Rave Reviews
Speaker Presentations
June 14, 2022


Preconference Hands-on, Interactive Workshops
9:00 a.m. –
12 p.m.

Choose Workshop A or B (Refreshment Break at 10:30)

A. STARS 101: Back to Basics “Nuts & Bolts” Workshop

This workshop will include an in-depth review of all elements of the Star Ratings program. We’ll cover everything you need to know about Star Ratings, including:

  • Detailed review of Star measures, cutpoints and ratings calculation
  • Deep dive into data sources used in Star Ratings, including timing and scoring
  • Detailed review of new technical program changes and new measures
This hands-on, interactive workshop will help staff new to Stars thoroughly understand the program at a foundational level – and is a great refresher for long-time Stars staff!

Workshop Leaders:

Melissa SmithExecutive Vice President, Consulting and Professional ServicesHealthmine

Cynthia Pawley-MartinSenior ConsultantHealthmine

B. Foundations of Health Equity Workshop

This workshop will include training on Heathy Equity and Diversity. We will cover everything you need to know to prepare for current and future Health Equity program and reporting requirements, including:

  • Deep Dive into the components of Health Equity, NCQA Accreditation standards, HEDIS measures, and future Star Rating Implications
  • Understand how patient-centeredness and cultural competence can be used to build trust with vulnerable member populations, and enhance the success of quality interventions
  • How to effectively analyze and disseminate data on health equity and social factors to enhance population health and quality programs, benefit design, and member communications
This hands-on, interactive workshop will help staff to thoroughly understand Health Equity at a foundational level and how to prepare now to be successful with future Heathy Equity strategies

Workshop Leaders:

Kimberly SwansonSenior Vice President of Consulting & Professional ServicesHealthmine

Dwight PattisonVice President of Consulting & Professional ServicesHealthmine

12:00 – 1:00

Lunch Sponsored by

1:00 p.m. -
4 p.m.

Choose Workshop C or D (Refreshment Break at 2:30)

C. Advanced Stars Workshop: Deep Dive into Hot Topics & Emerging Issues

This workshop will include a detailed discussion of a variety of hot topics impacting Star Ratings in 2022, including:

  • Emerging trends in data interoperability and health equity and their impact on Member & Provider Engagement 
  • Cross-functional member engagement strategies for sustainable CAHPS ratings and member retention
  • Using the Health Equity Imperative and SDOH strategies to accelerate Star Ratings evolution
This hands-on, interactive workshop will provide specific tools and insights to help you earn and sustain your 4+ star rating in an era of rapid change!

Workshop Leaders:

Melissa SmithExecutive Vice President, Consulting and Professional ServicesHealthmine

Cynthia Pawley-MartinSenior ConsultantHealthmine

D. HEDIS Success in a Digitized Measurement Workshop

As NCQA implements its transition to fully digitized HEDIS measurement and reporting, this workshop will include a deep dive into everything you need to know for success including:

  • Detailed discussion of the measure specifications and data structure used in ECDS measurement
  • Interactive discussion regarding the evolutions needed within member and provider interventions as NCQA phases out hybrid reporting options
  • What to do next for Stars success on HEDIS measures during the accelerated implementation of ECDS reporting models
This hands-on, interactive workshop will help attendees thoroughly understand how to sustain strong performance in the new worked of digitized HEDIS measurement.

Workshop Leaders:

Dwight PattisonVice President of Consulting & Professional ServicesHealthmine

Kimberly SwansonSenior Vice President of Consulting & Professional ServicesHealthmine


Workshops Conclude

June 15, 2022

Networking Breakfast


Chairperson’s Welcome and Opening Remarks

Rex WallacePrincipleRex Wallace Consulting


Stars in the Aftermath of the Pandemic: Success in an Era of Sustained Change

This session will include a technical and regulatory update including confirmed changes impacting our work in 2022 as well as proposed changes on the horizon for 2023. We’ll cover an array of emerging measure and industry developments impacting clinical strategies, organizational priorities, member engagement and provider engagement.

Melissa SmithExecutive Vice President, Consulting and Professional ServicesHealthmine


Panel Discussion: Member Engagement in a Post Pandemic World: New Approaches


Kimberly SwansonSenior Vice President of Consulting & Professional ServicesHealthMine


Samantha BartholomewStars Program SpecialistPriority Health

Daniel WeaverExecutive Vice President of Product Operations and Stars StrategyNationsBenefits


Building a Cross-Functional, Multi-Cultural Member Engagement Team to Maximize Data Sharing and Boost Performance Scores

Closing gaps in care for diverse population groups requires distinct member engagement strategies. Members often experience social barriers to care and require culturally appropriate engagement strategies to understanding preventive care and necessary health screenings. Too often, multiple teams are designing and implementing member engagement strategies to close gaps in care that can cause uncoordinated and siloed work across the organization or become duplicative creating member abrasion. This session will engage attendees on how to strategically redesign member engagement strategies to address social barriers to care, provide culturally tailored support and work to close gaps in care. After this presentation, attendees will be able to:

  • Learn the components of gathering information to assess the impact on your organization on member engagement including the situation, background, assessment, and recommendation(s).
  • Identify how to build a cross-functional team within your organization.
  • Understand how to leverage data to boost Star measures.

Jamie Galbreath, PhD, MPH, CHESQuality Improvement Associate DirectorUCare


The Recipe for 5-Star CAHPS: Transparency, Engagement and Outcomes

  • Creating CAHPS Transparency: Deploying machine learning and artificial intelligence to identify the members that will have the greatest impact on your CAHPS scores
  • Engaging Members: Building an effective CAHPS engagement timeline across the year to elevate CAHPS scores and improve the member experience
  • Engaging Providers: Identifying which providers are caring for your negative CAHPS raters to activate collaborative CAHPS and member experience efforts
  • Measuring Outcomes: Setting a process to analyze CAHPS and member experience intervention results for sustained improvement

Saeed Aminzadeh Chief Executive OfficerDecision Point Healthcare Solutions

Kim Barrus Director, Clinical and Outcomes ManagementSelectHealth


Networking Refreshment Break


Staying Ahead of the Star Rating Curve – A Case Study

Focusing on identifying opportunities and gaps within health plan quality performance.

  • Overview of major upcoming changes in the Medicare Stars program including removal of COVID EUC protections and new Tukey Outlier methodology
  • Discuss tactics and opportunities for HEDIS and medication adherence reporting and ways to best identify member chase lists
  • Case study for leveraging industry best practices to identify CAHPS opportunities and strategies for improvement

Linda Lee Managing Principal Health Management Associates

Christina Byrne, ASA, MAAA Consulting Actuary Wakely Consulting Group, an HMA Company

Ann Pogrebitskiy, ASA, MAAA Associate ActuaryWakely Consulting Group, an HMA Company


Moving the Needle on Member Engagement: Adopting Healthcare Consumerism to Mitigate SDoH Barriers

Healthcare consumerism is a top trend as members seek the level of personalization they have become accustomed to in retail, travel and hospitality interactions. To meet these expectations in a way that leads to increased engagement and improved health outcomes, health plans need to be proactive in their pr in their predictive analytics, personalized in their outreach, and in their health offerings. This requires an understanding of SDoH barriers to accessing care and a willingness to offer tailored benefits to address them. Attendees will learn how to:

  • Identify Stars Ratings variables that drive major member trends
  • Use product design analysis to address SDoH barriers
  • Leverage personalized SDoH strategies to improve health outcomes and boost quality measure performance

Sara RatnerSVP, Government Markets & Strategic InitiativesIcario

Monisha Machado-PereiraSenior PartnerMcKinsey & Company


Networking Lunch

Sponsored by


Panel Discussion: Boosting CAHPS & HOS Performance Scores


Molly BonnevilleSenior Market Research AnalystBoston Medical Center HealthNet Plan/Well Sense Health Plan


Cory BusseVice President, Engagement Strategy & Client SuccessIcario

Dr. Shannon I. Decker, M.Ed., M.Ed., MBA, MBA, PhD.Vice President,Clinical PerformanceBrown & Toland Physicians

Jamie Galbreath, PhD, MPH, CHESQuality Improvement Associate DirectorUCare


Increase Your Supplemental Data, Coordinate with Risk Adjustment and Improve Member Experience Outcomes

  • Implementing a year-round medical record review strategy
  • Developing interoperable record sharing strategies with providers
  • Partnering with Risk Adjustment to collect and store records
  • Leveraging clinical integration partners to obtain supplemental risk adjustment and quality data
  • Outreach strategy to address both clinical and member experience measures
  • Engaging with members who are most likely to engage with the health plan utilizing the mode of communication they prefer

Mallory Mueller Director Quality Health IntegrationNetwork Health

Josh WeisbrodVice President Risk AdjustmentNetwork Health


Networking Refreshment Break


Influencing Physician & Member Behavior to Enhance Performance & Increase Participation

COVID has left everyone weary and none more so than our healthcare workers: asking to keep up with recommended quality performance may be the tipping point. Too patients are trying to rebound and reengage, getting back on track with their recommended screenings to stay healthy. Take the guess work out of trying various strategies, especially as the landscape has changed. Learn how to be relevant, regardless of the challenges you may have in your market and get the best performance and participation from your physicians and patients.

Dr. Shannon I. Decker, M.Ed., M.Ed., MBA, MBA, PhD.Vice President, Clinical PerformanceBrown & Toland Physicians


Risk Adjustment and Stars: Where’s the FHIR?

In this session we will look at whether the emerging HL7/FHIR Da Vinci interoperability standards are mature enough for Risk Adjustment and Stars operations. We will map core business capabilities to the Da Vinci stack to assess what will be usable within 6 months, 6-12 months, or more than a year. We will highlight gaps, stumbling blocks, and workarounds for payer organizations to consider as they implement FHIR for Risk Adjustment and Stars.

Brent ZenobiaChief StrategistNovillus


Don’t Forget The Administrative Measures

Everyone is talking about the CAHPS weight change, but don’t forget the administrative measures weights are changing too. Learn why these measures are so important and what you can do to be in control of them. CMS has proposed changes to CTMs and the return of BAPP. What should you be doing to prepare?

Laura AdamsDirector, Medicare StarsMedical Mutual of Ohio

Mark E Halford, MBASenior Government Programs Data Analyst Medical Mutual of Ohio


Networking Reception

June 16, 2022

Networking Breakfast


Chairperson’s Remarks

Rex WallacePrincipleRex Wallace Consulting


Panel Discussion: New Product Innovations Designed to Boost Care Quality & Performance Scores


Rex Wallace,Principle,Rex Wallace Consulting,


Aanchal FalkenVice President, Strategy & Business DevelopmentIcario

Josh Hoover, CEBS,Regional Sales Leader,Amplifon Hearing Health Care

Devraj Mukherjee,SVP, Revenue,DUOS Living Inc


Understand the Meaningful Measures Initiative: Transition to Digital & Interoperability

  • Explain how meaningful measures initiative impacts your comprehensive Stars strategy and ratings
  • Describe how to translate meaningful measures initiative awareness into action to address short and long term intervention strategies
  • Understand how forward-thinking health plans are acting on recent NCQA and CMS proposed guidance and measure changes

Julianne Eckert RN BSN, CCM, CMCN, ACMPDirector of Quality ImprovementClover Health

Katharine IskrantPractice LeaderHealthy People

Rex WallacePrincipleRex Wallace Consulting


Closing Gaps in Care Through Provider Portals Using NLP

Data capture for quality gap closure requires capturing information in multiple different ways.  Allowing providers to directly supply this information to the health plan gives them real time control over closing that gap for the member.  Along with that, we’re all trying to do more with less, and increase efficiency of the activities we’re using to close those gaps.  We explored using provider portals and NLP software to increase data capture and meet our quality goals.

Sarah WinskiDirector of Clinical Quality Services for HEDIS Gateway Health


The Role of a Clinical Pharmacist in Medicare Stars

Given the role of medications in Medicare Stars, this session will share ideas and tools on the role of the clinical pharmacist in the following arenas:

  • Medication Therapy Management
  • Deprescribing/ Polypharmacy
  • Medication Adherence
  • Health Equity

Lynn Deguzman, Pharm.D., BCGPRegional Clinical Operations ManagerKaiser Permanente Northern California


Networking Refreshment Break


Provider Incentive Programs & Value Based Care to Drive Health Outcomes

  • Review the history and evolution of our MA Quality Incentive Program.
  • Discuss the various types of incentives we offer and how they have positively impacted our member experience and health outcomes.
  • Share lessons learned, talk about the impact of COVID and explore plans for the future.

Francie SheltonProgram Manager, Medicare Quality Incentive ProgramCambia Health Solutions


Hospital To Home- Integrative Approach for Acute Care to Reduce Readmissions

Hospital to Home program extends CCA’s patient-centered and coordinated care model into the acute care setting by partnering with hospitals to leverage alternatives to admission and support inpatients, thereby improving member experience, outcomes, and cost of care. The Interprofessional team is able to identify members presenting to the ER in real-time, and collaborate with hospital and ER staff as well as outpatient resources.   In addition, the team is able to  assess unmet medical, behavioral, and social needs, and engage members who are frequently representing to the ER.

Lauren EastonVice President of InnovationsCommonwealth Care Alliance


In-home Interventions: Meeting Members Where They Are

Social determinants of health and social isolation can inhibit one’s ability to seek care and maintain a healthy lifestyle. Through the use of internal and external partnerships, one health plan was able to address members’ SDoH and social isolation needs while also promoting care gap closure and elevating the member experience. During this session we will explore various approaches that can be used to support members without them having to leave the comfort of their own homes.

Haley KeslerStar Rating ManagerHealth Alliance Medical Plans


Conference Concludes