QR Newsletter - Winter 2021 by WilmingtonFRA

RISE CONFERENCES RETURN AS LIVE EVENTS Sneak Peek: Star Ratings Master Class

E S RI

RISE National Headliners

New Health & Safety Protocols

S W E N

RISE National 2022 Keynotes

Ryan Avery & Nancy Messonnier, M.D.

ter 2021

nº8 - Win

THE LATEST NEWS 14 things to know about Medicare Advantage, Medicare Part D plans in 2022

Dems reach deal on drug pricing reform, allow Medicare D to negotiate prices directly with manufacturers

Medicare premiums will skyrocket in 2022—here’s why

Seema Verma to present keynote at RISE’s 2022 Summit on Social Determinants of Health

Regulatory update: CMS repeals MCIT/R&N Rule; Feds sue Uber for overcharging physically disabled people; Average family premiums spiked in 2021

Regulatory update: Feds drop plans to add dental, vision benefits to original Medicare; HHS plans to reverse Trump administration’s Sunset rule

OIG estimates UPMC received $6.4M in overpayments for high-risk diagnoses

Commonwealth Fund: Older adults on Medicare and those near Medicare age face costs barriers to care New BMA report finds MA helped sustain providers, enabled faster telehealth adoption during the pandemic Deft Research survey uncovers the key to member loyalty in the individual under 65 market

UnitedHealthcare sues TeamHealth, alleging $100M fraud

CMS releases 2022 MA and Part D Star ratings

OIG: 20 MA plans used questionable billing practices to maximize risk adjustment payments The high cost of dental and hearing care: Seniors face big bills whether they are in traditional Medicare or Medicare Advantage

CMS policy updates: The latest on final RADV audit rules, ESRD payment rule, risk adjustment model changes for ACA market, and so much more CMS OPPS/ASC final rule aims to increase patient safety and access to quality care

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READ ALL OF OUR INSIGHTS & ARTICLES

Letter From the Chair

TOO CLOSE FOR COMFORT

3 STAR RATING TRENDS Was your 2022 Star rating score too close for comfort? Pay attention to these 3 trends as you look to the (near) future.

1. The “consumerization” of health care is here to stay COVID toppled persistent barriers and hastened digital health at breakneck speed. It pushed consumers to rely on digital channels for care, with most embracing the innovation and realizing that the flexibility and convenience born of technology led to empowerment for self-management of their conditions. Consumers are setting new priorities, developing a new experience-centered

mindset, a greater sense of urgency about their well-being, and a strong desire to actively manage and direct their own health. Today, more than ever consumers expect care solutions that are uniquely personalized, help achieve their individual goals and deliver integrated care experiences within a “healthsphere” of payers, providers, and suppliers all working together to improve outcomes and value.

Tip: Loyalty and good will can be earned by offering health plan members information, tools, and an abundance of options to access their care how, when, and where they want.

2. If you want “extreme trust” lead with “extreme transparency” Recent federal mandates and shifting consumer expectations are democratizing health data more and more each day. Don’t resist this important trend. Information transparency empowers members to dynamically engage in their own care, participating fully as part of their care team and making the choices that work best for them. How do we gain members’ trust so that they engage with our quality programs, tools, and services? One-size fits all approaches no CLICK TO SEE OTHER ARTICLES

longer work. Treat each member as a unique person, instead of a “persona,” and tailor their health experiences based on individual preferences. By letting each member decide what they’re willing to share with us during each interaction, we can show them the value they receive through sharing information with us. In its excellent piece, The Health Experience Reimagined, Accenture describes “pushing out an alert with tailored nutrition options because a patient’s blood pressure jumped outside his or her target range due to food eaten” as an example of how this concept could be applied. And we shouldn’t just be transparent about the data we collect, we should also wholeheartedly embrace the latest mandates (Interoperability, Hospital Price Transparency, Transparency in Coverage, and the No Surprises Act) supporting the electronic exchange of data that ease the way for the flow of cost-sharing and pricing information that consumers need. The more we share, the more our members will trust us to create truly meaningful health care experiences for them.

Tip: Organizations that lead with pricing transparency and combine that information with quality and outcomes transparency will reap the benefits of being trustable partners for the long term.

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3. Meeting members “where they are” increasingly means meeting them at home The shift from traditional care settings to home-based care is happening at lightning speed, and COVID has only served to accelerate this trend. Payers and providers should reimagine care delivery, freeing it from the limitations of time and place. Why should patients be limited to receiving care in physical locations and only during the times those offices are open? Whenever possible, we should rethink where, when, and how care is delivered… leveraging technologies like telehealth, home testing, telemonitoring, and devices that facilitate the self-administration of treatment to facilitate care for patients whenever and wherever they need it, especially in the home. Tools, platforms, and services that facilitate care coordination will be critical to ensuring patients connect with what they need when facing a diagnosis of a long-term condition or an acute health event. More and more, patients are being discharged from hospitals to home, when they may previously have been discharged to a skilled nursing facility. Payers and providers can provide support to ensure patients follow medication and treatment regimens and participate in follow up appointments, no matter when or where that care takes place. And for those that need extra help adding personalized services, such as concierge, care navigation, or coaching

helps ensure access to the right care at the right time. Tip: Benefits that facilitate self-direction, self-efficacy, and the delivery of care on each member’s own terms will be the key to driving higher satisfaction and improved health outcomes.

Looking ahead to 2022 As we close out this year and look forward to the year ahead, we expect these trends to continue. Pay close attention to these trends when planning for benefit design, quality programs, operational structure, resource allocation, and future investment. Doing so will go a long way towards aligning your organization’s key initiatives with a strategy that will pay dividends when it comes to member retention, higher satisfaction, and improved health outcomes, all factors that lead to sustained Star ratings success.

Ana Handshuh, CHC, Principal, CAT5 Strategies RISE Quality & Revenue Community Chair

SUBSCRIBE TO OUR PODCAST Join the RISE team as we chat with industry leaders and explore ever-changing policies, regulations, and challenges faced by health care professionals in our three communities: Quality & Revenue, Medicare Member Acquisition & Experience, and Social Determinants of Health. Produced by RISE, the number one source for information on all things Medicare Advantage.

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Melissa Smith & Liz Haynes on 2022 Medicare Star ratings and what plans must do to maintain those scores

riseradio.buzzsprout.com

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RISE STAR RATINGS MASTER CLASS PREVIEW:

ALL-STAR SPEAKERS, KEY SESSIONS YOU DON’T WANT TO MISS Our 12th annual conference will take place Dec. 14-15 at the Manchester Grand Hyatt San Diego. Check out the sessions and speakers we’ve planned to help you boost your Star ratings in 2022. Regulatory and policy updates, strategies to improve member engagement and Part D measures, and how social determinants of health (SDoH) are intertwined with Star ratings will be among the topics discussed at the upcoming 12th annual Star Ratings Master Class. We’ve highlighted a few of the sessions planned. Click here to access the full agenda.

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Policy update and the future of Stars Ana Handshuh, principal, CAT5 Strategies and chair of the RISE Association’s Quality and Revenue Community, will moderate a fireside chat on upcoming regulatory changes and adjustments to the Star Ratings program. Our blockbuster panel includes Micah Cost, PharmD, MS, the CEO of Pharmacy Quality Alliance; Kristine Toppe, AVP of state affairs, National Committee for Quality Assurance; and Ashby Wolfe, M.D., MPP, MPH, regional chief medical officer, Centers for Medicare & Medicaid Services.

A holistic approach to raising Star ratings Keynotes Melissa Smith, EVP, consulting and professional services, HealthMine, and Liz Haynes, MSN, RN, CCM, director risk adjustment & Stars– Government Programs, Blue Cross and Blue Shield of Kansas City, will explore the Stars life cycle and why it’s imperative

to keep your entire population at the center of your efforts. Check out a preview of their session here.

In-depth focus on member experience and satisfaction Due to the impending increased weight on these measures, we will devote several sessions on member experience, including: Innovative approaches to improve member experience: Dave Etling, senior vice president and general manager, Incomm Healthcare, will moderate the discussion with panelists: Archie Dey, director of consumer experience and insights, SCAN Health Plan; Rachel Sterner, MPH, Stars program manager, UCare; and Handshuh. Employ behavioral science to drive member and provider engagement: Learn tried-and-true strategies to set expectations, raise satisfaction, and drive engagement with Kathleen Ellmore, managing director, Engagys, and Bahar

T H E 1 2 TH A N N U A L

Sedarati, M.D., national medical director, Humana. Dismantling siloes for a unified approach to Stars: In this session, speakers identify strategies to implement a cohesive culture of Stars awareness to help improve member experience. Kathleen Faulk, SVP and GM, government programs, Regence BlueCross BlueShield of Oregon, will moderate the session. Panelists include Ryan Dodson, regional manager, risk adjustment, New Vision Healthcare Solutions/Choice Medical Group; Rhonda Farrar, senior manager analytics and data quality, Advantmed; and Randi Escobedo, AVP, risk adjustment, Providence Health Plan. Results of the RISE-Engagys sixth annual survey of healthcare consumer engagement practices: Ellmore will return to lead this special session that reveals the current state of member/ patient engagement and which tactics and channels are effective, which programs are ineffective, and where there are pockets of excellence.

This year’s survey also uncovered information on SDoH. While health plans often have SDoH services in place, they don’t always have the best means of communicating this information. As a result, members don’t take advantage of benefits because they don’t realize they have access to them. To increase utilization of SDoH, Ellmore says payers can focus on increasing and optimizing member communications. For example, personalizing messages and capturing member barriers has shown to yield strong results. Input from the survey indicated that health plans have been squeezed in 2021 and, unsurprisingly, ROI and cost became far more important when evaluating SDoH programs. Respondents noted that ROI jumped as a SDoH success measurement focus by nearly 200 percent this year. SDoH and Stars: Learn what forward-thinking health plans are doing to improve patient experience and increase access to care for unique member populations with Lindsay Dornfeld, senior manager product management, Pulse8;

Julianne Eckert, senior director of quality improvement and Stars operations, Clover Health; and Rex Wallace, principal, Rex Wallace Consulting, LLC. Addressing the unique concerns of Special Needs Plans: Speakers will explore strategies for tackling extra SNP measures with limited resources to increase member satisfaction and which supplemental benefits can help reduce disparities and engage hard-to-reach populations. Panelists include Christine Uranaka, R.N., BSN, national quality auditor, AHF; Deborah Paone, DrPH, MHSA, performance evaluation lead and policy consultant, SNP Alliance; and Kurt Cegielski, SVP, client success, Icario. The 12th annual Star Ratings Master Class will take place December 14 and 15 at the Manchester Grand Hyatt San Diego. Click here to access the full agenda, roster of speakers, and how to register for the event.

Proof of COVID-19 vaccination is required to attend the event. See p. 10 for all RISE conference health and safety protocols. CLICK TO SEE OTHER ARTICLES

WORLD-CLASS PUBLIC HEALTH LEADER AND EMMY-AWARD WINNING JOURNALIST TO HEADLINE

RISE National 2022— the #1 trusted source for all things Medicare Advantage—returns to Nashville, Tenn. on March 7-9 as a live, in-person event and will feature two blockbuster keynotes.

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Nancy Messonnier, M.D., former director of the Center for Disease Control’s National Center for Immunization and Respiratory Diseases (NCIRD), will present a keynote address on lessons learned about the pandemic at RISE National 2022, which will take place March 7-9 at the Gaylord Opryland in Nashville, Tenn. Dr. Messonnier, who currently serves as the executive director for Pandemic Prevention and Health Systems at the Skoll Foundation, will discuss the current health care landscape, immunization hesitancy, and the future of public health on Wednesday, March 9, the second day of the main conference. Emmy-award winning journalist Ryan Avery will present a motivational address on leadership on Tuesday, March 8. Avery, a two-time bestselling author and the youngest World Champion of Public Speaking in history, says in the competitive world we live in, it is no longer acceptable to offer a product, a solution, or even be a leader. He will bring insights into how attendees can become the product, the solution, and the leader to follow. The third keynote will be announced shortly.

About Dr. Messonnier

RISE National attendees will get an inside look at the nation’s response to the pandemic during Dr. Messonnier’s keynote. She was the chief architect of the COVID-19 vaccine implementation program as well as CDC’s Vaccinate with

Confidence initiative, which works with national organizations to strengthen public trust in vaccines and prevent vaccine-preventable disease outbreaks.

and MD from the University of Chicago School of Medicine and completed internal medicine residency training at the University of Pennsylvania.

In 2019, Dr. Messonnier directed NCIRD to activate a center-based response to the COVID-19 pandemic. She led efforts to distribute, administer, educate, and provide partner engagement, safety, and effectiveness evaluation and access for hard-to-reach populations with the goal of ensuring that a safe and effective COVID-19 vaccine would be available to every American who wanted one.

About Ryan Avery

In her current role at the Skoll Foundation, she plans to continue effectively addressing the ongoing COVID-19 outbreak and focus on helping build out the global system needed to prevent another COVID-like pandemic in the future. Dr. Messonnier has been a long-time champion for the prevention of disease, disability, and death through immunization and control of vaccine-preventable diseases. She played a pivotal role in the successful public-private partnership to develop and implement a low-cost vaccine to prevent epidemic meningococcal meningitis in Africa. More than 150 million people in the African Meningitis Belt have been vaccinated with MenAfriVac since 2010, with remarkable impact. Dr. Messonnier also has been a leader in CDC’s preparedness and response to anthrax, including during the 2001 intentional anthrax release and in evaluating simplified schedules for use of licensed anthrax vaccine. Her public health career began in 1995 as an epidemic intelligence service officer and she has held several leadership positions across CDC. She served as acting director for the Center for Preparedness and Response (CPR), deputy director for NCIRD, acting director of the Division of Global Health Protection in the Center for Global Health and Chief of the Meningitis and Vaccine Preventable Diseases Branch in NCIRD.

Avery is one of the most profound keynote speakers on strategic communications and leadership. At age 25, he became the youngest World Champion of Public Speaking in history, competing against more than 30,000 contestants from 116 countries to claim the 2012 World Championship for Toastmasters International. As an Emmy-award winning journalist, two-time best-selling author and world record holder, Avery has delivered more than 500 keynotes in 33 countries around the globe. His mission is to show leaders and their teams how to become the leaders in their industries using proven strategies that everyone can use to be the best version of themselves. RISE National 2022 will take place March 8-9, with preconference workshops on March 7, at the Gaylord Opryland in Nashville, Tenn. Proof of COVID-19 vaccination is required to attend the event. Click here to see the full conference agenda, roster of speakers, and how to register. See our health and safety protocols for conference attendance on page 10.

Dr. Messonnier has written more than 140 articles and chapters and has received numerous awards. She received her BA from the University of Pennsylvania CLICK TO SEE OTHER ARTICLES

RISE is excited to return to in-person conferences. To ensure the health and safety of attendees, speakers, exhibitors, and staff, RISE will require proof of full COVID-19 vaccination status to attend the events. Here’s everything you need to know before you make your travel arrangements.

Please note that these protocols may vary depending on the state where the event is taking place and the legislation implemented by that state. Please visit specific conference websites to learn what will be expected at each event. RISE is pleased to announce a return to live events with conferences planned all over the country. Before you register for our upcoming conferences, be aware that our health and safety protocols for the events have changed. Please note that these protocols may vary depending on the state where the event is taking place and the legislation implemented by that 10

QUALITY & REVENUE COMMUNITY NEWSLETTER

state. Please visit specific conference websites to learn what will be expected at each event.

Health screenings

Until further notice, in-person events require:

Proof of COVID-19 vaccination Upon arrival, attendees must certify several statements upon check in, indicating they have not been exposed to COVID-19 in the past 14 days and are not experiencing any symptoms. A person is considered fully vaccinated*:

Hand sanitizing

• Two weeks after his or her second dose in a two-dose series, such as the Pfizer and Moderna vaccines, or • Two weeks after a single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine A physical copy of the Centers for Disease and Control Prevention’s (CDC) COVID-19 vaccination card or a photo of the card, along with a photo ID, will be accepted as proof of vaccination at the registration desk.

Hand sanitizing stations will be set up throughout the event in conjunction with the CDC recommendation of thorough hand washing.

Physical distancing

* This guidance applies to COVID-19 vaccines authorized for emergency use by the U.S. Food and Drug Administration (i.e., Pfizer-BioNTech, Moderna, and Johnson and Johnson (J&J)/Janssen COVID-19 vaccines).

Face coverings

RISE encourages physical distancing through a color-coded system for attendees to self-select their comfort level for interacting with others.

• Green means you are okay with highfives and handshakes and interacting close to peers. • Yellow means you are interested in interacting but would like some distance between peers. • Red means you prefer no contact and ask that peers stay at least six feet apart. Exhibitor hall: All exhibitors are asked to set up their exhibit booths with physical distancing in mind, as well as provide a touchless experience so attendees can comfortably interact and shop for solutions. Speaker podiums: All speaker podiums will be physically distanced from attendees; therefore, speakers will not be required to wear a face covering while speaking. For panel sessions, panelists will be physically distanced and all AV equipment will be sanitized after each session. Friendly reminders: RISE will place signage throughout the event to serve as friendly reminders of event protocols. Not feeling well? If you aren’t feeling well or have reason to believe you may have been exposed to COVID-19, RISE strongly urges you to follow the CDC guidelines for self-quarantine and not travel.

Additional safety measures All individuals are required to wear face coverings in accordance with CDC recommendation. Masks are required in indoor conference spaces except for when attendees are eating or drinking and, in a location, where they can maintain a minimum distance of six feet between other attendees.

Limited seating: All conference sessions will be set up with limited seating per table. Food and beverage protocols: All food and beverage items will be individual servings or served by hotel staff. Networking: RISE has instituted a color-coded system to allow attendees to self-select and display their comfort level for interacting with peers:

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RISE ACCEPTING NOMINATIONS FOR 2022 QUALITY AWARD SUBMIT BY DEC. 31 ST

DR. MARTIN L.

BLOCK AWARD 12

QUALITY & REVENUE COMMUNITY NEWSLETTER

Nominations are now open for RISE’s annual Martin L. Block Award for Innovation & Excellence. RISE’s highest honor recognizes excellence and clinical leaders’ passion to improve patient care. The annual award is dedicated to the memory of the late Dr. Martin L. Block who made it his mission throughout his career to improve the delivery of quality patient care. This prestigious award acknowledges an individual’s effort to enhance the lives of America’s seniors through clinical leadership, policy vision, and by superior example of RISE’s mission to promote continuous improvement in the health care system.

ELIGIBLE NOMINEES: • Must work within the clinical field as either an MD, NP, RN, PA, DO, or otherwise clinically credentialed • May work for a health plan, provider organization, accountable care organization, or a vendor-supplier to the health care marketplace

• Must have fulfilled one of the following criteria: Contributed to significant process improvement in the care of seniors and/or dedicated more than 10 years to exemplary work in this industry The nomination form must be filled out completely with necessary documentation by December 31, 2021 in order to be considered by the committee. The award will be presented at RISE National 2022 on March 7-9, 2022 in Nashville.

regional medical director of Landmark Health. In 2020, as we faced the early months of the coronavirus pandemic, RISE decided to waive the traditional criteria of the Block award and dedicated it in honor of health care professionals who contracted and died from COVID-19.

CLICK HERE TO SUBMIT YOUR NOMINATION

PAST AWARD WINNERS Previous award winners include Dr. Heather O’Toole, chief medical officer with Innovation Care Partners; Mark Dambro, M.D. (pictured right), senior vice president of health informatics for Signify Health; Dr. Manjusri Vennamaneni, chief medical director and chief quality director for Access Health Care Physicians, LLC.; Michelle Lupoli, R.N. vice president of medical management for Neighborhood Health Plan of Rhode Island; and Dr. John Broderick,

About the Dr. Martin L. Block Award The award is given in honor of the late Dr. Martin Block, pictured left, a regular speaker at RISE National (formerly known as RISE Nashville), and an expert in the risk adjustment industry who had a natural ability to engage and inspire audiences and a passion to improve patient care. Dr. Block, or Marty, graduated from Northwestern University Medical School with a Doctor of Medicine degree. He completed his internal medicine residency in 1978 at Washington University in St. Louis and began his private practice in Riverside, Calif., where he was active in the medical community. Dr. Block’s focus on delivering quality patient care led him into healthcare administration early on in his career. As a doctor of 35 years, his dedication to improve medicine fueled his rise among the ranks of several major health plan management companies, including Blue Cross Blue Shield, Cigna, Aetna, and United Healthcare. No matter his title–medical director, chief medical officer, or vice president of clinical services–he stayed fixated on his mission to improve quality of care, and he worked long hours every day to develop and improve processes that benefit patients and healthcare professionals. As a certified professional coder, Dr. Block gained critical insights into risk adjustment, quality, and outcomes management. He eventually moved to Scottsdale, Ariz., and went on to earn several awards for his dedication and passion. Dr. Block died in October 2013 of brain cancer at the age of 62. In recognition of his contributions to innovations in risk adjustment, and to honor his life’s work, the RISE Association named the award in his honor and posthumously recognized him with the first Martin L. Block Award in March 2014. CLICK TO SEE OTHER ARTICLES

UPCOMING EVENTS Close the Gap on Post-acute Care Performance and Payment with Live Data December 08, 2021 at 1:30 EST Also available on demand

The 12th Annual RISE Star Ratings Master Class December 14 - 15, 2021 Manchester Grand Hyatt, San Diego

Women in Health Care Leadership Summit December 14 - 15, 2021 Manchester Grand Hyatt, San Diego

SEE WEBINAR DETAILS

VISIT THE EVENT WEBSITE

SEE WEBINAR DETAILS

December 16, 2021 at 1:30 EST

Optimize Chart Retrieval Outcomes with New and Innovative Technology

SEE WEBINAR DETAILS

January 27, 2022 at 1:30 EST

RISE National 2022 March 7 - 9, 2022 Gaylord Opryland, Nashville

QUALITY & REVENUE COMMUNITY NEWSLETTER

VISIT THE EVENT WEBSITE

COMMUNITY PARTNER NEWS 6 important questions you should ask your quality analytics and technology vendor

What health plans need from their postacute network Real Time Medical Systems

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Strategies for health plans to achieve health equity

Using technology to reduce the risk of RADV audit

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Episource Post-COVID-19 health impacts: Executive insights on the increased risk to insurers RISE - Change Healthcare

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