2023 Medicaid Managed Care Summit

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

8:15am – 9:00am
The Promise of 988: Building an Inclusive, Sustainable and Responsive Crisis System
A year into the 988 program it is important to understand the promise of 988 for people of all ages experiencing crisis.  We will discuss:

• How response rates and the capacity for text and chat have impacted access to crisis services for everyone
•  Develop a responsive crisis system informed by youth and people with disabilities
• The development of the crisis continuum
• Federal, State and community engagement in building sustainable crisis systems to help everyone

Wendy Martinez Farmer, LPC, MBA
RVP National Crisis Center of Excellence
Elevance/Carelon Behavioral Health

9:00am – 9:45am
Complex Discharge Program: Reducing Health Disparities in Access through Managed Care
Washington State’s Complex Discharge Program leverages the power of managed care in a collaborative approach to create solutions in the health care system. Our most vulnerable populations often experience challenges to access, and these disparities can create complexities that lengthen a member’s hospitalization.  Care coordination through managed care in Washington State has successfully reduced health disparities, hospital length of stay, and improved health outcomes.

Glory Dole, BSN, MA, RN
Section Manager
Medicaid Contracts and Compliance
Medicaid Programs Division
Washington State Health Care Authority 

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

10:15am – 11:00am
Engaging Your Patients:  Strategies for Success
Patient engagement has a direct impact on the success of the strategies healthcare organizations develop to address the physical and psychosocial needs of the Medicaid population.  Organizations need to think of new practical ways to address the challenges of engagement and move away from traditional methods.  The presenter will share strategies used by the care team to engage patients and their caregivers.  

Joann Sciandra
AVP Population Management
Geisinger Health Plan 

11:00am – 11:45am
Will I Show up for My Appointment? How to Mitigate Transportation Barriers for Members Between NEMT Brokers and Managed Care Organizations through Effective Case Management Interventions
The presenter will explore mitigation strategies and understanding trends in how members access out of plan non-emergency medical transportation (NEMT) benefit and coordination between NEMT brokers and managed care organizations. The presenter will use Rhode Island’s performance management pilot program using mixed method analysis to determine the effectiveness to reduce member no-shows for critical care appointments. This will look at the coordination for transportation and reminders from members through MCO case managers and how to best implement strategies between two organizations to support members who are chronic no-shows.  

Mark Kraics, DBA, MBA, MAPP
Deputy Medicaid Program Director, Managed Care Oversight
State of Rhode Island 

11:45am – 12:30pm
Incorporating LTSS into Medicaid Managed Care: Do’s and Don’ts from Idaho’s Implementation
The intersection of Medicaid managed care and the LTSS landscape spanning home and community-based services to institutional care can be difficult to navigate successfully. The dynamic duo responsible for implementing Idaho’s fully integrated managed care program for Medicare Medicaid beneficiaries will share key lessons learned (and pitfalls) that shaped the program over the last decade. This session’s overview will include strategies in relationship-building, IT solutions, and process improvement.

Chris Barrott
Program Manager, Bureau of Long Term Care
Idaho Department of Health and Welfare 

Alexandra (Ali) Fernández, MHS
Bureau Chief, Bureau of Long Term Care
Idaho Department of Health and Welfare 

12:30pm – 1:30pm
Lunch Break 

1:30pm – 2:15pm
Connecting Payers and Providers to Enhance the Delivery of Care and Improve Outcomes
Payers—including private and public health insurance companies, government-run Medicare and Medicaid, and a variety of managed care plans—are finding ways to expand their role in healthcare. In addition to their traditional functions such as collecting their members’ premium payments, negotiating rates for services, and paying a percentage of provider claims, they are beginning to influence actual care delivery. Oftentimes, payers are more apprised of an individual’s health, lifestyle, and utilization patterns than primary care physicians and other care team members. Their motivation for this shift is clear. Payers desire better health outcomes, which can lower their costs. When outcomes are improved and costs reduced, their members are healthier, increasingly satisfied, and more likely to be retained. Healthcare providers have a similar motivation. They also seek better outcomes and related benefits, including the positive impact on their reputation, greater patient satisfaction, the opportunity to execute more effective capitation contracts and valued-based contracts, and even financial incentives. This session will explore how payer-provider collaboration can improve outcomes.

Errol Pierre
Senior Vice President, State Programs
Healthfirst 

2:15pm – 3:15pm
Panel: Addressing Mental Health in Medicaid
Behavioral health poses a great challenge to Medicaid managed care. States and the federal government instituted changes this year that officials hope will allow enrollees to get the care they need and providers to be paid fairly and in a timely manner. State strategies to address the behavioral health workforce shortage fall into four key areas: increasing rates, reducing burden, extending workforce, and incentivizing participation.

Because most Medicaid enrollees receive coverage through health insurance plans, those companies will be intricately involved in addressing the crisis. Making sure enrollees have access to mental health specialists challenges not only Medicaid but the entire healthcare system. This session will explore strategies to expand access to mental health.

Panelists:
Ralph Choate
Chief Operating Officer
State of Colorado Health Care Finance and Policy  

Jennifer Joyce, LICSW, MBA
Behavioral Health Coordinator
Health Care Delivery Management Administration
DC Department of Health Care Finance

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

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

3:45pm – 4:30pm
Navigating the World of Medicaid Risk Adjustment Coding
What is Risk Adjustment and how it is applied in the world of Medicaid Managed Care.  The presenter will review the different models and approaches applied by each state. In conjunction with the obstacles presented as the rules and coding approaches differ per state.  The challenges faced retaining coders that want to work the Medicaid Product line in addition to vendors that can configure their platforms to the different models and state requirements.  This session will dive deeper into the scope of capturing the data for our Medicaid population. Some transient, some migrants, and combating ghost providers, the chart chase for these members makes closing gaps in care tough.  We will cover the lessons learned.  Helping the audience discover that by creating an accurate risk score and closing gaps of care, we can better serve our members. 

Abigail Carroll, RHIT, CRC, RAP
Leader, Risk Adjustment Coding
MVP Health Care

4:30pm – 5:15pm
Community Partnerships to Address Enrollee Social Needs
Many Medicaid managed care organizations (MCOs) now screen enrollees and connect them to community-based organizations (CBOs) to address unmet social needs. COVID-19 significantly disrupted healthcare delivery and overall economic activity in the U.S. This session will explore how partnerships between Medicaid MCOs and CBOs to address social determinants of health have been affected by the pandemic, how fostering these partnerships can improve care delivery, and current and future trends.

Jim Milanowski
President/CEO
Genesee Health Plan 

5:15pm
End of Day One

7:15am – 8:00am
Networking Breakfast 

8:00am – 8:15am
Chairperson’s Recap 

8:15am – 9:00am
Dismantling Structural Racism in Medicaid: Moving Towards an Equitable Care Delivery System

TBA

9:00am – 9:45am
Best Practices to Supplier Diversity
A supplier diversity program is a proactive business initiative which encourages the procurement of goods and services from diverse (and in some cases small) suppliers. Those suppliers defined as diverse typically include but are not limited to those owned by women, minorities, veterans, and members of the LGBT community. These programs also include small business initiatives that typically follow the guidelines as defined by the Small Business Administration (SBA). Supplier Diversity is not directly correlated with supply chain diversification, although utilizing these types of vendors may enhance supply chain diversification. Supplier diversity programs recognize that sourcing products and services from previously underutilized suppliers helps to sustain and progressively transform a company’s supply chain, thus quantitatively reflecting the demographics of the community in which it operates by recording transactions with diverse suppliers. This session will explore best practices to supplier diversity in Medicaid managed care.

Ronald B. Baldwin Jr., C.P.M.
Director, Supplier Management & Diversity
Director Supplier Diversity, DE&I
AmeriHealth Caritas

Michael Bowman
Principal
Rittenhouse LTD 

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

10:15am – 11:00am
Current Trends in Medicaid Managed Long-Term Services and Supports
In 2020, an estimated 5.8 million people used paid long-term services and supports (LTSS) delivered in home and community settings and 1.9 million used LTSS delivered in institutional settings. Most people ages 65 and older and many people under age 65 with disabilities have Medicare, but Medicare does not cover most LTSS and instead, Medicaid is the primary payer for LTSS. To qualify for coverage of LTSS under Medicaid, people must meet state-specific eligibility requirements regarding their levels of income, wealth, and functional limitations. An unknown, but probably even larger number of people, use unpaid LTSS that is provided by family, friends or neighbors. LTSS encompass the broad range of paid and unpaid medical and personal care services that assist with activities of daily living (such as eating, bathing, and dressing) and instrumental activities of daily living (such as preparing meals, managing medication, and housekeeping). They are provided to people who need such services because of aging, chronic illness, or disability, and include nursing facility care, adult daycare programs, home health aide services, personal care services, transportation, and supported employment. These services may be provided over a period of several weeks, months, or years, depending on an individual’s health care coverage and level of need. As the population ages and as advances in medicine and technology enable people with serious disabilities to live longer, the number of people in need of LTSS is expected to grow. Looking forward, there will likely be continued interest among policymakers in expanding the availability of LTSS and improving their quality, though identifying the resources to do so will be challenging. State Medicaid programs increasingly use managed care as one of several strategies to improve care coordination and manage costs for populations with complex health care needs and disproportionately high Medicaid expenditures. This session will explore how one state has used managed LTSS and other tools to serve this population as well as opportunities for the future.

Katie Evans
Chief of LTSS
TennCare 

11:00am – 11:45am
Medicaid Unwinding in New Jersey: Strategies and Experiences
Understanding that if you “know Medicaid in one state, you know Medicaid in one state”, this presentation will explore New Jersey’s experience with Medicaid Unwinding and resumption of redetermination operations.  Communications and community outreach strategies employed by Horizon NJ Health will be highlighted as well as the unique way Unwinding intersected with the introduction of Cover All Kids legislation in the State.

Mildred Menos
Director, Product Administration-Medicaid
Horizon Blue Cross Blue Shield of New Jersey 

11:45am – 12:30pm
Advances in Telehealth Treatment of Opioid Use Disorder
Opioid overdose deaths remain at epidemic levels, and individuals covered by Medicaid suffer disproportionately. Buprenorphine is one of the three FDA-approved medications for opioid use disorder, and the only one which can be prescribed electronically, filled at commercial pharmacies, and taken at home. Prior to the COVID-19 Public Health Emergency, it was a requirement that providers see patients in person prior to prescribing buprenorphine, yet that was put on hold during the pandemic. As a result, the telehealth model of opioid use disorder care grew rapidly and now treats tens of thousands of patients across the country. This session will take a deep dive into the telehealth model, including how it is structured, the pros and cons of this modality, how telehealth extends the workforce to address treatment deserts, how patients interact with providers on telehealth, outcomes related to telehealth care and, finally, discuss challenges and opportunities with some predictions for the future.

Scott Weiner
Director of Research
Bicycle Health 

12:30pm
Conference Concludes

Anne Jacobs
Principal and Founder
Riverstone Health Advisors