Continue the conversation in your organization by downloading the presentation materials about strategies and best practices for managing your Medicare, Medicaid and Dual populations. To continue the conversation with us, contact your Express Scripts account team or market strategist.
Thank you for participating in the 2019 Regulated Markets Summit
Gap Analysis: Working Session
Eric Hilleman, MBA – Sr. Medicare Market Strategist, Express Scripts and Ember Montunnas – Director Medicare Market Strategy & Development, Express Scripts
Ember and Eric shared insights into why we created the gap analysis assessment, as well as highlights from the plans that have completed it. Many plans scored themselves highly on the gap analysis but are not performing as strongly as you might expect on Stars or growth. Eric led a group activity in which participants developed strategies for addressing some of the key areas of opportunity from the gap analysis results.
Ember and Eric shared insights into why we created the gap analysis assessment, as well as highlights from the plans that have completed it. Many plans scored themselves highly on the gap analysis but are not performing as strongly as you might expect on Stars or growth. Eric led a group activity in which participants developed strategies for addressing some of the key areas of opportunity from the gap analysis results.
Emerging Models in Medication Adherence
Eric C. Cahow, MBA, Ph.D. – Director, Navigant
While adherence rates are moving upward at a slower pace, cut points remain unstable. The “standard toolkit” leveraged by plans has reached maturity. Eric from Navigant explained that plans wanting to accelerate their performance need to look at new methods. Improvements in HEDIS can offer great insight to driving better Star Ratings.
While adherence rates are moving upward at a slower pace, cut points remain unstable. The “standard toolkit” leveraged by plans has reached maturity. Eric from Navigant explained that plans wanting to accelerate their performance need to look at new methods. Improvements in HEDIS can offer great insight to driving better Star Ratings.
Bringing More Value to Networks
Jen Awsumb – Vice President, Channel Solutions, Express Scripts
Traditionally, networks have been a powerful cost lever in the pharmacy benefit, but they have the power to do so much more. Jen discussed expanded Medicare network offerings for 2021 and how plans can take advantage of the benefits of value-based network solutions to deliver more coordinated, higher quality care for members, plus added savings for your plan. She also explored opportunities for enhanced pharmacy services.
Traditionally, networks have been a powerful cost lever in the pharmacy benefit, but they have the power to do so much more. Jen discussed expanded Medicare network offerings for 2021 and how plans can take advantage of the benefits of value-based network solutions to deliver more coordinated, higher quality care for members, plus added savings for your plan. She also explored opportunities for enhanced pharmacy services.
Bid Best Practices
Todd M. Wanta, FSA, MAAA – Consulting Actuary, Milliman and Amy R. Giese, FSA, MAAA – Principal & Consulting Actuary, Milliman
2020 open enrollment may be in full swing, but you’re already looking at what’s needed to stay ahead of the curve for your 2021 bids. Todd and Amy from Milliman discussed what you should prepare for in terms of regulation, risk scoring and proposals impacting Part B, C and D, and what it could all mean for premiums and Star Ratings.
2020 open enrollment may be in full swing, but you’re already looking at what’s needed to stay ahead of the curve for your 2021 bids. Todd and Amy from Milliman discussed what you should prepare for in terms of regulation, risk scoring and proposals impacting Part B, C and D, and what it could all mean for premiums and Star Ratings.
A Prescription for Cost Savings: Medical Benefit Drug Management (MBDM)
Curtis Lucas, RPH, MBA – Senior Clinical Account Executive Express Scripts and Andy Wheaton, PharmD – Medicare Pharmacist – Network Health Plan
Nearly half of all specialty medications are billed through the medical benefit each year, contributing to inappropriate and unnecessary utilization, and -- potentially -- waste. Andy shared his plan’s perspective alongside Curtis, who explained how comprehensive strategies designed to address prescriber and patient needs, plus the latest in technical innovations, delivered significant savings and support for improving patient outcomes.
Nearly half of all specialty medications are billed through the medical benefit each year, contributing to inappropriate and unnecessary utilization, and -- potentially -- waste. Andy shared his plan’s perspective alongside Curtis, who explained how comprehensive strategies designed to address prescriber and patient needs, plus the latest in technical innovations, delivered significant savings and support for improving patient outcomes.
2019 Dual Eligible Member Study
Tim Brousseau – VP of Client Services, Deft Research
Overall D-SNP enrollment has grown 50% over the last 12 years, yet non-dual low income seniors, who may be eligible for Medicare Savings Programs and Low-Income Subsidies, have not enrolled. In fact, according to a 2019 research report by Deft Research, less than 20% of low-income non-duals have applied for some sort of Medicare assistance program in the past. In this session, Tim took a deeper dive into this question, and shared findings from Deft’s report on how social determinants of health play a role, as well as how best to communicate with these individuals.
Overall D-SNP enrollment has grown 50% over the last 12 years, yet non-dual low income seniors, who may be eligible for Medicare Savings Programs and Low-Income Subsidies, have not enrolled. In fact, according to a 2019 research report by Deft Research, less than 20% of low-income non-duals have applied for some sort of Medicare assistance program in the past. In this session, Tim took a deeper dive into this question, and shared findings from Deft’s report on how social determinants of health play a role, as well as how best to communicate with these individuals.
Engaging with Your Duals Population
Sharon Jhawar, PharmD, MBA, BCGP – CVP & Chief Pharmacy Officer, SCAN Health Plan and Julie Nowfar-Rad, PharmD – Sr. Director, Health Plan Division, Express Scripts
While there is no silver bullet when it comes to managing duals, there is a balance of tailored care needed across the wide range of care and services these members require. Sharon shared some best practices and successes SCAN has experienced within its duals population.
While there is no silver bullet when it comes to managing duals, there is a balance of tailored care needed across the wide range of care and services these members require. Sharon shared some best practices and successes SCAN has experienced within its duals population.
Dual SNP: Turning Stars Challenges into Successes
Derek Douglas – Sr. Manager, Medicare Client Support & Strategy, Express Scripts
Derek shared our analysis, which identified measures where D-SNP focused strategies may be beneficial and help plans to evaluate their overall Star Rating beyond other D-SNP plans. He then led a group activity during which participants worked to identify strategies to drive improved performance for D-SNP plans and members.
Derek shared our analysis, which identified measures where D-SNP focused strategies may be beneficial and help plans to evaluate their overall Star Rating beyond other D-SNP plans. He then led a group activity during which participants worked to identify strategies to drive improved performance for D-SNP plans and members.
Leveraging Social Determinants of Health to Risk Adjust Quality Measures
Matt Pickering, PharmD – Sr. Director, Research & Quality Strategies, Pharmacy Quality Alliance (PQA)
Social determinants of health have become a major focus within health care due to their impact on utilization, cost and ultimately outcomes. As Matt shared, understanding the influence, however, does not address what information is beneficial to collect, how to collect it, and what can be done with the information once it’s obtained. He discussed how he and other stakeholders within his organization are working to develop a framework to address how information can be leveraged when it comes to patient care and performance management.
Social determinants of health have become a major focus within health care due to their impact on utilization, cost and ultimately outcomes. As Matt shared, understanding the influence, however, does not address what information is beneficial to collect, how to collect it, and what can be done with the information once it’s obtained. He discussed how he and other stakeholders within his organization are working to develop a framework to address how information can be leveraged when it comes to patient care and performance management.
Mental Health Management: A Preview
Kelcey Blair, PharmD – Sr. Director, Clinical & Trend Solutions, Express Scripts and Zac Goodman, MD – Director, Clinical Innovation, Express Scripts
The impact of mental illness is widespread in Medicaid. Kelcey and Zac previewed a new mental health management solution that will allow us to screen, engage and improve care delivery for those who need it most. As part of this collaborative discussion, Kelcey and Zac took questions and ideas from the audience on the proposed components of this solution and what additional components would be helpful to include prior to launch.
The impact of mental illness is widespread in Medicaid. Kelcey and Zac previewed a new mental health management solution that will allow us to screen, engage and improve care delivery for those who need it most. As part of this collaborative discussion, Kelcey and Zac took questions and ideas from the audience on the proposed components of this solution and what additional components would be helpful to include prior to launch.
Medicaid Performance Networks
Rusty Moore – Director, Regulated Markets, Express Scripts, Gene Jay, PharmD – Sr. Director, Supply Chain Customer Solutions, Express Scripts and Jamie Reuter, PharmD – Vice President, Enterprise Pharmacy Solutions, EmblemHealth
Plans are looking beyond value-based arrangements with health systems and prescribers and applying this same practice of value-based payment models among retail pharmacies. The goal is to grow value-based payments/reimbursements and optimize quality performance in Medicaid. Gene highlighted some key areas plans should be thinking about, while Jamie shared firsthand how EmblemHealth is putting value-based pharmacy models into practice for its Medicaid population.
Plans are looking beyond value-based arrangements with health systems and prescribers and applying this same practice of value-based payment models among retail pharmacies. The goal is to grow value-based payments/reimbursements and optimize quality performance in Medicaid. Gene highlighted some key areas plans should be thinking about, while Jamie shared firsthand how EmblemHealth is putting value-based pharmacy models into practice for its Medicaid population.
An Insider’s Perspective on Emerging Medicaid Trends
Anne Winter – Managing Principal, Health Management Associates (HMA)
Anne highlighted how Medicaid continues to be a rapidly changing environment that’s increasingly competitive. States are accelerating moving the most complex populations into managed care and placing more complex requirements in recent state RFPs. In addition to sharing current and potential future trends. Anne discussed how health plans can leverage their PBM partner to develop new programs that keep them competitive and help them stay ahead of the curve.
Anne highlighted how Medicaid continues to be a rapidly changing environment that’s increasingly competitive. States are accelerating moving the most complex populations into managed care and placing more complex requirements in recent state RFPs. In addition to sharing current and potential future trends. Anne discussed how health plans can leverage their PBM partner to develop new programs that keep them competitive and help them stay ahead of the curve.
Gap Analysis: Working Session
Groups worked together to develop strategies for addressing key areas of opportunity from the composite gap analysis results. Download the full document to learn more about the best practice considerations identified by your peers.
Dual SNP: Turning Stars Challenges into Successes
During this session, participants worked to identify strategies to drive improved performance for D-SNP plans and members. Download the full document for insights into the proposed solutions.