Registration and Continental Breakfast

Sponsored by:

Keynote Presentation
Strategies for Medicaid at the Federal and State Level: Insights from the President of MHPA

    • The overall direction of Medicaid and Medicaid Managed Care
    • Accountable Care Organizations
    • Serving dual eligibles
    • Forecast for growth

Thomas L. Johnson, President and CEO, Medicaid Health Plans of America, Washington, DC

Panel Discussion

Supporting the Patient Centered Medical Home in Medicaid

    • Understanding the principles of the Patient Centered Medical Home
    • Developing and implementing a Patient Centered Medical Home
    • Current outcomes supporting the value of the Patient Centered Medical Home
    • Changes in the health care delivery system to support the
       Patient Centered Medical Home
    • Payment methodology
    • Developing standards, outcomes and evaluation
    • Partnering with multiple states to establish Patient Centered Medical Homes
      to improve quality and reduce costs in Medicaid

Moderator:
Janet Parenteau, Business Solutions Director, Care Management, DST Health Solutions, Pennsylvania  

Panelists:
Debra Smyers, Senior Director, Program Development, Medicaid/SNP/CHIP, UPMC Health Plan, Pennsylvania
Michael Richards, Executive Director, Government Relations and External Affairs, Gundersen Lutheran Health System, Wisconsin  

Margaret Brockman, RN- Program Specialist Physician Services, State of Nebraska

Case Study:  The State Perspective on Promoting Healthier Outcomes
Leveraging Partnerships with Key Stakeholders to Improve Birth Outcomes in South Carolina

    • What are the primary goals and workgroup structure of SCBOI?
    • How were interventions implemented statewide through a large group of public
      and private stakeholders?
    • What obstacles/barriers have been indentified since inception of SCBOI to
       achieving our goals?
    • What fiscal impact do we expect from effectively integrating the BOI model?

M. Melanie "Bz" Giese, RN, Deputy Director, Medical and Managed Care Services, South Carolina Department of Health and Human Services

Morning Refreshment Break

Case Study: The Plan Perspective on Promoting Healthier Outcomes
Partnering with Community Organizations to Administer a Health Education Program Focusing on Obesity Prevention

The problem of childhood obesity in the United States has grown considerably in recent years. According to the American Academy of Child and Adolescent Psychiatry, between 16 and 33 percent of children and adolescents are obese. Factors contributing to this epidemic include improper nutrition, physical inactivity, genetics and lifestyle.

AmeriHealth Mercy Health Plan created the "Healthy You, Healthy Me" childhood obesity initiative. The program was designed to help youth, their parents and caregivers in both home and community settings.

AmeriHealth Mercy Community Outreach Department partners with community organizations to administer this health education program focusing on obesity prevention.
The Healthy You, Healthy Me program has specific goals for children that include:

    • Increasing physical activity
    • Improving nutrition through smart snacking
    • Increased consumption of fruits and vegetables
    • Increased healthy lifestyle awareness
    • Reduction of Body Mass Index (BMI)

Robert Cooper, Manager, Community Affairs, AmeriHealth Mercy Health Plan, Pennsylvania

Getting Ready for Health Insurance Exchanges: A Roadmap for 2014

Moderator:
Clint Fuhrman, Director Government Healthcare Programs, Lexis Nexis Risk Solutions, Florida

Panelists:
Stephanie Sullivan Chrobak, Director of Commonwealth Care Program, Commonwealth Health Insurance Connector Authority (Health Connector), Massachusetts
Robert M. Damler, FSA, MAAA and Consulting Actuary, Milliman, Indiana
Patty Conner, Director, Utah Health Exchange, Governor's Office of Economic Development, State of Utah

Luncheon

Sponsored by:

Systems for Eligibility Determination:  How to Get 30 Million New Enrollees as Defined by the HITECH Portion of the Affordable Care Act

This session will discuss how to develop eligibility determination systems that are built for current and future needs, focusing on:

    • Reducing redundant data entry across all eligibility programs and benefit programs
    • Decreasing processing time for changes and redeterminations
    • Minimizing the need for technical assistance when creating and deploying
      eligibility rules
    • Raising eligibility worker productivity
    • Lowering participants' reliance on face-to-face agency contact
    • Giving convenient access to policy and procedural guides
    • Improving the customer experience and increases customer satisfaction
    • Simplifying the overall eligibility determination processes

Thomas Derrick, President, MariChris, LLC, Florida

Strategies for Balancing Ease of Enrollment with Fraud Prevention

    • Why is it important to build your provider network with fraud prevention controls
       in place? (briefly discuss fraud stats, describe a few fraud schemes that prey on
       poor enrollment controls)
    • Strategies for addressing CMS 6028 rule changes in your enrollment processes.
      (how to handle non-participating providers, medical residents/interns, enrollment fees)
    • Why should non-Medicare/Medicaid insurers care about the CMS 6028 rules?
    • Strategies for minimizing the impact of fraud controls on your enrolling providers

Moderator:
Richard Yadon, President and CEO, Managed Medicaid Services

Panelists:
Robin Raveendran, Chief Program Administrator, Arkansas Department of Human Services Division of Medical Services - Program Integrity Unit
Bill Clark, Director, Provider and Member Relations,
Department of Vermont Health Access
Julio Arias, Vice President for Operations, Health Integrity, LLC

Business Development Innovations to Expand the Product Portfolio

    • How to expand and diversify your product portfolio when all you know is Medicaid
    • Exploring the Build/Buy decisions and opportunities
    • Identifying and overcoming organizational challenges
    • Applying lessons learned from commercial insurers to Medicaid MCOs
    • Launching a commercial product line and working with an Exchange

Scott Polansky, Chief of Business Development, BMC HealthNet Plan, Massachusetts

Successfully Managing Projects in the Health Reform Vortex

David C. Kumpf, PMP, President and CEO, Optimetra, Inc., Colorado

Afternoon Refreshment Break

Sponsored by:

Home and Community Based Service Waivers: Maximizing Benefits for States and Plans

States continue to move traditional Fee for Service populations and benefits into managed care arrangements. As states are contemplating adding HCBS Waivers, health plans need to think about how they will gear up to incorporate these benefits. We will discuss Waiver types, managed care contracting, care coordination, assessment, care plan development and HCBS network development. The session will primarily focus on HCBS Waivers for elderly members.

Beth Nelson, Medicaid Development Director, ClearStone Solutions, Minnesota

Moving the TPL Model From Pay and Chase to Cost Avoidance

Jeff Gottlieb, Director, Special Projects, SXC Health Solutions, Illinois

Cocktail Reception

Continental Breakfast

Sponsored by:

The Changing Face of Medicaid: A Profile of the 2014 Medicaid Population and Interventions that Work

Genesee Health Plan (GHP) is a community-based non-profit that provides primary care & other basic services to 27,000 low-income, uninsured adults in Genesee County, Michigan, one of the most economically depressed areas of the U.S. The Genesee Health Plan is the only local one in Michigan that is funded directly by the community through a special millage. The plan reduced its enrollee’s’ use of emergency department services by 51% and hospital admissions by 15% between 2006-2007. The success of the Genesee Health Plan has demonstrated that any community–even one with scare resources–can provide basic, affordable health services to uninsured adults.

    • A demographic and medical profile of the uninsured population eligible for
      Medicaid post reform
    • An analysis of mental health and substance abuse service needs
    • Interventions that work to reduce emergency room inpatient and improved
      healthy behaviors
    • Ongoing safety-net needs

Linda Hamacher, President & CEO, Genesee Health Plan of Michigan
Senior Consultant, Health Management Associates, Michigan

Dual Eligibles: Opportunities and Challenges for Managed Medicaid Plans

    • Review of current federal and state initiatives to facilitate integration of care
      and financing for dual eligibles
    • What does the dual eligible population look like?
    • What will managed Medicaid plans need to consider in pursing state contracts
      for these populations
    • Lessons learned from states with dual and managed LTC programs

Holly Michaels Fisher, Vice President, Government Program Management and Strategy, OptumInsight, Minnesota
Dr. Scott Howell, National Senior Medical Director for the Clinical Performance and Compliance, OptumInsight, Minnesota

Case Study
State Leadership in Health Transformation:  The Ohio Example

This session will look at the role of states in providing leadership to improve overall health system performance. What do high-performers have in common -- and what do low performers lack? Using Ohio's recent successes as an example, we will discuss how states can:

    • Get organized to meet the complex demands of health transformation
    • Align problems, policies, and politics to improve health outcomes while also
      containing costs
    • Modernize Medicaid by establishing a single point of coordination for the
      most at-risk populations
    • Streamline health and human services programs, systems, and governance
    • Engage private sector partners to improve overall health system performance
      by leveraging purchasing power to standardize and publicly report performance
      measures, and reform the health care delivery payment system

Greg Moody, Director, Governor’s Office of Health Transformation, State of Ohio

Marketing Survival Course: A Primer on How to Prepare and Compete in 2014 and Beyond

With the anticipated policy changes, lawsuits, Supreme Court review and confusion related to various provisions of the “Affordable Care Act” it’s not too early to begin preparing for the massive influx of new Medicaid members beginning in 2014.

    • Is your Brand ready for prime time?
    • Are you ready for a new kind of member?
    • Do you have the right marketing mix to reach the new member?
    • How do you find the right agency partner to capitalize on this historic opportunity?

Garry Raim, Partner, EVP of Direct and Interactive Marketing, GKV, Maryland
Kevin Kempske, Partner, EVP, Public Relations and Grassroots Outreach, GKV, Maryland

Morning Refreshment Break

Maximizing Care Management Opportunities for High Utilizers

    • Developing innovative ways to case manage the Medicaid population across the
      age span, condition mix, and care continuum
    • Implementing an intensive community based case management model for
      complex/high risk membership
    • Changing care transitions activities to the fullest outreach activities: is there an
      impact? A look at the results.
    • High risk prenatal care and care management impact
    • Physical and behavioral integration across the care continuum
    • Integration of HEDIS engagement activities across the care management continuum

Pamela Tropiano, RN, CCM, BSN, MPA, Senior Vice President, Health Services, CareSource, Maryland
Cheryl Slagle, RN, CMCN, CCM, Vice President, Health Services, CareSource, Maryland

Utilizing Mobile Messaging to Cost Effectively Connect with Members

Technological advances in mobile messaging provide a low cost option for health plans to connect with members, which generally increases overall member satisfaction. This session will focus on:

    • Learning the increased member retention based on increased engagement
    • Evaluating different uses for mobile messaging, including recertification,
      appointment reminders, and flu shot reminders
    • Analyzing the cost-saving benefits of utilizing mobile messaging

Tammy Johnston, Relationship Manager, Assurance Wireless

Access to Care:  Balancing the Challenge Created by the Surge of Medicaid Beneficiaries with Diminishing Provider Acceptance

    • Creating partnerships through communications
    • Work your plan-Plan your work
    • Strengthen your Payor/Provider relationships by developing a VIP program
    • Know your health plan’s strengths

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

Luncheon

Ensuring Financial Sustainability in an Era of Revenue Compression

State budget challenges including a weak economy, revenue deficits, the loss of Federal funds and expanding coverage for an increasing number of new beneficiaries are among the many factors challenging Medicaid plans today. This session will focus on:

    • Living with the factors you can’t change/influence
    • Leveraging your strengths
    • Strategies for success, including:
          • Concentrating on effective programs to reduce health care cost trends and
            absolute expenditures
          • Identifying administrative cost reduction/improved efficiency opportunities

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

Case Study
The Blue Button of Medicaid: Consumer Engagement

Karen Parker, Director, Bureau of Medicaid Financial Management and Administrative Services, State of Michigan

Harnessing Social Media and Marketing and Other Innovations to Affect Behavioral Modifications

Can a social media intervention empower adolescents aged 13-17 to better utilize their health insurance benefits? While 88% of California teens have health insurance, research suggests teens don’t make full use of their benefits. The T2X project, funded by a National Institutes of Health (NIH) research grant, attempts to answer this question by testing whether an intervention using bean online social network can increase low-income teens' capacity to access and use their insurance, become more engaged in their health care and health behavior decisions, and develop pro-health attitudes. 

    • Creating a website that offers a teen-only community of users, with teen
      and professionally produced content, competitions, games, quizzes, blogs, video
      sharing and other interactive and participatory communication methods
    • Addressing lifestyle issues for teens to help them live life to the fullest and accomplish
      their goals, including how to access their health benefits to accomplish this
    • Establishing a framework for the intervention with social, theme and domain activities
    • Evaluating success based on pre- and post- questionnaires and control groups
    • Linking social network usage with actual healthcare utilization records and self-report
      questionnaires to assess changes in healthcare utilization patterns, understanding of
      health insurance benefits, rights and responsibilities, primary care provider encounters,
      health-information seeking, attitudes, and health behaviors

As health insurance coverage becomes more prevalent, we need to find ways to help people access and utilize their benefits most effectively to positively impact their health. Because social media is gaining such widespread adoption, it holds great promise for influencing health-related behaviors among populations that use it most.

Hoa Su, Manager, Health Education, Health Net, Inc., California

Conclusion of Conference