Continue the conversation in your organization by downloading the presentation materials about strategies and best practices for managing your Medicare and Medicaid populations. To continue the conversation with us, contact your Express Scripts account team or market strategist.
Thank you for participating in the 2020 Regulated Markets Summit
Getting ahead of the curve - insights and best practices for Stars and HEDIS quality metrics
Moderator: Laura Crawn, Vice President, Regulated Markets - Market Strategy
Speakers: Lisa Hines, PharmD, CPHQ, Vice President, Performance Measurement, Pharmacy Quality Alliance (PQA); Mary Barton MD, Vice President, Performance Measurement , National Committee for Quality Assurance (NCQA)
Hear industry experts from the Pharmacy Quality Alliance (PQA) and the National Committee for Quality Assurance (NCQA) to discuss the current quality landscape, new measure development and best practices for state and federal programs.
Speakers: Lisa Hines, PharmD, CPHQ, Vice President, Performance Measurement, Pharmacy Quality Alliance (PQA); Mary Barton MD, Vice President, Performance Measurement , National Committee for Quality Assurance (NCQA)
Hear industry experts from the Pharmacy Quality Alliance (PQA) and the National Committee for Quality Assurance (NCQA) to discuss the current quality landscape, new measure development and best practices for state and federal programs.
Health Connect 360
Presenters: Kodi Reel - Director, Care Coordination; Colleen McKibben - Population Health Manager; Yusuf Rashid - VP, Pharmacy & Vendor Relationship Management, Community Health Plan of Washington
Health care can be fragmented and disconnected, leading to preventable gaps in care, lack of care coordination, and less personal patient engagement.
Health Connect 360℠ uses a whole-person health approach to provide better, more effective clinical care management. By integrating care at the individual level, a more complete, connected view of a patient’s needs can be established. The result is more personalized engagement, providing the right clinical care support to the right patient at the right time.
Health care can be fragmented and disconnected, leading to preventable gaps in care, lack of care coordination, and less personal patient engagement.
Health Connect 360℠ uses a whole-person health approach to provide better, more effective clinical care management. By integrating care at the individual level, a more complete, connected view of a patient’s needs can be established. The result is more personalized engagement, providing the right clinical care support to the right patient at the right time.
Evernorth Digital Health Formulary, offered by Express Scripts
Presenters: Zac Goodman, MD - Director, Clinical Innovation; Kyle Amelung, PharmD, BCPS - Director, Clinical Solutions
With more than 300,000 digital health solutions on the market and 200+ more introduced every day, we’ve entered a chaotic virtual reality where navigating the digital health landscape can be confusing, costly and time-consuming. Payers need help to carefully manage these emerging technologies, which often lack adequate oversight to ensure privacy and safety, as well as a user-friendly experience.
The Evernorth Digital Health Formulary, offered by Express Scripts, is a clinically based, expertly evaluated platform of digital health solutions. All included solutions have been vetted by Evernorth review committees, and deemed to provide therapeutic value for patients based on clinical and member experience.
With more than 300,000 digital health solutions on the market and 200+ more introduced every day, we’ve entered a chaotic virtual reality where navigating the digital health landscape can be confusing, costly and time-consuming. Payers need help to carefully manage these emerging technologies, which often lack adequate oversight to ensure privacy and safety, as well as a user-friendly experience.
The Evernorth Digital Health Formulary, offered by Express Scripts, is a clinically based, expertly evaluated platform of digital health solutions. All included solutions have been vetted by Evernorth review committees, and deemed to provide therapeutic value for patients based on clinical and member experience.
Unlocking the Keys to Growth & Staying Competitive in Medicare
Moderator: Ember Montunnas, Director, Regulated Markets Medicare Market Strategy, Express Scripts
Speakers : Diane Hollie, Vice President, Sales Marketing and Strategy, Gorman Health Group; Pritpal Virdee, President, CoVantage Health Partners
Status quo simply won’t do if you hope to grow your Medicare business. What will it take for your plan to grow and remain competitive in the market? This session will explore what is working for Medicare health plans today and what plans need to be thinking about for the future.
Speakers : Diane Hollie, Vice President, Sales Marketing and Strategy, Gorman Health Group; Pritpal Virdee, President, CoVantage Health Partners
Status quo simply won’t do if you hope to grow your Medicare business. What will it take for your plan to grow and remain competitive in the market? This session will explore what is working for Medicare health plans today and what plans need to be thinking about for the future.
Members first: a sneak peek into a unique white glove experience
Speakers: Ember Montunnas Director Regulated Markets - Medicare Market Strategy, Express Scripts; Liz Johnson, Senior Principal, Operations, Express Scripts; Sharon Jhawar PharmD, MBA, BCGP, CVP & Chief Pharmacy Officer, SCAN Health Plan
During these unprecedented times, one thing is for sure, medication access has never been more important. And, with the Centers for Medicare & Medicaid Services (CMS) putting more weight on member experience, access and complaints Star metrics, every member experience needs to be a positive one. In this session you will learn about opportunities to enhance the member experience through the pharmacy benefit and how one plan is providing ‘white glove’ service to its members.
During these unprecedented times, one thing is for sure, medication access has never been more important. And, with the Centers for Medicare & Medicaid Services (CMS) putting more weight on member experience, access and complaints Star metrics, every member experience needs to be a positive one. In this session you will learn about opportunities to enhance the member experience through the pharmacy benefit and how one plan is providing ‘white glove’ service to its members.
PDE Stars Advisor
Presenter: Lee Zervos - Senior Advisor, Medicare Market Strategy
Managing Star Rating adherence measures – diabetes, hypertension, and statins – starts with information that is actionable and delivered in a timely fashion. That is why Express Scripts created – a user-friendly dashboard and suite of reports generated every other week, designed to quickly identify actions to improve adherence. In addition to the report suite, we have resources prepared to work with our clients to resolve PDEs, the data source used to calculate Star Ratings.
Managing Star Rating adherence measures – diabetes, hypertension, and statins – starts with information that is actionable and delivered in a timely fashion. That is why Express Scripts created – a user-friendly dashboard and suite of reports generated every other week, designed to quickly identify actions to improve adherence. In addition to the report suite, we have resources prepared to work with our clients to resolve PDEs, the data source used to calculate Star Ratings.
Emerging Trends Shaping Managed Medicaid
Moderator: Rusty Moore, Director, Regulated Markets - Medicaid Market Strategy, Express Scripts
Speakers: Donna E. Checkett, MPA MSW, Vice President of Business Development, Health Management Associates (HMA); Pat Mitsch Associate Vice President of Pharmacy, UCare
There is an increasing trend in States seeking more control over their pharmacy benefits cost controls. This approach is forcing Medicaid managed care plans to get creative in strategies that go beyond table stakes levers traditionally pulled. This session will discuss some of these trends and new tactics plans are employing to help them differentiate and grow.
Speakers: Donna E. Checkett, MPA MSW, Vice President of Business Development, Health Management Associates (HMA); Pat Mitsch Associate Vice President of Pharmacy, UCare
There is an increasing trend in States seeking more control over their pharmacy benefits cost controls. This approach is forcing Medicaid managed care plans to get creative in strategies that go beyond table stakes levers traditionally pulled. This session will discuss some of these trends and new tactics plans are employing to help them differentiate and grow.
Tackling Social Determinants of Health in Medicaid
Moderator: Josh Linck, Senior Manager - Medicaid Market Strategy, Express Scripts
Speakers: Rochelle Henderson, Vice President of Health Services Research, Express Scripts; Amy Riegel Director, Housing, CareSource
As payers and providers, focusing on social determinants of health (SDOH) is critical in ensuring the best outcomes for your Medicaid members. In this session, learn about industry trends and client best practices, a view into state initiatives taking place, and how social determinants of health is factoring into the development of future tools and solutions.
Speakers: Rochelle Henderson, Vice President of Health Services Research, Express Scripts; Amy Riegel Director, Housing, CareSource
As payers and providers, focusing on social determinants of health (SDOH) is critical in ensuring the best outcomes for your Medicaid members. In this session, learn about industry trends and client best practices, a view into state initiatives taking place, and how social determinants of health is factoring into the development of future tools and solutions.
Encounter Advisor
Presenter: Michael Shoemaker - Director, Claims Processing & Reporting
Encounter Advisor is a collaborative service offering that provides clients with a designated advisor to manage their plan encounters. The advisor collaborates with the plan to remediate errors, determine strategies to mitigate potential errors, and discuss concerns with the state, and/or influence state guidance based upon their plan's performance. Encounter Advisor also includes the administrative tasks associated with managing encounter development, submission, and response processing.
Encounter Advisor is a collaborative service offering that provides clients with a designated advisor to manage their plan encounters. The advisor collaborates with the plan to remediate errors, determine strategies to mitigate potential errors, and discuss concerns with the state, and/or influence state guidance based upon their plan's performance. Encounter Advisor also includes the administrative tasks associated with managing encounter development, submission, and response processing.