The 14^th Medicare Stars, HEDIS^®, Quality & Risk Summit

Registration & Networking Continental Breakfast

2 Pre-Conference Interactive Workshops: Adapting Your Stars Strategy in Real- time & Measuring & Improving Member Trust

From Chaos to Clarity: Adapting Your Stars Strategy in Real-time

In the fast-evolving world of Medicare Advantage, Stars success isn’t about working harder, it’s about working smarter. This hands-on workshop embraces the challenge of “building a new plane while we fly it,” with interactive discussions and hands-on activities to:

• Deep dive through the latest regulatory and technical updates.
• Diagnose common pitfalls preventing 5-star success on new Star measures.
• Sharpen our skills driving high-stakes decisions and changes.
• Practice silo-busting techniques to drive faster, more effective execution.

With a roll-up-our-sleeves approach, we’ll help attendees position their organization for success.

Panelists:

Networking Lunch

Measuring & Improving Member Trust

This interactive workshop will explore the concept of trust, measuring member trust within your own population, the profile of members who trust their plan and provider, and how to take action to improve member trust.

• Four pillars of trust within an organization, how they are defined and how each apply to your membership
• Differences in behavior, compliance, and engagement at a member-level
• Practical methodologies to identify and improve member trust
• Member-level insights drive a focused engagement strategy to support members who need the most attention and guidance to better navigate their care

With a roll-up-our-sleeves approach, we’ll help attendees position their organization for success.

Moderator:

Panelists:

Workshop Ends

Registration & Networking Continental Breakfast

Chairperson’s Welcome & Opening Remarks

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

Panel Discussion: Strategies to Improve Performance Scores in the Face of Fierce Competition, Regulatory Uncertainty, Financial Challenges and Changing Demographics

• Back to Basics: Building Flexible, Agile Operations to Survive & Thrive
• Short- and Long-term Solutions
• Harnessing Technology tools (on a budget) to Streamline Operations, Build Efficiencies, Cut Costs, Improve Care Quality
• Assessing & Integrating Vendor Solutions.

Panelists:

Leading & Managing Change During Tumultuous Times

• Embracing Change
• Communicating a Clear Vision with Transparency
• Building Trust
• Leading by Example: Walk the talk
• Encouraging Adaptability, Innovation and Resilience

Designing a New Stars Playbook: Turning Policy Change into Actionable Strategy

With new leadership at HHS and CMS, the Medicare Advantage and Star Ratings landscape changing quickly. This session will:

• Review the latest technical and regulatory updates impacting Star Ratings
• Examine the Stars impact of federal policy changes, industry trends and competitive dynamics
• Identify opportunities to accelerate success under the new HHS and CMS administration
• Share actionable strategies to future-proof your Stars success

Networking Refreshment Break

Panel Discussion: David vs. Goliath: How Can New, Small, or Emerging Health Plans Optimize the Unique Performance Levers in Medicare Stars to Gain Competitive Advantage?

In the fiercely competitive Medicare Advantage landscape, smaller and emerging health plans often face significant challenges when competing against industry giants. However, size and scale aren’t everything—strategic optimization of Medicare Stars performance can create powerful advantages. This panel will explore how new, small, and growing plans can leverage their agility, innovation, and unique market positioning to drive Star Ratings success. Industry experts will share proven strategies, regulatory insights, and operational best practices to maximize quality outcomes, enhance member experience, and unlock financial opportunities. Attendees will gain actionable takeaways on how to compete effectively, navigate evolving CMS requirements, and turn performance excellence into a sustainable competitive edge.

Moderator:

Panelists:

Feature Presentation

Plan-Wide Collaborations to Boost Performance Scores, Increase Operational Efficiency, Lower Costs and Improve Quality of Care

Back to Basics: What You Need to Do Before Implementing AI – Focus on Members and Providers

Networking Lunch

Topic Specific Roundtable Discussion Groups – Exclusive Information Exchange Forums

Join one of these small group, highly interactive discussions to get your questions answered on the spot, generate innovative ideas and hear from your industry colleagues. The intimate setting is conducive for sharing “off podium” ideas, innovations and challenges.

A. Real-time Follow-Up and Intervention – Immediate Response to Health Events & Targeted Interventions to Boost Outcomes & Enhance Member Satisfaction

As CMS continues to introduce the Universal Foundation to Quality Rating Systems and increases focus on developing real-time follow-ups to member needs, it is more important than ever to be able to be nimble and spring into action as Plans receive data.   Join a Roundtable discussion with fellow industry experts to discuss best practices and learn new ideas on how Medicare Advantage Plans can play a role in addressing beneficiary needs as they appear – whether those are Social Determinant of Health related, the result of a Hospitalization, or anything else that may come our way!

Group Leader:

B. Addressing ECDS Transitions and other NCQA Quality Measures

• Pivot: Electronic Clinical Data Systems (ECDS) measure transitions.
• Prepare: Sunset of NCQA hybrid measures over the next 5-years.
• Navigate: NCQA catalog release dates.
• Improve: Immunization hesitation and exhaustion.

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C. Breaking Down Silos: Building Effective, Collaborative Inter-departmental Teams

• What is the best way to ensure Stars and Quality becomes an organization wide effort?
• How do you engage teams that are resistant to breaking out of their silo?
• We all know resources are thin in most health plans, how do you continue the path to Stars and quality excellence with limited resources (both people and money)?
• Many departments within health plans have work that has tight deadlines, therefore leading to limited support for other work within the organization. How do you work with leadership to build support from teams that directly impact Stars and quality with limited time available?
• Ensuring recognition of collaboration in and across teams is very important to Stars and quality success. How have you recognized your teams and shown appreciation for their support?

Group Leaders:

D. Responding to the Latest CMS & NCQA Regulatory Changes – Positioning Your Plan to Thrive Long-term

• Given that the 2026 Advance Notice indicates a 0.69% decline in the Stars QBP, how can plans proactively adjust their strategies to maintain or increase incentives for achieving higher quality measures?
• In light of the current political climate, what strategies can DOGE employ to mitigate the potential risk of funding cuts, and what measures could be taken to safeguard essential resources?
• With the same theme in mind, what is one specific action you hope DOGE can take to influence CMS and prevent harmful changes that could impact the sector?
• What are some of the unintended impacts of the IRA that you are observing, and what actions can be taken to either capitalize on the positive effects or address any negative consequences already emerging?

Group Leader:

E. Patient Experience: It's All About Perception

Join us for an engaging and interactive panel dedicated to exploring the nuances of a great patient experience. Our session is designed to immerse attendees in realistic scenarios, drawing out the fundamentals of exceptional care. Participants will have the opportunity to share their insights, discuss personal experiences—both positive and negative—and brainstorm solutions for improvement.

Learning Objectives:

• Explore Best Practices: Dive into real-life scenarios to understand what makes a patient experience truly outstanding.
• Reflect on Challenges: Reflect on past patient experiences, identify areas for improvement, and formulate actionable strategies for change.
• Empower Change: Discover practical ways to engage your staff in patient experience initiatives, fostering a culture of continuous improvement.

Topics We Will Cover:

• Prioritizing Patient Experience: Do we really have time for patient experience?
• Perception Gaps: Why don’t our patients see how great we are?
• Innovative Approaches: Is there a different way to do this?
• Coordinated Care: Whose job is it to coordinate care?

Prepare to leave with valuable insights and strategies to transform patient interactions and advocate for lasting change within your organization.

Group Leader:

Networking Refreshment Break

Why Can’t We Be Friends: Achieving Shared Data Strategy Goals Through Enterprise-wide Partnerships

Collaborating & Compromising with Competing Business Units and Resource Needs for Maximize Quality Data Acquisition and Management
In today's interconnected and aspiring to be interoperable healthcare world, cross-functional collaboration is no longer a luxury or achieving “best in class,” but a necessity for financial sustainability. This presentation explores the challenges and opportunities inherent in working with competing business units fighting for limited technical and data resources and provides a framework for navigating these complexities.
The importance of understanding the organizational landscape will be discussed, including stakeholder analysis, power dynamics, and cultural context. Building strong relationships through open communication, active listening, and seeking common ground is at the cornerstone of successful collaboration for an enterprise-wide Win-Win-Win.
The presentation also highlights strategies for finding mutually beneficial solutions through brainstorming, compromise, and focus on overarching organizational goals.  By implementing these strategies, attendees can foster stronger cross-functional relationships, navigate power structures, break down silos, and achieve shared success of higher member satisfaction and engagement that optimizes value and outcomes, lowers
provider burden and inefficiencies, and increases the bottom line of financial sustainability and market success for the enterprise

Navigating A Rapidly Changing Star Environment At A Growing Health Plan Through Change Management

The Star and Medicare landscape are constantly evolving with changes to regulations and policies not to mention the dynamic competitive landscape. At Point32Health, we had to navigate not only the external complexities of our high dynamic world, but also had to manage through a merger/acquisition, new markets, and a rapidly changing internal team environment. Using strong change management principals, we were able to stave off many headwinds and adapt to the new reality we faced.

Impacting the Changing Face of Member Experience & Expanding Access to Care

Feature Session

Unlocking CAHPS Performance: Enhancing Member Experience at all Touchpoints

Navigating the complexities of CAHPS performance is no easy feat. The survey aims to capture a comprehensive view of members' experiences with their health plan and provider network. With a wide range of questions, the potential interactions and touchpoints that influence member experience are vast. In this session, SelectHealth will share their approach to enhancing member experience through various lenses, including employee, provider, broker, and member interventions.

• Analyze Data to Set Priorities: Discover how to leverage available data to identify key focus areas.
• Build a Network of Champions: Learn the importance of creating a supportive network to drive initiatives.
• Collaborate on Next Best Actions: Explore collaborative approaches to determine the most effective actions.
• Assess Intervention Effectiveness: Understand methods to evaluate the success of implemented interventions.

Panel Discussion: Practical Approaches to Elevating CAHPS, HOS, And Member Retention Through Targeted, Equitable Member Engagement

• Digital Tools
• AI/ML
• Member Outreach – calls, text, mail, email
• Reduce Member Abrasion through Interdepartmental Collaborations
• Improving Care Quality
• Addressing Access to Care Challenges
• Care Quality Enhancements (supplemental benefits)

Panelists:

Networking Reception

Networking Continental Breakfast

Chairperson’s Remarks

Panel Discussion: Leveraging Data & Technology to Enhance Care Delivery to Boost Performance Scores

• Provider Data Sharing Collaborations
• AI & ML to Improve Care Coordination
• Remote Patient Monitoring
• Tracking & Reporting
• Improving Access to Care – Telehealth, Mobile Clinics, Home Care Solutions

Enhancing Member Engagement to Improve Quality and Star Ratings

As outreach fatigue and scam concerns grow, engaging members is more challenging than ever.  However, when outreach provides immediate, meaningful support, members are more likely to engage—leading to improved member health and quality performance. Discover how unified engagement can:

• Close care gaps.
• Link members to plan-specific benefits and services.
• Reduce outreach fatigue and member abrasion.

Tools & Strategies to Improve HEDIS® & Quality Measures

Transitioning from ECDS to an Advanced Digital Format: Leveraging Data Analytics, Real-Time

As the industry continues to move from ECDS to Digital Quality, health plans are focusing on how to adapt their Medicare programs to a "post-hybrid world”. In this session, we will spotlight how UPMC Health Plan is moving towards a fully digital quality infrastructure.

Topics include:

• Benefits of pushing beyond ECDS to all-digital
• Technology innovations needed to drive change
• How to maximize access to and operationalize use of clinical data
• Results and future work

Networking Refreshment Break

Case Study: AI for HEDIS® -- Transforming HEDIS® Operations to Foster Innovation, Expand Opportunities, Ensure Compliance & Promote Data Integrity and Privacy

From Strategies to implementation, hear best practice solutions to transform HEDIS® processes to accelerate decision making:

• Understand AI for HEDIS® potential.
• AI for HEDIS® and HEDIS® certified software opportunities.
• AI for HEDIS® nuances.
• AI for HEDIS® ethics.

Leveraging Strategic Pharmacy Partnerships to Close Gaps in Care

Find out how pharmacy partnerships can help you identify members who are not compliant with care, gain insight into their challenges and opportunities, and proactively engage with members to close gaps in care. Strategic partnerships aid in building relationships with members who are non-compliant and disengaged from the healthcare system. Learn how to strategically leverage pharmacy partnerships to engage members, connect them to primary care, and close preventive gaps in care.

• Understand how to identify strategies that are member-centric and recognize diversity
• Learn how to engage members on health outcome measures
• Identify how to implement pharmacy partnerships to close gaps in care

Mastering Part D Star Ratings: From the Tried and True Medication Adherence Measures to the Shiny and New Polypharmacy Measures -- Learn How You Can Build a Successful Part D Star Ratings Strategy

• How Stars, Quality, and Pharmacy all work together; how to avoid “the silo effect”
• Journey of an MA to improve their Part D Star Rating
• Discuss how to approach the polypharmacy-focused Part D Star measures
• Optimizing the member’s experience of navigating their pharmacy benefit

Networking Lunch

Expanding Access to Care: Colorectal Cancer Screening Paves the Way for Mobile Clinics & Diabetic Eye Exams

At Health Alliance Medical Plan, we're committed to improving access to care and closing gaps in colorectal cancer (CRC) screenings. Our innovative Cologuard program has transformed the way we reach members, offering convenience, support, and better outcomes.

• Targeted Approach: Closing Payer Gaps through Data-Driven Decisions
• Member Satisfaction & Enhancing the Experience
• Proven Results: Higher Adherence & Improved HEDIS® COL Rates
• Empowering Communities: Socially Responsible, Privacy, Convenience
• Health Equity Focus: Addressing Disparities
• Looking Ahead: Diabetic Eye Exams & Mobile Clinics

Re-Vitalizing Provider-Payor Partnerships to Boost Star Ratings

Leveraging Value-based Partners to Align Risk & Quality

The intersection between Quality and Risk Adjustment presents a multitude of opportunities to boost performance, strengthen provider relationships, and effectively drive holistic care for members. Strategic designs in value-based contracts and operating models can help providers maximize earning opportunities while helping payers optimize quality performance and key Risk Adjustment program elements including coding accuracy, audit readiness, condition recapture documentation. This session will address a variety of strategic paths to boost Quality scores and strengthen accurate

Addressing the Health Equity Index – What Can You Actually Do Beyond Data Collection

Health Equity: Why it Still Matters

As we continue to navigate the current landscape, it is important to ensure that Medicare Advantage plans still remain focused on Health Equity.  Brendan Generelli will speak about the inherent value of ensuring Plans are doing all they can to reduce disparities in care and continue focusing on Social Risk Factors in the population – and how this can benefit Plans on their Star Ratings!

Integrating Health Equity, Diversity, SDOH into Stars & Quality Programs

• Incorporating Health Equity into Organizational Operations
• Strategic focus to promote equitable care for all members
• Increased analytics to drive targeted outreach and approaches to care

Close of Conference