Medicaid Innovations Forum
2018 Agenda

Wednesday, January 31, 2018

Pre-Conference Workshops
12:00 PM - 1:30 PM

A Comprehensive Assessment and Management Solution to Reduce Opioid Abuse - State Contract Quality Initiatives and Health Plan Responses

Cynthia Knorr-Mulder MSN, BCNP, NP-C, Administrative Director - Pain and Palliative Medicine, Pain Management Nurse Practitioner, Englewood Hospital & Medical Center

1:40 PM - 3:10 PM

How to Move from Medicaid Fee-For-Service To Medicaid Full Risk Capitation in an ACO Environment

There are many considerations that states have to balance when designing a Medicaid capitated risk program, but what about the considerations of the individual organization taking on that capitated contract. What does it take for an organization to form and launch a full risk capitated ACO? How does an ACO take the high-level state program guidelines and translate that to on the ground care and coordination? To launch a full risk ACO there are two major buckets of planning: administration and model of care. Administration involves leadership and governance, finance and contracting, reporting and compliance, data and analytics, and network development. Model of care involves provider networks, behavioral health integration, physician engagement and education, working with community partners, care management and coordination, managing social determinants of health, and ensuring cultural competency.

  • What does it take to launch a full risk capitated ACO
  • What are the administrative and model of care components that must be considered when launching an ACO
  • Lessons learned from and challenges of launching a full risk ACO
  • What can states learn from the experience of an individual organization launching an ACO
Sarah Matousek, Senior Consultant, Day Health Strategies

3:20 PM - 4:50 PM

Using Medicaid Management Information Systems as Strategic Tools and Not Hurdles to Innovation

All State Medicaid Agencies have management information systems that support Medicaid business processes, including the determination of Medicaid applicant eligibility, adjudication of claims, issuance of capitated rate payments, receipt of encounter data, and analysis of data. The effectiveness of these systems can have significant impacts on Medicaid Managed Care Organizations (MCOs). This workshop will include a discussion on:

  • The federal requirements underlying the development of Medicaid Enterprise Systems
  • Ways in which States have optimized interfaces and interoperability with the systems in use by Medicaid Managed Care organizations
  • Major Medicaid Enterprise Systems efforts, such as T-MSIS and the Social Security Number Replacement Initiative
  • The move to modularity and the potential impact on Medicaid MCOs

Elena Nicolella, Executive Director, New England States Consortium Systems Organization

5:00 PM - 6:30 PM

How to Design an Intelligent Member Engagement Program that Delivers on Performance — Complimentary to All Attendees

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

6:30 PM - 7:30 PM

Welcoming Reception in the Exhibit Area

Day One, Thursday, February 1, 2018

7:00 AM

Registration and Continental Breakfast

Sponsored by:   Medicaid Innovations Forum

7:50 AM - 8:00 AM

Chairperson’s Welcome

Clay Farris, Director of Operations, Mostly Medicaid

8:00 AM - 8:30 AM

Evaluating the Impact of the Mega Reg: Identifying Multiple Channels for Transformation

Jeff Myers, President, MHPA

8:30 AM - 9:10 AM
Panel Discussion

Upcoming State Innovations in Medicaid

  • Experiences for expansion states
  • Funding models
  • Shared Responsibility
  • Block grants
  • Flexible benefit design and new funding models
  • Medicaid waivers
Leonard J. Kirschner, Immediate Past President, AARP Arizona

Bernard “Deck” Decker, Executive Director, Office of Administrative and Technology Services, Kentucky Cabinet for Health and Family Services
Clay Farris, Director of Operations, Mostly Medicaid
Jenny Ismert, Vice President, Health Policy, UnitedHealthcare Community & State
Elena Nicolella, Executive Director, New England States Consortium Systems Organization

9:10 AM - 9:40 AM

Balancing the Needs of Small, Yet High Cost, Medicaid Population Segments (Duals, LTC, HCBS, etc.) Against the Broader Population Segments

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

9:40 AM - 10:20 AM
Panel Discussion

Medicaid Managed Care Innovations: Developing Innovative Medicaid Plan Strategies in the Face of Budget Challenges, Market Disruption, and Future Program Uncertainties

  • Thriving in an era of block grants and market consolidation
  • Making shared responsibility
  • Special needs populations and complex conditions
  • Long Term Care needs and LTSS
Henry W. Osowski, Managing Director, Strategic Health Group LLC

Lawrence J. Kissner, Chief Executive Officer, Aetna Better Health
Robert Robidou, Vice President, Operations, Children’s Medical Center Health Plan
Cynthia Hatcher, National Vice President, Medicaid Products and Innovation, WellCare Health Plans, Inc.

10:20 AM - 10:50 AM

Leveraging Mobile Health Messaging and Multimodal Outreach to Drive Members to Action

Neng Bing Doh, CEO, HealthCrowd

10:50 AM - 11:20 AM

Morning Refreshment Break

11:20 AM - 12:00 PM
Panel Discussion

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

Linda Roman, Vice President, Human Arc

Barbara Dusenberry, BSN, RN, Manager, Care Management, Medicaid, Priority Health
Michelle G. Turano, Vice President, Public Policy & Government Affairs, WellCare Health Plans, Inc.
Greg Moody, Director, Ohio Office of Healthcare Transformation
Sheela Ramamurthy, EVP of Client Services, VirtualHealth

12:00 PM - 12:30 PM

Developing Strategies for Effective Medicaid Member Engagement—Taking a Whole Person Approach to Develop Targeted Interventions That Work

  • Early engagement strategies following enrollment using a member-centric, culturally competent, collaborative approach to care
  • Assigning a dedicated Care Coordination team to each new member who use a combination of telephonic and community outreach strategies to ensure ongoing member contact and engagement
  • Completion of a health needs assessment and development of an individualized care plan with member selected goals
  • Commitment to a shared decision-making model between the Care Coordination team and the member
Lisa Holden, Vice President, Accountable Care, Independent Care Health Plan

12:30 PM - 12:50 PM

Third Party Liability and Cost Avoidance Solutions

  • The current political climate and how changes in Medicaid funding may impact Third Party Liability across the country.
  • The latest trends and best practices in Other Health Insurance Discovery as reported to us by our customers
  • Case studies that show the economic impact that prospective TPL cost avoidance delivered through ProTPL can offer
  • Audit mechanisms that can help you to gauge the success of your current TPL processes.

Steve Konsin, RPh, Principal, Syrtis Solutions

12:50 PM - 1:50 PM


Sponsored by:  Medicaid Innovations Forum

1:50 PM - 2:30 PM
Panel Discussion

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

Clay Farris, Director of Operations, Mostly Medicaid

Phil Stalboerger, Vice President, Medical Affairs, MTM, Inc.
John R. Emery, Deputy General Counsel, New Mexico Human Services Department
Bill Clark, Medicaid Compliance Officer, Department of Vermont Health Access

2:30 PM - 3:00 PM

Kentucky’s Section 1115 Demonstration Waiver: Challenges and Successes to Date

Bernard “Deck” Decker, Executive Director, Office of Administrative and Technology Services, Kentucky Cabinet for Health and Family Services
Jennifer Harp, Deputy Executive Director, Office of Administrative and Technology Services, Kentucky Cabinet for Health and Family Services
Kristi Putnam, Program Manager - Kentucky HEALTH Medicaid Transformation, Kentucky Cabinet for Health and Family Services

3:00 PM - 3:30 PM

Streamlining the Provider Enrollment and Credentialing Processes to Ensure Network Adequacy and Quality Care

3:30 PM - 4:00 PM

Afternoon Refreshment Break

4:00 PM - 4:40 PM
Panel Discussion

Using MLTSS as a Strategy for Expanding HCBS, Promoting Community Inclusion, Ensuring Quality, and Increasing Efficiency

Holly Michaels Fisher, Head, Dual Eligible Markets, Aetna

Cindy Wichman, M.S., HCBS Director, Kansas Department for Aging and Disability Services
Bill Moss, Assistant Secretary, Aging and Long-term Support Administration, Washington State Department of Social and Health Services
Randy Ricker, Vice President of Managed Long Term Services and Supports, Optima Health

4:40 PM - 5:20 PM

Moving Members from Fee-for-Service to Managed Care to Control Spending, Coordinate Care, and Improve Outcomes

  • Understanding the lift – and the risks
  • Managing expectations – even those that conflict
  • Understanding and addressing the stakeholders
  • Planning and preparation – anticipate the best and worst
  • Execution and adjustment
Randy Ricker, Vice President of Managed Long Term Services and Supports, Optima Health

5:20 PM - 5:50 PM

Value-Based Payment Models: Aligning Financial and Clinical Incentives to Maximize Payer/Provider Collaboration

Joseph A. Stankaitis, MD, MPH, Chief Medical Officer, Monroe Plan for Medical Care

5:50 PM - 6:20 PM

Innovations in Oregon’s CCO System

  • Brief overview of Oregon’s Medicaid Waiver & CCO System
  • Presentation on the structure of the PacificSource Regional CCO Model including our unique partnership for community governance
  • Strategies for engaging Medicaid members in the transformation of healthcare
  • Reinvesting funding across communities to improve population health
Molly Taroli, Project Coordinator, Central Oregon CCO, PacificSource Community Solutions
Trudy Townsend, Community Health Development Coordinator, PacificSource Community Solutions

6:20 PM - 7:20 PM

Cocktail Reception in Exhibit Area

Sponsored by:  Medicaid Innovations Forum

Day Two, Friday, Feburary 2, 2018

8:00 AM - 8:30 AM

Genesee Community Health Innovation Region Model to Address Emergency Department Utilization and the Social Determinants of Health

  • Collaboration between a community backbone organization, Patient Centered Medical Home (PCMH) practices, and Medicaid Health Plans to identify high, inappropriate, and preventable Emergency Department utilizers
  • Implementing a community-wide strategy to address the Social Determinants of Health
  • Utilizing community-based social workers, nurses, and community health workers to facilitate clinical community linkages for Medicaid patients
  • Utilizing health informatics tools to facilitate clinical and community service referrals between healthcare and non-healthcare entities
  • Assessing impact on emergency department utilization and hospital admissions

Jim Milanowski, President and CEO, Genesee Health Plan
Kirk Smith, President & CEO, Greater Flint Health Coalition

8:30 AM - 9:00 AM

Emergency Room Utilization – Implementing Multiple Strategies to Solve a Complex Problem

  • Embedding Community Health Workers into the busiest ER on the west side of Michigan
  • Working with members to get connected with their PCP/Medical Home so that future care, as appropriate, can be delivered there
  • Developing the Pathways Program with a specially created ER Utilization Pathway that can be utilized for those members frequenting the ER
  • Leveraging MedNow, a virtual application gaining that can replace the ER visit
  • Connecting members to the community resources that they need through Priority Health Connect

Barbara Dusenberry, BSN, RN, Manager, Care Management, Medicaid, Priority Health

9:00 AM - 9:30 AM

Addressing Social Determinants of Health: Collecting and Using Data to Understand the Health-Related Social Needs of Medicaid Members and to Create Care Models that Improve Outcomes

Holly Cunningham Piggott, Director GBD Special Programs, Anthem Indiana Medicaid
Katherine Tavitian, Director of Business Development, Anthem Indiana Medicaid

9:30-10:00 AM

Engaging in Community Partnerships and Community-Based Organizations to Meet the Needs of Medicaid Members and Improve Care Coordination, Access and Delivery

Karin Van Zant, Executive Director, Life Services, CareSource

10:00 AM - 10:30 AM

Care Coordination Innovations to Improve Outcomes in a Medicaid Population

Trusted Health Plan- a targeted, high-touch health plan focused on total health and optimization - is flexible, adaptable and has demonstrated ability to coordinate services across multiple populations and demographics.

  • "Know your Numbers"- Just as we know our numbers, our address, height, weight, etc.
    • An effective Care Coordination Program must know it's numbers, i.e. Who, What, When, How, Where, Why of our population.
    • Our results prove that our approach achieves the triple aim - to improve population health, improve enrollee experience of care and reduce the per capita cost of health care.
  • Population Health Assessment- assessing members' health status utilizing predictive modeling methodology, to identify members who have gaps in their care (e.g. members that do not receive recommended services per evidence-based guidelines). We continually measure, monitor, and manage member care in accordance with the Health Effectiveness Data and Information Set (HEDIS®)
  • Precision Care Management, System-wide Integrated interventions that are high touch, member centric and Data Driven.
  • Care Performance & Outcome Measures- Marching to the tune of "One Brand One Sound"

Karyn Wills, MD, Chief Medical Officer, Trusted Health Plan
Robin Barclay, Director of Development, Trusted Health Plan
Ernestine Johnson, MPA, BSN, RN, Director, Utilization Management, Trusted Health Plan

10:30 AM - 11:00 AM

Morning Refreshment Break

11:00 AM - 11:40 AM
Panel Discussion

Improving Care Transitions Between Settings to Reduce Avoidable Readmissions and Improve Outcomes

Erine Gray, Founder and President, Aunt Bertha
Mindy Smith, BSPharm, RPh, Vice President, Pharmacy Practice Innovation, PrescribeWellness
Cheryl Lulias, MPH, President & Executive Director, Medical Home Network (MHN), CEO, MHN ACO
Manik Bhat, Co-Founder and CEO, Healthify

11:40 AM - 12:10 PM

Implementing and Sustaining a Patient Centered Medical Home Initiative for Medicaid

Melanie Cavaliere, Chief, Innovative Care Delivery, Center for Health Information Technology & Innovative Care Delivery, Maryland Health Care Commission

12:10 PM - 12:40 PM

Developing Targeted Case Management Medicaid Waivers for Unique Crisis Situations

Danis Russell, CEO, Genesee Health System
Dr. Lauren Tompkins, Vice President, Clinical Operations, Genesee Health System
Elizabeth Burtch, LMSW, IMH-E® (III), Manager of Coordinated Family Support Services, Genesee Health System

12:40 PM - 1:40 PM


1:40 PM - 2:10 PM

Vermont’s Medicaid Next Generation ACO Model: Challenges and Successes to Date

Amy Coonradt, Senior Policy Advisor, Department of Vermont Health Access

2:10 PM - 2:40 PM

The Changing Healthcare Landscape: Lessons Learned, Gaps, and Paths Forward to Improve Medicaid Populations Health and Address Systemic Deficits of Social Determinants of Health

  • Improving health insurance coverage
  • Emphasizing health promotion and prevention
  • Driving outcome by value based payment
Using New York City as rich backdrop of more than 8.5 million people from diverse, ethnic, cultural, and socioeconomic backgrounds, how the City spearheads innovations (3 case studies) in consumer engagement, direct care access, and all payors benefit alignment to bridge service gaps and address health equity, focusing on the low income, social-economically disadvantaged, medically complex, or immigrant populations.

Mina Chang, Ph.D., Assistant Commissioner, Primary Care Access and Planning, NYC Department of Health and Mental Hygiene

2:40 PM - 3:10 PM

Integrating Innovative and Value-Based Benefit Design into a Medicaid Health Home Program

Kerda DeHaan, Management Analyst, DC Department of Health Care Finance

3:10 PM - 3:40 PM

Afternoon Refreshment Break

3:40 PM - 4:10 PM

Challenges and Opportunities of Electronic Clinical Data in Alternative Payment Models

William Golden MD MACP, Professor of Medicine and Public Health, University of Arkansas for Medical Sciences, Medical Director, Arkansas DHS/Medicaid

4:10 PM - 4:40 PM

Improving Care and Service Delivery for Dual Eligibles: Lessons Learned from the Financial Alignment Initiative and a Look at the MMACO Model

4:40 PM

Conclusion of Conference


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Medicaid Innovations Forum

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Medicaid Innovations Forum

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Medicaid Innovations Forum

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Medicaid Innovations Forum

Medicaid Innovations Forum