Optimize Risk Adjustment Through Technology-Enabled Payer/Provider Collaboration

  • September 27, 2018
  • 1:30 PM – 2:30 PM ET
  • Online

In today’s value-based care world, health plans and providers in at-risk contracting arrangements are equally responsible for risk adjustment and quality outcomes, and not just at the integrated delivery system level. To be successful, health plans and providers must set aside previous challenges and come to the table as equals to foster a strong working relationship. As a health plan, your organization’s adoption of technology can promote better collaboration for enhanced VBC performance. Through the lens of UPMC’s risk adjustment transformation journey over the last 5 years, this webinar will explore the modern technology framework required to enable effective payer – provider collaboration to improve risk adjustment outcomes.

Attendees will learn:

  • Learn about the tools, technology, people, and process coming together across UPMC’s health plan, health system, and provider network to achieve major risk adjustment goals.
  • Discover the technology framework UPMC utilized to support and enhance their risk adjustment transformation including a NLP-powered suite for retrospective and prospective review, physician education, data sharing, and clinical documentation improvement.
  • Hear about the overarching improvement methodology UPMC utilized to map, plan, and organize their risk adjustment transformation.
  • Compare the clinical, operational, and financial results they were able to realize against their stated objectives.
  • Develop a strategic understanding of how to incorporate NLP-powered solutions into your organization’s technology ecosystem.


Adele L. Towers, MD MPH FACP,
Senior Clinical Advisor
UPMC Enterprises

Dr. Towers is the Senior Clinical Advisor for the UPMC Technology Development Center. She is directly involved in the development of healthcare related technology, with emphasis on use of Natural Language Processing (NLP) for coding and clinical documentation improvement. Prior to this role, she has served as the Medical Director for Health Information Management at UPMC with responsibility for Clinical Documentation Improvement as well as inpatient coding denials and appeals. She has been on the faculty in the Division of Geriatric Medicine at the University of Pittsburgh for over 20 years, and continues to see patients at the Benedum Geriatric Center in UPMC. She is the former Medical Staff President at UPMC Presbyterian, and her prior positions have been as Vice Chair for Quality Improvement and Patient Safety for the Department of Medicine, Medical Director of the Benedum Geriatric Center and Medical Director of Primary Care at the Western Psychiatric Institute and Clinic. Dr. Towers has presented the experience at UPMC with use of NLP for coding at multiple regional and national conferences.

Adam Gronsky
Vice President
Advisory Services

With experience in all three main sectors of health care – provider, payer and health system, Adam Gronsky brings deep industry and technology experience to Health Fidelity, and leads a team of statistical, data-driven consultants to help risk-bearing organizations achieve financial success under risk-based contracts. Prior to joining Health Fidelity, Adam was Product Manager of Software Development at the UPMC Technology Development Center concentrating on medical intelligence solutions that leverage natural language processing including CDI, Quality Measurement, and Risk Adjustment solutions. The applications he generated have generated a combined $50M annually in incremental revenue to UPMC. Adam has a Bachelor’s and Master’s Degree in Health Management Systems from Duquesne University.