A recognized expert in risk adjustment, Debbie Conboy has over 30 years of healthcare experience and comprehensive process development, technology integration, documentation, analytics, and risk strategy skills. She is well versed in quality measures and value-based care.
Before joining Wakely Consulting Group, an HMA Company, Debbie was senior vice president of risk adjustment and quality at Signify Health. She led the Clinical Documentation Integrity (CDI), Coding, Auditing, and Clinical Referral departments as well as the Organizational Risk Adjustment Strategy for Medicare Advantage (MA) and Affordable Care Act (ACA) and Medicaid initiatives. In this role, she advised executive leadership on regulatory changes and developed strategies to mitigate effects, resulting in revenue protection of $12 million.
Throughout her career, Debbie has prioritized continuous improvement, driving operational efficiency and cost reductions. For Signify, Debbie reduced unit costs from $11 to under $5 through operational improvements. These included reduced touches on a single medical record, reduction in complex coding guidelines that raised the number of charts per coder by 47%, and improved recapture rates from 65% to 83%. As vice president of risk adjustment and STARS for Capital Blue Cross, she designed and launched a strategy to insource risk adjustment activities, resulting in an annual cost savings of $18 million.
Debbie’s MA expertise supports her operational improvement efforts. She leverages her in-depth understanding across Stars, Healthcare Effectiveness Data and Information Set (HEDIS), compliance, Centers for Medicare and Medicaid Services (CMS) files, the CMS Hierarchical Condition Category (HCC) model, enrollment requirements, and claims processing to drive revenue and growth as well as Encounter Data Processing System (EDPS) submissions. She has developed a Risk Adjustment Data Validation (RADV) playbook that was successfully deployed to complete a RADV within 12 weeks and has advised multiple plans on how to effectively operationalize and optimize a RADV. She has also led Stars activities, driving improvements across multiple measures and building team culture and capacity.
In addition to her MA and risk adjustment expertise, Debbie has direct experience with the Chronic Illness and Disability Payment System (CDPS Rx), Adjusted Clinical Groups (ACG), and the Health and Human Services (HHS) HCC models. She has also led risk adjustment departments supporting the ACA, including Enrollee-Level External Data Gathering Environment (EDGE) submissions and HRADV.
