As health care continues to dominate the national conversation, it’s more essential than ever to participate in the National Conference on Medicare, Medicaid and Dual Eligibles. We’ll take a closer look at the policy, regulatory, and operational issues affecting Medicare Advantage and Part D, Medicaid managed care, and programs to better serve those who are dually eligible.
Across four vibrant, information-packed days, you’ll engage with leadership from CMS and the administration, health insurance provider executives, government officials, health policy professionals, and industry thought leaders.
Check out the full agenda for more information, including speakers.
The Director of CMS Medicare-Medicaid Coordination Office (MMCO) and MMCO staff will review priorities and progress of integrated care models for Medicare-Medicaid “dual eligibles” for the coming year, efforts to connect dual eligible enrollees with COVID vaccines, and areas for potential collaboration with integrated plans.
Speakers in this session will explore different ways that social barriers and resulting health disparities manifest in their member’s lives. They will review a range of initiatives and innovative strategies that Medicaid plans are using to improve health equity across a range of communities.
This session will present a program implementation framework for helping payers that want to get started in Medicaid managed care. The framework covers all phases of implementation from strategy development through program go-live and steady state operations. Learn about a variety of topics crucial to standing up a managed Medicaid program operation, such as developing a multiyear roadmap, program methodology and governance, clinical model development and platform agnostic technology solutions.
For over 50 years, Medicaid has been an essential safety net for tens of millions of children, seniors, people with disabilities and veterans. As economic, political, social and health dynamics have evolved, service delivery for Medicaid members has too. Join this session to explore how a leading health plan is evolving to better retain Medicaid members and provide access to the right care at the right time. Learn about approaches that improve access by meeting Medicaid members where they are.
Increasingly risk, quality and value-based care are converging to improve outcomes and manage costs across the healthcare ecosystem. This session will explore a cohesive approach to transform the care delivery and payments process. Real world examples from chronic conditions to simple procedures to maternity episodes will be discussed to highlight the opportunities and complexities relative to effectively addressing risk, quality and value-based care across lines of business.
This session will explore the current landscape of legal issues that are likely to shape the trajectory of Medicaid policy.
This session will provide an overview of emerging trends, including direct contracting entities (DCEs), strategies and innovations for coordinating state, provider, and plan information on care transitions.
Medicaid plans are well positioned to improve their members’ health and social well-being through strategies directed at reducing both social and clinical risk factors. This session will explore how value-based programs (VBP) can be leveraged to align incentives across clinical and health equity initiatives to assess whole person care. Learn how to improve health outcomes and reduce costs of care for your members.
This session will explore the role of data in assessing social needs, reporting, communicating risks, and connecting with enrollees and resources to promote health equity. Speakers will also discuss challenges around collecting race and ethnicity data, and impacts on COVID vaccination rollout.
Rising medical costs and increasingly complex treatments and patient needs have prompted several innovative state health agencies to explore Medicaid payment reform for maternity and other conditions – with some states having mandated bundled payment models. Hear from state agency and payment reform leaders as they outline the reasons for initiating episode-based payment models, and future considerations for MCOs and providers preparing for additional value-based transformation in Medicaid.
This session will explore how telemedicine is positioned to bridge access gaps and improve outcomes in substance use disorder (SUD) treatment, long after the COVID-19 pandemic. Speakers will discuss the unprecedented results of a cohort of Washington state Medicaid beneficiaries undergoing virtual addiction treatment. Learn how to build a digital strategy for addiction care, including considerations for how to select, launch, and measure the success of a telehealth SUD partnership.
The new Director of the Center for Medicaid and CHIP Services (CMCS) will review the status of the Medicaid program, the Administration’s priorities for Medicaid in the coming year, and the likely evolution of initiatives that Medicaid programs and Medicaid plans will face together.
Medicaid pays for the majority of long-term services and supports (LTSS) in the U.S., but what if eligibility for LTSS was no longer tied to income? A panel of experts will explore the policy and fiscal implications for decoupling LTSS from Medicaid for people who rely on LTSS, their caregivers and direct care workers, state Medicaid programs, Medicare, and the federal budget.
Medicaid directors from four states will reflect on the opportunities and challenges facing their states amid the shifting terrain of the COVID pandemic, an expanding enrollment base, new imperatives from Congress and CMS, and competing demands for expanded coverage and fiscal restraint.
In this session, speakers will examine implications of the end of the COVID public health emergency at the state and federal levels: changes in the Medicaid regulatory framework and program flexibilities, state financing (end of enhanced FMAP and MOE, glide path) Medicaid enrollment (redeterminations).
Explores what states are looking for these days in Medicaid managed care procurements, including performance metrics and rewards; and initiatives to address SDOH, health equity, and program integrity.
This session will explore plan strategies and innovations for outreach and engagement, and provision of physical and behavioral health services to enrollees experiencing homelessness.
While digital therapeutic solutions are proven to drive engagement and value in commercial populations, there is a perception that Medicaid populations may be less able to successfully engage with technology. New data challenges are also often cited as barriers to implementing digital health solutions for Medicaid members. In this session, we’ll explore examples from successful deployments and outline key characteristics digital health solutions require to deliver value for payers and members.
This session will provide an environmental scan of the opioid pandemic, reviewing where it stands in 2021, exploring collateral impacts of COVID-19 on addiction, substance use disorder (SUD) treatment and recovery, and developments in treatment, SUD waivers, and the legal process.
Leaders of Medicare-Medicaid dual eligible plans will highlight strategies their plans have employed to engage their members and connect them with vaccines, care, and services over the course of the COVID pandemic.
This session will explore how MCOs can use analytics in today’s value-driven healthcare environment to improve care delivery and optimize cost of care. Examine a use case focused on how advanced analytics can make value-based and pay-for-performance (P4P) programs more effective to help earn back annual Medicaid withholds, improve provider performance and member-level insights, and better utilize available data sources beyond what’s being used today to improve performance on program measures.
This panel will review policy considerations and progress in extending Medicaid coverage for women postpartum and the role of postpartum coverage in improving maternal health outcomes and reducing health disparities. Speakers will also review other policy initiatives directed at improving maternal health.
Panelists in this session will explore current drug issues in Medicaid, ranging from the implications of new Alzheimer’s treatments and other drugs in the development pipeline for Medicaid programs to the outlook for state prescription drugs carve-outs and implications of the recent Medicaid best price rule.
The traditional health care delivery approach is limited in its ability to meet the changing care needs of individuals receiving Long Term Services and Supports. This session will explore proactive and coordinated ways to deliver quality care to LTSS beneficiaries while improving health outcomes and reducing cost of care. Learn how the optimal mix of technology, care delivery, and care solutions more effectively address individual and population needs.
In the time of COVID-19, basic human needs like access to safe housing, nutritious food and social connections are more essential than ever to health and well-being. Explore how one health plan has used strategic outreach campaigns to successfully bridge the gap between members at-risk for food insecurity and CalFresh/SNAP benefits. Learn how to build scalable and adaptable engagement campaigns across communities to maximize impact.
The director of CMS’ Division of Managed Care Policy will review progress in managed Medicaid programs and the new Administration’s Medicaid priorities for managed care.
A diverse group of experts will explore how people with Medicaid can be served through the Internet, and issues with technology such as the Lifeline program, rural broadband, telehealth, and text-based member engagement programs.
The former leader of the CMS Medicare-Medicaid Coordination Office will explore aspects of recent conceptual models of integrated service delivery for Medicare-Medicaid dual eligibles, and prospects for transformation of the traditional Medicare-Medicaid paradigm.
CMS’ Administrator will highlight the agency’s priorities for the Medicare Advantage and Part D programs for the 2022 contract year and beyond.
This session will provide the latest information on demographics and trends in Medicare, including increasing enrollment and the diversity of populations served by Medicare Advantage plans.
This session will highlight updates on the CMS Innovation Center’s latest initiatives for improving quality of care and reducing health care costs for Medicare beneficiaries through MA and Part D models.
Research suggests that the number of plans is growing, benefits are competitive, and consumers want an uncomplicated user experience during the Medicare Annual Enrollment Period (AEP). Medicare Advantage plans must make the most of every sales lead during AEP. This session will examine the research and real-world use cases of how plans have leveraged AI to better manage and prioritize leads, improve conversion rates, and enable a more consistent (and compliant) enrollment experience.
Digital tools have gained traction with employers, but Medicare plans have been slower to adopt. Join this session to explore one plan’s approach to vetting, assessing and selecting a digital health solution for Medicare members as well as listen to new insights on one digital program’s clinical results and usage patterns for adults over 65. Gain timely knowledge to guide plan decision-making now that digital blood pressure readings can be used to satisfy quality measure reporting requirements.
Healthy aging programs that engage members in activities like fitness and social engagement support member attraction and retention, but do they improve overall health? Speakers will share data from an independent evaluation of the impact of a senior health and fitness program on health outcomes and costs and will include a health plan perspective on investing in programs to support healthy aging. The panel will also discuss the value of these programs to older adults and impact on outcomes.
Speakers will discuss a recent study as well as plan and other stakeholder efforts to provide needed care and additional benefits to diverse Medicare Advantage enrollees, including dual eligibles.
A recent data-driven study found key differences in utilization, cost and quality among high-need Medicare Advantage (MA) members compared to similar Medicare FFS members. Speakers will highlight findings, explore how they may be related to incentives in MA to better coordinate care and provide preventive services and flexible non-medical benefits, and offer real-world examples of how MA plans are using new incentives to provide better care at lower cost for the most vulnerable.
Each year, MA and Part D plans anxiously await receipt of CMS program audit engagement letters and work diligently to ensure audit preparedness. This session will explore strategies for working with your PBM for a successful audit experience. Speakers will share best practices and tips to demonstrate Compliance Program Effectiveness (CPE) for services delegated to the PBM.
The changing landscape of the pandemic continues to push innovation and the need for flexibility in health care. Adoption of virtual care has soared, as has the need for human touch services. Emerging from this pandemic, how will health care companies continue to equip at-risk groups―specifically those with social care needs―with virtual health technology and services? We will explore how the combination of social work, coupled with technology, can help seniors and other at-risk groups thrive.
This session will provide an overview of the mitigation and investigative approaches used to address the COVID-19 fraud schemes.
*This session will not be available on demand following the conference.
As the competitiveness of MA markets increase, so does the importance of coding and documentation. Stars member experience weightings and digital quality measures are recent trends MA plans must leverage to succeed. SDOH exist at the nexus of these trends. Attend this session to learn insights about recent trends affecting MA plans, followed by case studies that illustrate how SDOH can inform member and provider engagement to improve risk and quality performance.
Family caregivers face numerous barriers to participating in loved-ones’ care journeys despite the proven impact they have on patient health outcomes. This session will examine the value of including caregivers in coordinated care and how virtual care delivery presents opportunities to integrate support for chronic conditions and behavioral health needs. Learn how new legislation and technology can be leveraged for caregivers to serve as key players in patient-centered care.
Medicare Advantage plans are seeking new ways to improve the customer experience and reduce churn. Advanced Process Automation (APA) is central to these efforts. However, MAOs may struggle with achieving the level of automation needed to realize value due to a set of common challenges. In this session, we will explore the value of APA for MAOs through use cases. Gain actionable guidance on overcoming common challenges in implementing process automation across your organization.
Speakers will discuss strategies to identify disparities and improve health equity through quality reporting and measurement.
In a recent survey, 1,000 Medicare members were asked about their consumer experiences (CX) and digital consumer experiences with their health plans. Their responses were compared and contrasted with Medicare-payer responses, as well as members of Medicaid and commercial health plans. This session is designed to give payers current and market-specific insights into CX trends and is timely given the huge growth in Medicare eligibility and the digital acceleration of the recent pandemic.
Health plans often rely on a traditional approach to claims payments using old thinking and workflows to address new problems. Accurate, transparent payment management in health care may feel out of reach, but modern technology has the ability to alleviate common pain points and make payments a success. In this session, you will learn how innovative technology can help payers address the ever-evolving Medicare policies and fee schedules, and ultimately transform their claims payment operations.
This session will outline the final CMS ruling for Real-Time Benefit Tools (RTBT) and the current progress on the NCPDP Standard. Speakers will explain how eligibility and formulary, real-time benefit, and electronic prior authorization tools work together. Learn how prescribers and pharmacists are benefitting from the broader sharing of information and hear the latest data on the impact for patients that these tools have.
In this session, speakers will discuss accelerated approvals for new generation drugs, as well as cost, coverage, and other implications.
The speaker will discuss her vision and priorities for improving quality of care and providing affordable choices for Medicare beneficiaries.
This session will highlight the critical importance of strong partnerships between the public sector and private markets to promote health equity as evidenced through the Vaccine Community Connectors Program. Speakers will also provide insight on how health insurance providers successfully helped millions of seniors and others in underserved communities receive COVID vaccines and how this important work can influence more private-public partnerships to promote health equity.
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.
Virtual Primary Care (VPC) is a frontrunner for the health care buzz term of 2021. While most health plans know they need a VPC program many don’t fully realize the true impact these programs can have. During this session attendees will hear real-life patient stories from a practicing virtual PCP to see how VPC programs can close gaps in care and improve patient outcomes, especially for those on Medicare. Learn how this directly translates into cost savings and member engagement.
This session will provide attendees with an overview of the influence of socioeconomic and environmental factors on the health and health outcomes of Medicare Advantage, Medicaid, and dual eligible patients. Attendees will hear examples of approaches to combining publicly available data with survey data on member attitudes, lifestyles, and behaviors. Insights from these approaches can inform target interventions in underserved communities within Medicare member populations.
Adverse drug events result in significant morbidity and mortality. It is even more concerning because many adverse drug events are predictable and preventable with the right technology. This session will review the results of a recent study that highlights the risk of premature mortality associated with adverse drug events, implications for Medicare and Medicaid beneficiaries, and available technology to identify and reduce adverse drug events.
Speakers will discuss the current state and trajectory of supplemental benefit offerings to improve care and address the needs of Medicare Advantage enrollees.
Medicare Advantage organizations that depend on homegrown processes to manage benefit plans experience operational inefficiencies. This session will explore how health plans can address those challenges by auto-generating documents (ANOCs, EOCs and Summary of Benefits), simplifying competitive intelligence, and automating Plan Benefit Package (PBP) bid submissions. Learn how a single source can help health plans minimize errors, increase speed-to-market, and improve compliance.
Research has shown that more than a third of American adults skipped or delayed medical care in 2020 due to concerns around COVID-19 exposure, and more than a quarter of parents delayed care for their children. This session will review the longer-term impact of care delays, methods to identify at-risk populations, and strategies to re-engage members and improve population health.
High-quality provider networks are at the core of a health plan’s success. Embracing digital innovation during the network development process will allow Medicare Advantage plans to secure critical partners in an extremely competitive environment. This session will explore a technological innovation that can transform how health plans manage health care administration and credentialing projects. Join us to learn how to save time and resources with an innovative approach.
This session will focus on findings and policy recommendations from a recent study on Medicare-Medicaid “partial dual eligibles”, people who have full Medicare benefits but limited Medicaid benefits.
Addressing member needs and improving outcomes is challenging, especially for hard-to-reach communities heavily impacted by social risk factors. In this session, you’ll learn how to improve member engagement, outcomes, and ROI in these communities. We’ll also discuss ways health plans can improve Quality/Star Rating program outcomes, identify and address social determinants of health needs, and reduce cost of care through targeted, cost-effective approaches to population health engagement.
Each year headlines report the rising cost of health care. Conversations lead to solutions aimed at addressing the issue, while some are pursued, many others wither on the vine. However, major overhauls of the system may not be necessary to control costs. This session will explore how a newly established clinically integrated network (CIN) can support better outcomes and address rising costs, help payers see immediate value, while allowing providers to remain autonomous.
Enrollment is a member’s first active interaction with the health plan and to excel in the competitive Medicare Advantage market, it is imperative for health plans to give members a truly digital enrollment experience. In this session, we will explore various strategies that health plans can employ to overcome challenges in Medicare enrollment processes and provide members with a digital, simplified enrollment experience that can build trust and act as catalyst for enhanced member engagement.
Speakers in this session will explore strategies and initiatives to address disparities in medication adherence among members of different racial and ethnic groups.
This session will provide a three-step action plan to expanding your Medicare Advantage footprint. Through real-world case studies, learn how this three-step process, powered by an end-to-end analytics platform, can help identify gaps in your expansion strategy; build strong provider networks; and maximize success in Medicare Advantage.
Medicare is making great strides towards adopting innovative and proven solutions. However, there are many restrictions in place that limit what care a patient can receive based upon their condition, which can impact delivery of whole person care. Adjusting benefits and coverage to enable interdisciplinary care will offer significant cost reductions to Medicare/Medicaid and improve patient outcomes. Explore the role of digital health care and how it should fit into the Medicare landscape.
Legal experts will review the current landscape of legal issues affecting the
policy and regulatory agenda for Medicare Advantage and Part D plans.
Member centric, digitally enabled, and real time health risk-based care management is increasingly important in Medicare. This session examines the interplay of technology, payer-provider collaboration, and SDOH for community-oriented care delivery to the Medicare population. As interoperability becomes pervasive, and the population ages, digital and AI have the potential to substantially enhance understanding of member health, foster personalized health journeys, and improve clinical outcomes.
This session will address the future of Medicare, including the critical role of Medicare Advantage and Part D in ensuring the future success of the Medicare program.
Expect a vibrant, professionally produced experience of a caliber only AHIP can deliver. The same level of expert-hosted content you expect from AHIP conferences, now in an interactive format that makes it easy to:
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