• Background image of session at Client Congress
    October 6 – October 8, 2019

    Client Congress 2019

    Mandarin Oriental — Washington, DC

  • Background image of the interior of the Library of Congress
    October 6 – October 8, 2019

    Client Congress 2019

    Mandarin Oriental — Washington, DC

  • Background image of a man pointing to a video monitor displaying date while giving a presentation
    October 6 – October 8, 2019

    Client Congress 2019

    Mandarin Oriental — Washington, DC

Sunday, October 6
12:00 p.m. Early Registration
1:00 p.m. Quality Measurement and Improvement Workshop Risk and Financial Performance Workshop Advisory Services Workshop
1:00 p.m.

Electronic Clinical Data Systems & The Future of HEDIS®: How to Adapt

As healthcare becomes more data-driven, industry stakeholders and regulatory organizations are feeling the pressure to evolve and adapt. Recognition of the extensive information accessible in electronic clinical quality datasets led to the introduction of Electronic Clinical Data Systems (ECDS) reported by NCQA. In addition, NCQA has approved the use of clinical data extraction to retrieve supplemental data electronically from patient health data beyond the medical record. In this session, listen in as technical experts discuss strategies and best practices for ECDS reporting. Attendees will learn from the experiences of other health plans that have navigated this new system to prepare for the 2020 quality measurement and reporting season.

Data-Driven Insights for Navigating the Regulatory Landscape

The most successful health plans understand that their ability to provide high-quality care to members is driven largely by their capacity to rapidly access and take action on patient-specific insights while proactively managing regulatory changes that impact their business. In this session, hear from policy experts on past, present and future federal policy changes and what those changes mean for your risk adjustment program. Learn how health plans are leveraging dynamic advanced analytics to navigate new CMS requirements to remain competitive and compliant.

Looking Ahead: What’s Next for Part D?

With focus shifting from rebate reform to other areas of Part D policy, what should the industry expect? Will Congress act to make changes to the program? What might be next from the Administration? What will the market look like in 2020 and beyond? This session will discuss the current policy and regulatory landscape as well as industry-driven trends and consider implications for key healthcare stakeholders, including plans, manufacturers and patients.

2:00 p.m.

Innovation Driving Quality Excellence

190 million people are enrolled in health plans that report HEDIS® results, making it one of the industry’s most widely used tools measuring performance in healthcare where improvements can make a meaningful difference in people’s lives. In this session, learn how health plans are leveraging this powerful program to explore technology innovations and other opportunities to impact organizational initiatives such as Star Ratings improvement, accreditation program opportunities, clinical data exchange for supplemental data, and natural language processing automation to accelerate speed-to-value in delivering a quality program of excellence.

Why Data Matters & the Impact to Risk Score Accuracy

Prospectively identifying high-risk members to improve outcomes and forecast adverse health events can be extremely difficult without vital data elements to ensure precise and accurate predictive outcomes. Comprehensive patient data, including member claims, encounters, laboratory prescription drug and enrollment data, among many other data elements, allow health plans to predict ‒ with a high-probability of confidence ‒ the patient risk gaps and the right intervention strategy to engage to close healthcare gaps. Industry experts will share the key data elements that deliver the most accurate, predictive analytic insights, as well as which data elements impact quality versus risk gap prediction to empower patient encounters.

Drug Payment: Are there Alternative Ways to Finance High Cost Drugs?

New gene therapies can cure diseases with one dose, but they come at a high cost. In this session, Avalere will explore alternative reimbursement approaches that could be considered in the marketplace, identify some of the associated regulatory barriers and discuss implications for both manufacturers and payers.

3:00 p.m. Break
3:15 p.m.

Auditor Insights into Quality Performance

In this always highly-anticipated session, join seasoned auditors as they reflect on lessons learned in 2019 and hear what's in store for the 2020 HEDIS® quality measurement and reporting season – from new measures and measure changes to key strategies and best practices for success.

Managing a Comprehensive Risk Adjustment Program

To successfully deliver on the goal of providing consumers affordable, high-quality care, health plans need a comprehensive risk score accuracy program in place that enables a holistic, member-specific view. This includes thorough evaluation of the member’s health, accurate documentation of conditions, creation of an appropriate treatment plan and recommendations for follow-up care. Join this session to hear from healthcare experts as they share data-driven strategies for building and managing a best-in-class risk score accuracy program that will help provide coordinated, high-quality care.

Risk Adjustment: Can Risk Adjustment Be Improved to Support Pharmaceutical Innovation?

As innovation drives high-cost therapies to market, the Medicare Advantage risk adjustment program could evolve to more appropriately and accurately compensate plans for drug costs. This session will review how Medicare Advantage currently accounts for pharmaceutical utilization in the risk adjustment model. Attendees will learn potential approaches to reform and how to remain competitive in this evolving regulatory landscape.

4:15 p.m.

Work Smarter, Better, Faster, Stronger: The Value of Big Data Processing & Analytics

For health plans, the ability to improve the operational efficiency of their quality measurement and reporting program enables time and resources to be refocused and invested in quality improvement efforts, population health initiatives, and much more. Inovalon’s next-generation solution, QSI-XL™, is enabling significant improvements in scale, efficiency, flexibility, speed, and functionality that are unmatched when compared to non-cloud-based solutions, including the ability to improve staff efficiency by an average 50 percent. Join our experts as they provide insight on 2020 HEDIS® changes and explore how new advancements in QSI-XL™ are driving even greater quality program effectiveness and efficiency, enabling health plans to stay focused on what’s really important – the patient.

Need More Data? Leveraging Multiple Data Streams to Mitigate Risk and Regulatory Audit Reform

Generating precise member and HCC target lists to ensure members are receiving care that is commensurate with their needs and that membership disease burden can be accurately documented requires access to complete claims data as well as clinical data to capture a truly holistic view. Many diagnoses that are difficult to document can be improved by leveraging machine learning capabilities to mine clinical data elements and provide HCC validation. Join this session to hear from artificial intelligence experts as they explain the value of marrying data and technical innovation within your program to drive documentation success.

Unlocking the Power of Data

Billions of health- and non-health-related data on individuals are being collected every day, but the ability to link disparate data sources to garner the insight you need to impact outcomes can be challenging. All this data, in combination with one of the industry’s largest proprietary datasets, the MORE2 Registry®, comprising of 271 million patients and 45 billion medical events, has the potential to truly transform how our healthcare system works by improving outcomes, predicting disease, identifying optimal health-related interventions, lowering healthcare costs, and enabling true personalized medicine. In this session, our experts will share real-world approaches to leveraging data for social determinants of health, lab and biomarker values and combining external data sources to fuel high-value healthcare.

6:30 p.m. Welcome Reception
Monday, October 7
8:00 a.m. Registration Desk Opens
8:30 a.m. Breakfast & Roundtables
9:35 a.m.


Keith Dunleavy, M.D., Chairman of the Board and Chief Executive Officer, Inovalon

10:15 a.m.


Mona Siddiqui, M.D., MPH, Chief Data Officer, HHS

10:55 a.m.


Zak Kohane, M.D., Ph.D., Marion V. Nelson Professor of Biomedical Informatics, Harvard Medical School,
Chair of the Department of Biomedical Informatics, Harvard Medical School

11:55 a.m. Lunch & Networking
1:00 p.m.

Connecting Healthcare: The Future of Clinical Interoperability

In today’s data-driven world, the need for speed and transparency to capture a holistic patient view plays an integral role in delivering quality care. In this session, gain a multi-stakeholder perspective on how payers, providers, pharmacies and patients are finding value in new approaches to interoperability and data sharing, a look at what is on the horizon, and insight into the impact of federally-proposed rules like TEFCA, which aims to enable and support the nationwide exchange of electronic health information across disparate networks. Join the discussion as data connectivity experts explore how healthcare electronic exchange standards are transforming the interoperability landscape to solve today’s common challenges around provider connectivity and patient engagement, care gap closure, and the ability to leverage advanced, intelligent clinical decision support.

The Next Frontier of Innovation: Artificial Intelligence

In recent years, no technology innovation has generated more buzz than artificial intelligence (AI). In this session, industry experts will discuss how expanding AI capabilities are impacting the healthcare industry – enabling real-time access to the right insights at the right time to drive improved patient outcomes and economic performance. Attendees will hear about common misunderstandings and speculation surrounding AI’s ability to add tangible value to the healthcare space and gain insight into what new AI innovations are on the horizon.

Three Futures: Accelerating Data-Driven Healthcare

Changes to policy, the introduction of industry disruptors and the evolution of how patients interface with the healthcare system are shaping the environment for all stakeholders across the healthcare ecosystem. To effectively navigate these changes, healthcare leaders need to prepare their organizations for the shifts in healthcare industry dynamics. In this session, industry experts will discuss the key market changes that will affect plans, providers and operators in the next 5 years and beyond.

2:00 p.m.

Data on FHIR®

As CMS moves full speed ahead in the adoption of HL7 FHIR® (Fast Healthcare Interoperability Resources) data standards to support seamless, on-demand information exchange across the industry, healthcare stakeholders in all facets of the care continuum are following suit. As one of the most popular standards used today, HL7 FHIR® is providing greater opportunities for data sharing and enabling organizations to leverage their existing systems to improve care delivery and patient outcomes. In this session, learn about FHIR® ’s impact on interoperability and hear real-world examples of how current and emerging features of FHIR® are empowering data-driven healthcare by enhancing analytic outputs and supporting real-time clinical decision making.

All in Design: Leveraging Data to Optimize Your Provider Network and Empower Benefit Design

Just as insight into the performance of your current provider network is essential, so too is the ability to understand how that performance compares to providers outside your network. This transparency into competitor performance plays an integral role in a health plan’s ability to address network performance issues and adjust to market conditions. In this session, listen in as experts discuss how one of the industry’s largest datasets, coupled with 100 percent CMS Medicare fee-for-service data, is empowering health plans to build high-performing provider networks that deliver improved quality outcomes while decreasing total cost of care. Learn about scientific advancements of the past decade that have impacted provider performance, emerging strategies and best practices for remaining competitive in your given market, and how greater benefit flexibilities recently formalized by CMS are impacting provider network optimization initiatives.

Measuring Performance Beyond Clinical Factors: How SDH Data Levels the Playing Field & Improves Outcomes

There is growing consensus that social determinants of health (SDH) are powerful influencers on outcomes, utilization and cost but there is less agreement as to how to collect and use this information in patient care, performance measurement and payment systems. In this session, industry experts will examine the current quality performance measurement system and how leveling the playing field to account for factors beyond clinical care is critical to reducing disparities, accurately representing plan performance and improving quality. Attendees will learn about new data-driven models that are delivering key insights into the impact of non-clinical factors, like food insecurity and unemployment, on patient outcomes. 

3:00 p.m. Break
3:15 p.m.

How Data-Driven Insights Provide Holistic Views of High-Touch, High-Cost Patient Populations

High-cost, high-touch patients who receive a large amount of their care through a specialty pharmacy represent one of the fastest growing segments in the industry. And yet, connectivity today between stakeholders invested in improving a patient’s health is, at best, sporadic. Join industry experts to learn how integrating specialty pharmacy data elements within a clinician’s workflow allows for greater transparency into the patient’s journey as he/she tackles the complicated nature of his/her diagnoses. Attendees will gain insight into the newest technology innovations that are meaningfully reducing time-to-fill, costs and error rates, while empowering advanced functionality and focus on clinical and quality outcomes.

Population Health Analytics Impacting Patient Outcomes

Population health analytics help organizations effectively manage not only the mobility of a specific patient, but the holistic management of the overall health of a patient population. The ability to stratify risk and predict costs, utilization, medication adherence, and readmission risk in real time enables a data-driven approach to care coordination and management. Join the discussion as we redefine population health in today’s data-driven ecosystem and explore the potential applications of population health analytics. In this session, hear from healthcare organizations across the care continuum as they discuss how leveraging artificial intelligence and population health analytics to provide real-time insights into patients’ risk levels relative to broader populations is empowering healthcare organizations to improve key population health outcomes.

Right Drug, Right Patient, Right Time: Why Data-Driven Provider Segmentation Matters

Every day, innovations within the pharmaceutical and life sciences industries are driving the development of new drugs to prevent, treat and cure some of the most devastating and complex diseases of our time. How do we ensure that the right treatments are highly accessible by the patients most likely to benefit from them? Payers and providers need the ability to access, understand and use provider data that gives comprehensive insight into the care they provide to their patients regardless of insurance type. In this session, industry experts will discuss how a broader view of provider quality and cost performance can enable payers and pharmaceutical companies to prioritize, segment and elevate engagement with providers to improve access to the right treatments for the right patients. Learn how organizations are leveraging data to identify and segment health systems and provider groups to determine optimal impact opportunity cohorts.

4:15 p.m.

The Impact of Encounter Data on the CMS HCC Risk Adjustment Model

Up to half of a health plan’s revenue is determined by the health status of its membership. As the Centers for Medicare & Medicaid Services (CMS) seek new approaches to enhance Medicare Advantage (MA) payment accuracy, the potential changes could have major financial implications for MA plans across the country. Join former CMS experts and risk adjustment policy developers as they share new insights on the recalibration of the MA risk adjustment model using encounter data and what it could mean for your organization. 


Guiding Patients Through Their Care Journeys: Preparing Patients for Shared Decision Making

Patients facing a serious new diagnosis feel overwhelmed by the myriad decisions they face and often lack practical guidance for how to approach their new realities. Avalere leveraged patient focus groups and a human-centered design process to develop a Preparation for Shared Decision-Making Tool that offers a new way to guide patients and caregivers. This session will explain how these tools were developed, what patients say about how they meet their needs, and what role they can play in care management.

Artificial Intelligence in Action: Real-World Application Delivering Value

Real-world healthcare data that is continuously enriched allows for the precise and effective development of artificial intelligence (AI) solutions. Through a data-driven approach, AI solutions can deliver superior insights informing not only the identification of patient-specific care and documentation gaps, but also the ideal venues for patient encounters, operational logistics, and engagement methodologies to meaningfully improve quality outcomes and financial performance. In this session, hear about real-world applications of AI and how Inovalon is unlocking the power of our data to deliver highly differentiated, easily adoptable, transparent AI solutions to the healthcare marketplace.

6:30 p.m. Client Appreciation Dinner
Tuesday, October 8
8:00 a.m. Registration Desk Opens
8:30 a.m. Breakfast & Roundtables
9:30 a.m.


Joe Grogan

Director of Domestic Policy Council, The White House

10:15 a.m.

Keynote: The Future of Medicare: Where are We Headed and Why?

Dan Mendelson, Founder, Avalere, Inovalon Fellow

11:00 a.m.

Keynote: The Patient Perspective

11:45 a.m. Lunch & Networking

Get In Touch

Conference Coordinator: Suzanne Binnendijk at cbinnendijk@inovalon.com or (301) 809-4000 x1156
Housing and Registration: Mary Mandish at mmandish@inovalon.com or (301) 809-4000 x2768
For general inquiries, email clientcongress@inovalon.com


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© 2019 Inovalon. All rights reserved.

Conference Coordinator: Suzanne Binnendijk
at cbinnendijk@inovalon.com
or (301) 809-4000 x1156

Housing and Registration: Mary Mandish
at mmandish@inovalon.com
or (301) 809-4000 x2768

For general inquiries, email