Value Visit: ACA & Government Programs

TUESDAY, FEBRUARY 28

6:00PM

Welcome Reception

WEDNESDAY, MARCH 1

8:00AM

Breakfast and Registration

9:00AM

Welcome and Introductions

9:30AM

KEYNOTE ADDRESS: How Regional Health Plans can compete differently in the ACA individual market and government-sponsored programs

10:45AM

Panel Discussion: Your Under-65 individual consumers portfolio play

11:30AM

Consumer focus: How ACA shoppers interact with a complex choice environment

12:15PM

Lunch

1:15PM

Deft Research: Putting your best foot forward with brokers and consumers

2:30PM

How to serve the whole member and meet the expectations of consumers and regulators alike

3:30PM

The great debate: The long-term viability of virtual-first product designs

6:00PM

Networking dinner hosted by the Alliance

THURSDAY, MARCH 2

8:00AM

Working Breakfast: Office hours with Alliance members and topic experts

9:30AM

Flash Case Studies: How Alliance member health plans are stretching their resources in creative ways

10:30AM

Panel Discussion: Your Over-65 individual consumers portfolio play

11:30AM

The next evolution of Stars and Shifts in the broader Quality Landscape

12:30PM

Lunch

1:30PM

Achieving Provider alignment: The challenge is real – the rewards are great

2:45PM

The CMS Scalpel is here: A deep dive into CMS’ proposed risk adjustment model for 2024

3:45PM

Panel discussion: The evolving Medicaid landscape and how states are raising the stakes for payer contractors

6:00PM

Networking dinner hosted by the Alliance

FRIDAY, MARCH 3

7:30AM

Networking breakfast

8:30AM

Motivational interviewing – Avera Health plan case study

9:30AM

Use motivational interviewing to help people change behavior and achieve their very best

11:00AM

From the trenches: Real-world efforts to engage your members and impact satisfaction

12:00PM

Adjourn

6:00PM

Welcome Reception at Mesa Mezcal at the Westin

8:00AM

Breakfast and Registration – Harmony B

9:00AM

Welcome and Introductions – Harmony A

9:30AM

KEYNOTE ADDRESS: How Regional Health Plans can compete differently in the ACA individual market and government-sponsored programs

The state of play is rapidly changing across the ACA, Medicaid, SNPs and Medicare. The individual market – particularly subsidized and government-sponsored LOBs – is a critical portfolio play for regional players. The looming end of the PHE, combined with shifting consumer sentiment and a tougher regulatory environment, are creating unique opportunities. But there is also opportunity cost: The double hitter of smart growth and risk capture looms if your strategy doesn’t line up. That’s why HPA member plans need to think differently about how we develop products, position them in our markets, and engage intentionally in member retention efforts. In this session, industry luminary Kurt Waltenbaugh invites the audience to grapple with the tough questions facing regional plans as we look down the barrel of economic upheaval, ongoing political tensions, and public health challenges directly impacting individual health care consumers.

Together, we’ll dig into:

• How regional players can finally leverage all the consumer data we’ve been collecting to drive micro-targeting efforts so we can win market share, capture risk, and deliver on high quality outcomes

• The unique value proposition HPA members offer – the promise of a differentiated customer experience with higher quality outcomes – and how we can target the populations that aren’t just shopping for price

• The ongoing conversation around health equity and how states and the federal government are incorporating mandates related to SDOH into how they define quality

• The prognosis for virtual care as a viable methodology to improve access, lower costs and improve quality. What CMS is signaling and what we’re learning from the trenches

This session will invite HPA members to think again about how they imagine individual consumers’ personas and how they craft experiences to support populations facing transitions big and small to optimize lifetime value and compete differently in a rapidly evolving playing field.

Kurt Waltenbaugh
Advisor

Unite Us

10:30AM

Break

10:45AM

Panel Discussion: Your Under-65 individual consumers portfolio play

Regional payers are considering carefully how they want to attract individual consumers under 65. Some Alliance members view the ACA as a direct feeder into their MA product and design offerings with 55 yr-old+ consumers in mind. Others think about multiple transition moments, starting with 26 yr-olds suddenly shopping for health insurance for the first time. Is it time for regional players to think differently about how they segment individual consumers and where they are investing in diversification strategies? In this session our panel of experts seek to define the right formula for building products that attract the right risk, reduce abrasion, and round out your individual portfolio strategy in the smartest way.

We’ll explore:

• Where the ACA is moving: The proposed rule to reduce the quantity of standardized plans and how to think about subsidies near and long term
• What to consider when it comes to competing On or Off exchanges: From competing with a public option to incorporating dental and vision offerings
• How to think about Association Health Plans and similar short-term offerings as part of your portfolio
• If you had a well-designed ICHRA, could you productize that and offer it as a commercial play substitute? Where ICHRAs are gaining more traction and how regional players can position themselves for success
• The ACA market’s social needs and how the end of the PHE will disrupt the care of very vulnerable cohorts. How can regional players be ready?

David Burnett

Chief Growth Officer

Neighborhood Health Plan of Rhode Island

Mark Mixer
President
Alliant Health Plans

Andrew Weintraub
VP, Sales and Retention
Health Alliance Medical Plan

Moderator:

Tricia Beckmann
Director
Faegre Drinker Consulting

11:30AM

Consumer focus: How ACA shoppers interact with a complex choice environment

Dig into the consumer behavior research in the ACA marketplace with the Margolis Center for Health Policy at Duke University. David Anderson, a Research Associate in the Health Policy Evidence Hub, walks Alliance member health plans through key findings he and his team have identified after studying millions of consumer data points. From barriers consumers experience when exploring plans online to the implications of Automatic re-enrollment and the member experience, David shares how health plans can directly impact the ACA consumer’s experience at every stage of your relationship. He also offers key considerations you and your team should stress test back home, such as unintended impacts on your population’s risk profile.

Together, we’ll:

• Understand the barriers preventing consumers from finding the best ACA plan when searching online – and your options to make an impact here

• Explore the implications of the automatic re-enrollment framework and the potential paths for insurers when it comes to plan design

• Learn how consumers respond to HDHP design and how the pace of claims adjudication directly impacts the amount of avoidable spend

• Identify the biggest moments of friction for ACA shoppers and connect the dots on how it impacts your potential risk adjustment payout

David Anderson, Research Associate, Health Policy Evidence Hub

Margolis Center for Health Policy

Duke University

12:15PM

Networking Lunch – Harmony B

1:15PM

Deft Research: Putting your best foot forward with brokers and consumers

Alliance members across the country navigate challenging terrain when it comes to articulating our value proposition. We can demonstrate that regional and provider-aligned health plans outperform national carriers when it comes to quality, and consistently our plans win prestigious customer service awards. But threading the needle with our brokers and consumers isn’t easy. Add the growing pressures of a tough economic environment with heightened price sensitivity, and we’ve got our work cut out for us. Can all the stellar work we do on the service and population health side translate well into a value proposition sales and marketing can use? In this session Deft Research offers food for thought around these key drivers and hot topics:

• Most consumers are shopping for premium, but some cohorts are looking for something different. What steps can you take to understand that cohort and meet them where they are?
• Virtual-first plan designs continue popping up. Are these viable long-term and for which consumer segment? What should you consider if you want to experiment with offering a Virtual-first plan at a lower price point and with a different value proposition?
• The enduring debate: PPO vs HMO and implicates for remote workers as well as the 65+ crowd
• Are consumers really embracing a digital mindset and how is that changing how they shop for and engage with their healthcare?

Tim Brousseau

SVP of Client Services

Deft Research

2:15PM

Break

2:30PM

How to serve the whole member and meet the expectations of consumers and regulators alike

Once again expectations for healthcare insurance are shifting. Our approach to whole person care, particularly the meaningful connection between physical and behavioral health, but with new energy around dental, vision, and hearing, is critical to our success in government subsidized and government sponsored care. We must also capture social drivers of health, understand their implications, and effect change through intelligent and coordinated interventions with CBOs and other key players in our local healthcare ecosystem. This is both a health equity mandate and an important lever that impacts costs, captures risk, and directly influences our quality scores and outcomes. (Not to mention value add benefits and services like dental and OTC are big drivers for shoppers and switchers.) In this session our expert panel explores how regional payers should think about whole person care, from the intelligence we gather to the products and services we offer, and how to make the most of our unique place in our local healthcare ecosystem.

Together we’ll examine:

• Moving from hype to hero: What programs are truly making an impact, changing behavior, and bending the cost curve?
• How do we treat the whole member as the environment and expectations are changing?
• Offering supplemental benefits is one thing… integrating utilization into a 360-degree view of the member is something else entirely.What have we learned from dental so far and what opportunities lie ahead?
• What are consumer expectations when buying and using their benefits? Where does the introduction of a supplemental benefit or value-add service introduce high risk of abrasion and how to guard against it in the execution?

Mike Adelberg

Executive Director

National Association of Dental Plans

Darin Buxbaum

CEO

Wider Circle

Tyler Cromer

Principal

ATI Advisory

Moderator:

Anna de Paula Hanika

CEO/Co-founder

Uno Health

3:30PM

The great debate: The long-term viability of virtual first product designs

The global pandemic accelerated the journey to where many healthcare experts long thought we’d be: telehealth is now an acceptable mode of care delivery. But the real question is – will telehealth move from acceptable to normalized? Or even preferred?

In this session we set aside the debate on clinical efficacy and instead focus on the following issues:

1. How likely is CMS to support the expansion of telehealth through continued reimbursement and regulatory consideration that directly impact risk capture and network adequacy requirements?
2. Consumer sentiment is difficult to measure and nuanced by segment: Is there a viable, long-term path for a virtual first plan design?
3. At a time when PSHPs want to increase the number of aligned lives with their provider owners, what role can telehealth play and how do you approach market segmentation in a way that doesn’t negatively impact your brick-and-mortar provider owners and partners?

Almost all Alliance members have had positive experiences with virtual behavioral health, particularly to meet adequacy issues. Together we’ll explore if it’s possible for regional health plans to augment their current product mix with a virtual care option while maintaining alignment with provider partners and owners and delivering a strong experience to your individual consumers.

Andrey Ostrovsky, MD, FAAP

Managing Partner

Social Innovation Ventures

Former US Medicaid Chief Medical Officer

Jordan Taggart

SVP Payer & Provider Growth

Vida Health

4:30PM

Sessions Adjourn

6:00PM

Networking Dinner at Mercy Bar & Lounge

340 W Las Colinas Blvd, Ste 200

Irving, TX 75039

8:00AM

Working Breakfast: Office hours with Alliance members and topic experts - Harmony B

At top universities and think tanks, Office Hours are when thought leaders connect meaningfully with learners and practitioners to dive deep into sticky issues and explore new possibilities. We’re kicking off day two with a robust, 90-minute session for powerful idea exchanges on critical issues affecting Alliance health plan leaders. Specific Office Hours topics will be chosen and communicated to registered attendees in advance so they can RSVP for their preferred topic. Important! Office Hours leaders will ask attendees to prepare some light pre-work to ensure the discussion is focused and impactful. We’ll keep you informed and on-task in the final weeks prior to the event.

Office hours topics include:

• Tactics that generate sales
• Where are the riches in your niches?
• Going beyond the VBC narrative: Practical learnings from supporting payers and providers in the trenches of VBC
• Choosing and assessing supplemental benefits
• Moving the needle on RA, HEDIS, and Care management
• The end of the PHE and Redetermination
• When to build vs. Buy – and maintain accountability
• Member engagement and experience

Note: All event registrants were asked to select their office hours and sign up in advance. Because seats are limited, please check in with the Alliance staff if you have not chosen an office hours session or if you are hoping to join a different session.

Office hours schedule:

• 8:00am – Breakfast buffet and get settled
• 8:15am – office hours session begins
• 9:20am – office hours adjourn

Refresh your coffee and visit the restroom before rejoining the main session before 9:30am.

Andrew Weintraub
VP, Sales and Retention
Health Alliance Medical Plans

Carrie Meyer, AuD

Director of Clinical Programs

Amplifon Hearing

Whitney Chernoff

SVP, Client Engagement

Vatica Health

Hunter Schouweiler, MS-HSM

Senior Consultant

Wakely Consulting Group

Evelyn Chojnacki

Director, Health Plan Product Strategy

Sword Health

Jordan Hersh

SVP, Channel Distribution

Valenz Health

Christian Bagge

Vice President, Member Experience & Engagement

MPulse Mobile

Kaleb Holt

Medicare Advantage Program Manager

SelectHealth

9:30AM

Flash Case Studies: How Alliance member health plans are stretching their resources in creative ways – Harmony A

In this line up of flash case studies we dig into how Alliance member plans are stretching their resources in creative ways. Operational excellence and the ability to protect innovation are both key components if you want to compete. Hear how others are approaching this challenge and walk away with fresh ideas and perspectives to fuel your brainstorming back home. Case studies may cover:

• Tools and resources that are automating plan documentation and filing
• Accounting appropriately for Quality Initiatives to ensure your MLR accurately reflects how you’re using your resources
• Smart sensemaking of aggregated data to inform highly targeted and effective sales and marketing strategies

Melinda Frometa

Manager, Product Management

Avmed

Tonia Gordon

Director, Customer Success

Simplify Healthcare

Toni Tashiro
Chief Revenue and Strategy Officer
Trusty.care

10:30AM

Panel Discussion: Your Over-65 individual consumers portfolio play

The Medicare-eligible individual consumer space remains a powerful growth opportunity for regional payers.  But competing against the national players is tough; in fact, nationally, regional players are only capturing a fraction of this market each AEP. What creative approaches and new innovations will amplify our ability to capture the hearts and minds of the Over 65 consumer? In this session our panel of experts digs into the MA landscape and plots a path forward to smart growth in this dynamic market.

We’ll explore:

• Leveraging data to make decision on which markets to pursue and what product mix to consider including
  • Exploding SNPs market! CSNPs, DSNPs, FIDE SNPs and more.Which is the right path for you? What does it take to be successful and when is the right time to add this to your portfolio?
  • Supplemental Benefits – what benefits are table stakes; which benefits may differentiate
    • The Part B buy back problem; new programs/options
  • There’s more than one way to MA: HMO vs PPO, MA vs Med Supp.Key considerations when developing your approach
• Benchmarking how the market performed in 2022 (Age-ins +AEP)
  • National Plans and Regional Plans
  • How/Which Regional Plans succeeded during 2022 including Age-ins and AEP
  • Best Practices
• Using predictive analytics to identify your best fit consumers and understand the tactics and messaging mix that will resonate with them.
  • Optimize marketing spend and sales outreach efforts, driving higher conversion at a lower cost
• Understanding your new member mix earlier and how they may impact things like Star Ratings and Risk Adjustment.

Brian Dwyer

AVP, Health Sales

Unite Us

Gabriel Ayerza

Sr. Director Medicare Strategy and Performance

Community Health Plan of Washington

Alicia Kelley

VP, Government Programs

CDPHP

Penny Ransom

Chief Administrative Officer

Network Health

Amy Sepko

Medicare Program Manager

Health New England

11:30AM

The next evolution of Stars and Shifts in the broader Quality Landscape

• Changes in the calculations, the anticipated impact and how to get ahead of it
• Moving from hype to hero: What programs are truly making an impact, changing behavior, and bending the cost curve?

• How do we treat the whole member as the environment and expectations are changing?
• What smart QI investments also keep a careful eye on the MLR?

Melissa Smith
Executive VP, Consulting & Professional Services
Healthmine

12:30PM

Lunch – Harmony B

1:30PM

Achieving Provider alignment: The challenge is real – the rewards are great

Building on the themes introduced during our opening Keynote session, our faculty digs into the unique value proposition HPA members offer: the promise of a differentiated customer experience with higher quality outcomes. Our strong relationships with our provider owners and partners provide powerful fuel to materially impact patient satisfaction, which plays a bigger role in plan assessment and is increasingly an area of focus for health equity, QHPs, Medicaid RFPs, Quality accreditation, HEDIS and Stars.

Together, we’ll unpack the following key challenges Alliance members are focusing on now:

• Threading the needle between risk adjustment, experience and VBC arrangements. No matter where you are on the continuum of VBC, continued improvement is challenging. What differentiates the high performers from the organizations still treading water?
• How to lean in on your aligned lives: From differentiated product offerings and narrow networks to concierge customer service and digital front doors
• Getting beyond reports: What sensemaking and intelligence sharing are Alliance members using to connect differently with their owners and partners?

Joe Caldwell

CFO

Denver Health Medical Plan

Amber Harris, CPC, CRC

Director, Risk Adjustment

MediGold

Mallory Sheth

Director, Strategy and Transformation

Sharp Health Plan

Moderator:

Khanh Gia Nguyen

CEO

Cozeva

2:30PM

Break

2:45PM

The CMS Scalpel is here: A deep dive into CMS’ proposed risk adjustment model for 2024

• What has CMS proposed for 2024 – which codes and HCCS have been added/deleted and why?
• Connecting the dots: now that the proposal is out, let’s trace back through the recent government reports for clues on what CMS is proposing for 2024?
• How does this proposed change align with the recent RADV final rule?
• Which plans are winners and losers in the proposed model?
• Which cohorts are winners and losers in the proposed model?
• Are particular geographies adversely impacted?
• What is the impact on downstream delegated risk providers?
• What is the long-term read-through
• Will CMS adopt this model or phase it in?

Tim Murray

Principal

Wakely Consulting Group

3:45PM

Panel discussion: The evolving Medicaid landscape and how states are raising the stakes for payer contractors

Dig into Medicaid national trends during this panel discussion, in which we translate authority needs and models into operational practicalities for payers and providers. We’ll discuss the elements more and more states are incorporating into their public health strategies and how the large payers are competing so effectively for these contracts. In addition, we dig into the six themes regional payers must infuse into their organizations’ DNA to score as well as the national payers and examine potential pitfalls when it comes to the ability to execute:

• Population health as the beating heart of your health plan
• Increased integration of payer, provider, and CBOs
• Purposeful use of technology
• Serving as the data hub for your providers, members, and CBOs
• Meaningfully incorporating behavioral health into care plans
• Driving quality outcomes with value-based purchasing approaches

Kacey B. Dugan
Director – Policy & Regulatory Affairs
Faegre Drinker Consulting

Liz Lopez Cepero
VP, Government Programs
Baylor Scott & White Health Plan

Lori A. Johnston

President

Paramount Health Plan

Moderator:

Patrick Sims, MS, CPHQ

Vice President, Growth

FoodSmart

4:45PM

Sessions adjourn

6:00PM

Networking Dinner at Hugo’s Invitados

5240 N O’Connor Blvd #160

Irving, TX 75039

7:30AM

Breakfast – Harmony B

8:30AM

Engaging members to close care gaps and capture risk

It’s not new for health plan risk, quality, and care management team members to be “working the phones,” reaching out directly to beneficiaries to encourage enrollment in chronic care management programs, or to close gaps and improve outcomes for the populations you serve. However, the results of such efforts can be discouraging. In this case study, Avera Health Plans describes how their team uses a specific communication tool called “Motivational interviewing” to make these conversations more member-centric and productive. In fact, Avera achieved a powerful $1.2M impact on their business by leveraging their trained motivational interviewers in a focused outreach campaign designed to mobilize members and capture their population’s risk completely and accurately in an incredibly tight timeline. Avera leaders share how they use 4DX principles to manage projects and focus on their wildly important goals, plus how they have leveraged their motivational interviewers over time to identify and strengthen individuals’ reasons to change behaviors.

Sara Hansen

Director of Quality & Health Management

Avera Health Plans

9:30AM

Use motivational interviewing to help people change behavior and achieve their very best

This course is a meaningful introduction to Motivational Interviewing and provides a set of tools and techniques to help providers find new ways to help people overcome barriers, make changes, and achieve their goals. This hands-on, enjoyable and 'motivating' course supports anyone who wants to use Motivational Interviewing with the members they serve, the teams they lead, and for themselves through skills building to overcome their own barriers to change and achievement. Together we examine the importance of empathy, genuineness, and unconditional positive regard and how they impact the development and achievement of goals. Motivational Interviewing is also used frequently during staff development meetings to help the individual achieve their very best and in turn, help make the company become more successful.

Together we will cover:

• What is Motivational Interviewing?

• What is behavior change and how does it happen?
• How can we help people overcome barriers to change?
• What are Motivational Interviewing strategies and how can we use them? How do we help people maintain constructive behavior change?
• How can we help people to deal with relapse?

• What is relapse and why does it happen?

Jane Riehl, LMFT, CEAP, MINTee

Motivational Interviewing Trainer

11:00AM

From the trenches: Real-world efforts to engage your members and impact satisfaction

Don’t miss the final session of our event! This dynamic discussion is a capstone spanning our agenda topics of competing differently and innovating to attract and retain consumers. We will feature the freshly published Healthcare Consumer Experience Index, the second bi-annual national signature research study commissioned by Change Healthcare and fielded by the Harris Poll. Empowered by healthcare consumer empathy, Alliance Member’s strategic priorities can be accelerated with an eye on impacting Stars, CAHPS, retention and referral rates. You’ll walk away with fresh perspectives, backed by data, to fuel your team’s efforts to move the needle on these difficult measures.

• Alliance Members will be among the first to know:
• The “effort index” consumers perceive across the 29 tasks of finding, accessing, and paying for healthcare
• The impact that effort has on consumer behavior
• Meaningful shifts from 2020 to 2022
• The moments of friction Alliance members can best differentiate upon

Keith Roberts

Consumerism Practice Director
Change Healthcare

12:00PM

Meeting Adjourns