We’re Excited to announce that the SNP Alliance will host its 2025 Fall Forum on October 27th & 28th at the Yours Truly Hotel in Washington, D.C. This annual event brings together key voices from the SNP community to discuss critical policy issues, share innovations, and strengthen the voice of organizations that serve individuals living with significant complex needs.
Medicare Advantage Special Needs Plans (MA-SNPs) are facing an unprecedented array of pending and highly probable changes which will impact care delivery and general operations. Developing a well-defined Change Management approach tailored to SNPs is essential. CMS is working on the statutorily mandated Interim Final Rule on H.R. 1 Medicaid eligibility changes and State Medicaid Agencies are well underway with program and budget changes. At the same time, the MA-SNP space will have two regulations this year – a second version of a Final CY 2026 Parts C and D Rule and a CY 2027 Parts C and D Proposed Rule. Finally, an MA Reform short-term Congressional legislative package already is in discussion. The SNP Alliance Fall Forum will include its typical unique, in-depth technical sessions but will be framed by the keynote, plenaries, and a special workshop on how to build a Change Management Strategy to ensure plan stability as well as access to quality care for the people who need SNP levels of support.
Meeting & Hotel Location: Yours Truly DC – 1143 New Hampshire Avenue NW Washington D.C. 20037. Please use the links below to register for the meeting and for hotel reservations. The hotel Reservation deadline is October 7th.
Please note that the Destination fee will show during the booking journey. However, per the agreement, no guest will be charged the destination fee and can ignore that.
If you have any questions, please email Sam Amaya at samaya@snpalliance.org. We look forward to seeing you in October!
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Fall Forum Meeting Agenda | ||
Monday, October 27th | ||
Breakfast & Member Networking 7:30 - 8:30 | ||
TOPIC | SPEAKERS | TIME |
Keynote: Change Management and Special Needs Plans: Structure and Process for Advancing Specialty Care in Times of Change There is an array of Change Management models. The Keynote will provide insights on recommended models and approaches for SNPs highlighting approaches which mitigate risk and leverage opportunities, including those which may have first appeared as threats. The Fall Forum will offer three C-Suite plenaries – Chief Executive Officers, Chief Strategy Officers and Chief Operations Officers. The Keynote speaker also will discuss these plenaries in the context of the recommended Change Management approach. | Chad Carden, Founder & CEO, The Carden Group | 8:30 – 9:00 |
Government Relations – Short, Near and Long-Term Medicare Advantage Reform
For several years, Congress has discussed aspects of the Medicare Advantage program which required reform. Now, in a bipartisan manner, Congress is taking a much broader approach to MA Reform, pulling together an array of legislative proposals as well as recommendations from Federal Advisory Commissions. During this session, participants will hear about these efforts as well as alignment with CMS priorities. Learning Objectives:
| Ginger G. Loper, Principal, Loper Consulting LLC Elizabeth Barnett, Partner, Avenue Solutions Hill Staff (Invited) | 9:00 – 10:00 |
C-Suite Plenary 1 – CEO Perspectives on Change Management CEOs play a crucial role in change management, often being the driving force behind organizational transformation. They are responsible for articulating a clear vision, developing strategic plans, and ensuring effective communication to guide their teams through transitions. Some key CEO perspectives on change management include articulating a higher purpose, establishing a clear vision, motivating staff and creating an imperative for change and innovation. During this plenary, three plan CEOs will discuss their approach to Change Management tied back to today’s current and unfolding SNP challenges and opportunities. | Chad Carden, Founder & CEO, The Carden Group Dr. Felix Nunez, CEO, Gold Coast Health Plan Toby Douglas, Senior Vice President, Medicaid, Kaiser Permanente Jeremy Dressen, President, Curana Health Plans, CEO, Align Senior Care | 10:00 – 10:45 |
Break & Networking 10:45 – 11:00 | ||
From Insight to Action: Equipping Frontline Teams to Reach the Most Vulnerable Dual Eligibles
D-SNP and MLTSS plans are under intense pressure. Medicaid redeterminations are exposing critical care gaps, margins continue to tighten, and frontline teams are operating at capacity. While many health plans have access to robust data and analytics, they struggle with a fundamental challenges — translating insights into actionable interventions that drive real outcomes. This session examines how leading plans are bridging the execution gap by transforming predictive and causal AI into targeted frontline engagement strategies. The session will explore practical approaches that deliver measurable improvements in quality scores, optimize reimbursement rates, and reduce avoidable medical spending.
Learning Objectives:
| Suzanne Gore, JD, MSW, Principal, State Health Partners, SNP Alliance Consultant Trey Sutten, Co-Founder & CEO, Siftwell
Erin Henderson Moore, President and CEO, Fidelis Care NJ Molly Dean, Senior Consultant, State Health Partners | 11:00 – 11:50 |
Risk Adjustment Data Validation Audits (RADV) – Implications for SNPs
In a May 21, 2025, press release, CMS stated its intent to conduct Risk Adjustment Data Validation (RADV) audits of all Medicare Advantage (MA) contracts from 2019 to 2024, and have these audits completed by the middle of 2026. To date, CMS has selected plans for the 2019 audits and is likely to select plans for the additional years in the coming weeks or months. CMS’ approach identifies diseases (Hierarchical Condition Categories (HCCs) on enrollees with high-risk scores. Under CMS’ approach, SNP enrollees, because they tend to have higher risk scores, are more likely to be targeted for audit than non-SNP enrollees. Under these audits, CMS intends to extrapolate payment recoveries from the sample of 35 enrollees, which can create major challenges for smaller SNP plans. In this session, attendees will hear about the status of the RADV audits and potential challenges plans face in the audits, as well as some of the potential legal issues associated with the RADV audits. Learning Objectives:
| Tom Kornfield, MPP, MAST Health Policy Solutions, SNP Alliance Consultant Jason Christ, Board of Directors /Member of the Firm, Epstein Becker Green Mark Hassenstab, VP Risk Adjustment & Product Optimization, Curana Health | 11:00 – 11:50 |
Break & Networking 11:50 – 12:00 | ||
H.R. 1: Opportunity in a New Era of Health Care Policy
While much of the H.R. 1 Medicaid provisions are set to go into effect in 2027 and 2028, state Medicaid agencies will need not only to begin to develop processes to be ready to go into effect in 2026 but also to reevaluate their budgets for associated costs and losses in federal funding. A notable challenge for SNPs, despite the carve-outs provided under the H.R. 1, will be the administrative processes that states will need to develop to implement certain enrollment restrictions, meet redetermination requirements, and screen the Death Master File. States and plans may experience similar challenges experienced during post-COVID Unwinding. Additionally, many Medicaid agencies will face budget shortfalls which could potentially impact eligibility, coverage, benefits, and rates. In this session, attendees will hear about Medicaid risks as well as recommended action steps to prepare and the potential interactive effects of Medicaid policy changes on other H.R. 1 impacted programs including SNAP and Low-Income Tax Credits which often help finance affordable Assisted Living. Learning Objectives
| Matthew McLarnon, MBA, Integration Policy Manager, SNP Alliance Steven R. Counsell, MD, Medical Director, Division of Aging, Indiana Family and Social Services Administration | 12:00 – 12:50 |
Part D Risk Adjustment Model Under the Inflation Reduction Act, CMS has set minimum fair prices (MFPs) for ten selected drugs for 2026. The Part D risk adjustment model for 2026 incorporates these prices into the model. As additional drugs are negotiated, CMS appears likely to continue to use this approach – that is, use the MFPs for the newly negotiated drugs in the risk adjustment model. However, this approach could create challenges as the risk adjustment model uses gross prices (that is, rebates are included), and the MFPs are essentially net prices. In addition, because plans are responsible for a larger share of plan liability under the Part D risk adjustment model, the model’s accuracy, or inaccuracy, could have implications for SNPs if the payments under the model do not reflect patients’ expected drug costs. This session will include a discussion of potential concerns around how CMS is using the MFPs in the Part D risk adjustment model, along with how the model accuracy could be impacted from the higher plan liability under the IRA. Learning Objectives
| Tom Kornfield, MPP, MAST Health Policy Solutions, SNP Alliance Consultant Nicholas Johnson, FSA, MAAA, Principal & Consulting Actuary, Milliman David Mike, CFO, Aetna | 12:00 – 12:50 |
Lunch & Member Networking 12:50 - 1:45 | ||
Outlook for Special Needs Plans (Virtual Clip) - Dr. Mark McClellan, MD, PhD, Director, Duke-Margolis Institute for Health Policy at Duke University | 1:45 – 2:00 | |
C-Suite Plenary 2 – CSO Perspectives on Change Management The role of Chief Strategy Officers (CSOs) has evolved significantly in recent years, expanding beyond traditional strategic planning to encompass a crucial leadership role in organizational change. CSOs typically are at the forefront of driving transformative initiatives and navigating their organizations through dynamic landscapes. Key functions include strategic planning and execution, change leadership, stakeholder engagement, innovation, and performance monitoring and talent development. SNP CSO’s may be driving efforts such as assessing the viability of a C-SNP, expanding an I-SNP into Institutional Equivalent, and assessing integration models. During this session three CSOs will discuss the top priorities for their SNPs and how they are tackling the work. | Chad Carden, Founder & CEO, The Carden Group Eve Gelb, CSO, Gold Coast Health Plan Steven R. Whitehead, Vice President, Government Programs, Sentara | 2:00 - 2:50 |
Break & Networking 2:50 - 3:00 | ||
Measuring Quality and Managing Care within Special Needs Plans: Challenges & Opportunities Part 1 – Current & Future Standards in Quality Measurement & the MA Quality System Evidence supports the finding that the MA quality measurement system does not adequately adjust for complex, chronic, high social risk population characteristics as served within Special Needs Plans (SNPs) nor does the current system provide the information needed for benchmarking or improvement. In addition, the transition to digital quality measurement (DQM) is underway. Within this environment, there are opportunities that can be explored. Learning Objectives
| Deborah Paone, DrPH, MHSA, Performance Evaluation Lead & Policy Consultant, SNP Alliance Karen Sheares, MD, PhD, VP of Quality Sciences, NCQA Sherri Simko, MSW, Sr. Director, SNP, UPMC Health Plan (PA) Lisa Benrud, PhD, JD, Senior Manager, Regulatory Oversight & Improvement, Medicaid & SNP Products, Medica (MN) | 3:00 - 3:50 |
Polypharmacy in Special Needs Plans: Strategies for Safer, Smarter Medication Management
Polypharmacy is a common and complex challenge in Special Needs Plans (SNPs), where members often have multiple chronic conditions, high medication use, and increased risk for adverse drug events. This session will explore the unique considerations for medication management in SNP populations, including regulatory requirements, interdisciplinary collaboration, and evidence-based deprescribing strategies. Participants will learn practical approaches to optimize medication regimens, improve adherence, and enhance both safety and quality outcomes for members. Learning Objectives
| Thomas von Sternberg, M.D., Medical Director, M.D., Medical Director, HealthPartners Health Plan Steve Buslovich, Chief Medical Officer, PointClickCare | 3:00 - 3:50 |
Break & Networking 3:50 - 4:00 | ||
Measuring Quality and Managing Care within Special Needs Plans: Challenges & Opportunities Part 2 – Care Management Opportunities & Quality Improvement Strategies This second session continues exploration of how SNPs can work within the quality measurement system to utilize methods and information toward improving performance in special population care management. Participants will discuss strategies around the approach, technologies, tools, and resources needed--such as through enhanced use of data and data analytics, robust care management, and member journey-mapping, starting with enrollment.
Learning Objectives
| Deborah Paone, DrPH, MHSA, Performance Evaluation Lead & Policy Consultant, SNP Alliance Karen Sheares, MD, PhD, VP of Quality Sciences, NCQA Sherri Simko, MSW, Sr. Director, SNP, UPMC Health Plan (PA) Lisa Benrud, PhD, JD, Senior Manager, Regulatory Oversight & Improvement, Medicaid & SNP Products, Medica (MN) | 4:00 - 4:50 |
C-SNP Development Within Current Regulation and Policy Outlook
The SNP Alliance has identified an array of C-SNP challenges which will impact their ability to meet the demand of a growing population living with multiple chronic conditions requiring complex care management and non-medical supports to maintain health and overall function. Additionally, while the number of C-SNPs and enrollment have grown, many condition categories remain untouched. This session will provide an overview of the C-SNP marketplace to-date, operational challenges and existing solutions, and approaches to addressing challenges. Learning Objectives
| Regan Hunt, Associate Director of Policy, SNP Alliance Elizabeth Ritter, Senior Consultant, Health Management Associates | 4:00 - 4:50 |
Reception 5:00 – 6:00 | ||
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Tuesday, October 28th | ||
Breakfast & Networking 7:30 - 8:30 | ||
I-SNP Innovations: New and Noteworthy Approaches in ISNPs This session explores how Institutional Special Needs Plans (ISNPs) are leveraging innovative models to improve care for residents in long-term care settings. Participants will hear directly from ISNP leaders and their partner organizations about cutting-edge strategies that enhance member engagement, integrate care delivery, and manage complex chronic conditions. From onsite care teams to data-driven population health strategies, these approaches demonstrate measurable improvements in quality, cost, and member satisfaction. Attendees will gain practical insights into replicable models and policy-aligned practices shaping the future of ISNP care.
Learning Objectives
| Jill Sumner, MPH, MBA, SNP Alliance Consultant Kathy Boles, Director of Managed Care and Advanced Payment Models, TLC Management Lynne Katzmann, CEO, Juniper Communities LLC
Jay Mutchnik, VP of Rehab Jessica Garrison, Regional Director of Rehab Clinical Development Molly Companion, Regional Director of Speech – Language Pathology | 8:30 - 9:30 |
Dementia Care Management and the CMS GUIDE Model As the prevalence of dementia continues to rise, healthcare organizations must have robust programs to meet the growing medical, functional, and psychosocial needs—and costs—of dementia patients and their caregivers. Launched in July 2024, the CMS GUIDE program (Guiding an Improved Dementia Experience) is an 8-year alternative payment model offering a structured, value-based approach to dementia care management. While designed for dementia, the GUIDE Model’s framework is grounded in evidence-based care coordination to improve patient quality of life, reduce caregiver burden, and minimize unnecessary utilization. Its principles of proactive follow-up, interdisciplinary care, and better care navigation can be applied across a wide range of complex care populations. This session will examine the components of effective dementia care management, explore how the GUIDE Model aligns with current quality and payment priorities, and offer practical strategies for integrating its principles not only into dementia care, but also into other specialties managing complex, multi-comorbid individuals across various settings. Additionally, there will be a focus on the role of SNP plans in supporting or delivering this optimal model of care coordination. Learning Objectives
| Thomas von Sternberg, M.D., Medical Director, M.D., Medical Director, HealthPartners Health Plan R. John Sawyer, PhD, ABPP-CN + Board Certified Clinical Neuropsycholoist, Ochsner Neuroscience Institute | 8:30 - 9:30 |
C-Suite Plenary 3 -- Chief Operating Officers and Change Management COOs play a crucial role in change management by ensuring that organizational transitions are executed smoothly. They adopt a strategic approach to navigate transitions, communicate transparently, and build a strong change management team. COOs are also natural change champions, driving innovation through operational excellence, and are essential in managing the human side of change. They leverage their operational expertise to boost organizational resilience and value creation. SNPs undergo notable operating environmental changes with Medicaid as well as with near term MA Reform. COOs will be leaders in the transition to, and day to day operations in a new organizational structure or model. Three SNP COOs will discuss how they would lead such change, create feedback loops to make improvements as needed, as well as ensure team members feel heard and included during transition and when voicing concern about new operations. | Chad Carden, Founder & CEO, The Carden Group Holly Brenier, CEO, Associated Care Ventures, Simpra Advantage, Alabama Select Network Hollie Caupp-Maxfield, COO, SCAN Health Plan Dana Mott, Divisional Senior Vice President, HCSC | 9:30 - 10:30 |
Break & Networking - 10:30 - 10:45 | ||
CMS Panel During this session, participants will hear about CMS priorities and engage in an interactive question and answer session with officials from the Center for Medicare, MMCO, and the Center for Medicaid and CHIP Services. | Marla Rothhouse, MMCO Kerry Branick, MMCO Sara Vitolo, Deputy Administrator for Medicaid and CHIP Services Center for Medicare (Invited) | 10:45 - 11:45 |
Closing Keynote: Key Factors to Consider in Special Needs Change Management Based upon the opening Keynote remarks on Change Management, C-Suite plenary observations and her expertise and experience, Executive Advisor, Melanie Bella, will offer her thoughts on action steps SNPs should consider in their future strategic planning. | Melanie Bella, Executive Advisor, Cressey & Company | 11:45 - 12:15 |
