Hear from Aetna, Tufts Health Plan, UPMC, Highmark, Clover Health, CareSource, Gateway Health, Excellus BCBS, Harvard Pilgrim Health Care, Select Health, Florida Blue, Priority Health, Johns Hopkins, Capital Blue Cross, Molina, SCAN Health Plan, Providence Health Plan, Health Alliance, Martin’s Point Health Care, BCBS Arizona Advantage, & Geisinger, at the 10th Medicare Star Ratings, Quality Assurance & Risk Adjustment, scheduled for June 11-12, 2019, in San Diego. Find out how to align Star Ratings, Quality Assurance & Risk Adjustment to more effectively navigate the ever-changing Medicare Advantage landscape and successfully compete -- 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
  • 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

  • In Home Assessments: Closing Gaps in Care
  • Embracing Technology to Transform Care Delivery and Improve Health Outcomes
  • Effective Community Pharmacy Partnerships Aimed at Boosting Star Medication Adherence Performance
  • Position Your Plan to Respond to Rising Cut Points While Addressing Other Part D Measures

  • Risk Adjustment Revenue Management

  • 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


2019 Distinguished Faculty
Harvard Pilgrim Health Care

Gaurishankar Chandrashekhar

Director Revenue Management
Providence Health Plan

Wynda Clayton, MS, RHIT

Risk Adjustment Manager
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
Molina Healthcare

Donovan Lemelin

Director of Operations, Medicare Pharmacy
BCBSAZ Advantage

James Lewis III

Vice President of Quality/STAR & Risk Revenue Programs
Capital BlueCross

Susan Lira

Manager, Plan Performance & Improvement
Martin’s Point Health Care

Karen Manning

Director Strategic Quality Programs, Interim Director Medicare Revenue Operations
Johns Hopkins Advantage MD

Angelica Ortman, MHA, MBA

Senior Program Manager
Geisinger Health System

Michelle Passaretti

Senior Director of Innovations
Health Alliance Medical Plans

Dawn Peterson

Director of Utilization Management and Risk Adjustment Solutions
Clover Health

Erica Pham

Deputy General Counsel and Head of Government Affairs
UPMC Health Plan

Tim Plank

Manager of CMS Encounter Data
Excellus BlueCross BlueShield

Alyssa M. Tutino, PharmD

Quality Improvement Clinical Pharmacist
Aetna

Dr. Tracey Veal, PhD, MBA

Sr. Director, Strategic Programs
Gateway Health

Dan Weaver

Vice President, Stars Quality
CareSource

Karen Van Zant

Vice President, Executive Director, Life Services
UPMC Health Plan

Debra J. Zeh BSN, RN

Sr. Director, Quality Improvement, Provider Performance
Highmark

Olga Ziegler

Vice President, Revenue Program Management
Exhibitors
  • Disease Management by Population Segment to Boost Performance Scores, Increase Care Quality & Minimize Risk

RAVE REVIEWS FROM
2018 Delegates!