Speaker Presentations
Tuesday, September 10, 2019

Registration & Continental Breakfast


Chairperson’s Welcome & Opening Remarks

Scott Rinefort Senior Director, Product DesignAnthem/CareMore

Organizational Building Blocks: An Integrated Approach to Benefit Design

Pleasing All Stakeholders in the Product Design Concept.  Is It Possible?

“Give me the most competitive product to sell.”  “Be sure to develop a profitable product.”  “Make sure the product can be operationalized.”
If you are familiar with those types of stakeholder comments – you’re not alone.    While there is no silver bullet or secret sauce, this session will cover how to engage your stakeholders early in the benefit design process to ensure everyone gets a seat at the table.

Jill V. SelbyCorporate VP, Strategic Initiatives/Product DevelopmentSCAN Health Plan


Case Study: Linking Benefit Design to Quality, Outcomes & Plan Performance

Medicare Advantage plans are slowly transitioning from purely market-driven plan designs to a more balanced approach that incorporates input from members, providers, care managers, and even actuaries. SelectHealth is learning to incorporate feedback from various stakeholders and evaluate potential benefit enhancements through the lens of their impact on member care and engagement. We think intuitively that certain high-value benefits will have a positive impact on member care that outweighs the cost, but creating a business case to demonstrate these impacts is daunting. This discussion will cover the small steps SelectHealth is currently taking to incorporate clinically-nuanced benefit design concepts into its MA plan, and how they are evaluating the impacts on chronic conditions, Stars/HEDIS, and the member experience.

Kaleb HoltMedicare Advantage Program Manager,SelectHealth


De-Mystifying the ‘Black Box’ of Pricing in MA Benefit Design

Pricing is an important piece of the Medicare Advantage benefit design puzzle, yet the pricing / bidding process is often seen as a ‘black box’ by non-technical stakeholders. While general market forces and pricing strategies apply to Medicare Advantage in a manner similar to other markets, the nuances of MA funding mechanisms and regulations bring additional complexity to the pricing of MA products. In this session, Ivy will decode this black box by:

  • Providing an overview of the key components contributing to MA revenue determination;
  • Investigating the interactions between plan benefits, member premium, company margin and market competitiveness, and;
  • Exploring emerging regulations and potential impact on plan design and pricing.

Ivy Dong Senior Manager, ActuarialClover Health


Networking Refreshment Break


A Value Based Approach to the Medicare Advantage Market

Analyzing benefits from multiple plans and service categories can be a challenging task. This session will walk attendees through a value based benefits approach that will help you understand what benefits bring the most value to members. We will give examples of how a plan can better structure their benefit design to bring more value to their members, as well as look at reasons that members will choose plans that have less value than others.

Adam Barnhart Consulting ActuaryMilliman

Janis Lehrer Associate ActuaryMilliman

Ari Kramer Associate ActuaryMilliman


Case Study: Impact of Data on Medicare Advantage Product Design

Learn how a local state-based company in the Medicare Advantage market utilized data to better understand their population in order to design a sustainable product that provides specific benefits and services to the current and projected membership.

  • Overview of membership data points that provide helpful insights
  • Aligning membership data points to the product goal in order to create a viable product
  • Developing dashboards to visualize the data for analysis
  • Pulling together the insights in order to make improvements to the product

Lisa Modi Product Development ManagerJohns Hopkins HealthCare


Understanding What Your Operational Systems Can and Can’t Deliver

Sara N. Wedlock Senior Product Manager, Medicare Business SegmentHarvard Pilgrim Health Care

Products that Deliver Supplemental Benefits Including Social Determinants of Health, Flexible Benefits, and Benefits with “Sizzle”

Panel Discussion: Benefits With Sizzle: Incorporating Supplemental Benefits in the Design Stage

Although insurers praised CMS’ policy giving MA plans unprecedented flexibility to offer supplemental benefits, thus potentially allowing more tools to address Social Determinants of Health, it wasn’t widely adopted in 2019. But some leading health plans immediately embraced the new policy with a range of benefits for 2019 aimed at addressing SDOH and other issues, and continue to refine their product designs to meet members’ unique needs. This lively panel discussion will delve into how plans are incorporating supplemental benefits in the design stage, what benefits plans are offering, how those benefits are being received, and what the return on investment has been.


Lauren Flynn KellyManaging EditorAIS Health, an MMIT company


Scott RinefortSenior Director, Product DesignAnthem/CareMore

Jill V. SelbyCorporate VP, Strategic Initiatives/Product DevelopmentSCAN Health Plan

Stacey MullerPrincipal and Consulting ActuaryMilliman

Catherine MacphersonVP Product Strategy Development and CNOMom’s Meals NourishCare


Networking Lunch


Case Study: Flexible Benefits--An Opportunity to Improve Quality of Care

CMS has relaxed their requirement for benefit uniformity. Starting with the VBID demonstration project in 2017, CMS now waives the uniformity requirements giving Plans the opportunity to enhance quality of care for members in a targeted manner. Plans, however, must proceed cautiously to appropriately identify the vulnerable populations, ensure compliance, and minimize administrative burden. This session will address decision factors in the population’s determination, designing the program, and the analytics behind these decisions.

Helene Weinraub Vice President of MedicareUPMC


Case Study: Flexible Benefits – A Walk Through Benefit Design From Conception to Implementation

For 2019, Medicare Advantage plans were allowed to take advantage of a reinterpretation of the uniformity requirement by CMS. Plans were now permitted the ability to reduce cost sharing for certain covered benefits, offer specific tailored supplemental benefits, and offer specific tailored supplemental benefits for enrollees that meet specific medical criteria. In this session, we will walk through Health New England’s experience in planning, developing, and operationalizing our care management flexible benefit program for enrollees identified with both Diabetes and CHF.

Amy SepkoMedicare Program ManagerHealth New England


Case Study: Creative Benefit Design Solutions for the Unique Challenges of the Dual Population

Many challenges are facing our Special needs populations through social determinates of health, to navigating through the health system, and ultimately landing on a health plan to help fulfill all their needs. It is our goal as a health plan to try and begin uncoupling and identifying the right mix of benefits and programs to better support our members. Through this session we will discuss barriers, hurdles, regulations, and opportunities to be considered.

Aaron LaverickDirector of Product Management and Development (Medicare Programs)Gateway Health Plan


Networking Refreshment Break


Case Study: Implementing a CSNP in the world of VBID

Learn how a community based not-for-profit Medicare Advantage plan made the decision to and ultimately implement the first chronic condition special needs plan in its community. Key points that will be covered are:

  • Choosing to offer a CSNP versus filing for VBID
  • CSNP Model of Care Development
  • CSNP Implementation Considerations

Dawn Odrzywolski, CHC, PMPVice President Medicare ProgramsIndependent Health


Develop Winning Plans Utilizing Self-Serve Analytics

Identifying, collating, analyzing and summarizing big data can be cumbersome, challenging and time consuming. With limited time and resources, many organization struggle to get the data they need at the pace at which they want it. While many payers look outside of the organization for assistance with market or product intelligence, the support they often receive is costly and unpredictable. Take back control of your strategy, reduce your budget impact, and free up resources by leveraging self-service analytics, dashboards & product simulations. Join the TEG team as we explore how self-serve data can not only help with benefit design, but also developing the next winning plan!

Leverage self-serve analytics to reduce expense & capitalize on efficiencies Optimize your position in the Medicare Plan Finder through OOPC simulations Identify how to tweak the delicate balance between benefit design and financial outcomes Leverage SDoH and big data to design plans that meet the needs of your targeted population Discover how to create and test multiple benefit scenario’s before submitting a bid

Arvind NagpalFounder & CEOTEG Analytics

Jereme AyersClient PartnerTEG Analytics


How to Make the Pharmacy Medicare Advantage Design Attractive

The Pharmacy benefit is arguably the most visible benefit offered by a Health Plan. What steps do you take to provide a high quality/cost effective benefit to members. Is there still room for changes in pharmacy benefit design. How will Part D Modernization impact the pharmacy benefit?

  • How to position your prescription benefit in the market place
  • What sources are being used to help design the benefit
  • Promoting the pharmacy benefit to members, brokers and providers
  • Working with your QI department to improve design and Star/Hedis measures
  • Impact of rebates on plan design and how this may change in the future.

Gary MelisClinical PharmacistNetwork Health


Focus on Innovative Benefit Designs With Automated CMS PBP Submissions and Document Generation (ANOC, EOC, SB, Kits, Highlight Sheets)

  • How to create innovative benefit designs
  • Automating the CMS PBP submissions
  • Enable collaboration across all stakeholders through efficient workflows
  • Faster speed-to-market with 75% reduction in time and eff­ort required to build Medicare / Medicare Advantage products

Mohammed VaidCEO and Chief Solution ArchitectSimplify Healthcare


Designing Universal and Adaptive Benefit Data

Raw data is voluminous and messy, and it lives in a variety of places and in a variety of formats. Many times, it comes together as information only though the brute force efforts of manual labor or loose system ‘integrations’. An outcome fraught with inefficiencies, inaccuracies, and error-ridden data fragmentation that is extremely costly in a highly regulated and sensitive industry. In this session, learn about the importance of developing a single source of data upfront that can then adapt to the context of its destination across the enterprise.

Brian YavorskyChief Technology OfficerCody Consulting


Networking Reception

Supported By: Strategic Solutions Network (SSN), based in Boca Raton, FL, is the parent company of the Medicare Risk Adjustment & Revenue Management Management, Plus Quality and Star Ratings and a series of related conferences.

Wednesday, September 11, 2019

Networking Continental Breakfast


Chairperson’s Remarks

Scott Rinefort Senior Director, Product DesignAnthem/CareMore

Capturing Member Intelligence for Product Development

Leveraging Market Research Across Key Audiences to Drive Plan Results

Session will focus on critical primary and secondary research tools to enhance plan and member behavior:

  • Providers – data that drives performance and member results
  • Internal sales channels – Tools and data to understand benefits to drive member behavior
  • Brokers – data that encourages compliance and delivering sales strategies that are member focused
  • Internal reporting – Key reports that drive costs savings and member behavior
  • Primary market research – on-going research to continually drive plan and member performance

Christine LeoVice President, Senior ProductsCigna


Align Your Providers with Your Benefit Innovations -
Don’t Forget Your Provider Network: The Other Side of Innovation

While most of the attention on Medicare Advantage innovations is focused on new benefits, there are also significant and complementary opportunities to innovate and transform provider networks to improve outcomes, reward efficiency, and raise star ratings. In this session, we will discuss:

  • New tools to align your providers with care management and benefit design innovations;
  • Mechanisms to drive members to your highest value providers;
  • Changes to CMS rules that enable you to better recognize your most-invested providers.

Michael S. AdelbergPrincipal & Lead, Healthcare Strategy PracticeFaegre Baker Daniels Consulting


Product Packaging – Designing Benefits With Member Perception & Overall Health in Mind

  • Creating products that are easier to sell and to buy
  • Creating Benefits that are hassle free, easy to understand, and improve access to care
  • Packaging SDOH for your members
  • Incorporating Your Marketing Message

Elizabeth BenzVice President Government ProgramsNetwork Health


Networking Refreshment Break

Provider Engagement – Designing Benefits in Collaboration with Providers

SDOH as Part of a Clinical Delivery System Powered by a Health Plan

This session will provide a deep dive into the innovation of SDoH solutions by leveraging a clinical delivery system that is aligned with a health plan.  Organizational culture and mission are fundamental imperatives that underscore efforts to deliver on SDoH solutions.  Attendees will hear about products to support members with chronic conditions, supplemental benefits and the targeting of benefits for specific sets of members. Attendees will also hear about an innovative model of care that focuses on people with uncontrolled chronic conditions using home-delivered meals, which can serve as an example for payer teams looking at the how benefit design intersects with clinical delivery.

Scott RinefortSenior Director, Product DesignAnthem/CareMore


Case Study -- Provider & Community Partnerships: Putting Patients and Primary Care in Charge to Deliver the Ultimate Medicare Experience

  • Medicare Advantage model designed to deliver the ultimate Medicare experience by virtue of an innovative partnership with the health plan and physician group working together
  • Development of disruptive and innovative plan design
  • Benefits designed to promote PCP relationship and living well
  • Patient-centered benefit design

Lori RundVice President, Product Management & Market IntelligenceHealth Alliance Plan (HAP)

Jana PerryVice President of Strategy & GrowthHealth Alliance


Close of Conference