2022 Managed Care Summit
The Future of Healthcare Delivery
October 17-18, 2022 * JW Marriott Orlando Grand Lakes *Orlando, FL

2022 Managed Care Summit

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About the Conference:

Today, manage care is the predominant form of healthcare in the U.S. Efforts in managed care programs over the past decade have led to improved care delivery across the country. Advancements have empowered providers to focus on care quality over cost, helping to improve member engagement and outcomes while impacting costs at the same time. Healthcare leaders must expand their focus from merely data and measurement. It must be complemented by a focus on workforce development and increasing teams’ quality competencies. Additionally, leaders must clarify and validate the knowledge and skills that each healthcare role must learn to successfully shift to outcome-focused, value-based care. By developing specific competencies in quality, population health, care coordination, data analytics, governance and care delivery, MCOs can empower their workforces to meet the challenges and opportunities presented by this new model—and ultimately improve health care outcomes for all.

Today, consumers have more healthcare options and more control over them. Managed care has evolved into a more holistic part of the consumers’ world. It’s no longer just about copays, deductibles, and premiums, but has become part the overall quality of life for individuals and families. Members will be able to tailor their healthcare with more flexibility and ease. The care they receive should be whole-person centered, holistic, and integrated, accommodating the full range of their clinical, behavioral, social and spiritual health needs.

Another key to creating effective care delivery models is developing effective partnerships with key stakeholders. There is no one-size-fits-all solution in managed care. Nuances abound — across markets, regions, cultural competencies, geographies, and member populations — and each factor plays into how well any system can deliver care. There are significant opportunities to develop more effective managed care delivery models.

This conference will help you navigate this new world of managed care and bring you the education, networking, tools and resources to achieve improvements in both clinical and economic healthcare outcomes. Topics to be discussed will include health equity, member engagement strategies, payer-provider collaboration strategies, the impact of COVID-19 on managed care performance incentives, program integrity, leadership change management strategies, disruptive trends transforming healthcare, the adoption of emerging technologies, risk management, supplementing patient care coordination with telehealth, quality measurement and improvement, ways to boost Star ratings, patient safety, Medicare Advantage trends and more.

 

Who Should Attend?

C-Level Executives from Health Plans; ACO’s; Medical Groups; Government Agencies; Community Health Centers; Managed Care Organizations; Medicare; Medicaid; Star Ratings; Hospitals; Health Systems

  • CEO’s
  • CFO’s
  • VP’s
  • Patient Engagement
  • Quality Improvement
  • Risk Adjustment
  • Healthcare Operations
  • Performance Improvement
  • Clinical Services
  • Medical Directors
  • Managed Care Directors
  • Growth Officers
  • Social Determinants
  • Value Based Care
  • Population Health
  • Actuarial Services

Also of Interest to Vendors and Solution Providers

Conference Agenda

Day One - Monday, October 17, 2022

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

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

8:15am – 9:00am

Keys To Realizing Health Equity
As the COVID-19 pandemic continues to widen existing health and health care disparities in the United States, the attainment of health equity looms large and is arguably our most pressing national priority to curb the pandemic. Social and economic vulnerabilities that have long preceded COVID-19 have perpetuated staggering challenges. Many in our nation now understand what public health experts have known for decades—underlying socioeconomic conditions in communities across the country predict health and health care outcomes more reliably than health care delivery itself. Eliminating health disparities has moved from a goal post for public health agencies, nonprofits, philanthropists, community-based organizations, and researchers, to a necessity for the private sector—including the nation’s health plans. Health plans assume the risk for millions of Americans and are responsible for the health of most Americans. In a healthcare delivery system that is highly fragmented, health plans are uniquely positioned to coordinate whole-person care across the lifespan. They are also poised to lead efforts in health equity that will address the systemic and structural factors that have perpetuated health inequities for too long. To succeed in achieving health equity in these companies, it is crucial that investments in health equity leadership be made, at the highest level, and that health equity is weaved into the organizational fabric, strategic plan, and business goals of every health plan. This session will explore how health plans can integrate health equity into their business model.

Michael Currie
Senior Vice President and Chief Health Equity Officer
UnitedHealth Group

9:00am – 9:45am
High-Impact Member Engagement Strategies
The healthcare industry is no stranger to its share of changing variables, so Medicaid plans should be prepared to optimize their engagement strategies as trends across the industry—and among enrollees—shift. Member engagement is a powerful tool for Medicaid plans and managed care organizations. When members are actively engaged, everyone involved benefits. Increased engagement compels members to focus on high-value activities, making them more likely to take actions that prevent serious or chronic conditions. This leads to healthier members and populations, improved health outcomes, stronger plan performance and a better overall health care system. That said, many Medicaid members deal with real social factors that impact care and make it challenging for plans to engage. Social determinants, such as unstable living conditions or uncertainty about where the next meal or paycheck will come from, are concerns that often take precedence over dealing with health care. Medicaid engagement programs need to factor in the social determinants of health that affect members. Understanding and acknowledging uncertain circumstances helps plans and managed care organizations communicate with their members more effectively. This session will explore look strategies plans can take to actively engage members.

Jamie Galbreath, PhD, MPH, CHES
Quality Improvement Director
UCare

9:45am – 10:15am
Networking & Refreshments Break 

10:15am – 11:00am
Payer and Provider Collaboration: The Key to Improving Long-Term Outcomes
When it comes to managing the care of a patient or health plan member, each interaction provides a new piece to the puzzle of helping him or her get healthy and stay healthy. When it comes to health plans and providers, collaboration is critical to this success. By enabling effective communication between the provider and the health plan there are more resources available to ensure care tasks are completed and that the patient is well taken care of. Together, they can establish who is responsible for post-discharge follow up, for reminding the member of upcoming preventive screening eligibility, for educating the patient on how to manage their condition. This session will explore strategies to enable more effective collaboration, including sharing information, assigning care tasks, and incentivizing success.

Nikki Hungate, MS, MHA
Director, Medicare Government Programs Product Strategy
MVP Health Care 

11:00am – 11:45am
How a Health Plan is Addressing SDOH Barriers to Drive Improvements in Health Equity and Reduce Health Disparities Using a Community Health Worker Model

This session will highlight how a payer started a journey that entailed a retrospective look at its approach to traditional care models to an SDOH pilot later yielding a fully scaled program, committed to whole-person care to improve outcomes rooted in addressing social needs. At a glance Horizon Neighbors in Health is promoting the following for our members and the communities we serve.

Workforce Development

  • Creating hyper-local jobs (CHW’s) in underserved communities, aiding financial wellness
  • Connecting members to job training and development resources

Day-to-Day Stability

  • Creating hyper-local jobs (CHW’s) in underserved communities, aiding financial wellness
  • Connecting members to job training and development resources

Equitable Healthcare

  • Increasing access to care with providers who understand the needs of the community
  • Raising awareness of the impacts of implicit and explicit biases to eliminate health disparities and improve health outcomes

Health Education

  • Promoting understanding of how to utilize benefits appropriately
  • Fostering trusting relationships with CHWs and care teams

Tracy Parris-Benjamin (She/her/hers), LMSW, FHELA
Director, Clinical Design Community Health
Horizon Blue Cross Blue Shield of New Jersey 

11:45am – 12:30pm
Building and Evolving Your Program Integrity Compliance Program
Program integrity activities are meant to ensure that federal and state taxpayer dollars are spent appropriately on delivering quality, necessary care and preventing fraud, waste and abuse. Like other administrative activities, program integrity responsibilities are shared between states and the federal government. This session will explore contracted managed care organizations program integrity responsibilities.

Deb Curry, MBA, RHIA, CCS-P, CRC
Director, Risk Adjustment & Recoveries
Actuarial Services
Paramount 

12:30pm – 1:30pm
Lunch Break 

1:30pm – 2:15pm
Leadership Change Management Strategies
Whether change involves a merger, acquisition, or reorganization, healthcare leaders must constantly evaluate the circumstances of the changes they face so that they can effectively make the right decisions. It is imperative that leaders determine how they respond so that they can help their organizations prepare, manage, and navigate the sometimes violent turbulence of organizational disruption. This session will explore change management strategies and takeaways for managed care executives as the changing face of leadership continues to proliferate.

Naomi Irvin
Chief of Staff – Government Markets
Blue Cross and Blue Shield of North Carolina

2:15pm – 3:15pm
Panel: Quality Measurement and Improvement in Managed Care
In recent years the number of Americans receiving healthcare services through some sort of managed care organization has increased greatly. While managed care has been heralded as a means to reduce costs associated with the delivery of healthcare services, there has been much concern that this cost saving will be achieved by sacrificing the quality of care. Because of this, measuring and assuring the quality of care in managed care settings has become a priority. Government agencies, nonprofit organizations, and consumer groups have all begun to focus on the two major aspects of this issue: measurement and improvement. Measurement efforts include developing tools, collecting data, determining indicators of health care quality, analyzing the data and reporting it. After this is done, steps must be taken to ensure that the quality of care is up to par, and to make improvements, where necessary, through education initiatives. Information on the quality of care provided under managed care plans is useful to consumers and employers when trying to chose the best plan to purchase, and also to the plans themselves to determine where improvements need to be made. This session will provide tools about quality measurement and improvement in managed care.

Panelists:

Katelyn Fitzsimmons
Product Management Director Sr, Medicaid Specialized Populations and Programs
Elevance Health

Meghan Hyland, CAPSW
Enrollment and Eligibility Director
Lakeland Care 

Chantel Neece DNP, MBA, APRN, FNP-BC, GERO-BC, CPHQ, SSBBP
Director- SDoH, Member Outreach & Community Development
Virginia Premier

3:15pm – 3:45pm
Networking & Refreshments Break 

3:45pm – 4:30pm
Mobile Integrative Health: A Population Health Model Using Community Paramedics to Reduce Unnecessary ED Visits and Hospitalizations
Mobile Integrative Health is an innovative program that blends clinical assessment, case management and social work.  This program uses a familiar health care resource in the community:  The Community Paramedic.  This is a specially trained and experienced EMS professional that is comfortable in the members home, and in which the community has a high degree of trust.  If we plan to be successful in gaining trust, cooperation, and improved outcomes we must change the way we approach our members.  This presentation will illustrate examples of successful projects, testimonials and outcomes experienced in an MCO Market. At the conclusion of this presentation the audience will be able to:

  • Discuss what is Mobile Integrative Health, and who are Community Paramedics;
  • Identify appropriate Community Paramedic Providers, and Mobile Integrative Health candidates;
  • Explain the evolution of Mobile Integrative Health;
  • Describe the various services provided and where the services can be performed;
  • Illustrate the process to build the partnership between the Managed Care Organization and the MIH providers;
  • List specific MIH programs supported by a managed care organization and how this can benefit the patient and the medical community

Jerry A. Allison, MD, MSH, CPE
Medical Director
Molina Healthcare of Texas 

4:30pm – 5:15pm
Disruptive Trends Transforming Healthcare
Spiraling costs, poor quality outcomes, and inequities in access to care are driving significant and long overdue changes to the way healthcare is administered and managed in the U.S. And while the U.S. spends more on healthcare per person than other wealthy countries, its health outcomes are no better than those in other developed countries. In fact, it performs worse in several health metrics, including life expectancy, infant mortality, and unmanaged diabetes. These types of poor clinical outcomes are often driven by inequitable access to good healthcare in low-income neighborhoods. And a growing body of evidence suggests that an individual’s U.S. ZIP code—where people live—is a more accurate predictor of future health outcomes than genetics or medical care. This session will explore disruptive health care trends that will intensify in the coming year and ultimately improve healthcare in America.

Nebeyou Abebe
SVP, Social Determinants of Health
Highmark Health 

Joseph Stankaitis, MD
Chief Medical Officer
Highmark Wholecare 

5:15pm
End of Day One

Day Two – Tuesday, October 18, 2022

7:15am – 8:00am
Networking Breakfast 

8:00am – 8:15am
Chairperson’s Recap 

8:15am – 9:00am
Maryland's Health Equity and State Integrated Health Improvement Strategies
Deputy Secretary Schuh will discuss Maryland's commitment to reducing disparities in health outcomes and promoting health equity through interrelated initiatives, including the Maryland Commission on Health Equity and the Statewide Integrated Health Improvement Strategy, or SIHIS. SIHIS reflects an agreement between the Centers for Medicare and Medicaid Innovation (CMMI) and the State of Maryland and an important component of the State's Total Cost of Care Model. Through SIHIS, Maryland has identified overdose mortality, maternal and child health, and diabetes as its population-health priorities.

Steven R. Schuh
Deputy Secretary for Health Care Financing and Medicaid
Maryland Department of Health

9:00am – 9:45am
Florida Blue's Journey into Interoperability --- Investing in New Technology, Adjusting Processes and Changing Behaviors
Hear how Florida Blue, a Health solutions company, invested in technology, adjusted processes and changed behaviors in order to transition to a more Interoperable workflow with their provider partners and prepare for the CMS/ONC Interoperability API mandates. Successes, lessons learned and strategy for the future.

Tab Harris
Senior Director
Provider Connectivity Solutions/Interoperability
Florida Blue 

9:45am – 10:15am
Networking & Refreshments Break 

10:15am – 11:00am
The Positive Impact of Telemedicine in the Intellectual and Developmental Disabilities field: A Managed Care Approach
Partners Health Plan (PHP), a not-for-profit managed care organization, is dedicated solely to providing supports and services for persons with intellectual and other developmental disabilities (IDD). PHP is continuously looking to improve the type, accessibility, and quality of healthcare services available for members. As part of this innovative approach, an Urgent and Emergent Telemedicine Program was piloted in collaboration with StationMD. The success of this pilot program demonstrated the potential for achieving quality healthcare outcomes for people with IDD.  A full-scale program was implemented enabling proactive, vital 24/7 healthcare support during the COVID-19 pandemic.  Data gathered and analyzed illustrates consistent results in achieving high quality medical care with a significant financial cost reduction.

Scott Doolan, RN, BSN, MBA
AVP Health Care Management
Partners Health Plan

11:00am – 11:45am
Ways to Boost Star Ratings and Retain Members
The Five-Star Quality Rating System isn’t just a mechanism to improve the patient experience; it has also changed the industry from an insurer’s perspective. A distinct correlation has been found between the number of complaints about Medicare Advantage plans and the number of customers withdrawing from these plans. This session will explore steps health plans can take to reduce customer complaints, improve Medicare star ratings, and lower member attrition rates.

Gary Melis, RPh
Pharmacist
Network Health 

11:45am – 12:30pm
How to Build a Physician Advisor Program to Develop Relationships with Managed Medicare Payers, Improve Utilization Review Processes, and Ensure Medicare Compliance
This session will outline how to get started, give examples of lessons learned, and provide data to support the positive impact to the bottom line through the reduction of Denials, and ultimately how collaboration with CDI has taken the program to the next level.

Todd W. Gray, MD
Hospitalist Medical Director and Physician Advisor
Care Coordination, Hospital Medicine
Genesis Health System 

Julie Van Dusen, MSN, RN
Director, Care Coordination
Genesis Health System 

12:30pm – 1:30pm
Lunch Break 

1:30pm – 2:15pm
How Culture fits into a Quality Strategy
Lakeland Care, a Medicaid Managed Care Organization, has maximized the strengths of its engaged workforce to support individuals with disabilities and the aging population to live a full life in their community. This session will reveal several lessons learned and strategies to support improved organizational quality and culture which has resulted in a high-performing, five star organization. 

Meghan Hyland, CAPSW
Enrollment and Eligibility Director
Lakeland Care 

2:15pm – 3:15pm
Managed Care’s Effect on Outcomes
While much research has been conducted on whether managed care delivery systems result in better outcomes than traditional fee for service, there is no definitive conclusion as to whether managed care improves or worsens access to or quality of care for beneficiaries. This session will explore outcomes associated with managed care delivery systems, including aspects of Medicaid managed care that may affect access to and quality of care, and the relationship between managed care, access and quality.

Panelists:

Angela Lynn
Director
Blue Cross and Blue Shield of North Carolina 

Additional panelists TBA

3:15pm
Conference Concludes

Workshop - Tuesday, October 18, 2022

3:30pm - 5:15pm
HCC Coding: Best Practices to Implement in Medicare Advantage

A hot topic in healthcare right now, especially in the medical coding world is the Hierarchical Condition Category (HCC) risk adjustment model and how accurate coding affects healthcare organizations’ reimbursement. With almost one third of Medicare beneficiaries enrolled in Medicare Advantage plans, it’s more important than ever for healthcare organizations to pay attention to this model and make sure physicians are coding diagnoses appropriately to ensure fair compensation. This workshop will walk through basics of the risk adjustment model, why coding accuracy is so important, and five action items for interdisciplinary work groups to take, including:

  • Having an accurate problem list
  • Ensuring patients are seen in each calendar year
  • Improving decision support and enterprise risk management optimization
  • Widespread education and communication.
  • Tracking performance and identifying opportunities

Tom Lutzow
Principal
Health Management Associates 

Featured Speakers

U. Michael Currie

U. Michael Currie

Senior Vice President and Chief Health Equity Officer

UnitedHealth Group

Jamie Galbreath, PhD, MPH, CHES

Jamie Galbreath, PhD, MPH, CHES

Quality Improvement Director

UCare

Nikki Hungate, MS, MHA

Nikki Hungate, MS, MHA

Director, Medicare Government Programs Product Strategy

MVP Health Care

Tracy Parris-Benjamin (She/her/hers), LMSW, FHELA

Tracy Parris-Benjamin (She/her/hers), LMSW, FHELA

Director, Clinical Design Community Health

Horizon Blue Cross Blue Shield of New Jersey

Deb Curry, MBA, RHIA, CCS-P, CRC

Deb Curry, MBA, RHIA, CCS-P, CRC

Director, Risk Adjustment & Recoveries

Actuarial Services
Paramount

Naomi Irvin

Naomi Irvin

Chief of Staff – Government Markets

Blue Cross and Blue Shield of North Carolina

Joseph Stankaitis, MD

Joseph Stankaitis, MD

Chief Medical Officer

Highmark Wholecare

Steven R. Schuh

Steven R. Schuh

Deputy Secretary for Health Care Financing and Medicaid

Maryland Department of Health

Tab Harris

Tab Harris

Tab Harris

Provider Connectivity Solutions/Interoperability
Florida Blue

Scott Doolan RN BSN, MBA

Scott Doolan RN BSN, MBA

AVP Health Care Management

Partners Health Plan

Gary Melis, RPh

Gary Melis, RPh

Pharmacist

Network Health

Meghan Hyland, CAPSW

Meghan Hyland, CAPSW

Enrollment and Eligibility Director

Lakeland Care

Todd Gray

Todd Gray

Hospitalist Medical Director and Physician Advisor Care Coordination, Hospital Medicine

Genesis Health System

Julie VanDusen

Julie VanDusen

Lean Specialist

Genesis Health System

Nebeyou Abebe

Nebeyou Abebe

SVP, Social Determinants of Health

Highmark Health

Tom Lutzow

Tom Lutzow

Principal

Health Management Associates

Katelyn Fitzsimmons

Katelyn Fitzsimmons

Product Management Director Sr, Medicaid Specialized Populations and Programs

Elevance Health

Chantel Neece DNP, MBA, APRN, FNP-BC, GERO-BC, CPHQ, SSBBP

Chantel Neece DNP, MBA, APRN, FNP-BC, GERO-BC, CPHQ, SSBBP

Director- SDoH, Member Outreach & Community Development

Virginia Premier

Jerry A. Allison, MD, MSH, CPE

Jerry A. Allison, MD, MSH, CPE

Medical Director

Molina Healthcare of Texas

Nebeyou Abebe

Nebeyou Abebe

SVP, Social Determinants of Health

Highmark Health

Joseph Stankaitis, MD

Joseph Stankaitis, MD

Chief Medical Officer

Highmark Wholecare

Angela Lynn

Angela Lynn

Director

Blue Cross and Blue Shield of North Carolina

Venue

VENUE

JW Marriott Orlando Grand Lakes
4040 Central Florida Pkwy
Orlando, FL 32837
407-206-2300

** Mention BRI Network for a discounted rate of $289/night ** or use the link below to make reservations

https://book.passkey.com/go/BRINetworkOCT2022

Sponsors and Exhibitors

 

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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