innovative strategies and product solutions to drive … · 2018. 5. 24. · identifying innovative...

Now and in the future,

Medicare, Medicaid, and

the Health Insurance

Marketplace are the leading

sources of revenue for

insurers and providers

alike. Nailing a sound

strategy and tactics to

master these programs and

the regulatory complexities

they bring is where this

event comes in.”

- John Gorman, Founder & Executive Chairman, Gorman Health Group

• Product strategy – identifying the return on investment on your member experience and driving more strategic product development in marketing and sales

• Vendor management and oversight from a technology perspective

• Predictive and actionable insights from better integration of data and technology

• Tactics to improve compliance readiness for 2017 from a pharmacy perspective

• Best practices in provider network strategy and coordinating risk adjustment and Star Ratings

• Understanding the new rulebook behind the Health Insurance Marketplace and how to be successful

Gather your organization’s key people and bring them to New Orleans!

The Gorman Health Group 2017 Forum is unique because it is designed for team attendance. Grab your colleagues and join us for this one-of-a-kind event that breaks down operational silos within plans and provider groups. Timely updates, critical insights, and practical advice become actionable only when you can share them with your team. We’ve factored in ample time to meet and discuss the sessions and immediately develop an action plan.

Want to set up time to meet with one of Gorman Health Group’s subject matter experts while onsite? Let us know.

Join us in New Orleans, Louisiana, April 26-27, 2017, for a unique event designed for cross-functional leadership teams working in government-sponsored health programs.

This year, our unique healthcare event promises to be the best one yet – offering fresh perspectives, deep insights, and product knowledge on the major challenges facing our industry today in one of the most vibrant and thriving cities in the country. Our focus will be on identifying innovative strategies and product solutions to drive your business forward as well as effective compliance program management, product development, network adequacy, emerging trends in technology solutions, Star Ratings, and risk adjustment – plus what to focus on now.

We welcome not only individual registrations but also urge you to attend with your colleagues as the Gorman Health Group 2017 Forum is designed for cross-functional leadership and operations teams. Hear best practices, share knowledge, network with other industry experts, and plan for future initiatives in a content-charged atmosphere. The topics we are exploring this year are: • Emerging trends in Star Ratings to improve 2018 scores

• Revenue optimization and innovative technology available today

• Efficient operations currently driving market share growth

• Effective compliance program management – what’s working and what’s not across the industry

INNOVATIVE STR ATEGIES AND PRODUCT SOLUTIONS TO DRIVE BUSINESS

APRIL 26-27, 2017

THE JW MARRIOTT

NEW ORLEANS

NEW ORLEANS, LA

www.gormanhealthgroup.com

Discount codes cannot be issued retroactively. Any requests for group rates must be made by contacting [email protected] prior to registering.

Questions? Contact us at [email protected].

Space is limited for this exclusive event, so please register now to secure your organization’s attendance. All individuals must register through the online registration form, while all groups must contact [email protected] for registration.

Gorman Health Group has negotiated a preferred room rate of $259 per night for all attendees. Book your room before this negotiated rate expires on March 28, 2017. To make your reservation, visit the JW Marriott New Orleans online with Gorman Health Group’s event link.

Come to learn, stay to explore! Nestled in the heart of the illustrious French Quarter, the JW Marriott is steps from celebrated restaurants, thrilling Bourbon Street nightlife, legendary live music venues, and the unforgettable New Orleans Jazz and Heritage Festival following our event, April 28-May 7.

If you would like to extend your stay through Jazz Fest weekend, the above mentioned discounted rate of $259 per night will still apply through Sunday, April 30, 2017! This rate is based on hotel availability, so please book your reservation as soon as possible to take advantage of this special rate. All Jazz Fest weekend reservations should be made by calling the hotel directly at 1-877-622-3056. Be sure to mention the Gorman Health Group Forum when making your Jazz Fest weekend reservation.

WHO SHOULD ATTEND? This exclusive event provides an intensive examination of the state of government healthcare programs to support health plans, providers, and their business partners; best practices and innovative strategies for continued growth of Medicare Advantage (MA) and Part D markets; as well as new opportunities in the Health Insurance Marketplace and dual-eligible populations.

WE ENCOURAGE DECISION-MAKERS FROM THE FOLLOWING ORGANIZATIONS TO ATTEND:• MA and Part D Plans

• Pharmacy Benefit Managers (PBMs)

• Provider Systems

• Participants in the Health Insurance Marketplace

• Medicaid Plans

• Special Needs Plans (SNPs)

THANK YOU TO OUR SPONSORS

NEXT STEPS To register for the Gorman Health Group 2017 Forum:

Visit: https://www.gormanhealthgroup.com/ gorman-health-group-2017-forum/

Email: [email protected]

Call: 202-315-4482

PRICING AND GROUP BENEFITS Health Plan, Provider, and PBM Pricing Structure and Group Discounts: HEALTH PLAN, PROVIDER, AND PBM INDIVIDUAL RATE $775

GROUP RATES Three team members 15% discount Four team members 20% discount Five team members 25% discount Six or more Request rate

*Please note – vendor registrations will NOT be accepted. All registrations will be reviewed, and vendor registrations will be cancelled.

To find out more about group rates, contact us at [email protected].

Time 7:00 - 8:00 AM

8:00 - 9:00 AM

9:00 - 10:00 AM

Morning Networking Break with Refreshments 10:00 - 10:15 AM

10:15 - 11:10 AM

Day 1 - April 26, 2017 Registration Breakfast

Grand Ballroom — ILE DE FRANCE I & II – Welcome and Opening Remarks John Gorman, Founder & Executive Chairman Gorman Health Group

Grand Ballroom — ILE DE FRANCE I & II – Welcome to New Orleans Working with Your Providers and Vendors Warren Murrell, Chief Executive Officer Peoples Health

TRACK 1 ORLEANS / ROSALIE / ST CLAUDE

CMS Audit Trends - Lessons Learned in 2016 and Where to Focus in 2017 - Part 1

This session will explore the 2017 the Centers for Medicare & Medicaid Services (CMS) audit process and provide tactics for success and lessons learned from 2016. The panel will discuss challenges to plans based on the audit changes, overall risk mitigation, and impact on Star Ratings and performance.

• Universe Preparation – Executing the fundamentals

• Medication Therapy Management (MTM) Audit – Creating a game plan

• Best Practices – Best defense is a good offense

• Case Studies – Lessons from the field

Tina Bailey, Senior Director, Compliance Solutions Gorman Health Group

Wayne Miller, Senior Director, Pharmacy Solutions Gorman Health Group

Caron Wingerchuk, Senior Director, Pharmacy Gorman Health Group Anita McCreavy, Senior Consultant Gorman Health Group Mayling Naputi, Senior Consultant Gorman Health Group

Anita Green, Senior Consultant Gorman Health Group

TRACK 2 ILE DE FRANCE III

Innovative Methods to Driving Your Star Ratings Program

Achieving and maintaining strong Star Ratings requires continuous innovation. This session will share insights into innovative methods being used by top-performing plans and will touch on areas where previous innovations have become industry standard or out of date. We’ll talk about using medication management as a foundation for improving health outcomes, strategies to impact survey measures, how to use the many new medication and care coordination measures under development by CMS to realign the roles of the medical and pharmacy teams, and opportunities to leverage your PBM.

Melissa Smith, Vice President, Stars Gorman Health Group

Lisa Erwin, Senior Consultant Gorman Health Group

TRACK 3 (Tech Track) CONDE / FRONTENAC

Big Data Cusomized for You

With great technology comes great responsibility and way too many choices! However, if big data (your data) is customized and analyzed for your business and strategic needs, then the return is greater both financially and operationally. Listen to Gorman Health Group discuss how your data from membership, revenue, and claims experience can be tailored to your operation, so dashboards become action plans. As a key component of the MA operation, we will also look at membership data from the beginning and how it moves throughout your organization.

Jessica Smith, Vice President, Healthcare Analytics & Risk Adjustment Solutions Gorman Health Group Nancy Djordjevic, Director Healthcare Analytics Gorman Health Group


Innovative Strategies and Product Solutions to Drive Business Forward

12:10 - 1:00 PMNetworking Luncheon

Day 1 - April 26, 2017 continued Time11:15 AM - 12:20 PM

1:00 - 1:55 PM


CMS Audit Trends - Lessons Learned in 2016 and Where to Focus in 2017 - Part 2

This session will explore the 2017 CMS audit process and provide tactics for success and lessons learned from 2016. The panel will discuss challenges to plans based on the audit changes, overall risk mitigation, and impact on Star Ratings and performance.

• Universe Preparation – Executing the fundamentals

• MTM Audit – Creating a game plan

• Best Practices – Best defense is a good offense

• Case Studies – Lessons from the field

Tina Bailey, Senior Director, Compliance Solutions Gorman Health Group

Wayne Miller, Senior Director, Pharmacy Solutions Gorman Health Group

Caron Wingerchuk, Senior Director, Pharmacy Gorman Health Group Anita McCreavy, Senior Consultant Gorman Health Group Mayling Naputi, Senior Consultant Gorman Health Group

Anita Green, Senior Consultant Gorman Health Group


340B and Medicaid Managed Care - What You Need to Know

In a changing healthcare environment, identifying opportunities for partnerships that deliver value is essential. Policy changes in the Medicaid fee-for-service space from CMS have impacted the approaches states are taking regarding reimbursement for 340B program-covered entities. As the Medicaid managed care market continues to evolve, there are emerging opportunities to support these safety net providers and create models that work for reimbursement. Attend this session to receive an update about the strategies being tested and proven successful for collaboration with 340B entities.

Learning objectives:

• Provide an overview and update on the 340B program.

• Describe trends in 340B Medicaid state plan amendment approaches pursuant to the final AMP Rule.

• Share best practices in 340B-Medicaid partnerships regarding duplicate discount prevention.

Chris Hatwig, Chief Executive Officer Apexus

Deb Devereaux, Senior Vice President Pharmacy Solutions and Clinical/ Quality & Stars Gorman Health Group


Social Impact Bonds

With increasing competition and a continued shift towards value-based contracting, finding new funding to support clinical innovation and Star Ratings outcomes measures can be challenging. Join us for a discussion of new funding mechanisms available to support clinical innovations: social impact investing.

John Gorman Founder & Executive Chairman Gorman Health Group



Aligning Your Operational Areas and Finance Department

They say opposites attract, but when it comes to Operations and Finance it can seem like they repel. This session will discuss strategies to ensure that Operations and Finance stay connected and moving towards the same goals.

Topics

• Financial Transparency

• How Operations Impacts Finance

• Risks in Misalignment

• Ways to Coordinate between Operations and Finance

Julie Billman, Vice President, Operational Performance Gorman Health Group

Roshan Desai, Director, Operational Performance Gorman Health Group



Product Demonstrations


Afternoon Networking Break with Refreshments 3:55 - 4:10 PM

Day 1 - April 26, 2017 continued Time

2:00 - 3:55 PM

4:10 - 5:05 PM

GRAND BALLROOM - ILE DE FRANCE I & II

Keynote Address: Practice Area Leaders (PALs) Panel & Health Plan Leadership

Maintaining your competitive advantage in the marketplace today requires innovation and thought leadership. Gorman Health Group’s Senior Leadership team, along with top health plan leadership, will discuss practical examples of how health plans, providers, and multidisciplinary teams have worked collectively to design and implement consumer-centric product offerings and the programs that ensure their success. This facilitated panel discussion will provide actionable, proven solutions to breaking down silos to achieve superior performance outcomes in both the short – and long-term for your organization

Deb Devereaux, Senior Vice President, Pharmacy Solutions and Clniical/Quality & Stars Gorman Health Group

Regan Pennypacker, Senior Vice President, Compliance Solutions Gorman Health Group


Jessica Smith, Vice President, Healthcare Analytics & Risk Adjustment Solutions Gorman Health Group

Nilsa Lennig-Rudisill, Vice President, Sales & Marketing Services Gorman Health Group

Facilitated by Charro Knight-Lilly, Chief Sales Officer Gorman Health Group


Sales and Marketing Strategies for Dual Eligible Special Needs Plans - Should You be Investing in this Market?

Are you considering whether or not your organization should offer a Dual Eligible Special Needs Plan (D-SNP)? Join us as Gorman Health Group explores:

• What makes D-SNPs a viable option?

• Marketing and communication strategies to reach this population

• How to design your Sales channels

• Understanding what benefits are attractive to the D-SNP population

Carrie Barker-Settles, Director, Sales & Marketing Services Gorman Health Group

Diane Hollie, Senior Director, Sales & Marketing Services Gorman Health Group


Are You Audit Ready? Gorman Health Group Technology and Compliance experts will walk you through how to prepare your organization for a CMS program audit and demonstrate Gorman Health Group tools that were developed to support organizational audit readiness. This session would be appropriate for Compliance, Operations, and Technical staff who are interested in methods for:

• Generating universes and validating their accuracy

• Running timeliness tests

• Techniques to support case review

• Corrective Action Plan (CAP) development

Melissa Bailey, Senior Consultant Gorman Health Group


OMT™ Client Workshop

Jill Stillman, Associate Director, Compliance Products Gorman Health Group



Jill Stillman, Associate Director, Compliance Products Gorman Health Group


Gorman Health Group 2017 Forum Welcome Reception 6:00 PM

Day 2 - April 27, 2017

7:00 - 8:00 AM

8:00 - 8:55 AM

Registration and Breakfast TRACK 1 GRAND BALLROOM - ILE DE FRANCE I & II

Round Table - Top-Tier Star Ratings Plans Share Their Approach

Join this roundtable session to hear from top-tier plans regarding what’s working (and what’s not) for Star Ratings success. We’ll cover a wide range of topics – from strategies to tactics, from member engagement to provider engagement, and from new measures to old ones. Join us to hear the latest from high-performing plans.


Heidi Syropoulos, Medical Director of Government Markets Independence Blue Cross

Lauren Hampshire, Director of Corporate Clinical Quality CareSource

Melissa DeGoede, VP of Population Health Network Health Plan


Compliance 301: Partnerships, Communication, Monitoring, and Auditing

Join us for a discussion on advanced Compliance strategies for managing FDRs. We will explore methods to encourage effective lines of communication, enhance awareness of regulatory requirements through training and education, and partner with FDR leadership for building a culture of compliance.

Topics:

• Using performance guarantees in contracting

• Communication: More than just bi-weekly conference calls (putting faces to names)

• Post-delegation FDR onboarding, training, and education

Melissa Bailey, Senior Consultant Gorman Health Group



Sentinel Elite™ Client Workshop

Michael Fox, Vice President, Products, Gorman Health Group

April Fleming, Senior Vice President, Products Gorman Health Group

Day 1 - April 26, 2017 continued Time5:10 - 6:00 PM


“What’s the Return on Your Members’ Experience?”

This session will focus on identifying the areas of critical importance to the member experience and shared accountability for improving the member experience across the enterprise. We will look at ways to prioritize your retention initiatives looking at external influences, internal communications, and ongoing surveillance of data, all which contribute to creating a positive member experience.

Nilsa Lennig-Rudisill, Vice President, Sales & Marketing Services Gorman Health Group




Provider Directory Compliance

CMS has released the results and methodology from the first round of MA online directory audits. How would you fare if audited today? Join Gorman Health Group as they review the results and guidance as well as these other key topics:

• Regulatory requirements and compliance enforcement

• Downstream impact directory inaccuracy and data integrity has on plan operations

• Sales & Marketing, the Annual Election Period (AEP) effect, member retention, and member experience

• Impact, regulatory guidance, and enforcement on other government-sponsored plans

• Preparing for success and best practices

Ellie Martin, Senior Director, Provider Innovations Gorman Health Group





10:00 - 10:55 AM TRACK 1 ORLEANS / ROSALIE / ST CLAUDE

CDAG Workshop

The session will discuss hot topics within the Coverage Determinations, Appeals, and Grievances area in an interactive program. No formal presentations – real-life cases will guide discussions facilitated by Gorman Health Group experts. Cases chosen will highlight the following:

• 2016 CDAG Audit findings – Been there done that.

• Updates/reminders related to common CDAG compliance challenges - Did you get the memo?

• Elements of a compliant beneficiary notice – But it was just a misunderstanding.

• Outreach expectations – Don’t just call me ‘maybe’.

Caron Wingerchuk, Senior Director, Pharmacy Solutions Gorman Health Group

Roxanne Newland, Senior Consultant Gorman Health Group

Lisa Artale-Bross, Senior Consultant Gorman Health Group


Provider Network Strategy

As a plan, your largest asset is your provider network. The network strategies that existed even a few years ago are no longer viable options with the CMS required shift from fee-for-service to value based/risk/alternative reimbursement models, Star Ratings, and the spotlight on network adequacy. The session will focus on:

• Ensuring your provider agreements for government-sponsored programs align with the requirement to have a portion of the reimbursement tied to quality measures and ensuring the agreements support the plan’s overall clinical and financial goals.

• Ensure the proper cross-functional provider engagement architecture is in place to support incentive plans and Star Ratings measures

• Do you know the pain points of your providers, from the small independent doctor to the large integrated delivery system in your market, and are you meeting their needs?

Ellie Martin, Senior Director, Provider Innovations Gorman Health Group





Day 2 - April 27, 2017 continued Time

9:00 - 9:55 AM TRACK 1 ORLEANS / ROSALIE / ST CLAUDE

Model of Care Programs That Deliver When it comes to the Model of Care, is your organization utilizing the architecture and wrapping it with the structure to succeed?

• Advice and expertise regarding current Part C and Part D regulations and guidance and National Committee for Quality Assurance (NCQA) requirements and guidance,

• Advice on Medicare Operations and best practices regarding current CMS audit protocol,

• Advice on Medicare Operations and providing best practices for the MA program and NCQA, including Health Services, organization determinations, and appeals and grievances,

• Guidance and counsel for Government Programs regarding the shift of Medicare and subsequent process, structure, and staff changes, and insights to maintain synergy with other current efforts (e.g., Star Ratings initiatives).

Mayling Naputi, Senior Consultant, Gorman Health Group

Anita McCreavy, Senior Consultant Gorman Health Group


Data Mining Customer Service Calls – Improving Compliance and Operational Efficiencies Customer Service calls provide insight into how various plan areas are operating. All too often, outside of trending call categorization, this critical and plentiful data goes underutilized to improve operational performance. This session will discuss ways this information can be used and how to take the information to the next level to improve operational efficiencies and compliance.


Katie Lepsevich, Senior Director, Operational Performance Gorman Health Group






Morning Networking Break with Refreshments 10:55 -11:15 AM

12:15 - 1:00 PM TRACK 1 ORLEANS / ROSALIE / ST CLAUDE

Assessing Your Risk Adjustment Vendors & Best Practices for Implementation

Need help selecting, implementing and managing your risk adjustment vendors? Risk adjustment vendors are a critical component of a successful risk adjustment program. Gain insights into:

• Vendor evaluation and selection best practices

• Successful onboarding and implementation of new vendors

• Strategies to monitor and assess vendor performance


Which Direction Do I Take My Service Area? Let the Analytics Drive Your Strategy

Are you one of the following:

• Looking to enter the MA market

• Expand your service area or

• Get your service area more competitive and profitable?

Let Gorman Health Group walk you through some of the analytics that will help you develop your strategy. We will discuss different ways you can look at your market and have an interactive discussion to help you build a game plan that will work for you.

Diane Hollie, Senior Director, Sales & Marketing Services Gorman Health Group

Nancy Djordjevic, Director, Healthcare Analytics Gorman Health Group


Product Demonstrations

Day 2 - April 27, 2017 continued Time11:15 AM - 12:10 PM


ODAG Workshop

The ODAG (Organization Determinations, Appeals, and Grievances) world has sharp edges – identifying some of the operational challenges that may cut holes in your compliance efforts and the practical solutions to keep our members and our health plans safe. Join us to explore the challenges and solutions to sharpen your plan to a compliant and successful ODAG future.

Mayling Naputi, Senior Consultant, Gorman Health Group



Pharmacy & Case Management - Better Outcomes In a perfect world, health plan case managers would have all the information needed from all the members of the interdisciplinary care team to make decisions which would positively affect the member’s healthcare outcomes. This session will describe strategies to integrate pharmacy and medication information in the case management process.

• Matching medications and diagnosis

• Cost-effective and efficacious medications for members

• Medication management through transitions of care

• Feedback loops for members to engage in self-management

Deb Devereaux, Senior Vice President, Pharmacy Solutions and Clinical/Quality & Stars Gorman Health Group

Cynthia Pawley-Martin, Senior Clinical Consultant Gorman Health Group


Your Sales Data is Talking to You. Are You Listening?

The combination of data and powerful predictive analytics tools offers health plans the opportunity to get results—if they ask the right questions and listen to the answer. During this session, Gorman Health Group will share with you reasons agents fail to complete their annual certification and onboarding, reasons for high sales allegations within the external sales channels, and why some newly contracted/certificated agents never produce a single application. Join us for a rare look into how this data can control sales team outcomes and predict sales success.

Carrie Barker-Settles, Director, Sales & Marketing Services Gorman Health Group



Grand Ballroom Closing Remarks and Lunch John Gorman, Founder & Executive Chairman, Gorman Health Group 1:00 - 1:30 PM

We are your partner in government-sponsored health programs

Operational Performance Bringing excellence to every aspect of your implementation, from enrollment to claims payment.

Sentinel Elite™ is a module-based software solution designed to assist government managed care organizations onboard agents, provide training, manage ongoing oversight activities, and pay commissions effectively and compliantly.

Strategy & GrowthDriving profitable growth and member retention through strategic marketing, sales, and product development.

Provider InnovationsSupporting network design and medical cost control implementation.

ComplianceOffering guidance and support in every strategic and operational area to ensure alignment with the CMS and state Medicaid programs.

Healthcare Analytics & Risk Adjustment SolutionsAssessing, designing, and implementing cross-functional risk adjustment programs with corporate initiatives for medical trend management and quality improvement.

PharmacyLeading experts in Part D, pharmacy benefit management, formulary, and pharmacy programs.

Clinical, Quality & Star RatingsChanging how you approach Medical Management, Quality, and Star Ratings.

™

™

™

™

The Insider provides in-depth analysis and expert summaries of the most critical legislative and political activities impacting and shaping your organization and the future of Medicare, Medicaid, and the Health Insurance Marketplace.

Gorman University™ provides training sessions on a varety of industry topics, each designed to meet the unique needs of your organization.

Valencia™ provides rigorous, compliant, and transparent workflow controls that ensure your operational processes – and the resulting payment – are as accurate as possible.

CaseIQ™ not only captures all of the data points needed to categorize, work, and report MA and Part D appeals and grievances, it also guides case processors through each case to minimize the risk of non-compliance due to user error.

OMT™ is the complete compliance toolkit designed to centralize ongoing monitoring and auditing, manage regulatory notices, document corrective actions, and streamline member material review.

ONE-STOP ACCESS TO EXPERT ADVICE, GUIDANCE, AND SUPPORT IN EVERY STRATEGIC AND OPERATIONAL AREA

www.gormanhealthgroup.com follow us for fresh content

CONTACT US! STAY CONNECTED to industry news and gain perspective on how to navigate the latest issues by subscribing to our weekly newsletter at https://www.gormanhealthgroup.com/subscribe and visiting our website at www.gormanhealthgroup.com.

GORMAN HEALTH GROUP is always looking for leading professionals in the healthcare industry to further enhance our team of experts. Visit us online to learn more about job opportunities, or contact us at [email protected] for more information.

CONTACT Mail: 5335 Wisconsin Avenue NW, Suite 340, Washington, DC 20015

Email: [email protected]

Phone: 202-364-8283

www.gormanhealthgroup.com follow us for fresh content

innovative strategies and product solutions to drive … · 2018. 5. 24. · identifying innovative...

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