Hear from Aetna, Tufts Health Plan, Cigna-HealthSpring, UPMC Health Plan, Highmark, Gateway Health, Excellus BlueCross BlueShield, Harvard Pilgrim Health Care, Select Health, Florida Blue, Priority Health, Capital Blue Cross, & SCAN Health Plan at the 10th Medicare Star Ratings, Quality Assurance & Risk Adjustment. Find out how to align Star Ratings, Quality Assurance & Risk Adjustment to more effectively navigate the ever-changing Medicare Advantage landscape presents unique competitive advantages -- Plans working collaboratively across silos will be in the best position to tackle the many challenges presented by CMS.

Changes in threshold guardrails, weighting of CAHPs, HOS, Hospitalization, Pharmacy and Administrative Measures as well as implementation of Transitions of Care measures, and Supplemental Benefits, demand creative solutions.

This is the only forum that brings together both sides of the market for a deep dive into how plans are meeting CMS challenges, engaging providers and members, launching social determinants of health programs, building coding best practices, breaking down silos & minimizing redundant processes.

... Get step-by-step CASE STUDY Best Practices on your most pressing challenges and biggest opportunities:

    Integrating Stars, Quality & Risk Adjustment to Boost Performance Scores, Ensure Compliance & Control Costs

  • Balancing CMS Regulations With Your Business Needs
  • Aligning Quality, Stars & Risk Adjustment
  • Breaking Down Silos and Coordinating Process Flows
  • Harnessing Advanced Technologies – A Business Strategy Panel Discussion

  • Provider Engagement & Data Sharing

  • Maximizing Provider Data and Data Sharing
  • Building Provider Relationships to Engage Members
  • Supplemental Data Collection and Utilization to Boost HEDIS & Stars Performance
  • Utilizing Chart Retrieval Year Round
  • Coordinating Incentives Across Programs with Competing Priorities

  • Member Engagement & Transparency

  • Improving Consumer Survey Results (CAHPS) – Lessons Learned
  • Boosting Performance on the 5 HOS STARs Measures
  • Integrating Social Determinants of Health to Increase Performance Measures
  • Community Partnerships & Population Health

  • Cost & Quality Control of Care Delivery

  • Population Health Management – Harnessing Analytics to Identify High Risk Members
  • Integrating Behavioral Health
  • Reducing Readmissions
  • Combatting the Opioid Crisis
  • Chronic/Complex Care Management
  • In Home Assessments: Closing Gaps in Care

  • Risk Adjustment Revenue Management

  • Compliance with New CMS Risk Adjustment Models
  • Combining Resources to Align Prospective Programs to Identify Gaps in Care
  • Validating Coding Accuracy
  • Reconciliation of RAPS and EDPS Data
  • RADV – Preparing for and Surviving a CMS Audit

  • Integrating Provider, Pharmacy & Payer

  • Effective Community Pharmacy Partnerships Aimed at Boosting Star Medication Adherence Performance
  • An Integrated Approach to Total Performance Across All Part D Measures
  • Medication Adherence Measures & MTM Completion Rates

2019 Distinguished Faculty
Harvard Pilgrim Health Care

Gaurishankar Chandrashekhar

Quality Director Revenue Management
Tufts Health Plan

Debra A. Corbett

Program Director, Senior Products Clinical Services Strategy
Health Alliance Medical Plans

Christine Freehill

Director of Quality Management
SCAN Health Plan

Michelle Fujii

Manager, Medicare Star Quality
Florida Blue

Aldiana Krizanovic, MPH, CPH

Senior Health Policy Consultant for Federal Government Relations
Select Health

David L. Larsen RN, MHA

Director, Quality Improvement
Capital BlueCross

Susan Lira

Manager, Plan Performance & Improvement
Health Alliance Medical Plans

Dawn Peterson

Director of Utilization Management and Risk Adjustment Solutions
UPMC Health Plan

Tim Plank

Manager of CMS Encounter Data
Priority Health

Reva Sheehan

Sr. Improvement Specialist – Medicare Quality
Excellus BlueCross BlueShield

Alyssa M. Tutino, PharmD

Quality Improvement Clinical Pharmacist

Dr. Tracey Veal, PhD, MBA

Sr. Director, Strategic Programs
Quality Improvement Highmark

Dan Weaver

Vice President, Stars Quality, Gateway Health

John Mark Willis, M.Ed.

Senior Director-Star Operations
UPMC Health Plan

Debra J. Zeh BSN, RN

Sr. Director, Quality Improvement, Provider Performance

Olga Ziegler

Vice President, Revenue Program Management

2018 Delegates!