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May 20
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Showing of Streams
5:00pm - 6:00pm

Evening Cocktail Reception

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9:15am - 10:00am 45 mins
Plenary Sessions
The Current Managed Care Landscape Nationwide
  • Alexander Shekhdar - Principal, Sycamore Creek Healthcare Advisors
  • Ari Gottlieb - Principal, A2 Strategy Group
10:00am - 10:45am 45 mins
Plenary Sessions
Payer and Provider Transformation: a Deep Dive into Innovative and Evidence-Based Frameworks incorporating the Patient Voice
  • Moderator Christine McSherry - Executive Director, Co-Founder, Jett Foundation
  • Panelist Larry Bauer - Sr. Regulatory Drug Expert, Hyman, Phelps, & McNamara, P.C.
  • Panelist Tracy Wall, R.N., M.S.N. - Director of Patient Advocacy and Innovative Partnerships, Stealth BioTherapeutics
10:45am - 11:15am 30 mins
Plenary Sessions
Networking Break
11:15am - 12:00pm 45 mins
Plenary Sessions
Best Practices for Fraud, Waste & Abuse in Medicaid Managed Care
  • Richard Munson - Vice President, Investigations, UnitedHealthcare
  • Louis Saccoccio - CEO, National Health Care Anti-Fraud Association
  • Gary Cantrell - Deputy Inspector General, Office of Investigations, Department of Health and Human Services
  • Kelly Bennett - Office of Medicaid Program Integrity, Division of Health Quality Assurance, Agency for Health Care Administration
12:00pm - 12:45pm 45 mins
Plenary Sessions
Addressing Challenges for Medicaid Health Plans
  • Clay Farris - Senior Healthcare Executive, Mostly Medicaid
12:45pm - 1:40pm 55 mins
Plenary Sessions
Lunch
1:40pm - 1:45pm 5 mins
Specialty Populations and Programs
Chairperson's Remarks
  • Jenn McNary - Advocacy and Outreach Director, Beauhawks
1:40pm - 1:45pm 5 mins
Innovation & Technology in Managed Care
Chairperson's Remarks
  • Jon Hamdorf - Director, Navigant Consulting and Former Kansas Medicaid Director, Navigant Consulting and Former Kansas Medicaid Director
1:45pm - 2:30pm 45 mins
Info
Specialty Populations and Programs
An Integrated Health Care Delivery System: A Texas Children’s Health Plan Experience with Complex Children
  • Diane Scardino - Vice President, Texas Children's Health Plan

STAR Kids is a Medicaid-managed care plan for children and young adults with disabilities that was created in 2014. These children are more likely to use multiple healthcare services, encounter barriers to healthcare, larger out-of-pocket costs, and poor health outcomes with frequent hospital admissions. The Medically Dependent Children Program (MDCP) is a home and community based services program for a subset of STAR Kids determined to be the most fragile and vulnerable. With their extensive healthcare costs, children with disabilities account for one-third of the overall healthcare expenditures in the US. The purpose of this abstract is to describe our success with this complex population using an Integrated Delivery System to provide care in the most clinically appropriate, cost-effective setting. Methods The Texas Children Health Plan (TCHP), a Medicaid managed care organization in Houston, Texas, started serving members of STAR Kids in 2016. The health plan serves 16% and 20% of the STAR Kids and MDCP population in Texas, respectively. TCHP partnered with children’s hospitals, network providers, and regional community services in Texas, to ensure minimal disruption of treatment. Many of these members receive the majority of the care at TCHP’s affiliated institution, further enhancing integration. In addition, home and telephonic visits with Service Coordinators to assess needs, develop individual care plans, manage inpatient to home transitions, and connect member to services/providers were regularly scheduled. Furthermore, proactive care management by annual member reassessments and daily coordination calls for timely information and seamless handoffs was employed. A specialized team that is fully dedicated for MDCP members was also established. Retained members between 2016 and 2018 were included in this analysis. Results The TCHP serves 26,036 STAR Kids and 1,042 MDCP members. To provide adequate personal care services and private duty nursing, the TCHP invested 13% and 117% above reported historic expenses for those services, for STAR Kids and MDCP respectively. By 2018, an overall cost of care savings of 3.4% were demonstrated for STAR Kids members accompanied by 6% decrease in hospital admissions. While cost savings are yet to be seen in MDCP, better health outcomes evident by 15% drop in hospital admissions were achieved. Finally, 61% STAR Kids and 80% MDCP member retention rates since the inception of the program in 2016 were reported. Conclusion STAR Kids, and MDCP in particular, pose a significant challenge to the healthcare system due to their complex medical needs and large expenses. In only two years, our comprehensive collaborative approach demonstrated decreased hospital admissions, improved health outcomes and quality of care, and eventual decrease in cost of care. It is our belief that even the most vulnerable population can be managed with an Integrated Delivery System that is able to address patient specific needs holistically at an individual level rather than a population level. Financial Disclosure: None of the authors has a financial interest in any of the products mentioned in this article.

1:45pm - 2:30pm 45 mins
Info
Innovation & Technology in Managed Care
Person-Centered Digital Family Engagement in Foster Care Services
  • Rini Gahir - Co-founder and CBDO, Mozzaz Corporation

Every year, over 20,000 youth age out of foster care, entering adulthood without the support most teens receive from family and friends. At one of the most critical junctures of their lives, the support systems these youth have come to rely on abruptly disappear, leaving them unprepared to adapt to the demands of daily life. Youth aging out of the foster care system are extremely vulnerable, often facing futures of homelessness, incarceration and poverty with enormous societal costs over their lifetimes. Youth Villages, based in Memphis TN, is a leader in the field of children’s mental and behavioral health with programs and services across the country. In this session, learn how Youth Villages (YV) and Mozzaz have collaborated to provide a digital engagement solution that provides enhanced support for young adults before and after discharge. Young adults have access to a smartphone app that offers supportive resources, regular check-ins, instant messaging and calling capabilities with their YV care team, as well as customized schedules and alerts. Through the platform, YV can gather post discharge data to track program outcomes and intervene when required. In the therapeutic Foster Care program, prospective foster care parents are using this innovative digital health tool to help obtain certification through training and tracking resources. Using the Mozzaz platform, active TFC parents have 24/7 access to content to support and maintain our youth in their homes, including digital tools that facilitate Collaborative Problem Solving. 1. Learn about the effectiveness of incorporating digital strategies for treatment programs, outreach and follow-up services as a way to "extend" care. 2. Learn how organization change was managed from top-down to implement a new digital model into core service lines. 3. Learn through a demonstration of the solution best practices and engagement techniques used in the design and development of the solution.

2:30pm - 3:15pm 45 mins
Info
Specialty Populations and Programs
Critical Connections: Reaching Behavioral Health Patients During a Crisis at the Point of Care
  • Deborah Jean Parsons, Ph.D. - Director of Integrated Health, Aspire Health Alliance

Aspire Health Alliance is managing two MassHealth Behavioral Health Community Partner programs and developing a better system for helping those with mental or behavioral illnesses—while managing Medicaid costs. Deborah Parsons, Director of Integrated Health, shares how Aspire Health Alliance used alerting technology to find and connect with even the most transient patients—including homeless populations—and increase program opt-in rates 150%.

2:30pm - 3:15pm 45 mins
Info
Innovation & Technology in Managed Care
Partnership’s Between Managed Care and Technical Assistance Centers: A Model for Successful Behavioral Health Implementations
  • Andrew Cleek, Psy.D - Chief Program Officer, NYU McSilver Institute for Poverty Policy and Research
  • Boris Vilgorin, MPA - Health Care Strategy Officer, McSilver Institute for Poverty Policy and Research - New York University Silver School of Social Work

This presentation will describe a model of partnership between Medicaid Managed Care Plans and technical assistance centers to improve the implementation of behavioral health payment changes. New York State will be used as a model.

3:15pm - 3:45pm 30 mins
Specialty Populations and Programs
Networking Break
3:15pm - 3:45pm 30 mins
Innovation & Technology in Managed Care
Networking Break
3:45pm - 4:30pm 45 mins
Info
Specialty Populations and Programs
What Community Based Organizations want you to know: Lessons from the Home and Community-Based Services (HCBS) Business Development Learning Collaborative
  • Erica Lindquist - Senior Director, National Association of States United for Aging & Disabilities

Three state teams comprised of community-based organizations (CBOs) that serve people with disabilities , state agencies and other related partner organizations form the Home and Community-Based Services (HCBS) Business Development Learning Collaborative. This collaborative is working to identify pathways to better connect their services to those provided by health care providers and managed by health plans. As direct service providers, these organizations impact SDOH on a daily basis. Doing so is no easy feat and there is much they’d like others to know. In this session, attendees will gain insight into the opportunities and challenges disability CBOs experience as they manage SDOH and what they see as pathways to successful outcomes from collaboration between payers and providers.

3:45pm - 4:30pm 45 mins
Innovation & Technology in Managed Care
eConsults: The Promise of Technology in Improving Access to Care in Underserved Communities
  • Gil Addo - CEO & Co-founder, RubiconMD
4:30pm - 5:00pm 30 mins
Info
Specialty Populations and Programs
Community-Based Care: Keeping High-Need Members Home
  • Andy Friedell - Senior Vice President of Strategic Solutions and Public Affairs, Maxim Healthcare Services

Building on 30 years of experience managing home and community-based workforces, Maxim has developed innovative Community-Based Care solutions that close gaps in care and avoid unnecessary utilization.  Maxim’s offering, homeAlign, consists of a suite of five interchangeable tools that wrap around existing programs while also coordinating community-based services through partner entities as necessary. These tools focus on identifying, engaging, assessing, supporting and coordinating care for target populations.  

4:30pm - 5:00pm 30 mins
Info
Innovation & Technology in Managed Care
Telemedicine and Telehealth: Understand how Technology can Dramatically Improve Care Outcomes and Reduce Cost for the Medicaid Members Your Serve
  • John Whitman - Faculty, The Wharton MBA Health Care Program, & Executive Director, The TRECS Institute
  • Peri Avitan - CEO, LiveCare

Presented by: John Whitman, Faculty, The Wharton MBA Health Care Management Program & Executive Director, The TRECS Institute

Including an interview with: Peri Avitan, CEO, LiveCare

Implementing telemedicine and telehealth services for your high risk Medicaid members can produce not only significant improvements in quality outcomes, but also generate a very impressive ROI. This program will discuss the benefits of offering virtual physician bedside visits in skilled nursing facilities as well as the use of a new, two-way video pendant coupled with medically appropriate remote monitoring devices for your high risk members both upon discharge from hospitals and SNFs and beyond while they live in the community. This sessions will discuss the specific impact on quality improvement these programs can offer your members as well as cost and ROI potential for your organization. Finally, an interview will be held with the founder of a new, two-way video pendant that qualifies as a PERS Unit as well as for reimbursement under Medicare's telemedicine codes. 

5:00pm - 6:00pm 60 mins
Evening Cocktail Reception