Speaker Presentations

Tuesday, January 25, 2022

Continental Breakfast


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,


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.
Join Michael Wood, Insightin Health’s Chief Strategy Officer, to discuss speeding your organization’s path to the retail healthcare experience. Michael will discuss a practical approach using technology and data that meets Health Plans where they are on the journey to provide a meaningful experience, create engagement that delivers better insights and better health outcomes.

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.
After completion of this session, you will be able to:

  • Have meaningful conversations to explore various departments that impact risk adjustment at your plan
  • Assess vendor relationships to leverage clinical data that can assist in having earlier and greater insight into member health status
  • Effectively evaluate how your plan’s provider network is addressing accurate diagnosis coding
  • Discover innovative approaches in adding risk adjustment in value-based contracting with your provider network

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


Feature Presentation


Networking Lunch

Sponsored by

Strategic Solutions Network (SSN), based in Boca Raton, FL, is the parent company of the Medicare Risk Adjustment & Revenue Management Management, Plus Quality and Star Ratings and a series of related conferences.

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:

  • Learn how AI can analyze ambient sensor data to understand daily living patterns
  • Explore how care management workflows can improve with home intelligence
  • Learn how everyday behavior and deviations from normal patterns can predict health events; improve management of chronic disease; and prolong older individual independence.

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

6:00 -7:00

Networking Reception in the Exhibit Hall

Sponsored by

Strategic Solutions Network (SSN), based in Boca Raton, FL, is the parent company of the Medicare Risk Adjustment & Revenue Management Management, Plus Quality and Star Ratings and a series of related conferences.

Wednesday, January 26, 2022

Networking Continental Breakfast


Chairperson’s Remarks


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.

  • Aligning benefits to member needs
  • Increasing CAHPS-related satisfaction
  • Preserving premium adequacy
  • Qualifying and preparing members
  • Referring-and-following

Dr. Thomas Lutzow, Former CEO, iCare


Feature Presentation

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.

  • Defining health equity
  • Discussion of health equity as a part of SDOH foundation
  • Examples of how Life Services is impacting minority populations

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


Feature Presentation


Networking Lunch


Value Based Payment Models – Keys to Success and Outcomes Results with Primary Care Attribution Models

  • Payer/ Provider Collaboration
  • Episodes of Care/ Bundled Payments
  • From Shared Savings to Shared Risk

Steven R. Peskin, MD, MBA, MACP, Executive Medical Director, Population Health, Horizon Blue Cross Blue Shield of New Jersey


Feature Presentation


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

  • Ensuring compliance of all marketing and outreach activities
  • Growing market share under CMA Marketing Flexibility rules
  • How do you stand out from the noise while being compliant?
  • Measuring effectiveness

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