2020 Star Ratings & Quality Improvement Summit
Operational and Engagement Strategies to
Enhance Star Ratings and Quality Performance

January 26-28, 2020 * Fairmont Scottsdale Princess * Scottsdale, AZ

2020 Star Ratings & Quality Improvement Summit

Day(s)

:

Hour(s)

:

Minute(s)

:

Second(s)

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
  • Medicare Star Ratings
  • Behavioral Health
  • Member Outreach & Engagement
  • Informatics
  • Data Management
  • Chief Medical Officers
  • Analysts
  • Sales
  • Government Programs
  • Clinical Director

Also of Interest to Vendors; Solution Providers; Pharmaceutical

Conference Agenda

Day One – Sunday, January 26, 2020

4:00pm – 6:00pm

Exhibitor Set-up

6:00pm – 7:00pm

Cocktail Reception

Day Two – Monday, January 27, 2020

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

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

8:15am – 9:00am
Key Measures to Close Gaps in Care, Improve HEDIS Scores and Boost Star Ratings

Achieving or maintaining HEDIS scores and/or target Star Ratings isn’t a guessing game, it’s a science. Not all measures are created equal and many intervention activities can have both positive and negative impacts on multiple measures. This session will provide insights into successful strategies for building the best strategy for measure targeting and intervention execution designed to improve HEDIS measures and boost Star Ratings

Daniel Weaver
VP Stars, Quality, and Risk Adjustment
Gateway Health Plan

9:00am – 9:45am
Payor (Health Plan) and Provider Collaboration and Partnerships to Boost Star Rating

This session will discuss developing and implementing collaborative partnerships between Payors and Providers to improve quality and boost star ratings. HealthSun is a 5 star rated plan and has incorporated effective collaborative partnerships with providers. The talk will discuss these partnerships and programs.

Karen W. Connolly, RN
Senior Vice President/Quality Improvement and Accreditation Services
HealthSun Health Plans, Inc.

9:45am – 10:15am
Networking Break

10:15am – 11:00am
Applying Population Health Principles to Quality Improvement

Population Health provides a framework for improving quality for low risk, rising risk and high risk populations. This session will review strategies for identifying and addressing social determinants. Additionally, the significance of health disparities in interpreting star ratings will also be discussed.

John Zweifler, MD, MPH
Medical Director for Clinical Integration and Graduate Medical Education
Adventist Health Hanford

11:00am – 11:45am
Identifying Metrics for Targeted Star Ratings Improvement

Health Plans are challenged to impact measures that contribute to Medicare Star Ratings, including HEDIS, Pharmacy, CAHPS, HOS Survey, and Operational Measures. This session will explore ways to prioritize these measures, focusing on leading indicators and key interventions to impact your Medicare Star Rating.

Karen Manning, MBA, BSN, RN
Director Strategic Quality Programs
Martins Point Health Plan

11:45am – 1:00pm
Lunch

1:00pm – 1:45pm
Collaboration, Trust, and Payment Redesign: Key Success Factors to Achieve Quality Improvement

This session will chronicle the Horizon-BCBSNJ decade long journey to build trust through collaborative operational and clinical management models embracing clinical organizations as partners rather than entities to be managed or monitored. The session will describe the guiding principles of payment redesign, data and analytics, shared learning and coordinated care management to achieve improved quality and efficiency of care.

Steven R Peskin, MD, MBA, FACP
Senior Medical Director, Clinical Innovations
Horizon BCBSNJ

1:45pm – 2:30pm
Medicare Innovation Models

This session will cover the latest models that have been released by the Center of Medicare and Medicaid Innovation Center. The talk will also examine UnityPoint’s unique experiences in participating in the models over the last eight years and share a proposal made to CMS by a group of health systems to combine ACO and Medicare Advantage into a new demonstration.

Sabra Rosener, JD
Vice President, Government & External Affairs
UnityPoint Health

2:30pm – 3:00pm
Networking Break

3:00pm – 4:00pm
Panel Discussion: Payor and Provider Collaboration and Incentive Programs to Boost Performance and Achieve Value Based Care

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

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

Daniel Weaver
VP Stars, Quality, and Risk Adjustment
Gateway Health Plan

4:00pm – 4:45pm
Innovative Medication Adherence Programs to Drive Improvement and Boost Star Ratings?

This session will present a Case study on how SelectHealth recently completed a best practice benchmarking initiative by conducting interviews with three top rated plans regarding medication adherence for diabetes, statin and hypertensive medications. The talk will review lessons learned by SelectHealth in developing and implementing a medication adherence program.

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

4:45pm – 5:30pm
Implementing Sustainable Quality Programs In A Value-Based Environment

During this session, a review of quality program components, data & technology needs and staff skillsets will be reviewed. Acknowledging the ever-changing market, how do providers and plans implement sustainable teams that can meet the challenges of growing quality programs? How will the use of data and technology shape programs, partnerships and policy? One organization will share the lessons learned as they strive to meet the needs value-based care transformation.

Karen Marie Wilding
Corporate Senior Director of Quality and Value-based Care
Affiliate Compliance Officer
UM Quality Care Network, Transform Health MD and Population Health Service Organization
University of Maryland Medical System (UMMS)

5:30pm
End of Day One

Day Three – Tuesday - January 28, 2020

7:15am – 8:00am
Networking Breakfast

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

8:15am – 9:00am
Best Practices to Implement An Effective Operational Structure to Obtain Five Star Ratings

Designing and managing an effective operational structure is key to obtaining a 5 Star Rating but is no easy feat. This session will provide tips and tricks to creating a structure that provides a solid accountability system and aligns/coordinates intervention efforts across a company.

Rachel Sterner, MPH
UCare’s Stars Program Manager
UCare

9:00am – 9:45am
Quality Payments From Provider-Payor Partnerships

This interactive and provocative presentation analyzes collaborating with payors, identifying metrics, and the results leading to measurable payments. The talk will also discuss potential benefits and pitfalls behind the utilization of quality metrics in competitive markets. Through active review and discussion; we will tackle how to best identify and utilize an array of clinical and patient satisfaction metrics. The presentation will review the ethical and operational implications in the active utilization of quality data to create distinct market differentiation.

Les Jebson, MHA
Executive Director
Texas A&M Health

9:45am – 10:15am
Networking Break

10:15am – 11:00am
Strengthening Provider Engagement to Improve Quality and Enhance Star Ratings

This session will discuss provider engagement in current landscape and examine how to build a quality culture and implementing relationships and integrity. The talk will also review clinical versus non-clinical, practice based contact, and consultative approaches. The presentation will also discuss maintaining for future initiatives.

Liz Haynes MSN, RN, CCM
Director, Medicare Advantage Quality and Stars
Blue Cross and Blue Shield of Kansas City

11:00am – 11:45am
Engaging Members to Reach for the Stars: Getting Everyone Involved in Quality

Helping member’s live healthier lives and ensuring they have access to affordable, high-quality care and seek all preventable health screenings. Sounds easy, right? Well, not so fast. This discussion will identify skills needed to support our team and members in achieving better health and improved Star ratings. The talk will also discuss how understanding change theory and motivational interviewing are key concepts to coaching members. Other influencing factors such as how location, health literacy and social determinants impact our plan for members to close gaps. The presentation will also explore how team-work and relationships with other departments can impact the success of the big picture.

Judy Hamlin, RN, MS, CCM, FNP-C
Manager Quality Improvement
Universal American

11:45am – 12:30pm
The Star Ratings Landscape and Quality Improvement Strategies

We will review the current Star Ratings landscape, including impending program changes. During this session, we will review trends and findings from the 2020 Star Ratings and dive deeper into the increasingly heavily weighted patient access and experience measures. Participants will learn practical ways to use data and partner with providers to manage populations, outcomes and experiences for strong Star Ratings.

Melissa Smith
Senior Vice President of Sales, Marketing, Strategy and Stars
Gorman Health Group, LLC (GHG)

12:30 – 1:15pm
Strategies to Improve Elusive Star Measures

This session will provide case studies of how root cause analyses and analyses of variation were utilized to identify and target areas for improvement on measures that are difficult to move the needle on. The measures discussed will include All Cause Readmissions, HOS measures and Star Pharmacy Related Measures.

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

1:15pm
Conference Concludes

Workshop – Tuesday, January 28, 2020

1:30pm – 3:30pm
Succeeding in a New Era of Star Ratings

During this workshop, participants will brainstorm opportunities, tactics and solutions to two of the most pressing challenges in Star Ratings today. The Workshop will discuss:

• Strategizing practical ways to earn strong Star Ratings on new and emerging measures
• Strategizing on improving member experiences in the emerging era of flexible benefits, expanded supplemental benefits and condition-specific benefits.

Melissa Smith
Senior Vice President of Sales, Marketing, Strategy and Stars
Gorman Health Group, LLC (GHG)

About the Workshop Leader:
Melissa Smith is Senior Vice President of Sales, Marketing, Strategy and Stars at Gorman Health Group, LLC (GHG). In this role, she is responsible for leading a team of Star Ratings, strategy, sales, and marketing experts to support the needs of health plans, providers, pharmacy benefit managers, and industry vendors. Melissa’s team helps clients improve performance within quality ratings systems such as Star Ratings, improve health outcomes and the member experience, evaluate market dynamics and opportunities, optimize distribution channels, and supports our clients’ strategic planning needs.

Melissa brings 25 years of healthcare experience to GHG, including more than five years serving in a leadership capacity at Cigna-HealthSpring. Melissa has extensive experience developing strategic and tactical solutions to meet client needs and a strong background of building productive partnerships across internal teams and with external vendors to improve performance on clinical, medication, patient survey, and administrative quality measures.

Before working in Medicare Advantage and quality ratings systems, Melissa was an Associate Director at Vanderbilt University Medical Center. Melissa received her degree from Purdue University and began her career at KPMG, LLP. Melissa’s unique background of business process, regulatory compliance, and healthcare quality offers our clients unique access to healthcare strategy, quality performance, and revenue optimization.

Featured Speakers

Daniel Weaver

Daniel Weaver

VP Stars, Quality, and Risk Adjustment

Gateway Health Plan

John Zweifler, MD, MPH

John Zweifler, MD, MPH

Medical Director for Clinical Integration and Graduate Medical Education

Adventist Health Hanford

Karen Manning, MBA, BSN, RN

Karen Manning, MBA, BSN, RN

Director Strategic Quality Programs

Martins Point Health Plan

Karen W. Connolly, RN

Karen W. Connolly, RN

Senior Vice President/Quality Improvement and Accreditation Services

HealthSun Health Plans, Inc.

Steven R Peskin, MD, MBA, FACP

Steven R Peskin, MD, MBA, FACP

Senior Medical Director, Clinical Innovations

Horizon BCBSNJ

Sabra Rosener, JD

Sabra Rosener, JD

Vice President, Government & External Affairs

UnityPoint Health

Kathleen Faulk

Kathleen Faulk

General Manager of Government Programs

Regence Blue Cross Blue Shield

Karen Marie Wilding

Karen Marie Wilding

Corporate Senior Director of Quality and Value-based Care, Affiliate Compliance Officer

University of Maryland Medical System (UMMS)

David L. Larsen RN, MHA

David L. Larsen RN, MHA

Director, Quality Improvement

SelectHealth

Rachel Sterner, MPH

Rachel Sterner, MPH

UCare’s Stars Program Manager

UCare

Les Jebson, MHA

Les Jebson, MHA

Executive Director

Texas A&M Health

Liz Haynes MSN, RN, CCM

Liz Haynes MSN, RN, CCM

Director, Medicare Advantage Quality and Stars

Blue Cross and Blue Shield of Kansas City

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

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

Manager Quality Improvement

Universal American

Debra Corbett

Debra Corbett

Program Director, Senior Products Clinical Services Strategy

Tufts Health Plan

Melissa Smith

Melissa Smith

Senior Vice President of Sales, Marketing, Strategy and Stars

Gorman Health Group, LLC (GHG)

Venue

Fairmont

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

“Mention BRI Network for a special discounted rate of $269/night”

Sponsors and Exhibitors

TBA

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

Request Brochure

Register Your Team Today!

Register Now

Special Discount Offer Until October 25th – Mention Promo WB200 and save an additional $200 off the Early Bird!

Ask A Question

Be A Thought Leader And Share!

Pin It on Pinterest