1 Healthcare Education Associates and the Risk Adjustment Initiative & Society for Education Proudly Present Bonus! Special risk adjustment workshop! Health Insurance Exchanges Practical Implementation, Marketing and Risk Adjustment Strategies The only conference in the industry that focuses on actual implementation strategies November 29-30, 2012 The NEW Tropicana, Las Vegas Enrollment & Retention Strategies Product design & EHP Risk Adjustment Federally Facilitated Exchanges, State-Based Exchanges, Private Exchanges EXCHANGES Reinsurance, Risk Adjustment & Risk Corridors Technology Medicaid Expansion Demographics Product Development Network Strategy Pricing Operations Conference Sponsors Platinum: Silver: Bronze: Valuable Take-aways for Successful Insurance Exchange Implementation! Managing the risks associated with the new enrollee population Pricing products on the exchanges Getting your operational structure set and ready to go Practical tips for product design & Essential Health Benefit construction Getting your network strategy right Lessons learned from states: success stories & challenges dissected Federally facilitated exchanges: How will they work? Implications of the expansion of medicaid Exploring the role of private exchanges PLUS: A Special Workshop: Effective Risk Adjustment on the Exchanges To Register: Call or visit us at
2 The Summit Sponsors healthcare Education Associates is a division of Financial Research Associates, LLC. HEA is a resource for the healthcare and pharmaceutical communities to improve their businesses by providing access to timely and focused business information and networking opportunities in topical areas. Offering highly targeted conferences, Healthcare Education Associates positions itself as a preferred resource for executives and managers seeking cutting-edge information on the next wave of business opportunities. Backed with over 26 years of combined conference industry experience, the producers of HEA conferences assist healthcare professionals, actuaries, attorneys, consultants, researchers and government representatives in their professional endeavors. See for more information on upcoming events. RISE is the first national association totally dedicated to enabling healthcare professionals to meet the challenges of risk adjustment. We strive to serve our members on three fronts: Networking, Education, and Industry Intelligence. Enrollment is free for providers and health plans. To join, visit rasociety.org At many healthcare conferences, there s talk about how health insurance exchanges might work. But where s the practical guidance for marketing, risk adjustment and all the nuances of truly making exchanges successful? Healthcare Education Associates and RISE (the Risk Adjustment Initiative and Society for Education) are pleased to announce a health insurance exchange conference that we promise will deliver real, actionable, take-aways for effective exchange implementation. Join us this November in Las Vegas to discuss: The very latest regulatory updates Ways to segment your market How churn between the exchanges and Medicaid might affect your plan Ways plans will price exchange products based on risk adjustment, risk corridors and reinsurance Product design considerations and Essential Health Benefits making it all work Managing the landmines of pricing and risk: capital preservation for the high-impact members Getting your network strategy down pat Coping with the enormous operational and IT challenges How the Federally Facilitated Exchanges and State-Federal partnership models will work...and much more! PLUS: We re offering a special 3-hour workshop Effective Risk Adjustment on the Exchanges. In this workshop, you will learn: How risk adjustment will work after the risk corridor and reinsurance programs are phased out What the risk adjustment models look like What plans need to do now to get ready Lessons from the federal model for risk adjustment Turn the page and peruse the entire agenda and you ll see even more benefits of attending! Register today! Call or register online at Sincerely, Laura Garza Laura Garza, Senior Vice President HEALTHCARE EDUCATION ASSOCIATES P.S. Hear directly from an all-star State panel about their experiences! Top Reasons to Attend 1. Learn to manage the landmines of pricing and risk on the exchanges 2. Hear directly from states about how they re implementing their exchanges 3. Discover how private, public and hybrid exchanges will work 4. Effectively prepare your operations and IT departments to handle the enormous challenges they face 5. Determine the best way to optimize your network strategy 6. Understand how the three Rs will work: risk adjustment, risk corridors & reinsurance 7. Uncover the best ways to approach product design 8. Network with a veritable who s who of the industry at our breaks, luncheons and reception 9. Attend a focused session on risk adjustment at our special workshop 10. Come back to your office with actionable strategies to boost your chances of success! To Register: Call or visit us at Our Renowned Speaking Faculty Albert Lowey-Ball, UC BERKELEy SChOOL OF PUBLIC health Anna Lau, UNITED health CARE April Todd-Malmlov, MINNESOTA DEPARTMENT OF COMMERCE Brian Haile, STATE OF TENNESSEE Brian Melanson, PREMERA BLUE CROSS Brian Rosman, health CARE FOR ALL Carl D. Smith, FLORIDA BLUE Chad Westover, WELLPOINT, INC. Chantel Sheaks, BUCK CONSULTANTS Dan Rizzo, INOVALON Deborah Gordon, NETWORK health Gregory A. Franklin, CALIFORNIA TEChNOLOgy AgENCy H. Scott Sarran MD, MM, BLUE CROSS BLUE ShIELD OF ILLINOIS John J. Kaelin, UNITEDhEALThCARE COMMUNITy AND STATE John Spitz, INOVALON Jonathan Seib, STATE OF WAShINgTON Michael A. Nolin, ThE hilltop INSTITUTE Miki Antonelli, ThE MERCER group Neil Sullivan, NEW JERSEy DEPARTMENT OF BANKINg AND INSURANCE Norman K. Thurston, Ph.D., STATE OF UTAh Patricia MacTaggart, george WAShINgTON UNIVERSITy health POLICy DEPARTMENT Patrick Holland, WAKELy CONSULTINg group Rodney G. Hood, MD, MULTICULTURAL PRIMARy CARE MEDICAL group, IPA Rong Yi, PhD, Director, MILLIMAN Shannon M. McMahon, CENTER FOR health CARE STRATEgIES Thomas Johnson, MEDICAID health PLANS OF AMERICA Vince Ashton, healthpass NEW york Who Should Attend? From Managed Care Organizations, Medicaid, and Commercial Plans: Chief Executive officers Chief Financial Officers Chief Operating Officers Chief Marketing Officers Chief Medical Officers Chief Information Officers Chief Administration Officers Heads of Product Development Heads of Marketing/Sales/Business Development Heads of Enrollment Heads of Technology Heads of Operations Heads of Regulation/Policy From State Plans: Exchange Work Force Medicaid Officers Department of Health & Human Services Heads of Technology Heads of Operations Heads of Regulation/Policy Heads of Healthcare Reform AND: Private Exchanges Advocacy Groups Broker & Agents Consultants Software & Technology Providers Law firms Actuaries Sponsorship and Exhibit Opportunities Enhance your marketing efforts through sponsoring a special event or exhibiting your product at the Star Ratings Leadership Summit. We can design custom sponsorship packages tailored to your marketing needs, such as a cocktail reception or a unique networking event. To learn more about sponsorship opportunities, please contact Kevin Weigel or
3 Health Insurance Exchanges DAy ONE: Thursday, November 29, :00 8:30 Registration, & Continental Breakfast 8:30 8:45 Chair's Opening Remarks: Dan Rizzo, Chief Innovation Officer, INOVALON 8:45 9:45 Regulation & Policy Update: Where Are We Now and What Do We Need to Do to Move Forward? What are the latest state and federal regulations affecting the exchanges? What plans does the NAIC have ready for plan certification? What is it going to take to certify your plan? What are the implications of the optional Medicaid Expansion? Moderator: Chantel Sheaks, Principal, BUCK CONSULTANTS Panelists: Thomas Johnson, President & CEO, MEDICAID health PLANS OF AMERICA John J. Kaelin, Senior Vice President, Health Reform, UNITEDhEALThCARE COMMUNITy AND STATE Jonathan Seib, Executive Policy Advisor, Governor s Executive Policy Office, STATE OF WAShINgTON 9:45 10:30 Demographics, Socioeconomics, and Income Considerations: What Should Your Expect from this Market? Realistic Opportunities, Challenges, & Churn Expectations What will the new pool of enrollees look like? What should you do to prepare for this market? Useful analysis of the new market segmentation How will churn between the exchanges and Medicaid affect your plan? - Logistically - Pricing How will you manage the risk affiliated with this population? Capitalizing on new market opportunities Albert Lowey-Ball, Health Economics and Medicaid Advisor, California Program on Access to Care, UC BERKELEy SChOOL OF PUBLIC health 10:30 10:45 Morning Break 10:45 11:45 A Sizzling Discussion on the Three R s: Risk Adjustment, Risk Corridors, & Reinsurances on the Exchanges How will plans price products on the exchanges based on risk adjustment, risk corridors, and reinsurance? What are the feds looking for? What are the risk scores and how are plans calculating them? What can the exchanges learn from their counterparts in Medicare on risk adjustment? How will plans conduct risk adjustment on the exchanges? Examining the interaction between the three risk programs and the MLR requirements What are the most important operational considerations to be ready: - data - collections - claims - infrastructure Carl D. Smith, FSA, MAAA, Actuarial Analyst, Office of Health Care Reform, FLORIDA BLUE Rong Yi, PhD, Director, Risk Adjustment and Predictive Modeling Practice; Senior Consultant, MILLIMAN Anna Lau, Director of Healthcare Economics, UNITED health CARE 11:45 1:00 Luncheon for all attendees & speakers 1:00 2:00 Product Design and Essential health Benefits: Practical Construction Considerations for the Exchanges What does Essential Health Benefits look like? What are the nuances around EHB that need to be ironed out? Actuarial benefit tension & trade-offs: what are your options? Meeting the actuarial value of 68-72AV How many choices are too many? Which types of products will be available on the exchanges? Do all products work for the new market? Value-based performance outcome: Can you place value on some benefits, like gyms? Norman K. Thurston, Ph.D., Health Reform Implementation Coordinator, STATE OF UTAh Brian Rosman, Research Director, health CARE FOR ALL 2:00 2:45 Managing the Landmines of Pricing & Risk for the Exchanges: Capital Preservation for the High-Impact Population What are the increased enrollment effects on rates? How much will price change based on the unknown elements of the new market? How do you price a product when you don t know what will happen? Morbidity and health risk How do you strategically price to maximize enrollment? How do you price for risk adjustment mechanisms? Claim cost considerations Examining the many effects of adverse selection How will brokers/commissions affect pricing strategies? Gregory A. Franklin, Assistant Secretary, Health Information Technology, CALIFORNIA TEChNOLOgy AgENCy Additional speaker TBA 2:45 3:15 The Technical Aspects of Risk Adjustment: a Deeper-Dive Specific strategies for 2013 to prepare for the roll-out year - Understanding zero-sum risk adjustment: what to do about the new theory of relativity - How your risk score compares to competitors What confronts your plan in Time is nature's way of keeping everything from happening at once doesn t apply to Exchange risk adjustment - Preparing for Exchange RADV: every plan, every year (not your Grandmother s Medicare RADV) Richard Lieberman, Executive Vice President of Plan Strategy PEAK health SOLUTIONS 3:15-3:30 Afternoon Break 3:30 4:15 Evolving Network Strategy: The Importance of Provider Partnerships Balancing highly price-sensitive and narrow networks ACOs, HMOs, Medical Homes and bundling: How the pieces fit together for the exchanges AQHC networks Will the networks go in or out of Medicare/Medicaid? What provider networks are the users comfortable with? Quality care initiatives on the exchanges Are contracts that carriers have with providers priced too high for the exchanges? Cost saving considerations Which hospital systems should they include in their product? Will payer discounts be available for higher volume? Medicaid-like networks vs. narrow networks vs. current network H. Scott Sarran MD, MM, Chief Medical Officer, Government Programs, Health Care Service Corporation, BLUE CROSS BLUE ShIELD OF ILLINOIS Rodney G. Hood, MD, President, MULTICULTURAL PRIMARy CARE MEDICAL group, IPA To Register: Call or visit us at
4 Practical Implementation, Marketing and Risk Adjustment Strategies 4:15 5:00 Coping with the Enormous Operational and IT Obstacles Facing Plans on the Exchange What will the interface between federal, state, plan, provider, and member look like? How will you manage all of it? How do you use multiple platforms? How will you put it all together in a short period of time? Who will have access to what and when? What is the connectivity look like? Who s going to do what? Are the exchanges equipped to deal with multiple approaches? What lessons have we learned from other states, billing for premiums, subsidies, etc.? Who is going to do all the operations? Going beyond staffing considerations Gregory A. Franklin, Assistant Secretary, Health Information Technology, CALIFORNIA TEChNOLOgy AgENCy Patricia MacTaggart, Lead Research Scientist/Lecturer, george WAShINgTON UNIVERSITy health POLICy DEPARTMENT 5:00 End of Day One 5:00-6:00 Cocktail Reception Immediately Following Contact Kevin Weigel for more information on our sponsorship opportunities at or DAy TWO: Friday, November 30, :00-8:30 Continental Breakfast 8:30 8:45 Recap of Day One Dan Rizzo, Chief Innovation Officer, INOVALON 8:45 10:00 Spotlight State Panel: State Experiences in Working on the Health Insurance Exchanges Where are we now and what do we need to do before 2014? What have we learned from those states in the trenches? Mechanics of the exchanges Facilitating private involvement Success stories and biggest obstacles What are the challenges moving forward? Moderator: Michael A. Nolin, Executive Director, ThE hilltop INSTITUTE Panelists: Ann Tousignant, Director, Business Development, NETWORK health, LLC Norman K. Thurston, Ph.D., Health Reform Implementation Coordinator, STATE OF UTAh April Todd-Malmlov, Exchange Executive Director, MINNESOTA DEPARTMENT OF COMMERCE Neil Sullivan, Assistant Commissioner, Life and Health, NEW JERSEy DEPARTMENT OF BANKINg AND INSURANCE Brian Haile, Director of Insurance Exchange Planning Initiative, STATE OF TENNESSEE 10:00 10:15 Morning Break Open Mic Q&A Here is your chance to get your specific questions answered by our panel of superstar state representatives. Our team will have the wireless mics ready and waiting for you! Don t hold anything back! 10:15-10:45 Federally Facilitated Exchanges (FFE): State- Federal Partnership Models On the Exchanges: How Will they Work? Why would states only go half way? What are the pros/cons of partnership models? What would the states be responsible for? Ensuring operational efficiencies Which will your plan elect: plan management or consumer assistance functions (or both)? What does plan management consist of, exactly? Website and consumer hotlines expectations Staffing intricacies Patrick Holland, WAKELy CONSULTINg group 10:45 11:30 Confronting the Plethora of Medicaid Expansion Issues States Face and the Effect on the Exchanges What are the implications for health plans vis-à-vis Medicaid market/exchange market What are the implications for the health insurance exchanges? - State-based exchanges? - Federal exchange? - State-Federal partnership exchanges? Will exchange subsidies and cost-sharing reductions be available to residents between % FPL? Future opportunities for innovation in states Christian Heiss, Program Officer, CENTER FOR health CARE STRATEgIES Miki Antonelli RN MS, Principal, Government Human Services Consulting, ThE MERCER group 11:30 12:30 Examining Marketing, Sales, and the Role of Private Exchanges: Dealing with Market Positioning, Brokers, New Distribution Channels, Enrollment, & Retention Strategies How will you reach this new population? How will the exchanges affect your current agent/broker relationships? What is the role of brokers on the exchanges? Navigators what will they look like and what will their role be (state- by-state)? Managing internet portals Effective distribution through stores, malls, mini clinics, etc. How do the public, private and hybrid exchanges differ? Will private exchanges do their own risk adjustment? How will private exchanges affect small businesses? What will their options/pricing look like? What type of private exchanges exist and how do they differ? Do private exchanges offer tax credits? How? Vince Ashton, President & CEO healthpass NEW york Brian Melanson, Director Distribution & Ancillary Strategy PREMERA BLUE CROSS Media Partners: 12:30 Main Conference Concludes Exhibit Tear-Down To learn more about sponsorship opportunities for the Star Ratings Leadership Summit, please contact Kevin Weigel or
5 Health Insurance Exchanges 12:30 Luncheon for workshop attendees Optional Post- Conference Workshop: 1:45 4:45 Effective Risk Adjustment on the Exchanges This post-conference workshop will walk attendees through the intricacies of effective risk adjustment. Get the answers to these questions by attending this captivating discussion on the hottest topic affecting the exchanges: How will risk adjustment work after the risk corridor and reinsurance programs are phased-out? What do the risk adjustment models look like? What are your options? What can the plans on the exchanges learn from their Medicare counterparts? How can plans determine pricing with a population that has so many unknowns? How are plans gearing up to implement risk adjustment on the exchanges? What should states be looking at? What s the federal methodology for dealing with risk adjustment? What are the most important operational considerations? How will states collect data to see where they are for pricing? How will plans implement risk adjustment? What do plans need to do now to get ready? What is certified risk adjustment? How is it working in the exchanges today? How does it need to change? How will plans analyze their coding? How should plans handle staffing, communication, data management, and so much more? Workshop Faculty: Carl D. Smith, FSA, MAAA, Actuarial Analyst, Office of Health Care Reform, FLORIDA BLUE Anna Lau, Director of Healthcare Economics, UNITED health CARE Dan Rizzo, Chief Innovation Officer, INOVALON Troy Dinkel, MD, Chief Product Officer, INOVALON Conference Sponsors Platinum: Inovalon is a healthcare technology Company that combines advanced data analytics with highly targeted interventions to achieve meaningful impact in clinical outcomes and financial performance across the healthcare landscape. Our unique achievement of value is delivered through the effective progression of Turning Data into Insight, and Insight into Action. Proprietary datasets, sophisticated analytics, deep subject matter expertise, and nationwide incommunity personnel deliver a seamless, end-to-end platform of technology and operations. Driven by data, Inovalon uniquely identifies gaps in care, quality, data integrity and financial performance- while also bringing to bear the resources to resolve them. This differentiating combination provides a powerful capability suite touching more than 120 million Americans, driving high-value impact, and improving the quality and economics for health plans, hospitals, physicians, patients, and researchers. Silver: Altegra health is the result of the combination of five highly recognized healthcare industry leaders. Our suite of technology-enabled services includes proven solutions for risk adjustment, data analytics, encounter reporting, medical chart audit and coding, member engagement, eligibility and enrollment, and quality performance improvement. These solutions, combined with our reimbursement and advisory services professionals knowledge of the payer and provider markets, enable us to deliver enhanced revenue, strengthened compliance, and improved overall performance to our health plan and provider clients. For additional information, please find us at Peak health Solutions focuses on delivering Risk Adjustment and Quality Solutions to provide our clients with full service and customized options that give you the ability to choose services which best meet your needs. Peak provides top quality staff, a state-of-the-art technology workflow, chart reviews, in-home assessments, chart retrieval and HEDIS abstraction and analytics specific to your needs. With Peak as your partner, you will receive quality, timely results from a caring team of professionals that will guide you through the challenges of this ever changing industry. Advance health is dedicated to assisting health insurance companies navigate the challenges of the current and future environment by helping members lead healthy and productive lives. Advance Health offers prospective health risk assessment, readmission prevention and care management services. Our providers capture data about members using our proprietary ipad application. Electronic capture means data needed for a prospective campaign, HEDIS capture or care management initiatives are available almost instantly in a searchable database. We partner with our clients to offer real-time reporting and transparency into our operations Important Information To Register: Fax: Phone: Online: Health Insurance Exchanges November 29-30, 2012 Mail: Healthcare Education Associates NE Cedar Drive Battle Ground, WA $75/night room rate - act quickly The NEW Tropicana 3801 Las Vegas Boulevard South Las Vegas, NV Reservations: Due to the budget-sensitive nature of the municipal, state and federal agencies attending the conference, Healthcare Education Associates has negotiated a room rate of $75 per night. We urge you to book your room early in order to receive this special rate. We expect the hotel will sell out well prior to the block cut off date of October 12, Once the block is sold out, room rates and availability will be solely at the hotel s discretion. To make your room reservation simply call and mention you are attending the Health Insurance Exchanges conference. Fees and Payments: The fee for attendance at health Insurance Exchanges is: $1895 Government and non-profit rate: $895 Health plan and provider rate: $1495 The optional post-conference workshop Effective Risk Adjustment on the Exchanges $395 Please make checks payable to Healthcare Education Associates, and write code H155 on your check. You may also pay by Visa, MasterCard, Discover, or American Express. Purchase orders are also accepted. Payments must be received no later than November 22, Team Discounts: Three people will receive 10% off. Four people will receive 15% off. Five people or more will receive 20% off. In order to secure a group discount, all delegates must place their registrations at the same time. Group discounts cannot be issued retroactively. For more information, please call Theresa Powers or Cancellations: If we receive your request to cancel 30 days or more prior to the conference start date, your registration fee will be refunded minus a $ administrative fee. Cancellations occurring between 29 days and the first day of the conference receive either a 1) $200 refund; or 2) a credit voucher for the amount of the original registration fee, less a $ administrative fee. No refunds or credits will be granted for cancellations received after a conference begins or for no-shows. Credit vouchers are valid for 12 months from the date of issue and can be used by either the person named on the voucher or a colleague from the same company. Please Note: For reasons beyond our control it is occasionally necessary to alter the content and timing of the program or to substitute speakers. Thus, the speakers and agenda are subject to change without notice. In the event of a speaker cancellation, every effort to find a replacement speaker will be made. About the Venue Trendy. Stylish. Hip. These weren't the words associated with the Tropicana, a rare remaining Las Vegas landmark having opened in But they are now. Bronze: To Register: Call or visit us at Located on the corner of Las Vegas Boulevard and Tropicana Avenue, this revitalized property sits at the southern end of the Strip and within walking distance to many of the city's large-scale resorts and favored attractions. The Tropicana has embraced a South Beach-inspired theme, complete with a breathtaking four-acre pool and beach club area. It even boasts a fresh redesign of every hotel room and suite.
6 Health Insurance Exchanges To Register: Fax: Call: Online: Mail: Healthcare Education Associates NE Cedar Drive Battle Ground, WA Healthcare Education Associates 200 Washington St. Ste. 101 Santa Cruz, CA PRSRT STD U.S. POSTAGE PAID BURLINGTON,VT PERMIT NO. 21 Please Mention This Priority Code When Registering n Yes! Register me for the conference: $1895 n I qualify for the health plan and provider rate: $1495 n I qualify for the government/non-profit rate: $895 n also please register me for the optional post-conference workshop Effective Risk Adjustment on the Exchanges - $395 n Please contact me: I m interested in a Group Discount Rate for my team. n Please contact me: I m interested in Marketing Opportunities at this event. n I wish to receive updates on HEA s upcoming events via fax, and phone. Signature: Name Title Company Dept. Address City State Zip Telephone: Fax: Please bill my: n MasterCard n Visa n Amex n Discover Card Number Exp.Date Name on Card Signature n Cheque enclosed n Please bill me later Make checks payable to Healthcare Education Associates and write H155 and attendee s name on your check. Conference Code: H155 Healthcare Education Associates and the Risk Adjustment Initiative & Society for Education Proudly Present Bonus! Special risk adjustment workshop! Health Insurance Exchanges Practical Implementation, Marketing and Risk Adjustment Strategies The only conference in the industry that focuses on actual implementation strategies November 29-30, 2012 The NEW Tropicana, Las Vegas Product design & EHP Risk Adjustment Network Strategy Federally Facilitated Exchanges, State-Based Exchanges, Private Exchanges EXCHANGES Reinsurance, Risk Adjustment & Risk Corridors Technology Medicaid Expansion Demographics Product Development To Register: Call or visit us at Pricing Operations