Medicaid Networking Breakfasts

Wednesday, September 12, 2012
7:15 am – 8:15 am

 Approaches to Support Health Insurance Exchanges and Integrated Eligibility Systems
Presented by Softheon, Inc.

Along with the fast approaching 2014 ACA mandate deadlines, CMS and states are modernizing legacy Medicaid Eligibility and Enrollment Systems. For successful interface to Data Service Hub, Federally Facilitated Exchange and State Health Benefit Exchanges, it is critical for payers to understand CMS' Medicaid Information Technology Architecture (MITA) 3.0 guidelines; the separation of business processes, communication bus, and secure service oriented architecture modules from core admin systems. This session will also address the service development lifecycle and establishment of HIX and IES interface testing opportunities for payers. Attendees will learn about release artifacts and the process by which payers can consume developed services.

  • Eugene Sayan, Chief Executive Officer, Softheon, Inc.


Five Fundamentals of Healthcare Economy – Phase II
Presented by PaySpan, Inc. 

The new healthcare economy is having a broad impact on payer operations and creating new demands to achieve unprecedented financial, analytical, and connectivity capabilities in order to improve quality, reduce costs, and build a sustainable business. As the industry emphasizes a value-based economic approach payers must rethink how they interact throughout the healthcare economy. This session will provide you with an understanding of how changing business processes and new strategies are empowered or threatened by the fundamental economic factors. The speakers will offer additional insight around the constituents, interactions and basic principles needed to enable strategies that will succeed and create a sustainable market.

  • Bill Nordmark, Senior Vice President, Sales and Marketing, PaySpan
  • Glendon Schuster, Senior Vice President and Chief Technology Officer, Centene Corporation 


The Duality of the Duals: Navigating a Massive Opportunity and Major Challenges
Presented by Deloitte 

The coming Centers for Medicare and Medicaid Services demonstration projects to integrate care and financing for dual eligible populations may prove transformational for many health plans. Leveraging this historic opportunity will likely require careful planning, thoughtful decisions, and strategic bets. The speakers in this session will discuss the many unanswered questions surrounding the duals demonstrations, and consider the surprises and challenges that could unfold as implementation proceeds. The speakers will share their perspectives on what health plans may want to consider in their strategic planning.

  • Lucia Giudice, Senior Manager, Deloitte Consulting LLP
  • Sarah Wiley, Director, Deloitte Consulting LLP


What Can Be Done to Reduce Waste and Fraud While Improving Outcomes in Medicaid and the Dual Eligible Population?
Presented by OpenConnect  

We all recognize the importance of Medicaid's efforts to reduce fraud, waste, and inefficiency, especially in the dual-eligible population. We also know that Medicaid managed care organizations have a track record of reducing all three. But can that record of achievement be improved, both saving money and improving the quality of care? This panel discussion will focus on the barriers that prevent integrated care and opportunities to achieve quality, coordination, and cost-effectiveness of care for this high-need population.

  • Mark D. Birdwhistell, Chief External Affairs Officer, University of Kentucky Medical Center; Former Secretary, Kentucky Cabinet for Health and Family Services
  • Merrill Matthews, PhD, Resident Scholar, Institute for Policy Innovation
  • Ed Peters, Chief Executive Officer, OpenConnect

Thursday, September 13, 2012
7:15 am – 8:15 am

Making Sense of the Dual Eligible Environment
Presented by Robert E. Nolan Company

This forum provides a framework for successfully managing through the key challenges of the Medicaid/Medicare dual eligible market. The speakers in this session will outline key factors for identifying where managed care models differ and how to align your plan for operational success. The panel will discuss operational practices for managing dual eligibility requirements, and cost and care coordination.

  • David Gutwald, Practice Director, Healthcare, Robert E. Nolan Company
  • Mary Hood, Practice Director, Healthcare, Robert E. Nolan Company


Medicaid Expansion Market Impact: Implications of Expansion on Insurers, Providers, States, Employers and Individuals
Presented by Navigant Healthcare

The reaches of the Accountable Care Act throughout the healthcare marketplace are significant, affecting health plans, members and providers. Expansion of the Medicaid population will impact those health plans that are contracted with the state to provide Medicaid services. This session will address implications of the Medicaid Expansion ruling on key stakeholders, including state budget issues, population volumes, political backlash, hospital and provider compensation, and uncompensated care.

  • Cheryl Duva, Managing Director, Healthcare Practice, Navigant Healthcare


Quality Care & Cost Savings for Accountable Care Organizations: Case Management, Care Coordination & Population Health IT
Presented by Symphony  

Multiple studies and CMS demonstration projects have resulted in cost savings that has been used to introduce accountable care organizations. The speakers in this session will examine the success of these interventions and initiatives, and highlight the infrastructure and building blocks necessary for reproducing this work in other systems. Attendees will have a better understanding of some of the basics of care redesign in support of accountable care organizations including how to identify high risk cases, complex case management, care coordination and the supporting resources, tools and infrastructure including - population health information technology.

  • Andrew Dahl, ScD, Senior Consultant, Symphony Corporation 
  • Ron Parton, MD, MPH, Chief Medical Officer, Symphony Corporation


The Importance of Program Integrity in Sustaining Medicare and Medicaid Programs
Presented by HMS

This session provides a unique opportunity to examine the changing public healthcare environment, including programs such as the Dual Eligible pilots and Accountable Care Organizations (ACOs). The speaker will discuss why program integrity initiatives can be productive oversight tools in managing costs and ensuring quality. Additional topics to be discussed include the value and use of fraud detection, clinical reviews, and coordination of benefits.

  • Maria Perrin, Chief Business Officer, HMS 


Optimizing Medical Record Retrieval
Presented by Enterprise Consulting Solutions, Inc.

This session will address common issues associated with medical record retrieval projects and highlight successful strategies for Medicare risk adjustment audit retrieval, Medicaid Risk adjustment audit retrieval and HEDIS record retrieval. Our speaker will discuss how to ensure proper documentation is captured for Risk Adjustment and STARS and examine factors to consider when outsourcing medical record retrieval. Tips for choosing the right medical record retrieval vendor will also be provided.

  • Craig Mercure, Vice President, Enterprise Consulting Solutions, Inc.