2019 Agenda

September 23, 2019

8:00 - 9:00 AM
Workshop and Conference Registration

9:00AM - 12:00 PM

Workshop: Exploring the Relationship Between Product Design, Risk Adjustment, and Revenue

  • Understand the calendar of CMS mid-year adjustments, “sweeps” activities, and assumptions that factor into your bid cycle milestones 
  • Learn howongoing risk adjustment activities  such as retrospective and prospective contribute to revenue projections 
  • Dialogue with risk adjustment professionals about how actuarial assumptions need to factor in conservatism and hedge against risks 
  • Learn how risk adjustment assumptions dial into your revenue modeling for the CMS bid 
  • Compare the impact to revenue projections of new-to-Medicare membership growth and OEP membership changes
  • Determine what other product design professionals do to manage ambiguity in this interactive workshop 

  

Shannon Decker, MEd, MBA, MBA, PhD, VP, Clinical Performance

Brown & Toland

 

Lucretia Hydell, Director of Actuarial Services

John Hopkins HealthCare

12:00 - 1:00 PM
Conference Registration and Networking Lunch

1:00 PM - 1:10 PM

Welcome and Chairperson’s Opening Remarks

Danica Holliston, Medicare Product Manager 

Regence BlueCross BlueShield of Oregon 

1:10 - 1:55 PM

The Early Numbers on Supplemental Benefits Flexibility

  • Hear plans’ preliminary results from introducing health-related supplemental benefits newly allowed by CMS starting in 2018 
  • Better understand how investing in social programs like housing, food, and transportation reduces healthcare costs 

 

Paul Cotton, Director, Federal Affairs  

National Committee for Quality Assurance (NCQA) 

1:55 - 2:40 PM

KNOW YOUR REGS: Part C Regulatory Changes Impacting Product Design

  • Prepare your organization to satisfy the CMS Interoperability and Patient Access Proposed Rule 
  • Hear how plans are tackling financial challenges of the CHRONIC Care Act 
  • Learn the fallout from the restored OEP 
  • Get insight into how CMS might craft next year’s Final Call Letter 
  • Discuss other proposed CMS actions such as Medicare for all 

 

Shannon Decker, MEd, MBA, MBA, PhD, VP, Clinical Performance

Brown & Toland 

 

2:40 - 3:00 PM
Afternoon Networking Break

3:00 - 3:45 PM

KNOW YOUR REGS: Part D Reforms Impacting Product Design

  • Know the impact the bipartisan effort to cap out-of-pocket medication costs may have on your bottom line
  • Prepare for potential legislative and regulatory changes for Part Dbenefit designs and rebates
  • Delve into the proposed changes to the coverage gap, the catastrophic threshold, low-income subsidies, and boosting of generics over brand-name drugs

 

Gary Melis R.Ph., Clinical Pharmacist

Network Health

 

Matt Hayes, FSA, MAAA, Consulting Actuary 

Milliman 

3:45 - 4:30 PM

KNOW YOUR REGS: Managing the Disconnected Timelines Between CMS Notices and the Bid Process

  • Hear how plans are responding to the spate of new legislation and Administrative actions
  • Gain new strategies: learn how different plans approach submission deadlines in the absence of final CMS rules
  • Discover how plans link product build strategy and process timelines to CMS deadlines

 

Moderator: Hank Osowski, Managing Director 

Strategic Health Group  

 

Panelists:

 

Naomi Irvin, Manager, Divisional Compliance - Sales, Marketing & Communications

BlueCross BlueShield, North Carolina

 

Hannah Neylon, Government Programs Manager

Network Health

 

Danica Holliston, Medicare Product Manager 

Regence BlueCross BlueShield of Oregon 

4:30 - 5:15 PM

Increase Your Plan’s Competitiveness

  • 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 best practices for analyzing competitive intelligence  
  • Understand your market to secure differentiation and growth 

 

Julia Friedman, FSA, MAAA, FCA, Consulting Actuary 

Milliman 

 

Nick Lewis, FSA, MAAA, FCA,  Actuary 

Milliman 

5:15 - 6:15 PM
Networking Cocktail Reception

September 24, 2019

8:00 - 9:00 AM
Networking Breakfast

9:00 - 9:10 AM

Summary of Day One and Opening Remarks

Danica Holliston, Medicare Product Manager 

Regence BlueCross BlueShield of Oregon 

9:10 - 9:55 AM

New Ways to Tailor Benefits to Special Populations

  • Examine examples of value-based initiatives, CSNP, and SSBCI and how you can implement them 
  • Expand your DSNPS and ISNPS and move towards better integration 
  • Discuss how to document the criteria used to define your population subsets 

Hank Osowski, Managing Director 

Strategic Health Group 

9:55 - 10:40 AM

Leveraging Big Data for Targeted Plan Design

  • Leverage SDoHand big data to design plans that meet the needs of your targeted population 
  • Optimize your position in the Medicare Plan Finder through OOPC simulations
  • Discover how to create and test multiple benefit scenarios before submitting a bid
  • Leverage self-serve analytics to reduce expense & capitalize on efficiencies

 

Jereme Ayers, Client Partner

TEG Analytics

 

Aditya Kumar, Manager, Healthcare Product Strategy

TEG Analytics

 

10:40 - 11:00 AM
Morning Networking Break

11:00 - 11:45 AM

MAPD Product Life Cycle: You Can’t Manage What You Don’t Measure

  • Optimize product design and financial performance via centralized data management 
  • Improve product life cycle management with actionable analytics 
  • Connect data sources to downstream operations 
  • Optimize operations and connect the dots between departments to support product success 

 

Dave Neiman, FSA, MAAA, Principal and Senior Consulting Actuary 

Wakely Consulting Group 

 

Sion Hughes, Consultant – Market and Provider Strategist 

Wakely Consulting Group 

11:45-12:30 PM

Managing Part D Formulary to Optimize Star Ratings and Population Health Management

  • Learn how to leverage pharmacy for member engagement
  • Explore use of preferred pharmacy networks for better adherence
  • See how formulary development and contracting fit into the product design timeline

Moderator:

 

Julia Friedman, FSA, MAAA, FCA, Consulting Actuary

Milliman

 

Panelists:

 

Ryan Davis, Manager, Pharmacy Medicare Programs

Kaiser Permanente

 

Dominic Vu, Director of Pharmacy Services

USI Securities

 

Gary Melis R.Ph., Clinical Pharmacist

Network Health

12:30 - 1:30 PM
Networking Lunch

1:30 - 2:15 PM

Focus on Innovative Benefit Designs with Automated CMS PBP Submissions and Document Generation (ANOC, EOC, SB, Kits, Highlight sheets)

  • Leverage single-source plan and benefit information to improve accuracy, consistency and efficiency 
  • Reduce benefit and compliance errors, benefit inquiry call time, and administrative costs for easier Medicare and MA product build
  • Shift away from manual processes to accommodate last minute changes needed in output and documents
  • Enable collaboration across all stakeholders through efficient workflows

Mohammed Vaid, CEO and Chief Solution Architect  

Simplify Healthcare Technology 

2:15 - 3:00 PM

A Deep Dive into the Risks and Opportunities of Supplemental Benefits Flexibility

  • Ensure proper utilization via strategic implementation – supporting brokers and sales during AEP, IT during building in encounter claim data, and member relations for an elevated member experience 
  • Hear innovative approaches and best practices for how plans configured their ROI processes for newly allowed supplemental benefits
  • Structure vendor/supplemental benefit relationships around aligned incentives
  • Determine missing and needed metrics for use of programs and impact to quality of care, members’ plan selection, and plan revenue

Moderator: Joseph Corson, National Manager, Strategic Partnerships 

Connect America  

 

Panelists: 

Lucretia Hydell, Director of Actuarial Services 

Johns Hopkins HealthCare 

 

Hannah Neylon, Government Programs Manager 

Network Health

 

Kimberlie Breu, MBA, Product Manager – Senior Care Products 

BlueCross BlueShield of Tennessee

 

3:00 PM

Chairperson’s Closing Remarks and Conference Concludes

Danica Holliston, Medicare Product Manager 

Regence BlueCross BlueShield of Oregon