I had the privilege of attending RISE National this week. As usual, it did not disappoint. Here is a summary:
The landscape of Medicare Advantage has changed significantly and the need for increased oversight and strong compliance were discussed throughout the entire conference. Accuracy in coding, clinical documentation improvement and financial integrity will be crucial for continued success. It was clear that the focus on risk adjustment as the main financial driver to ensure revenue will be moving to a more integrated approach that includes risk adjustment, quality, and utilization management.
AI and Interoperability were hot topics. There are many exciting advancements that will allow us to work and scale much faster. AI will help us in all aspects of the work we do from member engagement to reducing administrative burden. However, human oversight will be crucial to ensure accuracy and compliance. As interoperability continues to be a focus in our healthcare system, I will be closely following the progress of the Trusted Exchange Framework and Common Agreement (TEFCA). This framework strives to remove barriers in sharing health information to improve patient care, public health, and healthcare efficiency.
Being only a few months into a new administration, there is still much that we do not know currently. What is certain is that we will continue to be challenged with competing priorities. Organizations that can be fluid, agile and nimble will continue to succeed and thrive in this new era.
- Colleen Gianatasio, VP – Compliance (CoventBridge Group)
