Our annual conference heads to Jacksonville, Fla. in January for a deep dive into bid essentials and how to navigate the crucial changes affecting the current bid landscape.
Pharmacy benefit reforms that impact revenue, the new V28 risk score model, Star ratings, and CMS updates to the Health Plan Management System (HPMS) and Plan Benefit Package (PBP) tools for bid submissions are just a few of the hot topics on this year’s CMS Bid Boot Camp agenda.
The 8th annual conference, which will take place January 22–23, 2024, at the Sawgrass Marriott Golf Resort & Spa, Jacksonville, Fla., brings together product managers and other CMS bid stakeholders to explore steps and strategies to optimize their CMS bid. Here’s what we’ve planned:
Preconference workshop
RISE will offer a two-part preconference workshop (separate registration required) beginning at 9 a.m. Monday, January 22.
Part 1 will provide a deep dive into bid basics and the PBP. Workshop leaders Ana Handshuh, principal, CAT5 Strategies, and Zachary White, associate actuary, Milliman, will review key terms, files, reports, and timelines for the bid. They’ll help attendees understand the connection between the bid and the Medicare Plan Finder, provide an update on HPMS, and will offer an overview of the PBP and strategies to give their health plans a competitive edge.
Part 2 begins at 10:45 and will focus on the financial side of the bid. Anant Galande, director, corporate actuarial, Blue Cross Blue Shield of Michigan, and Matt Kridgen, consulting actuary, Milliman, will explain how decisions on the benefic package connect to the actuarial work done in the bid pricing tool. They’ll discuss base bids, benchmark rates, risk scores, and other bid variables in the CMS bid calculation. Galande and Kridgen will also go over CMS tools and tests that determine pricing.
Main conference session highlights
CMS keynote: As previously announced, Michael de la Guardia will kick off the main conference at 1:25 p.m. Monday, with a presentation on the future of CMS’ value-based insurance design (VBID) model.
During his keynote address, de la Guardia will offer insight into the future of the CMS VBID model as well as what CMS has learned from the model about improving health outcomes and addressing health inequities while containing costs. He’ll also discuss the reporting requirements for the model as well as future plans for the VBID hospice benefit component.
RELATED: CMS exec to present keynote at RISE’s upcoming CMS Bid Boot Camp
Year-round project management and process strategies: Learn best practices to optimize your bid with Capital District Physicians’ Health Plan’s Mike Spicer, vice president, product, and Puneet Budhiraja, chief actuary. They’ll review the CMS schedule, help you design the perfect bid team with players from across the organization, and explain how to create a successful project management structure with a multi-disciplinary review resulting in an optimal bid that meets CMS deadlines and internal strategic goals.
Defining your market strategy: This session will provide an overview of CMS changes that may create revenue headwinds for your health plan. Joshua Phelps, vice president, chief actuary, Florida Blue Medicare, and Katie Lavelle, director of business development, Medline, will explain how to analyze key factors and data about your market to gain an edge on your competition. They’ll also discuss how to gather the necessary data to determine what benefits your current and prospective members want and need and how to plan your strategy for retention and growth, even when budgets are tight.
Trends and innovations in supplemental benefits: Ana Handshuh, principal, CAT5 Strategies, and Jenn Kerfoot, chief strategy & growth officer, DUOS, will lead this session. Attendees will discover supplemental benefit trends and explore unique offerings, learn techniques for determining what supplemental benefits are most cost-effective, how to price and include them in their bid, and how they can help address social determinants of health. Handshuh and Kerfoot will also assess the pros and cons of participating in Special Supplemental Benefits for the Chronically Ill (SSBCI), VBID, and other special programs.
Pharmacy benefit reforms: This session will review the massive pharmacy benefit reforms resulting from the Inflation Reduction Act (IRA) and explore how they will impact the bid. Attendees will get tips for navigating the uncertainty of future pharmacy revenues and national coverage determinations for Alzheimer’s medications and other new high-cost drugs. Session leaders Anant Galande, director, corporate actuarial, Blue Cross Blue Shield of Michigan, and Omar Daoud, director of pharmacy, Community Health Plan of Washington, will also go over Part B vs. Part D benefit design to maximize rebates and minimize cost and help attendees prepare for even bigger changes in 2025 that will affect the next bid.
Part D changes: Get tips for building a balanced bid for long-term financial stability, even with the impact of pharmacy benefit changes from CMS and the IRA, with session leaders Omar Daoud, senior director of pharmacy, Community Health Plan of Washington, and Greg Collins, associate actuary, Milliman. They’ll also discuss how the IRA could affect member behavior and how to strengthen your bid to compete in the current climate. Attendees will also learn how to leverage their pharmacy benefit manager (PBM) to support their bid.
The new V28 risk score model and its impact on the bid: This session will focus on how V28 will affect risk score assumptions and revenue modeling for the bid. Presenters will explain how to build up a risk profile based on current members while aligning the bid and operations for maximum performance. They’ll also explore how ongoing retrospective and prospective risk adjustment activities contribute to revenue projections. Speakers include Shannon Decker, Ph.D., MBA, MBA, M.Ed, principal, VBC One; Laura Sheriff, vice president, risk adjustment, Southwestern Health Resources; and Brandon Solomon, vice president, chief growth officer, Convey Health Solutions.
Improve Star ratings while meeting new requirements: A panel moderated by Carrie Meyer, Au.D., director of clinical programs, Amplifon Hearing Health Care, will provide an overview of the changes to Star ratings and how they will impact the bid. Panelists will explore bid strategies to improve Star ratings, considering the new Health Equity Index, and explain how bid changes impact different members and how to ensure member retention and growth. Panelists include Rex Wallace, principal, Rex Wallace Consulting, LLC, and Daniel Weaver, senior vice president, Stars and quality, Zing Health.
Bid submission for a special needs plan (SNP): This panel will review recent SNP trends, help determine whether C-SNP, D-SNP, or I-SNP is right for your market, and why SNP memberships are churning and what you can do to avoid it. Panelists include Meg Jordan, SNP program director, Prominence Health, and Steve Wrangham, associate vice president, Medicare product, Bright Health/Central Health Plan of California/Brand New Day. Gabriel Hitchcock, vice president of business development, Healthrageous, will moderate the session.
CMS desk review: The final session will offer tips for handling the increased scrutiny of CMS reviewers, discuss current hot button issues, provide best practices to limit mistakes and bid reuploads, and how to prepare for CMS’ announcement on Part D National Average Bid Amount (NABA) and its impact on your bid planning. The presenter is Kaleb Holt, director of Medicare products, SelectHealth.
Networking opportunities
In addition to the learning sessions, the conference features plenty of opportunities to network with peers and exhibitors, including breakfast, lunch, and breaks throughout the conference.
A networking cocktail reception, including drinks and hors d’oeuvres, will take place Monday evening.
The CMS Bid Boot Camp will take place January 22-23, 2024, at The Sawgrass Marriott Golf Resort & Spa, Jacksonville, Fla. Click here for the complete list of speakers, preconference workshops, the agenda, and how to register for the program. Separate registration is required for preconference workshops.