Effectively impacting social determinants of health requires investment into community partnerships and resources that can address the needs of the whole person—including housing, food insecurities, transportation, and health equity, among others. In this workshop, collaborate with peers and break down siloes as you create a dialogue to enhance collaboration between states, plans, providers, and community based organizations.

Lay the Groundwork for Successful Partnerships to Combat Social Determinants

• Invest in a community network of services to broaden your reach
• Understand what resources are available in the community, and what can and cannot be billed under Medicaid
• Educate CBOs on interacting with plans by helping them understand what it takes to be a good partner
• Develop clear intentions and specifications for job descriptions and what is needed out of peer services roles
• Integrate peer services workers with a clear purpose and understand what is needed to retain them
• Share case examples of successful partnerships
• Discuss how to involve the broader community in addressing community level health concerns

— Court system — Housing groups — Public health — Providers — Families

Outline How to Improve Information Exchange With Local or County Departments

• Discuss what information can be shared, what is sensitive, and when consent is needed
• Assess how partners can provide the information and resources you need for different populations
• Identify how to make sure plans and community organizations are focusing on reaching those who are the sickest
• Analyze what data is needed and how to collect it

An integrated, data-driven approach to quality and risk adjustment provides the vehicle for targeting members and providers who benefit the most from program interventions. This approach better aligns for a successful implementation of the 21st Century Cures Act, which is more inclusive of diagnosis codes including mental health, substance abuse, and chronic kidney disease, within the CMS risk adjustment model. A key methodological change for Part C Insurers is the incorporation of CMS Hierarchical Condition Category codes and the adoption of the Encounter Data Processing System. This workshop provides guidelines to build a proactive approach to phasing in the RAPS to EDPS transition and manage the financial implications for the upcoming years.

Discuss Workflow Changes Due to the 21st Century Cures Act Requirements

• Minimize reductions in productivity while adjusting to the newly incorporated HCC codes
• Break down silos to build out an integrated approach to quality care
• Discuss strategies to ensure accuracy and completeness of RAPS and EDPS data submissions

Impact Finances for the 2019 Payment Year

• Prepare for the financial implications of correcting and processing encounter data to CMS
• Learn ways to minimize costs and maximize revenue throughout the continuum of the transition

Case Study: Strategize a Multi-Year Plan to Target Risk Adjustments, Quality Measures, and Costs

• Build a tactical 5-year business model by examining internal infrastructures and setting desired goals
• Operationalize initiatives by aligning quality, risk adjustment, and high risk/cost programs
• Monitor performance through predictive data analytics and dashboard reporting to ensure compliance and performance