2019 Star Ratings & Quality Improvement Summit
Operational and Engagement Strategies to Enhance Star Ratings and Quality Performance
January 28-29, 2019 * Fairmont Scottsdale Princess * Scottsdale, AZ

2019 Star Ratings & Quality Improvement Summit

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About the Conference

In achieving the Triple Aim and promote patient centric care, health plans are creating and implementing new approaches to achieve success under the evolving CMS Five Star Quality Rating System. In order to both obtain and maintain the desired 4 or 5 star rating, health plans have implemented innovative programs, established collaborative partnerships and other initiatives to improve patient outcomes, quality and performance, optimized member engagement and satisfaction while reducing costs and increasing revenue. As the Star measures continue to change and evolve, health plans are also following suit in order to achieve high star ratings which will determine reimbursement revenues, bonus payments, member enrollment and marketing opportunities. As is 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, and drive your quality goals forward.

We have created an exciting, high level forum featuring knowledgeable leaders and executives from the nation's leading Health Plans and health systems who will share their perspectives, valuable insights and expertise on how to be best equipped for the rapidly evolving and critical changes in achieving high Star Ratings. Attendees will benefit from learning about new best practices, initiatives and strategies that have been deployed to address the challenges presented under the Affordable Care Act to improve the quality and delivery of healthcare while reducing costs, boosting revenue and improving member satisfaction. By attending the 2019 Congress for Star Ratings and Quality Improvement Summit you will learn about innovative programs and initiatives that have been implemented at leading Health Plans to successfully achieve and maintain high star ratings.

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, January 28, 2019

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

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

8:15am – 9:00am
Why Quality and Patient Experience are a Myth
Rush University Medical Center is the first health system in the world to utilize a soft scanning solution for Epic Rover. This talk will focus on how the implementation of this technology has resulted in a decrease in patient errors and improve quality, outcomes and efficiencies. The presentation will review how this results in a decrease of medication errors, costs and improves patient safety, thus achieving the Triple Aim.

Shafiq Rab, MBBS, MPH, CHCIO
Senior Vice President and Chief Information Officer
Rush University Medical Center

9:00am – 9:45am
Value Based Contracting to Drive Quality Performance and Boost Star Ratings
This session we will examine Value-Based Contracting (VBC) through the lens of Disruptive Innovation, to focus on financial models that align payer and provider incentives to drive Quality and Patient Satisfaction outcomes while lowering cost. The talk will discuss powerful Behavioral Economics concepts as core to VBC success. The presentation will also explore changes to the healthcare delivery system engineered to support Value-Based Contracting.

Raymond Zastrow, MD, FAAFP
Chief Medical Officer
Molina Healthcare

9:45am – 10:15am
Networking Break

10:15am – 11:00am
The Impact of Social Determinants of Health on Star Ratings
This session will examine how to effectively address social determinants of health to enhance Star Ratings. The health of our patients are impacted by the communities they live in. Identifying the social determinants of health including housing insecurity, food insecurity, and substance use disorders is the first step in addressing barriers to care. The most efficient way to tackle social determinants is to partner with and support community agencies working in the field. Improving quality scores including HEDIS depends upon systematic implementation of team based approaches to care. Introducing population health principles can illuminate health disparities and support targeted interventions. This presentation will offer real world examples and recommendations from one of the most impoverished areas in our country that will improve star ratings for even the most challenging populations.

John Zweifler, MD
Medical Director
Adventist Health Plan

11:00am – 11:45pm
How Successful Health Plans Measure and Manage Beneficiary Experience and Operational Measures to Improve Star Ratings
This talk will discuss proven strategies on measuring and managing the member experience, as well as the associated operational components. The presentation will explore how to ensure high call center measure performance through training, tracking and real-time issue resolution. It will also discuss how to manage appeals measures throughout the year by tracking measure scores and promptly acting on opportunities. The talk will also cover how to work CAHPS scores year-round by analyzing cross-departmental data sources within your health plan.

Jessica Assefa
Medicare Stars program Manager
UCare

11:45am – 1:00pm
Lunch

1:00pm – 1:45pm
Using Episodes of Care to Improve Star Ratings
Learn how Horizon Blue Cross Blue Shield of New Jersey is using Episodes of Care to improve Star ratings for their Medicare Advantage members. The discussion will address the impact of episodes on quality improvements, as well as trying quality metrics to payment. The talk will also review how to construct episodes that focus on key quality metrics.

Lili Brillstein, MPH
Director, Episodes of Care
Horizon Blue Cross Blue Shield of New Jersey

1:45pm – 2:30pm
Star Ratings ROI
What is the true benefit of an investment in Star Ratings? This session will discuss the financial impact of a highly performing Star Ratings contract, including measuring the direct and indirect benefits from high performance. The talk will also address how to utilize ROI to make a business case for quality improvement interventions. This session will also examine the opportunity cost to choose which interventions to prioritize.

Joshua Edwards, MBA, MSc
Medicare Stars. Programs Manager
Martin’s Point Health Care

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 will 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

Michelle Coberly
Manager, Medicare Compliance & Quality
Priority Health

Kathleen Faulk
General Manager of Government Programs
Regence Blue Cross Blue Shield

Scott Hewitt
Vice President, Payment Strategy & Innovation

UnitedHealthcare Networks
UnitedHealthcare

4:15pm - 5:00pm
Risk Adjustment & Quality Management – How Collaboration Leads to Alignment and Transparency
In this session you will 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 incorporating risk adjustment for streamlined processes, and how to develop contracts with providers that support risk adjustment and Star Ratings. This talk will also explore how strong “Partnerships” are critical (both internal and external), how member engagement is a key component, the goal of coordinated medical record retrieval and education to reduce burden typically placed on staff at each provider site. The presentation will also discuss the benefits, including: enhanced care coordination, transitions of care, quality, patient outcomes, PQS/ P4Q performance, coding, clinical documentation, and claims processing, fraud/waste/abuse awareness and payment integrity.

Yvonne S. Krashkevich MS, MBA
Director Quality & Accreditation
Geisinger Health Plan

Kris Trafton
Director, Risk Adjustment
Geisinger Health Plan

5:00pm
End of Day One

Day Two – Tuesday, January 29, 2019

7:15am – 8:00am
Networking Breakfast

8:00am – 8:15am
Chair’s Recap of Day 1

8:15am – 9:00am
Using Data to Drive Provider Behavior Change: The Key to Improving Quality
Getting over-burdened clinicians to look at quality data, much less respond to it, is a challenge. This talk will share successful translational approaches of both quality data and best clinical evidence that are driving behavior change and improving downstream quality and cost. Specifics on how these techniques impacted the Excellus BlueCross BlueShield Spine Health Program will be shared as will specific strategies embracing the ‘Choosing Wisely’ initiative.

Brian D. Justice, MD
DC Medical Director
Excellus BlueCross BlueShield

9:00am – 9:45am
Managing Post Acute Care Transitions: Improving Quality and Optimizing Performance on Related STAR Measures
In selecting measures, NCQA's HEDIS and CMS' STARs programs are increasingly focused on coordination of care. Measures such as Follow-up after Hospitalization for a Mental Illness, Medication Reconciliation Post-Discharge, the new HEDIS Transitions of Care, and the tripled weighted Medicare Stars Measure Plan All Cause Readmissions, all call for effective management of member transitions post- inpatient discharge. This session will discuss Tufts Health Plan's Senior Products Division's experience in designing and implementing Transitions of Care protocols with the aim of improving the quality of care member receive while maximize performance on related STAR and HEDIS measures.

Debra A Corbett
Program Director, Senior Products Clinical Services Strategy
Tufts Health Plan

9:45am – 10:15am
Networking Break

10:15am – 11:00am
ACO Collaboration

Tricia Nguyen, MD
Chief Executive Officer
Inova Commonwealth Health Network
Inova Health System

11:00am - 11:45am
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. This session 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

11:45am - 12:30pm
Addressing Hard to Improve Star Measures
This conference session will focus on Medicare Advantage Star measures that have traditionally been hard for Medicare Advantage plans to improve their performance. Best practice examples will be provided for measures such as hypertension control, diabetes control, osteoporosis screening, HOS measures, colorectal cancer screening, and medication reconciliation. The examples will focus on multifaceted targeted action plans addressing data capture as well as both provider and member interventions.

David L. Larsen RN, MHA
Director of Quality Improvement
SelectHealth

12:30pm
Conference Concludes

Workshop – Tuesday, January 29, 2019

12:30pm – 2:30pm
Structure Your Star Ratings Program for Success: Enhancing Operational Efficiencies and Integrating Quality Improvement Programs to Boost Star Ratings

This workshop will focus on how to prepare your organization to succeed in achieving higher star ratings by examining organizational focus and execution. The workshop leaders will address how to evaluate potential weaknesses in your organizational structure to understand how these pose internal threats to Stars performance. We will also address some of the common execution challenges that plans face in realizing 4 or 5 Star status. We’ll review effective strategies on identifying threats and strengthening the organizational focus. And we will offer observations on how to avoid those operational Topics to be discussed will include:

- An overview of the Stars domains and identifying how to have the greatest impact.
- Designing the organizational structure to assemble your team and build Stars champions, with communication strategies that lead to success.
- Conducting an effective, cross-functional training program to improve Star Ratings
- Developing and delivering department-specific presentations to ensure a global understanding of Stars and role of each department in achieving desired results across your organization
- The power of efficient, timely and effective data collection and analysis to support program operation
- Developing ROI models that demonstrate the value of program improvements
- Empowering key staff and functional leaders with actionable information
- Performance measurement reporting designed to inform stakeholders and collaboratively effectuate change
- Strategies that encourage provider engagement and improve provider performance, including aligned performance incentives
- Discussion of common execution obstacles and effective avoidance planning
- Incorporating Six Sigma methods
- Achieving synergies among quality, risk and revenue to optimize risk scores

Richard Trembowicz
Associate Principal
ECG Management Consultants

Jacob Luria
Senior Manager
Insurance Services
ECG Management Consultants

Featured Speakers

Shafiq Rab, MD, MPH, CHCIO, FCHIME

Shafiq Rab, MD, MPH, CHCIO, FCHIME

Senior Vice President and Chief Information Officer

Rush University Medical Center

Raymond Zastrow, MD, FAAFP

Raymond Zastrow, MD, FAAFP

Chief Medical Director

Molina Healthcare

John Zweifler, MD

John Zweifler, MD

Medical Director

Adventist Health Plan

Jessica Assefa

Jessica Assefa

Medicare Stars program Manager

UCare

Lili Brillstein, MPH

Lili Brillstein, MPH

Director, Episodes of Care

Horizon Blue Cross Blue Shield of New Jersey

Joshua Edwards, MBA, MSc

Joshua Edwards, MBA, MSc

Medicare Stars Programs Manager

Martin’s Point Health Care

Michelle Coberly

Michelle Coberly

Manager, Medicare Compliance & Quality

Priority Health

Kathleen Faulk

Kathleen Faulk

General Manager of Government Programs

Regence Blue Cross Blue Shield of Oregon

Scott Hewitt

Scott Hewitt

Vice President, Payment Strategy & Innovation

UnitedHealthcare

Yvonne S. Krashkevich MS, MBA

Yvonne S. Krashkevich MS, MBA

Director Quality & Accreditation

Geisinger Health Plan

Kris Trafton

Kris Trafton

Director, Risk Adjustment

Geisinger Health Plan

Brian D. Justice, DC

Brian D. Justice, DC

Medical Director

Excellus BlueCross BlueShield

Debra A. Corbett

Debra A. Corbett

Program Director, Senior Products Clinical Services Strategy

Tufts Health Plan

Tricia Nguyen, MD, MBA

Tricia Nguyen, MD, MBA

Senior Vice President, Population Health

Inova Commonwealth Health Network
Inova Health System

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

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

Manager Quality Improvement

Universal American

David L. Larsen RN, MHA

David L. Larsen RN, MHA

Director, Quality Improvement

SelectHealth

Richard Trembowicz

Richard Trembowicz

Associate Principal

ECG Management Consultants

Jacob Luria

Jacob Luria

Senior Manager, Insurance Services

ECG Management Consultants

Venue

Fairmont Scottsdale Princess
7575 E. Princess Drive
Scottsdale, AZ 85255
480-585-4848

“Mention BRI Network to get the discounted rate of $269/Night – Reserve Early!

Sponsors and Exhibitors

Exhibitors

Norvo Nordisk, a global healthcare company, has been committed to discover and developing innovative medicines to help people with diabetes lead longer, healthier lives for 95 years. This heritage has given us experience and capabilities that also enable us to help people defeat other serious chronic conditions including hemophilia, growth disorders and obesity. With U.S. headquarters in NJ we employ nearly 6,000 people throughout the country. Visit novonordisk.us;follow us on Facebook and Twitter.

 

 

Pharmacy Quality Solutions Pharmacy Quality Solutions (PQS), exists to help manage performance information between payers and providers so patients and members can receive the highest quality of care. PQS delivers the quality insights and guidance necessary to support its customers' efforts to optimize the quality of medication management and use for the populations they serve. PQS connects medication use stakeholders to actionable, quality information in a consistent and reliable fashion, allowing them to move more quickly from measurement to improvement. Its industry-leading platform, EQuIPP™, provides consistent and reliable measurement and reporting on key medication use quality measures, including addressing medication adherence, gaps in care, and patient safety. PQS provides measurement insights that are timely, actionable, and simply understood.

 

 

Health Data DecisionsHealth Data Decisions is a Massachusetts-based health data analytics firm founded in 2008. We offer strategic analytics and data solutions for health plans, health IT vendors, and regulatory bodies. Our client base spans across the continental US, as well as Puerto Rico and Hawaii. HDD brings broad expertise in data management, performance measurement and analytics, medical economics and risk adjustment. We have a strong focus on HEDIS® program optimization and analytics, as well as CMS Stars, risk adjustment, outcomes measurement and regulatory reporting. Our consultants have an average of 15 years of health care data analytics and management experience.

mPulse Mobile, the leader in Conversational AI solutions for the healthcare industry, drives improved health outcomes and business efficiencies by engaging individuals with tailored and meaningful dialogue. mPulse Mobile combines behavioral science, analytics and industry expertise that helps healthcare organizations activate their consumers to adopt healthy behaviors. With over a decade of experience, 70+ healthcare customers and more than 150 million conversations annually, mPulse Mobile has the data, the expertise and the solutions to drive healthy behavior change.

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 4 weeks prior to the event will receive a refund minus the administration fee of $225. Cancellation received less than 4 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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