The 2022 OPEN MINDS Health Plan Partnership Summit

February 17, 2022 | 8:00am – 4:45pm

Are strategic initiatives aligned for both health plans and provider organizations? Health plan priorities are being reshaped to meet new challenges of the changing health and human services landscape, and they’ve got “big data” behind their every move. For provider organization executives, understanding the dynamics of the health plans in their market is the key to creating preferred health plan relationships. During this one day event, we will hear from executives from health plans and provider organizations alike on specific case studies with regard to partnership opportunities. You will see how the right management tools, strategic insights, and the expert advice can help you navigate strategic health plan/provider partnerships in order to better serve consumers with complex support needs.

8:00 a.m. – 8:30 a.m. ET: Registration & Breakfast

8:30 a.m. – 9:00 a.m. ET: Welcoming & Introduction

Kickoff the Summit with co-chairs Cathy Gilbert, Senior Associate, and Richard Louis, III, Vice President, Western Region at OPEN MINDS presenting a high-level overview of health plan priorities in the “next normal”.

Cathy Gilbert, Senior Associate, OPEN MINDS
Richard Louis, III, Vice President, Western Region, OPEN MINDS

9:00 a.m. – 10:00 a.m. ET: Keynote AddressFinding Your Seat At The Table: How United Healthcare Is Defining The Performance Measures For A Successful Payer/Provider Partnership

As provider organizations are implementing their 2022 strategy for sustainability post-pandemic, health plans are rethinking their market positioning with a new focus on payer – provider alignment. Lessons can be learned from both sides so that shared consumers have positive outcomes, ensuring your organization remains sustainable and meets performance standards. With value-based reimbursement models on the rise, health plans are increasingly interested in working with providers that are able to deliver services that meet aligned performance metrics within narrow networks. How can your organization be positioned to have a seat at that table? In this keynote address we will hear how United Healthcare has created an internal organizational culture to prioritize engagement with performance driven provider partners. Learn about what “not to do”- and what health plans are looking for in providers in order to meet high standards for the delivery of coordinated care and identified deliverables. Our speaker will tell you that setting expectations early on in a partnership is key to ensuring organizations are aligned for both positive consumer, and business outcomes, which can help accelerate your organization’s performance metrics into excellence.

Joyce Wale, North East Regional Behavioral Health Executive Director, United Healthcare Community and State

10:15 a.m. – 11:30 a.m. ET: Out Of The Shadows: How Substance Use Disorder Has Helped Pave The Way For Partnership Opportunities

Over 70,000 Americans died in 2019 from an opioid overdose, and this number is estimated at over 90,000 for 2020, the highest it has ever been. How can providers work with health plans to ensure they offer the most up-to-date treatment (behavioral and medication assisted), while balancing quality care with improved and measurable consumer outcomes? Programs and facilities receiving distinction as a center for excellence must demonstrate coordinated multidisciplinary care plan for consumers, and must also provide timely access to quality medical and psychosocial care in all phased of treatment. The Blue Distinction Specialty Care program helps consumers find quality treatment and care in the area of substance use disorders. These nationally designated facilities must demonstrate a commitment to delivery improved consumer outcomes, and safety while demonstrating objective measures. Hear from one such provider organization who is doing exactly that, while working together within the Blue Distinction Program and the intricacies of navigating that partnership.

11:45 a.m. – 1:00 p.m. ET: Weathering The Covid Storm: Patient-Driven Grouping Models (PDGM) Implementation During A Volatile Time

Patient-Driven Grouping Models (PDGM) was the most sweeping change to happen in the reimbursement world for home health organizations since the year 2000. In order to provide a more accurate episode of care, co-morbidities are taken into account when examining case mix to optimize reimbursement. When this was implemented the learning curve was vast, but many rose to the occasion and were able to implement these coding, workforce, and billing changes prior to the pandemic hitting. Now, almost two years later, many are making it work, even as further changes are on the horizon. With the changes the pandemic brought about, this has provided other opportunities for home health agencies to incorporate telehealth into their overall plans of care and business development model. Hear from two home health organizations that met this challenge head on, incorporated the changes PDGM brought about, and how it has affected their sustainability and growth overall.

1:00 p.m. – 2:00 p.m. ET: Lunch & Networking

2:00 p.m. – 3:15 p.m. ET: Social Determinants Of Health (SDoH) Is A Win-Win For Payers & Providers

To better manage the rising costs for the complex consumer population, we’re seeing a continued focus on value-based reimbursement and models of care coordination across medical, behavioral, pharmacy, and social support systems. Given that over half of the factors that influence a consumer’s health status are related to lifestyle issues, it isn’t surprising that health plans have a growing interest in addressing social determinants of health (SDoH). Though their approaches are different, it’s clear that health plans recognize the value in social support services—with the current focus on identifying the programs and services that have the greatest effect on health care costs for their members.

3:30 p.m. – 4:45 p.m. ET: Looking For Quality Outcomes? It Starts With Innovative Value-Based Contracting

The shift away from traditional fee-for-service reimbursement models to value-based reimbursement (VBR) has turned “business as usual” on its head for many specialty provider organizations. It has forced executive teams to continue their current operations, while simultaneously implementing new services, technology, and data-driven systems that are necessary for VBR success. New or redesigned services linked to quality outcomes need to be built, negotiated, and piloted. Technology that drives outcomes and creates operational efficiencies needs to be identified, funded, and implemented. And, a culture of using data to ensure standardized, results-oriented outcomes across the organization must be built. Provider organizations need to move from an understanding of the key competencies required in the VBR model to tactical initiatives for implementing the talent, technology, and systems that deliver quality and value within value-based contracts.