Speaker Presentation
Tuesday, May 14, 2019

Registration & Continental Breakfast


Chairperson’s Welcome

Dr. Dirk Wales Chief Medical Officer,Cigna-HealthSpring


Panel Discussion: Regulatory & Policy Changes Impacting Population Health Initiatives


Dr. Dirk Wales Chief Medical Officer,Cigna-HealthSpring


Lisa Truitt Director of Healthcare Delivery Management,D.C. Department of Health Care Finance

Tricia Barrett Vice President, Product Design & Support,NCQA

Helene S. Forte, RN, MS, PAHM formerly Vice President, Public Plans Emerging Markets,Tufts Health Plan


Panel Discussion: Value-based Care & Population Health: The Building Blocks for Healthcare Transformation


Catherine Brisland, DO, MBA, FCCPMedical Director,Optima Health


Dr. John JohnsonChief Medical Officer,Virginia Premier

Seth MorrisDirector Network Development,Anthem

Friso van Reesema, M.P.H. M.B.A.VP of Managed Care,CipherHealth


CASE STUDY: How Value-based Care and Setting Bold Health Goals Can Improve Population Health

With 8,760 hours in a year, the average person only spends about three to four of those at the doctor’s office. This means that for the other 8,756 hours, patients need help getting and staying healthy. Humana’s population health and value-based care teams are focused on helping not only our members, but communities of people live better lives as they age. We are working with physicians, nonprofit organizations, government and business leaders to address clinical barriers as well as social and environmental barriers to health both inside and outside of the doctor’s office. This session will explore the vast potential that value-based care and setting bold health goals have on improving population health as well as on the health care industry and ecosystem.

Caraline Coats, Vice President, Bold Goal & Population Health Strategy, Humana

Oraida Roman, Vice President of Value Based Strategies, Humana


Networking Refreshment Break

Sponsored By: Strategic Solutions Network (SSN), based in Boca Raton, FL, is the parent company of the Medicare Risk Adjustment & Revenue Management Management, Plus Quality and Star Ratings and a series of related conferences.


Panel Discussion: Social Determinants of Health – A Holistic Approach

  • Poverty, employment, education, transportation, food & nutrition, etc.
  • Collaborations with Community Organizations
  • Clinical and Financial Outcomes


Caraline Coats, Vice President, Bold Goal & Population Health Strategy, Humana


Dr. John Johnson, Chief Medical Officer, Virginia Premier

Haleta Z. Belai, Director of Social Determinants of Health, Centene

Jacob Reider, MD, FAAFP, Chief Executive Officer, Alliance for Better Health

Clayton Duncan, Vice President of Corporate Development and Strategy, TAVHealth


Going Digital: The Decisions that Drive Adoption

The digital age has long been upon us. In nearly every walk of life, we are growing more comfortable and adept at having both long and short form conversations over digital airwaves. Why then are we still talking about strategies for going digital in the healthcare space? Why isn't it just 'happening' - like it is in every other area of our lives? We'll explore those reasons and some decisions you can make today to accelerate digital adoption in consumer health.

Michael Zagami, Senior Director Product Innovation, HMS Eliza


Utilizing SDOH for Risk Stratification Methodology to Better Identify Medicare Members’ Needs

IEHP has created a comprehensive risk stratification methodology to address high cost expenditure and disparities in health care. IEHP has employed a biopsychosocial model on administrative data which takes into consideration the social determinants of heath, as identified by Healthy People 2020. This original model utilizes John Hopkins ACG system Care Coordination Markers and diagnosis-based markers of Frailty Flag, Resource Utilization Bands, and Hospital Dominant Morbidity Types to address our population’s unique health care needs. The methodology includes predictive markers of Probability High Total Cost and Probability of Persistent High User. Members above the 50% threshold move to the Highest-Risk care coordination. IEHP’s population health risk stratification is moving toward the right direction by predicting Members who will have a higher health care expenditure, while taking into consideration regression to the mean with PPHU.

  • Identify the components of Risk Stratification
  • Explain how behavioral and social attributes amplify risk
  • Describe the advantages of enhanced risk stratification

Maria Pugo, Health Services Evaluator,Inland Empire Health Plan


Networking Lunch


Pairing Social Determinants of Health with Predictive Analytics for a 360-Degree Member View

Many organizations continue to struggle to truly understand their members. This session will focus on key strategies to better understand member behaviors, barriers to care and varying determinants impacting their health outcomes. Dr. Keck will demonstrate how building a 360-degree member view supports critical decision making around outreach, engagement and most effective care planning. Pairing robust member insights with predictive analytics ensures resources are allocated to members and populations who are most likely to engage and ultimately improve health outcomes.

  • Gain an understanding of practical uses of SDoH data combining combined with other data sets for use across population health strategies
  • Learn how building meaningful data layers and profiles delivers clear insight into member behaviors, trends and most effective methods of engagement
  • See how predictive analytics can inform what who to engage, what care should be delivered and how to best deliver care and engage with members in order to achieve improvements in clinical and financial outcomes

Dr. Kevin Keck, Chief Medical Officer,SCIO Health Analytics (an EXL Company)


CASE STUDY: Integrating Physical Health and Behavioral Health, Member Engagement and Community Resources

  • Overview of Commonwealth Care Alliance Integrated Model of Care
  • Interdisciplinary Teams to Support Integration and Effectively Manage Complex Members
  • Enhancing Care Continually by Improving Communication and Collaboration with Community Providers
  • Case Example

Lauren Easton, Senior Director, Behavioral Health,Commonwealth Care Alliance


Using Data to Design, Evaluate, and Scale Interventions Across a Population

This session will explore how a myriad of data sources (medical and pharmacy claims, lab data, health survey data, and health information exchange data) can be used for segmenting the population, scoping possible intervention opportunities based on MLR and Stars impact, and designing, evaluating, piloting, and scaling interventions. Particular emphasis will be given to the role of prototyping and experimentation in intervention design, as well as member engagement strategies through both digital and non-digital channels. The role of data science in contributing to this work will also be described.

Kurt R. Herzer, MD, PhD, MSc, Director of Population Health,Oscar Health Insurance


Panel Discussion: Collecting, Sharing & Utilizing Data to Boost Outcomes


Noreen Hurley Program Manager, Star Quality & Performance, Harvard Pilgrim Health Care


Brittany U. Carter, DHSc, MPH Director of Health & Research, Wellsource

Kurt R. Herzer, MD, PhD, MSc Director of Population Health, Oscar Health Insurance

Paige Mantel, Chief Marketing Officer,mPulse Mobile


Networking Refreshment Break


Harmonizing EMR & Claims Data to Improve Analytics and Patient Care at the Point of Contact

This session will describe the evolution of Horizon BCBSNJ health information exchange.  The session will explain the rationale for creation of the HIE.  Foundational elements of the HIE will be delineated and our expectations for how data harmonization will improve care management, efficiency and clinical outcomes.

Steven R. Peskin, MD, MBA, FACP Executive Medical Director Population Health, Horizon Blue Cross Blue Shield New Jersey


Strategies for Effective Provider Engagement in Value Based Programs

Through case studies from a statewide patient-centered medical home program, this session will provide examples to help improve provider engagement. Concise education materials, clear financial reporting, and shared quality goals will be reviewed as a basis for enhanced collaboration.

Dr. Jeanne James, Chief Medical Officer, Blue Care Tennessee


Reduce Avoidable Admissions by Identifying the Gaps in Care for Seniors

There are many factors that contribute to avoidable admissions, but often the underlying cause is related to social determinants that inhibit the member from adhering to the plan of care. As care shifts to the home, the care team is presented with an opportunity to take advantage of new and varied sources of data that exist outside the doctor’s office, pharmacy, and hospital, and can help address these care gaps. Discuss the types of services and people that can be utilized to fill the gaps and address the social determinants that are keeping people from staying or getting healthy.

  • Determine the most common “gaps” that lead to admissions for Medicaid beneficiaries
  • Consider how data algorithms can be useful to address populations at highest risk for avoidable admissions
  • Discuss how new sources of data and information can impact the case management model how and case managers can expect to coordinate care for Medicaid beneficiaries

Bryan Fuhr, VP of Connected Health, GreatCall, Inc.


Networking Reception

Wednesday, May 15, 2019

Networking Continental Breakfast


Chairpersons’ Remarks

Dr. Dirk Wales Chief Medical Officer,Cigna-HealthSpring


Member Engagement, Satisfaction, Compliance – Building TRUST

This presentation will describe a framework for understanding and promoting engagement that begins with a foundational step of earning trust and follows through members becoming advocates of health plan services.

  • Operational definitions of engagement in the context of multiple use cases for MA, MC, and Dual members
  • The role of behavioral science in developing population-level engagement strategies
  • Considerations for testing engagement strategies in rapid-cycle fashion
  • Ways of measuring the success of engagement strategies
  • Integrating engagement optimization into quality initiatives Digital contacts
  • Personal contacts

Ellen Beckjord, PhD, MPH, Associate Vice President, Population Health and Clinical Affairs, UPMC


Impact of Incentives on Changing Member Behavior

How do we most effectively engage our members and improve our Star scores? One tool that CMS now embraces is incenting members for specific activities – is this a good idea? How do you avoid not just paying out for members who will be compliant regardless of a program like this? What should you reward and for how much? Which channel is most effective to reach the members you need to influence? This presentation will share one plans experience and lessons learned in the first year of an incentive program.

Noreen Hurley,Program Manager, Star Quality & Performance, Harvard Pilgrim Health Care

Saeed Aminzadeh,CEO, Decision Point Healthcare Solutions


Tapping the Greatest Untapped Resource in Healthcare:  Patient Engagement through Health Coaching Services

The promise of Population Health relies on a largely untapped resource: Patient engagement in their own health and well-being.   In industry, we often seek to do things to patients and members rather than inspiring them to do for themselves.  The rapid expansion of evidence-based health coaching programs marks a change to that approach.  While the coaching field is still nascent, early best practices have begun to emerge.  In addition to facilitating positive health changes in members, health coaching services are also a way to demonstrate value to, and deepen loyalty with, members.  This presentation will address the following topics:

  • Overview of evidence-based lifestyle interventions – What works and what doesn’t
  • The building blocks of launching a health coaching program
  • Show me the ROI on health coaching
  • Anticipating the future of health coaching
  • Catherine Serio, Ph.D., AVP, Digital Behavior Solutions, UPMC


    Networking Refreshment Break


    Community Partnership Strategies for Population Health Improvement with Vulnerable Populations

    It’s widely known that Dual Eligible members are distinctly different from other populations and face more challenges in managing their health. A one-size-fits-all approach should give way customized services and community partnerships that are uniquely tailored to the needs and characteristics of these populations. Our ultimate goal is to improve health equity for our dual, special needs members. As a health plan, we can best accomplish by working together with non-traditional providers, communities and stakeholders that more intimately understand our members’ different life circumstances, upbringing, culture and past experience with healthcare.

    • Develop a method for population segmentation and barrier identification for key sub-sets of your population.
    • Use quantitative & qualitative data to inform customized, targeted interventions and outreach strategies.  
    • Engage with and develop partnerships with non-traditional providers and community organizations uniquely capable of linking members to services and resources that improve population health.

    Jessica Assefa, Medicare Stars Program Manager, UCare


    Behavioral And Medical: Integration of Case Management Across the Continuum

    Case Management has a strong history of success in coordinating care for complex individuals. However, in the future, the case manager will become either a leader or participant in a variety of community care settings - beyond traditional case management. The challenges will require a culture change for the case manager and organizations caring for these complex individuals. This presentation will address lessons learned from the experience of integrating medical, behavioral, long term services and supports, patient centered medical homes and primary care settings.

    • Describe three steps to initiate culture change;
    • Understand how integration will improve patient experience while achieving quality outcomes;
    • Describe the role of the case manager in the community care model.

    Dr. Jeanne James, Chief Medical Officer, Blue Care Tennessee


    Engaging a Medicare Population in Managing End of Life Decisions

    There is a growing awareness that end of life decisions are critical within a Medicare population.  The value of preparing, discussing options and then coordinating those decisions can be very valuable to the member, the physician, the family and the health plan.  Having a formal program with dedicated personnel can provide a key mechanism within a health plan to provide this service and enable the member to better manage their health all the way through their life.  There are a few key elements within this type of program that always need to be considered and this presentation will provide those key elements for consideration

    • How to evaluate the population for a palliative care program
    • Implementation considerations
    • Outcome measures

    Dr. Dirk Wales, Chief Medical Officer, Cigna-HealthSpring

    John W. Halsey, Vice President, Business Development,Turn-Key Health


    Close of Conference