The 9th Annual
Medicare Advantage Leadership Innovations

Registration & Networking Continental Breakfast

Chairperson’s Opening Remarks

Growing & Competing Amidst Dramatic Market Changes

Panel Discussion: Pivoting Post-Election

The recent re-election of President Donald Trump and Republican majorities in both the Senate and House may potentially have a significant impact on Medicare Advantage plans and beneficiaries. This panel will:

• Explore how the nomination of Dr. Mehmet Oz to lead the Centers for Medicare and Medicaid Services may impact the Medicare Advantage program
• Explore how current CMS rule proposals for major reform to MA, MAPD and PACE may be modified or eliminated by new leadership
• Understand how the nomination of Robert F. Kennedy, Jr. as head of Health and Human Services may influence policy for the Medicare and Medicaid programs

Moderator:

Panelists:

What's in Store for MA Regulation & Why Government Affairs is Critical

Over the past few years, MA had faced significant downward policy and operational pressure from CMS and Congress. With a new presidential administration and Congress, come find out what policymakers in Washington, DC are thinking about and how health plans can engage.

Medical Loss Ratio and its Impact on the Future Growth of Medicare Advantage Plans

Explore the basics of MLR and MLR based Population Health management. Discover opportunities in benefit design based on data insight and population segmentation. Understand cost containment and revenue building opportunities in the competitive environment of Medicare Advantage plans.

Quality & Service Innovations on a Budget

Addressing 3 Predictable & Preventable High-Cost Conditions Affecting MA Patients

Diabetes, heart failure, and falls collectively cost MA plans billions of dollars - and poor brain health is a key driver of expenses in each. This session will address how a brain health CCIP can lower your costs, improve outcomes, and delight members.

Networking Refreshment Break

Panel Discussion: Real World Product, Service & Technology Innovations to Streamline Operations, Reduce Costs & Improve Quality

• Understand how recent innovations have already impacted plan operations and costs
• Explore other frontiers for potential next generation innovations
• Learn about opportunities for using Artificial Intelligence (AI) to enhance care and the member experience

Moderator:

Panelists:

Case Study: Can Enterprise AI Boost Margins and Elevate Quality for Medicare Advantage?

Medicare Advantage (MA) providers are under relentless pressure, grappling with shrinking revenues from CMS HCC model transitions and skyrocketing costs from increased utilization, workforce demands, and soaring drug prices. How can MA organizations tackle these challenges while improving both margins and quality?
The answer lies within their own data—currently fragmented across disconnected sources. Advanced data science and AI technologies hold the power to unlock actionable insights from these data, enabling MA organizations to transform operations and thrive.
Join Jared Turley, CFO of Nivano Physicians and Controller at PromiseCare, and Dr. Arun Hampapur, Founder and CEO of Bloom Value, as they discuss their collaborative journey in leveraging AI to transform MA operations.

1. The key challenges of running an MA business
2. High-impact opportunities for AI-driven automation
3. Real-world examples in risk adjustment, claims adjudication, revenue and eligibility, 5-star ratings, and beyond
4. The strategic advantage of an Enterprise AI platform over point solutions and services

Networking Lunch Sponsored by

Concurrent Roundtable Discussion Groups – Addressing Challenges & Solutions in a 1:1 Small Group, Interactive Format

Join one of these small group, highly interactive discussions to get your questions answered on the spot, generate innovative ideas and hear from your industry colleagues.

Health Equity, Diversity & Inclusion – Moving Beyond Data to Effective Population Management

Networking Refreshment Break

Case Study: Addressing Health Equity & Social Determinants of Health Across All Plan Operations to Help Members Access Services

• Identifying populations who are not accessing health plan services and support.
• Conducting root cause analysis to identify barriers across communities.
• Developing interventions and measuring increased access.

Partnering with Community Based Organizations (CBOs) to Address Social Isolation, Social Needs & Provide Care Closer to Home in Rural Communities

• How to effectively engage and build trust with CBO partners to drive impact leveraging data
• Breaking down barriers, considerations and lessons learned when forming a partnership
• Case studies/examples effectively connecting healthcare to social care with demonstrated impact

Addressing Health Equity in Medicare Advantage: A Holistic Approach to Care to Reduce Disparities

Join Keslie Crichton, BeneLynk and Jennifer Callahan, COO ATRIO Health Plans to explore how Medicare Advantage plans can play a pivotal role in reducing health disparities and ensuring equitable access to care. Attendees will learn about the impact of social risk factors, including Veteran status, on health outcomes and strategies for reducing disparities in underserved populations. The session will also cover how Medicare Advantage plans can use both their supplemental benefits along with community programs to address health-related social needs (HRSN) and promote health equity.

• Focus: The role of Medicare Advantage plans in addressing health disparities and ensuring equitable access to healthcare.
• Key Points:
  • Identifying members with health-related social risk factors and how human to human engagement can impact retention and health outcomes.
  • Strategies for reducing disparities among underserved populations.
  • How Medicare Advantage plans can use tailored benefits and community partnerships to address inequities.

Bridging Gaps: Collaborative Approaches for Health Plans and Providers to Advance Social Determinants of Health and Health Equity Programs

In an increasingly complex healthcare landscape, health plans and providers are uniquely positioned to address social determinants of health (SDOH) and advance health equity. This session will explore a structured approach to implementing SDOH and health equity programs through successful partnerships between health plans and providers. We will share insights from a recent program highlighting best practices in coordination, role definition, and data tracking to improve patient well-being and address health disparities. Participants will gain actionable strategies for defining partner roles, establishing clear workflows, and leveraging data to monitor and evaluate outcomes effectively. Join us to learn how collaborative efforts can close gaps in care, improve quality, and create a more equitable healthcare experience for all.

Networking Reception

Sponsored By:

Networking Continental Breakfast

Chairperson’s Remarks

Strategies to Elevate Quality Performance Scores Amidst Seismic Change

With the rapid pace and sweeping nature of Star Ratings, Risk Adjustment and regulatory changes in MA, this session will focus on innovative, practical strategies for quality improvement amidst the current seismic changes. Within the context of the changing Administration, the session will:

• Review current and proposed Star Ratings and regulatory changes
• Discuss proven member and provider engagement and activation strategies
• Demonstrate methods to harvest ROI from quality improvement beyond QBPs

Integrating Stars, HEDIS®, Quality & Risk Adjustment to Drive Significant Improvements in Health Care Outcomes

• Increase return on investment with collaborative interventions
• Boost innovation for interventions by capitalizing on strengths
• Reduce member and provider abrasion with aligned outreach
• Improve staff engagement and stewardship
• Better prepared new and changing measures

Panel Discussion: Supplemental Benefits – Innovations on Budget, Tracking Utilization & Linking ROI to Cost of Care

1. Educate on Supplemental Benefits Strategy
• Provide insights into how Medicare Advantage health plans budget for and prioritize supplemental benefits such as transportation, meal programs, and in-home support services.


2. Highlight Utilization and ROI Tracking
• Explore methodologies and tools for tracking the utilization of supplemental benefits and linking their impact to medical cost savings and overall return on investment (ROI).


3. Showcase Innovative Approaches
• Share examples of creative benefit designs and innovative partnerships (e.g., with vendors or community organizations) that enhance member outcomes and reduce costs.


4. Discuss Challenges and Solutions
• Address common challenges health plans face in integrating supplemental benefits, such as regulatory constraints, member engagement, and resource allocation.


5. Inspire Future Thinking
• Encourage the audience to think about emerging trends in supplemental benefits, including how technology and evolving CMS policies might shape the future of Medicare Advantage.


6. Foster Audience Engagement
• Provide an interactive forum for industry professionals to ask questions, share perspectives, and connect with thought leaders on a critical topic in healthcare.

Moderator:

Panelists:

Networking Refreshment Break

Marketing, Sales & Distribution: Competing with Market Disruptors and Adapting to New Member Demographics While Ensuring Compliance

Marketing & Distribution Strategies to Ensure Compliance and Harness the Latest Technology Tools to Control Costs and Improve Member Experience

• Why you should Simplify, standardize, and automate
• Optimizing your operating model
• Improving member experience across channels while remaining compliant

Boosting Member Engagement & Satisfaction – Meeting Members Where They Are

Managing Member Expectations as Benefits Change or Decrease

• Valuing the volume of benefit degradations in member materials and messaging
• Marketing and selling products in a new environment
• Creating communications plans across the health plan with internal and external partners
• Developing innovative benefits with reduced funding
• Balancing member needs with member desires – what does the data tell us?

Networking Lunch

Leveraging Data-Driven Personalization to Enhance Customer Retention

In this session we will cover strategies and tools for using data analytics to create personalized customer experiences, which in turn drive long-term engagement and retention. Specific areas we will cover are:

• Why Retention is a relationship metric vs a transaction metric.
• The role of machine learning and AI in personalizing user experiences.
• Identifying key data points for understanding customer behavior and preferences.
• Implementing data-driven customer segmentation for targeted retention strategies.

Health Risk Assessments (HRA) - Improve Completion Rates and Utilize the Responses for Improved Health Outcomes Versus Just Checking the Box

• HRAs are essential to identify beneficiary's health status and needs to ensure they are receiving the right care at the right time in the right setting to holistically improve their health and wellbeing.
• Explore techniques and methods on how to reach and engage enrollees to improve rate of completion especially with difficult to reach enrollees.
• Successfully capture the HRA through effective outreach efforts from the initial enrollment stage and during follow up outreach as the care team monitors and manages an enrollee's health status or change in condition.
• Utilize the responses in the comprehensive questionnaire to deliver an impactful personalized and patient-centered care model.

Product/Benefit Design Meets Clinical and Quality Care – Managing Regulations and Costs

Benefits vs Clinical Programs ---– Navigating the Gray Areas While Meeting Quality Standards & Regulations

Want to offer a program or innovation in your plan?  Learn how to determine if you need to file a new innovation or program as a benefit or not. Understand when it is best to implement following the plan year cycle and when you can implement mid-year.  Know what constitutes a pilot and what does not and when to use pilots and how to measure success, all while remaining compliant and not compromising quality.

Adapting to Part D Regulatory Changes and Evolving Product Needs

This session will provide an overview on regulatory updates that have transformed Medicare's prescription drug benefit landscape in recent years. This session will focus on how health plans have adapted to these changes, particularly in light of rising drug costs and evolving member demographics. The discussion will include insights from teams responsible for designing and implementing new strategies, ensuring compliance, and managing member communications to navigate these transitions. Attendees will learn how one organization has leveraged cross-functional collaboration, including input from marketing and operations, to effectively address shifting regulatory requirements. With upcoming policy changes on the horizon, the session will also explore how health plans can continue to evolve their benefit designs to meet both regulatory standards and member needs. Case studies will be presented to showcase how successful approaches have been enacted to maintain competitiveness and compliance in the Medicare Advantage market

Close of Conference