2022 Agenda

Take a look at the January 2022 agenda to learn what you can expect when you join us next year.

Thursday - January 13, 2022

9:00 AM 9:10 AM

8:00 AM 8:10 AM

7:00 AM 7:10 AM

6:00 AM 6:10 AM

Pre-Conference Workshop: Welcome and Chairpersons Opening Remarks

Ana Handshuh, Principal 
CAT5 Strategies 
Chair 
The RISE Association, Quality & Revenue Community

9:10 AM 10:20 AM

8:10 AM 9:20 AM

7:10 AM 8:20 AM

6:10 AM 7:20 AM

Orientation to the Bid Part 1: Building the Bid Up in the Model

  • Identify key terms, files, and reports crucial to successful bid submission 
  • Build a strategy-supporting calendar that connects interdepartmental input and project management timelines to the CMS bid submission schedule 
  • Make the most of the CMS Bid Training Modules as a reference and technical guidance tool

 

Ryan Swenson, Consulting Actuary 

Milliman 

 

Ali Heinrich, Consulting Actuary  

Milliman 

10:20 AM 10:40 AM

9:20 AM 9:40 AM

8:20 AM 8:40 AM

7:20 AM 7:40 AM

Break

10:40 AM 12:00 PM

9:40 AM 11:00 AM

8:40 AM 10:00 AM

7:40 AM 9:00 AM

Orientation to the Bid Part 2: Financial Impacts of Changing CMS Bid Variables

  • Discover how base bids, benchmark rates, risk scores and other bid variables in CMS bid calculation affect health plan revenue 
  • Prioritize CMS tools and tests – and their dependencies – that determine pricing  
  • Optimize the financial mechanics behind lower rebates and higher provider group payouts, base bids and benchmarks, and other bid relationships 

 

Ryan Swenson, Consulting Actuary 

Milliman 

 

Ali Heinrich, Consulting Actuary 

Milliman 

12:00 PM 12:30 PM

11:00 AM 11:30 AM

10:00 AM 10:30 AM

9:00 AM 9:30 AM

Lunch Break

12:30 PM 12:40 PM

11:30 AM 11:40 AM

10:30 AM 10:40 AM

9:30 AM 9:40 AM

Welcome and Chairperson’s Opening Remarks

Ana Handshuh, Principal 
CAT5 Strategies 

Chair 

The RISE Association, Quality & Revenue Community 

12:40 PM 1:05 PM

11:40 AM 12:05 PM

10:40 AM 11:05 AM

9:40 AM 10:05 AM

The Bid Calendar: Project Management and Year-Round Process Design Strategies

  • Discuss how to make the perfect bid team 
  • Discover how various health plans construct their timelines to coordinate inputs from a multitude of functional areas for optimal bid build 
  • Create a successful project management structure with C-suite buy-in, a multi-disciplinary review, and CMS deadline-driven project schedule for a smoother bid process 

Lisa Franklin, Manager, Government Product Lifecycle 
CareFirst BlueCross BlueShield 

 

Monica Pagels, Senior Product Manager
Health Alliance Plan (HAP)

 

1:05 PM 1:15 PM

12:05 PM 12:15 PM

11:05 AM 11:15 AM

10:05 AM 10:15 AM

Break

1:15 PM 2:00 PM

12:15 PM 1:00 PM

11:15 AM 12:00 PM

10:15 AM 11:00 AM

Competitive Intelligence and Variables That Drive Shopping Decisions

  • 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 which key variables drive shopping decisions and how to weigh each in the bid strategy 
  • Consider the cons and maximize the pros of offering virtual options to your members 
  • Project your success rate in a limited budget reality: evaluating strengths, weaknesses, and what brings the most value to your target market 

Kristy Croom Tucker, Director of Marketing
BayCare Health Plans

 

Jessica Collins Hill, Director, Medicare Segment 
Blue Cross NC 

 

2:00 PM 2:10 PM

1:00 PM 1:10 PM

12:00 PM 12:10 PM

11:00 AM 11:10 AM

Break

2:10 PM 2:55 PM

1:10 PM 1:55 PM

12:10 PM 12:55 PM

11:10 AM 11:55 AM

Leverage the Bid to Improve Star Ratings

  • Discuss bid strategies that support and improve Star ratings  
  • Use the bid to improve the member experience, which is now 58% of Star measures 
  • Dive into the new cut-point methodology changes for Stars measures and the significance of CMS implementing guard rails for this first time  
  • Analyze the two new HEDIS measures coming to Stars 
  • Dissect the impact Covid will have and what to expect for the next Star ratings 

Rex Wallace, Founder and Principal
Rex Wallace Consulting

 

Lauren Driscoll, CEO & Founder 
NourishedRx 

2:55 PM 3:05 PM

1:55 PM 2:05 PM

12:55 PM 1:05 PM

11:55 AM 12:05 PM

Break

3:05 PM 3:50 PM

2:05 PM 2:50 PM

1:05 PM 1:50 PM

12:05 PM 12:50 PM

Understand How Risk Adjustment Drives Revenue Projections

  • Survey how various plans structure the risk adjustment piece of the CMS bid, and with what combination of finance, actuarial, and analytics work  
  • Discuss who drives the risk score assumptions and how assumptions figure into revenue modeling for the bid 
  • Learn how to build up a risk profile based on current members  
  • Understand how ongoing retrospective and prospective risk adjustment activities contribute to revenue projections 

Shannon Decker, Vice President, Clinical Performance
Brown & Toland Physicians

 

David Koenig, Consulting Actuary 
Milliman 

“Choose Your Own Adventure” Facilitated Group Discussion 3:50 PM - 4:30 PM 2:50 PM - 3:30 PM 1:50 PM - 2:30 PM 12:50 PM - 1:30 PM

3:50 PM 4:30 PM

2:50 PM 3:30 PM

1:50 PM 2:30 PM

12:50 PM 1:30 PM

Navigating the Minimum Loss Ratio During the Pandemic

Discussion Group 1

Facilitator: 

 

Puneet Budhiraja, Senior Vice President, Value Based Analytics, and Chief Actuary

Capital District Physicians' Health Plan (CDPHP)

3:50 PM 4:30 PM

2:50 PM 3:30 PM

1:50 PM 2:30 PM

12:50 PM 1:30 PM

Supplemental Benefits Trends to Consider for 2023

Discussion Group 2

Facilitator: 

 

Lisa Franklin, Manager, Government Product Lifecycle

CareFirst BlueCross BlueShield

 

3:50 PM 4:30 PM

2:50 PM 3:30 PM

1:50 PM 2:30 PM

12:50 PM 1:30 PM

The Impact of Medicare Expansion and OTC Hearing Aids

Discussion Group 3

Facilitator: 

 

Rebecca Ballou, Regional Sales Leader

Amplifon Hearing Health Care

3:50 PM 4:30 PM

2:50 PM 3:30 PM

1:50 PM 2:30 PM

12:50 PM 1:30 PM

Best Practices for ANOC and EOC Submission

Discussion Group 4

Facilitator:

Monica Pagels, Senior Product Manager, Medicare Product Oversight
Health Alliance Plan (HAP)

3:50 PM 4:30 PM

2:50 PM 3:30 PM

1:50 PM 2:30 PM

12:50 PM 1:30 PM

Leverage Supplemental Benefits to Attract, Retain, and Manage Membership

Discussion Group 5

Facilitators:

Brandon Solomon, Vice President, Client Advisory & Business Development 

Convey Health Solutions and Pareto Intelligence 

 

Zain Jafri, Vice President, Innovation & Analytics 

Pareto Intelligence 

Friday - January 14, 2022

9:00 AM 9:05 AM

8:00 AM 8:05 AM

7:00 AM 7:05 AM

6:00 AM 6:05 AM

Second Day Opening Remarks

Ana Handshuh, Principal 
CAT5 Strategies 

Chair 

The RISE Association, Quality & Revenue Community 

9:05 AM 9:50 AM

8:05 AM 8:50 AM

7:05 AM 7:50 AM

6:05 AM 6:50 AM

Member Retention Through Part D: Optimize Your Formulary Design

  • Understand the components and how the rebate allocations work  
  • Learn what can optimize your Part D formulary tier structure to boost member retention and Star ratings 
  • Discuss CMMI’s Part D Senior Savings Model and strategies for plan revenue 

 

Andy Wheaton, Pharmacy Department Manager  

Network Health 

9:50 AM 10:00 AM

8:50 AM 9:00 AM

7:50 AM 8:00 AM

6:50 AM 7:00 AM

Break

10:00 AM 10:40 AM

9:00 AM 9:40 AM

8:00 AM 8:40 AM

7:00 AM 7:40 AM

Managing the Part B Professionally Administered Drugs Effectively

  • Capitalize on Part B drug rebates and select the right vendor
  • Discover strategies to manageyour drug expenditure while maintaining outcomes 
  • Drug trends and how to prepare for the future
  • CMS guidance on Part B step therapy programs 

 

Omar Daoud, Director of Pharmacy 

Community Health Plan of Washington 

 

10:40 AM 10:50 AM

9:40 AM 9:50 AM

8:40 AM 8:50 AM

7:40 AM 7:50 AM

Break

10:50 AM 11:35 AM

9:50 AM 10:35 AM

8:50 AM 9:35 AM

7:50 AM 8:35 AM

Deep Dive into Flex, Special Supplemental Benefits for the Chronically Ill (SSBCI), and Value Based Insurance Design (VBID): Analysis and Benchmarking

  • Get a clear roadmap and framework to the seemingly endless benefit possibilities, from companion providers to pet sitting to transportation 
  • Learn what plans are offering and where in the bid benefits were placed 
  • Compare what was filed and what CMS accepted 
  • Discuss how COVID impacted benefit selection and financials 

 

Mike Spicer, Director, Product Innovation & Research

Capital District Physicians' Health Plan

 

Tom Pelegrin, Senior Vice President & Chief Revenue Officer  

Convey Health Solutions 

11:35 AM 11:45 AM

10:35 AM 10:45 AM

9:35 AM 9:45 AM

8:35 AM 8:45 AM

Break

11:45 AM 12:30 PM

10:45 AM 11:30 AM

9:45 AM 10:30 AM

8:45 AM 9:30 AM

Case Study Learnings to Clear the Confusion Around Meal and Grocery Benefits

  • Get the step by step, how one plan successfully incorporated grocery benefits for better member outcomes 
  • Parse the options, from prepared meals to a la carte, nonperishable groceries, fruit and veg to best serve the communities within your membership 
  • Gain assessment frameworks to determine the best food benefit application, whether OTC dollars, SSBCI, or other options 

 

Ashley Tyrner, Founder and CEO

FarmboxRx

 

Ana Handshuh, Principal
CAT5 Strategies

Chair
The RISE Association, Quality & Revenue Community

12:30 PM 1:00 PM

11:30 AM 12:00 PM

10:30 AM 11:00 AM

9:30 AM 10:00 AM

Lunch Break

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

10:00 AM 10:45 AM

Optimize Vendor Selection, Timing and Strategies to Ensure You Delight Your Members

  • Gain methodologies and best practices for researching and vetting benefit providers to ensure you partner with the best choice 
  • Discuss timetables for vendor research, selection, and involvement relative to bid development and submission 
  • Get a blueprint of essentials to assess and of what to avoid, to make selections efficiently and confidently 

 

Hannah Neylon, Manager, Government Products and Relations

Network Health

 

Dan Weaver, EVP Product Operations and Stars Strategy 

NationsBenefits 

1:45 PM 1:55 PM

12:45 PM 12:55 PM

11:45 AM 11:55 AM

10:45 AM 10:55 AM

Break

1:55 PM 2:40 PM

12:55 PM 1:40 PM

11:55 AM 12:40 PM

10:55 AM 11:40 AM

Differentiate Your Plan Through Competitive Benefit Design for Vulnerable Populations

  • Discuss challenges of the CHRONIC Care Act and how health plans are responding through innovative benefit offerings 
  • Create frameworks for determining the special needs to address with an appropriate SNP  
  • Learn how to build product designs, case management, pick benefits, and select and onboard the best providers for the SNP 

Puneet Budhiraja, Senior Vice President, Value Based Analytics, and Chief Actuary
Capital District Physicians’ Health Plan (CDPHP)

Donna Doebler, AVP, Medicare SNP Product & Analytics
UPMC Health Plan

2:40 PM 2:50 PM

1:40 PM 1:50 PM

12:40 PM 12:50 PM

11:40 AM 11:50 AM

Break

2:50 PM 3:35 PM

1:50 PM 2:35 PM

12:50 PM 1:35 PM

11:50 AM 12:35 PM

Desk Review, Audits and Required Changes After Bid Submission

  • Survey recent health plans’ experiences with bid desk review and audits, to get advance knowledge on what bid reviewers scrutinize 
  • Learn how best to analyze your performance post-bid to measure attractiveness to beneficiaries, to assess competitiveness, and to evaluate the accuracy of bid pricing assumptions 
  • Gain best practices to limit mistakes and bid reuploads 
  • Prepare for CMS’ announcement on Part D National Average Bid Amount (NABA) and its impact to your bid planning 

 

Ana Handshuh, Principal 
CAT5 Strategies 

Chair 

The RISE Association, Quality & Revenue Community 

 

Thomas Grivakis, Senior Consulting Actuary 

Wakely Consulting Group  

3:35 PM 3:45 PM

2:35 PM 2:45 PM

1:35 PM 1:45 PM

12:35 PM 12:45 PM

Break

3:45 PM 4:30 PM

2:45 PM 3:30 PM

1:45 PM 2:30 PM

12:45 PM 1:30 PM

Build Back Better: How the Reconciliation Bill Would Impact MCOs

  • Get up to speed on the status and trajectory of Biden Administration proposals and legislative reform to Medicare Advantage and Part D 
  • Assess the continuing impact of COVID-19 tumult on bids and how that informs bid strategy for 2023 
  • Prepare for rulemaking changes and their downstream impacts to 2023 bids 

 

Alex Cires, Consulting Actuary   

Milliman 

4:30 PM 4:30 PM

3:30 PM 3:30 PM

2:30 PM 2:30 PM

1:30 PM 1:30 PM

Closing Remarks and Conference Concludes

Ana Handshuh, Principal 
CAT5 Strategies 

Chair 

The RISE Association, Quality & Revenue Community