2018 Star Ratings & Quality Improvement Summit
Operational and Engagement Strategies to Enhance Star Ratings and Quality Performance
May 21-22, 2018 * Orlando, FL

2018 Star Ratings & Quality Improvement Summit

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About the Conference

To be best in class in today’s healthcare environment, a high Star Rating is just the beginning of a comprehensive quality assurance strategy. Challenging timelines and multiple performance areas make managing a Star program a complex and sometimes perplexing process. Increasing competitiveness requires us to continually strive for improvement even in those areas where we are performing well. Success necessitates constantly considering new tools and processes.

Savvy health plans that are attuned to member needs are building infrastructures and integrating key departments to drive quality from within. From capturing and implementing data to building a quality-oriented culture, these plans have excelled beyond traditional performance levels.

Also, with CMS setting high stakes and moving targets for Star Ratings, it is more important than ever to develop a winning game plan that will revamp your operational strategies, enhance your data gathering and analytics execution, and drive your quality goals forward.

Drive your plan forward by getting the latest techniques at the conference showcasing proven best practice strategies and innovations as implemented by top health plans and hear how they achieved high ratings. We’re bringing together leaders to explore the toughest questions that the industry struggles to answer, including – how do you continue to improve quality to earn and maintain 4 or 5-Star ratings? Join a range of experts from top-rated health plans and industry innovators to share information that you can put to use to boost quality in your own organization.

Who Should Attend?

From Health Plans; Health Systems/Hospitals; Service Providers; Consultants

  • Quality Improvement
  • Medicare Advantage
  • Pharmacy Administration
  • Utilization Management
  • Marketing
  • Product Development
  • Star Ratings
  • Care Management
  • Clinical Improvement
  • Business Development
  • CAHPS
  • Customer Service & Member Experience
  • Quality Analytics
  • Member Outreach & Engagement
  • Informatics
  • Data Management
  • Chief Medical Officers
  • Analysts
  • Sales
  • Government Programs
  • Clinical Director

Conference Agenda

Day One – Monday, May 21, 2018

7:15am – 8:00am
Registration & Networking Breakfast

8:00am – 8:15am
Chairperson’s Opening Remarks

8:15am – 9:00am
Strategies to Improve Overall Star Rating and Difficult Measures
This presentation will focus on how to improve your plans overall star rating in the dynamic Medicare Advantage marketplace. Special emphasis will be on best practices and strategies to help elevate your plan to achieve that coveted 4 and 5 Star Rating. An emphasis around difficult measures and how plans can overcome those challenges will be a focus.
Shawn Shuman, MSN, RN
Senior Director, Clinical and Business Development
UPMC Health Plan

9:00am – 9:45am
Breaking Down Silos for Better Outcomes
This session will share best practices for combining risk adjustment and HEDIS efforts along with other internal efforts to enhance your program. We will share what worked and some challenges we faced along the way in bringing these programs together internally and with our provider network.
Colleen Gianatasio
Risk Adjustment Quality and Education Program Manager
Capital District Physician’s Health Plan

9:45am – 10:15am
Networking Break

10:15am – 11:00am
The Star Ratings Landscape
For health plans, an understanding of CMS’s 2018 Star Ratings and what’s in store for the future is crucial to developing and implementing effective operational and quality improvement strategies. This keynote will examine the current healthcare landscape and its impact on Star Ratings for health plans. Topics to be discussed will include:
– Highlights of CMS Star Ratings for Medicare Advantage plans
– Overview of future changes to CMS Star Ratings
– Quality improvement strategies to focus on
– Policy changes & impact
Melissa Smith
Vice President, Stars and Quality Innovations
Gorman Health Group, LLC

11:00am – 11:45am
Conduct an Effective Cross-Organizational Stars Training Program
– Develop department-specific presentations to ensure a global understanding of Stars across your organization
– Empower key staff and functional leaders with information to direct measure focus and intervention development
– Incorporate overall program goals and individual measure goal-setting into your training agenda
– Provide ongoing support to key stakeholders throughout the year to maintain momentum and keep the organization on track
Jessica Assefa
Medicare Stars Program Manager
Ucare

11:45am – 1:00pm
Lunch

1:00pm – 1:45pm
Developing an Effective Incentive Program: A Vital Tool to Enhance Star Ratings
This session will examine how to use a quality incentive program to drive improvement. Examine how to improve outcomes and enhance engagement, and deliver a comprehensive incentive program with quality as the driver. Topics to be discussed will include:
– Initiating an incentive program
– Compliance and reporting requirements
– Measuring the outcomes of an incentive program
Dan Weaver
Director of Program Management
Government Business, Quality Improvement

Highmark

1:45pm – 2:30pm
Excellent Quality Performance Requires “Culture of Quality” with Strong Analytics Support
This session will discuss the enterprise strategy for high quality performance and improvement. Examine how to align population health management and consumer engagement strategies to improve health outcomes and member experience. Topics to be discussed will include:
– Key factors impact on Star rating
– Strategies to improve clinical health outcomes and member experience
– Infrastructure including strong data and analytics capabilities
– Building the enterprise “Culture of Quality” for sustaining high Star rating performance
Qi Zhou
Vice President, Performance Analytics and Quality Management
Blue Cross Blue Shield of Massachusetts

2:30pm – 3:00pm
Networking Break

3:00pm – 4:15pm
Panel Discussion: Best Practices to Achieve Excellent Star Ratings
During this panel discussion, top-rated plans will share inside tips on making it to the top of Star Ratings. They’ll discuss specific interventions and processes that have helped them along the way. This discussion is designed to give you the opportunity to learn from your peers and colleagues in the Star Ratings trenches. Topics to be discussed will include:
– Strategies used to manage difficult populations and overcome barriers
– Member and provider engagement techniques vital for success
– Processes that have been used to maintain their highest ratings
Panelists:
Emily Fahey
Risk and Performance Manager
Care Wisconsin

Violet Jones, BSN, RN, CCM
Director, Stars and Quality Improvement
AmeriHealth Caritas

4:15pm – 5:00pm
Senior Whole Health: The Journey from 3.5 to 4.5 Stars
Senior Whole Health (SWH) struggled many years with the CMS Stars incentive program. With its dual-eligible members, who are older, frail and challenged with multiple chronic conditions, meeting the clinical quality measures posed a significant challenge. This difficulty was compounded by the low educational status of the members, and the many languages they spoke. As pressure to perform in the program intensified, SWH took significant steps starting in 2014 to rebuild its quality program. New leadership developed a comprehensive plan that embraced the complicated model of care and diversity of the membership to develop a no-holds barred approach to improving the measurement results. In the years since, the plan has made steady progress, first to 4 Stars and recently to 4.5 Stars. In this presentation, the quality improvement director will outline some of the key actions taken to rebuild the program, and some of the steps included in the comprehensive approach. Attendees will see how the steps were tied to measured improvements, which led to the company’s success in the Stars program.
Andrew McClure
Director of Quality Improvement
Senior Whole Health

5:00pm
End of Day One

5:15pm – 6:15pm
Cocktail Reception

Day Two – Tuesday, May 22, 2018

7:15am – 8:00am
Networking Breakfast

8:00am – 8:15am
Chair’s Recap of Day One

8:15am – 9:00am
Managing a Star Ratings Program Across a Matrix Organization
An effective Star Ratings program requires the input of everyone working within the organization. Departmental silos are seen as a pain point in many highly successful organizations. It is imperative that leadership prepares and equips teams with the tools needed to effectively eliminate silos, without negatively impacting working relationships. This session will discuss how to create a unified vision for success and develop and implement a collaborative team to focus on improving Star Ratings, including:
– Establishing a culture of quality improvement
– Cross-departmental responsibilities for outcomes and execution
– Steps to execute Star Rating projects across different departments
– Setting measurement goals for departments and getting their buy-in
– Tools needed to communicate the plan and results to the executive level
Jennifer Sheppard, MSW
Director, Health Plan Quality Assurance
CareOregon

Jonathan K. Weedman, CCTP, LPC
Director of Clinical Operations, Population Health Partnerships
CareOregon

9:00am – 9:45am
Improving the Effectiveness of Stars Interventions Through Predictive Modeling
This session will examine how to leverage predictive analytics to target the members most likely to engage within a given intervention. The model seeks to address the challenge inherent in many Stars interventions, which is to provide the right messaging to the right member through the right channel to drive the right outcome. Examine the basic concepts of predictive modeling, including where it is commonly used and the potential applications—and limitations—of predictive models for Star Ratings and other quality measures. Topics to be discussed will include:
– Approaches to using predictive techniques to identify potential health risks that can be proactively targeted for interventions
– Fundamentals of how predictive modeling can drive quality improvement
– Types and components of predictive models that can be used for quality measures and Star Ratings
Samuel Young, MD, MBA, CPE
Senior Medical Director – Medicare
Florida Blue

9:45am – 10:30am
Engaging Members to Reach for the Stars: Getting Everyone Involved in Quality
Use the culture of your organization to get everyone working together to improve Stars. In this session, Judy Hamlin will review successful strategies used to engage plan staff, members and providers to improve quality health measures. Health plans have so many different departments reaching different customers; the quality team is the contact that can disseminate the tools and resources needed to move the Stars programs forward. Discussions will include understanding patterns of compliance and design of targeted interventions to reach members in a meaningful way to successfully close gaps using teach-back and taking social issues under advisement.
Judy Hamlin, RN, MS, CCM, FNP-C
Manager Quality Improvement
Universal American, A WellCare Company

10:30am – 11:00am
Networking Break

11:00am – 11:45am
Integrating Risk Adjustment and Quality Improvement to Boost Scores
In this session you will learn about learn about how to boost quality scores by better integrating your risk adjustment and quality improvement programs. Hear about strategies for more effective utilization of both quality and risk data that can enhance intervention development. Understand the benefits of fully incorporation risk adjustment for streamlined processes, and how to develop contracts with providers that support risk adjustment and Star Ratings.
Gerri Cash
Vice President, Quality Programs
Tessellate

11:45am – 12:30pm
Mastering the Dual Eligible Model of Care to Optimize Quality and Regulatory Compliance
The discussion will include processes to manage the SNP Model of Care to meet CMS compliance requirements, maintaining and improving CMS Stars and quality measures. Strategies include the deliberate organization of activities addressing social determinants, behavioral health challenges and barriers to care. A focus on how a health plan has met these challenges though alignment of centralized and community supports.
Roseann DeGrazia
Vice President Regional Network Management
UPMC Health Plan

12:30pm
Conference Concludes

Workshop – Tuesday, May 22, 2018

12:45pm – 2:45pm
Improvement Programs to Boost Star Ratings
This workshop will prepare your organization to achieve higher star ratings by examining organizational focus. The workshop leader will address how to identify threats and weaknesses in your organizational structure and deliver targeted interventions to positively impact Stars performance and ultimately health outcomes. Topics will include:

– Educating employees about what Star ratings are and why they matter to our business
– Creating a cross-organizational message framework to drive awareness and understanding
– Engaging employees and communicating their accountability for Stars ratings
– Developing and delivering foundational training to improve Star ratings
– Supporting department and vertical leaders responsible for cascading messaging and driving change
– Achieving synergies between quality, risk and revenue to optimize risk scores

Through an interactive exercise, you will also walk away with a “prescription” to improve the Stars ratings for your plan.

Christopher Miladinovich
Co-Founder, Principal and Senior Vice President of Consulting
ProspHire

As ProspHire’s Senior Vice President of Consulting, Christopher oversees client service for the 35-person firm. He has 17+ years’ experience in healthcare management consulting leading large scale, complex technology and business transformation programs at Deloitte and other firms. He is adept at recommending and delivering targeted interventions to positively impact health outcomes and measures across the continuum. Beyond the boardroom, Christopher serves on Duquesne University’s Information Systems Management Advisory Board. He is a Board Member for Off the Floor Pittsburgh, the Treasurer of the Condor Aero Club, Inc., and is an instrument-rated, commercial pilot and certified flight instructor. Christopher is PMP certified and has degrees in both Information Systems Management and Marketing from Duquesne University.

Featured Speakers

Colleen Gianatasio

Colleen Gianatasio

Risk Adjustment Quality and Education Program Manager

Capital District Physician’s Health Plan

Melissa Smith

Melissa Smith

Vice President, Stars and Quality Innovations

Gorman Health Group, LLC

Jessica Assefa

Jessica Assefa

Medicare Stars Program Manager

Ucare

Dan Weaver

Dan Weaver

Director of Program Management

Government Business, Quality Improvement
Highmark

Qi Zhou

Qi Zhou

Vice President, Performance Analytics and Quality Management, BCBSMA

Blue Cross Blue Shield of Massachusetts

Andrew McClure

Andrew McClure

Director of Quality Improvement

Senior Whole Health

Jennifer Sheppard, MSW

Jennifer Sheppard, MSW

Director, Health Plan Quality Assurance

CareOregon

Jonathan K. Weedman, CCTP, LPC

Jonathan K. Weedman, CCTP, LPC

Director of Clinical Operations, Population Health Partnerships

CareOregon

Judy Hamlin, RN, MS, CCM, FNP-C

Judy Hamlin, RN, MS, CCM, FNP-C

Manager Quality Improvement

Universal American, A WellCare Company

Gerri Cash

Gerri Cash

Vice President, Quality Programs

Tessellate

Christopher Miladinovich

Christopher Miladinovich

Co-Founder, Principal and Senior Vice President of Consulting

ProspHire

Shawn Shuman, MSN, RN

Shawn Shuman, MSN, RN

Senior Director, Clinical and Business Development

UPMC Health Plan

Emily Fahey

Emily Fahey

Risk and Performance Manager

Care Wisconsin

Violet Jones, BSN, RN, CCM

Violet Jones, BSN, RN, CCM

Director, Stars and Quality Improvement

AmeriHealth Caritas

Samuel Young, MD, MBA, CPE

Samuel Young, MD, MBA, CPE

Senior Medical Director – Medicare

Florida Blue

Roseann DeGrazia

Roseann DeGrazia

Vice President Regional Network Management

UPMC Health Plan

Venue

Omni

Omni Orlando Resort at ChampionsGate
1500 Masters Boulevard
Champions Gate, FL 33896
800-843-6664

Discounted Rate of $177/night (includes $20 Resort Fee) – Mention BRI Network to get the discounted rate or use the link below:
https://www.omnihotels.com/hotels/orlando-championsgate/meetings/bri-network

Cut-off date: April 27th, 2018

Sponsors and Exhibitors

Luncheon Sponsor

healow Insights is an innovative, cloud-based solution with service offerings designed to automate the bidirectional exchange of actionable data between health plans and providers. Through on-demand Medical Record Retrieval, EHR Data Aggregation and Point-of-Care Alerts, health plans may reduce overhead costs, improve compliance, and boost ratings on key quality measures.

FAQ

Are there group discounts available?

  • Yes – Register a group of 3 or more at the same time and receive an additional 10% off the registration fee

Are there discounts for Non-Profit/Government Organizations?

  • Yes – please call us at 800-743-8490 for special pricing

What is the cancellation policy?

  • Cancellations received 3 weeks prior to the event will receive a refund minus the administration fee of $185. Cancellation received less than 3 weeks prior to the event will receive a credit to a future event valid for one year.

Can the registration be transferred to a colleague?

  • Yes – please email us in writing at info@brinetwork.com with the colleague’s name and title

Where can I find information on the venue/accommodations?

  • Along with your registration receipt you will receive information on how to make your hotel reservations. You can also visit individual event page for specific hotel information. The conference fee does not include the cost of accommodations.

What is the suggested dress code?

  • Business casual. Meeting rooms can sometimes be cold so we recommend a sweater or light jacket
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