V4 DW 8.10.18
December 11-12, 2018 | Fairmont Grand Del Mar Hotel
STAR RATINGS MASTER CLASS QUALITY IMPROVEMENT’S NEW “CONSUMERISM” IMPERATIVE— PREPARE YOUR PLAN FOR THE SEISMIC SHIFT
Top-rated plans + leading innovators share tools to boost your organization’s Medicare Star Ratings in 2019 and beyond
ALL STAR LINEUP Karen Schulte, MHA, Chief Operating Officer, CAREMORE HEALTH PLAN
Karen examines the innovative quality improvement strategies that led her to be named one of Modern Healthcare’s Top 25 COOs in Healthcare for 2018.
Angela L. Perri, MBA, AVP Medicare, SNP & STARS, UPMC HEALTH PLAN
In this special presentation, Angela reveals how consumer data can be integrated into clinical and claims data analytics to achieve improved care quality by better understanding members’ needs.
Tracey Veal, PhD, MBA, Sr. Director, Strategic Programs, AETNA MEDICARE
Tracey explains how building a “journey map” charting your plan’s member touch points leads to better engagement and improved member experience scores.
SPONSOR SHOUTOUT 2
WHY THIS YEAR’S EVENT IS A MUST-ATTEND! We are digging into some of the most pressing developments facing Stars professionals in years. The recent CMS Final Rule, combined with other new CMS provisions, ensures a radical change in the way Star Ratings will be earned in coming years. Medicare Advantage plans need to prepare now for a seismic shift in Star quality measurement which will prioritize member satisfaction, encouraging health plans to understand and serve their customers in ways other service businesses already excel at.
CMS is reinforcing their promise to put patients first in all their programs.
….And CMS is indicating that it may further increase the weight of these measures in the future.
There’s more from CMS… CMS is now allowing Medicare Advantage plans to provide new kinds of supplemental services to increase quality of care and has reinterpreted MA uniformity requirements. To take maximum advantage of these new possibilities, MA plans must take a new look at their members’ needs through an individualized, consumer-focused lens.
Customer-friendly companies such as Amazon and Apple are getting into the healthcare business… Now, health plans are considering mergers with large retailers who specialize in understanding consumers. A host of industry trends are converging that will require Medicare Advantage plans going forward to improve care quality-- and Star Ratings-- by better understanding their members as consumers of healthcare services.
Our Master Class focus Our focus is on the key trends, with special features on how to “ride the new wave of consumerism to higher Star Ratings.” Additionally, top-rated plans and leading innovators will share a broad range of proven strategies you can use to boost quality scores at your organization. Don’t miss this year’s RISE Star Ratings Master Class for the insights you need to stay ahead of the curve in 2019 and beyond!
The 2019 measurement year will see an increased weight of patient access and experience Stars measures from 1.5x to 2x. As expressed by Gorman Health–our platinum sponsor--if this change “had been effective for the 2018 Star Ratings, these measures would have comprised 49% of the overall Star Rating (compared to their current 37% of the overall rating)”!
TOP 10 REASONS TO ATTEND 1. Hear how to increase your Star Ratings by better understanding your members as healthcare consumers 2. Find out what new supplemental benefits other plans are offering to improve quality 3. Get this year’s important CMS updates 4. Learn how to optimize scores by more effectively dealing with appeals and grievances 5. Hear how to boost your score on the Statin Use for Persons with Diabetes measure 6. Find out how to improve member experience scores by creating a map of all your plan’s member touch points 7. Learn innovative new ways to engage providers in achieving top scores 8. Get guidance from industry innovators on using trial surveys to improve member survey scores 9. Understand how to integrate consumer data with clinical data analytics to improve care quality 10. Come away with secrets to success from top-rated plans
topics with critical updates
subject matter experts
planned networking satisfied attendees opportunities
WHO SHOULD ATTEND? Medicare Advantage Health Plan leaders, service providers and consultants with responsibilities in the following areas:
• Star Ratings • Quality Improvement • HEDIS • CAHPS • HOS • Physician Outreach & Education • Member Outreach/Engagement/Experience • Risk Adjustment & HCC Management • Care Management • Network Management • Customer Service
OTHER DISTINGUISHED SPEAKERS Kari Hadley,
Jessica Vander Zanden,CHC,
Senior Director, Medicaid and Quality Products PULSE8
Vice President Quality Improvement ALIGNMENT HEALTHCARE
MBA, Medicare Product Manager REGENCE BLUE CROSS BLUE SHIELD OF OREGON
Senior Vice President of Sales, Marketing, Strategy & Stars GORMAN HEALTH GROUP
Quality Improvement Vice President MEDICAL CARD SYSTEM
Director of Operations and Quality GOLDEN STATE MEDICARE HEALTH PLAN
VP, Administrative Services NETWORK HEALTH
Program Manager PROVIDENCE HEALTH PLAN
PREVIEW PAST ATTENDEES Accenture
Denver Health Medical Plan
IBM Watson Health
Accordion Health, Inc.
Physician Health Partners
Advent Advisory Group LLC
Indiana University Health Plans
PHYSICIANS HEALTH PLAN
EyeMed Vision Care, LLC.
Inter Valley Health Plan
EHC - Universal Health Services
Johns Hopkins Health Care
L.A. Care Health Plan
Prominence Health Plan
ATRIO Health Plans
Gateway Health Plan
Geisinger Health Plan
Medical Card System, Inc.
Bloom Insurance Agency
Golden State Health Plan
Blue Cross Blue Shield
Gorman Health Group
Memorial Health System
Regence BlueCross BlueShield of Oregon
Blue Peak Advisors
Mile High Healthcare Analytics
Cambia Health Solutions
Capital Blue Cross Performance
Capitol Coding Management
Health Care Services Corporation
Care N’ Care Insurance Company
Health Choice Management Co.
Health Data Decisions (HDD)
Health First Health Plans
Cascade Comprehensive Care
Health Partners Plan
National Committee for Quality Assurance (NCQA)
HealthCare Partners of Nevada
Centers for Medicare & Medicaid Services
Christus Health Cigna HealthSpring
HealthTexas Medical Group Healthways
Regeneron Revel Health RxAnte SCAN Health Plan Shield HealthCare SouthWest Medical Associates SPH Analytics Tessellate
The SSI Group, Inc.
North East Medical Services
Triple S Advantage
Ultimate Health Plans
CIOX Health (Healthport)
Heritage Victor Valley Medical Group
Oliver Wyman, Inc.
UNM Medical Group
Commonwealth Care Alliance
UPMC Health Plan
Community Health Plan of Washington
Home Access Health Corporation
PacificSource Health Plans
Housecall Doctors Medical Group
Peak Risk Adjustment Solutions
Dean Health Plan
RAVE REVIEWS FROM PAST RISE STARS MASTER CLASS CONFERENCES “Great speakers, great information.”
KIMBERLY JOHNSON, ASSOC. DIRECTOR, CLINICAL QUALITY, UNITEDHEALTHCARE
“The speakers are all willing to share what worked, what didn’t work, and why.” MARGARET CRAMER, OWNER, CRAMER CARE CONSULTING
“Good mix of topics, vendors, member experience overview.” RYAN COOK, DATA ANALYST, CENTENE CORPORATION
TUE SDAY, DECEMBER 11 , 2 0 1 8 8:00
Exhibits Set-Up, Registration, & Continental Breakfast
Chair’s Opening Remarks
CMS ADDRESS An update on CMS policy as it pertains to the Medicare Stars program, including a review of recent quality measures. This special session also includes an update on CMS policy related to Medicare Advantage and the work CMS is involved in related to overall quality improvement and health system transformation. Ashby Wolfe, MD, MPP, MPH, Chief Medical Officer, Region IX* CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) (VIA TELECONFERENCE) *INVITED
Even though healthcare in this country is the world’s largest service industry, health plans have only recently begun in-depth efforts to understand customers and how they feel about their care. This year the arrival of customer-friendly companies such as Amazon and Apple on the healthcare scene combines with CMS initiatives and a host of other developments to put the focus squarely on the member as a consumer of healthcare services.
I. SPOTLIGHT: What’s Behind the New Imperative to See Members as Consumers CMS has announced that the weight of patient access and experience Star Ratings measures will increase from 1.5x to 2x for the 2019 measurement year, while signaling its intention to further increase the weights of these measures in the future. These and other recent developments provide a consumer-centric lens through which MA plans should make decisions on their Star Ratings strategies and investments for the foreseeable future. Melissa Smith, Senior Vice President of Sales, Marketing, Strategy & Stars GORMAN HEALTH GROUP
10:30 II. SPOTLIGHT: Integrating Consumer Data with Clinical and Claims Data Analytics to Improve Quality Scores Utilizing members’ non-healthcare data-- such as home ownership, education level, or buying habits, obtained from public or private sources—as a focus of quality improvement efforts constitutes a new frontier in population health. MA plans are seeing that getting to know their members as individuals beyond the clinical setting is paying dividends in creating more accurate predictive models and improved care quality. This session studies: • Where to obtain the most useful consumer data • Analytics strategies including machine learning that facilitate application of diverse types of data • Tailoring interventions, programs, and messages using consumer data to achieve the highest impact • Strategies for keeping costs in line • Addressing privacy concerns Angela L. Perri, MBA, AVP Medicare, SNP & STARS UPMC HEALTH PLAN
3-Part Special Feature: RIDING HEALTHCARE’S NEW WAVE OF CONSUMERISM TO HIGHER STAR RATINGS
III. SPOTLIGHT: Utilizing Journey Mapping to Better Understand Your Members’ Experience and Make Your Health Plan More Customer-Centric Creating a journey map provides a diagram of all the various touch points your health plan has with its members, such as onboarding or member outreach efforts. Actual positive and negative member experiences are documented relative to the individual’s expectations and concerns, identifying opportunities for improvement at each step. In addition, information about members comes into focus, such as their motivations and what most influences their experience with the health plan. We will look at: • Understanding how you can create a journey map for your plan’s membership, setting parameters and establishing goals • Using data from journey mapping to improve member experience overall • Utilizing the diagram format to pinpoint interrelated problems • Making your organization more customer-centric by systematically identifying and resolving member issues that arise • Diabetic journey map case study Tracey Veal, PhD, MBA, Sr. Director, Strategic Programs (Quality , Risk Adj. & Ops) AETNA MEDICARE
Luncheon for all attendees & speakers
KEYNOTE PRESENTATION Day 1 Unique insights on healthcare quality improvement from a notable industry figure. Speaker: TBA
Boosting Stars Scores by Better Understanding How Measures Are Interrelated The effectiveness of quality improvement initiatives can be dramatically increased by studying how different measures tie in with one another. Innovative health plans are getting an extra boost in scores by looking beyond measure categories and analyzing how a single quality improvement effort can help further multiple goals. • Learning about the crossover connection for several high weighted measures • Better understanding the link between Part C and Part D measures and member compliance • Studying new ways to query your data to gain a better understanding of overlapping denominators that can be used to focus efforts and target high impact members Kari Hadley, Senior Director, Medicaid and Quality Products PULSE8
Optimally Leveraging a Trial CAHPS Survey to Improve Your Scores Consistent success in achieving high CAHPS scores is increasingly seen as a key to reaching 5-Star status. As a result, more MA plans are distributing their own sample CAHPS survey in order to better understand their members’ perspectives. This session will include: • Customizing your survey to address specific challenges • Working with your CAHPS survey vendor to streamline operations • Including questions related to HOS • Interpreting the responses • An overview of effective strategies to boost scores Linda Lee, Quality Improvement Vice President MEDICAL CARD SYSTEM
Kyle Mendez, MBA, Director of Operations and Quality GOLDEN STATE MEDICARE HEALTH PLAN
Reaching for the Stars: Improving Data Exchange with Providers
Medicare Advantage plans are working with providers in new ways to ensure that their quality improvement departments have the information they need to close care gaps and improve quality scores. This special session looks at some innovative initiatives that have made a difference in improving care quality.
WEDNE SDAY, DECEMBER 12 , 2 0 1 8 7:30
Chair’s Recap of Day 1
KEYNOTE PRESENTATION Day 2: Innovative Quality Improvement Strategies that Led Our Speaker to Be Named One of Modern Healthcare’s Top 25 COOs in Healthcare for 2018 Karen Schulte, MHA, Chief Operating Officer CAREMORE HEALTH PLAN
9:15 SPECIAL PERSPECTIVE from a 5 Star Plan: A Key to Our Success is Innovatively Engaging Providers to Achieve Top Ratings Providence Health Plan has spent many years fostering a strong relationship with their provider groups. This partnership has become a key factor in their success as a Medicare Advantage plan in a number of ways, going far beyond initiatives to address Stars-related care gaps. • Establishing meaningful provider relationships • Leveraging engaged provider groups in quality and risk programs • Creating quality initiatives that complement and support providers • Serving as a strategic partner, not just another payer Sara Gardner-Smith, Program Manager PROVIDENCE HEALTH PLAN
FEATURED SESSION: How this Plan Systematically Advanced Its Quality Scores An in-depth look at the strategies and methods this innovative MA plan employed to shift the focus from payments to people. In the process, they cut costs and improved quality of care by unraveling inefficiencies and rapidly moving patients and providers toward a common goal of wellness. Christina Latterell, Vice President Quality Improvement ALIGNMENT HEALTHCARE
How Plans are Taking Advantage of CMS’ Expanded Definition of HealthRelated Benefits for 2019 to Increase Quality The agency says it will now allow supplemental benefits “if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization,” which opens up a new range of possibilities and offers unprecedented freedom for Medicare plans. In addition, CMS is reinterpreting MA uniformity requirements and further expanding supplemental benefits for chronically ill members in 2020. • What health plans are doing to improve quality through new types of supplemental benefits • Identifying new opportunities at your plan to provide additional benefits
• Strategizing for future benefit enhancement Danica Holliston, MBA, Medicare Product Manager REGENCE BLUE CROSS BLUE SHIELD OF OREGON
The Statin Use in Persons with Diabetes (SUPD) Measure-- Strategies for Success CMS is proposing that this measure be 3x-weighted in the 2020 ratings, so MA plans are looking to optimize their score as soon possible. This special session looks at how some plans are focusing on SUPD including: • Reviewing the measure requirements • Provider outreach and education • Incentive programs to encourage compliance
Luncheon for all attendees & speakers
Boosting Your Plan’s Star Rating by Improving Measures Related to Appeals and Grievances With five measures related to appeals and grievances increasing from 1.5x to 2.0x weight for the 2019 measurement year, we look at original strategies to boost scores.
• Using clinical coordinators to help expedite handling of cases • Enhanced training programs for member service personnel to minimize complaints and resolve issues • Optimizing call center operations using call logs • Establishing internal controls and monitoring to track performance Jessica Vander Zanden, CHC, VP, Administrative Services NETWORK HEALTH
Overcoming Hidden Behavioral Health Barriers to Member Adherence Research has shown that the risk of patient nonadherence to recommended treatment regimens increases by more than 25% if a patient is depressed, while physicians fail to diagnose as many as 50-70% of patients with the disorder. Other behavioral health issues can be even more detrimental to patient compliance while being similarly difficult to recognize. These health plans are making a difference with innovative programs to understand hidden obstacles and help members maintain compliance.
Master Class concludes
• Improving collaboration between clinical, compliance, utilization management and quality departments to avoid appeals
CPE CREDITS Financial Research Associates is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: www.nasbaregistry.org.
Program Level: Overview Anticipated CPE Credits: 13 Recommended Field(s) Of Study: Specialized Knowledge Prerequisites: None Advance Preparation: None Instructional Delivery Method: Group Live Learning Objectives: Upon completing the course, participants will:
• Understand how to improve Medicare Advantage Star Ratings by improving member experience • Understand how to create more accurate quality improvement analytical models by incorporating members’ non-healthcare consumer data • Learn how MA plans are taking advantage of CMS’ expanded definition of health-related benefits for 2019 For more information, visit our website:
San Diego, CA 92130 (858) 314-2000 We have a limited number of hotel rooms reserved for the conference. The negotiated room rate of $249 per night will expire on November 19, 2018, although we expect the block to sell out prior to this date. To ensure you receive a room at the negotiated rate book well before the expiration date. Upon sell-out of the room block, availability will be at the hotel’s discretion. Please call (858) 314-2000 to book your room, and mention the “Star Ratings Master Class” to receive the negotiated rate.
Relax, soak, or dine in the comfort of your private and tranquil Southern California retreat
5300 Grand Del Mar Ct
“Capturing the elegance and charm of an old-world Mediterranean estate, San Diego’s luxury Fairmont Grand Del Mar golf resort and spa welcomes guests to Southern California with breathtaking architecture, acclaimed dining and impeccable service. Magnificently situated on 400-acres in a pristine coastal canyon five miles from the Pacific Ocean, Fairmont Grand Del Mar shines as the #1 Luxury Hotel in San Diego as voted by TripAdvisor.”
FAIRMONT GRAND DEL MAR
PRICING EARLY BIRD RATE ENDS 10/12/18
Service Providers & Consultants
TEAM DISCOUNTS Three people will receive 10% off Four people will receive 15% off Five people or more will receive 20% off
In order to secure a group discount, all delegates must place their registrations at the same time. Group discounts cannot be issued retroactively. For more information, please call Kathie Eberhard at (704) 3412439 Refunds & Cancellations For information regarding refund, complaint and/or program cancellation policies, please visit our website: www.frallc.com/thefineprint.aspx
THE CONFERENCE ORGANIZER RISE is the premier community for healthcare professionals who aspire to meet the extraordinary challenges posed by the emerging landscape of accountable care and government healthcare reform. Recognized industry-wide as the number one source for information on risk adjustment and quality improvement within healthcare, RISE strives to serve the community on four fronts: networking, education, industry intelligence and career development. Through cutting-edge conferences, online courses, in-house training, webinars as well as an association comprised of over 2,500 members, RISE provides professionals with industry insights and critical information they need to stay ahead of the curve. RISE produces more than 30 conferences annually, focused on sophisticated topics and ample networking opportunities for thousands of executives from mid- to senior-level and C-suite. Our team of subject matter experts is often first to market with emerging topics and we pride ourselves on consistently delivering on top-quality operations and logistics to produce a seamless event.
Established in 2006 as an extension of Healthcare Education Associates (HEA), RISE now operates as the sole healthcare arm offering the original capabilities of HEA as well as an expanded product line. Headquartered in Charlotte, North Carolina, RISE operates alongside its counterpart, Foundation Research Associates (FRA), which serves the finance, law enforcement, government, legal and compliance communities in a similar capacity.
SPONSORSHIP & EXHIBIT OPPORTUNITIES Enhance your marketing efforts through sponsoring a special event or exhibiting your product at this event. We can design custom sponsorship packages tailored to your marketing needs, such as a cocktail reception or custom-designed networking event. To learn more about sponsorship opportunities, please contact contact Kevin Weigel at 704-341-2448 or firstname.lastname@example.org.
PLATINUM As the leading consulting and software solutions firm specializing in government health programs, Gorman Health Group (GHG) combines innovation with proven, integrated approaches and technology solutions to help organizations operating in Medicare, Medicaid, and the Health Insurance Marketplace reduce costs, improve quality, and optimize revenues. Since 1996, GHG’s unparalleled teams of subject matter experts, former health plan executives, and seasoned healthcare regulators have been providing strategic, operational, financial, and clinical services to the industry across a full spectrum of business needs. Further, GHG’s software solutions have continued to place efficient and compliant operations within our clients’ reach. GHG’s mission is to empower health plans and providers, through a compliant, member-centric focus, to deliver higher quality care to members at lower costs while serving as valued, trusted partners. Learn more at www.gormanhealthgroup.com.
PULSE 8 Pulse8 is the only Healthcare Analytics and Technology Company delivering complete visibility into the efficacy of your Risk Adjustment and Quality Management programs. We enable health plans and providers to achieve the greatest financial impact in the Medicare Advantage, Medicaid, and ACA Commercial markets as well as with Value-Based Payment models for Medicare. Pulse8 has developed a suite of uniquely pragmatic solutions that are revolutionizing Risk Adjustment and Quality Management. Our advanced analytic methodologies and flexible business intelligence tools offer real-time visibility into member behavior and provider performance. Pulse8’s products are powered by our patent-pending Dynamic Intervention Planning to deliver the most cost-effective and appropriate interventions for closing gaps in documentation, coding, and quality. For more company information or to schedule a demo, please contact Scott Filiault at (732) 570-9095 or email@example.com. You can also visit us at http://www.Pulse8.com, and follow us on Twitter @Pulse8News.
GOLD N O V U H E A LT H NovuHealth is the health care industry’s leading consumer engagement company. Combining performance analytics, behavior science and comprehensive technology solutions, our rewards and engagement programs enable health plans to increase high-value member activities—improving member health and driving plan performance.
PHARMMD PharmMD is a data-driven healthcare technology leader in medication adherence insights and health outcomes. Our solutions are tailored for Medicare Advantage, Managed Medicaid, commercial plans, as well as self-insured employers where we deliver to achieve value-based care initiatives of higher quality and lower cost of care. As always, we continue to put people first, one person at a time. For more information, please visit www.pharmmd.com.
H E A LT H C R O W D HealthCrowd is the industry’s first end-to-end communications solution for payers. Our vision? To transform healthcare communications from tactical activity to strategic lever. The company’s product suite comprises its flagship Unified Communications Platform, Clairvoyance(TM) for advanced campaign analytics, and HealthNeuron(TM) to comply with federal and industry regulations around digital member outreach. HealthCrowd helps health plans unify, automate and optimize multimodal communications to deliver member-centric engagement, at scale, in a risk-managed way. The impact is profound: A positive difference in members’ perception of health plan communications and significant, quantifiable savings to the health plan.
REVEL Revel is a bold healthcare technology company that is reinventing health engagement to make a profound difference. Our health engagement platform, Revel Connect helps health plans and providers improve healthcare member experiences, drive better outcomes and redefine what’s possible. From closing gaps in care to boosting Star ratings, our engagement engine helps healthcare organizations leverage data for personalized connections that drive better experiences and higher quality. Join the health engagement revolution at www.revel-health.com.
W U N D E R M A N H E A LT H Wunderman Health (www.wunderman.com/health) is a global healthcare marketing agency that integrates data, creative and technology to amplify brand awareness, drive acquisition, and strengthen customer relationships. Clients across healthcare sectors include pharmaceutical and biotechnology, insurance and provider systems, and medical device and technology. Committed to improving health outcomes, Wunderman Health delivers communications that engage and empower both consumers and professionals by connecting them to moments that truly matter. Wunderman is part of WPP (NASDAQ: WPPGY).
SILVER EPISOURCE Episource provides a complete and integrated set of services and products to simplify the way Medicare, Commercial and Medicaid health plans manage their Risk Adjustment and Quality programs. We work with health plans and healthcare organizations to absorb the most challenging aspects of program implementation, operations, and management. We simplify by modernizing workflows to better assess the full cycle of Risk Adjustment and Quality programs to improve clinical outcomes and financial performance.