Business Research Intelligence Network Presents:

Star Ratings and Quality Improvement Summit

Achieve and Sustain High Star Ratings, Enhanced Quality,
Performance and Engagement Strategies
May 4-5, 2023

Star Ratings and Quality Improvement Summit

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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. 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/ Managed Care Organizations:

  • Chief Executive Officers
  • Chief Operating Officers
  • Chief Financial Officers
  • Chief Marketing Officers
  • Chief Medical Officers
  • Chief Strategy Officers
  • Chief Pharmacy Officers
  • Chief Information Officers

Also Presidents, Vice Presidents, Directors and Managers of:

  • Star Ratings
  • Medicare
  • Senior Products
  • Quality Improvement
  • Marketing
  • Compliance
  • Care Management
  • Operations
  • Strategy
  • Business Development
  • Regulatory Affairs
  • Risk Management
  • Utilization Management
  • Business Development
  • Medicare Stars
  • Medicare Advantage
  • Government Programs
  • Data & Analytics
  • Sales
  • Medical
  • Product Development
  • Finance
  • Quality
  • Pharmacy
  • Disease Management
  • Community Health
  • Network Management
  • Pharmacy

Also of interest to Pharmacy Benefit Managers; Solution Providers; Healthcare Consultants; Vendors

 

Conference Agenda

Day One - Thursday, May 4, 2023

7:15am – 8:00am

Conference Registration & Networking Breakfast

 

8:00am – 8:15am

Chairperson’s Opening Remarks

 

8:15am – 9:00am

How Prioritizing Health Equity Can Improve Star Ratings for Health Plans

With a commitment to advancing health equity and addressing inequities within their policies and programs, in 2022 CMS has announced several proposed changes to the Star Rating program focused on health equity. This announcement's significant theme and focus is around how the healthcare industry can realign incentives and commitments to better support health equity goals. Potential changes would be implemented as new measures and calculations, and methodology changes. When devising Star strategies, health plans should not focus on one specific new potential measure but consider health equity broadly. This session will explore how to help members overcome barriers to equal healthcare opportunity by meeting them where they are, and how health plans can improve patient experiences, health equity, and Star Ratings.

 

9:00am – 9:45am
How to Optimize Medicare Advantage Star Ratings: Setting Up Your Plan for Success in 2023 and Beyond

For Medicare Advantage plans, the stakes are high. Good Star Ratings yield significant benefits for a plan in the form of improved enrollment and bonus payments, while low ratings can be a competitive disadvantage, yield financial penalties, and even lead to termination. This session will explore strategies that will enable health plans to track, predict and model their Star Ratings, as well as better understand and priorities the actions needed to offer better care to a growing Medicare Advantage population and to optimize bonus payments.

 

9:45am – 10:15am

Networking & Refreshments Break

 

10:15am – 11:00am

How to Optimize Star Ratings in the Medicare Advantage Market

As health plans flood the Medicare Advantage market, it is increasingly challenging for payers to compete.

In this competitive environment, the CMS Five-Star Quality Rating System is now more important than ever when it comes to proving value. Used as a benchmark for prospective members, these ratings are key in plan comparison and, ultimately, decision, with higher scores driving recruitment and revenue. Incremental shifts in ratings have both benefits and consequences. This session will explore strategies for payers to elevate Star Ratings in the Medicare Advantage market.

 

11:00am – 11:45am

Creating a Culture of Quality from the Top Down

To successfully improve and maintain high Star Ratings, health plans must employ an ongoing commitment to creating a culture of quality from the top down. Leadership must make Star Ratings a focal point of their organization. This session will examine how to empower a multi-departmental team responsible for developing and implementing a comprehensive Star Ratings strategy that includes objectives, goals, resource management, frequent evaluation and management updates.

 

11:45am – 12:30pm

Incentive Programs: Best Practices to Improve Member Health

Implementing a compliant incentive program that impacts Star Ratings is no easy task. For health plans to differentiate themselves, incentive plans need to take their cues from consumer loyalty programs—healthcare is more about the individual than ever before—and missing the mark on a consumer engagement strategy can result in a budget deficit, or even fines. This session will examine best practices for successful incentive rewards programs that impact Star Ratings. Topics to be discussed will include how to implement an incentive program and incentivizing with savings and experiences.

 

12:30pm – 1:30pm

Luncheon

 

1:30pm – 2:15pm

Survival of the Fittest

Health plans need to secure high Star Ratings to survive in the world of Medicare Advantage. The growing success of Medicare Advantage stems from the ability of consumers to choose the best plan for their needs in an open marketplace. Beneficiaries place very high value on the ability to shop around for services—and with an average of almost 40 plans to choose from, members are often quick to rebuff plans falling short of expectations. The Medicare Advantage Star Ratings system is intended to provide a data point as a reference for consumers when choosing a health plan for their healthcare insurance needs. The ratings condense dozens of complex quality, member experience and other plan performance factors into a simple give-star graphic members can use to inform their choice. In addition, Star Ratings affect plans’ rebate percentages. This session will explore plans need to know about the Star Ratings and how can they outperform their peers to thrive in this challenging environment.

 

2:15pm – 3:15pm

Panel: Strategies for Star Ratings Success

Improving Star Ratings can be difficult as each year CMS develops cut-points based on the performance of all plans for each measure over the previous year. Maintaining performance year after year is not enough to sustain a high Star Rating. As all health plans improve their quality, the distribution of scores shifts toward a more high-performing end. Therefore, it becomes increasingly harder for a plan to move from four to five stars because the threshold is also rising. This session will explore how an organization-wide commitment that is focused on patient experience, preventive health, care coordination, and customer service can lead to Star Rating success.

 

3:15pm – 3:45pm

Networking & Refreshments Break

 

3:45pm – 4:30pm

How to Address Social Determinants of Health and Medication Adherence to Improve Star Ratings Outcomes for Dual Special Needs Plans

CMS estimates that across the U.S., there are more than 12 million consumers dually eligible for Medicare and Medicaid. Of that population, 37 percent are reportedly enrolled in Medicare Advantage Dual Special Needs Plans. These dually-eligible consumers often have high rates of chronic illness, behavioral health conditions and long-term care needs. Patients with chronic conditions are also more likely to experience social determinants of health (SDOH) challenges compared to non-dually eligible Medicare Advantage enrollees. Some of the most common SDOH needs of dually eligible consumers include lack of access to transportation, food insecurity and social isolation or loneliness. Unmet SDOH factors can make it difficult to access and follow care recommendations and medication regimens, resulting in poor medication adherence, avoidable hospitalizations and emergency department visits. In turn, these vulnerable patients with chronic conditions often have higher utilization rates, poorer health, higher healthcare spending and lower-quality measure scores. For Dual-Eligible Special Needs Plans, these factors negatively affect Medicare Advantage Star Ratings, which determine plan eligibility for value-based bonuses from CMS. This session will explore how to address SDOH and medication adherence to improve Star Ratings Outcomes for Dual Special Needs Plans.

 

4:30pm – 5:15pm

Improving the Status Quo

More than 24 million Americans are currently enrolled in a Medicare Advantage (MA) plan, doubling over the past decade, and this number is expected to rise significantly by 2030. The MA program consists of private healthcare plans that are approved and regulated by the federal government. Since 2007, CMS has evaluated MA plans using the Star Ratings program, a 1–5 star scoring system based on each plan’s performance across a number of measures over a prior 18-month period. The major goals of the MA star rating program are to incentivize insurers to improve their performance and to help patients compare and choose high-quality plans. This requires the collection and curation of meaningful data. Given its increasing importance, the star rating scoring program must be reassessed to ensure that it captures the impact of plan performance on the health of beneficiaries while enabling meaningful differentiation amongst competing plans. This session will assess the Star Ratings program and ways to improve measures.

 

5:15pm

End of Day One

Day Two – Friday, May 5, 2023

7:15am – 8:00am

Networking Breakfast

 

8:00am – 8:15am

Chairperson’s Remarks

 

8:15am – 9:00am

How Member Engagement Can Improve Star Ratings

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 insurers are beginning to provide proactive, knowledgeable and skillful member engagement tactics throughout the year to improve member satisfaction and retention, and ultimately, improve STAR ratings. This session will explore best practices to ensure member satisfaction and retention all in a strategic effort to improve STAR rating.

 

9:00am – 9:45am

Regulatory Update

This session will help prepare you for the future of Star Ratings. Topics to be discussed will include:

  • Where to find the most credible and accurate sources of information to stay updated on new and proposed technical changes
  • Key updates to Star Ratings
  • Changes and what they mean for plans moving forward
  • New measure retirements and additions, including how to make accurate data calculations throughout the year and determine which members should be prioritized to make the greatest impact on your quality goals
  • Review of significant changes introduced by CMS to rewards and incentives programs for MA plans, and how to ensure your program maintains compliance when they take effect

 

9:45am – 10:15am

Networking & Refreshments Break

 

10:15am – 11:00am

Telehealth Impact to Star Ratings and Risk Adjustment for Medicare Advantage

Providers have continued to rely on telehealth to deliver care to many of their patients. To make delivering care via telehealth easier, CMS has relaxed requirements related to the use of telehealth for Medicare Advantage populations. This session will provide insight on the impact of telehealth visits for Star Ratings and risk adjustment. Learn how telehealth can help health plans improve Star Ratings by actively engaging members and delivering better, more frequent care.

 

11:00am – 11:45am

How Medicare Advantage Plans Can Boost Star Ratings with Proactive, Data-Driven Care

In order for Medicare Advantage plans to achieve the highest possible Star Ratings, it is important that they leverage clinical data and high-quality healthcare providers to offer proactive care in an efficient, convenient, and consumer-friendly way. This session will examine the following topics:

  • Using data to identify opportunities to improve care delivery
  • Curating a high-quality provider network built for success
  • Proactively engaging beneficiaries in their care

 

11:45am – 12:30pm

Improving the Effectiveness of Stars Interventions Through Predictive Modeling

This session will examine how to leverage predictive analytics to target the members most likely to engage within a given intervention. The model seeks to address the challenge inherent in many Star Ratings interventions, which is to provide the right messaging to the right member through the right channel to drive the right outcome. Examine the basic concepts of predictive modeling, including where it is commonly used and the potential applications—and limitations—of predictive models for Star Ratings and other quality measures. Topics to be discussed will include:

  • Approaches to using predictive techniques to identify potential health risks that can be proactively targeted for interventions
  • Fundamentals of how predictive modeling can drive quality improvement
  • Types and components of predictive models that can be used for quality measures and Star Ratings

 

12:30pm

Conference Concludes

 

 

Workshop - Friday, May 5, 2023

12:45pm – 2:45pm

Workshop

How to Adequately Identify and Improve Quality Measures to Improve Star Ratings

Financial incentives and increased enrollment are some of the benefits associated with a health plan having strong Medicare Advantage (MA) Star Ratings, but knowing where to start and how close they may be to reaching the next Star can be tricky. With CMS making regular adjustments to MA Star Ratings, it is common to see measures increase or decrease in weight and be added and retired over time. However, while these changes have come to be expected, plans are still challenged with keeping up with these changes and building a strong quality team that can accurately measure compliance. In addition, plans need to consider finding efficient methods of closing quality gaps on non-standard supplemental data, unstructured data that are buried in medical notes that are most often overlooked when data is abstracted manually. This session will explore how to adequately identify and improve quality measures to improve Star Ratings.

Venue

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

*Mention BRI Network to get discounted rate of $279/night

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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