This year’s annual conference featured more than 80 speakers and 30 sessions on timely topics, such as tips to overcome barriers to member engagement, risk adjustment strategies in a changing market, and how to address social needs and advance health equity. Here are 15 takeaways from these conference sessions:
Assessing risk for Medicare Advantage plans, providers, and downstream entities
Carolyn Kapustij, senior advisor for managed care at the Office of Inspection General (OIG), offered the following advice during a keynote session on areas of risk for Medicare Advantage (MA):
Compliance is key: It’s critical for MA to develop a culture of compliance to instill trust in their plans. Allow people to come forward and report issues. People in your plans care about compliance, so while it is difficult, tending to it will reap benefits.
Focus areas at OIG will be new types of audits and evaluations, including supplemental benefits review, MA efforts to reduce health disparities, and use of prior authorization in post-acute settings.
Successful programmatic approaches in risk adjustment and quality operations
During a panel discussion on risk adjustment and quality operations, Greg Dadlez, MHA, VP, value-based performance, Ochsner Health Network; Liz Haynes, MSN, RN, CCM, DVP, risk adjustment & Stars government programs, Blue Cross and Blue Shield of Kansas City; and Rebecca Welling, vice president risk adjustment, Intermountain Health, shared the following information on successful strategies and programmatic approaches:
Look at more than just risk adjustment. Manage the population medically and ensure partners have adequate resources through true continuity of care, not just scores for high quality.
The market is switching, it’s critical to become more agile.
Prioritize health equity: Create awareness around equity and ensure the focus remains on equity, not equality. We may need to treat some differently to achieve true equity.
Addressing the aging population’s social needs
Nebeyou Abebe, senior vice president of social determinants of health, Highmark Health; Dr. Seun Ross, executive director, health equity, Independence Blue Cross; and David Knight, executive director, California Community Action Partnership Association (CalCAPA), offered the following tips during a session on how to scale social determinants of health (SDoH) programs for the aging population:
Build a curated network of community-based organizations (CBOs) that have incentives to accept referrals and provide data back.
Acknowledge that non-access to the internet is a driving SDoH and find ways to engage non-digital users, such as going to providers’ offices to engage them and/or calling them directly.
Find innovative ways to fund CBOs, such as leveraging dollars from a core business, philanthropic funds, and various grant funding, because engaging them is critical to addressing SDoH.
Focus on efficiency with vendors, CBOs, and other partners to streamline efforts and avoid redundancy.
Prioritize engagement with vendors, internal stakeholders, and members.
Member engagement strategies
Vision and dental benefits are critical to members and will oftentimes guide their decision in a plan.
Don’t overcommunicate with them and inundate them with phone calls.
Educate members on the difference between an annual well visit and an annual physical, as many are confused between the difference.
Streamline the patient experience so that members don’t have to retell the back story each time they speak with someone.
Provide members with support in finding a specialist and getting a timely appointment.