Agenda

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

Part I: Stars 101 Program Overview

Jessica Assefa, Senior Director of Star Ratings, GHG Advisors, will provide a detailed Stars Program 101 overview, including perspectives on the upcoming changes. This module will include in in-depth review of:

• Star Ratings as a transformational tool
• The technical Star Ratings framework and data sources
• Methodology for calculating summary and overall Star Ratings
• Quality bonus payment (QBP) implications and calculations
• The financial implications of Star Ratings
• Other potential regulatory changes under consideration and more!

Do you have a Star Ratings plan that you cannot implement? Join Cary Badger, Principal, HealthScape, as he shares the real-world problems that Stars program leaders face on a daily basis, and actions that plans can take to implement an impactful Star Ratings program.

• How to successfully effectuate Star Ratings strategy within your organization.
• Infuse Star Ratings into your provider-facing initiatives

Advanced Stars Workshop:  Preparing for Success in an Era of Change

This workshop will include a detailed review of the technical specifications and best practices for success for new Star measures which go into effect on 1/1/2022, including:

• Transitions of Care
• Follow-up After ED Visit for People with High-Risk Multiple Chronic Conditions
• Plan All-Cause Readmissions

• Changes to HEDIS, CAHPS, HOS and other measure specifications
• Issues impacting Star Ratings, including telehealth, COVID, the new Administration, etc
• Ways to manage the new “Math Path” to 4+ stars

Welcome & Introduction: How to Maximize Your Virtual Conference Experience

Impact of the New Administration and the Pandemic on Star Ratings & Quality Assurance: How are Plans Reacting and Changing?

Build a Strategic Plan to Engage Your Whole Company on the Path to 5 Stars

Why Personalized Digital Engagement is Critical to a Better Consumer Experience, Higher CAHPS/HOS Scores & Improved Star Ratings

The increased emphasis on member experience due to higher weighting for CAHPS and HOS measures in Star Ratings is no longer new news. The question is: What can you do about it? Digital engagement is scalable, cost-effective, and can be rapidly deployed to deliver targeted messages to members. And with the right technical architecture in place to automate the ingestion and organization of member data, digital engagement can be personalized across an entire population with no manual effort from the plan. This session will help you build a digital engagement strategy rooted in personalized experiences that improve members’ satisfaction with their plan, and ultimately, survey-related measures.

Networking Break

Driving Cost and Quality Metrics through Virtual Care Coordination

Examine how virtual care is uniquely positioned to support coordinated care plans through an integrated medical and behavioral health strategy that drives key cost and quality metrics for health plans. VP of Medical Affairs, Dr. Prentiss Taylor, will share new insights on increases in correlations between patients with a chronic condition and a behavioral health diagnosis and their propensity for continuing treatment as part of a coordinated care plan. These new findings highlight the impact that care coordination has on population health, access to care, and preventive care utilization.

Attendees will gain a meaningful understanding of a patient journey that includes integrated medical and behavioral health as a critical feature of a coordinated, longitudinal care plan. Additionally, we’ll unpack how this strategy impacts metrics of health plan success and improves patient health outcomes.

High-Value Pharmacy Services: Improving Quality, Health Outcomes, and Member Experience in Medically Complex Medicare Populations

Medicare members who are “medically complex” – managing multiple chronic conditions with several maintenance medications – experience unique pharmacy challenges. Learn how Mosaic Pharmacy Service uses population health analytics and clinical decision support technology to improve medication use and health outcomes unlike any other pharmacy. The session will include a review of clinical outcomes and case studies that demonstrate benefits to both the health plan and the member.

• Review the unique challenges of a medically complex and vulnerable health plan population
• Understand how analytics-powered member selection creates a unique value proposition to MAPD health plans and enables value-based programs
• Learn about the key differentiating capabilities of Mosaic, and how data makes the difference in delivering superior quality and health outcomes

Aligning Quality and Risk Adjustment as the Pandemic Wanes

COVID-19 forced unexpected changes on both Quality and Risk Adjustment strategies in 2020 that have carried over into 2021. However, as the year progresses and more of the US population gains access to vaccinations, health plans are faced with the dilemma of how to return their Quality and Risk Adjustment programs to a state of normalcy. The need to better align efforts across these programs becomes increasingly important this year as plans pandemic concessions expire and each member encounter becomes more meaningful. This session will explore strategies to better align Quality and Risk Adjustment programs to better educate members, drive engagement, capitalize on each encounter, and optimize results as the pandemic’s impact continues to evolve.

Improving Member Retention & Satisfaction Though Benefit Design

Learn how a plan’s Stars Strategy can inform plan design decisions, create differentiation in the market and improve member retention.

Networking Lunch Break in the Exhibit Hall

Panel Discussion: Member Experience Innovations: Achieving Higher Member Satisfaction Scores for CAHPs & HOS

Moderator:

Panelists:

Expressing Compassion, Empathy and Caring -- Virtually -- to Provide Exceptional Member Experience

COVID-19 changed the way our world works. Instead of face-to-face encounters, patients were forced to engage with their healthcare providers through a phone or computer screen. Telehealth and telemedicine is the new normal. Compassion and caring were already important to patients and now even more so in this digital age. In the age of consumerism, healthcare organizations must operate like any other industry and learn to engage patients in an empathetic and understand way to maintain and enhance the digital patient experience.

• Develop a strong understanding of patient experience in the age of COVID-19.
• Understand how empathy can influence the patient experience.
• Learn effective ways to express compassion, empathy, and caring through a screen

Deep Dive into CAHPS Scoring Methodology

With the upcoming measure weight increase for Star Ratings’ patient experience measures, the CAHPS survey has been the topic of many conversations as of late. But CAHPS measures don’t use the standard clustering methodology to determine cut points and assign stars. In this session we’ll review Relative Distribution and Significance Testing and learn how CAHPS measures get their stars!

Networking Break

Sustained CAHPS and Member Experience Improvement Through Targeted Member-Provider Engagement

• By 2023 CAHPS and member experience will account for over 50% of CMS Star Ratings and become the single most important Star measure grouping.
• Understanding how member experience and clinical behavior are intertwined
• Devising strategies and processes that enable us to excel at CAHPS while also impacting other Star measures
• Building a CAHPS focused, action-oriented engagement timeline
• Leveraging mock-CAHPS response data to measure CAHPS risk on a member-level across a population
• Becoming a CAHPS-centric organization to boost overall member experience while also improving CAHPS ratings

Transforming Provider Engagement in the Age of Interoperability -- Are You Ready?

In this session Novillus will share our holistic approach for using interoperability to drive provider performance, which includes:

• EHR integrations with FHIR/DaVinci
• Incentive and performance management
• Actionable care gap experience, including time-sensitive TRC measures
• Timely care gap refreshes to optimize data accuracy
• Multichannel engagement (email, EHR & provider portal notifications)
• Correcting inaccuracies in gap data

Pivoting from Telehealth to In-Person: What Do We Keep? Lessons Learned on Maximizing Telehealth Opportunities

New Benefits Boost Star Ratings, Don’t They?

We all want to believe that adding new benefits lead us to higher star ratings. Maybe they do, but how do we know? In this panel, Mike Adelberg, a former CMS and MA Plan executive, discusses the challenges associated with linking benefit enhancements with stars. Join him for live problem-solving session with two experts as they problem-solve how to overcome this critical challenge.

Moderator:

Panelists:

Close of Module #4: Virtual Networking Reception in the Exhibit Hall

Integrating Health Equity & SDoH into Star Measures

Clearly, disparities and SDoH impact gap in care closure and quality outcomes within member populations.  In this session, SelectHealth will share an overview of how they are working to learn more about their population, exploring opportunities to enhance outcomes and initiatives being implemented to better support the populations they serve.

Transitions of Care and Follow-up on Inpatient & ED Visits for FIDA IDD Members

To improve care transitions, Partners Health Plan has implemented a care transition program for its vulnerable members with IDD that has resulted in reduction of avoidable ER visits, Inpatient admissions, and an increase in HEDIS rates for transitions of care quality measures. The presentation will focus on an overview of Partners Health Plan’s multipronged interventions aimed at ensuring optimal health outcomes across transitions in care settings, with the goal of reducing avoidable emergency room visits and inpatient readmissions.  Strategies include active discharge planning; post-hospital discharge visits; timely notification of admission and discharges to member’s provider, medication reconciliation and comprehensive medication therapeutic review by Clinical Pharmacist, risk stratification screenings, and data analysis targeted at identifying high-risk members.

Impact of Various Clinical Strategies on the CMR Completion Rate for CMS STAR Ratings

Star Ratings continue to evolve as measure specifications, benchmarks, and inclusion into the overall calculation continue to change. Maximizing performance for many clinical part D Star measures, such as the MTM Program Completion Rate for CMR continue to be a challenging endeavor, especially given its dynamic nature. This session will discuss the impact of various clinical strategies and outreach methodologies that can be implemented to help improve Star performance for this measure.

Medication Adherence: Interactive Voice Response (IVR) Barrier Follow Up and Driving Members to Mail Order

Insights into Geisinger’s initiatives to follow up and close member adherence barriers identified through IVR and utilizing the mail order initiative to increase member adherence.

The Quality Measure “Moneyball”- Accountable Partnerships with Undervalued Providers to Improve Medication Adherence

Find out how to develop accountable pharmacy-pharmacist partnerships to improve quality measures, specifically medication adherence. The focus will be capitalizing on the long-undervalued pharmacist profession and particularly independent pharmacies.

Close of Conference