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 


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  




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 



Nick Lewis, FSA, MAAA, FCA,  Actuary 


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



Julia Friedman, FSA, MAAA, FCA, Consulting Actuary





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  



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