With significant transformation underway and at the guidance of HHS, states are working to transform their Medicaid programs through innovative reforms. Hear how federal policies and initiatives will impact states and MCOs in 2019.
- Highlight how CMS is supporting state-led reform efforts and what CMS sees in store for 2019
- Discuss the state of innovations in managed care and how they impact relationships with MCOs and the care beneficiaries are receiving
- Outline the recent proposed revisions to the final Managed Care rule, the goals of the proposed changes, and how they may affect plans in areas of quality, actuarial soundness, and provider networks
Senior Counselor, Office of the Administrator
Centers for Medicare & Medicaid Services (CMS)
The types of Medicaid program structures, waivers, populations, and provider networks can vary greatly from state to state. Learn what is top of mind for regional plans in creating a truly integrated and value-based approach to managed care.
- Gain insight into the operational considerations of payers, providers, and states when transitioning to managed care
- Understand how different states work with provider networks to bring them on board and integrate services
- Discuss the scope of managed care as a system, and how relevant information from services like LTSS and HCBS must be shared across the system
While stakeholder collaboration and aligned incentives are keys to enhancing value-based care and quality outcomes, having these pillars of success in place is not always the reality. Understand how to navigate challenges around information sharing and data interpretation, particularly for high risk populations, and assess the changing dynamics in managed care to improve relationships between the MCO, CBO, and state.
- Effectively structure networks to align incentives and share data and information on high risk populations
- Hear the top priorities and pain points of both MCOs and states when developing contracts and risk stratifying populations
- Amid changes in state and federal priorities, contracts, and RFPs, learn how states and plans can keep the provider community engaged and participating in processes that identify social determinants of health to fulfill the needs of the membership, as well as issues related to the opioid and other crises impacting their constituents
Senior Vice President, Population Health
Many states are using or plan to use waivers to impact the health of the Medicaid population through community engagement, training, and expanding or reducing eligibility. Hear how waivers are being used to implement state goals, and the infrastructure and systems that need to be in place for these initiatives to be carried out.
- Evaluate waiver benefits and drawbacks, including scope, support needed, timelines, and monitoring
- Discuss how waivers can be used to build value-based purchasing models
- Survey the impact of work requirements/community engagement, including the strengths and weaknesses of the process and how eligibility is affected
- Assess how managed care can be a vehicle to innovate and improve the health of Medicaid populations
Executive Director, Medicaid Policy
Former Medicaid Director
Long Term Services and Supports (LTSS) are steadily becoming more integrated into managed care, a transition that impacts beneficiaries, providers and caregivers, as well as managed care plans.
- Discuss next steps in advancing a more integrated medical and
psychosocial approach to care management, while developing
a truly person-centered approach, through
-HCBS and medical provider collaboration – Caregiver supports – Addressing challenges of person-centered care
- Evaluate the status of MLTSS quality metrics and the opportunities available to move the needle on quality outcomes
Director, Market Development - Complex Care
Value-based agreements often put the onus of outcomes on payers and providers, but strong performance is contingent upon equally motivated members and vendor partners. Innovative strategies focus on sharing the risk of clinical outcomes with members and vendors to drive better care between provider visits. Discover how end-to-end alignment of incentives leads to success in value-based agreements.
- Analyze how innovation in value-based contracts impacts and incentivizes payer-provider collaboration and patient outcomes
- Consider creative ways to align member incentives with value-based care quality metrics
- Define the role of vendors in achieving performance and quality goals
- Build in performance measures to meet the targets states are setting
Director, Medicaid Payment Reform and Healthcare Innovation
New York State Department of Health
Vice President, Population Health Strategy
Chief Executive Officer
Clinical Director, Division of General Internal Medicine; Ambulatory Medical Director
Mount Sinai Hospital
Associate Professor, Department of Medicine & Department of Geriatrics and Palliative Medicine
Icahn School of Medicine at Mount Sinai
There are different levels of risk an MCO must take into account; one, is getting providers comfortable in accepting a certain level of risk across stakeholders and feeling like they have support out there to be able to help grow and develop independence to promote quality of life. On the business side, MCOs must be able to plan and predict for certain levels of risk, be supported by the state through the transition, and prepare and scale providers to work in risk-based arrangements. Learn how to manage risk while promoting transparency and collaboration across stakeholders in outcomes-based arrangements.
- Identify the biggest vulnerabilities or risks that go unmitigated, from an operational and compliance perspective
- Prepare to transition into PMPM arrangements, move toward downside risk, and manage high acuity cohorts
- Discuss strategies to manage markets with multiple players, with varying levels of actuarial soundness
- Consider the implications of any risk adjustment program impacting the organization and how to adequately manage them
Chief Financial Officer
Actuarial Research Corporation
Health plans utilize technology to not only engage the member but also connect the person with the care team and gain insight into their condition. To do so, there must be appropriate incentives in place to engage and align the plan, provider, and patient with the care plan in order to prevent disease progression. Learn ways to get the care team involved and connect members to social services to promote engagement and support adherence.
- Assist providers to create more efficient and scalable adherence initiatives, and prevent care management duplication
- Determine ways to better use data and metrics to manage care for the member
- Discuss how the right platform can spark collaboration between payers and providers
Chief Executive Officer and Co-Founder
emocha Mobile Health
As states, managed care plans, and community-based organizations (CBOs) work to establish effective and sustainable programs to address social determinants of health (SDOH), it is often the case that poor communication and silos can hinder those efforts. Maximize relationships to create an integrated, team approach, and ensure that partners understand their strengths and their role in the execution of interventions.
- Evaluate the strengths of prospective CBO partners to focus on social services delivery
- Understand the interaction between the health plan, CBOs, and states, and discover models to effectively integrate services
- Identify SDOH interventions that can be replicated and scaled to make processes more efficient
- Discover models to integrate funding sources between the health plan and public health
Senior Director, Business Acumen
National Association of States United for Aging and Disabilities (NASUAD)
Director, Marketing, Community Relations and Outreach
AmeriHealth Caritas District of Columbia