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The 8th Annual

HEDIS & Quality Improvement Summit ÂŽ

Breaking New Ground in Optimizing Quality Scores October 29-30, 2018 | The Eden Roc Hotel | Miami, Florida

Join us for the only conference dedicated to providing cutting-edge insight specifically on HEDISÂŽ and related quality-improvement efforts. This intensive, two-day event features leading innovators and top-scoring plans sharing actionable knowledge you can use to take your quality improvement work to the next level.




To Register: Call 866-676-7689 or visit us at


V11 DW 9.20.18

WHO S HOU LD AT TEND? From Plans and Providers—Vice Presidents, Directors, Managers and Specialists of: • HEDIS® • Medicare Stars/Star Ratings • Quality Improvement • Data Management • HEDIS® Auditor • HEDIS® Data Analyst • Operations • Performance Management

• Provider Engagement • Analytics • Medicare • Product Development • Pharmacy Administrator • Care Management • Member Engagement

TOP RE A SONS TO AT TEND 1. Get the latest insights on new and evolving HEDIS® measures 2. Hear how one health plan boosted its quality scores, going from 3 to 5 Stars in just four years 3. Get concrete strategies from a health plan that is making a difference in the opioid crisis 4. Create your game plan for boosting CAHPS scores 5. Learn routes for success with the new HEDIS® transitions of care measures

GET ANS WER S TO THE S E IMP ORTANT QU E S TIONS • How can I use predictive analytics to maximize chart chase outcomes? • What can I do to more effectively engage my PBM? • How can I leverage the latest possibilities for member incentives? • What are the newest strategies for sharing real-time data between my health plan and various care settings? • How can I improve my use of supplemental data?


“This is one of the best conferences I have ever been to.” Holli Hampton, Aetna Better Health of Ohio

“This is the first conference I’ve been to in a while where I didn’t miss a session.” Elaine Rosenblatt, UW Medical Foundation

“I have learned some interesting solutions to some of our issues, especially how to approach difficult measure improvements.” Althea Thompson, Universal American

“Presenters that actually face the same challenges as me. Not so vendor focused.” Marilyn Ventura, Molina Healthcare

“Exchange of information & ideas with folks with similar goals.” Rebecca Fee, Blue Cross Blue Shield Minnesota

DAY ONE: MONDAY, OCTOBER 29, 2018 8:00 Exhibits Set-Up , Registration, & Continental Breakfast 9:00 Chair’s Welcome and Opening Remarks

9:15 - HEDIS® IN MOTION—A Detailed Examination of New and Changing Measures FOR 2019 and What They Mean for Your Organization • • • •

Strategies for integrating new measures into your quality program Examining measures that have changed Effectively adapting to measure evolution Preparing for future changes

Keith Bell, MPH, Director, Quality Management and Improvement HEALTH DATA DECISIONS

10:00 - SPOTLIGHT: How One Health Plan Boosted Its Quality Scores, Soaring from 3 to 5 Stars in Just Four Years In this special session, we examine the strategies that propelled HealthSun, a health plan with an 82% dual eligible and low-income subsidy population, to the highest levels of quality ratings. We will examine: • Strategic development of an Internal Multi-Disciplinary Team • Engagement & empowerment of the Primary Care Physicians • Implementation of incentive programs • Enhanced use of data reports & implementation of report cards • Identification of best practices & implementation of P4P Karen W. Connolly, RN, Senior Vice President, Quality Improvement and Accreditation Services HEALTHSUN HEALTH PLANS

10:45 Morning Break

11:00 - FEATURE: The Opioid Epidemic - Strategies from a Health Plan That Is Making a Difference The National Institute on Drug Abuse reports that more than 115 Americans die every day after overdosing on opioids and that the total “economic burden” of prescription opioid misuse in the U.S. is estimated at $78.5 billion a year, leading the government to declare a nationwide public health emergency. Blue Cross Blue Shield North Carolina is leading the way in addressing the crisis. With a higher rate of opioid use disorder than other Blue Cross plans, and a report showing about 15% of first-time acute opioid prescriptions in the state exceeding the limit imposed by a new law, BCBS North Carolina is devoting $10 million to combat opioid use and addiction. This session examines the strategies they are using to achieve results. Anuradha Rao-Patel, MD, Medical Director


11:45 - SPECIAL CASE STUDY: A Health Plan President’s Insights on Addressing Social Determinants of Health Quality improvement professionals are increasingly studying the significant factors that drive a member’s health which are outside the clinical care setting. These “social determinants of health” have been shown to account for as much as 60% of a person’s health risks and outcomes. In this special session, hear from a health plan president what your organization can do and learn how to make the case for leadership buy-in on social determinants initiatives at your health plan. Housing as Health at UPMC This program provides stable housing as well as social and medical supports to low- income homeless disabled adults. Over eight years, the program has reduced unplanned care, improved adherence to recommended treatments, and reduced care costs. The session explains how to: • Identify an appropriate target population • Find compatible partners and build a mutual business case • Define goals • Assess actual outcomes John G. Lovelace, President, Government Programs and Individual Advantage UPMC HEALTH PLAN

12:30 Luncheon for all attendees & speakers

1:30 - Effectively Unifying Quality and Risk Adjustment Programs You can help ensure alignment of your plan’s resources and goals by working to integrate these two programs. • Reasons for unifying Risk and Quality programs • Establishing a framework for integration • Overcoming roadblocks • Achieving buy-in from stakeholders Sujata Bajaj, Vice President Product Development EPISOURCE

2:00 - Developing Inventive Campaigns to Boost CAHPS and HOS Scores With health plans increasingly grouping in the middle ranges of quality scores, those that can move the needle on measures like CAHPS, that have traditionally been difficult to improve, can greatly improve their chances of advancing to the highest levels of quality ratings. • Stratifying off-cycle CAHPS performance data by member demographic characteristics • Using segmented data to identify meaningful, actionable opportunities for key sub-sets within the population • Developing targeted interventions to improve member experience and increase CAHPS measure rates Jessica Assefa, Medicare Stars Program Manager UCARE

Andrew McClure, MBA, Director of Quality Improvement SENIOR WHOLE HEALTH

2:45 - Afternoon Break

3:00 - CASE STUDY: Innovations in Working with Supplemental Data While supplemental data augments HEDIS® reporting, it can also serve to build a more complete view of population-level quality and process improvement opportunities. • The importance of cross-organizational development of standard supplemental data technical specifications • Using risk based contracting and clinical integration as a value-prop to providers to obtain buy-in • Lessons learned from baseline year • Impact not only to HEDIS® and Star ratings, but also to improved care management Kimberly Swanson, Director of Quality Improvement NETWORK HEALTH

Kara Uitenbroek, Manager of Quality NETWORK HEALTH

3:45 - Member Incentives—Leveraging the New Possibilities As regulation loosens to allow more types of member rewards and incentives, health plans are developing innovative programs that are helping to improve outcomes. • Looking at what is permitted • Using data to focus engagement goals • Examining the care model for engagement possibilities • Utilizing the latest technologies Daniel Weaver, Director of Government Quality , Medicare Stars HIGHMARK

Jordan Mauer, Executive Vice President of Marketing & Member Engagement NOVUHEALTH

4:45 - Cocktail Reception

DAY TWO: TUESDAY, OCTOBER 30, 2018 8:00 - Continental Breakfast

8:55 - Chair’s Recap of Day 1 9:00 - Strategies for Success with the New HEDIS® Transitions of Care Measure Poor hospital transitions are not only associated with poor health outcomes but also increased health care utilization costs due to duplication of medical services, medication errors, increased emergency department visits and hospital readmissions. This session presents some strategies for optimizing scores in this new measure. • Ensuring communication between inpatient and outpatient providers • How to be sure that follow-up occurs within 30 days • Leveraging telehealth and other technologies • Pitfalls to avoid in satisfying the medication reconciliation post-discharge requirement Claire O’Rear, Stars Director Alabama, Mississippi, North Florida CIGNA-HEALTHSPRING

9:45 - Engaging Your PBM—Innovative Approaches to Optimize this Key Relationship In theory, PBMs and health plans should be close partners. In practice, the relationship can be fraught with tension and distrust. This session presents strategies that help avoid problems. • Communication approaches that ensure synergy • Effective oversight strategies • Tools for effective monitoring • PBM/Sponsor resource identification • Sponsor/PBM roles in understanding regulatory expectations & Medicare Part D law Twila Johnson, Pharm. D., former Director of Pharmacy Services SECURITY HEALTH PLAN

10:25 - Morning break

10:40 - Using Predictive Analytics to Maximize Chart Chase Outcomes This session examines strategies for leveraging predictive analytics to increase chart chase efficiency, reducing costs while increasing record retrieval yield. • Finding the right charts using prior years chart chase results • Forecasting the likelihood of chart hits • Predicting chart hits in real time throughout the chart chase season Michael Blumental, President HEALTH DATA DECISIONS

11:10 - CASE STUDY: Improving Quality by Creating a Large-Scale, BiDirectional Data Sharing Process Between a Health Plan and Providers In the past two years, Moda Health has built a system which gathers EHR data from providers as well as providing feedback to them to enhance quality scores. This case study examines: • Designing a custom data-sharing system to achieve your goals • Use of the system to obtain supplemental data for quality metrics • How the system can provide feedback to providers for quality improvement activities Nathan Trenholme, MPH, Manager of Informatics and Quality Metrics MODA HEALTH

11:50 - Proven Strategies for Improving Medication Adherence The World Health Organization has said that “increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments.” • Identifying patients at risk for non-adherence • Tools and partnerships that have proven effective • Creating a medication advisor program • Leveraging the latest technologies Daniel Weaver, Director of Government Quality , Medicare Stars HIGHMARK

Twila Johnson, Pharm. D., former Director of Pharmacy Services SECURITY HEALTH PLAN

12:30 - Luncheon for all attendees & speakers

1:30 - Strategies for Sharing Real-Time Data Between the Health Plan and Various Care Settings Increasing data interoperability means helping health information systems work together within and across organizational boundaries in order to advance the effective delivery of healthcare and improve outcomes. Here we look at strategies that have shown success. • Examining technologies that facilitate data interoperability • Transforming the payer-provider relationship through improved data access • Giving clinicians the information they need to close care gaps during an office visit • Driving population health through blockchain & AI technology John Poikonen, Pharm. D., Adjunct Professor, Biomedical Informatics MCPHS UNIVERSITY

2:15 - HEDIS® Audit: Preparing for the New Heightened Requirements Increased and changing audit requirements are putting extreme pressures on HEDIS® professionals’ time and resources. As a result, careful planning and execution are more crucial than ever. • What changes is NCQA making for 2019? • Strategies for a successful audit • Managing medical record review • Will these changes ensure integrity? • Beyond 2019 Karen W. Connolly, RN, Senior Vice President, Quality Improvement and Accreditation Services HEALTHSUN HEALTH PLANS

3:00 - Summit Concludes


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: 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 use predictive analytics to maximize chart chase outcomes • Learn how to improve their use of supplemental data • Understand the latest insights on new and changing HEDIS® measures For more information, visit our website:

TE AM DISCOU NTS • Three people will receive 10% off • Four people will receive 15% off • Five people or more will receive 20% off 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 contact Erica Conway at 704-341-2647 or

REFU NDS AND C ANCELL ATIONS For information regarding refund, complaint and/or program cancellation policies, please visit our website:


In the heart of the city at the edge of the sea, Eden Roc Miami Beach provides a modern, comfortable setting to relax and enjoy the view. Our spacious rooms include oversized balconies overlooking the ocean or the city skyline, with three distinct pools, beachfront cabanas, award-winning on-site dining and contemporary design—in a central location in the middle of Miami Beach. EDEN ROC


4525 Collins Avenue Miami, FL 33140 786.801.6886

We have a block of rooms reserved at a special rate of $249/night. This rate expires on October 8, 2018. Mention the “HEDIS and Quality Improvement Summit” when placing your room reservation by phone to receive the negotiated rate. Call (305) 520-7197 to book your room or simply click the link here

OTHER VENUE OPTIONS Due to the popularity of the HEDIS & Quality Improvement Summit, the host hotel is sold out. We have opened additional overflow room blocks. Please mention HEDIS & Quality Improvement Summit when securing your room. GRAND BEACH HOTEL – MIAMI BEACH 4835 Collins Ave Miami Beach, FL 33140 (305) 538-8666 $229/night Cutoff: 9/28

BOOK NOW MIAMI THE CONFIDANTE 4041 Collins Ave. Miami Beach, FL 33140 (305) 424-1234 $229/night Cutoff: 10/12

BOOK NOW FAENA HOTEL 3201 Collins Avenue Miami Beach, FL 33140 (786) 655-5575 $299/night Cutoff: 9/28


THE CONFERENCE ORGANIZER RISE (Resource Initiative & Society for Education) Vision: To build a community and an educational system that promotes successful careers for professionals who aim to advance the quality, cost and availability of health care. RISE provides: • A forum to build professional identity and a network of colleagues • A platform to capture and share knowledge and insights • A venue to develop and share benchmarks and document best practices • Career track development support • A channel for building alliances, partnerships, and affiliations that fulfill the vision

RISE (Resource Initiative & Society for Education) Mission: RISE is the first national association totally dedicated to enabling healthcare professionals working in organizations and aspiring to meet the challenges of the emerging landscape of accountable care and health care reform. We strive to serve our members on four fronts: Education, Industry Intelligence, Networking and Career Development. To learn more about RISE and to join, visit us online:

PRI CING Early Bird

Standard Rate

Health Plans/ Providers*



Service Providers & Consultants

$ 1895

$ 2095

(ends September 28)


866-676-7689 com/H550 Wilmington FRA 3420 Toringdon Way, Suite 240 Charlotte, NC 28277


Make checks payable to Wilmington FRA and write H550 on your check.

S P ONSOR S HIP AND E XHIB IT OPP ORTU NITIE S 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 a custom-designed networking event. For more information about our sponsorship opportunities contact Kevin Weigel at 704-341-2448 or kweigel@healthcare-conferences. com

SPONSORS PL ATINUM Health Data Decisions provides strategic and analytic consulting related to quality, efficiency and population health. We help health plans, at-risk provider groups and analytics vendors to maximize the use of their data for predictive and retrospective measurement and modeling. Our team brings decades of experience with measurements including HEDIS, Stars, QRS, AHRQ and P4P in management, analytics, and programming. We can manage your team, your vendors and your data to improve your HEDIS 2017 project. Talk to us about improving the value of your data and your overall measure rates.

GOLD 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. Our services include: Retrospective Chart Reviews, HCC Gaps and RAF Campaign Workflow (epiAnalyst), Encounter Data Error Resolution and Financial Analytics (epiEncounter), HEDIS & STARS Analytics & Reporting, Gaps in Care Reporting, and HEDIS Retrieval & Abstraction. We also offer clinical services such as HRAs (Health Risk Assessments) and NP programs. For more company information, please contact Claudia Gallardo at (424) 295-0491, visit us at, or follow us on Twitter @EpisourceLLC 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. 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.

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 Apixio is the data science company for healthcare. Apixio’s proprietary artificial intelligence platform extracts and analyzes clinical data in electronic and PDF records, generating deep insights into patient health. These insights feed applications such as HCC Profiler, which uncovers supported HCC codes with speed and accuracy, enabling comprehensive code identification and compliance auditing for Medicare Advantage and ACA programs.

S ILVER Optum is a leading health services and innovation company dedicated to helping make the health system work better for everyone. With more than 124,000 people worldwide, Optum combines technology, data and expertise to improve the delivery, quality and efficiency of health care. Optum uniquely collaborates with all participants in health care, connecting them with a shared focus on creating a healthier world. Hospitals, doctors, pharmacies, employers, health plans, government agencies and life sciences companies rely on Optum services and solutions to solve their most complex challenges and meet the growing needs of the people and communities they serve. Eliza, an HMS Company gets modern healthcare consumers to act by engaging them in personalized conversations at enterprise scale. Your top priorities have never been clearer: improved quality, better cost management, incremental revenue generation, and a better consumer experience. The Eliza Health Engagement Management solution integrates a scalable multi-channel technology platform, proprietary data sources, industry leading analytics, and experience-driven program design to help clients achieve outcomes that make a difference. CitiusTech, recognized by 2017 HCI 100, is a provider of healthcare technology services & solutions to health plans, medical technology companies, providers, & life sciences organizations, with over 2,900 healthcare IT professionals worldwide and serving over 80+ healthcare organizations globally. CitiusTech offers services around integration and interoperability, data management, performance management and data analytics. CitiusTech helps customers accelerate innovation in healthcare with solutions across quality reporting, big data, cloud, mobile & predictive analytics.


8th Annual HEDIS & Quality Improvement Summit  

Providing cutting-edge insight specifically on HEDIS and related quality-improvement efforts. This intensive, two-day event features leading...

8th Annual HEDIS & Quality Improvement Summit  

Providing cutting-edge insight specifically on HEDIS and related quality-improvement efforts. This intensive, two-day event features leading...