Monday, January 27, 2020
Pre-Conference In-depth Workshop Series
($300 ALL ACCESS WORKSHOP PASS to any or all 3 of the pre-conference workshops)



Workshop A:
Stars Tutorial: An In-depth Look at Preparing for and Implementing New and Proposed CMS Measures

Noreen Hurley,Program Manager, Star Quality & Performance,Harvard Pilgrim Health Care

Gregory A. Hanley, FACHE, CPHQ,Vice President, Quality Management & Pharmacy,UCare


Workshop B:
Designing, Integrating & Managing Telehealth Benefits

Megan S. Herber,Director, Faegre Baker Daniels Consulting,Policy Consultant, American Telemedicine Association


Workshop C:
Strategic Provider Partnerships on Risk Sharing Models and Product Design

Lori Rund,Vice President, Product Management & Market Intelligence,Health Alliance Plan (HAP)


Close of Workshops

Tuesday, January 28, 2020
Industry Firsts: Top Quality Innovations to Boost Plan Performance

Registration & Continental Breakfast


Chairperson’s Welcome and Opening Remarks

Christine Leo, Vice President, Senior Products,Cigna


Succeeding in an Increasingly Competitive and Regulated MA Market – Responding to Market Disruptors in the Evolving Value-based Arena


Person-Centric Value-based MA Models Focused on Core Benefit Design, Healthy Members and Communities

UPMC is an integrated delivery system having world-class hospitals and clinics combined with a 4.5 STAR Rated health plan; however, it is not a staff model like Kaiser. There is a working tension between the two so the need to foster alignment is incredibly important. To that end, UPMC has worked to create and foster mutual incentives and value structures designed to systematically promote personalization and patient-centeredness for years.
This synergistic approach informs how we view “health.”
The future we are creating today is being designed with health at its core rather than conditions or social determinants or any other influencing factor as the driver of effort…
This session will explore how to overcome the payment model tension; redefining health; and how those actions produce quality outcomes and cost effectiveness.

Angela Perri, Vice President, Strategic Alignment, Transformation & Consumer Innovation, (Business Transformation Office),UPMC Health Plan


The Business Case for Population Health:  How Humana Integrates Social Determinants of Health to Reduce Costs, Boost Quality of Care and Enhance Member Experience

In 2015, Humana created a Bold Goal to improve the health of the communities it serves by 20 percent by 2020 and beyond. This means improving Health-Related Quality of Life, measured using CDC’s Healthy Days tool, by addressing social and clinical needs that impact physical and mental health. By collaborating with community-based organizations, Humana works to address Health-Related Social Needs (HRSN) - the social determinants of an individual’s health.
Social needs gaps can prevent people from accessing healthy food, physical activity and social connections critical for a happy, healthy and purposeful life. The prolongation and exacerbation of social needs gaps puts individuals at higher risk for new chronic conditions, progression of current disease, and is strongly associated with higher healthcare resource utilization and total cost of care.  We are integrating Social Determinants of Health and Health-Related Social Needs into everything we do at Humana – from developing advanced analytic tools to working with physicians to testing new interventions to integrating into current clinical operating models. 

By addressing Social Determinants of Health and improving Healthy Days, we expect to lower healthcare resource utilization and lower total cost of care. This creates the business model that allows us to sustain and scale our population health strategy.

Caraline Coats, Vice President, Bold Goal & Population Health Strategy,Humana


Panel Discussion: Designing, Implementing and Managing New Quality Initiatives that Increase Plan Performance


Amy Sepko, Medicare Program Manager,Health New England


Networking Refreshment Break


Challenges, Opportunities and Strategies for Payers Looking to Grow Medicare Advantage Lines of Business

With 11,000 Baby Boomers turning 65 every day, it’s no wonder health plans are actively growing their Medicare Advantage businesses. To learn more about how payers are approaching this growing market, HealthEdge and independent research firm Survata surveyed more than 200 Medicare executives on their growth plans and strategies around Medicare Advantage. This session will explore the drivers, considerations and strategies that health plans are considering to capitalize on this significant opportunity.

  • The value-based model of care for Medicare Advantage is a considerable factor in health plans’ decisions to grow their Medicare Advantage line of business and helps support healthcare’s triple aim
  • Health plans must consider that Baby Boomers are digitally-savvy and use online means to shop for coverage and participate in their healthcare; a poor member experience will send Boomers elsewhere, and this trend is only going to grow as younger, more tech-savvy generations age
  • Considering social determinants of health - as newly emphasized by CMS and supported by the value-based nature of Medicare Advantage - will play a critical role in keeping Medicare Advantage beneficiaries in good health, as the Boomer population is and will continue to be affected by socioeconomic and demographic factors

Harry Merkin,Vice President, Marketing,HealthEdge


Quality Innovations for Special Needs Plans – CSNPs, DSNPs, ISNPs

Every plan faces a variety of challenges to growing membership, achieving performance objectives, balancing costs and care, but Special Needs Plans face challenges that can be even more daunting. Overcoming those challenges requires innovation and strategic planning. This session will provide a high-level overview of Special needs plans and their unique challenges and provide insights that have helped Gateway Health plan achieve performance goals and build a strategic plan for a successful future.

Dan Weaver Vice President,Stars Quality,Gateway HealthFormerly Director of Program Management, Government Business, Quality ImprovementHighmark


Palliative Care & The Hospice Carve-in: Evaluating Unrealistic Expenses, Ensuring Data Transparency, & Improving Care Coordination

Torrie Fields,Program Director, High Value Solutions,Blue Shield of California


Networking Lunch


How In-Home Care Can Help Improve Outcomes and Reduce Potentially Avoidable Hospitalizations

NY-Based Premier Home Health Care found a recipe for success by utilizing real-time data from the home, collected by home health aides, to drive positive outcomes, meet quality incentive measures and help reduce potentially avoidable hospitalizations in the post-acute setting.

Jennifer Gentzlinger,Vice President, Strategic Development,Premier Home Health Care Services

New Product Development – Supplemental Benefits Including Social Determinants of Health (SDoH) and Flexible Benefits in the New Value–Based Care Environment

What Consumers Want from Value-adds and (New) Supplemental Benefits

Get new research study results on Medicare Advantage consumer preferences for supplemental and value-added benefit offerings on a national, regional and local level. Explore the variations between what is offered and what consumers expect from their insurance coverage. Get new data on rising senior populations’ interests from a recent consumer insights online panel.

Michael Spicer,Director of Product Innovation & Research,Capital District Physicians’ Health Plan


Flexible Benefits: Targeting the Right Customers With the Most Relevant Benefits

  • What do your customers think they want?
  • What do you think or know your customers need?
  • How do you bring those two perspectives together to create value for your customers and for your plan.

Christine Leo, Vice President, Senior Products,Cigna


Networking Refreshment Break


Panel Discussion: Social Determinants of Health -- Focus On Implementation & ROI

There are many factors woven into the success of SDoH programming including (but not scratching the surface) accessibility, affordability, willingness to change, support system to sustain the changes. How are others addressing these factors and leading programs at scale?


Amanda Hazer,Director of Population Health,Oscar Health

Kevin Moore,Vice President, Policy – Health and Human Services,UnitedHealthcare

Boosting Plan Performance Measures: STARS, HEDIS and More

Reaching for the Stars: Impacting Performance Ratings for Leaders

Finding useful, valid and reliable information to immediately begin work to improve Stars performance is easier said than done. In this session, we'll discuss real-life solutions from an expert charged with overseeing Stars performance at two different health plans. After attending, you'll understand how to take control of this extraordinarily complex process and...

  • Ensure your plan has the right strategic leadership,.tools and guidance in place to move the needle on Stars
  • Gain full transparency into all measures impacting Stars performance 
  • Realistically project future Stars performance

Ian Wolfman,CEO,Hyperlift


Panel Discussion: Building a 5 Star, Top Quality HEDIS Plan: 3 Secret Success Ingredients

  • Integrating Quality & Risk Adjustment, Revenue Management
  • Integrating Performance Measures: STARS, HEDIS


Not Just Growth. Profitable Growth!

Health plans must discover and satisfy the complex and varied preferences of current and potential members in order to sustain profitable operations and achieve strategic growth. This requires a 360- degree view of each member that accounts for personal differences, predicts choices, and determines health risk factors – while also engaging them more productively in their own health. In this session, you will learn:

  • How to go beyond survey response reporting by utilizing data visualization dashboards and predictive models that dynamically add demographic, socioeconomic, SDoH, and geographic data
  • How to capture the direct voice of the consumer through targeted email surveys delivered strategically during the plan year
  • New strategies for achieving a granular, data-driven complete view of your plan consumers
  • Tactics for optimizing plan performance and member engagement for sustainable growth

Kurt Waltenbaugh,CEO,Carrot Health


Networking Reception

Wednesday, January 29, 2020

Networking Continental Breakfast


Chairperson's Remarks


“And the Winner Is…”
An Awards Presentation for 2020’s Best Performers in Open Enrollment and Benefit Innovations

By late January 2020, we will know which Medicare Advantage Organizations gained the most enrollment and which MAOs are offering the most interesting new benefits. In this session, see who gained in 2020 enrollment, who is offering the most innovate benefits, and consider the correlation between the two. Discuss with Mike Adelberg, former Director of Medicare Advantage Operations at CMS, what we might see from CMS in 2020 and what benefit trends might influence 2021 bids.

Michael S. Adelberg,Principal, Lead, Healthcare Strategy Practice,Faegre Baker Daniels ConsultingFormerly, Director of Medicare Advantage Operations CMS


Product Strategy, Member Experience & Star – Working Together For Success

Medicare Advantage success relies on leveraging multiple components. Organizational alignment will vary with each company and “optimal” organizational structure is not easily defined. Harvard Pilgrim has recently created a new department that combines Product Strategy, Member Experience and the Star Program. We have found synergies between these areas that were not initially expected that will enable us to improve our overall performance. These are dynamics that can be leveraged in any MA plan regardless of “official” organization, and we would like to share them with you.

Noreen Hurley,Program Manager, Star Quality & Performance,Harvard Pilgrim Health Care


Cross-Functional Stars Improvement:  Moving Beyond Clinical Measures to CAHPS, HOS and Operational Measures

As the weight of Star ratings moves to outcome and patient reported measures, there is a greater need to include the entire organization in the effort to maintain and improve Star ratings.  This includes specific efforts on CAHPS, HOS, Pharmacy and operational measures.  In this session, we will discuss organizational strategies to engage cross-departmental support to improve performance.  Additionally, we will discuss approaches to impacting CAHPS and HOS results.

Gregory A. Hanley, FACHE, CPHQ,Vice President, Quality Management & Pharmacy,UCare


Networking Refreshment Break

Focus on the Pharmacy Benefit: Preparing for Regulatory and Industry Change

Integrating Part B Office Administered Medications with Retail Pharmacy Benefits Using Prior Authorization – Plus Preparing for Rebates

How are you promoting your pharmacy benefit to members and brokers? Are you looking at integrating the Part D benefit with the Part B office administered medications? How do you work through the objections that may be encountered from the provider office or the member? Who do you partner with to make this possible? Will recently approved bio-similar medication change the formulary structure?  How rebates impact your formulary design and what happens to your formulary if rebates go away? Share your ideas as we take the next step in managing the prescription benefit.

Gary Melis,Clinical Pharmacist,Network Health

Harnessing Technology Innovations to Cut Costs
and Drive Quality of Care and Member Satisfaction

Telemedicine to Reduce Readmissions and ER Visits

This session will explore ways that plans can work at the intersection of technology, data, and human systems to improve healthcare value. Examples include helping members safely recover at home after hospital stays and preventing avoidable ER visits. The use an integrated team of telemedicine physicians, nurses, social workers, and non-clinical care guides will be described as well as the data and technology stack that enables their work.

Kurt R. Herzer, MD, PhD, MSc,Director of Population Health,Oscar Health Insurance


360 Degree MA Plan Integration – Technology & Teamwork

Khoi Ta,Chief Actuary,Clover Health

Provider and Member Engagement & Incentives

Gain Share Risk Model Linked to Quality -- Value Based Contracting, Alternative Payment Model

As health care moves along the continuum from volume to value, providers are still not ready to take on risk. Upside risk sharing, better known as Gain Share, is a key alternative payment model (APM) in which the providers get to share in a portion of savings achieved against a cost target if they are also able to achieve certain quality measures.
This model aligns the incentives of the provider and payor by focusing on the following:

  • Using timely and actionable data to address gaps in care
  • Through predictive analytics and population health management, determine future cost and care complexity and proactively implement programs to get members to the right care setting to achieve more efficient outcomes
  • Reducing readmissions and inappropriate emergency room use 
  • Improve the Health Plan’s overall HEDIS and Stars measure by offering the right incentives for each provider partner to improve their respective performance around these quality measures

Randy Walker,Vice President, Provider Network Management & Partnerships,Health Alliance Medical Plan


Networking Lunch


Panel Discussion: Data Sharing Initiatives, Interoperability and Success Stories


Engaging Members through Onboarding and Voice of Customer Program

  • Member Onboarding Process – how critical it is in setting up expectations
  • Voice of the Customer Program – understand the unmet and latent needs of members to drive Service Recovery Process
  • Person Centered Design to create unique experiences which are meaningful to members
  • Archie Dey,Director of Customer Experience Insights,SCAN Health Plan

    Operational Strategies and Tools that Drive Plan Performance

    Compliance Training in Action: Using Learned Leadership Tools to Affect Positive Change

    Using your leadership tool box to turn compliance issues into compliance success stories.  In this session you will hear examples and studies of how using the skills found in Crucial Conversations and Crucial Accountability workshops can help build relationships between Compliance and Operational areas from one of adversarial to mutual respect.

    • Safety Problems: Defending, accusing or debating
    • Shared Pool of Meaning: It’s not about what I want
    • Root Cause Analysis – What is lying below the surface

    Tracy Jones,Senior Compliance Coordinator, SummaCare Health Plan


    Integrating Risk Adjustment Objectives Plan-Wide: Ensuring Accurate and Meaningful Data Capture, Maximizing Provider Engagement and Understanding Risk Adjustment and Revenue Reconciliation

    • What risk adjustment is and what it is not
    • The purpose of data integrity -- different approaches that drive risk adjustment: suspecting, financial, and operational reporting
      • EMR and Chart Retrieval
    • Focus on health plan departments that impact and are impacted by risk adjustment (Working cooperatively towards the common goal of quality improvement and cost management)
    • To vend or not to vend (or both): In-house vs. vending various risk adjustment elements
      • Full vended, hybrid, and full in house
      • Plug and play with EMR (Industry view: where we are and where we want to be)
      • Machine Learning and NLP: plus/deltas
    • Engagement approaches to include risk adjustment in risk agreements with network partners
      • How to increase shared ownership in risk adjustment documentation and coding practices with provider partners
      • Provider engagement approaches and incentives to support code recapture

    Dawn Peterson,Director of Risk Adjustment, Martin’s Point Health Care


    Close of Conference