Join us Thursday for First in New Webinar series: Risk adjustment in the exchanges

On Thursday July 26th at 1pm ET we’ll kick off our new webinar series, “Lessons from Medicare Advantage and Part D”, a monthly webinar series around what we’ve learned in Medicare that can be applied to the  exchanges and other aspects of health reform. We’ll begin with a deep dive on risk adjustment in the exchanges.

Risk adjustment is the defining health care finance issue of the decade, and MA and Part D represent the largest experiments in risk adjustment on the planet.  MA and Part D’s risk adjustment system is the blueprint for ACOs, the exchanges, and a growing number of state Medicaid programs as well.  We’ll explore the risk adjustment provisions in the ACA and the final regulation, and apply what we’ve learned in the last 7 years to the future of health plan payment, with our partner Dr. Jack McCallum, CEO of GHG sister firm CenseoHealth.  Bring your CFO, Chief Strategy Officer, CMO,Chief Marketing Officer, and your actuaries for a geektastic discussion on how to follow the money post-2013.   In the coming months we’ll examine other reform topics where the Medicare, Part D and Medicaid Dual Eligible experience shines a light:   In early September: Distribution In and Around the Exchanges: Lessons from MA and Part D. We’ll explore how individuals with subsidies and small groups will be sold the “metal” plans, especially in the Exchanges through Navigators and other impartial facilitators, to the deployment of brokers and sales management.  Our focus will be on the Federally-Facilitated Exchange, which could operate in as many as 40 states, with updates on specific states as applicable.   In late September: we’ll explore the Nuts and Bolts of the Federal Exchange: Lessons from MA and Part D. We’ll focus on how the Federal Exchange will function from a 10,000-foot level perspective, where the plan interfaces are and the broad strokes of anticipated reporting requirements.   In late October: Product Strategy in the Exchanges: Lessons from MA and Part D. How subsidies will work based on income determinations; a landscape view of where states are on accepting ACA Medicaid expansion dollars in the wake of the SCOTUS ruling.  For Red States: what the new “near-Medicaid coverage gap” means in those states that refuse the ACA funds.  We’ll examine how to segment the market for Platinum, Gold, Silver, and Bronze plans, and the allowability of supplemental insurance products (like dental) in the exchanges. What existing commercial and government programs provider networks mean to product pricing and strategy.  The imperative for a database of local individual claims to wargame product designs on.   More to come.  The scars on our collective backsides in Medicare the last 16 years provide some great “teachable moments” for the new world post-ACA.  We look forward to the discussion.