National Conference on Health Policy and Government Health Programs

Concurrent Sessions

• Government Health Programs Policy, Operations, and Emerging Trends

  *CMS Proposed Part D PBM DIR Changes: What Are Potential Impacts?

  Speakers

  • Brooks Conway, FSA, MAAA, Oliver Wyman
  • Laura Crawn, Express Scripts
  • David Schwartz, CareFirst BlueCross BlueShield

  Details

  With CMS’ proposed rule for Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs, the agency included significant revisions to the use of Direct and Indirect Remuneration (DIR) by plan sponsors in the program. This session will explore the ramifications of implementing this proposal for plans and the Medicare prescription drug program if finalized, from the public policy, operational, and actuarial perspectives.
  

  *This Concurrent Session is closed to the media and will not be available on demand.

• Employer-Sponsored Health Coverage, Marketplace Policy, and Emerging Trends

  Legal Challenges to the No Surprises Act

  Speakers

  • Katy Johnson, American Benefits Council (ABC)
  • Katie M. Keith, JD, MPH, Georgetown University Law Center

  Details

  Speakers in this session will provide an overview of the long-standing issue the No Surprises Act was enacted by Congress to solve; the Federal regulations promulgated to operationalize the program; and the litigation landscape involving (in particular) the factors to be used by arbitrators in addressing payment disputes between health insurance plans and providers.

• Health Equity, SDOH, and Community Health

  The Road to Health Equity is Paved with Socio-Clinical Risk Adjustment

  Presented by

  Speaker

  • Sandeep Wadhwa, MD, MBA, 3M Health Information Systems

  Details

  The concept of social determinants of health can be used to augment existing health care risk adjustment tools, which are often used in setting payment rates or calculating performance on quality measures. This session will discuss strategies for incorporating social needs, behavioral and functional health into risk adjustment to address social needs and impact health equity.

• Technology, Business Solutions and Product Innovations

  Omnichannel Personalization to Drive Outcomes and Reduce Costs

  Presented by

  Speakers

  • Shannon Eubank, Zipari
  • Dani Tedesco, Zipari

  Details

  A recent survey asked 1,500 Medicare and Medicaid members about their consumer experiences (CX) and digital consumer experiences with their health plans. Their responses were analyzed to identify significant themes within each population, and to determine how these differ from or align with commercial health plan members. This session gives health insurance providers current and market-specific insights into CX trends to help prioritize digital CX efforts most likely to drive positive outcomes.

• Government Health Programs Policy, Operations, and Emerging Trends

  State Perspectives on Medicaid Redeterminations and Exchange Transitions

  Speakers

  • Matt Salo, National Association of Medicaid Directors (NAMD)
  • Anne L. Schwartz, PhD, Medicaid and CHIP Payment and Access Commission (MACPAC)
  • Kinda Serafi, Manatt Phelps & Phillips, LLP

  Details

  The COVID-19 public health emergency will likely end this year; and with that, states will once again begin conducting redeterminations of eligibility for the nearly 83 million people enrolled in Medicaid. Experts on this panel will explore the challenges states will face and their options for verifying ongoing eligibility for all their Medicaid enrollees, transitioning people no longer eligible to other coverage, and potential impacts on continuity of care for Medicaid enrollees.

• Health Equity, SDOH, and Community Health

  Culture-Centered Approaches to Advancing Equity

  Presented by

  Speakers

  • Rudy Bozas, Tufts Health Plan, a Point32Health Company
  • Greg Buchert, MD, MPH, GSB Health Management Solutions
  • Abner Mason, SameSky Health

  Details

  This session explores a real-world example of how taking a culture-centered approach to engaging Medicaid members of diverse backgrounds resulted in a marked improvement in one health plan’s 90-day member retention rates and helped to advance the plan’s health equity initiatives. Join us to learn how to remove barriers to health and form meaningful relationships with members from diverse cultures that traditionally have been difficult to reach.

• Care Management, Delivery Transformation and Value

  When Galaxies Collide: How an Integrated Analytics Strategy Improves Outcomes

  Presented by

  Speakers

  • Courtney Breece, Inovalon
  • James Clement, Inovalon
  • Kevin Greer, AmeriHealth Caritas
  • Leah Hannum, BlueCross of Idaho
  • Paige Kilian, MD, Inovalon

  Details

  This session will explore the current universe of siloed quality and risk programs and the merits of moving to an integrated approach. Speakers will discuss how an integrated analytics strategy can empower providers and positively impact member experience and outcomes. Join us to learn key steps for fostering successful organizational change and support of an integrated program.

• Technology, Business Solutions and Product Innovations

  Open Enrollment’s Influence on Member Experience and Health Plan Costs

  Presented by

  Speaker

  • Luke Raymond, SilverCloud Health

  Details

  This session will focus on the impact open enrollment has to reduce leading drivers of healthcare costs for chronic and co-morbid mental health conditions, with emphasis on Medicare and Medicaid given the higher rates of chronic health conditions in these populations. Attendees will learn how digital health tools can empower members to create positive changes in their behavior and mental health while also enabling health plans to address the rising costs related to chronic conditions.