Agenda

Chairman’s Review of Population Health Innovations

The Transition to Value-Based Care: Strategies for Success in New Medicare and Medicaid Payment Models

Can we improve our population health while reducing wasteful costs through a focus on outcomes and the total cost of care, instead of on fee-for-service transactions? As new payment models advance value-based care, our challenge is to change the care model while fee-for-services revenues are still dominant. In this presentation we will:

• Review the impetus to move to value-based care
• Discuss the challenges to participation in value-based care models
• Consider Medicare and Medicaid payment contracts
• Highlight key strategies for success
• Ask “How do we pay for the new focus?”

PANEL: Regulations for Health Equity: Insights on the Emerging New Regulations on Health Equity and SDoH: How Payers Can Prepare for Population Health Regulations and What to Expect

Learn from an impressive panel of speakers about the government’s roll out of health equity regulations and SDoH. Learn how health plans could leverage these policies and future federal health programs to provide a more equitable and efficient healthcare.

• The Biden administration's interest and actions related to SDOH and equity (from early executive order to RFPs, demonstration models, and regulatory text)
• What this might mean for plans -- ideas include the need for alignment across payers/programs, incentivizing partnerships across providers (including community-based services), addressing data (standardization, collection, sharing and analysis)
• What is next on the regulatory horizon?
• How can payers partner with their provider network in a meaningful way to achieve the goals of these regulations to appropriately identify patient’s need and address them in a meaningful way using healthcare systems as a potential entry point.
• What are the goals of the regulations? How do we ensure the regulatory goals align with meaningful connections between clinicians and patients?
• How do we ensure regulations/requirements are not perceived negatively by clinicians and clinical teams as “one more thing” and lead to a “check the box” approach?
• Nuances of various nationally recognized tools – how can payers be subject matter experts by evaluating/recommending various tools, supporting consistent data mapping standards, and providing implementation support?
• Data sharing between patients, clinicians/health care organizations, community organizations and payers. Who and how should data be shared? Patient consent?
• How should payers address clinical team concerns about lack of resources to address some social determinants/social needs that may be identified?
• What messaging can we use to promote these efforts even if all solutions are not in place (e.g. benefits of collecting data for future advocacy, improving connections with patients, future incorporation into risk adjustment models, etc.)
• Organizations with the least resources often have the largest percentage of patients with social needs. How can payers ensure these organizations have access to expertise/best practices/shared resources?

Moderator:

Panelists:

Mid-Morning Networking Break

Breaking Down the Silos to Support Members Across the Care Continuum

According to the Population Health Alliance, a PHM program strives to address health needs at all points along the continuum of health and well-being through participation of, engagement with, and targeted interventions for a population. Often, the siloed programs provided by health plans result in either so engagement or conflicting engagement. This presentation will look at ways to address the siloed programs to better meet the needs of the member. The presentation will include:

• Overview of silos that exist in health plans that create barriers for population health initiatives.
• Discussion of segmentation and stratification models for establishing risk levels.
• Strategies for identifying the most important need of the member.
• Approaches for sharing insights across the organization for continued improvement.

Lessons from a Pandemic: Potential Paths to Success

During a once-in-a-century global pandemic, the medical community was faced head-on with the reality that the Fee-For-Service system is fragile and unreliable. But how do we create meaningful and sustainable advanced payment models? The Medicaid and Medicare populations are typically vastly different but equally challenging in the coordination of their healthcare. Payers often end up creating new programs in a vacuum, trying to find the right balance of forward improvement and provider reward. Providers struggle to engage these members in a way that would yield best health outcomes. Looking for the right ways to be responsible stewards of member dollars is a challenge when payers and providers don’t align on incentives. Lisa White will present on the complexity and potential paths to success with this population by using co-created advanced payment models coupled with critical analytics support.

Virtual Lunch and Exhibit Area Networking

Kaiser Permanente Case Study: CalAIM's Vision to Integrate Non-Traditional Services into Medi-Cal Managed Care

CalAIM is a multi-year initiative by California’s Medicaid regulator - the Department of Healthcare Services.  It started January 1, 2022 to improve the quality of life and health outcomes of California’s Medicaid population by implementing broad delivery system, program, and payment reform.  Under CalAIM, the Medi-Cal delivery system will move to a population-based/person-centered model of care with an emphasis on coordinating community- based services and addressing patient's non-medical needs. This presentation will include:

• Overview of Community Supports Services (e.g., housing navigation, meals) designed to meet non-medical needs
• Description of how these services are expected to impact the patient/member experience
• Insight into how the new services impact health plans and the delivery system
• Challenges and mitigation strategies

Deploying True Population Health Management Through Data-Driven Whole Person Care

• Uncovering social determinant information from traditional plan data sources, public domain data sources, as well as consumer data sources to paint the full picture of the member
• Leveraging all member data available to activate holistic member predictions that guide more meaningful, impactful, and efficient interventions around compliance, utilization, behavioral health, and more
• Building an effective engagement strategy to activate true population health management

Examining Three paradigm Shifts for Payers and Providers in Value-Based Care

CMS recently released its 2022 strategic plan for health equity which puts renewed focus on providing high-quality healthcare that is affordable and accessible to all. Experts agree that value-based care is here to stay, and those health plans that strategically navigate the paradigm shifts will find themselves on top. Join in on an interactive exchange around ways health care organizations can better partner to level the playing field for patient care. In this session, the presenters will share perspectives on:

• Payers and providers holding each other accountable for equity
• Leveraging data to foster the quality and effectiveness of care
• Ensuring equal and open access to behavioral, physical and social health care

Afternoon networking break

A SCAN Health Plan Case Study: The Population Health Approach for Duals

SCAN Health Plan, a non-profit Medicare Advantage plan, operates the only FIDE SNP in California and has created a population health approach to support dual beneficiaries to achieve health and independence.  With 45 years’ experience service duals in the health plan and in the community, the SCAN model centers on care navigation and social needs in conjunction with health needs. This presentation will include:

• Overview of the FIDE SNP model and the dual population
• Specifics about the SCAN population health approach and outcomes

The 2023 MA Program Regulation and CMS’s New Vision for D-SNPs

D-SNPs are rapidly growing, both in terms of the number of plans and their enrollment. But, besides their enrollees, what is special about these Special Needs Plans? In its most recent Medicare Advantage regulation, CMS establishes several new requirements for D-SNPs that will push D-SNPs toward Medicare-Medicaid integration, member-centrism and health equity, and state-federal oversight partnerships. In this session, the former head of Special Needs Plans and Medicare Advantage Operations at CMS will discuss new D-SNP requirements and their ramifications for D-SNPs and other MA plans.

End of Day One

Integrating Behavioral Health into Primary care to Improve Population Health for Medicare patients: The Johns Hopkins Experience

Modeled after CMMI's national Comprehensive Primary Care Plus Model, the Maryland Primary Care Program (MDPCP) supports participating practices in making transformative changes to care delivery for Medicare patients. The Johns Hopkins Medicine Alliance for Patients participates in this program as a Care Transformation Organization, providing enhanced Behavioral Health, Case Management, Community Health Worker, and Pharmacy services to the participating practices. This presentation will describe the Behavioral Health integration model successfully employed in the MDPCP program. We will discuss:

• Comparisons to the traditional Collaborative Care Model employed in other primary care settings
• Experiences of the behavioral health and primary care practitioners in MDPCP
• Current outcomes and future goals for integrated Behavioral Health in MDPCP and beyond

Geisinger Case Study: Using Food as Medicine to treat Type II Diabetes and Other Diet Responsive Conditions

• levering technology to target populations
• creating programming that drives positive impact and sustainable results
• partnering with community based organizations to provide care closer to home
• levering resources to create a comprehensive care plan

Mid Moring Break Networking Break

Innovations in Community-based Organizations Partnering with Health plans and Local Stakeholders for Health Equity: Case study of Green & Health Homes Initiative (GHHI)and Affinity by Molina:

As plans struggle with outreach to CBOs, hear from this “out-of-the-box” partnership - a new model of private sector funding to reduce Asthma for NYC Medicaid recipients with Affinity and other partners. This innovative model is designed to address and help remedy preventable hospitalizations while greatly improving member lives. Such projects are fine examples of how to successfully address SDoH and establish a model that is scalable and replicable.  Topics will include:

• Incorporating third party capital to fund services that address SDoH
• Utilizing value-based payments to account for the impact of SDoH services
• Removing the barrier of “premium slide” / “re-racking” to invest in SDoH services

CareSource CASE STUDY: Care Source Partnership on a Unique SUD Home Program

CareSource, a nationally recognized nonprofit health plan partners with a leading, value-based provider of high- touch care coordination and treatment services for those with Substance Use Disorder (SUD), the model focuses on addressing the complex social, medical and behavioral needs of this important population. The presentation will focus on the collaborative model, the learnings, challenges and lessons learnt.

Leveraging Data and Technology to Accelerate Improved Outcomes in a Value-Based Care Environment.

• Data and technology offer new methods and opportunities to address the US epidemic of obesity-related chronic conditions in ways that are both systematic (efficient and consistent) and personalized (consider individual patient situations and preferences).
• Patient success with the key, daily self-management activities related to disease prevention and management requires that we use data and technology to increase personalization and focus on the question: How do we help patients live healthier lives?
• Digital tools and an omnichannel approach to engaging patients enables us to scale methods of assessment, treatment, and support for patients.
• This opportunity has been accelerated because of the changes to the system and to patient expectations post- COVID. We can now leverage a blended virtual and in-person care delivery model, with access to an expanded care team that is not geographically bound.
• Patients are willing to share this information. A poll of Americans conducted in 2021 showed that 97% of Americans are willing to spend time prior to doctor visits answering online surveys about their daily health habits if that information allows their provider to help them reach their health goals (e.g., lose weight, eat healthy, prevent or manage chronic disease).
• Using technology to efficiently and consistently collect key patient data in advance of scheduled visits allows in-person treatment time to focus on problem solving, solutioning, and planning with the patient.
• A holistic, patient-centered approach that is informed by patient-generated personal information will reduce health inequities by enabling clinicians to tailor patient care plans to the specific, culturally relevant, geographically relevant issues, barriers, and social factors that impact patient and population health.
• Leveraging new IT is critical as it can be low friction for care teams. It offers multitouch and multichannel options for engaging patients in both short-term and long-term care.
• Population-level data and AI will add a next level of value resulting from patient-generated and patient- reported data (wearables, remote home monitoring, and behavior diagnostics, etc). When this data is added to the existing data lake, it will power efficiencies and new insights that can drive our approach to value-based care at scale.
• Business models are shifting to support more widespread adoption of these technologies and approaches. In a value-based care model, these technologies will enable shifts in activities from those that are low-value or have exclusively short-term impacts to those that are high-value and have longer-term health benefits.
• The highly diverse clinical needs of the Medicare/Medicaid/Duals population will require more in-depth condition specific tools to collect key information/data.
• Use of technology to collect data more efficiently paired with meaningful interventions by clinical staff will drive ongoing patient engagement.
• Data collection and of patient populations can be instrumental in process improvement for clinical staff, potentially identifying gaps in system programs, or individual clinician performance.

Panelists:

Virtual Lunch and Exhibit Area Networking

PROVIDER PANEL: Provider Strategies to Integrate SDoH into the Medical Mainstream to Deliver Whole-Person Care

• What are provider perceptions of how SDoH affect their patients and practice
• What are provider experiences with SDoH integration into their workflow?
• What approaches are successful with providers when asked to address SDoH?
• Physical & Behavioral Health Integration Models in Managed Care
• Holistic approach to improving Member experience, addressing SDOH and applying meaningful interventions

Moderator:

Panelists:

PANEL: Lessons Learned in Developing Services and Contracts Between Payers and Community-based Organizations to Address Social Determinants of Health.

Discussion topics would include

• Building service delivery models with community-based organizations
• Increasing capacity of community-based organizations to be able to have contractual relationships with payers
• Payment models between payers and social service providers

Panelists:

Networking Awards Winners Announced & Close of Conference