Agenda

Registration

Join this exclusive Think Tank workshop where industry leaders present top of mind opportunities and challenges in an intimate program format. This highly acclaimed, popular conference feature is your best opportunity to get questions answered on the spot, share winning solutions, lessons learned and challenges. Go home armed with information critical to your plan’s success.

Setting Yourself Up for Success in 2024

Future Proof your Stars program through active sessions with your colleagues to be prepared for success amidst the many changes on the horizon. This session will include interactive, workshop-style activities to help participants:

• Resourcing and actioning Health Equity and the HOS outcomes measures taking effect in 2024
• Embracing Continuous Quality Improvement to hardwire Stars success in an era of change
• Manage Up through the wave of existential change CMS is introducing to MA and Star Ratings beginning in 2024

Workshop Leaders:

Close of Workshop

Registration and Continental Breakfast

Chairpersons’ Opening Remarks

What Got Us Here Won’t Get Us There

Journey of 5 Stars eight years in a row has come to a standstill realization for our health plan, road ahead is not straight, destination is getting farther from our reach, landscape has changed, the only way to regain our Stars necessitates doing things differently.

Taking Action: Operationalizing the Health Equity Index and the Impact of Social Risk Factors through Provider VBC and Other Incentive/Risk Sharing Arrangements

To maximize the opportunity to succeed in performance amidst the changing landscape of Medicare STAR, learn how a community-based regional plan leverages value-based contracts and provider incentive programs to achieve quality goals.  Find out how the MA plan worked with Independent Physician Associations (IPAs) to build processes and workflows to identify members eligible to low- income subsidies in an effort to diversify membership and position the plan to succeed with HEI requirements. Gain an understanding of how social risk factors were built into value-based reimbursement models, and what efforts the plan took to communicate the change and gain support from the provider community.

Case Study: Community Collaborations to Reduce SDOH and Ensure Health Equity

Many health care organizations focus on addressing the physical health care of individuals while inadvertently overlooking social care needs. Building community partnerships is a key component to understanding those gaps in social care. In this session, we’ll discuss how to close meet social determinants of health needs and ensure focus shifts to the whole-person care approach.

Networking Refreshment Break

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Panel Discussion: Integrating Health Equity, Diversity, SDOH into Stars & Quality Programs

This panel will explore ways that organizations are leveraging unique solutions to address and overcome barriers associated with Social Determinants of Health in ways that positively impact health equity, racial diversity disparities, and measurable program results such as Medicare Star Ratings. This discussion will explore unique programs, incentive and engagement strategies, in-home and community-based solutions, and the role that the upcoming Health Equity Index component of the Star Ratings program will have on strategic investments and Stars performance planning. Finally, we will explore ways that these initiatives and solutions have been and can be effectively integrated into daily health plan operational DNA.

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Clinical Cross-Collaboration to Improve Star Ratings and Quality Measures

As CMS changes Star measures, health plans have to pivot to meet new requirements. It is critical for health plans to collaborate to build internal relationships to address those needs while ensuring members are receiving quality healthcare and closing quality gaps. In this session we will go through a real example on how to explore changes, create new processes, and analyze data to yield positive Star rating results.

Stars Success in 2024: Preparing for a Year of Change and Evolution

This session will include:

• In-depth review of 2024 Star Ratings performance and discussion of emerging national trends
• Technical update regarding key known and proposed changes to the Star Ratings program and discussion of how they may impact attendees
• Overview of emerging operational and regulatory issues impacting Star Ratings performance and sharing best practices for success

Networking Lunch

Case Study: Digital Innovation for the Most Vulnerable Populations

How to build a program to empower members to create a lifetime of healthy habits:

• Whole health solutions supporting simple but powerful actions. Creating programs that offer daily, frictionless support
• Aligning internal & external programs that invest in communities by addressing the non-medical barriers to achieving quality health outcomes
• Review results including improved medication adherence and reductions in utilization

Leveraging Artificial Intelligence to Improve Medication Adherence Outreach Efficiency

• Medication adherence is a continuous problem in healthcare that leads to negative health outcomes and increased medical spending.
• Approximately $100 - $300 billion in annual healthcare costs could be reduced by addressing medication adherence. This includes around 50% of all treatment failures, 125,000 deaths, and up to 25% of all hospitalizations. [1]
• Traditional methods of outreach to correct medication adherence are reactive, whereas AI can identify proactive intervention opportunities.
• AI-based segmentation models can help identify members who are most at risk of becoming non-adherent and focus outreach efforts accordingly.

Benjamin Vicidomina,VP Analytics and Quality Improvement, Blue Cross Blue Shield of Louisiana

Jack Holloway,Manager Data Science, Blue Cross Blue Shield of Louisiana

Zachary Kirby,Data Scientist, Blue Cross Blue Shield of Louisiana

Taking a Proactive Approach to Post-Acute Care to Improve Star Ratings and Quality Measures

Delve into the rapid evolution of post-acute care and the need for health plans to redefine their strategies. With post-acute care currently accounting for more than $2.7 trillion of healthcare spending in the United States, the shift towards value-based care models, patient preferences for care in the home, and the imperative to reduce costs and improve quality ratings, there’s a compelling landscape for innovation. Join us as we explore the pressing challenges faced by health plans and examine the strategies necessary to overcome them. Get invaluable insights on how health plans can improve performance on Star Ratings and HEDIS measures through technology and insights.

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Networking Refreshment Break

Maximizing the Member Experience through Targeted Engagement

Learn how top MA plans are seeing outsized results by leading with the member experience. We’ll break down the system plans are activating to improve CAHPS survey responses, tackle real and perceived issues, enhance the overall member experience, and reap the ancillary benefits that span across outcomes of importance.

• Building an effective engagement timeline across the year that takes into account risk, propensity, and determinants
• Raising awareness among providers and driving organic buy-in around member experience improvement
• Identifying the members and providers that have the greatest impact on plan experience and CAHPS performance
• Tacking member experience inflection points and responding to events within the member journey that are significant

Case Study: Member Centric Outreach: A Data-driven, Cultural Adaptation Approach to Improve Outcomes

A member’s culture background impacts whether and where they seek health care, understand medical information, and how they make health care decisions. Building strong relationships and designing member centric intervention strategies can positively influence behaviors, close gaps in care, reduce social risk factors and improve health outcomes. Members may avoid proper care due to health literacy, cultural norms and practices, access, or social barriers that prevent them from taking care of their individual health. Building a data-driven and cultural adaptation approach that integrates an individual’s cultural norms, beliefs, values, language, and literacy skills should be applied to outreach strategies. This session will explore how to strategically engage enrollees who are not receptive to seeking care from a member-centric approach on completing in-home test kits for diabetes and colon cancer screening. After this presentation, attendees will be able to:

• Understand how to identify strategies that are member-centric and recognize diversity
• Learn how to engage members on health outcome measures
• Identify how to implement in-home testing to address screening gaps

Leveraging Experiential Data - from Engagement to Encounters - to Increase CAHPs Scores & Retention

During this interactive learning session, we will discuss opportunities and best practices for leveraging data from engagement to encounters and everything in between. Attendees will walk away with actionable insights and a fresh take on strategies to improve and impact the member experience.

Panel Discussion: Enhancing Member Experience to Improve Satisfaction and Boost Retention

Improving member experience has been the top focus on Medicare Advantage plans for several years. Through identification of the top dissatisfiers with your plan members, you can focus on top cohorts impacting performance. By identifying and resolving these issues with your members, you can boost retention. Ongoing work throughout the measurement year is needed to ensure members have the best experience possible and remain with their chosen plan. Hear from these industry leaders about how they are boosting member satisfaction and increasing retention.

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Networking Reception

Sponsored by:

Networking Continental Breakfast

Chairpersons’ Remarks

Member Experience – Increasing Your CAHPS Scores to Retain Your Membership Plus Strategies for the Return of the HOS Measures

• How changes to CAHPS measures weighting will impact your overall star rating
• Why it is still important to focus on overall member experience
• A comprehensive strategy to mitigate CAHPS impacts and how to address CAHPS gaps member by member
• Strategies that are quick and easy to impact and improving physical/mental health HOS measures

Panel Discussion: Innovative Products & Services to Improve Quality, Cut Costs, and Boost Performance Scores

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Case Study: From Customer Service to Concierge Care: Building a Member-Centric Health Plan

BCBSRI will discuss the evolution of their customer service model – from a call center responding to inbound calls to a partner in healthcare dedicated to improving members’ health and peace of mind by facilitating their access to affordable, high-quality healthcare.

Networking Refreshment Break

CASE STUDY: Provider Partnering & Incentive Programs to Balance Risk & Quality Gaps – Stars, HEDIS®, Risk

Collaboration between Risk Adjustment and Quality Improvement is critical to being successful in outcomes and financials.  In this session, Select Health will share how to develop incentives from a Provider Point of View and vary program implementation to be flexible enough to meet providers where they are.

Care Management Data and Closing Gaps in Care

With the introduction of ECDS measures from NCQA, Care Management data can be a rich source for HEDIS® gap closure. This talk will aaddress the specific documentation needed from Care Managers that qualify for gap closure pertaining to follow-up measures. We will also identify the CPT codes that match this documentation to drop the proper pseudo-claims. Finally, we will identify gray areas within the process that can cause problems and identify solutions for rectifying those issues.

Case Study: Tips from a 5-Star Plan – What to Focus on and When

• Develop strategies to achieve Star goals during turbulent times.
• How to course correct and prioritize what measures to invest in.
• Leverage performance on quality measures completely within the health plan’s control.

Partnering with Your Product Team to Align with STARS & HEDIS ® Goals

Creating synergies and cultivating a culture of collaboration between Product & Quality teams is vital to the success of a Medicare Advantage organization. This session emphasizes the significance of this partnership in optimizing health outcomes, patient satisfaction, and operational efficiency. Learn how working together fosters innovation, leading to tailored interventions and solutions that address specific healthcare challenges and improve overall performance. By promoting open communication and leveraging each other's expertise, attendees will learn how this collaboration can drive meaningful impact, ensuring success in achieving Stars and HEDIS goals while delivering top-quality care to beneficiaries.

Close of Conference