The HMA Fall Conference: Unlocking Solutions in Medicaid, Medicare, and Marketplace

Sponsored by Well Centric, DC

Chuck Milligan, Chief Executive Officer, HMA

Unlocking Solutions to Today’s Healthcare Challenges Through Innovation

Dr. Darshak Sanghavi is among the first employees of the Advanced Research Projects Agency for Health (ARPA-H), a newly created multibillion dollar agency within the U.S. Department of Health and Human Services. ARPA-H is poised to both disrupt and modernize today’s healthcare landscape – from the modes used to deliver care to services and technology and payment. Dr. Sanghavi will discuss historical challenges to innovation in the healthcare sector and a framework for overcoming these.  

Speaker:
Darshak Sanghavi, MD, Advanced Research Projects Agency for Health (ARPA-H), U.S. Department of Health and Human Services

The Long Game: Improving Outcomes for All

Solutions that reduce barriers to health and improve outcomes take different forms depending on the politics and cultural priorities of different stakeholders. Federal and state leaders may call it different things, but health equity is really about reducing disparities and improving outcomes for all. This panel will provide a broader viewpoint on these goals, discussing the durability of the commitment, and the roles of federal policy initiatives, multi-disciplinary collaborations, and state program approaches to reduce healthcare disparities.

Speakers:
Leticia Reyes-Nash, Principal, HMA
Sara Singleton, Leavitt Partners, an HMA Company

Partnerships, Policy, and Program Strategies for Health Equity

Does better health start with finding a home? Efforts to address the social determinants of health are focusing on the intersection of housing and health. This panel of national leaders will discuss programmatic innovations, policies, partnerships, and funding to overcome the health and housing challenges.  

Speakers:
Catherine Anderson, Senior Vice President, Health Equity Strategy, UnitedHealth Group
Shaun Donovan, Chief Executive Officer, Enterprise Community Partners and former Secretary of the U.S. Department of Housing and Urban Development
Jennifer Leimaile Ho, Commissioner of Minnesota Housing and former Deputy Director at the U.S. Interagency Council on Homelessness
Jeff Olivet, Executive Director of U.S. Interagency Council on Homelessness 

Moderators:
Tia Cintron, Managing Director, Housing Services and Supports, HMA
Robin Preston, Senior Vice President, HMA

Payer Innovation: Scaling Innovations, Tools, and Technology to Achieve Whole Person Care

Our panel of speakers will shed light on solution-oriented approaches health plans are taking to Big Issues of the day. Hear how they plan to adapt to the demands for value-based care, the tools they have and those still needed to deliver, measure, and improve on person level quality initiatives; the future of integrated care for dually eligible individuals; headwinds due to enhanced scrutiny of payment; the rise of AI in healthcare, and other critical topics on the horizon.  

Speakers:
Michael Carson, President and CEO, Wellcare
Denise Napier, CEO, Jefferson Health Plans
Brian Powers, Vice President for Clinical Strategy, Humana  

Moderator:
Christine Rein, Principal, HMA

Navigating Provider Sustainability Options in Traditional Medicare

Physicians, nurse practitioners, clinical psychologists and other providers participating in Medicare Fee-for-Service are facing reductions in reimbursement while hospitals and other providers remain concerned their annual payment updates are not keeping pace with the cost of delivering care. Workforce shortages across the healthcare system exacerbate these challenges. This session will talk about pathways for Medicare to pay providers sufficiently while ensuring Medicare, beneficiaries and the taxpayer are getting value for their spending. Speakers will consider the role of new technologies, value-based care models, incentives for serving complex populations, and other novel opportunities to better balance access, quality, and reimbursement with program sustainability.

Innovations to Improve Outcomes for Medicare-Medicaid Dually Eligible Individual

Join us to explore the transformative impact of the 2024 Medicare Advantage policies on the integrated care landscape for dually eligible individuals. This session will focus on the strategic choices states can pursue to enhance continuous coverage, coordination, and integration efforts for dual eligibles. Speakers will highlight strategies, data, and innovations needed to achieve integrated care for duals, diving into the pivotal policy decisions that offer insights for state leaders, Medicare Advantage and Medicaid managed care plans, providers, and stakeholders.

Marketplace Affordability Initiatives

Healthcare costs and affordability of insurance are top of mind concerns for government leaders and consumers as well as the health plans and providers that serve them. More states are undertaking initiatives to address affordability, from the rise of PDABs to cost containment commissions, cost growth benchmarks, transparency, and examining mergers and acquisitions. This discussion will focus on how these broader efforts are showing up in the individual market/ACA marketplace, which provides an increasingly important landing place for consumers.

Raising the Bar on Health Equity

The Robert Wood Johnson Foundation (RWJF) is funding a program that provides technical assistance to healthcare providers looking to embed equity throughout their workflow to improve health outcomes for all. This discussion will discuss the opportunity this presents, from the point of view of both the funder and the recipients of the RWJF grants, along with the HMA team providing the technical assistance.

Sickle Cell Treatment Innovation & Strategies to Improve Access

The newly approved treatment for sickle cell disease is a groundbreaking innovation that can be life changing for those who suffer with the diagnosis. However not only is it an innovative genetic treatment, but the therapy requires a different model of care placing a different burden on both the patient and the provider. States across the country will be faced with the opportunity to bring this therapy to patients, but it likely will require a different approach, as reflected in the proposed payment model from CMMI. This session will present a very timely discussion on the challenges and opportunities to create new payment models for innovative cell and gene therapies that can be a roadmap for future innovation.

Meeting Medicare’s New Expectations for Health Equity and Improved Beneficiary Outcomes

CMS is using its regulatory power to put downward pressure on Medicare Advantage rates, while also creating financial incentives to shape supplemental benefits to address equity gaps and improve outcomes for Medicaid beneficiaries. Stakeholders of the Medicare Advantage program need to understand how CMS’ approach to rates might impact them and pathways they can take to meet changing expectations. This discussion will look at value-based payment strategies, opportunities with differentiated supplemental benefits, and the way that both MA and FFS fee-for-service Medicare partners might respond to this call.

Roadmap for Improving Children’s Behavioral Health and Addressing the National Crisis

During this interactive session you will have an opportunity to learn from a dynamic and inspiring panel including youth with lived experience of mental illness and institutionalization, family members of children with serious mental health conditions, and state leaders who have made significant progress in advancing more equitable access to a comprehensive continuum of behavioral health care for children. You will have the opportunity to participate in four topical discussion groups – governance, service array, financing, and engagement – to develop a blueprint that any entity can leverage to guide transformative child and youth system change.

What’s Next for the ACA Individual Insurance Market?

The ACA marketplace is the most stable it has ever been, in terms of interest and participation, with enrollment and carrier participation at an all-time high. However, the future is unstable, as once again we face the potential for major disruption. This session will feature plans that have had market success, discussing the unique considerations of this market, what makes for a successful experience, and how they are planning for the future.

Initiatives to Build Workforce Capacity

Healthcare delivery systems have struggled to afford, attract, retain, and engage care providers. These challenges have hit equally hard for public and private systems, regardless of their mission and financial status. This discussion will highlight innovative approaches taken by different leading systems to rethink the workforce that is needed to meet present challenges but also to adapt to future challenges.

Innovation is a Buyer’s Market

Innovation in government-sponsored markets is highly sought after. Hear from former officials and current innovators on effective approaches to understand – and meet — states and payer needs, their processes, where innovators can have impact, and how those priorities translate into purchasing.

Providers at Risk: Innovative Community-Driven Care Delivery Strategies

Lessons learned by federally qualified health centers (FQHCs), public hospitals, and entrepreneurial startups on how to better serve populations with diverse acute and ambulatory needs.

Speakers:
Hugh Lytle, Founder, Chairman, and CEO, Equality Health
Wil Franklin, President and Chief Executive Officer, KC CARE Health Center
Andie Martinez Patterson, CEO, Alameda Health Consortium

Moderator:
Warren Brodine, Principal, HMA

Re-examining Coverage Strategies in Behavioral Health

Beyond just expanding capacity, this panel will discuss a behavioral health system designed to serve needs across payers, across agencies, employing updated practices and innovative care strategies.

Speakers:

Jane Beyer, Senior Health Policy Advisor, Washington’s Office of the Insurance Commissioner
Teresa Claycamp, Behavioral Health Strategic Advisor, Division of Behavioral Health and Recovery, Washington’s Health Care Authority
Julie Collins, MSW, LCSW, Vice President of Practice Excellence, Child Welfare League of America
Ann Gillespie, Acting Director, Illinois Department of Insurance

Hear from Medicaid Directors implementing different strategies to equitably improve outcome, sustain coverage and improve the customer experience with the Medicaid program. State leaders will share insights on major initiatives underway in their states to address health disparities, manage ongoing crises in mental health and substance use disorders including among children and youth, their perspectives on strategies to integrate care for the Medicare-Medicaid dual eligible population, use of AI and other timely topics.

Speakers:
Stephanie Azar, Commissioner of the Alabama Medicaid Agency
Amir Bassiri, Deputy Commissioner of the Office of Health Insurance Programs and New York State Medicaid Director
Elizabeth Matney, Medicaid Director, Iowa Department of Human Services
Dana Flannery, Medicaid Director, New Mexico Human Services Department

Moderator:
Farah Hanley, Principal, HMA and former Michigan Medicaid Director

Honest talk with policy changemakers on both sides of the aisle about the future of health policy that balances sustainability and access to serve the public good. These leaders will delve into the issues and dynamics that will shape the future healthcare landscape in 2025 and beyond, including healthcare affordability, their views on future work to address health disparities, sustainability of public coverage programs, among other emergent issues.

Network with new colleagues and partners over a lunch or grab a boxed lunch if you must leave us sooner.