Speaker Presentation
Monday, January 28, 2019



Conference Welcome and Introduction


Stars Tutorial: An in-depth Look at Preparing for and Implementing New and Proposed CMS Measures

  • Medicare Star Ratings will debut 3 new measures with dates of service next year
    • Hospitalization for Potentially Preventable Complications
    • Follow-Up After Emergency Department Visit for People With High-Risk Multiple Chronic Conditions
    • Transitions of Care
  • Review the complex specifications for these three measures
  • Examine the data needed to succeed at the measures
  • Investigate the populations that make up two of the measures denominator
  • Identify proactive steps plans can take to prepare for these measures now

Josh Edwards, MBA, MSc,Medicare Stars Programs Manager, Health Plan Quality,Martin's Point Health Care


Lessons from Leaders: The 7 Habits of High-Performing Health Plans

As a leader in a Medicare Advantage plan, you already know your plan’s performance is largely tied to how well you engage your members and motivate them to take action. And you also know that improving engagement can result in better satisfaction, retention and results.

As an industry leader in consumer health engagement, we’ve seen first-hand what works and what doesn’t. Join Cory Busse, Sr. Director, Health Care Engagement Strategist at NovuHealth, for some foundational and actionable best practices that separate high-performing plans from the rest.

  • Learn how to align your member engagement strategies with core business objectives and KPIs
  • Uncover how to identify which members to target and which ones are most likely to act
  • Determine whether you’re overspending or underspending on rewards and incentives
  • Hear about new ways to optimize your communications channels and personalize your content

Cory Busse,Sr. Director, Health Care Engagement Strategist,NovuHealth


Conference Opening Reception

Tuesday, January 29, 2019

Registration & Continental Breakfast


Chairperson's Remarks

Christine Leo, Vice President, Senior Products,Cigna


New Benefit Flexibility – Maximizing Opportunities, Avoiding Pitfalls, Measuring Success

With new CMS regulations allowing for benefit flexibility and new supplemental benefits, what should be considered to maximize plan design for the future. We also will discuss how to avoid poor implementation that results in negative consequences and how to determine success of new benefits that goes beyond the sale.

  • Effectively integrating plan performance objectives into plan design
  • Avoiding common pitfalls of poor implementation
  • Integrating post-sale new benefits

Christine Leo, Vice President, Senior Products,Cigna


Case Study: Building a 5-Star Plan With a Dual Eligible and Low Income Population

HealthSun has propelled from a 3 star to a 5 star plan in a few short years. This session will examine the strategies that ensured a health plan with 84% dual eligible and low income subsidy population reached the highest level of the CMS quality rating. Specifically, we will examine the strategic development of an internal multi-disciplinary team, enhancements of data reports and report cards, identification of best practices with implementation of a P4P program, and engagement and empowerment of the primary care physician.

Karen W. Connolly, RN, Senior VP/Quality Improvement and Accreditation Services,HealthSun Health Plans, Inc.


MA Performance Questions You Should Have Asked

Health plans are constantly having to shift priorities and refine their focus based on the needs of their consumers, and within the confines of the regulatory requirements.  Every year health plans are having to play offense and defense simultaneously, with the understanding that the final score won’t be released until after the game is over.  Learning quickly from the past is the best way to prepare for the future, and these are the questions you and your executive team should be discussing internally.

  • Data integration and interpretation in real-time is critical
  • Collaborative, integrated leadership teams need structure to solve for complex problems
  • Choose your vendor partners who can align their reimbursement with your success
  • Understand how a management by objective process can drive accountability

Kent Holdcroft,Chief Revenue Officer,PharmMD


Panel Discussion: Filtering through the Noise -- Products and Innovations that Really Boost Outcomes and Cut Costs


Christine Leo, Vice President, Senior Products,Cigna


Catherine Macpherson, MS, RDN, Vice President Product Strategy and Development, Chief Nutrition Officer,Mom's Meals NourishCare

John Halsey, Vice President, Business Development,Turn-Key Health

Dru Coleman,Director of Sales and Marketing,EPIC Hearing Healthcare

Connie Ducaine, PhD,Vice President, Strategic Solutions,Vital Decisions


Networking Refreshment Break


Social Determinants of Health: Your Zip Code Matters More Than Your Genetic Code

It is increasingly clear that health care itself contributes a relatively minor part in determining health outcomes, with social factors such as income and education level, personal behaviors, such as diet and smoking, and genetic heritage account for most of the difference.  As this has become more apparent, health systems and health plans have invested resources into understanding these needs for individuals and into addressing them.   Innovations in housing supports, addressing food insecurity, and health coaching are examples of ways in which the health care system approaches initiatives to mediate the impact of these issues.   In recognition of these factors, CMS has begun to allow Medicare Advantage plans to offer supplemental benefits that are shown to address health needs and the needs to address chronic conditions.   In this session, we will address some key factors in implementing initiatives, incorporating them in to health risk assessments and care plans, and evaluating results.

John Lovelace,President,UPMC for You, Inc.President, Government Programs and Individual Advantage,UPMC


Transitional Care Management and “RTD—Real Time Data“

“Access” and “Communication” between providers of health care services and health plans has historically been fragmented in delivery of care with factors related to social determinant of health and behavioral health further complicating achievement of successful health outcome and cost goals.
In this session, learn about a new and unique Home Health Care model working alongside with Medicare Advantage plans and other payers focusing on “access to care “and “real time data” communication. This program maximizes Premier’s diversified community based service delivery platform in conjunction with a pharmaceutical solution to improve both member health care outcomes and reduce health plan costs by reducing member hospital events.

  • Learn how Premier Home Health Care Services, Inc. seeks to maximize the value of the home health care Aide in the home, utilizing enhanced EVV technology, dashboard management of outcomes, and the company’s diversified community based service delivery platform to provide a comprehensive and integrated care solution to reduce hospital events i.e. ER visits, admissions and re-admissions.
  • “RTD-Real Time Data” – The Home Health Aide transmits Quality Incentive and PAH target Diagnosis Data daily to Care Manager and Agency
  • Access to Care + Real Time Data Communication = Improved Outcome Management
  • Improved Outcome Management = Better Care/ Better Health / Lower Costs

Rick L. Mabe,Chief Operating Officer, Managed Care,Premier Home Health Care Services


Reinventing Member Engagement to Close Gaps in Care

Is your health plan scrambling to close gaps in care at the end of the year? Do you understand the barriers that your members face to close those gaps? With an integrated, cohesive data strategy, and actionable insights from social and behavioral determinants of health (SDoH), you can dramatically improve the effectiveness of your care management, Medicare Star ratings, HEDIS ratings, and risk adjustment operations. Join Kurt Waltenbaugh, Carrot Health CEO, to learn how you can take the guesswork out of your health plan’s member engagement initiatives:

  • How to develop a consumer-centric data strategy for your organization
  • How a "window" into your membership, combining multiple data sources in real time, will optimize your member engagement and Star rating results
  • When to use consumer data to prioritize measures and specific member groups for outreach
  • How predicting member willingness to close gaps can save money by making outreach more effective

Kurt Waltenbaugh,CEO,Carrot Health


Networking Lunch


Keys to Building a Profitable and Loyal Medicare Advantage Membership

Health insurers large and small are investing in expanding their footprint in Medicare Advantage. CMS has also announced increased reimbursements and willingness to explore additional payment models in 2019 and going forward. With 11,000 Baby Boomers turning age 65 every day, Medicare Advantage remains a fertile ground for growth. The key to member acquisition and retention is and will always be effective communication with new enrollees. This session will share critical data from two new studies of Medicare eligible members showing their requirements for health plans to earn their loyalty.

Harry Merkin,Vice President, Marketing,HealthEdge


Resetting Benefits to Improve Access, Growth & Retention Through MA Partnerships

  • Updated NE Ohio Market & New MA Payers
  • A look at the changing landscape of Medicare Advantage offerings in NE Ohio
  • Expansion of Existing Payers – Ex. Humana/CC Co-branded Updates to product expansions and membership growth
  • The Role of the Cleveland Clinic Concierge Team/Navigators Connecting with those most at risk & closing care gaps
  • Product to Product Engagement Working to improve benefits for our shared consumer
  • Unique Marketing Initiatives A few clever initiatives
  • Updates on the Cleveland Clinic in Ohio & Beyond A snapshot of today & tomorrow

Sharon Reichart, RDH, CRM,Director of Product Development, Market & Network Services,Cleveland Clinic

Kathleen Cox,Market Development Advisor,Humana


Panel: Where to Focus Your MA Time, Energy & Resources in the Changing Healthcare Environment

This panel will examine effective resource allocation to optimize:

  • Ability to react to changing regulatory mandates
  • Adaptability to adjust to rapid-change market conditions
  • Keeping team focus on key objectives at all times
  • Feedback loops to ascertain required progress


John Lovelace,President,UPMC for You, Inc. President, Government Programs and Individual AdvantageUPMC


Jonathan Harding,Senior Medical Director,Tufts Health Plan

Friso van Reesema, M.P.H. M.B.A.,VP of Managed Care,CipherHealth

Stuart Rosenblum,Strategic Alliances Director,Anthem


Networking Refreshment Break


The Path to an Advisory Focused Member Experience

Jenny Graham,Partner,Zelus


Population Health Management: Precisely Identifying and Caring For Your Most Vulnerable Members

Vulnerable member populations are the hardest to isolate and treat. This session will help you:

  • Effectively identify vulnerable populations
  • Conduct accurate needs assessments so treatments are tailored for best outcomes
  • Devise reporting mechanisms to assess compliance and medication adherence
  • Deploy outcomes-based interventions when required

Piyush Gupta,Regional Medical Officer, Caremore Health Plan


Prevention and Improving Chronic Conditions: Best Practice Action Plans and Proven Innovations for Performance Improvement

This session will share in-depth strategies to effectively manage:

  • Hypertension Control
  • Diabetes Care
  • Osteoporosis Management
  • Colorectal Cancer Screening
  • Medication Reconciliation
  • HOS measures related to Reducing the Risk of Falling, Improving Bladder Control, and Monitoring Physical Activity.

David L. Larsen RN, MHA,Director, Quality Improvement,Select Health


Virtual Health Assistance Blueprint: Preparing for AI- and Voice-enabled In-home Support

Virtual health assistants have the potential to provide extraordinary value to those with complex chronic illness at home. And while voice processing technology and artificial intelligence may not be advanced enough to deliver this effectively today, we consider it an imperative to prepare for this future. This session will explore Humana Innovation’s journey into virtual health assistance:

  • Key learnings from two years of exploratory research, testing, and development with Alexa and MA aged population
  • Principles for building an in-home virtual health assistant, i.e., the Virtual Health Assistance Blueprint
  • Process and goals in solution development with rapidly changing technology platforms

Anjuli Calvert,Senior Innovation Designer,Humana


Networking Reception

Wednesday, January 30, 2019

Networking Continental Breakfast


Chairperson's Remarks

Donna Sutton,Healthcare Informatics, Director of Medicare Star Quality Programs,SCAN Health Plan


Deeper Population Insights- Humanizing Analytics to Close Care Gaps

Stuart Rosenblum,Strategic Alliances Director,Anthem


Innovations in Improving Care for the Seriously Ill for Medicare Beneficiaries Including Palliative Care Solutions

This session will discuss the unique challenge of managing the needs of high risk members. We will review the reason for focusing on seriously ill MA members, the measures they impact, and techniques for improving care coordination for this population. This session will cover Blue Shield of California's approach to managing members with serious illness through the development of home-based palliative care programs, in-home supports and services, and improved case management functions. It will share preliminary results on these initiatives as they pertain to improved care coordination, patient satisfaction, risk adjustment, and quality ratings.

Torrie Fields, MPH,Senior Manager, Advanced Illness & Palliative Care, Healthcare Quality & Affordability,Blue Shield of California


Focusing Provider Messaging for Maximal Impact

  • Overcoming limited provider receptive bandwidth but also sending multiple health plan messages
  • Prioritizing messages so the important ones come through the noise
  • Coordinating Star, Risk Adjustment, CM, and Financial group performance management work to decide on the most important messages to give to each provider

Jonathan Harding,Senior Medical Director,Tufts Health Plan


Networking Refreshment Break


Building Transparent Provider Relationships – Honest, No Buzz Words, No Games

Provider partnerships are a key component to quality care. Too often provider relations are conflict-heavy and adversarial and work counter to the best interest of all parties. This session will show you how to:

  • Understand what providers really need and value
  • Learn how to recognize dissonance before it escalates into a problem
  • Set up consultative intervention to fix problem issues early
  • Develop good feedback mechanisms so providers feel part of the solution

Kathleen Faulk,General Manager, Government Programs,Regence Blue Cross Blue Shield


Innovative Compliance, Audit and Fraud, Waste & Abuse Practices

Get hands-on insights on the changes coming to Medicare Advantage Plans and the ways to successfully navigate a dynamic landscape.  Participates will learn innovative ideas, processes and best practices related to compliance, audits and FWA.  Lisa and Keri have over 20 years' experience each in this industry and have built compliance and FWA programs from the ground up.  Bring your ideas, we welcome a lively discussion!

Keri Steege,Medicare Compliance Officer,Providence Health Assurance

Amy Ocheltree,Medicare Compliance Program Manager,Providence Health Assurance


A Model For Achieving Efficacy In Benefit Design and Care Plan Implementation for Chronically Ill Medicare Members

  • Learn how to apply actuarial and analytical techniques to construct efficacious plan designs under CMS's Value Based Insurance Design (VBID) initiative
  • Develop a working model to customize  care plans for the chronically ill
  • Become familiar with the various publicly available data sources and gain an understanding of how they can be used

Puneet Budhiraja, V.P.,Chief Actuary,Capital District Physicians' Health Plan, Inc.

Rajesh Munjuluri ASA MAAA,Medicare Actuary,Capital District Physicians' Health Plan, Inc.


Clinical Innovations to Decrease & Divert ER Utilization

  • CCA's overview of Model of Care and Patient Engagement
  • Development of clinical structures and Interventions to decrease overall Utilization
  • Community Partnerships to support Diversion for ED Utilization
  • Case Presentation

Lauren Easton,Senior Director, Behavioral Health,Commonwealth Care Alliance


Networking Lunch


Seeking Positive Performance: Transitioning from FFS to Value Based Payments

Multi-year, long-term and annual business planning is essential to realizing positive performance under Value Based Payment Arrangements. Transitioning from a fee-for-service model carries risks that need to be identified, evaluated, and measured with the intent to mitigate. This presentation will address key elements related to the planning process, implementation, and operations required to work toward success under contemporary value based concepts. Through a “top down” approach, discussion will focus on the necessity for a long-term forecast as to financial and operating performance; governance and infrastructure demands; annual business plan development, implementation and measurement; and, tactics to consider to manage utilization.

Lawrence Kuk,Director, Network Engagement,Priority Health


Assembling an Interdisciplinary Pharmacy Team to Provide Care Coordination: Integrating Plan, Provider and Community Resources for Optimal MTM Results

  • Ways to promote the clinical expertise of your pharmacy team and the value the team brings to other departments in your company
  • How to market your pharmacy department to your outside partners
  • Member education on the value of MTM
  • Benefits of using a MTM hybrid approach with your PBM

Gary Melis,Clinical Pharmacist,Network Health


Navigating Operations and Cultural Changes for an Integrated Medicare/Medicaid Plan

Learn an effective approach for integrating your duals plan into the overall structure of your organization by using a business planning tool and setting goals and initiatives to drive compliance, accountability and performance. Find out how to develop the plan, gain support from key stakeholders and build dashboards to report progress toward your set goals. This approach is especially effective in an organization where dual health plans may not be the primary focus

Garrison Rios,Executive Director, Medicare, LA Care


Close of Conference