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VALUE VISIT: Operational Excellence

Event Date: 5/5/2025 - 5/8/2025

Event Overview

5/5/2025 - 5/8/2025
Miami, Florida
Participation is limited to Health Plan Alliance members and invited guests

HPA members talking Regional health plans face mounting pressure to optimize administrative costs while maintaining their competitive edge in personalized service. With national insurers leveraging economies of scale, the challenge lies in strategically reducing expenses without sacrificing the high-touch, localized care that sets regional plans apart. This balancing act is crucial for ensuring long-term sustainability, keeping member costs affordable, and freeing up resources for vital investments in care management and innovation.

This Value Visit is the culmination of our "Take Cost Out" discussions, delivering actionable strategies for administrative excellence across your organization. Through intensive sessions on automation, workforce optimization, vendor partnerships, and operational waste reduction, you'll gain practical tools for immediate implementation. The event features real-world case studies, collaborative peer discussions, and expert insights on leveraging AI technologies and data-driven approaches to enhance operational efficiency while maintaining superior member experiences. From streamlining member services to optimizing payment integrity programs, you'll discover targeted solutions that drive measurable outcomes for your organization.

Who Should Attend

Executive stakeholders and leaders involved in health plan operations, project management, process improvement, vendor management, and optimizing organizational performance and efficiency won't want to miss this meeting.

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

05/05/2025 6:00 PM - 8:00 PM
Reception: Monday
05/06/2025 8:00 AM - 9:00 AM
Networking Breakfast Be sure to let us know if you have dietary restrictions.
05/06/2025 9:00 AM - 10:00 AM
Keynote - Cutting Costs Without Cutting Corners: Strategic Approaches to Cost Containment Health plans are under increasing pressure to reduce costs—but where and how you cut can make all the difference. This session will explore strategies for reducing administrative, medical, and vendor costs while avoiding common pitfalls like cutting too deep or failing to reinvest savings effectively. From outsourcing in CM/UM and optimizing claims strategies to navigating sub-capping challenges and product benefit design trade-offs, we’ll examine what’s working, what’s not, and where health plans should focus their efforts to maximize value. Expect insights from Blues, large, and regional plans on striking the right balance between efficiency, sustainability, and growth. Speaker(s): Doris Stein, Managing Director Ken Barrette, Managing Director Alvarez & Marsal Healthcare Industry Group
05/06/2025 10:00 AM - 10:15 AM
Time to refill your cup and stretch
05/06/2025 10:15 AM - 11:15 AM
Leading Through Change: Navigating Morale and Retention in an M&A Transition Workforce reductions and organizational transitions can challenge even the strongest teams, but effective leadership and strategic change management can make all the difference. This session explores how to maintain staff morale, engagement, and retention during an acquisition, balancing transparency, communication, and cultural continuity. Hear insights on navigating uncertainty, sustaining employee trust, and leading through change in a way that strengthens—not weakens—your organization. Speaker: Sarah Morgan, Vice President of Human Resources Health New England
05/06/2025 11:15 AM - 12:15 PM
Getting It Right: Strengthening Alignment for Operational and Strategic Success Executing on strategic priorities requires more than good intentions—it demands alignment across teams, processes, and decision-making. This session highlights how one health plan is optimizing internal operations, from reengineering meeting structures to drive efficiency, to refining sales presentations that clearly articulate their market differentiators, to realigning key teams like Stars under Product for greater impact. Gain insights on practical changes that improve execution, enhance collaboration, and position organizations for long-term success. Speaker: Debbie Schiffman, VP, Operations Quartz
05/06/2025 12:15 PM - 1:15 PM
Networking Lunch
05/06/2025 1:15 PM - 2:15 PM
Presbyterian’s Integration Journey: Breaking Down Barriers for Operational Success As health plans and provider systems integrate more deeply, navigating the evolving plan-system relationship requires new strategies, stronger coordination, and a shared enterprise mindset. This session highlights Presbyterian’s journey, offering a real-world look at how one health plan is aligning with its parent system to enhance efficiency, reduce friction, and drive financial sustainability. Hear from Kelly on how Presbyterian has reimagined member and patient engagement through centralized scheduling, self-service digital tools, and call center automation. Seth will share how Presbyterian is realigning horizontal integration—streamlining payment integrity, claims processing, and encounters—while also considering how plan decisions impact system care and how to strengthen partnerships with the delivery system. Join us to explore Presbyterian’s integration story—what’s working, what’s next, and key lessons for other health plans on a similar path. Speaker(s): Kelly Garcia, VP of Customer Service Center Seth Wilcox, VP of Operations Presbyterian
05/06/2025 2:15 PM - 3:15 PM
Best in Class Plans and Economies of Scale What does it take to be a best-in-class health plan, and how do economies of scale impact operational success? In this session, Douglas Sherlock will draw from two recent papers to examine the key drivers of top-performing health plans and the role of scale in enhancing efficiency and sustainability. Attendees will gain actionable insights into how data-driven strategies and benchmarking tools can help plans streamline operations, improve performance, and achieve sustainable success in a competitive landscape. Speaker: Douglas Sherlock, CFA, Senior Health Care Analyst Sherlock Company
05/06/2025 3:15 PM - 3:30 PM
Time to refill your cup and stretch
05/06/2025 3:30 PM - 4:30 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.
05/06/2025 6:00 PM - 8:00 PM
Dinner: Havana 1957 819 Lincoln Rd, Miami Beach, FL 33139
05/07/2025 8:00 AM - 9:00 AM
Networking Breakfast
05/07/2025 9:00 AM - 10:30 AM
Rethinking Vendor Management: Lessons from Outside Industries Health plans often focus on vendor pricing, but a broader value-driven approach can unlock greater efficiency, innovation, and cost savings. This session brings an outside industry perspective to vendor management, exploring how private equity and cross-portfolio strategies optimize vendor relationships, mitigate risk, and drive long-term value. We’ll discuss where vendor agreements create system exposure, how physician decisions impact P&L, and why addressing leakage requires greater rigor. Join us for insights on reshaping vendor strategy to enhance performance and financial outcomes. Speaker: Chris Windfelder, Principal/Partner Ernst & Young
05/07/2025 10:30 AM - 10:45 AM
Time to refill your cup and stretch
05/07/2025 12:00 PM - 1:00 PM
Networking Lunch
05/07/2025 1:00 PM - 2:00 PM
Risk Adjustment, Payment Integrity…Now What? CoventBridge will guide you through the essential steps to create a comprehensive Fraud, Waste, and Abuse (FWA) program. This session will empower you with the tools and strategies needed to detect, prevent, and effectively combat FWA within your organization. Learn how to build a robust framework that safeguards your health plan’s financial and operational integrity while ensuring compliance and efficiency. Don't miss this opportunity to strengthen your defenses against these costly challenges. Speaker(s): Ray Evans, Vice President - Healthcare Sales Amanda Brown, Vice President - Revenue Integrity CoventBridge Group
05/07/2025 2:00 PM - 3:00 PM
Mastering Risk Adjustment: How Smarter Member Engagement Drives Financial Performance With revenue challenges across product lines, health plans know that success hinges on more than just managing claims—it’s about proactive member engagement and precision to drive accurate risk capture at scale efficiently. This session explores how mid-sized and regional plans can turn common plan challenges—like risk adjustment volatility, data demands, competitive pressure, and member churn—into opportunities for improved financial outcomes using modern toolsets from consumer engagement. Learn how targeted, personalized member outreach, predictive modeling, and optimized care engagement strategies are helping plans lower their un-engagement rate to increase revenue accuracy and reduce transfer payment exposure by 1-3% to stabilize margins efficiently and effectively. Speaker(s): David Magrini, CEO Volute Jacob Luria, President N1Health
05/07/2025 3:00 PM - 3:15 PM
Time to refill your cup and stretch
05/07/2025 3:15 PM - 4:15 PM
Spotlight on Leadership: Insights in Action Participants will break into small groups in this interactive session to discuss critical leadership challenges and share actionable insights. Guided by thought-provoking questions, each group will explore topics such as navigating uncertainty, fostering innovation, aligning teams with long-term goals, and balancing short-term wins with strategic vision.
05/07/2025 6:00 PM - 8:00 PM
Dinner: Stiltsville Fish Bar
05/08/2025 8:00 AM - 9:30 AM
Networking Breakfast For those that have later flights, we will meet at the hotel restaurant for a come and go breakfast.