Description: Beginning with the 2019 Benefit Year, CMS (the Centers for Medicare and Medicaid Services) has provided guidance that allows Medicare Advantage Plan Sponsors much greater flexibility in tailoring benefits to promote clinical, care management, and financial goals. The guidance allows for a broader menu of supplemental benefits and also enables plans to target benefit enhancements to beneficiaries afflicted with specific disease states. This session explores the ramifications of the policy changes on Plan Sponsors and beneficiaries, and discusses the different ways that Plan Sponsors are taking advantage of the additional flexibility.

Description: Shared savings deals are all the rage these days. Significant numbers of payers and provider groups in many markets around the U.S. want to engage in shared savings contracts covering commercial, Medicare and Medicaid patients. The fundamental question underlying a value-based contract is, for whom is the value accruing? Ostensibly, value is accruing to the sponsor—whether employer or public payer—but should be accruing to the provider as well. Often design flaws in value-based arrangements and contracts and/or the inability to execute in a value-based paradigm diminish the savings that could have accrued, create inequities in value or drive unintended consequences. This presentation will provide attendees with insights into how to design a workable value-based payment initiative, how to educate both payer and provider participants, and how to oversee the initiative’s operations. Specific topics will include: • Attribution logic: prospective, retrospective and the details in between • Risk adjustment: why one model doesn’t fit all arrangements, and even if it does, how do you implement? • Data and reporting: matching business needs to the payer’s willingness to be transparent and provider capabilities • Quality improvement as a component of payment: actionable and tied to the attributed population or just “out there?”