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Dual Eligibles and CMS 5 Star Measures: Investigation of Member Level Performance 
 
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Overview
Inovalon has just completed a comprehensive Dual Eligibles study that provides insights into how clinical, sociodemographic and community resource characteristics impact health outcomes and Medicare Advantage (MA) plan Five-Star ratings. Inovalon conducted this research in collaboration with Cigna-HealthSpring, Healthfirst, WellCare, Gateway Health, BCBS Minnesota and Blue Plus, Health Care Service Corporation (HCSC), the Special Needs Plan (SNP) Alliance, and Medicaid Health Plans of America (MHPA), and consulted with multiple other industry partners.

The findings provide detailed information about which member characteristics most affect quality measures to support development of population-wide and highly-specific patient-level solutions to improve quality when serving populations with challenging sociodemographic and community resource risk factors.

As the first large-scale, independent study to investigate health outcomes of Medicare beneficiaries enrolled in MA plans at the member-level, their research revealed that disadvantaged beneficiaries—such as dual eligible beneficiaries covered by both Medicare and Medicaid—have worse health outcomes that cannot be attributed to a health plan’s quality of service. Moreover, additional factors beyond the high-risk chronic health conditions that members present may contribute to worse health outcomes. The study findings indicate that MA plans serving disadvantaged beneficiaries may provide higher-quality care than their ratings reflect under the current Five-Star Rating System Medicare uses to assess the performance of plans.

Please join Inovalon's Christie Teigland, PhD; Cigna-HealthSpring's Dr. Paige Reichert and Healthfirst's Joyce Chan on Wednesday, June 24th, 2015 at 2PM Eastern as they share research findings, insights, and perspectives in the HealthcareWebSummit event: Dual Eligibles and CMS 5 Star Measures: Investigation of Member Level Performance
 
Learning Objectives
Participants will be able to:
  1. Examine research findings from the Inovalon study: An Investigation of Medicare Advantage Dual Eligible Member-Level Performance on CMS Five-Star Quality Measures.
  2. Identify which member characteristics most affect quality measures.
  3. Quantify the clinical, sociodemographic and community risk factors most associated with the worst-observed outcomes for a majority of Medicare measures used to assess the performance of Medicare Advantage (MA) health plans in delivering quality of care.
  4. Explore how applicable member characteristics support development of population-wide and highly-specific patient-level solutions to improve quality when serving populations with challenging sociodemographic and community resource risk factors.
  5. Ascertain what additional factors, beyond the high-risk chronic health conditions that members present, may contribute to worse health outcomes.
  6. Consider how a higher prevalence in the dual eligible population of high-risk clinical conditions, sociodemographic factors, and community resource factors, result in worse outcomes given the same access and quality of care.
  7. Engage in interactive learning through online question submission, attendee feedback and opportunity for follow-up questions, and networking with attendees, faculty and other professionals through a dedicated LinkedIn group.
Who Should Attend
Interested attendees would include:
  • C-Suite Executives
  • Medical Directors
  • Care Management Executives and Staff
  • Medicare Operations Executives and Staff
  • Quality Management Executives and Staff
  • Regulatory and Policy Executives and Staff
  • Strategy and Planning Executives and Staff
  • Health Reform, Transformation and Innovation Executives and Staff
  • Analytics, Business Intelligence and Other Research Analysts
  • Managed Care Executives and Staff
  • Dual Eligible and Special Needs Operations Staff

Attendees would represent organizations including:

  • Health Plans
  • Accountable Care Organizations
  • Provider Networks
  • Hospitals and Health Systems
  • Care Management Organizations
  • Government Agencies
  • Pharmaceutical Organizations and PBMs
  • Solutions Providers 
  • Associations, Institutes and Research Organizations 
  • Media
  • Other Interested Parties


Registration
Dual Eligibles and CMS 5 Star Measures: Investigation of Member Level Performance 
 
  Individual Registration Fee: $195. Post-event materials, with video syncing slides and recorded audio, plus presentation pdf file: $45 for attendees; $260 for non-attendees after the event. Register online or download the event brochure.
 
 
 
Register Now   Corporate Site licensing also available. Click here to register or call 209.577.4888 We look forward to your participation in this event!
 
 
Faculty
Christie Teigland, PhD

Christie Teigland, PhD
Director, Statistical Research
Inovalon
  Dr. Teigland serves as Director of Statistical Research for Inovalon where she leads a team of ten healthcare research professionals in the design and implementation of internal and external health outcomes research projects, including comparative effectiveness and pharmacoeconomic studies, risk modeling and predictive analytics, and performance measure development and testing. She serves on the Pharmacy Quality Alliance (PQA) Measures Work Group and has directed performance measure projects awarded by the National Committee on Quality Assurance (NCQA) and Heart Rhythm Society.

Prior to joining Inovalon, Dr. Teigland specialized in quality measurement and quality improvement research at the Foundation for Long Term Care in New York where she directed the development of innovative technology solutions to advance the use of data-driven decision making to improve outcomes and reduce healthcare costs. Dr. Teigland served as Principal Investigator for large grant funded studies, including an Agency for Healthcare Research and Quality (AHRQ) patient safety project that developed predictive risk alerts for adverse events common in the elderly population, along with patient centered risk profiles to guide preventive actions. She developed new quality of life measures for patients with dementia under two Alzheimer’s Association grants, including a predictive model to identify undetected pain.

Dr. Teigland has served on CMS expert panels including a CMS workgroup to improve the Five Star Rating System, participated in development and field-testing of the AHRQ CAHPS satisfaction and patient safety tools, and serves on the American Medical Director’s Association (AMDA) Technology Work Group.

 

Paige Reichert, MD

Paige Reichert, MD
Senior Medical Director of Quality Improvement
Cigna-HealthSpring
  Dr. Paige Reichert is the Senior Medical Director of Quality Improvement for Cigna-HealthSpring, a Cigna company and industry leader in serving the senior population primarily through Medicare Advantage and Medicaid products and services. Her role includes oversight of the structure and implementation of Partnership for Quality, a Cigna-HealthSpring designed program that is similar to pay-for-performance models and emphasizes collaboration with health care professionals to incentivize and improve the quality of health care. She also oversees the development and adoption of clinical practice guidelines, provides guidance for Special Needs Plans, and supports health plan quality improvement projects.

Dr. Reichert is board certified by the American Board of Internal Medicine and is a Fellow of the American College of Wound Specialists. She is a member of the American College of Physicians, the American Academy of Wound Management, and the American Association for Physician Leadership. Prior to joining Cigna-HealthSpring, Dr. Reichert practiced internal medicine and wound care for 15 years. During that time, she established a wound care center that was recognized as a Center of Distinction for its successes with limb salvage in patients with diabetes and peripheral vascular disease.

Dr. Reichert earned her Medical Degree from the University Of Alabama School Of Medicine in Birmingham, Alabama. She completed her internship and residency at Vanderbilt University in Nashville, Tennessee. She resides with her family in Nashville.
 

Joyce Chan

Joyce Chan
Vice President of Clinical Performance
Healthfirst
 

Joyce Chan is the Vice President of Clinical Performance at Healthfirst, a not-for-profit managed care organization sponsored by major New York not-for-profit and public healthcare systems. Joyce is responsible for using analytics, reporting, and incentives to improve clinical quality and member satisfaction. Her role includes oversight of quality bonus programs and performance as well as provider quality. Prior to joining Healthfirst, Joyce was a consultant in the Global Health Practice at Booz Allen Hamilton, where she advised providers, payers, and pharmaceutical companies on strategy and operations. With a deep interest in reducing health disparities, Joyce is an active contributor to a number of industry workgroups and speaks regularly with policymakers and regulatory agencies on this topic. Joyce received a B.S in chemical engineering and B.A. in Plan II Honors from The University of Texas at Austin, and she holds an MBA from the University of Michigan.

 
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