ACO/Payer Innovation Fusion

Some Topics being Addressed during this session

Removing blind spots to patient engagement: Activate your network for higher success

Learn how innovative technology and advanced analytics are helping providers, physicians, payers and ACOs efficiently and effectively increase engagement and extend their services to more members starting from the acute setting. Hear how organizations are succeeding in value-based care by receiving:

• The visibility to know where patients are receiving care
• The intelligence to prioritize the right patient, at the right time with the right resources
• The engagement opportunities to influence your patient’s care plan

Effective Critical Decision Making for Healthcare Leaders – Executive Director at Texas A&M Rural and Community Institute (ARCHI)

• Understanding the importance of critical decision making for health care leaders.
• Recognize the role of organizational culture in decision making.
• Explore the conscious and unconscious ways leaders make decisions.
• Illustrate critical skills useful for healthcare leaders to make informed and effective decisions

Hyperlocal care management and remote patient monitoring - Chief Operating Officer/Chief Medical Officer at United Healthcare Medicare Advantage for Texas

• Why hyperlocal care management is better than a national call center
• How to utilize care management to address STARS and RAF
• Can remote patient monitoring be cost effective?

Prescribing Excellence: Navigating the Landscape of Clinical Quality Measures

Discover the critical role of clinical quality measures in the realm of value-based care programs and gain insights on effectively navigating this complex landscape. Join us as we explore strategies to optimize healthcare quality, enhance patient outcomes, and drive performance excellence within your organization

• Why CQMs are a critical to value-based care.
• Strategies to optimize quality.
• Learn how to drive performance excellence

Front-Line Innovation in a Value-Based World - Chief Clinical Innovation Engineer at Atrius Health

• How re-envisioning what team-based care looks like can impact the lives of patients and improve workforce satisfaction.
• Opportunities to expand access to digital tools for patients while improving the financial well-being of the organization
• Creative solutions for implementing and expanding partnerships with employers

Duals Integration Best Practices - Senior Director, Medicare Strategic Business Operations & Compliance at Centene

• Best Practices for MMP and DSNP look alike plan transition to DSNP (CA did this effective 1/1/23)
• DSNP(Dual special Needs) only H-Contract-importance of relationships with State Medicaid regulators

Social Determinants Of Health - Medical Director, Research at Wellspan Health

• Importance of Social Determinants Of Health
• Current Status of SDH Clinical Data
• SDH AI algorithms and SDH Social interventions to improve access to quality care and improved outcomes

Network Strategy - Supplier Relationship Management - National Executive Director - Care at Home Sourcing at Kaiser Permanente

• Supplier Relationship Management
• Governance & Oversight

PCP Driven ACOs - Proven Results - National Vice President, Strategic Payer Partnerships at Aledade, Inc.

• PCPs account for 8% of medical spends
• PCP driven ACOs can control `90% of total medical spend
• PCP driven ACOs help small practices on the pathway to increase downside risk

Making Health Equity an Intrinsic Part of the Corporate Culture - Market Chief Medical Officer at CareSource - - Indianapolis, IN

• Building the Foundation and Paving the way for the Cultural Shift
• Outline the business, financial and social rationale for managed care organizations to prioritize health equity right now.
• Identify the essential elements of persuasive communication to articulate the need for change and resonate with your audience.
• Explore CareSource’s journey to evolve into a culture of equity by identifying champions, garnering support, creating a vision and executing strategic initiatives to support a diverse membership.

The Preventive Care Powerhouse: How Wondr Health is Transforming Health Care and Driving Down Claims Costs

• Learn about the anti-obesity medication landscape, including trends and challenges.
• Identify the risks and benefits of covering anti-obesity medications.
• Understand why tailored medication management is key and why pairing a quality behavior-change program with anti-obesity medications is critical for payers who want to stay ahead of the curve in achieving long-term clinical outcomes and cost savings.
• Get industry-leading expertise to inform and define your anti-obesity medication strategy

Medicaid Unwinding - Director, Medicaid Product Administration at Horizon Blue Cross Blue Shield of New Jersey

• Over the course of the next year, 15 million people are expected to lose access to their Medicaid coverage. This workshop will center on the rollback of COVID-era protections around Medicaid coverage, otherwise known as “Medicaid Unwinding”.
• New Jersey’s experience with resumption of redetermination operations will be highlighted as well as the unique way Unwinding intersected with the introduction of Cover All Kids legislation in the State.
• Guidance on designing impactful communications and community outreach strategies for maximum effectiveness in the midst of a shifting policy landscape.

Next-Generation Sequencing–Based Tests: Challenges, Opportunities, and Potential Solutions - Deputy Director at Orlando Health Cancer Institute

• Describe Next-generation sequencing (NGS) in cancer
• Understand risk–benefit profile of NGS–based testing
• Describe the current landscape of whether and how payers cover
• Discuss barriers
• How to overcome such barriers to help public and private payers for coverage

Innovation in Healthcare using AI - Head of Strategic Partnerships at Health Care Service Corporation

1. Drive to innovation within Healthcare Payer space is leading to multiple opportunities.
2. Artificial Intelligence is presenting opportunities across
   • Value-Based Care Enablement
   • Optimizing Provider Networks
   • Improving Efficiency in Claims Management
   • Enabling Personalized Member Engagement
   • Implementing Data-Enabled Decision-Making

From Data to Intuitive Analytics that Drive Action

• Overcoming the challenges of integrating data from multiple sources
• Turning gaps in care, HCC codes, and vertical integration of services system into a clinically relevant seamless process
• The central role of intuitive analytics to support effective physician behavior and proactive health risk management

What Can Physician-First Care & Guidance Do For You (and Your Members)

• Find out how the care journey changes when members gain immediate access to a live physician in less than 60 seconds, connecting the moment of need to the point of care.
• Learn how Advanced Virtual Primary Care will complement and optimize in-network resources.