Quality and Risk Workshop

Las Vegas, NV US
December 20, 2021 to December 21, 2021

Activity description

It is well known that patients with multiple serious medical conditions have higher costs of care and require more resources. In a typical fee-for-service model there are limited mechanisms to recognize and address these discrepancies. Risk Adjustment is a model that adjusts reimbursement based on the presence or absence of serious medical conditions such as diabetes or heart failure. Over time, more accurate coding results in more accurate reimbursement. As we continue to evolve the health care system to a more closely aligned fee-for-value model, risk adjustment plays a key role and has the potential to truly align resources and care.

This activity will review the basics of the risk adjustment system in Medicare and how accurate and appropriate diagnosis, documentation, coding, and care lead to improved patient benefits, such as transportation, and lower copays—as well as improved reimbursement for health plans and providers. The activity will move from an overview to a condition-focused review.

This activity is jointly provided by OptumHealth Education and OptumCare.

Commercial support
No commercial support was received for this activity.

Hardware/Software Requirements
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Target Audience

These materials are intended only for those that attend the live activity on Monday, December 20, 2021.  This activity is designed to meet the educational needs of physicians—including family physicians—and other health care professionals who have an interest in health care economics and risk adjustment.

Learning Objectives

At the end of this educational activity, participants should be able to

  • Identify how risk adjustment provides an opportunity to align care across the health care delivery spectrum.
  • Understand how accurate and appropriate risk adjustment leads to sufficient resources to increase patient benefits.
  • Explain why medical practices should improve their documentation in response to the transition from fee for service to fee for value.
  • Describe how to follow disease improvement or progression using ICD-10 codes reflecting the patient’s condition.
  • Discuss how ICD-10 codes may be used in the pay-for-performance program.
  • Discuss the level of detail required by the new system and how to improve accuracy and specificity in documentation.
Activity summary
Available credit: 
  • 12.00 AAFP (American Academy of Family Physicians)
  • 12.00 AMA
  • 12.00 Attendance
Activity opens: 
Activity expires: 
Event starts: 
12/20/2021 - 9:00am
Event ends: 
12/21/2021 - 3:00pm
OptumCare Community Center
5820 South Eastern Avenue
Suite 100
Las Vegas, NV 89119
United States

Faculty Listing
Nikki Macalalad, MSN, APRN, FNP-C
Associate Director of Clinical Coding Education, CDQI
Southwest Medical Associates--part of OptumCare
Las Vegas, Nevada

Activity Planners
Kevin Heath, MD, MHL, FACP
National Medical Director for Education Solutions
Clinical Performance, OptumCare

Tania Miedico, MD
Medical Director

Sarah Chart, RN
Vice President
OptumHealth Education

Rebecca Gleason, RN, CCM
Activity Manager
OptumHealth Education

V. Silverstein, MD
Eagle Creek Medical Communications
Durham, North Carolina

Disclosures of Relevant Financial Relationships
In accordance with the Accreditation Council for Continuing Medical Education's (ACCME) Standards for Integrity and Independence in Accredited Continuing Education, OptumHealth Education (OHE) requires all those in control of educational content to disclose their financial relationships with ineligible companies within the prior 24 months. Ineligible companies are defined by the ACCME as companies whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients. Individuals must disclose all financial relationships, regardless of the amount, with ineligible companies and regardless of their view of the relevance of the relationship to the education. OHE ensures that the content is independent of commercial bias.

The activity faculty and planners have no financial relationships to disclose.

Accreditation Statement
Joint Accreditation Logo In support of improving patient care, this activity has been planned and implemented by OptumHealth Education and OptumCare. OptumHealth Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE) and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.


Credit Designation Statements

OptumHealth Education designates this live activity for a maximum of 12.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Academy of Family Physicians
The AAFP has reviewed Quality and Risk Workshop, and deemed it acceptable for AAFP credit. Term of approval is from 10/02/2021 to 10/02/2022. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Physician Assistants
The American Academy of Physician Assistants (AAPA) accepts credit from organizations accredited by the ACCME.

AAPC-Certified Coders
AAPC will honor 1-for-1 CEUs for any live event offering CME credit or AMA PRA Category 1 Credit™. A certificate of attendance or completion is necessary to show participation. The certificate will give the total CMEs possible for the offering. Physicians are advised to claim only the actual hours that they were present during the education. We ask that AAPC-certified members abide by this request also. One hour of instruction is worth 1 CEU.

Nurse Practitioners
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts credit from organizations accredited by the ACCME and ANCC.

A certificate of attendance will be provided to learners upon completion of activity requirements, enabling participants to register with licensing boards or associations that have not been pre-approved for credits. To apply for credit types not listed above, participants should use the procedure established by the specific organization to which you wish you apply credit.

Available Credit

  • 12.00 AAFP (American Academy of Family Physicians)
  • 12.00 AMA
  • 12.00 Attendance
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