Speaker Presentation
Tuesday, May 15, 2018

Registration & Continental Breakfast


Chairperson's Welcome & Opening Remarks

Dr. Jeanne James, Chief Medical Officer,Blue Care Tennessee


Keynote Address: Impact of Population Health in a Value-based World

Rose D. Maljanian Chairman and Chief Executive Officer, HealthCAWS, Inc.,Chairman of the Board, Population Health Alliance


Panel Discussion: Regulatory & Policy Changes -- Impact on Your Population Health Initiatives

In this panel discussion, you will learn how to align your performance measures (e.g. Stars ratings), accreditation programs and access to benefits to optimize quality and manage costs in an evolving policy environment.


Rose D. Maljanian Chairman and Chief Executive Officer, HealthCAWS, Inc.,Chairman of the Board, Population Health Alliance


Helene S. Forte, RN, MS, PAHM, Vice President, Public Plans Emerging Markets, Tufts Health Plan

Dr. Jeanne James, Chief Medical Officer, Blue Care Tennessee

DaShawn Groves DrPH, MPH,, Lead Project Manager, Health Care Reform and Innovation , DC Department of Health Care Finance

Tricia Barrett Vice President, Product Design & Support,NCQA

Derdire Coleman, Management Analyst, Division of Quality and Health Outcomes, DC State Medicaid Agency, Department of Health Care Finance


Networking Refreshment Break

Organizational Building Blocks

Health Plan Medical Operations Transformation: Moving from Siloed Clinical Teams to Cross Functional, Inter-Departmental Collaborations

CareOregon is transforming how its clinical care teams engage with members by breaking down silos and working across clinical programs putting members at the center of the work. In this session, attendees will learn about how CareOregon is transforming its clinical work, the results they are seeing, and lessons learned along the way:

  • Key planning strategies used
  • Critical elements to put in place to enable collaboration
  • How to stage change to achieve desired outcomes
  • Some important lessons learned

Jonathan Weedman, Director of Population Health, CareOregon

Amy Parkhurst, Population Health Integration Manager, CareOregon


The New Medicaid Quality Ratings System (QRS): Update And Forecast

Alexander Shekhdar, Vice President of Policy, Medicaid Health Plans of America


Hidden Helpers: Supporting the Informal Caregivers Behind Our Members

Learn about the importance of caregiver support and the impact it can have on dual members. We will discuss the various stages of need and the areas of focus. Participants will also learn the critical role care managers can serve in providing support and encouragement of caregivers. After the sessions participants will be able to describe why caregiver support is becoming increasingly important. They will have an understanding of what areas to focus on. Attendees will also learn about external organizations that can provide additional information around caregiver support initiatives and learnings.

Laura Sankey, Staff Vice President Operations - Complex Care,Centene Corporation


Networking Lunch


Enabling the Data Sharing Pipeline to Drive Population Health Outcomes

How do we achieve a strong business case to compel a network partners to share data and allow meaningful improvements to population health? This session will discuss a strategic pathway to align internal resources with customer facing tools (provider and member). Key Learning Objectives:

  • Understand the landscape of data sharing opportunities
  • Leverage internal resources to support the business case
  • Integrate data needs with existing enterprise programs
  • Create a sustainable feedback loop to enrich risk stratification for intervention impact

Gabriel L. Medley, MHA, MBA Vice President, Quality and Risk Revenue, Gateway Health

Care Management

Case Study: Value-based Patient Centered Medical Home in Medicaid Managed Care

In depth discussion of implementation of value based payment patient centered medical home in a Medicaid managed care organization. Session will address key design features, quality metrics, efficiency measures and total cost of care metrics, and provider recruitment and engagement. Key features of success will be identified, and opportunities for improvement and expansion.

Dr. Jeanne James Vice President & Chief Medical Officer, BlueCare Tennessee


Networking Refreshment Break


Population Health Innovation: Optimizing Patient Engagement to Improve Health Plan Performance

This session highlights innovative approaches to improve Population Health management. From leveraging technology and automation to applying evidence-based techniques to drive behavioral change, patient engagement is key. The presentation provides insights to health plans on how their pharmacy network partners can drive quality performance and reduce healthcare costs.

Mark Gregory RPh, Director, Medication Adherence Division, Omnicell

Bjorn Thommesen, Director Strategic Accounts, Medication Adherence Division, Omnicell


Case Study: Depression Care Management Solution for Duals With Complicating Conditions

During this session we will share our approach for identifying these patients, prioritizing their care based on risk-based needs showing the analytic and actionable tools we've built to aid the care provider. We'll discuss our organizational goals and share the results we've achieved with this program.

Joseph Crimando, Population Health Solutions Manager, Kaiser Permanente Information Technology


Panel Discussion: Integrating Behavioral and Medical Care


Joseph Crimando, Population Health Solutions Manager, Kaiser Permanente Information Technology


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

Bill Jonakin, MD, Medical Director, Medicare Advantage and Risk Adjustment, St. Luke's Health Partners

Frances Martini, BSN, MBA, Vice President, Population Health, BlueCare Tennessee


Networking Reception

Wednesday, May 16, 2018

Continental Breakfast


Chairman's Remarks

Dr. Jeanne James, Chief Medical Officer, Blue Care Tennessee


Case Study: Saving Lives -- How Health Plans Can Impact the Opioid Crisis

Dependence on opioids is the primary public health challenge that we face today. Health Plans can play an important and effective role in mobilizing resources to help our members and communities address it. This presentation will highlight a comprehensive strategy created by UPMC Health Plan that includes partnerships with other community stakeholders, reductions in opioid prescribing through collaborative efforts with providers, enhancing the quality of and access to treatment resources, and approaches to enhance engagement of members and their families. It will include details about multiple programs and evaluations of efforts to date.

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


Case Study: Timely Prenatal and Postpartum Care -- Provider and Member Engagement

Analysis of improved prenatal and postpartum performance through a multidisciplinary approach. A quality examination of provider collaborations, member outreach, and incentives.

Katarina Powdrell, Senior Specialist, Quality & Population Health, Molina Healthcare of New Mexico


Population Health and Alternative Payment Applied to the Pediatric Setting

Over the past decade, owing to massive health care reform efforts, a great deal of attention has been directed towards payment models in healthcare with a focus on how financing and reimbursement may impact the delivery of care. Reforms have been proposed which seek to ensure that financial incentives are aligned ways to promote ideal care. The traditional fee-for- service (FFS) model reimburses for the volume of care and requires a great deal of effort to identify and code specific diagnoses being treated and to count specific procedures and services provided during the encounter. Alternative payment models (APM) on the other hand, seek to shift from this volume of service, or counting, approach to a reimbursement model that pays for the quality of the care delivered, so called value defined as value = quality/cost. Applying this value approach to Pediatrics requires special attention to the developmental and longitudinal aspects of child and adolescent health care. Pediatric quality and preventive measures have a different return on investment paradigm and APMs should not be limited to a benefit plan year since much of the potential benefit in Pediatrics may extend beyond that period as in as would be seen with immunizations and obesity prevention.

Angelo P. Giardino, MD, PhD, CMQ, Senior Vice President/Chief Quality Officer, Texas Children's Hospital


Networking Refreshment Break


Innovations in Primary Care: Home-Based Intervention For At-Risk Populations

Neighborhood Health Plan of Rhode Island is the largest Managed Care Organization (MCO) in Rhode Island, serving both Medicaid and Medicare populations. In 2014, Neighborhood launched an innovative program, [email protected], in which Nurse Practitioner led interdisciplinary teams provide in-home primary care for high risk, vulnerable populations. Today's presentation will cover the model of care, program operations and an evaluation of the first two program cohorts, demonstrating both short and long-term impacts in reducing rates and associated costs of Medical and Behavioral Health inpatient hospital admissions and Emergency Room visits.

Nancy Harrison RN MPH, Director of Operations and Strategy - Primary Care, Neighborhood Health Plan of Rhode Island

Michelle Bicket, Manager of Program Evaluation, Neighborhood Health Plan of Rhode Island

Member Engagement

Improving Performance Through Impactful, Holistic Member-Centric Outreaches

How can plans improve performance across multiple measures and targeting multiple outcomes without over-communicating with members? Can plans be effective in orchestrating impactful, yet efficient, member-centric outreaches spanning multiple domains?
In this session, Ms. Hurley and Mr. Aminzadeh will discuss how Harvard Pilgrim has deployed a proactive member outreach strategy by evaluating each member based on their behavioral and engagement risk, and deploying outreaches that are targeted to the member's areas of greatest need. The session will cover targeting members for selected outreaches, blending member outreaches that cover multiple domains - such as HEDIS and CAHPS - and coordinating the timing of outreaches to yield the greatest impact.

Noreen Hurley, Program Manager, Star Quality & Performance, Harvard Pilgrim Health Care

Saeed Aminzadeh, Chief Executive Officer, Decision Point Healthcare Solutions

Provider & Community Engagement

Panel Discussion: Strategies for Addressing Social Determinants of Health of Care

  • Understand the role of social determinants on health outcomes
  • Identify areas of opportunity to address social determinants as a healthcare organization and align resources within the community
  • Develop innovative solutions around food insecurity, housing and transportation
  • Measure outcomes and demonstrate positive clinical and financial impact
  • What if we could eliminate hunger and reduce the impact of chronic disease?
  • What is the impact of social determinants on the health of our patients and communities (financial and clinical)?
  • What can we as a healthcare organization do to impact SDOH?


Frances Martini, BSN, MBA, Vice President, Population Health, BlueCare Tennessee


Allison Hess, Associate Vice President, Health and Wellness, Geisinger

April Canetto, MSW, Manager, Cultural and Linguistic Services, Health Net

Catherine Macpherson, MS, RDN, Vice President Product Strategy and Development, Chief Nutrition Officer, Mom's Meals Nourish Care


Networking Lunch


CASE STUDY: Developing Innovative Care Delivery in Partnership with Communities

BlueCare Tennessee has over 20 years of managing a Medicaid population in the State of Tennessee. We are focused on enhancing our population health program to include partnerships within the community. In addition to state sponsored programs, we identified innovative approaches to transitioning services from a successful grant to a value-added service for our Medicaid population. This presentation will be a case study on our process for analyzing, planning and implementing a program for pediatric asthma and high risk OB.

Frances Martini, BSN, MBA, Vice President, Population Health, BlueCare Tennessee


Provider Incentives and Advanced Alternative Payment Models-Designing Risk Sharing Models to Attract Providers

The concept of risk is present in financial models trying to incentivize fee for value care delivery over fee for service. There are at least two problems with this. First, most clinicians are not use to thinking in terms of "financial risk." Secondly, even the term "two sided risk" is not intuitively understandable for most clinicians. This confusion prevents practices from considering participation in two sided risk models which are one of the required aspects for practices wanting to be included in advanced alternative payer models (aAPMs). Faced with uncertainty and confusion practices may opt to stay in a MIPS care category instead of the more care transformative aAPMs. Government and commercial payers need to understand this confusion and design payment models that attract practices as knowledgable participants. The financial risk sharing must have adequate guardrails such that patient outliers do not dissuade the caregivers from collaborating in innovative clinical models that have the potential of improving care to the patient and their families and doing so in a less costly manner.

Peter Aran, M.D., Chief Medical Officer, Associate Dean of Clinical Affairs, University of Oklahoma School of Community Medicine


Close of Conference