CARE TRANSFORMATION INNOVATIONS

Developing Whole Person Care Models and Strategies for Complex Populations: Advancing Patient- Centered Physical, Behavioral, Social and Oral Care for Medicaid, Medicare, and Duals

Event Schedule

Workshop Registration

2:00-5:00 Navigating the Supplemental Benefit Landscape for 2026 and Beyond

This pre-conference workshop is dedicated to providing comprehensive insights into the future of supplemental benefits. Designed for industry professionals, this interactive workshop offers a deep dive into strategies that will shape the supplemental benefits landscape in the coming years. Register to gain access to a proven framework focusing on cost reduction, data optimization, and actuarial approaches to benefit design.

Key focus areas will include:

  • Strategies to reduce costs while maintaining attractive and robust benefits
  • Techniques for optimizing vendor relationships to obtain the best data possible
  • In-depth analysis of supplemental benefits design from an actuarial perspective

Join us to equip yourself with the knowledge and strategies needed to excel in the evolving landscape of supplemental benefits. This workshop promises to provide valuable insights and practical approaches for future-proofing your benefit offerings

Workshop Leaders:


Jason Montrie

SVP Healthcare and Products

NationsBenefits


Cyndi Alexander,

Vice President, Healthcare Service Solutions

NationsBenefits


Additional Speaker TBA

Continental Breakfast

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Chairperson’s Welcome


Driving the Success of Integrated Care Initiatives:  Developing a Team-Based Leadership Approach and Breaking Down Silos to Launch Programs that Improve Outcomes


Nicole Hungate,

Director, Medicare Product Solutions

Medical Mutual of Ohio

INTEGRATED CARE MODELS/CARE COORDINATION


Panel Discussion: Leveraging Integration Necessary for a Comprehensive Approach to Health Outcomes—Integrating Social, Behavioral, Physical, and Oral Care

Seiji Hayashi, MD, MPH, FAAFP,

Interim Chief Medical Officer, Community Health Plan of DC,
Lead Medical Director for Government Programs,

CareFirst BlueCross BlueShield


Jim Milanowski,

CEO,

Genesee Health Plan


Fostering Whole Person Care: Innovating Integrated Models and Incentive Alignment in Healthcare

This presentation explores strategies for healthcare delivery, spotlighting the integration of services and alignment of incentives to enhance patient outcomes. By examining innovative care delivery models and incentive structures, the session underscores the importance of whole person care in optimizing patient experience and cost-effectiveness. Attendees will glean valuable insights into the transformative potential of integrated care and incentivized alignment, particularly within the context of Medicaid, in shaping the future of healthcare delivery.

Elise Cooper,

Director of Provider Services,

Colorado Access


Sarrah Knause,,

Manager of Payment Reform,

Colorado Access

Success with Integrated Whole Person Care:  It’s Not How You Pay, But How You Plan

  • Interdisciplinary is not synonymous with integrated;  just because everyone is at the table does not mean they are connected or coordinated.
  • Truly integrated care requires a formal model for person-centered collaboration, in which the patients health resource-community works toward common goals by sharing responsibility, authority and accountability for achieving results. 
  • There are other industries that achieve mission-critical performance goals in dynamic environments characterized by complexity and diverse human factors.
  • This presentation will share an operating model for whole-person integrated care, in which teams of technical and interpretive experts, each of whom has mastered their specific discipline, come together to create concordant, goal-directed experiences for patients.
  • This framework is grounded in a structured framework for care planning that can be implemented independent of models of payment.

Steve Merahn, MD,

Medical Director,

Partners Health Plan and Care Design NY

Identifying Complex Patients’ Needs to Develop Patient-Centered Care Models for High-Cost, High-Need Beneficiaries and Reduce Unnecessary ER Visits

One of Medicaid Managed Care Plans’ biggest expense is Avoidable ED Encounters and Hospitalizations. An effective intervention to decrease this is a Follow to Hospitalization/ED Encounter that assures the member has a follow up with their PCP or Specialist however most plans do not have the bandwidth to do this. This session will focus on partnering with community base organizations to do the following:

  • Using Health Home intensive case management to intervene that includes Transition in Care Follow up to ED/Hospitalizations and scheduling a follow Medical/Psychiatric Appointment
  • Review VNSHealth quality assurance intervention to decrease the volume of avoidable ED Encounters and Admissions that includes a monthly case conference with the Health Home.
  • Understanding behavioral change and need for patience.
Alan Rice,

Population Health Specialist,

VNSHealth Health Plans

Morning Refreshment Break

Panel Discussion: Developing a D-SNP Model of Care: Addressing the Barriers that the Dual Eligible Population Faces through Tailored Solutions within a Unified Framework

Panelists:


Chris Esguerra, MD,

Chief Medical Officer,

Health Plan of San Mateo


Optimizing Transitional Market Segments: Age-Friendly Care for Medicaid, Medicare, and Duals Populations

Discuss strategies to optimize care for Medicaid, Medicare, and Duals populations in a rapidly evolving market. Explore how to turn gaps into opportunities in chronic disease management and post-acute care. Enhance outcomes and brand equity by integrating these key elements:

  • Lifestyle Chronic Disease Management: Reduce total care costs
  • Post-Acute Care Transition: Prevent adverse outcomes and readmissions
  • Smart Analytics and Tools: Deliver timely, person-centered care
  • Value-Based Pathway: Meet people where they are with age-friendly, whole-person care
Mina Chang, Ph.D.,

Senior Policy Adviser,

Ohio Department of Aging

Luncheon

Panel Discussion: The Landscape and Reality of Value Based Care: Understanding What is Needed from Payors and Providers to Drive Success

Panelists:


Jennifer Callahan,

Chief Operating Officer,

ATRIO Health Plans

Regina Berman, R. N., M.A.,

Value Based Care Executive,

Adventist Health

Developing Multidisciplinary Care Models Including Innovative Community Partnerships and Virtual Care: Taking a Team-Based Approach

Simone Brooks,

Executive MBA,

Nonprofit Board Member and Health Care Leader & Consultant

Health Plan of San Mateo’s Oral Health Integration Pilot: A Case Study

  • Describe the challenges of disintegrated oral health care
  • Describe the necessary components of going live
  • List several observations from the first two years of HPSM's integration pilot

Chris Esguerra, MD,

Chief Medical Officer,

Health Plan of San Mateo

Afternoon Refreshment Break

Panel Discussion: Developing Comprehensive, Equitable Maternal Health Models: Connecting Clinical, Behavioral, and Social Services During Pregnancy and Postpartum to Improve Maternal and Infant Health Outcomes

Panelists:


Chantel Neece DNP, MBA, APRN, FNP-BC, GERO-BC, CPHQ, SSBBP,

Sr. Director-Maternal/Child Services & Member SDOH,

Sentara Health Plans

Seun Ross, DNP, MS, CRNP-F, NP-C,

Executive Director, Health Equity,

Independence Blue Cross

Case Study: Leveraging Partnerships to Ensure Access to Equitable, High- Quality Care for Mothers and Infants: Overcoming Disparities for Stronger, Healthier Newborns and Increased Maternal Wellness

Designing Integrated Care Models to Strengthen Transitions of Care


Bridging the Preventive Care Gap: Deep Root Cause Analysis of Patient Care Journey for Personalized Care and Improved Outcomes


Despite significant progress in healthcare, substantial gaps persist in preventive care, leading to missed opportunities for early intervention and hindering optimal patient outcomes. This presentation explores the potential of integrated deep root cause analysis, encompassing medical, behavioral, pharmacy data, and Social Determinants of Health (SDOH) data, through the patient care journey to identify actionable pathways and drivers of preventive care delivery. By connecting these data points, we can develop personalized care plans that leverage insights to inform targeted interventions and programs, ultimately bridging preventive care gaps and improving overall well-being.

Frank Song, Ph.D., PMP, CPHQ,

Director, Healthcare Informatics,

Inland Empire Health Plan

Cocktail Reception



BEHAVIORAL HEALTH


Continental Breakfast

Banner University Health Plans Case Study: Behavioral Health/Clinically Integrated Network Innovations

  • The risks of untreated behavioral health conditions from an overall healthcare perspective
  • Banner Health Plans’ Innovations focused on Integrated Care: Behavioral and Physical Health, HRSNs and Health Disparities
  • Essential component of extensive outreach and engagement for high-risk populations
  • Clinically Integrated Networks Strategy and Outcomes
  • Leveraging Value-based Care
Sandra Stein, MD,

Chief Medical Officer,

Banner Health Plans

Identifying Opportunities to Embed Behavioral Health Into Health and Wellness Programs and Primary Care Settings

  • Integrated Care Delivery: Coordinating Physical, Behavioral, and Social Health
    • Comprehensive Patient-Centered Care: Highlight how integrated care delivery coordinates physical, behavioral, and social health together to provide comprehensive patient-centered care, particularly for complex populations. Additionally, discuss how it can translate to large benefits for organizations at scale.
    • Whole Person Approach: Emphasize the importance of a whole person approach to care. Spotlight how an intimate relationship between primary care and behavioral health care teams is effective in improving health outcomes, quality of care, and cost-effectiveness, meeting the needs of high-risk, high-cost beneficiaries.
    • Social Determinants of Health (SDOH): Discuss the identification and integration of SDOH in care delivery to address factors such as housing, education, and socioeconomic status, which impact all health outcomes.
  • Access Points and Quality of Clinical Care
    • Different Access Points: Explore various access points for behavioral health care, including virtual, on-site, and collaborative care, and assess their quality and effectiveness with their integration of care.
    • Clinical Training Options: Present options for clinical training, such as licensed clinicians, apps, AI therapy bots, life coaches, and health coaches, and their roles in behavioral health care delivery.
  • Case Study, Best Practices, & Panel Discussion/Activity
    • Case Studies and Best Practices: Showcase case studies and best practices from integrated care in an employer-based model with complex populations demonstrating successful integration of behavioral health into workplace wellness programs.
    • Panel Discussion: Facilitate a panel discussion with clinicians and client representatives to talk through different access points, clinical training options, and strategies for prevention and intervention, providing real-world insights and experiences.
    Erin Thase, Ph.D,

    National Director of Mental Health,

    Marathon Health

Embarking on Our Journey to Zero: Implementing the Zero Suicide Framework

  • Learn about how to implement the Zero Suicide Framework into behavioral health and healthcare systems to improve care and outcomes for individuals who are at risk for suicide
  • Learn how to develop consistent, uniform screening and referral processes for individuals in residential, crisis residential and outpatient programs
  • Learn about program workflows, key metrics, evidence-based practices and lessons learned

Kasie Pickart, MPH,

Behavioral Health Grants Project Director,

Hope Network

Maggie Sweeney, LPC

Suicide Prevention Clinical Specialist,

Hope Network


Morning Refreshment Break

HEALTH EQUITY/SDOH


Panel Discussion: Ensuring Cultural Competency in Care Delivery Initiatives—Providing Culturally Aware Care through Hiring Diverse Care Providers and Using Data to Address Disparities

Ensuring a Greater Emphasis on SDoH: Working with Community Based Organizations to Add and Provide More Comprehensive Care

Jim Milanowski,

CEO,

Genesee Health Plan

Improving Health Equity Through Integration – A Strategy to Reduce Disparities

Angela Lynn,

Director, Care Management,

Blue Cross Blue Shield of North Carolina

Conclusion of Conference