Twitter Linkedin

Wednesday, June 21, 2017
2:30 PM - 3:00 PM      Conference Registration
3:00 PM - 4:30 PM      Special Afternoon Workshop

How to Design a Healthcare Engagement Program Based on Leading Consumer Loyalty Programs

In this session participants will learn how healthcare can design engagement programs using best practices from leading consumer loyalty programs and deliver business objectives. We will discuss the core elements and benefits of an intelligently designed engagement program and share a case study showcasing the process and results. Learn how to differentiate your brand and position for long-term success.

Jordan Mauer, Executive Vice President of Marketing and Engagement, NovuHealth

Thursday, June 22, 2017
8:00 AM      Networking Continental Breakfast
9:00 AM      Chairperson’s Opening Remarks

Rex Wallace, Principal, Rex Wallace Consulting

9:10 AM      CMS Call Letter Implementation and Outlook: Care Coordination and Changes to the Display
                   Page and More

Melissa Smith, Vice President, Star Ratings, Gorman Health Group, LLC
Jessica Smith, Risk Revenue, Gorman Health Group, LLC

9:50 AM      Achieving Synergies Between Quality, Risk and Revenue to Optimize Risk Scores, Integrate Chart
                   Reviews, Increase Star Ratings and Receive Higher Reimbursements

The presentation will highlight the strategies deployed by The Health Plan and how they helped integrate quality, risk and revenue.

  • Discover the unique corporate structure for overseeing Quality, Star Ratings, and Risk Adjustment
    • Internal Reorganization – Linking Quality, Finance, Clinical and Claims teams
    • Partnering with new vendors
    • Creating an internal task force aimed at improving rates for risk adjustment and HEDIS
  • Learn how the plan incorporates systems with outside vendors and internal quality and risk departments
  • Optimizing our use of analytics

Valerie Ogilbee, Director, Quality Analytics, The Health Plan
Matt Davis, Stars Manager, The Health Plan
10:30 AM      Networking Refreshment Break
10:50 AM      The Value of Claims Data Validation for Accurate Risk Adjustment
  • Why every organization should do Claims Data Validation
  • Meeting the CMS requirements for "looking both ways"
  • Next steps based on CDV data

Tim Buxton, Director of Coding, Episource
11:30 AM      Integrating HEDIS and Risk Adjustment Efforts
Integrating HEDIS and risk adjustment efforts can increase efficiency through more effective use of resources, and lead to optimization of patient outcomes and accurate scores.

Topics to be covered in this talk include:

  • Setting priorities, identifying opportunities and defining goals;
  • Maximizing time with the patient;
  • Provider education and engagement;
  • Cross-functional data sharing and examples of how to implement processes based upon this data;
  • The role of retrospective chart reviews and prospective assessments;
  • Best coding and billing practices to ensure the most accurate risk and HEDIS scores.

Tara A. Russo, MPH, CPC, CPMA, CRC, VP of Medicare Risk Adjustment and HEDIS Quality Initiatives, VP of Navigate Directorate, Island Doctors

12:10 PM      Networking Lunch
1:10 PM      A Triage Workflow for EDS Analysis Requests—Identifying the Submission Problem and Routing to
                   the Best SMEs to Fix it

So you think you might be under-submitting HCCs on EDS. How do you find out what the problem is so you can address it? EDS applies more stringent data quality edits than RAPS, and the submission process is more complex, so it’s difficult to know which SMEs are best equipped to investigate: Medicare Operations, Revenue Management/Actuarial, Information Technology, Claims Processing, Membership, or Provider Education. If your research request gets routed to the wrong team, it can waste resources and cause your request to be lost in the organizational cracks. This is particularly true during RAPS/EDS reconciliation audits, which are difficult and complex to conduct. In this presentation you will learn how asking a few key early questions in the right sequence can quickly identify which kind of EDS submission problem you are having, and which team of SMEs is best equipped to fix it.

Brent Zenobia, Ph.D., Senior Business Architect for Medicare and ACA, Cambia Health Solutions

1:50 PM      Integrating Interventions With Provider Partners to Improve Star Ratings
  • Define types of provider partners vs. independent practitioners.
  • Understand the structure implemented to partner with providers around population health.
  • Share interventions for improving priority star ratings.
  • Development and deployment of monthly data at the provider partner level; and individual practitioner level to focus on improving priority star measures.

Jane R. Elliott, Executive Director of Quality Management, Health Alliance
2:30 PM      Networking Refreshment Break
2:50 PM      Value Payment Perfect Storm – MACRA, MIPS, Bundles, APMs, QPP

Navigate your way through the clinical quality and payment perfect storm. See how alignment with MACRA can be a win-win for private payers and providers and STAR ratings!

At the conclusion of this session the learner will be able to:

  • Describe MACRA and its major components including the two payment options:
    • MIPS : Merit-based Incentive Payment System
    • APM: Alternative Payment Model
  • Recognize the impact of MACRA on providers and their relationship to private payers incentive and value payment models for Quality Stars
  • Show providers the benefit of risk adjustment efforts in relation to MACRA
  • Demonstrate one approach to align strategies for providers and payers to achieve common clinical and financial goals

Dr. Amy Helwig, Vice President, Quality Improvement and Performance, (UPMC) University of Pittsburgh Medical Center Insurance Services Division

3:30 PM      Panel Discussion

The Elusive HOS & CAHPS Measures—Member Engagement Strategies

Melissa Smith, Vice President, Star Ratings, Gorman Health Group, LLC

Rex Wallace, Principal, Rex Wallace Consulting
Jordan Mauer, Executive Vice President of Marketing and Engagement, NovuHealthh
Ellen Harrison, SVP, Market Strategy and Consulting, Eliza Corporation
David L. Larsen, RN, MHA, Director, Quality Improvement, SelectHealth

4:10 PM      Case Study
                  A Case Study of Cambia’s Member Engagement Model: Improving the Effectiveness of Stars
                  Interventions Through Data Analytics and Predictive Modeling

Cambia Health Solutions will present an overview of its Member Engagement Model that leverages predictive analytics to target the members most likely to engage within a given intervention. The engagement model seeks to address the challenge inherent in many Stars interventions which is to provide the right messaging to the right member through the right channel to drive the right outcome.

Kristine Walhof, Program Director, Medicare Star Ratings, Cambia Health Solutions
Michael Brown-Hayes, Manager Advanced Analytics and Data Science, Cambia Health Solutions

4:50 PM     Networking Reception


Friday, June 23, 2017
8:00 AM      Continental Breakfast
9:00 AM      Chairperson’s Remarks

Rex Wallace, Principal, Rex Wallace Consulting

9:10 AM      Building Enterprise Synergy Between Care Coordination and Risk Adjustment Activities

Health Plans are challenged with delivering results for their quality and revenue generating programs while enabling cost savings through clinical models of care. To successfully navigate a member through the healthcare continuum, the enterprise must be synchronized to maximize the member’s 360 experience. MCO must partner with Network Provider groups to enable savings through community models, behavioral health initiatives, and VBP risk share arrangements based on quality metrics.

How will you leverage your enterprise effort to enhance care coordination performance while generating a revenue stream? How will your Health Plan communicate effectively with your communities to maximize participation in these programs? This session will discuss approaches to prepare for and meet these challenges of creating synergies across all lines of business.

  • Interactive discussion on how to increase clinical interventions while generating a positive ROI
  • Discover key commonalities between clinical, community activities, and chronic conditions to drive revenue and reduce cost
  • Determine levers to drive participation rates for high risk or undocumented members
  • Understand pathways to educate internal and external resources to enable synergies

Gabriel L. Medley, MHA, MBA, Vice President, Quality and Risk Revenue, Gateway Health
9:50 PM      RADV – What Can You Do To Mitigate Risk

Donna Malone, Sr. Manager Enterprise Risk Adjustment Coding, Quality Assurance & Provider Education, Tufts Health Plan

10:30 AM      Networking Refreshment Break
10:50 AM      Case Study
                     Bridging the Gap Between Finance and Quality--Structure Your Star Ratings Program for Success
  1. Empower leaders in functional areas
  2. Expedite the decision making process
  3. Coordinate your Stars strategy with quality program efforts across products

Jessica Assefa, Medicare Stars Program Manager, UCare
11:30 AM     Panel Discussion
              Hard to Improve Measures: Osteoporosis, Care Coordination, Diabetes, Case Management and More

Rex Wallace, Principal, Rex Wallace Consulting

David L. Larsen, RN, MHA, Director, Quality Improvement, SelectHealth
Melanie Richey, Vice President of Clinical Solutions, Centauri Health Solutions
12:10 PM     Close of Conference


Keep me inform


Medicare Risk Revenue Management, Plus  Quality and Star Ratings

Medicare Risk Revenue Management, Plus  Quality and Star Ratings

Medicare Risk Revenue Management, Plus  Quality and Star Ratings

Medicare Risk Revenue Management, Plus  Quality and Star Ratings

Medicare Risk Revenue Management, Plus  Quality and Star Ratings