2020 Agenda

January 27, 2020

8:00AM – 9:00AM
Registration and Networking Breakfast

9:00AM – 9:10AM

Welcome and Chairperson’s Opening Remarks

Ana Handshuh, CHC, Principal 

CAT5 Strategies 

9:10AM – 10:00AM

Orientation to the Bid, Part 1: Building the Bid Up In the Model

  • Identify key terms, files, and reports crucial to successful bid submission
  • Build a strategy-supporting calendar that connects interdepartmental input and project management timelines to the CMS bid submission schedule
  • Make the most of the CMS Bid Training Modules as a reference and technical guidance tool


Benjamin Nadler, Director, Actuarial Services

Independent Health


Amy Garrow, Manager, Actuarial Services

Independent Health

10:00AM – 10:50AM

Orientation to the Bid, Part 2: Understanding the Financial Impacts of Changing CMS Bid Variables

  • Discover how base bids, benchmark rates, risk scores and other bid variables in CMS bid calculation affect health plan revenue
  • Prioritize CMS tools and tests – and their dependencies – that determine pricing
  • Explore how to optimize the financial mechanics behind lower rebates and higher provider group payouts, base bids and benchmarks, and other bid relationships


Kathryn Y. Qin, FSA, MAAA, Corporate Vice President and Chief Actuary

SCAN Health Plan

10:50AM – 11:10AM
Networking Morning Break

11:10AM – 12:00PM

The Bid Cycle: Project Management and Year-Round Process Design Strategies

  • Create a successful project management structure with C-suite buy-in, a multi-disciplinary review, and CMS deadline-driven project schedule for a smooth annual bid process
  • Coordinate simultaneous inputs from multiple departments strategically, for optimal bid build
  • Build out a provider network that meets CMS adequacy requirements and improves member satisfaction


Moderator:  Roderick Kersch, Vice President of Healthcare Solutions Sales & Marketing  

InComm Healthcare 



Kimberlie Breu, MBA, Product Manager – Senior Care Products 

BlueCross BlueShield of Tennessee 


Tara Richardson, Director of Actuarial Services 


12:00PM – 12:45PM

Define Your Market Strategy and Create Your Most Impactful Bid

  • Explore the key factors you should know about your market and where to find the data to strategically gain an edge on your competition
  • Learn which key variables drive shopping decisions and how to weigh each in the bid strategy
  • Project your success rate in a limited budget reality: evaluating strengths, weaknesses, and what brings the most value to your target market


Paul Cain, AVP Medicare Product


12:45PM – 1:45PM
Networking Lunch

1:45PM – 2:30PM

Internal Analytics to Better Customize Your Plan and Boost Membership

  • Learn key waysto analyze your membership characteristics to help improve plan performance 
  • Discover innovative approaches and best practices for how plans configured their ROI processes for new supplemental benefits
  • Identify missing and needed metrics to better assess program utilization, impact to quality of care, members’ plan selection, and plan revenue


Puneet Budhiraja, Chief Actuary and Senior Vice President 

Capital District Physicians Health Plan 


2:30PM – 3:15PM

The Early Numbers on Supplemental Benefits Flexibility

  • Assess plans’ preliminary results from introducing health-related supplemental benefits newly allowed by CMS
  • Better understand how investing in social programs like housing, food, and transportation reduces healthcare costs
  • See whether and how the uniformity requirements flexibility impacted quality of care, members’ plan selection, and plan revenue


Allison Hess, Vice President of Health Innovation


3:15PM – 3:30PM
Networking Afternoon Break

3:30PM – 4:15PM

Estimating the Value of Incorporating Benefit Changes Using Social Determinants of Health (SDOH) Elements

  • Uncover approaches to identify members needing assistance with addressing specific SDOH needs
  • Explore actuarial methodologies to estimate the size of the financial opportunities of addressing SDOH needs
  • Delve into the financial impacts of offering SDOH related benefits to the MAPD bid process
  • Gain a framework for closing the communication loop between the various entities involved in addressing SDOH needs – the health plan, the Community Based Organization (CBO), the healthcare provider and the member


Rajesh MunjuluriDirector and Medicare Actuary 

Capital District Physicians Health Plan

4:15PM – 5:00PM

Entering the Medicare Advantage Market, it’s as Easy as ABC

  • Discuss a partnership model that addresses the creation of a Medicare Advantage Plan 
  • Learn about operational expertise for successful implementation 
  • Hear about a partnership that takes risk and puts up a capital contribution and minimizes your financial outlay 


Pritpal Virdee, President 



Kiran Kuchibotla, Vice President, Client Implementations 


5:00PM – 5:45PM

“Choose Your Own Adventure” Conversation Session

Join a facilitated roundtable discussion on such topics as:


  • Related Party bid requirements and business considerations


Facilitator:  Tara Richardson, Director of Actuarial Services, Cigna  


  • Assess plans’ preliminary results from introducing health-related supplemental benefits newly allowed by CMS


Table 1 Facilitator:  Kathryn Qin, FSA, MAAA, Corp. VP, Actuarial Services, SCAN Health Plan 


Table 2 Facilitator:  Rajesh Munjuluri, Director and Medicare Actuary, Capital District Physicians Health Plan 


  • Identify the benchmarks, targets, and areas to research to make sure your product is on track and viable 


Facilitator:  Danica Holliston, Medicare Product Manager, Regence BlueCross BlueShield of Oregon  


  • Project Management and Year-Round Process Design Best Practices


Facilitator:  Kimberlie Breu, MBA, Product Manager – Senior Care Products, BlueCross BlueShield of Tennessee  


  • Gain insight and tactics to financially manage a plan/product after it’s released 


Facilitator:  Angela M. Moczan, CPA, Chief Financial Officer, Medicare Products, UPMC Insurance Services 


  • Calculating persona based OOPC, supplemental benefit value, and other benefit design metrics to improve competitive positioning.


Facilitator:  Anirudh Bhutani, Lead Data Scientist, TEG Analytics 

5:45PM – 6:45PM
Networking Reception

January 28, 2019

7:30AM – 8:30AM
Networking Breakfast

8:30AM – 8:35AM

Day Two Opening Remarks

Ana Handshuh, CHC, Principal 

CAT5 Strategies 

8:35AM – 9:20AM

Risk Score Mechanics and Impact to Plan Revenue

  • Learn how risk adjustment assumptions dial into your revenue modeling for the CMS bid
  • Discover how the on-going risk adjustment activities – such as retrospective and prospective –contribute to revenue projections
  • Understand the calendar of CMS mid-year adjustments, “sweeps” activities, and assumptions that factor into your bid cycle milestones


Michiru Shibata, Consulting Actuary 

Health First Health Plans 

9:20AM – 10:05AM

Leveraging Your Plan Data to Drive Medicare Advantage Bid Strategy

  • Use your internal data to build strategy, design your product, determine incentives, and more
  • Learn how to mine your own plan data to use in your bid process


Lucretia Hydell, Director of Actuarial Services 

Johns Hopkins HealthCare 

10:05AM – 10:50AM

Part D: Ensuring it Makes (Not Breaks) Your Plan

  • Leverage both clinical and financial goals to lower costs 
  • Understand the levers to optimize your formulary tier structure and design a pharmacy plan to boost member retention and star ratings
  • Benchmark strategy and pricing of biosimilar drugs newly on the market


Ryan DavisManager, Pharmacy Medicare Programs 

Kaiser Permanente 

10:50AM – 11:10AM
Networking Morning Break

11:10AM – 11:50AM

Critical Considerations as ESRD Eligibility Expands in 2021

  • Review the previous and current ESRD eligibility and payment methodology
  • Survey ESRD eligibility changes required by the 21st Century Cures Act
  • Identify key questions each plan should consider for 2021


Kelly Backes, Principal and Consulting Actuary



Gokce Yilmaz, Actuary 



Douglas Rodrigues, Associate Actuary 


11:50AM – 12:20PM

A SUCCESS STORY: From Predictions and Assumptions to a Financial Turnaround

  • Identifying the Problem: What went wrong, and how and when did we figure it out? 
  • Weighing the Options: Assessing the pros and cons of various solutions, and how we got executive buy-in 
  • Projecting the Unknown: Predicting member behavior and estimating migration assumptions 
  • The Results: Monitoring the outcome, measuring profitability, and lessons learned


Benjamin Nadler, Director, Actuarial Services 

Independent Health 


Amy Garrow, Manager, Actuarial Services 

Independent Health 

12:20PM – 1:20PM
Networking Lunch

1:20PM – 2:00PM

After the Bid is in: Desk Review, Audits and Required Changes

  • Best practices to limit mistakes and bid reuploads
  • Avoid road bumps in the bid process by understanding what bid auditors pay close attention to
  • Prepare for CMS’ announcement on Part D National Average Bid Amount (NABA) and its impact to your bid planning


Thomas Grivakis, ASA, MAAA, Consulting Actuary  

Wakely Consulting Group 

2:00PM - 2:30PM

SPECIAL PRESENTATION: Part C Legislative and Regulatory Updates and Market Trends to Watch

  • Understand what’s changing and how to build your bid strategically for potential impacts to plan revenue
  • Discuss proposed CMS and legislative actions


Ana Handshuh,  CHC, Principal 

CAT5 Strategies 


Tim Murray, Director and Senior Consulting Actuary  

Wakely Consulting Group 

2:30PM – 3:00PM

Part D Legislative and Regulatory Updates

  • Prepare for significant Part D benefit design changes currently being considered in both chambers of Congress
  • Explore the proposed solutions, such as having plans take more liability, eliminating the coverage gap and reducing member out-of-pocket costs
  • Understand the potential impact to financial stakeholders, current pricing strategies, preferred pharmacy networks and Pharmacy DIR 


Matt Hayes, FSA, MAAA, Consulting Actuary 



Closing Remarks and Conference Concludes

Ana Handshuh, CHC, Principal 

CAT5 Strategies