Pre-Conference Workshop: Sunday, Sept. 30, 2018
1:00pm – 5:00pm
A Primer on the Medicaid Landscape
Medicaid is an incredibly complex program, with wide state variation in structure, benefits, payments, and policies. Even experts lack a complete understanding of how the program works in each of the 50 states and Washington, DC. That’s why HMA is happy to offer a special Pre-Conference Workshop called Medicaid 101: A Primer on the Medicaid Landscape. During this interactive workshop, HMA consultants will provide attendees with an understanding of the basic building blocks of Medicaid and an update on the changing landscape for Medicaid programs and policies. Topics of discussion will include Medicaid waivers and State Plan Amendments, Medicaid managed care, delivery system reform and practice transformation initiatives, payment and funding models, and more.
This Live activity, Medicaid 101: A Guided Tour with the HMA Experts, with a beginning date of 09/30/2018, has been reviewed and is acceptable for up to 3.25 Prescribed credit(s) by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Conference Day One: Monday, October 1, 2018
7:00am – 8:00am
8:00am – 9:00am
Medicaid in an Era of Community Engagement and Shared Responsibility
The Trump administration’s decision to support work requirements and other eligibility restrictions marks a dramatic turning point in the nation’s 50-year-old Medicaid program. It’s also the first salvo in the administration’s stated goal of increasing community engagement and shared responsibility in Medicaid, including an emphasis on employment, healthy behaviors, premiums, drug screening, health savings accounts, and innovative approaches designed to drive accountability down to the member. The potential implications are far-reaching and raise important questions about the future of Medicaid financing, membership growth, payment models, and the design and structure of the program. During this keynote address, a leading health care expert will assess how the emerging community engagement movement will impact the future of Medicaid, with a special emphasis on the opportunities and pitfalls facing Medicaid managed care plans, providers and states.
Mike Leavitt, General Partner, Leavitt Partners
Jonathan Freedman, Vice President, HMA (Los Angeles, CA)
9:00am – 10:30am
State Medicaid Director Q&A Session
How States Are Fostering Community Engagement and Innovation in Medicaid
States have increased flexibility under the Trump administration to experiment with a wide variety of new approaches to Medicaid, including work requirements, member premiums, and other forms of community engagement as well as new funding mechanisms like value-based care delivery. During this Q&A keynote session, state Medicaid directors will discuss how they are using waivers to restructure Medicaid programs to meet the unique needs and priorities of their states, with an emphasis on member engagement, payer and provider accountability, and innovation. Medicaid directors will also discuss the growing role of Medicaid managed care plans and assess the future of provider-led Medicaid managed care initiatives.
Mari Cantwell, Chief Deputy Director, Health Care Programs, California Department of Health Care Services
Stephanie Muth, Associate Commissioner, Medicaid/CHIP Medical and Social Services Division, Texas Health and Human Services Commission
Justin Senior, Secretary, Florida Agency for Health Care Administration
Allison Taylor, Director of Medicaid, Indiana Family and Social Services Administration
Matt Wimmer, Administrator, Division of Medicaid, Idaho Department of Health and Welfare
Lori Coyner, Managing Principal, HMA (Portland, OR)
10:30am – 11:00am
11:00am – 12:30pm
Medicaid Managed Care Keynote Q&A Session
The Next Wave: How Medicaid Plans are Positioning Themselves for Success
Medicaid managed care plans have enjoyed unprecedented success, but they also face growing challenges. Along with a push by the Trump administration to implement community engagement, work requirements and other restrictions on eligibility, Medicaid plans are struggling with slowing membership growth, concerns over the actuarial soundness of capitated payments, and the threat of a fundamental restructuring of Medicaid financing at the federal level. Medicaid plans are also being pressed to rethink care delivery by addressing social determinants of health, partnering with providers in value-based payment arrangements, and supporting behavioral health and other integrated care initiatives. During this keynote Q&A session, chief executives from leading health plans will discuss what’s next for Medicaid managed care, including a look at the types of investments, partnerships, and initiatives that will best position the industry for success.
Catherine Anderson, SVP, Policy & Strategy, UnitedHealth Community & State
John Baackes, CEO, L.A. Care Health Plan
Scott Markovich, VP, Medicaid Growth and Provider Development, Aetna Inc.
Donna Checkett, Vice President, HMA (Chicago, IL)
12:30pm – 2:00pm
2:00pm – 3:30pm
Breakout Session 1
Medicare-Medicaid Integration: Emerging Models and Opportunities
One of the biggest opportunities for state Medicaid agencies and health plans is better integration of services for individuals who are dually eligible for Medicare and Medicaid. This high-cost population consumes an outsized share of Medicaid and Medicare dollars and comes with a specific set of demanding needs and challenges. States and the federal government are increasingly turning to managed care to integrate and improve the quality of care and outcomes, as well as realize cost-efficiencies. During this session, regulators and health plan executives will outline emerging models and opportunities for Medicare-Medicaid integration. The discussion will look at the recent trend among states to require managed care organizations to operate both a Medicaid plan and a Medicare Advantage Dual Eligible Special Needs Plan. The session will also provide an update on the future of the CMS Dual Eligible Financial Alignment Demonstration, among other topics.
Bernadette Di Re, CEO, UnitedHealthcare Community Plan of Massachusetts
Peter Fitzgerald, EVP, Policy and Strategy, National PACE Association
Michael Monson, SVP, Long-Term Services & Supports, and Dual Eligibles, Centene Corp.
Cheryl Phillips, MD, President, CEO, SNP Alliance, Inc.
Sarah Barth, Principal, HMA (New York, NY)
Addressing Social Determinants of Health: Emerging Payer-Provider Partnerships
No one doubts the important role social factors play in the health of a population of people. The question is how can health care organizations best address social determinants of health such as unemployment, poverty, housing shortages, substandard education, and inadequate access to care? During this breakout session, health plans, providers and community-based organizations will discuss growing efforts to address social determinants of health in Medicaid populations, including a look at the types of services and partnerships health plans and other payers are most likely to support.
Kathye Gorosh, SVP, Strategic Initiatives, AIDS Foundation of Chicago
James Kiamos, CEO, CountyCare Health Plan, Cook County Health and Hospitals System
Cheryl Lulias, President, Medical Home Network and CEO MHN ACO
Karin VanZant, VP, Executive Director, Life Services, CareSource
John O’Connor, Acting Managing Director, HMA Community Strategies (Los Angeles, CA)
Behavioral Health: How Value-Based Contracting Is Driving Payer-Provider Partnerships
The nationwide rollout of value-based payments could benefit traditional providers of behavioral health care. That’s because behavioral health is in many ways the ultimate valued-based service, with low costs and high impacts on health outcomes. The challenge is making sure that behavioral providers can fully participate in value-based opportunities, which require access to robust information technology infrastructures capable of capturing, analyzing and sharing data across the continuum of care. During this panel, health care executives from leading payers and providers will outline strategies for ensuring that behavioral health providers have the tools and resources they need to successfully make the transition to emerging value-based payment methodologies.
Lou Dierking, SVP, Behavioral Health Payer Channel Lead, Optum
David Guth, CEO, Centerstone America
Jim Spink, Former President, Mid-Atlantic Region, Beacon Health Options
Ann Sullivan, Commissioner, NYS Office of Mental Health
Josh Rubin, Principal, HMA (New York, NY)
3:30pm – 4:00pm
4:00pm – 5:30pm
Breakout Session 2
Beyond the Basics: The Future in Medicaid Pharmacy Management and Pharmaceutical Care
Pharmacy benefits are moving beyond being just a commodity to becoming part of an integrated care model for Medicaid members and other vulnerable populations. The change is driven by state demands for improved outcomes as well as pressure to control costs given the explosion of biotech drugs and an evolving generic market. During this session, Medicaid managed care plans, pharmacy benefit managers, providers, and pharmaceutical manufacturers will discuss a wide variety of emerging partnerships, innovations, and initiatives designed to better manage pharmacy benefits and engage members, driving improvement in medication adherence, fostering appropriate utilization, and addressing gaps in care.
James Gartner, VP Pharmacy and Retail Strategy, CareSource
Andrew Fox, Director, Healthcare Segment Development, Walgreens
Paul Jeffrey, Director of Pharmacy, MassHealth
John Stancil, Jr., Director of Pharmacy, DMEPOS, Home Care and Ancillary Services,
Division of Medical Assistance, North Carolina Department of Health and Human Services
Scott Streator, Managing Principal, Government Program Services, Medimpact Healthcare Systems, Inc.
Krista Ward, Senior Director, Medicaid, Express Scripts
Anne Winter, Principal, HMA (Phoenix, AZ)
Best Practices in Medicaid IT and Business Process Transformation
Most Medicaid programs have undertaken major information technology and business process transformation projects in recent years, most notably impacting functions traditionally managed with eligibility systems and Medicaid Management Information Systems (MMIS). Several states have noted that these projects are major priorities over the next three to five years, figuring prominently in efforts to implement delivery system and payment reforms, quality improvement initiatives, improved provider and managed care plan monitoring, population health management, and cost containment. During this session, a panel of Medicaid program leaders will share their approaches to IT and business process transformation projects, followed by an interactive discussion focused on best practices to implement and pitfalls to avoid.
Garfield Collins, COO, NextLevel Health
Jennifer Harp, Deputy Executive Director, Office of Administrative and Technology Services, Kentucky Cabinet for Health and Family Services
Jared Linder, CIO, Indiana Family and Social Services Administration
Luis Sylvester, Executive Account Manager, U.S. Virgin Islands, Molina Medicaid Solutions
Juan Montanez, Principal (Washington, DC)
How Health Plans and Providers Are Joining Forces to Improve Patient Care
Convergence in health care is real, blurring the lines between payers and providers, and recasting how health care services are financed and delivered. That’s true of health care in general and for Medicaid specifically. During this session, leading health care executives will address how convergence is changing the way care is paid for and delivered, with an emphasis on the implications for Medicaid populations. Speakers will also discuss how health plans and providers can best position themselves for success in this evolving market.
Edward Fishman, Managing Director, Cain Brothers
Brent Layton, EVP, Chief Business Development Officer, Centene Corp.
Pete November, SVP, Chief Administrative Officer, Ochsner Health System
James Schroeder, Vice President, Safety Net Transformation, Kaiser Permanente
Ed Stellon, Executive Director, Heartland Alliance Health
Karen Batia, Principal, HMA (Chicago, IL)
Roxane Townsend, MD, Managing Principal, HMA (Raleigh, NC)
5:30pm – 7:00pm
Conference Day Two: Tuesday, October 2, 2018
7:00am – 8:00am
8:00am – 9:00am
What's Next for Integrated Care: A Status Report and Forecast
One of the most important – and often elusive – goals in health care is delivery system reform designed to fundamentally change the way care is delivered to patients. Whether driven by new funding mechanisms, incorporating new provider-led care management entities, or relying on partnerships between health plans and providers, the goal is the same: Integrating, coordinating, and managing the physical, behavioral and social factors that impact an individual’s health and wellness. During this keynote address, a leading health care expert will provide an update on the state of integrated care for Medicaid populations, assess which models are most likely to succeed, and discuss how health plans and providers can work together to take integrated care delivery to the next level.
John Jay Shannon, MD, Chief Executive Officer, Cook County Health & Hospitals System
Pat Terrell, Vice President, HMA (Chicago, IL)
9:00am – 10:30am
Integrated Care for High-Cost Populations
Managing Chronically Ill Medicaid Patients - Emerging Payer-Provider Models
Successfully managing high-cost, chronically ill members is an important focus for Medicaid managed care plans. Initiatives have included a variety of disease management efforts, partnerships with patient-centered medical homes, and even the acquisition of primary care centers and clinics focused on high-risk patients. During this session, Medicaid plans, providers and states will address emerging models for serving chronically ill Medicaid populations, ensuring the most cost-effective care, and pointing the way to fundamental changes in the way care is delivered and financed.
Leanne Berge, CEO, Community Health Plan of Washington
Rebecca Kavoussi, President – West, Landmark Health
MaryAnne Lindeblad, State Medicaid Director, Washington State Health Care Authority
Susan Mende, Senior Program Manager, Robert Wood Johnson Foundation
Betsy Jones, Managing Principal, HMA (Seattle, WA)
10:30am – 11:00am
11:00am – 12:30pm
The Role of Value-Based Payments in Fostering Delivery System Reform
Medicaid programs across the nation continue to experiment with a wide variety of value-based payment models designed to incentivize providers to change the way care is delivered. Whether it’s through Coordinated Care Organizations in Oregon, Delivery System Reform Incentive Payment initiatives in New York and California, or accountable care efforts in Alabama, Colorado, and North Carolina, the emphasis is on fostering care coordination, behavioral integration, and access to community-based services. During this session, leading providers, payers and states will provide an update on the successes and setbacks of their value-based payment initiatives, including insights into how health plans and providers can work together to help drive policies that promote more efficient use of Medicaid funding and services.
Mandy Cohen, MD, Secretary, North Carolina Department of Health and Human Services
James Sinkoff, Deputy Executive Officer, CFO, HRHCare Community Health
Emily Stewart, Vice President of Policy, Planned Parenthood Federation of America
Lisa Trumble, SVP of Accountable Care Performance, Cambridge Health Alliance
Dorothy Teeter, Principal, (Seattle, WA)