Interoperability, the Cornerstone of Payment Integrity and Risk Adjustment Operations | Kisaco Research

In today’s complex healthcare ecosystem, interoperability - the seamless exchange and utilization of data across diverse systems - is the linchpin for success in payment integrity and risk adjustment. When health plans, payers, providers, and vendors collaborate through standardized and efficient data sharing, the results are transformative: accurate payments, fraud prevention, and streamlined processes that scale innovation. However, the absence of a disciplined interoperability strategy can lead to significant inefficiencies.


This keynote will emphasize the critical need for a proactive, stakeholder-driven interoperability plan. Drawing parallels to Six Sigma principles, it highlights how early standardization of data formats, security protocols, and transfer methods prevent downstream inefficiencies, reduce costs, and enhance scalability. Attendees will leave with actionable insights into how interoperability not only smooths immediate business processes but also lays the foundation for long-term industry transformation.


Join us to explore why interoperability isn’t just a technical challenge but a strategic imperative—an essential cornerstone for a resilient, innovative, and efficient healthcare system.

Lesson Objectives:

- Understand the Impact of Interoperability: Learn how seamless data exchange and standardization, improve operational efficiency.
- Explore Real-World Lessons: Case studies help underscore the consequences of poor interoperability planning and the benefits of thoughtful standardization.
- Actionable Strategies for Stakeholder Collaboration: Discover how to develop a disciplined interoperability plan.

Session Topics: 
Payment Integrity
Sponsor(s): 
AMS Intelligent Analytics
Speaker(s): 

Author:

Dave Cardelle

Chief Strategy Officer
AMS

Dave Cardelle, R.Ph., is on the executive team at AMS and serves as the Chief Strategy Officer. He leads a dedicated team of professionals focused on transforming the payment integrity (PI) industry. With a BS in Pharmacy from the Massachusetts College of Pharmacy in Boston, MA, Dave brings a unique blend of healthcare expertise and domain knowledge to his role.
As the CSO, Dave leverages years of experience in the PI industry, including working for both Payer and Provider organizations to help AMS grow through innovative product, sales, marketing, and client relationship strategies.
Throughout his career, Dave has consistently demonstrated a keen understanding of healthcare-related matters, a skill that proves invaluable in the context of payment integrity. His passion for advancing the industry and commitment to maintaining the highest standards of integrity have earned him a reputation as a true industry expert.

Dave Cardelle

Chief Strategy Officer
AMS

Dave Cardelle, R.Ph., is on the executive team at AMS and serves as the Chief Strategy Officer. He leads a dedicated team of professionals focused on transforming the payment integrity (PI) industry. With a BS in Pharmacy from the Massachusetts College of Pharmacy in Boston, MA, Dave brings a unique blend of healthcare expertise and domain knowledge to his role.
As the CSO, Dave leverages years of experience in the PI industry, including working for both Payer and Provider organizations to help AMS grow through innovative product, sales, marketing, and client relationship strategies.
Throughout his career, Dave has consistently demonstrated a keen understanding of healthcare-related matters, a skill that proves invaluable in the context of payment integrity. His passion for advancing the industry and commitment to maintaining the highest standards of integrity have earned him a reputation as a true industry expert.