Agenda

Welcome & Introduction

Panel Discussion: Impact of the Pandemic & the Election on Medicare Advantage – How Plans are Reacting and Changing

Moderator:

Panelists:

Advancements in Interoperability to Drive Value-Based Care

There has been a long-standing challenge of accessing medical record data in a timely fashion. Join Apixio’s Vice President of Solutions, Bryan Lee, as he discusses how Interoperability is key to improving collaboration among payer and provider to drive real-time bi-directional data exchange. In this presentation, Bryan will address the challenges that payers and providers face and provide considerations to mitigate these challenges in an informed and deliberate manner.

2021 Stars & HEDIS/Quality

Clover Health/Walmart Partnership – Together, Insurance and Retail Lower Barriers to Care

A key component to helping people stay healthier is providing them with the ability to access basic healthcare in places that are convenient to them. In this presentation, Clover Health Chief of Staff, Theresa Safe, discusses the importance of insurance companies and brick & mortar retailers working together to "decentralize care" through innovative and mutually beneficial partnerships. The talk will include a case study on Clover's work with Walmart as well as one other (currently unannounced!) national retail chain. Attendees will learn how to think outside the current constructs of the healthcare system to better address the unique needs of different communities.

Break

Cross-Functional Performance Transformation Methodologies
to Boost Member Engagement, CAHPS & HOS Stars Scores

With CMS shifting the weighting of member experience measures in the Star Rating equating, plans are adjusting strategies to achieve their Star Rating targets. Whether a high performing plan looking to maintain excellence or an underperforming plan pushing to achieve performance targets, all plans must make adjustments to achieve success. This session will explore proven performance transformation methodologies with a focus on the member experience including:

• Identifying the most effective short, mid, and long term strategies for performance improvement
• Revising your operating model to improve collaboration, shared-accountability, and partnership across the matrix
• Key strategies for establishing a culture of continuous improvement and operational excellence

Supplemental Benefits – Key Drivers to Plan Success

Today's Medicare beneficiaries have a lot of choice. In fact, 90% of Medicare enrollees have access at least ten Medicare Advantage Plans. What can you do to make your plan stand out? In this session, Dave Olson, Senior Vice President of Network and Medicare Advantage for DentaQuest will cover how strategically leveraging supplemental benefits like Dental and Vision can give your Medicare Advantage plan an edge in this crowded market. Specifically, you will learn:

• How plan design can impact the attractiveness of your plan
• How to strategically include supplemental benefits in your plan
• How your supplemental benefits can improve your bottom-line
• Which Dental benefits are most important to Medicare Advantage enrollees

Rapidly Changing Digital Landscape for Medicare Advantage Members: Marketing, Engagement, Telehealth

The COVID-19 public health emergency has disrupted the lives of the people we love and care for in countless ways. That disruption has accelerated changes in how, when, and where people access health care services—changes that are here to stay. The perception that seniors will not engage in digital health has been replaced with high engagement and broad adoption as the new normal. How these seniors take part in their health has never been more important as telehealth adoption soars and policymakers, health plans, and providers shift from reactive to cohesive digital strategies. Hear our observations on the innovative approaches that are driving enrollment, engagement, and results.

• Older Americans’ disposition to technology and willingness to adopt digital health technologies continue to be misunderstood.
• As recently as 2019, only a subset of health plans offered telehealth, but offering telemedicine has become the norm in the matter of only 24 months (Especially for Medicare Advantage plans). While coverage has expanded quickly, many plans still lack a cohesive strategy.
• The new “table stakes” is a whole-person solution that can connect in-person care with virtual care easily and comprehensively to include physical and mental well-being.
• Hybrid analog engagement techniques combined with digital interventions can be a powerful combination to drive activation and results.
• As with most things, you get one chance to surprise and delight consumers in a virtual health care experience. Moving from a reactive to comprehensive strategy is the first step in doing so.

CAHPS: Approaches to Taking Action on the New King of Star

• By 2023, CAHPS and member experience will account for over 50% of CMS Star Ratings and become the single most important Star measure grouping
• CAHPS season is fast approaching with surveys being deployed in under two months – what you can do now to make an impact
• Understanding how member experience and clinical behavior are intertwined
• Devising strategies and processes that enable us to excel at CAHPS while also impacting other Star measures

Close of Module

Opening Remarks

Maintaining Compliance in a Fluid Medicare Advantage World

• Partnering with Operational Areas to ensure compliance
• Changed the reporting structure of the Medicare Compliance Team
• Tearing down the silos - communication is key
• Preparedness to meet the challenges and changes

• Pivoting to comply with new requirements such as Interoperability, COVID-19 and State of Emergencies
• 2020 – not the clear “vision” we had planned for
• Streamlining processes wherever possible with other Lines of Business
• Medicare Advantage as the guide

Case Study: Creating a Seamless Member Experience from Sales to Retention

Optima Health recognizes continued success on its growth trajectory and is expected to double the number of Medicare Advantage Members by the end of 2021. One of our top priorities is a seamless member experience. A member centric approach to sales and marketing, education, and member retention are the keys to propelling our revitalized Medicare Advantage Program forward into the future.

Panel Discussion: Member Engagement Innovations -- New Opportunities to Retain Members, Maximize Outcomes & Improve Satisfaction

Moderator:

Panelists:

Hidden Access: Make Access Measures Your Key to Star Ratings Success

When CMS announced the weight increase for patient experience, complaints, and access measures a shockwave tore through our industry. Since then much of the commotion (and resource allocation) has focused on member experience through the CAHPS survey, while the four measures capturing access have received little attention. Why don't we focus on access for a bit?
Let's deep dive into these measures, talk potential pitfalls to avoid, and possible strategies to improve them for measurement year 2021 and beyond.

Break

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

Moderator:

Panelists:

Focusing on Social Factors that Impact Health and Quality of Life

The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” In developing approaches to enhance the lives of older adults, it is important to understand and address social factors that impact their health outcomes and quality of life. This session will discuss on these factors and approaches to addressing them.

Panel Discussion: Be More Generous to Save Money: A Discussion of Benefits that Demonstrate Cost Savings

There’s a lot of conversation about supplemental benefits that, in theory, should produce savings for MA plans by improving the lives of members. But how many of these benefits have actuarially modeled savings or demonstrated savings with other plans? On this panel, innovative benefit vendors and actuaries will present documentation of the cost offsets that they can deliver MA plans through actuarial modeling and client case studies

Moderator:

Panelists:

Close of Module #2

Preparing for “Table Stakes Benefits 3.0” – Tailored Benefit Innovations to Overcome Barriers to Care

To date, there have been two large waves of Medicare Advantage benefit innovations. In the first wave, plans offered dental, vision, hearing and gym benefits that formed the basis of “Table Stakes Benefits 1.0.” Since 2018, plans have taken advantage of liberalized CMS guidance to offer a new wave of benefits, the most popular of which—including OTC, transportation and meals—are emerging in competitive markets as “Table Stakes 2.0.” In this session, participants will be re-exposed to the first waves of benefit innovations, but the focus will be on the emerging third wave of benefit innovations which will be focused on specific chronic conditions and the social determinants of health. Join the presenter for a norm-challenging discussion about tailored benefits, and what innovation will look like in Plan Year 2022 and beyond.

Integration of Behavioral Health in Vulnerable Populations

• Addressing Social and Behavioral Health Needs in an integrated Model
• Enhance Primary Care Access with an Intergenerational Model
• Engaging Members to ensure access to care and decrease overall Utilization

Integrating Community Health Assistants into the Care Team

• Gain a more thorough understanding of the role of the unlicensed care team member
• Manage a complex population through the use of telehealth
• Deploy home based strategies in the wake of a pandemic

Population Health:  Integrating Social Factor Data to Improve Health and Address Health Disparities

How can we use more data sources to identify and address the factors that contribute to poor health and negative outcomes?  Through the incorporation data beyond claims, we can identify the social factors that create barriers to better health.  Additionally, we are able to begin to address health disparities within sub-populations.  This presentation will discuss the journey we are on to move upstream in the implementation of interventions to help our members achieve their best health.

Case Study: Value-based Contracting to Optimize Revenue Streams Through Real-time, Concurrent Code Review -- A Win-Win Partnership Between a Payer and their PCPs

Value based contracting is becoming increasingly prevalent in the health care industry.  This session will focus on risk adjustment based contracting between payer and PCP in a network model.  Hear progress, challenges and lessons learned from CDPHP’s innovative partnership with their primary care providers and learn how these win-win arrangements can be operationalized.  Gain insights in how real-time, concurrent code review can optimize revenue streams for both parties and reduce RADV audit risk.

2021 -- An Opportunity to Expand Chronic Care Management through Expanded Use of Telemedicine

• The experience from COVID in 2020 affecting adoption of telemedicine
• What have we learned about what care can and cannot be delivered through telemedicine
• What do we need to do to expand telemedicine use beyond the pandemic

NLP and AI technology – How it Works, What it’s Used for, and Why it’s Better Today

• Why Engage in Second Level Review (2LR)
• How to evaluate NLP Technology
• What Artificial Intelligence brings to the table
• Use cases for AI Powered NLP

Real Time Data (RTD) - A Cost-Effective Solution for Population Health Management

Premier’s RTD is made up of three critical components: Training, Data Collection, and Data-Driven Intervention Management. Through this innovative model, our partners have realized improved member health outcomes, success in raising quality incentive measures, and savings through reductions in potentially avoidable hospitalizations in the post-acute setting. As options for coverage of in-home services expand, being able to leverage access to information in the home to inform timely interventions is key to managing members.

Close of Module #3

Real Time Risk Adjustment – Data and Program Designs to Optimize Point of Care Risk Adjustment

With a market shift towards EMR integrated and technology enabled risk adjustment solutions, we need to reconsider how data and processes are handled in order to stay nimble while still maintaining robust analytics and reporting. This session will discuss best practices for designing programs in parallel with data infrastructure to support real-time integration, identify key pieces of information that are needed for governance, reporting, and valuation, and explore how this framework can be extrapolated for more generalized interoperability in the future.

Lars Johnson, FSA MAAA,
Manager, RPM Program Analytics, Actuarial Services,
Highmark Inc.

Innovative Tools & Interventions for Transitions of Care Before and During the Pandemic: Lessons Learned

This session highlights Fallon Health’s innovative care delivery model with an emphasis on transitions of care. Dr. Langer will describe Fallon’s interdisciplinary approach to successfully managing transitions of care and to promoting integration across individuals’ physical, behavioral health, long term services & supports, and social needs to improve health outcomes. This presentation will also address adaptations to the transitions of care program necessitated by the COVID-19 pandemic. Dr. Langer will conclude by summarizing lessons learned and new tools and interventions to further enhance transitions of care management.

Carolyn Langer, MD, JD, MPH,SVP and Chief Medical Officer, fallonhealth

Case Study: Value-based Purchasing for Home Health Care to Reduce Readmissions

This session will focus on an innovative Readmission Prevention Program using a Value-Based Purchasing agreement for member-centered case management provided by community Home Health Agencies following a hospitalization.

• Historical 30 day Readmission Prevention efforts
• The ROI for the 90 day Follow to Home Program
• Expansion opportunities for Gap Closure

Break

End Stage Renal Disease: What Happened During AEP? What are You Doing to Improve Outcomes and Manage This New Population?

Medicare Senior Savings Model Insulin Copay Caps: Plan Considerations for Participation

Brian Smolich, Vice President of Pharmacy Services for Health Alliance Medical Plans, will discuss his plan’s decision to participate in the Senior Savings Model for 2021. This discussion will cover the thought process in deciding to participate as well as given background information to how the program is structured. The Senior Savings Model caps Part D expenses for members that require insulin for management of Diabetes.

Close of Conference