Conference Speaker Presentations

Tuesday, June 6, 2017

Networking Continental Breakfast

7:45 -9:15 Breakfast Workshop:

NextGen Engagement: Leveraging Artificial Intelligence and EMR Data for Innovative Engagement

The workshop will highlight the cutting edge engagement which can be done with EMR, Consumer data, Artificial Intelligence, Machine Learning and Natural Language Processing.

Paul Rosenthal, VP, Engagement Solutions,Indegene Healthcare

Tarun Mathur, Chief Technology Officer,Indegene Inc


Chairperson’s Opening Remarks

Sue Brown, Director Quality Management, Amerigroup Iowa, an Anthem Company


Upcoming Regulatory Impact on Managed Care: Understanding What is on the Horizon

Melissa Smith, Vice President,Gorman Health Group, LLC


What About the Marketplace? Impact to Medicaid Expansion Programs & Block Grants

Jeff Myers,President and CEO,Medicaid Health Plans of America


Panel Discussion: How All Sides of the Market are Preparing for Impending Regulatory Changes


Melissa Smith, Vice President,Gorman Health Group, LLC


Dr. Don Casey, Chief Clinical Affairs, Medecision

Angela Lappin,Director, Population Health,St. Luke’s Health System

Lauren K. Hampshire, RN, BSN,Director, Corporate Clinical Quality, CareSource


Networking Refreshment Break

Population Health Data Analytics: A Foundation to Capture & Deploy Usable Data

Deploying a Holistic Member Engagement Strategy

To consistently yield positive outcomes across disparate performance metrics, plans must move from silo-ed engagement approaches to a holistic, 360 approach designed to address and overcome barriers and improve outcomes.

A simple as this may sound, it requires change: changes to the types of data available for members, the approach to member interventions, and most importantly to the health plan’s philosophy and internal, departmental-level responsibility of impacting multiple outcomes.

In this session, Mr. Aminzadeh will discuss how plans have deployed a holistic member engagement approach as part of their population health strategy. This includes:

  • Understanding and predicting every facet of a member’s health experience
  • Balancing, targeting and engaging members that are at greatest risk for undesirable, disparate outcomes
  • Cross-departmental responsibilities for outcomes and execution

Saeed Aminzadeh, Chief Executive Officer,Decision Point Healthcare Solutions


Networking Lunch


Case Study:

Honorary Clinicians-- The Value of Integrating Data Experts into the Clinical Management Process

This session will include data-driven strategies to manage a Medicaid population to improve outcomes and decrease costs. Through discussion and case examples, the presentation will enable the attendee to:

  • Describe the role for analytics staff on the care team to turn data into action.

  • Understand how analysis of sub-populations can drive strategy and allocation of resources.

  • Recognize the importance of increasing the understanding of data/analytics for the clinical team.

Frances Martini, BSN, MBA,Director, Clinical Programs,BlueCare Tennessee

Charlie Steinhice,Manager of Internal Analytics and Reporting in Information Delivery,BlueCross BlueShield of Tennessee


Socioeconomic Determinants of Health: Factors to Decrease Costs and Increase Quality-adjusted Life Years

Luis Arbelaez, PhD, Senior Director, Research & Development & Analytics,Gateway Health Plans

360° Anticipation of Member Needs: Effective Behavior Analytics

Networking Refreshment Break


Digital Outreach: Achieve Rapid ROI Across Quality, Retention & BH Initiatives

Effectively engaging your member population using digital communications is not a one-size-fits-all solution. It requires tailoring, analytics and rapid optimization in order to create outreach programs that deliver outcomes. Showcasing a health plan in NY with a major Medicaid line-of-business, both HealthCrowd and health plan will share, step-by-step, how they were able to launch their enterprise digital strategy rapidly across 3 departments while generating an ROI in the first year alone. In this session we will discuss:

  • Maximizing member reach and activation for important HEDIS measures

  • Using data to remove internal compliance barriers

  • Improving premium collection rates

  • Trailblazing early efforts in BH interventions

Stephen Kindl, Director, Digital Strategy - Managed Care, HealthCrowd


Case Study : Innovations in Chronic Disease Management Analytics: Victories, Challenges, and Lessons Learned

Initial insights into an innovative analytics-based Chronic Disease Management Program for dual eligibles and Medicaid SSI beneficiaries integrating clinical practice guidelines and evidence-based medical outcomes with care management and transitions of care, pharmacy services focusing on adherence and identification of change in condition, and telehealth options for members in the home, including remote monitoring of chronic disease and video-based telemedicine visits

Linda S. Ellis, MD, MJ, MA, VP,Chief Medical Officer,iCare-Independent Care Health Plan


Understanding Key Categories of Member Risk For Effective Risk Stratification

Understanding and acting upon various risk/cost combinations within your population is critical to increasing clinical and financial success. This presentation will examine four key risk populations and discuss how organizations may apply a differentiated strategy to each subset. The key populations that will be examined include:

  • High Risk and High Cost members

  • High Risk and Moderate-Low Cost members

  • Emerging risk members

  • Members with no risk indication

Jeff Bedenbaugh,Director - Analytics, Healthcare Economics,Florida Blue


Networking Reception

Wednesday, June 7, 2017

Networking Continental Breakfast


Chairperson's Remarks

Sue Brown, Director Quality Management, Amerigroup Iowa, an Anthem Company


A Predictive Analytics Approach for Population Health Management

  • Growing Population health initiatives by payers

  • Predictive analytics

    • Reducing Inpatient admissions for Ambulatory Care Sensitive Conditions

    • Avoidable visits to the Emergency Department

  • Lesson Learned so far with Population health initiatives.

  • A Predictive Modeling Approach for Palliative Care

Puneet Budhiraja ASA MAAA, Medicare Chief Actuary, Capital District Physicians' Health Plan, Inc.

Rajesh Munjuluri ASA MAAA, Medicare Actuary,Capital District Physicians' Health Plan, Inc.

Stratifying Care Coordination & Other Interventions for Maximum Impact

An Integrated Approach to Care, Quality and Revenue Management for Medicare's Highest Risk Beneficiaries

Robb Cohen, Vice President, Government Affairs, PopHealthCare


Networking Refreshment Break


Effective Strategies For Physical And Behavioral Health Integration For Individuals In Both Primary Care And Specialty Behavioral Health

Evidence based approaches exist that effectively address physical and behavioral health challenges in both primary care and behavioral health settings. This session will review these opportunities as well as implementation and information technology requirements. The areas of focus will include:

  • Screening and treatment of behavioral health disorders in primary care
  • Strategies to engage and support individuals with serious mental illness
  • How managed care companies can effectively support the development of integrated care systems

James Schuster, MD, MBA,Chief Medical Officer, Medicaid and Behavioral Services, and VP, Behavioral Integration, UPMC Insurance Division


Going Beyond Predictive Analytics--A Person-Centered Model Of Care For Duals

  • Comprehensive look at Community Care Alliance person centered model of care for duals
  • The importance of going beyond predictive analytics to better risk stratify the dual population
  • The value of social determinants of health for risk stratification and management of the dual population

Dr. Concetta L. Zak, DNP, MBA, FNP-BC Vice President, Healthcare ManagementCommunity Care Alliance of Illinois


Conclusion of Conference