Agenda

Networking Continental Breakfast

Co-Chairpersons’ Welcome & Opening Remarks

Follow Thy Members, Stars Follow YOU

• Are we chasing numbers rather than members?
• Are we waiting for jazzy data insights over listening to the canaries in our coal mines?
• Member-centricity - how do we turn it from FAD to FAB

Rapid Performance Improvement and Value-Based Contracting

• Examine California delegated model and how it relates to directly contracted networks
• Case study examples of variability seen whenever performance is measured at the physician or medical group level
• Explore incentives that motivate specific behaviors related to performance in areas of interest to the health plan
• Discuss what options are available to a health plan, when modification of practitioner/provider incentives takes too long or is deemed unlikely to improve performance
• Case study of one strategy being deployed by Blue Shield of California around member experience

The New Value Proposition- Cost Avoidance: Using Data to Go Upstream to Address Chronic Disease Prevention

We now have access to multiple sources of data that informs the programs we develop to address chronic conditions. We also have data to identify and intervene with members who have a higher risk of developing chronic conditions. We are able to move into the new value proposition of cost avoidance. In this session we will discuss:

• Available data sources
• Models for identifying high-risk members
• Interventions and measurements for evaluating programs

Networking Refreshment Break

Panel Discussion: Enhancing Member Experience: Tools and Strategies

Moderator:

Panelists:

Feature Presentation

Case Study: How to Use Data to Inform Your Business: Sorting Through the Noise

Choose Your Own Adventure: Combined Benefit Package Trends

The 2023 benefit landscape in the MA market includes an increase in combined benefit offerings. This benefit design allows a health plan to offer multiple supplemental benefits to beneficiaries under a combined limit, or multiple benefit selections from a menu of benefits, or both. There are multiple ways to structure a combined limit package and from product design, to marketing, to actuarial, there are complex issues to consider. This presentation will focus on the growth of combined benefits in the 2023 MA market and trends in combined benefit offerings, as well as what to expect for the future.

Networking Lunch

Panel Discussion: Integrating Data from Population Health, Behavioral Health, SDOH into Care Coordination and other Clinical Teams – Breaking Down Silos

Moderator:

Panelists:

Activating Family Caregivers to Reduce Hospitalizations tor Frail Elderly Members

The key to reducing any hospitalization is to detect and address a change in condition, before it worsens. Who better to detect a change in condition in the member than a family caregiver who has regular -- often 24/7 -- visibility into their loved one’s health? Learn how activated family caregivers break the cycle of costly deterioration that accompanies hospitalizations, avoiding downstream costs. Outcomes and insights from a clinical study of Ceresti’s Digital Caregiver Activation Program will be presented.

Panel Discussion: Embracing Digital Transformation Across All Departments/Functional Areas to Support Aging in Place

Moderator:

Panelists:

Networking Refreshment Break

Addressing Interoperability: A Multi-Pronged Approach to Close Gaps in Care and Drive Value

Building a real-time health data exchange can address gaps in care, improve patient outcomes, and reduce costs. The purpose of this session is to highlight a multi-pronged approach for data integration across disparate platforms. This session will go into a health plan’s journey for building a portfolio of capabilities to electronically exchange health information and insights between disparate health care systems at provider, patient, and payer settings.

Older + Wiser: Engaging Medicare Members in Digital Health

Best practices, key takeaways and insights about how a Medicare population engages with a digital health program. In this session, hear from Hinge Health’s Vice President of Medicare Austin Weaver as he debunks myths about the Medicare population’s relationship with digital health technologies.

Leveraging Data and Digital Solutions to Target SDOH Needs of Medicare Members

Framework for collecting data, reviewing and developing programs and solutions based on the needs of your members is important for implementing a whole person care approach and creating a longitudinal health record.  Levering relationships with community based organizations and digital solutions allows you to expand your reach, scale your efforts and provide care closer to home. Social needs screenings allow you to identify areas of opportunity and social care needs based on individuals and communities, and when paired with a referral option, it allows for a closed-loop referral process to support your population health efforts.

Networking Reception

Sponsored by:

Networking Continental Breakfast

Co-Chairpersons’ Remarks

Integrating Health Equity Data into all Plan Operations – Setting Up the Infrastructure to Support Success

Elizabeth will discuss how Network Health is integrating health equity data throughout the plan to drive better member experiences and quality outcomes.

• ​Integrating data from multiple sources including leveraging provider, market and HIE data
• Incorporating data to meet regulatory CMS and NCQA requirements
• Driving quality outcomes and benefit decisions by leveraging data

Innovative Products, Benefits, and Engagement Programs Designed to Boost Quality Outcomes, Attract & Retain Members, and Control Costs

Another AEP season is behind us, 2024 design planning is already underway, and the impacts of 2024 Star Ratings are rippling across the nation. This session will explore emerging trends in product and benefit designs including one plan’s approach to growth and retention in a competitive landscape; evolving engagement programs that boost participation and outcomes including ways MVP Health has bolstered member engagement; and operational integration strategies to align growth, quality, and medical expense cost control.

Partnering Up to Empower Members to Revolutionize HEDIS Care Gap Closures and Member Experience

• Learn how Clover's forward-thinking approach and collaboration with Walgreens allowed them to create new innovative strategies that delivered best in class member experience and closed HEDIS care gaps.
• Discover why building care strategies around a member to create hyper-personalized & scalable approach to gap closure provides health plans with a success strategy to orchestrate better outcomes while hitting HEDIS, HOS, CAHPS and member experience measures.
• Consider why it is critical to have your HEDIS auditor be a strong partner to gain compliance in innovative programs.

Organizational Alignment: The Foundation of Executing a Successful Star Ratings Strategy

• Establish collective Stars’ goals & milestones with clear accountabilities allowing team members to know what to focus on and when
• Agree on KPIs and data to ensure transparency while measuring progress and results
• Develop a routine meeting cadence under an accountable governance model to empower leaders & inform flexible strategies

Networking Refreshment Break

Feature Presentation

Panel Discussion: Innovative Products & Benefits Designed to Attract & Retain Members, Boost Outcomes, Control Costs

Feature Presentation

Networking Lunch

Supporting Specialists at the Point of Care to Ensure Compliance and Optimize Care Management & Coordination Through Integrated Technology

Comprehensive patient care requires collaboration with a delivery team comprising primary care, specialists, and care management coordinators. UPMC Health Plan has historically collaborated with primary care providers regarding documentation for risk adjustment as well as identification of patients who could benefit from care management. Patient care has become increasingly complex, and many patients see specialists as their primary care providers. See how UPMC, an Integrated Delivery Finance System, has leveraged NLP and care coordination technology to primary care and specialists to improve documentation and care opportunities.

How to Get EMR Data from Providers and Sharing Health Plan Data with Providers

Ensure Compliance When Utilizing Electronic Queries – Protect Your Plan’s Reputation & Financial Security

With the ever-increasing scrutiny on accurate reimbursement for coding and documentation it is more important now than ever to ensure your electronic query process/solutions meet established guidelines. Join us for an interactive discussion on what the OIG and DOJ are targeting. We will review the elements of a compliant query that are required regardless of the method used. This is a discussion you cannot miss if you want to ensure that your organization’s reputation and financial security is protected!
Our discussion will include:

• OIG and DOJ activity overview
• Elements required for a compliant query
• Understanding your data to ensure success

Leverage Comprehensive Health Screening Programs for Early Detection of Comorbidities to Help Improve Overall Quality, Cost, and Patient Outcomes

• See how innovative Providers/Payviders and Health Plans have successfully implemented widespread screening programs for earlier detection of comorbidities in their patient populations
• Learn why Payviders and Health Plans are screening all patients regularly, not just certain risk populations
• Understand the range of different solutions Payviders and Health Plans can employ to get a better assessment of patient risk and health.
• Hear about these leaders’ real-world outcomes and observations from implementing these programs

Close of Conference

Networking Continental Breakfast

Chairperson’s Opening Remarks

Streamlining & Simplifying Provider/Plan Interactions – Innovative Provider Payments & Contracting Methodologies & Operations

• Provider Relations: Implementing Concise Provider Education Tools
• Innovative Contracting: Simplifying Alternative Payment Models to Ensure Appropriate Reimbursement
• Claims Payments: Creating Clear, Consistent, Timely, Easy-to-Understand Policies
• Policies & Procedures: Building a Good Searchable Engine, Offering Cheat Sheets & Minimizing Legalize

Systemically Achieving Value-based Core Measures through Clinical Workflow, Metrics & Patient Experience

• Operationalizing systemic value-based care in a provider practice by developing a Senior focused evidence-based care model
• By focusing on the patient experience, develop workflows and scheduling structure that ensures completing the care model
• Supplement the workflows and tools by creating a dashboard to monitor and promote healthy competition
• Tie success in the care model to physician incentive compensation
• Discuss ways in which payors can work collaboratively with providers to ensure patient satisfaction and clinical quality.

Achieving the Triple Aim of Outcomes, Cost, and Patient Satisfaction Through the Application of Patient Reported Outcome Measures: The Henry Ford Health Experience

As health care continues its transition to a value-based reimbursement system, there will be increasing emphasis on measuring, reporting, and optimizing the outcomes that matter most to patients.  The best way to measure these outcomes is through Patient Reported Outcome Measures (PROMs).  However, most providers struggle to measure and incorporate these tools into daily practice due to logistical, technical, and financial constraints.  This session will highlight how to incorporate these tools at scale in the pursuit of achieving the payvider "triple aim" of improved quality, reduced costs, and enhanced patient satisfaction.

Networking Refreshment Break

Case Study in Rural Healthcare: Innovation and collaboration in implementing a new MA product

This session will focus on a shared decision-making structure leading to a new Medicare Advantage product. Specifically, pulling healthcare delivery system and health plan leadership together for a top to bottom product development in the MA space. We will deep dive into innovative approaches to risk management including virtual care strategies and others unique to rural healthcare access embedded in our product design.

• Focus on shared decision-making structure in building a system product vs. health plan only product
• Incorporating an innovative provider/payer approach with unique focus in virtual care
• Uniqueness of being part of a system that is the largest rural health care provider and our ability to manage risk
• Application of learnings in standing up a shared MA product and its impact on other shared populations/lines of business

Building Out a Compliant Risk Adjustment Team

As the healthcare system continues to move towards more value based payment models, it is critical to have a high performing risk adjustment program.  To build a successful program you must have good people, strong policies and procedures, and technology.  These three pillars will make it easy for your provider partners to compliantly document to the highest level of specificity.

Market Expansion and Growth Strategies – Replication of Your Clinical Assets Across State Lines

• Research local needs and gaps in care
• Analyze market and regulatory environment
• Build strategic partnerships with complementary, mission-aligned community-based organizations and with government agencies
• Adapt Clinical Innovation Asset to local needs

Creating a Compliant Approach to Provider Initiated Marketing

Being a Payvider presents significant benefit for marketing but poses compliance risk to ensure adherence to CMS Marketing and Communication guidance. In this session we will look at compliant provider-initiated marketing that meets the needs of their patients. With ever growing scrutiny on Medicare Advantage marketing practices learn tactics that promote compliance while still meeting growth goals. We will also discuss organization structure that promotes oversight and creates a clear line between the payor and provider.

close of summit