Agenda

June 25,2019

12:30 pm
Registration and networking Breakfast

1:00 pm

SNIPs 101: Critical Factors from Concept to Launch

Review applications do and don’ts
Understand how to establish network adequacy
Learn how to demonstrate financial alignment
Hear about strategies for stratifying risk 
Gain what you need to know to master ICT’s (interdisciplinary care team) and ICP’s (interdisciplinary care plan)
Examine examples of value-based initiatives and how you can implement them
Review strategies on how to effectively negotiate and manage MIPPA agreements 


Hank Osowski, Managing Director
STRATEGIC HEALTH GROUP 
 
Laura Cline MSN, FNP-BC, C-NE, RAC-CT, Director of care coordinator 
CANTEX CONTINUING CARE NETWORK
 
Patsy Tschudy, Director of Managed Care
CANTEX CONTINUING CARE NETWORK 

5:00pm
Cocktails

June 26, 2019

7:30 am

Welcome Remarks

 Kara Curtis, Program Manager, Dual Eligible Special Needs Plans
BOSTON MEDICAL CENTER, HEALTHNET PLAN

8:30 am

Keynote: Examining the Challenges and Opportunities Facing SNP Plans

  • Understand new policies effecting implementation and growth of SNP’s 
  • Review dynamics that are getting in the way of advancing integration 
  • Examine what is getting in the way of growing special needs plans 
  • Look into the future for opportunities we have 
  •  yet to explore 

 

Cheryl Philips, President and CEO

SNPs ALLIIANCE  

9:15 am

The Future of D-SNPs and State Integration

  • Understand key differences between D-SNP, FIDE SNP and Medicare-Medicaid Plan (MMP) plan types 
  • Examine trends in state SNP and MMP markets 
  • Review of new integration and integration sharing standards for plans
  • Understand states’ perspective with maximizing the opportunities and managing the challenges of FIDE SNP transition 
  • Learn about opportunities for working well with State Medicaid Agencies on integrated D-SNP programs
Nancy Archibald, Senior Program Officer
CENTER FOR HEALTH CARE STRATEGIES
 
10:00 am
Networking Break

10:20 am

How ISNPs Fit in An Integrated World

  • Examine Medicaid efforts to increase the use of home and community-based services and understand how this impacts states’ views of I-SNPs. 
  • Learn how to help states see the value of I-SNPs. 
  • Discuss potential strategies that I-SNPs can use to partner with states to promote person-centered, integrated care.   

 

Karen Kimsey, Chief Deputy Director

State Health Partners

 

Suzanne Gore, Founder and CEO 

State Health Partners 

11:00 am

Leveraging Supplemental Benefit Authority to Address the Social Determinants of Health

  • Examine SNP goals to address Social Determinants of Health with strategic alignment to the model of care
  • Review challenges and barriers to address SDOH in SNP population
  • Inform financial risk through data analysis and evaluation of each specific supplemental benefit identified to address social determinant of health in the SNP population
  • Consider supplemental benefit impact to HEDIS and CMS Stars measure performance 
  • Operationalize business activities to enhance member access of supplemental benefits to meet SDOH needs through communication, risk identification and trigger events
 
Roseann DeGrazia, Vice President Regional Network
UPMC HEALTH PLAN

11:40 am

Meaningful Language Access Workshop

  •  Recognize the unique and essential role of an interpreter, service provider, and how together, they honor the voices that are often unheard; 
  • Explore how effective interpretation impacts the power, privilege and access to communication and information; 
  • Share and exchange interpreting tools and techniques to reduce interpreter error and improve access. 

 

Toc Soneoulay-Gillespie, MSW, Social Service Manager  

CareOregon 

12:20 pm
Lunch

1:20 pm

Effective Strategies for Integrating Behavioral Health

  • Engaging primary care providers in identifying and coordinating behavioral health services 
  • Delivering primary care services where the member is, not where you want them to be 
  • Tapping into community behavioral health resources to supplement a member’s personal care plan 

 

Lauren Easton, Vice President of Innovation 

COMMONWEALTH CARE ALLIANCE 

2:00 pm

Care Management Strategies (HRA’s, Transitions, and Individualized Care Plans):

  • Learn about Care Oregon's Regional Care Team Model  
  • Learn how to improve HRA completion rates 
  • Triaging the work 
  • Transitions of Care  
  • Strategically utilize telephonic, community-based, and embedded staff  
  • Understand how to best utilize technology  
  • Understand how individualized care plans are built from assessments within our care management platform, GSI Health Coordinator 
  • Population Segmentation; Proactively identify populations to target  
  • Evaluate of Technology solutions 

  

Karissa Smith, LPC, CADC ISenior Operations Manager 

CAREOREGON 

Melodie FarmerQuality Assurance Program Manager 

CAREOREGON 

2:40 pm

PANEL: An Examination of Challenges for Moving towards Medicare-Medicaid Integration

Moderator:

Kara Curtis, Program Manager, Dual Eligible Special Needs Plans 

BOSTON MEDICAL CENTER, HEALTHNET PLAN 

 

Panelist: 

Taib Dedic, Director, Product Development 

CENTENE CORPORATION  

 

Lauren Easton, Vice President of Innovation

COMMONWEALTH CARE ALLIANCE 

 

Garrison Rios, Executive Director of Cal MediConnect and Medicare Operations 

L.A. HEALTH CARE PLAN 

 

3:20 pm
Networking Break

3:50 pm

Campfire Discussion: Moving to the Future Utilization of Technology: Evaluation, Implementation and Considerations

  •  Examine the rapid convergence of technology, networking and care
    • Telehealth
    • Robotics
    • AI and Machine Learning
  • Understand goals for technology
    • Increase understanding and usage of data exchange
    • Means to better utilize human resources
    • Provide previously unattainable conclusions and predictions
  • Review the regulatory and technical challenges of care management and remote patient monitoring  
  • Learn how others evaluate and implement technology 
    • Ie: what team members do you involve  
 
Kara Curtis, Program Manager, Dual Eligible Special Needs Plans
BOSTON MEDICAL CENTER HEALTHNET PLAN

4:30 pm

Fireside Chat: Brainstorming on The Future of Social Issues in Healthcare – How Will We Build ROI?

  • Understand how investing in social programs like housing, food and transportation reduces healthcare costs 
  • Examine analytics needed to demonstrate use of programs – “closing the loop” 
  • Definition of what ROI will look like in this future 

 

Cynthia Napier Rosenberg, M.D., Associate Vice President, Medical Services 

UPMC HEALTH PLAN  

 

James D Milanowski, President & CEO 

GENESEE HEALTH PLAN 

5:15 pm
Closing Remarks
5:30 pm
Networking Cocktail Reception

June 27, 2019

8:00 am
Networking Breakfast

9:00 am

Opening Remarks

Chairman: Kara Curtis, Program Manager, Dual Eligible Special Needs Plans 

BOSTON MEDICAL CENTER HEALTHNET PLAN 

9:00 am

Communication Strategies for Membership Acquisition and Retainment

  • Review of systems for meetings and training 
  • Understand effective strategies prior to enrollment
    •  Gass roots marketing 
  • Examine verification systems throughout the sales process: 
    • Verification of Key Providers
    • Verification of Meds to ensure there are no changes in copays 
    • Verification of pending processes to ensure continuity of care 
  • Learn how to implement a sales checklist 
    • Ensure the completed checklist is handed off to the Clinical team 
    • Conduct Welcome Calls
Yisel De Llano, Senior Director SNPs Plans
FLORIDA BLUE

9:45 am

So, You Got Your Audit Engagement Notice…. What Happens Now?

  • Understand what you are going to go through during a program audit 
  • Review the CMS Audit Protocols and recent CMS Changes 
  • Understand the areas that plans are regularly failing and how to ensure you don’t 

 

Nancy E. Erickson, BSN, MHA, Director  

BLUEPEAK ADVISORS 

10:30 am
Networking Break

11:00 am

Operationalization of Systems for Smooth Audits

  • Understand how Human operationalized audit preparedness  
  • Learn how compliance and quality work together  
  • Hear about Humana’s audit methodology and tools 
  • Discuss ongoing monitoring and reporting  
  • Hear about new technologies that help Humana streamline audit preparedness 

 

Gretchen Wagner, Home Compliance & Risk Management Healthcare Services 

HUMANA 

 

Kim Chen, Director of Operations 

HUMANA 

11:45 am

CASE STUDY: Maximizing Audit Preparedness: Effectively Preparing for the Unique Challenges of SNPs

  •            Adopt best practices to prepare for and prevent common mistakes in a CMS Audit 
  •            Prepare a Corrective Action Plan to meet audit requirements
  •            Understand the Validation Audit process
  •            Overcome common compliance issues specific to SNPs

 

AngelaLloyd, Director Medicare Audit & Corrective Action 

HEALTH PARTNERS PLANS 

 

Michelle Fogg, Manager Medicare Operational Compliance 

HEALTH PARTNERS PLANS 

12:30 pm
Networking Lunch

1:30 am

Case Study: Datamining Approach Assessing Supplemental Benefits

  • Learn how Gateway Health has designed a comprehensive data integration effort aimed to formulate evidence-based strategies that enhance member satisfaction, improve cost control, and optimize quality scores. 
  • Review categories of data integration needed for a thorough analysis  
  • Administrative Data 
  • Clinical Data 
  • External Data 
  • Examine methodology and reasoning on population segmentation 
  • Review how Gateway formulated its strategy based on data 
  • Analyze Gateway’s design and evaluation of interventions 

 

Fernando Arbelaez, Senior Director, Research, Development and Analytics 

Gateway Health 

2:15 pm

Model of Care Narrative Designs for Audit Readiness

  • Examine ways to balance MOC commitments and flexibility 
  • Understand how to analyze your MOC to identify risk areas  
  • Review considerations for risk stratification  
  • Learn how to leverage the off-cycle/”redlined” MOC submission 

 

Caroline Wilson McDonald, Principal 

PRIZM HEALTH ADVISORY, LLC 

3:00 pm
Closing Remarks

Kara Curtis, Program Manager, Dual Eligible Special Needs Plans 

BOSTON MEDICAL CENTER HEALTHNET PLAN