Monday, December 2, 2019
Pre-Conference In-depth Workshop Series

($300 ALL ACCESS WORKSHOP PASS to any or all 3 of the pre-conference workshops)


Workshop Registration

12:30 Workshop A:

The Payer & Patient Centered Medical Home (PCMH) – Improving Gap Closure, Outcomes & Cost Savings

The PCMH model has been shown to improve gap closure, outcomes and cost savings. There are a variety of ways a health plan can engage with network clinicians related to PCMH. Payer support ranges from in-kind assistance offers of resource and tools to financial programs or a combination of both. During this workshop the group will explore several opportunities for a health plan to support clinics in their transformation to a patient centered medical home delivery model.

Kim Barrus, MSN, BSCIS, RN, PMP, Medical Home Manager, SelectHealth

1:40 Workshop B:

DSNP 101: Understanding the Basics of a Dual Eligible Special Needs Plan in a Medicare World-- Improving Quality, Ensuring Compliance and Boosting Performance

This workshop will focus on the basic principles of DSNP plans including what makes them different from a Medicare Advantage plan and what unique challenges DSNP plans face. This workshop is intended for individuals who are new to a DSNP plan, want to connect with other folks in DSNP plans, or just want to learn more about DSNPs.

Dan Weaver, Vice President, Stars Quality, Gateway Health Formerly Director of Program Management, Government Business, Quality Improvement, Highmark

2:50 Workshop C:

Enhancing the Pharmacy Benefit: Preparing for Part D Modernization, New MTM Initiatives and More

The goal of this workshop is to openly discuss current and future opportunities on the pharmacy benefit. With prescription drug costs continuing to grow, how do you continue to create value on this highly visible benefit? What role does Part B and D Step Therapy have? Where does consumerism come into play? How can you leverage your pharmacist staff to provide greater value to your members? How do you promote the pharmacy benefit? This workshop is intended for individuals who are interested in learning how to maximize the member experience using their pharmacy benefit.

Andy Wheaton, Medicare Pharmacist, Network Health


Close of Workshops

Complimentary Kick Off Session

The ROI on R&I: How to Make Your Member Rewards Program Do More for Less

Quality directors are increasingly being held accountable for delivering a positive return on their reward and incentive program investments. Yet all too often, plans don’t know how to design an optimized program strategy that provides the most cost-efficient path to the next Star rating or correctly measure or attribute ROI.
As the industry’s leading member engagement company, we know how to drive performance, revenue and growth while also delivering a positive program ROI. Join us for an in-depth look at how we helped one plan design a program that’s projected to deliver a 12:1 ROI and a 4X lower cost per care gap closed.

  • Discover how to accurately estimate your R&I program’s ROI and why it’s more than likely delivering a negative return on your investment
  • Learn how an optimized (opt-in) program strategy delivers more closed care gaps for significantly less reward spend
  • Hear about 5 proven strategies to drive quality (and revenue) while driving down overall program costs

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


Close of Complimentary Kick Off Session

Tuesday, December 3, 2019

Registration & Continental Breakfast


Chairperson’s Welcome & Introduction

Organizational Building Blocks to Boost STARS & HEDIS Scores

Balancing CMS Regulations With Your Business Needs

This session will provide a brief overview of recent Medicare Advantage changes in regulation and initiatives.

  • Review major MA regulatory changes finalized in the past year
  • What can we expect from MA in 2020 and beyond?
  • How to be proactive in regulatory process
  • Use of forthcoming regulatory changes to guide your business strategy

Aldiana Krizanovic, MPH, CPH, Senior Health Policy Consultant for Federal Government Relations, Florida Blue


Case Study: 3 Keys to 5-Star Success -- Organizational Culture, Member Satisfaction and Provider Engagement

Hear how to transform organizational culture, boost member satisfaction and engage providers to achieve and maintain 5-star ratings. Find out how Cigna-HealthSpring moved the needle from 4+ to 5 stars during 2019 Star Ratings. Learn how providing the tools and venues for the health plan, providers, and members to collaborate to drive the best patient experience, quality of care and outcomes.

  • Find out how to drive organizational culture to achieve 5-Star results
  • Learn how patient experience improvements support the desired overall outcomes
  • Create ongoing performance monitoring processes to engage providers

Tamara Matos, Business Project Manager, Stars Operations Director-Miami, Cigna-HealthSpring of Florida


Case Study: Gaining Interdepartmental Buy-in to Achieve 5 Star Ratings

  • Creating sustainable, continuous process improvement
  • Creating a high performing 5 Star Team
  • Avoiding pitfalls that jeopardize long term improvement

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


Networking Refreshment Break


Integrating STARS & HEDIS Measures to Boost Performance Scores

Health Plans are challenged to close Quality Gaps in Care for the HEDIS Star measures.  HEDIS measures contribute about 25% of your Stars score – what are you doing to impact performance on these measures?  This session will explore key interventions to improve HEDIS rates and impact your Medicare Star Rating.

  • Share a common goal and vision for all teams to strive towards
  • Include all levels of leaders and staff in the planning
  • Track progress and ensure stakeholders are active in the entire process
  • Collaborate with provider partners to share successes and strategies
  • Communicate progress and celebrate wins

Karen Manning, Director Strategic Quality Programs, Martin’s Point Health Care


Panel Discussion: Secrets to Achieving Higher STAR and HEDIS Scores


Karen Manning, Director Strategic Quality Programs, Martin’s Point Health Care


Recipe for Success: The Secret Sauce to Immediately Improve Stars Performance

Mick Twomey, President and Chief Operating Officer, Hyperlift, Inc.

Enhancing Member Experience & Engagement to Improve Satisfaction

Case Study: CAHPS & HOS – Improving Patient Experience

Combat challenges in member perception of care and identify strategies to improve satisfaction of care as it relates to CAHPS & HOS results. Learn Best Practices from a 5-Star Plan -- Acquire knowledge to improve scores. Gain an understanding of the patient perspective.

Ana Luisa Esquivel, Stars Improvement Lead, CarePlus HealthPlans / Humana Inc.


Networking Lunch


Panel Discussion: HOS – Boosting Those Elusive Scores


Karen Manning, Director Strategic Quality Programs, Martin’s Point Health Care

Noreen Hurley, Program Manager, Star Quality & Performance, Harvard Pilgrim Health Care

Kim Barrus, MSN, BSCIS, RN, PMP, Medical Home Manager, SelectHealth


Feature Presentation


Customized Connections – A Personalized, Concierge Approach to Member Engagement

This session will review a 360° approach to member engagement -- Making the most of your member connections to close HEDIS gaps in care, increase adherence, boost member satisfaction and more. 

  • Reimagine the personalized experience
  • Anticipate the needs of your future and existing MAPD populations
  • Build trusted relationships through meaningful conversations

Reva Sheehan, Sr. Improvement Specialist – Medicare Quality, Priority Health


Networking Refreshment Break


Case Study: Journey Mapping to Enhance Member Experience, Engagement & Retention

CMS has made clear that member experience will continue to be a key driver in achieving quality success for the Star program, and other quality initiatives. Journey Mapping is a fundamental approach for understanding and improving how your members experience your plan and what you can do to improve that experience. It is also a great way to bring a team together to foster collaboration. This session will explore:

  • How to decide which journeys to explore
  • How to structure your event
  • Identifying pain points and how to fix them
  • Keeping focus and insuring something gets done – always the hardest part!

Noreen Hurley, Program Manager, Star Quality & Performance, Harvard Pilgrim Health Care

Saeed Aminzadeh, CEO, Decision Point Healthcare Solutions


Case Study: Behavioral Health -- Member Engagement and Provider Collaboration

Lauren Easton, Vice President of Innovations, Commonwealth Care Alliance


Case Study: Community Engagement to Identify Social Determinants of Health and Build Member Trust

CareSource has worked to build unique partnerships with Employers & Community Based Organizations since 2015. This session will focus on lessons learned, pitfalls to avoid & how to develop mutually beneficial relationships.

  • How to address quality measures through CBO & Employer Partners
  • Lessons learned from both pilot programs and moving to scale
  • Open discussion on moving forward.

Karin VanZant, MPA, VP, Integrated Community Partnerships, CareSource


Identify the Next Best Action for Stars Engagement

Enam Noor, CEO & Founder, Insightin Health


Panel Discussion: Improving Member Satisfaction, Experience & Engagement to Increase Plan Performance


Michael Cipullo, Director of Stars, Blue Cross Blue Shield Massachusetts


Networking Reception

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, December 4, 2019

Networking Continental Breakfast


Chairperson’s Remarks

Enhancing the Pharmacy Benefit: Interdisciplinary
Teamwork, Member Compliance & Improving Outcomes

Case Study: Part D Stars -- An Interdisciplinary Approach to Improving Star Ratings

The pharmacy benefit is arguably the most visible benefit offered by a Health Plan.  What steps do you take to collaborate both internally and externally to improve your metrics?  Where are the opportunities to create meaningful benefits to both your members and your plan?

  • Collaborating with you QA team to improve STAR measures
  • How is you PBM working with you to improve STARS?
  • Learn how MTM and STARs go hand in hand
  • Incorporating your STAR measures into your pharmacy benefit
  • Working with Sales/Agents on STARs

Andy Wheaton, Medicare Pharmacist, Network Health


Matching Outreach to the Member: Targeting Interventions to Improve Pharmacy Quality and Financial Outcomes

Learn how health plans, pharmacies, and providers can collaborate in member outreach and get more from medicines. For nearly a decade, RxAnte has been helping to create more effective outreach initiatives to improve prescribing and adherence; aligning goals among plans, providers, and pharmacies; and creating tools and technologies to support pharmacy- and provider-led interventions. Join this session presented by Kerri Petrin, VP of Strategy and Business Development at RxAnte, to observe intervention programs in the field and discover how the latest trends in population health are carving out a bigger role for comprehensive pharmacy services directed toward medically complex patients.

  • Understand the connection between improved intervention targeting and health plan quality and financial outcomes
  • Discover a calculated approach to assessing intervention strategies and identifying opportunities for improved targeting for nonadherent members
  • Learn the value of rethinking the pharmacists' role in interventions as it relates to financial and health outcomes for the plan and plan member

Kerri Petrin, Vice President, Client Services, RxAnte


STAR Pharmacy Related Measure Outreach Campaign Results and Common Reasons for Non- Compliance

This presentation will discuss the results of Provider and Member outreach campaigns on the Star measures below.  The analyses conducted to identify root causes of non-compliance will be shared, along with how the results have been used to shape future outreach campaigns and other QI interventions.

  • Osteoporosis Management in Women who had a Fracture 
  • Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis
  • Statin Use in Persons with Diabetes
  • Statin Therapy for Patients with Cardiovascular Disease
  • Part D Medication Adherence Measures

Debra A. Corbett, Program Director, Senior Products Clinical Services Strategy, Tufts Health Plan


Networking Refreshment Break


Case Study: Medication Adherence and Member Compliance – New Initiatives to Improve Outcomes

Medication adherence measures continue to be highly weighted making them a critical facet of any Stars strategy. Challenges for these measures are diverse and complex demanding a thoughtful multifaceted approach. With this understanding, SelectHealth has incorporated new elements to their medication adherence strategy informed by interviews with high performing plans, feedback from their provider network and discussions across the integrated system. This session will provide an overview of that work and highlight strategy interventions.

  • Shared learnings from 3 high performing plans.
  • Overview of how the plan implemented provider network feedback into the medication adherence strategy.
  • Preview early results from newly implemented interventions.

Kim Barrus, MSN, BSCIS, RN, PMP, Medical Home Manager, SelectHealth

Maximizing Quality of Care to Improve Outcomes

Panel Discussion: Transition of Care -- Avoiding ED Admissions and Readmissions with Complex Beneficiaries

When beneficiaries and health plan members leave an acute care facility, providers and payers have the opportunity to work together to ensure a safe transition. By engaging complex Medicare beneficiaries, health plans can improve outcomes such as reduced readmissions.

During this panel, attendees will learn about how state initiatives and technology are empowering health systems and health plans to work collaboratively to better serve their communities.

  • Learn the strategies and impact of beneficiary engagement from both the provider and health plan perspective
  • Hear how health plans and care providers are working collaboratively to improve health outcomes
  • Understand how to capitalize on innovative delivery approaches, data sets, and beneficiary engagement to achieve Star Rating improvement


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


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

Shara Cohen, Vice President, Customer Experience, Wolters Kluwer


Networking Lunch


Addressing Social Determinants of Health -- Changing the Way We Care for Our Members

Addressing social determinants of health (SDOH) and health disparities requires a multi-faceted approach between clinical teams and insurance providers.  Geisinger has moved beyond traditional medical care to provide coordinated social services and opportunities to our patients and health plan members while connecting them to programs that address health disparities and improve health outcomes.

  • Highlight the impact of SDOH on our patients and members
  • Learn about addressing food insecurity through a “Food As Medicine” approach
  • Understand how you can reduce barriers to care with a transportation pilot
  • Understand how health insurance benefits are utilized
  • Share proposed benefit redesign at insurance provider level

Maria Welch, Sr. Wellness Specialist, Geisinger


Overcoming Barriers to Achieving Stars from an Equity Perspective

Join us in discussing how we can expand the support of our members facing challenges in health literacy, understanding their health plan benefits, impacted by social determinants of health barriers, and collectively improve the effectiveness of early interventions.

Toc Soneoulay-Gillespie, MSW, Social Services Manager, Population Health Partnerships, CareOregon

Anna K. Lynch, MPH, Member Engagement Manager, CareOregon


Networking Lunch


Tailoring Interventions to Increase Health Outcomes for Dual Eligible Populations

Dual eligible populations respond differently to interventions tailored to traditional Medicare Advantage populations. A substantial portion of UCare’s dual eligible membership are immigrants who face cultural and language barriers that can limit the amount of influence a health plan has in regards to managing their health. It has also been a challenge to work with our special needs populations on prioritizing preventive screenings and filling out CMS surveys since most are dealing with underlining health issues such as chemical dependency and managing multiple chronic conditions. To solution this, UCare performed a population segmentation and barrier identification analysis to inform the creation of customized, targeted intervention and outreach strategies for key subsets of these populations.

  • Describe methods behind population segmentation and barrier identification analysis
  • Examples of customized, target interventions for immigrant and special needs members
  • Lessons learned and looking towards the future

Rachel Sterner, Stars Program Manager, UCare


Lessons Learned: Transformation into a High-performing DSNP Stars Program

Gateway Health has never achieved 4.0 Stars but is on the fast track to Stars success.  Learn how an underperforming DSNP plan underwent a transformation into a high-performing organization set on achieving and maintaining 4 Star performance. We will review changes to the operating model, organizational structure, program management, and innovation strategies that have led to significant performance improvements and a culture of Operational Excellence.

Dan Weaver, Vice President, Stars Quality, Gateway HealthFormerly Director of Program Management, Government Business, Quality Improvement Highmark


Case Study: Maximizing the Value of the In-Home Health Assessment for Stars, HEDIS & Risk Adjustment

Does your plan offer in-home health assessments for members? If so, have you fully utilized all data elements collected in the home to boost your HEDIS rates with additional gap closures? Join me as we review the benefits and impacts of in-home health assessments not just for your members but for your plan. Maximizing the various elements of the assessment connects the member to additional plan offerings while connecting dots internally. This session will dive deeper in to the data collected in the home which has positively impacted our enrollment process, care management, operations, HEDIS, Stars and risk adjustment.

Jennifer Cobb, Manager 5-Star Quality, Priority Health


Networking Refreshment Break

Provider Engagement & Incentives: Building Collaborative Models

Transitioning Providers to Value based Reimbursement by Integrating Monetary and Clinical Resource Incentives

Effectively incentivizing providers requires more than a carrot and stick methodology.  Incentive programs need to be designed to effectively shift both PCP and specialist providers from FFS mentality to value based reimbursement.   Establishing a program that integrates both monetary incentive with resource support will maximize quality results.

  • Understand the need for both monetary and non-monetary based incentives
  • Explore inclusion for both PCP and specialist providers
  • Discuss the value of a well-executed incentive program

Jennifer Hayes, DNP, CPC, CPCO, CDEO, CRC, AAPC Fellow, Manager, Quality, HEDIS & Coding Revenue Program Management, Highmark


Rethinking the PCP Incentive Program to Drive Quality Results

More providers are engaging in value-based contracts and payment arrangements. More payers are looking to drive better quality and clinical results. This session will discuss how Johns Hopkins HealthCare developed their Medicare Advantage PCP Incentive program that significantly increased their star rating as well as the basics for structuring a program that drives results.

Damien Doyle, MD/CMD/FAAFP, Medical Director, Medicare Advantage MD / USFHP, Johns Hopkins HealthCare

Lucretia Hydell, Director of Actuarial Services, Johns Hopkins HealthCare


Close of Conference