Wednesday, September 22
Thursday, September 23
7:30-8:30AM - Breakfast
MC: Catherine Anderson, UnitedHealthcare Community & State
Speaker: Senator Ron Wyden (D-OR)
Speaker: Jennifer Kucera
Mission Sponsor: UnitedHealthcare
10:15-11:15AM - Concurrent Educational Sessions
Events in 2020 and 2021 have brought to nationwide focus the wide disparities in how healthcare is managed and delivered in underserved communities. Medicaid health plans have a critical role to play in addressing the root cause barriers to equity and improving health equity for the communities they serve. In addition our research shows that beyond advancing equity for the communities, achieving equity for employees and the members they serve can help MCOs grow and reduce costs.
Over the last year we have reviewed 200+ healthcare equity initiatives across health plans and providers, as well as codified best practices on how to deliver healthcare equity programs through health plans.
During the sessions we will explore:
- How MCOs can work to identify the areas where they can have the highest impact on building an equitable health ecosystem
- What are some table stakes interventions that MCOs can quickly implement to help reduce health access and outcomes disparities
- How MCOs can implement best practices within their organizations to bring the same rigor and effectiveness to health equity initiative as they bring to core business strategic issues
Speaker: Errol Pierre, HealthFirst
Speaker: Dr. Carlos Pardo Martin, McKinsey & Co.
Speaker: Andrew Ramish, McKinsey & Co.
While the march to HCBS is certainly not a new trend, the COVID-19 pandemic has intensified concerns about institutional care and accelerated interest in developing innovative policy solutions for seniors and people with disabilities who need long-term services and supports. MCOs continue to excel at rebalancing the delivery of long-term care by increasing access to high quality HCBS services, but more should be done at both the federal and state level to make HCBS a reality for all Medicaid enrollees who prefer to remain in such settings. This session will focus on what additional actions should be taken by Congress, the Biden-Harris Administration, and States to make HCBS a reality for all Medicaid enrollees who desire HCBS.
Speaker: Charles Wayland – United in NJ
Speaker: Carol Cianfrone – Horizon NJ
Speaker: Brendan Harris – UPMC
Moderator: Michelle Martin – UnitedHealthcare
Aetna Better Health®, a CVS Health® company, and iFoster are proud to share the latest results of their innovative Connections for LifeTM program. iFoster is a leading national non-profit providing foster care youth with the resources and opportunities to become successful, independent adults. Together, the companies help ease the burdens of foster care youth by closing technology gaps and increasing resources.
In the year since its launch in West Virginia, the Connections for Life program has provided nearly 300 Aetna Better Health foster youth members with laptops and tablets to help them access geographically tailored transition resources and improve many social, financial and educational facets of life. These resources are available for all Aetna Better Health of West Virginia foster youth members (ages 13-26) through the iFoster portal.
The portal contains helpful resources and information to empower and support foster youth to achieve self-sufficiency. Members can access their own secure digital locker where they can save vital personal documents. And the portal has been evaluated to reduce needs and improve well-being.
Plans are underway to expand the benefit in other markets where Aetna oversees and coordinates the managed health care services of child welfare programs and youth in foster care.
Speaker: Andrew Wilson, Aetna Medicaid
Speaker: Kathy Szafran, Aetna Better Health of West Virginia
Speaker: Serita Cox, iFoster
11:30-12:30PM - Concurrent Educational Sessions
The CMS Interoperability and Patient Access rule requires Medicaid and other CMS-regulated plans to provide consumers access to their healthcare information on third-party apps and the ability to transfer that information when changing plans. The rule, which includes provisions that become effective in 2021 and 2022, is intended to facilitate better decision-making, care coordination and outcomes.
However, for the goals of this rule to be realized, payers, agencies and app developers must be able identify and verify more than 300,000 possible endpoints to connect with and exchange data. For Medicaid plans in particular, complying with the CMS rule and navigating these connections can put a strain on time and resources.
In this session, we will discuss industry efforts to build on the Office of the National Coordinator for Health Information Technology (ONC) FHIR at Scale Task Force (FAST) recommendations and create a single, trusted directory that will enable all parties to quickly and efficiently find and validate endpoints.
Speakers at this session will explain how stakeholders have come together to enable Medicaid plans to meet upcoming regulatory deadlines, reduce the burden associated with connecting and exchanging information with app developers and empower consumers with greater access to their health information.
Speaker: April Todd, CAQH, Senior Vice President, CORE and Explorations
Speaker: Patrick Murta, Humana, Chief Interoperability Architect & Fellow, Enterprise Architecture
Moderator: Colby Tiner, CAQH, Health Policy Manager
State Medicaid programs have two primary options available when it comes to purchasing drugs for Medicaid enrollees: they can directly manage the purchasing through fee-for-service programs, or they can use managed care organizations (MCOs) and their pharmacy benefit managers (PBMs) to manage the pharmacy benefit. This session will highlight recent research on the benefits of carving pharmacy into managed care including the impact on costs, care coordination, and clinical outcomes. Dr. Anthony Lo Sasso will highlight his recently published study comparing the costs of Hepatitis C drugs in Illinois and Michigan, which took different paths with respect to their specialty pharmacy benefits. Michigan opted to centralize purchasing of most specialty pharmacy products while Illinois used MCOs and PBMs to manage purchasing and utilization of specialty pharmacy products. In Illinois, MCOs in partnership with PBMs were able to move much more swiftly into significantly cheaper generic alternatives when they became available, thus lowering the costs for these drugs overall. Dr. Andrea Bennett will highlight Aetna data across commercial, Medicare and Medicaid that highlights the benefits of integrating pharmacy and medical benefits including the impacts on care coordination and clinical outcomes.
Speaker: Dr. Andrea Bennett, CVS Health/Aetna
Speaker: Dr. Anthony Lo Sasso, DePaul University
Medicaid finances more substance use treatment than all private payers combined. With COVID, overdoses have increased roughly 50%, and 2021 is on track for being the worst year for the Opioid Crisis on record. We know MAT saves lives and proactive outpatient care improves health outcomes while decreasing total cost of care. We also know that peer support programs improve patient activation and decrease reliance on costly rescue care. Despite clinical evidence, billions of dollars spent, and improved access to substance use disorder (SUD) services, an estimated 80% of those with SUD fail to engage in treatment.
To narrow this gap, AmeriHealth Delaware (ACDE) has partnered with Marigold Health, a virtual peer support program designed to engage and retain members at greatest risk of being lost to follow-up. Far more people participate in nonclinical support groups through organizations like AA or sites like Reddit, both unmonitored and isolated from care providers, than access SUD treatment. Marigold’s program combines holistic 1-1 coaching from a certified peer with 24/7 access to asynchronous support groups to increase activation and recovery capital in patients engaged. Our presentation will examine the uptake, retention, and downstream outcomes of Marigold’s program on ACDE’s members with SUD.
Speaker: Dr. Jordan Weisman, AmeriHealth Caritas Delaware
Speaker: Shrenik Jain, Marigold Health
This year, our Health Plan Leadership panel includes three stellar and influential Medicaid managed care industry all-stars, including John Barger III (President of Humana Medicaid), Francoise Culley-Trotman (CEO of AlohaCare), and Peter Jakuc (Senior Vice President and Chief Development Officer for AmeriHealth Caritas). They will discuss their top priorities for their organizations and how their companies continue to drive access, quality, and outcomes for Medicaid beneficiaries. This roundtable conversation will be moderated by Craig Kennedy, President and CEO of the Medicaid Health Plans of America.
Speaker: John Barger III, Humana
Speaker: Francoise Culley-Trotman, AlohaCare
Speaker: Peter Jakuc, AmeriHealth Caritas Family of Companies
Moderator: Craig A. Kennedy, MHPA President & CEO
2:30-3:30PM - Concurrent Educational Sessions
Humana’s Bold Goal is improving the health of communities we serve by co-creating evidence-based, scalable, and financially-sustainable solutions with community-based organizations and providers. The success of the population health strategy depends on a methodical approach, including:
- Data collection and measuring the impact
- Analyzing local needs and tailoring focus areas accordingly
- Fostering collaboration and trusted partnerships between varied stakeholders
- Innovation through pilot initiatives
- Applying the relationships, resources, and insights to our Medicaid clinical model
This framework creates a foundation to enhance our community partners’ reach and impact. Through a discussion of our partnerships, initiatives, and progress in one state, we will highlight how we’re improving whole-person health and reducing avoidable healthcare costs.
Speaker: Andrew Renda, M.D., MPH – Humana, VP, Bold Goal & Population Health
Medicaid and CHIP are critical to ensuring the healthy growth and development of the millions of children served by these safety net programs. The pandemic has severely exacerbated issues surrounding the health care status of low-income children, particularly children with behavioral health concerns and/or chronic conditions. Through a health equity lens, this session will feature senior MCO officials with clinical backgrounds and responsibilities to discuss how MCOs can continue to be part of the solution in closing gaps in care and services for the vulnerable children.
Speaker: Dr. Arethusa Stevens-Kirk – UnitedHealthcare
Speaker: Dr. Johanna Vidal-Phelan – UPMC
Speaker: Dr. Daniella Heller – Centene
Speaker: Dr. Gary Proctor - Anthem/Beacon Health Options
Moderator: Nicole Truhe – UnitedHealthcare
MCOs face significant challenges in their effort to identify individuals entering and exiting incarceration due to disparate systems fractured by limited healthcare data sharing and uncoordinated reentry policies sand programs. Many justice-involved beneficiaries suffer from substance use disorders and severe mental illness, further burdening the healthcare system.
One such MCO, CareSource Ohio, worked with data and analytics provider Appriss Insights to cross-reference member information with expansive and timely criminal justice data to gain unparalleled insight into the needs of the formerly incarcerated and develop tools for prioritizing care and support for these members.
By consistently identify individuals entering and exiting incarceration, CareSource is able to meaningfully stratify health needs and outcomes for justice-involved people, improve health outcomes and reduce costs, and potentially reduce the rate of recidivism in the sample population.
Speaker: Kieran Hurley, CareSource
Speaker: Cheston Newhall, Appriss Insights
4:00-5:00PM - Concurrent Educational Sessions
Approximately 5 percent of the Medicaid population accounts for half of the healthcare costs. This vulnerable population suffers significant health disparities due to the failure of traditional delivery systems to meet complex needs in an accessible, interdisciplinary manner that these members require -- thus perpetuating the cycle of high cost and poor health outcomes. Typical barriers include silos between medical, behavioral health, and social services, lack of scalability of home care programs, and weak alignment between providers and health plans.
Molina Healthcare of California worked with MedZed, a mobile, tech-enabled complex care provider, to redesign the care experience for Molina’s high-need members. The program provides longitudinal, integrated health and social services, relying on community health workers and nurses in the home linked by technology to remote clinicians. The program includes algorithm-derived member selection, multi-modal engagement processes, and home-based care, at scale.
Critical to success of this intervention is tight alignment of health plan and provider incentives and resources. We developed a shared financial risk model that promotes coordination and timely flow of information between parties, offering important lessons for health plans seeking to improve clinical outcomes and costs for this highest-need population. This presentation shares key insights from that program.
Speaker: Dr. Sayeed Khan, MD, Molina Healthcare of California
Speaker: Dr. Neil Solomon, MD, MedZed Physician Services
Leading up to and during the COVID-19 pandemic, States and their MCO partners adjusted quickly to the new reality while continuing to deliver comprehensive and coordinated care to our nation’s most vulnerable and underserved communities in a rapidly changing policy and operational environment. This panel discussion will explore how the pandemic transformed Medicaid, States, and the MCOs that administer the program, and look at next steps for transitioning to a post-pandemic world. What COVID-19- related changes and flexibilities should be kept past the end of the Public Health Emergency? How should CMS work with states on redeterminations and better connecting enrollees to other health coverage options? What is the future of telehealth, prior authorization, and the potential need for COVID-19 vaccine boosters? All of this and more will be discussed during this session.
Introduction by: Dr. Meera Mani – McKinsey
Speaker: Cheryl Roberts – DMAS
Speaker: Jerry Mammano – CEO, Aetna Better Health of Virginia
Speaker: Jenny Reynolds – Plan President, VA Medicaid, Anthem
Speaker: Tameeka Smith – CEO, VA Community & State, UHC
Speaker: Darrin Johnson - President/CEO, Molina Healthcare VA
Moderator: Jeanine Boyle, JD, MPH - MHPA Policy Consultant
Partners Health Plan (PHP) and StationMD launched a demonstration project aimed at improving access to quality medical care for people with intellectual and/or developmental disabilities (I/DD) while also significantly reducing Medicaid expenses by use of telehealth services. PHP is a specialized managed care plan providing coverage for disability and health services to the dual Medicaid/Medicare I/DD population in the metropolitan New York City area. StationMD is a physician practice specializing in treating people with I/DD via telemedicine 24/7. The service is used for urgent matters like fevers, seizures, mental health issues, and routine matters such as skin issues, prescription refills or general medical questions. Creating alternative healthcare access is a key life-saving measure for individuals with I/DD, direct support professionals, and families during the pandemic and beyond. Benefits of the program include:
- Significant cost savings in avoidable ED visits and transportation;
- Potential cost savings to hospitals as complicated discharges can lead to longer length of stay in this population;
- Cost savings to the Developmental Disability agency related to staffing and necessary ratios at residential facilities, and
- Reduction in complex, time-consuming and traumatic transfers to emergency departments and urgent care facilities;
- Superior, specialized, I/DD-tailored medical support resulting in improved health outcomes.
Speaker: Kerry Delaney, Partners Health Plan
Speaker: Maulik Trivedi, MD, FACEP, StationMD
Friday, September 24
7:30-8:30AM - Breakfast
MHPA is thrilled to announce that Chiquita Brooks-LaSure, the Administrator of the Centers for Medicare and Medicaid Services (CMS), will address MHPA21. Administrator Brooks-LaSure was confirmed to her position in May. She has decades of experience in federal government, on Capitol Hill, and in the private sector, and played a key role in getting the Affordable Care Act passed and implemented. The Administrator has proven herself as a tireless advocate for quality, affordable health care for everyone across the country, and we are excited to welcome her to our conference as we join together to move managed care forward.
MC: Kelly Munson, Aetna Medicaid President
Speaker: Chiquita Brooks-LaSure, CMS Administrator
Mission Sponsor: Aetna Medicaid
10:15-11:15AM - Concurrent Educational Sessions
The National Doula Network (NDN) is a mission driven initiative to increase access to insurance covered doula services. Founded in 2019, NDN is working with managed care organizations in Florida to improve utilization of the Florida Medicaid Expanded Benefits for birth doula services authorized by the FL Agency for Healthcare Administration in December 2018.
NDN’s partnership with Simply Healthcare Plans, initiated in May 2021, improved accessibility of the birth doula and expanded benefit availability statewide. NDN and Simply Healthcare Plans are working together to develop educational resources for medical providers, and building community-based partnerships with birth centers and maternal care networks to increase access and benefit utilization for Medicaid enrollees.
In this session, NDN and Simply Healthcare Plans will share a case study example of their work and partnership to enhance the delivery of coordinated, comprehensive perinatal care and access to birth doula services across the State of Florida. We will review early implementation results from the first 6 months of the program and discuss ongoing strategies for improving community-based partnerships with doulas, health plan members, organizations and maternal health care providers.
Speaker: Elizabeth Simmons, National Doula Network
Speaker: Ellen Syvertsen, Simply Healthcare Plans, Inc.
Once the Public Health Emergency (PHE) officially ends, millions of Americans are likely to lose their Medicaid coverage when states begin verifying and updating beneficiaries’ eligibility status, commonly known as redetermination. Though the Biden administration had indicated the PHE will continue through 2021, MCOs are already considering the potential ramifications of redeterminations while balancing their state partners’ competing interests. This session will explore the risks and concerns associated with redetermining eligibility, state-federal partnerships, and the mechanics of the redetermination process, and how MCOs will help eligible beneficiaries maintain access.
Speaker: Steve Cozzo – AmeriHealth Caritas
Speaker: Tony Solem – Gateway
Speaker: Patti Barnett - Centene
Moderator: Stephanie Wilkinson – UnitedHealthcare
Arizona Medicaid health plans have focused on loneliness and social isolation solutions and were the ‘first movers’ to do this on a statewide basis. In this panel discussion, three Arizona Medicaid Managed Care executives and Jami Snyder, Arizona’s Director of AHCCCS, Arizona’s Medicaid Program share why it is essential for plans to address loneliness and social isolation, and how doing so has improved member outcomes, solved for social determinant of health issues, avoided unnecessary emergency room visits and hospitalizations, and reduced healthcare spending.
This panel will discuss the limitations of traditional methods to address loneliness and will share how new approaches are helping them tackle loneliness through innovative methods leveraging a combination of human companionship and technology. These innovative plans are now able to support early and targeted outreach, engage members to screen for loneliness, and connect high-risk/high-utilizing members to timely medical care and interventions to resolve social barriers to care.
The panel will be moderated by Gary Jessee, Managing Director of Sellers Dorsey and former Deputy Executive Commissioner of Health and Human Services in Texas and the former Director of Texas Medicaid.
Speaker: Jami Snyder, Director of AHCCCS, Arizona’s Medicaid and CHIP Programs
Speaker: James Stover, Medicaid Plan President, Arizona Complete Health–Complete Care Plan
Speaker: Joel Conger, Director of System Transformation, Molina Complete Care of Arizona.
Speaker: Kathy Oestreich, Vice President and CEO, Banner University Health Plans, Retired
Moderator: Gary Jessee, Sellers Dorsey Consulting, Managing Director
11:30-12:30PM - Concurrent Educational Sessions
If we’ve learned anything from COVID-19, it’s that social determinants of health (SDOH), like food insecurity, can have a tremendous impact on member outcomes and spending. Fortunately, a growing body of research show medically tailored meals programs appear to be associated with fewer hospital and skilled nursing admissions and less overall medical spending.
This session will debut the results of a home-delivered meals pilot program conducted by UPMC Health Plan with the help of Mom’s Meals. What impact, if any, would a 13-week home-delivered meals program have on members living with multiple chronic conditions, a severe mental illness, or those with at least one hospitalization in the past year?
Presenters will review member survey and claims analysis data from the pilot to see what impact meals had on patient outcomes, satisfaction, ED utilization and total cost of care.
Speaker: Catherine Macpherson, Mom's Meals
Speaker: Katie Domalakes, MSW, LSW, UPMC Health Plan
This panel features senior Capitol Hill staff from the Senate Finance and House Energy and Commerce Committees with expertise in Medicaid and other health care programs and issues. The discussion will be structured as an off-the-record Q&A session, where staff will answer questions on what Medicaid-related federal legislative activity we can expect for the remainder of 2021 and looking forward to 2022.
Speaker: Rick Van Buren, House Energy & Commerce Committee staff – Dem
Speaker: Seth Gold, House Energy & Commerce Committee staff – Rep
Speaker: Liz Dervan, Senate Finance Committee staff – Dem
Speaker: Stuart Portman, Senate Finance Committee staff – Rep
Moderator: Shannon Attanasio – MHPA Vice-President
The healthcare industry has high hopes that technology can impact care, reduce disparities, and improve outcomes. Traditionally, technology has been deployed in siloed environments where health plans, providers, Departments of Health, et al. each try to deploy their own solutions with varied results and low levels of care coordination. In 2020, AmeriHealth, Babyscripts, and local DC providers partnered to create a care model allowing stakeholders to work together on the same technology platform to better coordinate care, identify pregnant members, engage and educate Medicaid beneficiaries on pregnancy, and use RPM to detect risk faster and triage. Through Babyscripts, 429 AmeriHealth members at participating hospitals were identified as pregnant at their first OB appointment, and enrolled in a virtual maternity care experience that included remote BP monitoring, enabling access to at-home care. Of those, Babyscripts identified 80 patients with abnormal blood pressure changes that enabled immediate healthcare provider interventions. Babyscripts identified multiple SDOH and health risks through provider integration and virtual service including 37 members with depressive disorders, 16 requiring food assistance, and 27 that had a history of preterm birth. While outcomes and cost of care results are currently being collected, the Babyscripts program across the country demonstrates similar success.
Speaker: Juan Pablo Segura, Babyscripts
Speaker: Karen Dale, AmeriHealth Caritas District of Columbia
Medicaid Directors from four states – Arizona, California, and North Carolina – will discuss how they and their Governors are working to ensure access to needed healthcare services for our nation’s underserved and vulnerable populations while highlighting their close collaboration with managed care organizations to move the needle on quality and outcomes. This roundtable conversation will be moderated by Sellers Dorsey’s Managing Director, Gary Jessee, a former Texas Medicaid Director.
MC: Chris Priest, Centene Corporation
Speaker: Jami Snyder, Arizona
Speaker: Jacey Cooper, California
Speaker: Dave Richard, North Carolina
Speaker: Stephanie Stephens, Texas
Moderator: Gary Jessee, SellersDorsey
Mission Sponsor: Centene Corporation