This conference has concluded.


Health Plan Accreditation National Summit


February 19-20, 2020
Luxor Hotel | Las Vegas, NV
#AccreditationIEN

19

February 2020

Wednesday

Day One

  • 7:45 AM
    Workshop Registration and Networking Breakfast
  • 8:30 AM

    Optional Pre-Conference Special Workshop: Success with Credentialing and Network Management Standards

    Studying NCQA’s* five new “must-pass” elements related to credentialing Expert insights for success on meeting standards related to:

    • • Effectively verifying provider credentials
    • • Ongoing monitoring of sanctions and complaints
    • • Protecting transfer of patient information
    • • Maintaining an adequate provider network
    • • Providing access to appointments
    • • Continued access to care
    • • Providing accurate directory information

    Susan Adams, Director of Corporate Credentialing
    AMERIHEALTH CARITAS

    Keysa Shaw Sanders, RN, CCM, Manager, Enterprise Accreditation Programs
    AMERIHEALTH CARITAS

    Jan Smith Reed, Vice President of Payer & Hospital Solutions
    VERISYS

  • 11:15 AM
    Conference Registration Begins
  • 11:30 AM
    Networking Luncheon
  • 12:30 PM
    Chair’s Welcome and Opening Remarks

    Jan Smith Reed, Vice President of Payer & Hospital Solutions
    VERISYS

  • 12:45 PM

    Examining NCQA’s* New 2020 Star Rating System for Accreditation

    In an effort to make accreditation ratings more transparent, NCQA* is switching to a 5-star accreditation ratings system for 2020. This session looks at:

    • • How standards scores will now be calculated
    • • How standards scores will be used with along with performance on HEDIS®** and CAHPS measures to calculate the star rating
    • • How individual star ratings will be calculated for each accredited product line (instead of being averaged as before)
    • • Implications of the new system for health plans

    Deborah Wheeler, MSPH, Vice President, Quality
    MOLINA HEALTHCARE

  • 1:30 PM

    Overcoming the Most Common Pitfalls in Health Plan Accreditation

    In an effort to make accreditation ratings more transparent, NCQA* is switching to a 5-star accreditation ratings system for 2020. This session looks at:

    • • Ensuring reforms are instituted with enough lead-in time to meet the requirements of the review
    • • Establishing a culture of compliance with accreditation requirements at your plan
    • • Ensuring appropriate departments are educated on changes in accreditation standards
    • • Achieving leadership buy-in for accreditation goals

    Scott Gullatt, Manager, Network Operations
    MARTIN’S POINT HEALTH CARE

    Linda Lee, Vice President Quality Improvement
    MCS

  • 2:30 PM
    Afternoon Networking Break
  • 2:45 PM

    A Deeper Understanding: Comparing NCQA*, URAC, and AAAHC Health Plan Accreditation

    In order to better comprehend the value and significance of accreditation, we compare and contrast the accreditation programs of the three organizations that accredit health plans.

    • • Requirements of each organization for a health plan to be accredited
    • • Ratings or differentiation of various levels of accreditation
    • • Significance and value to health plans of being accredited by each organization

    Karen Connolly, RN
    KW CONNOLLY & ASSOCIATES
    Senior Vice President, Quality Improvement and Accreditation Services
    HEALTHSUN HEALTH PLANS

    Thomas Goddard, PhD, JD, CEO
    INTEGRAL HEALTHCARE SOLUTIONS

  • 3:30 PM

    SPECIAL FEATURE: Success with Utilization Management Standards

    • • Strategies for success on NCQA’s* two new “must-pass” UM elements
    • • Update on other UM standards changes for 2020
    • • Best practices for meeting standards requiring fair and timely utilization evaluations using objective, evidence-based criteria, including:
      • • Collection and use of relevant clinical information to make utilization management decisions
      • • Ensuring qualified health professionals are assessing requests and making UM decisions
      • • Evaluations of appeals and grievances
      • • Timeliness of UM decisions

    Sarah Dencker RN, BSN, Director Utilization Management
    NETWORK HEALTH PLAN

  • 4:15 PM

    Networking Roundtable Discussions

    This is a unique opportunity to compare notes with other accreditation experts. Choose a topic and go deep — get answers to your specific questions and hear insights from fellow attendees on the challenges you face.

    • • Conquering Common Accreditation Challenges
    • Deborah Dorsch, Director, Regulatory and Accreditation
      GATEWAY HEALTH PLAN

    • • Best Practices at Preparing for your Onsite Survey Review with the Auditors
    • Linda Lee, Vice President Quality Improvement
      MCS

    • • Aligning Your Health Plan to Achieve Accreditation Goals
    • Lisa Pelky, Manager, QI Programs (NCQA Accreditation)
      UPMC HEALTH PLAN
  • 5:00 PM
    Cocktail Reception Immediately Following
  • 6:00 PM
    End of Day

20

February 2020

Thursday

Day Two

  • 8:00 AM
    Networking Breakfast
  • 9:00 AM
    Chairperson’s Welcome Back

    Jan Smith Reed, Vice President of Payer & Hospital Solutions
    VERISYS

  • 9:10 AM

    SPOTLIGHT: Examining Population Health Management and Complex Case Management Standards

    This special session looks at updates to the Population Health Management standards and provides innovative insights on meeting PHM standards related to:

    • • Data integration
    • • Population assessment
    • • Identification of key social determinants of health
    • • Population segmentation
    • • Targeted interventions
    • • Member outreach
    • • Practitioner support
    • • Impact measurement and quality improvement
    • • Complex case management
    • • Wellness and prevention

    Yvonne Heredia, PhD, Manager of Care Management
    NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND

  • 10:00 AM
    Extended Morning Networking Break
  • 10:30 AM

    SPECIAL FEATURE: Aligning Your Health Plan’s Departments for Accreditation Success

    In an effort to make accreditation ratings more transparent, NCQA* is switching to a 5-star accreditation ratings system for 2020. This session looks at:

    • • Setting and communicating accreditation goals
    • • Ensuring collaboration across departments
    • • Optimizing communication among all stakeholders
    • • Creating a dashboard to track progress toward goals

    Anthony Davis, MBA, Senior Director Quality, Regulatory and Strategy Innovations
    UPMC HEALTH PLAN

    Lisa Pelky, Manager, QI Programs (NCQA Accreditation)
    UPMC HEALTH PLAN

  • 11:30 AM

    Leveraging Mock Surveys and Preparation for Review to Increase Scores

    • • Structuring a team to conduct regular reviews of your plan’s accreditation standards
    • • Conducting mock-surveys during the look-back period to identify gaps and necessary improvements
    • • Performing off-site documentation review and on-site assessment of documentation
    • • Utilizing NCQA’s* Interactive Review Tool (IRT) for a pre-survey self-assessment

    Deborah Dorsch, Director, Regulatory and Accreditation
    GATEWAY HEALTH PLAN

  • 12:15 PM
    Networking Luncheon
  • 1:15 PM

    Meeting NCQA* Requirements for Oversight of Delegated Entities

    In order to better comprehend the value and significance of accreditation, we compare and contrast the accreditation programs of the three organizations that accredit health plans.

    • • Optimizing key elements of delegation agreements
    • • Ensuring the delegate is in continuous compliance with standards
    • • Meeting accreditation standards related to outsourcing
    • • Reviewing the delegate’s credentialing activities

    Veronica C. Locke, MS, Consultant
    THE MIHALIK GROUP

  • 2:00 PM

    Optimally Integrating Quality Improvement and Accreditation Efforts

    This session looks at NCQA* Health Plan Accreditation as a three-legged stool, focusing on the interdependence between accreditation standards, HEDIS®**/ CAHPS measurement, and the quality improvement cycle in order to increase accreditation levels.

    • • Examining how the three elements interact
    • • Leveraging these synergies to optimize impact
    • • Integrating QI and accreditation work throughout the years

    Aurora V. Adams, Principal Consultant
    ADAMS QUALITY SOLUTIONS

  • 2:45 PM

    Summit Concludes

  • *National Committee for Quality Assurance
    **Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of the National Committee for Quality Assurance (NCQA).

    NCQA is not affiliated with this Summit and does not endorse the content presented at this event.

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