2021 Star Ratings & Quality Improvement Summit
January 21-22, 2021
(VIRTUAL CONFERENCE)

2021 Star Ratings & Quality Improvement Summit

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COVID-19 Advisory: BRI Network holds above all else, the health & safety of our attendees and their families. Our events will be hosted on a virtual platform until such time that health agencies deem travel safe. We look forward to continuing providing you with the best possible conference experience now and when we meet again in person.
About the Conference

Organizations are continuing to implement innovative new approaches to improve performance and quality measures as the nation continues to move forward in achieving Value-Based Health and success with CMS Star Ratings. As the Five Star Quality Rating System continues to evolve and expand and set higher stakes, organizations are seeking out new methods and interventions which will allow them to maintain or achieve the desired four or five-star ratings. Health plans and providers are engaging in collaborative partnerships to improve quality, close gaps in care, improve patient outcomes, engage members while reducing spending creating savings. 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.

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 four or five 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 2020 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
  • Medicare Star Ratings
  • Behavioral Health
  • Member Outreach & Engagement
  • Informatics
  • Data Management
  • Chief Medical Officers
  • Analysts
  • Telehealth
  • Sales
  • Government Programs
  • Clinical Director

Also of Interest to Vendors; Solution Providers; Pharmaceutical

Conference Agenda

Day One – Thursday, January 21, 2021

10:00am
Opening Remarks

10:05am – 10:50am
Getting Member Outreach into Gear: Developing Our Voice

The speakers will discuss how they keep things simple for the member and maximize messaging. Topics to be discussed will include:

  • Developing oversight over multiple areas internally
  • Prioritizing projects and course-correcting when necessary
  • Protecting the member experience, by preventing over-communication and mixed messaging

Laura Adams, MBA
Director, Medicare Stars
Medical Mutual

Molly McDonnell
Senior Customer Experience Project Manager
Medical Mutual

10:55am – 11:40am
Breaking Down Silos: Working Quality/Stars in Conjunction with Risk Adjustment

* Coordinating with each department to prevent provider abrasion
* Aligning provider incentives to prevent patient abrasion
* Delivering a streamlines provider training package

Ryan Dodson, CRC
Regional Manager Risk Adjustment
Molina Healthcare

11:45am – 12:30pm
Innovative Practices for Effective 5-Star Medicare Advantage Member Engagement

Medicare Advantage carriers typically focus their business development efforts on annual enrollment sales for growing new members. But while the annual enrollment period is certainly important, smart health plans are beginning to employ member engagement tactics throughout the year to improve member experience, retention and satisfaction, and ultimately, improve STAR ratings. This session will examine successful member engagement tactics both prior to and during the pandemic to improve member loyalty–and ultimately increase STAR ratings.

Carolyn Langer, MD, JD, MPH
Senior Vice President and Chief Medical Officer
Fallon Health

12:30pm – 1:00pm
Lunch Break

1:05pm – 1:50pm
Obstacles and Opportunities to Advance Quality Gap Closure & Improved Stars Ratings

Many health plan executives view value-based arrangements as a strategic priority, but health plans and providers have encountered headwinds in advancing Quality and improving Star Ratings.

Join Rob Pinataro, Payspan CEO, who will explore the barriers and keys to success for the health care industry as it moves toward paying for quality instead of quantity.

Learning Points include:

  • Impediments to Quality care gap closure
  • Strategies to overcome obstacles to improved Star Ratings
  • Impacts of COVID on the delivery of Value-Based-Care

With the largest healthcare network in the U.S., Payspan offers payment solutions for health plans and providers seeking to increase provider adoption of electronic payments, engage patient-members and accelerate quality care. Our solutions reduce costs, drive revenue, and help boost Star Ratings and HEDIS scores by leveraging the largest multi-payer, provider-centric electronic payment network. www.payspan.com

Rob Pinataro
CEO
Payspan

1:55pm – 2:55pm
Panel Discussion: Best Practices to Achieve Excellent Star Ratings

During this panel discussion, 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

Moderated by:
Rob Pinataro
CEO
Payspan

Panelists:

Amanda Calvert, MPH
Senior Clinical Program Manager, Medicare Stars
Blue Shield of California 

Jonathan Harding, MD
Senior Medical Director, Senior Products Division
Tufts Health Plan 

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

3:00pm – 3:45pm
Five-Star Quality Population Health Management

This session will examine star quality improvement strategies, including successful care management efforts. Topics to be discussed will include:

  • Distinguishing between star rating measures that are provider-centric vs. plan-centric
  • Assessing star quality improvement initiatives
  • Provider and member engagement strategies to address areas for potential improvement
  • Preparing for challenges and risks
  • Improving population health management results

Yvonne Heredia
Senior Manager of Care Management       
Neighborhood Health Plan of Rhode Island

3:50pm – 4:35pm
Aligning Physician Engagement to Boost Quality, Patient Satisfaction and Star Ratings

Provider engagement is key to nearly all Star Ratings measures. This presentation will focus on proven strategies to increase provider engagement and improve Star Ratings. Topics to be discussed will include:

  • How to develop unique and targeted interventions to improve satisfaction of population segments within product lines
  • Analyze results by provider to identify, inform and improve performance of outliers within your network
  • Building a collaborative environment with your provider groups to establish a partnership

Ryan Dodson, CRC
Regional Manager Risk Adjustment
Molina Healthcare

4:40pm – 5:25pm
Creating a Collaborative Model to Improve Patient Care

This session will examine how collaboration between different stakeholders can facilitate efforts toward achieving optimal Star Ratings. Topics to be discussed will include:

  • 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

Daniel Weaver
Vice President Medicare and Medicaid Quality Programs
Gateway Health Plan

5:25pm
End of Day One

Day Two – Friday - January 22, 2021

10:00am – 10:05am
Recap of Day 1

10:05am – 10:50am
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. We 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.  We will also explore how teamwork and relationships with other departments can impact the success of the big picture.

Judy Hamlin, RN, MS, CCM, FNP-C
Manager Quality Improvement
WellCare Health Plans, Inc.

10:55am – 11:40am
Overcoming Barriers to Achieving Stars from an Equity Perspective

Join us in discussing how we can expand the support of our members facing challenges in health literacy, understanding their health plan benefits, impacted by social determinants of health barriers, and collectively improve the effectiveness of early interventions.

Following this presentation, audience members will be able to:

  • Recognize how effective interpretation impacts the power, privilege and access to communication and information;
  • Understand the value of including interpreters as part of the multi-disciplinary team;
  • Use a trauma-informed framework to improve the experience of limited English proficient consumers.

Anna Lynch
Member Engagement Manager
CareOregon 

Toc Soneoulay-Gillespie, MSW
Social Services Manager, Population Health
CareOregon

11:45am – 12:30pm
Improving Stars through Member Rewards and Incentives

In this presentation we will explore a provider-sponsored health plan’s journey from having no Medicare Advantage Rewards and Incentives to having a robust program offering rewards for a variety of Stars-related activities, including innovative rewards to engage members most likely to be non-compliant with key preventive care activities. We will discuss creating the business case for rewards and getting leadership buy-in and support as well as program administration lessons learned and opportunities for optimization

Carly Bressler-Archambeau
Director, Medicare Stars Program
Optima Health / Sentara Health Plans

12:30pm – 1:00pm

Lunch Break

1:05pm – 1:50pm
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. Topics to be discussed will include:

  • Improving quality of life, clinical outcomes and healthcare resource utilization
  • Patterns in compliance
  • Common errors in the stratification of member sub-groups
  • Informing the design of targeted interventions
  • Working with physicians and community stakeholders to address root causes of chronic diseases
  • Interventions that have been effective in overcoming quality improvement challenges inherent in our communities’ social determinants of health
  • How the data related to the social determinants of health will be evaluated and used to promote higher quality scores

Sarah Bezeredi
National Vice President, Quality Solutions Delivery
UnitedHealth Group

1:55pm – 2:40pm
Increasing Medication Adherence and Compliance

As CMS shifts focus to member experience/access and complaints measures in the Medicare Stars Program, it is vital that plans do not lose focus on the heavily weighted medication adherence measures that can make or break your overall rating. This session will examine impactful tactics to start improving pharmacy quality goals and member medication adherence strategy in 2021, including:

  • Intervention strategies
  • Incorporating your member experience strategy
  • Reaching members at the right time

Rachel Sterner
Stars Program Manager
Ucare

2:45pm – 3:30pm
How Teledentistry Can Help Improve Star Ratings and the Value Dental Can Bring to Medicare Advantage Programs

This session will explore how teledentistry can help improve member satisfaction and engagement, access to important preventive care, data collection to help with disease management programs and ultimately star ratings.  Presenters will also discuss the advantages of including dental options with Medicare Advantage programs, including membership and retention growth and an association between offering dental and lower medical cost of care.

Mike Davis
President and Chief Operating Officer
Dominion National 

Chris Davis
Vice President of Ancillary Services
Capital BlueCross 

Frank Fernandez
Senior Vice President of Government Programs
Capital BlueCross 

Jeff Schwab
Vice President, Marketing
Dominion National 

3:30pm
Conference Concludes

Featured Speakers

Carolyn Langer, MD, JD, MPH

Carolyn Langer, MD, JD, MPH

Senior Vice President and Chief Medical Officer

Fallon Health
Amanda Calvert, MPH

Amanda Calvert, MPH

Senior Clinical Program Manager

Blue Shield of California
Jonathan Harding, MD

Jonathan Harding, MD

Senior Medical Director, Senior Products Division

Tufts Health Plan
David L. Larsen, RN, MHA

David L. Larsen, RN, MHA

Director, Quality Improvement

SelectHealth
Laura Adams, MBA

Laura Adams, MBA

Director, Medicare Stars

Medical Mutual
Molly McDonnell

Molly McDonnell

Senior Customer Experience Project Manager

Medical Mutual
Yvonne Heredia

Yvonne Heredia

Senior Manager of Care Management

Neighborhood Health Plan of Rhode Island
Ryan Dodson, CRC

Ryan Dodson, CRC

Regional Manager Risk Adjustment

Molina Healthcare
Daniel Weaver

Daniel Weaver

Vice President Medicare and Medicaid Quality Programs

Gateway Health Plan
Sarah Bezeredi

Sarah Bezeredi

National Vice President, Quality Solutions Delivery

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

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

Manager Quality Improvement

WellCare Health Plans, Inc.
Anna Lynch

Anna Lynch

Member Engagement Manager

CareOregon
Toc Soneoulay-Gillespie, MSW

Toc Soneoulay-Gillespie, MSW

Social Services Manager, Population Health

CareOregon
Carly Bressler-Archambeau

Carly Bressler-Archambeau

Director, Medicare Stars Program

Optima Health / Sentara Health Plans
Rachel Sterner

Rachel Sterner

Stars Program Manager

Ucare
Venue
(VIRTUAL CONFERENCE)
Sponsors and Exhibitors

Education Underwriter

PaySpan

With the largest healthcare network in the U.S., Payspan offers payment solutions for health plans and providers seeking to increase provider adoption of electronic payments, engage patient-members, and accelerate quality care. Our solutions reduce costs, drive revenue, and help boost Star Ratings and HEDIS scores by leveraging the largest multi-payer, provider-centric electronic payment network. www.payspan.com

 

Accreditation Statement:

 

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) and the Business Research & Intelligence Network, LLC (BRINetwork).  ABQAURP is accredited by the ACCME to provide continuing medical education for physicians.

The American Board of Quality Assurance and Utilization Review Physicians, Inc. designates this live activity for a maximum of 8.5 AMA PRA Category 1 Credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABQAURP is an approved provider of continuing education for nurses. This activity is designated for 8.5 contact hours through the Florida Board of Nursing, Provider # 50-94.

 

About ABQAURP

Established in 1977, the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is the nation’s largest organization of interdisciplinary health care professionals. Through its ultimate goal to improve the quality of health care provided to the public, ABQAURP is dedicated to providing health care education and certification for physicians, nurses, and other health care professionals. For more information: call 800.998.6030 or visit www.abqaurp.org

  • Membership & Fellowship
  • CME & CEU Accredited Online Courses, Live Conferences & Home Studies
  • The Only Health Care Quality and Management Certification Exam Administered
    Through the National Board of Medical Examiners® (NBME®)!
  • Sub-Specialty Certifications may be earned in the following categories:
    • Physician Advisor*
    • Transitions of Care
    • Managed Care
    • Patient Safety / Risk Management
    • Case Management
    • Workers’ Compensation

* The Health Care Quality and Management Certification and the Physician Advisor Sub-Specialty Certification are endorsed by the American College of Physician Advisors.

“National Board of Medical Examiners®” and “NBME®” are registered trademarks of the National Board of Medical Examiners.

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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