June 4, 2024
Join this Pre-conference Hands-on, Interactive Workshop: 3-Hour, Topic-specific, Small Group SessionJoin 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. |
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12:00 |
Registration |
1:00 |
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.
Workshop Leaders:Lisette RomanVice President of AnalyticsDecision Point by mPulse Reva SheehanSenior Director, Customer Insights mPulse |
4:00 |
Close of Workshop |
June 5, 2024
7:00 |
Registration & Networking Breakfast
Sponsored by |
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8:00 |
Co-Chairpersons’ Opening Remarks
Jessica AssefaChief Quality OfficerATRIO Health Plans Melissa SmithFounder, Senior AdvisorNewton Smith Group |
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Strategic Initiatives to Remain Competitive Amid Dramatic Market Changes | ||
8:10 |
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. Michael Bagel Associate Vice President of Public Policy Alliance of Community Health Plans |
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8:40 |
Achieving Stars Success in an Era of Change: Focusing on New & Evolving Technical & Regulatory ChangesAs CMS continues introducing significant measure-level and program changes to Medicare Advantage and Star Ratings, this session will include:
Melissa SmithFounder, Senior Advisor Newton Smith Group |
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9:10 |
Increasing Resources to Expand STARS & HEDIS® Programs – Communicating the Value Story & Business Case to Your LeadershipExcelling 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. Kim ShellPrincipalFreedom Healthcare Consulting |
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9:40 |
Case Study: Data Driven Strategies to Integrate Stars, Quality & Risk – Breaking Down SilosIn 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. Chayla BeasonDirector, MA Clinical Data Strategy & Execution, Senior Health Services Blue Cross Blue Shield of Michigan |
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10:10 |
Networking Refreshment BreakSponsored by |
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10:40 |
Optimizing Medicare Stars Unique Performance LeversImproving 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. Rex WallacePrincipal & Founder Rex Wallace Consulting, LLC Mick TwomeyChief Executive Officer Hyperlift Jessica MuratoreChief Operating Officer Rex Wallace Consulting, LLC Phil CollinsDirector Customer Success Hyperlift |
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Operationalizing the Health Equity Index & SDOH | ||
11:10 |
Panel Discussion: Integrating Health Equity, Diversity, SDOH into Stars & Quality ProgramsThis 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:Andrew BellMedicare Stars Practice Leader ProspHire Panelists:Michael BagelAssociate Vice President of Public Policy Alliance of Community Health Plans Tamara Migut Director of Quality Management Health Alliance Sabrina ZerzouriSr. Program Manager, Medicare Quality Point32 Health |
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11:55 |
Networking Lunch
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12:55 |
Case Study: Navigating the Health Equity Index: Elevating Health Outcomes and Safeguarding Star Ratings
Brendan Generelli Lead Program Manager for Stars and QualityBlue Cross Blue Shield of Rhode Island |
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1:25 |
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.
Keslie Crichton Chief Sales OfficerBeneLynk Jennifer Callahann Chief Operating OfficerAtrio Health Plans |
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Member Engagement Solutions to Boost CAHPS & HOS Scores & Increase Retention |
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1:55 |
Approaching the New Member Experience Landscape
Saeed Aminzadeh, Chief Executive OfficerDecisionPoint by mPulse Brendan Generelli, Lead Program Manager for Stars and QualityBlue Cross Blue Shield of Rhode Island |
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2:25 |
Best Practices: Enhanced Member Outreach Strategy through Interdepartmental Collaboration
Eden Anne Encarnacion, MHA,Sr. Manager, HEDIS – Medicare Star ProgramBlue Shield of California Tamara Khachikyan,Operational Program Manager, Medicare Star ProgramBlue Shield of California Kirstine Donato,Senior Program ManagerBlue Shield California |
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2:55 |
Networking Refreshment Break
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3:25 |
Panel Discussion: Innovative Tools and Strategies to Improve Quality and Star Ratings
Moderator:Jessica Assefa Chief Quality OfficerATRIO Health Plans Panelists:Jonathan Davis CEO and FounderTrualta Keith Michael Sr. Director of ProductGiftCard Partners Joel Brill, MD Executive Medical AdvisorHello Heart |
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4:00 |
Improving Star Ratings and Reducing Costs Amid CMS Regulatory Changes through Scalable Social Care: A Data and Case Study ReviewAs 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. Maddie Hirsch,Director of Client Operations, Papa |
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4:30 |
Best Practices: Leveraging Your Appeals and CTM’s Measures to Boost Star Rating Scores
Moraima Rios Gonzalez Medicare STARS Program DirectorMedical Card System, Inc. |
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5:00 |
Best Practices: Unlocking the Power of HOS: Elevating Your Star Ratings Strategy
Jessica AssefaChief Quality OfficerATRIO Health Plans Bonnie Thompson, MSN, MBA, PMPVP, Strategic Consulting, Press Ganey |
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5:30 |
Networking Reception |
June 6, 2024
7:00 |
Networking Continental Breakfast
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8:00 |
Co-Chairpersons’ Remarks
Jessica AssefaChief Quality Officer,ATRIO Health Plans Melissa Smith Founder, Senior Advisor,Newton Smith Group |
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Enterprise-wide Team Work to Break Down Silos: STARS, QA & Risk | ||
8:05 |
Case Study: Quality & Risk Collaborations to Reduce Care GapsLearn 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. Becky Simmons, RN, BSN,Stars Program Manager Security Health Plan Katie Capadona,Manager – Risk Adjustment Revenue Security Health Plan |
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8:35 |
Best Practices: Building Strong Provider Relationships to Drive Medicare Excellence in VBC Models – Beyond Metrics
Jenna Pinnelle,Medicare Quality Program Manager, Elevance Health Giuliano Torelli,Medicare Quality Program Manager, Elevance Health |
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Expanding Access to Care – Reaching Underserved Populations through CBO Partnerships |
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9:05 |
Case Study: Increasing Access to Care for Underserved Communities: Rural and Urban -- Building Trust & Enhancing HealthThis 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. Camille Clarke-Smith, EdD, MS, CHES, CPT, Program Director, Quality Improvement, Medicare/SNP STARs, UPMC Health Plan Elizabeth Zahar, Program Manager with the Medicare Faith and Wellness Program, UPMC Health Plan |
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9:35 |
Improving Quality of Life Really Does Decrease Healthcare CostsWhile 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. Jayme Ambrose, DNP RN CCMChief Executive Officer Adobe Population Health Michael P. FranksSr. Vice President, Plan Product, Western Region Wellcare |
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10:05 |
Networking Refreshment Break
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Tools & Strategies to Improve HEDIS® & Quality Measures | 10:35 |
Best Practices: Provider Group Strategies to Achieve Nation Leading HEDIS® Results
Stephen P. Winn, CPHQSenior Director, QualityPermanente Medicine |
11:05 |
Case Study: Implementing a Hospital to Home Program to Maximize Transitions of Care and Reduce ReadmissionsThis 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. Mike FarinaVice President of Healthcare QualityCapital District Physicians’ Health Plan |
11:35 |
Case Study: Addressing Interoperability: A Multi-Pronged Approach to Close Gaps in Care and Drive ValueBuilding 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. Nazanin SalehitezangiManager, Health Data Exchange Adoption and Analytics,Health Care Service Corporation (HCSC) |
Pharmacy Spotlight: Improving Medication Adherence & Staying Ahead of Evolving Regulatory Changes | ||
12:05 |
Case Study: Innovative Approaches to Improve Part D Quality Measures
Omar DaoudSenior Director of PharmacyCommunity Health Plan of Washington |
12:35 |
Close of Conference
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