Rave Reviews from December 2019 Attendees

Conference At-A-Glance

June 8: Pre-Conference Stars 101 Workshop

DAY ONE: June 9: Star Ratings

DAY TWO: June 10: Stars & HEDIS/Quality & Risk Collaboration

DAY THREE: June 11: HEDIS/Quality Assurance

STARS 101 Intensive Workshop: Back to Basics
Monday, June 08, 2020


1:00 - 5:00

The “Nuts and Bolts” Behind the Star Ratings: How to Build and Grow Your Stars Program to Integrate All Measures

During this workshop, we’ll review the technical construct of the Star Ratings program. From measure specifications to financial impacts, we’ll cover the full spectrum of technical aspects of Star Ratings. This workshop will include in in-depth review of:

  • The technical Star Ratings framework and data sources
  • Methodology for calculating summary and overall Star Ratings
  • The financial implications of Star Ratings
  • A review of the various measures included in the Star Ratings program
Get specific tools and strategies for:
  • The impact of measures being added, removed and adjusted (including the Transitions of Care and Plan All-Cause Readmissions measure)
  • Weighting changes for the difficult-to-impact member experience measures
  • Other potential regulatory changes under consideration
This hands-on, interactive workshop allows plenty of time to ask questions from the leading experts in the Star Ratings field today! Workshop participants will be able to share their own knowledge and experiences, and industry colleagues will weigh in with insights on what they are focusing on, and how they are identifying and solving their challenges in pursuit of 4+ star ratings and seizing opportunities along the way.

Workshop Leaders:

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

Melissa Smith is Senior Vice President of Stars & Strategy at Gorman Health Group. In this role, she is responsible for leading a team of experts to support the needs of health plans, providers, Pharmacy Benefit Managers, and industry vendors in their pursuit of success. Melissa’s team helps clients improve performance within quality ratings systems such as Star Ratings, improve health outcomes and the member experience, evaluate market dynamics and opportunities, optimize distribution channels, and supports client’s strategic planning needs.

Melissa has served the many clients of Gorman Health Group for five years, and brings 25 years of healthcare experience to clients, including more than five years serving in a leadership capacity at Cigna- HealthSpring. Melissa has extensive experience developing strategic and tactical solutions to meet client needs and a strong background of building productive partnerships across internal teams and with external vendors to improve performance on clinical, medication, patient survey, and administrative quality measures.

Jessica Assefa Senior Director, Star Ratings, Gorman Health Group

 Jessica provides expertise to health plans regarding Quality Improvement (QI), the Centers for Medicare & Medicaid (CMS) Services Quality Bonus Programs (QBP) and Star Ratings. Jessica is an accomplished nurse and brings clients over twenty years of diverse experience and achievement in managed care, quality improvement and clinical care in addition to strong Medicare, Medicaid, Marketplace and Dual- Special Needs Plans (D-SNP) programs knowledge. Prior to joining Gorman Health group, Jessica led the Medicare, Marketplace and Medicaid Star Ratings Programs and Quality Ratings Systems (QRS) for an independent, nonprofit health plan in the state of Minnesota, successfully achieving 4, 4.5 and 5 Star Ratings for the plan’s multiple Medicare and Marketplace contracts and product lines.

Cynthia Pawley-Martin Senior Director, Stars, Gorman Health Group

Cynthia provides expertise to health plans and provider practices regarding Quality Improvement (QI), the Centers for Medicare & Medicaid Services (CMS) Quality Bonus Programs, Quality Rating System (QRS), and Star Ratings. Cynthia is a Registered Nurse (RN) certified in Healthcare Quality and brings GHG clients more than 15 years of experience in the healthcare industry. Her areas of expertise include CMS regulatory requirements (Quality/Star Ratings/Physician Quality Reporting System (PQRS), Healthcare Effectiveness Data and Information Set (HEDIS®), Consumer Assessment of Healthcare Providers and Systems (CAHPS®), Health Outcomes Survey (HOS), Models of Care (MOCs), and providing support for Patient-Centered Medical Home (PCMH) and PQRS. Prior to joining GHG, Cynthia served as Director of Star Ratings for a leading organization and has held numerous positions in Quality and managing HEDIS® for multiple products in the managed care arena.

Boosting Star Ratings Through Member & Provider
Engagement in the Evolving Regulatory Climate
Tuesday, June 09, 2020

Registration and Continental Breakfast


Chairperson’s Opening Remarks

Amy Lung COO, HealthMine, Inc.


Achieving and Sustaining Strong Star Ratings in the Constantly
Changing and Increasingly Competitive MA Market

Discuss known and potential Star Ratings program changes

  • Review measures being added, removed and adjusted (including NCQA’s Transitions of Care and Plan All-Cause Readmissions HEDIS measures)
  • Share successful strategies to deal with weighting changes for the difficult-to-impact member experience measures
  • Share strategies to successfully focus on member experiences and health outcomes through integrated Star Ratings and Risk Adjustment interventions
  • Review other potential regulatory changes under consideration

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


Panel Discussion: The New Epidemic: Loneliness & Social Isolation -- Programs that Produce Real ROI

  • Medication Adherence
  • Depression
  • Gaps in Care
  • Neediness & Impact on Member Services


Savannah GonsalvesManager of Quality, Hometown Health

Dan WeaverVice President, Stars Quality, Gateway Health

Tamara MatosBusiness Project Manager, Stars Operations Director-Miami, Cigna


Collect, Utilize & Interpret Inter-departmental Data to Create Enhanced Member Experience Programs

Reva SheehanSr. Improvement Specialist – Medicare Quality, Priority Health


Networking Refreshment Break


Panel Discussion: Improving Member Communications


Josh EdwardsMedicare Stars Programs Manager, Martin’s Point Health Care


Combatting the Opioid Epidemic – Strategies to Engage Patients and Providers

The opioid epidemic is affecting communities across the country, yet engagement of patients and providers by health plans can be challenging. This session will explore strategies implemented by UCare to address gaps and move towards safer opioid utilization.

Erika Bower, PharmD, BCACPClinical Pharmacist, UCare


Livongo Feature Session


Networking Lunch


Cross Functional Member Engagement to Boost Patient Experience

Engaging our members and improving their experience with both the health care system and their health plan is critical to success in the Stars program as well as retention and controlling medical costs. This requires collaboration both across your organization and with provider, vendor and community partners. Building and maintaining these alliances is rewarding, but can also be complicated. Let’s explore this topic a bit more.

Noreen HurleyManager, Product Strategy, Member Experience and Star Quality, Harvard Pilgrim Health Care


Optimizing CAHPS Performance When Access and Availability is a Challenge

Every year CAHPS become a great area for continuous improvement with an incremental impact on health plans overall Star Ratings. CMS is increasing CAHPS measures weight and is exploring to develop new measures around customer perceived satisfaction and net promoter scores. Considering that access and availability is one of the first steps to care and customer experience with the plan and network, during this session we are going to:

  • Hear strategies to combat access and availability challenges
  • Learn how to prioritize resources and best practices
  • Understand the steps we can focus on to drive incremental improvements by reducing access
  • and availability barriers

Tamara Matos Business Project Manager, Stars Operations Director-Miami, Cigna


Networking Refreshment Break


Panel Discussion: Influencing CAHPs and HOS Scores


Noreen HurleyManager, Product Strategy, Member Experience and Star Quality, Harvard Pilgrim Health Care

David LarsenDirector Quality Improvement, SelectHealth


Feature Presentation


Breaking the Mold: Innovative Corporate Stars Awareness and Education

Lack of corporate alignment, program knowledge, and general awareness are often highlighted reasons that plans struggle to achieve or maintain Stars performance. This session will dive into the process for designing, implementing, and reinforcing an effective corporate education and awareness campaign that will help build the business case to secure necessary funding as well as achieve program outcomes. The session will also highlight two proven programs and their results.

Dan Weaver Vice President, Stars Quality, Gateway HealthFormerly Director of Program Management, Government Business, Quality ImprovementHighmark


Building Nimble Data Analytics for Stars

David Dodge Medicare Star Ratings Program Director, Cambia Health Solutions


Developing A Provider Incentive Program for the Delegated Model -- Developing Structure, Participation Agreements and a Pay Out Model that Works to Get Buy-In from Your Provider Groups

Don't be out prioritized by other health plans, learn how to develop a robust incentive program. A well designed incentive program can enhance the quality of care and improve Medicare Star rates.  Learn how to create alignment within your organization and with your providers.  A well-developed incentive program with a provider-friendly payout foundation can achieve the results you are looking for.

  • Learn how to select metrics that align with your strategic goals while making it feasible for your providers to keep the provider incentive process simple
  • Benchmarking performance is critical, determine how to use benchmarks that are achievable and recognizable whether they are internal or the CMS Thresholds
  • Display measures are an integral part of setting the stage for the provider group to begin to prepare for measure changes.  Why including display measures in your incentive program can improve star rates
  • How to develop a Tier Payout that will get your small and large groups engaged

Rene’ Mack Senior Clinical Program Manager, Medicare Stars Program, Blue Shield of California

Amanda Calvert Clinical Program Manager, Medicare Stars Program, Blue Shield of California


Networking Reception

Integrating Stars, HEDIS, Quality & Risk
Wednesday, June 10, 2020

Registration and Continental Breakfast


Chairperson’s Remarks


Moving to Digital Quality Measures – NCQA Keynote Session

NCQA is working to make HEDIS® measures digital, moving away from claims-based quality measures to automated digital quality measures (dQMs) that streamline reporting. Join us to learn how dQMs can reduce burden, improve accuracy, provide better feedback and measure more of what matters. You also can participate in an open discussion and Q&A, bring your questions.

Paul Cotton Director of Federal Affairs, NCQA


Panel Discussion: Working In Sync: Aligning Stars, Quality & Risk


Debra J. Zeh BSN, RN Sr. Director, Quality Improvement, Provider Performance, UPMC Health Plan

Mark Gregory Director, Pharmacy Consultant, Population Health Solutions, Omnicell


Key Interventions to Improve HEDIS Measures and Drive Star Ratings

HEDIS measures are a key input to Medicare Star Ratings and can be some of the easiest measures to report on. They should also be the easiest to improve – especially compared to member survey measures, outcomes measures, or medication adherence measures – just close a gap in care. But they’re not. This session will explore key interventions to improve HEDIS measures rates, maximize quality department budgets, and boost Star Ratings.

Josh Edwards Medicare Stars Programs Manager, Martin’s Point Health Care


Networking Refreshment Break


Aligning Provider Incentives Through Risk Adjustment and Quality

The provider incentive program is designed to promote early detection and on-going assessment of chronic medical conditions for our members.  The program is aligned with the CMS strategic quality initiatives that focus on members receiving the highest quality of care and customer service by creating metrics designed around the measures from HEDIS and CAHPS.  Risk Adjustment aligns with these metrics through Care Coordination by providing Primary Care Physicians with historical data around patient chronic conditions and suspected conditions based on clinical indicators for the PCP to address during the calendar year.  The goal of these three components of the program is identifying and rewarding primary care providers that provide favorable clinical outcomes and the highest patient satisfaction for our members.

Savannah Gonsalves Manager of Quality, Hometown Health

Brian May Manager of Risk Adjustment, Hometown Health


Overcoming Barriers to Achieving High Performance Scores from an Equity Perspective

There is no one-size-fits-all approach to access. For the limited English proficient consumers, lack of meaningful language access leads to well-documented suboptimal health outcomes. There’s often a misconception that having an interpreter is enough to ensure that consumers understand how to navigate the health system and can communicate their own health needs. To truly engage with consumers and cultivate well-being, it’s important to recognize that interpreters have a distinct role as part of the multi-disciplinary team. Through conversation and active engagement, this workshop will allow participants to explore the art of serving limited English proficient consumers and other marginalized populations.

  • Understand how to hear the voices of marginalized populations and include them in the decisions about their own health.
  • Through a trauma-informed framework, improve the experience of limited English proficient consumers.
  • Recognize how effective interpretation impacts the power, privilege and access to communication and information.

Toc Soneoulay-Gillespie, MSW Social Services Manager, Population Health Partnerships, CareOregon


Aligning the Quality Cosmos: One Health Plan’s Efforts to Integrate HEDIS and Stars

Many would call those who love working in HEDIS® chart chase a little crazy. Unlike with other components of STARs, HEDIS® chart chase allows us a retrospective view into what has happened with our member quality. And although we cannot change the past, we are profoundly focused on using these results to influence the future. This session will showcase UnitedHealthcare’s Quality Solution Delivery team’s innovative approach at influencing quality outcomes through operational acumen, data, and technology, in order to drive better STAR ratings and more importantly, help our members live healthier lives.

Sarah Bezeredi Vice President, Quality Solutions Delivery, UnitedHealthcare


Networking Lunch

Interactive 1 Hour Round Table Discussion Groups

A. Influencing Member Survey Responses, Improving the Patient Experience and Minimizing Grievances & Complaints

B. Improving Hard to Improve Measures

Osteoporosis (OMW), Hypertension (CBP)m Medication Adherence and More!


    David Larsen Director Quality Improvement, SelectHealth

C. Understanding and Implementing New STARS Measures

Controlling Blood Pressure, Transitions of Care, Follow-up after ED Visit for Patients with MCCs and More!


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

D. Interoperability and Provider Data Sharing


    Staci Zink Member Experience Program Consultant, MA Quality Improvement and Stars, BlueCross BlueShield of Tennessee

E. Preparing for Telehealth and the Impact on STARS & HEDIS Programs


From Garage Band to Rock Stars… How We Made it Happen

How we transformed from a new MA plan with unsophisticated strategies to achieving our first set of 4.0 ratings.  Topics will include establishing accountability and ownership, member engagement and the continued evolution of our strategy.

Laura Adams, MBA Director, Medicare Stars, Medical Mutual


Networking Refreshment Break


Linda Brenner Director, Quality Measurement and Performance, Tufts Health Plan


Engagement Centers: Integrating Primary Care, Urgent Care, Behavioral Health and Social Determinants

  • Enhance patient access to Primary Care and Behavioral Health in a non-judgmental supportive environment
  • Decrease Inpatient Utilization and Readmissions through engagement and intervention
  • Improve quality measures through partnerships in the community.

Lauren Easton Vice President of Innovations, Commonwealth Care Alliance


Feature Presentation


Risk Adjustment 101 and the Future of Risk Adjustment Data Submission – Moving from RAPs to EDPS

Medicare Advantage Organizations (MAOs) are required to submit risk adjustment data through RAPS and EDPS but as promised, RAPS is being phased out – are you prepared? Many organizations have faced challenges with EDPS data submission, but this crucial role has a significant impact on Medicare Advantage revenue. UPMC Health Plan will explain the importance of complete and accurate data submission, review the HCC Models and the financial impact between RAPS and EDPS, and finally discuss the evolution of risk adjustment data submission as we shift from RAPS to EDPS.

Tim Plank Director, Government Revenue Risk Adjustment, Insurance Services Division UPMC Health Plan


Networking Reception

HEDIS & Quality – Clinical and Operational
Provider Engagement Programs and Strategies
Thursday, June 11, 2020

Continental Breakfast


Chairperson’s Remarks


Transitions of Care Measures – Innovative Approaches to Working with Providers

When members are discharged from a healthcare facility, providers and payers have the opportunity to work together to ensure a successful transition to home for members. Engaging members and providing support at the right time during the transition is key and incorporates team members from multiple areas to create a holistic approach and better member experience.   During this session, you will learn more about how an integrated health system works collaboratively to better support members to reduce readmissions.

  • Learn the strategies we have incorporated using Care Coordination to improve readmission rates.
  • Hear how our health plan incorporates a multi-disciplinary approach to working collaboratively with provider systems.
  • Understand how to capitalize on varied approaches, data sets, and addressing SDoH barriers to achieve Star Rating improvement

Kena Hahn Director of Medicare Stars & Outpatient Care Coordination, Health Alliance


Make Your MTM Program Work for You to Improve Medication Adherence, Star Ratings and Provide Quality Care to Members

This session examines a hybrid program where a dedicated internal MTM pharmacist enables the health plan to work more effectively with their external MTM company. It has been successful in reducing cost as well as improving member satisfaction, and the health plan has achieved a 5-Star rating on MTM for the past 2 years.

  • Using medical and pharmacy claims data to enable the health plan pharmacist to target higher risk MTM qualified members for specific interventions
  • Working with the case or disease management nurse to improve medication adherence and member understanding of prescribed medications
  • Collaboration between the MTM pharmacist and the quality improvement team to improve Part C measures
  • Strategies to improve Medication Adherence for your members

Gary Melis Clinical Pharmacist, Network Health


Electronic Clinical Data Systems: Ensuring Connectivity to Gather 100% of Data from Multiple Sources

The Health Care Industry continues to struggle with comprehensive integration of electronic health data resulting in the inability to access health information when and where it is needed, regardless of where the care was initially provided. For 2020, the Pennsylvania Department of Human Services (DHS) tasked Pennsylvania’s Medicaid Managed Care Organizations with reporting requirements which include mandatory quality measure submission using Electronic Clinical Data Systems (ECDS).  This presentation aims to share UPMC Health Plan’s data integration journey towards ECDS from a clinical, non-technical perspective working with our regional health information exchanges and network providers of varying levels of technology capabilities. There are currently seven Medicare quality measures in the HEDIS ECDS domain available for 2020 reporting. Has your MCO begun the journey towards ECDS?  Please join this discussion of the opportunities and challenges.

Debra J. Zeh BSN, RN Sr. Director, Quality Improvement, Provider Performance, UPMC Health Plan


Member and Provider Outreach to Close Gaps in Care: Breaking Down Silos

Staci Zink Member Experience Program Consultant, MA Quality Improvement and Stars, BlueCross BlueShield of Tennessee


Networking Refreshment Break


Operationalizing Complex Care Management

This session will outline a systematic process for implementing a comprehensive Complex Case Management program. The presenter will focus on methodology, population target, system needs, assessment, self-management planning and documentation.

Yvonne Herdia Manager of Care Management, Neighborhood Health Plan of Rhode Island


Provider Data Retrieval

In order to be successful at HEDIS chart collection, you first have to know your providers. Provider data is the key to a smooth chart collection season, and that often goes beyond the data that is typically collected and stored by health plans. Knowing your provider data, how your providers are setup and how they function, can help to make the HEDIS chart collection season much smoother.

Sarah Winski Director of Clinical Quality Services for HEDIS, Gateway Health


Projection Model Driven HEDIS Improvement

Improvement of HEDIS performance relies on data availability and analytics.  At our health plan, we see forecast modeling from two sets of lenses – one is to project where the final rates might land in the end of the reporting year; the other is to project the movement of the benchmark.  In our presentation, we will share our practice of forecasting our star rating based on NCQA rating methodology.

Belinda (Beilei) Zhang, PhD, MHA Chief Quality Officer, Trusted Health Plan


Networking Lunch


How a Provider-Based COPD Program Interacts With a Local Insurer to Improve Outcomes

Learn how a local insurer uses Quality Bonus money from STARS to work with a provider to improve COPD outcomes.

  •   Collaboration  between provider and insurance company pharmacy department improves outcomes and member satisfaction
  • Pharmacotherapy Management of members improves by referrals between both departments
  • Program results show a decrease in Emergency Room and Hospital admits

Robyn West Registered Respiratory Therapist, BS, Clinical Coordinator, Cardiac and Pulmonary Rehab Department, Ascension St. Elizabeth


Enabling the Disabled: Strategies to Boost Quality Results for Populations With Disabilities

With growing attention on addressing Social Determinants of Health, developing innovative supplemental benefits, and staying ahead of the quality curve it is important to develop an effective strategy for engaging disabled populations. Hear from a high performing DSNP / Medicaid plan regarding strategies to impact this population to achieve continued success, innovate for the future, and adopt to constantly changing program requirements.

Dan Weaver Vice President, Stars Quality, Gateway Health


Closing Town Hall Meeting: 3 Key Take Home Action Items


Conference Concludes