|Pre-Conference In-depth Workshop Series
($300 ALL ACCESS WORKSHOP PASS to any or all 3 of the pre-conference workshops)
Close of Workshops
|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
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.
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.
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
Scott Mancuso, MD, Chief Clinical Officer,Landmark Health
Christine Muldoon, VP Marketing & Strategy,WebMD Health Services
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
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
Solving Medicare Advantage Operational Challenges with AI
MA plans are under increasing pressure to provide correct, timely reporting to CMS around patient risk and quality performance, and to reduce abrasion with provider partners. Artificial Intelligence (AI) is being deployed by leading MA plans across the nation to streamline workflows and improve the accuracy of key operational activities. This session will explore how AI can support risk, quality, and provider outreach programs and showcase some of the AI applications available in the market today.
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
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
Catherine Macpherson,VP, Product Strategy and Development, Chief Nutrition Officer,Mom’s Meals
|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...
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
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
Kurt Waltenbaugh,CEO,Carrot Health
Deliver an Enhanced Member Experience by using Design Thinking Strategies to Streamline Processes and Improve Employee Engagement
Across healthcare, organizations are hyper focused on the member experience. We talk a lot about member engagement, but how can organizations make forward progress that is cost neutral, and a win for employees? When employees are satisfied, the member experience improves. We’ll talk about opportunities to streamline internal operations and how decisions to be more efficient help both your employees and the customer. We’ll focus on opportunities to support member facing employees as they resolve complex member issues.
Jenny Graham,Partner,Zelus Consulting Group
Networking Continental Breakfast
“And the Winner Is…”
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
Technology-Enabled Care Management Program to Achieve the Triple Aim for Members with Dementia
This session will provide insights into how to determine the prevalence and utilization for members with dementia from claims data, and detail an approach and outcomes for improving members’ cost and quality outcomes by empowering and supporting their family caregivers.
Dirk Soenksen,Co-founder & CEO,Ceresti Health
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.
Randy Walker,Vice President, Provider Network Management & Partnerships,Health Alliance Medical Plan
Engaging Members through Onboarding and Voice of Customer Program
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.
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
Dawn Peterson,Director of Risk Adjustment, Martin’s Point Health Care
Close of Conference