AI Summit

June 2-3, 2025 | Atlanta, GA

Renaissance Atlanta Airport Gateway Hotel

Agenda

Join us for the AI Summit 2025, a premier event bringing together healthcare leaders to explore the transformative role of AI in payment integrity and cost containment. Kicking off with a networking reception on the evening of Monday, June 2, the full-day Summit on Tuesday, June 3, will feature impactful keynotes, expert panels, and collaborative discussions designed to inspire and drive a more efficient and effective healthcare system.

Monday, June 2nd
Late afternoon	Attendee arrivals
6:30-8:30 p.m.	Evening Networking Reception (Onsite at the Renaissance Gateway)
Tuesday, June 3rd
8:00-9:00 a.m.	Breakfast
9:00 – 9:15 a.m.	Opening Address – Pioneering the Future of Payment Integrity Musheer Ahmed, PhD Founder of the AI for PI Community Join Musheer Ahmed, as he sets the stage for a day of collaboration and innovation. In this opening address, Musheer will share the compelling journey of how the AI for PI Community has grown from a vision to a movement of forward-thinking healthcare leaders united in their mission to transform payment integrity through AI-driven early intervention. Drawing from real implementations and community success stories, Musheer will explore the industry’s urgent need to shift from reactive to proactive approaches and the critical role of provider collaboration in successful transformation.
9:15 – 10:00 a.m.	Industry Keynote: AI Innovation and Early Intervention: Transforming Healthcare Economics U.S. Congressman Jay Obernolte California’s 23rd District in the U.S. House of Representatives As healthcare organizations seek to move payment integrity upstream through AI-driven early intervention, understanding the policy landscape becomes crucial. Congressman Jay Obernolte, Chairman of the bipartisan House Task Force on Artiﬁcial Intelligence in the 118th Congress, brings unique insight as both a computer scientist and AI policy leader. His keynote examines how emerging AI frameworks can support the industry’s shift from post-payment recovery to pre-payment accuracy while addressing broader healthcare cost challenges. Drawing from his work with the National Science Foundation in developing sector-speciﬁc AI solutions, Congressman Obernolte will explore how policy and innovation can enable operational efficiency while minimizing disruption. His perspective bridges technical expertise and policy leadership, oﬀering guidance on advancing AI adoption in an evolving healthcare landscape.
10:00 – 10:15 a.m.	Break
10:15 – 11:00 a.m.	From Recovery to Prevention: Modernizing Payment Integrity through AI Lynn Garbee Partner, HealthScape Advisors This session explores the urgent need to transform traditional payment integrity approaches that have reached a point of fatigue within the industry. As healthcare plans chase affordability through post-payment models that rely on manual review and complex rules, they often create provider abrasion, administrative waste, and strained relationships. Our discussion will examine how AI and machine learning are enabling a fundamental strategic reset—”moving left” (upstream in the adjudication process) and “moving in” (regaining control of outsourced processes). Drawing from HealthScape’s strategic outlook research, we’ll explore how progressive technologies are transforming cost containment while strengthening provider partnerships. Attendees will learn practical strategies for implementing early intervention models that could create “colossal change in SG&A for both plans and providers” while relieving tremendous burden on the system.
11:00 a.m. – 11:45 a.m.	Government Program Excellence: AI-Driven Payment Integrity in Medicare and Medicaid Kelly A. Bennett, JD, CFE, AHFI, CIG Chief Medicaid Program Integrity Florida for Health Care Administration Sonja Allen-Smith Inspector General State of Georgia, Department of Community Health Government programs present distinct challenges for payment integrity transformation—stringent compliance requirements, network adequacy concerns, and heightened scrutiny from CMS. This session explores how leading payers are successfully implementing AI-driven early intervention strategies within the Medicare and Medicaid framework while maintaining regulatory compliance and strengthening provider partnerships. Our panelists will share practical approaches to balancing innovation with compliance, ensuring clinical appropriateness, and engaging providers effectively throughout the transformation journey. Key Discussion Points: Navigating Medicare/Medicaid compliance requirements while implementing AI solutions Building provider education and engagement strategies specific to government programs Ensuring clinical appropriateness in pre-payment review processes Documentation and audit trail considerations for AI-driven decisions Managing risk adjustment and RADV audit concerns in an AI environment Creating technology frameworks that satisfy CMS requirements
11:45 – 12:30 p.m.	Driving Early Intervention: Georgia’s AI-Powered Approach to Fraud Prevention and Payment Accuracy Panelists Johnny Brooks Director, Program Integrity State of Georgia, Department of Community Health Derik Ciccarelli Director, Fraud Scope Operations Codoxo Moderator Rena Bielinski, PharmD, AHFI VP of Customer Success Codoxo Join Sonja Allen-Smith , Inspector General, and Johnny Brooks , Director of Program Integrity at the Georgia Department of Community Health, as they share the agency’s journey in adopting AI to enhance fraud prevention and improve payment accuracy. Learn how their strategic shift to early intervention will enable more proactive identification of threats, reduced administrative burden, and strengthened the integrity of healthcare payments across the state. This session will offer real-world insights into using AI to move upstream in the payment lifecycle—and the measurable impact it’s having on cost containment and program integrity.
12:30 – 1:15 p.m.	Lunch
1:15 – 2:00 p.m.	Artificial Intelligence for PI Benchmarking Master Class Priscilla Alfaro MD, FAAP, CPC, CPMA, COC, CIC, CFE VP of Payment Integrity, Blue Cross NC Jim Brady VP of Analytics, Codoxo This interactive session provides a comprehensive framework for establishing and optimizing AI-driven payment integrity benchmarks. Participants will learn how leading organizations quantify early intervention success through measurable KPIs, from provider satisfaction metrics to cost avoidance calculations. Attendees will develop actionable benchmarking strategies to measure, validate, and maximize their AI investments as well as evaluate their AI initiatives against industry standards.
2:00 – 2:30 p.m.	Healthcare Executive Perspectives: AI’s Role in Transforming Cost Control and Provider Relations Meghan Dierks Chief Artificial Intelligence Officer, U.S. Department of Health and Human Services Join an exclusive panel of healthcare executives for a dynamic discussion on how top payers are harnessing the power of AI to tackle their most critical challenges. Explore strategies for pre-claim cost reduction, network optimization, payment accuracy, strengthening provider relationships, and seamless technology integration. The session will highlight: Strategies for reducing pre-claim costs through AI-driven intervention Innovative approaches to network optimization and provider retention How AI is transforming payment integrity while reducing provider abrasion Real-world examples of successful technology integration in payer operations Future outlook on AI’s role in reshaping payer economics
2:30 – 2:45 p.m.	Break
2:45 – 3:30 p.m.	CEO Visionary Perspective: Navigating Healthcare’s Transformation Through Technology and Transparency A.J. Loiacono CEO, Capital Rx In this closing keynote, A.J. Loiacono, CEO of Capital Rx, offers his distinctive insights on the rapidly evolving healthcare landscape. Drawing from his experience transforming pharmacy benefit management through technology-driven transparency, Loiacono will share his perspective on the critical intersection of cost containment, technological innovation, and patient care. Loiacono will explore emerging market trends reshaping healthcare economics, the strategic technology investments delivering the greatest ROI in the current landscape, and how forward-thinking organizations can implement novel approaches to sustainable cost control. His keynote will provide a compelling vision of healthcare’s near-term horizon and the pivotal role that transparency and AI-driven solutions will play in reshaping payment models.
3:30 – 4:15 p.m.	Building Tomorrow’s Infrastructure: Essential Tech Investments for Early Intervention Panelists Matt Pearson Head of Healthcare and Life Sciences BD, AWS Amlan Dasgupta SVP & CTO Product Development, Healthedge Moderator Joanne Galimi Healthcare Market Lead Gartner Healthcare & Life Sciences Consulting Practice As healthcare payers race to shift payment integrity upstream, the right technology infrastructure becomes critical. This pragmatic session brings together technology and operations leaders to examine the essential components needed to enable effective pre-payment intervention. Key Discussion Points: Technical requirements for moving from post to pre-payment Cloud infrastructure needs and considerations Data integration challenges and solutions Real-time processing capabilities AI/ML model deployment strategies Workflow automation requirements Security and compliance considerations Integration with existing systems
4:15 – 4:30 p.m	Closing

Monday, June 2nd
Late afternoon	Attendee arrivals
6:30-8:30 p.m.	Evening Networking Reception (Onsite at the Renaissance Gateway)

Tuesday, June 3rd
8:00-9:00 a.m.	Breakfast
9:00 – 9:15 a.m.	Opening Address – Pioneering the Future of Payment Integrity Musheer Ahmed, PhD Founder of the AI for PI Community Join Musheer Ahmed, as he sets the stage for a day of collaboration and innovation. In this opening address, Musheer will share the compelling journey of how the AI for PI Community has grown from a vision to a movement of forward-thinking healthcare leaders united in their mission to transform payment integrity through AI-driven early intervention. Drawing from real implementations and community success stories, Musheer will explore: • The industry’s urgent need to shift from reactive to proactive approaches • How early adopters are achieving breakthrough results • The critical role of provider collaboration in successful transformation • Emerging trends and opportunities in AI-driven payment integrity
9:15 – 10:00 a.m.	Industry Keynote: AI Innovation and Early Intervention: Transforming Healthcare Economics U.S. Congressman Jay Obernolte California’s 23rd District in the U.S. House of Representatives As healthcare organizations seek to move payment integrity upstream through AI-driven early intervention, understanding the policy landscape becomes crucial. Congressman Jay Obernolte, Chairman of the bipartisan House Task Force on Artiﬁcial Intelligence in the 118th Congress, brings unique insight as both a computer scientist and AI policy leader. His keynote examines how emerging AI frameworks can support the industry’s shift from post-payment recovery to pre-payment accuracy while addressing broader healthcare cost challenges. Drawing from his work with the National Science Foundation in developing sector-speciﬁc AI solutions, Congressman Obernolte will explore how policy and innovation can enable operational efficiency while minimizing disruption. His perspective bridges technical expertise and policy leadership, oﬀering guidance on advancing AI adoption in an evolving healthcare landscape. Key focus areas: AI policy frameworks supporting payment transformation Innovation strategies for operational efficiency Balancing technological advancement with implementation challenges Future outlook for AI-enabled healthcare cost containment
10:00 – 10:15 a.m.	Break
10:15 – 11:00 a.m.	From Recovery to Prevention: Modernizing Payment Integrity through AI Lynn Garbee Partner, HealthScape Advisors This session explores the urgent need to transform traditional payment integrity approaches that have reached a point of fatigue within the industry. As healthcare plans chase affordability through post-payment models that rely on manual review and complex rules, they often create provider abrasion, administrative waste, and strained relationships. Our discussion will examine how AI and machine learning are enabling a fundamental strategic reset—”moving left” (upstream in the adjudication process) and “moving in” (regaining control of outsourced processes). Drawing from HealthScape’s strategic outlook research, we’ll explore how progressive technologies are transforming cost containment while strengthening provider partnerships. Attendees will learn practical strategies for implementing early intervention models that could create “colossal change in SG&A for both plans and providers” while relieving tremendous burden on the system.
11:00 a.m. – 11:45 a.m.	Government Program Excellence: AI-Driven Payment Integrity in Medicare and Medicaid Kelly A. Bennett, JD, CFE, AHFI, CIG Chief Medicaid Program Integrity Florida for Health Care Administration Sonja Allen-Smith Inspector General State of Georgia, Department of Community Health Government programs present distinct challenges for payment integrity transformation—stringent compliance requirements, network adequacy concerns, and heightened scrutiny from CMS. This session explores how leading payers are successfully implementing AI-driven early intervention strategies within the Medicare and Medicaid framework while maintaining regulatory compliance and strengthening provider partnerships. Our panelists will share practical approaches to balancing innovation with compliance, ensuring clinical appropriateness, and engaging providers effectively throughout the transformation journey. Key Topics: Navigating Medicare/Medicaid compliance requirements while implementing AI solutions Building provider education and engagement strategies specific to government programs Ensuring clinical appropriateness in pre-payment review processes Documentation and audit trail considerations for AI-driven decisions Managing risk adjustment and RADV audit concerns in an AI environment Creating technology frameworks that satisfy CMS requirements
11:45 – 12:30 p.m.	Driving Early Intervention: Georgia’s AI-Powered Approach to Fraud Prevention and Payment Accuracy Panelists Johnny Brooks Director, Program Integrity State of Georgia, Department of Community Health Derik Ciccarelli Director, Fraud Scope Operations Codoxo Moderator Rena Bielinski, PharmD, AHFI VP of Customer Success Codoxo Join Sonja Allen-Smith , Inspector General, and Johnny Brooks , Director of Program Integrity at the Georgia Department of Community Health, as they share the agency’s journey in adopting AI to enhance fraud prevention and improve payment accuracy. Learn how their strategic shift to early intervention will enable more proactive identification of threats, reduced administrative burden, and strengthened the integrity of healthcare payments across the state. This session will offer real-world insights into using AI to move upstream in the payment lifecycle—and the measurable impact it’s having on cost containment and program integrity.
12:30 – 1:15 p.m.	Lunch
1:15 – 2:00 p.m.	Artificial Intelligence for PI Benchmarking Master Class *Panel Discussion* Priscilla Alfaro MD, FAAP, CPC, CPMA, COC, CIC, CFE VP of Payment Integrity, Blue Cross NC Jim Brady VP of Analytics, Codoxo This interactive session provides a comprehensive framework for establishing and optimizing AI-driven payment integrity benchmarks. Participants will learn how leading organizations quantify early intervention success through measurable KPIs, from provider satisfaction metrics to cost avoidance calculations. Attendees will develop actionable benchmarking strategies to measure, validate, and maximize their AI investments as well as evaluate their AI initiatives against industry standards.
2:00 – 2:30 p.m.	Healthcare Executive Perspectives: AI’s Role in Transforming Cost Control and Provider Relations Meghan Dierks Chief Artificial Intelligence Officer, U.S. Department of Health and Human Services Professor of Healthcare Informatics, Harvard Join an exclusive panel of healthcare executives for a dynamic discussion on how top payers are harnessing the power of AI to tackle their most critical challenges. Explore strategies for pre-claim cost reduction, network optimization, payment accuracy, strengthening provider relationships, and seamless technology integration. The session will highlight: Strategies for reducing pre-claim costs through AI-driven intervention Innovative approaches to network optimization and provider retention How AI is transforming payment integrity while reducing provider abrasion Real-world examples of successful technology integration in payer operations Future outlook on AI’s role in reshaping payer economics
2:30 – 2:45 p.m.	Break
2:45 – 3:30 p.m.	CEO Visionary Perspective: Navigating Healthcare’s Transformation Through Technology and Transparency A.J. Loiacono CEO, Capital Rx In this closing keynote, A.J. Loiacono, CEO of Capital Rx, offers his distinctive insights on the rapidly evolving healthcare landscape. Drawing from his experience transforming pharmacy benefit management through technology-driven transparency, Loiacono will share his perspective on the critical intersection of cost containment, technological innovation, and patient care. Loiacono will explore emerging market trends reshaping healthcare economics, the strategic technology investments delivering the greatest ROI in the current landscape, and how forward-thinking organizations can implement novel approaches to sustainable cost control. His keynote will provide a compelling vision of healthcare’s near-term horizon and the pivotal role that transparency and AI-driven solutions will play in reshaping payment models.
3:30 – 4:15 p.m.	Building Tomorrow’s Infrastructure: Essential Tech Investments for Early Intervention *Executive Panel Discussion* Panelists Matt Pearson Head of Healthcare and Life Sciences BD, AWS Amlan Dasgupta SVP & CTO Product Development, Healthedge Moderator Joanne Galimi Healthcare Market Lead Gartner Healthcare & Life Sciences Consulting Practice As healthcare payers race to shift payment integrity upstream, the right technology infrastructure becomes critical. This pragmatic session brings together technology and operations leaders to examine the essential components needed to enable effective pre-payment intervention. Key Discussion Points: Technical requirements for moving from post to pre-payment Cloud infrastructure needs and considerations Data integration challenges and solutions Real-time processing capabilities AI/ML model deployment strategies Workflow automation requirements Security and compliance considerations Integration with existing systems
4:15 – 4:30 p.m	Closing

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Full Agenda

Monday, June 2nd

Late afternoon

Attendee arrivals

6:30-8:30 p.m.

Evening Networking Reception (Onsite at the Renaissance Gateway)

Tuesday, June 3rd

8:00-9:00 a.m.

Breakfast

9:00 – 9:15 a.m.

Opening Address – Pioneering the Future of Payment Integrity

Musheer Ahmed,
Founder of the AI for PI Community

Join Musheer Ahmed, founder of the AI for Payment Integrity Community, as he sets the stage for a day of collaboration and innovation. In this opening address, Musheer will share the compelling journey of how the AI for PI Community has grown from a vision to a movement of forward-thinking healthcare leaders united in their mission to transform payment integrity through AI-driven early intervention.

Drawing from real implementations and community success stories, Musheer will explore:

• The industry’s urgent need to shift from reactive to proactive approaches
• How early adopters are achieving breakthrough results
• The critical role of provider collaboration in successful transformation
• Emerging trends and opportunities in AI-driven payment integrity

9:15 – 10:00 a.m.

Opening Keynote: AI Innovation and Early Intervention: Transforming Healthcare Economics

U.S. Congressman Jay Obernolte,
California’s 23rd District in the U.S. House of Representatives

As healthcare organizations seek to move payment integrity upstream through AI-driven early intervention, understanding the policy landscape becomes crucial. Congressman Jay Obernolte, Chairman of the bipartisan House Task Force on Artiﬁcial Intelligence in the 118th Congress, brings unique insight as both a computer scientist and AI policy leader. His keynote examines how emerging AI frameworks can support the industry’s shift from post-payment recovery to pre-payment accuracy while addressing broader healthcare cost challenges. Drawing from his work with the National Science Foundation in developing sector-speciﬁc AI solutions, Congressman Obernolte will explore how policy and innovation can enable operational efficiency while minimizing disruption. His perspective bridges technical expertise and policy leadership, oﬀering guidance on advancing AI adoption in an evolving healthcare landscape.

Key focus areas:

AI policy frameworks supporting payment transformation
Innovation strategies for operational effeciency
Balancing technological advancement with implementation challenges
Future outlook for AI-enabled healthcare cost containment

10:00 – 10:15 a.m.

Break

10:15 – 11:00 a.m.

From Recovery to Prevention: The Early Intervention Revolution

Lynn Garbee,
Partner, HealthScape Advisors

An intimate conversation exploring healthcare’s critical shift from reactive to preventive approaches through AI innovation. This session examines how early intervention strategies can simultaneously improve patient outcomes, strengthen provider relationships, and reduce system-wide costs. The discussion will explore practical frameworks for implementing AI-driven early intervention across clinical, operational, and financial domains, offering insights on building a more proactive and efficient healthcare ecosystem.

Key Themes:

Transforming patient care through early intervention
Building sustainable provider partnerships
Balancing innovation with operational efficiency
Creating frameworks for system-wide implementation
Impact on healthcare economics and quality outcomes

11:00 – 11:45 a.m.

Government Program Excellence: AI-Driven Payment Integrity in Medicare and Medicaid

Case Study Presentation

Kelly A. Bennett, JD, CFE, AHFI, CIG
Chief Medicaid Program Integrity
Florida for Health Care Administration

Sonja Allen-Smith
Inspector General
State of Georgia, Department of Community Health

Government programs present distinct challenges for payment integrity transformation—stringent compliance requirements, network adequacy concerns, and heightened scrutiny from CMS. This session explores how leading payers are successfully implementing AI-driven early intervention strategies within the Medicare and Medicaid framework while maintaining regulatory compliance and strengthening provider partnerships. Our panelists will share practical approaches to balancing innovation with compliance, ensuring clinical appropriateness, and engaging providers effectively throughout the transformation journey.

Key Topics

Navigating Medicare/Medicaid compliance requirements while implementing AI solutions
Building provider education and engagement strategies specific to government programs
Ensuring clinical appropriateness in pre-payment review processes
Documentation and audit trail considerations for AI-driven decisions
Managing risk adjustment and RADV audit concerns in an AI environment
Creating technology frameworks that satisfy CMS requirements

11:45 – 12:30 p.m.

Driving Early Intervention: Georgia’s AI-Powered Approach to Fraud Prevention and Payment Accuracy

Panelists

Johnny Brooks
Director, Program Integrity
State of Georgia, Department of Community Health

Derik Ciccarelli
Director, Fraud Scope Operations
Codoxo

Moderator

Rena Bielinski, PharmD, AHFI
VP of Customer Success
Codoxo

Join Sonja Allen-Smith , Inspector General, and Johnny Brooks , Director of Program Integrity at the Georgia Department of Community Health, as they share the agency’s journey in adopting AI to enhance fraud prevention and improve payment accuracy. Learn how their strategic shift to early intervention will enable more proactive identification of threats, reduced administrative burden, and strengthened the integrity of healthcare payments across the state. This session will offer real-world insights into using AI to move upstream in the payment lifecycle—and the measurable impact it’s having on cost containment and program integrity.

12:30 – 1:15 p.m.

Lunch

1:15 – 2:00 p.m.

Artificial Intelligence for PI Benchmarking Master Class

Industry Panel Discussion

Priscilla Alfaro MD,
VP of Payment Integrity, Blue Cross NC

Jim Brady,
VP of Analytics

This interactive session provides a comprehensive framework for establishing and optimizing AI-driven payment integrity benchmarks. Participants will learn how leading organizations quantify early intervention success through measurable KPIs, from provider satisfaction metrics to cost avoidance calculations. Attendees will develop actionable benchmarking strategies to measure, validate, and maximize their AI investments as well as evaluate their AI initiatives against industry standards.

2:00 – 2:30 p.m.

Healthcare Executive Perspectives: AI’s Role in Transforming Cost Control and Provider Relations

Executive Panel Discussion

Meghan Dierks,
Chief Artificial Intelligence Officer and Professor of Healthcare Informatics Harvard
U.S. Department of Health and Human Services (HHS)

Join an exclusive panel of PBM Chief Executive Officers for a dynamic discussion on how top PBMs are harnessing the power of AI to tackle their most critical challenges. Explore strategies for pre-claim cost reduction, network optimization, payment accuracy, strengthening provider relationships, and seamless technology integration.

The session will highlight:

- Strategies for reducing pre-claim costs through AI-driven intervention
- Innovative approaches to network optimization and provider retention
- How AI is transforming payment integrity while reducing provider abrasion
- Real-world examples of successful technology integration in PBM operations
- Future outlook on AI’s role in reshaping PBM economics

2:30 – 2:45 p.m.

Break

2:45 – 3:30 p.m.

CEO Visionary Perspective: Navigating Healthcare’s Transformation Through Technology and Transparency

Anthony J. Loiacono,
CEO, Capital Rx

In this closing keynote, A.J. Loiacono, CEO of Capital Rx, offers his distinctive insights on the rapidly evolving healthcare landscape. Drawing from his experience transforming pharmacy benefit management through technology-driven transparency, Loiacono will share his perspective on the critical intersection of cost containment, technological innovation, and industry transformation.

Loiacono will explore emerging market trends reshaping healthcare economics, the strategic technology investments delivering the greatest ROI in the current landscape, and how forward-thinking organizations are implementing novel approaches to sustainable cost control. His keynote will provide a compelling vision of healthcare’s near-term horizon and the pivotal role that transparency and AI-driven solutions will play in reshaping payment models.

3:30 – 4:15 p.m.

Building Tomorrow’s Infrastructure: Essential Tech Investments for Early Intervention

Executive Panel Discussion

Speakers

Matt Pearson
Head of Healthcare and Life Sciences BD, AWS

Amlan Dasgupta
SVP & CTO Product Development, Healthedge

Moderator

Joanne Galimi
Healthcare Market Lead
Gartner Healthcare & Life Sciences Consulting Practice

As healthcare payers race to shift payment integrity upstream, the right technology infrastructure becomes critical. This pragmatic session brings together technology and operations leaders to examine the essential components needed to enable effective pre-payment intervention.

Key Discussion Points:

- Technical requirements for moving from post to pre-payment
- Cloud infrastructure needs and considerations
- Data integration challenges and solutions
- Real-time processing capabilities
- AI/ML model deployment strategies
- Workflow automation requirements
- Security and compliance considerations
- Integration with existing systems

4:15 – 4:30 p.m.

Closing