2019 Agenda

October 23, 2019

12:00 PM - 1:00 PM
Workshop Registration & Pre-Conference Registration

1:00 PM - 4:00 PM

Workshop: Navigate the Member Experience from the HEDIS & Quality Improvement Lens

New for this year, please join RISE for an interactive workshop designed to guide health plans on enhancing the member experience to drive HEDIS efforts. As CMS is shifting to weighed scores, member experience is more critical to quality scores than ever before. Led by an expert in the quality space, this workshop arms health plans with strategies to better member outreach, intervention, and impact cost / quality. 


Seats are limited – register today! Takeaways include:  

  • Learn to use member feedback to develop more effective policies, processes and customer service initiatives 
  • Examine approaches to coordinated outreach and discuss the impacts from a process and patient experience perspective  
  • Look beyond CAHPS survey scores and more broadly at interventions - including assessing barriers in SDoH   
  • Discuss the most appropriate way to engage providers and co-own member satisfaction initiatives  



Karen W. Connolly, RN, Senior VP/Quality Improvement and Accreditation Services 
HealthSun Health Plans, Inc.

October 24, 2019

8:00 AM - 9:00 AM
Registration and Networking Breakfast

9:00 AM - 10:10 AM

Welcome Remarks

Jennifer Pereur, Vice President of Solutions

9:10 AM - 10:10 AM

KEYNOTE: Coloring Outside the Lines - Creating a NEW Customer Experience in Healthcare

  • Disrupt the status quo – hear tactics, tools and techniques on customer engagement from an out-of-industry expert  
  • Distinguish between customer service vs. customer experience to better inform your member engagement strategy  
  • Discover new ways to navigate customer touch points from best practices in other industries and gain a new perspective on member engagement and coordinating outreach both internally and externally  


Jeff Tobe, M.Ed, CSP, Customer Experience Expert and Author
“Coloring Outside of the Lines”

10:10 AM - 10:55 AM

Featured Plenary Talk: Innovative Care Management Models with Payers & Providers

  • Hear a high-level perspective on provider engagement correlating to closing gaps in quality care measures  
  • Gain a big picture on value-bare care, homing in on the nuances that incentivize and/or demotivate providers to engage in HEDIS programs – and how to overcome that  
  • Examine the Aetna joint venture model with case specific examples around provider engagement and the impact on HEDIS scores  

Sunil Budhrani, MD, MPH, MBA, Chief Executive Officer and Chief Medical Officer
Innovation Health

Jessica Miller, Medical Economics Manager
Innovation Health


10:55 AM - 11:15 AM
Networking Break

11:15 AM - 12:00 PM

The 30,000 Foot View: What Value-Based Care Means for the Future of Quality

  • Take a step back - discuss the current state and future implications of value-based care on healthcare quality and how HEDIS fits into the bigger picture  
  • Explore the best strategies for closing gaps in a world of value-based care   
  • Discuss what it takes to play the long game in value-based care arrangements – keys to a holistic approach between payers / providers    

Josh Hetler, Vice President of Customer Success 
Datalink Software 

Dave Meyer, Vice President of STARS

12:00 PM - 12:45 PM

Maturing Quality Approach - Exploring Synergies between Value and HEDIS

  • Understand the paradigm shift in HEDIS – From Prospective data collection to proactive health management 
  • Learn about the strategies that are important not just for the maturity of your HEDIS program but also for your health plan’s ongoing business growth
  • Explore how the current HEDIS landscape drives quality improvement and explores synergies between Value and HEDIS

Jeffrey Springer, Senior Vice President of Healthcare Solutions  
Citius Tech  

Kishore Huilgol, Senior Manager, IT
Florida Blue


12:45 PM- 1:45 PM
Networking Lunch

1:45 PM - 2:30 PM

Panel: How Payers can Partner with Providers to Boost HEDIS Scores through Engagement Rather than Burnout

  • Join a candid, multi-stakeholder discussion outlining challenges, concerns and potential solutions for payer / provider collaboration in HEDIS care management 
  • Dig deep into the key issues surrounding successful payer / provider collaboration including aligning incentives, office staff engagement and addressing “burnout”   
  • Hear it straight from providers – what’s needed to address misalignment and ultimately, increase member satisfaction    


Ryan Dodson, CRC, Principal
Dodson Consulting

Jatin Dave, Chief Medical Officer
New England Quality Care Alliance

Mark Wendling MD, Executive Director
Valley Preferred/Lehigh Valley Physician Hospital Organization

Adele L. Towers, MD MPH FACP, Director of Risk Adjustment
UPMC Enterprises


2:30 PM - 3:15 PM

Case Study: Integrating HEDIS/Stars with Risk Adjustment to Minimize Provider and Member Engagement

  • Hear a case example of merging HEDIS and Risk Adjustment initiatives at Blue Cross Blue Shield Louisiana  
  • Discuss creating internal buy-in, governance and accountability, analytics, and implementation perspective needed to take on this effort  
  • Gain insight from challenges and lessons learned that you can implement within your organization 


Benjamin Vicidomina, Vice President Analytics and Quality Improvement 
Blue Cross Blue Shield Louisiana 

Charles Folk-Cruthirds, Manager of Analytics  
Blue Cross Blue Shield Louisiana 

3:15 PM - 3:40 PM
Networking Break

3:40 PM - 4:30 PM

Panel: Payer Perspectives on Closing Gaps in Care to Increase HEDIS / Star Measures

  • Hear a variety of health plans’ perspectives on achieving high performance scores on each of their CMS & HEDIS measured areas in today's hyper-competitive market 
  • Examine HEDIS-related measures including member engagement, CAHPS & programs and in turn, identify areas of improvement for your own organization   
  • Discuss internal structures, and approached to coordinated outreach / data collection that have a clear correlation to HEDIS / Star measures  

Daniel Weaver, Vice President of Stars, Quality and Risk Adjustment
Gateway Health Plan


Karen W. Connolly, RN, Senior VP/Quality Improvement and Accreditation Services 
HealthSun Health Plans, Inc.

Erik Baldwin, Director of PA Pay for Value
Gateway Health Plan


4:30 PM - 4:45 PM
Closing Remarks

Jennifer Pereur, Vice President of Solutions

4:45 PM - 5:45PM
Networking Cocktail Reception

October 25, 2019

8:00 AM - 9:00 AM
Networking Breakfast

9:00 AM - 9:10 AM

Opening Remarks

Jennifer Pereur, Vice President of Solutions

9:10 AM - 10:00 AM

Panel: Keys to Optimizing HEDIS and Quality Across All Lines of Business - Medicare, Medicaid and Commercial

  • Hear expert perspectives and strategies on HEDIS & quality alignment across all lines of business 
  • Gain insights on harmonizing measures across all products, including a “performance network” case example  
  • Discuss how to close gaps from members that were commercial and are now aging in, touching on the agent process 
  • Consider new ways to shift the focus on quality of care and onboarding of new members into HEDIS care management  



Daniel Weaver, Vice President of Stars, Quality and Risk Adjustment
Gateway Health Plan


Creagh Milford, DO, MPH, Chief Medical Officer
Healthcare Highways, Inc.

Erik Baldwin, Director of PA Pay for Value
Gateway Health Plan

Anthony Davis, Senior Director, Quality, Regulatory, and Strategy Innovations
UPMC Health Plan

10:00 AM - 10:45 AM

Fireside Chat: Insights into the Future for HEDIS®  

  • Hear an on NCQA's strategic direction for the future of HEDIS and the impact for payers in 2020 
  • Discuss current hot topics, including the move towards transitions of care, electronic measures and more  
  • Hear an update on NCQA's efforts to optimize data collection (i.e measuring data sources that health plans already have access to and supporting exchange with providers such as DaVinci DEQM) 
  • Get a recap of NCQA's 2019 Digital Quality Summit 

Jennifer Pereur, Vice President of Solutions

Benjamin N. Hamlin, MPH, Senior Research Informaticist
National Committee for Quality Assurance (NCQA)®


10:45 - 11:00 AM
Networking Break

11:00 AM - 11:45 AM

Case Study: Year-Round Approach to HEDIS Data Collection

  • Hear about a new strategy at AmeriHealth Caritas for year-round data collection which supports the hybrid season through the NCQA process  
  • Get the know-how to apply the right pressure points at the right time of year and balance the data collection to get access to medical records without over burdening providers  
  • Discuss year-round data collection from the chart review perspective and learn how to make this a year-round process that’s financially feasible  

Vandna Pandita, Vice President of HEDIS Strategy 
AmeriHealth Caritas 

11:45 AM - 12:30 PM

Case Study: Optimizing HEDIS and Quality Through Cross-Departmental Collaboration – From the Case Management & Quality Lens

  • Hear lessons learned from a cross-collaboration at AvMed, designed around high-risk members, between case management and quality with outcomes   
  • Gain insights into the day-to-day workflow and ways that this collaboration helped to close gaps in care  
  • Discuss the effects of this collaboration on member experience, HEDIS scores and revenue generation – and take away lessons learned for your own organization  

Cynthia Weiss, Director of Quality, Accreditation and Wellness

Susan Bearden, BS, RN, AC, CCM, Director of Case Management

12:30 PM - 1:30 PM
Networking Lunch

Partake in an intimate Q&A with Ben Hamlin of the NCQA® from 12:45PM to 1:30PM. Space is limited to 8 to 10 attendees - sign up onsite!

1:30 PM - 2:15 PM

Case Study: First-Hand Research on Member Engagement – A Look into the Secret Shopper Pilot at BCBS

  • Hear how BCBS of NJ initiated, executed and learned from a secret shopper pilot and the takeaways from a quality lens  
  • Gain lessons learned around engagement – with both members and providers – and how those activities coincide with closing gaps in care 
  • Discuss the impact of member engagement activities on HEDIS scores and examine opportunities for increased member engagement within your organization  

Steven R. Peskin, MD, MBA, FACP, Executive Medical Director of Population Health  
Horizon BCBSNJ  

2:15 PM - 3:00 PM

Panel: Examining the Digitization of Quality Measures and Thoughts for 2020

  • Hear from experts on the technical aspects and “digitization” of HEDIS measures, including insights on data collection, analytics, electronic quality, how plans are working with health information exchanges and everything in between    
  • Discuss the move to ECDS reporting and the move to real time data – challenges, early lessons learned and opportunities to optimize data collection 
  • Examine the process aspects of data mining, ways to become more efficient and ultimately the implications for HEDIS scores / Star ratings   


Adele L. Towers, MD MPH FACP, Director of Risk Adjustment
UPMC Enterprises 


Anthony Davis, Senior Director, Quality, Regulatory, and Strategy Innovations
UPMC Health Plan

Daniel Weaver, Vice President of Stars, Quality and Risk Adjustment
Gateway Health Plan

Vandna Pandita, Vice President of HEDIS Strategy
AmeriHealth Caritas


3:00 PM - 3:10 PM

Closing Session

Jennifer Pereur, Vice President of Solutions