Rise

Chairperson Welcome Remarks

Shannon Decker, Vice President of Clinical Performance
Brown & Toland Physicians

Pre-Conference Workshop: Examine the Critical Connections Between Product Design, Quality Measures, and Risk Adjustment

• Comprehend the importance of member engagement, social influence, and member satisfaction in relation to product design and improving quality measures
• Assess how to improve your current operations to abide by new CMS guidelines related to Stars ratings, specifically in a virtual environment, including CMS’s shift away from clinical outcomes as a main criterion
• Identify the impact of CMS’s hold on Stars data and utilizing last year’s data on your plans revenue
• Calculate how behavioral health during time of isolation can impact member health, satisfaction, and quality measures and how to overcome this issue
• Examine how risk adjustment coding will change due to the necessity for the majority of member interactions being virtual
• Discuss new CMS guidelines on virtual healthcare and supplemental benefits and how they could manipulate your future product offerings
• Interpret the impact of SDoH on quality measures and how they will be determined

Shannon Decker, Vice President of Clinical Performance
Brown & Toland Physicians

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

Session Transition

Chairperson Welcome Remarks

Shannon Decker, Vice President of Clinical Performance
Brown & Toland Physicians

Deep Dive into CMS CY 2021 Final Rule for Part C and Part D

• Discuss CMS Policy regulation revisions related in response to COVID-19 and how it can a catalyst for future changes to MA
• Examine changes to Stars, HEDIS, CAHPs and HOS regulations that may influence product design
• Analyze relaxed regulations for providing hospital services outside of the hospital itself and adaptations to the CMS requirements for telehealth
• Evaluate the likely impact of the CY 2021 and 2022 MA and Part D Proposed Rule on product design and member benefits
• Assess potential influence of 2021 MA Capitation Rates and Part C and Part D Payment Policies

Hank Osowski, Managing Partner
Strategic Health Group

Session Transition

Star Ratings Considerations for Plan Design

• Get Star Rating updates from the interim final rule 
• Understand the quality measures that impact a contract’s Star Rating 
• Leverage benefit design to improve challenging Stars measures
• Maximize provider engagement to improve measure performance

Rex Wallace, Founder and Principal 
Rex Wallace Consulting

Lunch

Panel Discussion: The Impact of COVID-19- Adaptation of Product Design

• Examine the changes in delivery of healthcare that need to be accounted for in future product design
• Re-imagine the way that you market to members, and service your current members in this new era with remote monitoring and virtual healthcare
• Assess how others have adapted successfully to borrow from their success and remain competitive within your market
• Overcome fear of change with your members and providers by implementing support and education exercises

Ryan Conran, Associate Director of Insurance Product, Medicare Advantage
Oscar

Jamie Benedict, Chief Strategic Growth Officer
MediGold

Session Transition

Differentiate your Organization Through Advanced Supplemental Benefit Selection

• Utilize data and trends to identify what your benefits are mast valuable to your membership and potential members
• Calculate what zero-dollar co pay offerings will increase enrollment and identify what competitor plans are offering to stay ahead of the game
• Tailor your benefits to meet the needs of low-income membership to improve healthcare outcomes and reduce cost of care

Danica Holliston, Medicare Product Manager
Regence BCBS

Ryan Davis, PAHM Manager, Pharmacy Medicare Programs
Kaiser Health Plan

Session Transition

Strategies to Maximize Flexible Benefits while Targeting the Right Customers with the Most Relevant Benefits

• Customizeand optimize SDoH benefits based on certain member population needs to improve healthcare outcomes 
• Analyze the impact of the benefits offered to drive shopping decisions
• Gather feedback from membership on what the most essential benefits are to them to improve product offering for future years

Paul Cain, Senior Advisor Medicare Advantage
Cigna

Chairperson Closing Remarks

Shannon Decker, Vice President of Clinical Performance
Brown & Toland Physicians