Agenda

June 28, 2021

8:00AM - 8:45AM
Registration and Networking Breakfast
8:00AM - 6:00PM
Exhibit Hall Opens

9:00AM - 9:45AM

Keynote Address: CMS Quality Measures Update

An in-depth analysis of the overall CMS expectations for quality ratings in 2021 and beyond 

Richard E. Wild, MD, JD, MBA, FACEP, Chief Medical Officer, Atlanta and Boston Regional Offices
Centers for Medicare and Medicaid Services (CMS)

9:45AM - 10:30AM

CAHPS Best Practices to Improve Member Satisfaction and Perception

  • Explore how to capture and leverage data/ CAHPS metrics at scale to better understand members and behavioral drivers 
  • Examine the shift in focus to member experience and assess how to allocate resources to pivot effectively 
  • Hear how to optimize member touchpoints and understand how to work cross functionally in the enterprise to impact member perception and satisfaction 
  • Discuss a consumer-centric model and best practices to help members understand benefits while avoiding abrasion and reducing complaints and grievances 

Moderator:
Ana Handshuh, Principal
CAT5 Strategies
Chair
RISE Revenue & Quality Community

David Larsen, Director, Quality Improvement
SelectHealth

David Meyer, Senior Vice President, Quality Outcomes and Informatics
NationsBenefits

Rex Wallace, Principal
Rex Wallace Consulting

10:30AM - 11:00AM
Networking Break

11:00AM - 11:45AM

Provider Perspective Panel Discussion

  • Hear from providers on effective communication and education efforts around quality and Stars  
  • Get insights into successful incentive programs used with providers to steer behavior  
  • Understand strong motivators for providers and how to foster a strong patient/provider partnership 
  • Gain best practices on EMR adaptability and integration into provider’s workflow to reduce burnout 
  • Discuss the Provider Engagement/Patient Engagement/Quality system dynamic 

Dr. Shannon Decker, M.Ed., MBA, PhD., Vice President, Clinical Performance
Brown & Toland

Vishal Bhalla, MBA,MS,CPXP,SPHR, Vice President and Chief Experience Officer
Parkland Health & Hospital System

Dr. Jatin Dave, Chief Medical Officer and Director of Clinical Affairs
MassHealth

11:45AM - 1:00PM
Networking Lunch

1:00PM - 1:45PM

Concurrent Sessions

Track A: Member Experience Journey - Full 360 View of Touchpoints

Member Services Spotlight: Insights and Tactics into Elevating Customer Experience

  • Gain insights into call volume trends, top concerns, and wait times 
  • Examine ways to proactively support and train the member services team  
  • Discuss best practices to develop tracking of members with unresolved issues that might result in CTMs and ways to escalate them 
  • Hear how to proactively address pain points and identify them 

Holly Moore, ‎Director of Operations
‎Regence BlueCross BlueShield of Oregon

Elizabeth Dreher, Manager, Operations Regulatory Logistics
Regence

Track B: Population Health

Making SDoH Practical: Embedding SDoH in Quality Programs

  • Examine health disparities and understand how to embed SDoH into quality program initiatives to create scalable impact  
  • Hear initiatives to impact specific populations through alignment of quality and SDoH efforts 
  • Discuss ways to strategize and use social determinants of health to drive and tailor services and remove barriers 

Kurt Waltenbaugh, Founder and CEO
Carrot Health

1:45PM - 2:30PM

Concurrent Sessions

Track A: Member Experience Journey - Full 360 View of Touchpoints

Marketing/Member Acquisition Spotlight: Impacting Member Perception from a Marketing Lens

  • Gain insights into disenrollment trends and member engagement strategies  
  • Hear how to draw attention to benefits to impact member perception  
  • Understand how to look at member behaviors to tailor communication preferencesavoid member abrasion, and ensure positive survey results 

Track B: Population Health

Case Study: Hear from California Department of Health 2020 Health Equity Award winning program, Insulin Advisors at Scan Health Plan. A targeted engagement initiative for Spanish-speaking members with diabetes.

Melanie Weir, Chronic Condition Project Principal,
Scan Health Plan

Rosaneli Loza, Manager, Connecting Provider to Home
Scan Health Plan

2:30PM - 3:00PM
Networking Break

3:00PM - 3:45PM

Concurrent Sessions

Track A: Member Experience Journey - Full 360 View of Touchpoints

Provider Relations Spotlight: Actionable Ways to Boost Member Satisfaction through provider Engagement

  • Understand major pain points and challenges for the provider relations team 
  • Hear best practices on provider training when dealing with members and how to set appropriate expectations  
  • Discuss waiting room protocol strategies and ways to improve wait time 
  • Explore value-based contracting strategies to tie back contract to overall performance not just gap closure 

Track B: Population Health

Population Health Strategies and Analyzing the Impact of the Pandemic

  • Understand how to stratify member population to best target and meet members’ needs 
  • Explore which population health initiatives have been most effective and hear ways to gauge or measure results 
  • Discuss looking at quality measures through a health equity lens and hear how to educate providers to speak the right language 

Tejaswita Karve, Ph.D., Director, Quality Improvement
Johns Hopkins HealthCare

Janine Sala, Director, Population Health, Quality Improvement
UnitedHealthcare

3:45PM - 4:30PM

Concurrent Sessions

Track A: Member Experience Journey - Full 360 View of Touchpoints

Case Study: Highmark’s interdepartmental outreach effort that successfully engaged members with deferred care and at least one chronic condition to receive care and close gaps for MY2020.

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

Track B: Population Health

The Impact of the Pandemic on the Behavioral Health Population

  • Discuss the different mental health and substance abuse implications of thepandemic and how to manage care moving forward  
  • Hear best practices to engagebehavioral health patient population and encourage medication adherence  
  • Prognosticateon the future of telehealth and teletherapy in behavioral health and how it can evolve to continue to meet members’ needs 

Kimberly Swanson, MPA, Vice President, Quality and Clinical Integration,
Network Health

4:30PM - 5:15PM

Actionable Collaboration between Quality and RA to Achieve Optimal Results

  • Identify medical record collection overlap and understand how to optimize converging member touchpoint efforts to avoid member abrasion 
  • Gain insights into simultaneous review of risk and care gaps as one unified goal between RA and quality 
  • Train staff more effectively for better interdepartmental alignment and synergy  
  • Understand considerations for risk adjustment and quality around telehealth encounters, appropriate coding, and closing gaps in care 

Pulse8 speaker 

5:15PM - 6:15PM
Networking Cocktail Reception

June 29, 2021

8:00AM - 8:45AM
Networking Breakfast
8:00AM - 3:00PM
Exhibit Hall Opens

8:45AM - 8:50AM

Opening Remarks

8:50AM - 9:30AM

Keynote

To be announced

9:30AM - 10:15AM

Industry Roundtable: Stars Landscape Review and Lessons Learned from 2020

  • Explore annual wellness visits revamp in 2021 and strategic messaging around safety  
  • Look into new measures and weights such as Transitions of Care and Member Experience measures and discuss ways to modify strategies to tackle them 
  • Address deferred care across the board through patient stratification and discuss the impact of the pandemic on chronic condition management and spending in 2021 
  • Prognosticate on upcoming changes by the Biden administration and how it will affect the Stars landscape  
  • Navigate the future of telehealth and examine opportunities with leniency from CMS   

David Larsen, Director, Quality Improvement
SelectHealth

Katharine Iskrant, MPH, CHCA, CPHQ, Practice Leader
Healthy People, Inc.

Daniel Weaver, VP Stars and Government Quality Improvement Programs
Gateway Health Plan

10:15AM - 11:00AM ET

Building Culture of Quality and Service Excellence to Achieve or Maintain 5 Stars

  • Hear best practices to advocate for quality with leadership while showing value and obtaining commitment from higher ups in the organization 
  • Provide evidence-based research and understand how to show trends and improvements in higher level data   
  • Dive into strategies to build-up staff and create structure for an organization devoted to quality and service excellence  
  • Explore ways to focus resources on key measures that will move the needle and maximize quality results  

Kristy Smith, HEDIS Program Manager
Martin’s Point

Joshua Edwards, STARS Program Manager
Martin’s Point

 

11:00AM - 11:30AM
Networking Break

11:30AM - 12:15PM

Concurrent Sessions

Track A: HEDIS

HEDIS 365: A Year-Round Approach to Quality

  • Get best practices for a more robust interventions during “off-season”  
  • Discuss supplemental data strategies to close gaps throughout the year  
  • Explore innovative ways to engage members and close gaps in a COVID-19 environment 
  • Hear provider training tactics to understanding HEDIS and Stars as a year-round process 

Track B: Part D Focus

Medicare Part D 5-star Strategy to Boost Member Experience

  • Discuss correlation between access to medication and CAHPS and how to thrive in a COVID-19 environment  
  • Examine ways to synergize efforts between part D and part strategies to maximize quality results 
  • Navigate regulatory changes coming down the pipeline in part D around CMS rebates and pricing that can impact customer satisfaction  

Noris Reyes, Chief Operating Officer
PrimeHealth Physicians

Ryan Davis, Medicare Market & Operations, Senior Manager
Centene

12:15PM - 1:30PM
Networking Lunch

1:30PM - 2:15PM

Concurrent Sessions

Track A: HEDIS

HEDIS Data Collection Strategies and the Move to Digital Measures

  • Navigate the move to digital measures and how payers are positioning themselves to tackle this new shift 
  • Hear how plans continue to work with providers to collect data and close gaps in a COVID-19 environment while avoiding abrasion 
  • Discuss provider incentive structure for data and chart collection and hear what should be incentivized for optimal results 
  • Address barriers to care and examine initiatives to work around them such as in-home kits and telehealth to meet patients’ needs 

Katharine Iskrant, MPH, CHCA, CPHQ, Practice Leader
Healthy People, Inc.

Track B: Part D Focus

Best Practices to Improve Medication Adherence

• Hear innovative ways plans are encouraging medication adherence in their outreach efforts during COVID-19

• Navigate communication strategies to foster medication adherence without creating member abrasion

• Explore strategies like 90-day supply allowance for applicable medications to raise adherence rates

• Discuss how addressing social determinants of health can help drive medication adherence

2:15PM - 3:00PM

Concurrent Sessions

Track A: HEDIS

Here to Stay: Exploring the Telehealth Momentum and Maximizing Opportunities

  • Explore comprehensive provider education program around telehealth quality coding and RA reporting    
  • Analyze best practices on how payers are connecting members to providers to drive telehealth engagement and removing access barriers  
  • Understand how to capture optimal data in virtual care encounters to close on measures 
  • Discuss management and monitoring of quality for telehealth program beyond the pandemic

Dr. Shannon Decker, M.Ed., MBA, PhD.
Vice President, Clinical Performance
Brown & Toland

Track B: Part D Focus

Optimal Outcomes from Medication Therapy Management (MTM)

• Explore the exponential rise of MTM star cut points and discuss strategies to achieve positive results

• Navigate plan design from an MTM perspective and hear ways to maximize member savings and medication adherence

• Understand challenges and opportunities of in-house, vendor, or hybrid MTM programs

Gary Melis R.Ph., Clinical Pharmacist
Network Health

3:00PM - 3:15PM
Networking Break

3:15PM - 4:00PM

Deep Dive into HOS Initiatives and Best Practices

  • Understand how to empower members to have HOS related conversations with providers 
  • Address health literacy with members and providersHear best practices when creating PCP visit checklist/tip sheet for successful visit with PCP focusing on HOS measures 
  • Integrating data to identify at risk members and having strategic interventions in place to help members with declining care especially around physical and mental health 
  • Explore ways to educate customer service team on how to ask the right HOS related questions when interacting with member 

Rex Wallace, Principal
Rex Wallace Consulting

Ana Handshuh, Principal
CAT5 Strategies
Chair
RISE Revenue & Quality Community

4:00PM - 4:40PM

Member Experience User Panel

Join RISE for a candid conversation with Medicare and Medicaid clients on their experience and journey as members.

Moderator:
Kathleen Ellmore, Co-Founder and Managing Director
Engagys

4:40PM - 4:45PM

Closing Remarks