Tuesday, January 25, 2022
Chairperson’s Welcome & Introduction
A New Path for Medicare Advantage? The Biden Administration’s MA Regulations
By the end of 2020, the Biden administration has projected it will publish two draft regulations setting new rules for the Medicare Advantage program. Discuss these regulations and the Biden administration’s posture toward Medicare Advantage with former Director of Medicare Advantage Operations at CMS.
Michael S. Adelberg,Principal, Lead, Healthcare Strategy Practice,Faegre Baker Daniels ConsultingFormerly, Director of Medicare Advantage OperationsCMS
Panel Discussion: Meeting Members Where They Are -- Re-engage & Support Members in the New Post-Covid Environment
Kent Holdcroft,Executive Vice President of Growth,Healthmine
Christine Leo, Vice President, Senior Products,Cigna
Gretchen Shanofsky,Vice President of Plan Operations,Clover Health
Dr. Julia Hoffman,Vice President Clinical Strategy, Behavioral Health, Teladoc Health
Paula LeClair,US General Manager,Healthy.io
Adopting Innovations to Influence Star Ratings and Leveraging Them to Reduce Disparities
Melissa Smith,Executive Vice President, Consulting and Professional Services, Healthmine
Aligning STARs, QA/HEDIS & Risk Adjustment
to Boost Outcomes & Member Experience
Boosting STARs & Quality Ratings: Plan-wide Initiatives to Improve Member-facing Experiences and Provider-facing Relationships
Priyanka Jain,Vice President, Medicare Quality and Member Experience,Point32Health, Harvard Pilgrim Health Care & Tufts Health Plan
Networking Refreshment Break in the Exhibit Hall
Build Tomorrow’s Retail Healthcare Experience Today: A Roadmap for Next Best Action Wherever You are on the Journey
According to a recent JD Power study, more than 90% of Medicare participants would like to receive
better communication and information from their plans. PWCI reports that 80% of Americans suggest
that speed, convenience, knowledgeable help and friendly service are the most important elements of a
positive customer experience.
Michael Wood, Chief Strategy Officer, Insightin Health
What’s the Real Risk in Risk Adjustment? Finding Collaborative Approaches to Maximize All Available Resources Across Your Plan
Having a clear and compliant picture of the health status of the membership is dependent on accurate
risk adjustment of the population. This task is critical for both risk adjustment operational and revenue
expectation of the health plan. Success in accurate and compliant risk adjustment is dependent on
collaboration across various departments, vendors, and the provider network. This session will explore
various approaches available to all of us and provide questions you can take back to your plan, vendors,
and provider network to ensure collaboration across key stakeholders in successful execution of a risk
adjustment programs are being explored and implemented.
Dawn Peterson, Director of Risk Adjustment,Martin’s Point Health Care
|Data Management & Technology Advances for MA Plans|
Data-driven Interventions and Evaluation of Effectiveness: Identifying Sub-Populations including Health Inequities
To meet our performance goals, we cannot use a one-size-fits all strategy for developing improvement initiatives. We must develop robust data sources to identify and understand the many sub-groups that make up our membership. Through the analysis of these data sets, we are able to identify the specific needs of the sub-groups and develop and evaluate tailored interventions to help members achieve their best health.
Gregory A. Hanley, FACHE, CPHQ, Vice President, Quality Management & Population Health, UCare
Value Based Contracting with Vendors
Christine Leo, Vice President, Senior Products, Cigna
Case Study: Florida Blue's Journey into Interoperability --- Investing in New Technology, Adjusting Processes and Changing Behaviors
Hear how Florida Blue, a Health solutions company, invested in technology, adjusted processes and changed behaviors in order to transition to a more Interoperable workflow with their provider partners and prepare for the CMS/ONC Interoperability API mandates. Successes, lessons learned and strategy for the future.
Tab Harris,Senior Director, Provider Connectivity Solutions & EDI Operations,Florida Blue
Networking Refreshment Break in the Exhibit Hall
Technology Investments Supporting Aging in Place: Machine Learning, Sensor Technology and Smart Speakers
As the population ages, there will be a greater demand for seniors to live at home rather than reside in a facility. Caregivers can support independent living using insights from activities of daily living. Furthermore, our ability to manage chronic disease can improve with knowledge of home activity and biometric data rather than reliance upon infrequent nurse calls or visits (virtual or in-person). There have been great advances in analysis of passive sensors and smart speaker data to aid in understanding individual activities that might predict health events or poor outcomes. During this presentation, we will:
Darren Schulte,MD, President of Advanced Technology, Centene
Panel Discussion: Integrating Data from Population Health, Behavioral Health, SDOH into Care Coordination and other Clinical Teams – Breaking Down Silos
Gregory A. Hanley, FACHE, CPHQVice President, Quality Management & Population Health,UCare
Dr. Stephen Bekanich M.D,Chief Medical Officer, Iris Healthcare
Jessica Assefa,Senior Director, Sales, Marketing & Strategy, GHG Advisors
Digital Caregiver Empowerment Program Reduces Utilization and Costs for Members with Dementia
We will present outcomes and insights from a study in which we deployed the Ceresti Caregiver Empowerment Program (CCEP) to family caregivers of Medicare Advantage members with dementia. We evaluated the impact of this digital health program, versus a propensity matched control group, on member healthcare cost and utilization; and on caregiver healthcare costs, mental health and satisfaction. CCEP process metrics were also tracked to evaluate caregiver engagement and compliance with completing remote risk assessments.
Dirk SoenksenCEO & Co-founderCeresti Health
|Innovations for In-Person & Remote Care Delivery|
Panel Discussion: Innovative Products & Benefits Designed to Attract & Retain Members, Boost Outcomes, Control Costs
Henry W. OsowskiManaging PartnerStrategic Health Group
Jim Egan, Vice President of Health Plan Sales, WEX Health
Carrie Meyer, Au.D. Doctor of AudiologyAmplifon
Elaine Taverna, SVP Quality & Risk Adjustment, Advantasure
Having Difficult Conversations: 4 Key Results from Advance Care Planning Discussions
Unnecessary care delivered to people with serious illnesses is the largest driver of waste in our healthcare system. Advance Care Planning (ACP) has been proven to address this problem by allowing individuals to communicate their end-of-life preferences through conversations with healthcare professionals and document these preferences in Advance Directives. While ACP has been shown to dramatically improve member experience, it has largely been underutilized due to the sensitivity of the topic. Developing an ACP program to support clinicians and members through the advance care planning process results in 1) reducing unnecessary healthcare utilization and costs; 2) improving quality of care; 3) improving health outcomes and 4) improving healthcare worker satisfaction.
Dr. Stephen Bekanich M.D, Chief Medical Officer, Iris Healthcare
Networking Reception in the Exhibit Hall
Wednesday, January 26, 2022
Networking Continental Breakfast
Appreciating LTSS Transfer Value
Medicare and Medicaid plans regularly find that a sub-set of members has needs that are better suited for long term services and supports. These members may be in the wrong program. It is fortunate if these plans operate in a state that contracts with MLTSS sponsors. In this case, these qualifying members can be assisted to transfer to more appropriate coverage that aligns to their needs, regardless of the organization that sponsors the programs. Qualifying eligible members, preparing these members for a successful transition, engaging the Aging and Disabilities Resource Center staff, following the member through transition are all components for high-impact on CAHPS scores, provider satisfaction, and margin relief.
Dr. Thomas Lutzow, Former CEO, iCare
|Improving Member Experience & Outcomes: Whole Person Care, Population Health, SDOH & Value Based Care|
Physical & Behavioral Health Integration Models – a Holistic Approach to Boost Outcomes & Member Experience
Geisinger has implemented strategies that address Medicare Advantage member needs in an integrated manner. Embedded and collaborative care models in Primary Care leverages the partnership between physical and behavioral health needs, with a primary focus on a holistic approach. From a Population Health perspective, the unique needs of the Medicare Advantage group require risk analysis and targeted interventions for a happier and healthier member experience.
Amie Hoffman, LCSW, MHA, Director of Behavioral Health, Geisinger Health Plan
Home-delivered Meals Advancing Stars
Learn how a program of home-delivered meals for members after discharge or managing a chronic condition can deliver ROI and advance the Stars rating of your MA plan. Condition-appropriate fully-prepared meals can have many positive impacts on members and health plans. When provided after discharge, meals help members to rest and recover and avoid a readmission. In new SSBCI models, meals “beyond a limited basis” can help members to better control chronic conditions and avoid hospitalization. With Stars measures putting more value in member self-reported measures including “Improving or Maintaining Physical Health” and “Rating of Health Plan,” meals programs that help members improve their health and drive satisfaction with their health plan can also contribute to higher Stars ratings for MA plans.
Catherine Macpherson,SVP Healthcare Strategy and Chief Nutrition Officer, Mom’s Meals
Incorporating Health Equity in SDOH Strategy
Many of the programs that address social determinants are addressing symptoms of deep societal issues that have plagued our communities for centuries. Racism, sexism, agism are all root causes of many neighborhoods that have lacked investment, growth and opportunities for generations. CareSource is embedding health equity into all aspects of care and ensuring that is serves as a foundation of the Life Services and Care management models.
Karin VanZant,Vice President National SDOH Strategy, CareSource
Networking Refreshment Break
Benefit Design Innovations to Improve Access
to Care, Quality Care & Member Engagement
Panel Discussion: Investing in Supplemental Benefits and Services to Save Medical Money
There’s a lot of talk about the ROI that the new flexible supplemental benefits and services can return to a MA plan. But which of the many extravagant claims are supportable? Join the panel for a discussion of ROI based on vendor case studies and actuarial commentary.
Michael S. Adelberg, Principal, Lead, Healthcare Strategy Practice, Faegre Baker Daniels Consulting Formerly, Director of Medicare Advantage Operations,CMS
Daniel Weaver, Executive Vice President of Product Operations and Stars Strategy, NationsBenefits
Tim Murray, Director and Senior Consulting ActuaryWakely Consulting Group
Evelyn Chojnacki,MPH, Director, Health Plan Product Strategy,SWORD Health
Elizabeth Klodas, MD FACC. FounderStep One Foods
Value Based Payment Models – Keys to Success and Outcomes Results with Primary Care Attribution Models
Steven R. Peskin, MD, MBA, MACP, Executive Medical Director, Population Health, Horizon Blue Cross Blue Shield of New Jersey
Medicare Flexibilities Accelerate Medicare Advantage COVID Fraud Vulnerabilities
While the Public Health Emergency (PHE) – COVID-19 pandemic accelerated changes in regulations and policies to ensure access to patient care and medications, these new Medicare flexibilities also brought increased exposure to fraud, waste and abuse (FWA). Medicare Advantage plans are ripe for fraudsters seizing the opportunity to take advantage of COVID-19-enhanced payments and loosened policies that enable FWA to pass through undetected and are continuing to do so. Session will review new and evolving COVID fraud waste and abuse threats, including Identity Theft, Telemedicine, Laboratory schemes, Pharmaceutical risks and more. Session will review areas MA plans should focus their fraud waste and abuse analytics and investigation ideas to identify and address this growing area of vulnerability.
Lisa Jensen, Director of Payment Integrity, Providence Health Plan
|Marketing & Sales Strategies To Expand Market Share & Increase Retention|
Maximizing CMS’ Marketing Flexibility to Grow Market Share: Ensuring that Communications are Compliant, Educational, and Effective
Naomi Irvin, Chief of Staff, Government Markets, Blue Cross and Blue Shield of North Carolina
Investing in the Digital Experience: Responding to the Shift in How Consumers Shop for Medicare Coverage, and Meeting Members Where They Are
Kortney Cruz, Vice President, Medicare Sales and Marketing,Independence Blue Cross
Close of Conference