Agenda

Join this Pre-conference Hands-on, Interactive Workshop: 3-Hour, Topic-specific, Small Group Session

Join this exclusive Think Tank workshop where industry leaders present top of mind opportunities and challenges in an intimate program format. This highly acclaimed, popular conference feature is your best opportunity to get questions answered on the spot, share winning solutions, lessons learned and challenges. Go home armed with information critical to your plan’s success.

Registration

Creating a Multi-Dimensional Member Journey that Drives Star Ratings & Health Equity

Understanding member needs, barriers to positive health outcomes, drivers of dissatisfaction, and disparities across our populations are key to delivering member-centric experiences and improving performance across Star Ratings & Quality Improvement Programs.

  Furthermore, what are the methodologies for evaluating the effectiveness of engagement campaigns, channels, and vendors? Member outreach efforts can sometimes remain untouched and unquestioned for years before they are vetted and updated. This session will dive into ways in which to ensure campaign effectiveness and measurable outcomes.  

Register for this interactive workshop that will cover a proven and practical framework to activating holistic and effective journeys for your members.  

Key focus areas will include:

• Personalized Engagement: Identifying barriers and tailoring outreach based on member needs and risk factors
• Outreach Channel Diversity: Ways to intervene using a diverse range of channels, meeting the members where they are and understanding each individual member’s likelihood to engage 
• Equity First: Understanding the disparities in health status, access, and quality of care – reviewing practical approaches to member selection and program enrollment helping to bring equity to the forefront 
• Targeted Education: Closing knowledge gaps and driving health outcomes by ensuring members receive adequate education around their unique challenges and those key moments for navigation within their healthcare journey

Workshop Leaders:

Lisette RomanVice President of AnalyticsDecision Point by mPulse

Reva SheehanSenior Director, Customer Insights mPulse

Close of Workshop

Registration & Networking Breakfast

Sponsored by

Co-Chairpersons’ Opening Remarks

Anticipate & Adapt: Navigating Regulatory Changes for Star Ratings and HEDIS®

How can your organization stay ahead of the dynamic nature of regulatory changes in Medicare Advantage (MA) while remaining nimble? Join The Alliance of Community Health Plans’ (ACHP) Michael Bagel as he shares insights into optimizing your MA star strategy and leveraging cross-functional teams, provider engagement and data management to enhance performance. This session will also feature an analysis of recent regulatory changes and a lookahead into what to expect next. Michael will share an overview of the policy recommendations in ACHP’s MA for Tomorrow initiative and how these strategies can spark positive change for the future of MA. Don’t miss this session, where you can stay ahead of the ever-evolving MA landscape while discovering ways to enhance performance and ensure adaptability for your health plan now and in the future.

Achieving Stars Success in an Era of Change: Focusing on New & Evolving Technical & Regulatory Changes

As CMS continues introducing significant measure-level and program changes to Medicare Advantage and Star Ratings, this session will include:

• Review of known and proposed Star Ratings changes impacting 2024 and 2025
• Review of key Medicare Advantage operational changes impacting Star Ratings
• Discussion of the impact known and proposed changes will have on operations, budgets and QBPs
• Aligning the organization around the New Needs of Stars

Increasing Resources to Expand STARS & HEDIS® Programs – Communicating the Value Story & Business Case to Your Leadership

Excelling in Star Ratings requires tenacity and investment in time, effort and sometimes money. While there is no “silver bullet” in achieving optimal star performance, there are things to consider when asking leadership for investment. During this session, come and discuss ways to be successful in your ask of leadership to enable them to act.

Case Study: Data Driven Strategies to Integrate Stars, Quality & Risk – Breaking Down Silos

In a value-driven climate, increased collaboration, and identification of synergies across “like areas” have proven advantages, particularly as it relates to health care data.  Learn how taking a strategic approach toward health information management, interoperability, electronic health record exchange can provide the full member picture while enabling better care and achieving risk adjustment and quality outcomes.

Networking Refreshment Break

Sponsored by

Optimizing Medicare Stars Unique Performance Levers

Improving a health plan’s Star Ratings can generate millions of dollars of additional revenue each year through Quality Bonus Payments (QBP) and rebate percentages. There are performance levers that exist that are unique to Stars and have the potential to add or subtract dozens of points to a health plan’s overall Stars score. These levers include the 5-weighted Quality Improvement (QI) measures, the Reward Factor (RF), and the upcoming Health Equity Index (HEI). Join this session to hear from industry experts who will share their views on why to focus on these levers, how to quantify the impact, and tactical actions to optimize them.

Panel Discussion: Integrating Health Equity, Diversity, SDOH into Stars & Quality Programs

This panel will explore ways that organizations are leveraging unique solutions to address and overcome barriers associated with Social Determinants of Health in ways that positively impact health equity, racial diversity disparities, and measurable program results such as Medicare Star Ratings. This discussion will explore unique programs, incentive and engagement strategies, in- home and community-based solutions, and the role that the upcoming Health Equity Index component of the Star Ratings program will have on strategic investments and Stars performance planning. Finally, we will explore ways that these initiatives and solutions have been and can be effectively integrated into daily health plan operational DNA.

Moderator:

Panelists:

Networking Lunch

Case Study: Navigating the Health Equity Index: Elevating Health Outcomes and Safeguarding Star Ratings

• Learn the Ins and Outs of CMS’ Health Equity Index and how to ensure your plan is prepared for what’s next in Stars
• How to engage plan leadership and providers, equip them for the challenges of this calculation, and hold them accountable for performance 
• Balance your HEI Strategy with your oganization’s overall Equity Strategy
• Learn how HEI preparations can improve your overall Stars scores – even among the landscape of plans that does not meet the population requirements

Brendan Generelli Lead Program Manager for Stars and QualityBlue Cross Blue Shield of Rhode Island

Beyond Risk – The Importance of Dual Advocacy

Dual Advocacy was the first social care program to see widespread adoption among Medicare Advantage plans. For more than two decades MA organizations have worked to identify members who are eligible for Medicaid, Medicare Savings Programs, or the Low-Income Subsidy and helped them enroll. They have also provided assistance to help those members through the annual renewal to maintain those benefits. An effective program increased risk adjustment revenue for the plan and provided vital financial assistance to the member. Today, these initiatives are more important than ever as CMS has identified Dual members, including those receiving LIS, as having significant Social Risk Factors and counted them into the denominator of the Health Equity Index. 

We will review one client's initiative to deliver meaningful social care through one integrated member engagement campaign. Together, we'll examine how this drives accurate risk adjusted revenue, closes gaps in care, and helps members to live better lives.

Approaching the New Member Experience Landscape

• Member needs have evolved significantly in recent years, impacting the ways in which we must engage our populations, deliver care, and maintain a positive experience across both Medicare and Medicaid lines of business. This session will showcase associated data, trends, and why understanding this evolution is critical to serving our members
• The recommended actions to take at the member and provider level when improving access to care, quality of care and the overall member experience to continue to drive Star Ratings and Health Equity in today’s landscape

Best Practices: Enhanced Member Outreach Strategy through Interdepartmental Collaboration

• Creating a tactical plan utilizing various departments within the organization
• Calculated and thoughtful messaging with several modalities
• Collaborating with outside vendors to compliment Blue Shield of California Marketing Communications strategy

Networking Refreshment Break

Panel Discussion: Innovative Tools and Strategies to Improve Quality and Star Ratings

Moderator:

Panelists:

Improving Star Ratings and Reducing Costs Amid CMS Regulatory Changes through Scalable Social Care: A Data and Case Study Review

As Medicare Advantage plans navigate major regulatory shifts from CMS and tighter-than-expected margins, improving Star Ratings and reducing costs are paramount. In this session, you’ll hear from a population health expert about proven strategies that take a scalable approach to social care, and as a result, help plans close care gaps, improve Star Ratings, and meet evolving CMS requirements. Through case studies and compelling data—including from one of the largest data sets on social health among older adults—you’ll walk away with strategies you can apply to significantly impact your population.

Best Practices: Leveraging Your Appeals and CTM’s Measures to Boost Star Rating Scores

• Learn first-hand strategies to implement to increase the likelihood that IRE is aligned with you.
• Discover Best Practices that can help you prevent CTM’s in order to minimize its impact on your Star measures.

Best Practices: Unlocking the Power of HOS: Elevating Your Star Ratings Strategy

• Maximize Star Ratings Success:

  Discover how strong Health Outcomes Survey (HOS) measure performance is the key to achieving and sustaining high Medicare Star Ratings. Uncover the strategies that will propel your health plan to the top tier.

• Strategic Insights from CMS Reports:

  Explore the untapped potential of HOS data beyond star ratings. Learn how detailed CMS reports can be leveraged to drive actionable insights, enhance member outcomes, and strengthen your overall healthcare strategy.

• Navigating Changes for Future Success:

  Stay ahead in the dynamic landscape of HOS with insights into recent and upcoming CMS proposed and codified changes. Understand the impact on star ratings math and gain strategies for adapting to ensure continued success.

• Practical Strategies and Interventions:

  Delve into effective member and provider- facing strategies that have a high impact on HOS. Learn actionable interventions that can be implemented to improve member experiences and elevate HOS scores.

Networking Reception

Networking Continental Breakfast

Co-Chairpersons’ Remarks

Case Study: Quality & Risk Collaborations to Reduce Care Gaps

Learn how to break down silos within a health plan by collaborating and working smarter, not harder. This case study examines how collaboration can create positive experiences for members, improve health outcomes, maximize work efforts, and minimize member abrasion. Participants will discover practical strategies for emphasizing the importance of trust and engagement in achieving significant health outcomes for Medicare Advantage members, simultaneously increasing star ratings. The study also highlights innovative techniques a health plan uses to leverage Clinician Quality Coordinators who work in a multidisciplinary approach to close coding and quality gaps. The plan has streamlined outreach efforts to ensure members receive the highest quality care possible.

Best Practices: Building Strong Provider Relationships to Drive Medicare Excellence in VBC Models – Beyond Metrics

• Explore how provider groups can be set up to succeed in VBC despite wide geographic markets with varying resources, demographics, and organizational strengths and weaknesses
• Discover new ways to approach providers through relationship building with both internal and external stakeholders.
• Gain insight into balancing “enterprise” goals with “local” realities

Case Study: Increasing Access to Care for Underserved Communities: Rural and Urban -- Building Trust & Enhancing Health

This presentation will explore the impactful role of community-based partnerships in enhancing Medicare beneficiary engagement. It will focus on the UPMC for Life Medicare Faith and Wellness Program, a pioneering initiative by UPMC Health Plan that leverages Faith-Based Organizations (FBOs) to improve health outcomes in underserved communities. This session will highlight how the program utilizes the unique trust and network of FBOs to bridge healthcare gaps and positively influence Medicare Advantage plan ratings. Insights will be shared on how adopting a holistic, community-centered approach to wellness leads to increased preventive care, improved member satisfaction, and better-quality measures. Attendees will learn about effective strategies for building community networks, with an emphasis on the importance of trust and engagement in achieving significant health outcomes in the Medicare sector.

Improving Quality of Life Really Does Decrease Healthcare Costs

While Medicaid and Medicare health plans seek to address some aspects of SDOH, historic care management resources (either internal or outsourced) have struggled to effectively identify, assess and manage SDOH factors at the individual level. The inability to capture, assess and take action on a broader scope of a member’s needs are compromised by several factors, including the siloed nature of supporting resources, a lack of technology-based interoperability and the financial incentives are often not aligned with a more comprehensive approach. Because of this, critical factors such as SDOH can often slip through the cracks. Adobe Population Health developed a proprietary app called MASLOW to identify and provide solutions to SDOH needs in our communities we serve. Adobe's partnership with health plans improve health benefit ratios and quality of life in rural communities to affect population health outcomes.

Networking Refreshment Break

Best Practices: Provider Group Strategies to Achieve Nation Leading HEDIS® Results

• Review provider engagement tactics that focus on patient care and reduce abrasion
• Discuss strategies to create actionable reports to close care gaps and improve HEDIS®

Stephen P. Winn, CPHQSenior Director, QualityPermanente Medicine

Case Study: Implementing a Hospital to Home Program to Maximize Transitions of Care and Reduce Readmissions

This hospital to home program is designed to provide members with a positive experience while in the hospital making sure they are prepared for discharge and have a plan for follow up care. The goals of this program are to increase the use of transitional management visits, decreasing hospital readmission, and providing the member with a positive inpatient experience increasing their quality of healthcare and satisfaction while also  promoting increased provider and hospital collaboration and satisfaction.

Case Study: Addressing Interoperability: A Multi-Pronged Approach to Close Gaps in Care and Drive Value

Building a real-time health data exchange can address gaps in care, improve patient outcomes, and reduce costs. The purpose of this session is to highlight a multi-pronged approach for data integration across disparate platforms. This session will go into a health plan’s journey for building a portfolio of capabilities to electronically exchange health information and insights between disparate health care systems at provider, patient, and payer settings.

Case Study: Innovative Approaches to Improve Part D Quality Measures

• Case study by Community health Plan of Washington highlighting Medicare adherence Pilots
• Leveraging Community resources to engage members in medications adherence
• Hybrid models to move the needle on CMR completion rates
• Customizing your approach to meet your member populations

Close of Conference