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Our team had the pleasure of attending RISE National 2025, one of the premier gatherings for executives and senior leaders shaping the future of Medicare Advantage. The event brought together over 1,600 attendees from health plans, provider groups, integrated health systems, and ACOs, all sharing strategies and solutions to navigate a rapidly evolving regulatory and operational environment. From in-depth conversations on the exhibit floor to standout speaker sessions, one theme was clear: The industry is undergoing a pivotal shift—one that demands agility, data-driven precision, and innovative partnerships. Here are some of the key takeaways from the Arbital Health team: |
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1. Risk Adjustment and Stars are Evolving—It’s Time to Look Deeper
As our Chief Actuary, Tim Smith, observed, risk adjustment and Stars programs have long been a cornerstone of Medicare Advantage success. But as these models mature, health plans and ACOs are realizing that surface-level optimization is no longer enough. The focus is moving upstream to clinical drivers of cost and quality, particularly in care management.
“I was most excited to see our client Nymbl working together with industry leader, Dr. Bob Mirsky, as they discussed the impact of their solution for seniors to prevent falls. Falls are not only costly but can be devastating to quality of life, so helping clients like these through our financial modeling to get their solution out to more seniors is very rewarding to see” - Tim Smith, Chief Actuary at Arbital Health
2. Data Access Has Improved—Now Comes the Deployment Challenge
Our VP of Commercial, Tassanee Khouri, noted a significant shift: Providers have made great strides in data access, whether related to Social Determinants of Health (SDOH), contract performance, or risk adjustment metrics. The challenge now? Deploying this data effectively.
From capitalizing on SDOH insights for CMS’s new Health Equity Index to ensuring clean, reliable data for contract monitoring, leaders are eager for best practices and actionable strategies. Many of our conversations revolved around how Arbital Health’s platform can simplify the complexities of Medicare Advantage contract management, providing real-time visibility into contract performance and helping teams stay ahead of financial risk.
3. The Regulatory Landscape is Shifting—Proactive Compliance is Key
It’s no surprise that regulatory changes, particularly around Medicare Advantage and Medicaid, were top-of-mind throughout the conference.
As our Sales Director, Dana Fieni, shared, organizations are taking a proactive stance on compliance, recognizing that financial stability hinges on adapting quickly to new mandates.
Attendees expressed a growing appetite for leveraging AI-driven tools, advanced analytics, and predictive models—all areas where Arbital Health’s technology is designed to provide a critical edge, especially when it comes to HCC coding, risk adjustment audits, and payment integrity efforts.
4. Member Engagement & SDOH Remain at the Forefront
Another encouraging theme was the continued emphasis on reducing healthcare disparities and enhancing member engagement. CMS’s push for greater integration of SDOH data signals a broader industry commitment to equity and outcomes-based care.
5. Looking Ahead: Innovation Through Partnership
Perhaps the most energizing observation? Amid all the challenges, there’s palpable optimism and openness to partnership.
Organizations are not just bracing for change—they’re actively seeking vendors and collaborators who can help them stay ahead of regulatory shifts, harness AI, and optimize care delivery.
At Arbital Health, we’re proud to stand alongside payers, providers, and risk enablers, offering actuarially backed, technology-driven solutions that take the guesswork out of managing Medicare Advantage contracts at scale.
Final Thoughts:
RISE National reaffirmed what we at Arbital Health believe deeply: The future of Medicare Advantage hinges on data-powered decisions, clinically driven strategies, and aligned partnerships.
As regulations tighten and value-based models become more complex, organizations that invest in the right tools and relationships will be best positioned to deliver meaningful care while maintaining financial sustainability.
