Agenda

Speaker Presentations

Tuesday, January 25, 2022
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7:00

Networking Welcome Breakfast

Sponsored by

Strategic Solutions Network (SSN), based in Boca Raton, FL, is the parent company of the Medicare Risk Adjustment & Revenue Management Management, Plus Quality and Star Ratings and a series of related conferences.

8:00

Chairperson’s Welcome & Introduction

Christine Leo,Vice President, Senior Products,Cigna

8:05

A New Path for Medicare Advantage? The Biden Administration’s MA Regulations

By the end of 2020, the Biden administration has projected it will publish two draft regulations setting new rules for the Medicare Advantage program. Discuss these regulations and the Biden administration’s posture toward Medicare Advantage with former Director of Medicare Advantage Operations at CMS.

Michael S. Adelberg,Principal, Lead, Healthcare Strategy Practice,Faegre Baker Daniels ConsultingFormerly, Director of Medicare Advantage OperationsCMS

8:35

Panel Discussion: Meeting Members Where They Are -- Re-engage & Support Members in the New Post-Covid Environment

Moderator:

Kent Holdcroft,Executive Vice President of Growth,Healthmine

Panelists:

Christine Leo, Vice President, Senior Products,Cigna

Gretchen Shanofsky,Vice President of Plan Operations,Clover Health

Dr. Julia Hoffman,Head of Mental Health Strategy, Teladoc Health

Paula LeClair,US General Manager,Healthy.io

9:15

Adopting Innovations to Influence Star Ratings and Leveraging Them to Reduce Disparities

CMS has made it abundantly clear that heath equity must be a priority for Medicare Advantage plans in 2022 and beyond. In this presentation, Melissa Smith will explore how plans can keep health equity top of mind while making critical performance decisions, as well as the best strategies for MA plans to pursue in 2022. Topics include:

  • How CMS’ new guidelines are accelerating innovation in healthcare
  • Why plans must rethink the goal and impact of all operations in order to build member trust and advance health equity
  • How to use planning, persistence, and precision to meet and exceed members’ growing expectations
  • How to create personalized experiences for members using omnichannel engagement tactics

Melissa Smith,Executive Vice President, Consulting and Professional Services, Healthmine

Aligning STARs, QA/HEDIS & Risk Adjustment
to Boost Outcomes & Member Experience
09:45

Boosting STARs & Quality Ratings: Plan-wide Initiatives to Improve Member-facing Experiences and Provider-facing Relationships

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Denise Doucette-Ginise, MSN, RN, CCM, CHPN,Director Care Management, Senior Products, CarePartners of Connecticut,Tufts Health Plan & Hartford HealthCare

10:15

Networking Refreshment Break in the Exhibit Hall

Sponsored by

10:45

Build Tomorrow’s Retail Healthcare Experience Today: A Roadmap for Next Best Action Wherever You are on the Journey

According to a recent JD Power study, more than 90% of Medicare participants would like to receive better communication and information from their plans. PWCI reports that 80% of Americans suggest that speed, convenience, knowledgeable help and friendly service are the most important elements of a positive customer experience.

Join Carissa Stajnrajh, Insightin Health’s VP of Clinical Strategy, and Jim Pospychala, MoreCare’s VP of Operations , to discuss speeding your organization’s path to the retail healthcare experience. Michael will discuss a practical approach using technology and data that meets Health Plans where they are on the journey to provide a meaningful experience, create engagement that delivers better insights and better health outcomes.


Carissa Stajnrajh,Vice President of Clinical Strategy, Insightin Health

Jim Pospychala,Vice President of Operations, MoreCare

11:15

A Cost-effective Solution for Population Health Management

Identifying patient changes in real time is critical to implementing interventions to prevent decline and increase improved health outcomes. Accessing this data in real time is closer than you think. By leveraging one of the greatest untapped assets in the health care system—the home care aide—we are able to secure real time data from the home that provides symptomatic triggers and changes in conditions to social determinants of health and patient specific behaviors that can be indicating decline or creating barriers for improved health outcomes. Learn how Real-Time Data combines actionable data in real time, specialty training (Observe, Ask, Report (OAR)) and a population health approach to home care. When we are able to identify trends in utilization (ED & Hospitalization), compliance with Medications and patient specific wellness routines that impact HEDIS and STAR measures, we can build a more cost-effective approach to quality health care.

Jennifer Gentzlinger Chief Operating Officer Premier Home Health Care Services, Inc

11:45

Data-driven Interventions and Evaluation of Effectiveness: Identifying Sub-Populations including Health Inequities

To meet our performance goals, we cannot use a one-size-fits all strategy for developing improvement initiatives. We must develop robust data sources to identify and understand the many sub-groups that make up our membership. Through the analysis of these data sets, we are able to identify the specific needs of the sub-groups and develop and evaluate tailored interventions to help members achieve their best health.

Gregory A. Hanley, FACHE, CPHQ, Vice President, Quality Management & Population Health, UCare

12:15

Networking Lunch

Sponsored by

Strategic Solutions Network (SSN), based in Boca Raton, FL, is the parent company of the Medicare Risk Adjustment & Revenue Management Management, Plus Quality and Star Ratings and a series of related conferences.

Data Management & Technology Advances for MA Plans
1:15

Value Based Contracting with Vendors

Christine Leo, Vice President, Senior Products, Cigna

1:45

Case Study: Florida Blue's Journey into Interoperability --- Investing in New Technology, Adjusting Processes and Changing Behaviors

Hear how Florida Blue, a Health solutions company, invested in technology, adjusted processes and changed behaviors in order to transition to a more Interoperable workflow with their provider partners and prepare for the CMS/ONC Interoperability API mandates. Successes, lessons learned and strategy for the future.

Matthew Ketterman,Sr. Manager Provider Interoperability,Florida Blue

2:15

Technology Investments Supporting Aging in Place: Machine Learning, Sensor Technology and Smart Speakers

As the population ages, there will be a greater demand for seniors to live at home rather than reside in a facility. Caregivers can support independent living using insights from activities of daily living. Furthermore, our ability to manage chronic disease can improve with knowledge of home activity and biometric data rather than reliance upon infrequent nurse calls or visits (virtual or in-person). There have been great advances in analysis of passive sensors and smart speaker data to aid in understanding individual activities that might predict health events or poor outcomes. During this presentation, we will:

  • Learn how AI can analyze ambient sensor data to understand daily living patterns
  • Explore how care management workflows can improve with home intelligence
  • Learn how everyday behavior and deviations from normal patterns can predict health events; improve management of chronic disease; and prolong older individual independence.

Darren Schulte,MD, President of Advanced Technology, Centene

2:45

Networking Refreshment Break in the Exhibit Hall

Sponsored by

Strategic Solutions Network (SSN), based in Boca Raton, FL, is the parent company of the Medicare Risk Adjustment & Revenue Management Management, Plus Quality and Star Ratings and a series of related conferences.

3:15

Panel Discussion: Integrating Data from Population Health, Behavioral Health, SDOH into Care Coordination and other Clinical Teams – Breaking Down Silos

Moderator:

Henry W. OsowskiManaging PartnerStrategic Health Group

Panelists:

Michelle Werr,Managing Director, HealthScape Advisors

Gaurav Kumar Ciox Director of Product Management,Ciox

Patrick Carroll, MD Chief Medical Officer,Vida

4:00

Digital Caregiver Empowerment Program Reduces Utilization and Costs for Members with Dementia

We will present outcomes and insights from a study in which we deployed the Ceresti Caregiver Empowerment Program (CCEP) to family caregivers of Medicare Advantage members with dementia. We evaluated the impact of this digital health program, versus a propensity matched control group, on member healthcare cost and utilization; and on caregiver healthcare costs, mental health and satisfaction. CCEP process metrics were also tracked to evaluate caregiver engagement and compliance with completing remote risk assessments.

Dirk SoenksenCEO & Co-founderCeresti Health

Innovations for In-Person & Remote Care Delivery
4:30

Panel Discussion: Innovative Products & Benefits Designed to Attract & Retain Members, Boost Outcomes, Control Costs

Moderator:

Henry W. OsowskiManaging PartnerStrategic Health Group

Panelists:

Jim Egan, Vice President of Health Plan Sales, WEX Health

Carrie Meyer, Au.D., Director of Clinical Programs,Amplifon Hearing Health Care

Elaine Taverna, SVP Quality & Risk Adjustment, Advantasure

Reva Sheehan, Customer Insights Director,mPulse Mobile

5:15 -6:15

Networking Reception in the Exhibit Hall

Sponsored by

Strategic Solutions Network (SSN), based in Boca Raton, FL, is the parent company of the Medicare Risk Adjustment & Revenue Management Management, Plus Quality and Star Ratings and a series of related conferences.

Wednesday, January 26, 2022
7:00

Networking Continental Breakfast

8:00

Chairperson’s Remarks

Darren Schulte,MD,President of Advanced Technology, Centene

8:05

Appreciating LTSS Transfer Value

Medicare and Medicaid plans regularly find that a sub-set of members has needs that are better suited for long term services and supports. These members may be in the wrong program. It is fortunate if these plans operate in a state that contracts with MLTSS sponsors. In this case, these qualifying members can be assisted to transfer to more appropriate coverage that aligns to their needs, regardless of the organization that sponsors the programs. Qualifying eligible members, preparing these members for a successful transition, engaging the Aging and Disabilities Resource Center staff, following the member through transition are all components for high-impact on CAHPS scores, provider satisfaction, and margin relief.

  • Aligning benefits to member needs
  • Increasing CAHPS-related satisfaction
  • Preserving premium adequacy
  • Qualifying and preparing members
  • Referring-and-following

Dr. Thomas Lutzow, Former CEO, iCare

8:35

Disease Management 2.0: The Future of Body and Mind Healthcare for Seniors

Traditional care management solutions in Medicare Advantage plans have long been challenged to engage members and produce sustainable outcomes. Value-based providers have taken on some of these responsibilities, but they lack the virtual and technical capabilities to engage and monitor members with chronic conditions. Integrated care models across physical and mental health, (using a hybrid of virtual and in-person care) show promise, but have mostly been deployed for Commercial populations.

As we evaluate virtual and digital care solutions for seniors, we should be asking ourselves two critical questions: What elements of virtual, integrated care will deliver ROI in Medicare Advantage populations, and how do these models complement existing value-based care partnerships? We need virtual capabilities to help us deliver on our promises of improving access to care, but bringing seniors into the next generation of disease management means providers must go further than virtual delivery.

Join us to learn more about:

  • Why virtual management is an effective tool to engage a Medicare Advantage population and deliver sustained outcomes
  • How Plans can continue to deliver value-based care within an integrated ecosystem, and
  • What the expected outcomes for the next generation of condition management can look like in a Medicare Advantage population

Patrick Carroll, MD Chief Medical Officer Vida

Jordan Taggart Vice President, Market Access Vida

Improving Member Experience & Outcomes: Whole Person Care, Population Health, SDOH & Value Based Care
9:05

Physical & Behavioral Health Integration Models – a Holistic Approach to Boost Outcomes & Member Experience

Geisinger has implemented strategies that address Medicare Advantage member needs in an integrated manner. Embedded and collaborative care models in Primary Care leverages the partnership between physical and behavioral health needs, with a primary focus on a holistic approach. From a Population Health perspective, the unique needs of the Medicare Advantage group require risk analysis and targeted interventions for a happier and healthier member experience.

Amie Hoffman, LCSW, MHA, Director of Behavioral Health, Geisinger Health Plan

9:35

Home-delivered Meals Advancing Stars

Learn how a program of home-delivered meals for members after discharge or managing a chronic condition can deliver ROI and advance the Stars rating of your MA plan. Condition-appropriate fully-prepared meals can have many positive impacts on members and health plans. When provided after discharge, meals help members to rest and recover and avoid a readmission. In new SSBCI models, meals “beyond a limited basis” can help members to better control chronic conditions and avoid hospitalization. With Stars measures putting more value in member self-reported measures including “Improving or Maintaining Physical Health” and “Rating of Health Plan,” meals programs that help members improve their health and drive satisfaction with their health plan can also contribute to higher Stars ratings for MA plans.

Catherine Macpherson,SVP Healthcare Strategy and Chief Nutrition Officer, Mom’s Meals

10:05

Incorporating Health Equity in SDOH Strategy

Many of the programs that address social determinants are addressing symptoms of deep societal issues that have plagued our communities for centuries. Racism, sexism, agism are all root causes of many neighborhoods that have lacked investment, growth and opportunities for generations. CareSource is embedding health equity into all aspects of care and ensuring that is serves as a foundation of the Life Services and Care management models.

  • Defining health equity
  • Discussion of health equity as a part of SDOH foundation
  • Examples of how Life Services is impacting minority populations

Amy Reigel,Senior Director, CareSource

10:35

Networking Refreshment Break

Sponsored by

Strategic Solutions Network (SSN), based in Boca Raton, FL, is the parent company of the Medicare Risk Adjustment & Revenue Management Management, Plus Quality and Star Ratings and a series of related conferences.
Benefit Design Innovations to Improve Access
to Care, Quality Care & Member Engagement
11:05

Panel Discussion: Investing in Supplemental Benefits and Services to Save Medical Money

There’s a lot of talk about the ROI that the new flexible supplemental benefits and services can return to a MA plan. But which of the many extravagant claims are supportable? Join the panel for a discussion of ROI based on vendor case studies and actuarial commentary.

Moderator:

Michael S. Adelberg, Principal, Lead, Healthcare Strategy Practice, Faegre Baker Daniels Consulting Formerly, Director of Medicare Advantage Operations,CMS

Panelist:

Daniel Weaver, Executive Vice President of Product Operations and Stars Strategy, NationsBenefits

Tim Murray, Principal and Senior Consulting Actuary, Wakely Consulting Group

Evelyn Chojnacki,MPH, Director, Health Plan Product Strategy,SWORD Health

Elizabeth Klodas, MD FACC. FounderStep One Foods

11:50

Conference Exclusive: Milliman Unveils Most Impactful Benefit Changes to Drive Membership Increases

Milliman’s industry leading Medicare Advantage actuarial consultants present an overview of the 2022 Medicare Advantage competitive landscape with an emphasis on benefits that drive membership increases. This presentation will evaluate plan components prevalent amongst the strongest plan offerings in the market, including supplemental benefit prevalence, member cost sharing, and Milliman’s MACVAT Value Added metric. Attendees will better understand which benefits drive the most significant membership changes, as well as how to think about the most impactful benefit changes for 2023.

Adam Barnhart, FSA, MAAA Principal and Consulting Actuary Milliman, Inc.

Jordan Cates, FSA, CERA, MAAAActuary Milliman, Inc.

Julia Friedman, FSA, MAAA Senior Consulting Actuary Milliman, Inc.

12:20

Networking Lunch

1:20

Value Based Payment Models – Keys to Success and Outcomes Results with Primary Care Attribution Models

  • Payer/ Provider Collaboration
  • Episodes of Care/ Bundled Payments
  • From Shared Savings to Shared Risk

Steven R. Peskin, MD, MBA, MACP, Executive Medical Director, Population Health, Horizon Blue Cross Blue Shield of New Jersey

1:50

Make the Most of Your Benefit Dollars and Quality Investments with TOTALLY NEW Food Programs that Radically Engage Members and Address SDOH

  • Case Study: how one health plan successfully incorporated fresh grocery reward benefits to increase HRA engagement and enhance members’ access to healthy food
  • Effectively communicate program benefits to members and inspire lifestyle changes to drive action through a one-stop-solution for providing food and overall wellness
  • Promote member engagement and retention by committing to care, instilling trust, and developing healthy relationships with your membership base
  • Address social barriers to improve members’ health and lead to appropriate healthcare utilization and cost

Ashley Tyrner, Founder and CEO, FarmboxRx

2:20

Medicare Flexibilities Accelerate Medicare Advantage COVID Fraud Vulnerabilities

While the Public Health Emergency (PHE) – COVID-19 pandemic accelerated changes in regulations and policies to ensure access to patient care and medications, these new Medicare flexibilities also brought increased exposure to fraud, waste and abuse (FWA). Medicare Advantage plans are ripe for fraudsters seizing the opportunity to take advantage of COVID-19-enhanced payments and loosened policies that enable FWA to pass through undetected and are continuing to do so. Session will review new and evolving COVID fraud waste and abuse threats, including Identity Theft, Telemedicine, Laboratory schemes, Pharmaceutical risks and more. Session will review areas MA plans should focus their fraud waste and abuse analytics and investigation ideas to identify and address this growing area of vulnerability.

Lisa Jensen, Director of Payment Integrity, Providence Health Plan

Marketing & Sales Strategies To Expand Market Share & Increase Retention
2:50

Maximizing CMS’ Marketing Flexibility to Grow Market Share: Ensuring that Communications are Compliant, Educational, and Effective

  • Ensuring compliance of all marketing and outreach activities
  • Growing market share under CMA Marketing Flexibility rules
  • How do you stand out from the noise while being compliant?
  • Measuring effectiveness

Naomi Irvin, Chief of Staff, Government Markets, Blue Cross and Blue Shield of North Carolina

3:20

Investing in the Digital Experience: Responding to the Shift in How Consumers Shop for Medicare Coverage, and Meeting Members Where They Are

Kortney Cruz, Vice President, Medicare Sales and Marketing,Independence Blue Cross

3:50

Close of Conference