Agenda

Networking Continental Breakfast

Chairperson's Welcome

What's Behind the New Imperative to See Members as Consumers

CMS has announced that the weight of patient access and experience Star Ratings measures will increase from 1.5x to 2x for the 2019 measurement year, while signaling its intention to further increase the weights of these measures in the future. These and other recent developments provide a consumer-centric lens through which MA plans should make decisions on their Star Ratings strategies and investments for the foreseeable future.

Data-Driven Medicare Star Rating Improvement

Medicare Advantage Star ratings cut points are moving targets. How do you know whether your efforts this year will maintain, increase or decrease your rating? If you used consumer data to prioritize measures and member groups for outreach, would it make a difference in gap closure? Improving your plan's Star rating performance means knowing where next year's cut points are likely to go… identifying the key measures where you can have the most impact… understanding exactly which members to target with outreach… and measuring the results in real time. With the right strategy informed by data and consumer segmentation, you can take the guesswork out of your Star rating improvement plan.

NCQA and the Future Direction of HEDIS® Outcomes-based Measures

Discussion of the future of HEDIS® based on NCQA's trend toward outcomes based measures. The discussion will focus on HEDIS® Effectiveness of Care measures: Medication Reconciliation Post- Discharge (MRP) and Transitions of Care (TRC). HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Networking Refreshment Break

Eliminate Organizational Silos to Improve Star Rating Outcomes

An effective Star Ratings program requires the engagement and action of everyone working at the health plan. Stars measures are impacted by every aspect of operations at the health plan as well as what the provider partners do. Working as one unified team towards a common goal is the only way to reach top decile performance. Departmental silos are seen as a pain point in many highly successful organizations. With the financial impact Star Ratings have on Medicare Advantage products, it is necessary that leadership, from the top down, prepare and equip all teams with a strategy that will eliminate silos, and encourage collaboration and improvement among the entire organization.

• 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

CASE STUDY: Integrating HEDIS & STARS in Pay-for-Performance Programs

SelectHealth utilizes pay-for-performance programs as a tool to help improve HEDIS and Stars measures. This session will provide an overview of the SelectHealth Patient Centered Medical Home program. During this presentation SelectHealth will share the measure selection process, how the SelectHealth team supports participating primary care offices, impact on measure performance at participating clinics and lessons learned.

Networking Lunch

Feature Presentation

CASE STUDY: How to Measure & Manage Beneficiary Experience & Operational Measures to Improve Star Ratings

CASE STUDY: Improving CAHPS & HOS Rates

CAHPS and HOS are like the last frontier in Stars Improvement. However, this area represents an increasingly large percentage of the Stars Measures. Learn how a regional Health Plan in Puerto Rico uses an interdepartmental Satisfaction Committee and a Simulated CAHPS/HOS Satisfaction Survey to improve CAHPS and HOS rates.
This Session will describe the MCS Satisfaction Committee and how it is empowered to survey, analyze, and recommend initiatives and incentives for Providers and Members, to increase overall Member Perception on Satisfaction and Health. This session will also give an overview of how this regional Health Plan implemented an annual CAHPS and HOS-like Satisfaction Survey, conducted by the Plan’s CAHPS/HOS vendor, to determine which member demographics may require interventions and focused initiatives.

A CAHPS-Centric Approach to Holistic Member Engagement & Medicare Star Improvement

CAHPS measures are not stand-alone concepts. A member's perception of access and satisfaction significantly impacts their health, health-seeking behavior and their attitude towards the plan. How can plans deploy a CAHPS-centric approach to improving performance across multiple measures and targeting multiple outcomes without over-communicating with members? Can plans be effective in orchestrating impactful, yet efficient, member-centric outreaches spanning multiple domains?

In this session, Mr. Aminzadeh will discuss approaches to improving overall CAHPS performance while also impacting other critical metrics such as reduction in voluntary disenrollment, and improvement in quality, adherence and utilization.

Networking Refreshment Break

CASE STUDY: Harnessing Data for Member Incentives

Member incentives have become one of the newer levers that we can push to both engage our members and improve certain gaps in care. Data and analysis can help us optimize this tool and increase the effectiveness of rewards for both the plan and the members. We'll discuss traditional/non-traditional data sets, segmentation and selective campaigns as tools to enrich an incentive program.

CASE STUDY: Effectively Engaging Customers in an Ongoing Process

CASE STUDY: Reducing Readmissions Through Improved Transition in Care Management

Plan All Cause Readmissions is a tripled weighted Medicare Stars measure, and a key indicator of Health Plan quality. This session will discuss how Tufts Health Plan's Senior Products Division adapted the Project Red (Re-engineered Discharge) protocols for implementation in a managed care setting.The tools used and processes designed to conduct Health Care Facility gap analyses, analyze root cause of readmissions, predict risk of readmission, as well as for care management post discharge, 2 day assessment, 7 day medication reconciliation and week 2 thorough 4 follow-up will be described. Lessons learned to data will be shared.

CASE STUDY: Overcoming Social Determinants of Health Barriers That Prevent Members From Getting Care

Social Determinants of Health (SDOH) are the structural determinants & conditions in which people are born, grow, live, work, and age. They include factors like economic stability, physical environment, education, food, and transportation. As much as 60% of an individual’s health outcomes are impacted by SDOH. Anthem is building solutions that address SDOH at the national and local level.

• Providing transportation solutions that reduce inappropriate ER utilization via partnerships with ride share vendors and local municipalities.
• Addressing one of the biggest drivers of health and wellbeing by exploring ‘food as medicine’ opportunities.
• Expanding availability by empowering paramedics to provide more care in the home and community.
Supporting ‘housing first’ initiatives and employment opportunities for members in partnership with key national accounts and community partners.

Networking Reception

Networking Continental Breakfast

Chairperson’s Remarks

Building a 5-Star Plan With a Dual Eligible and Low Income Population

HealthSun has propelled from a 3 star to a 5 star plan in a few short years. This session will examine the strategies that ensured a health plan with 84% dual eligible and low income subsidy population reached the highest level of the CMS quality rating. Specifically, we will examine the strategic development of an internal multi-disciplinary team, enhancements of data reports and report cards, identification of best practices with implementation of a P4P program, and engagement and empowerment of the primary care physician.

Improve Your Part C Appeal Measures to Increase Your Overall Star Ratings

Both Part C appeal measures have a weighted average of 1.5. This session will identifying opportunities to improve your star ratings by:

• Tracking and trending your plans coverage determinations
• Tracking and trending the IRE’s redeterminations
• Monthly audit of the IRE’s appeal decisions and timeliness report
• When Is it okay to contact the IRE

CASE STUDY: Integrating Physical Health and Behavioral Health, Member Engagement and Community Resources

Networking Refreshment Break

The Impact the Timeliness Monitoring Project (TMP) has on the Four Appeals Measures

In the 2019 Call Letter, CMS announced scaled reductions for Appeals IRE data completeness issues. CMS introduced the Timeliness Monitoring Project (TMP) in CY 2017. The scaled reduction methodology will be a three-stage process using the TMP data or audit. This session will explore how to apply the methodology and for plans to test and evaluate performance throughout the year.

Case Study: Improving Star Ratings and Member Satisfaction with text message-based Conversational AI

This session will go in-depth on how Kaiser Permanente leverages the mPulse Mobile Conversational AI solution to improve chronic condition medication adherence by 14 percentage points in their non-adherent Medicare population. Nicholson will walk through solution design, implementation and outcomes while demystifying the mobile behaviors of the Medicare population. If you are looking for effective solutions for improving Star Ratings, this is a not-to-be-missed session.

Networking Lunch

CASE STUDY: Provider Engagement & Education – Best Practices for a Quality Incentive Program

Join us for a session that will introduce best practices for Quality Incentive Program provider education and training. We will examine documentation requirements that will allow providers and their clinical coders to submit and close HCC care gaps on claims, as well as discuss best practices for addressing and submitting quality measure information that will satisfy HEDIS requirements.

CASE STUDY: Provider Engagement and Education: How a Small Plan is Going Big

CASE STUDY: An Integrated Approach to Total Performance Across All Part D Measures

Strong performance across Part D measures is critical to overall Medicare Star Rating success. We will explore everything from formulary considerations, retail pharmacy partnerships, the importance of a strong MTM program, and targeted medication adherence programs working together to boost overall Part D performance.

CASE STUDY: Effective Community Pharmacy Partnerships Aimed at Boosting Star Medication Adherence Performance

As health plans recognize the substantial impact of the triple weighted Star Medication Adherence measures in relation to overall Star rating performance, efficient member engagement strategies will need to be deployed to either sustain or boost Star ratings. This session will discuss the advantages of establishing community pharmacy partnerships, and best practices for successful implementation for sustainable Medication Adherence Star measure results.

• Recognizing the advantages and disadvantages of Medication Adherence pharmacy partnerships
• Effectively designing pharmacy partnerships for greatest Star measure impact
• Strategies to optimize the value and performance of Medication Adherence pharmacy partnerships

Close of Conference