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Last Year's Agenda

Thursday - August 6, 2020

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Welcome and Chairperson’s Opening Remarks

Matt Hayes, FSA, MAAA, Consulting Actuary 

Milliman  

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Part D Legislative and Regulatory Updates

  • COVID-19 updates: expanded telehealth, surveillance reports, new rates and more 
  • Get a deeper understanding of the Part D changes finalized in MA CY 2021/2022 and the Part D Technical Rule
  • Learn about CMMI’s Part D Senior Savings Model and what it means for your plan 
  • Prepare for legislative proposals to reform the Part D program 

 

Aldiana Krizanovic, Senior Health Policy Consultant  

Florida Blue

 

David Mike, FSA, MAAA, Consulting Actuary 

Milliman 

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Tech Break

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COVID-19: Part D Operational Considerations

  • Develop a new strategy to respond to CMS’ changed assessment method of plan sponsors’ 5-star metrics
  • Establish oversight over the changes made because of COVID centric guidance
  • Inventory monitoring practices to aid preparations for CY2022

 

Ryan Davis, Manager, Pharmacy Medicare Programs 

Kaiser Permanente 

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Understand the Impact to Part D: Litigation, Legislation, and CMS Changes Built to Combat Opioid Overuse

  • Discuss recent Part D changes to drug management programs* and new program audit protocols
  • Get guidance around CMS’ Overutilization Monitoring System (OMS) to prevent and combat opioid overuse
  • Understand the ongoing concern of opioid multidistrict litigation (MDL) to manufacturers, wholesalers and pharmacies

 

Amy A. Poe, Attorney

Hall, Render, Killian, Heath & Lyman

 

Brian Wehneman R.Ph., Director, HCS Compliance and Risk Management  

Humana 

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Tech Break

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Perfecting the Framework for Your Medication Therapy Management Program

  • Learn how other plans are prioritizing and determining who is at-risk and who should get the resources
  • Review the 2020 Overutilization Monitoring System guidance from CMS and its potential impact to CY2021
  • Discuss the most common Medicare noncompliance issues for MTMs and how to fix them

 

Gary Melis R.Ph., Clinical Pharmacist
Network Health

 

 

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Tech Break

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Special Considerations Around Formulary Design

  • Leverage formulary design to drive selection, efficiency, quality, and financial results
  • Study the connection between how rebates are addressed within the PBM contract and your CMS bid
  • Understand the financial nuances with formulary placement for biosimilar drugs as their presence grows in the market
  • Discuss the all new guidance around Medicare covered transplants (ABII)

 

Cody Olsen, PharmD, BCPS, Pharmacy Operations and Quality Manager 
SelectHealth 

 

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Tech Break

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Managing of Benefits

  • Learn how various plans review cases and make coverage determination calls 
  • Delve into the pitfalls for the compliant administration of Part B versus Part D coverage determinations 
  • Study how to successfully operationalize other Part D specific requirements, such as Transition Logic, timeliness requirements, and ESRD 

 

Ryan Davis, Manager, Pharmacy Medicare Programs
Kaiser Permanente

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Chairperson’s Summary of Day One

Matt Hayes, FSA, MAAA, Consulting Actuary 

Milliman  

Friday - August 7, 2020

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Day Two Chairperson’s Welcome

Ana Handshuh, CHC, Principal
CAT5 Strategies

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Find the Contract Strategy that Fits Best

  • Understand the different PBM models and the impact to your contract strategy 
  • Learn which key components need to be included in your PBM contract to drive high performance, measure results, and enforce actions 
  • Discover how to structure contracts to best contain costs 
  • Discuss the trend in vertical integration and the impact to your data integrity and your relationship with your PBM 

 

Matt Hayes, FSA, MAAA, Consulting Actuary

Milliman

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Tech Break

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Partnering with Your FDRs for Compliance and Mutual Benefit

  • Assess various approaches to managing the business relationship with your FDR  
  • Identify obligations and goals, and ascertain how to get there
  • Manage and mitigate issues of non-compliance
  • Discuss methods to build trust and a collaborative relationship with your delegates  

 

Yusuf Rashid, Vice President 

Community Health Plan of Washington 

 

Dominic Vu, Senior Vice President, Pharmaceutical Strategies 

USI Insurance Services 

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Tech Break

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The CMS Program Audit: Overview and Preparedness

  • Understand what’s included in the audit and how best to prepare 
  • Best practices around compliance and coordination with PBM 
  • Identify how to validate what your PBM prepared including your universes 

 

Athena Patrikios, PharmD, Director, Pharmacy-Medicare
Horizon Blue Cross Blue Shield of New Jersey

 

Joy Enright, Director, Client Audit 

CVS Health 

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Lunch Break

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Expanding Mock Audits to Prepare for CMS Review

  • Identify the critical elements for building and maintaining an effective mock audit program 
  • Review who needs to be involved and how to get their buy-in for audit preparation and ongoing compliance 
  • Learn best practices for identifying issues prior to an audit and preparing flawless universe data to protect your audit score 

 

Ana Handshuh, CHC, Principal 
CAT5 Strategies 

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Tech Break

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You’ve Been Audited. What Do You Do Next?

  • Review steps that will ensure you’re in compliance over the four years before your next audit 
  • Learn best practices around independent validation of your monitoring activities  
  • Gain insight from first-hand experience of the different audits 
  • Discuss compliance program monitoring to be prepared for future audits  

 

Joy Enright, Director, Client Audit 

CVS Health 

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Tech Break

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Prepare Flawless Universe Data and Meet New Data Challenges

  • Discuss how to best prepare immaculate universe data  
  • Learn new ways to further evaluate your data for assured accuracy  
  • Identify and tackle challenges to prepare your audit universes of required samples for CMS 
  • Assess various controls and strategies that test data universes for operational compliance success 

 

David Reid, Senior Director, Operational Performance, Risk & Support 

Florida Blue 

 

Kimberly Detuccio, Data Governance Business Lead 

Florida Blue 

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Chairperson’s Closing Remarks and Conference Concludes

Ana Handshuh, CHC, Principal
CAT5 Strategies

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