8:15 am
Mohit M. Ghose
Mohit M. Ghose
Vice President, Government Relations
Beacon Health Options

Alexander Shekhdar
Alexander Shekhdar
Sycamore Creek Healthcare Advisors

8:30 am
J. Mario Molina
J. Mario Molina, MD
Former Chairman and Chief Executive Officer
Molina Healthcare

9:15 am


Mohit M. Ghose
Mohit M. Ghose
Vice President, Government Relations
Beacon Health Options


Caleb Graff
Professional Staff - Healthcare Committee on Energy and Commerce
U.S. House of Representatives

Troy Timmons
Troy Timmons
Director, Strategic Initiatives
Western Governors' Association

10:30 am
  • Discuss the status of Duals Demonstrations, and how to align the goals of states and plans
  • Understand the plan and state partnership, and how this collaboration has advanced integration in Idaho
  • Identify the benefits and challenges throughout the process, and areas where course correction was necessary
Jenny Robertson
Jenny Robertson
Director, Government Programs
Blue Cross of Idaho

11:10 am

The goal of the Value-Based Insurance Design (VBID) model is to improve quality and reduce costs for beneficiaries with chronic disease. VBIDs, which began in 7 states in 2017, are now expanding to 15 more states in 2019. Hear the lessons learned from the initial roll out and evaluate how plans are catering benefit design to specific populations.

  • Review the impact of VBIDs and how specific populations are being targeted
  • Consider specific health plan VBID designs for 2019 and beyond, and how they can deliver value to members in need while reducing cost sharing
Andrew Allison
Andrew Allison
Head, Next Generation Clinic Enterprise Strategy, Value-Base Solutions and Medicare Network Operations

11:50 am
1:00 pm

While health plans want to move providers along the value-based care and contract continuum in the shift toward value, the realities of siloed care teams, misaligned incentives, and risk aversion all serve as obstacles to achieving this goal. Learn strategies to increase provider risk and manage performance while establishing effective partnerships with common goals.

  • Discover synergies in payer and provider goals, and understand how risk sharing works in more recent successful models like Next Gen ACOs
  • Establish partnerships that enable coordinated outreach to members
  • Discuss new payment models for Medicare and the need for flexibility amidst constant change
Elena Tkachev
Senior Director, ACO Analytics
Collaborative Health Systems, a WellCare Company

1:40 pm

With the increased tenacity for critical evaluation of risk-adjusted data, combined with changes in the algorithm for how plans are selected, it is paramount to establish compliance and integrity with documentation. Assess the current state of RADV audits and how increased scrutiny can impact your plan in 2019 and beyond.

  • Understand the scope and intent of the recent increased CMS attention toward RADV audits
  • Review how to mitigate errors and retrieve information targeted by CMS in the audit
  • Discuss the need to align provider contracts to include governmental audits such as RADV
Donna Malone, CPC, CRC
Senior Manager, Enterprise Risk Adjustment
Tufts Health Plan

2:50 pm

As care becomes more firmly rooted in value as opposed to volume, the need for timely, accurate, and usable data is a necessity. Not only do plans and providers need to effectively share information, providers must also be able to interpret data to understand more about how total cost of care works for each patient. Discuss the importance of effective data management and its impact on quality, efficient care.

  • Empower providers and PCPs to understand the scope of total cost of care for each patient
  • Discover how to influence and improve total cost of care while maintaining high levels of quality
  • Provide actionable information to providers to make informed care decisions
Matthew J. Kramer
Matthew J. Kramer, FSA, CERA, MAAA
Consulting Actuary

Kyle McClone
Kyle McClone, FSA, MAAA
Consulting Actuary

Andrew C. Mueller
Andrew C. Mueller, FSA, MAAA
Principal and Consultant Actuary

3:30 pm

Medicare patients often have unique and complex care needs, which take into account medical care, pharmacy spend, and post-acute care that may involve SNF and home health costs, among others. Consider the critical nature of how care coordination and transitions affects outcomes for seniors, and strategize ways to improve quality while reducing costs.

  • Discuss how a patient with chronic illness is defined, and understand the competition outside the traditional provider realm
  • Assess the need for high intensity and low intensity interventions and know when and how to tailor them based on the condition and severity
  • Encourage a value-based approach for patients with chronic illness
Namita Ahuja
Namita Ahuja, MD, MMM
Senior Medical Director, Medicare
UPMC Health Plan

4:15 pm

Evaluate the changing landscape of VA Health Care, and consider ways the VA can learn from other government healthcare purchasers and they can learn from VA.

Anne Jacobs
Anne Jacobs, PhD
Principal and Founder
Riverstone Health Advisors

4:50 pm
Karen M. Dale
Karen M. Dale
Market President
AmeriHealth Caritas District of Columbia


Pamela Greenberg
Pamela Greenberg, MPP
President and Chief Executive Officer
Association for Behavioral Health and Wellness