RISE National recap: What MA plans need to know

The Reveleer team recently arrived home from San Antonio where we spent the last few days at RISE National with 2,000+ attendees, all of whom work for or with Medicare Advantage (MA) plans and their members. The group of health systems, ACOs, government and non-profit organizations, and fellow technology companies discussed the state of MA and strategies to improve member outcomes.

At RISE, attendees talked about everything from risk adjustment to member experience, social determinants of health to artificial intelligence (AI), all with the aim of collaboratively shaping the future of Medicare. Below, we’ll unpack some of the major themes that emerged and what health plans need to know about the current state and outlook of MA.

A sharp eye on compliance is key

As MA plans navigate a new Administration in Washington and prepare for potential changes to Medicare, RISE attendees spent a significant amount of time focusing on security and compliance.

Expert-led panels touched on topics like navigating waves of compliance enforcement and modernizing audit preparation for RADV compliance. Sessions also covered building compliant risk adjustment programs and helping attendees home in on the most effective (and efficient) strategies to maintain compliance.

Tightening up compliance procedures, leveraging technology to prepare for audits, and ensuring accuracy of data and accountability was clearly a priority for RISE attendees aiming to make MA as effective for its members as possible.

MA plans need a smarter approach to risk adjustment

As in previous years, risk adjustment was a popular topic at RISE National. This year, however, there was a particular focus on smarter approaches to retrospective risk adjustment and strategies to unite retrospective and prospective risk adjustment.

Panelists covered various risk-related topics including the power of prospective risk adjustment to improve access to care, the relationship between risk adjustment and care management, and how to effectively engage clinical voices in the risk adjustment process. They also focused on the role of risk adjustment technology to make workflows more efficient and effective, improving access and quality for MA members.

A renewed focus on member experience has wide-ranging benefits

MA plans and other attendees at RISE National also turned their attention to enhancing the member experience. From health equity to AI, attendees and panelists discussed various strategies to improve member satisfaction and strengthen the relationship between plans and their members.

For example, sessions like “Making a Right Turn in The Intersection of Quality and Member Experience in a Dual eligible Environment” focused on the importance of member-centered initiatives. There were also discussions around community-driven solutions for health equity as well as the potential of communication automation and agentic AI solutions to help members navigate the healthcare system.

AI is laying the foundation for value-based care success

Finally, it was clear at RISE National that MA plans are increasingly looking to AI-powered solutions to help solve their data management problems, advance their risk adjustment programs, and achieve their value-based care goals.

The Reveleer team was honored to lead the panel, “The Power of AI in Value-Based Care: Achieving Holistic Patient Insights for Better Decision-Making". Paul Burke, Reveleer’s Chief Product Officer, facilitated the panel featuring Dr. Reza Alavi from Johns Hopkins Medicine and Dr. Henish Bhansali from Medical Home Network.  

During the session, the panelists and attendees discussed how AI technology in healthcare is critical to value-based care workflows. This technology can support aggregating and aligning structured and unstructured data to stratify patient risk more accurately and consistently meet quality benchmarks. Furthermore, data-powered, AI-driven value-based care platforms will help MA plans better navigate the transition to the V28 model and optimize their performance.

To make the uptake of AI-powered technology successful, the panel discussed the importance of implementing transparency measures, ensuring explainability, and conducting vulnerability testing. In general, MA plans and other RISE National attendees expressed a lot of curiosity around autonomous coding and discussed the challenge of facilitating payer-provider interactions in value-based care technology.

Shaping the future of Medicare

The breadth and depth of content presented at RISE National—and the engaging discussions that occurred among MA plans, partner organizations, and technology vendors—showcased a range of challenges and opportunities shaping the future of Medicare. The diverse group of attendees were all committed to discovering strategies to shore up compliance, better engage members in their care, and ultimately drive improvement in member outcomes. As AI-powered technology advances and healthcare leaders continue to find new and innovative ways to manage MA, it’s clear that the future of Medicare is bright.