Medicare Stars for Non-Health Plan Partners

An AMCP and Optum^® Corporate Training Program

Audience

Brand and payer marketers, account executives, field and HQ-based HEOR leads, payer medical leads. AMCP members & non-members 

Program Description

Medicare Advantage is the fastest-growing line of business for many health plans. With increasingly more plans on the market, the CMS Star Ratings are important. Introduced in 2008, the ratings were part of a system-wide push to improve quality of care, patient and member experience, and value-based payments. The original intent behind the Star Rating system was to help enrollees make informed health insurance decisions, however, the quality bonus payment has driven health plans to create member and provider strategy targeting Star Ratings measures. By understanding how the current Medicare Star Rating program is designed and the challenges and incentives created for plan sponsors, life science companies looking for opportunities to partner can prepare an informed approach to their value proposition.

Program Goals

At the completion of this program, participants should be able to: 

• Understand the key components of the Star Rating  program including: 

  • Star Ratings Program Overview and Financial Implications.

  • Quality Opportunities from Payer Perspectives. 

  • Quality Interventions and Activities.

• Gain real customer insights — AMCP thought leaders and experts bring insight into the evolving demands of quality programs in Medicare and how plan sponsors structure their programs to adapt.

  • Understand the top medication-related Star Ratings priorities for health plans. 

  • Discuss challenges health plans face in improving Part D Star Ratings measures. 

  • Explore PBM-health plan relationships and how this impacts Star Ratings.

Moderator

Jason Fehr
Senior Director, Optum Pharmacy Advisory Services

Jason has 20+ years in healthcare and healthcare delivery, with pharmaceutical industry expertise in product management, marketing, market access, account management, sales, and long-term care.  He is responsible for leading Optum Pharmacy Advisory Services consulting efforts with life science customers.  Prior to joining the Optum Pharmacy Advisory Services team, he spent more than 15 years with Boehringer Ingelheim Pharmaceuticals.

Faculty

Sharon K. Jhawar, PharmD, MBA, BCGP
Chief Pharmacy Officer, SCAN Health Plan

As Chief Pharmacy Officer, Sharon Jhawar optimizes prescription benefits and clinical programs for SCAN Health Plan. She provides direction on the development of innovative, pharmacy care programs that ensure safe and appropriate member medication use, and manages contracting, oversight and compliance of pharmacy benefit manager (PBM) operations.

Sharon works cross-functionally to help drive SCAN’s overarching organizational goals of: person-centered quality care; growth and retention; operational excellence, strong CMS Star ratings; and positive member experience. For more than 18 years, Sharon has served as a key organizational voice influencing Medicare policy. Her passion for ensuring seniors have access to the right medication at the right time, at an affordable cost, continues to drive SCAN’s mission to keep seniors healthy and independent. 

Prior to joining SCAN in 2003, Sharon completed a geriatric residency program at the VA Greater Los Angeles Healthcare System, Sepulveda division. She holds a doctorate in pharmacy from the University of Southern California and a master of business administration from the Paul Merage School of Business at the University of California, Irvine. She is a board-certified geriatric pharmacist and a certified healthcare insurance executive.

Sharon is an active member of several professional organizations including the Academy of Managed Care Pharmacy (AMCP), the American Society of Consultant Pharmacists (ASCP) and the Pharmacy Quality Alliance (PQA), where she has served in various roles and capacities including, most recently, as a member of PQA’s board of directors.

Sharon speaks at a wide array of healthcare forums and has been published in prominent journals including Managed Healthcare Executive, Journal of American Geriatrics Society (JAGS), Journal of Managed Care Pharmacy (JMCP), and Pharmacy Times.

Helen Kurre, PharmD, MBA
Senior Director Optum Quality Advisory Services, Stars Practice Lead

Helen Kurre is practice leader for Stars within Health Management Consulting for Optum. She has experience in both payer and provider programs with particular expertise in health care quality programs. Helen’s clinical background and quantitative focus, combined with her prior experience with provider organizations give credibility in developing solutions that deliver results.

Prior to joining Optum, Helen held leadership roles in health care, including on the payer and the delivery system side.  In her prior role leading quality at a health plan, she helped achieve a CMS 5-Star rating.  In addition to Stars accountability, she led the organization’s provider incentive quality programs, medical home network development, practitioner and facility credentialing, HEDIS and CAHPS, Medicaid, commercial, exchange and large employer group quality programs, and NCQA health plan accreditation.   She has also had leadership roles at the medical group within the same integrated delivery system, including hospitalists program and graduates medical education clinic operations across six area hospital locations.  Through this work, Helen understands the importance of provider engagement and integration to health plan performance.

 

Laurin Dixon, PharmD
Director, Medicare Star Ratings at Arkansas Blue Cross Blue Shield

Laurin Dixon is the Director of Medicare Star Ratings at Arkansas Blue Cross and Blue Shield. In this role, she is responsible for developing the Medicare Advantage Organization’s quality program, strategy, and clinical practices. Laurin leads a team overseeing all facets of quality including patient experience (CAHPS), clinical outcomes (HEDIS), physical and mental health improvement, administrative plan performance, and pharmacy measures. Prior to her current role, she served as the Director of Pharmacy Quality and Stars at Humana, where she was responsible for driving Humana to the highest pharmacy Star measure performance ever achieved and directly contributed to Humana’s industry-leading position of over 94% of members in a 4 Star plan. In addition, she was accountable for innovative collaborations with national and regional pharmacies to develop test-and-learns focused on Star measures as part of the Pharmacy Quality Network. Before joining Humana, Laurin completed an Executive Fellowship at the Pharmacy Quality Alliance. She remains actively engaged with PQA through involvement with different committees and Task Forces. She earned her Doctor of Pharmacy degree from the University of Mississippi: School of Pharmacy, where she currently serves as a member of the Dean’s Board of Visitors.

Fred Goldstein
President and Founder at Accountable Health, LLC

Fred Goldstein is the founder and president of Accountable Health, LLC, a healthcare consulting firm focused on population health, health system redesign, new technologies, and analytics. He has over 30 years of experience in HMO and hospital operations, and population health program development and operations.

During his career, he founded a disease management company that provided services to employer groups and 10 state Medicaid programs, operated a Medicaid/Commercial HMO that was ranked the highest quality Medicaid Health Plan in Florida and was also awarded a Medicare Demonstration project, developed an award-winning mobile health app, and worked with employers, health systems, and vendors to develop population health programs, services, analytics, and platforms. He was also directly responsible for the inclusion of the Medicare Annual Wellness Visit in the Affordable Care Act.

Fred is an Instructor at the John D. Bower School of Population Health at the University of Mississippi Medical Center, serves on the Editorial Board of the journal Population Health Management, the founding Advisory Board of Population Health News, and is Past Chair of the Board of Directors of the Population Health Alliance. Fred has testified before the legislature in the states of Alaska, Florida, Kentucky, and Texas on population health management and their application to state employees and Medicaid. He is also the co-founder and lead host of PopHealth Week, a weekly podcast featuring thought leaders in population health.

Fred received his MS in Health Care Administration from Trinity University and a BA in Zoology from the University of California, Berkeley.

 

Todd Boyer
Director, Clinical Pharmacy Operations, Medicare Part D, Magellan Health 

Todd Boyer is the Director of Clinical Pharmacy Operations for Medicare Part D at Magellan Health.  Todd has worked in the Medicare Part D space for 15 years.  Todd has been employed with both PBMs and Health Plans to help develop and drive clinical programs to improve enterprise wide Medicare Star rating strategies.  Todd received his Pharmacy degree from Purdue University and his law degree from Chase College of Law.

About Optum Advisory Services

Optum^® Advisory Services specializes in helping health care leaders address their biggest challenges with insights and strategies to assert control over their organization’s future. Our diverse capabilities and real-world experience help hardwire meaningful results. 

About AMCP Corporate Training

AMCP is the professional association leading the way to help patients get the medications they need at a cost they can afford. Creating real-world, relevant training for life science companies - we build your health care business acumen so you can step out in confidence, equipped for customer engagements that drive positive patient outcomes. We’ve shaped our learning forums to connect you with thought leaders and experts. This, plus AMCP tools and resources, fast-tracks you to what’s relevant and keeps you informed about the newest insights. We’ll help you learn about the health care reforms that are most meaningful to you, your account teams and your clients – guiding you to customer-targeted solutions. 

For questions about the corporate training program, please email corpopportunities@amcp.org.