Agenda

Registration

Choose Workshop A or B (Refreshment Break at 10:30)

A. STARS 101: Back to Basics “Nuts & Bolts” Workshop

This workshop will include an in-depth review of all elements of the Star Ratings program. We’ll cover everything you need to know about Star Ratings, including:

• Detailed review of Star measures, cutpoints and ratings calculation
• Deep dive into data sources used in Star Ratings, including timing and scoring
• Detailed review of new technical program changes and new measures

Workshop Leaders:

B. Improving Health Equity: Bringing Practical Strategies and Tactics to Life to Reduce Disparities, Improve Care and Succeed in Stars

This workshop will include education and collaboration on Heathy Equity and Diversity. We will cover everything you need to know to prepare for current and future Health Equity program and reporting requirements, including: This workshop will include education and collaboration on Heathy Equity and Diversity. We will cover everything you need to know to prepare for current and future Health Equity program and reporting requirements, including:

• Deep Dive into the components of the Health Equity Index, NCQA Accreditation standards, HEDIS measures, and future Star Rating Implications
• Understand how patient-centeredness and cultural competence can be used to build trust with vulnerable member populations, and enhance the success of quality interventions
• How to effectively analyze and disseminate data on health equity and social factors to enhance population health and quality programs, benefit design, and member communications

Workshop Leaders:

Lunch Sponsored by

Choose Workshop C or D (Refreshment Break at 2:30)

C. Advanced Stars Workshop: Deep Dive into Known & Proposed Technical Changes

This workshop will include a detailed discussion into the technical changes impacting Star Ratings in 2023 and 2024, including:

• Known and Codified technical changes
• Changes socialized by CMS but not yet codified
• Using the Health Equity Imperative and SDOH strategies to accelerate Star Ratings evolution

Workshop Leaders:

D. Digital Quality Measurement: Understanding and Evolving dQM, FHIR, ECDS and Interoperability

As NCQA implements its transition to fully digitized HEDIS measurement and reporting, this workshop will include a deep dive into everything you need to know for success including:

• Detailed discussion of the measure specifications and data structure used in ECDS measurement
• Interactive discussion regarding the evolutions needed within member and provider interventions as NCQA phases out hybrid reporting options
• What to do next for Stars success on HEDIS measures during the accelerated implementation of ECDS reporting models

Workshop Leaders:

Registration & Networking Continental Breakfast

Chairperson’s Opening Remarks

Stars in the Aftermath of the Pandemic

This session will include a technical and regulatory update including in industry landscape update based on the 2023 Star Ratings and a detailed review of known and proposed changes on the horizon for 2023. We’ll cover an array of emerging industry developments impacting HEDIS, CAHPS, HOS and Part D measures.

Member Experience: Using Claims Analytics to Increase CAHPS Scores

Worried about member satisfaction? Annual CAHPS scores not providing enough data and insight to drive improvement programs in this area? Join Hagy from Buckeye Health Plan and her longtime consultant and collaborator Liz to explore the projects and challenges they’ve worked on together for the past 6 years. Dive into new claims-based indicators that the team is using to measure member experience on a monthly basis to get real-time insight into pain points and opportunities for improvement. Come away from this session with creative ideas to implement in your own organization to address member experience and satisfaction.

Prepare a Winning HEDIS and DV Star Strategy for Today and Tomorrow

This session will explore actionable steps to prepare for existing, new, and future HEDIS Star measures. Learn tips and tricks for the BCS and COL Star transition to ECDS reporting and how to get ready for Social Need Screening and Intervention (SNS-E), a possible future Star. Develop reporting synergies between the HEDIS and Data Validation Star measures including: Comprehensive Medication Review, Transitions In Care, SNP Care Management and Care of Older Adults.

Panel Discussion: Member Experience & Engagement Tools & Strategies – Increasing CAHPS & HOS Scores

Moderator:

Panelists:

Networking Refreshment Break

Charting a Path to 5-Star CAHPS: Challenges, Strategies, and Lessons Learned

• Engaging Members: Building an effective CAHPS engagement timeline across the year to elevate CAHPS scores and improve the member experience
• All Hands On Deck: Pulling together key influencers across domains to break down silos and establish a cohesive approach
• Creating CAHPS Transparency: Deploying machine learning and artificial intelligence to identify the members that will have the greatest impact on your CAHPS scores
• Just-in-Time: Identifying the members that will have the greatest impact on CAHPS if surveyed and building a multi-faceted pre-CAHPS engagement strategy around the findings
• All-the-Time: Turning every planned member outreach into a CAHPS and member experience improvement opportunity to become a CAHPS-centric organization

Case Study: Interoperability Realized: Harnessing NLP & AI for Data Capture and Quality Measurement

This session will engage participants about a health plan’s road map to utilize technology for data capture and quality measurement.

• Utilizing machine learning and artificial intelligence for quality
Harnessing Natural Language Processing How providers and health plans can work together to ensure clinical documentation is complete and enable the provider to focus on patient health care goals

Obtaining Clinical Data at Scale is the Only Way to Win at Stars and HEDIS!

Clinical data acquisition is at the heart of CMS’s strategy to relieve the burden from providers for chart requests and get to outcome measures that matter.  NCQA's roadmap is to eliminate hybrid in the next 5 years and go only digital measures.  What can you do about that?  We will discuss strategies that work.  There is no silver bullet, just lots of data access channels and a lot of hard work.

Networking Lunch

Exploring the Evolving Supplemental Benefit and Other New Products and Services to Boost Outcomes and Member Experience

This panel will explore how emerging products and services help health plans deliver exceptional member experiences and boost quality outcomes and scores. Hear how leaders in supplemental benefits and clinical solutions are: reinventing product delivery; embracing changes to Stars, marketing guidelines, and benefit design policies; and working with health plan partners to define, measure, and impact critical performance metrics.

Moderator:

Panelist:

Star Measure Updates: 2023 Results and 2024 Changes

• Analyze changes in 2021 quality performance and the resulting 2023 Star Ratings
• Discuss how the increased weight in CAHPS measures has had a varying impact on different Medicare Advantage Organizations
• Preview how the removal of Tukey outliers will impact future Medicare Advantage star ratings and payments

How to Tackle the New CMS 2024 Medicare Stars Clinical Measures

• Explore follow-up after ED visit for members with multiple chronic conditions and transitions of care measures
• Best practices for utilizing admission, transfer, and discharge feeds to improve follow-up care
• Increase internal outreach and supplemental data to ensure excellent outcomes
• How to leverage value-based contracts so proper follow-up care is completed

Networking Refreshment Break

Balance Compliance with SMS Outreach to Engage Medicare Members and Improve Outcomes

What does it take to balance compliance concerns with modern outreach to engage more Medicare members toward better health? Learn how one health plan satisfied internal requirements and successfully expanded outreach beyond mailers and email to savvy seniors with SMS technology.
Key learnings in this session:

• Sharpen how to monitor and adjust progress while waiting for results
• Discover which engagement strategies work best
• Explore future considerations for conversational engagement success

Developing Innovative Partnerships for Diverse Populations with Severe and Persistent Mental Illness to Close Gaps in Care

Disparities across various preventive measures go beyond addressing race/ethnicity and one’s language. Disparities also exist between population groups for members who experience severe and persistent mental illness (SPMI). These individuals are at risk of dying 10-20 years earlier than the general population. Closing gaps in care for these unique population groups require distinct engagement strategies. In addition, these members often experience social barriers to care and require culturally appropriate engagement strategies to understand preventive care and necessary health screenings. This session will engage attendees on how to strategically leverage community partnerships to address social barriers to care, provide culturally tailored support and work to close gaps in care for the SPMI population. After this presentation, attendees will be able to:

• Identify partnerships in your community that serve the SPMI population.
• Learn how community organizations can empower members to address their health screenings.
• Understand how partnering with community organizations that support the SPMI population can make a difference on closing gaps in care for preventive screens.

Networking Reception

Sponsored by

Networking Continental Breakfast

Chairperson’s Remarks

Maintaining Market Share as a 5 Star Plan in a 5 Star Market

Hear from a community based, not-for-profit health plan about the impacts of being a 5 star plan in a 5 star market.  In 2022, this plan found itself in the unique position of earning a 5 star on all three of it’s contracts.  While a record number of other plans also earned this achievement in 2022, the Western New York market had two other organizations with this 5 star rating on one of it’s contracts which set up for a very interesting 2022 selling season.  We will discuss the impacts star ratings having on beneficiary plan selection, enrollment data in a very competitive market, as well as considerations for brokers and other marketing factors while maintaining and growing market share in a very competitive environment.

Panel Discussion: That Nobel Dream -- Targeted Approaches for Raising Particular Star Measures

Each year, invest more in raising their star ratings and with recent policy changes set to lower star ratings, these investments are more necessary than ever. The tried and true star rating strategies discussed in other sessions is good and important, but in this session, you’ll learn about unconventional star-raising strategies focused on particular measures. They include: Rx Real Time Benefit Tools that substantially lower the drug spend, drug alternatives that lessen the need for adherence monitoring, and platforms that successfully manage in-home services that can either raise or crash CAHPS scores.

Moderator:

Panelists:

Utilizing the Local Pharmacist for Interventions that Drive Quality Performance and Member Experience

The local Pharmacist can execute on clinical intervention engagement and completion to drive quality performance for health plans. Pharmacists interact with their patients more often than any other healthcare provider and we’re seeing improvement on quality and the member experience. Leveraging the relationship between the local pharmacist and the community they serve, has shown to be a successful model for engagement and maintaining relationships. During this presentation, you will see how presenting these opportunities allows pharmacists to act in a timely and efficient manner in their everyday practice.

Networking Refreshment Break

Key Strategies to Overcoming the New Hurdles to Attaining/Maintaining High Star Ratings

• Recap of CMS Stars rating and impact on a plan’s enrollment and revenue
• What exactly has changed in terms of Clinical measures to Member experience
• Six Key Strategies to attaining/maintaining high Star ratings

Moderator:

Panelists:

The Growing Intersections Between SDOH Needs and Care Gaps

This session will highlight several of the surprising data intersections between SDOH needs and care gaps that DUOS has surfaced in our work supporting Medicare Advantage populations and the resulting impacts - and opportunities - for critical health plan performance indicators.

Addressing SDOH Barriers to Drive Improvements in Health Equity through a Community Health Model

This session will highlight how a payer started a journey that entailed a retrospective look at its approach to traditional care models to an SDOH pilot later yielding a fully scaled program, committed to whole-person care to improve outcomes rooted in addressing social needs. At a glance Horizon Neighbors in Health is promoting the following for our members and the communities we serve.

Workforce Development

• Creating hyper-local jobs (CHW’s) in underserved communities, aiding financial wellness
• Connecting members to job training and development resources

• Creating hyper-local jobs (CHW’s) in underserved communities, aiding financial wellness
• Connecting members to job training and development resources Equitable Healthcare
• Increasing access to care with providers who understand the needs of the community
• Raising awareness of the impacts of implicit and explicit biases to eliminate health disparities and improve health outcomes

• Promoting understanding of how to utilize benefits appropriately
• Fostering trusting relationships with CHWs and care teams

Unpacking the New HEDIS Social Need Screening and Intervention (SNS-E) Measure

In this session take a look at the technical specifications for the new ECDS SNS-E measure and gain a better understanding of the screening tools and codes that are required for numerator compliance.  We will explore current state of SDOH data in relationship to the SNS-E measure.

Close of Conference