Pre-Conference Workshop: Sunday, October 29
1:00pm – 5:00pm
Behavioral Health at the Intersection of Health and Human Services
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 30
7:30am – 8:30am
Registration & Breakfast
8:30am – 9:15am
Leading the Charge on Value, Equity and Growth: The Future of Publicly Sponsored Health Care
Publicly sponsored healthcare programs like Medicare, Medicaid, and the Marketplaces have taken center stage in driving value, equity, and growth in the U.S. healthcare system. During this keynote address, a leading healthcare expert will discuss how these public programs came to be the industry standard bearers and what this shift means for outcomes, affordability, policy, and the overall direction of U.S. health care. Attendees will come away with an understanding of the future of publicly sponsored health care, how the various pieces will fit together, and the kinds of issues, concerns, and government actions likely to impact industry opportunities for improvement and growth.
Alan Weil, Editor-in-Chief, Health Affairs
Leticia Reyes-Nash, Principal, HMA
9:15am – 10:30am
The Dynamic World of Publicly Sponsored Health Care: Trends and Innovations
Never before has there been more action and innovation in the world of publicly sponsored health care. Medicare, Medicaid, and the Marketplaces are driving change even as they continue to face challenges in funding, access, and outcomes. During this plenary session, some of the nation’s leading voices in innovation and publicly sponsored health care will engage in a spirited conversation on industry trends and emerging models. Topics will include new payment models, quality and equity initiatives, new products and services, workforce, likely policy initiatives, and new ways of reaching and serving members.
Jessica Altman, Executive Director, Covered California
Paul Masi, Executive Director, MedPAC – Medicare Payment Advisory Commission
Kate Massey, Executive Director, MACPAC
Julie Morita, MD, Executive Vice President, Robert Wood Johnson Foundation
Meggan Schilkie, Vice President, Strategic Focus Areas, HMA
10:30am – 11:00am
11:00am – 12:15 pm
Health Plan Plenary Session
Positive Change and the Growing Importance of Managed Care in Publicly Sponsored Health Care
Health plans have taken a central role in publicly sponsored health care. Whether it’s through Medicaid managed care, Medicare Advantage, or Marketplace plans, insurers are helping to reshape the landscape for public healthcare programs and have emerged as key drivers of innovation. During this plenary session, executives of the nation’s leading health plans will discuss the future of publicly sponsored health care, outline promising initiatives aimed at improving coverage and care, and address key concerns over funding, policy, equity, and coordination between government, plans, providers, and members. Speakers will also address touchpoints between different programs, including the dynamics of serving dual eligibles, member churn between Medicaid and Exchanges, and emerging programs aimed at addressing housing, food insecurity, and other social determinants of health.
Nathan Linsley, SVP, Government and Individual Markets, Health Care Service Corp.
John Lovelace, President, Government Programs, Individual Advantage, UPMC Health Plan
Tim Spilker, CEO, UnitedHealthcare Community & State
David Thomas, CEO, Markets & Medicaid, Centene Corp.
Lisa Wright, President and CEO, Community Health Choice
Michael Engelhard, Co-Managing Director, Regional Managed Care Organizations, HMA
12:15pm - 1:30pm
1:30pm - 3:00pm
Breakout Session 1
Understanding and Meeting New Health-Related Social Needs Requirements
Rules, regulations, and even the very language used to define and ultimately address equity and health-related social needs (HRSN) are changing rapidly. The upshot is payers, providers, and other healthcare organizations are scrambling to understand and meet new federal guidelines and state requirements across a broad spectrum of programs, operations, and workflows. During this breakout session, leading HRSN experts will provide an environmental overview, including a look at what’s driving these demands and how organizations are specifically working to address the new mandates. Attendees will also hear from community-based organizations who are moving the needle on addressing HRSN, including efforts to address housing and food insecurity.
Richard Ayoub, CEO, Project Angel Food
Bryan Buckley, Director for Health Equity Initiatives, National Committee for Quality Assurance
Paul Leon, CEO, National Healthcare & Housing Advisors
Enrique Salgado, Enterprise Health Equity Business Development Manager, Elevance Health
Leticia Reyes-Nash, Principal, HMA
The Importance of ACA Insurance Marketplaces in Health Plan Growth Strategies
Medicaid and Medicare plans interested in growing both locally and regionally are turning to an unlikely opportunity: Qualified Health Plan (QHP) offerings through the Affordable Care Act insurance Marketplaces. During this breakout session, health plan executives will discuss how Marketplaces can act as a springboard for a multi-market growth strategy, helping to offset costs, build networks, and foster relationships. Attendees will also get an update on Marketplace plan performance, including a look at profitability, risk adjustment, product options, and the impact of the end of the public health emergency.
Jessica Altman, Executive Director, Covered California CEO
Patrick Besler, Director of Government Relations, Blue Cross and Blue Shield of Illinois
Linnea Koopmans, CEO, Local Health Plans of California
Caleb Wallace, Divisional Chief Legal Officer, VP Health Policy, Contracting & Business Development, UPMC Health Plan
Zach Sherman, Principal, HMA
The Future of Delivery Systems: Achieving Operational and Financial Sustainability
Delivery systems continue to face headwinds as they struggle to shore up finances, optimize staffing during workforce shortages, and stabilize operations for future success. While seeking short-term wins in revenue cycle management and supply chain improvements, some systems are also considering longer-term initiatives, such as service line growth and potential mergers and acquisitions. During this breakout session, executives from leading delivery systems will discuss a wide range of practical approaches to prepare for the future, including managing cash flow, optimizing the workforce, developing long-term reimbursement plans, improving operational efficiency, and addressing changes in government policy.
Jay Shannon, MD, Principal, HMA
Digital Health, Interoperability, and Information Sharing: From Compliance to Innovation
There have been four interoperability regulations released by federal authorities mandating clinical and claims data sharing between payers, providers, and individuals. Unfortunately, most organizations have focused only on regulatory compliance, rather than how the rules will allow them to provide personalized information and services, further whole-person care, and dramatically reduce administrative inefficiencies. During this session, a panel of early adopters will show how they have moved from compliance to innovation by embracing data sharing, FHIR APIs, and third-party applications using real-time data. The goal: reinventing how information and services are delivered to providers and patients.
Kirk Anderson, Vice President & Chief Technology Officer, Cambia Health Solutions
Adimika Meadows Arthur, Executive Director, CEO, Health Tech for Medicaid
Sharlene Newman, Executive Director, Alabama Life Research Institute
Anna Taylor, AVP, Population Health & Value Based Care, MultiCare Connected Care
Sheryl Turney, Director II, Technology, Elevance Health
Ryan Howells, Principal, Leavitt Partners, an HMA company
Effective Minority and Women Business Enterprise Subcontracting Partnerships and Teaming Agreements
Minority and women business subcontracting partnerships and teaming agreements help providers achieve value and equity. These relationships are key to developing strong community connections. The relationships can help address workforce shortages, achieve supply chain improvements, and facilitate targeted outreach and engagement with communities. During this session, leaders of healthcare and technology firms will discuss effective partnerships and teaming agreements that facilitate improved healthcare outcomes and patient engagement. Speakers will present case studies on projects that use data mining and recent advances in AI technology to enhance telepsychiatry, engage Medicaid patients, and implement best practices in correctional health.
Debra Carey, Principal, HMA
3:00pm – 3:30pm
3:30pm – 5:00pm
Breakout Session 2
Real Talk from the Trenches of Value-based Payments
Are value-based payments worth the effort? That’s the question providers and payers are asking as they assess whether their value-based payment initiatives are clinically and financially viable. During this breakout session, you’ll learn about the advantages and pitfalls of value-based payments, with important insights from organizations that have made it work. You’ll also gain insights on the policies and practices that have worked well within various CMS and CMMI programs.
Barry Dahllof, Vice President – Enterprise Contracting & Payor Relations, Christiana Care Health System
Cesar Herrera, CEO, Yuvo Health
Eric Mattelson, Chief Actuary, Zing Health
Eric Pfleger, SVP, Population Health, Southeast Primary Care Partners
The Pitch: Innovative and Potentially Disruptive Models in Care Delivery
In this Shark Tank-like session, early-stage healthcare companies will present their solutions for improving care delivery, addressing equity, managing risk, and engaging members through innovative models and new technologies. A seasoned panel of managed care executives will listen to “the pitch” and weigh in on each company’s value proposition. Attendees will learn about some of the latest innovations in care delivery models and will also gain an understanding of how to best approach managed care partners when considering value-based contracting or other network arrangements.
Nick D’Addabbo, VP, Strategy, Innovive Health
Robert Garnett, VP, GBD Analytics, Elevance Health
Jesse Hunter, Operating Partner, Welsh, Carson, Anderson & Stowe
Tim McDonald, Partner, Guidon Partners
Joe McDonough, CEO, Innovive Health
Carter Paine, CEO, Wayspring
Bob Pirtle, SVP, Business Development, PulseData
Daniel Weinrieb, Head of Strategic Partnerships, Jukebox Health
Jaimie White, SVP, Medicaid Operations, Humana
Greg Nersessian, Managing Director, HMA Investment Services
Medicaid and Individuals in Carceral Settings: Improving Coordination, Managing Transitions
California recently became the first state approved to offer certain Medicaid services to individuals in carceral settings, an experiment certain to yield important lessons for other states looking to initiate similar programs. Meanwhile, states continue to struggle to manage the challenges associated with individuals transitioning in and out of these settings, with implications for behavioral health, substance use disorder treatment, primary care, and chronic disease management. During this breakout sessions, experts from health plans, providers, and state and local correctional systems will outline best practices and pitfalls for coordinating care for individuals who are justice-involved – and what it means for the broader publicly sponsored healthcare system. Speakers will also discuss the implications of the California experiment, including the likelihood that other states will follow suit.
Lynn Carr, Chief, Agency Operations, Medical Care Services, County of San Diego Health & Human Services Agency
Nai Kasick, Vice President Medi-Cal Lead, Health Net (Centene)
Peter Koutoujian, Middlesex Sheriff, Middlesex County, MA
Navigating Change in Medicare Advantage: A Roadmap for Success
The Medicare Advantage market is facing dramatic operational changes, driven in part by new rules out of the Centers for Medicare & Medicaid Services aimed at addressing utilization management, prior authorization, network adequacy, and reports of irregularities in marketing and risk adjustment. During this breakout sessions, policymakers and insurers will discuss what Medicare Advantage plans must do to meet the demanding, new requirements – all against a backdrop of continued efforts to improve equity, access, outcomes, and cost.
Liz Goodman, Chief Legal and Public Affairs Officer, Commonwealth Care Alliance
Ivette Granja, RN, BSN, Vice President of Home Health, Integrated Home Care Services, Inc.
Mark Hamelburg, SVP, Federal Programs, AHIP
Amy Bassano, Managing Director, Medicare, HMA
ASAM 4th Edition: The New Criteria as a Vehicle to System Transformation
The American Society of Addiction Medicine is expected to release in September 2023 the fourth edition of the ASAM Criteria, the most widely used and comprehensive set of guidelines concerning recommended levels of care utilized in the treatment of individuals with substance use disorder. During this breakout session, experts in the treatment of substance use disorder will outline changes and additions to the criteria. Speakers will also discuss how these changes can transform the system; what providers, payers, and policy makers need to know to be ready; and opportunities for certification to serve as a tool to verify the level of care being delivered.
Debbi Witham, Principal, HMA
5:00pm – 7:00pm
Conference Day Two: Tuesday, October 31
7:30am – 8:30am
8:30am – 9:15am
Practical Approaches to Ensuring Equity in Publicly Sponsored Healthcare Programs
“Equity” has emerged as an important goal in discussions about the future of publicly sponsored healthcare programs like Medicaid and Medicare. At its core, equity is defined as “the state in which everyone has a fair and just opportunity to attain their highest level of health.” Getting there, however, is no easy task. During this address, a leading healthcare equity executive will provide practical approaches to addressing equity, including an overview of efforts by policymakers, health plans, and providers to make equity the central component of all initiatives to improve healthcare outcomes, access, and health-related social needs.
Karen Dale, Chief Diversity, Equity, and Inclusion Officer, AmeriHealth Caritas
Robin Preston, Regional Vice President, HMA
9:15am – 10:15am
Medicaid Director Plenary Session
Medicaid in a Post-Pandemic World: Challenges, Opportunities, and a Renewed Focus on Equity
The end of the public health emergency brings a wide variety of challenges and opportunities to state Medicaid programs. The most pressing involve the impact of eligibility redeterminations and the phasing out of enhanced federal Medicaid matching funds. More broadly, states face challenges to provider sustainability, workforce shortages, and potential pressures on funding should the economy slip into recession – all at a time when states have dramatically increased efforts to expand access and benefits in areas like postpartum care, behavioral health, substance use disorder, health-related social needs, dual eligible integration, crisis response and more. During this plenary session, state Medicaid directors will provide a status report on all this and more, including a special emphasis on how equity plays into planning and policy decisions.
Kelly Cunningham, Administrator, Division of Medical Programs, Illinois Department of Healthcare and Family Services
Susan Philip, Deputy Director, Health Care Delivery Systems, California Department of Health Care Services
Drew Snyder, Executive Director, Mississippi Division of Medicaid
Stacie Weeks, Administrator/Medicaid Director, Division of Health Care Financing and Policy, Nevada Department of Health and Human Services
Caprice Knapp, Principal, HMA
10:15am – 10:30am
10:30am – 11:30am
The Future of Serving Individuals Who Are Medicare-Medicaid Dually Eligible and the Growing Role of D-SNPs
The market for serving individuals who are dually eligible for Medicaid and Medicare is changing dramatically as states increasingly transition from dual demonstrations to Dual Eligible Special Needs Plans (D-SNPs). Meanwhile, federal regulators are tightening D-SNP requirements in hopes of applying some of the lessons learned from years of pilots. During this session, representatives from states, health plans, and federal regulatory agencies will provide a status report on serving individuals who are dually eligible for Medicaid and Medicare, outline some of the lessons learned from past demonstrations, and present case studies of states that are moving to D-SNPs, including the implications for health plans and members. The session will also address the importance of ensuring equity in dual eligible programs.
Mitchell Evans, Market Vice President, Policy & Strategy, Medicaid & Dual Eligibles, Humana
Susan Philip, Deputy Director of Health Care Delivery Systems, California Department of Health Care Services
Tiffany Huyenh-Cho, Senior Staff Attorney, Justice in Aging
Javier Sanchez, Executive Director, Medicare Programs, CalOptima Health
Julie Faulhaber, Managing Director, Medicare and Dual Eligibles, HMA
11:30am – 12:30pm
Crisis System Development and Sustainability: An Update on Policy, Financing, Innovation, Equity
Growing behavioral health demand highlights the importance of robust crisis continuums. Federal and state funding is supporting expansion of the crisis continuum and subsequent innovation in model design. During this panel discussion, leading crisis systems experts will provide an update on the status of state crisis system initiatives, with a look at policy, financing, innovation, and the role these systems play in furthering health equity. Speakers will also provide case studies on successful crisis system initiatives, including newly implemented 988 hotlines, mobile crisis units, and other innovations in crisis stabilization.
Monica Johnson, Director of the 988 & Behavioral Health Crisis Coordinating Office, SAMHSA
Jamie Pothast, Senior Director of Crisis and Inpatient Services, Community Bridges
Gina Lasky, Co-Managing Director, Behavioral Health, HMA
Have Questions? Contact Us
Transfers, Cancellations and Refunds Policy
Registrants may transfer their registration to another person at any time by notifying Gabby Palmieri ([email protected]) in writing. Cancellations must be made in writing to Lindsey Beck ([email protected]). Refunds minus a 20% service charge are available for cancellations received in writing 45 days or more prior to the start of the conference. No refunds are available thereafter.