Medicare Advantage Benefit Innovations and the Challenge of Estimating ROI Presenters: Michael Adelberg, Elizabeth Klodas, MD, FACC, Damian Rippole
Medicare Advantage Benefit Innovations and the Challenge of Estimating ROI
Presenters: Michael Adelberg, Elizabeth Klodas, MD, FACC, Damian Rippole
The session will consist of an overview of benefit innovations in the Medicare Advantage program, including newly-permissible supplemental benefits, VBIDs and 'proximate flexibilities, such as rewards programs and provider network flexibilities that have the potential to impact member utilization and outcomes. The lead speaker is a former CMS leader and health plan product development VP who has spoken/written extensively on this topic. He will recruit two unconventional benefit vendors to speak regarding their benefit's potential to positively impact utilization and therefore partially offset the costs of their service.
Pathways to Success: Ride the Wave
Presenters: David Byron, FSA, MAAA, Julie Witt, FSA
In CMS's continued push toward value-based care, this session will discuss the evolution of the ACO program, specifically, the Pathways to Success (P2S) track. This will include a broad overview of the P2S program and CMS's goal to put more risk in the hands of providers. We will review some of the challenges faced by provider groups who are evaluating or currently participating in the program including the financial opportunities and risks.
Beyond the Bid: Monitoring Part D Financials from An In-house Actuary's Perspective
Moderator: Jackie Lee, FSA, MAAA
Presenters: Maxwell Hanna, ASA, MAAA, Kathryn Qin, FSA, MAAA
Many plan sponsors use external consulting actuaries to develop D Bids each June for the following year. After these bids, how should in-house actuaries monitor Part D experience over the next 18 months? During this session, the presenters will share their experiences in performing this role. First will be an overview of the common data sets available to plan sponsors and how they utilized them to develop special Part D reserves each month. After that, how to build a robust model to forecast Part D financials, including how to incorporate emerging experience, model monthly seasonalities and conduct meaningful scenario testing, will be covered