Agenda

• Analyze the NCQA population health standards that are a cornerstone of health plan accreditation
• Examine the importance of population health in Long-Term Services & Support, Case Management, and Patient-Centered Medical Home standards
• Discuss the population health goals in CMS’ future Merit-based Incentive Payment System (MIPS) Value-based Pathways (MVPs).

Paul Cotton, Director, Federal Affairs
National Committee for Quality Assurance

• Strategies to ensure a specific, accurate, and complete representation of the population illness burden to ensure appropriate financial support for care 
• Enable complete insight on every member to maximize population health, enhance individual care, and lower overall cost 
• Utilize quality measures as a vehicle to reduce overall costs and maximize member health and satisfaction 
• Obtain Medicare Advantage Quality Bonus Payment for additional support for care of your members 

William Jonakin, MD, CPC, CRC, Medical Director, Medicare Advantage and Risk Adjustment
St. Luke’s Health Partners
Principal, Clinical Discernment, LLC 

• The move from fee-for-service to value-based payment is accelerating, opening new doors of opportunity to address populations health
• The work will be more place-based and cross-sector, requiring health care to become a convener and collaborator 
• Mindset shifts such as the use of design thinking and systems thinking are key to being successful in the new ecosystem

Jason Helgerson, Chief Solutions Officer
Helgerson Solutions Group
Former New York State Medicaid Director

Juliette Price, Solutions Architect for the Social Determinants of Health
Helgerson Solutions Group

Sander Koyfman, MD, Behavioral Health Medical Director- New York
WellCare

• Analyze what it takes to process available data narrow it down for the right intervention at the right time 
• Understand how data regarding opioids is  a single variable within a population management strategy is only 
• Learn how to look at population who may have depression, chronic pain, diabetes etc., and how to manage that population when opioids are part of that mix 

William Jonakin, MD, CPC, CRC, Medical Director, Medicare Advantage and Risk Adjustment
St. Luke’s Health Partners
Principal, Clinical Discernment, LLC

Sander Koyfman, MD, Behavioral Health Medical Director- New York
WellCare

Saeed Aminzadeh, CEO
Decision Point Healthcare Solutions

NCQA- Question & Answers Roundtable

An exclusive opportunity to meet face to face with the Director or Federal Affairs at the NCQA to obtain information that can improve your current health plan operations.

Paul Cotton, Director, Federal Affairs
National Committee for Quality Assurance

• Initiate coaching strategies in order to prepare members for changes in lifestyle to eliminate falls and injuries 
• Maximize SDoH to interact with members through technology, transportation and food services to improve care 
• Understand policies required for a successful member in home service program 

Lois Simon, Executive Vice President of Policy and Programs
Seniorlink

Jessica Kinowski, MPH, Clinical Program Director
National Health Services – Cigna Medicare 

• Review a description of medications used in the treatment of opioid use disorder   
• Examine federal laws and regulations that apply to these medications 
• Analyze factors that affect access, such as practitioner availability, stigma, and costs/insurance coverage and the Federal efforts to expand access to treatment, and recommendations to better measure progress toward this goal       

Will Simerl, Assistant Director, Health Care Team
U.S. Government Accountability Office

• Demonstration of data and how to utilize that for better addiction policies 
• Review CDC’s newest guidelines for prescribing medication to kids  
• Learn how to identify high-risk patients and how to intercede

Alanna Lavelle, Senior Principal, Life Sciences
MITRE

• Examine the implementation process of a broad-spanning population health initiative in Illinois in order to replicate 
• Identify key partners and SDOH areas of focus for population health programs for partnerships 
• Evaluate critical quality improvement strategies to implement throughout population health initiatives 
• Learn how to replicate this best practice in your state 

Jessica Grabowski, AM, LCSW, Executive Director
Coordinated Care Alliance

• Review how plans who have started to manage at-risk populations and have programs for tracking opioid prescriptions filled 
• Analyze how those programs are looking at appropriate use of medication versus tipping over the edge and providing interventions before it becomes and addiction  
• Define what are the different methods and processes to look at from a 30,000 ft level as a health plan 

Joseph Albright, PharmD | Pharmacist, Team Lead, Clinical Pharmacy Services
BCBSNC

Stacy Garrett-Ray, MD, MPH, MBA, Vice President, UMMS, Medical Director, Population Health Services Organization, President, Quality Care Network, President, Transform Health MD
University of Maryland Medical System

• Evaluate the impact of the Flint water crisis and how it raised awareness of the health care coverage challenge 
• Describe the process developed by the Genesee Health Plan to implement the Multicultural System of Care 
• Discuss the usefulness and value of Community Engagement/Community Voices to enhance member satisfaction 
• Examine the Conversation process for identifying cultural differences and challenges to bridge the gaps in care 

Jim Milanowski, President/CEO
Genesee Health Plan

• Review how to use OUD data to develop targeted strategies for high risk cohorts and patients not engaged in treatment 
• Understand ways to support development of MAT programs in primary care through learning collaboratives, technical assistance, and alternative payment models 
• Examine how to convene a multi-stakeholder task force to develop a regional strategy to reduce opioid-related harms 

Melissa Joy Brewster, PharmD, BCPS, Pharmacy Director, Columbia Pacific CCO                            CareOregon  

Keshia Bigler, Population Health Portfolio Manager                                                                        CareOregon 

• Utilize in home face to face programs to drive medical cost savings and increase health for the most medically complex members 
• Intensive chronic care coordination:  Program provides robust, multichannel care management related to diet, exercise, self-measurement, preventive care, and medication use offered in multiple settings.  Support and guidance to be delivered to help clients and their families acquire the skills, confidence, and problem-solving techniques to manage their chronic illness, resulting in enhanced peer-to-peer support, networking opportunities, goal setting and problem solving 
• Encourage self-funded employers to take ownership of population health and use benefit design to influence appropriate care and SDoH strategies 

Jessica Culver, CHES, Senior Manager, Population Health
Moda Health

• Discuss if we are under prescribing treatment when medically necessary and if/how this negatively impacts treatment 
• Review new “toolbox” that can be brought in and considered for pain management 
• Discuss doctor education on alternative plans including the language they use when discussing pain with patients 

Moderator:
Edward D Shanshala II, MSHSA, MSEd, CEO
Ammonoosuc Community Health Services, Inc (AHCS)

John M Ventura, DC,
Spine Care Partners, LLC
Clinical Instructor, Family Medicine, University of Rochester School of Medicine

Nicholas DeGregorio, MD, FACP, MMM, Senior Medical Director
UPMC for You