Professional Staff - Healthcare Committee on Energy and Commerce
U.S. House of Representatives (Invited)
In April 2018, CMS released guidance that lifted some of the uniform benefit burdens and enabled health plans to provide benefits in a more targeted way to MA beneficiaries. This direction allows for more flexibility in the type of services that can be provided for the most vulnerable seniors. Review the current guidance and assess how it will evolve into 2020.
- Identify how plans have revised supplemental benefits in the first half of 2019
- Consider how CMS will continue to change guidance into 2020
- Discuss how to impact health with supplemental benefits and how to contract with organizations that may not be health care specific
- Communicate and engage with members regarding coverage changes in the coming year
As plans establish community partnerships to address social determinants of health, they must overcome the challenge of working with different types of providers that may be unfamiliar with health care – including those focused on housing. Discuss how to leverage local partnerships and work within the guardrails of the Medicaid program to establish housing models that translate to quantitative health care results.
- Build the case for investing in community partnerships by determining a plan for reimbursement, evaluation, and ROI
- Implement strategies for data sharing and funding that encompass a whole-person approach
- Discuss how to overcome challenges of working with service providers outside the traditional scope of health care
Vice President for Medicaid Policy & Director of Strategic Operations
Association for Community Affiliated Plans (ACAP)
- Review advancements in whole person health, and the funding and operational challenges currently faced in the long term care space
- Discuss how to balance services and utilize information to manage care in an aging population
Staff Vice President, Medicaid and LTSS Specialty Organization
Anthem, Inc (Invited)
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
Head, Next Generation Clinic Enterprise Strategy, Value-Base Solutions and Medicare Network Operations
CMS has recently focused on interoperability as a key component to achieving value-based care. As plans, states, and providers look to more seamlessly share information to achieve population health goals and quality outcomes, these changes must in turn integrate with workflow demands as well as exchange of information with patients. Hear the status of one pilot program that explores a path forward for state-level information systems.
- Review the barriers and achievements toward the integration of various data sources and what platforms are currently being piloted
- Consider how to design platforms for data exchange that result in a positive patient experience and promote engagement with immunizations
- Hear how similar use cases may be built around a centralized hub and include standards that focus on quality measures
Director, Public Health Innovation
Office of the Chief Technology Officer (HHS)
Enabling older adults and individuals with disabilities to live in the setting of their choosing is an integral part of State expectations and person-centered planning for managed care organizations. Various pathways exist to reach State goals around rebalancing, as health plans support members to transition from institutional to community settings.
- Understand the landscape of Money Follows the Person and other resources to support the process
- Consider the big picture of rebalancing such as increased access to services, independence, quality of life, and improved health outcomes
- Learn how Centene’s philosophy for transitions is operationalized and impacts are identified
Director, Market Development - Complex Care
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
- Prepare for future mergers between payer and provider groups
There are many established models and more new models that embrace medical homes and collaborative care to more effectively promote whole person health. In this session, discuss how to continue to expand access to care and services that take a transparent approach to behavioral health care and encourage the right care at the right time.
- Assess the models being used in Medicaid to increase access to behavioral health providers and improve parity
- Consider the touch points needed to best manage high utilizers while still managing resource allocation
- Ensure quick integration of behavioral health services and onboarding new populations once they are carved in
- Consider the array of populations and interventions that can have the most impact
- Understand how to target solutions to different complex populations and engage them in interventions with the most success
President and Chief Executive Officer
Partners in Care Foundation
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
Senior Manager, Enterprise Risk Adjustment
Tufts Health Plan
Through advances in technology that enable more detailed tracking and recording of a person’s health data, plans can better understand how conditions change over time, as well as pinpoint certain events that impact health. Learn how to better use technology to support patient care and member engagement through a personalized and person-centered approach.
- Understand the key elements of a system needed to manage complex populations
- Identify how managed care organizations are using various technologies to better engage members with chronic, co-morbid conditions
- Apply technology to health risk assessments and care plan assessments to create a more individualized approach to care
- 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
Director, Government Programs
Blue Cross of Idaho
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
Principal and Consultant Actuary
Many states are using or considering using waivers to change how Medicaid is delivered, including through waivers that expand or streamline coverage, as well as through new waivers that restrict eligibility to Medicaid, such as taking coverage away from people who don’t meet community engagement or work requirements. In this session, we will evaluate the goals, impact, and status of these initiatives to see what states may be looking to do next.
- Hear an update on work requirements – who is using them and the impact they’re having
- Consider the infrastructure needed to implement different waivers
- Discuss the value of different Medicaid waivers for the state and Medicaid beneficiaries
Center on Budget and Policy Priorities
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.
Principal and Founder
Riverstone Health Advisors
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
Senior Medical Director, Medicare
UPMC Health Plan
*Shared session with Business of Government Health Care
Administrator, Division of Health Care Financing and Policy
Nevada Department of Health and Human Services
North Carolina Medicaid
Market President / Chief Executive Officer
AmeriHealth Caritas District of Columbia