Speaker Presentation
Tuesday, December 4, 2018

Networking Continental Breakfast

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.


Chairperson's Welcome

John Mark Willis, M.Ed., Senior Director-Star Operations, Cigna-HealthSpring

Building Blocks for 5-Star & HEDIS Success

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.

Melissa Smith, Senior Vice President of Sales, Marketing, Strategy & Stars, Gorman Health Group


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.

Kurt Waltenbaugh, CEO, Carrot Health


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

Kena Hahn, Director Medicare Stars & Health Improvement, Health Alliance


Networking Refreshment Break


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.

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


Driving Efficiency and Adherence Lift for Part D Star Ratings

Proper prescribing and medication adherence will make up 38% of 2020 MAPD Star Ratings performance, including the new triple-weighted SUPD measure. Being able to meet Star Ratings and internal quality goals requires access to the right information and workflows to improve targeting, timing, effectiveness, and scale. See how one RxAnte client tackled these obstacles in order to improve their adherence outcomes.

  • Understand the value of predictive analytics in improving population level adherence lift
  • Gain insight to the efficiency benefits of a workflow solution to manage monitoring/reporting tasks
  • Learn the value of identifying a blend of scalable interventions to optimize Star Ratings

Kerri Petrin, MPH, Vice President, Client Services, RxAnte

Member Experience Performance Success Ingredients for the New Consumerism Era

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

  • Ensure high call center measure performance through training, tracking and real-time issue resolution.
  • anage appeals measures throughout the year by tracking measure scores & promptly acting on opportunities.
  • ork CAHPS scores year-round by analyzing cross-departmental data sources within your health plan.
  • Jessica Assefa, Medicare Stars Program Manager, UCare


    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.

    Linda Lee, Vice President of Quality Improvement, MCS Healthcare Holdings, LLC


    Networking Lunch


    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.

    Saeed Aminzadeh, Chief Executive Officer, Decision Point Healthcare Solutions


    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.

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


    CASE STUDY: Effectively Engaging Customers in an Ongoing Process

  • Being aware of changing perspectives in customer engagement can impact outcomes related to customer health
  • Ensuring effective resources are available to customer can lead to improved customer satisfaction and improve retention
  • Coaching is key to success with difficult customers
  • The development of partnerships with the customer, provider, and payer are important for long-term improvement of health outcomes
  • John Mark Willis, M.Ed., Senior Director-Star Operations, Cigna-HealthSpring

    Boost Quality of Care to Achieve 5 Star Outcomes & Maximize HEDIS Scores

    Networking Refreshment Break


    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.

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


    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.
    This session will explore Anthem’s focus on SDOH as a means of improving the health and wellness of our members.

    Kathy Rowerdink MPH, MBA, Director, Clinical Strategy, Anthem


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

  • Overview of Commonwealth Care Alliance Integrated Model of Care
  • Interdisciplinary Teams to Support Integration and Effectively Manage Complex Members
  • Enhancing Care Continually by Improving Communication and Collaboration with Community Providers
  • Case Example
  • Lauren Easton, Senior Director, Behavioral Health, Commonwealth Care Alliance


    Reduce Risk and Improve Results: Leading Practices for Year-Round Stars Management

  • What Do We Need To Improve And Why?
  • How Should We Go About Improving Performance?
  • How Do We Make Sure We Actually Deliver On These Improvements?
  • Mick Twomey, President and Chief Operating Officer, Hyperlift


    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 5, 2018

    Networking Continental Breakfast


    Chairperson’s Remarks

    John Mark Willis, M.Ed., Senior Director-Star Operations, Cigna-HealthSpring


    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.

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


    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

    Cynthia Aguglia, Medicare Stars Administrator, Capital District Physicians’ Health Plan


    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.

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


    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.

    Chris Nicholson, Co-founder and CEO, mPulse Mobile

    Optimize Provider Engagement, Incentives and Education to Boost Star Ratings

    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.

    Marnie Frasier, CPC CRC, Medicare Provider Training & Education Specialist, Regence Blue Cross Blue Shield

    Kellee Mills, CPC, Medicare Provider Performance Manager, Regence Blue Cross Blue Shield


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

  • Increasing the size of provider engagement staff instead of pulling back
  • Improving visibility and partnerships with all physicians
  • Focusing on long term quality goals for the plan and its provider partners
  • Developing community partnerships
  • Valerie Ogilbee, Director, Provider Engagement, The Health Plan

    Controlling Medication Costs, Increasing Adherence and Building Community Pharmacy Partnerships to Optimize Star Ratings

    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.

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


    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.

    Concepts include:
    • 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

    Jeffrey Ledgerwood, PharmD, BCGP, Medicare Clinical Pharmacist, Excellus BlueCross BlueShield


    Close of Conference