Risk Adjustment & Revenue Cycle Management Value Visit 2016

Event Date: 1/25/2016 - 1/27/2016

Event Overview

Commercial Exchange and Medicare Advantage Products
What We Learned in 2015 and Tactics for Success in 2016

With the release of 2015 CMS’s Risk Adjustment Transfer Payment report both Commercial and Medicare Advantage plans intensified their efforts in risk adjustment and risk scoring as part of an overall effort to manage revenue cycle. During this timely Value Visit we will discuss the experience of health plans both nationally and specifically among Alliance members and we will share our lessons learned and evolving best practices.

Who should attend?

The meeting is designed as a multi-disciplinary meeting for managers of both commercial and Medicare Advantage risk adjustment initiatives. There is much the two products can learn from one another.
Executives and managers with responsibility for: Actuarial, Compliance management, Exchanges, Financial management, Health Care Reform and implementation of ACA, Provider relations, Risk Adjustment, Risk Management, Underwriting.

Agenda

To download the most updated, detailed agenda, click the Documents tab

Note: the detailed agenda referenced above was last updated on November 4, 2016

AGENDA AT A GLANCE

Mon, Jan 25
12pm	Registration and Lunch
1pm	Welcome and introductions
2pm	2015 results and trends overview: Key take aways for the risk adjustment learning curve
3pm	Break
3:15pm	Payment transfer formula – the mystery revealed
4:15pm	Case study: One plan’s commercial risk adjustment journey
6pm	Dinner

Tues, Jan 26
7:30am	Breakfast
8am	Taming the formula: Taking an RA-informed approach to the upcoming QHP filing
9am	Break
9:15am	Case study: Engaging all parts of an integrated system in the risk adjustment strategy
10:15am	Case study: Engaging providers through data transparency and performance insights
11:15am	Case study: Engaging providers around case management efforts
12:15pm	Lunch
1:15pm	The political landscape: How today’s environment will impact risk adjustment
1:45pm	Panel presentation: Strategies for risk score improvement
3:30pm	Case study: Ensuring data integrity on the edge server
6pm	Dinner

Wed, Jan 27
8:30am	Breakfast
9am	Enhancing risk adjustment transfers with benefit design, formulary and provider contracting
10am	Break
10:15am	Case study: Engaging physicians and members in collecting and maintaining risk adjustment data
11:15am	Open discussion and wrap up

Documents

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1/25/2016

Presentation: 2015 results and trends overview: Key take aways for the risk adjustment learning curve
A recognized expert in risk adjustment and a seasoned consultant in the exchange market, Alexis Levy offers a bird?s eye view of the 2015 marketplace results and an overview of the emerging trends: How plans? performance stacked up against their expectations and what the smartest plans are doing now in the new year

1/25/2016

Presentation: Case study - One plans commercial risk adjustment journey
Presbyterians team shares the organizations experience with risk adjustment for individual plans in 2014, including lessons learned so far. The team also walks through the back-end analysis that was completed with a focus on how to use that information for future projections.

1/25/2016

Audio: 2015 results and trends overview: Key take aways for the risk adjustment learning curve
A recognized expert in risk adjustment and a seasoned consultant in the exchange market, Alexis Levy offers a birds eye view of the 2015 marketplace results and an overview of the emerging trends: How plans performance stacked up against their expectations and what the smartest plans are doing now in the new year

1/25/2016

Audio: Case study - One plans commercial risk adjustment journey
Presbyterians team shares the organizations experience with risk adjustment for individual plans in 2014, including lessons learned so far. The team also walks through the back-end analysis that was completed with a focus on how to use that information for future projections.

12/29/2015

Agenda: Risk adjustment and revenue cycle management value visit_01252016
The risk adjustment and revenue cycle management value visit is Jan 25-27, 2016 in Albuquerque.

12/29/2015

Coding improvement for commercial exchange plans
As we end the second year with plans offered in the ACA marketplace, health insurance companies are trying to understand the value and potential return on investment of ensuring accurate and complete coding of diagnoses in order to maximize risk scores.

12/29/2015

ACA playbook: Informing 2017 product and marketing strategies
The latest publication of 2014 risk corridor results demonstrates the economic imbalance in the ACA market with only $362 million in funding and $2.87 billion in expected payouts to issuers. Understanding this imbalance, health plans are actively developing their 2017 product and marketing strategies to improve profitability and find the right product and member mix to be successful in a risk adjusted market.

12/29/2015

A risky state of affairs
On June 30th, the Department of Health and Human Services (?HHS?) released a report on risk adjustment transfer payments by company for the 2014 benefit year, as well as key state market-level metrics. In this report, HHS noted that absolute transfer payments as a percent of total premium equated to 10%, 21% and 6% in the individual, catastrophic and small group markets respectively. On September 17th, HHS released an updated version of this report, which included additional detailed results for each state market. Based on this report, we calculated the transfer payments as a percent of total premium for each state market. One limiting factor in HHS? report is that transfer payments were calculated at the issuer level and not necessarily the parent company level. Our analysis corrects for the issuer/parent issue to provide an accurate representation of transfers between parent companies.

12/29/2015

2016 HHS risk adjustment model changes: update for final rule
The Department of Health and Human Services (?HHS?) recently published its Final Rule to recalibrate the risk adjustment model for the Commercial ACA population. The Final Rule confirms HHS?s intent to use a three year blended approach in calculating risk weights for the model. In the Proposed Rule (released November 2014), HHS published risk weights calibrated using 2010-2012 data with the option of using more recent data (if available). The Final Rule confirms that 2011-2013 data will be used to calibrate the 2016 risk weights and that the weights will be updated each year with the most recent three years of available data. As HHS indicated in the Proposed Rule, the intent is to better align the risk factors with more recent treatment patterns and cost.

12/29/2015

Risky business the sequel: 2014 risk adjustment results
On June 30th, the Department of Health and Human Services (?HHS?) issued health plans in the ACA Individual and Small Group markets their estimated Risk Adjustment transfer payments and Reinsurance receipts for 2014. HHS also released a summary report that provided transfer payments and reinsurance receipts by issuer, state and risk pool with supporting market-level data. HealthScape analyzed the reports, and leveraged our first-hand experience in the market to uncover several key insights.

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