Organizations continue to implement innovative new approaches to improve performance and quality measures as the nation continues to move forward in achieving value-based health and success with CMS quality ratings. As the Five-Star Quality Rating System continues to evolve and expand and set higher stakes, organizations seek out new methods and interventions that will allow them to maintain or achieve the desired four or five-star ratings. Health plans and providers are engaging in collaborative partnerships to improve quality, close gaps in care, improve patient outcomes, and engage members while reducing spending, thus creating savings. As the quality measures continue to change and evolve, health plans are also following suit to achieve high star ratings, determining reimbursement revenues, bonus payments, member enrollment, and marketing opportunities.

This high-level forum featuring knowledgeable leaders and executives from the nation's leading health plans and health systems will share their perspectives, valuable insights, and expertise on how to be best equipped for the rapidly evolving and critical changes in achieving four or five-star ratings.

Benefit from learning about new best practices, initiatives, and strategies that have been deployed to address the challenges presented under the Affordable Care Act to improve the quality and delivery of healthcare while reducing costs, boosting revenue, and improving member satisfaction.

At the conclusion of this activity, attendees should be able to:

• Examine successful member engagement tactics both prior to and during the pandemic to improve member loyalty and ultimately increase star ratings
• Define strategies used to manage difficult populations and overcome barriers
• Evaluate star quality improvement initiatives when managing population health
• Define the development of unique and targeted interventions to improve satisfaction of population segments within product lines
• Discuss steps to execute star rating projects across different departments
• Identify skills needed to support your team and members in achieving better health and improved star ratings
• Recognize how effective interpretation impacts the power, privilege, and access to communication and information
• Discuss creating the business case for member rewards and getting leadership buy-in and support
• Analyze how the data related to the social determinants of health will be evaluated and used to promote higher quality scores
• Examine impactful tactics to start improving pharmacy quality goals and member medication adherence strategy

Faculty includes:
Carolyn Langer, MD, JD, MPH, CHCQM
Amanda Calvert, MPH
Jonathan Harding, MD
David L. Larsen, RN, MHA
Ryan Dodson, CRC
Daniel Weaver
Judy Hamlin, RN, MS, CCM, FNP-C
Anna Lynch
Toc Soneoulay-Gillespie, MSW
Carly J. Bressler-Archambeau, MPH, LPTA, FHIAS
Sarah Bezeredi
Rachel Sterner

About the Authors
Members of the CME Committee, Planners, and Faculty have disclosed to ABQAURP any relevant financial relationships. No relevant financial relationships or conflicts of interest exist in regard to the content of this online activity.

ACCREDITATION & CREDIT
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American Board of Quality Assurance and Utilization Review Physicians, Inc. and the Business Research & Intelligence Network, LLC (BRINetwork). The American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

ABQAURP designates this enduring material for a maximum of 7.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABQAURP is an approved provider of continuing education for nurses. This activity is designated for 7.0 contact hours through the Florida Board of Nursing, Provider # 50-94.

This program is approved for Category 2 credit by the American Osteopathic Association.

This activity is valid from June 22, 2021 through January 20, 2024. Original release date: January 21-22, 2021.

Pricing:
Diplomate Members $230.00
Professional Members $270.00
Non Members $330.00

This course is intended for Physicians of all specialties, Nurses, and Other Health Care Professionals with appropriate CME / CE credit offered for each profession.

All participants must achieve a final assessment score of at least seventy percent (70%) for recertification and continuing education credits. You have 60 days to complete the course after ordering.

About the Authors
Members of the CME Committee, Planners, and Faculty have disclosed to ABQAURP any relevant financial relationships. No relevant financial relationships or conflicts of interest exist in regard to the content of this online activity.

Carolyn Langer, MD, JD, MPH, CHCQM, Senior Vice President and Chief Medical Officer, Fallon Health (Dr. Langer was considered for the ABQAURP 2017 CHCQM award)
Carolyn Langer, MD, JD, MPH, CHCQM is the Chief Medical Officer at Fallon Health and has an extensive career as a physician executive, including positions as Chief Medical Officer of MassHealth (the Massachusetts Medicaid program) and Medical Director for several commercial payers. She has served on the Massachusetts statewide Autism Commission, currently sits on the Commission’s subcommittee on health care, and previously served on the Commission’s subcommittees on Workforce Development and on Transition Age Youth. Dr. Langer has also been involved in initiatives supporting CYSHCN, including the Massachusetts Child Health Quality Coalition (co-chair), the Massachusetts CYSHCN Systems Integration Project (Executive Team), and the Standards for Systems of Care for CYSHCN National Work Group. Dr. Langer is an Instructor at the Harvard T.H. Chan School of Public Health and an Associate Professor at the University of Massachusetts Medical School. She received her medical degree from Jefferson Medical College and completed her residency at the Harvard School of Public Health. Dr. Langer holds a law degree and a Master’s in Public Health from Harvard University. She is also a retired Colonel and former flight surgeon in the Army National Guard.

Amanda Calvert, MPH, Senior Clinical Program Manager, Medicare Stars, Blue Shield of California
Amanda Calvert, MHP is the Senior Clinical Program Manager of Medicare Stars for Blue Shield of California. Through engagement, the program can improve groups' Medicare stars performance by providing data analyses, lending program management expertise and linking the right teams to collaboratively strategize with internal and external stakeholders to identify areas of potential collaboration, ensure alignment with business goals. and execute. to the program will evaluate and analyze outcomes to continually drive progress. Ms. Calvert previously worked for Molina Healthcare as the Director of Projects; making data-driven decisions for interventions and processes that aim to improve HEDIS rates. During this time, she launched a practice facilitation team that now works in four counties. Ms. Calvert managed relationships between Molina and plan partners through updates and meetings, managed corrective action plans, was the project manager in the building of a perinatal database, and launched a provider advisory committee.

Jonathan Harding, MD Senior Medical Director, Senior Products Division, Tufts Health Plan
Jonathan Harding, MD is the Senior Medical Director, Senior Products Division for the Tufts Health Plan comprising a population of over 120,000 Medicare and Retiree members at Tufts Health Plan in Massachusetts. Dr. Harding has been a Physician Surveyor for NCQA for 29 years, developing Health Plan and Disease Management accreditations, Special Needs Plan MOC review, and PCMH recognition. Prior to this position, he was at Touchstone Health Partnership, where he served as Vice President for Health Services.

Yvonne Heredia, PhD, RN, Senior Manager at Neighborhood Health Plan of Rhode Island
Yvonne Heredia is a Doctor of Public Health and is a masters-prepared registered nurse with more than 20 years of expertise in women’s health (specifically) birth outcomes. Dr. Heredia is also a subject matter expert on the topics of social determinants of health, health disparities, and population-based health. Dr. Heredia is currently a Senior Manager of Care Management at Neighborhood Health Plan of RI. Dr. Heredia is passionate about working with the underserved/unserved populations. She volunteers regularly at homeless shelters, recreation centers, and schools to provide education on health topics that are both culturally and linguistically appropriate. Dr. Heredia has been awarded, recognized, and honored by many local and national organizations for her leadership and commitment to the community. Dr. Heredia also speaks nationally at healthcare conferences on Population Health topics.

David L. Larsen, RN, MHA, Director, Quality Improvement, SelectHealth
David L. Larsen is the director of quality improvement for SelectHealth, formerly IHC Health Plans, in Salt Lake City, for the past 16 years and has worked for Intermountain Healthcare for 22 years. SelectHealth is a mixed model HMO with approximately 475,000 members in Utah and Idaho. Intermountain Healthcare is an integrated healthcare delivery system with 19 hospitals and 450 employed physicians. Mr. Larsen is responsible for maintaining NCQA accreditation, as well as HEDIS performance measurement. He also fills the role of data manager for Intermountain’s Primary Care Clinical Program. He is responsible for the oversight and development of chronic disease registries, performance measurement and web based reporting systems, quality improvement pay for performance incentives for physicians, and directs patient improvement interventions related to chronic illnesses.

Ryan Dodson, CRC, Regional Manager Risk Adjustment, Molina Healthcare
Ryan Dodson was formerly Regional Manager Risk Adjustment, Molina Healthcare and is currently the Senior Vice President Operations at New Vision Healthcare Solutions (since recording webinar). His background in management and operational processes extends over 20 years, and he began working in the Risk Adjustment arena 15 years ago. Ryan has proven himself by helping Medical Groups raise their RAF scores to their proper levels. He directed the movement of a 10,000 member group up 43% over a two-year period, and an 1,800 member group up 53% in the first year. Ryan achieves these results through chart documentation audits, provider and staff documentation training, and provider relationship building. In his most current role, Ryan works with multiple groups to optimize their RAF score, while at the same time achieving CMS Five-Star quality. Ryan explains to these groups that getting their RAF score to the correct level will not only drive revenue, but it will also lead to better patient care with improved documentation habits. Ryan is a Certified Risk Adjustment Coder (CRC) credentialed through the AAPC.

Daniel Weaver, Vice President Medicare and Medicaid Quality Programs, Gateway Health Plan
Daniel Weaver spent the first fifteen years of his career advancing through various departments at an international BPO organization. With experience managing multiple disciplines including analytics, business development, operations, financial modeling, and performance management, Daniel advanced to the Director of Analytics and Vice President of Corporate Planning prior to accepting a role in the healthcare industry with Highmark Inc. in 2013. Dan helped establish and grow a Stars Quality organization within Highmark, serving as the Director of Programs and successfully achieving 4.0+ stars ratings for over five years. Dan recently joined the Gateway Health team as the Vice President of Stars, Quality, and Risk Adjustment. In his first year at Gateway, Dan was able to lead the company to its first 4.0 star rating. Dan is focused on establishing a Stars Quality program that consistently delivers 4.0+ stars while improving performance across multiple state-based government programs and delivering the highest quality risk adjustment results possible. Throughout his career, Dan has overseen the development and implementation of analytic-driven and customer-focused programs. Dan leveraged deep analytics expertise and a strong focus on team development to create a methodology and infrastructure that have driven consistent results for one of the 10 largest Medicare Advantage health plans in the U.S. The impact of these efforts during Daniel’s time at Highmark led to increasing and maintaining performance levels at 4.5 stars out of 5 across Highmark’s largest contracts, representing nearly 300,000 annual lives and roughly $1B in quality bonuses. Dan is an industry thought leader that believes in challenging the status quo and embracing innovation.

Judy Hamlin, RN, MS, CCM, FNP-C, Manager Quality Improvement, WellCare Health Plans, Inc.
Judith F. Hamlin, MS, FNP-C, RN, CCM, has been the Manager of Clinical Quality Improvement at WellCare/Universal American since 2015. Ms. Hamlin supports the development, implementation, and ongoing monitoring of quality improvement processes and quality measurement systems for the Medicare side of the health plan. She works to ensure measurable improvements in clinical outcomes, operational excellence, customer satisfaction, and economic health, along with supporting STAR and HEDIS projects. Ms. Hamlin supervises and manages Quality Improvement staff that maintains a 4-star Medicare plan. Prior to this position, Ms. Hamlin was a Nurse Practitioner Telephonic Case Manager, also with WellCare/Universal American, where she provided members with chronic and acute conditions support, education, and assistance in the prevention and/or maintenance of their disease and/or health and wellness state. She was also tasked with increasing member compliance with treatment plans; engaging community resources to support the member’s optimal functioning; and improving the collaborative coordination of care to affect waste and inefficiency. Ms. Hamlin achieved her Master's Degree in Nursing, Family Nurse Practitioner, in May 2011, from Upstate Medical University, College Of Nursing in Syracuse, NY.

Anna Lynch, Member Engagement Manager, CareOregon
Anna Lynch is the Member Engagement Manager at CareOregon. She leads member engagement activities by integrating and aligning efforts across all CareOregon departments and CCOs to meet organizational performance excellence. Anna Lynch has been with CareOregon since 2014 and prior to that worked as Operations Director for The Wallace Medical Concern where she led the transition from a small volunteer based clinic into a Federally Qualified Health Center. She has over twenty years’ experience in healthcare with a background in health promotion, health education, organizational development and member engagement. She holds a Master’s of Public Health from the University of Portland and a Bachelor of Arts in Philosophy from Mount Holyoke College.

Toc Soneoulay-Gillespie, MSW Social Services Manager, Population Health, CareOregon
Toc Soneoulay-Gillespie has over 20 years of experience working with and advocating for refugees and immigrants. As a 1.5 generation refugee, she brings a unique perspective for understanding the strengths and complexities of this community. She holds a bachelor’s degree in Anthropology/Sociology from Eastern Oregon University and a Master of Social Work from the University of Alaska Anchorage. As an interpreter, consultant, trainer, and community organizer, she believes strongly in raising awareness about meaningful language access and when introduced with humility, can reshape the narratives of historically under-served limited English proficient communities and ultimately transform systems. Ms. Soneoulay-Gillespie serves as a commissioner on the Governor’s Advocacy Commission, Oregon Commission on Asian Pacific Islander Affairs and is a member of the Governor’s Behavioral Health Advisory Council. In her current role as the Social Services Manager at CareOregon, she continues to be a fierce advocate, promoting health equity across the healthcare network.

Carly J. Bressler-Archambeau, MPH, LPTA, FHIAS, Director, Medicare Stars Program, Optima Health / Sentara Health Plans
With more than a decade of physical therapy experience working closely with Medicare beneficiaries, ranging from acute care hospital to skilled home health care, Carly brings a clinical eye to the growing Stars Program at Sentara Health Plans. Leading cross-functional, interdisciplinary efforts, Carly now focuses on stars strategy and opportunities to optimize the member experience. Carly is a licensed physical therapist assistant and trained public health professional, having attained her Master of Public Health in 2019. Carly is now working towards a PhD in Health Services, with a concentration in Leadership, at Walden University. In her free time, Carly enjoys time outdoors with her husband and four-year-old son, as well as training for various distance running and triathlon events and participating in fundraising efforts for the Alzheimer’s Association and United Way.

Sarah Bezeredi, National Vice President, Quality Solutions Delivery, UnitedHealth Group
Sarah Bezeredi is the National Vice President of Quality Solutions Delivery for UnitedHealthcare within the Population Health division of United Clinical Services. In her current role, Ms. Bezeredi is responsible for HEDIS®, CAHPS® and state measure reporting for all UnitedHealthcare Medicare/DSNP, Commercial and Medicaid health plans totaling over 46.4 million members. During her four year tenure at UHC, Ms. Bezeredi has focused on driving quality results for the organization through education, advanced analytics, program evaluation and operational efficiency. Ms. Bezeredi has over 20 years of industry experience including previous positions held within the quality areas of Humana, Anthem and BCBS of Florida. Ms. Bezeredi earned her Bachelor of Arts in Political Science and Masters of Business from Stetson University. In addition, Ms. Bezeredi received her Masters of Science in Health Law with a specialty in Accreditation and Compliance from Nova Southeastern University – Shepard Broad Law School. Ms. Bezeredi is also a member of NCQA’s Technical Measure Advisory Panel where she provides strategic guidance on HEDIS® measure creation, changes and retirement to NCQA.

Rachel Sterner, Stars Program Manager, UCare
Rachel Sterner, MPH has almost 10 years of extensive knowledge and experience working in Minnesota’s quality landscape, both on the government and payer side. She has experience improving health outcomes for individuals in a variety of insurance types including Medicare, Medicaid, Dual- Eligible, and Special Needs. As the Stars Program Manager at UCare, Rachel has responsibility for the facilitation and coordination of the Star Ratings program for UCare’s five Medicare Advantage and Dual Eligible products. In addition, she plays a significant role in working with UCare’s provider network on joint ventures aimed towards increasing ratings. UCare’s Medicare offerings include: UCare Medicare (Medicare Advantage), Minnesota Senior Health Options (MSHO) which is a D-SNP plan combining Medicare and Medical Assistance benefits/services to low income seniors, EssentiaCare (Medicare Advantage) between Essentia Health (local care system) and UCare, Connect + Medicare (Special Needs Basic Care) combines benefits /services of Medicare and Medical Assistance for individuals with certified disabilities aged 18 to 64, and UCare Medicare with Fairview and North Memorial (Medicare Advantage) between UCare and two local care systems. Rachel has been a key contributor in increasing UCare’s MSHO Star Rating to 4 Stars and maintaining 4.5 for UCare Medicare.

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