Texas Covered Clinical Leadership Forum

The Texas Covered Clinical Leadership Forum is an invitation-only forum for clinical leaders across Texas health plans, including medical, pharmacy, dental, vision, and behavioral health.

The forum is designed for collaboration on policy updates, sharing practical ideas, and addressing common challenges facing Texas health plans and the communities they serve

đź”’ Attendance is limited to health plan clinical leaders and approved event sponsors.

Stephen F. Austin, Capitol Ballroom B

701 Congress Ave., Austin, TX

Jul 28, 2026

9:00 am - 3:15 pm

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Agenda

9:00am

Opening Remarks + Announcements

9:10am

State & Federal Policy: Updates & Trends

Speaker: Margaret Tatar, Vice President, Client Solutions, HMA

10:00am

Solving the Dementia Crisis Through Personalized Care Ecosystems for Patients and Families

Dementia is a hidden driver of unsustainable medical spend. Patients living with dementia use the ER and inpatient services at 2x the rate of their peers, often due to limited management of the condition. Dr. Joel Salinas examines why traditional care models fail dementia patients, resulting in high-acuity events and premature institutionalization. He’ll analyze the industry’s pivot toward the CMS GUIDE Model and similar frameworks, which stabilize the patient and caregiver by reducing ED utilization and improving clinical outcomes.

Speaker: Dr. Joel Salinas, Behavioral Neurologist; Chief Medical Officer and Co-Founder, Isaac Health

10:50am

From Lost to Engaged: A Social-First Model to Reconnect Medicaid Members back to Care and Improve Quality

Across Medicaid, a driver of poor outcomes and cost is the “unengaged” member—patients attributed to a health home, but who have not had a meaningful connection with their primary care provider for 18+ months; in Texas, this unengaged member rate ranges from 20% to 40% depending on the health plan. This session shares a social-first, data-driven engagement model designed to identify “lost” members, stratify risk, and deploy a multi-channel outreach approach led by care teams—with clear escalation pathways for higher-risk members and facilitate proper coordination.

Speaker: Dr. Sherri Onyiego, Senior Market Medical Director, Equality Health

11:40am

Beyond the Device: Scaling Health Plan Savings with RPM V2.0

Device costs and logistics have kept traditional Remote Patient Monitoring (RPM) confined to the highest-risk 1% of members — leaving rising-risk populations invisible until a high-cost claims event forces a response. This session explores how AI-driven, smartphone-based monitoring eliminates those barriers, enabling health plans to detect undiagnosed conditions earlier, intervene before disease progression accelerates, and extend proactive care across broader populations — driving better clinical outcomes, stronger HEDIS and Stars performance, and measurable MLR improvement.

Presenter: Eric Rock, CEO and Co-Founder, Percipio Health

12:10pm

Expanding the Cost Containment Toolkit: Beyond Prior Authorization

Prior auth is essential under CMS-0057, but it remains downstream of utilization that has already occurred. The greater opportunity is proactive cost containment addressing avoidable utilization through timely, informed care management across the continuum. The advantage is not more staff or data, but clinical context at critical moments, especially transitions of care. Knowing risks, medications, and follow-up needs turns outreach into intervention, driving adherence, reducing readmissions, and closing gaps. Plans that act on timely data will outperform as CMS focuses on outcomes.

Presenter: Nicole Sunder, Vice President, Solution Design, PointClickCare

12:30pm

Lunch + Peer Networking

1:15pm-3:15pm

Closed Door Collaborative Session - Clinical Leaders Only - The Future of ABA Care: Aligning Clinical Guidelines, Compliance, and Quality

This discussion brings together a unique mix of perspectives to talk about how clinical guidelines and plan oversight are changing. We’ll look at the latest trends in clinical criteria, the real-world challenges providers face on the ground, and what pediatric patients actually need. Our goal is to discuss how health plans can use clear clinical criteria to catch fraud, waste, and abuse early, without getting in the way of necessary patient care.
Panelists:
  • Margaret Tartar, Vice President, Client Solutions at Health Management Associates (HMA)
  • Dr. Nhung Tran, Co-chair of our Autism Taskforce and Developmental/Behavioral Pediatrician
  • Sarah Johnson, MD, MSc, EMBA, Senior Medical Director for InterQual Behavioral Health
  • Ellen Rhoads, Public Policy Group President, TxABA
Speakers

Dr. Sherri Onyiego

Senior Market Medical Director, Equality Health

Eric Rock

CEO and Co-Founder, Percipio Health

Dr. Joel Salinas

Behavioral Neurologist; Chief Medical Officer and Co-Founder of Isaac Health

Nicole Sunder

VP, Solution Design, PointClickCare

Margaret Tatar

Vice President, Client Solutions, HMA

Become a Sponsor

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