2024 Agenda

Continental Breakfast

Chairperson’s Welcome

Medicaid Innovations: A Federal Perspective

The Center for Medicare and Medicaid Innovation Center (CMMI) has a growing portfolio testing various payment and service delivery models that aim to achieve better care for patients, smarter spending and healthier communities. Since the Innovation Center deployed their strategic refresh in 2021, there has been an increased emphasis on health equity, multi-payer alignment and Innovation in Medicaid. Hear about CMMI’s latest work to align, implement and scale innovative payment and care delivery models for all Americans.

• Innovation Models
• Maternal Health
• Behavioral Health
• Making Care Primary
• Alignment between Medicare and Medicaid

The Pandemic is Over:  Medicaid in the New World

• Managing care
• State funding challenges
• The importance of efficiency
• Differentiating your plan to stay competitive and drive growth

Lessons Learned from the Unwinding: Managing Coverage Issues and the Ongoing Impacts on Medicaid

• Looking back: all hands on deck in 2023
• What we know about coverage losses – and gains – during the unwinding
• The role of Medicaid health plans in promoting coverage renewal
• How not to let a crisis go to waste: fixing Medicaid eligibility policy going forward

Panel Discussion: Leadership Innovation through 1115 Waivers: A Scan of Waivers Throughout the Country that Address Eligibility, SDoH, Care Delivery, and Behavioral Health

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Morning Refreshment Break

Panel Discussion: Aligning Health Equity Goals to Enterprise Goals: Developing an Equity Centered Framework to Address Health Disparities and Social Determinants of Health

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Panelists:

Recognizing Individual Social Equity (RISE):  Developing A Value-Based Program to Address Socioeconomic Disparities

• Structural racism creates health inequities related to race, ethnicity, disability, sexual orientation, gender identity, language, and geography resulting in various socioeconomic factors that adversely impact individuals and communities.
• Payers need to incorporate new elements into existing Alternative Payment Models (APMs) to advance health equity. Without a mechanism for risk adjustment for providers who serve a larger volume of patients with high social risk factors they will be at a disadvantage in terms of having a fair opportunity to be resourced to deliver high-value care.
• The Health Care Payment Learning & Action Network – Health Equity Advisory Team released in 2021 the Advancing Health Equity Through APMs and specifically focuses on social risk adjustment— a core design element of the HEAT’s theory of change for how APMs advance health equity and increase the number of providers (especially safety net providers) that successfully participate in APMs.

Karen M. Dale, R.N., MSN, Market President, Chief, Diversity, Equity and Inclusion Officer,, AmeriHealth Caritas DC

Engaging Members through Technology:  Developing Strategic Partnerships with Community Based Organizations and Vendors to Connect with Hard-To-Reach Members

Luncheon

 Quality Improvement and Cost-Effective Care in the NICU: Improved Outcomes and Reduced Cost

Innovations for Medicaid Patients in Primary Care Groups

• Partnering with Behavioral Health Telemedicine Providers in Primary care
• Partnering with Community Based Organizations and Community Health Workers to close gaps in care
• Using Social Work in primary care to achieve health equity
• Partnering with payers to close gaps in care in patients with an identified SDOH

Addressing Youth Mental Health Crisis: Blue Shield of California’s BlueSky Program, Implementing California’s Child and Youth Behavioral Health Initiative, and Ensuring Behavioral and Social Supports through Population Health Management

OhioRISE: Youth Behavioral Health System of Care Coordination

• History and goals of OhioRISE
• View of the first 18 months of the program
• Projecting the future of OhioRISE in meeting the needs of youth with complex BH needs

Marti Taylor,CEO, OhioRISE, Vice President,Aetna/Medicaid

Afternoon Refreshment Break

Panel Discussion: Expanding Access to Behavioral Health Services: Integrating Behavioral Health with Primary Care and Community Settings

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Responding to Increased Workforce Shortages and Unmet Needs Among the LTSS Population: Ensuring Access through Home and Community Based Services

Strengthening Medicaid Coverage for Crisis Care: State Approaches to Mobile Crisis and 988 Integration

This session focuses on the real-world implementation of the Crisis Now Model, which is considered a national best practice model for crisis care. The Crisis Now model includes ensuring that people in crisis have someone to call, someone to respond, and somewhere to go, in addition to a set of essential principles and practices.

Numerous laws, incentives, and funding programs at the federal, state, and local level have created enabling contexts for the transformation of crisis services in the U.S., but coordination across historical and newly developed entities and authorities require the highest levels of coordination and cooperation. This session will provide a national landscape, with a focus on systemic and structural elements of crisis services.

Transformational change and underlying social and cultural paradigm shifts take significant time, coordination, and resources. This session will consider next steps and future directions being pursued in the U.S. to realize the vision of an integrated system of behavioral health crisis services that is recovery oriented and trauma informed, with a focus on Virginia's story.

Cocktail Reception

Sponsored by:

Continental Breakfast

Chairperson’s Recap

Integrating Primary and Behavioral Healthcare

Designing a Multi-Payer VBC Initiative to Support Integration of Primary Care and Behavioral Health

• Leveraging the power of public-private partnerships to develop meaningful Medicaid payment reform to support whole-person care
• Using a third-party convener, Medicaid managed care organizations partner together and with providers to develop flexible care models that support primary care providers and improve access to behavioral health for children in Virginia
• How to leverage the flexibility of managed care to while aligning payment models across payers, reducing administrative burdens, supporting whole-person care, and increasing access to behavioral health services

Panel Discussion: Increasing Integration for Dual Eligibles Using the D-SNP Model: Improving Access to Coordinated Care for this Rapidly Growing Population

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Panelist:

Prior Authorization Regulations and Response: Moving Towards Trusted Partner with a Case Study on Hospital and SNF Transitions

• Understand the current authorization landscape from the provider perspective
• List legislative efforts impacting authorizations
• Describe the elements that move away from focusing on authorizations

Morning Refreshment Break

Let’s Take Triple Aim at IDD: Intellectual and Developmental Disabilities

Individuals with IDD have varied primary diagnoses and are often difficult to identify in standard stratification or complexity models. However, as a population they have distinctive and common patterns of risks, conditions, and functional limitations that often result in lower quality of health, higher levels of preventable utilization, and lower rates of access to care and preventive services; as an NIH-designated health disparities population, traditional standards of care may not be standard for people with IDD. Based on our experience leading a novel health plan exclusively dedicated to people with IDD, we will share an “IDD-Tailored” framework for Medicaid plans of all types to care for their members with IDD, in order to improve the quality of care of both individuals and the overall population, while ensuring effective and efficient resource allocation.
Participants will learn how to:

• Define the distinctive characteristics of the IDD community in order to support person- centered targeting, care planning and program development
• Understand the challenges and best practices for caring for people with IDD in order to create value for members, families/caregivers, provider networks and health plans themselves
• Educate and activate their provider network to integrate principles and best practices for delivering IDD-Tailored Care

Payor and Provider Collaboration in a Changing Healthcare Landscape

•          Disruption and Consolidation are impacting all aspects of healthcare
•          Consumer Expectations have and will continue to evolve with a demand for a more personal health journey
•         New Payment and Alignment Models challenge the status quo business model for all of us
•        Working With Regulatory Agencies much more closely is table stakes
•         "All of Us" rather than "Us vs Them" working toward solutions is how we pave the way forward

Sustaining Investments for Community Health Workers: Maintaining a Strong CHW Presence Throughout the Enterprise to Ensure Informed Approaches to Public Policy and Programs

Peer-Led, Patient-Centered Population Health Management for Serious Mental Illness

• Peer-led approaches to engagement and enhancement of clinical care
• Patient involvement in care decisions for improved treatment adherence and outcomes
• Deepening trust between individuals living with Serious Mental Illness (SMI) and healthcare providers
• Integrating medical, behavioral, and social support
• Empowering self advocacy around needs, preferences, and concerns with care and aspirations for recovery

Joe Parks, MD, Chief Medical Officer, firsthand, Medical Director, National Council for Mental Wellbeing

Conclusion of Conference