Episode 27: Innovation roadmap: Cotiviti on a proactive approach to risk adjustment

As regulatory pressures intensify and the demand for measurable ROI grows, health care organizations are rethinking how they approach risk adjustment. The landscape is shifting—from retrospective reviews to real-time, proactive strategies powered by smarter technology and deeper clinical insight. In this 38-minute episode of RISE Radio, senior leaders from Cotiviti and Edifecs share how their recent partnership is fueling a new era of innovation across the full risk adjustment lifecycle. From Medicare Advantage to Medicaid and ACA markets, they explore how scalable tech, strategic foresight, and clinical expertise are helping organizations stay ahead of compliance demands and financial pressures. About the speakers Branka Sustic, vice president of risk and quality solutions, Cotiviti, provides leadership and oversight into product and business development, client program management, and strategy to assist health plans in meeting their quality and risk adjustment goals, optimization of revenue, and risk mitigation. She is a leader with more than two decades of health care experience, blending a strong customer service and analytic foundation with experience leading change management throughout her career. Sustic is known for creating and establishing operational and support plans leading to increased client satisfaction and performance. Dr. Summerpal Kahlon , chief medical officer at Edifecs, a Cotiviti business, works across products and functions to guide clinical strategies and policies. His career spans over 20 years of experience in diverse health care settings, businesses, and markets. Dr. Kahlon has deep expertise in value-based care and risk adjustment, and brings unique insight to help customers make the most comprehensive, informed, and clinically relevant decisions for their populations. He is a practicing physician with Veterans Affairs and an assistant professor of internal medicine at the University of Central Florida. About Cotiviti Cotiviti enables health care organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States. Cotiviti’s solutions increase transparency and collaboration between payers and providers while empowering them to reduce medical and administrative costs, enable better health, improve claims payment efficiency, streamline operations, drive interoperability, and advance value-based care. Its customers serve the majority of U.S. health care consumers, providing coverage and care for over 300 million members and patients.

You can listen to Episode 27: Innovation roadmap: Cotiviti on a proactive approach to risk adjustment online on Radio and Podcast. Open the player on this page to stream the available audio.

Episode 27: Innovation roadmap: Cotiviti on a proactive approach to risk adjustment is an episode from RISE Radio by Ilene MacDonald.

This episode is 38:20 long.

This episode was published on Nov 20, 2025.

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