• How to assess your organization’s revenue cycle management - from pre-service authorization and eligibility checks to billing and receivables
• Managing revenue and monitoring denial trends
• Understanding and tracking various payer requirements including timely filing and corrected claim resubmission time frames

• Overview of the root causes of employee burnout and disengagement including Covid-19’s role.
• Real-life stories of disruption from provider organizations and implemented solutions.
• Central strategies on supporting the workforce while keeping any eye on restoring pre-pandemic revenue.

• An understanding of health plan expectations when contracting with provider organizations.
• A how-to discussion on the best methods to manage and track payer contracts.
• A review of crucial contract particulars that are pertinent to track.

• The OPEN MINDS Four Phase model for strategic planning
• A review of how to manage strategy implementation for success
• Case study presentations from organizations on their strategies for sustainability

• Key competencies of a "change agent" leadership role.
• Best practices and tactics for successfully managing change in a complex market.
• Example of change management tactics utilized by executives to guide their organizations through change, and the challenges of managing in a turbulent market.

• How your organization stacks up on HEDIS measures
• Understanding what measures payers need
• Rearranging your operations and changing your procedures to improve your scores to be more attractive to payers

• How to demonstrate your organization’s value in a way that will capture health plan’s interest
• Keys to developing partnerships
• Tips for engaging payers

• A guide to building a superior employment value proposition.
• A review of the key elements to building a recruitment plan to support change and growth.
• New models for retaining top talent and preventing burnout among staff.

• The drivers of the move to case rates and other value-based reimbursement models
• A guide to developing a case rate proposal and preparing your organization for managing case rate contracts
• Examples of successful case rate contracting models

• How collaborations with payers can create new programming aimed at better quality of life and reduction of population health costs.
• How to leverage provider relationships to build a network infrastructure and communicate to payers.
• In what ways can payer-funded programming help with the experience of care and employee satisfaction and health.

• A deeper understanding on the reasons for audits.
• Steps to take when faced with an audit.
• Proactive preparation organizations can take to minimize the likelihood of an audit.

• Best practices in keeping abreast of environmental & cultural shifts that can impact a board’s makeup.
• Discussion on how non-profit organizations should best consider diversity, equity, and inclusion when building a board.
• Case studies from organizational executives sharing real-world experiences in assembling a board that meet all needs of the organization.

• Best practices in recruiting, hiring, and onboarding talented staff.
• New models for retaining top talent and preventing burnout among staff.
• How to help the workforce embrace new technology as a tool to increase productivity and augment staffing shortages.

• How to capture data on consumers to identify what social service programs are needed.
• How to measure social determinant outcomes as a part of whole person care.
• Case study presentations from organizations that have integrated SDoH into their service lines.

• Why consumer engagement is essential in a value-based market.
• How to develop a consumer engagement strategy to improve performance and increase consumer satisfaction.
• Case studies from provider organizations who have successfully implemented consumer engagement strategies.

Agenda

• 8:00am – 9:00am: Registration/Breakfast
• 9:00am – 9:30am: Welcoming/Introduction/Health Plan Partnership State-of-the-State Opening the Health Plan Partnership Summit, OPEN MINDS vice president Richard Louis, III and senior associate Cathy Gilbert, will provide a national overview of the post-pandemic health plan market. They will discuss the impact of payer mergers, acquisitions and strategic partnerships among the major plans, payer movement towards adopting whole person care and integrated service delivery approaches to improve member outcomes and reduce cost, as well as the growth of digital/virtual behavioral health services market, including the quick adoption of this approach by payers. Finally, we will explore the impact of these trends both regionally and nationally and what that may mean for the future success for specialty provider organizations.Cathy Gilbert, Senior Associate, OPEN MINDS Richard Louis, III, Senior Associate, OPEN MINDS
• 9:30am – 10:30am: Transformation To A Collaborative Care Model – A Reimagined Partnership ApproachWith seismic shifts in the behavioral health space, Magellan Health is taking the opportunity to partner with its provider network to reimagine how behavioral health is delivered. Caroline, Carney, M.D., Chief Medical Officer at Magellan, will share insights on how the company is working with its provider network to refocus on accessibility to services and measurement-based care. In this session, Dr. Carney will also provide greater detail on how her company has recommitted to the collaborative care model, and, as a c-suite payer executive and practicing clinician, uniquely and anecdotally share what both provider organizations and payers are looking for in partnerships in the next normal.

  This keynote will cover:

  • A unique perspective on how to partner with health plans in the next normal.
  • New technologies and innovations advancing integrated, collaborative care.
  • How the overall behavioral health market has shifted and what it means for the future.
  Dr. Caroline Carney, MD, Chief Medical Officer, Magellan Health
• 10:30am - 10:45am: Break
• 10:45am - 11:45am: CareOregon: A Case Study In Provider Network Stabilization & Patient Experience ImprovementIn addition to its recent multi-million-dollar investment in the state’s behavioral health service providers, CareOregon is partnering on several upstream solutions to strengthen the behavioral health ecosystem over the long run. In this case study presentation, CareOregon will share how it’s elevating provider and member voices in the conversation to improve the state’s behavioral health system, relieving the administrative onus of “partner providers” for keener focus on patient care, and supporting provider efforts to increase capacity and explore models that could increase payment parity.

  This case study presentation will cover:

  • Payer/provider partnership initiatives in Oregon that address provider burnout, payment disparities, and care accessibility gaps.
  • How strong partnerships between payers and providers require support from government and public-sector communities.
  • How one managed care organization advocated on behalf of its providers in conversations with state and elected officials.
  Eric Hunter, President & Chief Executive Officer, CareOregon
• 11:45pm - 1:00pm: Lunch & Learn “P” Is For Payers, Priorities, Partnership … & Platforms - Sponsored by NetsmartRapid access. Innovation. Demonstrated outcomes. Peer support. Expanding service lines. The list of payer priorities is longer than ever before, but one thing hasn’t changed: the need for technical solutions and partners to help manage them. Join Netsmart and one of their leading human services clients as they share common payer needs, ways to measure and communicate metrics that matter, and how data can build trust in relationships. Hear an example of a right-fit care management platform – one that is interoperable, includes social determinants of health and offers robust solutions - empowers providers to deliver quality care, stay nimble in decision-making and manage costs.
• 1:00pm - 2:00pm: Uplift Family Services: A Case Study In Building A Strong Community Payer/Provider Partnership Through Innovative, Research-Based CareWith the rapidly changing public health landscape in the state of California, forging strong, innovative relationships between payers and provider organizations is increasingly important. Uplift Family Services is a long-standing behavioral health services specialty provider organization offering a state-of-the-art whole person care approach for children, adolescents, and adults with complex behavioral health challenges. In this case study presentation, attendees will learn how Uplift built a strong infrastructure developing its organization through utilization of implementation science, project and change management, staff development, and relationship development and communication with payers.

  The case study will cover the following:

  • Uplift Family Services Health Homes’ program serving complex California managed care Medi-Cal beneficiaries
  • Keys to successful relationship development and communication when establishing health plan partnerships
  • Coordinating behavioral health and primary care to meet growing payer expectations for improved consumer outcomes
  Eleanor Castillo Sumi, Ph.D., BCBA-D, Vice President of Research and Program Development, Uplift Family Services
• 2:00pm - 3:00pm: Windstone Health: A Southern California Success Story Of SustainabilityIn this session, privately-owned managed behavioral health organization Windstone Health Services, will share its unique dynamic as a combination payer/provider organization that contracts with large medical groups and IPAs providing coordinated care and integrated services. During the case study presentation, Windstone will also share health plan partnership achievements such as the successful behavioral health risk assessments it provides plan members across the country.

  This case study presentation will cover:

  • Health plan partnership success stories of a longtime behavioral health provider organization with a nationwide presence
  • Lessons learned from a state/market hit hardest by the pandemic
  • Key features all provider organizations should strive for to optimize payer partnership success
  Peter J. Davidson, Chief Executive Officer, Windstone Health Services Krystal Melgoza, Provider Relations Manager, Windstone Health Services Lesley Nolen, Director of Business Development, Windstone Health Services
• 3:00pm - 4:00pm: Executive Roundtable Featuring Summit co-chairs and speakersAt the end of the day, join Summit co-chairs Cathy Gilbert and Richard Louis, III as they wrap up with a roundtable discussion with all Summit speakers where attendees can dialog with presenters, ask questions about health plan partnership challenges and opportunities, and discuss perspectives on the future of payer and provider organization relationships.