VALUE VISIT: Clinical Excellence 2025

Event Date: 9/23/2025 - 9/26/2025

Event Overview

9/23/2025 - 9/26/2025
Baltimore, Maryland
Participation is limited to Health Plan Alliance members and invited guests

HPA members talking

Reimagine Care, Cost and Collaboration

Clinical leaders across the Alliance are facing the same challenge: how to deliver higher-value care in a system under strain. At Clinical Excellence 2025, we’ll dig into the strategies health plans are using to move faster, work smarter, and stay clinically grounded—without losing sight of cost or quality.

This year’s agenda brings a sharper focus to what’s shaping the future of care delivery—from the rise of AI-driven clinical tools and modernized UM models, to the growing impact of value-based partnerships and aligned provider strategies. You’ll hear from standout plans, proven vendors, and trusted peers on what’s working—and what’s next.

With space for candid conversations and practical takeaways, this is a meeting designed for CMOs, medical directors, and clinical ops leaders who are ready to lead through transformation.

Who Should Attend

Decision-makers and teams responsible for optimizing care delivery, managing high-cost populations, and driving sustainable cost reductions won't want to miss this meeting. Whether you’re shaping strategy, leading clinical programs, or executing cost-containment initiatives, this meeting will provide valuable insights and actionable solutions.

Recommended For:

Chief Medical Officers (CMOs) and Medical Directors
Clinical Operations Leaders
Utilization Management (UM) and Case Management (CM) Leaders
Pharmacy and Behavioral Health Executives
Provider Network and Value-Based Care Leaders
Actuarial and Finance Leaders focused on medical cost management
Quality, Population Health, and Health Equity Leaders

Why Attend

Collaborative Impact: Immerse your team in intensive working sessions where you'll collaborate directly with peers to solve your organization's most pressing challenges through interactive workshops and hands-on activities.
Real-World Results: Learn from in-depth case studies and proven strategies implemented by peer health plans, gaining practical templates and solutions you can implement immediately within your organization.
Strategic Networking: Build lasting connections with carefully selected peer organizations facing similar challenges, creating a valuable professional network that extends beyond the event through ongoing collaboration.
Hands-On Learning: Skip the theory and dive into practical demonstrations and discussions with plans that have successfully navigated your current challenges, gaining insights you can apply to your own initiatives.
Included with Your Membership: While similar industry events cost thousands, this powerful networking opportunity is included in your membership—giving you unparalleled access to meaningful collaboration with regional, provider-sponsored, and independent health plan leaders.

Thank you to our event sponsors

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Agenda

09/24/2025 8:00 AM - 9:00 AM
Networking Breakfast Menu: Scrambled eggs, toast/bagels, Old Bay potatoes, applewood smoked bacon, chicken apple sausage, greek yogurt with local granola/homemade berry compote, sliced fruit/berries
09/24/2025 9:00 AM - 10:00 AM
Strategic Modeling in Action: How Medical Economics is Driving Investment Decisions Medical economics is emerging as a core lever for aligning clinical strategy with financial stewardship—but building a model that actually informs decision-making takes more than just good data. Dr. Charles Bloom shares how Health Alliance Plan created a medical economics infrastructure that ties together UM, CM, population health, claims, and administrative spend. He’ll walk through how the team evaluates internal investments, calculates ROI, and drives enterprise strategy with a clinical lens. Speaker(s): Dr. Charles Bloom, CMO Health Alliance Plan
09/24/2025 10:00 AM - 11:00 AM
From Data to Delivery: Building Medical Economics from the Ground Up Standing up a medical economics function is about more than just reporting on trends—it’s about building trust, navigating silos, and turning insights into action. Dr. White offers a behind-the-scenes look at how Presbyterian is developing this capability from scratch. He’ll share how his team is using data to identify high-impact initiatives, navigate internal buy-in, and move from idea to implementation—laying the foundation for a more strategic and accountable approach to spend. Speaker(s): Dr. Clinton White, CMO Presbyterian Health Plan
09/24/2025 11:00 AM - 11:15 AM
Networking Break Energy Boost - assorted pressed juices, chocolate covered espresso beans, trail mix and granola bars
09/24/2025 11:15 AM - 12:30 PM
Pharmacy Strategy 2026: Aligning Insights, Innovation, and Impact Pharmacy spend is under the spotlight—and the stakes are only rising. This session brings together member case studies and consultant insights to explore what plans should be prioritizing now for 2026. We’ll cover internal readiness strategies like prescriber grading and PBM RFP prep, evaluate in-house vs. outsourced functions, and break down emerging disruptors and regulatory shifts. The session also spotlights tools for member-focused oversight, including dashboards, KPIs, and integration of medical and pharmacy benefits. Walk away with clear takeaways and a sharper strategy for what’s next. Speaker(s): Kiran Biring, Chief Pharmacy Officer, Western Health Advantage Lynn Nishida, Chief Pharmacy Officer PayerAlly
09/24/2025 12:30 PM - 1:30 PM
Networking Lunch Menu - pita chips/hummus, chickpea salad (olive, tomato, red onion, cucumber, artichokes, basil balsamic), dill/cucumber salad (shaved cucumber, green onion, dill yogurt dressing), herb and white bean soup, rolls/butter, Souvlaki style roasted chicken, beef keftedes, falafel, Gemista style couscous (tomatoes, squash, bell pepper), roasted vegetables, baklava (walnut, pistachio, rosewater), rice pudding (cardamom, orange blossom)
09/24/2025 1:30 PM - 3:00 PM
Integration in Practice: Health System Alignment Case Studies What does meaningful integration—or alignment—look like in the real world? In this session, leaders from Ochsner Health and Network Health share their unique experiences navigating the complexities of plan-system relationships. Ochsner Health offers a look at what full integration can achieve, showcasing innovative care programs made possible through tight plan-provider collaboration. Network Health brings a different lens—sharing how they’re working to deepen operational alignment with their health system partner while maintaining organizational independence. Whether you're on the road to integration or focused on better alignment, these case studies offer valuable lessons and lived experience. Speaker(s): Dr. Sandy Spitale, CCO Ochsner Health Mushir Hassan, CMO Network Health
09/24/2025 3:00 PM - 3:15 PM
Networking Break Candy Bar!
09/24/2025 3:15 PM - 4:15 PM
Peer-to-Peer Roundtable: What’s Working and What’s Not End the day with a collaborative peer-to-peer roundtable designed to foster candid discussions about real-world challenges and innovative solutions. Using a guided handout, attendees will share what’s working, what isn’t, and what they’re trying next in their organizations. This interactive session is the perfect opportunity to learn from your peers and gain fresh ideas to take back to your teams.
09/24/2025 6:00 PM - 8:00 PM
Dinner: Wednesday - Cinghiale Family Style - Market Vegetable Bruschetta, Housemade Ricotta; Chilled Shrimp Spiedini, Castelvetrano Olives; Grilled Lamb Spiedini, Lemon, Chili Oil, Rosemary; Fontina Spiedini, Roasted Peppers. Arugula Salad, Frisée, Radicchio, Preserved Lemon, Parmigiano, Lemon Vinaigrette Casarecce, Tomato Basil Sauce Choice of: Grilled Mediterranean Bronzino, Artichokes, Yellow Tomato Confit, Capers, Lemon Butter Sauce or Saltimbocca: Prosciutto-Wrapped Chicken, Swiss Chard, Creamy Polenta, Fresno Chili, Sage Reduction. Choice of: Traditional Tiramisu, Espresso & Liquor-Soaked Vanilla Sponge, Mascarpone Coffee Crème, Caramel Sauce or Crostata, Woerner Orchard Peaches & Thyme, Honey Chantilly, Lemon Sauce
09/25/2025 8:00 AM - 9:00 AM
Networking Breakfast Healthy & Fresh - mixed berries, sunflower morning toast (sunflower butter, strawberries, granola crumble, honey drizzle), sunshine parfait (mango compote, raspberry, toasted coconut), egg white frittata (tomato, baby kale, feta cheese), chicken apple sausage
09/25/2025 9:00 AM - 10:00 AM
Prior Authorization, Automation, and Provider Collaboration: A Case Study in Efficiency and Cost Reduction In the evolving landscape of utilization management, automation isn't just about speeding up approvals—it's about reshaping how payers and providers work together. This session showcases a real-world example of how one health plan is advancing its prior authorization processes through automation while deepening collaboration with a major provider partner. The result? Not only faster turnaround times and reduced administrative burden, but also a renegotiated rate decrease that benefits both sides. Join us to explore the strategy, the technology, and the shared wins that made it possible. Speaker(s): Dr. Dee Bialecki-Haase, Chief Medical Officer Medical Mutual
09/25/2025 10:00 AM - 11:00 AM
Activating Quality at Every Touchpoint: Two Paths to Performance Improvement What does it take to improve quality—operationally and measurably? In this session, two health plans share distinct strategies. Select Health reveals how it builds internal champions and aligns operations to elevate member experience and CAHPS scores. CDPHP showcases its use of AI-driven abstraction to streamline HEDIS gap closure and lay the foundation for digital quality measurement. Together, these case studies offer contrasting but complementary views on how health plans can raise performance by investing in what matters most—people and precision. Speaker(s): Michael Farina, VP Health Care Quality CDPHP Kim Barrus, AVP Quality & Accreditation Select Health
09/25/2025 11:00 AM - 11:15 AM
Networking Break Appalachian trail - build your own trail mix, Field Trip jerky, chips and granola bars
09/25/2025 11:15 AM - 12:00 PM
Where AI Is Headed—and What It Looks Like in Practice In this session, we’ll go deep into a practical case study with Clarity Care, showcasing how AI is being deployed in utilization management to reduce burden without losing clinical nuance. See how AI bots can now manage intake, verify eligibility, flag benefit mismatches, and suggest guideline matches—while keeping a clinical expert in the loop. Explore how “agentic” AI is redefining roles across the UM workflow, and what oversight, transparency, and safeguards look like in a real-world implementation. Speaker(s): Hermine Tranie, Co-Founder ClarityCare
09/25/2025 12:00 PM - 12:30 PM
HealthHelp’s Collaborative Approach to Specialty UM Join us to explore how HealthHelp is transforming specialty benefit utilization management (UM) through its consultative approach to prior authorization (PA). Unlike traditional UM methods that often rely on strict denial processes, HealthHelp specialists engage directly with physicians to jointly determine the best course of action for patient care. This collaborative model has led to a remarkable decrease in denial rates, improving both clinical alignment and physician satisfaction. Geisinger Health Plan will be highlighted as a case study, demonstrating the success of this consultative model in improving patient outcomes, streamlining workflows, and maintaining cost containment. This session offers valuable insights for payers looking to enhance their specialty UM processes while maintaining a focus on quality care. Speaker(s): George Gjermano, Chief Product Officer HealthHelp Kyle Kanaga, Vice President, Business Development HealthHelp
09/25/2025 12:30 PM - 1:30 PM
Networking Lunch Menu - Asian salad (cabbage, shaved carrots, bell peppers, edamame, spicy cashew dressing), salted cucumber salad (mint, sesame, miso dressing), vegetable summer rolls (rice noodles, carrots, zucchini, cucumber, Gochujang dressing), chicken stir fry (sweet and sour, scallions), salmon and bok choy (miso glaze, sesame), crispy tofu (sweet chili sauce, sesame seeds), ginger lemongrass stir fried vegetables, jasmine rice, yuzu matcha tart, coconut rice pudding (mango gelee)
09/25/2025 1:30 PM - 2:15 PM
From Data to Value: Realigning Strategy for Measurable Impact Facing growing demands for quality, cost control, and accountability, Johns Hopkins Health Plans took a fresh look at its population strategy. This session explores how a segmentation-driven approach enabled JHHP to focus on the members and measures that matter most—resulting in improved outcomes in diabetes, maternity care, and ED utilization. Learn how the team aligned clinical operations, optimized vendor partnerships, and empowered care teams to work at the top of their license—all without adding headcount. A practical, scalable model for delivering results in today’s evolving health care environment. Speaker(s): Kristin Poth, VP Medical Management JHHP Donna Logan, Population Health Strategist Illustra/JHHP
09/25/2025 2:15 PM - 2:30 PM
Networking Break Popcorn Party!
09/25/2025 2:30 PM - 3:00 PM
Enhancing MSK Care with myHealthTrack In this session, we’ll explore how myHealthTrack is addressing key challenges in musculoskeletal (MSK) care by providing digital recovery programs. With 74% of patients failing to complete traditional physical therapy (PT), myHealthTrack’s platform offers a solution by enabling remote guidance and tracking. This approach not only drives higher adherence and faster recovery but also offers a cost-effective alternative to traditional PT, making it a strategic tool for health plans looking to optimize MSK care delivery and reduce overall care costs. Speaker(s): Jason Burns, CEO myHealthTrack Steven Seidman, COO myHealthTrack
09/25/2025 3:00 PM - 4:00 PM
Reimagining Clinical Operations: Delivering Impact Through BPaaS In this interactive panel, industry leaders from Clearlink Partners and Ochsner Health explore how Business Process as a Service (BPaaS) is reshaping clinical operations for health systems and managed care organizations. Hear firsthand how Ochsner transitioned from a traditional vendor model to a tech-enabled BPaaS solution—accelerating performance, improving scalability, and achieving measurable results in a compressed timeframe. Panelists will discuss what makes BPaaS different, how to evaluate the right partner, and what outcomes to expect across implementation, optimization, and long-term delivery. A must-attend for anyone seeking a modern operational model built for agility, value, and growth. Speaker(s): Sean Murphy, Partner, Client Success Clearlink Partners Christina Turner, Partner, EVP Solution Delivery Clearlink Partners Dr. Sandy Spitale, CCO Ochsner Health Plan
09/25/2025 6:00 PM - 8:00 PM
Dinner: Thursday - Ampersea Choice of caesar salad or Maryland crab soup, grilled rosemary lemon chicken or fresh catch or seasonal risotto, garlic mashed potatoes and broccolini, chocolate fudge brownie and lemon bars
09/26/2025 8:00 AM - 9:30 AM
Breakfast - Maximon For those that have later flights, we will meet at the hotel restaurant for a come and go breakfast.