2023 Medicaid Managed Care Summit

March 30-31, 2023 * Embassy Suites Downtown * Nashville, TN

2023 Medicaid Managed Care Summit

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About the Conference:

Medicaid is the single largest source of health coverage in the U.S. Now more than ever before, states are relying heavily on managed care organizations to serve their Medicaid beneficiaries to improve the quality of care delivered and control costs. Managed care plays a key role in the delivery of health care to Medicaid enrollees.

 

Bringing together Medicaid leaders from states and health plans, as well as government leaders and policymakers, this summit will address the most pressing issues facing state Medicaid managed care. You will learn about national trends and innovative programs to best serve the growing Medicaid population, current federal and state policies and regulations, ensuring equitable access to care, expanding access to behavioral and mental health; improving outcomes and lowering costs; standards for provider network adequacy and more.

Who Should Attend?
From State & Government Agencies:

Directors and Managers of:

  • State Medicaid
  • Managed Care
  • Health Services/Healthcare Programs
  • Human/Social Services
  • Medical Assistance
  • Strategic Planning
  • Policy Analysis
  • Compliance
  • Quality Assurance
  • Quality Improvement
  • Healthcare Financing

From Health Plans & Managed Care Organizations:

Chief Executive Officers, Chief Operating Officers, Chief Financial Officers, Chief Medical Officers, Chief Strategy Officers, and Chief Information Officers

Also, Presidents, Vice Presidents, Directors and Managers of:

  • Medicaid
  • Long-Term Care
  • Behavioral Health
  • Sales and Marketing
  • Network Development
  • Compliance
  • Clinical Affairs
  • Finance
  • Operations
  • Quality
  • Risk Management
  • Public Policy
  • Utilization Review
  • Medicare
  • Managed Care
  • Clinical Services

This Program is Also Relevant to:

Organizations Providing Services for:

Care Management Technology * Care Management for the Elderly * Pharmacy Benefit Administrators * Health Management Solutions * Behavioral Health Services * Revenue Enhancement Services * Reinsurance Services

 

Conference Agenda

Day One - Thursday, March 30, 2023

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

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

8:15am – 9:00am
The Future of Oversight
The Office of Inspector General (OIG) recently issued a report that speaks volumes about the oversight of Medicaid managed care organizations.  As the OIG puts it, CMS has “opportunities” to “strengthen states’ oversight.”  An alternative framing would be that CMS and many states have not met minimum standards of stewardship for Medicaid funds and the beneficiaries in Medicaid managed care. This session will explore the future of oversight of Medicaid managed care and how to best ensure access to quality in Medicaid and CHIP managed care programs.

Elizabeth Matney
Director
Iowa Medicaid
Iowa Department of Health and Human Services 

9:00am – 9:45am
Sponsored Session 

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

10:15am – 11:00am
Expanding Access to Behavioral and Mental Health
Behavioral health conditions—including mental illnesses and substance use disorder (SUD)—are especially common among Medicaid enrollees. States are taking advantage of new federal policy options to address behavioral health issues in Medicaid and are also developing other initiatives to improve mental health and substance use outcomes. This session will provide insights on integrating behavioral health services within a comprehensive managed care arrangement and will help you understand how to develop integrated care approaches that leverage existing capacity and account for variations in managed care.

Cristen Bates, MPH 
Office Director, Office of Medicaid & CHP Behavioral Health Initiatives & Coverage (BHIC)
Deputy Medicaid Director
Colorado Department of Health Care Policy & Financing 

11:00am – 11:45am
Medicaid, Health Equity and Social Determinants of Health
The COVID-19 pandemic has highlighted and exacerbated longstanding racial and ethnic disparities in healthcare. Prior to the pandemic, people of color fared worse than white people across many measures, reflecting inequities within the healthcare system as well as across social determinants of health. Medicaid programs can help to address health disparities. This session will examine the role Medicaid can play in advancing health equity, including:

  • How does health coverage vary by race and ethnicity?
  • How can Medicaid help to reduce racial health disparities?
  • What are key issues to watch looking ahead?

Nicholas DeGregorio, MD, MMM, FACP
AVP Medicaid Services
UPMC Health Plan 

11:45am – 12:30pm
State Delivery System and Payment Strategies Aimed at Improving Outcomes and Lowering Costs in Medicaid
State Medicaid programs are using managed care and an array of other service delivery and payment system reforms, financial incentives, and managed care contracting requirements to help achieve better outcomes and lower costs. Common delivery and payment reform models used by state Medicaid programs include patient-centered medical homes (PCMHs), ACA Health Homes, accountable care organizations (ACOs), and episodes of care. However, there is variation in which models are most widely used, how states combine and implement these models, and how long states have been engaged in efforts to transform payment and delivery systems. Some models may be implemented in Medicaid fee-for-service (FFS) delivery systems while other payment and delivery system reform models are implemented through managed care. This session will explore:

  • What delivery system and payment reform initiatives are in place across states?
  • How are states using financial incentives and non-financial incentives as part of efforts to improve quality and outcomes?
  • How are states leveraging managed care plan contracts to advance delivery system and payment reform initiatives?

Errol Pierre
Senior Vice President, State Programs
Healthfirst 

12:30pm – 1:30pm
Lunch Break

1:30pm – 2:15pm
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 and will be continued to be included as part of our benefits package.  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 

2:15pm – 3:15pm
Panel: Medicaid Managed Care Industry Trends
Medicaid continues to be the dominant health insurance program in the U.S. as measured by enrollment and remains the largest source of funding for health-related services for people with low income. This session will provide an overview of Medicaid managed care trends, including the modernization of Medicaid, business model transformation, healthcare reform, healthcare ecosystems, Medicaid expansion, and consumerism.

Panelists:

Pamela Tropiano, RN, BSN, MPA, CCM
VP, Healthcare Services
Molina Healthcare of Ohio 

Additional panelists TBD

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

3:45pm – 4:30pm
Addressing Health Equity in Medicaid Managed Care
Advocates have long pushed states and CMS to improve Medicaid data collection and reporting on health disparities with little to show for it. It is now long past time for the agency, Congress and other health policymakers to fulfill that principle with real and urgent action. This session will provide tools to understand the various Medicaid managed care requirements for collecting and reporting data on health equity. Many barriers, including both a lack of funding and political will, continue to obstruct such reporting. We will also explore the potential of CMS’s new data reporting system, T-MSIS, for improving the quality, frequency and transparency of health disparities data in Medicaid.

Pamela Tropiano, RN, BSN, MPA, CCM
VP, Healthcare Services
Molina Healthcare of Ohio 

4:30pm – 5:15pm
The Role of Medicaid Managed Care Plans in Addressing the Opioid Crisis
Medicaid managed care plans are poised to play a significant role in helping states address the opioid crisis by incentivizing utilization of effective therapies and developing policies that help stem the flow of prescription opioid drugs. Health plans are also developing models aimed at coordinating and improving treatment of opioid use disorder. This session will examine opioid initiatives and a roadmap for future treatment and prevention strategies.

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

5:15pm
End of Day One

Day Two – Friday, March 31, 2023

7:15am – 8:00am
Networking Breakfast

8:00am – 8:15am
Chairperson’s Recap 

8:15am – 9:00am
Standards for Provider Network Adequacy
CMS issued final rules for provider network adequacy in Qualified Health Plans (QHPs) offering coverage in the Marketplaces that the federal government operates through HealthCare.gov. Under these rules, which come with the title, “Notice of Benefit and Payment Parameters” (NBPP), CMS will require QHP provider networks to meet minimum time-and-distance standards beginning in 2023 and minimum standards for appointment wait times beginning in 2024. Strong network adequacy standards are necessary to achieve greater equity in healthcare and enhance consumer access to quality, affordable care through the Marketplaces. The same applies to the other coverage programs that CMS administers—Medicare, Medicaid and CHIP. In each of these programs, managed care plans are paid to organize provider networks to deliver covered services to beneficiaries. If the networks are not adequate, beneficiaries will have difficulty accessing the services they need. The starting point for access is the setting and enforcement of network adequacy standards. This session will examine all this and more related to standards for provider network adequacy.

Michael Hales
Senior Director Government Healthcare Programs
University of Utah Health 

9:00am – 9:45am
Fee-for-Service vs. Managed Care
States are continually challenged by the high and growing cost of caring for people in need of long-term services and supports (LTSS). As a result, we’re seeing an increasing number of states providing LTSS through capitated Medicaid managed care programs called managed long-term services and supports (MLTSS). States look to MLTSS programs in an effort to rebalance their Medicaid expenditures away from institutional care and toward home- and community-based services. This provides a streamlined way for beneficiaries to access all of the services necessary to live their best lives in the location of their choosing. This session will break down the difference between providing LTSS through a managed care model versus a fee-for-service model.

Carol Cianfrone
Senior Director of Medicaid Care Management Programs
Horizon NJ Health 

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

10:15am – 11:00am
Quality and Accountability in Medicaid Managed Care
Over the past two decades, state Medicaid programs have been on a steady march away from fee-for-service toward payment and delivery systems designed to bring greater budget predictability, quality and accountability. For most states, this has meant increasing reliance on Medicaid managed care. Today, managed care is the primary delivery system for Medicaid nationally. With this growth has come similar growth in expectations. States are covering a broader array of services for more high-need enrollees, bringing more rigor to their contracting, oversight, and payment processes, and holding managed care plans accountable for achieving targeted goals. This session will explore tips on leveraging managed care accountability tools, locating state quality data, and improving state reporting on health disparities.

Gwendolyn B. Zander, Esq. 
Director, Bureau of Managed Care Operations
Office of Medical Assistance Programs
Pennsylvania Department of Human Services 

11:00am – 11:45am

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

11:45am – 12:30pm

Meghan Hyland, CAPSW
Enrollment and Eligibility Director
Lakeland Care 

12:30pm
Conference Concludes

Workshop - Friday, March 31, 2023

12:45pm – 2:45pm

Workshop: Medicaid PHE Unwinding
This continuous enrollment provision is set to end on March 31, 2023, and the enhanced federal Medicaid matching funds will phase down through December 2023. For the COVID-19 pandemic, Congress enacted a requirement for Medicaid programs to keep people continuously enrolled through the end of the COVID-19 public PHE in exchange for enhanced federal funding. During this time Medicaid enrollment has grown significantly and the uninsured rate has dropped; however, when the continuous enrollment provision ends, millions of people could lose coverage and there could be a reverse in coverage gains. The Kaiser Family Foundation (KFF) estimates 5 to 14 million people will lose Medicaid coverage when the continuous enrollment provision ends. Communication and outreach will be key to help assure folks don’t lose coverage. MCOs should seek to collaborate with states and other stakeholders to conduct outreach to enrollees for completion of their renewal during the PHE unwinding. There will also be an opportunity for MCOs that have Medicaid and Exchange plans to help individuals that are no longer eligible to Medicaid to transition to an Exchange plan. This could be a great option for individuals if the MCO has the same network across plans because it would allow transitioning individuals to maintain their same providers in the new plan.

Jason Silva, JD
Associate Principal 
Health Management Associates 

Venue
Embassy Suites Downtown
708 Demonbreun Street
Nashville, TN 37203
202-800-0844

BRAND NEW PROPERTY IN DOWNTOWN NASHVILLE!
Mention BRI Network to get the discounted rate of $269/night

Sponsors and Exhibitors

 Refreshment Break Sponsor

 MedImpact currently provides Medicaid Pharmacy Benefit Management (PBM) services to 14 Medicaid programs serving more than 3 million lives across 11 states. We are striving to bring a new and creative way to manage your members and improve their experience. As Medicaid programs continue to evaluate their business models, our modular open-architecture solutions are MITA aligned and certification ready. MedImpact helps states deploy their next generation of public sector solutions.

 

Exhibitor

Kaizen Health is removing transportation as a barrier to living a healthy and happy life by increasing access to everything that people need to be healthy, including: clinical care, grocery stores, pharmacies and social care. Kaizen Health builds diverse transportation/delivery/courier networks and powers them through their intelligent platform. This allows for there to be one place to go to arrange all transportation to serve diverse populations (curb-to curb, door-to-door, door-through-door, bed-to-bed and delivery/courier serves). Kaizen Health’s platform manages all eligibility & business rule requirements of any of their clients and can internally process and adjudicate Medicaid/Medicare Advantage claims. Kaizen Health serves a diverse client such as: Medicaid/ Medicare Advantage/commercial health plans, healthcare systems, clinician/staff transportation, clinical trials, senior living, in-home healthcare, non-profits, K-12 schools and municipalities. 

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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