Health plans are asked to raise Stars and HEDIS® performance every year while providers juggle competing quality programs, disconnected systems, and too many clicks. In this RISE-supported session, Reveleer brings together Tony Tran of UPMC Health Plan and Grant Rowholt of Novillus, a Reveleer company, to show how health plans engage and enable provider groups year round, across every channel, without adding abrasion.

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What the session covers:

• How to define engagement and enablement so your outreach activates busy providers and gives them the tools to act.
• How to design omnichannel outreach across email, portal messaging, phone, and text that coordinates rather than competes.
• How to launch a year-round prospective engagement program in weeks instead of months.
• How to reach both large integrated groups and the long-tail of smaller and rural practices.
• How single sign-on, integrated incentives, and reduced clicks lift provider participation in gap closure.
• How to apply AI to first-level chart abstraction while keeping clinical review in human hands.
• Which utilization, gap-closure, and turnaround metrics tell you the program is working.

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The session pairs a practical framework with UPMC Health Plan's live experience running Care Gap Manager across owned and non-owned providers. Watch to see how Reveleer helps health plans turn fragmented outreach into coordinated, year-round healthcare provider engagement that closes care gaps and strengthens the payer-provider partnership.

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Provider Engagement FAQs

What is the defensibility standard in value-based care?

The defensibility standard is the ability to substantiate every submitted risk score with traceable evidence, from the source clinical document through the final diagnosis. CMS is moving toward more frequent RADV audits across a wider set of Medicare Advantage contracts, so health plans can no longer treat documentation as something to assemble after an audit notice arrives. Meeting the standard means maintaining a continuous chain of custody for clinical data, so that when an auditor questions a condition, the plan produces the supporting record and the path it traveled rather than reconstructing it under deadline pressure. Reveleer builds this traceability into risk adjustment workflows, so audit readiness becomes a byproduct of daily operations instead of a separate scramble.

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