Medicaid Sexy? Absolutely!!

This will be a non-traditional workshop providing key insights on how to engage your consumers on a grassroots level. The panelists will provide practical lessons learned from an urban community, highlighting unique approaches and partnerships to drive consumer engagement and in support of brand stickiness and care management. Participants will engage in conversations and exercises that encourages participants to think beyond the obvious, breakdown mental barriers and rethink what collaboration means to achieve higher consumer engagement through innovative cost effective solutions. In an all about me society, this workshop will encourage participants to creatively think about their approach to collaborations, consumer engagement and making Medicaid sexy!

Chenelle D. Harris, Managing Principal, Defining Image
Maynard G. McAlpin, President & CEO, Chartered Health Plan
ParminderSethi, Chief Operating Officer, Chartered Health Plan

Using Technology to Transform Fraud, Waste, and Abuse While Maximizing ROI

Verizon will offer a panel discussion exploring these critical topics:

     • What is the driving force behind fraud, waste, and abuse?
     • What tools and techniques create a winning strategy for combating fraud,
       waste, and abuse?
     • What are the analytic technologies behind fraud prevention?
     • How can you transform from a reactive to proactive model?
     • What are some creative funding approaches for public and private payers?

David BotskoPh.D, CFE – Verizon Managing Principal
Jeffrey Getchius – Verizon Systems Analyst and Solution Developer
Alan Hansen – Verizon Fraud Management Product Manager

Building the Integrated Health Home: What To Do Before You Pick Up the Hammer

This workshop will explore methods of integrating behavioral and medical care in a patient centered health home. Speakers will discuss their experiences implementing integrated health homes, exploring possible issues, barriers and best practices. The workshop will focus on the important role of care coordination on managing high need/high cost patients. It will also explore how an innovative technology tool can facilitate care and case management in a population based accountable care environment.

Richard Chung, MD, Chief Clinical Officer, APS Healthcare
Joseph Parks, MD, Chief Clinical Officer, Missouri Department of Mental Health
Michelle Probert, Director of Strategic Initiatives, MaineCare Services (via WebEx)

Registration and Continental Breakfast

Sponsored by:

Medicaid Managed Care in 2013: Challenges and Opportunities

Joe Moser, Director of Government Affairs, Medicaid Health Plans of America

Panel Discussion:
Evaluating the Implications of the 2012 Election on the Future of Medicaid

Moderator:
Leornard J. Kirschner, M.D. M.P.H., Member, The National Advisory Board on Improving Healthcare Services for Seniors and People with Disabilities sponsored by Amerigroup

Panelists:
Dr. Gregg Pane, Fellow, National Academy of Public Administration, Former Medicaid Director, Virginia and Health Director, District of Columbia
Henry W. Osowski, Managing Director, Strategic Health Group LLC
Bill Clark, Director, Managed Care Compliance, State of Vermont

Managing the Challenges of Medicaid Expansion

Bill Clark, Director, Managed Care Compliance, State of Vermont

Creating, Operating and Supporting a Bridge to Home Discharge Planning ProgramTo Reduce Preventable Readmissions

    • Identifying the problem
    • Strategies to "stratify" populations at risk for unplanned transitions
    • Operational solutions to allow for efficient and effective interventions
    • Development of processes to meet goals
        • Facilitate self-management
        • Decrease ER use
        • Decrease unnecessary admission/readmission
        • Improved quality of life
        • Increase member satisfaction
    • Outcomes

Cheryl Slagle, Vice President, Health Services, CareSource

Using Identity and Predictive Analytics to Prevent Fraud and Improve Provider and Member Management

Clint Fuhrman, Director, National Director, Government Healthcare, LexisNexis

Morning Refreshment Break

Sponsored by:

Health Insurance Exchanges: Shifting Your Thinking from Medicaid to Commercial Operations

Moderator:
Jill Spencer, Executive Vice President, Business Development, Human Arc

Panelists:
John Kaelin, Senior Vice President, Health Reform, UnitedHealthcare Community and State
Paul Zurlo, Senior Director, New Business Development, Health Care Reform, EmblemHealth
Henry W. Osowski, Managing Director, Strategic Health Group, LLC
Andy Sullivan, Senior Vice President, Health Care Operations and Technology, Optum

Leveraging Pharmacy Real Time Risk Prediction to Improve Outcomes

The use of real-time risk information, gathered from pharmacy claims, offers substantial advantages to plans attempting to manage healthcare utilization and costs. Actionable information, delivered in a timely manner, is imperative to provide relevant disease management programs, identify patients for case management, and target individuals most in need of, and/or likely to respond to interventions. Pharmacy claims, with standardized formats and immediate payment mechanisms, offer advantages over medical claim information for these purposes. Catamaran has incorporated an internationally recognized risk prediction methodology into its pharmacy claims processing system. Use of this real time risk assessment methodology allows Catamaran to identify drivers of risk, monitor patients for changing levels of risk over time, and design and deliver targeted, effective clinical solutions designed to mitigate risk, improve care and lower overall costs. Outcomes analysis of actual medical and pharmacy costs indicate significant savings in total healthcare costs in patients receiving real time interventions based on pharmacy risk information.

Deborah Creten, Manager of Product Development for Integrail Services, Catarmaran

Luncheon

Sponsored by:

Developing a Consumer Experience Initiative: Operationalizing Brand Position and Creating an Intentionally Designed Experience That Generates Advocates Among the Medicaid Population

Why can't a health plan be an elite consumer experience company like Apple or Zappo's? That is the question we have posed at CareSource to challenge our organization and will pass on our learnings thus far. In this session, you will learn what consumer experience really means, why it can be an amazing differentiator and how critical your brand position is in that effort. We will discuss how it is possible to intentionally design the consumer experience and the steps to getting there. Finally, you will learn from our journey in gaining organizational buy-in.

David Mezzanotte, Vice President, Sales and Marketing, CareSource

Encouraging and Facilitating Greater Involvement in Health Self-Management Among Beneficiaries with a First of Its Kind Medicaid Application

Keelie Honsowitz, State Administrative Manager, Third Party Liability Division, Health Insurance Liability Section, State of Michigan
Sashi Ravipati, Technical Director, CNSI

Coordinating Efforts to Ensure Projects are Implemented on Time to Meet CMS Regulations

Deb Mabari; CEO/Founder, Cody Consulting Services, Inc.
Alphonse Valenti, Senior Consultant, Cody Consulting Services

Afternoon Refreshment Break

Sponsored by:

The Great Experiment: Real Time Quality Payments

This presentation describes a quality improvement initiative that was highly successful in impacting clinical outcomes. The initiative was targeted at individual fee-for-service physicians participating in Anthem’s Indiana Medicaid Managed Care program and could be implemented for other programs or products, nationally.

Participants will learn the key components of the program that resulted in improved HEDIS scores including promoting preventive care, encouraging and rewarding best practices, creating a lever for medical home-based care, and improving data capture. And, most importantly, that real-time payment initiatives can be much more effective than traditional Pay-for-Performance programs.

Shawnette Patterson, Director, Revenue Optimization, Wellpoint

Aligning Payment Incentives for Delivery of High Quality Coordinated Care

Dawn Zekis, Director, Healthcare Innovation, Arkansas Department of Human Services

Taking a Community Partnership Approach to Reducing Unnecessary ER Visits and Preventable Readmissions

Emergency room (ER) usage for non-urgent avoidable visits presents significant quality of care issues that include lack of continuity of care and the inability of the ER to adequately care for persons who truly require emergency care. Many of these visits could be prevented with appropriate primary care visits, thus avoiding the use of costly emergency rooms services. This presentation will provide an overview of a collaborative quality improvement project to reduce avoidable ER visits with L.A Care Health Plan, the largest public entity Medicaid health plan in the country, and Children's Hospital Los Angeles, one of the largest quaternary children's hospitals in the United States. By providing timely patient and provider level interventions, the health plan is able to engage the member earlier and hopefully avoid future unnecessary visits. This four year collaborative project will be described from the perspective of the presenting problem, interventions, and lessons learned.

Laura Linebach, Quality Improvement Director, L.A. Care

Modernizing Medicaid Eligibility Determination Systems and Processes

Thomas Derrick, President, MariChris LLC

Cocktail Reception

Sponsored by:

Continental Breakfast

Sponsored by:

Preparing for the Opportunity and Challenge of Dual Eligible Integrated Care Programs

Holly Michaels Fisher, Vice President, Government Programs, EmblemHealth

A New Frontier for Medicaid?- Care Redesign and the Prospective Budget

    • Profiles into statewide initiatives targeting person centered care
    • Activating the patient in disease management
    • And the top 5 overall strategies to successfully manage under a prospective budget

Jeffrey Moser, Vice President, Sg2

Establishing an ACO Within Your Medicaid Program

Scott Leitz, Assistant Commissioner of Health Care, Minnesota Department of Human Services
Marceil E. Case, BA, BS, Accountable Care Collaborative Program Manager, Department of Health Care Policy & Financing, Colorado Department of Health Care

Innovative Policy, Contracting and Financial Strategies for Adapting to Medicaid Expansion

Robert M. Damler, FSA, MAAA, Principal and Consulting Actuary, Milliman
Reiko Osaki, President, Ikaso Consulting
SeemaVerma, President, SVC

Morning Refreshment Break

Sponsored by:

Controlling Advanced Diagnostic Imaging with Specialty Benefit Management: Two Case Studies

Mark D. Hiatt, MD, MBA, MS, Chief Medical Officer, HealthHelp

Preventing and Detecting Fraud and Abuse in Medicaid Managed Care Organizations

    • MCOs Downstream Agreements with Providers and Subcontractors;
    • Defining Fraud & Abuse in the Medicaid Managed Care Environment;
    • Medicaid Managed Care Fraud and Abuse
           • Procurement of the Managed Care Contract
           • Marketing, Enrollment and Disenrollment
           • Underutizilation
           • Claims Submission and Billing procedures
           • Antitrust Violations
           • Embezzlement and Theft
    • Roles of Medicaid Purchasers in Controlling Fraud Abuse
    • Data Needed to Detect and Prosecute Fraud and Abuse in Medicaid Managed Care;
    • Key Components of an Effective Managed Care Fraud and Abuse Program

Markus Cicka, Director of the Missouri Medicaid Audit and Compliance Unit (MMAC), Missouri Department of Social Services

Design Thinking for a New Era of Healthcare

David Kumpf, President, Optimetra

Luncheon

Innovations in Medical and Behavioral Health Integration

The session focuses on findings from an innovativefive-year community-based approach to the integration of medical/behavioral health in the uninsured population. The session will describe the Behavioral Health Partnership between Genesee Health Plan and Genesee County Community Mental Health Authority (Flint, Michigan), discuss demographic and behavioral/medical diagnostic trends of the Medicaid expansion population, and provide data and analysis related to hospital ER and inpatient hospitalizations cost savings and improved outcomes.

Linda Hamacher, President & CEO, Genesee Health Plan of Michigan, Senior Consultant, Health Management Associates
Danis Russell, MA, MBA,Chief Executive Officer, Genesee County Community Mental Health

Trends, Updates and Developments in Member Engagement: Incentives and Wireless Communication

Creating a healthy Medicaid population is a financial incentive for health plans. Approximately 25% of Medicaid members represent 70% to 80% of Medicaid spending. Incentive programs have been siloed within health plans and new programs target specific populations and tailor rewards to the program. Health Plans seek to reward members for smart health choices at the point of sale.

Unfortunately, many Medicaid members are transient by nature, which can make communication a challenge. Less than 60% of mail communications actually reach members. Financial restraints make it difficult for members to maintain a consistent line of communication withthe health plan. This session will discuss:

    • Strategies for keeping your members safe and connected to medical services
    • Innovative new programs that can help marry incentive programs to free mobile phones
      as mechanism to engage, educate and empower members to live healthier

Suzanne O'Hara, Director, Business Development and Relationship Management - Health Initiatives, Medagate

Building a High Quality Network Despite the Medicaid Provider Shortage

Rob Robidou, Director, Network Development, Cook Children’s Health Plan

Conclusion of Conference