Many Americans face challenges meeting social needs, with factors like food insecurity, housing stability, lack of education, employment, and social support networks all acting as barriers to good health outcomes. These social drivers of health (SDOH) create obstacles for emotional and physical well-being, as people who struggle with meeting their basic needs face greater likelihood for chronic health issues and are less able to devote resources and effort to positive behavioral changes. This session will explore the impact SDOH can have on health outcomes of individuals and the communities in which they live and work. Speakers will explore ways that health plans, employers and other organizations can address SDOH and partner to maximize impact. This session will also highlight the experience of a community and population health-focused health insurance provider and care delivery system committed to identifying and addressing patients’ needs and working with employers to help them think about SDOH issues. Join us to learn some of the steps that employers and health insurance providers can take to address SDOH by leveraging resources through impact investing in the community, improving screening practices, and building partnerships with social support services to increase coverage and reduce gaps.

Amidst the broader shift from a fee-for-service (FFS) payment structure to a value-based U.S. health care marketplace, concerns have arisen over a medical product pipeline that is full of innovative and transformative —but also high-cost—therapies without long-term data. These concerns have led to increased interest in developing new payment and alternative financing models for health care that strive to ensure better outcomes for the dollars spent, and thus higher value. This session will focus on the limited but growing experience that exists with these types of arrangements, broadly referred to here as Value-Based Payment (VBP) arrangements. In VBP arrangements, payments are intended to reflect measures of value not volume—that is, better health outcomes and lower total costs of care. The speakers will explore key issues related to the adoption of innovative new models and examine actionable next steps. Join this session to understand the real-world application of VBP models for medical products and current challenges; the implementation of a framework developed by a leading university to better define when outcomes-based approaches are most appropriate; and what outcome-based models might look like for commercial payers and within Medicaid at the state levels.

Accurate data is fast becoming a key differentiator for payers and providers alike in their efforts to deliver better care at a greater value. Could data hold the key to transforming the future of health care through predictive and proactive opportunities? This session will focus on tangible steps payers can take to effect access and apply data and analytics-based solutions meaningfully to their ecosystem.

The COVID-19 pandemic has had an unprecedented impact on everyday life, and largely altered the way providers and patients connect for routine and COVID-19-related care. Legislative and policy changes at both the federal and state level have played an important role in this unprecedented expansion of telehealth. They have also added complexity and uncertainty, as health care organizations find themselves navigating a plethora of new telehealth regulations — and wondering which if any will remain in place after the pandemic. Speakers will examine the most important telehealth-related legislative and regulatory changes associated with the COVID-19 pandemic, and discuss the state of these changes post-pandemic. Join this virtual fireside chat to learn more about state expansion of telehealth and licensing waivers, expanded telehealth access and reimbursement for Medicaid and Medicare, telehealth federal funding opportunities, and which changes are likely here to stay.

This session will provide an in-depth look into the policy guidelines informing home-delivered meals benefit design for Medicare Advantage (MA) and managed Medicaid organizations. Attendees will gain a better understanding of how and why to introduce a benefit, reasons MA plans might file under uniformity or as a special supplemental benefit for the chronically ill (SSBCI), and ways to integrate a meals benefit into a broader approach to addressing social determinants of health (SDOH). The speakers will examine how home-delivered meals can impact clinical measures, readmission rates, and member satisfaction, and what details health plan teams should consider when developing a home-delivered meals program of their own. This session will feature perspectives from both a leading nationwide meal delivery vendor, and a health plan that has designed a meals benefit using two different approaches.

In the wake of COVID-19, employers need information that can help support their ongoing efforts to evaluate conditions and mobilize employees to return to work and remain at work. They must consider factors unique to each location and individual employee, along with additional protocols they may need to put in place to help protect vulnerable employees. Join us to learn how data and insights can assist businesses in reopening the workplace, with a focus on keeping employees healthy and informed.

Prior authorization is a medical management tool to ensure safe and effective care and promote adherence to clinical guidelines. Technology solutions and bidirectional exchange are an important opportunity to streamline and automate workflow between health plans and clinicians. These approaches increase transparency of information about prior authorization requirements and patient specific health plan coverage. The real-time access to information can enable efficient care delivery and inform treatment decisions. To succeed in deploying and optimizing use of these technology solutions to improve prior authorization requires collaboration among all health care stakeholders. This session will highlight examples of these types of initiatives to reduce administrative burden, streamline workflow and ideally shorten the time to therapy or service for patients. Panelists actively involved throughout the prior authorization landscape will share the progress to date as well as the business challenges their work is tackling related to prior authorization and the result of early adoption programs. Attendees will learn how emerging industry standards can address prior authorization use cases and what it may take to scale the efforts to positively impact patients, providers, and health plans.

2020 is not the year we thought it would be. And, your member population is not who you thought they would be due to COVID-19. The only way to provide the support your members need now and into the future is to leverage social determinants of health (SDOH) and understand how to make them actionable. Join this session to learn key results from a recent consumer survey, and explore how the right data and technology can help you improve member engagement and drive total health and wellbeing.

The pandemic has brought the future quickly into focus and compelled everyone to reevaluate the speed at which they intend to implement advanced technologies, such as AI and Intelligent Automation. How then, do you adjust your business models and strategic plans to navigate this new virtually connected world? Join this session to learn how health insurance providers can build resiliency and prepare to accelerate out of the COVID-19 curve.

Many payers are willing to make the shift from being a health insurance provider to becoming a wellness organization. Effective complex care delivery and increased member engagement are two areas that require special focus in order to achieve this vision. Join this session to learn how one health insurance provider is leveraging physician-enhanced care plans, social determinants of health (SDOH) and technology to keep hospital readmission rates lower than average and their members healthier. Speakers will share best practices and lessons learned from a successful complex care delivery program and other transformation journeys.

Achieving success in value-based care requires effective use of data and a holistic patient view to inform patient care and population health improvement. This session will provide a multi-stakeholder perspective on new approaches to interoperability and data sharing and the value they can bring. The speakers will explore how health care electronic exchange standards are enabling greater interoperability to and improving the ability of providers to access information and clinical decision support. These tools will help providers better engage their patients, close care gaps, and achieve better outcomes.

Health plans are increasingly being challenged to identify and proactively manage the most vulnerable members with actionable targeted next steps. Precision care delivery enables payers to match patients to the right care at the right time. Speakers in this session will discuss emerging innovations in precision delivery that can be utilized by payers today in a scalable and real-time manner.

When uncertain times upset the workplace norm, opportunities abound to redesign and position the payer organization to be more agile, adaptive, productive, and resilient in the face of disruption. Developing a comprehensive elastic digital workplace can be accomplished by focusing on six dimensions: culture and adoption, elastic collaboration, virtual work environment, seamless networking, distributed continuity, and adaptive security. This session will examine these dimensions, workforce planning strategy and management, and the experience of a leading payer in embracing fast-moving change and innovating at speed and scale. The presenters will explore the solutions, structures, tools, and processes that enable an elastic workplace—one that is ready to flex and withstand a quickly changing environment.

The effects of COVID-19 on primary care are staggering and threaten to permanently shutter many practices and clinics. This, in turn, could lead to a rise in avoidable ER visits and increase the burden on hospitals. Join us to learn how recent policy changes have made it easier for virtual care programs to improve member access to full mind and body care and enhance clinical quality.

Design thinking is a human-based approach to innovation that draws on ethnographic research, user experience, visualization, and storytelling. When design thinking methodologies are applied to health care they lead to a human focus and an openness to generate and test lots of ideas to find more inventive, far-reaching solutions. In this session, a leading expert in this field will explore the case for applying the principles of design thinking to the real-world health care challenge of COVID-19.

As COVID-19 creates unprecedented challenges for the U.S. health care system, health plan leaders must adapt swiftly to a transformed health insurance landscape while keeping an eye on routine business requirements to ensure they are prepared for a post-pandemic world. In this session, a leading national thought leader will share perspectives on the rapidly evolving regulatory environment surrounding COVID-19 testing and treatment and the strategic, financial, and operational challenges this disease presents for health insurance providers.

COVID-19 has accelerated the adoption of digital health solutions and emerging technologies in an unprecedented way. Remote monitoring and telehealth platforms and AI-powered assessment apps and devices have all become the new norm. In this session, a panel of innovative thinkers and health tech influencers will offer perspectives on how patients will access health care in the future as the traditional delivery system is augmented by technological advances in a post-COVID-19 world.

The COVID-19 pandemic is reshaping the health care industry and highlighting the need for continued innovation to adapt to the new normal. In this session, a self-made serial entrepreneur and influencer will share insights on how health insurance providers can harness innovation to create value and effectively navigate the shifting terrain. She will also explore trends that are emerging from the crisis and how to make innovation a strategic imperative.

Employers play a critical role in the health care system, leveraging purchasing power, market efficiencies and plan design innovations to address health care cost and the delivery, financing, affordability and experience of health care. This session will offer perspectives on how the nation’s employers are viewing potential health policy changes for the year ahead, as well as more broadly what it means for employer health benefits in 2021 and beyond.

Approximately seventy-five percent of U.S. employers say their workplace has been directly affected by opioid usage, but only seventeen percent feel well prepared to deal with the issue, according to a 2019 National Safety Council survey. Workplace overdose deaths involving drugs or alcohol have increased by at least twenty-five percent for five consecutive years. When employees in a company’s workforce have an opioid problem, it affects job performance, absenteeism, and the other employees around them on a personal level. This session will explore innovative strategies health insurance providers are employing to address substance and opioid use disorders, while also ensuring members have access to high-quality treatment and care.

Join this session to learn how one health plan has launched a value-based care model that supports providers in identifying and addressing food insecurity, housing, social isolation, and loneliness among its Medicare Advantage (MA) members. Speakers will share exciting results from this care model, and how it is encouraging clinicians to provide more holistic care that goes beyond traditional medical treatment.

What are the essential elements needed to drive digital transformation in an organization? As health care continues to trend toward consumerism – a movement to make the delivery of health services more efficient, convenient, and cost-effective – the industry needs to find better ways to connect with members. When organizations seek digital transformation, the most common mistake they make is to focus solely on the technology. While it’s a critical component of a digital transformation, it’s more imperative to define the experience you want your consumers to achieve. This session will address the elements that drive a successful digital transformation and how conversational AI in health can help improve the overall member experience.

The current health care ecosystem suffers from fragmentation, making it difficult for health insurance providers and clinicians to provide low cost, longitudinal care and avoid preventable negative outcomes. In this session, the speakers will discuss how enabling a consumer-centric health care ecosystem with a common digital and physical experience could improve the care experience. Speakers will examine proven strategies that can assist health plans in improving the patient experience, improving clinical outcomes and closing gaps in care.

COVID-19 has added to the complexity of care and benefit management for many of the most challenging, high-cost patients. In this session, a distinguished group of specialty physicians will explore impacts of COVID-19 on complex medical conditions, and discuss future trends for member populations experiencing cancer, kidney disease, transplants, obesity and musculoskeletal conditions.

There is growing consensus that social determinants of health (SDOH) are powerful influencers on outcomes, utilization and cost. But, there is less agreement as to how to collect and use this information in patient care, performance measurement and payment systems. In this session, speakers will examine the current quality performance measurement system and how leveling the playing field to account for factors beyond clinical care is critical to reducing disparities, accurately representing plan performance and improving quality. Attendees will learn about new data-driven models that are delivering key insights into the impact of non-clinical factors, like food insecurity and unemployment, on patient outcomes.

Payers and providers are increasingly entering into value-based partnerships like Alternative Quality Contracts (AQC). Join this session to learn about best practices and tools for realizing success in complex new payment models. From their first-hand experience, the speakers will describe their team approach to provider performance improvement, including maintaining a transparent “single source of truth” for rolling measurement of contract performance; dynamic benchmarking to quantify the size of the opportunity; and the importance of payer/provider collaboration to ensure significant rewards for both parties.

Integrating outputs from machine learning models, multiple data sources and real-time data can allow for continuous monitoring to enable personalized interventions tailored to a member’s overall health. Join this session to learn how one health insurance provider has streamlined high volumes of member referrals coming from multiple sources in order to target the care and/or intervention that a member may need. Speakers will discuss how their identification and stratification processes have supported their plan to create efficiencies and catch members earlier in their care management journey to prevent catastrophic illness and disease. Join us to learn how to build unique data identification and stratification processes for your organization, and how you can empower your care management teams to use data to drive member assessments and health interventions.

In the United States, one in five adults and one in six youth (ages 6-17) experience a mental health disorder each year. Offering end-to-end services to patients in a digital format within clinics and primary care settings is one way to help ensure early detection, diagnosis and access to evidence-based cognitive behavioral therapy programs for depression, anxiety, insomnia, chronic pain, obsessive compulsive disorder and drug/substance use. Readily available and confidential, digital screening and digital cognitive behavioral therapy can easily integrate with wraparound services, coaching and crisis intervention, and provide a vital, cost-saving alternative to traditional screening and therapeutic services. The speakers will explore the value of providing mental health screenings and therapeutic services digitally; discuss how to identify which patients could benefit from treating their behavioral health conditions digitally; and describe how an integrated, digital platform could allow patients to quickly and accurately receive necessary wraparound support and crisis management.

Virtual care was already becoming a top priority for health plans, plan sponsors and care providers. But once the COVID-19 pandemic struck, it was imperative for health plans to make high-quality, comprehensive health care available for everyone, giving members a “safe front door” to address their broad spectrum of concerns. In this session, you’ll hear how some health plans were able to expand virtual care services across populations – especially for the most vulnerable – during a time of unprecedented demand. Speakers will share their stories of success, lessons learned along the way, and discuss the value of a trusted, flexible, innovative virtual care partner, especially in times of crisis.

Join this session to learn how health plans are innovating their networks across preventive, chronic and catastrophic care with new primary and specialty care models, so they can align population risk, and address barriers to access and affordability. Attendees will learn about innovative models that blend people and technology, provide members with personalized options, and give members the ability to manage their own ‘hyper-networks.’ The panel will also examine health plan perspectives on creating closer payer-provider partnerships and alliances.

Specialty care accounts for about seventy percent of health care spend, but most alternative payment models focus on primary care. This overlooks a large population of patients who could benefit from value-based care. Specialists can excel in alternative payment models when three main criteria are met: the right chronic illness, the right member-reported data, and the right support. Join this session to learn how specialists are lowering health care spend and improving patient outcomes by working with commercial and government payers and leveraging that three-part formula. Attendees will learn how to engage specialists in unique alternative payment models, understand which kinds of specialties make the most sense for alternative payment model arrangements, and how to cultivate functionally collaborative relationships between payers and providers to advance value-based care.

Join this session to learn how one health plan is applying clinical and social determinant analytics to improve operational, financial, and clinical performance across its Medicaid, Commercial, and Medicare lines of business. Speakers will discuss how social determinant analytics can help decrease out-of-pocket spend for consumers, and help health plans and providers better align quality incentives.

Individual coverage health reimbursement arrangements (ICHRAs) are designed to provide employers a new and unique opportunity to offer health coverage at a predictable cost, with minimal administrative overhead. The economic impacts of COVID-19 will be long-lasting, and individual coverage arrangements will become the new norm for much of the industry. Health insurance providers will need to understand the key elements of ICHRAs, and when (and how) employers may elect to make use of them. In many cases, payers will need to determine how to add ICHRAs as a benefit option while still providing traditional group plans. This session will dive into ICHRAs, the benefits and challenges, early adoption trends, and best practices for implementation. Attendees will gain a greater understanding of how to embrace the post COVID-19 landscape and evaluate whether to leverage this new benefit option for their employer customers.

Did you know that exercise can help reduce depression, anxiety and stress? Amid COVID-19 and the mental health crisis, the need for virtual fitness has skyrocketed. People are skeptical to return to their gyms. Parents want to keep their families healthy and active. Health Insurance providers and employers are seeking safe, accessible, and comprehensive well-being solutions. Explore the strategy a global health provider and other organizations are employing for their workforce.

There is no one-size-fits-all approach to health care access. For limited English proficient consumers, lack of meaningful access to language services can lead to sub-optimal health outcomes. To truly engage with consumers and cultivate well-being, it is imperative to recognize the distinct and important role that language interpreters play as part of an effective multi-disciplinary health care team. Through conversation and active engagement, this session will allow attendees to explore the art of interpreting and serving limited English proficient consumers and other marginalized populations. Speakers will provide a simple and practical framework for participants to find a common thread and work collectively to improve consumer experience, understand community needs, and ultimately, improve adoption of preventive care. Join us to gain a better understanding of how to hear and listen to the voices of marginalized populations and include them in the decisions about their own health.

This session will describe the state of value-based care (VBC) sentiment through the eyes of the provider, and provide attendees with actionable takeaways for how to improve engagement and better optimize VBC program performance. Speakers will share results from a recent national study of more than 1,000 primary care physicians on their experiences with alternative payment models. They will also discuss the implications of the key findings and offer building blocks to consider as health plans continue to evolve their VBC programs.

Unknown treatment encounters, missing medication records and delays in prescription delivery can be dangerous and costly. Limited access to medication history tools and patient-specific benefit plan information can hinder a provider’s ability to make the best clinical and financial decisions for his or her patient. Technological innovations have helped to remove these barriers, by bringing the right information at the right time into the providers’ workflow. In this session, learn how technology can help providers make patient-specific medication treatment decisions using tools that allow their patients to start their treatment without delay.

In this session, learn how health plans can leverage machine learning to create an impactful, personalized member experience. By leaning on technology’s ability to present critical personalized information to each member during moments that matter most, health plans can successfully improve their member experience and improved outcomes by engaging people more frequently in their care.

Researchers have estimated that approximately 30% of U.S. health care expenses are related to unnecessary, inappropriate, or wasteful care. Speakers in this session will discuss the role that virtual medical expert consultations can play in curbing unnecessary health care spending, and how this can help health insurance providers offer more value and better outcomes for their members.

Emerging data continues to highlight the disproportionate impact that COVID-19 has on communities of color. Communities of color have historically faced structural inequalities that have led to poorer socioeconomic circumstances and disparities in health care access, which make them more susceptible to the health and financial hardships resulting from COVID-19. Join this session to learn about the racial and spatial disparities associated with COVID-19 and how social determinants of health are exacerbating and perpetuating these disparities. The speakers will provide insight as to what health plans can do to effectively reach out to communities of color to ensure they receive critical information regarding COVID-19 in culturally and linguistically appropriate ways, and to creatively bring COVID testing and treatment opportunities to underserved areas. The speakers will also highlight innovative ways health plans have continued to support community-based organizations in addressing socioeconomic needs during the pandemic.

This session will describe a unique episode-of-care (EOC) model which was developed for the reimbursement of radiation therapy. Using historical data on costs and distribution of radiation therapy modalities, a single payment rate for the provision of radiation therapy services to breast cancer patients was developed to replace existing fee-for-service methodology. Benefits of this model include the promotion of clinically appropriate, shorter course radiation therapy (hypofractionation) with fewer side effects; reduction in the time to treatment initiation by elimination of a prior authorization requirement; increased level of physician autonomy regarding selection of radiation therapy modalities; and administrative simplification for both payer and provider. Join us to learn about a unique program designed to modify the way radiation therapy services are reimbursed by combining all costs into a single payment rate.

With so many state and federal network adequacy and provider data accuracy regulations being proposed, it seems the entire industry is working to solve the provider data accuracy problem. This session will explore the coming of AI, including its promises, limitations, and potential downfalls. Join us to learn how innovative companies leverage AI to impact health care, and how this could potentially change provider data and network management.

Many transgender people experience stigma and discrimination in their day-to-day lives that can affect access to health care. This session will examine strategies and opportunities for delivering accessible and affirming health care. The speaker will explore the specific challenges facing transgender individuals and their employers and the role that health plans can play in improving access to and experience of health care for marginalized populations. Join us to learn best practices for improving access, affordability, and experience for transgender people as they navigate the health care system.

Post-acute care’s fragility was exposed when COVID-19 caught the world by surprise. However, Florida and Connecticut saw some early successes in managing the transition of patients out of the hospital and into the home. Health insurance providers must prepare now for what the future holds for future COVID-19-like outbreaks and the impact of delayed care and maintenance. Join this session to hear from speakers who prepared for, built, implemented and scaled a new paradigm of post-acute and home-based care delivery that stood up to COVID-19. The panel will also share their predictions on how providers should prepare for 2021.

Join this session to learn how gamification can maximize the effectiveness of your well-being program, and help members reach their personal wellness goals. In this session, speakers will discuss how they increased member engagement by launching successful wellness challenges that kept people engaged, active and promoted positive well-being.

Join this session to learn how one health insurance provider is pushing the envelope for value-based care arrangements across a spectrum of health providers and systems, with the goal of serving fifty percent of their membership under value-based agreements this year. Speakers will discuss how their organization is driving health care transformation, while assuring member access to primary care, and supporting the unique needs of independent practices in risk-bearing, value-based care models.

Understanding the social, economic and environmental factors that influence a patient’s health are vital to providing personalized care that improves health outcomes. But while many are aware of the impact of social determinants of health (SDoH) on populations, there are varied opinions on how to build a business case for its use, operationalize the use of the data or calculate its impact. Join this session to hear speakers discuss key topics around SDoH data use, including industry views around the appropriate use of SDoH, and data-related factors health insurance providers should consider when building and implementing SDoH-based programs.

Through new, expanded flexibility in Medicare Advantage, health insurance providers are now able to offer non-medical supplemental benefits. This session will present the results of a quantitative analysis of these new supplemental benefits, including insights about where the benefits are being offered, and how these benefits are designed. This session and its contents are unique as they are the result of a diverse working group, comprised of health insurance providers, think tanks, advocates, and providers – all national experts on Medicare Advantage and long-term services and supports. The gathering of this diverse working group offers a holistic perspective of how new supplemental benefits can shape Medicare policy, as well as caution to plans and policymakers of these benefits’ limitations and challenges. Join us to learn how Medicare Advantage plans are taking advantage of using new program flexibility to offer innovative non-medical supplemental benefits, understand the barriers plans and service providers face in offering and providing delivering these benefits, and appreciate the challenges in communicating these new benefits to beneficiaries and policymakers.

Health care can be a very disjointed experience for members dealing with chronic conditions. This session will explore a capability that can help members with high-risk conditions proactively manage their health by combining health services, prescriptions, and self-care products all in one place. Join us to learn how access to high-quality, local, convenient care can help improve adherence and outcomes, lower cost of care, and keep people on their path to better health.

By partnering with the thousands of community development organizations in neighborhoods across the country, health insurers can more efficiently and safely make place-based investments that successfully address community needs and improve important social determinants of health. This session brings together three leaders from the sectors of health insurance, public health, and community development to highlight a unique partnership which is investing directly into a low-income neighborhood to improve the health of the whole community. Join this session to better understand the role the community development sector is playing in supporting place-based health care investments and maximizing positive impact on community needs.

The integration of community-based palliative care and primary care has proven challenging. Join this session to learn how one health insurance provider is using data and technology-enabled insights from providers to target its most complex members for additional palliative and supportive care services in order to improve member health outcomes and lower medical expenses. Attendees will learn how to determine which data streams can be used to identify health plan members for enhanced supportive/palliative care, and how to effectively leverage data and technology to improve care for health plan members.

The future of health is in the home and in the community. But what happens when the environments we live and work in aren’t healthy? We know that health is created by more than our genetics – it is also dependent on our social environment – access to fresh food, transportation, education, employment, and safe and affordable housing. In our current system, human services that address these social needs and health services are siloed, leading to a disconnect between the health of our communities and the health of individuals. How do health insurance providers identify their members’ needs and connect them with social services? How can they partner with community-based organizations to coordinate whole-person care? What can employers do to support their workforce, as well as their larger community through impact investing and corporate social responsibility? This session will explore how one health insurance provider is collaborating with state and county leaders to reduce access barriers and target interventions informed by human service relationships in order to improve health outcomes. Join us to learn more about how to build data partnerships to link health and human services.

This session will examine how evolving needs in the market will directly impact the design of health benefit plans. In the current economic environment, employers are re-thinking their benefit strategies and members are facing new coverage challenges. Learn how HSA, ICHRA, and MA each provide unique opportunities to address the changing market, while ensuring access to quality health care options.

Over the past year, the American Medical Association and Centers for Medicare & Medicaid Services worked together to achieve the first overhaul of CPT® and Medicare coding guidelines and documentation for evaluation and management services in over 25 years. These landmark revisions will affect nearly every specialty, and significantly reduce administrative burden for health care providers. Join this session to learn more about these important changes and how to implement them by January 1, 2021.