Start off the morning with breakfast and networking. Use this time to catch up with colleagues, discuss the day’s upcoming sessions with our team of expert speakers, and meet new people.

Join Aetna Better Health of California’s Chief Medical Officer, Dr. Rafael Gonzalez-Amezcua, MD, for an overview of key components of integrated health for effective health care delivery to obtain desired patient and system outcomes. The session will highlight integrated health care systems delivering care to complex populations and touch on health equity themes and social determinants of care concepts as important inclusions for valued based care in the next normal.

Join us for a follow-up session with our keynote speaker. Use this time to ask questions and continue the morning’s discussion.

Financial Track

Provider organizations that understand how to manage payments and denials, while delivering quality service and better outcomes, will be the best positioned to thrive in the value-based world. Although many organizations have revenue cycle management systems in place, most organizations do not track revenue and payments and manage denials effectively.

In this session, we will cover:

• 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

Administrative Track

A recent survey of 500+ health care executives by staffing solutions firm AMN Healthcare found that staff burnout, disengagement, and the resulting shortages that follow are the most disruptive forces facing health care provider organizations over the next three years. In this informative session, we will hear from provider organizations who have faced such disruptive forces and learn how they addressed the challenge.

This session will include:

• 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.

Financial Track

As an ever-growing number of historically publicly funded provider organizations enter into agreements with health plans, and states move to MCO's for administration of Medicaid health care benefits, provider organizations have more payer contracts to manage and track. This session will cover payer contract mandatories and tracking the various requirements, focus on how to create and utilize a contract tracker, and review of contract essentials you need to know about. The session will also include guidelines on how to determine whether you can manage using a spreadsheet, or access databases, or when to consider investing in contract management software.

This session will include:

• 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.

In the post pandemic job market, many employers are finding it difficult to hire and retain staff. Even before COVID-19, there was a shortage of behavioral health care professionals which has been exacerbated by the pandemic. The uncertainty of this past year has also changed what many employees want from their place of employment.

Join our experts to find out:

• What factors are impacting employees’ decisions when considering new opportunities
• How to improve employee retention

The luncheon, hosted by Tridiuum, will provide executives with an update on the emerging approaches for using consumer data to enhancing treatment planning and consumer engagement.

This session will update participants on the use of consumer data in treatment planning, best practices in data-driven treatment planning, and available tools. The session will also include a case study on the use of metrics-based management by ex-Kaiser executive and Tridiuum Chief Operating Officer Paul Castaldo. He held a wide range of clinical and leadership positions during his 30-year career at Kaiser where he provided direct patient care services and directed large medical center behavioral health departments. Mr. Castaldo will present his experiences at Kaiser in improving mental health outcomes in practice—where he oversaw the implementation of a mental health outcome management system involving over 2,000 clinicians and hundreds of thousands of patients. Mr. Castaldo stated, “It’s an honor to share the Kaiser experiences of utilizing consumer data to drive better outcomes.

Administrative Track

In the current environment and new normal, one essential skill that all executives need to master is the ability to evaluate and modify current services – and to develop new services to meet the challenges and opportunities in the market.

This session will focus on the tools and insights organizations need to strategically reposition themselves for sustainability in today’s changing health and human services environment, including:

• 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

Administrative Track

The health and human service field is currently an active change management laboratory — from newly empowered consumers to rapid turnover of employees and leadership, to new tech, to new competition, to new financing systems, and to new performance expectations. The requirements for sustainability are changing so quickly that thriving seems close to impossible for many leaders who are under pressure to deliver on value-based contracting. Change management is integral to all performance management — from identifying targets, setting goals, and managing a team with strong metrics. In this environment, the demand for leaders that can lead provider organizations through change management initiatives — “change agents” — is extremely high. In this session, we will discuss why having a “change agent” mindset is key for health and human service executives to successfully position their organizations for the future.

The session will include:

• 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.

Clinical Track

Many health plans have programs designed to help providers meet HEDIS measures through education, tools, and bonuses. Working with payers to meet these goals helps increase the effectiveness of care and can be an important source of revenue for providers.

In this session, we will discuss:

• 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

Engagement Track

Health plans whose network teams are shrinking are looking to expand their networks with quality provider organizations. They need you as much as you need them. Even if you are not proactively pitching an idea to a payer, it is important to nurture strong relationships. You want your organization to be top-of-mind when they have a new program to implement. So how do you stay on the forefront?Join us to learn the best practices for engaging payers, including:

• 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

Administrative Track

The talent issue is a critical one for most health and human service provider organizations. By 2025, there will be a shortage of an estimated 250,000 behavioral health professionals. Strategically, the goal for every organization is to bring maximum value (the performance-to-cost ratio) for their investment in human capital. The path to achieving that maximum value is multi-faceted — optimal processes to improve productivity and having each team member operate at the top of their capabilities. In this session, we will discuss the operational and strategic challenges of and organizational responsibility for recruiting and retaining staff in a complex market.

This session will include informative case studies addressing:

• 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 instabilities created by COVID-19 and the implications it created for Mental Health and Substance Abuse urgently forced behavioral health organizations to rethink business processes, clinical and financial workflows, access to care, and more. In this session, Streamline Healthcare Senior Product Manager Tim Pratt will share real-world stories from client organizations about the challenges their executive teams faced and provide best practice research on how they were able to quickly pivot and transform operational hurdles into opportunities for improvement through the acceleration of innovative thinking and strong change management principles.

This session will provide:

• Examples of how organizations successfully engaged in the revisioning of key services in order to safeguard access to care
• How to successfully perform in the short term, and the importance of innovative thinking, having the right team in place, and the valuable role technology plays
• Best practice strategies around change management and executive leadership’s role in determining and setting the appropriate strategic course for their organization

Evidence-based practice (EBP) is a term we encounter frequently in today’s health care environment. But what does it really mean for the health care provider? What are health plans looking for?

In this session, our panel of payers and provider executives will discuss:

• The EBPs health plans need
• How they support the authorization process
• How to restructure if there are gaps

Start off the morning with breakfast and networking. Use this time to catch up with colleagues, discuss the day’s upcoming sessions with our team of expert speakers, and meet new people.

The public health and economic effects of the pandemic continue to put pressure on Medicaid spending and enrollment nationwide. Most states are projecting overall FY 2021-22 enrollment to exceed original projections, as more people enroll in Medicaid, increasing program spending at the same time state tax revenues may be falling.

Our panel of experts will discuss the some of the funding challenges state Medicaid systems will face as we continue in the post pandemic new normal well into 2022. These county and state Medicaid executives will share their insights about the growing emphasis on integrated and whole person care approaches in the delivery of coordinated care for complex populations as a strategy to reduce payer cost and improve outcomes, as well as thoughts on payer-provider partnerships to execute these strategies.

Join us for a follow-up session with our keynote address panel participants. Use this time to ask questions and continue the morning’s discussion.

From mobile scheduling, treatment plan updates and progress notes, to supervisory approval, learn how others in the industry use a truly mobile application to access information in the field and provide high-quality service to clients.

Financial Track

Thoroughly understanding how to develop bundled payments/case rates will ensure that your clinical services deliver outcomes-based care and provide the necessary revisions needed for billing, financial reporting, and data tracking are made to fit this payment model.

This session will provide attendees with a guide to developing and managing a successful case rate payment model and will include:

• 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

Engagement Track

Covid has shown us the importance of networking and the weakness of America’s health safety nets. We are already moving on customer experience areas and provider integration, but what opportunities lie in payer relationships? Are there areas we can forge new alignments outside of basic billing and collections? Join us for a provider/payer case study presentation and discussion on the innovative ways partner organizations have begun working together and envisioning a collaborative future.

Join us as we discuss:

• 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.

Administrative Track

Audits are a fact of life in the health care industry and with increased scrutiny to keep public health care solvent, coding audits are certain to continue and likely increase. In this session we will learn more about what triggers an audit and what main steps to take upon being notified of one. Audits likely cannot be avoided, but this session will discuss how best to increase the probability that submitted codes stand up to scrutiny.

This session will include:

• 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.

Administrative Track

With the ever-evolving dynamics in non-profit organizations, the role of governance boards has changed. Organizations need to attract board members that are not only competent and strategic but also address the call for diversity, equity, and inclusion. Organizations need to be familiar with the major environmental and cultural forces affecting the market and are aware of the resources needed to meet the organization’s mission while remaining competitive. In this informative session, organizational executives will share case studies that provide insight on board selection and effective board management for creating a competitive advantage and long-term sustainability.

This session will include:

• 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.

Administrative Track

For any service provider organization, their workforce is their most important strategic asset, and managing that asset is a critical competency and a challenge. Strategically, the goal for every organization is to bring maximum value (the performance-to-cost ratio) for their investment in human capital. The path to achieving that maximum value is multi-faceted —optimal processes to improve productivity, having each team member operate at the top of their capabilities (and top of their license if they are clinical), and using technology as a substitute or enhancement of human labor. In this session, we will discuss the operational and strategic challenges of recruiting and retaining staff in a complex market.

The session will include:

• 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.

Clinical Track

The growing list of programs focused on the social determinants of health (SDoH) is diverse in approach and size. To deliver better health outcomes, social determinants — including poverty, food insecurity, lack of education, unstable housing, and environmental conditions — must be addressed to find success with whole person, value-based care. For provider organizations, the complexity of SDoH paired with current organizational priorities and services makes it difficult for provider organizations to know where to focus.

This session will include strategic discussions on:

• 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.

Engagement Track

A running theme in the market shift to value-based care is the importance of consumer engagement—both to increase consumer participation in the management of complex conditions and to increase consumer satisfaction. If your organization has consumers who are engaged in their health care, chances are, you have an edge over your competitors – because your consumers are better informed, are more proactive in their health care and insurance coverage, have better outcomes, and cost less.

In this session we will discuss consumer engagement strategies in the new world of value-based care, including:

• 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.

Today’s electronic health records (EHR) allow provider organizations to collect more data about their practice, clinicians, consumers, and reimbursements than ever before. With this wealth of information, how do you know where to start? Which metrics are best for your analyses, and what should your goals be moving forward? In this session, Jesse Weidner, Solutions Consultant Manager, and Angellica Eddleman, Vice President of Sales, both from Qualifacts + Credible will showcase how organizations are utilizing a fully configurable EHR to effectively collect and analyze data, and provide visually compelling graphs for informed decisionmaking. Faculty will demonstrate multiple reporting options and show how they can be turned into visually compelling custom reports and dashboards to suit the needs of any organization, even those operating within a value-based reimbursement model.

As we move into the post pandemic next normal of 2022, health plan priorities are being reshaped to meet new challenges of the changing health and human services landscape. Health plans are facing growing price pressure from private and public clients – and repositioning to meet that challenge through mergers and acquisitions, adopting new tech solutions, and better aligning network provider incentives. This shifting market landscape is creating new opportunities for win-win payer-provider partnerships.

For provider organization executives, understanding the dynamics of the health plans in their market is the key to creating preferred health plan relationships. The question executives are asking themselves is ‘how?’ We will explore the answer to that question in this engaging summit designed to help executives understand the new needs of payers, reposition existing service lines through payer-oriented solution marketing, and build mutually beneficial health plan partnerships.

This summit’s agenda will include a market briefing on the state of payer system realignment, informative case studies with key opinion leader executives, thought leader discussions, and interactive dialogue with attendees.

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 Netsmart Rapid 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.

Julie Hiett, Senior Director of Population Health, Netsmart
Kimberly Macakiage, Medicaid Waiver Director, Integral Care
Michelle Berthon, LPC, MHSP, Optum

• 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.