Medicare Advantage Plans: Integrating Risk Adjustment and Quality of Care

MA Plans: Integrating Risk Adjustment & Quality of Care

HealthcareWebSummit: Integrating Risk Adjustment and Quality of Care Initiatives

The smartest plans have already discovered that face to face member evaluations are the ideal way to bring risk adjustment and quality improvement together into one initiative. It is possible for this one activity to impact your STAR score across multiple measures; not only HEDIS, but also the more elusive member satisfaction measures as well.

The learning curve of implementation and execution, however, remains steep. From most effectively stratifying the membership to actually completing the evaluations within your target dates, prospective programs are fraught with challenges.

To add to the complexity, most plans are unprepared to effectively fold the evaluations’ premium impact back into benefit design. Once you’ve completed a target group of evaluations, how do you allocate the premium impact to maintain the required MLR?

This in-depth session is advanced, but highly practical and designed to offer tangible take aways. The webinar examines the challenges health plans face while designing, implementing, and executing their prospective risk adjustment programs. In addition, it offers insight and commentary on best practices and innovative thinking from other health plans around the country.

Participants will be able to:

Use what you know about your members to determine the best methodology for your prospective evaluations
Idenitfy and apply key considerations when choosing which members to evaluate
Ensure your process effectively closes the loop with medical management, the member, and the PCP
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 dedicated LinkedIn group

Interested attendees would include:

C-Suite Executives
Medicare Executives and Staff
Medical Directors
Case Management Executives and Staff
Quality Improvement Executives and Staff
Revenue Management Executives and Staff
STARS Program staff

Attendees would represent organizations including:

Health Plans
Provider Networks
Government Agencies
Solutions Providers
Associations, Institutes and Research Organizations
Media
Other Interested Parties

Individual Registration Fee: $195. Audio Conference CD-ROM: $40 for attendees; $285 for non-attendees after the event.

Corporate Site licensing also available. Click here to register or call 209.577.4888 We look forward to your participation in this event!

Jack McCallum, MD, PhD
Chief Executive Officer,
CenseoHealth

Jack McCallum, MD, PhD is a pioneer in Medicare Risk Adjustment. His involvement goes back to the implementation of the HCC methodology in the Medicare Advantage program after a distinguished career in medicine.

Prior to founding Censeo Jack was founder, President, and Chief Medical Officer of one of the first companies to apply clinically based algorithms to Medicare risk adjustment. Before this he was a founding member of North Texas Specialty Physicians, a multi-specialty, risk-taking provider group that serves over 30,000 members in the Dallas/Ft. Worth area.

Before building a successful IPA and two groundbreaking service companies, Jack practiced adult and pediatric neurosurgery in Fort Worth for almost thirty years, while also serving as head of the medical staff at Fort Worth Children’s Hospital. His medical training and depth of experience fuels CenseoHealth’s unique, clinically sophisticated process.

During a wholly unsuccessful first attempt to “retire,” Jack earned a doctorate in history from TCU and is currently AdRan Professor of the History of Science at TCU. He has written a number of books and articles and given numerous presentations on health care policy and medical history.


RaeAnn Grossman Senior Vice President Gorman Health Group		RaeAnn Grossman is one of the nation’s leading experts on risk adjustment strategies, network management, provider and payer alliance configurations, along with health care business and product development. She brings Gorman Health Group clients more than twenty years of professional experience in a wide variety of healthcare organizations including Health Plans, Medical Groups, and Physician Hospital Organizations (PHOs), Integrated Hospital systems and Institute of Health Professionals Education. RaeAnn has held executive positions encompassing her areas of expertise, which include: HCC & Medicaid Risk Adjustment, international provider network management, executive client relationship management, predictive modeling, provider contracting, reimbursement modeling and implementation, business development, strategic planning, Centers of Excellence execution, financial analysis, health benefit design and program implementation, acute and chronic care pathway creation, and product development and implementation for healthcare companies. RaeAnn rejoins Gorman Health Group from Ingenix, where she was the Vice President of Medicare and Medicaid Solutions. She is also one of the founders of iPatient, a global health care consulting firm. In the past six years, RaeAnn led Gorman Health Group’s network Management Division. She was also one of the founders and principal investors in the first full-service HCC management company for Medicare Advantage where she held the position of Chief Client Services Officer. Prior to that, RaeAnn worked as HealthNet of Arizona’s VP of Network Strategy and Development and also at BCBSAZ as a Senior Manager in Network Management.

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