Registration & Continental Breakfast
|VALUE-BASED CARE & POPULATION HEALTH MANAGEMENT – BALANCING REGULATIONS & QUALITY|
Panel Discussion: Regulatory & Policy Changes Impacting Population Health Initiatives
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
Alexander Shekhdar Vice President of Policy,Medicaid Health Plans of America
Panel Discussion: Value-based Care & Population Health: The Building Blocks for Healthcare Transformation
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
|INTEGRATING & IMPLEMENTING SOCIAL DETERMINANTS OF HEALTH PROGRAMS & STRATEGIES|
Panel Discussion: Social Determinants of Health – A Holistic Approach
Dr. John Johnson, Chief Medical Officer, Virginia Premier
Haleta Z. Belai, Director of Social Determinants of Health, Centene
April Canetto, Manager, Cultural and Linguistic Services, Health Net
Jacob Reider, MD, FAAFP, Chief Executive Officer, Alliance for Better Health
Using Value-based Benefits to Impact Social Determinants in Medicaid
The conversation will start with a review of key population health statistics on spend and trend nationally, as well as learning more about the Virginia State of the Region Report – a publication that provides regional communities in Virginia with an overview on economic trends on each major industry sector. As one can imagine, healthcare is a major sector with national impacts but requires local assessment with a diverse set of providers and solutions.
Kelly Brown, Senior Director for Medicaid Product Development and Programs, Anthem Government Business Division
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.
Maria Pugo, Health Services Evaluator,Inland Empire Health Plan
CASE STUDY: Integrating Physical Health and Behavioral Health, Member Engagement and Community Resources
Lauren Easton, Senior Director, Behavioral Health,Commonwealth Care Alliance
|POPULATION HEALTH INFORMATICS & DATA ANALYTICS –
COLLECTING, SHARING & UTILIZING DATA FROM MULTIPLE SOURCES
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
Brittany U. Carter, DHSc, MPH Director of Health & Research, Wellsource
Kurt R. Herzer, MD, PhD, MSc Director of Population Health, Oscar Health Insurance
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
|BOOSTING PROVIDER & MEMBER ENGAGEMENT|
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.
Bryan Fuhr, VP of Connected Health, GreatCall, Inc.
Networking Continental Breakfast
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.
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
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:
Catherine Serio, Ph.D., Senior Director, Lifestyle Interventions, Insurance Services Division, UPMC
Networking Refreshment Break
|COMMUNITY COLLABORATIONS TO EXPAND ACCESS TO CARE|
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.
Jessica Assefa, Medicare Stars Program Manager, UCare
|CARE COORDINATION & QUALITY INITIATIVES TO BOOST OUTCOMES|
Integration of Case Management Across the Continuum: A Marriage or Just Living Together?
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.
Frances Martini, BSN, MBA, Vice President Population Health, BlueCare 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
Dr. Dirk Wales, Chief Medical Officer, Cigna-HealthSpring
Close of Conference