A Bold CMS Prediction, Behavioral Science, and What You Missed at RISE National 2026

Why It Matters

The convergence of AI, behavioral nudges, and new data‑exchange models promises to streamline care delivery, improve member outcomes, and reduce fraud risk, reshaping payer strategies in a rapidly evolving health‑care landscape.

Key Takeaways

• CMS predicts AI will halve specialist visits in future
• Behavioral science drives personalized nudges improving medication adherence
• Neuro‑symbolic AI enhances coding accuracy and compliance for payers
• Hallmark leverages custom cards to boost member engagement and retention
• Data exchange acceleration remains top priority for risk‑adjustment initiatives

Summary

The Rise National 2026 conference brought together payers, providers, and innovators to discuss the future of health‑care data, behavioral science, and artificial intelligence. Highlights included a provocative opening keynote from CMS Innovation Center director Abe Sutton, who warned that AI could eventually reduce the number of specialists a patient needs to see, reshaping the 20th‑century specialist model. Sutton emphasized the need for robust data collection to evaluate voluntary and mandatory payment models, while exhibitors showcased how behavioral economics can nudge patients toward better adherence. Adhere Health’s Chandra Osborne described a real‑world case where tailored outreach, motivational interviewing, and barrier removal lifted a diabetic member’s medication compliance. Neuro‑symbolic AI startup Rapid, represented by CEO Cheton Harika, demonstrated technology that simultaneously prevents under‑coding revenue loss and over‑coding compliance risk, offering a defensible documentation layer. Meanwhile, Hallmark’s Marcel Powell explained how personalized greeting cards are being repurposed to close care gaps and improve member and employee satisfaction. Collectively, these developments signal a shift toward AI‑augmented clinical decision‑making, data‑driven program evaluation, and unconventional engagement tools—all aimed at lowering costs, enhancing outcomes, and tightening regulatory compliance for health‑plan stakeholders.

Original Description

Drip campaigns and cookie-cutter nudges do not change patient behavior. Health plans are finally realizing that you cannot automate empathy.

This video covers the ground truth from the RISE National 2026 exhibit hall. We talk with industry leaders like Chandra Osborn from Adhere Health, Chetan Parikh from RAAPID, Marcel Powell from Hallmark Business Connections, ELLKAY, InterSystems, Surescripts, MRO, and Lirio. You will get an inside look at how top payers are using behavioral economics, clinical data, and unexpected tactics to move the needle on member engagement and compliance.

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Learn more about RISE National at https://risehealth.org/

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⏰ Jump to the Moments That Matter

0:00 The Payer Conference Worth Your While

1:48 A Bold CMS Prediction on the Future of AI

4:39 Why Behavioral Science Beats Drip Campaigns

5:49 Adhere Health Shares a Real Patient Intervention

8:31 Solving the Over-Coding and Under-Coding Dilemma

10:42 Why Hallmark Showed Up at a Healthcare Conference

13:31 Exhibit Hall Insights on Interoperability and Adherence

18:28 Final Thoughts and Event Wrap Up

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