Medicaid Innovations Forum

Wednesday, February 1, 2017

Pre-Conference Workshops
1:00 PM - 2:30 PM

Medicaid, DSRIP and Value Based Payment: Challenges, Opportunities and Success

Holly Michaels Fisher, Managing Director, PricewaterhouseCoopers, LLP
Caroline R. Piselli, RN, DNP. MBA, FACHE, Health Industries Advisory Managing Director, Price Waterhouse Management Consultants

2:45 PM - 4:15 PM

Serving the Most Challenging Medicaid Members: An Interactive Case Conference for Dealing with Attendees’ Most Difficult and Complex Cases

Case conferences, using a multi-experienced interdisciplinary care team, are an effective and proven methodology for dealing with challenging and complex member conditions and co-morbidities. Members of the ICT are able to bring the wealth of their specific clinical and social experiences to a collaborative discussion designed to prepare/modify and optimal individualized care plan for complex members.

In this workshop, we will rely on the collective backgrounds and experiences of the attendees to assist their colleagues think freely about methods and tactics that might more effectively engage the Medicaid members in the execution of the care plan. We request each workshop attendee submit in advance one or two of their most challenging cases for review and discussion with other workshop participants. Each attendee will be given a brief opportunity to outline the case summary and challenges before a robust discussion among attendees.

Henry W. Osowski, Managing Director, Strategic Health Group, LLC

4:20 PM - 5:50 PM

How to Design an Intelligent Member Engagement Program that Delivers on Performance

Attend this workshop to learn how intelligent member engagement impacts quality, risk adjustment and member experience. Jordan will lead an evidence-based discussion on how intelligent incentives can drive high-value behaviors, and create a deeper, more personalized connection between member, their health and their health plan.

Jordan Mauer, EVP of Marketing & Engagement, NovuHealth

5:50 PM - 6:50 PM

Welcome Cocktail Reception

Day One, Thursday, February 2, 2017

7:00 AM

Registration and Continental Breakfast

Breakfast Sponsor:   Medicaid Innovations Forum

7:40 AM

Chairperson’s Welcome

Clay Farris, Director, Operations, Mostly Medicaid

7:50 AM - 8:20 AM

Medicaid 2017: Key Issues, Trends, and Final Rule Implications

Jeff Myers, President, Medicaid Health Plans of America

8:20 AM - 8:50 AM

Leveraging Health Risk Assessments to Identify and Influence Social Determinants of Health and Drive Healthy Behaviors

Dr. Srinivas Merugu, Medical Director, United Healthcare Community Plan of Ohio

8:50 AM - 9:20 AM

Making Premium Assistance Work: Best Practices and Lessons Learned from Indiana’s Premium Assistance Program (HIP Link)

  • Program Overview—HIP Link is part of the HIP 2.0 expansion waiver which makes this program different than other states.  We took lessons from other states and integrated their ideas into our HIP Link model. 
  • How we qualify employers—rules and guidelines for prospective employers.  Explain why employers were denied, how affordability is determined, and how we compared employer’s health insurance plans with our CMS approved Alternative Benefit Plan to ensure employer sponsored benefits offered sufficient coverage.
  • Voluntary Participation—employers are not required to participate so HIP Link has to be “sold” to potential businesses/organizations.  Explain how this was done with a tiny staff, a small budget, and a lot of creativity.
  • Member Participation—members have the same eligibility as our other Medicaid recipients (less than 138% FPL).  Explain how we presented the program to potential members and got member buy-in to grow the program.
Sara Hall, HIP Link Program Director, Indiana Family and Social Services Administration

9:20 AM - 9:50 AM
Both Sides of the Coin—Insights from Both Sides of Managed Medicaid

  • View from the State administration side
    • Top 3 drivers MCO’s need to know
  • View from the Managed Care Organization
    • Key performance indicators
    • Strategies to help your State look good

Lawrence J. Kissner, Chief Executive Officer, Aetna Better Health

9:50 AM - 10:10 AM

Ensuring an Improved Care Experience for Dual Eligibles

Diane Sargent, Senior Director, Dual Eligible Product Management & Program Implementation, Health Net, a wholly owned subsidiary of Centene Corp.

10:10 AM - 10:40 AM

Morning Refreshment Break
 Medicaid Innovations Forum

10:40 AM - 11:20 AM
Panel Discussion

Integrating Long Term Care into Medicaid Benefit Structures: Using MLTSS as a Strategy for Expanding HCBS, Promoting Community Inclusion, Ensuring Quality, and Increasing Efficiency

Jill Spencer, EVP, Business Development and Client Relations, Human Arc

Sam Taylor, Director of Solutions, HHS and Public Sector, Eccovia Solutions
Alison Croke, Vice President, Medicare-Medicaid Integration, Neighborhood Health Plan of Rhode Island
Kathleen Dougherty, Chief, Managed Care Operations, Division of Medicaid and Medical Assistance, State of Delaware
John Cole, CEO, Shared Health

11:20 AM - 11:50 AM

Improving Health Outcomes with Data-Driven Outreach

Scott W. Dahl, Senior Director, Healthy Communities Institute, Conduent Community Health Solutions

11:50 AM - 12:10 PM

Ensuring Effective Care Coordination for Complex and Chronically Ill Populations

Anthony Evans, SVP Integrated Care and Home Health Services, CareSource

12:10 PM - 12:30 PM

Third Party Liability and Cost Avoidance Solutions

Steve Konsin, RPh, Principal, Syrtis Solutions

12:30 PM - 1:30 PM


Medicaid Innovations Forum

1:30 PM - 2:00 PM

Why Acting Like Medicine Results in Better Managed Behavioral Health Care: South Florida Behavioral Health Network’s Coordinated Systems of Care

John Dow, President and CEO, South Florida Behavioral Health Network, Inc.
Laura M. Naredo, MS, CHC, CHPC, Vice President CQI, South Florida Behavioral Health Network
Michael Jarjour, President and CEO, ODH, Inc.

2:00 PM - 2:40 PM
Panel Discussion

Behavioral and Acute Care Health Integration: Bringing Behavioral Health into the Care Continuum to Improve Quality and Reduce Costs

Henry W. Osowski, Managing Director, Strategic Health Group, LLC

Wendy White Tiegreen, Director, Office of Medicaid Coordination and Health System Innovation, Georgia Department of Behavioral Health and Developmental Disabilities
Sheila Wilson, Director, Care Management—Medicaid, Priority Health
Jim Milanowski, President and Chief Executive Officer, Genesee Health Plan
Candace T. Saldarini, M.D., Director, Medical Strategy, ODH, Inc.

2:40 PM - 3:10 PM

Active Management: How to Optimize Compliance and Value in Home Care

  • Challenges and vulnerabilities in home care and how payers can reduce risk
  • Why active management is critical to success for providers, plans and states
  • Going beyond EVV, and why collaboration and communication is integral to compliance
  • Creating valuable compliance metrics and how to drive performance through peer-to-peer comparisons

Tom Meyer, Chief Program Integrity Officer, HHAeXchange

3:10 PM - 3:40 PM

Adopting an Episode-Based Payment Model: Rewarding Care that Achieves Measured Quality

William E. Golden, M.D., Professor of Medicine and Public Health at the University of Arkansas for Medical Sciences, Medical Director, Arkansas Medicaid

3:40 PM - 4:10 PM

Afternoon Refreshment Break

 Medicaid Innovations Forum

4:10 PM - 4:50 PM
Panel Discussion

Reducing ER Visits, Readmissions and Avoidable Admissions with a Unique Case Management, Transition Management and Outreach Model

Henry W. Osowski, Managing Director, Strategic Health Group, LLC

Phil Stalboerger, Vice President, Medical Affairs, MTM, Inc.
Beth B. Nelson, Director, Medicaid Programs, Blue Cross Blue Shield of Minnesota
Jan Reed, Director, Health Plan Services, RelayHealth Pharmacy Solutions
Stanton Sipes, EVP, Business Development, Veyo

4:50 PM - 5:20 PM

Centene’s Community and Natural Supports Pilot Program in Arizona

Bridgeway Health Solutions (Centene’s Long Term Care Medicaid health plan in Arizona) launched a volunteer-based pilot program to promote achievement of quality of life planning goals, improve member self-care management, and enhance community engagement by creating best practices akin to a neighborhood naturally occurring retirement communities (NORC) or village community model. Members select services that they can offer to other members in their community and that they wish to receive from community volunteers and other members. NORCs are geographies in which high concentrations of senior individuals live. These geographies may be as small as a single apartment building or may encompass a small rural region. NORCs have also been effective in addressing social needs and improving quality of life through fostering recreational interaction between members, reducing health problems associated with social isolation. These communities emphasize promoting aging in place, coordinating efforts of voluntary and formal support systems, enhancing social capital among older adults, promoting consumer engagement, and enhancing the availability and accessibility of existing services.

For Arizona’s Medicaid Long Term Services and Support members living in the rural area of Pinal County, this new project offers a built-in support community where members can participate to their level of comfort. All Bridgeway Medicaid members will continue to receive the same level of service, based on each member’s service plan. This session will explore the origins of this program and share early program highlights.

Session Objectives:

  • Discuss strategies to support the well-being of Medicaid members who can safely live in home and community-based settings
  • Review how members’ quality of life is enhanced by improvements to self-care management and fostering interpersonal relationships
  • Evaluate the various enhanced opportunities for member community engagement and support
Kijuana Wright, Manager, Innovation and New Product Development, Centene Corporation

5:20 PM - 5:50 PM

Implementing and Sustaining a Patient Centered Medical Home Initiative for Medicaid

Cyrus Huffman, MD, Senior Medical Director, BlueCare Tennessee

5:50 PM - 6:20 PM

Don’t Find Fault, Find a Remedy – Collaborating to Focus on Quality for Duals

Amanda James, MSN, FNP-C, Director of Utilization Management, Blue Cross of Idaho
Chris Barrott, Contract Manager, Idaho Department of Health and Welfare

6:20 PM - 7:20 PM

Cocktail Reception

Day Two: Friday, February 3, 2017

7:00 AM

Continental Breakfast

7:50 AM - 8:00 AM

Chairperson’s Recap

Clay Farris, Director, Operations, Mostly Medicaid

8:00 AM - 8:40 AM
Panel Discussion

Implications of the Recent Election on Medicaid: What Does the Future Hold?

Leonard J. Kirschner, M.D., M.P.H, Immediate Past President, AARP Arizona

Henry W. Osowski, Managing Director, Strategic Health Group, LLC
Clay Farris, Director, Operations, Mostly Medicaid

8:40 AM - 9:10 AM

Roadmap to Data Driven Marketing & Member Engagement

Peter Rodes, Senior Vice President, Strategic Planning, Wunderman Health
John E. Burich, Vice President, Strategy and Business Development, Passport Health Plan

9:10 AM - 9:30 AM

Bridging the Client Engagement and Care Coordination Gap to Improve Outcomes: The Colorado Medicaid Nurse Advice Line Model

The Colorado Medicaid Nurse Advice Line aids clients in determining the appropriate level of care, provides health education and region-specific referral information based on individual needs, and facilitates care coordination. This session will discuss this patient-centered care coordination model.

Michelle Miller, MS, RN, PMP, Chief Nursing Officer, Colorado Department of Health Care Policy & Financing

9:30 AM - 9:50 AM

Contract Writing and Management for Successful Medicaid Program Administration and Modernization

This presentation will offer lessons learned and best practices to write and manage contracts that improve:

  • Multi-organization collaboration
  • Program modernization
  • Provider and client-centeredness and experiences
  • Provider administrative burden and errors
  • Client appeals filing and outcomes
  • Stakeholder engagement and experiences
  • Quality assurance
  • Contract adherence
  • Payment incentives
  • And additional built-in contract options for contract non-compliance

Erin Collins, Utilization Management & Client Appeals Unit Manager, Colorado Department of Health Care Policy & Financing

9:50 AM - 10:20 AM

Leveraging Data Analytics, Predictive Modeling and Forecasting to Improve Care for High-Risk, High Cost Patients

Heidi Wold, MSN, ARNP, ANP-BC, Vice President, Chronic Care, Matrix Medical Network

10:20 AM - 10:50 AM

Morning Refreshment Break

10:50 AM - 11:20 AM

Encounter Data Standards: Implications for State Medicaid Agencies and Managed Care Entities from the Final Medicaid Managed Care Rule

A fundamental part of developing capitation rates for risk-based managed care programs is the selection and usage of historical data to be used as the base data. Relative to other sources of data that may be used in developing capitation rates—summarized managed care entity (MCE) utilization and cost experience, fee-for-service data, statutory financial statements, etc.—encounter data provides the most transparent view of an MCE's provision of healthcare services. Encounter data is also the basis for many other required activities resulting from managed care programs, including risk adjustment, quality measurement, value-based purchasing, program integrity, and policy development.

However, encounter data that is incomplete, missing information, or reported incorrectly can render the data of limited use in evaluating an MCE’s financial experience and delivery system performance. Recognizing that quality encounter data is imperative in creating greater transparency in Medicaid managed care programs, the Centers for Medicare and Medicaid Services (CMS) has made ensuring encounter data quality a high priority for states and MCEs.

The final Medicaid managed care rule provides a comprehensive modernization of Medicaid managed care rules and regulations, including addressing encounter data quality and submission requirements in detail. In this session, we summarize new regulatory requirements for Medicaid encounter data from the final rule, identify best practices for state Medicaid agencies and MCEs in the development and submission of encounter data, and envision how improvements to Medicaid managed care encounter data quality may change the industry.

Paul R. Houchens, FSA, MAAA, Principal, Consulting Actuary, Milliman
Jeremy Cunningham, FSA, MAAA, Consulting Actuary, Milliman

11:20 AM - 11:50 AM

Using Mobile Technology to Improve Outcomes within the Medicaid Population

James Bush, MD, FACP, State Medicaid Medical Officer, Office of Health Care Financing, State of Wyoming

11:50 AM - 12:20 PM

Combating Provider Fraud, Waste, and Abuse: Leveraging Data and Analytics to Detect and Prevent Fraud

Justin Hyde, Director, Market Planning, LexisNexis Risk Solutions

12:20 PM - 12:40 PM

Pricing Practices that Impact Your Bottom Line and Client Retention

Gregory S. Everett, President & CEO, Payer Compass

12:40 PM - 1:40 PM


 Medicaid Innovations Forum

1:40 PM - 2:10 PM

Lessons Learned from New Section 1115 Waiver Program: Health Care Coverage for People Impacted by Flint Water

Jim Milanowski, President and Chief Executive Officer, Genesee Health Plan

2:10 PM - 2:40 PM

Taking a Multidisciplinary Approach to Care Management and Delivery: Creating Provider, Health System, and Community Partnerships

Priority Health created the Medically Complex Children’s Program to improve the member experience. A team of Pediatricians, Care Managers, Community Health Workers, Nurses and Specialists within the Academic General Pediatric Residency Clinic (part of the Spectrum Health System), coordinate care for members and provide assistance with basic needs like food, housing, clothing, medication management and transportation. One of our most vulnerable members, a child whose family was new to the United States, arrived to the hospital with acute liver failure and was in need of a transplant. His parents lacked the resources that the child needed for proper care, so he was enrolled in the Medically Complex Children’s Program. After he was enrolled, a complex care plan was created with input from all team members, including the member and family. The care team assigned to his case helped plan ahead, anticipate his needs between appointments, provide ongoing reinforcement of the care plan and minimize unnecessary Emergency Department visits. The program focuses on one patient, one family, one care plan and one care team to create a better member experience and better health outcomes!

We have, quite literally, transformed the level of care within this clinic and are now spreading this concept to Pediatric Practices within our network.

Sheila Wilson, Director, Care Management—Medicaid, Priority Health
Barbara Dusenberry, BSN, RN, Manager, Care Management, Medicaid, Priority Health

2:40 PM - 3:10 PM

Improving Network Adequacy: Strategies for Increasing Provider Participation in Public Programs

Rob Robidou, Vice President, Operations, Children’s Medical Center Health Plan

3:10 PM

Conclusion of Conference


Keep me inform


Medicaid Innovations Forum

 Medicaid Innovations Forum

 Medicaid Innovations Forum


Medicaid Innovations Forum
Medicaid Innovations Forum

Medicaid Innovations Forum


Medicaid Innovations Forum

Medicaid Innovations Forum

Medicaid Innovations Forum