10th Annual Medicare Star Ratings & Quality Improvement Summit

Hear from top MA plan experts on strategic, tactical and practical solutions to
new regulatory updates and technologies in an era of constant change and declining budgets

Event Schedule

Pre-conference Hands-on, Interactive Workshops: Topic- Specific, Small Group Sessions


Workshop Registration & Continental Breakfast

Talking CAHPS: Live From New Orleans


The popular webinar series goes on the road! Join CAHPS and Stars experts for an interactive and in-person session where we will discuss best practices and provide actionable strategies for leveraging data-driven insights, using digital technology and engagement tools to impact member experience and quality performance.

During this workshop, we will provide a proven and practical framework that can be used as the foundation for your member experience strategy or integrated within existing programs.

Key focus areas will include:

  • The changing face of member experience and the evolution of the underlying data
  • Practical approaches to an equity-first engagement ecosystem
  • Operationalizing member experience excellence to achieve and sustain 5-Stars


Moderator:

Dan Ready,

Director of Business Development,

mPulse



Panelists:

Reva Sheehan,

Senior Director, Customer Insights,

mPulse


Rex A. Wallace, CEBS,

Chief Executive Officer,

Rex Wallace Consulting, LLC

Nate Lucena,

Chief Strategy & Analytics Officer,

Rex Wallace Consulting, LLC


Saeed Aminzadeh,

Chief Executive Officer,

DecisionPoint by mPulse

Networking Lunch

Turning Complexity into Clarity: Practical Problem-Solving for Star Ratings Success

Join us for an intimate, hands-on workshop designed for professionals who are ready to tackle the most pressing challenges in the evolving world of Star Ratings. This isn't just another presentation session—it's a practical, problem-solving experience where you'll collaborate closely with like-minded colleagues facing similar hurdles. What to Expect:

  • Practical Solutions: Dive deep into the new 2025 Pharmacy and Health Outcomes Survey (HOS) measures with actionable insights that you can apply immediately.
  • Collaborative Problem-Solving: Work side by side with your peers in interactive roundtable discussions, brainstorming real-world solutions to your most urgent challenges.
  • Learning from Experience: Hear firsthand from other Medicare Advantage plans about their successes and lessons learned so you can avoid common pitfalls and replicate what works.
  • Focused Strategies: Walk away with concrete, prioritized strategies tailored to your organization's unique needs, whether you're navigating new regulatory requirements or driving innovations for Star Ratings success.

By the end of this workshop, you'll understand the latest changes and leave with a clear plan of action to implement in your organization. This is your chance to connect, collaborate, and conquer the complexities of the Star Ratings landscape—together.
Join us and return to your team with the confidence and tools to lead in the rapidly changing world of Star Ratings.


Melissa Smith,

Founder and Senior Advisor,

Newton Smith Group


Kim Shell, MBA,

Principal,

Freedom Healthcare Consulting

Andrew Bell,

Medicare Stars Practice Leader,

ProspHire

Close of Workshops

Conference Registration & Networking Continental Breakfast

Chairperson’s Welcome & Opening Remarks


Kena Hahn, MHA,

Director, Medicare Stars & Outpatient Care Coordination,

Health Alliance


Actionable Strategies to Maintain & Improve Performance Scores in a Zero Budget Environment


Elevating Your Star Ratings Game

Dive into the newest technical updates and get up to date insights on strategies for swift success in Medicare Advantage Star Ratings.

  • Review the latest technical and regulatory updates impacting 2025 Star Ratings performance
  • Examine the new 2025 Math Path with new measures and the Health Equity Index
  • Gain insights to propel your organization to the top
  • Learn ways to improve experience and health outcomes as members change formularies and benefits in 2025
  • Discuss strategies to use Reality-based Quality Improvement to activate the organization

Melissa Smith,

Founder and Senior Advisor,

Newton Smith Group


Swimming Uphill Against the Flow: Driving Outcomes and Continuously Improving in the Face of Financial Headwinds and a Wildly Erratic Legal and Regulatory Landscape

The Medicare Advantage landscape is undergoing substantial evolution in financial models, Star Rating program specifications, and many of the underlying operational aspects associated with running a successful plan. Reduced benefits, tighter budgets, an evolving yet more competitive landscape, lawsuits, retroactive regulatory changes, an industry wide Star Rating result recalculation, and multiple pending program specification changes are forcing plans to innovate, refine processes, build stronger relationships with regulators, and brace for the future. This session will tackle these topics, showcase how a smaller, startup plan is navigating adversity to grow successfully, and highlight tactics to transform performance despite monumental challenges.


Dan Weaver,

Senior Vice President, Stars & Quality

Zing Health

Case Study: Going Back to the Basics: Building from the Ground Up and Preparing Your Plan for Uncertainty

Strong foundations take work and great foundations, once built, are not visible, but they are felt. In the ever-evolving space of Medicare, it is more critical than ever to ensure a strong foundation has been built in which your Stars program can stand on and while not visible, is one that has the necessary buy-in from your organization to ensure the attention it needs for long term success. In this session we will take you on a journey discussing the necessary components of a strong foundation that will grow into a program that doesn’t succumb to the unpredictable changes, but rather embraces them and rises to the occasion to ensure creativity and innovation keeps your plan on top.


Sara Lords,

Medicare Stars Program Manager,

Blue Cross of Idaho

Networking Refreshment Break

Beyond Strategy: Fail-proof Execution for Performance Improvement


Priyanka Jain

Vice President

Martin’s Point Health Care

Tools & Strategies to Address HEI & SDOH: What’s Actually Working?


Social Needs Screening & Connection – Gathering Actionable Data & Creating a One-Stop Data Shop

A look at how a high-performing plan is taking on the challenge of social determinants of health screening in preparation for SNS-E measure debut. Learn how a multi-modal screening ecosystem was built to reach wide into the Medicare population to identify and address unmet social care needs.


Jessica Thomas

Director of Quality

Independent Health

Panel Discussion: Real-life Implementation Tools and Strategies to Address the Health Equity Index – What Can You Actually Do Beyond Data Collection

  • How do you use Health Equity Index data to develop HEI-focused interventions?
  • What is the importance of targeted member and provider engagement strategies for reducing healthcare disparities?
  • Outline innovations that help improve access to care in vulnerable populations.
  • Provide an initial framework for partnering with community-based organizations to engage HEI populations.

Moderator:


Nate Lucena

Chief Strategy & Analytics Officer

Rex Wallace Consulting


Preparing for HEI Even Though Your Plan May Not Meet Demographic Requirements

A strategic approach to the current and future CMS Health Equity Index despite existing membership eligibility.

  • Starting from within: How internal Diversity, Equity, Inclusion and Belonging efforts improve the organizational Health Equity operational design and implementation
  • Identifying multi-layer equity barriers through data preparedness and analysis
  • Comprehensive plan wide approach to improving health disparities
  • Leveraging regulatory requirements for successful implementation
  • What to do next: Addressing current requirements while planning for the future

Shelly McCombs, MPH

Senior Manager Quality Improvement and Accreditation,

Health New England


Networking Lunch


Concurrent Roundtable Discussion Groups


Join one of these small group, highly interactive discussions to get your questions
answered on the spot, generate innovative ideas and hear from your industry colleagues.

A. Back to Basics: Cross Functional Workgroups -- Who Does What? Where is the Data? Communicating Inter-departmentally and with Leadership

  • Getting Buy-In - How do you encourage the organization to prioritize Stars?
  • Finding your Champions - Building relationships across departments and developing new Advocates for MA Members and the Stars Program
  • Building a Culture of Open and Clear Communication - Developing trust in the team and trust in the data to promote transparency up and down the board


Group Leader:

Brendan Generelli,

Director of Medicare Stars & Quality,,

Johns Hopkins Health Plan


B. Optimizing Your Teams: How to Help Your Stars Team and Matrix Partners Reach Their Full Collective Potential

  • A perfect Stars strategy is only as good as the trust between the teams executing it. The best strategies fall flat if the teams cannot work together.
  • How leveraging behavioral and cognitive assessments can increase understanding and transform your teams' performances.
  • Hire based on cognitive abilities; engage based on behavioral traits.
  • Build trust within and across teams.
  • Create a shared understanding of goals across teams.
  • Equip teams and program managers with insights into their matrix partners and their keys to engagement.
  • Turn your team and its collaboration with matrix partners into competitive advantages.


Group Leader:

Rex A. Wallace, CEBS,

Chief Executive Officer,

Rex Wallace Consulting, LLC



C. Maintaining and Improving Performance Scores in an Era of
Constant Change

  • What is keeping you up at night?
  • What is your health plan’s Star Rating corporate goal? Are all employees in the organization aware of this goal?
  • What is the buy-in from your physicians? Do the physicians themselves participate in QI activities?
  • How is your health plan staying current with the measure and weight changes? What tools (if any) do you have in place to help track?
  • What actions are you taking to improve CAHPS and HOS rates? Have these been implemented? What are your outcomes?
  • Describe your strategies to bring members into compliance with closing care gaps?

Group Leader:

Mary A. Goble, MSN, RN,

Director of Clinical Quality,

Capital Health Plan


D. Vendor management 101: Oversight of Vendors in Tough Financial Times






  • Do you buy vs build in house
  • Tools and process to vet out new vendors
  • Negotiating pricing
  • Communication expectations and navigating the inevitable “hiccups,”
  • Resetting expectations for new needs of MA/Stars
  • Challenge vendors to maximize their services/programs to be more impactful
  • Heightened compliance (supp ben reporting, nondiscrimination)

Group Leader:

Kena Hahn, MHA,

Director, Medicare Stars & Outpatient Care Coordination,

Health Alliance

Build it and They Will Come: Boosting Your Visibility and Building a Cross- Functional Team to Improve Stars Measures

  • Gaining interdepartmental support and expertise by creating collaboration amongst multiple health plan teams
  • Share what tools and structure we use to create small rapid improvement workgroups
  • How to build the buy in across multiple teams and create collaboration and share accountability
  • Learn how to pivot and create flexible teams to review and create action plans
  • Focus on breaking down silos amongst teams

Kena Hahn, MHA,

Director, Medicare Stars & Outpatient Care Coordination,

Health Alliance

Addressing Health-Related Social Needs in Your Veteran Population

Veterans have unique health-related social needs (HRSNs) that often extend beyond traditional medical care. Join Keslie and Jen as they explore how ATRIO Health Plans is utilizing VA medical records beyond risk adjustment and closing HEDIS gaps to profoundly impact the veteran population. They will discuss ATRIO’s plan to leverage a unique combination of services to overcome barriers associated with HRSNs, ultimately aiming to enhance member satisfaction, retention, and overall health outcomes for veterans.

    Key topics covered will include:
  • Collecting VA medical records: Strategies used by BeneLynk for the efficient gathering and managing of VA medical records.
  • Abstracting HRSNs: Techniques for extracting health-related social needs from VA medical records.
  • Targeted Outreach: Strategies for engaging veterans with community assistance programs to address and overcome HRSNs.
  • Tailored Solutions for Veterans: Designing and implementing programs that address the unique social challenges faced by veterans.
  • Collaboration and Community Partnerships: Leveraging partnerships with veteran organizations and community resources to build a robust support network.
  • Documentation: Best practices for documenting HRSNs to ensure continuity of care.

Gain valuable insights and practical strategies for providing holistic support that honors and supports our veterans.


Keslie Crichton,

Chief Sales Officer,

BeneLynk

Jennifer Callahan,

Chief Operating Officer,

ATRIO Health Plans

Networking Refreshment Break

Optimizing HEDIS/QI Performance During MRR Season

Capturing HEDIS measure performance through chart retrieval during medical record review season is a standard business practice in the Medicare world. Jefferson Health Plans had been declining in overall HEDIS performance year over year and began to see declines in chart retrieval rates and drops in QI performance. In collaboration with ProspHire, the Jefferson Health HEDIS and Quality teams were able to not only improve chart retrieval rates to the highest on record, but also achieved all HEDIS measure level goals, and captured quality improvement measure performance to maximize performance potential. This case study will give an in-depth overview of how teams came together, navigated complex provider relationships, improved performance, and ultimately created a sustainable and scalable model for chart retrieval during MRR season with a keen eye toward the future.


Andrew Bell,

Medicare Stars Practice Leader,

ProspHire

Alyssa Mullen, MHA,

AVP, Quality Improvement and Performance,

Jefferson Health Plans

Panel Discussion: Product, Service & Technology Innovations Designed for the Unique Needs of Your Plan, Your Members and Providers

Managing Member Expectations & Communications & Providing Quality Care in an Era of Shrinking Budgets & Benefit Changes


Impacting the Changing Face of Member Experience

Practical approaches to elevating CAHPS, HOS, and member retention through targeted, equitable member engagement.


Saeed Aminzadeh,

Chief Executive Officer,

DecisionPoint by mPulse

Networking Reception


Networking Continental Breakfast

Chairperson’s Remarks

Kena Hahn, MHA,

Director, Medicare Stars & Outpatient Care Coordination,

Health Alliance

Best Practices: CAHPs & HOS – Managing Providers and Supporting Them to Boost Quality

You can’t see the label from inside the jar. Sometimes it is hard to see the path to optional member satisfaction from the seat you sit in daily. Member satisfaction is not just a nice to have, it is crucial. It helps create a stickiness, can improve member retention, and is a cornerstone of CAHPS measures. Join us,and go beyond the basics of surveys and learn new ways to create lasting loyalty.


Kim Shell, MBA,

Principal,

Freedom Healthcare Consulting

Case Study: Harnessing the Power of Medicare Advantage Incentives and Rewards to Enhance STARS Ratings

In the evolving and competitive landscape of healthcare, the Medicare Advantage Incentive and Rewards Program stands out as a pivotal tool for driving improvements in STARS ratings. This session will delve into how strategically designed incentives and rewards can elevate the performance of Medicare Advantage plans, leading to better patient outcomes and higher satisfaction rates. We will share insights on best practices, and real-world examples that illustrate the positive impact of effective incentive and reward systems. Gain a comprehensive understanding of how to design and implement these programs to maximize their potential and increase plan enrollment.


Jenna Horner,

Director of Medicare Advantage Product Strategy,

Cigna


Customizing Member Communication to Support Access to Care

  • Tips on member communication in driving access to care in CAHPS & Star Ratings.
  • Importance of personalizing messages based on member preferences.
  • Helping members access quality healthcare is our job.
  • Why do we think more messages and portals is the answer to 5 Stars?

Leon W. Lead,

AVP, Medicare Stars & Quality Improvement,

Molina Healthcare

Networking Refreshment Break

Excellence Beyond Measure(s) : Driving Provider Success in Medicare VBC Models


Jenna Pinnelle

Medicare Program Manager, Maine

Elevance Health

Addressing Specific Quality Measures – Provider Education & Engagement


Every Patient Counts

During the presentation I will present a case study on CHP’s data results where CHP missed the 4 Star cut point for Diabetes control (HbA1C < 8) by less than one patient. I will discuss the interventions CHP applied during the following measurement year that demonstrated improvement.


Mary A. Goble, MSN, RN,

Director of Clinical Quality

Capital Health Plan

Case Study: Transitions of Care: Getting in Front of Chart Review

An overview of a health plan’s monthly proactive program which allows the plan to evaluate numerator compliance with the TRC sub-measures based on recent hospital discharges. Learn how this plan interacts with providers to educate them about the importance of the measure and how providers can interact with local hospital systems to ensure they receive the required information in a timely fashion.


Michael Farina

Vice President of Healthcare Quality,

Capital District Physicians’ Health Plan

Close of Conference