—and what it may signal for future program design
Speaker
Christina M. Medrano
Sr. Director ACA Risk Adjustment Operations at Florida Blue
Speaker
Jenni Monfils
AVP, Risk & Quality Provider Engagement Education/CDI at Molina Healthcare
Speaker
Melissa Soto
Sr. Director – Advanced Analytics at Florida Blue
10:05 AM – 10:55 AM
Track B: Clinical Alignment
Reimagining Physician Training & Education
- Identify key physician pain points related to administrative burden and outdated educational models
- Design query feedback loops that drive action and improve documentation quality at the point of care Anticipate how upcoming
- CMS strategies may impact risk adjustment, coding, and clinical documentation
10:55 AM
10:55 AM – 11:10 AM
Track B: Clinical Alignment
Tools & Technology Spotlight
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.
10:55 AM – 11:10 AM
Track A: Redesigning Care
Tools & Technology Spotlight
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.
11:10 AM
11:10 AM – 11:50 AM
Networking Break
11:50 AM
11:50 AM – 12:40 PM
Track B: Clinical Alignment
Impacts of the RxHCC Shift
- Examine the latest changes to the Part D RA model and how the 2025 RxHCC updates are reshaping revenue strategy, especially for chronic and high-cost conditions
- Understand how rising specialty drug spend—and its growing influence on risk scores—requires tighter alignment between medical and pharmacy data
- Hear real-world insights into how health plans are adapting their protocols to respond to the new RxHCC landscape
11:50 AM – 12:40 PM
Track A: Redesigning Care
Risk Adjustment in ACOs: Strategies for Financial Sustainability
- Analyze the role of risk adjustment in ACO payment models, including shared savings, capitation, and full-risk arrangements
- Discuss key challenges ACOs face in risk adjustment, including data capture, patient attribution, and provider engagement
- Examine how ACO REACH incorporates risk adjustment methodologies and its impact on health equity and financial sustainability
Speaker
Jeremy Powell
Chief Commercial Officer at Keebler Health
Speaker
Ryan Beres
SVP, Accountable Care at CINQCARE
12:40 PM
12:40 PM – 12:45 PM
Session Transition
12:45 PM
12:45 PM – 1:25 PM
Industry Leader Conclusion Panel: Lessons Learned
- Summarize the most critical takeaways from recent CMS changes, including increased audit activity and evolving guidance
- Reflect on real-world lessons learned from implementing AI, analytics, and audit-readiness strategies across risk adjustment programs
- Identify practical ways organizations are embedding payment integrity and audit preparedness into operations
Speaker
Laura Sheriff
Risk Adjustment Industry Expert
Speaker
Rafi Cices
Head of BOI, Coding & Billing at CityBlock
1:25 PM
1:25 PM – 1:30 PM
Closing Remarks
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