Agenda

Networking Continental Breakfast

Written in the Stars: The Journey to 5 Goes Through The Final Rule. Are You Ready to Chart Your Course?

Hands-on, interactive, 3-hour workshops!

Join us at these small group sessions to get your questions answered on the spot and gain exclusive insights on how to navigate your way through the sea changes in Stars and HEDIS® measures.

• Compare and contrast the Health Equity Index (HEI) Reward versus Reward Factor
• Improvement Measure Hold Harmless - High performers versus low performers impact analysis
• Bridging the Gap between HEI and the Improvement Measures
• Understanding how much improvement you need
• Can I get to 4 or better by reducing disparities?
• Member Experience
• New Part C & D measure cut point predictions
• Industry-wide analysis on Final Rule provision impact
• Subject Matter Expert Panel Q&A - Ask Anything!

Rex WallacePrincipal & FounderRex Wallace Consulting

Mick Twomey Chief Executive Officer Hyperlift

Nate LucenaSenior ConsultantRex Wallace Consulting

Jessica MuratoreSenior ConsultantRex Wallace Consulting

Luis CerdaStars ConsultantRex Wallace Consulting

Networking Refreshment Break

Networking Lunch

Healthmine Workshops

Choose from A or B Concurrent Workshops

Networking Refreshment Break

Networking Continental Breakfast

Chairperson’s Welcome

Focusing on the New STARS & HEDIS® Measures – What’s Most Important? – Interpreting the Dramatic Regulatory Changes

Laying the Foundation for Success With the Health Equity Index

• Internal and value based contracting reporting to identify health disparities
• Working cross functionally with stars committee, diversity inclusion and social justice committee, and regulatory leaders to ensure setup for success
• Point of care testing kit pilot results

Devon LorClinical Quality Manager Network Health

Panel Discussion: Health Equity, Diversity and Social Determinants of Health – Interpreting the New Regulations and Positioning Your Plan for Success

Harnessing AI & ML to Improve Health Equity Metrics – Partnering with Your IT Team

Networking Refreshment Break

Navigating the Engagement Spectrum to Boost Outcomes

This session will explore various innovative member engagement and experience strategies across benefit, program, and intervention design and execution. Learn how plans are applying intentional engagement tactics into broader experience strategies to increase program participation, drive appropriate benefit utilization, boost satisfaction and retention, and reduce unnecessary outreach efforts and abrasion. This session will explore ways that plans are moving from transactional service resolution models toward concierge care designs and highlight tools and technologies, engagement optimization tactics, and proactive education and awareness tactics for success.

Mpulse Mobile Feature Presentation

Case Study: Taking Initiative with HOS – a Proactive Action Plan

With HOS being a mainly provider-driven domain of the Stars program, Blue Cross Blue Shield of Arizona (BCBSAZ) has historically left HOS up to their providers to drive initiatives. This has led to final HOS ratings with room to improve. Listen to how BCBSAZ has taken initiative and implemented a comprehensive HOS action plan. With initiatives focused on providers, members, data, and internal operations this is the plan’s first attempt at tackling improving these scores in a big way.

Networking Lunch

Panel Discussion: Improving CAHPS & HOS Scores Through Innovative Member Engagement Products, Tools and Strategies

Collaboration Driven Stars Improvement

Quality is a team sport which requires cross functional collaboration of multiple stakeholders across the health plan.  In this session, we explore challenges and solutions for successfully navigating a changing Stars landscape.  We will also discuss our experiences in breaking down silos, success stories, and ongoing opportunities.

Care Management Data and Closing Gaps in Care

What you need to do to start capturing Care Management Data for HEDIS® gap closure?

With the introduction of ECDS measures from NCQA, Care Management data can be a rich source for HEDIS® gap closure. This talk will address the steps needed to ensure gap closure from data that already exists within a care management tool. This is data that is naturally generated during the course of normal care management work. This talk will also address the steps needed in order to capture data that is not normally capture through care management. What do you need to put in place to capture gap closure that may be foreign to the typical care management process? We will address how to get easy wins, and mistakes to avoid throughout the development of this new workflow.

Networking Refreshment Break

Sponsored by:

Understanding the Connection Between Unmet Social Needs and Star Ratings Performance

• Connecting the dots between SDoH and Quality Improvement to break down barriers to health equity
• Identifying diverse needs in your population and creating actionable insights to improve member experience and access to care
• Instilling vendor alignment to boost member experience and satisfaction while building health plan affinity

Maximizing Supplemental Data to Prioritize Quality Initiatives Based on Real Time, Current Data

• Leverage standard supplemental data from provider EMRs and HIEs
• Innovative ways to capture other measures via ADT Systems
• Coding behind the scenes without additional clicks
• Capture data digitally outside a claim

Activating a Provider-Driven Member Experience Program

• Identifying your highest impact CAHPS providers and determining which providers are worth focusing your CAHPS time and attention 
• Raising member experience awareness with your providers and driving organic buy-in
• Highlighting patient experience opportunities for every provider to establish a glidepath to greater accountability
• Key philosophies to follow when leading a successful provider-driven member experience program and lessons learned along the way

Provider Engagement, Incentives and Risk Sharing

In this session you will hear my experience and recommendations for building a strong relationship with providers, while also driving outcomes necessary for high quality scores in Medicare Stars and NCQA. Some items for discussion:

• Member and Provider Incentives
• Quality Outcome Reporting
• Health Plan led Gap in Care campaigns
• Aligning Risk and Quality Strategies
• Partnership on changes to the HEDIS® landscape

Networking Reception

Sponsored by:

Networking Continental Breakfast

Chairperson’s Remarks

Panel Discussion: Tools and Strategies to Boost Care Quality & Improve Member Experience

Panelists:

In Home Whole Person Care: Prevention, Assessment & Screenings

Women who are 65 and older are at greater risk for osteoporosis especially after a fracture. Members who are at an increased risk for certain health conditions often times don’t get the necessary screening or care that they need. Members may avoid proper care due to health literacy, access, or social barriers preventing them to take care of their individual health. This session will engage attendees on how to strategically engage members on conducting in-home bone density scans for osteoporosis while also providing other care coordination services including assessing members homes for fall risks, understanding their mental and physical health status, providing health education on preventive screens, and addressing social barriers to care. After this presentation, attendees will be able to:

• Understand how to address whole person care by providing health education on preventive screens.
•  Identify how to implement in-home bone density scans for osteoporosis.
• Learn how to engage members on health outcome measures including assessment for falls, and mental and physical health.

Cross Functional Strategies to Align all Departments and Leadership with STARS & HEDIS® Goals – Increasing Resources

Networking Refreshment Break

Supplemental Benefits: How Can They Impact Star Ratings?

Supplemental Benefits are sometimes a mystery to figure out how to improve our overall MA product performance. During the presentation, I will review how our teams determine which supplemental benefits we choose, as well as how we structure our supplemental benefit implementations and track performance with vendors and our analytics and actuarial teams. A key piece of supplemental benefit design is collaboration with the whole health plan team, including your actuaries and sales teams to build a great proposal and structure that meets all the needs of the health plan as well as following up with analytics to track ROI and performance related to Stars closely.

Operational Excellence to Reduce Complaints About the Plan (CTMs)

• Challenges that our plan experienced newly entering the MA market.
• How we identified the problems, developed solutions, and implemented
• Positive outcomes that we saw a result: Drastic reduction in our number of CTMs received.

Rebecca Adam, MBAStars Program ManagerCareFirst BlueCross BlueShield

Using Medication Therapy Management to Improve Stars and Medicare Plans

• Progression of MTM over time
• Regulatory compliance for MTM
• MTM as a Stars booster
• How the 2024 Proposed Rule impacts MTM planning

Close of Conference