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2018 Summit Report

April 22-24 Stony Brook, NY


I thought last year was great, but this year was even better. It will be interesting to hear what others thought, but each of the sessions were well developed and insightful. I especially thought that each session tied back well to core Softheon strengths and highlighted why you are so unique. Ferris Taylor, Executive Director, HCEG


Overview

Softheon Summit 2018 When you gather some of the healthcare industry’s top minds, great things happen. At this year’s Softheon Disruptive Innovation Summit, great things did happen. We had a vast array of attendees from all segments of the industry; from health plans and state governments, to trade groups and valued vendor/partners. The discussions centered around the evolution of healthcare, from trends and growth to destabilization and fortification. The emergence of Enhanced Direct Enrollment (EDE), the increase in popularity with HSAs, new legislation surrounding Association Health Plans, 1115/1332 Innovation Waivers, and Work Requirements are taking healthcare into a different direction than years past. Our group led the discussion on the importance of new processes and new technology to pave the way for a brighter, healthier future.

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Table of contents 2

Overview

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Featured speakers

7

Attendee list

10

Enhanced Direct Engagement

12

The future of SBMs & Social Determinants of Health

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Public health programs’ roles & goals

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Summit insights

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Softheon by the numbers

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Featured speakers Christopher Condeluci Principal, CC Law & Policy PLLC Rosemarie Day President, Day Health Strategies Heather Foster Vice President, ACAP Alan Gilbert Advisor, Commonwealth Health Advisors Jane Good Founder, JGood Advisors Tim Jost Emeritus Professor, Washington and Lee University School of Law Jon Kingsdale Senior Strategy Advisor, Wakely Consulting Group Jimmy Lee CEO, SimpLee Healthcare Consulting Juan MontaĂąez Principal, Health Management Associates Elena Nicolella Executive Director, NESCSO Charles Stellar President & CEO, WEDI Ferris Taylor Executive Director, Healthcare Executive Group (HCEG) Jim Wadleigh Former CEO, Access Health Connecticut 6


Attendee list

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LouAnn Anstis Vice President, Benefit Card Program Management, UMB

Joe Fox Consultant for Health Plan Ops, Kaiser Permanente

Steven Bressler Vice President, Parthenon Capital Partners

Carmen Francis Director, Information Technology, Centene

Bernie Buonanno Vice President, Parthenon Capital Partners

Alan Gilbert Advisor, Commonwealth Health Advisors

John Carbone SHOP Sales Manager, Access Health CT

Jane Good Founder, JGood Advisors

Christopher Condeluci Principal, CC Law & Policy PLLC

Burke Harris IT Director, Kaiser Permanente

Christopher Dass Vice President, Healthcare Investment Banking, Mizuho

Ben Harristhal IT Manager, Centene

Rosemarie Day President, Day Health Strategies

Paul Horner Director, Healthcare and Life Services, West Monroe Partners

Gary D’Orsi Director, Product Development, Access Health CT Small Business

Tim Jost Emeritus Professor, Washington and Lee University School of Law

Michelle Farmer-Anderson Director, Health Plan Service Administration, Kaiser Permanente

Fran Kannady Staff Vice President, Information Technology, Centene

Lana Fertel Senior Manager, Strategic Partnerships, Kaiser Permanente

Kevin Kareliussen Operations Strategy Lead, Cigna

Jay Fleming Director, AARP

Jon Kingsdale Senior Strategy Advisor, Wakely Consulting Group

Heather Foster Vice President, ACAP

Kelli Krueger Assistant Controller, Total Health Care


Mindy Lamb Vice President Operations, Individual and Family Plans, Cigna Jonathan Lee Managing Director, Mizuho Jimmy Lee CEO, SimpLee Healthcare Consulting Brian Maude Chief Financial Officer, Community Health Choice

Amanda Novak VP Healthcare Services, UMB Evelyn Olatunbosun Director, Operations Strategy, Community Health Choice Scott Orr Vice President, Strategic Accounts, Allison Payment Systems Tina Patel Senior Manager, West Monroe Partners

Kevin McCabe Senior Director, LexisNexis

Abhinav Ranjan Investment Banking Analyst, Mizuho

John McLeod Associate, Mizuho

Matthew Richardson Vice President, Business Development, UMB

Juan Montañez Principal, Health Management Associates

Joe Rolewicz Managing Director, Alliance Project Group

Jimmy Lee CEO, SimpLee Healthcare Consulting

Charles Stellar President & CEO, WEDI

Juan M. Montañez Principal, Health Management Associates

Elena Nicolella Executive Director, NESCSO

Tim Moylan Chief Information Officer, Florida Health Care Plans

Charles Stellar President & CEO, WEDI

Nicole Munden Strategic Account Representative, Allison Payment Systems, LLC Douglas Nelson Senior Director, Centene Elena Nicolella Executive Director, NESCSO

Ferris Taylor Executive Director, Healthcare Executive Group (HCEG) Jim Wadleigh CEO, Access Health Connecticut Angela Waltman Vice President, Sales and Member Operations, Community Health Choice 8


Attendee profile

Health Plan 46%

Consultants 24%

Health Advocacy Group 4%

Bank 22%

Overall attendance has grown 58% year over year since 2014


Enhanced Direct Engagement The original Direct Enrollment tool (DE Classic), was designed to give issuers a way to sell their Marketplace products through a branded, issuer-managed enrollment experience. While it undermines a basic tenet of the Marketplace – where applicants can compare multiple issuers’ products and pricing – DE provides a means for issuers to establish brand loyalty and increase retention by limiting the shopping experience to their products. The constraint, however, is that DE Classic was (and is) confined to initial enrollment. So, while it’s been an important tool for issuers and web-brokers, it’s very limited in terms of actual policy maintenance. Once the member is enrolled, any changes needed to the policy must be made through Healthcare.gov or by contacting the Marketplace Help Desk. Enhanced Direct Enrollment has expanded the functionality of its foundation (DE Classic), taking it beyond that initial application into an all-encompassing policy management portal. Using a series of real-time APIs that allow the EDE technology partner to exchange data with CMS, a member (or agent/broker) can use their EDE portal to enroll in a new policy, change their address a month later, add a spouse or newborn mid-year, retrieve CMS-based documents, and (hopefully) renew. All of those transactions still use CMS as the system-oftruth for eligibility validation, but the logic is happening behind the scenes. To the user, EDE becomes their all-purpose Marketplace engagement portal for maintaining their policy.

The Softheon Summit 2018 was a great opportunity to hear fresh ideas, listen to lively debates on public and private marketplaces, and to reinforce our appreciation for healthcare consumerism. Improving business operations is certainly a hallmark of Softheon, and being part of the session on real-time data exchange and using Blockchain changed my views on the power of data security and integrity by using this new technology. Charles Stellar, President & CEO, WEDI

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The future of State-Based Marketplaces The Federal Marketplace is destabilizing, and there are several key factors: The end of cost sharing reduction payments to insurers in 2018, the elimination of the individual mandate for OE 2019, the expansion of non-ACA compliant plans (short-term health plans, Association Health Plans), and the continued uncertainty among the various stakeholders in the industry. There are a few primary drivers of premium increases. One is medical trend, which is the change in costs of medical services and prescription drugs, utilization levels, and mix of services, contributing to 5-8% increase in premiums. A health insurer tax goes into effect after a 2017 moratorium, which increases premiums 2.7%, and the CSR subsidy has been eliminated. The rest of the increases could be attributed to decreased competition in the market and increased uncertainty. State marketplaces are outnumbered, but they did better during Open Enrollment. In 2018 Open Enrollment, Federally-facilitated Marketplaces had 28 states, State-based Marketplaces had 12 states, State-based Marketplaces on the Federal platform had 5 states, and Statepartnership Marketplaces had 6 states. Over the last two years, enrollment in FFM states declined by 10.5 percent and enrollment in state-based marketplaces increased by 1.5 percent.

Social Determinants of Health Affecting a broad range of health and quality-life outcomes, socioeconomic, and environmental factors constitute what is known as Social Determinants of Health (SDoH). SDoH are the conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels. As the industry moves towards consumerism, states must build a multi-dimensional SDoH view of their financially-assisted populations to positively influence consumer behaviors, reduce costs, increase consumer satisfaction, and identify outliers. SDoH trends are driving states and managed care organizations (MCO) to achieve the best outcomes at the lowest cost. These groups are championing the opportunity to better understand how Big Data and Machine Learning can be leveraged to address the social needs of health beneficiaries and provide better user experiences and service. Studies and insights from early state innovators are looking at policy improvements which can inform patient-level interventions, population health management, research and evaluation, and broader delivery system reform. 12


Attendees by title

C-suite 24%

VP 24%

Director 30%

2018

Manager 14%

Other 8%

78% of summit participants were CEOs, presidents, founders, or directors.


Public health programs’ roles & goals The initial elements of healthcare safety net The goal of the healthcare safety net is to make health insurance affordable for people with little income or financial resources. Medicaid and SCHIP have proven to significantly improve access and reduce disparities in care. These programs plus Medicare also support public hospitals, community health centers, and other elements of the health care safety net that directly provide health care to people without health insurance.

Covering home and community-based services, other chronic, rehab, and personal care support Public programs insure a disproportionate percent of Americans with disabilities or severe health problems. Medicaid’s services have adapted to this population’s needs, covering home- and community-based long-term care as well as support services like targeted case management, rehabilitation services, and personal care. It also covers long-term care and other services not covered by Medicare for low-income seniors (so-called “dual eligibles”). Medicare itself covers non-elderly people who receive Social Security Disability Insurance after a waiting period. Beyond these explicit eligibility rules, these programs serve as highrisk pools because of the correlation between costs, age, and impoverishment. Often, the reasons for low income are health-related and vice versa: low income creates stresses that diminish health.

Balancing, managing risk Public programs help private insurers manage risk… but balancing and managing the risk pool has proven to be tricky.

Flexible choice of providers, predictable coverage, relatively low administrative costs, and high ratings on access and satisfaction Some public programs, like Medicare, offer an alternative to private insurance in covering Americans. While Medicare has historically offered virtually free choice of health care providers, predictable coverage, relatively low administrative costs, and high ratings on access and satisfaction… it is having challenges encouraging primary and preventative care over specialist care.

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Summit insights Please indicate your overall satisfaction with the 2018 Softheon Summit

Registration Process Softheon Summit Content Speakers Venue Food & Beverage Networking Events Organization of the event Overall Event General Sessions Breakout Sessions 0%

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Summit insights How was your experience at Danfords Hotel & Marina?

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Dinner

Cocktail Hour

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Accommodations

85%

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Softheon By the numbers

60+ insurance carriers ~33% of HIX suppliers

$4B premiums processed HIX commerce

Compatible with Cognizant/TriZetto FACETS & QNXT, DST, Amisys, ikaSystems, HealthEdge, EPIC, & more

15 years providing advanced SaaS BPaaS solutions

3.2 million members ~37% of ACA membership

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About

Softheon Our mission at Softheon is to create simple, innovative solutions that make health insurance affordable, accessible, and plentiful. We create software that is trusted by over 60 healthcare payers participating on public exchanges, managing 37% of the overall ACA membership. From enrollment and premium billing to reporting and reconciliation, we are revolutionizing how health plans and states serve their members. We have a rich history of providing turnkey Software-asa-Service (SaaS) and Business Process as a Service (BPaaS) solutions that address state and health plan needs. For over 15 years, our solutions have provided the end-to-end tracking, monitoring, and reporting of business activities for individual and small group enrollment, financial management, and customer service processes.

(800) 236-7941 | info@softheon.com | www.softheon.com

Softheon 2018 Post Summit Report  

When you gather some of the healthcare industry’s top minds, great things happen. At this year’s Softheon Disruptive Innovation Summit, grea...

Softheon 2018 Post Summit Report  

When you gather some of the healthcare industry’s top minds, great things happen. At this year’s Softheon Disruptive Innovation Summit, grea...