Opal Events - HCC Best Practices for Proactive Medical Management 2010 Agenda

   HCC Best Practices for Proactive
    Medical Management
   Practical Strategies for Impacting Bottom Line Revenue,
      Boosting Clinical Care, Enhancing RADV Defense &
      Harnessing the ICD-10 Opportunity

April 15-16, 2010
Hyatt Regency Riverfront, Jacksonville, FL
PAST CONFERENCE AGENDA (as of 4-12-10)

	2010 Attendees:
	Medicare Director, Advantage by Bridgeway Health Solutions (HMO) Head of Revenue Optimization & Analytics, Aetna Medicare Senior Medical Director, Aetna Agent, Aflac Principal, Alert MD Chief Medical Officer, American Health Medicare Chronic Care Management Director, American Health Medicare Quality Manager, American Health Medicare Vice President, Finance, Amerigroup Corp. Manager, HCC, Arcadian Health Plans SVP, Chief Clinical Officer, Arcadian Health Plan VP, Medical Economics, Arcadian Health Plans Medical Director, ATRIO Health Plans Risk Adjustment Program Manager, ATRIO Health Plans UM/QA, ATRIO Health Plans Lead HCC Auditor, Bakersfield Family Medical Lead HCC Auditor, Bakersfield Family Medical Business Analyst, Blue Cross Blue Shield Florida Business Development Consultant, Blue Cross Blue Shield Florida CMO & VP, Delivery System, Blue Cross Blue Shield Florida Manager, Blue Cross Blue Shield Florida Senior Manager, Medicare Reconciliation, Blue Cross Blue Shield Florida Senior Markets, Blue Cross Blue Shield Florida VP, Senior Markets, Blue Cross Blue Shield Florida Health Care Analyst, Blue Cross Blue Shield Michigan Health Care Analyst, Blue Cross Blue Shield Michigan Medical Director, Blue Cross Blue Shield Minnesota Operations Team Leader, Blue Cross Blue Shield Rhode Island Director, Bravo Health Director of Risk Adjustment, Bright Health Physicians VP, Medical Products, Capital District Physicians Health Plan Director, Analytics & Actuarial Services, Capital Health Plan Financial Analyst, Capital Health Plan Medical Record Supervisor, Capital Health Plan CFO, Care1st Health Plan CFO, CareMore Medical Enterprises Director, Clinical Analysis and Risk Adjustment, CareMore Manager, Coding & Regulatory Affairs, Carle Clinic Associations/Health Alliance Medical Plans Clinical and Coding Specialist, Central Health Plan of California Project Manager, Citizens Choice Healthplan Senior Project Manager, Citizens Choice Healthplan CFO / COO, Clarian Health Plans, Inc. CAO, Clark & Daughtrey Medical Group Director Risk Management, Clark & Daughtrey Medical Group Director, Implementation, Comprehensive Behavioral Health Plan VP, Clinical Services, Comprehensive Behavioral Health Plan VP, Support Services, Comprehensive Behavioral Care Health Plan RN, PHN, Certified Coder, Certified Auditor, Contra Costa Health Plan Director, Coventry Health Care Director, Finance, Coventry Healthcare of Kansas Director, QA, Coventry Health Care Director, Medicare Finance, Coventry Health Care President/CEO, CVInfosys VP/COO, CVInfosys VP Regulatory Compliance, CVInfosys VP, Sales & Marketing, CVInfosys Founder and President, DCA Director of Government Operations, DC Chartered Health Plan CEO, ecfirst CEO, Episource, LLC Medicare Program Director, FamilyCare Health Plans RN, Quality Care Director / MRA, Family Medical Centers MD, Associate Medical Director, Family Physicians Group, Florida COO, Family Physicians Group, Florida MPH, MRA/Care Management, Family Physicians Group, Florida CPC, MRA Coder, Family Physicians Group, Florida Certified Professional Coder, Family Care Partners VP, Membership Relations, Florida Hospital Association Vice President of Medicare Revenue Management, Freedom Health Inc. MD, Geriatric Services of Minnesota MD, Geriatric Services of Minnesota CEO, Gorman Health Group Senior Vice President, Clinical Innovation, Gorman Health Group COO, Guardian Healthcare Inc. CEO, Health Data Essentials Medical Coding Supervisor, Health Data Essentials Health Data Essentials Director, Admin Accounting, HealthPlus Manager, Medical Audit, HealthPlus of Michigan VP, First+Plus Health Plan Executive Director, First+Plus Health Plan Principal, Health Revenue Strategy SVP, Business Development, Health Risk Partners Senior Healthcare Consultant, Health Risk Partners HealthSpring Director, HealthSpring Manager, Coding and Performance, HealthSpring Manager, HealthSpring Manager, HealthSpring Manager of Health Services, HealthSpring		VP of Health Services, HealthSpring Director of Coding and Healthcare Management, HealthTexas Medical Group Vice President, HealthTexas Medical Group Managing Partner & CEO, Healthy Options Horizon Blue Cross Blue Shield NJ HCC Coder, Humana Inc. HCC Consultant, Infocrossing Senior Developer, Infocrossing Infocrossing Senior Vice President, Ingenix Ingenix Consulting Compliance Practice Leader, Kaiser Permanente Senior Practice Leader, Kaiser Permanente Director of Senior Product Development, Leprechaun President & CEO, Leprechaun Finance Manager, Life Lutheran Chief Financial Executive, Lovelace Health Plan HCC Sr. Program & Project Manager, Lovelace Health Plan Officer, Lovelace Health Plan Supervisor, Medicare Risk Adjustment, Lovelace Health Plan Benefits, Analysis and Quality Manager, MAPFRE Life Vice President, Business Development, MARA (Medicare Advantage Review Associates) President, Marketing Direct Inc. Manager, Revenue Management, Martin's Point Health Care CEO, Matrix Medical Network EVP, Matrix Medical Network Regional Director of Sales, Matrix Medical Network VP, Sales, Matrix Medical Network VP Sales, Matrix Medical Network VP, CMO, McKesson Health COO, MD Care Health Plan Director, Business Development, MedAssurant Director, CCS Advantage, MedAssurant Senior Product Manager, MedAssurant Director, Information Systems, MedAssurant Manager, Business Development, MedAssurant Vice President, Data Processes and Product Development, MedAssurant VP of Care Management, MedAssurant COO / CFO, MediGold President, MedXM Vice President, MedXM Sr. Vice President, Metcare of Florida SVP, Medical, Metcare of Florida MD, Molina Healthcare, Inc. Senior Vice President, Munich Health North America Data Analyst, MVP Healthcare Coding/Billing Compliance Auditor, Nemours Children's Clinic Medicare Risk Adjustment Reviewer, Network Health Plan Medicare Risk Adjustment Reviewer, Network Health Plan Supervisor, Network Health Plan Director, North Texas Specialty Physicians Healthcare Practice Leader, Outcomes Health Information Solutions VP, PerforMED University Physicians Health Plan Compliance Specialist, Physicians United Health Plan Director Network Management, Physicians United Health Plan CPC, Medical Coding Analyst, Physician's United Health Plan Medical Coding Auditor, Physicians United Health Plan Medical Coding Specialist, Physicians United Health Plan Medical Coding Specialist, Physicians United Health Plan MRA Coding Tech, Physicians United Plan Director, Business Development, Primaris Supervisor, Operations, Priority Health Medicare Risk Adjustment Administrator, Priority Health Supervisor Coding, Priority Health Manager, Medical Coding Administration, Providence Health Plan HCC Manager, SCAN Health Plan Actuary, Senior Whole Health COO/CFO, Senior Whole Health Executive Director, SecureHorizons Senior Financial Analyst, Sharp Community Medical Group Director Compliance, Sharp Rees-Stealy Medical Group Clinical Performance Improvement Coordinator, South Country Health Alliance Provider Education and Coding Manager, South Country Health Alliance Director of Finance, Sterling Life Insurance Company National Medical Director, Sterling Life Insurance Company MD, Talbert Medical Group Finance Manager, Triple S, Inc. Senior Network Account Manager, United Healthcare Senior Manager, Universal Health Care VP, Medicaid, Universal Health Care Clinical Doc, University Physicians Health Plan CFO, Vantage Health Plan Clinical Pharmacist, Head of Health Risk Management, Vantage Health Plan President & CEO, Veracity Data Systems Medical Director, VIVA Health VP, Corp. Development, VIVA Health Chief Medical Officer, VNS Choice Vice President, Finance, VNS Choice Medical Director, Wellcare Health Plans of Texas, Inc. Medical Director, Florida, WellCare Health Plans Director, Senior Risk & Recovery, WellPoint, Inc. Manager, Prospective Risk Programs, WellPoint, Inc. Medical Director, WellPoint CFO, Windsor Health Plan, Inc. Director, Medicare Revenue Enhancement, Windsor Health Plan, Inc. MD, Chief Medical Officer, Windsor Health Plan, Inc. Operations Manager, XLHealth


Conference Day One: April 15, 2010
7:15a		Continental Breakfast & Registration

8:00a		Opal Events' Welcome

8:05a		Chair's Welcome & Audience Demographics Conference Chair: MD, MPH, FAAFP, CHIE, CPE, FACPE, Senior Vice President, Clinical Innovations, GORMAN HEALTH GROUP

8:40a		Keynote Address: Medical Management that Matters: Implementing an Evidence-Based Utilization Management Playbook In the $2.5T health economy, there is no shortage on money spent on complex patient modeling, claims analysis, and other forms of IT-driven patient management. And now, new medical management infrastructures are moving into the spotlight – medical home and accountable care organizations. Health plans can make substantial progress toward effectively managing cost and quality of medical care by adopting a model that embraces a flexible, multidisciplinary team built around an evidence-based utilization management playbook. Learn practical strategies on how to maximize existing resources for practical, simple interventions. The result can drive great change in utilization patterns, quality of care, and member satisfaction. Speaker: CEO, GORMAN HEALTH GROUP

9:35a		Morning Refreshment and Networking Break

9:50a		Partnering with Providers: Best Practices for System Organization & Workflow to Enhance HCC Data and Outcomes Part 1: Creating Strategic Team Solutions to Improve Workflow Speakers: VP Support Services, CONTINUCARE CORPORATION, FLORIDA VP Sales & Marketing, CLEAR VISION INFORMATION SYSTEMS Partnering with Providers: Part 2 “Walking-Around HCCs” and Prospective Review Speaker: SVP, Business Development, MEDICARE ADVANTAGE REVIEW ASSOCIATES (MARA) Partnering with Providers: Part 3 Developing a Payer/Provider Relationship Best Practices Checklist • Know who to contact at each facility • Know the request process for each provider • Minimize the time impact on the provider • Provide feedback on diagnostic coding • Offer training and incentives for proper coding Speaker: MD, Associate UM Medical Director, FAMILY PHYSICIANS GROUP, FLORIDA Partnering with Providers Session Q&A: 20 minutes Speakers: VP Support Services, CONTINUCARE CORPORATION, FLORIDA MD, Associate UM Medical Director, FAMILY PHYSICIANS GROUP, FLORIDA SVP, Business Development, MARA Moderator: VP Sales & Marketing, CLEAR VISION INFORMATION SYSTEMS

11:00a		Establishing an Efficient and Integrated Roadmap to Risk Adjustment in Order to Improve Your Bottom Line Revenue • Recent reimbursement changes and regulations • Member/provider outreach programs • CMS audit - prospective & retrospective RADV • Chart reviews - prospective & retrospectiveHealth & physical prospective assessment • Health & physical prospective assessment Speaker: President, DCA

11:45a		Best Practices for Data Submission Leveraging Internal Process to Identify Additional HCCs for Submission Many health plans are sitting on data that is never submitted or accepted by CMS because data submission processes are not understood or well-coordinated. This session will cover: • Best practices for data submission • Techniques for reviewing and correcting RAPs file return errors • Ensuring sound coordination between Fiscal Services, Enrollment, Membership, Claims and Managed Care • Reconciling member demographics • Leveraging data to identify outreach and code review opportunities Speakers: President, VERACITY DATA SYSTEMS, INC. Product Manager, Risk Adjustment, DYNAMIC HEALTHCARE SYSTEMS

12:30p		Luncheon with keynote speaker

12:45p		Luncheon Keynote: Risk-Adjusted Health Plans and the New Surveillance Paradigm in Medicare Advantage • Compliance issues facing Medicare-Advantage health plans: RADV audits, Part C reporting paradigm, encounter data submission, etc. • Harnessing the data you will need for the Part C Data Reporting Paradigm for patient-specific and plan-level quality improvement • Preparing for submission of comprehensive encounter data • Maximizing the nexus between risk-adjustment compliance and revenue management • Using risk adjustment for outcome-oriented quality measurement • Cascading risk adjustment and documentation compliance down to the providers-- the benefits and pitfalls of EHRs and the "meaningful use" provisions. Speaker: CEO, HEALTH DATA ESSENTIALS

1:30p		Practical Strategies: Practitioner Case Studies Case Study 1: Sharp Community Medical Group Speaker: Senior Financial Analyst, SHARP COMMUNITY MEDICAL GROUP, CALIFORNIA (12 minutes, 3 minutes for Q&A) Case Study 2: Marian Polk Community Health Plan Advantage Speaker: Medical Management Supervisor, MARIAN POLK COMMUNITY HEALTH PLAN ADVANTAGE (12 minutes, 3 minutes for Q&A) Case Study 3: VNS Choice Speaker: MD, FACP, Chief Medical Officer, VNS CHOICE (12 minutes, 3 minutes for Q&A) Case Study 4: WellCare Health Plans, Texas Speaker: MD, MPH, MPA, Medical Director, WELLCARE HEALTH PLANS OF TEXAS, INC. (12 minutes, 3 minutes for Q&A)

2:30p		Panel Discussion: Risk Adjustment Chart Reviews: Moving Beyond Simply Finding Additional HCCs Part 1: Physicians United Plan Case Study There is much discussion on moving to a proactive approach to gathering HCCs. Documentation is still the issue whether using a retrospective or prospective approach to gathering HCCs. We know that working with providers on documentation requirements results in improved risk scores with fully supporting documentation. Accomplishing this on a real-time basis as opposed to working it on the back end presents special challenges along with the potential for increased long term benefit. Panelists will discuss the challenges, benefits, and administrative difficulties they experienced in implementing a prospective chart review and documentation improvement process. Panelists: MD, BOND & STEELE CLINIC, PA CPC, PHYSICIANS UNITED PLAN CPC, PHYSICIANS UNITED PLAN Moderator: Director Network Management, PHYSICIANS UNITED PLAN

3:15p		Afternoon Refreshment and Networking Break

3:45p		ICD-10 Focus: Understanding the Changes & What You Need to Do Now • Understanding the impact of ICD-10 • Important differences between ICD-10-CM and ICD-9-CM • Why a new coding system is needed Speaker: Director, Coding and Classification, AMERICAN HOSPITAL ASSOCIATION

4:30a		ICD-10 Focus, Part 2: Preparing a Risk-Adjusted Health Plan and its Providers for 2013 • ICD-10-CM presents a new opportunity for health plans to promote the benefits of accurate coding and clinical documentation improvement to the provider community • Ensuring accurate risk scores during and after transition to ICD-10-CM • Integrating ICD-10-CM into the provider contracting process • Training a health plan on ICD-10-CM Speakers: CEO, HEALTH DATA ESSENTIALS CPC, Medical Coding Supervisor, HEALTH DATA ESSENTIALS

5:15p		Day One Closing Remarks and Cocktail Reception LinkedIn Members: Come to the “Medicare Advantage Health Plan Colleagues” Group table at the Cocktail Reception to meet your fellow group members face-to-face.

Conference Day Two: April 16, 2010

7:00a		Continental Breakfast & Registration

7:45a		Chairs' Welcome & Day One Re-Cap Conference Chair: MD, MPH, FAAFP, CHIE, CPE, FACPE, Senior Vice President, Clinical Innovations, GORMAN HEALTH GROUP

8:00a		Keynote Address: News from Washington & Baltimore: MA Payments in 2011 and Beyond • MA payment reform update -- the latest from Capital Hill regarding MA payments and risk adjustment • Implications of the 2011 Call Letter -- CMS moves on compliance, payments & risk adjustment • First-look review at the 2011 Rate Book -- impact of the 2011 rates on products, benefits and operations • Success strategies: Ways MA plans are thinking about market segments and positioning Speaker: Senior Vice President, INGENIX CONSULTING

8:30a		Keynote Panel: The Associations’ View Panelists: Director, Coding and Classification, AMERICAN HOSPITAL ASSOCIATION Vice President for Membership Relations, FLORIDA HOSPITAL ASSOCIATION

9:15a		CFO / COO Panel Discussion Getting Back to Medical Management: What to Ask Your Provider Relations Team Panelists: SVP and CFO, VISITING NURSE SERVICE OF NY CFO, VANTAGE HEALTH PLAN Moderator: MD, Vice President, Clinical Innovations, GORMAN HEALTH GROUP

10:00a		Morning Refreshments and Networking Break

10:15a		Driving the MA Business Through the Leverage of Care Coordination • Following with HCC code capture, rather than leading with financial goals Speakers: VP, Medicare Products, CAPITAL DISTRICT PHYSICIANS HEALTH PLAN RN, MSN, MBA, VP of Clinical Services, KEYSTONE MERCY HEALTHPLAN PhD., SVP, Business Development, MARA

11:00a		Integrating Prospective Assessments into Medical Management Part 1 • What is a prospective assessment? • How do you identify members for a prospective assessment? Are they different from members in medical (case or disease) management? • What are the logistical steps to complete a prospective assessment? Can they be completed by the medical management staff? • What are the challenges to completing prospective assessments? How are they overcome? • How can the results of prospective assessments be used to support medical management? • What unique information does the prospective assessment bring to medical management? • What are the challenges in integrating prospective assessments and medical management? How are these overcome? • Blending a prospective program with your retrospective data Panelists: CEO, MATRIX MEDICAL NETWORK CEO, ITASCA MEDICAL CARE (IMCARE) President & CEO, LEPRECHAUN, LLC Part 2: WellCare Health Plan Case Study Speaker: Medical Director, Florida, WELLCARE HEALTH PLANS, INC.

12:00p		Preparing for a HIPAA \| HITECH Audit: Step Through a Checklist The HITECH Act, the HIPAA Security Rule, State regulations, PCI DSS, FACTA and other mandates require healthcare covered entities and business associates to comply with key Identity and Access Management (IAM) requirements to secure patient health information. These mandates are now enforced and non-compliance will result in financial penalties. How will your organization comply with these requirements and not negatively impact clinician workflows? This session will cover: • Examine the audit process used by CMS and OCR in 2008 and 2009 • Review new enforcement approaches as well as the tiers of penalties that have been defined • Step through significant requirements introduced for breach and notification • Understand how to prepare for an audit by organizations such as the OCR, CMS, OIG or the FTC • Identify critical steps for business associates to get started to meet the new requirements introduced by the HITECH Act Speaker: Chief Executive Officer, ECFIRST

12:30p		Luncheon Luncheon Keynote: Prospective Assessments Spotlight Speaker: President & CEO, LEPRECHAUN, LLC Note: Afternoon Refreshments will be available during the afternoon sessions.

1:30p		Risk Adjustment Chart Reviews: Moving Beyond Simply Finding Additional HCCs, Part 2 Speakers: Head of Revenue Optimization & Analytics, AETNA MEDICARE Senior Developer, INFOCROSSING

2:15p		RADV Audit Preparation 101: Compliance: Monitoring & Enforcement – Plus, Tips for Minimizing Bad Coding • RADV defense: Best practices • Understanding CMS RADV Audit methodology • The long-term impact of RADV audits • Coding red flags: Top 10 documentation errors • RADV audit experiences • RADV process • Compliance considering • Conducting a mock RADV audit: - Doing it yourself versus hiring outside help: - Internally, who should be involved in the mock audit? Speakers: VP, Medicare Revenue Management, FREEDOM HEALTH and OPTIMUM HEALTH Director, Business Development, PRIMARIS

3:15p		Measuring the Success of Proper Coding • A number of potential metrics, measures, and/or indices are possible with the initiation and maintenance of proper coding -- however, their implementation and content will vary depending on the operational platform and its capabilities, the needs, the integrity and reliability of source(s) of the information and the individual needs of the subject reviewed • Additionally, the “success” of proper coding may be found in assurances of the accuracy of the codes queued for submission -- this is especially important in the expanding world of vendors, but equally important in the reliability of synchronization and maintenance of integrity vis-à-vis claims, chart review, and HCC generation • Finally the implementation of prospective coding capability demands real time or short turn around error/integrity processes to assure timeliness Speaker: INGENIX CONSULTING Medical Director, Florida, WELLCARE HEALTH PLANS, INC.


4:00p		Conference Adjourns