Agenda

Registration & Networking Continental Breakfast

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Co-Chairpersons’ Opening Remarks

The Health Plan’s Role in Creating the Next Generation of Care Management for Seniors – Building Trusted Relationships with Members, Providers and Communities through Program and Technology Innovations

• Changing the conversation about aging with members and providers. Reframing aging from challenge to an asset with community/members and providers
• Centering and creating companion care management services with members in community and adjacent to providers-connecting social networks with health care.
• Creating product agonistic Care Management programs which serve to enhance equity, reduce complexity, strengthen and simplify care delivery services and improve the health of communities we serve.

Case Study: Centering Equity to Improve Social Determinants of Health for Individuals with Disabilities

• Understand the influence of equity on Social Determinants of Health for Individuals with disabilities enrolled in Medicaid and Medicare.
• Identify opportunities to narrow health inequities for this population through community engagement.
• Learn approaches to engagement, and how to apply engagement to advance health equity and SDoH in meaningful ways. Moriah Iverson, MS, Business Change Director, Government Business Division – Execution, Elevance Health

Case Study: Social Determinants of Health – Innovative Community Outreach Programs to Improve Access to Care & Outcomes

Understand the pivotal role of social factors such as housing, nutrition, education, and economic stability in shaping individuals' health and well-being. Gain insights as we share successfully established partnerships with local organizations, non-profits, and social service agencies to address social determinants of health. Discover how collaboration can amplify the impact of outreach programs to improve health equity, access to care, and health outcomes for Medicare Advantage beneficiaries.

Panel Discussion: Targeted Integration for Health Equity & Social Determinants of Health Across All Plan Operations

As research continues to emerge on the various social barriers that are impacting members' health, Medicare Advantage organizations must look within their own patient populations to find out where social determinants of health are having the biggest impact and consider whether current benefit designs are truly addressing care needs. With the addition of the new health equity index to the 2027 Star Ratings, MA organizations are further incentivized to identify disparities and improve care for enrollees with social risk factors. Find out what plans should be doing to assess the impact of these factors on their own patient population and integrate actions to address SDOH across all departments.

Moderator:

Panelists:

Networking Refreshment Break

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Case Study: Creating a One Stop Data Shop to Support CMS & NCQA Requirements

The Medicare Advantage landscape is changing at an unpresented rate with CMS focusing on Health Equity, Social Determinants of Health and Interoperability and NCQA's shift to ECDS measures and incorporation of Race/Ethnicity stratification. In this session:

• Learn how one health plan approached and aligned on new MA concepts systematically, including managing differing timelines, requirements and data elements
• Discover the challenges deploying a broad data strategy to address these new concepts and the solutions put in place to drive collaboration cross-functionally
• Walk away with a deeper understanding of how to approach CMS & NCQA's new concepts from a centralized data perspective

Navigating Interoperability and Digital Transformation from the Federal Landscape to Community Health Plan

Hear from the Alliance of Community Health Plans (ACHP) on the federal landscape of interoperability: how we got here, where we are going and what to prioritize. Martin’s Point Health Care, a ACHP member, will discuss their approach to addressing current requirements while planning for an integrated digital transformation that fully leverages interoperability.

How Behavioral Economics Can Unlock New Potential in your Star Ratings

More than half of critical Star Ratings measures rely on individual behavior. Medicare Advantage Plan members with complex chronic conditions and various social determinants of health face a heightened risk of non-adherence, escalated healthcare utilization, and severe health complications.

Join Wellth to discover the 'how' and 'why' behind decision-making to ignite a wave of positive outcomes. We will explore how behavioral science can revolutionize member engagement, bridge critical care gaps, curtail preventable high-cost healthcare utilization, and catalyze substantial enhancements in Star Ratings measures.

Networking Lunch

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Case Study: Rethink Behavioral & Physical Health Integration – Move from a One Size Fits All Model to Models Tailored for Holistic Care

• Localization
• Virtualization
• Measurement Based Care and
• Integrated Practice Units/Co-management

Case Study: Designing a Ground-breaking Four-Year Strategy for Benefit Design

Learn how to unlock the opportunity of retention and growth through thoughtful benefit design. Combining marketing buzz, broker activation, and impact/ROI tracking to turn a supplemental benefit into a growth driver and retention grabber. Discuss the Brand New Day (now Molina) success story as a case study.

Supplemental Benefits and Benefit Design – Beyond Marketing to Preparing for New Regulations & Reporting Requirements & ROI

Supplemental benefit reporting requirements are here, is your plan ready? 

• How will new regulations and reporting requirements impact your plan? 
• How might these new requirements impact competition?
• How will innovation and flexibility impact for future plan design?
• Will complying with these the new regulations and reporting impact your bottom line?
• What might the new reporting evolve into in future years.

Networking Refreshment Break

Panel Discussion: Innovative New Product, Service & Technology Innovations to Boost MA Plan Performance

• Explore the next generation of product, service and technology solutions likely to drive MA plan performance
• Understand the environmental landscape that is demanding and inviting new, innovative solutions
• Investigate the potential use of AI to improve outcomes for MA plan enrollees
• Explore plan – vendor partnerships that can change the trajectory of implementation

Moderator:

Henry W. Osowski, Managing Partner, Strategic Health Group

Panelists:

Kurt Cegielski, Chief Commercial Officer, MOBE

Jenn Kerfoot,Chief Strategy & Growth Officer, DUOS

Joel Brill, MD,Executive Medical Director, Hello Heart

Mindi Knebel,CEO, Kaizen Health

Russ Gagnon,Chief Product Officer, Wellth

Eliminate the Guessing Game: Understanding the Costs and Implications of Your Network Decisions

Sub-optimal networks are costing the healthcare industry millions of dollars a year, including your bottom line. Join us as we discuss the importance of aligning your business and provider network strategies. We’ll share how Medicare Advantage plans are examining and reimagining their network builds to stay competitive and meet the evolving needs of their members. You’ll gain a better understanding of what levers to focus on – compliance, network adequacy, data integrity, performance metrics – that can truly enhance the quality and affordability for your members, while recapturing lost profitability.

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.

Exploring the Real Value in Value-Based Contracting for MA Plans and Members

• Explore why value-based care networks are an optimal solution for Medicare Advantage populations
• Learn how MA plans are using value based care to improve quality
• Understand the key challenges of value based care models and how plans are finding solutions

Networking Reception

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Networking Continental Breakfast

Co-Chairpersons’ Remarks

Case Study: Focusing Digital Member Engagement Across the Continuum From Sales to On Boarding to Virtual Care

Effective member engagement is crucial for health plan growth, as well as overall member retention. The landscape of membership is changing and health plans must quickly evolve in a targeted way. Learn about real tools currently in use by a top regional health plan that have been proven successful:

• Utilizing a Customized Sales Comparison Tool to direct brokers, internal sales force, and customers to the plan that best meets their current health needs
• Drug Transparency Tool that allows for customers to understand the coverage and costs associated with their current prescriptions as well as see how quickly they may reach their annual TrOOP
• Electronic Enrollment to facilitate new enrollments and enrollment changes quickly and efficiently
• Proven telehealth tools that engage members and provide access to a multitude of services beyond urgent care, including primary and behavioral health care
• Addressing the digital divide – offering members free or low-cost hi-speed internet access, as well as guidance in accessing all digital tools

Case Study: Preparing for the Exponential Shifts in Quality/HEDIS® Measurement & STAR Ratings – A Multi-Year Strategic Action Plan

• Developing a multi-year strategy in the midst of exponential change that will mobilize your organization to take collective ownership in Medicare STAR Rating performance.
• Why your strategy should include the Social Needs Screening and Intervention (SNS-E) measure and the steps UPMC Health Plan is taking now.
• UPMC Health Plan case study on preparing for transition to ECDS measures and Digital Quality Measurement as part of their multi-year strategy.

Ally Thomas, Ph.D.,Associate Vice President, Quality Improvement, UPMC Health Plan

Brain Health is Pivotal to SDoH: How to Help Your Members

Leading authorities will discuss the role of brain health in SDoH, including:

• An early population health study that showed most of health inequity can be tied to cognitive disparities
• New 20-year SDoH data from the 2800-person ACTIVE Study
• Data on the impact of a memory fitness program on brain health

Panel Discussion: Innovative Programs and Technologies to Transform Member Engagement & Satisfaction

Today's Medicare Advantage beneficiaries are increasingly embracing technology for everything from shopping for plans during open enrollment to maintaining a healthy lifestyle. Find out what new technologies and programs plans are adopting to engage members throughout the year to boost satisfaction and increase retention.

Moderator:

Panelists:

Networking Refreshment Break

Leveraging the Most Powerful and Comprehensive Public Data Source in Healthcare

What would you do if you had comprehensive, low lag access to every claim in Medicare? This data set exists, and can empower health plans to make better business decisions using one of the most powerful, yet untapped resources in the U.S. healthcare market. Come learn how by utilizing this unique offering from CMS, plans can be better at physician targeting, member retention, stars ratings adherence, MAC strategy, interactive AWP Discount Benchmarking, and much more.

RADV – Are You Ready?

In early 2023, CMS issued the 2024 Risk Adjustment Data Validation (RADV) final rule. They outlined changed to the audit process for Medicare Advantage Organizations (MAOs) which has left everyone wondering, what do I need to do to be ready for the next RADV audit and how will this affect my health plan over the next three years as CMS phases in new risk models? Join me in RADV – Are you ready? To have a discussion about what this means for you and what this means for the Medicare Advantage program.

Digital Innovation: A Solution to the Growing Caregiver Crisis Affecting Seniors

Older adults rank support and transportation among their top barriers to care. With the 65 and older population set to increase approximately 31% from 2020 to 2030 and the number of potential caregivers per high-risk older adult estimated to drop 42% from 2010 to 2030, these obstacles are on track to become more profound than ever. In this session, hear how digital care models can help bridge growing gaps in senior care and why a holistic approach is critical.

Case Study: Community Engagement & Connection – Prime the Pre-65 Pipeline & Partner with Agents to Operationalize the Drive for Wellness

Leveraging local presence and finding opportunities for differentiation and connection has always been challenging.  Learn more about how a plan has tackled these complex opportunities as we discuss best practices around how to effectively:

• Prime the pre-65 pipeline
• Partner with agents
• Weave health and wellness into marketing
• Pilot, measure, and adjust tactics

Networking Lunch

Case Study: How BCBSKC Saw 93% Member Growth in 2 Years With Innovative Marketing Strategies and the Broker Channel

Find out how Blue Cross and Blue Shield of Kansas City’s go-to-market strategy resulted in a 93% Medicare Advantage member growth in two years.

• How Blue KC leveraged winning creative and data to inspire a marketing stimulus strategy
• How maximizing the broker channel through development and engagement accelerated growth

Angie Sutton, MS, LUTCF,Government Programs Marketing and Broker Development and Engagement,Blue Cross and Blue Shield of Kansas City

Case Study: Accessing Hard to Reach Rural Members with Virtual & Digital Innovations: Ensuring Quality Care

Sanford Health Plan has taken innovative approaches to engage with its rural MA members.  The approach beings with building trust with members, proactively contacting members and educating them on how their health plan is there to help serve them.  Sanford Health Plan is currently maturing its clinical outreach model that began with virtual preventive care visits that is evolving into a referral platform.  Recent focus is on learning how members best respond and creating simple ways to engage with their own health actions, making it easier for members to adhere to their care plans at home through investments in digital enablers and unique incentives.

Navigating the IRA, Benefit Design & Drug Price Negotiations to Control Costs & Boost Outcomes

• Navigating the Inflation reduction act in 2025 and beyond
• IRA impacts on pharmacy benefit design and potential opportunities
• Drug price negotiations and their impacts on formulary design and overall financials

Omar Daoud, Senior Director of Pharmacy,Community Health Plan of Washington

Close of Conference