Product Design, Pricing & Risk Adjustment on the Health Insurance Exchanges

Transcription

1 Healthcare Education Associates presents Product Design, Pricing & Risk Adjustment on the Health Insurance Exchanges Finalize Your Benefit Specifications & Pricing/Rates for 2015! February 17-18, 2014 The NEW Tropicana Hotel Las Vegas, NV Pricing & Rates Product Design Risk Adjustment Consumer -Driven Products Quality Data Narrow Networks Marketing Outreach THE ONLY CONFERENCE FOCUSING ON THE EXCHANGES UNIQUE CHALLENGES IN PRODUCT DESIGN, PRICING/RATES & RISK ADJUSTMENT! Critical Questions Driving Discussion Topics: Unique Plan Designs that are Going to Drive Competition Differentiation Premium Price Points versus Benefit Richness and Cost Sharing Driving Volume and Lowering Costs Through Narrow Networks Knowing Your Actual Market and Constructing Products for Them Filtering Your Data Quality and Pricing Process for 2015 The Significance of Risk Scores, Risk Adjustment, Reinsurance, and Risk Corridors on Pricing Refining Your Marketing Plan and its Effects on Your Allocation of Resources, Strategies, and Tactics SPONSORS GOLD SILVER

2 Healthcare Education Associates Presents WHY YOU CANNOT MISS THIS EVENT Do you have your benefit specifications & pricing/ rates ready for 2015? How will you adjust your rates based on current enrollment? How will enrollment volume, mix of enrollment, and provider contract rates impact your pricing adjustments? How do you plan to build consumer-focused products? How are narrow networks changing the playing field? Get the answers to these crucial questions and so much more at our Product Design, Pricing, & Risk Adjustment on Health Insurance Exchanges Summit, scheduled for February 17-18, 2014 in Las Vegas. Health plans simply cannot afford to miss this critical gathering of the best minds in the business; mistakes in product design, pricing & risk adjustment can substantially affect your plan. Invest in this one-of-a-kind event and arm yourself with the all the information you need to make the smartest benefit specification and rate decisions for A sample of the topics we ll address includes: Customer segmentation: Finally, an actual assessment of the genuine market population Revising strategies on pricing variations based on real data Responding to membership behavior on premium price points, benefit richness, and cost sharing Constructing consumer-focused products Responding to pricing and access concerns for narrow networks Managing the high-risk pool from a product perspective Revamping your marketing and outreach strategy Data quality, risk scores, and the pricing process: You can t afford to get any of it wrong! Designing your risk adjustment program to drive the quality and cost of care...and much more! This event will be an incredible way to find out how other plans are responding to the benefit specification and pricing for How much will they lower prices to gain market share or are they implementing other products that will drive competition differentiation? As you look to revise your pricing and product construction for your exchange operations, you won t find a better source for the very latest information! Register today! Call or online at Sincerely, Laura Garza Laura Garza, Conference Director SENIOR VICE PRESIDENT P.S. You can now earn 10.5 CPE credits for this event IMPORTANT INFORMATION To Register: Fax: Mail: Healthcare Education Associates NE Cedar Drive Battle Ground, WA Phone: Online: Product Design, Pricing, and Risk Adjustment on the Health Insurance Exchange February 17-18, 2014 The NEW Tropicana Las Vegas 3801 Las Vegas Boulevard South Las Vegas, NV p: We have a block of rooms reserved at a special rate of $100/night. This rate expires on January 28, 2014; 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 Product Design & Pricing on the Exchanges summit 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 (702) FEES AND PAYMENTS The fee for attendance at the Product Design, Pricing, & Risk Adjustment on the Health Insurance Exchange Summit is: $1895 standard rate $1495 plans and providers $895* Non-profit/government * Non-profit health plans do not qualify - subject to HEA approval Please make checks payable to Healthcare Education Associates, and write code H196 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 February 10, 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 contact Theresa Powers or tpowers@healthcare-conferences.com 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.

3 Product Design, Pricing & Risk Adjustment On The Health Insurance Exchanges OUR RENOWNED SPEAKING FACULTY Featuring Case Studies and Expert Presentations from: Adam Pittler, Senior Product Manager, UPMC Health Plan Allison Kean, Senior Manager of Strategy & External Affairs, Commonwealth Health Insurance Connector Amy Yao, FSA, MAAA, Vice President, Actuarial Services, Blue Shield of California Ann Lacy-Balliet, Executive Director, Access Health Colorado Armen Akopyan ASA, MAAA, Director Actuarial Pricing, Bill Bradley, Vice President of Product Management, Barbara Abbott, FSA, MAAA, Actuary, Milliman Camie Berardi, Associate Director, Public Information and Outreach Massachusetts Health Connector Celeste Curley, Senior Director Product Management, Blue Cross of Northeastern Pennsylvania Cheryl Britcher, Commercial Products Manager, Product Development, Priority Health Douglas M. Mertz, Vice President, Sales, MIB Gregory Franklin, Owner & Principal Consultant, Franklin Health Solutions (FHS) * Former Deputy Director, Health Care Operations, CA Department of Health Care Services * and Assistant Secretary, Health Information Technology at the CA Technology Agency Matt Henry, Executive Director, Health Care Audience Partners Meghan Cassidy, Director, Product Innovation, CDPHP Mickey Dodge, Director of Risk Analytics, BCBSNC Ryan Johnson, MPA, Principal, Mercer Richard Lieberman, Executive Vice President of Plan Strategy Peak Health Solutions WHO SHOULD ATTEND? Medicare, Medicaid, Commercial Plans, & States (all plans on the Exchanges): Product Development & Benefit Design Executives Risk Adjustment & HCC Executives CFOs Senior Finance & Economics Officers Actuarial Analysts Underwriting Officers Pricing & Valuation Executives Marketing & Sales Officers Heads of Enrollment Heads of the Exchanges Heads of Government Relations Plus: Consultants Actuaries Software & technology providers Private Exchanges Brokers & Agents Law firms TOP REASONS TO ATTEND 1. See how plans are responding to product design and rates for Get a real-time market population assessment 3. Discover how to meet the challenges of risk adjustment while still focusing on quality and cost of care 4. Learn how plans are revising their strategies to focus on consumer-based products 5. Effectively use data to calculate risk scores and risk adjustment on the exchanges 6. Overcome pricing and accessibility apprehensions of narrow networks 7. Discover how to drive volume and lower costs through narrow networks 8. Manage the high-risk population from a product perspective 9. Revise your marketing and outreach campaign: Learn what really works for this population 10. Overcome the obstacles in reaching hard-to-reach sectors of the exchange population 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 Jennifer Clemence at or jclemence@healthcare-conferences.com CPE CREDITS Healthcare Education Associates is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: Sponsored learning activities are measured by program length, with one 50-minute period equal to one CPE credit. One-half CPE credit increments (equal to 25 minutes) are permitted after the first credit has been earned in a given learning activity. Please note that not all state boards adopted this rule. Some participants may not be able to use one-half credit increments. This course is offered as a group-live course and does not require prerequisites or advance preparation. We offer advanced level courses. Although no prerequisite courses, experience, or advance preparation is required to participate in this program, working knowledge of Healthcare is required, as well as, prior knowledge of the program topic. For specific learning objectives and program description, please refer to the individual conference sessions topics in the conference brochure located on our website: The recommended CPE credit for this course is 10.5 credits in the following field(s) of study: Specialized Knowledge and Applications THE CONFERENCE ORGANIZERS 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. For more information on upcoming events, visit us online: RISE (Resource Initiative & Society for Education) Vision:To build a community and an educational system that promotes successful careers for professionals who aim to advance the quality, cost and availability of health care. RISE provides: A forum to build professional identity and a network of colleagues A platform to capture and share knowledge and insights A venue to develop and share benchmarks and document best practices Career track development support A channel for building alliances, partnerships and affiliations that fulfill the vision To join RISE, please visit OFFICIAL PUBLICATIONS AND MEDIA PARTNERS

4 Healthcare Education Associates Presents DAY ONE: Monday, February 17, :00 Registration Breakfast sponsored by 8:45 9:00 Co-Chairs Opening Remarks: 9:00 9:45 Customer Segmentation Opening Panel: A Look at Actual Market Population & Product Selection: Who Signed Up for What? What do we know about who has come into the marketplace? How have the uninsured responded? What are they selecting? What percentage took bronze vs. silver? What are your competitors doing? How did you stack up? Have plans flooded the market with various alternatives or did they stick with the metal products? How does the 2014 enrollee compare to 2013? Are members upgrading or dropping their coverage? Ann Lacy-Balliet, Executive Director Access Health Colorado Armen Akopyan ASA, MAAA, Director Actuarial Pricing Allison Kean, Senior Manager of Strategy & External Affairs Commonwealth Health Insurance Connector 9:45 10:45 A Special Focus on the Impact of Product Design on Pricing: Benefit Specifications & Pricing/Rates for 2015: What Will You Do Differently & Why? Adequately using book rates again for 2015 How are the following factors affecting rate changes: -Enrollment volume -Mix of enrollment -Provider contract rates Which providers got how much membership in the distribution from the open enrollment cycle? Risk & cost profiles How much more will the consumer have to pay? How are rate changes going to change? What can remain the same? Do you have enough information to make the adequate adjustments? How much do you lower prices to gain market share? Strategies on pricing variations What drove decisions for premiums on the exchanges? Amy Yao, FSA, MAAA, Vice President, Actuarial Services Blue Shield of California Bill Bradley, Vice President of Product Management Barbara Abbott, FSA, MAAA, Actuary Milliman 10:45 11:00 Morning Break sponsored by 11:00 12:00 How Do You Build Consumer-Focused Products: Knowing Your Market & Constructing Products for Them What have you learned about your market so far and how will you adjust your products accordingly? How does membership respond to premium price points versus benefit richness and cost sharing? What is the strength of brand in the purchase decisions for comparable products? What role did network play? Are people willing to switch doctors as a tradeoff for financial protection? What kind of variation of plan designs really exist across metal categories? Are any variations achieving any differential in enrollment? Consumer preferences Cost-share programs that appeal to consumers Cost plans Incorporating new and improved plan designs What is the next unique plan design that is really going to drive competition differentiation? Moderator: Bill Bradley, Vice President of Product Management Panelists: Ann Lacy-Balliet, Executive Director Access Health Colorado Cheryl Britcher, Commercial Products Manager, Product Development Priority Health Adam Pittler, Senior Product Manager UPMC Health Plan Meghan Cassidy, Director, Product Innovation CDPHP 12:00 1:15 Networking Luncheon 1:15-2:15 Narrow Networks: Startling Pricing & Access Concerns How will narrow networks and narrow network pricing affect the exchanges? How will the marketplace manage narrow networks? Will access be the next big worry for plans and members? Will plans need to incentivize for different levels of care? How will nurse practitioners, physician assistants, and provider extenders help? Driving volume and lowering costs through narrow networks Looking at the bottom line and its effects on revenue Political landmines: will the exclusion of some providers impact your larger health plan business relationships? Gregory Franklin, Owner & Principal Consultant Franklin Health Solutions (FHS) Former Deputy Director, Health Care Operations, CA Department of Health Care Services and Assistant Secretary, Health Information Technology at the CA Technology Agency Cheryl Britcher, Commercial Products Manager, Product Development Priority Health Celeste Curley, Senior Director Product Management Blue Cross of Northeastern Pennsylvania 2:15 3:15 Marketing Adjustments: What Do We Know Now and How Will You Adjust Your Marketing & Outreach Strategy? What s the most effective way to reach the new population: -Direct mail -TV -Newspaper -Bill boards -Radio -Electronic means Have search engines, web page design, and social media taken a front seat in marketing on the exchanges? Why/why not? What s the latest in technology solutions, applications, etc? Taking a closer look at traditional performance for: -Response rates -Conversion rates -Costs per lead -Cost per application How did your marketing plan play out against expectations and how will that affect your allocation of resources, strategies, and tactics? How did public relations play a role? Are community level activities and sponsorship playing a role? How do you drive people to choose your product when they get into the exchange to make a selection? Should you enhance your direct marketing strategies? Moderator: Matt Henry, Executive Director, Health Care Audience Partners Panelists: Camie Berardi, Associate Director, Public Information and Outreach Massachusetts Health Connector Ann Lacy-Balliet, Executive Director Access Health Colorado Adam Pittler, Senior Product Manager UPMC Health Plan 3:15 3:30 Afternoon Break sponsored by

5 Product Design, Pricing & Risk Adjustment On The Health Insurance Exchanges 3:30 4:15 What Did We Learn About SHOP? What Did We See on the Small Group? What did we see o the small group? What did we see from the small groups on the exchange? What have we learned and how will we tweak our strategy? What are the differences? Allison Kean, Senior Manager of Strategy & External Affairs Commonwealth Health Insurance Connector Additional Speaker TBA 4:15 5:00 Issuer Strategies Early in the Contract Year Using telephone health risk appraisals to triage members The role of the SF-36 health survey and disease inventories Prospective in-home assessments and other outreach early in the year Primary care provider workforce limitations and new high-risk enrollees ACA rollout debacle and managing risk adjusted members in 2014 Richard Lieberman, Executive Vice President of Plan Strategy Peak Health Solutions 5:00 End of Day One Mickey Dodge, Director of Risk Analytics BCBSNC Douglas M. Mertz, Vice President, Sales MIB 11:15 12:00 Part II: Risk Corridors & Reinsurance How Will Risk Corridors & Reinsurance Affect the Pricing Process? Taking a closer look at the financial implication for risk corridor & reinsurance How will they help smooth out risk? How will risk corridors & reinsurance affect pricing on the exchanges? Will reinsurance money help for pricing? How? Reinsurance & minimum loss ratio considerations Amy Yao, FSA, MAAA, Vice President, Actuarial Services Blue Shield of California 12:00-1:00 Networking Luncheon 1:00 End of Summit Cocktail Reception Immediately Following 5:00-6:00 Contact Jennifer Clemence for more information about our sponsorship opportunities at jclemence@healthcare-conferences.com or SPONSORS DAY TWO: Tuesday, February 18, :00 8:30 Continental Breakfast 8:35 8:45 Recap of Day One 8:45 9:30 Data Quality & the Pricing Process: Capturing the Appropriate Data for Risk Scoring in Order to Price Appropriately Getting the most out of your claims data? What does the data say about pharmacy costs? What are your members taking? What are the un-knowable factors you need to determine risk scores? Data quality or consumer behavior Clinical quality Are the assumptions you made valid? Data validation expectations on the part of HHS ICD-9 codes and the proper capture of diagnoses Provider billing accuracy on claims Mickey Dodge, Director of Risk Analytics BCBSNC Additional Speaker TBA 9:30-10:00 Lessons learned: Risk Adjustment within Public Programs Risk adjusting premiums Impact of data quality on risk adjustment results Uses and limitations of health-based models Using risk adjustment techniques for program evaluation and pricing Actuarial standards of practice GOLD 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. SILVER For over 100 years, MIB has been the industry standard for assessing applicant risk in 450 North American life and health insurance companies. To help our members adapt to healthcare reform, MIB introduces HealthRisk ID, an innovative service that lets insurers sort through the undifferentiated mass of new enrollees, identifying those with qualified medical conditions to fast-track into risk adjustment workflows. And, HealthRisk ID spots those individuals who can immediately benefit from disease management and wellness programs. HealthRisk ID informs through diagnosed medical conditions, lab test results, physical exams, self-admitted health information and tobacco use so health plans can be proactive with their risk assessment practices. Learn more at the MIB booth or visit: NHX is Audience Partners HIPAA-compliant national healthcare database built to target the uninsured population to inform, educate, persuade, and enroll. Data-driven targeted digital advertising is the most efficient and cost-effective way to reach the estimated 40 million uninsured and soon-to-be uninsured Americans with targeted messages that will resonate most with each audience segment. Ryan Johnson, MPA, Principal Mercer 10:00 10:15 Morning Break 10:15 11:15 NHX has created and integrated multiple data sets for the purpose of identifying Part I: Risk Adjustment the uninsured audience segments most important to government exchanges, Risk Adjustment on the Health Insurance Exchanges: A Constantly health insurers, providers and any organization that wants to raise awareness and recruit the uninsured. NHX is also designed to integrate client or government data Moving Target to target an addressable online audience. Regulatory updates on risk adjustment from CCIOO NHX is fully integrated with Audience Partners addressable media platform that What were the assumptions for risk adjustment? allows HIPAA-compliant data-driven targeted advertising across online video, Coding pitfalls display, TV, mobile, social and search. Do we know anything knew from the 2014 enrollees? Visit nationalhealthexchange.com or call (484) to schedule an What s looming down the pike with respect to risk adjustment? appointment at the conference or to learn more. Armen Akopyan ASA, MAAA, Director Actuarial Pricing

6 PRODUCT DESIGN. PRICING & RISK ADJUSTMENT ON THE HEALTH INSURANCE EXCHANGES To Register Mail: Healthcare Education Associates NE Cedar Drive Battle Ground, WA Call: Fax: Online: Healthcare Education Associates 200 Washington St. Ste. 201 Santa Cruz, CA Attention Mailroom: If undeliverable, please forward to the Product Development or Marketing PRSRT STD U.S. POSTAGE PAID VILLANTI Please Mention This Priority Code When Registering Yes! Register me for the conference: $ 1895 (standard rate) Yes! Register me for the conference: $ 1495 (plan or provider rate) Yes! Register me for the conference: $ 895* (non-profit/government) *Non-profit health plans do not qualify - subject to HEA approval Please call me; I m interested in a group discount for my team. Please call me; I m interested in exhibition or sponsorship opportunities at this event. 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: MasterCard Visa Amex Discover Card number: Exp. Date: Name on Card: Signature: Check enclosed Please bill me later Make checks payable to Healthcare Education Associates, and write H196 on your check. Please mention your priority code when registering: Conference Code: H196 Healthcare Education Associates Presents Product Design, Pricing & Risk Adjustment on the Health Insurance Exchanges Finalize Your Benefit Specifications & Pricing/Rates for 2015! February 17-18, 2014 The NEW Tropicana Hotel Las Vegas, NV THE ONLY CONFERENCE TO FOCUS ON THE EXCHANGES UNIQUE CHALLENGES IN PRODUCT DESIGN, PRICING/RATES & RISK ADJUSTMENT! Critical Questions Driving Discussion Topics: Unique Plan Designs that are Going to Drive Competition Differentiation Premium Price Points versus Benefit Richness and Cost Sharing Driving Volume and Lowering Costs through Narrow Networks Knowing Your Actual Market and Constructing Products for Them Filtering Your Data Quality and Pricing Process for 2015 The Significance of Risk Scores, Risk Adjustment, Reinsurance, and Risk Corridors on Pricing Refining Your Marketing Plan and its Effects on Your Allocation of Resources, Strategies, and Tactics