Sponsored Breakfast Briefings And Concurrent Sessions

Sponsored Breakfast Briefings and Concurrent Sessions (45 minutes in length; developed exclusively by National Conferences on Medicare and Medicaid Sponsors)

Sponsored breakfast briefings and concurrent sessions are sessions conducted by leading consultancies and companies providing services and products to the health insurance plan community. These sessions offer insights on trends and new research, or expertise on products and services by the solution providers who are behind the scenes making health care more efficient and effective. Schedule will be posted once available.


Changing the Game: An Automated Approach to Medicare Advantage Bid Submission and Document Generation

Powered by HighRoads

This session will illustrate how payers can modernize their approach to bringing Medicare Advantage plans to market. CMS oversight has never been stronger, putting more pressure on payers to generate compliant Annual Notice of Change (ANOC), Evidence of Coverage (EOC), and Summary of Benefits (SB) documents to plan participants in a tight timeframe. Attendees will learn how technology can dynamically convert plan data from plan benefit package software into codified data to compliantly generate these complex documents, streamlining this annual, recurring process.

  • Jeff Rivkin, Research Director of Payer IT Strategies, IDC

Are You Ready for a CMS Audit? Perspectives on What You Need to Know

Powered by Cody Consulting

This session will provide lessons learned from a Medicare Advantage plan recently subject to a CMS audit. Attendees will hear about one plan’s experience with the audit process and best practices for demonstrating compliance with CMS rules. The speaker will offer insight on steps plans can take prior to the start of the process and advice on how to best use technology solutions and other resources to address issues likely to arise during these audits.

  • Mike Turrell, CEO, Ultimate Health Plans and Member, Cody Consulting Group Advisory Board

Using Integrated Health Intelligence Technology to Improve Participant Outcomes & Lower Costs
Powered by Finity, Inc.

This session will provide the results of two Medicaid incentive programs powered by a health intelligence platform. Attendees will learn how to use health intelligence technology to improve participant outcomes and achieve lower costs. The speakers will also share program results to date, incentive and engagement plan design strategies, and closed-loop tracking plan design methodologies.

  • Alexandra MacDonald, Senior Vice President, Population Health Management, Finity
  • Matt Onstott, PhD, Vice President, Government Solutions, Finity

How Can We Be “Insights Poor” in an Era of Data “Richness”?
Powered by LexisNexis® Health Care

Though HHS has drawn considerable attention to the release of CMS data over the past several years, the promise of big data has yet to be realized across the Medicare and Medicaid programs. Access to data alone does not guarantee improvement in the areas of greatest need. It’s where big data, small data and analytics intersect that true intelligence can be achieved and leveraged to make decisions that lead to cost reductions, improved health outcomes and compliance. Join this session to explore the promise of data intelligence when socioeconomic information, public records data and analytics collide with your health programs traditional data sources.

  • Josh Schoeller, Vice President, Client Engagement, LexisNexis Health Care

Using Segmentation and Analytics to Optimize Plan Performance and Increase the Star Rating
Powered by Novu

If you are seeking to understand the inner workings of how analytics matched with omni-channel technology can improve your plans’ ability to meet beneficiary needs and increase your Star rating, then this session is designed for you. Join us to learn about the process, tools and technologies required to build a successful reward and incentive program for your health plan.

  • Tom Wicka, CEO and Co-Founder, Novu

Terms of Engagement: Reinforcing Payer-Provider Collaboration with Equally Beneficial Analytics
Powered by Pulse8

With provider groups assuming progressively more risk and with the proliferation of risk adjustment and quality metrics across all three lines of government business, market forces necessitate increased data sharing among payers and providers. To avoid sinking under all these data demands, risk-bearing entities need to leverage advanced analytics that will coordinate their gap closure efforts to simultaneously address both risk adjustment and quality initiatives. To reduce provider abrasion and alert fatigue, payers also need to collaborate with their network providers on efficient data collection methods. This session will explore how plans can leverage alternative data gathering and intervention modalities (such as EMR Integration and telehealth), and better integrate gap closure initiatives to more effectively nurture payer-provider collaboration. The speakers will also share the provider engagement and collaboration strategies that are essential to improve quality and fulfill mutually beneficial goals.

  • John Criswell, CEO, Pulse8
  • Scott Stratton, Chief Data Scientist and Vice President, Product Analytics, Pulse8

Changing Payer-Provider Relationship – Are You Prepared?
Powered by Payspan

This session will provide a snapshot of key changes taking place with new ACO alternative reimbursement models and how they will impact payer-to-provider relationships for reimbursement. These new dynamics will affect payers as providers struggle with performance base reimbursement and new governance requirements. The traditional relationship between payers and providers will change significantly in the coming years. Are you ready to handle these challenges while at the same time providing superior service to your members and meeting consumer expectations? Join this session to take a look ahead and discuss how you can apply solutions now.

  • Bill Nordmark, Chief Growth Officer, Payspan

Maximizing your MTM Programs to Drive Improved Health Outcomes
Powered by Express Scripts

The ever-changing Medicare landscape is requiring plans to adapt their Medication Therapy Management (MTM) programs by employing new strategies, innovative initiatives, and different uses of technology to be able to provide the best in class, holistic care your members need. Session attendees will learn how to strategically up their MTM game through care coordination amongst providers, members, nurse care coordinators and pharmacies to maximize health outcomes. We will also demonstrate how plan sponsors could be using MTM programs to tackle challenging performance measures and major healthcare issues like the opioid epidemic.

  • Kevin Boesen, PharmD, Chief Executive Officer, SinfoníaRx
  • Snezana Mahon, PharmD, Senior Director, Medicare, Express Scripts

The MACRA Rule and its Technology Implications for Payers with Medicare Lines of Business
Powered by HeathEdge

This session will provide an overview of key imperatives facing health plans with regards to the impending Medicare Access and CHIP Reauthorization Act (MACRA) rule. Attendees will learn about important preparations necessary for health plans with Medicare Lines of Business. This session will explore how technology will play a critical role enabling the agility essential for health plans to quickly and easily adapt to the value-based reimbursements and new provider contracts that MACRA requires. The speakers will share the implications that technology has for effectively dealing with the new dynamics that MACRA is bringing first to Medicare, and also to Medicare Advantage and Medicaid plans.

  • Harry Merkin, Vice President, Product Marketing, HealthEdge

Assessing Plan Efforts to Increase Effectiveness in Medicaid Managed Care
Powered by Xerox

In this session you will learn how your plan can assess its current service and infrastructure investments to maximize its effectiveness and/or alter your strategy in the growing Medicaid Managed Care environment. You’ll learn how to compare and select programs to improve care delivery outcomes, create a business roadmap to get more out of your initiatives, benchmark industry best practices and reduce existing costs. These skills will enable your plan to successfully address complex challenges such as provider reimbursement and value-based payment, care coordination and delivery, clinical analytics and predictive modeling, social determinants of health, contractual and regulatory compliance, population health and financial stability. After this session, you will be better equipped to assess options critical for success under the Medicaid Managed Care Final Rule.

  • Steve Reynolds, Vice President, Market Management, Government Healthcare Solutions, Xerox

Leveraging Telemonitoring to Reduce Hospital Readmissions and Cost of Care for Heart Failure Patients
Powered by AMC Health 

Patients with heart failure face a progressively deteriorating course of disease, with exacerbations and the accompanying debilitating symptoms that require urgent medical attention and often lead to frequent hospitalizations and emergency department visits. Patient self-monitoring of signs and symptoms offers a means to detect early signals of deteriorating conditions and the opportunity to intervene before urgent/emergent care and hospitalization is necessary. Learn how the addition of telemonitoring can further extend a case manager’s ability to monitor individuals with heart failure, improving patient’s clinical outcomes and cost of care. You will hear a living case study of one health plan’s journey.

  • Andrea Fenner-Koepp, MS, Director of Care Coordination and Integration, Geisinger Health Plan
  • Jonathan Leviss, MD, FACP, Chief Medical Officer, AMC Health

To SNP or Not to SNP
Powered by Change Healthcare

This session will present the regulatory and operational challenges faced by Medicaid and Medicare plans entering the MMP and DSNP markets. We will address audit requirements, operational and service impacts, analytics and reporting, impacts on community based care, claim filing, reporting and clinical staff.

  • Shelley Stevenson, Director, Government Programs Practice, Change Healthcare

Embedding Flexibility in Solutions to help Transform Payer Organizations
Powered by ikaSystems

This session will provide perspectives on current and forward-thinking solutions that help (and will help) payers transform their business so it can effectively compete and thrive in era of accelerated changes. Attendees will learn about real-world challenges related to driving engagement, regulatory compliance, and reducing administrative costs. Attendees will also learn why innovative flexible technology solutions are a must to address these payer challenges.

  • Girish Pathria, Vice President, Product Management and Marketing, ikaSystems

Delivering Meaningful Solutions for Individuals with Serious Mental Illness
Powered by Beacon Health Options

This session will highlight opportunities for health plans to improve both cost and quality outcomes for individuals with serious mental illness. Patients with serious mental illness face unique challenges, including a high frequency of co-morbid medical conditions and complex social needs. Remaining largely disconnected from the system of care, this population frequently relies on emergency departments or acute inpatient facilities for treatment. Attendees will learn about a recently launched pilot program that utilizes peer support to target the unique needs of individuals with serious and persistent mental illness. The speakers will also examine how addressing non-medical extensions of care can improve individual health outcomes while reducing health care costs.

  • Jeremy Hastings, Senior Vice President, Network Strategy, Beacon Health Options
  • Paul Mendis, MD, Chief Medical Officer, Neighborhood Health Plan

Transforming While Performing in a Rapidly Evolving Industry
Powered by Cognizant

Transformative market forces, coupled with rapid advances in digital technologies, are placing consumers at the center of an increasingly virtualized, personalized and delocalized healthcare system. Government health plans are looking for new ways to drive down costs and maintain compliance while shifting from volume to value and creating a personalized experience for their members. Addressing these challenges will require broad new capabilities, from improving administrative efficiencies, through building business models based on quality of outcomes, and implementing digitized processes that address consumer demands for product customization and more control over their care decisions. How will your organization embrace change and succeed in our rapidly evolving healthcare landscape when faced with so many competing priorities? Join us for a discussion of strategies that can help impact your organization’s success today and tomorrow.

  • Becky Erbe, Vice President, Government Solutions, Cognizant
  • Diana Sonbay-Benli, Vice President, Government Solutions Product Management, Cognizant

Improving Quality Reporting with Accelerated Big Data Processing
Powered by Inovalon

As the demand for more granular data insight increases, so does the need to better capture, process, and analyze patient data and measure performance. Disparate data, incomplete medical history and data latency are only a few of the challenges health plans face when trying to identify and address gaps in care. In this session, learn how big data platforms, accelerated processing and analytic capabilities can streamline the quality reporting process and have a positive impact on performance to improve health outcomes.

  • Courtney Breece, Senior Director, Product Development, Inovalon

Innovative Programs Proven to Engage and Empower Complex, High-Utilizing Members and Improve Their Well-Being
Powered by Matrix Medical Network

Engaging and retaining hard-to-reach members with complex or chronic health conditions is challenging work. In this session we’ll discuss and share the results of several innovative chronic care programs. You will learn how these programs help improve access to quality care, boost member participation in healthy behavior and improve health outcomes.

  • Troy Garland, MBA, BA, RN, Vice President Clinical Services, Health Choice Arizona, Health

Choice Generations, Health Choice Essential

  • Heidi Wold, MSN, ARNP, ANP-BC, Vice President, Chronic Care, Matrix Care Direct, Matrix Medical Network

Personalization: The Secret to Driving Engagement and Improving Health Outcomes
Powered by Welltok

The secret to fully understanding and engaging your senior members – both within and outside of the healthcare system – lies in taking a systematic approach to engagement centered around personalized member experiences. By using a combination of consumer data, applied analytics, incentive design, and multi-channel communications, you can improve the beneficiary experience and improve Stars performance – whether it’s member satisfaction and retention or diabetes care and gaps closure. This session will reveal new insights on seniors, including their increasing use of technology to improve their health and what it means for your engagement initiatives. Speakers will also explore how to leverage data, CMS-compliant incentives and enterprise-level technologies to create a truly personalized and rewarding experience for your Medicare members, that’s also scalable. Your seniors are ready, are you?

Network Adequacy Requirements in Medicare and Medicaid: What You Need to Know
Powered by BRG

Health plans are creating new and more complex provider networks in an effort to increase quality and reduce costs. These new networks are receiving increased scrutiny by regulators at both the federal and state level. In addition to the adequacy of the network itself, regulators and consumers are increasingly focused on provider directory accuracy given the complexity of new provider networks and the out-of-pocket costs associated with out-of-network services. Recent regulatory developments underscore the importance of this issue as well as the operational challenges health plans face in meeting these requirements. This session will provide an overview of the efforts to define adequacy and accessibility, including a discussion of recent developments in federal Medicare and Medicaid requirements.

  • Jeremy Earl, Partner, McDermott Will & Emery
  • Brian E. Hoyt, Managing Director, BRG

New Medicaid Regulations for Quality Measurement
Powered by DST Health Solutions

Recent Medicaid managed care regulations have established new requirements for state Medicaid programs and Medicaid Health Plans. For example, CMS will develop a quality ratings strategy for implementation to create more consistent nationwide measures across states. This session will provide attendees with an overview of CMS’ plans for quality ratings and how these regulations will help align these quality measures at a national level.

  • Amy Salls, Director, Population Health Strategy, DST Health Solutions
  • Rayvelle A. Stallings, MD, Vice President of Government Programs, Argus Health

Managing Opioid Utilization in Your Medicaid Benefit
Powered by Express Scripts

Opioid utilization is a topic that is center stage in the national spotlight, but has long been a focus of Medicaid plans. In this session, attendees will hear some of the latest observations about opioid utilization in the Medicaid population and learn best practices to help manage this increasingly concerning class of drugs. We will also share tools health plans can use to analyze their trend and make changes before problems start.

  • Brian Mischel, RPh, MBA, Director, Medicaid Innovation, Express Scripts
  • Krista Ward, MBA, Senior Director, Medicaid, Express Scripts

Managing the Masses: Leveraging Real-Time Data to Improve Medicaid Population Health
Powered by ZeOmega

Medicaid enrollees are often both more medically complex and harder to reach than other insured populations. This session will explore how real-time information combined with innovative outreach strategies are key to successful care management for today’s Medicaid population. Speakers will discuss a comprehensive population health management strategy and approach to encouraging access to health services for this challenging population.  Tools and resources necessary to drive operational efficiency, care quality and patient engagement will be discussed. Learn how a leading regional plan has implemented a population health management solution that connects with hospitals in real-time to expedite care transition management and avert avoidable re-admissions.

  • Christopher Mathews, MD, Senior Vice President and Chief Medical Officer, ZeOmega

Care Models That Work: Moving from Complex to Collaboration
Powered by Optum

What care models are delivering the best quality of care and most value for Medicare and Medicaid populations? Our industry continues to focus on the challenge of escalating medical spend while resources are limited to engage and deliver the spectrum of care required to manage populations at risk. This forces a new collaboration across payers, providers and consumers—with significant financial incentives to reduce costs and improve clinical and quality outcomes. In this session, we will explore care models that derive value by integrating care programs and delivering a person-centric approach.

  • Todd Spaulding, Vice President, Product Management and General Manager, Medicare and Health Plan Market, Optum

Modernize your MA Risk Adjustment Program with a 360 Degree Approach
Powered by Health Fidelity 

Through the real-world experience of a provider-sponsored health plan, this session will demonstrate how a comprehensive risk adjustment program that fits multiple lines of business while achieving operational economies is a necessity in today’s value-based care landscape. Attendees will discover how to best leverage retrospective risk adjustment approaches in partnership with point of care efforts, explore best practices for implementing new technology, and review analytics for measuring risk adjustment transformation.

  • Mary Beth Jenkins,Senior Vice President and Chief Operating Officer, UPMC Health Plan
  • Adele L. Towers, MD, MPH FACP, Senior Clinical Advisor, UPMC Enterprises 

RAPS to EDS Transition: The Necessary Partnership between Providers, Groups, and Health Plans
Powered by Episource, LLC 

In this new risk adjustment world where EDS (Encounter Data System) is quickly replacing RAPS (Risk Adjustment Processing System), it is integral that health plans, providers and other stakeholders work together to address the vast array of new challenges. Under EDS, CMS has significantly increased the complexity of the data necessary for submission for risk adjustment and payment purposes. This session will help health plans, providers and groups navigate this complexity by providing strategies on how to collaborate more effectively with each other. Specifically, the discussion will focus on how to understand and resolve rejected submissions, how to drive value from the MAO-004 reports (i.e. EDS version of accepted diagnosis codes for risk adjustment), and identify additional compliance and related RADV audit risks of potential concern for the industry. Attendees will learn how to prepare for this new EDS world, and what they need to be doing today in order to be successful tomorrow.

  • David Myer, Vice President, Healthcare Informatics, SCAN Health Plan
  • Tim Spaeth, Senior Vice President, Payer Solutions, Episource
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