Risk, quality and analytics on the agenda at RISE Summit


Best practices and essential strategies for successfully managing risk, quality, revenue and data analytics will be the subject of a presentation by Wu-Chyuan Gau and John Criswell at the 8th Annual RISE Summit to be held in Nashville on March 9-11, 2014.

Gau, the predictive modeling lead with Florida Blue health insurance and John Criswell, CEO of health insurance exchange marketplace Pulse8 will share strategies for utilization management control with predictive analytics in their presentation titled ‘Predictive Analytics and Strategies for Personalized Care Management.’

Attendees will learn how big data and improved data quality enhances probability to predict members for care management. Both speakers will share best practices, advanced strategies and unique tools for achieving care management and quality performance objectives for Medicare Advantage and Commercial Health Exchange “HIX” risk adjusted populations.

In light of recent guidance from CMS and the proposed cuts in reimbursement, payers need actionable strategies for reducing cost, optimizing risk adjustment, elevating quality performance, and boosting revenue.

A combination of cuts and changes in risk adjustment as it relates to face-to-face assessments, are challenges that will add complexity as payers attempt to achieve quality data and effective analytics to enhance member engagement, improve outcomes, and quality of care. Legacy and limited analytics tend to produce weak results that impact utilization and the ability to appropriately target members for care management.

The speakers will share how new predictive models and big data strategies are emerging with positive results.

RISE Summit, Risk, Quality, Revenue, Data Analytics, Florida Blue, Pulse8