Page 1

Market insights – Regulatory updates – Innovative strategies

September 23 - 24, 2019 Fairmont Dallas | Dallas, TX v6 ms 8.13.19

Back for its third year, the RISE Medicare Product Design Master Class brings an unmatched conference experience to product development and product design professionals from Medicare Advantage health plans. Expect to hear curated content that provides market insight, regulatory updates, and innovative strategies for product design while providing an open environment for interactive peer-led discussions focused on ideas to differentiate from national carriers to grow and retain your membership base year-on-year.


C A R EF UL LY CR A F T ED SE S SIONS FROM A N E S T EEMED L INEUP OF INDU S T RY T HOUGH T L E A DER S Join us for up-to-the-minute industry data, trends, and strategies to safeguard your place and prosperity in this space. Explore the opportunities and challenges associated with the current Medicare product design landscape in an intimate environment, primed for peer to peer exchange. Participate in interactive discussions designed to help you build your strategy, differentiate your product through competitive intelligence insights and how-tos, evaluate supplemental benefits and tailor them to special populations, and strategize through the recent and upcoming regulatory changes and the increasingly competitive market.

T OP R E A S ONS T O AT T END This year’s RISE Medicare Product Design Master Class will be comprised of two pre-conference workshops – for those who want a deep dive into member retention strategies or risk adjustment knowledge – plus eleven forward- and strategy-focused conference sessions, all presented by an esteemed lineup of industry thought leaders.

1

Hear plans’ preliminary results from introducing healthrelated supplemental benefits allowed by CMS as of 2019

4

Explore new ways to tailor benefits to special populations, such as valuebased initiatives, CSNP, and SSBCI and how you can implement them

2

r i s e h e a l t h . o r g /p r o d u c t - d e s i g n

2

Learn how risk adjustment assumptions dial into your revenue modeling for the CMS bid

5

Learn best practices for analyzing competitive intelligence to understand your market, differentiate from the competition, and grow.

3

Identify and overcome key operational challenges, such as interdepartmental coordination and adequately engaged members, for a properly built and utilized product

6

Learn quantitative and qualitative ROI measurement approaches for new supplemental benefits, and better understand how investing in social programs like housing, food, and transportation reduces health care costs.

September 23 -24 , 2 019


VENUE DETAILS

FAIRMONT DALL A S 17 17 N AK ARD ST DALL A S , T X 752 0 1 (21 4) 72 0 -2 0 2 0 Fairmont Dallas is ideally located in the heart of the downtown Dallas Arts District, surrounded by an array of fine-dining restaurants, shopping, arts and entertainment. Combining the elegance of classic hospitality with an authentic Texan flair, this iconic luxury hotel is located a few blocks from the Central Business District, less than one mile from the world-famous Sixth Floor Museum at Dealey Plaza, walking distance from the American Airlines Center and within easy access of Deep Ellum’s thriving nightlife scene and live music venues We have a block of rooms reserved at a special rate of $179/night. This rate expires on August, 30, 2019; although, we expect the block to sell out prior to this date. To receive a room at the negotiated rate book well before the expiration date. Mention the “Medicare Product Design Master Class” when placing your room reservation by phone to receive the negotiated rate. We urge you to book your room early as we expect the block will sell out. Upon sell out of the block room rate and availability will be at the hotel’s discretion. Please call 214-720-5249 to book your room. BOOK YO UR RO O M

Fa i r m o nt D a l l a s | D a l l a s , T X

Click Here to Register

3


WHO WILL AT TEND? This year’s event is designed primarily for those in Medicare Advantage product design, but also for those in sales and marketing, finance and revenue management, operations, who are looking to gain market insight, best practices for launching a new product and getting approval from CMS, and strategies for staying ahead of the competition. Conference participants will network with professionals including: 01

13

Product pricing directors

02 Medicare actuaries

14

Chief financial officers

03 Sales and marketing executives

15

Strategy & performance officers

04 Bid development specialists

16

Project managers

05 Vendor oversight

17

Product development consultants

06 Medicare advantage sales directors

18

Supplemental benefit providers

07

19

PBMs

Medicare product managers

Market strategies advisors

08 Financial analysts

20 Pharmacy services directors

09 Medicare product pharmacy program managers

21

10

Market research directors

23

11

Business development leaders

12

Chief operations officers

Risk adjustment managers

22 Market strategy consultants Enterprise quality and accreditation officers

24 Consultants and technology providers are also encouraged to attend.

R E G ISTE R TO DAY

4

r i s e h e a l t h . o r g /p r o d u c t - d e s i g n

September 23 -24 , 2 019


PAST AT TENDING COMPANIES A sample of over 150 past attending companies: Aetna

HealthTeam Advantage

ALC

Independent Health

AppleCare Medical Management

Jack Schroeder & Associates

Armadahealth

Johns Hopkins HealthCare LLC

BCBSM - COBX

Kaiser Permanente

Blue Cross and Blue Shield of Florida

Mazars USA LLP

Blue Cross Blue Shield Arizona

Medical Mutual of Ohio

Blue Cross Blue Shield of Kansas City

Medtronic Care Management Services

Blue Cross Blue Shield of Michigan

Memorial Hermann Health Plan

BlueCross BlueShield of Tennessee

Mercy

Capital District Physcians Health

Milliman

CareOregon Inc

Molina Healthcare

Centene

Nascentia Health

Clover Health

Network Health

CommunityCare

Optum

Complex Care Management

Oscar

Convey Health Solutions

Premera Blue Cross

eviCore healthcare

Priority Health

Evolent Health

Prizm Health Advisory, LLC

Excellus BlueCross BlueShield

Regence BCBS

Floyd ACO

Strategic Health Group

Geisinger Health Plan

Sutter Health

Gorman Health Group

TEG Analytics LLC

Harvard Pilgrim Health Care

Trinity

Health Care Service Corporation

TruHearing

Health First

Tufts Health Plan

Health Mine Inc

Vantage Health Plan

Health New England

Verscend

HealthMine, Inc.

Wakely

HealthNow New York Inc

Wellcare, Inc.

Healthscape Advisors

WPS Health Solutions

Fa i r m o nt D a l l a s | D a l l a s , T X

Click Here to Register

5


PRE-CONFERENCE WORKSHOPS: MONDAY, SEPTEMBER 23, 2019 8:00AM – 9:00PM

Workshop and Conference Registration

8:00AM – 6:00PM

Exhibit Hall Open

9:00AM – 10:30AM

WORKSHOP A:

WORKSHOP B:

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

Winning at the Member Experience

Par t 1: • Understand the calendar of CMS midyear adjustments, “sweeps” activities, and assumptions factor into your bid cycle milestones • Learn how the on-going activities work in risk adjustment such as retrospective and prospective activities contribute to revenue projections • Dialogue with risk adjustment professionals about how actuarial assumptions need to factor in conservatism and hedge against risks Manuel Gaidola, Director Devoted Health

• Build a comprehensive, cross-functional calendarized approach for member engagement • Ensure your marketing plan properly communicates what you’re building for proper utilization and customer satisfaction • Create and foster personalized, omnichannel communication with your members for member retention and growth Hannah Neylon, Government Programs Manager Network Health Kimberlie Breu, MBA, Product Manager – Senior Care Products BlueCross BlueShield of Tennessee

10:30AM – 10:45AM

Networking Break

Networking Break

10:45AM – 12:00PM

Par t 2:

Technology and Member Satisfaction

• Learn how risk adjustment assumptions dial into your revenue modeling for the CMS bid • Grasp the impact of new to Medicare membership growth versus OEP membership losses change the revenue projections compared to your bid • Determine what other product design professionals do to manage ambiguity in this interactive workshop

• Learn how technology can enhance the member experience and improve engagement • Tools that increase member satisfaction and retention

Manuel Gaidola, Director Devoted Health

6

Your Keys to Successful Member Retention

r i s e h e a l t h . o r g /p r o d u c t - d e s i g n

Naomi Irvin, Manager, Divisional Compliance - Sales, Marketing & Communications BlueCross BlueShield, North Carolina Jim Reilly, VP Telehealth Connect America

September 23 -24 , 2 019


CONFERENCE DAY ONE: MONDAY, SEPTEMBER 23, 2019 12:00PM – 1:00PM

Conference Registration and Networking Lunch

1:00PM – 1:10PM

Welcome and Chairperson’s Opening Remarks Danica Holliston, Medicare Product Manager Regence BlueCross BlueShield of Oregon

1:10PM – 1:55PM

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)

1:55PM – 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

2:40PM – 3:00PM

Afternoon Networking Break

3:00PM – 3:45PM

KNOW YOUR REGS: Part D Reforms Impacting Product Design • Understand Part D Payment Modernization model’s impact to program design and incentives • Know the impact the bipartisan effort to cap out-of-pocket medication costs may have on your bottom line • Prepare for the Administration’s proposed elimination of safe harbor protections for drug manufacturer rebates to pharmacy benefit managers • 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

Fa i r m o nt D a l l a s | D a l l a s , T X

Click Here to Register

7


3:45PM – 4:30PM

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

4:30PM – 5:15PM

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

5:15PM – 6:15PM

8

Networking Cocktail Reception

r i s e h e a l t h . o r g /p r o d u c t - d e s i g n

September 23 -24 , 2 019


CONFERENCE DAY TWO: TUESDAY, SEPTEMBER 24, 2019 8:00AM – 9:00AM

Networking Breakfast

8:00AM – 3:00PM

Exhibit Hall Open

9:00AM – 9:10AM

Summary of Day One and Opening Remarks Danica Holliston, Medicare Product Manager Regence BlueCross BlueShield of Oregon

9:10AM – 9:55AM

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

9:55AM – 10:40AM

Leverage Big Data for Your Membership Growth Strategy • Use public data sets to build financial models within budget • Find the best plan design for each market segment • Best practices to analyze your plan’s experience for projections and planning

10:40AM – 11:00AM

Morning Networking Break

11:00AM – 11:45AM

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

Fa i r m o nt D a l l a s | D a l l a s , T X

Click Here to Register

9


11:45AM – 12:30PM

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 Ryan Davis, Manager, Pharmacy Medicare Programs Kaiser Permanente Dominic Vu, Director of Pharmacy Services USI Securities Gary Melis R.Ph., Clinical Pharmacist Network Health

12:30PM – 1:30PM

Networking Lunch

1:30PM – 2:15PM

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

10

r i s e h e a l t h . o r g /p r o d u c t - d e s i g n

September 23 -24 , 2 019


2:15PM – 3:00PM

Craft Your ROI Process to Better Customize Your Plan and Boost Membership Acquisition • Hear innovative approaches and best practices for how plans configured their ROI processes • Learn quantitative and qualitative ROI measurement approaches for new supplemental benefits • Discuss which other departments need to be involved in both the quantitative and the qualitative components of the ROI process • Determine missing and needed metrics for use of programs and impact to quality of care, members’ plan selection, and plan revenue Moderator Jim Reilly, VP Telehealth Connect America Panelists: Lucretia Hydell, Director of Actuarial Services Johns Hopkins HealthCare

3:00PM

Chairperson’s Closing Remarks and Conference Concludes Danica Holliston, Medicare Product Manager Regence BlueCross BlueShield of Oregon

Due to our commitment to bring you the best program possible, our agenda is constantly evolving. To access the most upto-date version, please visit our website.

Fa i r m o nt D a l l a s | D a l l a s , T X

Click Here to Register

11


CONFERENCE R ATES EARLY BIRD RATE

STANDARD RATE

ONSITE RATE

Ends 8/02/19

Ends 9/22/2019

HEALTH PLANS & HEALTH CARE PROVIDERS

$1,495

$ 1,695

$ 1,895

SERVICE PROVIDERS & CONSULTANTS

$ 1,995

$ 2,195

$ 2,395

PRE-CONFERENCE WORKSHOP +$300

GROUP DIS C OUN T S A R E AVA IL A BL E Please contact Laura McLain at 704.341.2390 or lmclain@risehealth.org In order to secure a group discount, all delegates must place their registrations at the same time. Group discounts cannot be issued retroactively. For information regarding refund, complaint and/or program cancellation policies, please visit our website: https://risehealth.org/the-fine-print/

HOW T O R EGIS T ER

CALL

REGISTER ONLINE

704.341.2390

risehealth.org/product-design (Click to Register Online)

MAIL

Wilmington FRA 3420 Toringdon Way, Suite 240 Charlotte, NC 28277

Write H630 on your check. 12

r i s e h e a l t h . o r g /p r o d u c t - d e s i g n

September 23 -24 , 2 019


THE CONFERENCE ORGANIZER

RISE is the premier community for health care professionals who aspire to meet the extraordinary challenges posed by the emerging landscape of accountable care and government health care reform. Recognized industry-wide as the number one source for information on risk adjustment and quality improvement within health care, RISE strives to serve the community on four fronts: networking, education, industry intelligence and career development. Through cutting-edge conferences, online courses, in-house training, webinars as well as an association comprised of over 2,500 members, RISE provides professionals with industry insights and critical information they need to stay ahead of the curve. RISE produces more than 30 conferences annually, focused on sophisticated topics and ample networking opportunities for thousands of executives from mid- to senior-level and C-suite. Our team of subject matter experts is often first to market with emerging topics and we pride ourselves on consistently delivering on top quality operations and logistics to produce a seamless event.

LEARN MORE AT R IS E H E ALTH . O RG

SPONSORSHIP AND EXHIBIT OPPORTUNITIES Enhance your marketing efforts through sponsoring a special event or exhibiting your product at this event. We can design custom sponsorship packages tailored to your marketing needs, such as a cocktail reception or a custom-designed networking event. To learn more about sponsorship opportunities, please contact Sarah Scarry at 704.341.2442 or sscarry@risehealth.org.

Fa i r m o nt D a l l a s | D a l l a s , T X

Click Here to Register

13


GOLD SPONSORS

Milliman is among the world’s largest providers of actuarial, risk management, and related technology and data solutions. Our consulting and advanced analytics capabilities encompass healthcare, property and casualty insurance, life insurance and financial services, and employee benefits. With more than 3,800 employees and revenue of US$1.1 billion in 2018, the firm serves the full spectrum of business, financial, government, union, education, and nonprofit organizations. Founded in 1947, Milliman today has offices in principal cities worldwide, covering markets in North America, Latin America, Europe, Asia and the Pacific, the Middle East, and Africa. For further information, visit milliman.com.

SILVER SPONSORS

Connect America’s mission is to help you better serve your members, with industry-leading Connected Health Solutions that can reduce ER visits and hospitalization rates, improve outcomes and lower utilization costs. We are the nation’s largest independent remote patient monitoring company. We have regional offices throughout the U.S., partner with more than 1000 healthcare organizations and monitor more than 375,000 lives daily. Our solutions include; Personal Emergency Response Systems, Remote Patient Monitoring Solutions and Medication Adherence.

Simplify Healthcare provides market-leading solutions to health plans & TPAs for their benefit plan management, provider data-contract & value-based reimbursement needs. With our digital business process transformation suite Simplify9, we build highly configurable & modular solutions that enable health plans to improve their speed-to-market, efficiency, compliance and reduce costs & errors. eMedicareSync is the industry’s first turn-key MA product/plan configuration solution that automates CMS PBP-Bid process and auto-generates ANOC, EOC and SB compliance documents.

14

r i s e h e a l t h . o r g /p r o d u c t - d e s i g n

September 23 -24 , 2 019


Wakely is the premier source for healthcare actuarial consulting, helping clients understand the complex and evolving world of healthcare, using the best tools, talent, and data. Our consultants have substantive experience working with payers, purchasers, and healthcare providers. We help our clients succeed through disciplined and transparent work, assessment of options, creative problem solving, attention to deadlines, and the ability to clearly communicate and document complex issues. Wakely goes beyond the numbers.

BRONZE SPONSORS

Fa i r m o nt D a l l a s | D a l l a s , T X

Click Here to Register

15

Profile for WilmingtonFRA

Medicare Product Design Master Class [H630]  

Back for its third year, the RISE Medicare Product Design Master Class brings an unmatched conference experience to product development and...

Medicare Product Design Master Class [H630]  

Back for its third year, the RISE Medicare Product Design Master Class brings an unmatched conference experience to product development and...