It’s not too late. You can still participate in AHIP’s National Conference on Medicare, Medicaid and Dual Eligibles. Now through November 19, engage with leadership from Medicare Advantage and Part D plans, Medicaid managed care organizations, and programs for those who are dually eligible.
Revisit the conference or catch up on what you missed. You can log-in any time through November 19.
The speaker will discuss the impact of COVID-19 on the Medicare population and public health, including how communities of color are disproportionately impacted by this pandemic.
The speaker will discuss innovative strategies for providing and delivering care and other critical benefits to Medicare beneficiaries during the COVID-19 outbreak.
This session will highlight advances in dialysis treatment for Medicare beneficiaries and innovative MA plan strategies including preventive kidney care and home dialysis programs.
This session will provide updates on CMS Innovation Center’s latest initiatives for improving quality of care and reducing health care costs for Medicare beneficiaries, including the Part D Senior Savings and Medicare Advantage Hospice Benefit Models.
COVID-19 is far from over, and seniors remain the most vulnerable to the virus, with adults 65+ accounting for 8 in 10 COVID-19 deaths. Virtual care has emerged as a critical tool to help keep seniors safe during the pandemic. As older populations continue to become familiar and comfortable with telehealth, trends have emerged that can help health plans engage members in this safe modality of care. Join this session to learn best practices for engaging the Medicare population in virtual care.
Supporting dual eligibles is more important today than ever. It is critical to have the right strategy to optimally identify, engage, and support their needs. This session will examine how advancements in AI, behavioral science, and understanding of social determinants can deliver a more comprehensive approach to achieve risk and quality goals. Learn how analytics for dual-eligible identification, communications to build trust, and the shift to a more interconnected ecosystem can improve care.
In this session, you will learn how to leverage data to help meet CMS compliance requirements, increase Star ratings, and establish meaningful quality measures and targets. Speakers will share learnings from their experience in various health plan industry analytic leadership roles. They will also address the importance of partnering with providers to improve population health, quality, and value-based contract goals and investing in a partner to help incorporate established analytic methods.
Speakers will provide insight on practical tools and share best practices that MA organizations and Part D plan sponsors can implement to successfully prepare for program audits and improve performance.
This session will highlight AHIP’s Fast PATH Initiative which aims to improve prior authorization for patients and their doctors.
Thought leaders will provide their insights on legal and actuarial issues that will impact Medicare’s future and health plans’ continuing role in our health care delivery system.
With the final CMS/ONC interoperability rules, health plans are now on the path toward real-time data exchange. In this session, we’ll address best practices, and unforeseen challenges as plans navigate towards the compliance deadline of 7/21. All aspects of the interoperability rules will be covered along with insight into the expansive data needed; integration, mapping, validation, standards and security requirements while defining a health care experience for their members.
A recent survey revealed that the majority of health plans and care providers perceive the variation in payer processes and clinician workload to be challenges for providers in meeting risk adjustment and quality program requirements. Join this session to learn how to improve risk and quality performance without increased administrative burden and gain practical recommendations for helping providers meet and exceed risk adjustment and quality program requirements.
Speakers will discuss the use of supplemental benefits to address care and other needs of Medicare Advantage beneficiaries.
Legal experts will review the current landscape of legal issues affecting the policy and regulatory agenda for Medicare Advantage and Part D plans.
Low-value care and waste in the health care system increases financial burdens and leads to poor health care outcomes. Adoption and operationalization of value-based care models in health systems is an ongoing challenge. In this discussion, leaders from academia and industry will discuss practical steps that can be considered to overcome these challenges—both from a policy and technology perspective. Learn how AI and machine learning can be leveraged to enhance value-based care.
As the use of health technology in the home increases, the need for payer support is crucial. Common challenges include how to easily introduce, educate, and support older adults on how to use remote technologies, and how to encourage daily use or when/as needed. This session will outline the ways in which older adults can benefit from connected health solutions, and how offering these solutions to members can improve health outcomes, cost measures, and quality of life.
While we do not yet have a COVID-19 vaccination, we do have the ability to protect against the risks of seasonal flu. It is more important than ever that individuals get their flu vaccination. This session will provide strategic insight to help health plans deploy effective targeted outreach programs, including culturally adapted content, behavioral science-based messaging and barrier identification and collection. Join us to learn best practices for improving member reach rates.
With most of the causes of health risk outside or upstream of the traditional health system, social determinants of health (SDOH) continue to shape health outcomes in powerful ways. Join this session to discover how public health and public safety are influenced by barriers and inequities that prevent us from leading our healthiest lives. Learn how to leverage consumer behavior data to identify population and individual risk hot spots to achieve real-world benefits for your members.
Building a better model for care at home for seriously ill members requires home-based palliative care. In this session, a panel of experts will provide insights and best practices of home-based palliative care, and how to leverage it as a pathway to improved patient/caregiver satisfaction and outcomes. Learn how scalable solutions can help your organization effectively address social determinants of health, integrate care management, and apply AI/predictive analytics to identify member needs.
The value of accurate and complete managed care encounter data is at an all-time high. From compliance to revenue accuracy and value-based program performance, encounter data is the heart of these health plan initiatives. However, many health plans lack connected data visibility beyond the encounter lifecycle. Join this session to learn how to overcome operational challenges and how electronic data interchange and encounter submission technology can help “connect the data dots.”
The session will highlight current CMS initiatives and policies to address fraud, waste, and abuse in the MA and Part D programs, including managing risk during the COVID-19 crisis.
The speaker will highlight the agency’s priorities for the Medicare Advantage and Part D programs for the 2021 contract year and beyond.
This session will highlight the impact of social risk factors on Medicare Advantage Star Ratings and Medicare’s Value-Based Purchasing programs.
The COVID-19 crisis sparked conversations about care accessibility for vulnerable populations and how technology can help bridge health care inequities. In response, Congress passed Medicare legislation expanding telehealth access, making it easier to receive high-quality care. Speakers will examine early data and trends on MA reimbursement for telehealth services and beneficiary behavior. Learn how telehealth offerings can help you better serve Medicare populations and lower the cost of care.
With the COVID-19 pandemic impacting patients and overburdening health care providers across the globe, the need for standards-based interoperability solutions has been brought into sharp focus. This session will examine the regulatory status for real-time prescription benefit and electronic prior authorization and explore the latest developments in the NCPDP standards for these transactions. Join us to learn how Health IT can help bridge communication challenges between payers and providers.
This session will explore what’s coming with the CMS/ONC interoperability rules. Our regulatory expert will provide critical insights into tactical considerations for both plans and providers for each key requirement and strategies for leveraging current initiatives and how they will feed into compliance. Learn how a more holistic regulatory approach can lighten the burden of compliance and lead to better health outcomes, enhanced member satisfaction, and improved provider-payer relations.
Health plans are under enormous pressure to innovate and meet the ever-changing landscape of consumer demands and regulatory requirements. This especially holds true for Medicare Advantage (MA) plans. Join this session to explore how leveraging consumer experience (CX) technology that is built specifically for health insurance can help MA plans address four key challenges. Learn how to leverage new technologies and tools to innovate on CX to drive member engagement and personalization.
This session explores tools for plans to assist members in finding “best fit” medications to increase adherence and improve health outcomes. Discover how therapeutic interchange can lower high-cost prescriptions, increase customer satisfaction, and improve Star Ratings performance. Learn through real-world use cases how you can be more proactive with member outreach by targeting drug savings and encouraging members to engage with their physicians about options beyond generics.
For individuals with chronic conditions, high-quality nutrition can be an effective way to reduce medical costs, lower readmission, support higher satisfaction scores, and improve member health outcomes. Spurred by the challenges of COVID-19, recent changes in government policies offer health plans, particularly Medicare Advantage organizations, new flexibility to design and quickly implement targeted nutrition programs for their members.
Each year, millions of Americans suffer from unmet care needs for behavioral health and chronic conditions. Unfortunately, the problem of unmet need is highly complex due to the systemic, socioeconomic, and individual barriers to care. This session will examine the underlying causes of this issue, the impact on patients and payers, why improving access and adequacy may not be sufficient to solve the problem, and the proven strategies for identifying and re-engaging members with unmet care needs.
The Medicare Advantage (MA) marketplace continues to be a tremendous growth opportunity for many health insurance providers. This session will examine research-based learnings of MA member shopping behavior, key health care touchpoints, and experiential drivers of retention. Speakers will explore mechanisms that build consumer loyalty and the potential for leveraging supplemental benefits to increase engagement among MA members during their initial months of enrollment.
COVID-19 put the spotlight on social determinants of health and the need for individualized care and support like never before. This session will explore how and why building a new kind of Medicare Advantage health plan is so critical for not only the member experience, but also to support COVID-19 relief efforts and related health implications. Learn how one Medicare Advantage company is continuing to innovate in a COVID-19 world and proactively address both medical and social challenges.
Spending on serious illness too often includes care that is unwanted, unnecessary, and non-beneficial. Palliative care has proven to improve quality and lower costs in the face of serious illness, but it is a scarce resource and often delivered inefficiently. This session will dispel common misconceptions about advance care planning and illustrate through real-world case studies how it can be delivered with scale and consistency to vulnerable populations.
The speaker will discuss his priorities and provide updates on the latest MA and Part D models designed to improve quality of care and provide affordable choices for Medicare beneficiaries.
Speakers will provide their insights on the upcoming Presidential election including the role health care issues are likely to play in the campaigns.
Speakers will highlight how health insurance providers have continued to meet their members’ needs under extraordinary circumstances in this extraordinary year and discuss how health insurance providers have risen to the occasion with a variety of the innovations.
The COVID-19 pandemic has reshaped almost every aspect of daily life. In Medicaid, patterns of care and the timing and costs of that care have departed wildly from historical patterns. Speakers will review how COVID-19 has impacted utilization patterns, the ability of actuaries to project utilization and costs, and Medicaid rate actions taken by states to compensate for revenue shortfalls.
During this session we’ll discuss how the pivot towards telehealth, which was well underway prior to COVID-19, shifted into high gear during the pandemic, and helped stakeholders discover the expansive value of telehealth, particularly for the Medicaid population. Join us to learn how innovation drives engagement, awareness and adoption of virtual care in communities – ultimately resulting in lower costs, improved outcomes and excellent member satisfaction.
As government regulated health insurance markets continue to grow, successful plans are focusing on integrated performance maximization within their government programs. This session will review strategies for ensuring accurate and efficient revenue tracking, and effective medical expense waste and abuse management. Join us to learn best practices for enforcing accurate provider billing and claims processing that can enable health plans to offer richer benefits and drive membership success.
Many people with Medicare and Medicaid experience high levels of chronic medical conditions, functional impairments, and mental illness. Many of these conditions are complicated by social factors. Learn how health plans focus on reducing the effects of underlying social factors as they coordinate Medicare and Medicaid services and supports for “dually eligible” individuals.
Medicaid plans have been serving Medicaid enrollees and adding value to state Medicaid programs for more than four decades. This session will review recent research on the spectrum of value created by Medicaid health plans to engage members in their care; improve access to care; and support providers, and cost-effective management of public funds.
The “pay and chase” claims payment model used by many health plans can reduce provider satisfaction and increase regulatory risk. A shift to an AI-powered Payment Integrity (PI) model changes the focus from investment in payment platforms to a systemic use of automation to simplify the PI function. Join us to learn how you can leverage a self-driving PI program to improve provider satisfaction, reduce regulatory risk, and achieve cost savings that can be shifted to other AI projects.
Medicaid managed care plans work closely with state agencies and law enforcement to identify and mitigate fraud, waste, and abuse (FWA) in Medicaid programs. Speakers on this panel will review the current state of program integrity efforts and highlight new FWA concerns that have surfaced as a result of the COVID pandemic.
This session will feature a panel discussion with health plan and community-based organization leaders, highlighting the benefits of partnership with CBOs in the national aging and disability network to address social risk factors for Medicaid and dually eligible beneficiaries. The ‘value add’ of these partnerships to health plans will be articulated, as well as the evolution to an organizing model – Community Integrated Health Networks – that meets key quality and outcome benchmarks.
To maximize population health and care management, payers need to be able to identify opportunities for improvement at the system, provider and patient levels. A single data platform can ensure that all parties can trust information being used to drive organizational decisions. Join this session to learn how this single source of truth can not only help you identify individuals with the greatest needs for care management but also display appropriate patient data across the continuum of care.
The COVID-19 emergency has created a perfect storm for states, placing extraordinary demands on health systems and supply chains and decreasing state tax revenues while increasing unemployment and Medicaid enrollment. Medicaid officials from three states will explore some of the strategies that they’ve adopted to tackle these problems in their Medicaid and CHIP programs and provide early insights into their successes and lessons learned.
The speaker will address two areas of major significance to dual eligible programs in 2020: impacts of the COVID-19 pandemic on people with Medicare and Medicaid, and progress on the integration requirements for Medicare dual eligible special needs plans (D-SNPs) that go into effect on January 1, 2021.
What trends are driving the evolution of Medicaid programs now and over the next few years? How are COVID-19, the 2020 elections and state politics likely to shape the trajectory of Medicaid policy? This session will feature a lively discussion by three distinguished experts in Medicaid programs and policy, providing their unique commentary and perspectives on current and emerging trends.
This live Town Hall session will feature senior leaders from AHIP discussing considerations for COVID testing and the prospects for COVID vaccines in the near term, and the implications for coverage by health plans under various programs.
The COVID-19 pandemic has radically changed our social interactions, how we seek care, and our ability to engage with friends and family. Speakers in this session will explore collateral effects of the COVID-19 pandemic on the use of opioids and behavioral health, and the strains it has placed on services to treat substance use disorders and mental illness.
Speakers in this session will explore key principles and considerations for prescription drug value-based purchasing (VBP) arrangements, and how CMS’ recent VBP and Medicaid best price proposed rule is likely to affect the use of VBP arrangements in commercial and Medicaid drug coverage.
Home and community-based services (HCBS) programs have had to “thread the needle” during the COVID emergency, serving people in their homes while observing social distancing and the conditions of “stay at home” orders. Speakers will discuss the challenges they’ve encountered and the successes they’ve achieved in ensuring continuity of HCBS to members and supporting direct care service workers.
Unnecessary care delivered to people with serious illness is one of the largest drivers of waste in our health care system and creates poor outcomes for everyone. Advance care planning (ACP) is proven to address this problem but is currently underutilized. In this session, we will provide evidence of 4 key outcomes from ACP, along with practical solutions to engage members with serious illness in one of the hardest conversations in health care.
2020 has been a particularly challenging year for long term services and supports (LTSS) programs serving people with functional limitations and disabilities. Nursing home residents and staff have been hit hard by the pandemic, and HCBS programs have had to balance serving people in their homes in the midst of “stay at home” orders. Two national LTSS leaders will explore strategies states and MLTSS plans have used to bridge the gaps for people using LTSS.
Speakers will review integration requirements for dual eligible special needs plans (D-SNPs) going into effect in January 2021, discuss progress made by states and D-SNPs to implement the requirements, and highlight some of the practical approaches being used to exchange eligibility data and admission notifications.
COVID-19 continues to lay bare the disparities that exist in the US healthcare system and the structural inequities of American society. Health plans can fill critical roles in addressing disparities given their data infrastructure, resource capacity, partnerships, and standing in communities. This session will highlight strategies health insurance providers employ to identify and reduce disparities and will feature case studies that present best practices for addressing health inequities.
Spanish-speaking people in the U.S. experience numerous, well-documented health disparities, from worse maternal health outcomes to increased rates of chronic conditions. Despite many persistent barriers, particularly amid the coronavirus pandemic, there are still proven steps health insurance plans can take to meaningfully improve care outcomes. Join this session for actionable tactics to improve engagement, satisfaction, and outcomes among Spanish-speaking members.
How can our nation best provide for the health and welfare of women and children with Medicaid? Speakers in this session will review current trends and issues affecting Medicaid’s role in maternal and child heath, ranging from preserving access to routine care during the pandemic to legislation supporting recommended post-partum care.
No travel required for this year’s conference. All you’ll need is access to your computer or mobile device.
You’ll find a fully interactive conference experience – from start to finish. Chat with other conference attendees, speakers, exhibitors. Take the opportunity to ask questions in sessions. And, with a digital briefcase available for downloadable materials, no worries about stuffing your suitcase with valuable information.
Accenture is a leading global professional services company, providing a broad range of services and solutions in strategy, consulting, digital, technology and operations.
American Well is a telehealth platform in the United States and globally.
Remote monitoring solution for high risk seniors, to lower PMPM costs
Burgess helps leading American health insurers and ACOs set a new standard in payment accountability.
CareCentrix drives savings, improved outcomes, and patient satisfaction
Machine Intelligence for Precision Care Delivery
Improving healthcare outcomes and costs by matching patients to the right treatments by the right providers at the right times.
IBM Watson Health aspires to improve lives and give hope by delivering innovation, through data and cognitive insights
Driven by data, Inovalon identifies gaps in care, quality, data integrity, and financial performance
Mom’s Meals is a leading national provider of refrigerated, home-delivered meals and nutrition services.
NTT DATA is an end-to-end service provider of IT and business solutions for healthcare.
Optum combines technology, data and expertise to power modern health care.
Teladoc Health is the global virtual care leader, offering the only comprehensive virtual care solution.
The First and Only Consumer Experience Platform Built for Health Insurance