The 2022 Accountable Care Symposium Agenda features educational tracks on system transformation, practice transformation, and primary care leadership. This in-person education has been specially designed to support your organization in improving patient care, reducing costs, and embracing the transformative nature of value- based care. All general sessions and most breakout sessions will be livestreamed for our virtual attendees. Please note the Symposium agenda is subject to change. 

For a PDF version of the agenda, click here.

See highlights from the Sixth Annual Accountable Care Symposium>>
 


Explore the 2022 Accountable Care Symposium Agenda

Utilize the links below to jump through the Symposium agenda with ease.
 

CNE-Credit-Available50px-(1).png = Approved for Continuing Nursing Education* (Totaling 26.25 credit hours)
CME-Credit-Available50px.png =  Approved for Live AAFP Prescribed credits (CME)** (Totaling 27.25 credit hours)
 
6:00pm – 8:00pm

Onsite Registration

Sign in and collect your badge for the 2022 Accountable Care Symposium.


6:15pm – 7:45pm

Physician Leadership Networking Session

Connect with other physician leaders in value-based care at this networking event. 
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6:30am – 8:00am

Onsite Registration and Welcome Breakfast

Sign in and collect your badge for the 2022 Accountable Care Symposium. Then, join other symposium attendees for a hot breakfast.


7:00am – 8:00am

Nurse Networking Breakfast

After you've collected your badge and signed in for the symposium, enjoy breakfast with other nurses attending the 2022 Accountable Care Symposium.


8:00am – 10:00am

General Session

 

8:00am – 8:20am

Symposium Kick-off and Welcome

Join Tim Gronniger, CEO, Caravan Health and Executive Vice President, Accountable Care, Signify Health as he opens this year’s Accountable Care Symposium: Shaping the Future of Patient Care.

Speaker: Tim Gronniger



8:20am – 9:10am

Shaping the Future of Patient Care

Hear from experts about key factors and strategies providers need to know about the benefits and future of value-based payments. You will learn about the evolution of Medicare APMs and the influence of employers on the trajectory of value-based care.

Speakers: Lynn Barr and Kyle Armbrester



9:10am – 9:15am

Accountable Care Organizations Population Health Award Winners

Moderators: Greg Paris and Nicole Banister



9:15am – 10:00am

Panel Discussion: Looking Back to Move Forward for Better Patient Care

This year's Pioneer Award Winners will discuss how they overcame obstacles and share their success stories during an inspirational panel. Learn how they adopted innovative programs to better serve high-risk populations, utilized enhanced technologies like Caravan Coach, leveraged team-based care to expand their preventative care management, and implemented approaches to improve patient outcomes. 

Moderators: Greg Paris and Nicole Banister



8:00am – 5:00pm

Signify Health Lounge

Stop by the Signify Health Lounge to relax, charge up, grab a refreshment and connect with Signify Health experts to learn more about how they are supporting your value-based efforts!

10:00am – 10:15am

Break
 

10:15am – 12:00pm

Morning Breakout Sessions

Select an educational track to follow for breakout sessions, or mix and match. See track and session details below.
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System
Transformation


10:15am – 11:00am

Panel Discussion: Extending Excellence to Post-Discharge Care CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

With nearly 45% of Medicare beneficiary episode spending attributed to post-discharge care, providers in value-based programs are increasingly considering what happens when their patients are discharged. In this session, learn how some professionals from progressive hospitals and health systems have taken a more comprehensive approach to lowering costs in post-discharge care using operational, technological, and analytics capabilities to better connect the dots for patients after discharge. (0.75 credit hours)

Speakers: Rodney Reider, Dr. Leslie Sebba, and Dr. Ashok Roy
11:00am – 11:10am

Break


11:10am – 12:00pm

Panel Discussion: The Home as the Key to Success in Value-Based Arrangements CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

As Medicare’s value-based programs evolve, provider organizations are increasingly taking on additional risk and responsibility for what happens to patients “beyond the four walls.” While analytics and new technology can help to cultivate a deeper understanding of the patient care journey, a more adequate approach to managing risk begins by interacting with patients in their communities and in their homes. In this session, innovators in value-based care delivery outline how to capture and address clinical and social needs long before the patient enters the "four walls”. (0.75 credit hours)

Speakers:
Laurel Douty, Dr. Maria Han, Lisa Fry
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Practice
Transformation


10:15am – 11:00am

New Tools in COPD and Heart Failure CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

COPD and heart failure are two leading causes of the high cost of care in our country and are also the leading causes of morbidity and mortality. To improve the outcomes for these patients, we must implement new methods of care. Engage with us as we discover new ways to care for patients with chronic disease by identifying those at highest risk and developing new techniques to care for them. (0.75 credit hours) 11:00am – 11:10am

Break


11:10am – 12:00pm

Panel Discussion: Lessons Learned in COPD and Heart Failure CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Learn from those who can explain what it is like to launch Caravan Health’s new COPD or Heart Failure programs. Learn what worked well and what they would do differently. (0.75 credit hours)

Speakers: Ashley KilpatrickBeth Tracy and Heather Hanson

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Primary Care
Leadership


10:15am – 11:00am

Provider Spotlight: Compensation & Career Satisfaction CME-Credit-Available50px-(1).png

When health system objectives and provider objectives don't align, it is hard to accomplish... well... anything. When you shift focus to operational processes and quality you can better align what the system wants to accomplish and what providers want to accomplish. Learn from three different Caravan-supported ACO partners about how they did just that and saw success in their provider satisfaction, patient outcomes, and overall team alignment and communication. (0.75 credit hours) 11:00am – 11:10am

Break


11:10am – 12:00pm

Provider Spotlight: Aligning Staff Incentives CME-Credit-Available50px-(1).png

When health system objectives and provider objectives don't align, it is hard to be successful. When you shift your focus to operational processes and quality you can better align your goals. Learn from three Caravan Health ACO partners about how they successfully aligned to improve their provider satisfaction, patient outcomes, and overall team communication. (0.75 credit hours)

Speakers: Michael Ryan, Billie Jo Hennika, and Dr. Verlin Janzen


12:00pm – 1:00pm

Networking Lunch



1:00pm – 2:00pm

General Session

 

1:00pm – 2:00pm

Promoting Health Literacy: A Focus on Older Adults CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Only 12 percent of the U.S. adult population has the highest proficiency level of health literacy. This increases to 39% when we include adults aged 75 and older. Join in a conversation about the role of health literacy, how to make appropriate care decisions regarding cancer screenings, and how providers can adopt strategies for communicating effectively with elderly patients to reduce health disparities. (1.0 credit hours)

Speaker: Dr. Tamara Cadet



1:30pm – 4:00pm

Coach's Corner

Coach’s Corner is an opportunity for clients attending the 2022 Accountable Care Symposium to receive 1:1 Coach support. Register for a 15-minute time slot to review a topic of your choosing with a Caravan Subject Matter expert in order to deepen your understanding and share best practices for using Coach. Register Here>>


2:00pm – 2:15pm

Break



2:15pm – 5:00pm

Afternoon Breakout Sessions

Select an educational track to follow for breakout sessions, or mix and match. See track and session details below.
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System
Transformation


2:15pm – 3:00pm

Post-Acute Care Navigator: Strategies & Results CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

There are various strategies and tactics to tackle the complex world of post-acute care (PAC). Team-based care in the primary care setting can lead to improved patient outcomes and better-quality success and a team-based strategy is also essential to successfully navigating post-acute strategies. Learn how incorporating a team-based care approach can help lead to better care for patients who are transitioning from a SNF to their home.  (0.75 credit hours)

Speakers: Marie Harris and Paula Price


3:00pm – 3:10pm

Break


3:10pm – 3:55pm

Panel Discussion: Lessons Learned from Partner Networks in Post-Acute Care CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Support ACO success with the development of a post-acute care collaborative within your local or regional hospital service area. In this session, learn how to establish metrics and clinical integration with participating SNFs to help facilitate care transitions for patients discharged from the hospital. In partnership, learn how to manage the transition to community resources and help reduce hospital readmissions and improve quality. (0.75 credit hours)

Speakers: Kristine Miller and Dr. Christi Taylor
3:55pm – 4:05pm

Break


4:05pm – 4:55pm

Panel Discussion: Maximizing Your 340B Strategy CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Hear the lessons learned from healthcare professionals who implemented 340B drug discount strategies. (0.75 credit hours)

Speakers: Jill Ender and Chris Todd
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Practice
Transformation


2:15pm – 3:00pm

Strategies for Assessing Patient Education Materials CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

A comprehensive approach to increasing health equity and decreasing health disparities includes assessing and adapting patient education materials. When patient education materials are written at high literacy levels, we are not helping to ensure positive patient outcomes. Join in an interactive session to learn how to use one technique, the simple measure of gobbledygook and SMOG, to assess the reading grade level of your materials. (0.75 credit hours)

Speaker: Dr. Tamara Cadet

3:00pm – 3:10pm

Break


3:10pm – 3:55pm

Panel Discussion: Assessing Health Literacy CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Patient non-adherence can have a seriously negative impact on patient outcomes. Non-adherence can be mistaken for a patient who does not want to participate in their care; however, non-adherence can be a complex issue that takes a team-based approach to fully unravel. Hear directly from caretakers in the field who strive to dismantle these “silos” and open the lines of communication between care coordinators, providers, and patients to remove barriers to care, identify healthcare biases influencing the patient’s care, identify community resources to help the patient be successful, and build a relationship of trust between all parties. (0.75 credit hours)
 

3:55pm – 4:05pm

Break


4:05pm – 4:55pm

Strategies for Closing the Health Equity Gap CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Eliminating health disparities has moved from a public health goal to a necessity for health plans, hospitals, and health systems reeling from a relentless pandemic and social injustices. Achieving health equity will require that it is not just recognized, but also prioritized. This necessitates a focused investment and collaboration to rethink how we deliver and define the value of care. Hear from the operations director at Patient Quality Alliance to learn how they used HCC capture targeting high-risk chronic condition patient groups to improve health equities in their community.  (0.75 credit hours)

Speakers: Brad Rogers, Randee Hokanson, Katelyn Chandler, and Jennifer Bell
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Primary Care
Leadership


2:15pm – 3:00pm

100% Virtual Collaborative Care to Beat Clinician Burnout CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Physician experts share how implementing virtual collaborative care between behavioral health and primary care has helped to increase levels of joy and satisfaction in their practices. The session will highlight the benefits of collaborative care practices and explain the steps that have helped to reduce administrative burden and increase physician satisfaction prior to, and throughout, the pandemic. (0.75 credit hours)

Speakers: Dr. Eunice Yu, Dr. Doree Ann Espiritu, and Dr. Emmanuel Dizon
 

3:00pm – 3:10pm

Break


3:10pm – 4:55pm

Mentally Healthy Staff = Great Clinical Outcomes: Building a Culture of Replenishment CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png (In-person exclusive)

Listen to this interactive discussion about the ways the pandemic has disrupted the working environment for healthcare professionals and how to begin replenishing the workforce for clinicians and non-clinicians to continue to improve patient care outcomes. The ultimate outcome is the ability to continue to improve clinical outcomes for our patients. (1.5 credit hours)

Moderator: Dan Collard

5:15pm – 6:45pm

Brews by the Bay Cocktail Hour

Join us on the Sapphire Terrace with local craft brews, pub style appetizers, games and photobooth. This is a great time to mingle with fellow Symposium attendees as the sun goes down over the Bay of San Diego.
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6:30am – 7:00am

Walk & Talk - Wellness Program

Caravan Health’s Journeywell team is hosting a morning Walk-and-Talk featuring scenic views of the bayfront and downtown San Diego.


6:30am – 8:00am

Onsite Registration and Breakfast

If you haven't yet, sign in and collect your badge and some Symposium gear. Then, join other symposium attendees for breakfast.


8:00am – 10:30am

General Session


8:00am – 8:55am

Impacting Patient Care with a Replenished, Engaged Workforce CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

When maximizing the most important “capital” in your organization, your human assets, think beyond piecemeal “fixes.” A comprehensive approach is required that encompasses an array of interconnecting components that form an effective ecosystem to engage and retain talent. Quint Studer will introduce the six components of the ecosystem and provide sample tools and techniques to fully engage and motivate your workforce to provide the highest quality of patient care. (0.75 credit hours)

Speaker: Quint Studer



8:55am – 9:00am

Accountable Care Organizations Population Health Award Winners

Moderator: Greg Paris



9:00am – 9:45am

Meeting of the Minds: Partnering with CMS to Shape the Future of Patient Care CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Listen as Tim Gronniger and Liz Fowler discuss how to succeed in value-based care programs and the importance of partnering with CMS. They will talk about the future of CMS and cover health equity, social determinants of health, the new ACO REACH model, and how to continue delivering high-quality care in the evolving field of healthcare. (0.75 credit hours)

Speakers:
Liz Fowler (virtual) and Tim Gronniger

 

9:45am – 10:00am

2023 ACO Options: Basic, Enhanced, or REACH. Which one is right for you?

The REACH ACO Model provides new and enhanced opportunities for safety net providers to help improve quality of care. As you consider your next steps in accountable care, there are several important factors that should be considered.  Join Lynn Barr, Founder, Caravan Health, and Chief Innovation Officer, Signify Health to hear about new ACO options that are expected to significantly improve care for the underserved and reward providers for delivering whole patient care.

Speakers: Lynn Barr

 

10:00am – 10:30am

Legislative and regulatory briefing: The latest from Capitol Hill CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Get the inside track on healthcare policy priorities that stand to impact how healthcare is paid for and delivered. Experts will provide views from inside the beltway on the issues that will likely shape our industry, including the latest on CMS’s strategies to enhance value for beneficiaries in Medicare, Medicaid, and marketplaces, and how healthcare politics in an election year will or will not affect change. You will walk away from this briefing with fresh insights that will inform risk adjustment, population health, and cost-management strategies. (0.5 credit hours)

Speakers: Jennifer Young and Kimberly Brandt



10:30am – 10:45am

Break



10:45am – 12:30pm

Morning Breakout Sessions

Select an educational track to follow for breakout sessions, or mix and match. See track and session details below.
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System
Transformation


10:45am – 11:35am

Panel Discussion: Clinical-Community Linkages to Improve Patient Care CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Community paramedicine programs expand the roles of EMS professionals to provide health services in places where access to physicians, clinics and/or hospitals may be difficult, such as rural America. In this session, experts from McKenzie Health System will discuss the results of their Community Integrated Paramedicine program pilot, which focused on reducing readmission rates, reducing unnecessary emergency department visits, and better chronic care management for their patients. (0.75 credit hours)

Speakers: Karen Dickinson and Billi Jo Hennika

11:35am – 11:45am

Break


11:45am – 12:30pm

Key Resources to Prevent Post-Acute Bounce Back CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Prevent the post-acute bounce-back! Learn how Reid Health partnered with nursing homes to stop the revolving door and decrease nursing home readmissions by taking an inside-out approach as well as developing a Community Paramedic Program to reduce unnecessary emergency room visits. (0.75 credit hours)
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Foundational: 

Practice
Transformation


10:45am – 11:35am

Risk Adjustment in Team-Based Care CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

When patient complexities are communicated properly, your pool of high, medium, and low risk patients becomes more accuate. This is why it is so important to ensure that all of your patients' conditions are reflected in your documentation. But this documentation doesn't have to be the work of just one or two individuals. Come learn about how you can incorporate your entire team into coding and billing to help both relieve responsibilities and also paint a better picture of your patient population. (0.75 credit hours)

Speakers: Caroline Mei
11:35am – 11:45am

Break


11:45am – 12:30pm

Panel Discussion: Becoming Better Coders CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Do you have specific questions for coding, billing, and scheduling experts? Bring your questions to this interactive discussion. This panel will be an open forum to learn more about how to utilize your resources to better represent your patient population. (0.75 credit hours)

Speakers: Krystyna Sienkiewicz, Kristin Kohl, and Jayden Miracle

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Advanced: 

Practice
Transformation


10:45am – 11:35am

Panel Discussion: Advances in Episodes of Care Programs and Bundled Payments CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Episodes of care and bundled payment programs have become prominent value-based care arrangements for government and commercial payors. In this session, attendees will hear from episodes and bundled payment experts about recent policy developments, continued episode expansion from Medicare’s BPCI, a program to commercial payors, the interface and implications on other alternative payment models, and considerations for those deciding to participate in episodes and bundled payment arrangements. (0.75 credit hours)

Speakers: François de Brantes and Kim Holland

11:35am – 11:45am

Break


11:45am – 12:30pm

Understanding Quality in Episodes of Care Programs CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

The delivery and measurement of quality in value-based programs have been an increasingly hot topic of debate as a growing number, and variety, of value-based programs has been introduced. In this session, experts dive deeper into the clinical aspects of episodes of care and bundled payment program participation for Medicare and commercial programs, including how to measure success, and key quality levers. (0.75 credit hours)

Speakers: Sage Nakagawa and Dr. Amita Rastogi
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Primary Care
Leadership


10:45am – 11:35am

Communication: The Key to Care Coordination CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

The active engagement of senior leaders in care coordination is pivotal to a successful program. The use of evidence-based communication techniques, team-building initiatives, and leadership strategies are equally important. Take a journey with one organization and peek into the program then and now.  Learn how a department of one RN care coordinator grew into an award-winning, highly successful Medicare annual wellness visit clinic. (0.75 credit hours)

Speaker: Michelle Franklin

11:35am – 11:45am

Break


11:45am – 12:30pm

Improve Your Communication: Huddles and Team-Based Documentation CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Whether communication was never delivered or never received, there is always a risk of patient harm when communication breaks down. Effective communication can take place in a variety of ways, and it is important to determine which variation works best for everyone involved. If you have questions about how to get your team to communicate better, learn new strategies to make sure nothing slips through the cracks. (0.75 credit hours)

Speaker: Daniel Nelson


12:30pm – 1:30pm

Networking Lunch



1:30pm – 3:15pm

Afternoon Breakout Sessions

Select an educational track to follow for breakout sessions, or mix and match. See track and session details below.
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System

Transformation


1:30pm – 2:20pm

Panel Discussion: The Dynamics of Primary and Specialty Care in a Value-based World CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

In a value-based care environment, the dynamics between primary and specialty care are becoming more important as new government and commercial risk models emphasize co-management to drive optimal patient outcomes. Join industry experts as they discuss the importance of primary care in co-managing patients within specialty networks, obtaining the best possible specialist referrals, and engaging community specialists to drive horizontal integration with primary care and specialty care, rather than the classic vertical integration through health systems and hospitals. (0.75 credit hours)

Speakers: Francois de Brantes and Dr. Rachel Reid
 
2:20pm – 2:30pm

Break


2:30pm – 3:15pm

Panel Discussion: The Benefits of Partnering with Specialty Networks CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Even though specialty care makes up a significant portion of total medical spending, specialty care providers are often left behind in value-based payment and care delivery transformation.  In this session, leaders in specialty-based networks share their perspectives on how specialists can best engage with other providers and facilities to participate and collaborate in a value-based ecosystem. (0.75 credit hours)

Speakers: Francois de Brantes, Dave Spalding, and Kelsey Mellard

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Foundational: 

Practice
Transformation


1:30pm – 2:20pm

Using Pre-Visit Planning to Improve Scheduling CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Patient visits start long before the patient walks in the door because a significant amount of patient information can be gathered prior. What is the best strategy to collect this information? How can you best utilize your team to make sure that the right information is not only gathered but also communicated to the proper people? Learn these answers and discover ways to improve your pre-visit planning and scheduling strategies to make the biggest impact in your clinic. (0.75 credit hours)

Speakers: Francesca High and Kari Loken

2:20pm – 2:30pm

Break


2:30pm – 3:15pm

Reducing Unnecessary ED Visits CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Patients visit the Emergency Department (ED) for various reasons, but how can you make sure those visits are warranted? Is there a particular communication strategy that should be used with certain patient populations? By focusing your efforts on patients who are more likely to visit the ED and enhancing communication efforts, there are opportunities to help patients reduce unnecessary ED visits and provide better continuity of care. (0.75 credit hours)

Speakers: Dr. Steven Reeves, Stacy Coco-Curry, and Ifeekam Ozonuwe

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Advanced: 

Practice
Transformation


1:30pm – 2:20pm

Best Practice Tips in Care Management CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

The transition from hospital to home, or SNF to home, can be a struggle for patients. It is important to provide best practice support in the transition of care. Knowing an entire primary care team is on hand to provide support during these transitions will help to improve patient satisfaction and compliance which can decrease the risk of readmissions and help to improve the continuity of care. (0.75 credit hours)

Speakers: Paula Price and Ashley Kilpatrick
2:20pm – 2:30pm

Break


2:30pm – 3:15pm

Hybrid Presentation: The Role of Technology in Remote Patient Monitoring & Advanced Care Management CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

With remote patient monitoring (RPM), we now have the capability to treat the conditions our patients live with, as opposed to merely treating the symptoms as they present during a 15-minute office visit. Learn how to implement various technologies to improve your RPM, discover the keys to successful implementation, learn about the coding and billing requirements for RPM, and hear patient success stories. (0.75 credit hours)

Speaker: Melissa Hayse

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Primary Care
Leadership


1:30pm – 2:20pm

Utilizing Continuous Glucose Monitoring and Managing High-Risk Patients with Diabetes CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Continuous glucose monitoring (CGM) technology has changed the face of diabetes management and has been a key factor in improving diabetes outcomes for a small rural health clinic over the past five years.  CGM provides 24/7 glucose data that healthcare providers use to make informed and safe therapy adjustments for patients with diabetes which leads to higher patient and clinician satisfaction and better patient outcomes. Learn how you can start the framework for a successful CGM in your clinic. (0.75 credit hours)

Speaker: Sara Gaul

2:20pm – 2:30pm

Break


2:30pm – 3:15pm

Panel Discussion: Better Management of High Risk Patients with Diabetes CNE-Credit-Available50px-(1).png CME-Credit-Available50px-(1).png

Do you have questions surrounding high-risk patients with diabetes? Or how to utilize various technologies that contribute to better diabetes care? Learn how you can apply these diabetic care management strategies to your patients with diabetes and expand the steps to care for other patients with chronic diseases. (0.75 credit hours)

Speaker: Sara Gaul and Amy Dossey

 
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*Caravan Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

**The AAFP has reviewed 2022 Accountable Care Symposium: Shaping the Future of Patient Care and deemed it acceptable for up to 27.25 Live AAFP Prescribed credits. Term of Approval is from 05/25/2022 to 05/26/2022. Physicians should claim only the credit com7mensurate with the extent of their participation in the activity.
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