Agenda

Co-chairpersons’ Opening Remarks

Panel Discussion: Population Health Policy Initiatives – A Growing Focus in Medicare, Medicaid & Duals SNPs

Panelists:

Panel Discussion: Defining Population Health, SDoH and Health Equity – How Do You Think About Population Health Across Silos?

Moderator:

Panelists:

Leveraging Special Supplemental Benefit Authority for Members with Multiple Chronic Conditions

Re-examine the transformational parameters of an MA plan's authority to address the complete spectrum of needs for a member with multiple chronic conditions and functional impairments. Explore how MA plans can use the SSBCI authority to be innovative in confronting key non- health related influencers impacting health status.  Examine how some MA plans are using this authority to preemptively address the complex health needs of members rather than reacting to an acute episode.

Adapting and Integrating Existing Operations With CMS New Flexibility Rules

As healthcare systems navigate the new CMS flexibility rules, many are trying to determine how to integrate new and/or existing programs into benefit design successfully. Identifying which areas to address, aligning eligibility, as well as determining operational impact and management of the benefit, are some of the challenges when programs are already implemented. It is critical to institute these benefits with a tie back to analysis which allows for decision making moving forward. Hear more about our existing programs addressing these needs, and the challenges with aligning them to benefit design when there are other sources of funding contributing or eligibility requirements. Navigating through the requirements, identifying operational impact, determining eligibility and measuring for success will be discussed.

Panel Discussion: SDoH – Institute Accurate Financial Measures to Optimize Resource Allocation

With SDoH programs continuing to be implemented in several sectors in the industry, there is a need to ensure that measurement and analysis continues to occur to help successfully measure financial impact and determine resource needs. Measuring impact can be challenging as clinical and SDoH programs are commonly targeted on the same complex/high risk/high need patients. With several programs targeting towards improving health and cost of care, it becomes challenging to pinpoint which programs are moving the needle. Additional constraints with measurement include data sharing between organizations. Learn about the metrics being used today to measure impact clinically and financially on SDoH programming.

Panelists:

Close of Module #1

Opening Remarks

PROVIDER PANEL: Provider Strategies to Integrate SDoH Work Into the Clinical Initiatives Team

Given the increasing awareness of non-medical barriers affecting health and well-being, healthcare organizations are developing and deploying interventions to mitigate the Social Drivers of Health (SDoH). Critical to these interventions are strategies to integrate this work back into the medical mainstream in a coordinated fashion to deliver whole-person care. Join us at this panel to learn how 3 physician-leaders from across the country are leading the way in integrating SDoH strategies into traditional medical care. You will learn how their organizations are addressing this issue and what you can do to ensure the work being done in the SDOH space at your organization integrates with your physicians and extended medical team.

Moderator:

Panelists:

Transformation to Proactive Population Health

• Harnessing machine learning and AI technologies to identify the right members for management
• The importance of identifying and addressing social determinants of health
• Common challenges to proactive transformation
• Learnings and outcome measurement

Community Level Collaborations to Impact SDoH: Redefining the Health Plan’s Role in Moving “Upstream” to Improve Social and Economic Conditions

Should we focus on downstream interventions, addressing the immediate needs of individuals, or on upstream initiatives that work on eliminating factors that continue poor health in our communities? Some SDoH can most effectively be addressed moving upstream. Suggestions on how to use clinical and public data to address conditions in the community and how to engage with government and business to make change.

Impact of Member Perception on Outcomes of Population Health Programs

Designing Products for Behavior Change

When we build products, we often have very specific behavioral goals in mind, things we want users not just to think and feel but actually do. And yet our design process so rarely takes what we know about changing behaviors into account. Join behavioral scientist Matt Wallaert as he talks about Competing Pressures Design, a psychology-based method for thinking about product and service design, using science, startups, and plenty of practical examples to help you put theory into practice.

Collaborative Care Model: Integrating Behavioral Health into Primary Care

The degree of integration of behavioral care into the primary care setting may vary from selective screening, diagnosis, brief treatment, and referral to a fully integrated care approaches in which all aspects of primary care consider and incorporate both the physical and behavioral perspectives. Since launching our PCMH and ACO models in 2011, Horizon-BCBSNJ has appreciated the value of greater emphasis on Behavioral Health in the primary care setting. To that end, we developed and deployed tools to support BH in primary care. We have evolved our payment models. More recently, clinical decision support and virtual collaborative care models have been introduced.

Close of Module #2

Opening Remarks

Redesigning Case Management to Focus on Value Relationships – the Evolving Role of the Health Plan

• Analyze the population for the needs and barriers to care including those related to SDOH
• Engage and assess the provider population related to ancillary services
• Analyze the total medical cost around the medical and behavioral costs and drivers
• Identify and ensure appropriate services are available or created
• Provider driven-costs and incentives
• Vendor driven-costs and incentives
• Create DOR

Panel Discussion: Innovating Services for Dual Eligibles -- If You Can Make It There, You Can Make It Anywhere

Medicare-Medicaid Dual Eligibles are commonly considered hard to serve because they are, as a group, more prone to multiple chronic diseases and social determinants of health barriers. But leading D-SNPs are engines for innovation in serving this hard-to- serve population. In this session, hear from some of the leading innovators in the field about new ways to serve Duals with tactics that are working with hard-to-serve Duals. Engage in provocative conversation about the transferability of these innovations to your members.

Moderator:

Panelists:

Taking a Value-Added Approach to Opioid Addiction -- Combatting Substance Abuse Disorders (SUD)

• Review of medications used in treatment and their effectiveness
• Analyze factors that affect access, including providers expertise with treatment, stigma, and cost
• Learn how to use data to identify high risk patients and how to intervene 
• Examine how to use a community strategy to develop strategies for interventions 
• Strategies to increase training of primary care physicians to increase outcomes of their patients

VBID Case Study: 4 Innovative Rewards and Incentives Programs

Medicare has approved Optima to offer this Rewards and Incentives Program as part of the Value-Based Insurance Design (VBID) model.  Optima is offering 4 unique Rewards and Incentives opportunities to members in 2020 – Wellness and Health Planning, Diabetes and Behavioral Health, Medication Therapy Management, and Part D Vaccines.  Hear about this unique VBID model and why the federal government is moving forward and encouraging such programs.

Integrating SDoH Into Current Disease-Specific Programs – Capturing And Utilizing Data To Identify Gaps in Care

Leveraging SDoH data to inform and drive healthcare program management and delivery can maximize the positive effects on Member health outcomes. Data sources, such as claims data, survey data, encounter data provide insight on utilization, quality, and patient experience, however, does not capture Member choices related to SDoH needs. At Inland Empire Health Plan (IEHP), SDoH data is used to influence decision-making. Complementing existing healthcare data with Member SDoH data, allows IEHP to assess SDoH needs, link Members to appropriate community services, improve overall health, and drive health equity.

Making the Transition from Cost Containment to Cost Avoidance

In this session, we will review the complete transformation process from traditional health plan cost containment strategies to a comprehensive, data-driven Population Health Management program that results in cost avoidance.  We will discuss how the entire health plan must be engaged to support Population Health Management and the gaps that exist in most organizations.  We will cover each of the following areas:

• Population assessments and stratification and data management tools
• Programs that support the needs of members
• Organizational redesign to support PHM
• Vendors, Provider contracts and community resources
• Measurement of effectiveness

Case Study: Partnering with Analytical and Clinical Teams for Integrated SDoH Programs

• Partnering with various departments across the health plan for data analysis, program implementation, risk stratification, and targeting interventions.
• Breaking down silos to ensure there are no overlaps and/or adverse outcomes
• Leveraging resources across departments to help operationalize the program and remove road blocks
• Incorporating clinical interventions in SDOH programs
• Continuous monitoring, measuring results and post implementation analysis
• Fine tuning the program as per feedback being received from the members, community partners and results being seen from data analytics

Operationalizing SDoH, Population Health Case Management: Workflow, AI and Other Technology Tools

Learn how Kaiser has used the Epic EMR tools to incorporate the collection of Social Determinants of Health (SDOH) and how we can build care pathways to manage patient care and track action results. With the first instance of the solution available in the fall of 2019, we'll be evaluating the patient volumes referred for services, and their usage. We'll be evaluating improved outcomes and if we can measure improvement by addressing social care needs. We're also going to be looking at predictors to help us maximize services to help us achieve greater efficiencies in offering services. Our plans are clear, in this session I'm expecting to be able to present real solutions and initial assessment of performance.

Close of Conference