Best Practices in Financial Management for Medicare Advantage Plans

MA Financial Best Practices

Estimating Claim Costs

Predictive Modeling

Payment Patterns

Medical Cost Drivers

Medical Loss Ratio

Plan Pay Report

Risk Scores

Star Ratings

BEST PRACTICES IN

FINANCIAL MANAGEMENT FOR MEDICARE ADVANTAGE PLANS

Take-aways for Boosting Revenue and Cutting Costs in an Era of MA Cutbacks

August 26-27, 2013 The Princeton Club, New York

Discussion Highlights:• Examining the Impact of Healthcare

Reform on MA Revenue• Best Practices for Estimating Claim Costs

and Understanding Payment Patterns• Understanding Your Medical Cost Drivers• Effectively Managing Your Medical Loss

Ratio• Star Ratings and Risk Scores: Measuring

Results of Improvement Initiatives• Predicting Mid-Year and Final-Year

Payment Adjustments• Using Predictive Modeling and Analysis

to Impact Revenue and Lower Costs• The MA Bidding Process: Best Practices

and Lessons Learned• Assessing and Mitigating Your RADV

Audit Risk• Understanding CMS Payments and Fees

Reflected in Your Monthly Report• Best Practice Provider Contracting

Strategies • Risk Scores and Star Ratings: Delving

Deeply into Their Revenue Impact• An Examination of Part D Reconciliation

and Revenue Streams• Managing the Cost and Analyzing Data

Surrounding Part D Benefits SPO

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To Register: Cal l 866-676-7689 or v is i t us at www.heal thcare-conferences.com

Healthcare Education Associates and the Risk Adjustment Initiative and Society for Education Proudly Present


In a time of Medicare Advantage cutbacks, understanding and managing your MA plan’s financial and actuarial issues is absolutely crucial for your plan’s success. Join Healthcare Education Associates and RISE for our first ever Best Practices in Financial Management for Medicare Advantage Plans conference, taking place August 26-27, 2013 in New York City, and hear directly from prominent and knowledgeable industry experts on this vitaland multifaceted topic. We’ve undergone extensive research to provide you with the most informative and valuable agenda possible. Discussion topics include:

• An examination of the impact healthcare reform has on MA revenue

• A thorough discussion on best practices for estimating claim costs and understanding payment patterns

• Understanding your medical cost drivers• Effectively managing your medical loss ratio• Understanding risk scores and Star ratings and how they

impact MA revenue• Methods for accurately predicting mid-year and final-year

payment adjustments• Using predictive modeling and analysis to impact revenue

and lower costs• Best practices and lessons learned for the MA bidding

process• Understanding RADV audit methodology and mitigating

RADV audit risk• Understanding CMS payments and fees reflected in your

monthly report• Risk scores and Star ratings: measuring results of

improvement initiatives• Provider contracting strategies• A two-part session on Part D: Examination of Part D

reconciliation and revenue streams and managing the cost and analyzing data surround Part D benefits

You can’t afford to miss this unique and timely event! Register today! Call 866-676-7689 or register online at www.healthcare-conferences.com.

Sincerely,

Kara Lewis, Conference DirectorHEALTHCARE EDUCATION ASSOCIATES

Don’t forget about our great group discounts! Contact Theresa Powers at 704-341-2437 or [email protected] for more details

Our Renowned Speaking FacultyKeith Mazzoni, UPMC HEALTH PLANSarah Dixon, KELSEYCARE ADVANTAGEBrent Keesler, THE UNIVERSITY OF ARIZONA HEALTH PLANSRohit Gupta, INLAND EMPIRE HEALTH PLANPuneet Budhiraja, CAPITAL DISTRICT PHYSICIANS’ HEALTH PLAN, INC.Michelle Beozzo, DENVER HEALTH MEDICAL PLAN, INC.Carl Smith, FLORIDA BLUEEric Goetsch, MILLIMANBrad Piper, MILLIMANDave Neiman, WAKELY CONSULTING GROUPSpeaker TBD, INOVALONMichael Baxley, AUKDOK, INC.Sharlene Scott, CODING ACADEMY OF AMERICATim Courtney, WAKELY CONSULTING GROUP

Top Reasons to Attend• Benefit from an in-depth look at the impact healthcare

reform will have on MA revenue• Learn how to effectively manage your Medical Loss Ratio• Understand how top plans are predicting mid-year and

final-year payment adjustments• Network with your peers and industry leaders during

breaks, luncheons, and the reception• Examine ways for using predictive modeling and analysis

to impact revenue and lower costs• Understand the MA bidding process and strategies around

proper bid planning• Gain insight on how to assess and mitigate your RADV

audit risk• Learn how risk scores and star ratings impact MA revenue• Uncover the components of the Part D reconciliation

process and the various types of Part D benefit designs

Who Should Attend?

This conference is designed for those from MA health plans with the following titles (but not limited to):• CFOs• Finance Directors• Accountants• Financial Analysts• Actuarial Analysts

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 Kevin Weigel at 704-341-2448 or [email protected]

• Revenue Management Executives• Risk Adjustment Executives• Part D Management and Reconciliation• Recovery Analysts • Executives Controllers


8:00 – 8:45 Exhibits Set-Up & Continental Breakfast

8:45 –9:30 Examining the Impact of Healthcare Reform on MA Revenue• Moving from Pre-ACA rate to a percentage of FFS• Financial impact from Five-Star ratings in 2014 and beyond• Fee-for-Service rebasing and methodology changes• Coding intensity adjustments• Premium tax under healthcare reform• Impact of duals demo project on revenueBrad Piper, FSA, MAAA, Consulting ActuaryMILLIMAN

9:30 –10:15 Best Practices for Estimating Claim Costs and Understanding Payment Patterns• How do you estimate your total incurred claim costs?• Understanding the impact of various claim payment pattern

scenarios• Working with your utilization management and claims

processing teams to understand your organization’s claims payment patterns and make adjustments to completion factors

• Ensuring you have the right data and information to better inform your incurred but not reported (IBNR) estimation process

• Rx Cost IBNR—Is it worth the effort given the timeliness of payments?

Eric Goetsch, FSA, MAAA, Principal and Consulting ActuaryMILLIMAN

10:15 –10:30 Morning Break

10:30-11:15 Understanding Your Medical Cost Drivers• Breaking down your trend into components (Utilization/

Unit Cost)• Impact of selection due to benefit design• Effectively identifying issues as early as possible (incurred

vs. paid reporting)• Service category level reporting• Watching the checkbook—whom are you paying and for

what?• Incorporating benchmarks into your monitoring and

planning

Michael Baxley, President and CEOAUKDOK, INC.

11:15-12:00 Effectively Managing Your Medical Loss Ratio• How is it calculated?• MLR analysis by various segments of the population• Correctly categorizing administrative costs

◦ What improves health quality vs. what falls out as

other administrative expenses? ◦ Steps to take with vendors ◦ Taxes, licenses, fees and assessments: what’s

deducted from the denominator and what isn’t ◦ Increasing efficiency: how do you target and how do

you measure?• Significant medical management or risk score improvement

could result in having to pay backCarl Smith, FSA, MAAAActuarial Analyst, Revenue Program ManagementFLORIDA BLUE

12:00-1:15 Networking Lunch Sponsored by

1:15-2:00 Risk Scores and Star Ratings: Delving Deeply into Their Revenue Impact• Understanding your risk score’s impact on current payment• Understanding how and why risk scores change at the

different “true up” points with CMS• Star Ratings: Quantifying each component that goes into

star ratings—what will make an impact and what won’t?• How much does the QBP impact your premium and how

are you using that?• What are you doing to prepare if your plan doesn’t meet

the four star mark for year 2015 and beyond?Keith Mazzoni, Program Director, Risk AdjustmentUPMC HEALTH PLANTim Courtney, FSA, MAAA, Senior Consulting Actuary WAKELY CONSULTING GROUP

2:00– 2:45 Risk Scores and Star Ratings: Measuring Results of Improvement Initiatives

Speaker TBDINOVALON

2:45 – 3:30 Predicting Mid-Year and Final-Year Payment Adjustments • Separating your membership into meaningful membership

categories for forecasting• Timing—When should you/can you come up with reliable

estimates you can book?• How do you handle forecasts for members that were on

your plan for less than five months in the prior year?Sarah Dixon, Senior Financial AnalystKELSEYCARE ADVANTAGEKeith Mazzoni, Program Director, Risk AdjustmentUPMC HEALTH PLAN

3:30- 3:45 Afternoon Break

3:45 – 4:45 Using Predictive Modeling and Analysis to Impact Revenue and Lower Costs• Revenue

◦ Techniques for identifying missing diagnoses ◦ Identifying and quantifying RADV risks

• Costs

DAY ONE: August 26, 2013


◦ Identifying over-coding and measuring its impact ◦ Disrupting disease progression ◦ Latent risks

Speaker to be announced

4:45-5:45 Cocktail Reception Contact Kevin Weigel at [email protected] or 704-341-2448 about our sponsorship opportunities

8:00-8:45 Continental Breakfast

8:45 – 9:00 Chair’s Recap of Day One

9:00 –10:15 The MA Bidding Process: Best Practices and Lessons Learned• The 45 Day Advance Notice—analyzing and incorporating

it into your planning process• Critical steps that need to be completed early in the

process• Is your bid representing reality? Bids versus budgets• Using your own experience vs. national trends and other

data• Proper bid planning: What are strategy alternatives

surrounding bid preparation?• Rebate allocations• Planning for the August release of the National Part D bid

amounts and rebate reallocations • Administrative expenses: Projecting non-benefit expenses• What is the MLR requirement and how does it affect your

bid?Dave Neiman, Senior Consulting ActuaryWAKELY CONSULTING GROUP

10:15 –11:00 Assessing and Mitigating Your RADV Audit Risk• Understanding the RADV audit methodology• What are the implications for your HCC diagnosis coding

program?• Should you accrue? If so, how do you go about it and how

do you determine how much?• How do you mitigate the risk of a RADV audit?• Lessons learned: what can go wrong?Sharlene A. Scott, CPC, CPC-H, CCS-P, CCP-P, CPMA, AHIMA Approved ICD-10, CM/PCS Ambassador Trainer, PMCC Instructor, PresidentCODING ACADEMY OF AMERICA

11:00 – 11:15 Morning Break

11:15 –12:00 Understanding CMS Payments and Fees Reflected in Your Monthly Report• Breaking down the Plan Pay Report• Breaking down the Monthly Membership Report

(summing up to the Total Part D and Total MA Payment)• What is the “true” Part D payment in the MMR?• Tying the Plan Pay Report to the MMR and other sources

of supporting detail• Best sources of information when you have questionsBrent Keesler, Financial Analyst, Medicare ProgramTHE UNIVERSITY OF ARIZONA HEALTH PLAN

12:00 – 1:15 Luncheon for attendees and speakers

1:15-2:00 Best Practice Provider Contracting Strategies• Contracts that are based on Medicare fee schedule or

percent of revenue allow for sequestration pass through• Consider bonus payment for HRAs and required follow

up—could result in greater risk score coding improvement• What size of network is necessary?• Are your providers willing to take risk?Rohit Gupta, Director of MedicareINLAND EMPIRE HEALTH PLAN

Two-Part Session on Part D

1:30 – 2:15 An Examination of Part D Reconciliation and Revenue Streams • What are the components of the Part D reconciliation

process?• Correctly accounting for LICS, CGDP and Reinsurance cash

flows• Part D reconciliation estimates—when, what and how

should you calculate liabilities• Risk corridors and reinsurance explained• Impact of the coverage gap brand discount program• How should organizations accrue for Part D settlement

payment during the year?

Puneet Budhiraja, ASA, MAAACAPITAL DISTRICT PHYSICIANS’ HEALTH PLAN, INC.

2:15-3:15 Managing the Cost and Analyzing Data Surrounding Part D Benefits• What are the various types of Part D benefit designs?• Analysis of the Part D population• How will your formulary impact your finances?• Determining co-pays and/or coinsurance• Components of a Part D audit Michelle Beozzo, PharmD, Director of Pharmacy Services, Managed CareDENVER HEALTH MEDICAL PLAN, INC.

3:15 End of Conference Submit Evaluation Forms

DAY TWO: August 27, 2013


Important InformationTo Register:Fax: 704-341-2640Mail: Healthcare Education Associates 18705 NE Cedar Drive Battle Ground, WA 98604Phone: 866-676-7689Online: www.healthcare-conferences.com

Best Practices in Financial Management for Medicare Advantage PlansAugust 26-27, 2013

The Princeton Club15 West 43rd Street, New York, NY 10036(212) 596-1200If you require overnight accommodation for this conference, please contact any of the following nearby hotels to check their best available corporate rate over this time frame, or consult your local travel agent. Please note that HEA has not negotiated rates with any of these hotels.

Area Hotels:Mansfield Hotel – (212) 944-6050Algonquin Hotel – (212) 840-6800City Club Hotel – (212) 921-5500Royalton Hotel – (212) 869-4400Iroquois Hotel – (212) 840-3080Sofitel Hotel – (212) 354-8844

Fees and Payments:The fee for attendance at the Best Practices in Financial Management for Medicare Advantage Plans is:

Standard Rate: $1,895 Health Plan Rate: $1,495

Please make checks payable to Healthcare Education Associates, and write code H191 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 8/19/2013.

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 call Theresa Powers at 704-341-2437 or email her at [email protected]: 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 $250.00 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 $250.00 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.

Gold Sponsor

Bronze Sponsor

The Conference OrganizerHealthcare 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 network-ing 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 oppor-tunities. 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 profes-sional endeavors. See www.healthcare-conferences.com for more information on upcoming events.

RISE began as the first national association totally dedicated to enabling healthcare

professionals to meet the challenges of risk adjustment. Now, RISE has expanded its focus in recognition of the fact that risk adjustment, quality, revenue management and Star ratings are inexorably linked and that education in each of these areas is essential for plan and provider success. We strive to serve our members on three fronts: networking, education and industry intelligence via meaningful networking opportunities, round-tables, cutting-edge conferences and webcast presentations. RISE brings together multiple perspectives and facilitates high-ly interactive discussion between professionals and provides our members with the crucial information they need to stay ahead of the curve. To learn more about RISE, or to join, visit us online: www.rasociety.org

Inovalon™ is a healthcare technology company that combines advanced data analytics with highly targeted interventions to achieve meaningful

impact in clinical outcomes and financial performance across the healthcare landscape.Our unique achievement of value is delivered through the effective progression of Turning Data into Insight, and Insight into Action®. Proprietary datasets, sophisticated analytics, deep subject matter expertise, and nationwide in-community personnel deliver a seamless, end-to-end platform of technology and operations. Driven by data, Inovalon uniquely identifies gaps in care, quality, data integrity and financial performance- while also bringing to bear the resources to resolve them. This differentiating combination provides a powerful capability suite touching more than 120 million Americans, driving high-value impact, and improving million Americans, driving high-value impact, and improving the quality and economics for health plans, hospitals, physicians, patients, and researchers.

MA Financial Best Practices

Risk Scores

Star Ratings

Payment Patterns

Medical Loss Ratio

BEST PRACTICES IN

FINANCIAL MANAGEMENT FOR MEDICARE ADVANTAGE PLANS

Take-aways for Boosting Revenue and Cutting Costs in an Era of MA Cutbacks

August 26-27, 2013 The Princeton Club, New York

Healthcare Education Associates and the Risk Adjustment Initiative and Society for Education Proudly Present


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