RISE Bedrock of Health Care | Quality Agenda

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Quality

The Quality seminar provides best-in-class comprehensive education on quality programs for health plan professionals at a range of experience levels. From those beginning their work in quality improvement to those seeking to hone their skills or learn about a wider variety of quality measures and programs, this crucial training provides the information quality professionals need to know to help meet their plan’s goals for quality of care and member satisfaction. 

Tuesday - June 17, 2025

12:00 PM 12:05 PM

11:00 AM 11:05 AM

10:00 AM 10:05 AM

9:00 AM 9:05 AM

Opening Remarks

12:05 PM 12:55 PM

11:05 AM 11:55 AM

10:05 AM 10:55 AM

9:05 AM 9:55 AM

CMS, Medicare, and Quality

  • Explore the quality programs, their goals, and how they affect health plans  
  • Review the fundamentals of quality improvement methodologies and how they are applied     
  • Describe the structure and function of CMS, its role in setting quality standards, and how it interacts with health plans  
  • Delve into the basics of Medicare, Medicare Advantage, and Medicare Part D 

Ana Handshuh, Principal
CAT5 Strategies 

12:55 PM 1:05 PM

11:55 AM 12:05 PM

10:55 AM 11:05 AM

9:55 AM 10:05 AM

Break

1:05 PM 1:55 PM

12:05 PM 12:55 PM

11:05 AM 11:55 AM

10:05 AM 10:55 AM

Medicare Star Ratings

  • Gain an understanding of the key details of the Medicare Advantage Star Ratings Program   
  • Highlight crucial Stars Ratings factors that influence plan performance and quality assessment  
  • Examine and unpack the recently released Final Rules 

Melissa Smith 
Founder, Senior Advisor 
Newton Smith Group 

1:55 PM 2:05 PM

12:55 PM 1:05 PM

11:55 AM 12:05 PM

10:55 AM 11:05 AM

Break

2:05 PM 2:55 PM

1:05 PM 1:55 PM

12:05 PM 12:55 PM

11:05 AM 11:55 AM

The Essentials of Stars Math

  • Unpack the calculations behind determining Stars ratings  
  • Identify strategic levers that have the potential to add or subtract significantly to Stars scores, including QI measures, the Reward Factor, and the Health Equity Index  
  • Recognize potential financial implications of upcoming Stars changes 

 

Ryan Bernstein, Consultant 
Rex Wallace Consulting 

2:55 PM 3:05 PM

1:55 PM 2:05 PM

12:55 PM 1:05 PM

11:55 AM 12:05 PM

Break

3:05 PM 3:55 PM

2:05 PM 2:55 PM

1:05 PM 1:55 PM

12:05 PM 12:55 PM

CAHPS, HOS, and the Measurement of Member Satisfaction 

  • Explore the CAHPS member satisfaction survey and its relation to quality improvement programs
  • Leverage HOS Survey data for quality improvement 

Heidi Salerno, Member Experience Consultant 
Rex Wallace Consulting 

3:55 PM 4:00 PM

2:55 PM 3:00 PM

1:55 PM 2:00 PM

12:55 PM 1:00 PM

Day One Wrap Up

Wednesday - June 18, 2025

12:00 PM 12:05 PM

11:00 AM 11:05 AM

10:00 AM 10:05 AM

9:00 AM 9:05 AM

Welcome Remarks

12:05 PM 12:55 PM

11:05 AM 11:55 AM

10:05 AM 10:55 AM

9:05 AM 9:55 AM

The Fundamentals of HEDIS®

  • Become familiar with HEDIS® measure authors, certification, and the scope of HEDIS® measures  
  • Learn how to effectively track and measure HEDIS® data and become familiar with important supplemental data options and compliance issues   
  • Identify strategic areas for HEDIS® score improvement and techniques for moving the needle 

Karrie Baker, Manager, HEDIS® Measurement & Operations, Quality & Healthcare Performance
Premera Blue Cross

12:55 PM 1:05 PM

11:55 AM 12:05 PM

10:55 AM 11:05 AM

9:55 AM 10:05 AM

Break

1:05 PM 1:55 PM

12:05 PM 12:55 PM

11:05 AM 11:55 AM

10:05 AM 10:55 AM

HEDIS® ECDS Measures & the Move to Digital Quality Measurement

  • Discuss the ECDS measures and the future of HEDIS® quality measurement   
  • Operationalize the integration of ECDS measure data into existing processes   
  • Learn best practices for fully digital reporting, which does not include a hybrid reporting option 

Vandna Bhrany, Principal 
8BAdvisors 

 

1:55 PM 2:05 PM

12:55 PM 1:05 PM

11:55 AM 12:05 PM

10:55 AM 11:05 AM

Break

2:05 PM 2:55 PM

1:05 PM 1:55 PM

12:05 PM 12:55 PM

11:05 AM 11:55 AM

Additional Quality Programs

  • Select and design CCIPs and QIPs for efficient QI success    
  • Leverage HOS Surveys and measure MA health outcomes through PROMS   
  • Get to know the CMS Universal Foundation of Measures  
  • Review pharmacy-related quality measures and authors 

 

 

2:55 PM 3:05 PM

1:55 PM 2:05 PM

12:55 PM 1:05 PM

11:55 AM 12:05 PM

Break

3:05 PM 3:55 PM

2:05 PM 2:55 PM

1:05 PM 1:55 PM

12:05 PM 12:55 PM

Member Experience and Satisfaction

  • Learn why member experience is a revenue level, not just a survey, including how CAHPS, HOS, and complaints drive Star Ratings and impact bonus payments and plan growth
  • Understand member engagement strategies for improved experience and survey participation
  • Discuss provider engagement strategies for collaboration and improvement
  • Explore the member journey and touchpoints

Tina Dueringer, BSN, RN, CCM, PCC, CEO, Principal Advisor  
Dueringer Advisors, Inc   

3:55 PM 4:00 PM

2:55 PM 3:00 PM

1:55 PM 2:00 PM

12:55 PM 1:00 PM

Day Two Wrap Up