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  • 1. The ONLY Event to Address the Intricacies of Operations on the Exchanges! Healthcare Education Associates and the Risk Adjustment Initiative and Society for Education Proudly Present Technology & Operations on the Health Insurance Exchanges To Register: Call 866-676-7689 or visit us at www.healthcare-conferences.com Topics at a Glance • Operationalizing risk adjustment, risk corridors and reinsurance • Engaging the consumer with a top-notch enrollment system • Practical guidelines for enrollment reconciliation and reclamation • Effectively managing eligibility determination, maintenance and renewals • Leveraging technology to positively impact revenue • Best practices in data management • Keys to vendor selection • The expected hiccups in interfacing with the exchanges—and how to stop them before they start • The operational nuances of getting your product on the exchanges • Effectively training your brokers, agents and navigators Conference Sponsors: July 29-30, 2013 Park Hyatt Aviara Resort Carlsbad, CA Speaking Faculty Sarah M. Summer, JD, MPH Program Strategy and Development Lead State Exchange Group Center for Consumer Information and Insurance Oversight Centers for Medicare & Medicaid Services* *final confirmation pending Albert Lowey-Ball, Health Economics and Medicaid Advisor, California Program on Access to Care, UC Berkeley School of Public Health David Grant, PhD., Director, California Health Interview Survey, UCLA Center for Health Policy Research David Knutson, Senior Research Fellow, Health Policy, University of Minnesota ** Formerly with HHS Gregory A. Franklin, Assistant Secretary, Health Information Technology, California Technology Agency James Wadleigh, Chief Information Officer, Access Health CT Jim Hogan, Michigan Department of Technology, Management and Budget, Information Officer, State of Michigan Jonah Morrison, Director Exchange Operations, HealthPass Patricia MacTaggart, Lead Research Scientist/Lecturer, George Washington University Health Policy Department Patty Conner, Director, Office of Consumer Health Services, Governors’ Office of Economic Development, Utah Department of Health Peter B. Nichol, PMP, Six Sigma MBB, Associate Director of IT Systems & Operations, Connecticut Health Insurance Exchange Scott Devonshire, Chief Information Officer, Massachusetts Health Connector Shawna DeRousse, Chief Operations Officer, Silver State Health Insurance Exchange Sione Ayers, MBA, Encounter Data Manager, Care 1st Health Plan Rus Hargrave, Senior Health and Human Service Technology Advisor Oregon Health Authority and Human Services Office of Information Services Rich Moyer, Principal Milliman, Inc. Robbi McClane, Senior Director of Product Management Edifecs Michael Lemberg, President West Division Health Services Maximus Terry L. Fouts, M.D., Chief Medical Officer MedeAnalytics Gold: Hear from CMS* on Marketplace Model Transitions including IT Reuse *final confirmation pending Silver:
  • 2. Are you confounded by the many technical and operational processes required by the health insurance exchanges? If so, whether you’re a health plan or a state official, you’ll benefit by attending Technology & Operations on the Health Insurance Exchanges slated for July 29-30 in Carlsbad, California. You’ll hear directly from those who’ve actually executed health insurance exchanges, and receive the practical guidance you’ll need for operational success. A few key topics to be discussed include: • Effectively operationalizing risk adjustment, risk corridors, and reinsurance • Preparing for enrollment and optimizing the consumer experience • Handling the enrollment reconciliation and reclamation processes • Accurately determining eligibility and tracking members as they move through the system • Using data to stratify and target the exchanges population • Getting data collection, completion and submission right • Understanding how to conduct proper due diligence on your vendors • A look at the expected hiccups in interfacing with exchanges • What the federal exchanges will look like and how they will operate This is the only event that keys in on just the functional aspects of the health insurance exchanges. Don’t miss this opportunity to hear about the topics that could make or break your success. Register today! Call 866-676-7689 or register online at www.healthcare- conferences.com. Sincerely, Laura Garza Laura Garza, Conference Director HEALTHCARE EDUCATION ASSOCIATES P.S. This conference is co-located with the Defined Contribution Healthcare and Private Exchanges Summit, so you’ll network and learn from those attending both events! P.P.S. Hear the CMS* Perspective on Marketplace Model Transitions including IT Reuse *final confirmation pending To Register: Call 866-676-7689 or visit us at www.healthcare-conferences.com The Conference Sponsors Healthcare 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 networking 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 opportunities. 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 professional 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. Through meaningful networking opportunities, roundtables, cutting- edge conferences and webcast presentations, RISE brings together multiple perspectives and facilitates highly 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 Who Should Attend? From Health Plans on the Health Insurance Exchanges (Medicare, Medicaid, Commercial, etc.): • Head of the Exchanges • COOs/Head of Operations • Head of Enrollment & Eligibility • Head of IT or Technology/Chief Technology Officer • Chief Information Officers • Informatics • Data Analysts • Head of Compliance • Systems Analysts • Head of Data Management • Claims Processing Staff From the States: • Exchange Work Force • Medicaid Officers • Heads of Technology • Heads of IT • Heads of Operations • Heads of Enrollment & Eligibility Top Reasons to Attend • Hear directly from operations and IT people who’ve already implemented exchanges • Be on the cutting-edge of new developments in technology and operational issues facing the health insurance exchanges • Optimize your risk adjustment procedures • Effectively navigate the tricky operational issues within the enrollment process • Learn essential practical guidelines in managing enrollment reconciliation and reclamation • Determine how to accurately track members as they move through the system • Understand how to leverage data in plan design and redesign • Tackle best-practice issues in data collection, completion and submission • Learn what to outsource—and how to pick a vendor • Attend what is the ONLY event solely focused on IT and operations for health insurance exchanges! Rave Reviews from Past Healthcare Education Associates’ Conferences: “The information given is always up to date and gives our plan a whole picture of our business. This conference is something our plan looks forward to all year. It’s an important tool in our success and we will continue to attend every year.” Megan Lombardi, BCBS of Western NY “Content was relevant to the topic and perspectives provided by a variety of plans and vendors was informative” Menali Mathew, Tufts Health Plan “The topics are very helpful with the current challenges and the speakers were all very informative” Antonette Buenavides, LA Care Health Plan “It provided me the opportunity to meet many experts in the industry and to learn what other plans are doing, how they deal with challenges, and their best practices” Lisa Zhou, Kaiser Permanente 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 Jennifer Clemence at 704-341-2438 or email jclemence@healthcare-conferences.com
  • 3. To learn more about sponsorship opportunities, please contact Jennifer Clemence at 704-341-2438 or email jclemence@healthcare-conferences.com Technology & Operations on the Health Insurance Exchanges DAY ONE: Monday, July 29, 2013 8:00 – 8:45 Exhibits Set-Up, Registration & Continental Breakfast 8:45 – 9:00 Chairs’ Opening Remarks 9:00 – 10:00 Opening Discussion: Effectively Operationalizing Risk Adjustment, Risk Corridors and Reinsurance on the Exchanges • Capturing risk and controlling the cost for the new population • Do risk scores have portability and go with the member? • Risk adjustment: - Effectively calculating, tracking, and optimizing the data for risk adjustment - How are plans getting the proper data/coding to do the risk adjustment calculations? - How will the dedicated server work? - When can you send risk adjustment data and to whom? - Tolerances for errors - What information are you going to get back and from where? - What type of supporting documents are you going to get? - How will the reconciliation take place? - Using HRAs for risk adjustment • Risk Corridor: - What are the risk accounting issues? - How will it impact the plan offering? - Changes in outreach levels - How are you targeting & reaching out to members with chronic conditions? - What are the incentives? • Reinsurance: - How will reinsurance work? - How to price for capitated providers - How will they submit information for claim costs? David Knutson, Senior Research Fellow, Health Policy University of Minnesota Formerly with HHS Sione Ayers, MBA, Encounter Data Manager Care 1st Health Plan 10:00 – 11:00 Part I: Gearing up for Open Enrollment Navigating Enrollment for Enhanced Consumer Interaction & Education • Steering the system of enrollment & consumer interaction • Unraveling the consumer issues • So you login, now what? How do you chose health plan, doctor, metal plan, etc.? • What is the consumer experience going to be? • Effectively engaging the consumer • Are there incentives for good health behavior? • Making a solid case for mobile adoption Moderator: TBA Panelists: Patty Conner, Director, Office of Consumer Health Services, Governors’ Office of Economic Development Utah Department of Health Scott Devonshire, Chief Information Officer Massachusetts Health Connector Albert Lowey-Ball, Health Economics and Medicaid Advisor, California Program on Access to Care UC Berkeley School of Public Health 11:00 –11:15 Morning Break 11:15 – 12:15 Part II: Enrollment Reconciliation • What is it? Membership, premium payments and more • Who is the membership source of truth? The exchange or the payer? • Reconciling membership adds, updates, cancellations, terminations • How complicated will monthly audit reconciliation be? • Premium payment challenges - Who owes what money and what money has been collected vs. still owed - Delinquent payments and terminations - How to process refunds • Reconciling cost-sharing reduction subsidies • Optimizing for revenue recovery via encounter submission • Strategies for limiting claim payment risk exposures for delinquent enrollment accounts and encouraging eligibility checks Robbi McClane, Senior Director of Product Management Edifecs 12:15 – 1:30 Networking Luncheon Sponsored by 1:30-2:30 Integrated Eligibility & Accurate Eligibility Determination, Maintenance, & Renewals • Implementing a “No Wrong Door” policy • Managing and retaining members • Effectively tracking members as they move through the system • How will your plan deal with the Medicaid attrition and the expected churn rate? • Will the benefits and data travel with the members? • Eligibility systems and ACA readiness Moderator: Michael Lemberg, President West Division Health Services MAXIMUS Jim Hogan, Michigan Department of Technology, Management and Budget, Information Officer State of Michigan James Wadleigh, Chief Information Officer Access Health CT Rus Hargrave, Senior Health and Human Service Technology Advisor Oregon Health Authority and Human Services Office of Information Services 2:30 – 3:30 Leveraging Data & Technology and Their Impact on Revenue • Using data to stratify and target the population • Going beyond risk adjustment • Learning how to leverage data in plan design and re-design • How data & technology can enhance your provider contracting • Maximizing revenue through technology’s latest advances – what are other plans doing? Patricia MacTaggart, Lead Research Scientist/Lecturer George Washington University Health Policy Department Rich Moyer, Principal Milliman, Inc. 3:30 – 3:45 Afternoon Break
  • 4. To Register: Call 866-676-7689 or visit us at www.healthcare-conferences.com Technology & Operations on the Health Insurance Exchanges 3:45 – 4:45 DATA-DATA-DATA: The Crucial Link to Value & Care Management • Data collection, completion, and submission: Getting it right! • Looking beyond typical encounter and claims data • Collecting data and quality reporting • Where does it come from and how will it be used? • What are the top 10 conditions by race, conditions, locations, etc? • Transitioning to Encounter Data Processing Systems • Data collection, completion, and submission: Getting it right! • Data for risk adjustment and revenue • Data to help users select plans David Grant, PhD., Director, California Health Interview Survey UCLA Center for Health Policy Research Gregory A. Franklin, Assistant Secretary, Health Information Technology California Technology Agency Sione Ayers, MBA, Encounter Data Manager Care 1st Health Plan 4:45 End of Day One 4:45-5:45 Cocktail Reception Immediately Following Contact Jennifer Clemence for more information on our sponsorship opportunities at jclemence@healthcare-conferences.com or 704-341-2438 DAY TWO: Tuesday, July 30, 2013 8:00-8:45 Continental Breakfast 8:45 – 9:00 Chair’s Recap of Day One 9:00-9:40 The CMS* Perspective on Marketplace Model Transitions including IT Reuse Sarah M. Summer, JD, MPH, Program Strategy and Development Lead State Exchange Group Center for Consumer Information and Insurance Oversight Centers for Medicare & Medicaid Services *final confirmation pending 9:40-10:30 Technology Showcase*: We Have the Best & the Brightest Technology Providers in Today’s Healthcare Reform: Time to Put Their Products to the Test Compare and contrast the latest in technology products as our panelists discuss their innovations. Each panelist will be given a chance to discuss/ showcase their product. This interactive discussion will give the audience a chance to compare the latest in technology innovations. It is a chance for the application specialists to put their money where their mouths are and prove that their products are cutting-edge. Don’t miss it! • Where are the technology demands taking the Health Insurance Exchanges? • Meeting the challenging needs of front, middle, and back-office • Improving outreach programs • Using technology to compete in a competitive marketplace • Achieving increased levels of efficiency and scalability Moderator: Gregory A. Franklin, Assistant Secretary, Health Information Technology California Technology Agency Panelists: Terry L. Fouts, M.D., Chief Medical Officer MedeAnalytics Additional Panelists TBA *If you’re interested in joining the Technology Showcase please contact Jennifer Clemence at 704-341-2438 or jclemence@healthcare-conferences.com 10:30 – 10:45 Morning Break 10:45 – 11:45 Vendor Selection, Management, & Oversight • What should you outsource/insource? • Which types of things should you be looking for in a vendor? • Is your vendor exposing you to liability (HRA or otherwise)? • How do you contract with vendors in light of advance notice from CMS? • Fostering a relationship with firm commitments and payment tied to that • Conducting the proper oversight: What systems do you have in place to keep your vendors compliant? Jonah Morrison, Director Exchange Operations HealthPass Shawna DeRousse, Chief Operations Officer Silver State Health Insurance Exchange Peter B. Nichol, PMP, Six Sigma MBB, Associate Director of IT Systems & Operations Connecticut Health Insurance Exchange 11:45 – 12:15 Conducting the Proper Training & Oversight for Brokers, Agents, & Navigators • What type of training and guidance will CMS provide? • Supplemental training: What type of training do you need to provide brokers, agents, and navigators? • Aligning yourself with a broker, agent, or navigator who doesn’t have accusations against them • How are you providing oversight to your brokers/agents? • Avoiding the abuse that is inevitable Shawna DeRousse, Chief Operations Officer Silver State Health Insurance Exchange 12:15-1:30 Networking Luncheon 1:30 –2:30 Interfacing with the Exchange : What Are the Expected Hiccups? • What are the differences between state and federal exchanges? • Looking at differences among states • How will interfacing on the exchange work, operationally & logistically? David Knutson, Senior Research Fellow, Health Policy University of Minnesota Formerly with HHS Patty Conner, Director, Office of Consumer Health Services, Governors’ Office of Economic Development Utah Department of Health Scott Devonshire, Chief Information Officer Massachusetts Health Connector Rus Hargrave, Senior Health and Human Service Technology Advisor Oregon Health Authority and Human Services Office of Information Services
  • 5. Important Information To Register: Fax: 704-341-2640 Mail: Healthcare Education Associates 18705 NE Cedar Drive Battle Ground, WA 98604 Phone: 866-676-7689 Online: www.healthcare-conferences.com Park Hyatt Aviara Resort 7100 Aviara Resort Dr. Carlsbad, CA 92011 p: 760-448-1234 We have a block of rooms reserved at a special rate of $239/night. This rate expires on July 8, 2013; although, we expect the block to sell out prior to this date. To receive a room at the negotiated rate, book well in advance of the expiration date. Mention the “Insurance Exchanges Conference” when placing your room reservation by phone to receive the negotiated rate. We urge you to book your room early as we expect the block will sell out. Please note that once the block is full room rate and availability will be at the hotel’s discretion. Fees and Payments: The fee for attendance at Technology & Operations on the Health Insurance Exchanges is: $1795 Please make checks payable to Healthcare Education Associates, and write code H173 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 July 22, 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. Cancellations: 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. Technology & Operations on the Health Insurance Exchanges To learn more about sponsorship opportunities, please contact Jennifer Clemence at 704-341-2438 or email jclemence@healthcare-conferences.com About the Venue San Diego, California Hotel and Resort Situated on Southern California’s sun-drenched Pacific Coast, Park Hyatt Aviara Resort is a luxurious seaside hotel in Carlsbad, California, just north of San Diego, where you are inspired to relax and indulge. From atop a high ridge on the shore of Batiquitos Lagoon, a wildlife sanctuary and a place of natural beauty, and overlooking the Pacific Ocean, Park Hyatt Aviara is a AAA Five Diamond San Diego resort that’s far from ordinary. Secluded amid 200 acres of verdant hillsides and rolling valleys, within the master-planned community of Aviara, our luxurious San Diego area hotel and resort provides a spectacular setting for your vacation or event. The resort’s Spanish colonial architecture welcomes you with a sense of casual elegance, and the lush landscape, edged by one of the top golf courses in San Diego, surrounds you in beauty and tranquility. Media Partners: Conference Sponsor Gold: Edifecs provides healthcare software solutions that improve operational performance by streamlining the exchange of information among healthcare organizations. Our solutions modernize and automate transaction processing systems used to support key administrative functions including enrollment, claims and payments management. Additionally, Edifecs solutions enable compliance with mandates such as HIPAA, Operating Rules and ICD-10. More than 250 healthcare organizations use Edifecs technology, including the majority of Blue Plans nationwide and most of the State Medicaid Programs, as well as some of the largest commercial health plans and provider organizations in the country. Silver: MAXIMUS For nearly 40 years, MAXIMUS has operated under our founding mission of Helping Government Serve the People.® We deliver business process and consumer support solutions for Health Insurance Exchanges, state Medicaid and CHIP programs, and Medicare, as well as specialized consulting services. MAXIMUS offers a single-market focus and a unique understanding of how to deliver high quality, cost-effective solutions tailored for all levels of government. Headquartered in Reston, Virginia, MAXIMUS has approximately 8,800 employees located in the United States, Canada, Australia, the United Kingdom and Saudi Arabia. MedeAnalytics delivers performance management solutions across the healthcare system — including hospitals, physician practices and payers — to ensure accountability and improve financial, operational and clinical outcomes. The healthcare industry is undergoing profound change, accelerated by the passage of health reform (notably the more far-reaching provisions of bundled payments, value-based purchasing and accountable care organizations). MedeAnalytics helps organizations thrive in this dynamic and challenging environment by aggregating data from disparate sources and delivering relevant information in a timely, accurate and prescriptive manner, enabling a level of transparency that brings accountability to the system. 2:30 – 3:00 The Mechanical Process of Getting Benefits & Pricing on the Exchange Portal • From an operational perspective, how do you get your product developed? • How do you get your product approved? • Operational nuances of getting your benefits and pricing on the Exchange portal • What are the restrictions around language and age? • Can plans evoke their own processing for enrollment? - Identification cards - Premium invoices Speaker TBA 3:00 End of the Summit
  • 6. Healthcare Eductaion Associates 200 Washington St. Ste. 201 Santa Cruz, CA 95060 PRSRT STD U.S. POSTAGE PAID BURLINGTON,VT PERMIT NO. 21 Technology & Operations on the Health Insurance Exchanges To Register: Fax: 704-341-2640 Call: 866-676-7689 Online: www.healthcare-conferences.com Mail: Healthcare Education Associates 18705 NE Cedar Drive Battle Ground, WA 98604 q Yes! Register me for the conference: $1795 q Please contact me: I’m interested in a Group Discount Rate for my team. q Please contact me: I’m interested in Marketing Opportunities at this event. q I wish to receive updates onHEA’s upcoming events via fax, email & phone. Signature: ________________________________ Name Title Company Dept. Address City State Zip Telephone: Fax: Email Please bill my: q MasterCard q Visa q Amex q Discover Card Number Exp.Date Name on Card Signature q Check enclosed q Please bill me later Make checks payable to Financial Research Associates and write H173 and attendee(s) name on your check. Conference Code: H173 Please Mention This Priority Code When Registering The ONLY Event to Address the Intricacies of Operations on the Exchanges! Healthcare Education Associates and the Risk Adjustment Initiative and Society for Education hhProudly Present the Technology & Operations on the Health Insurance Exchanges Hear from CMS* on Marketplace Model Transitions including IT Reuse *final confirmation pending To Register: Call 866-676-7689 or visit us at www.healthcare-conferences.com July 29-30, 2013 Park Hyatt Aviara Resort Carlsbad, CA