Day One - December 9, 2019
10:30 am Registration Open and Visit with Sponsors
Room: Potomac Hall (2nd Floor)
1:00pm – 1:30pm Welcome and Introductions
1:30 pm – 2:15 pm Opening Keynote: Thriving in a World of Quality, Value and Risk
Room: Waterside 1&2 (2nd Floor)
Speaker: Dan Mendelson, Founder, Avalere Health and Operating Partner, Welsh Carson
2:15 pm – 2:45 pm Expanding Role of LTC/PAC Providers in PHM
Room: Waterside 1&2
Speakers: Mike Cheek, Senior Vice President, Reimbursement Policy, AHCA; Jill Sumner, Vice President, Population Health Management, AHCA
3:00 pm – 4:30 pm Breakout Sessions
These education sessions also serve as ice breakers for the structured social networking events following the breakout sessions. Attendees, please choose one session for this time block.
OPTION 1: Positioning Yourself for Plan/Provider Partnerships
Speakers: Tim Grimes, CEO, Post Acute Care Network (PACN); Rhonda Schechter, Managing Associate, Frost Brown Todd, LLC
Session Description: Value based partnerships that previously centered around acute care are now reaching post-acute care (PAC) providers and partners. In this session, you will learn how PAC providers are partnering to leverage existing CMS programs such as bundled payments to put PAC providers in control. Provider partners will share the legal, operational and clinical hot spots involved in creating and sustaining unique PAC-focused value-based arrangements with payers, and how these models will continue to drive the best care and opportunities for PAC in a value based world.
- Identify the benefits and risks in partnering with providers in unique PAC models and value-based arrangements
- Discover how to position PAC providers with payers to create unique opportunities
- Demonstrate a deeper understanding of the legal, clinical and operational models needed to achieve such partnerships
OPTION 2: Supplemental Benefits Options and Opportunities
Speaker: Anne Tumlinson, Founder/CEO Anne Tumlinson Innovations
Session Description: Supplemental benefits provided by Medicare Advantage Plans are used to attract beneficiaries and differentiate the plan from its competitors. They are not covered under Medicare FFS and are items or services individuals typically pay for out of pocket. New flexibility in supplemental benefits can present opportunities for LTC/PAC providers. Those that own health plans can select from a broader menu of benefits that can help to support their members/residents. Providers who offer services related to social determinants of health can begin to explore new opportunities for revenue. Hear about new options in supplemental benefits, challenges, and successes in operationalization.
- Identify the new categories of supplemental benefits and examples of each
- Discuss health plan adoption of new supplemental benefits, the challenges, and successes in implementation.
- Identify ways your organization, residents, members may benefit from these new options
OPTION 3: Achieving Care Model Transparency and Integration
Speakers: Angela Norman, DNP, GNP, ACNP, Director of UAMS Reynolds Institute on Aging Centers on Aging; Richard Feifer, MD, MPH, FACP, Chief Medical Officer, Genesis HealthCare and President, Genesis Physician Services
Session Description: One of the largest challenges in adopting a population health mindset is the successful integration of the model into current operations. Clinical processes must be aligned, staff trained in effective communication and information readily available to aid in decision making. Hear from clinical experts about the challenges and best practices for merging old and new practices.
- Identify the key elements of successful clinical integration
- Discuss strategies for overcoming challenges in clinical integration
- Describe options and techniques for care model communication and transparency
4:45 pm – 5:30 pm Structured Networking Sessions
Attendees, please choose one session for the structured social networking sessions.
OPTION 1: Social Determinants of Health: Next Generation Services
Facilitator: Michael Monson, CEO, Social Health Bridge, and SVP Medicaid and Complex Care, Centene
Session Description: New options in supplemental benefits demonstrates CMS’ commitment to providing beneficiaries with choices to support aging in place. Join the discussion to understand what benefits may support your residents and how to access them.
OPTION 2: Provider Owned Special Needs Plans and Partners
Facilitators: R.J. Gilson Senior Vice President, AllyAlign Health; Hank Watson, Chief Development Officer, American Health Plans; Rick Grindrod, President/CEO, Provider Partners Health Plan
Session Description: Meet and speak with the organizations that are spearheading LTC/PAC provider owned special needs plans movement. The discussion will include specific examples of how health plan ownership has both its challenges and rewards. Ask questions to understand more fully your options for ownership and/or collaboration.
OPTION 3: Legal Implications of PAC/LTC Provider Led Population Health Management Models
Facilitator: Katie Colgan, JD, Executive Director, Integrated Networks, AHCA/NCAL\
Session Description: Join this networking social to understand legal opportunities and pitfalls in provider led PHM models. The discussion will include key legal elements, particularly in provider partnerships – both with other providers and with payers, including privacy, anti-trust, and compliance.
OPTION 4: Emerging Models in PAC/LTC
Facilitators: Fred Bentley, MPP, MPH, Managing Director, Avalere Health; Sarah Keenan, RN, BSN, President, Bluestone Physician Services
Session Description: CMS continues to shift the healthcare system from paying for volume to paying for value through a range of models. Join this networking session to understand emerging models such as Direct Contracting and opportunities for SNFs and PAC, including innovation in AL.
Day Two - December 10, 2019
9:00 am – 10:30 am Breakout Sessions
Attendees, please choose one session for this time block.
OPTION 1: Nut and Bolts of SNP Development
Speakers: R.J. Gilson Senior Vice President, AllyAlign Health; Hank Watson, Chief Development Officer, American Health Plans; Rick Grindrod, President/CEO, Provider Partners Health Plan
Session Description: LTC/PAC provider-owned Special Needs Plans are rapidly being developed across the country. In an interactive workshop setting, work with AHCA/NCAL’s Population Health Management Council Partners to understand your organization’s options for health plan development and/or partnership.
- Describe the opportunities and challenges that come with health plan ownership
- Identify the key elements of health plan development and the required timeframes for implementation.
- Develop an organizational strategy around a health plan opportunity analysis
OPTION 2: Senior Housing and Social Determinants of Health
Speakers: Michael Monson, CEO, Social Health Bridge and SVP Medicaid and Complex Care, Centene; Rev. Kenneth Daniel, President and CEO, United Church Homes
Session Description: Explore how partnerships, affiliations, and joint ventures between nonprofit and for profit providers can be used to create solutions for underserved populations. In this session, you will learn how providers and payers are partnering, particularly in housing, assisted living, and HCBS settings and improving outcomes for low-income residents through new models, as well as how a national Medicaid payer is bridging the needs of senior residents to community services to improve social determinants of health.
- Analyze Social Determinants of Health affecting LTC population and ways of connecting community providers to improve health outcomes
- Develop a deeper understanding of your role in housing and other HCBS as a platform to improve health and create value for residents, clients and payers
- Identify potential value based arrangements between providers of LTC and health care payers
OPTION 3: Medicare Advantage Plan/Provider Compliance
Speakers: Jill Sumner, Vice President, Population Health Management, AHCA/NCAL
Session Description: Compliance with Medicare Advantage standards and regulations is an essential element of owning a Medicare Advantage plan. Providers need to understand a new set of expectations and regulations to be compliant.
- Summarize your responsibilities as a Medicare Advantage Plan Sponsor
- Identify the key elements of a Medicare Advantage Compliance Plan
- Prepare to effectively execute oversight responsibilities
10:45 am – 12:00 pm Role of Quality and Outcomes in PHM
Speaker: David Gifford M.D., MPH, Senior Vice President, Quality and Regulatory Affairs and Chief Medical Officer, AHCA/NCAL; David C. Grabowski, Ph.D, Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School
Session Description: Clinical execution is key for successful population health model implementation. What are the key clinical components that drive quality outcomes in PHM? Do they differ by model (MA plan vs ACO) or are there core common elements? Learn the latest on the link between quality and outcomes in population health models.
- Identify key quality indicators for population health management models
- Recognize the key elements that drive quality
1:30pm – 2:45pm Breakout Sessions
Attendees, please choose one session for this time block.
OPTION 1: Navigating the CMS SNP Bid Submission Process
Speakers: Cathy Murphy- Barron, Principal, Consulting Actuary, Milliman
Session Description: One of the most critical, complicated and fast-paced aspects of the Medicare Advantage Application process is the Bid. Hear an expert actuary walk through the financial underpinnings, technical specifications and necessary data elements to developing a strong Bid.
- Describe the purpose and process of the Bid
- Identify the key elements in the Bid process
- Explain your role in the Bid process
OPTION 2: Relationships with Medicaid Managed Care: Bane or Opportunity?
Speakers: Suzanne Gore, President, State Health Partnerships
Session Description: State adoption of Medicaid Managed Care poses challenges and opportunities for PAC/LTC providers. A former state official and national expert in MLTSS and Medicare/Medicaid integration will share information on options for PAC/LTC. Whether your state has fully embraced managed care or is in the due diligence process learn what steps you can take to position yourself for change.
- Understand the landscape of MLTSS and Medicare/Medicaid integration nationally
- Identify strategies for positioning your organization
OPTION 3: ACO partnerships
Speakers: Jason Feuerman, President, Genesis HealthCare ACO; Mike Hensley, Owner and Chief Marketing Officer, Burgess Square
Hospital and physician led ACOs continue to grow and are a key vehicle in CMS’ move to value based care. For ACOs, SNFs and PAC are cost centers and thus the relationship can have challenges and opportunities. Learn about different ways to participate in this growing alternative payment model.
- Define how SNFs can effectively engage community based ACOs regarding short stay populations.
- Describe how SNFs and PAC providers can participate directly in shared savings through ACOs for long-term care populations
- Identify key factors in successful partnerships.
3:00 pm – 4:00 pm Closing Keynote
CMS Panel – Outlook and CMS View:
Speakers: Heather Barkes, Director, Division of Policy, Analysis and Planning, Medicare Drug and Health Plan Contract Administration Group; Tim Engelhardt, Director, CMS Medicare-Medicaid Coordination Office; Kelly Cronin, Deputy Administrator, Innovation and Partnership at HHS Administration; Chris Smith Ritter, PhD, Director, Patient Care Models Group, Center for Medicare and Medicaid Innovation
Session Description: Recent changes in the Medicare program signal CMS’ interest in population health management models and, specifically, provider led solutions. CMS leadership will share views on program changes, innovations and where they see LTC/PAC providers taking a leadership role.