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The Impact of Risk Adjustment on Quality of Care: Next Steps in Better Case Management  
Risk adjustment remains the defining issue for Medicare Advantage health plans and is central to improving the quality of care provided to chronically-ill beneficiaries. Many health plans have already come to realize that prospective health risk assessments are the most effective way to bring risk adjustment and case management together to drive better revenue, better medical management, better Star Ratings and higher patient satisfaction.

For some though, the majority of diagnostic information is still collected from claims-based submissions often augmented by retrospective review of selected charts. Recent audit experience has repeatedly shown that this information to be incomplete and often incorrect—at great risk to the plan. In fact, studies done on risk adjustment implementation suggest that as many as 17% of claims-based submissions could not be supported by charts. RADV audits have documented variances closer to double that number.

In partnership with MCOL, join Gorman Health Group and CenseoHealth for a discussion on a new model for mastering the risk adjustment payment of Medicare Advantage plans on February 22 from 1:00-2:00 Eastern time.

Hear from Dr. Jack McCallum, CEO of CenseoHealth, on how a well-designed prospective risk adjustment program can help to ensure plan compliance. He’ll be joined by Nathan Goldstein, CEO of Gorman Health Group, for a discussion on practical program steps and enhanced techniques designed not only to drive risk-adjusted revenue, but also quality Star Ratings and enhanced medical management.
Learning Objectives
Participants will be able to:
  1. Understand the value of one best medical record: A simple step that goes a long way
  2. Examine the return of the house call: Improving risk adjusted revenues, Star Ratings and medical management
  3. Consider the power of patient evaluations: Which members carry the most risk, and how do you address it?
  4. Explore the next steps in revamping your chart review process: Making retrospective literally a thing of the past
Who Should Attend
Interested attendees would include:
  • Risk Adjustment Executives and Staff
  • Quality Improvement Executives and Staff
  • STARS Program Initiatives Executives and Staff
  • Revenue Management Executives and Staff
  • Case Management Executives and Staff

Attendees would represent organizations including:

  • Health Plans
  • Provider Networks
  • Care Management Organizations
  • Government Agencies
  • Solutions Providers
  • Associations, Institutes and Research Organizations
  • Media
  • Other Interested Parties
The Impact of Risk Adjustment on Quality of Care: Next Steps in Better Case Management 
  Individual Registration Fee: $195. Audio Conference CD-ROM: $40 for attendees; $285 for non-attendees after the event.

Corporate Site licensing also available. Click here to register or call 209.577.4888 We look forward to your participation in this event!

Jack  McCallum
Jack McCallum
  Jack McCallum, MD, PhD is a pioneer in Medicare Risk Adjustment. His involvement goes back to the implementation of the HCC methodology in the Medicare Advantage program after a distinguished career in medicine.

Prior to founding Censeo Jack was founder, President, and Chief Medical Officer of one of the first companies to apply clinically based algorithms to Medicare risk adjustment. Before this he was a founding member of North Texas Specialty Physicians, a multi-specialty, risk-taking provider group that serves over 30,000 members in the Dallas/Ft. Worth area.

Before building a successful IPA and two groundbreaking service companies, Jack practiced adult and pediatric neurosurgery in Fort Worth for almost thirty years, while also serving as head of the medical staff at Fort Worth Children’s Hospital. His medical training and depth of experience fuels CenseoHealth’s unique, clinically sophisticated process.

During a wholly unsuccessful first attempt to “retire,” Jack earned a doctorate in history from TCU and is currently AdRan Professor of the History of Science at TCU. He has written a number of books and articles and given numerous presentations on health care policy and medical history.


Nathan Goldstein
Nathan Goldstein,
Gorman Health Group
  Nathan Goldstein is a serial entrepreneur with a passion for reforming health care. As CEO of Gorman Health Group, he is responsible for ensuring that the solutions of GHG are calibrated to drive better outcomes for plans, providers and beneficiaries.

Before becoming CEO, Mr. Goldstein served as Executive Vice President for GHG where he was responsible for the development of new business solutions and consulting capabilities for the Government-sponsored health care industry. He also directed the development of partnerships that allow GHG to maintain a full suite of solutions for GHG clients. As a partner and member of GHG's senior leadership team since 2004, he has been central to the transformation of the industry’s most active professional services consultancy into a provider of technology-based solutions that empower health plans to deliver higher quality care to beneficiaries at lower costs.

With the recent shift by CMS towards value-based purchasing, Mr. Goldstein’s continuing focus is on redesigning the service model offered by payers and providers to beneficiaries. In recent years, other major development efforts have included OMT, a Medicare-specific operations dashboard; Valencia, a membership and PDE reconciliation software; Medicare Sales Certification, a compliance certification program for Medicare sales agents. He was also on the founding management team of the first company to provide full-service risk adjustment management for the managed care industry.

Mr. Goldstein is a nationally known speaker and presents at numerous industry events each year on topics including health reform, reimagining the health care service model and innovations in clinical practice.

Before entering health care, Mr. Goldstein's communications company had clients including presidential candidates, members of the U.S. Congress, network news anchors, Fortune 500 CEOs and one infamous Gonzo journalist. He specialized in writing on health care related topics, and, on behalf of his clients, his writings have been syndicated in over 100 newspapers nationwide. He is an avid guitarist and claims never to have been bored. 
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