SNP Alliance Virtual Forum 2026 Special Needs Plan Alliance Outlook for AI Policy and Practical Use of AI/Data Governance | ||
Thursday, July 30th | ||
Meeting Agenda | ||
TOPIC | SPEAKERS | TIME |
Welcome and Introductions | Mike Cheek, President and CEO, SNP Alliance Heather Kennedy, CEO, Abilis and SNP Alliance AI/Data Governance Advisory Group Co-Chair Jill Sumner, SNP Alliance Consultant – AI and I-SNP | 1:00 – 1:05 |
Current AI/Data Governance Policy Environment – Policy Landscape To-Date CMS is a proponent of technology to streamline plan operations and improve transparency. CMS has issued guidance on use, and each State has its own set of requirements. Additionally, Congress has begun discussions on the use of AI and requirements for Data Governance. During the opening plenary, Ms. McFadyen will provide an overview of the current landscape from federal and state perspectives. | Kate McFadyen, Senior Director, Government Affairs, American Health Information Management Association (AHIMA) | 1:05 – 1:15 |
Concurrent Sessions: | ||
Individual Care Plans The rapid expansion of Special Needs Plans (SNPs) underscores the operational challenge of managing highly complex populations while meeting rigorous, resource-intensive CMS requirements for care coordination and Model of Care (MOC) implementation. With increased scrutiny and evolving audit protocols, relying on manual, fragmented processes to execute Health Risk Assessments (HRAs) and Interdisciplinary Care Team (ICT) engagement is no longer sustainable. To deliver tangible outcomes, maintain strict compliance, and reduce clinical burnout, plans must integrate advanced technologies like predictive analytics, AI-driven workflow automation, and seamless interoperability platforms. In this session, we will explore practical strategies for leveraging these innovations to bridge the execution gap, alleviate documentation burdens, and optimize workflows to drive measurable quality improvements. | Andrew Dahlgren, Chief Medical Officer, Curana Health Maureen Murray, Vice President, Clinical Programs, Curana Health | 1:15 – 1:45 |
HRA/Assessments and Enrollee Risk Reports Artificial intelligence is transforming healthcare by making patient risk identification more accurate, efficient, and actionable. This presentation will explore how AI-powered, customized health assessments can generate comprehensive patient risk reports by combining patient-reported information with validated clinical measures. Attendees will learn how these insights support earlier intervention, improve documentation, enhance care planning, and strengthen collaboration across the healthcare continuum. The session will also highlight how responsible, patient-centered AI can improve outcomes while supporting value-based care and more informed clinical decision-making. | Jenni Gudapati, President & Founder, Healthy Insights AI | 1:15 – 1:45 |
Claims Processing Claims complexity is rising in Medicare Advantage especially as plans expand product options such as CSNP. Traditional rules engines struggle and plans end up with low auto-adjudication rates, growing pend queues, rework, and audits that review a small sample and hope it represents the rest. This session follows one plan's experience partnering to develop a customized AI solution to audit C-SNP claims. Hear why existing vendor tools fell short, how the plan trained and validated a model against its own claims history and benefit configuration, and how it handled human review and compliance documentation. | Jill Sumner, SNP Alliance Consultant, AI and I-SNP Ernie Ianace, Founder & CEO, CareAlly | 1:45 – 2:15 |
Artificial Intelligence and Engaging Members With Cognitive Impairment Plan members with Mild Cognitive Impairment (MCI) or dementia are some of the most difficult members to identify, diagnose, engage, and treat in a plan. As a result, with the difficulty in managing comorbidities and excess hospitalization and emergency room visits, effectively they become some of the most expensive members. Progress in AI in recent years allows for interventions that until very recently have been deemed unscalable to be built and made available to members. The new tools can be used for identifying, engaging, and treating members struggling with cognitive decline. This session discusses the scale of congnitive impairment within plan population, its impact, and what is possible now in terms of interventions using AI. | Babak Parviz, CEO, Newdays | 1:45 – 2:15 |
Overview of Recommended Action Steps Use of AI already is embedded in prior authorization workflows, care gap closure, risk stratification, and member outreach. However, SNPs face uniquely high standard due to the vulnerable, complex populations they serve as well as CMS and State oversite. This session gives SNP plan leaders a grounded, practical look at where AI is delivering real value in SNP operations today, what CMS now expects in terms of human oversight, audit trails, bias monitoring, and how to build a governance program that is operationally functional, not just a policy on paper. Additionally, during this session, participants will hear from member experts about meaningful use of AI in SNPs and explore possible SNP Alliance lines of technical support as well as advocacy. | Mike Cheek, President and CEO, SNP Alliance Heather Kennedy, CEO, Abilis and SNP Alliance AI/Data Governance Advisory Group Co-Chair Jill Sumner, SNP Alliance Consultant – AI and I-SNP | 2:15 – 2:45 |
Future AI/IT Policy Making in MA Space AHIMA provided an overview of the current state of play with AI and Data Governance. Ms. Seigel will provide her thoughts on future direction in policy development and guidance. She will categorize her thoughts into three areas: a) possible; b) possible but improbable; and c) probable. She will provide insight into Congress as well as CMS. | Randi Seigel, Partner, Manatt, Phelps & Phillips, Health Care Transitions and Regulatory Unit Leader | 2:45 – 3:15 |
Federal and State Policy Resources and SNP Alliance Future AI Technical Support and Advocacy Member Input Session As AI and Data Governance policy evolves, the SNP Alliance will be engaging by efficiently leveraging expert organizations, such as AHIMA, and working with other plan organizations. In keeping with the SNP Alliance's focus, its advocacy and technical support exclusively will focus on SNP-specific needs and complex care. During this session, the Chair of the AI and Data Governance Advisory Group and the President and CEO will facilitate a discussion on SNP and complex care population priority advocacy areas as well as identify needed technical support areas based upon member guidance. | Mike Cheek, President and CEO, SNP Alliance Heather Kennedy, CEO, Abilis and SNP Alliance AI/Data Governance Advisory Group Co-Chair | 3:15 – 3:30 |
